Del Dotto P, Gambaccini G, Caneparo D, Berti C, Bernardini S, Bonuccelli U
U. O. C. Neurologia, Ospedale Versilia (LU), Italy.
Neurol Sci. 2003 Oct;24(3):170-1. doi: 10.1007/s10072-003-0114-2.
Excessive daytime somnolence is a common adverse effect of dopamine-agonist treatment of Parkinson's disease (PD). Many factors, such as age and sleep disturbances, could be involved in the pathogenesis of this phenomenon. However, pharmacokinetic factors have never been considered. In this open, prospective, pilot study, nine consecutive non-demented PD patients in early disease stages on monotherapy treatment with dopamine agonists and with no significant sleep problems, were enrolled. They were selected based on the presence of excessive daytime sleepiness induced by the dopaminergic treatment. A fast switch-over from the dopamine agonist currently used to a single equivalent dose of cabergoline, a long-acting dopamine agonist, administered at bedtime was performed. All patients were evaluated by means of UPDRS and Epworth Sleepiness Scale (ESS). A significant 70% reduction of daytime sleepiness was observed during the 3-month study compared with baseline. Data from this study suggest that both pharmacodynamic and pharmacokinetic mechanisms are involved in the pathophysiology of dopamine agonist-induced sleepiness.
日间过度嗜睡是帕金森病（PD）多巴胺激动剂治疗常见的不良反应。许多因素，如年龄和睡眠障碍，可能参与了这一现象的发病机制。然而，药代动力学因素从未被考虑过。在这项开放性、前瞻性的试点研究中，连续纳入了9例处于疾病早期、接受多巴胺激动剂单药治疗且无明显睡眠问题的非痴呆PD患者。他们是根据多巴胺能治疗引起的日间过度嗜睡情况入选的。进行了从当前使用的多巴胺激动剂快速转换为睡前服用单剂量等效长效多巴胺激动剂卡麦角林的操作。所有患者均通过统一帕金森病评定量表（UPDRS）和爱泼华嗜睡量表（ESS）进行评估。与基线相比，在为期3个月的研究期间，日间嗜睡显著减少了70%。这项研究的数据表明，药效学和药代动力学机制均参与了多巴胺激动剂诱导嗜睡的病理生理学过程。
