Vol. 12. Núm. 73.
Páginas 4273-4284 (Marzo 2019)

Actualización
Enfermedad de Parkinson y parkinsonismos

Parkinson's disease and parkinsonism

F. Carrillo García
Doi : https://10.1016/j.med.2019.03.002
Opciones
Resumen

La enfermedad de Parkinson (EP) es el segundo trastorno neurodegenerativo más común, con una edad promedio de aproximadamente 60 años. Las manifestaciones clínicas cardinales de la EP son temblor de reposo, rigidez, bradicinesia y trastorno de la marcha. En la actualidad, la evidencia apoya un modelo etiológico combinado de influencias medio ambientales y factores genéticos. En las etapas iniciales, la terapia con levodopa y otros fármacos dopaminérgicos mejora los síntomas motores de la enfermedad. Sin embargo, el tratamiento a largo plazo con levodopa se acompaña de fluctuaciones motoras y discinesias, siendo las terapias de infusión y la estimulación cerebral profunda terapias efectivas en estadios más avanzados. Además, a medida que progresa la EP, los pacientes desarrollan síntomas que no responden bien a la terapia con levodopa. Los ensayos clínicos actuales están enfocados a estrategias para intentar modificar el curso natural de la EP, mediante la detención o la ralentización de la progresión de la enfermedad.

Palabras clave
Enfermedad de Parkinson
Levodopa
Fluctuaciones motoras
Síntomas no motores
Enfermedad de Parkinson avanzada
Abstract

Parkinson's disease (PD) is the second most common neurodegenerative disorder, with a mean age of approximately 60 years. The cardinal clinical manifestations of PD are rest tremor, rigidity, bradykinesia and gait disorder. Nowadays the evidences support an etiological model resulting from interactions between environmental and genetic factors. In early stages, levodopa and dopaminergic therapies improve motor symptoms. Nevertheless, long-term levodopa therapy is associated to motor fluctuations and dyskinesias; thus in advanced stages, infusion therapies and deep brain stimulation are more effective. Furthermore, as the PD progresses, new symptoms no responding to levodopa treatment appear. Current clinical trials are focused on new strategies that may modify the natural course of PD, either stopping or slowing the progression of the disease.

Keywords
Parkinson's disease
Levodopa
Motor fluctuations
Non-motor symptoms
Advanced Parkinson's disease

