Takano K, Ishiguro T
Department of Psychiatry, Jichi Medical School.
Seishin Shinkeigaku Zasshi. 1993;95(1):1-29.
Gilles de la Tourette Syndrome (Tourette syndrome) is a movement disorder characterised by both motor and vocal (phonic) tics, accompanied by coprolalia and frequently echolalia. Since Seignot discovered that administration of haloperidol (HPL) was effective in treating Tourette syndrome, the etiology of this syndrome has been hypothesized as abnormal metabolism in neurotransmitters. We studied the clinical pictures on nine typical cases of Tourette syndrome and measured the HVA, MHPG, and 5-HIAA in their cerebrospinal fluid (CSF). Diagnosis of Tourette syndrome were made of the nine cases (all males) by DSM-III-R. All cases had symptoms of either coprolalia or echolalia. Four cases had no history of treatment with neuroleptics (untreated group) and five cases were under treatment with HPL (treated group). CSF was obtained from each subject in the morning (between 9:00-9:30 a.m.), at rest with nothing by mouth since last night and it was rapidly frozen and stored at -80 degrees C. HVA, the metabolite of dopamine, MHPG, the metabolite of norepinephrine, and 5-HIAA, the metabolite of serotonin, were analyzed by HPLC. The same analyses were made in five males who were healthy volunteer controls (control group). Comparisons were made of the HVA, MHPG and 5-HIAA levels between the three groups (untreated, treated and control group). HVA was 63.5 +/- 8.4 ng/ml in the untreated group, which was significantly higher than the 35.6 +/- 8.6 ng/ml in the controls (p < 0.05). No significant difference was found in both MHPG and 5-HIAA between the untreated and control group. No significant differences were found in HVA or MHPG between the treated group and the controls. The treated group had significantly lower 5-HIAA levels than the controls (p < 0.05). A significantly lower levels of CSF HVA were found in the treated group than in the untreated group (p < 0.05), but there were no significant differences in MHPG or 5-HIAA in the treated and untreated group. Assuming that the untreated group was most indicative of Tourette syndrome during the study, higher levels of HVA may indicate dopaminergic hyperfunction.
吉勒斯·德·拉·图雷特综合征（抽动秽语综合征）是一种运动障碍，其特征为运动性和发声性（言语性）抽动，伴有秽语症且常伴有模仿言语。自从塞尼奥发现使用氟哌啶醇（HPL）治疗抽动秽语综合征有效以来，该综合征的病因被推测为神经递质代谢异常。我们研究了9例典型抽动秽语综合征病例的临床表现，并测量了他们脑脊液（CSF）中的高香草酸（HVA）、3-甲氧基-4-羟基苯乙二醇（MHPG）和5-羟吲哚乙酸（5-HIAA）。根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）对这9例病例（均为男性）做出抽动秽语综合征的诊断。所有病例都有秽语症或模仿言语的症状。4例无使用抗精神病药物治疗史（未治疗组），5例正在接受HPL治疗（治疗组）。在上午（9:00 - 9:30之间）从每个受试者获取脑脊液，自昨晚起禁食禁水并处于休息状态，然后迅速冷冻并储存在-80℃。通过高效液相色谱法（HPLC）分析多巴胺的代谢产物HVA、去甲肾上腺素的代谢产物MHPG和血清素的代谢产物5-HIAA。对5名健康男性志愿者对照组（对照组）进行同样的分析。比较三组（未治疗组、治疗组和对照组）之间的HVA、MHPG和5-HIAA水平。未治疗组的HVA为63.5±8.4 ng/ml，显著高于对照组的35.6±8.6 ng/ml（p < 0.05）。未治疗组与对照组在MHPG和5-HIAA方面均未发现显著差异。治疗组与对照组在HVA或MHPG方面未发现显著差异。治疗组的5-HIAA水平显著低于对照组（p < 0.05）。治疗组脑脊液中的HVA水平显著低于未治疗组（p < 0.05），但治疗组与未治疗组在MHPG或5-HIAA方面无显著差异。假设在研究期间未治疗组最能代表抽动秽语综合征，较高水平的HVA可能表明多巴胺能功能亢进。
