新抗Parkinson剤Akinetonの使用経験—とくにphenothiazine誘導体による錐体外路症状に対して

CLINICAL EXPERIMENT OF A NEW ANTIPARKINSON AGENT, "AKINETON":Especially for the extrapyramidal symptoms following the phenothiazine derivatives

I．はじめに

　現在多数のphenothiazine誘導体が精神疾患の治療に使用されているが，chlorpromazineの導入以来次々と開発されている薬物は次第に強力なものとなつてきておりそのmg／potencyが高まるにつれて副作用としての錐体外路症状の出現は増加する傾向にある。phenothiazine誘導体の主流はpromazine系→perazine系→perphena—zine系であるが，これら側鎖の変化と，さらにphe—nothiazine核の部分につくものがH→Cl→CF₃，と置換されることによつて量的ならびに質的に治療効果の相違をきたすことが知られている。いまchlorpromazineのtherapeutic potencyを1とすれば，mepazine, pro—mazine, methoxypromazineは1／2, trifluopromazineは3, prochlorperazineは3〜5, thiopropazateは4〜7，perphenazineは5〜10, trifluoperazineは8〜12，そしてもつとも強力なfluphenazineは10〜20である^2）3）。

　これらの薬物による錐体外路症状の出現頻度はAyd^3）によると3,775例中1,472例（38.9％）であるが，chlorpromazineでば35％，　trifluopromazineでは36％prochlorperazineでは43％，　thiopropazateでは44％perphenazineでは36％，　trifluoperazineでは60％，fluphenazineでは52％であつて，薬物によりその発現頻度をことにし，おおよそそのmg／potencyに比例するように思われる。錐体外路症状は一般に次の4つの型に分つことができる^2）3）。

We used Akineton for the extrapyramidal symp-toms: Akinesia, akathisia, parkinsonism, dyskinesia: which were seen in the drug treatment on 25 schi-zophrerics as side-effects of phenothiazine deriva-tives.

Observations on the effects are as follows.

1) 16 cases were effective, 8 cases were mildly effective, and 1 case was ineffective. In the classfica-tions of the extrapyramidal symptoms, 5 cases of akinesia were effective, 1 case was ineffective. 8 cases of akathisia were effective, 2 cases were mildly effective. 8 cases of parkinsonism were effective, 6 cases were mildly effective, and 1 case was ineffec-tive. 1 case of dyskinesia was effective.

2) The dosage was 4 to 10mg per day, but usually the dosage was 4 to 6mg per day with good result.

3) The side-effects were only seen in 20% of 25 cases, and the main side-effects of these cases were stomack discomfort, headache, dim eyes, and diz-ziness.

4) Akineton is a drug of choice for the therapy of extrapyramidal symptoms.