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Bibliografía
[1]
201903160608293588
201903160608293589
M.C. De Rijk, L.J. Launer, K. Berger, M.M. Breteler, J.F. Dartigues, M. Baldereschi, et al.
Prevalence of Parkinson's disease in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group.
Neurology, (2000), 54 pp. S21-S23
[2]
2019031606082935810
2019031606082935811
J.A. Obeso, M. Stamelou, C.G. Goetz, W. Poewe, A.E. Lang, D. Weintraub, et al.
Past, Present, and Future of Parkinson's Disease: A Special Essay on the 200th Anniversary of the Shaking Palsy.
Mov Disord., (2017), 32 pp. 1264-1310
[3]
2019031606082935812
2019031606082935813
L.M. De Lau, M.M. Breteler.
Epidemiology of Parkinson's disease.
Lancet Neurol., (2006), 5 pp. 525-535
[4]
2019031606082935814
2019031606082935815
A.J. Lees, J. Hardy, T. Revesz.
Parkinson's disease.
Lancet, (2009), 373 pp. 2055-2066
[5]
2019031606082935816
2019031606082935817
E. Sidrasnsky, M. Nalls, J.O. Aasly, J. Aharon-Peretz, G. Annesi, E.R. Barbosa, et al.
Multicenter analysis of glucocerebrosidase mutations in Parkinson's disease.
N Engl J Med., (2009), 361 pp. 1651-1661
[6]
2019031606082935818
2019031606082935819
M.M. Hoehn, M.D. Yahr.
Parkinsonism: onset, progression and mortality.
Neurology, (1967), 17 pp. 427-442
[7]
2019031606082935820
2019031606082935821
W. Maetzler, I. Liepelt, D. Berg.
Progression of Parkinson's disease in the clinical phase: potential markers.
Lancet Neurol., (2009), 8 pp. 1158-1171
[8]
2019031606082935822
2019031606082935823
K.R. Chaudhuri, D.G. Healy, A.H. Schapira, National Institute for Clinical Excellence.
Non-motor symptoms of Parkinson's disease: diagnosis and management.
Lancet Neurol., (2006), 5 pp. 235-245
[9]
2019031606082935824
2019031606082935825
E. Tolosa, C. Gaig, J. Santamaría, Y. Compta.
Diagnosis and the premotor phase of Parkinson disease.
Neurology, (2009), 72 pp. S12-S20
[10]
2019031606082935826
2019031606082935827
R.B. Postuma, A.E. Lang, J. Massicotte-Marquez, J. Montplaisir.
Potential early markers of Parkinson disease in idiopathic REM sleep behavior disorder.
Neurology, (2006), 6 pp. 845-851
[11]
2019031606082935828
2019031606082935829
M. Stacy.
Nonmotor symptoms in Parkinson's disease.
Int J Neurosci., (2011), 121 pp. 9-17
[12]
2019031606082935830
2019031606082935831
F. Carrillo García.
Actualización en sintomatología motora en la enfermedad de Parkinson.
Revista Española de Trastornos del Movimiento, (2018), 10 pp. 21-28
[13]
2019031606082935832
2019031606082935833
J.G. Goldman, H. Andrews, A. Amara, A. Naito, R.N. Alcalay, L.M. Shaw, et al.
Cerebrospinal fluid, plasma, and saliva in the BioFIND study: Relationships among biomarkers and Parkinson's disease Features.
Mov Disord., (2018), 33 pp. 282-288
[14]
2019031606082935834
2019031606082935835
W. Maetzler, I. Liepelt, D. Berg.
Progression of Parkinson's disease in the clinical phase: potential markers.
Lancet Neurol., (2009), 8 pp. 1158-1171
[15]
Parkinson's disease and movement disorder, Lippicott Williams Wilkins,
[16]
2019031606082935838
2019031606082935839
S. Fahn, D. Oakes, I. Shoulson, K. Kieburtz, A. Rudolph, A. Lang, et al.
Levodopa and the progression of Parkinson's disease.
N Engl J Med., (2004), 351 pp. 2498-2508
[17]
2019031606082935840
2019031606082935841
M.A. Hely, J.G. Morris, W.G. Reid, R. Trafficante.
Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years.
Mov Disord., (2005), 20 pp. 190-199
[18]
2019031606082935842
2019031606082935843
P.A. Kempster, S.S. O'Sullivan, J.L. Holton, T. Revesz, A.J. Lees.
Relationships between age and late progression of Parkinson's disease: a clinico-pathological study.
Brain, (2010), 133 pp. 1755-1762
[19]
2019031606082935844
2019031606082935845
J.R. Evans, S.L. Mason, C.H. Williams-Gray, T. Foltynie, C. Brayne, T.W. Robbins, et al.
The natural history of treated Parkinson's disease in an incident, community based cohort.
J Neurol Neurosurg Psychiatry, (2011), 82 pp. 1112-1118
[20]
2019031606082935846
2019031606082935847
E. Sinforiani, R. Zangaglia, R. Manni, S. Cristina, E. Marchioni, G. Nappi, et al.
REM sleep behavior disorder, hallucinations, and cognitive impairment in Parkinson's disease.
Mov Disord., (2006), 21 pp. 462-466
[21]
2019031606082935848
2019031606082935849
G. Rizzo, M. Copetti, S. Arcuti, D. Martino, A. Fontana, G. Logroscino.
Accuracy of clinical diagnosis of Parkinson disease: a systematic review and meta-analysis.
Neurology, (2016), 86 pp. 566-576
[22]
2019031606082935850
2019031606082935851
R.B. Postuma, D. Berg, M. Stern, W. Poewe, C.W. Olanow, W. Oertel, et al.
MDS clinical diagnostic criteria for Parkinson's disease.
