在齋戒月期間管控巴金森氏症


  【24drs.com】本回顧報告之目的是,患有巴金森氏症(PD)的穆斯林患者在齋戒月期間,須於黎明和黃昏之間禁食─包括禁止服用藥物時,應如何控制病況。
  
  這篇線上發表於12月27日JAMA神經學期刊的報告中,法國Nantes大學附屬醫院Philippe Damier醫師以及Al-Khaldiya科威特大學Jasem Al-Hashel醫師解釋,根據進行齋戒月的季節,禁食時間為每天11至18小時不等,這會導致PD患者的一些問題,這些患者大多有使用levodopa這種半衰期相當短的藥物作為他們的主要療法。
  
  他們指出,levodopa的給藥劑量至少是每天3次,在運動波動階段,每天服用levodopa的次數在某些患者可以增加到超過10次。延遲給藥常常會導致運動症狀以及非運動症狀再度出現,例如:疼痛、焦慮、憂鬱情緒、盜汗或呼吸困難。
  
  在最嚴重的情況下,患者可能僵硬無法移動、肌肉僵硬到幾乎不能一般地移動,這可能會導致脫水、發燒和橫紋肌溶解。最後,任何突然地停用多巴胺替代藥物的情況會與危及生命的惡性高熱症候群有關。
  
  作者們表示,每天服用1次抗巴金森藥物的初期階段患者,應該能夠遵循禁食,不會有重大的困難和風險。
  
  他們認為,至於輕度到中度波動的患者,如果他們的每日levodopa治療劑量相當於小於300 mg且可以耐受效果持續時間較長的多巴胺致效劑,也可以獲得控制。
  
  他們建議,將這類患者轉換為等效劑量、每天1次的緩釋多巴胺致效劑,或使用經皮貼片。可以用控制釋放型的levodopa製劑補充,在開始齋戒禁食的黎明之前服用,然後在黃昏停止進食之後服用。
  
  他們建議,在齋戒月前至少2週開始這些治療變化,以便有調整空間。
  
  在更嚴重的情況下,他們認為,治療是困難的,並且對患者的健康造成風險。應該提醒患者,宗教本文清楚地指出,慢性病患者不需要禁食。但是,如果患者仍然想要禁食,可以在較輕微的患者使用緩釋型多巴胺致效劑與levodopa製劑的相同組合,不過,他們提醒,在齋戒月開始之前逐漸減少多巴胺置換藥物的量是必要的,以防止惡性高熱的風險。
  
  他們建議,在非空腹時間添加一個劑量的每天1次的單胺氧化酶B型抑制劑,可以幫助延長症狀緩解,而且,在運動障礙的情況下,使用amantadine可能是有用的。
  
  作者們結論指出,齋戒月期間後,抗巴金森治療應逐漸調整回來。
  
  他們指出,在缺乏此一主題之具體研究的情況下,齋戒月期間可採用的巴金森氏症最佳療法、以及這段期間對於短期和長期之疾病控制的影響,仍有諸多問題存在。
  
  資料來源:http://www.24drs.com/
  
  Native link:Managing Parkinson's Disease During Ramadan

Managing Parkinson's Disease During Ramadan

By Sue Hughes
Medscape Medical News

How to manage Muslim patients with Parkinson's disease (PD) during the month of Ramadan, when fasting is advocated between dawn and dusk — including abstinence from medications — is the subject of a new review paper.

In the paper, published online in JAMA Neurology on December 27, Philippe Damier, MD, Centre Hospitalier Universitaire Nantes, France, and Jasem Al-Hashel, MD, University of Kuwait, Al-Khaldiya, explain that depending on the season in which Ramadan occurs, the fasting period varies from 11 to 18 hours a day. This causes problems for patients with PD, most of whom use levodopa, a drug with a very short half-life, as their mainstay therapy.

They note that levodopa is dosed at least three times a day, and at the stage of motor fluctuation, the daily number of levodopa intakes can increase to be more than 10 in some patients. A delay in drug administration often leads to the reappearance of motor symptoms as well as nonmotor symptoms, such as pain, anxiety, depressive mood, sweating, or dyspnea.

In the most severe cases, the patient might be frozen, hardly able to move with generalized muscle rigidity, which can lead to dehydration, fever, and rhabdomyolysis. Finally, any sudden withdrawal of dopamine replacement drugs is associated with the risk for a life-threatening malignant hyperthermia syndrome.

The authors say that a patient at the early stage of the disease with a once-daily administration of antiparkinsonian medication should be able to follow the fasting period without major difficulties and risks.

Patients with mild to moderate fluctuations can also be managed if they are treated with a daily levodopa equivalent dosage lower than 300 mg and are able to tolerate dopamine agonists, which have a longer-duration effect, they suggest.

They advise switching such patients to an equivalent dosage of an extended-release dopamine agonist administered once daily or by transdermal patch. This can be supplemented with a controlled-release levodopa formulation with one intake at dawn before the fasting starts and one intake at dusk when the fast is broken.

They recommend starting the changes to treatment at least 2 weeks before Ramadan to leave room for any adjustments.

In more severe cases, they say treatment is difficult and presents a risk to the health of the patient. The patient should be reminded that the religious texts clearly state that patients with a chronic disease do not need to fast, they write. But if the patient still wants to fast, the same combination of extended-release dopamine agonist and levodopa formulations can be used as in milder patients. However, it is essential to progressively reduce the amount of dopamine replacement drug before Ramadan starts to prevent the risk for malignant hyperthermia, they warn.

They suggest that adding a once-daily monoamine oxidase B inhibitor dose during the nonfasting time could help by extending the symptomatic relief, and the use of amantadine might be useful in the case of dyskinesia.

After the Ramadan period, the antiparkinsonian treatment needs to be adjusted back gradually, the authors conclude.

They add that in the absence of specific studies on this topic, many questions remain about the best way to adapt Parkinson's treatment during Ramadan fasting and the effect of that period on the short-term and long-term control of the disease.

Dr Damier reports he has received lecture fees from Medtronic, Teva Pharmaceuticals, and Novartis. The other authors have disclosed no relevant financial relationships.

JAMA Neurol. Published online December 27, 2016.

    
相關報導
AAN 2009:荷爾蒙可以使婦女免於巴金森氏症
2009/4/3 下午 03:10:00
AD/PD 2009:偵測失智症的生物標記出現
2009/3/27 下午 02:03:00
睡眠異常會導致巴金森氏症或者失智症
2008/12/30 下午 05:28:00

   1   2   3   4   5   6   7   8   9   10  




回上一頁