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金刚烷胺治疗帕金森病左旋多巴诱发的异动症

[Amantadine for the treatment of levodopa dyskinesias in Parkinson's disease].

作者信息

Cersósimo M G, Scorticati M C, Micheli F E

机构信息

Servicio de Neurología, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires.

出版信息

Medicina (B Aires). 2000;60(3):321-5.

Abstract

The development of dyskinesias is a common side effect during chronic levodopa therapy in parkinsonian patients. Recent reports suggest that amantadine, a drug with well known antiparkinsonian activity, is effective in the treatment of this complication. In order to evaluate its usefulness we conducted an open label, prospective and longitudinal study in 26 patients with Parkinson's disease (PD) on chronic levodopa therapy who presented peaks of dose dyskinesias. After 3 weeks' treatment dyskinesia severity was reduced by 70% (p < 0.0001) on the I SAPD scale and by 68.8% (p < 0.0002) on the UPDRS IV subscale. Patients were later evaluated every 45 days showing persistent drug benefit during follow-up ranging from 2 to 11 months (mean 6.5 months). One third of our series presented unwanted effects which were only severe enough in 2 cases to discontinue treatment. In the others, side effects were transient or readily abated with amantadine dose reduction. Our findings support amantadine as a safe and useful drug to treat levodopa-induced dyskinesias which on occasion prove as disabling as PD itself. Treatment with amantadine should routinely be considered before indicating pallidotomy for levodopa-induced dyskinesias.

摘要

运动障碍的发生是帕金森病患者长期左旋多巴治疗过程中常见的副作用。最近的报告表明,金刚烷胺这种具有众所周知的抗帕金森病活性的药物,对治疗这种并发症有效。为了评估其有效性,我们对26例接受长期左旋多巴治疗且出现剂峰异动症的帕金森病(PD)患者进行了一项开放标签、前瞻性纵向研究。治疗3周后,异动症严重程度在国际帕金森病和运动障碍协会(ISAPD)量表上降低了70%(p<0.0001),在统一帕金森病评定量表(UPDRS)IV分量表上降低了68.8%(p<0.0002)。此后每45天对患者进行评估,结果显示在2至11个月(平均6.5个月)的随访期间药物疗效持续存在。我们的研究系列中有三分之一出现了不良反应,其中只有2例严重到足以停药。在其他病例中,副作用是短暂的,或者通过减少金刚烷胺剂量很容易得到缓解。我们的研究结果支持将金刚烷胺作为一种安全有效的药物来治疗左旋多巴诱导的运动障碍,这种运动障碍有时被证明与帕金森病本身一样致残。在考虑对左旋多巴诱导的运动障碍进行苍白球切开术之前,应常规考虑使用金刚烷胺进行治疗。

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