Obeso J A, Luquin M R, Vaamonde J, Grandas F, Martinez Lage J M
Department of Neurology, University of Navarra, Medical School, Pamploma, Spain.
Can J Neurol Sci. 1987 Aug;14(3 Suppl):488-92. doi: 10.1017/s0317167100037963.
Complex motor fluctuations and dyskinesias ("on-off" phenomenon) in Parkinson's disease can be corrected by parenteral administration of levodopa, levodopa-methyl-ester, lisuride and apomorphine. Levodopa and levodopa-methyl-ester may only be administered intravenously because of their low solubility. Lisuride and apomorphine are readily absorbed after subcutaneous administration. Repeated or continuous intravenous infusions of levodopa have been given for a few days, using a wearable "jacket-like" pump, with good results. So far, lisuride is the only dopamine agonist used for chronic treatment by continuous infusion. The "on-off" effect is adequately controlled in most patients by subcutaneous lisuride administration (plus oral levodopa). However, adverse effects, particularly psychiatric complications, constitute a major limiting factor for routine applications of this form of treatment. Subcutaneous apomorphine infusion is unlikely to become a standard therapeutic procedure in Parkinson's disease, but it is a very valuable research method to gain further insight into the pathophysiology of motor fluctuations in Parkinson's disease.
帕金森病中的复杂运动波动和异动症（“开-关”现象）可通过胃肠外给予左旋多巴、左旋多巴甲酯、利苏瑞ide和阿扑吗啡来纠正。由于左旋多巴和左旋多巴甲酯的溶解度低，它们只能静脉给药。利苏瑞ide和阿扑吗啡皮下给药后很容易被吸收。使用可穿戴的“夹克样”泵，连续几天重复或持续静脉输注左旋多巴，效果良好。到目前为止，利苏瑞ide是唯一用于持续输注进行慢性治疗的多巴胺激动剂。大多数患者通过皮下注射利苏瑞ide（加口服左旋多巴）可充分控制“开-关”效应。然而，不良反应，尤其是精神并发症，是这种治疗形式常规应用的主要限制因素。皮下注射阿扑吗啡不太可能成为帕金森病的标准治疗方法，但它是深入了解帕金森病运动波动病理生理学的一种非常有价值的研究方法。
