Chulalongkorn Parkinson's Disease and Related Disorders Center of Excellence, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Neurology. 2013 Jul 30;81(5):463-9. doi: 10.1212/WNL.0b013e31829d86b6.
To make evidence-based recommendations regarding management of tardive syndromes (TDS), including tardive dyskinesias (TDD), by addressing 5 questions: 1) Is withdrawal of dopamine receptor blocking agents (DRBAs) an effective TDS treatment? 2) Does switching from typical to atypical DRBAs reduce TDS symptoms? 3) What is the efficacy of pharmacologic agents in treating TDS? 4) Do patients with TDS benefit from chemodenervation with botulinum toxin? 5) Do patients with TDS benefit from surgical therapy?
PsycINFO, Ovid MEDLINE, EMBASE, Web of Science, and Cochrane were searched (1966-2011). Articles were classified according to a 4-tiered evidence-rating scheme; recommendations were tied to the evidence.
Clonazepam probably improves TDD and ginkgo biloba probably improves TDS (both Level B); both should be considered as treatment. Risperidone may improve TDS but cannot be recommended as treatment because neuroleptics may cause TDS despite masking symptoms. Amantadine and tetrabenazine might be considered as TDS treatment (Level C). Diltiazem should not be considered as TDD treatment (Level B); galantamine and eicosapentaenoic acid may not be considered as treatment (Level C). Data are insufficient to support or refute use of acetazolamide, bromocriptine, thiamine, baclofen, vitamin E, vitamin B6, selegiline, clozapine, olanzapine, melatonin, nifedipine, fluperlapine, sulpiride, flupenthixol, thiopropazate, haloperidol, levetiracetam, quetiapine, ziprasidone, sertindole, aripiprazole, buspirone, yi-gan san, biperiden discontinuation, botulinum toxin type A, electroconvulsive therapy, α-methyldopa, reserpine, and pallidal deep brain stimulation as TDS treatments (Level U). Data are insufficient to support or refute TDS treatment by withdrawing causative agents or switching from typical to atypical DRBA (Level U).
通过回答 5 个问题，为迟发性综合征（TDS）的管理提供循证建议，包括迟发性运动障碍（TDD）：1）停用多巴胺受体阻断剂（DRBA）是否是治疗 TDS 的有效方法？2）从典型 DRBA 转换为非典型 DRBA 是否能减轻 TDS 症状？3）治疗 TDS 的药物疗效如何？4）患有 TDS 的患者是否受益于肉毒毒素化学神经切断术？5）患有 TDS 的患者是否受益于手术治疗？
检索 PsycINFO、Ovid MEDLINE、EMBASE、Web of Science 和 Cochrane（1966-2011 年）。根据四级证据评级方案对文章进行分类；建议与证据挂钩。
氯硝西泮可能改善 TDD，银杏叶可能改善 TDS（均为 B 级）；两者均应考虑作为治疗方法。利培酮可能改善 TDS，但不能作为治疗方法推荐，因为神经安定药可能导致 TDS，尽管可以掩盖症状。金刚烷胺和四氢大麻酚可能被认为是 TDS 的治疗方法（C 级）。地尔硫卓不应被认为是 TDD 的治疗方法（B 级）；加兰他敏和二十碳五烯酸可能不被认为是治疗方法（C 级）。数据不足以支持或反驳乙酰唑胺、溴隐亭、硫胺素、巴氯芬、维生素 E、维生素 B6、司立吉林、氯氮平、奥氮平、褪黑素、硝苯地平、氟哌啶醇、舒必利、氟奋乃静、噻丙嗪、氟哌啶醇、左乙拉西坦、喹硫平、齐拉西酮、氨磺必利、阿立哌唑、丁螺环酮、一甘三、比哌立登停药、肉毒毒素 A 型、电惊厥疗法、α-甲基多巴、利血平、苍白球深部脑刺激作为 TDS 的治疗方法（U 级）。数据不足以支持或反驳通过停用致病药物或从典型 DRBA 转换为非典型 DRBA 来治疗 TDS（U 级）。
