Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
J Neural Transm (Vienna). 2020 Dec;127(12):1599-1606. doi: 10.1007/s00702-020-02257-0. Epub 2020 Oct 9.
Despite anti-cholinergics being the oldest type of medication used for the treatment of Parkinson's disease (PD), the mechanism of action and exact benefit is unclear. This study compared the effectiveness of trihexyphenidyl (THP) and levodopa (LD) on motor symptoms in patients with PD. Patients with PD who are currently taking or had taken THP were recruited. UPDRS-III was done following overnight medication OFF state and 30 min, 60 min, 90 min, and 120 min after THP (4 mg). After a forty-eight-hour interval, UPDRS-III was assessed one hour after Levodopa/carbidopa (200/50 mg) in an overnight OFF state. Twenty patients with a mean age of 57.9 ± 7.8 years and mean duration of illness of 5.1 ± 3.6 years were recruited. UPDRS-III score reduction (%) with THP was maximum in the tremor sub-score (53.8 ± 22.8) and was significantly better compared to improvement in total-UPDRS-III (27.0 ± 14.7), bradykinesia-UPDRS-III (22.2 ± 27.2), rigidity-UPDRS-III (29.5 ± 28.0) and axial-UPDRS-III (8.1 ± 13.3) sub-score. In comparison, respective LD improvement was 67.1 ± 22.9 (tremor-UPDRS-III), 61.3 ± 14.4 (total-UPDRS-III), 67.9 ± 32.1 (bradykinesia-UPDRS-III), 65.3 ± 25.5 (rigidity-UPDRS-III) and 50.7 ± 16.0 (axial-UPDRS-III). Improvement (%) in tre-UPDRS-III post-THP was comparable to that of post-LD (53.8 ± 22.8 vs. 67.1 ± 22.9, p = 0.057). Those with same or better tremor response with THP had significantly milder baseline tremor severity than those who had better response with LD (tre-UPDRS-III-OFF, 10.0 ± 2.8 vs. 5.8 ± 4.0, p = 0.013). Both THP and LD showed significant improvement in UPDRS-III. With THP, the maximum degree of improvement was in the tremor sub-score and not significantly different to that obtained by LD. Those with better tremor response on THP had milder tremor severity.
尽管抗胆碱能药物是治疗帕金森病（PD）最古老的药物类型，但作用机制和确切疗效尚不清楚。本研究比较了三己酚（THP）和左旋多巴（LD）对 PD 患者运动症状的疗效。招募了目前正在服用或曾服用过 THP 的 PD 患者。在夜间停药状态下进行 UPDRS-III，然后在 THP（4mg）后 30min、60min、90min 和 120min 进行。在 48 小时间隔后，在夜间停药状态下评估左旋多巴/卡比多巴（200/50mg）后的 UPDRS-III 一小时。共招募了 20 名平均年龄为 57.9±7.8 岁和平均病程为 5.1±3.6 年的患者。THP 的 UPDRS-III 评分降低（%）在震颤亚评分中最大（53.8±22.8），与总 UPDRS-III（27.0±14.7）、运动迟缓 UPDRS-III（22.2±27.2）、僵硬 UPDRS-III（29.5±28.0）和轴性 UPDRS-III（8.1±13.3）的改善相比，差异有统计学意义。相比之下，相应的 LD 改善分别为 67.1±22.9（震颤 UPDRS-III）、61.3±14.4（总 UPDRS-III）、67.9±32.1（运动迟缓 UPDRS-III）、65.3±25.5（僵硬 UPDRS-III）和 50.7±16.0（轴性 UPDRS-III）。THP 后 tre-UPDRS-III 的改善（53.8±22.8）与 LD 后（67.1±22.9）相当（p=0.057）。THP 治疗后震颤反应相同或更好的患者与 LD 治疗后震颤反应更好的患者相比，基线震颤严重程度明显较轻（tre-UPDRS-III-OFF，10.0±2.8 vs. 5.8±4.0，p=0.013）。THP 和 LD 均能显著改善 UPDRS-III。THP 最大程度的改善是在震颤亚评分，与 LD 获得的改善无显著差异。THP 治疗后震颤反应更好的患者震颤严重程度较轻。
