Auzou P, Ozsancak C, Hannequin D, Moore N, Augustin P
Clinique Neurologique, Hôpital Charles Nicolle, France.
Acta Neurol Scand. 1996 Nov;94(5):329-36. doi: 10.1111/j.1600-0404.1996.tb07075.x.
The occurrence of psychosis is frequent during the evolution of Parkinson's disease. The reduction of therapeutics or the use of classical neuroleptics may improve the symptoms, but usually worsens parkinsonism. Clozapine is an atypical neuroleptic with only few extrapyramidal effects, which has been proposed at low dose in this indication since 1985. A review of the literature, about more than 200 patients shows good results in approximately 90% without worsening of extrapyramidal symptoms. Some patients even noted an improvement of their motor state while treated by clozapine alone or as dopatherapy was secondarily increased. More controversial results were obtained in demented or depressed patients. Sedation is one of the most frequently encountered side-effect but rarely necessitates the withdrawal of clozapine. Even if the risk of agranulocytosis is slight, regular blood cell counts must be done.
在帕金森病的病程中，精神病的发生很常见。减少治疗药物剂量或使用传统抗精神病药物可能会改善症状，但通常会加重帕金森综合征。氯氮平是一种非典型抗精神病药物，几乎没有锥体外系反应，自1985年以来就有人建议以低剂量用于该适应症。一项对200多名患者的文献综述显示，约90%的患者效果良好，且锥体外系症状未加重。一些患者甚至指出，在单独使用氯氮平治疗或随后增加多巴胺能治疗时，其运动状态有所改善。在患有痴呆或抑郁症的患者中，结果更具争议性。镇静是最常出现的副作用之一，但很少需要停用氯氮平。即使粒细胞缺乏症的风险很小，也必须定期进行血细胞计数。
