Matsuda Wakoto, Komatsu Yoji, Yanaka Kiyoyuki, Matsumura Akira
Department of Morphological Brain Science, Graduate School of Medicine, University of Kyoto, Konoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501 Japan.
Neuropsychol Rehabil. 2005 Jul-Sep;15(3-4):414-27. doi: 10.1080/09602010443000588.
The persistent vegetative state (PVS) and the minimally conscious state (MCS) are conditions of altered consciousness after severe brain damage due to a variety of pathologies. However, the specific pathophysiological mechanisms and a therapeutic strategy for intervention have not as yet been established. We review previous reports of levodopa treatment for patients in PVS, MCS, or other mental disorders, and have focused on five representative cases: four of PVS and one of MCS after severe brain injury. In summary, our review suggests the effectiveness of levodopa treatment is probably dependent upon the following criteria: (1) Diagnosis of PVS or MCS as distinct from other related conditions, (2) Concomitant symptoms of parkinsonism, and (3) Concomitant neuroradiological findings of high intensity lesions in the dopaminergic pathway on T2 weighted MRI. The apparent success of levodopa in the five cases described may reflect a specific subgroup of PVS and MCS patients, where the administration of levodopa is effective. However, we should not regard PVS or MCS as a single entity, since levodopa is unlikely to be effective in all cases. Therapeutic strategies should aim to identify the key pathophysiological mechanism for each patient and target interventions accordingly.
持续性植物状态（PVS）和最低意识状态（MCS）是由多种病理状况导致严重脑损伤后出现的意识改变状态。然而，具体的病理生理机制以及干预治疗策略尚未确立。我们回顾了先前关于左旋多巴治疗PVS、MCS或其他精神障碍患者的报告，并重点关注了五个典型病例：四例严重脑损伤后的PVS患者和一例MCS患者。总之，我们的综述表明左旋多巴治疗的有效性可能取决于以下标准：（1）PVS或MCS与其他相关状况相区分的诊断，（2）帕金森综合征的伴随症状，以及（3）T2加权磁共振成像（MRI）上多巴胺能通路高强度病变的伴随神经放射学表现。左旋多巴在所述的五个病例中明显有效的情况可能反映了PVS和MCS患者中的一个特定亚组，在该亚组中给予左旋多巴是有效的。然而，我们不应将PVS或MCS视为单一实体，因为左旋多巴不太可能在所有病例中都有效。治疗策略应旨在为每位患者确定关键的病理生理机制，并据此进行针对性干预。
