Casey D E, Gerlach J, Bjørndal N
Psychopharmacology (Berl). 1982;78(1):89-92. doi: 10.1007/BF00470596.
Tardive dyskinesia (TD), a syndrome of involuntary hyperkinetic movements, purportedly involves the development of dopamine (DA) receptor hypersensitivity following long-term receptor blockade with neuroleptic drugs. It has been proposed that through a process of receptor hypersensitivity modification, TD can be treated by reversing the receptor hypersensitivity with DA agonists. Thirteen patients with TD were treated for 4--8 weeks with levodopa plus benserazide, a peripheral decarboxylase inhibitor (Madopar, Roche, Basel, Switzerland) over a wide dose range corresponding to 3.0--9.0 g/day levodopa. Drug effects was assessed by blind evaluations of randomly sequenced videotapes made before, during, and for 6 weeks following treatment. TD scores moderately increased during levodopa. After the drug was discontinued, TD scores returned to pretreatment baseline levels without further improvement in those patients receiving concurrent neuroleptic medications (N = 9), but in the neuroleptic-free patient TD scores decreased 25% in three patients and were resolved in one younger patient. Psychological effects of depression or increased psychotic symptoms occurred at higher drug doses. These results do not support the proposal that receptor sensitivity modification with levodopa is an effective therapeutic approach to TD, though selected patient and drug treatment variables, including other DA agonists, are considerations for further investigation.
迟发性运动障碍（TD）是一种不自主运动亢进综合征，据称是在长期使用抗精神病药物阻断多巴胺（DA）受体后，DA受体超敏反应发展所致。有人提出，通过受体超敏反应调节过程，可用DA激动剂逆转受体超敏反应来治疗TD。13例TD患者接受左旋多巴加苄丝肼（外周脱羧酶抑制剂，商品名美多芭，罗氏公司，瑞士巴塞尔）治疗4至8周，剂量范围较宽，相当于左旋多巴3.0至9.0克/天。通过对治疗前、治疗期间及治疗后6周随机排序的录像带进行盲法评估来评定药物疗效。在使用左旋多巴期间，TD评分适度增加。停药后，在同时服用抗精神病药物的患者（N = 9）中，TD评分恢复到治疗前基线水平，且无进一步改善，但在未服用抗精神病药物的患者中，3例患者的TD评分下降了25%，1例年轻患者的TD症状得到缓解。在较高药物剂量时出现了抑郁或精神病症状加重等心理效应。这些结果不支持左旋多巴调节受体敏感性是治疗TD的有效方法这一观点，不过包括其他DA激动剂在内的特定患者和药物治疗变量值得进一步研究。
