Jean and Paul Amos Parkinson's Disease and Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, USA.
Department of Neurology, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
Lancet Neurol. 2019 Sep;18(9):880-890. doi: 10.1016/S1474-4422(19)30152-8. Epub 2019 Jul 3.
A large and ever-growing number of medications can induce various movement disorders. Drug-induced movement disorders are disabling but are often under-recognised and inappropriately managed. In particular, second generation antipsychotics, like first generation agents, are associated with potentially debilitating side-effects, most notably tardive syndromes and parkinsonism, as well as potentially fatal acute syndromes. Appropriate, evidence-based management is essential as these drugs are being prescribed to a growing population vulnerable to these side-effects, including children and elderly people. Prevention of the development of drug-induced movement disorders is an important consideration when prescribing medications that can induce movement disorders. Recent developments in diagnosis, such as the use of dopamine transporter imaging for drug-induced parkinsonism, and treatment, with the approval of valbenazine and deutetrabenazine, the first drugs indicated for tardive syndromes, have improved outcomes for many patients with drug-induced movement disorders. Future research should focus on development of safer antipsychotics and specific therapies for the different tardive syndromes and the treatment of drug-induced parkinsonism.
大量且不断增加的药物可引起各种运动障碍。药物引起的运动障碍会导致残疾，但往往未被充分认识和不当管理。特别是第二代抗精神病药，与第一代药物一样，会引起潜在的使人衰弱的副作用，最常见的是迟发性运动障碍和帕金森病，以及潜在致命的急性综合征。由于这些药物正被开给越来越多易受这些副作用影响的人群，包括儿童和老年人，因此，进行适当的、基于证据的管理至关重要。在开处方可能引起运动障碍的药物时，预防药物引起的运动障碍的发生是一个重要的考虑因素。最近在诊断方面的发展，如使用多巴胺转运蛋白成像来诊断药物引起的帕金森病，以及批准使用 valbenazine 和 deutetrabenazine（第一种用于迟发性运动障碍的药物），都改善了许多药物引起的运动障碍患者的预后。未来的研究应集中在开发更安全的抗精神病药物和针对不同迟发性运动障碍的特定疗法，以及治疗药物引起的帕金森病。
