唑尼沙胺Zonisamide治疗DLB病人的帕金森症状

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	唑尼沙胺Zonisamide治疗DLB病人的帕金森症状                                                        此文由章华医生提供  Chen Pin 翻译 病例来自日本富山大学附属医院神经内科，文章发表在：“神经内科和脑卒中”杂志(2014年第三期)。 一位路易体痴呆（DLB）的70岁老人服用唑尼沙胺后，帕金森运动状态好转，同时视幻觉未恶化，未诱发直立性低血压。病人最初服用左旋多巴、罗匹尼洛、多奈哌齐以治疗帕金森症状和视幻觉，接着加服司兰吉林，以此来延缓帕病进展。通过以上治疗后运动状况得到改善，但同时又出现负面作用，如出现视幻觉、直立性低血压和晕厥等症状。因此后来每天用25mg唑尼沙胺代替司兰吉林, 结果视幻觉, 直立性低血压很快得到缓解。.三个月后，他的小碎步也减轻。本病例描述服用唑尼:沙胺后，路易体痴呆病人的运动状态得到改善，而且不会产生视幻觉和直立性低血压的恶化。 因此那些因服用多巴胺剂后会产生视幻觉和直立性低血压的病人，服用唑尼沙胺是一个很好的选择。为证明唑尼沙胺对DLB患者的疗效，尚必须进行适当的临床实验。 附原文: Here, I report the case of a 70-year-old man with dementia with Lewy bodies (DLB) who experienced an improvement in Parkinsonism with zonisamide treatment without worsening of visual hallucinations or induction of orthostatic hypotension. The patient was initially medicated with levodopa, ropinirole and donepezil to treat Parkinsonism and dementia, as well as visual hallucinations. Selegiline was later added to help manage a subsequent aggravation of his Parkinsonism. Under this treatment regimen, motor symptoms improved, but adverse effects such as visual hallucinations, orthostatic hypotension and syncopal attacks appeared. Therefore, selegiline was replaced with zonisamide at a dose of 25 mg per day. Subsequently, the visual hallucinations and orthostatic hypotension rapidly improved and, 3 months later, the severity of his short steppage gait was alleviated. This case report describes a patient with DLB who experienced improvement in motor symptoms by incorporating zonisamide into the treatment regimen without deterioration of visual hallucinations or orthostatic hypotension. If adverse effects such as visual hallucinations and orthostatic hypotension are seen in patients with DLB following the use of dopamine agents, zonisamide might be a good alternative therapeutic option. Proper clinical trials need to be done to validate a therapeutic potential of zonisamide in DLB..

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	很专业的文章