Boylan Laura S, Hirsch Scott
New York University School of Medicine, Neurology, New York, NY10016, USA.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.06.2008.0205. Epub 2009 Feb 2.
Aripiprazole (APZ) is a novel antipsychotic agent which does not block dopamine (DA) receptors but is rather a partial DA agonist. Thus, it has been proposed that APZ may not induce tardive dyskinesia (TD), a disfiguring and sometimes disabling and irreversible side effect of neuroleptics. Our patient had Lewy body dementia (LBD) and developed severe worsening of parkinsonism over 1 month of APZ treatment. Within days of discontinuation of APZ dramatic orobuccal dyskinesias emerged. Treatment emergent worsening of parkinsonism improved but orobuccal dyskinesias persisted unchanged until his death 8 months later. Others have reported severe extrapyramidal reactions including neuroleptic malignant syndrome and TD with APZ. APZ has been suggested as a treatment for TD but treatment benefit may reflect "masked" dyskinesia. We conclude that, despite an attractive in vitro profile and promising animal data, APZ can induce serious extrapyramidal side effects, including TD.
阿立哌唑（APZ）是一种新型抗精神病药物，它并不阻断多巴胺（DA）受体，而是一种部分DA激动剂。因此，有人提出APZ可能不会诱发迟发性运动障碍（TD），这是一种抗精神病药物导致的毁容性、有时致残且不可逆的副作用。我们的患者患有路易体痴呆（LBD），在接受APZ治疗1个月后帕金森症严重恶化。停用APZ几天后，出现了严重的口颊部运动障碍。治疗引发的帕金森症恶化有所改善，但口颊部运动障碍一直持续到8个月后患者死亡时都没有变化。其他人也曾报告过使用APZ后出现严重的锥体外系反应，包括抗精神病药物恶性综合征和TD。有人提出将APZ作为TD的一种治疗方法，但治疗效果可能反映的是“隐匿性”运动障碍。我们得出结论，尽管APZ在体外实验表现诱人且动物实验数据很有前景，但它仍可诱发包括TD在内的严重锥体外系副作用。
