脳神経外科領域における意識障害，精神症状に対するL-DOPAの効果

L-DOPA TREATMENT IN PATIENTS WITH CONSCIOUSNESS AND MENTAL DISTURBANCES

Ｉ．はじめに

　近年，パーキンソン症候群に対する薬物療法として，L-DOPAが脚光をあびており，その効果は既に内外に認められている^{7）18）25）26）}。われわれは，L-DOPAがパーキンソン症候群患者の無気力，抑うつ等の精神症状にも効果があることや，他の神経疾患に対するL-DOPA療法^18）においても患者が明るくなり，積極的になるということに気づいた。そこで頭部外傷後や脳動脈瘤術後などにみられる意識障害，あるいは無気力，無関心，見当識障害等の精神症状にも有効なのではないかと考え投与を試みたところ，その有効性を認めたので報告する。

The authors reported the effect of L-DOPA in consciousness and mental disturbances. A total of 20 cases were treated in which were included 7 cases of head injury, 4 cases after the surgery for the cerebral aneurysms, 4 cases of cerebral arterial thrombosis and 5 cases of brain tumor. 15 of them were in some degree lethargic, hypoactive, apathetic and disoriented. 5 were completely comatose. Each patient was given 50 or 100mg of L-DOPA daily by intravenous drip infusion for 2 to 4weeks. In addition to the observation of the patient's facial expression and general behavioral changes, some scored tests such as aphasia test, calculation test, counter-tapping, Kohs block design etc. were carried out once or twice a week. 3 to 7 days after the course was started, most of the patients except for 5 cases of prolonged coma exhibited a marked im-provement in their consciousness level and the mental state with higher scores in many tests mentioned above. The awakening or alerting change, mood elevation, and improvement of locomotor activity were the common results in these patients.

In 2 cases, auditory hallucination and aggresiveness were encountered respectively, possibly due to over-dosis. Alerting effect and locomotor activation of L-DOPA were discussed with a brief review of the literature.