Todorova Antoniya, Samuel Michael, Brown Richard G, Chaudhuri Kallol Ray
*National Parkinson Foundation Centre of Excellence, Department of Neurology, King's College Hospital; and †Institute of Psychiatry and ‡King's College London, United Kingdom.
Clin Neuropharmacol. 2015 Jul-Aug;38(4):132-4. doi: 10.1097/WNF.0000000000000091.
In Parkinson disease (PD), compulsive behaviors, cumulatively termed impulse control disorders (ICDs), are known to develop in patients receiving dopamine-replacement therapy with oral dopamine agonists being particularly implicated. However, the effects of continuous infusion therapies have not been explored.
We report data from a 3-year clinical observational screening of our active cohort of patients receiving apomorphine (Apo) infusion and intrajejunal levodopa infusion (IJLI) for development or attenuation of ICDs.
Forty-one patients (24 male/17 female, mean age 61.9 ± 10.9 years; PD duration 14.2 ± 4.5 years) on Apo (mean dose 106 ± 24 mg; mean duration of infusion 16 h/d) and 19 patients (13 male/6 female, mean age 58.6 ± 8.2 years; PD duration 16.2 ± 5.7 years) on IJLI (mean dose 1990 ± 807 mg; mean duration of infusion 16 h/d) were screened and observed prospectively for development of nonmotor symptoms and ICD at 3 monthly follow-ups for up to 3 years.
In Apo group, 4 patients had preexisting ICD, and in 1 patient, ICD (binge eating) completely resolved after being started on Apo. In 3 others, ICDs continue but attenuated after Apo. However, 7 new cases of ICDs developed in the Apo group, but in only 1 (2.4%), Apo had to be discontinued. Furthermore, in 3 with binge eating, the ICDs resolved after 2 months with Apo infusion being continued. In the IJLI group, 8 patients with active ICDs showed attenuation of the behavior after IJLI initiation. At 3 years, 2 of these patients continue to have ICD. No new ICDs have developed.
Strategies utilizing continuous drug delivery appear to have a relatively low risk of development of ICD. Apomorphine and IJLI can be used in cases with ICD if clinically indicated, with IJLI therapy possibly emerging as the most advantageous in this setting.
在帕金森病（PD）中，强迫行为，统称为冲动控制障碍（ICD），已知在接受多巴胺替代疗法的患者中出现，尤其是口服多巴胺激动剂。然而，持续输注疗法的影响尚未得到研究。
我们报告了对一组接受阿扑吗啡（Apo）输注和空肠内左旋多巴输注（IJLI）的活跃患者进行的为期3年的临床观察筛查数据，以了解ICD的发生或缓解情况。
对41例患者（24例男性/17例女性，平均年龄61.9±10.9岁；PD病程14.2±4.5年）进行Apo治疗（平均剂量106±24mg；平均输注持续时间16小时/天），对19例患者（13例男性/6例女性，平均年龄58.6±8.2岁；PD病程16.2±5.7年）进行IJLI治疗（平均剂量1990±807mg；平均输注持续时间16小时/天），进行前瞻性筛查，并在长达3年的时间里每3个月随访一次，观察非运动症状和ICD的发生情况。
在Apo组中，4例患者已有ICD病史，1例患者在开始使用Apo后ICD（暴饮暴食）完全缓解。另外3例患者的ICD持续存在，但在使用Apo后有所减轻。然而，Apo组有7例新的ICD病例出现，但只有1例（2.4%）患者不得不停用Apo。此外，3例暴饮暴食患者在继续进行Apo输注2个月后ICD症状缓解。在IJLI组中，8例有活跃ICD的患者在开始IJLI治疗后行为有所减轻。3年后，其中2例患者仍有ICD。没有新的ICD病例出现。
采用持续药物输送的策略似乎发生ICD的风险相对较低。如果有临床指征，阿扑吗啡和IJLI可用于ICD患者，在这种情况下IJLI疗法可能是最具优势的。
