Fujino Yasuhiro, Nakajima Masashi, Tsuboi Yoshio, Baba Yasuhiko, Yamada Tatsuo
Department of Medicine (Neurology), Fukuoka University School of Medicine.
Rinsho Shinkeigaku. 2002 Jan;42(1):42-4.
Serotonin activity has been shown to be increased in the basal ganglia of patients with progressive supranuclear palsy (PSP), and may be responsible for its extrapyramidal features that do not respond to 1-dopa.
To investigate clinical effectiveness of 5-HT1A agonist, tandospirone citrate (TC), on various clinical features of PSP.
Clinical signs of eight patients (2 women and 6 men) who fulfilled NINDS-SPSP criteria of PSP were studied before and after administration of TC. Each of vertical gaze palsy, apraxia of eyelid opening, neck dystonia, bradykinesia, postural instability, gait disturbances, dysarthria, dysphagia, and bladder disturbances was graded, and evaluated before, and two and four weeks after oral administration of TC 30 mg/day.
TC was well tolerated in six patients for four weeks. The other two patients developed dizziness or liver dysfunction in the second week, and dropped out. Neck dystonia, postural instability, and bradykinesia were improved significantly in the fourth week. On the contrary, vertical gaze palsy, dysarthria, and dysphagia responded poorly to TC. Apraxia of eyelid opening was present in three patients, and was improved in two. Bladder disturbances were present in three patients, and did not respond to TC.
Among various clinical features in PSP, TC was effective preferentially on extrapyramidal ones. Suppression of serotonergic activities in the basal ganglia of PSP may be underlying in the effectiveness of this 5-HT1A agonist.
已表明进行性核上性麻痹（PSP）患者基底神经节中的5-羟色胺活性增加，这可能是其对左旋多巴无反应的锥体外系特征的原因。
研究5-HT1A激动剂枸橼酸坦度螺酮（TC）对PSP各种临床特征的临床疗效。
对符合PSP的NINDS-SPSP标准的8例患者（2例女性，6例男性）在服用TC前后的临床体征进行研究。对垂直性凝视麻痹、眼睑开合失用、颈部肌张力障碍、运动迟缓、姿势不稳、步态障碍、构音障碍、吞咽困难和膀胱功能障碍分别进行分级，并在口服30mg/天TC前、服药后2周和4周进行评估。
6例患者对TC耐受良好，持续4周。另外2例患者在第2周出现头晕或肝功能异常而退出研究。第4周时，颈部肌张力障碍、姿势不稳和运动迟缓有显著改善。相反，垂直性凝视麻痹、构音障碍和吞咽困难对TC反应不佳。3例患者存在眼睑开合失用，其中2例有所改善。3例患者存在膀胱功能障碍，对TC无反应。
在PSP的各种临床特征中，TC对锥体外系特征优先有效。PSP患者基底神经节中5-羟色胺能活性的抑制可能是这种5-HT1A激动剂发挥疗效的基础。
