运动障碍学会循证医学检查更新:治疗非帕金森病的症状。

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Seppi K, Weintraub D,科埃略,Perez-Lloret年代,福克斯SH Katzenschlager R, Hametner EM, Poewe W, Rascol O, Goetz CG,桑帕约C

运动障碍学会循证医学检查更新:治疗非帕金森病的症状。

,85 Mov Disord。2011年10月,26日:s42 - 80。doi: 10.1002 / mds.23884。

PubMed ID
22021174 (在PubMed
]
文摘

社会运动障碍(MDS)工作组在循证医学(EBM)的治疗帕金森病(PD)是首次出版于2002年,并于2005年更新掩盖临床试验数据与专注于2004年1月电机帕金森病的症状。在这个修订版MDS工作组决定有必要延长审查非症状。这项工作的目的是更新之前的循证医学评价与关注非治疗PD症状。个随机对照试验)报道,一级(随机对照试验的药物和非药物干预非帕金森病的症状,作为正式的文章发表在英文综述了2002年1月至2010年12月。入选标准和排名之后原来的计划大纲和坚持循证医学方法。功效的结论,治疗被指定:有效,可能有效,可能有效,non-efficacious或证据不足。安全数据编目和审查。基于综合有效性和安全性评估,对临床实践确定使用以下名称:临床上有用,可能有用,临床实验,可能有用,而不是有用的。54个新研究胜任功效而其他几个研究安全问题。更新和新功效的结论是所有的迹象。 The treatments that are efficacious for the management of the different non-motor symptoms are as follows: pramipexole for the treatment of depressive symptoms, clozapine for the treatment of psychosis, rivastigmine for the treatment of dementia, and botulinum toxin A (BTX-A) and BTX-B as well as glycopyrrolate for the treatment of sialorrhea. The practical implications for these treatments, except for glycopyrrolate, are that they are clinically useful. Since there is insufficient evidence of glycopyrrolate for the treatment of sialorrhea exceeding 1 week, the practice implication is that it is possibly useful. The treatments that are likely efficacious for the management of the different non-motor symptoms are as follows: the tricyclic antidepressants nortriptyline and desipramine for the treatment of depression or depressive symptoms and macrogol for the treatment of constipation. The practice implications for these treatments are possibly useful. For most of the other interventions there is insufficient evidence to make adequate conclusions on their efficacy. This includes the tricyclic antidepressant amitriptyline, all selective serotonin reuptake inhibitors (SSRIs) reviewed (paroxetine, citalopram, sertraline, and fluoxetine), the newer antidepressants atomoxetine and nefazodone, pergolide, Omega-3 fatty acids as well as repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression or depressive symptoms; methylphenidate and modafinil for the treatment of fatigue; amantadine for the treatment of pathological gambling; donepezil, galantamine, and memantine for the treatment of dementia; quetiapine for the treatment of psychosis; fludrocortisone and domperidone for the treatment of orthostatic hypotension; sildenafil for the treatment of erectile dysfunction, ipratropium bromide spray for the treatment of sialorrhea; levodopa/carbidopa controlled release (CR), pergolide, eszopiclone, melatonin 3 to 5 mg and melatonin 50 mg for the treatment of insomnia and modafinil for the treatment of excessive daytime sleepiness. Due to safety issues the practice implication is that pergolide and nefazodone are not useful for the above-mentioned indications. Due to safety issues, olanzapine remains not useful for the treatment of psychosis. As none of the studies exceeded a duration of 6 months, the recommendations given are for the short-term management of the different non-motor symptoms. There were no RCTs that met inclusion criteria for the treatment of anxiety disorders, apathy, medication-related impulse control disorders and related behaviors other than pathological gambling, rapid eye movement (REM) sleep behavior disorder (RBD), sweating, or urinary dysfunction. Therefore, there is insufficient evidence for the treatment of these indications. This EBM review of interventions for the non-motor symptoms of PD updates the field, but, because several RCTs are ongoing, a continual updating process is needed. Several interventions and indications still lack good quality evidence, and these gaps offer an opportunity for ongoing research. (c) 2011 Movement Disorder Society.

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