Asanuma M, Hirata H, Kondo Y, Ogawa N
Department of Neuroscience, Okayama University Medical School.
Rinsho Shinkeigaku. 1993 Mar;33(3):317-21.
A patient with progressive supranuclear palsy (PSP) showing severe akinesia, postural instability and gait disturbance like frozen gait was treated with amitriptyline (30 mg/day). Four weeks after drug administration, we recognized tendencies for improvement on akinesia, postural instability, frozen gait and vertical gaze palsy. Thereafter, gait disturbance almost disappeared and slow motor response and depression also improved with the amitriptyline for 8 weeks. The changes of cerebral blood flow (CBF) with amitriptyline treatment were evaluated in this case by 123I-IMP single photon emission computed tomography. Before the treatment, clear reduction of CBF was shown in the frontal lobes, especially in the frontal cortices, while this frontal hypoperfusion markedly improved 6 weeks after the treatment. These results, showing marked improvements of frontal hypoperfusion, as well as parkinsonism with amitriptyline treatment, may imply possibilities that these symptoms of PSP result from the frontal hypoperfusion and the improvement of the hypoperfusion with amitriptyline is involved in the improvement of these symptoms.
一名患有进行性核上性麻痹（PSP）的患者表现出严重的运动不能、姿势不稳和步态障碍，如冻结步态，接受了阿米替林治疗（30毫克/天）。给药四周后，我们发现运动不能、姿势不稳、冻结步态和垂直凝视麻痹有改善的趋势。此后，步态障碍几乎消失，缓慢的运动反应和抑郁在使用阿米替林治疗8周后也有所改善。在该病例中，通过123I-IMP单光子发射计算机断层扫描评估了阿米替林治疗后脑血流量（CBF）的变化。治疗前，额叶，尤其是额叶皮质显示出明显的CBF减少，而治疗6周后，这种额叶灌注不足明显改善。这些结果表明，阿米替林治疗后额叶灌注不足以及帕金森症有显著改善，这可能意味着PSP的这些症状可能是由额叶灌注不足引起的，而阿米替林改善灌注不足与这些症状的改善有关。
