Corona T, Rivera C, Otero E, Stopp L
Division of Medical Training, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico.
Clin Neuropharmacol. 1995 Aug;18(4):325-32. doi: 10.1097/00002826-199508000-00004.
Drug holidays as treatment in Parkinson's disease (PD) to ameliorate the effects of chronic L-dopa use are a controversial method. They are used in an attempt to resensitize dopamine receptors in the striatum so that L-dopa therapy can be reinstated at lower doses with fewer of the side effects that normally accompany long-term use of the drug. In the present study, 15 patients with PD were submitted to a 7-day L-dopa drug holiday and then followed for 3 years. The effect of the holiday on parkinsonian symptoms and grade of severity of PD was determined using the Webster and the Hoehn and Yahr scales, administered at intervals over the 3-year period. We found that within the first 6 months post-drug-holiday, there was a dramatic improvement in the rating of the symptoms of PD that was statistically significant (p < 0.005). At 12 months, Webster scale scores had risen, but they remained significantly improved (p < 0.05) in comparison with the first postholiday score. This level of improvement was maintained at 24 and 36 months. The grade of severity of the disease stabilized since Hoehn and Yahr scale scores improved for all patients, except one, for the length of the study. One patient left the study after 6 months for unknown reasons. Of the 14 patients that remained, three were given additional drug holidays: two patients at 12 months and one patient at 12, 24, and 36 months. All patients were able to be maintained on a reduced L-dopa dose regimen of 50-70% of their pre-drug-holiday level for the entire 3-year period. In the patients in whom the drug holiday was least beneficial overall, there was a notable reduction in rigidity and in the "on-off" phenomenon. We conclude that an L-dopa drug holiday is a valuable option in the treatment of PD.
药物假期作为帕金森病（PD）的一种治疗方法，用于改善长期使用左旋多巴的效果，这是一种存在争议的方法。使用药物假期的目的是使纹状体中的多巴胺受体重新敏感化，以便能够以较低剂量恢复左旋多巴治疗，同时减少长期使用该药物通常伴随的副作用。在本研究中，15名帕金森病患者接受了为期7天的左旋多巴药物假期，然后随访3年。在3年期间定期使用韦伯斯特量表和霍恩与亚尔量表来确定药物假期对帕金森症状和帕金森病严重程度分级的影响。我们发现，在药物假期后的前6个月内，帕金森病症状评分有显著改善，具有统计学意义（p < 0.005）。在12个月时，韦伯斯特量表评分有所上升，但与假期后首次评分相比仍有显著改善（p < 0.05）。这种改善水平在24个月和36个月时得以维持。由于霍恩与亚尔量表评分在研究期间除一名患者外所有患者均有所改善，疾病严重程度分级趋于稳定。一名患者在6个月后因不明原因退出研究。在其余14名患者中，有3名患者再次接受了药物假期：两名患者在12个月时接受，一名患者在12个月、24个月和36个月时接受。在整个3年期间，所有患者都能够维持在比药物假期前剂量水平降低50 - 70%的左旋多巴剂量方案上。在总体上药物假期益处最小的患者中，僵直和“开 - 关”现象有明显减轻。我们得出结论，左旋多巴药物假期是帕金森病治疗中的一个有价值的选择。
