Schachter M, Marsden C D, Parkes J D, Jenner P, Testa B
J Neurol Neurosurg Psychiatry. 1980 Nov;43(11):1016-21. doi: 10.1136/jnnp.43.11.1016.
Fluctuations in response to levodopa are a common and serious complication of long-term levodopa therapy. It may be possible to prolong the effect of each dose of levodopa by retarding the breakdown of dopamine. The selective monoamine oxidase type B inhibitor deprenyl, which is extensively metabolised to amphetamine and methamphetamine, has this effect as well as possible actions on dopamine release and re-uptake. In a double-blind crossover trial against placebo, deprenyl prolonged the action of levodopa and produced an objective improvement in mobility in five of 10 patients with dose-related response swings, and a subjective improvement in a further four patients. In another group of seven patients with random fluctuations in symptoms, only two noted subjective improvement, and there was an apparent increase in the severity of response swings in five patients. Deprenyl exacerbated dyskinesias, but had no serious side-effects. We conclude that deprenyl is unlikely to benefit patients with random response swings, and may cause deterioration in such cases. However, it may be a useful adjuvant in the management of dose-related response fluctuations in patients already on optional levodopa therapy.
对左旋多巴反应的波动是长期左旋多巴治疗常见且严重的并发症。通过延缓多巴胺的分解，有可能延长每剂左旋多巴的作用时间。选择性单胺氧化酶B型抑制剂司来吉兰可广泛代谢为苯丙胺和甲基苯丙胺，它具有这种作用，并且可能对多巴胺释放和再摄取产生影响。在一项与安慰剂对照的双盲交叉试验中，司来吉兰延长了左旋多巴的作用时间，在10例有剂量相关反应波动的患者中，有5例患者的运动能力得到客观改善，另有4例患者主观感觉有所改善。在另一组7例症状随机波动的患者中，只有2例患者主观感觉有所改善，5例患者的反应波动严重程度明显增加。司来吉兰加重了运动障碍，但没有严重的副作用。我们得出结论，司来吉兰不太可能使反应随机波动的患者受益，在这种情况下可能会导致病情恶化。然而，在已经接受最佳左旋多巴治疗的患者中，它可能是治疗剂量相关反应波动的有用辅助药物。
