Piccini P, Del Dotto P, Pardini C, D'Antonio P, Rossi G, Bonuccelli U
Istituto di Clinica Neurologica, Università di Pisa.
Riv Neurol. 1991 Nov-Dec;61(6):219-24.
Parkinson's disease (PD) patients show a good response to levodopa in the morning, and reduced duration or complete failure of response later in the day, but the pathophysiology of this phenomenon remains unclear. We evaluated motor performance hourly over a twelve-hour period in patients treated with levodopa/carbidopa (group A), with bromocriptine (group B), and in "de novo" patients (group C). At 8 am, 12 and 4 pm, group A patients received standard doses of levodopa/carbidopa, whereas patients of group B and C took, respectively, 5 mg bromocriptine and placebo. In "de novo" patients and in patients under bromocriptine we did not observe significant diurnal changes in motor score, whereas in patients under levodopa a progressive daytime worsening, which significantly correlated with progressive increase in 3-O-methyldopa plasma levels, was visible. These data seem to indicate a contributory role of pharmacokinetic or pharmacodynamic factors related to levodopa assumption, rather than to the underlying disease, in the afternoon worsening in PD.
帕金森病（PD）患者在早晨对左旋多巴反应良好，但在一天晚些时候反应持续时间缩短或完全失效，不过这一现象的病理生理学仍不清楚。我们在12小时内每小时评估一次接受左旋多巴/卡比多巴治疗的患者（A组）、接受溴隐亭治疗的患者（B组）以及“初发”患者（C组）的运动表现。上午8点、中午12点和下午4点时，A组患者接受标准剂量的左旋多巴/卡比多巴，而B组和C组患者分别服用5毫克溴隐亭和安慰剂。在“初发”患者和接受溴隐亭治疗的患者中，我们未观察到运动评分有显著的昼夜变化，而在接受左旋多巴治疗的患者中，可见白天病情逐渐恶化，且这与3 - O - 甲基多巴血浆水平的逐渐升高显著相关。这些数据似乎表明，在帕金森病下午病情恶化中，与左旋多巴摄入相关的药代动力学或药效学因素而非潜在疾病起了作用。
