48 巻 (2017) 5 号 p. 167-171
Parkinson's disease (PD) causes motor impairment, but motor dysfunction can be improved by treatment. However, the package inserts of PD therapeutic drugs state “do not drive a car” as an important precaution in Japan. In addition, the package insert of non-ergot dopamine agonist (DA) states specifically “do not drive a car or operate a machine” as a warning because non-ergot DA causes sudden sleepiness and somnolence. On the other hand, driving is a very important means of transportation for daily living and work. Even though doctors explain at the clinic that the patients should not drive while on medications, many patients are forced to drive in everyday life. In addition, somnolence and sudden sleepiness differ among individuals. Therefore, doctors are confused about instructing patients to refrain from driving. We investigated the relation between non-ergot DA and driving situation in PD patients, which is a serious issue in the clinical setting. All 362 PD patients who visited our offices were interviewed regarding their driving situation, and detailed medications and car accidents were examine in 154 patients who continued driving a car or stopped driving after the onset of disease. In the investigation of medications, 51 patients were taking non-ergot DA, 36 patients (70.6%) of whom continued to drive. In addition, 20 of 154 patients had serious car accidents, but only six of the accidents were associated with somnolence and sudden sleepiness. In the examination of medications at the time of accident, there was no difference between non-ergot DA and other medications. These results suggest that upon receiving instructions from healthcare professionals, PD patients drive while making appropriate judgment about medication-induced somnolence. However, in this study, the number of patients who experienced serious car accidents was small, and the numbers of patients taking ergot DA and non-ergot DA were limited. Further larger scale study is required to confirm the findings. Preparation of guidelines related to instructions on taking PD medications is necessary, which include medication taking during holidays, consideration of the occurrence of sudden sleepiness and somnolence, and judgement of whether to continue driving.