Gerlach J
Psychopharmacology (Berl). 1977 Mar 16;51(3):259-63. doi: 10.1007/BF00431633.
In a study of 16 psychotic patients with neuroleptic-induced tardive dyskinesia and 16 patients with Parkinson's disease and L-Dopa-induced hyperkinesia it was found that (1) tardive dyskinesia, compared to L-Dopa hyperkinesia, was localized almost exclusively to the oral region (P mean value of 0.01), whereas theL-Dopa hyperkinesia was more pronounced in the neck (P mean value of 0.05) and the extremities (P mean value of 0.05); (2) L-Dopa hyperkinesia showed an increasing tendency to oral preponderance with age, irrespective of the severity ofParkinsonism and extra-oral hyperkinesia, while tardive dyskinesia only itensified with age, without any change in distribution; and (3) extra-oral L-Dopa hyperkinesia was related to the localization and severity of pretreatment Parkinsonism, and more to bradykinesia than to rigidity and tremor. It is concluded that the irreversible neurotoxic effect of neuroleptic drugs may be associated with age-related changes in the oral somatotopic region of the basal ganglia (to be given consideration in any future search for the pathogenetic process underlying irreversible tardive dyskinesia), and that the pathophysiology of involuntary hyperkinesia in neuroleptic-treated psychiatric patients and in L-Dopatreated parkinson patients may consist of a primary dopamine deficiency (pharmacological or structural), and a secondary relative hyperactivity in the dopaminergic system ("dopaminergic hypersensitivity") possibly corresponding to hypoactivity in the cholinergic system.
在一项针对16名患有抗精神病药物所致迟发性运动障碍的精神病患者以及16名患有帕金森病且出现左旋多巴诱发运动障碍的患者的研究中，发现：（1）与左旋多巴诱发的运动障碍相比，迟发性运动障碍几乎完全局限于口腔区域（P平均值为0.01），而左旋多巴诱发的运动障碍在颈部（P平均值为0.05）和四肢（P平均值为0.05）更为明显；（2）无论帕金森病的严重程度和口外运动障碍如何，左旋多巴诱发的运动障碍随年龄增长有增加向口腔优势发展的趋势，而迟发性运动障碍仅随年龄加剧，分布无任何变化；（3）口外左旋多巴诱发的运动障碍与治疗前帕金森病的部位和严重程度有关，更多与运动迟缓有关，而非僵硬和震颤。研究得出结论，抗精神病药物不可逆的神经毒性作用可能与基底神经节口腔躯体定位区域的年龄相关变化有关（在未来探寻不可逆迟发性运动障碍潜在发病机制时应予以考虑），并且抗精神病药物治疗的精神病患者和左旋多巴治疗的帕金森病患者中不自主运动障碍的病理生理学可能包括原发性多巴胺缺乏（药理学或结构性）以及多巴胺能系统继发性相对亢进（“多巴胺能超敏反应”），可能对应胆碱能系统的功能减退。
