Djaldetti R, Ziv I, Melamed E
Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.
Isr J Med Sci. 1996 Dec;32(12):1224-7.
Most patients with Parkinson's disease develop response fluctuations after several years of chronic treatment with levodopa. Accumulating evidence suggest that pharmacokinetic mechanisms are the cause of some subtypes of response fluctuations, especially the "delayed-on" and "no-on" phenomena. Evaluation of gastric emptying in Parkinson patients with and without response fluctuations revealed that those with fluctuations had a significant delay in gastric emptying compared to patients without fluctuations. Treatment with cisapride, a prokinetic drug, causes amelioration of these fluctuations. The optimal solution is to bypass the stomach completely and deliver levodopa parenterally. This was done by levodopa ethylester injections, which reduced latency to "on" and prolonged "on" duration in patients with severe response fluctuations. These data emphasize the role of the stomach as one of the causes for deterioration in Parkinson's disease.
大多数帕金森病患者在接受左旋多巴长期治疗数年之后会出现反应波动。越来越多的证据表明，药代动力学机制是某些类型反应波动的原因，尤其是“起效延迟”和“无起效”现象。对有反应波动和无反应波动的帕金森病患者的胃排空情况进行评估后发现，有波动的患者与无波动的患者相比，胃排空明显延迟。使用促动力药物西沙必利进行治疗可改善这些波动。最佳解决方案是完全绕过胃部，通过肠胃外途径给药左旋多巴。这通过注射左旋多巴乙酯来实现，该方法减少了重度反应波动患者的“起效”潜伏期并延长了“起效”持续时间。这些数据强调了胃部作为帕金森病病情恶化原因之一的作用。
