Nakamura Y
Department of Neurology, Hiroshima City Hospital.
Nihon Rinsho. 1997 Jan;55(1):65-71.
It has been clarified that long-term levodopa therapy in Parkinson's disease may pose various serious problems of adverse reactions, such as dyskinesia, wearing-off effect, on-off effect, mental symptoms, and frozen gait. At our department, dyskinesia, wearing-off effect, on-off effect, mental symptoms and frozen gait were respectively noted in 29 (11.2%), 78(30.0%), 17(6.5%), 42(16.2%), and 51(19.6%) of 260 patients with Parkinson's disease who had been administered levodopa for over one year. In the statistical investigation by the multiple analysis, the time from first onset to initiation on levodopa therapy or the duration of levodopa therapy was not closely related to the development of any adverse reaction, while Hoehn and Yahr's stage and dosage levodopa had the most significant influence on the development of adverse reactions. Therefore, levodopa therapy may not be an important risk factor of adverse reactions even when it is started early after the onset of Parkinson's disease. In order to prevent adverse reactions to long-term levodopa therapy in Parkinson's disease, it is important to minimize the dose of this drug even when it is administered in combination with multiple anti-Parkinsonism drugs.
现已明确，帕金森病长期左旋多巴治疗可能引发各种严重不良反应问题，如运动障碍、疗效减退、开-关现象、精神症状和冻结步态。在我们科室，260例接受左旋多巴治疗超过一年的帕金森病患者中，运动障碍、疗效减退、开-关现象、精神症状和冻结步态的发生率分别为29例（11.2%）、78例（30.0%）、17例（6.5%）、42例（16.2%）和51例（19.6%）。在多因素分析的统计调查中，从首次发病到开始左旋多巴治疗的时间或左旋多巴治疗的持续时间与任何不良反应的发生均无密切关系，而霍恩和雅尔分期以及左旋多巴剂量对不良反应的发生影响最为显著。因此，即使在帕金森病发病后早期开始使用左旋多巴治疗，它也可能不是不良反应的重要危险因素。为预防帕金森病长期左旋多巴治疗的不良反应，即使与多种抗帕金森病药物联合使用，尽量减少该药剂量也很重要。
