BRAIN and NERVE－神経研究の進歩74巻5号

2022年05月発行

増大特集 次の一手—神経筋疾患難治例をどのように治療するか

耐えられない有痛性ジストニアを伴うパーキンソン病—パーキンソン病の疼痛分類と治療選択

著者： 梶山裕太¹ 望月秀樹¹

所属機関： ¹大阪大学大学院医学系研究科神経内科学

ページ範囲：P.462 - P.467

文献概要

耐えられない有痛性ジストニアは，パーキンソン病（PD）の経過の中で最も厄介な症状である。どのようにしてその痛みの治療をすればよいのか。本論では疼痛分類を踏まえてジストニア関連の痛みの治療を述べる。Painful bilateral dystonic foot spasmというPDの病初期に認める症状も重要である。PDの治療が早期から開始されているためか，その症状は認められなくなり，最近のPDにおける痛みの分類には含まれていない。PDのジストニアに関連する痛みは多様で，その治療は，それぞれの痛みの原因に合わせて対応しなければならない。PDのオンジストニアやジスキネジア関連の痛みにはL-ドパなど薬剤の減量が，また，早朝のジストニアやオフジストニアには薬剤増量が必要である。難治性ジストニアを治療するためには持続的ドパミン刺激治療，例えばL-ドパ・カルビドパ持続経腸療法なども1つの対応法である。

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