Lee Kelly C, Finley Ron, Miller Bruce
School of Pharmacy, Loma Linda University, Loma Linda, California, USA.
Pharmacotherapy. 2004 Mar;24(3):401-3. doi: 10.1592/phco.24.4.401.33174.
A 67-year-old woman with an 8-year history of Parkinson's disease and Lewy body dementia experienced difficulty in opening her eyelids (apraxia of lid opening [ALO]); she could close them without difficulty. This problem emerged 2 weeks after the patient's dosage of carbidopa 50 mg-levodopa 200 mg 3 times/day was decreased to twice/day. Two weeks after the onset of ALO the patient visited her physician, who suspected carbidopa-levodopa of causing the problem; the drug was discontinued. When the patient's condition worsened rather than improved, she was referred to a neuro-ophthalmologist, who confirmed the diagnosis of ALO. However, the neuro-ophthalmologist noted that this may not have been a true apraxia but rather a form of sustained blepharospasm that prevented the eyelid from opening. Carbidopa-levodopa was restarted, and her condition improved dramatically when her dosage was increased gradually to carbidopa 50 mg-levodopa 200 mg in the morning and at noon, and carbidopa 25 mg-levodopa 100 mg in the evening. Clinicians should be aware of adverse reactions, such as AOL, in patients taking carbidopa-levodopa who have dementia of the Lewy body type.
一名患有帕金森病和路易体痴呆8年的67岁女性出现了睁眼困难（睁眼失用症[ALO]）；她闭眼没有困难。这个问题在患者卡比多巴50毫克-左旋多巴200毫克每日3次的剂量减至每日2次后2周出现。ALO发病2周后患者就医，医生怀疑是卡比多巴-左旋多巴导致了这个问题；药物被停用。当患者病情恶化而非改善时，她被转诊至神经眼科医生处，后者确诊为ALO。然而，神经眼科医生指出这可能并非真正的失用症，而是一种持续性睑痉挛，导致眼睑无法睁开。卡比多巴-左旋多巴重新开始使用，当剂量逐渐增加至早晨和中午服用卡比多巴50毫克-左旋多巴200毫克，晚上服用卡比多巴25毫克-左旋多巴100毫克时，她的病情显著改善。临床医生应意识到，患有路易体痴呆的患者在服用卡比多巴-左旋多巴时可能会出现诸如AOL等不良反应。
