Benvenuti F, Baroni A, Bandinelli S, Ferrucci L, Corradetti R, Pantaleo T
Geriatric Department, INRCA, National Research Institute, Florence, Italy.
J Clin Pharmacol. 1988 Jul;28(7):600-8. doi: 10.1002/j.1552-4604.1988.tb03183.x.
Twenty-seven patients (19 women and 8 men, ages 63 to 88 years; mean, 74 years) displayed mild to moderate parkinsonism and altered ballistic motor performances during long-term flunarizine treatment. One month after, flunarizine withdrawal, 20 patients showed clear-cut improvements in both clinical features and ballistic motor performances; a complete recovery within 6 months was observed in all these patients but one, who still showed very mild slowness of movement. On the other hand, seven patients showed little clinical improvement and still maintained markedly altered ballistic motor performances 1 month after drug withdrawal. At the 2-month follow-up assessments, either they did not improve further or they deteriorated; they were successfully treated with L-dopa and, despite the ameliorations, after 12 to 24 months they still have definite parkinsonian syndrome. The authors conclude that (1) flunarizine, even at the recommended dose (10 mg daily), can induce reversible parkinsonism, at least in subjects older than 60; (2) the persistence of a marked symptomatology 2 months after flunarizine withdrawal should lead to starting treatment with antiparkinsonism drugs; (3) the study of ballistic movements is proposed as a useful tool for objective quantification and early detection of bradykinesia.
27例患者（19名女性和8名男性，年龄63至88岁；平均74岁）在长期服用氟桂利嗪治疗期间出现轻度至中度帕金森综合征，并伴有弹道运动表现改变。在停用氟桂利嗪1个月后，20例患者的临床症状和弹道运动表现均有明显改善；除1例仍有非常轻微的运动迟缓外，所有这些患者在6个月内均完全康复。另一方面，7例患者临床改善甚微，停药1个月后仍维持明显改变的弹道运动表现。在2个月的随访评估中，他们要么没有进一步改善，要么病情恶化；他们接受左旋多巴成功治疗，尽管症状有所改善，但在12至24个月后仍患有明确的帕金森综合征。作者得出结论：（1）氟桂利嗪即使在推荐剂量（每日10毫克）下，至少在60岁以上的患者中也可诱发可逆性帕金森综合征；（2）停用氟桂利嗪2个月后仍有明显症状应开始使用抗帕金森病药物治疗；（3）弹道运动研究被认为是客观量化和早期检测运动迟缓的有用工具。
