Kawasaki H, Yamamoto M, Okayasu H, Wakayama Y
Department of Medicine, Showa University, Fujigaoka Hospital.
Rinsho Shinkeigaku. 1991 Aug;31(8):878-81.
Clebopride malate is therapeutically used for the treatment of peptic ulcer. This drug has potent antidopaminergic activity that causes acute dystonic reaction, parkinsonism and tardive dyskinesia as adverse effects. Here, we have reported an 86-year-old man who developed abnormal involuntary movement of respiratory muscles and lower limb muscles after this drug had been given for four months. This involuntary movement appeared spontaneously at resting state and disappeared during sleep. Surface EMG demonstrated a synchronous grouping discharge in m. orbicularis oris, m. sternocleidomastoideus and m. interstales which synchronized with diaphragmatic movement on cinefluorography. Involuntary movement of the lower limbs was synchronous bilaterally and had little relationship with diaphragmatic movement. This involuntary movement was irregular not only in rhythm but also in duration. According to this irregular nature, we diagnosed this involuntary movement as respiratory dyskinesia with limb dyskinesia that belongs to tardive dyskinesia. After cessation of clebopride malate limb dyskinesia disappeared rapidly and respiratory dyskinesia markedly decreased. We emphasize that respiratory dyskinesia should be differentiated from psychogenic hyperventilation as easily misdiagnosed on initial examination.
苹果酸氯波必利在治疗上用于消化性溃疡的治疗。该药物具有强大的抗多巴胺能活性，会引起急性肌张力障碍反应、帕金森综合征和迟发性运动障碍等不良反应。在此，我们报告了一名86岁男性，在服用该药物四个月后出现呼吸肌和下肢肌肉的异常不自主运动。这种不自主运动在静息状态下自发出现，睡眠时消失。表面肌电图显示口轮匝肌、胸锁乳突肌和肋间肌出现同步成组放电，在荧光电影造影中与膈肌运动同步。下肢的不自主运动双侧同步，与膈肌运动关系不大。这种不自主运动不仅在节律上不规则，而且在持续时间上也不规则。根据这种不规则性质，我们将这种不自主运动诊断为属于迟发性运动障碍的呼吸运动障碍伴肢体运动障碍。停用苹果酸氯波必利后，肢体运动障碍迅速消失，呼吸运动障碍明显减轻。我们强调，呼吸运动障碍应与心因性过度通气相鉴别，因为在初次检查时容易误诊。
