臨床神経学

第49回日本神経学会総会

<シンポジウム8-4>パーキンソン病の臨床,基礎の最前線
パーキンソン病の治療―薬物療法のup to date―

村田 美穂

国立精神・神経センター病院神経内科〔〒187-8551 東京都小平市小川東町4-1-1〕

The prognosis of Parkinson's disease (PD) has been improved with developing anti-parkinsonian agents. Recently the re-evaluation of L-dopa and dopamine agonists is the topic in the world based on focusing non motor side effects of dopamine agonists such as sudden uncontrollable somnolence and valvulopathy in place of motor complication. The development of anti-parkinsonian drugs based on the new mechanism has been progressed such as CEP-1347, AAV-neuturin, AAV-GAD, and AAV-DDC. The most reliable new drug is zonisamide which is originally synthesized in Japan for epilepsy. A nation-wide randomized double blind study showed that Zonisamide improves motor function of advanced PD patients. Long-term efficacy was also shown. The mechanism of zonisamide for PD is the increase of dopamine synthesis and moderate inhibition of monoamine oxydase B activity. Inhibitatory effects of sodium channel and T-type calcium channel may also affects. Zonisamide has neuroprotective effects though inhibition of quinoprotein and increasing the levels of GSH and Mn SOD. Up to now we have no agents with clinically evidenced neuroprotective effects for PD. Base on the results of ELLDOPA study and "delayed start" clinical trials the most important concept for neuroprotection may be the early dopaminergic support for the degenerating dopaminergic system.
Full Text of this Article in Japanese PDF (285K)

(臨床神経, 48:986−988, 2008)
key words:L-dopa製剤, ドパミンアゴニスト, 非運動症状, ゾニサミド, 神経保護

(受付日:2008年5月17日)