Neuropathy as a Potential Complication of Levodopa Use in Parkinson's Disease
Neuropathy as a Potential Complication of Levodopa Use in Parkinson's Disease
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DOI：
10.1002/mds.22137
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发表时间：
2008-10-15
影响因子：
8.6
通讯作者：
Zochodne, Douglas
中科院分区：
文献类型：
--
作者：
Toth, Cory;Brown, Martin Sutton;Zochodne, Douglas
帕金森氏病(PD)患者周围神经病变(PN)的存在和潜在病因尚不清楚。我们检查了帕金森病患者是否存在PN。从500名PD患者中筛选出症状性PN的特征，进一步选择患者进行与PN相关的临床、电生理和实验室研究。将这组有特发性PN的PD患者(PD-IPN)与一组没有PN的PD患者(仅PD)和一大组无PD的特发性PN(IPN)患者比较Cbl、空腹同型半胱氨酸(HCy)和空腹甲基丙二酸(MMA)水平的异常。确诊为Cbl、Hcy或MMA水平异常的PD-IPN和IPN患者接受肌肉内Cbl治疗1-2年。在49例有症状性PN的PD患者中，34例(69%)为PD-IPN，32/34(94%)HY或MMA水平异常，而IPN患者为26/258(10%)。终生累积L-多巴剂量和空腹MMA水平与PN严重程度相关。CBL治疗使所有组的Hcy和MMA水平均有改善，PD-IPN患者的PN在治疗过程中趋于稳定。PD患者的PN可能与医源性Cbl代谢异常有关。另外，PN可能是PD的一种外周神经系统表现。(C)2008年运动无序协会。
The presence and potential etiologies of peripheral neuropathy (PN) in patients with Parkinson's Disease (PD) is unknown. We examined for presence of PN in patients with PD. From a PD patient population of 500 patients screened for features of symptomatic PN, patients were further selected for clinical, electrophysiological and laboratory studies related to PN. This PD patient population with idiopathic PN (PD-IPN) was compared to a group of PD patients without PN (PD-only), and a large group of patients without PD with idiopathic PN (IPN) for abnormalities in Cbl fasting homocysteine (HCy), and fasting methylmalonic acid (MMA) levels. PD-IPN and IPN patients identified with abnormalities in Cbl, Hcy, or MMA levels were treated with intramuscular Cbl for 1 to 2 years. Of 49 PD patients with symptomatic PN, 34 patients (69%) had PD-IPN, and 32/34 (94%) had abnormal Hey or MMA levels as compared to 26/258 (10%) of IPN patients. Cumulative lifetime L-dopa dosage and fasting MMA levels were associated with PN severity. Cbl therapy led to improvements in Hcy and MMA levels in all groups, and PN in PD-IPN patients stabilized during therapy. PN in PD patients may be associated with iatrogenic Cbl metabolic abnormalities. Alternatively PN may be a peripheral nervous system manifestation of PD. (C) 2008 Movement Disorder Society.