帕金森病中双相（亚治疗剂量）左旋多巴诱发的呼吸功能障碍
Biphasic (Subtherapeutic) Levodopa-Induced Respiratory Dysfunction in Parkinson Disease.
作者信息
van de Wetering-van Dongen Veerle A, Espay Alberto J, Marsili Luca, Sturchio Andrea, Holter Susanne Ten, Bloem Bastiaan R, Nijkrake Maarten J
机构信息
Department of Rehabilitation (VAvdW-vD, MJN), Radboud University Medical Center, Donders Center for Brain, Cognition and Behavior, Nijmegen, the Netherlands; Department of Neurology (AJE, LM, AS), UC Gardner Neuroscience Institute, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, OH; and Department of Neurology (STH, BRB), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands.
出版信息
Neurol Clin Pract. 2021 Aug;11(4):e402-e406. doi: 10.1212/CPJ.0000000000001043.
OBJECTIVE
To evaluate 3 cases illustrating a rarely recognized phenotype of Parkinson disease (PD), namely, biphasic levodopa-induced respiratory dysfunction manifesting as dyspnea.
METHODS
To appreciate the nature of the fluctuations of respiratory function in response to levodopa, we measured changes in respiratory muscle control before and after the best therapeutic response to levodopa in 3 PD patients with fluctuating dyspnea.
RESULTS
Episodes of breathlessness were accompanied by shallow tachypnea and reduced respiratory muscle control, as measured by maximal expiratory pressure, peak cough flow, and forced expiratory volume in 1 second.
CONCLUSIONS
The spectrum of respiratory dysfunction in PD includes a biphasic reduced respiratory muscle control accompanying periods when the effect of levodopa is subtherapeutic. This biphasic levodopa-related complication represents a rarely recognized nonmotor phenomenon in PD. Management requires increasing the levodopa dose, shortening the interdose interval, or implementing a program of continuous dopaminergic stimulation.
目的
评估3例帕金森病（PD）患者，这些患者表现出一种罕见的帕金森病表型，即双相性左旋多巴诱发的以呼吸困难为表现的呼吸功能障碍。
方法
为了解呼吸功能对左旋多巴反应的波动性质，我们测量了3例伴有波动性呼吸困难的帕金森病患者在对左旋多巴产生最佳治疗反应前后呼吸肌控制的变化。
结果
呼吸困难发作时伴有呼吸浅快以及呼吸肌控制能力下降，这可通过最大呼气压力、峰值咳嗽流速和1秒用力呼气量来衡量。
结论
帕金森病呼吸功能障碍的范围包括在左旋多巴疗效欠佳期间出现的双相性呼吸肌控制能力下降。这种与左旋多巴相关的双相性并发症是帕金森病中一种罕见的非运动现象。治疗需要增加左旋多巴剂量、缩短给药间隔或实施持续多巴胺能刺激方案。
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