薬剤性パーキンソニズム—脳神経内科の立場から

Drug-induced Parkinsonism as Viewed from Neurologist

薬剤性パーキンソニズム（DIP）は頻度の高い医原性運動障害疾患である。診断には，先行するドパミン遮断薬の使用が必要となる。本邦の脳神経内科でみるDIPの多くは，スルピリドが原因であり，抗精神病薬によるものは少ない。DIPの発症の背景には，前臨床期パーキンソン病が関係している。前臨床期パーキンソン病に生じたDIPであるか否かは，治療上重要である。ドパミン遮断薬投与時にDIPを疑った場合にはすみやかな対処が望まれる。

Abstract

Drug-induced Parkinsonism (DIP) is a common iatrogenic movement disorder. Its clinical manifestations cannot be distinguished from those of idiopathic Parkinson's disease. Prior exposure to dopamine receptor-blocking agents (DRBA) is required for diagnosis. This article reviews the epidemiology, pathophysiology, clinical features, ancillary testing, and treatment of DIP. Clinicians must always suspect DIP when a patient develops subacute Parkinsonism while taking DRBA. Ancillary testing such as DaT scans is often helpful in identifying prodromal Parkinson's disease. When DIP develops, steps should be taken to discontinue the offending agent or, in the case of antipsychotics, dose reduction or a change to an agent with a lower risk of DIP. L-dopa may be required to control parkinsonism in patients with DIP and prodromal PD.