Marconi R, Lefebvre-Caparros D, Bonnet A M, Vidailhet M, Dubois B, Agid Y
INSERM U 289, Hôpital de la Salpêtrière, Paris, France.
Mov Disord. 1994 Jan;9(1):2-12. doi: 10.1002/mds.870090103.
The aim of this study was to provide further insight into the phenomenology and pathophysiology of monophasic and biphasic dyskinesias induced by levodopa in Parkinson's disease. For this purpose, the type, localization, severity, and timing of dyskinesias were evaluated in 15 parkinsonian patients in relation to motor disability after administration of levodopa using a video-electromyographic recording device. Foot-dystonia, myoclonus, and akathisia were observed in most patients. The dyskinesias started in the foot, usually on the side most affected by the disease, and spread in an "ascending wave" to the contralateral side, the trunk, and upper extremities. In a few patients, onset was axial, spreading almost instantaneously to all limbs. The dyskinesias were dystonic and ballistic at the start, and became increasingly choreic as they attained the upper limbs. Their intensity was maximal in the lower limbs, then progressively decreased, while increasing in upper limbs and head. The results indicate that there is no strict dichotomy between biphasic and monophasic dyskinesias. In other words, there is a "continuum" between the first dyskinesias and those observed during the period of maximal clinical improvement. These dyskinesias can also appear in reverse order, as if there were an "oscillator" determining a sequence of alternating patterns.
本研究的目的是进一步深入了解帕金森病中左旋多巴诱发的单相和双相异动症的现象学和病理生理学。为此，使用视频肌电图记录设备，对15例帕金森病患者在服用左旋多巴后与运动功能障碍相关的异动症类型、部位、严重程度和发作时间进行了评估。大多数患者观察到足部肌张力障碍、肌阵挛和静坐不能。异动症始于足部，通常在疾病最严重的一侧，然后以“上升波”的形式扩散到对侧、躯干和上肢。少数患者的发作起始于躯干，几乎瞬间扩散到所有肢体。异动症开始时为张力障碍性和弹道性，随着累及上肢，逐渐变得越来越像舞蹈样动作。其强度在下肢最大，然后逐渐降低，而上肢和头部的强度则增加。结果表明，双相和单相异动症之间没有严格的二分法。换句话说，首次出现的异动症与临床改善最大期观察到的异动症之间存在“连续体”。这些异动症也可能以相反的顺序出现，就好像有一个“振荡器”决定了交替模式的序列。
