Kanzato Naomi, Nishihira Takeo, Murao Hiroshi, Takara Hanae
Department of Neurology, Okinawa Prefectural Nanbu Medical Center.
Rinsho Shinkeigaku. 2006 Jun;46(6):400-3.
A 29-year-old woman with two sons developed a rest tremor and motor slowness in her right limbs. She was diagnosed as Parkinson's disease (PD) and was treated with anti-cholinergic drugs. After three years of taking a dopamine agonist (cabergoline, 4 mg per day), she became pregnant. The patient and her husband decided to have an abortion because they worried that the cabergoline might have harmed the fetus. The patient hoped to prepare for future planned birth, so we canceled the cabergoline and gradually increased her carbidopa/levodopa dose. Her motor disability gradually worsened during the pregnancy, and she developed prominent bradykinesia while taking a high dose of carbidopa/levodopa (1,000 mg per day) and a continuous infusion of levodopa. A cesarean section was performed, and the patient gave birth to a healthy baby. After the delivery, she was treated with pramipexole (2 mg per day), and her bradykinesia decreased. The initial anti-PD medication schedule for fertile female PD patients should be carefully considered to lessen the harm to the fetus, especially during organogenesis. Motor disability may worsen during pregnancy, and appropriate childcare support should be prepared.
一名育有两个儿子的29岁女性出现右肢静止性震颤和运动迟缓。她被诊断为帕金森病（PD），并接受了抗胆碱能药物治疗。服用多巴胺激动剂（卡麦角林，每日4毫克）三年后，她怀孕了。患者及其丈夫决定堕胎，因为他们担心卡麦角林可能会对胎儿造成伤害。患者希望为未来的计划生育做准备，因此我们停用了卡麦角林，并逐渐增加她的卡比多巴/左旋多巴剂量。在怀孕期间，她的运动功能障碍逐渐恶化，在服用高剂量卡比多巴/左旋多巴（每日1000毫克）并持续输注左旋多巴时，出现了明显的运动迟缓。患者接受了剖宫产，生下了一个健康的婴儿。产后，她接受了普拉克索（每日2毫克）治疗，运动迟缓有所减轻。对于有生育能力的女性帕金森病患者，初始抗帕金森病药物治疗方案应仔细考虑，以减轻对胎儿的伤害，尤其是在器官形成期。怀孕期间运动功能障碍可能会恶化，应做好适当的育儿支持准备。
