Okajima Motoshige, Fujioka Shinsuke, Komorita Saori, Nishida Akihiro, Mishima Takayasu, Tsuboi Yoshio
Department of Neurology Fukuoka University.
Rinsho Shinkeigaku. 2021 Jun 29;61(6):398-400. doi: 10.5692/clinicalneurol.cn-001537. Epub 2021 May 20.
A 58-year-old man who was diagnosed with Parkinson's disease (PD) at age 46 developed levodopa-induced motor complications seven years after diagnosis, along with dyskinesia. Treatment with levodopa-carbidopa intestinal gel (LCIG) was introduced at age 57. His dyskinesia and freezing of gait (FOG) worsened after the introduction of LCIG. Considering the pathophysiological mechanism of diphasic dyskinesia, the dose of levodopa was increased since it was considered necessary to exceed the upper threshold of diphasic dyskinesia. As a result, dyskinesia and FOG became severe and he was admitted to our hospital. After reducing the levodopa equivalent dose to control the dyskinesia to an almost negligible level, his FOG also improved and his activities of daily living improved markedly. This case highlights the difficulty in treating dyskinesia and FOG in advanced-stage PD patients with a narrow therapeutic window.
一名58岁男性，46岁时被诊断为帕金森病（PD），诊断7年后出现左旋多巴诱导的运动并发症及异动症。57岁时开始使用左旋多巴-卡比多巴肠凝胶（LCIG）治疗。使用LCIG后，他的异动症和步态冻结（FOG）加重。考虑到双相异动症的病理生理机制，由于认为有必要超过双相异动症的上限阈值，遂增加了左旋多巴剂量。结果，异动症和FOG变得严重，他被收治入院。在将左旋多巴等效剂量降低以使异动症控制在几乎可忽略不计的水平后，他的FOG也得到改善，日常生活活动能力明显提高。该病例凸显了在治疗晚期PD患者的异动症和FOG时，治疗窗狭窄所带来的困难。
