Parkinsonismに対するL-DOPA治療と定位脳手術

EFFECTS OF L-DOPA IN POST-SURGICAL PARKINSON'S PATIENTS

緒論

　パーキンソン氏病の病理学的解明では，substantianigraの変性，大脳基底核の変性などが明らかとなつているが，その原因については不明である。このため治療法としても完全なものは無いが，現在まで薬物療法としてanticolinergic agentsが用いられており，又外科的療法として定位脳手術が行なわれて良好な成績をあげている。

　近年病理生化学的な検討が進められるにしたがい，カテコールアミンの先駆物質であるL-DOPAによる治療がBarbeau，^1），Birkmayerらによつてこころみられた。その後多くのL-DOPA治療による臨床報告^1）〜4）がなされている。

The results of L-Dopa treatment in 12 non-surgi-cal and 28 post-surgical Parkinson's patients were as follows: significant improvement was obtained in 36 cases among 40 (90%) and excellent improve-ment was observed in 50% of non-surgical patients (6 cases). The ratio of excellent improvement in non-surgical cases was higher than that of post-surgical cases.

As to akinesia, L-Dopa treatment was superior to stereotaxic surgery. With respect to rigidity both were effective. Rigidity of neck and body was reduced by L-Dopa while stereotaxic surgery showed a tendency to reduce the rigidity of distal part of extremities. The ratio of improvement of tremor was 90% by surgery and 40% by L-Dopa treatment. Since there are the different pattern of therapeutical effects between L-Dopa and surgery, the cases which showed unsatisfactory response to the medication of L-Dopa is the indication for surgical treatment.

Gastro-intestinal symptoms occurred in a highest percentage of the cases with L-Dopa administration (17 cases, 42%) and 4 cases (10%) among them suf-fered severely. Lowering of 20-30 mmHg of systolic pressure occurred in 8 cases (20%) and 20-10 mmHg in 16 cases (40%). Hyperkinesia was observed in 5 cases (13%). Loss of weight of 5-10 kg was recog-nized in 26 cases (65%). All side effects disappeared with the reduction of dosage.