帕金森病临床症状：
1)好发年龄50-60岁，平均55岁
2)男性略多于女性
3) 症状不对称：常由一侧上肢起病→同侧下肢
→对侧上肢及下肢
4)运动症状（四主征）：
静止性震颤、肌强直、运动迟缓 ( 随意运动减少，动作缓慢、笨拙) 和姿势步态异常(上肢摆臂幅度减小或消失，下肢拖曳。)
5)非运动症状（嗅觉障碍、便秘、抑郁、睡眠障碍等）
①感觉障碍：嗅觉减退或睡眠障碍，尤其是快速眼动期睡眠行为异常，中晚期常有肢体麻木、疼痛。有些患者可伴有不安腿综合征。
②自主神经功能障碍，如便秘、多汗、溢脂性皮炎等，后期也可以出现性功能减退、排尿障碍或体位性性低血压。
③精神和认知障碍：近半数患者伴有抑郁，并常伴有焦虑。
治疗原则
最小剂量，最佳效果；, 延缓治疗；调整剂量；缓慢停药。
1. 综合治疗：
药物治疗是最主要的治疗手段
手术治疗是有效补充
康复治疗、心理治疗及护理能在一定程度上改善症状
2. 用药原则：
剂量滴定，用药宜从小剂量开始逐渐加量
以较小剂量达到较满意疗效，不求全效
常用药物：
1、早期治疗：MAO-B抑制剂: (司来吉兰加维生素E) ；震颤为主早期患者口服苯海索；行动困难或僵硬为主应选用金刚烷胺或与抗胆碱药( 如苯海索) 合用。
2、中晚期治疗：左旋多巴类药物，左旋多巴、复方多巴后、舒必利、硫必利、巴氯芬。
3、其他辅助治疗：溴隐亭、培高利特、吡贝地尔；托卡朋、COMT抑制剂: 恩他卡朋
①DR激动剂
Clinical symptoms of Parkinson's disease:
1) The prone age is 50-60 years old, with an average of 55 years old
2) There are slightly more men than women
3) Symptom asymmetry: often from one upper limb to the same lower limb
→ contralateral upper and lower limbs
4) Motor symptoms (four main symptoms):
Static tremor, myotonia, bradykinesia (decreased random movement, slow and clumsy movement) and abnormal posture and gait (decreased or disappeared swing amplitude of upper limbs and dragged lower limbs.)
5) Non motor symptoms (dysosmia, constipation, depression, sleep disorder, etc.)
① Sensory disturbance: anosmia or sleep disturbance, especially abnormal sleep behavior during rapid eye movement. Limb numbness and pain are often found in the middle and late stage. Some patients may have restless legs syndrome.
② Autonomic nerve dysfunction, such as constipation, hyperhidrosis, seborrheic dermatitis, etc. in the later stage, sexual dysfunction, dysuria or postural hypotension can also occur.
③ Mental and cognitive disorders: nearly half of the patients are accompanied by depression and often anxiety.
Treatment principle
1. Comprehensive treatment:
Drug therapy is the main treatment
Surgical treatment is an effective supplement
Rehabilitation therapy, psychotherapy and nursing can improve symptoms to a certain extent
2. Medication principle:
For dose titration, the dosage should be gradually increased from a small dose
The satisfactory curative effect is achieved with a small dose, and the total effect is not required
1. Minimum dose, best effect;
2. Delaying treatment;
3. Adjust the dose;
4. Slow withdrawal.
Common drugs:
1. Early treatment: MAO-B inhibitor: (selegilan plus vitamin E); Patients with tremor were mainly treated with oral phenylhexol in the early stage; Amantadine or combined with anticholinergic drugs (such as phenylhexol) should be selected for difficult movement or stiffness.
2. Middle and late stage treatment: levodopa drugs, levodopa, compound dopa, sulpiride, tiapride and baclofen.
3. Other adjuvant therapy: bromocriptine, pergolide, piribedil; Tolcapone, COMT inhibitor: entacapone
① Dr agonist