Mov Disord., (2015), 30 pp. 1591-1601
[23]
2019031606082935852
2019031606082935853
T.A. Mestre, A. Gupta, A.E. Lang.
MRI signs of multiple sistema atrophy preceding the clinical diagnosis: the case for an imagingsupported probable MSA diagnostic category.
J Neurol Neurosurg Psychiatry, (2016), 87 pp. 443-444
[24]
2019031606082935854
2019031606082935855
D. Eidelberg.
Metabolic brain networks in neurodegenerative disorders: a functional imaging approach.
Trends Neurosci., (2009), 32 pp. 548-557
[25]
2019031606082935856
2019031606082935857
M. Estorch, V. Camacho, P. Paredes, E. Rivera, A. Rodríguez-Revuelto, A. Flotats, et al.
Cardiac (123) I-metaiodobenzylguanidine imaging allows early identification of dementia with Lewy bodies during life.
Eur J Nucl Med Mol Imaging, (2008), 35 pp. 1636-1641
[26]
2019031606082935858
2019031606082935859
A. Batla, R. Erro, M. Stamelou, S.A. Schneider, P. Schwingenschuh, C. Ganos, et al.
Patients with scans without evidence of dopaminergic deficit: a long-term follow-up study.
Mov Disord., (2014), 29 pp. 1820-1825
[27]
2019031606082935860
2019031606082935861
J.A. Vizcarra, A.E. Lang, K.D. Sethi, A.J. Espay.
Vascular parkinsonism: deconstructing a syndrome.
Mov Disord., (2015), 30 pp. 886-894
[28]
2019031606082935862
2019031606082935863
C.V.M. Verschuur, S.R. Suwijn, J.A. Boel, B. Post, B.R. Bloem, J.J. van Hilten, et al.
Randomized delayed-start trial of levodopa in Parkinson's disease.
N Engl J Med., (2019), 380 pp. 315-324
[29]
2019031606082935864
2019031606082935865
W.C. Koller, J.T. Hutton, E. Tolosa, R. Capilldeo.
Immediate-release and controlled-release carbidopa/levodopa in PD: a 5-year randomized multicenter study. Carbidopa/Levodopa Study Group.
Neurology, (1999), 5 pp. 1012-1019
[30]
2019031606082935866
2019031606082935867
C.W. Olanow, Y. Agid, Y. Mizuno, A. Albanese, U. Bonuccelli, P. Damier, et al.
Levodopa in the treatment of Parkinson's disease: current controversies.
Movement Disorders, (2004), 9 pp. 997-1005
[31]
2019031606082935868
2019031606082935869
R. Ceravolo, D. Frosini, C. Rossi, U. Bonuccelli.
Spectrum of addictions in Parkinson's disease: from dopamine dysregulation syndrome to impulse control disorders.
J Neurol., (2010), 257 pp. S276-S283
[32]
2019031606082935870
2019031606082935871
F. Carrillo, P. Mir.
Update in Parkinson's disease.
Mechanisms in Parkinson's disease – models and treatments, Londres, pp. 1-38
[33]
2019031606082935872
2019031606082935873
C. Trenkwalder, B. Kies, M. Rudzinsca, J. Fine, J. Nikl, K. Honczarenco, Recover Study Group, et al.
Rotigotine effects on early morning motor function and sleep in Parkinson's disease: a doble-blind, randomized, placebo-controlled study (RECOVER).
Mov Disord., (2010), 1 pp. 90-99
[34]
2019031606082935874
2019031606082935875
X.X. Yu, H.H. Fernández.
Dopamine agonist withdrawal syndrome: A comprehensive review.
J Neurol Sci., (2017), 374 pp. 53-55
[35]
2019031606082935876
2019031606082935877
T. Muller, C. Erdmann, S. Muhlack, D. Bremen, H. Przuntek, D. Woitalla.
Inhibition of catechol-O-methyltransferase contributes to more stable levodopa plasma levels.
Mov Disord., (2006), 3 pp. 332-336
[36]
2019031606082935878
2019031606082935879
A. Antonini, E. Moro, C. Godeiro, H. Reichmann.
Medical and surgical management of advanced Parkinson's disease.
Mov Disord., (2018), 33 pp. 900-908
[37]
2019031606082935880
2019031606082935881
J. Jankovic, E. Berkovich, E. Eyal, E. Tolosa.
Symptomatic efficacy of rasagiline monotherapy in early Parkinson's disease: post-hoc analyses from the ADAGIO trial.
Parkinsonism Relat Disord., (2014), 20 pp. 640-643
[38]
2019031606082935882
2019031606082935883
R. Borgohain, J. Szasz, P. Stanzione, C. Meshram, M.H. Bhatt, D. Chirilineau, et al.
Two-year, randomized, controlled study of safinamide as add-on to levodopa in mid to late Parkinson's disease.
Mov Disord., (2014), 29 pp. 1273-1280
[39]
2019031606082935884
2019031606082935885
J. Kulisevsky, M.R. Luquin, J.M. Arbelo, J.A. Burguera, F. Carrillo, A. Castro, et al.
Advanced Parkinson's disease: clinical characteristics and treatment (part 1).
Neurología, (2013), 28 pp. 503-521
[40]
2019031606082935886
2019031606082935887
K.A. Follett, F.M. Weaver, M. Stern, K. Hur, C.L. Harris, P. Luo, et al.
Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease.
N Engl J Med., (2010), 362 pp. 2077-2091
[41]
2019031606082935888
A. Sánchez-Martínez, M. Beavan, M.E. Gegg, K.Y. Chau, A.J. Whitworth, A.H. Schapira.
Parkinson disease-linked GBA mutation effects reversed by molecular chaperones in human cell and fly models.
Sci Rep., (2016), 6 pp. 31380