Vaamonde J, Ibáñez R, Hernández A, Gudín M, de Luis P, del Real M A
Servicio de Neurología, Complejo Hospitalario de Ciudad Real.
Neurologia. 2001 Feb;16(2):81-4.
[corrected] Entacapone was given to try to improve the motor complications in eight patients with Parkinson's disease (PD) treated chronically with levodopa, with daily severe motor fluctuations and dyskinesias.
We introduced entacapone (200 mg added to every dose of levodopa) to 8 parkinsonian patients (mean age: 68.25 +/- 2.3; range: 68-72; mean PD duration: 10.4 +/- 2.7 years) treated with oral levodopa, plus a dopa-decarboxylase inhibitor (mean dose: 706.25 +/- 2.3 mg/day; mean period of levodopa-treatment; 9 +/- 2.3 years). Dyskinesias were present in all patients (chorea: 8 patients; "off"--dystonia: 4; byphasic dyskinesias: 3). The type and duration (time "on" and "off") of fluctuations was categorized on the "on-off" charts drawn up by the patients or their relatives, and observation by the investigators after the introduction of entacapone. One patient, with severe impairment with entacapone, was evaluated (motor response) during i.v. apomorphine infusion (40 mg, during 3 hours).
The combination of levodopa and entacapone was associated with a net increase in "off" time in all patients (from 5.8 +/- 1.2 h to 12.4 +/- 4.4 h) without change in the URPD. In the patient studied with i.v. apomorphine, "off" periods appeared during the infusion.
These findings suggest that increased daily levodopa consumption may reduce striatal responsiveness to dopaminergic stimulation in severe parkinsonian patients. These data should be considered when planning the treatment strategy of complex parkinsonian patients.
给予恩他卡朋以尝试改善8例长期接受左旋多巴治疗、每日存在严重运动波动和异动症的帕金森病（PD）患者的运动并发症。
我们将恩他卡朋（每剂左旋多巴中添加200毫克）应用于8例接受口服左旋多巴治疗的帕金森病患者（平均年龄：68.25±2.3岁；范围：68 - 72岁；平均PD病程：10.4±2.7年），这些患者还同时服用多巴脱羧酶抑制剂（平均剂量：706.25±2.3毫克/天；平均左旋多巴治疗时间：9±2.3年）。所有患者均存在异动症（舞蹈症：8例；“关”期肌张力障碍：4例；双相异动症：3例）。根据患者或其亲属绘制的“开 - 关”图表对波动的类型和持续时间（“开”和“关”的时间）进行分类，并在引入恩他卡朋后由研究人员进行观察。1例对恩他卡朋反应严重受损的患者在静脉注射阿扑吗啡（剂量40毫克，持续3小时）期间进行了（运动反应）评估。
左旋多巴与恩他卡朋联合使用使所有患者的“关”期时间净增加（从5.8±1.2小时增至12.4±4.4小时），而不宁腿评分无变化。在接受静脉注射阿扑吗啡研究的患者中，注射期间出现了“关”期。
这些发现表明，在严重帕金森病患者中，每日左旋多巴摄入量增加可能会降低纹状体对多巴胺能刺激的反应性。在规划复杂帕金森病患者的治疗策略时应考虑这些数据。
