帕金森症的早期处理
薛老你好! 薛老真的很不容易,我很敬佩,也很后悔当时还收了你400元诊金,也明白你现时的担忧,也真的希望雷沙吉兰是一只可以真正有前途的治疗帕金森症的药物,这要时间来证明。然而,我始终认为,帕金森症的进展,此退行性神经疾病和脑部基底部神经节特别是黑质区的多巴胺神经元细胞凋亡是和某些特发性炎症有关,而且我判断是和胶质细胞活化有关,因为有很多的临床报告,但没有引起医疗界的重视,焦点一直是L-dopa,下面我附了其中一个报告,2003年由法国巴黎萨伯特总医院神经治疗学系的Hirsch EC等发表在美国国立卫生研究院下的美国国家生物技术信息中心期刊的文章,中文是:胶质细胞在帕金森症的反应和炎症作用The role of glial reaction and inflammation in Parkinson’s disease Hirsch EC, Breidert T, Rousselet E, Hunot S, Hartmann A, Michel PP.
INSERM U289, Experimental Neurology and Therapeutics, Hôpital de la Salpêtrière, 75651 Paris Cedex 13, France. hirsch@ccr.jussieu.fr
The glial reaction is generally considered to be a consequence of neuronal death in neurodegenerative diseases such as Alzheimer’s disease, Huntington’s disease, and Parkinson’s disease. In Parkinson’s disease, postmortem examination reveals a loss of dopaminergic neurons in the substantia nigra associated with a massive astrogliosis and the presence of activated microglial cells. Recent evidence suggests that the disease may progress even when the initial cause of neuronal degeneration has disappeared, suggesting that toxic substances released by the glial cells may be involved in the propagation and perpetuation of neuronal degeneration. Glial cells can release deleterious compounds such as proinflammatory cytokines (TNF-alpha, Il-1beta, IFN-gamma), which may act by stimulating nitric oxide production in glial cells, or which may exert a more direct deleterious effect on dopaminergic neurons by activating receptors that contain intracytoplasmic death domains involved in apoptosis. In line with this possibility, an activation of proteases such as caspase-3 and caspase-8, which are known effectors of apoptosis, has been reported in Parkinson’s disease. Yet, caspase inhibitors or invalidation of TNF-alpha receptors does not protect dopaminergic neurons against degeneration in experimental models of the disease, suggesting that manipulation of a single signaling pathway may not be sufficient to protect dopaminergic neurons. In contrast, the antiinflammatory drugs pioglitazone, a PPAR-gamma agonist, and the tetracycline derivative minocycline have been shown to reduce glial activation and protect the substantia nigra in an animal model of the disease. Inhibition of the glial reaction and the inflammatory processes may thus represent a therapeutic target to reduce neuronal degeneration in Parkinson’s disease.
PMID:12846989[PubMed - indexed for MEDLINE] 。文章内主要阐明了神经胶质细胞释放的有毒物质可能参与神经元变性的传播和延续,因此,抑制胶质细胞反应和炎症过程可以减少帕金森症神经元变性。而Hirsch EC主张以抗生素加以治疗,我觉的不妥,因为吡格列酮及米诺环素参与长久的抗帕治疗祸福难料,恐怕会有其他的副作用,所以,我作了大量的研究,最后我才选取一只名叫长春西碱的一种天然化合物,在欧洲叫Neurovin的专利药,在美国是Vinpocetine,它是非常理想的可以长期使用的抗炎剂,有关此药的抗炎作用我不详细说明了,因篇幅太长,在我的临床中,每天30mg,不要超40mg每日,分三次饭后,效果是正面的,也没有不量反应,讲个实例,2011年底,我一个以震颤为主的帕症病人,在以Vinpocetine及二种强烈抗氧化剂,一种是Glutathione,Glutathione在其他国家被一些医生采用静脉注射方式治疗帕症(为何要用强烈抗氧化剂,又是另一话题,和细胞的氧化应激有关),还有一种天然神经递质,恕我保留,这是和美国佛罗里达大西洋大学的Max Planck Florida Institute Dr.Jang Yen Wu的研究议题,没有使用一颗左旋多巴,现在情况已经稳定,由第一次驻拐杖进诊所到现在可以爬山,自行买菜煮饭。我相信Vinpocetine功不可抹,我相信自己的判断,可以说如同薛老判断雷沙吉兰在帕症中的作用一样,也希望各位病友早日把此药加入帕症的治疗中,更希望薛老的认同,(薛夫人来我诊所时我已推荐此药)可以一起探讨,因为此疗法是我的实际经验,我毫无保留,希望在帕金森症的治疗上可以添一份力,也是希望在帕症治疗中寻求一种更好更安全的方法。