Leckman J F, Cohen D J, Detlor J, Young J G, Harcherik D, Shaywitz B A
Adv Neurol. 1982;35:391-401.
There are conflicting data concerning the efficacy of clonidine in TS. Some TS patients, probably 50% or more, experience substantial, long-term symptomatic improvement with minimal side effects. However, their profile of response is often variable, with behavioral symptoms appearing to show the most consistent improvement. Maximal benefit may not be evident for 4 to 6 months. A minority of patients do not respond, and a few worsen on clonidine. The need for additional double-blind trials is clear. Additional metabolic and pharmacologic investigations are needed to understand the determinants of the response of TS patients to clonidine. The response to acute doses of clonidine on sedation, growth hormone release, blood pressure, and plasma MHPG levels may be predictive of eventual therapeutic response. The variable response to clonidine, however, suggests that noradrenergic mechanisms in TS may not be of primary pathogenic importance. The study of interactions between neurochemical systems may help illuminate the pathophysiology of TS and lead the way to improved treatment of this disabling condition.
关于可乐定在抽动秽语综合征（TS）中的疗效，存在相互矛盾的数据。一些TS患者，可能50%或更多，经历了显著的长期症状改善，且副作用最小。然而，他们的反应情况往往各不相同，行为症状似乎显示出最一致的改善。最大益处可能在4至6个月后才明显。少数患者无反应，还有少数患者服用可乐定后病情恶化。显然需要进行更多的双盲试验。还需要进行更多的代谢和药理学研究，以了解TS患者对可乐定反应的决定因素。急性剂量可乐定对镇静、生长激素释放、血压和血浆3-甲氧基-4-羟基苯乙二醇（MHPG）水平的反应可能预测最终的治疗反应。然而，对可乐定的可变反应表明，TS中的去甲肾上腺素能机制可能并非主要的致病因素。神经化学系统之间相互作用的研究可能有助于阐明TS的病理生理学，并为改善这种致残性疾病的治疗指明方向。
