筋痙直状態に対するTegretol-Diazepam併用療法

A COMBINATION THERAPY OF TEGRETOL WITH DIAZEPAM (VALIUM) IN PATIENTS WITH CENTRAL RIGIDO-SPASTICITY

I．いとぐち

　筋痙直（Rigido-spasticity）を示す主な疾患として，脳性小児麻痺・脳性麻痺後遺症・脳血管性障害および神経変性疾患があげられる。これらの疾患に対しては従来より薬物療法・外科的療法など種々の療法が試みられているが，満足すべき効果がみられないことが多く，精神症状をも含めてその予後管理の最も困難なものの一つに数えられている。とくに神経科を訪れる脳性小児麻癖．脳性麻痺後遺症・脳血管性障害などの中枢性運動障害の患者は，非常に重症なものが多く，その治療にあたつて手をこまねく場合が多いのは，日常われわれの経験するところである。

　ところで最近登場したTegretol〔5—Carbamyl−5H—dibenzo （b．f）—azepin〕はIminostilbene誘導体で，Thy—molepticaであるImipramineのIminodibenzyl核とよく似た構造を有し，また同薬品の誘導体であるInsidon4—〔3—（5H-Dibenzo　〔b,f〕azepine−5—yl）—propyl〕−1—（2—hydroxy-ethyl）—piperazine-ethanol dihydrochlorideと同じdibenzoazepin核を有している薬剤である。臨床的にはてんかん患者の発作抑制と精神症状面の改善^{2）4）7）9）10）12）15）16）17）18）21）}および三叉神経痛に対する鎮痛効果が報告^1）3）5）されている。また本剤は，Theobald^17）らによると動物実験ではMephenesin様作用を有するが，臨床的には筋弛緩作用を発揮しないと述べられており，本剤の中枢性筋弛緩剤としての臨床成績はまだ報告されていない。

A combination therapy of Tegretol with Diazepam was tried in 15 patients suffering from rigido-spasticity due to the C. N. S. Tegretol (100-800 mg) and Diaze-pam (1-45 mg) were given. The results were as follows :

1) Improvement of the symptom was seen in 7 patients with cerebral palsy; marked, moderate and slight improvement were 1, 5 and 1 patients respec-tively. There was improvement of the symptom in patients with sequela of apoplexia ; marked (1), mode-rate (2) and slight improvement (1). A moderate improvement was also seen in a patient with arterios-clerotic parkinsonism. But aggravation of the symptom was seen in 3 patients.

2) Psychical symptoms, such as inactivity, sullen and depressive states were also improved by this the-rapy. This was particularly effective for the patients who showed aggravation of psychical symptoms secondary to physical disturbance and vice versa.

3) In some of the patients, vertiginous sensation, aggravation of motor disturbance and loss of spon-taneity were noted during the period of this treatment. However, such side effects were relieved by decrease of a dosage of this medication. It was stressed that special attention to prevent appearance of such side effects should be taken in cases of cerebral vascular disorder.