Colorado-Ochoa H
Servicio de Medicina Interna, Hospital ISSSTE, Veracruz.
Gac Med Mex. 2000 Sep-Oct;136(5):505-9.
The purpose of this work is to report a case of tolcapone-induced akathisia. A 39-year-old woman with Parkinson's disease, Hohen-Yahr IV, Webster 18 points with 10 years within onset, presented lack of clinical response to levodopa-carbidopa, pergolide, selegiline and trihexiphenidyl, showing freezing and wearing-off phenomena and choreic dyskinetic abnormal movements of the upper and lower extremities, during the six months previous to her evaluation. Her hepatic function was normal. Levodopa-carbidopa and selegiline were diminished to add tolcapone, as described elsewhere. During the first three weeks, the patient showed marked clinical improvement of previous complications and sustained improvement during 12.5 weeks. At the 13th week of tolcapone therapy the patient developed constant orofacial, trunk, and superior and lower limb ínvoluntary movements associated to lack of stand still. Laboratory tests showed discrete elevation of oxaloacetic-glutamic transminase, direct bilirrubin, indirect bilirubin, and alkaline phosphatase. Electroencephalogram and CT scan were normal. Tolcapone therapy was finished, and levodopa-carbidopa, pergolide and selegiline were diminished, procuring the disappearance of akathisia within 72 h.
本文旨在报告1例托卡朋诱发的静坐不能病例。一名39岁的帕金森病女性患者，处于霍恩-亚尔分级IV级，韦氏评分18分，病程10年，在评估前6个月内，对左旋多巴-卡比多巴、培高利特、司来吉兰和苯海索无临床反应，出现冻结现象、剂末现象以及上下肢舞蹈样运动障碍异常动作。其肝功能正常。按照其他文献所述，减少左旋多巴-卡比多巴和司来吉兰剂量，加用托卡朋。在最初的三周内，患者先前的并发症有明显临床改善，并在12.5周内持续改善。在托卡朋治疗第13周时，患者出现持续的口面部、躯干以及上下肢不自主运动，伴有不能静立。实验室检查显示草酰乙酸-谷氨酸转氨酶、直接胆红素、间接胆红素和碱性磷酸酶轻度升高。脑电图和CT扫描正常。停止托卡朋治疗，减少左旋多巴-卡比多巴、培高利特和司来吉兰剂量，静坐不能在72小时内消失。
