Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Parkinsonism Relat Disord. 2012 Jun;18(5):514-9. doi: 10.1016/j.parkreldis.2012.01.020. Epub 2012 Feb 25.
Motor response complications that arise with repeated L-dopa administration for the treatment of Parkinson's disease are well understood but the relationship between motor response complications and affect are not. We proposed that patients with dyskinesias would report rebound worsening in affect during wearing-off of L-dopa effect.
Fifty Parkinson's disease patients with were assessed with the Purdue Pegboard test and rated Positive Affect and Negative Affect after overnight withdrawal of dopaminergic medications and half hourly for 6 h after a standard L-dopa challenge. Patients were carefully classified into stable responder (n = 12), fluctuator (n = 15), and dyskinetic (n = 23) groups.
Positive Affect was improved by L-dopa in dyskinetics and to a lesser degree in fluctuators but not in stable responders. At T = 4-6 h, Positive Affect rebounded below baseline in dyskinetics only. On regression analysis, rebound worsening positively correlated with ratings of dyskinesia severity. Negative Affect improved with L-dopa in all groups and tended to remain below baseline for 6 h after L-dopa challenge. Peak effects of L-dopa on Positive Affect and Negative Affect occurred significantly earlier than effects on Purdue Pegboard test and were positively correlated with L-dopa equivalent daily dose.
There is a clinical dissociation between L-dopa effects on motor function, Positive Affect and Negative Affect. Rebound worsening in Positive Affect occurred only in dyskinetic patients and the onset of rebound worsening occurred before the end of the motor benefit phase. These observations could explain why some Parkinson patients report wearing-off symptoms despite the external impression of good motor control.
由于重复给予左旋多巴治疗帕金森病而引起的运动反应并发症是众所周知的，但运动反应并发症与情感之间的关系尚不清楚。我们假设，在左旋多巴作用消退期间出现异动症的患者会报告情感的反弹恶化。
对 50 名帕金森病患者进行了评估，他们在停止使用多巴胺能药物过夜后，每半小时评估一次普杜斯钉板测试和正性情感和负性情感，持续 6 小时。患者被仔细分类为稳定反应者（n = 12）、波动者（n = 15）和异动症者（n = 23）。
左旋多巴改善了异动症患者的正性情感，在波动者中也有一定程度的改善，但在稳定反应者中没有改善。在 T = 4-6 小时，只有异动症患者的正性情感反弹低于基线。回归分析显示，反弹恶化与异动症严重程度评分呈正相关。所有组的负性情感均随左旋多巴改善，在左旋多巴挑战后 6 小时仍倾向于低于基线。正性情感和负性情感对左旋多巴的峰值效应明显早于对普杜斯钉板测试的效应，并且与左旋多巴等效日剂量呈正相关。
左旋多巴对运动功能、正性情感和负性情感的影响存在临床分离。只有在异动症患者中出现正性情感的反弹恶化，而反弹恶化的开始发生在运动获益阶段结束之前。这些观察结果可以解释为什么一些帕金森病患者尽管外表上运动控制良好，但仍会出现药物失效症状。
