Tratamento inicial da doença de Parkinson.
DOI:
https://doi.org/10.34024/rnc.2004.v12.8861Palavras-chave:
Doença de Parkinson, Tratamento inicial, Levodopa, Agonistas dopaminérgicosResumo
Na abordagem inicial da doença de Parkinson, é importante determinar se o paciente realmente necessita de tratamento sintomático. Quando os sintomas são ainda muito leves e não incapacitantes, selegilina, anticolinérgicos e amantadina podem ser utilizados. Quando os sintomas tornam-se problemáticos ou incapacitantes, deve-se optar entre tratar precocemente com levodopa ou empregar agonista dopaminérgico. Para pacientes jovens com maior risco de desenvolverem complicações com a terapia com levodopa, como flutuações motoras e discinesias, os agonistas dopaminérgicos são a melhor escolha. Por outro lado, em pacientes idosos (acima de 70 anos), a terapia com levodopa deve ser recomendada como tratamento inicial no sentido de evitar a maior incidência de efeitos colaterais cognitivos, como confusão mental e alucinações, freqüentemente associados aos agonistas dopaminérgicos. Ainda, as complicações motoras da levodopa são menos freqüentes em pacientes idosos.
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. Lang AE, Lozano AM. Parkinson’s disease. N Engl J Med 1998; 339: 1044-1053.
. Poewe W, Wenning G. Levodopa in Parkinson’s disease: mechanisms of action and pathophysiology of late failure. In Jankovic JJ, Tolosa E, editors. Parkinson’s disease and movement disorders. Philadelphia: Lippincott Williams & Wilkins, 2002. p.105-115.
. Wichmann T, Delong MR. Neurocircuitry of Parkinson’s disease. In Davis KL, Charney D, Coyle JT, Nemeroff C, editors. Neuropsychopharmacology: the fifth generation of progress. Philadelphia: Lippincott Williams & Wilkins, 2002. p.1761-1779.
. Freed CR, Greene PE, Breeze RE, et al. Transplantation of embryonic dopamine neurons for severe Parkinson’s disease. N Engl J Med 2001; 344: 710-719.
. Olanow CW, Goetz CG, Kordower JH, et al. A double-blind controlled trial of bilateral fetal nigral transplantation in Parkinson’s disease. Ann Neurol 2003; 54: 403-414.
. Nutt JG, Burchiel KJ, Comella CL, et al. Implanted intracerebroventricular glial cell line-derived neurotrophic factor: randomized, double-blind trial of glial cell-line derived neurotrophic factor (GDNF) in PD. Neurology 2003; 60: 69-73.
. Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson’s disease. N Engl J Med 1993; 328: 176-183.
. Jankovic JJ. Therapeutic strategies in Parkinson’s disease. In Jankovic JJ, Tolosa E, editors. Parkinson’s disease and movement disorders. Philadelphia: Lippincott Williams & Wilkins, 2002. p.116-151.
. Stern MB. The early treatment of Parkinson’s disease: levodopa, dopamine agonists or both. Parkinsonism Relat Disord 2001; 7: 27-33.
Miyasaki JM, Martin W, Suchowersky O, Weiner WJ, Lang AE. Practice parameter: initiation of treatment of Parkinson’s disease: an evidencebased review. Report of the quality standards subcommittee of the AAN. Neurology 2002; 58: 11-17.
Schults CW. Treatments of Parkinson’s disease. Arch Neurol 2003; 60: 1680-1684.
Parkinson Study Group. Pramipexol vs. levodopa as initial treatment for Parkinson’s disease: a randomized controlled trial. JAMA 2000; 284: 1931-1938.
Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE. A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa. N Engl J Med 2000; 342: 1484-1491.
Parkinson Study Group. Dopamine transporter brain imaging to assess the effects of pramipexole vs. levodopa on Parkinson’s disease progression. JAMA 2002; 287: 1653-1661.
Korczyn AD, Brun ER, Larsen JP, et al. A 3-year randomized trial of ropinerole and bromocriptine in early Parkinson’s disease. Neurology 1999; 53: 364-370.
Pezzoli G, Martigoni E, Pacchetti C, et al. Pergolide compared with bromocriptine in Parkinson’s disease: a multicenter, crossover, controlled study. Mov Disord 1994; 9: 431-436.
Baseman DG, O’Suilleabhain PE, Reimold SC, Laskar SR, Baseman JG, Dewey RB. Pergolide use in Parkinson disease is associated with cardiac valve regurgitation. Neurology 2004; 63:301-304.
Van Camp G, Flamez A, Cosyns B, et al. Treatment of Parkinson’s disease with pergolide and relation to restrictive valvular heart disease. Lancet 2004; 363:1179-1183.
Grosset KA, Grosset DG. Pergolide in Parkinson’s disease: time for a change? Lancet 2004; 363:1907-1908.
Horvath J, Fross RD, Kleiner-Fisman G, et al. Severe multivalvular heart disease: a new complication of the ergot derivative dopamine agonists. Mov Disord 2004; 19:656-662.
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Publicado: 2004-09-30
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