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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.53 no.1 São Paulo Mar. 1995

http://dx.doi.org/10.1590/S0004-282X1995000100001 

Tratamento da doença de Parkinson

 

Treatment of Parkinson's disease

 

 

Francisco Cardoso

Professor Assistente, Clínica de Distúrbios do Movimento (CDM), Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG)

 

  


RESUMO

Doença de Parkinson (DP) é a causa mais freqüente de parkinsonismo em nosso meio, responsável por 58% dos casos. Devem-se excluir outras causas, como uso de drogas antidopaminérgicas (20% dos casos). Levodopa é o agente mais importante para o tratamento de DP. Há controvérsia sobre quando se introduzir esta droga mas deve-se reservá-la para quando surgir substancial comprometimento funcional. Drogas acessórias são anticolinérgicos, úteis para o tremor; amantadina, para bradicinesia e rigidez; e agonistas dopaminérgicos que ajudam no manuseio de complicações da levodopa. A selegelina tem discreta ação sintomática e possível ação neuroprotetora. O tratamento de DP pode ser complicado por falha primária, falha secundária e problemas do uso da levodopa. A falha primária pode ser causada por uso de agentes antidopaminérgicos, presença de tremor de repouso severo ou erro diagnóstico. A causa mais comum de falha secundária é progressão da DP. As principais complicações do uso da levodopa são flutuações e discinesias. Outros problemas comuns são disautonomia, depressão, psicose e demência. Fenomenologia e manuseio destas complicações são discutidos. Perspectivas futuras incluem cirurgias para reversão de patologia.

Palavras-chave: parkinsonismo, doença de Parkinson, levodopa, discinesia, flutuação.


SUMMARY

Parkinson's disease (PD) accounts for 58% of patients with Parkinsonism. The second most common cause is drug-induced Parkinsonism, diagnosed in 20% of patients. Levodopa remains as the mainstay of PD treatment. Although there is controversy regarding the timing for beginning levodopa, it should be used when the patient develops significant disability. Other drugs that may be used are anticholinergic agents, useful for tremor; amantadine, for rigidity and bradykinesia; dopamine agonists, for the management of levedopa complications; and selegeline which may be a neuroprotector agent. Problems in the management of PD include primary failure, secondary failure and levodopa complications. Antidopaminergic drugs, severe rest tremor and diagnosis error may lead to primary failure. Progression of PD is the most common explanation for secondary failure.The most important levodopa therapy complications are dyskinesias and fluctuations. Other common problems are dysautonomia, depression, psychosis and dementia. The author discusses the phenomenology and management of these complications. Future perspectives include brain repair sugeries.

Key-words: parkinsonism, Parkinson's disease, levodopa, dyskinesia, fluctuation.


 

 

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Aceite: 18-agosto-1994.

 

 

Professor Assistente, Clínica de Distúrbios do Movimento (CDM), Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG).