メチクセンによる錐体外路系障害の治療

Treatment of Disturbances of Extrapyramidal System with Methixene Hydrochloride

I．緒言

　今日，精神科医療における薬物療法の進歩は著しいものであるが，種々の向精神薬物は，その有効量投与にさいして必然的ともいえるほどに，パーキンソン症候群およびNeurodyslepsieを随伴症状として示す。これらの症状は開口不能になるTrismus，眼球が上方に固定され，眼球運動不能となるBlickkrampfあるいはopistho—tonusなどの激烈で治療上きわめて支障をきたすものから，腱反射亢進，手指をはじめとする四肢，顔面などに見られる振戦，筋攣縮，四肢の筋強剛などの治療上の支障において，比較的軽度のものまで，向精神薬物の質，量，病状および個人差によりさまざまの症状を示す。われわれはこれらの向精神薬物の大量投与によつて惹起される一連の症状を一括して慣用上，薬物パーキンソニズムと称している。

　一方，筋強剛，振戦，運動緩慢などを主症状とするパーキンソニズムはその成因として日木脳炎，脳動脈硬化，頭部外傷，脳梅毒，薬物中毒，脳血管障害その他があげられ，錐体外路運動系の障害に起因するものといわれている。

Fifty-four cases having disturbances of extra-pyramidal system (so-called parkinsonian syndrome or parkinsonism) were treated per os with methixene HCl (2.5 mg/tab.), derivative of thioxanthene.

Target symptoms were followings.

I. Various parkinsonism ensued on organic dis-eases of central nervous system ; chronic and residual state of cerebral arteriosclerosis, encephalomalacia, encephalitis, cerebral palsy, brain trauma, cervical trauma, epilepsia, lupus erythematodes, idiopathic, etc. totaling 15 cases.

II. Parkinsonism ensued on several kinds of py-chotropic drugs ;

(A) thiothixene (taking strong neurodyslepsia). 17 cases

(B) combinational administration with other drugs (ex. chlorpromazine, levomepromazine, perphenazine, thioridazaine, imipramine, etc.). 22 cases

With the daily dosage of 7.5 mg to 30 mg of methixene HCl the marked effect coming up to 60% improvement was attained in cases of the group I, and 58. 8% in the group (A) and 54. 5% in (B) both among the group II.

Investigating the result of the improved cases, the stronger activity to tremor was found in me-thixene HCl in comparison with its activities to rigidity or tonus of muscles and to autonomic im-balance.

On the other hand, only negligible side effects such as orthostatic hypotensive asthenia, hypotension, hypomyotonia of extremities, visual disorder, gastro-intestinal disorder, swallowing disorder, increase of sputa, urticaria were seen in a little over 20% cases at the above doses.

However these were well tolerated and so there was no need to discontinue the administration or to decrease the dosage.

Besides, also there is no disturbance in liver func-tion nor disorder of blood components in each case during 7-294 clays administration.

Thus, methixene HCl is considered as one of the most useful drugs of first choice against tremor or various disturbances from the extrapyramidal system.