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左旋多巴诱发异动症的临床药理学

Clinical pharmacology of levodopa-induced dyskinesia.

作者信息

Nutt J G

机构信息

Department of Neurology, School of Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.

出版信息

Ann Neurol. 2000 Apr;47(4 Suppl 1):S160-4; discussion S164-6.

Abstract

Levodopa-induced dyskinesia (LID) is a major impediment to the successful therapy of Parkinson's disease. The development of LID is facilitated by dopaminergic denervation but may not require denervation. Repeated levodopa dosing is necessary to induce dyskinesia, implying the development of sensitization to levodopa. There is inconclusive evidence on whether repeated dosing lowers the threshold (shifts the levodopa-dyskinesia response curve to the left), increases the severity of dyskinesia (increases the maximum effect that is initially zero) or induces more complex changes in the dose-response curve. Once a patient develops LID, the severity of LID is not dose responsive, but the duration of dyskinesia is. Clinically, it is very difficult to separate the antiparkinsonian and dyskinetic effects of levodopa. Whether this separation is possible with more selective agonists with antiparkinsonian effects that are equipotent to levodopa is unknown. The fact that selective stimulation of the pallidum does not separate antiparkinsonian and dyskinetic actions implies that they are closely related anatomically and physiologically.

摘要

左旋多巴诱导的异动症(LID)是帕金森病成功治疗的主要障碍。多巴胺能去神经支配促进了LID的发生,但可能并非必需。重复给予左旋多巴是诱导异动症所必需的,这意味着对左旋多巴产生了敏化作用。关于重复给药是否会降低阈值(将左旋多巴-异动症反应曲线向左移动)、增加异动症的严重程度(增加最初为零的最大效应)或在剂量反应曲线中诱导更复杂的变化,证据尚无定论。一旦患者出现LID,LID的严重程度与剂量无关,但异动症的持续时间与剂量有关。临床上,很难区分左旋多巴的抗帕金森病作用和异动症作用。具有与左旋多巴等效的抗帕金森病作用的更具选择性的激动剂是否能够实现这种区分尚不清楚。选择性刺激苍白球并不能区分抗帕金森病作用和异动症作用,这一事实表明它们在解剖学和生理学上密切相关。

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