Leu-Semenescu Smaranda, Karroum Elias, Brion Agnès, Konofal Eric, Arnulf Isabelle
Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
Sleep Med. 2009 Apr;10(4):494-6. doi: 10.1016/j.sleep.2008.12.010.
A middle-aged architect, suffering from familial, idiopathic, levodopa-responsive restless legs syndrome (RLS) progressively abused levodopa for 10 years, to the point of taking 20 tablets/day (4000 mg/day) for 6 months. Such abuse (possibly linked to the rewarding effect of dopamine) has been recently monitored in the context of Parkinson's disease (PD) (the "dopamine dysregulation syndrome"). Physicians who now routinely treat RLS patients with dopaminergic agents should be aware of this abuse potential. This case also constitutes an experimental model. As levodopa abuse has only been described in patients with PD, it was suspected to be promoted by central dopamine depletion (with consequent sensitization of dopamine receptors). This idea should be revised because functional imaging showed that this RLS patient had no dopamine depletion. Later, he had no impulse disorders (no gambling, hypersexuality, excessive shopping), which occur with dopamine agonists, suggesting that levodopa abuse and impulse disorders can result through different mechanisms.
一名中年建筑师，患有家族性、特发性、对左旋多巴反应性的不宁腿综合征（RLS），逐渐滥用左旋多巴达10年之久，以至于连续6个月每天服用20片（4000毫克/天）。这种滥用（可能与多巴胺的奖赏效应有关）最近在帕金森病（PD）的背景下受到监测（“多巴胺失调综合征”）。目前常规用多巴胺能药物治疗RLS患者的医生应意识到这种滥用的可能性。该病例也构成了一个实验模型。由于左旋多巴滥用仅在PD患者中被描述过，有人怀疑它是由中枢多巴胺耗竭（进而导致多巴胺受体致敏）所促成的。这个观点应该修正，因为功能成像显示这名RLS患者没有多巴胺耗竭。后来，他没有出现多巴胺激动剂所引发的冲动障碍（无赌博、性欲亢进、过度购物），这表明左旋多巴滥用和冲动障碍可能通过不同机制产生。
