闵喆;薛峥;连立飞;

• 1:华中科技大学同济医学院附属同济医院

摘要(Abstract)：

目的分析药源性帕金森综合征(DIP)的临床特点,以及原发性帕金森病的鉴别诊断及治疗体会。方法回顾性分析21例诊断为DIP患者的临床资料。结果 21例患者均有明确的用药史,用药14d～2 a后出现帕金森综合征表现,19例双侧肢体起病,2例单侧起病。临床表现以行动迟缓、肌强直和震颤为主,部分患者合并迟发性运动障碍、静坐不能或肌张力障碍。停用相关药物并予以对症治疗后,多数患者症状缓解,但少数患者症状持续时间较长。结论 DIP的临床特点与原发性帕金森病类似,但不尽相同。DIP最好的治疗是预防,尽管多数患者预后较好,但仍影响患者生活质量并造成较重的经济负担,因此使用相关药物应严格把握适应征及禁忌证,控制疗程与用药剂量并加强监测。

关键词(KeyWords)： 药源性帕金森综合征;帕金森病;临床特点;鉴别诊断;不良反应

Abstract:

Keywords:

基金项目(Foundation): 国家自然基金重大研究计划项目(编号:91849121)

作者(Authors): 闵喆;薛峥;连立飞;

参考文献(References)：

• [1]SHIN H W,CHUNG S J.Drug-induced parkinsonism[J].J Clin Neurol,2012,8(1):15-21.DOI:10.3988/jcn,2012.8.1.15.
• [2]VAN GERPEN J A.Drug-induced parkinsonism[J].Neurologist,2002,8(6):363-370.DOI:10.1097/00127893-200211000-00006.
• [3]FACTOR S A,BURKHARD P R,CAROFF S,et al.Recent developments in drug-induced movement disorders:a mixed picture[J].Lancet Neurol,2019,18(9):880-890.DOI:10.1016/S1474-4422(19)30152-8.
• [4]HAN S,KIM S,KIM H,et al.Prevalence and incidence of Parkinson's disease and drug-induced parkinsonism in Korea[J].BMC Public Health,2019,19(1):1328.DOI:10.1186/s12889-019-7664-6.
• [5]THANVI B,TREADWELL S.Drug induced parkinsonism:a common cause of parkinsonism in older people[J].Postgrad Med J,2009,85(1004):322-326.DOI:10.1136/pgmj.2008.073312.
• [6]BONDON-GUITTON E,PEREZ-LLORET S,BAGHERI H,et al.Drug-induced parkinsonism:a review of 17 years’experience in a regional pharmacovigilance center in France[J].Mov Disord,2011,26(12):2226-2231.
• [7]DE GERMAY S,MONTASTRUC F,CARVA-JAL A,et al.Drug-induced parkinsonism:Revisiting the epidemiology using the WHO pharmacovigilance database[J].Parkinsonism Relat Disord,2020,70:55-59.DOI:10.1016/j.parkreldis.2019.12.011.
• [8]张辉,王运良.帕金森病的发病机制及治疗进展[J].中国实用神经疾病杂志,2021,24(15):1371-1380.DOI:10.12083/SYSJ.2021.15.026.
• [9]王正阳,刘颖,沈丽华.帕金森病影像学生物标志物的研究进展[J].中国实用神经疾病杂志,2021,24(14):1271-1276.DOI:10.12083/SYSJ.2021.14.017.
• [10]TANG Y L,YANG K,ZHAO J,et al.Evidence of Repurposing Drugs and Identifying Contraindications from Real World Study in Parkinson’s Disease[J].ACS Chem Neurosci,2019,10(2):954-963.DOI:10.1021/acschemneuro.8b00456.
• [11]LIM T T,AHMED A,ITIN I,et al.Is 6months of neuroleptic withdrawal sufficient to distinguish drug-induced parkinsonism from Parkinson’s disease?[J].Int J Neurosci,2013,123(3):170-4.DOI:10.3109/00207454,2012.732976.
• [12]RANDHAWA J,MEHANNA R.Drug induced parkinsonism:Symptomatic beyond 22 months[J].Parkinsonism Relat Disord,2019,66:267-268.DOI:10.1016/j.parkreldis,2019.08.009.
• [13]SAVICA R,GROSSARDT B R,BOWER J H,et al.Incidence and time trends of drug-induced parkinsonism:A 30-year population-based study[J].Mov Disord,2017,32(2):227-234.DOI:10.1002/mds.26839.
• [14]BENITO-LEON J,BERMEJO-PAREJA F,RO-DRIGUEZ J,et al.Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain[J].Mov Disord,2003,18(3):267-274.DOI:10.1002/mds.10362.
• [15]WENNING GK,KIECHL S,SEPPI K,et al.Prevalence of movement disorders in men and women aged 50-89 years(Bruneck Study cohort):a population-based study[J].Lancet Neurol,2005,4(12):815-820.DOI:10.1016/S1474-4422(05)70226-X.
• [16]KIM J S,YOUN J,SHIN H,et al.Nonmotor symptoms in drug-induced parkinsonism and drug-na?ve Parkinson disease[J].Can J Neurol Sci,2013,40(1):36-41.DOI:10.1017/s0317167100012920.
• [17]MORLEY J F,DUDA J E.Use of hyposmia and other non-motor symptoms to distinguish between drug-induced parkinsonism and Parkinson’s disease[J].J Parkinsons Dis,2014,4(2):169-173.DOI:10.3233/JPD-130299.
• [18]WARD K M,CITROME L.Antipsychotic-Related Movement Disorders:Drug-Induced Parkinsonism vs.Tardive Dyskinesia-Key Differences in Pathophysiology and Clinical Management[J].Neurol Ther,2018,7 (2):233-248.DOI:10.1007/s40120-018-0105-0.
• [19]FEARNLEY J M,LEES A J.Ageing and Parkinson’s disease:substantia nigra regional selectivity[J].Brain,1991,114 (Pt 5):2283-2301.DOI:10.1093/brain/114.5.2283.
• [20]VOLKOW N D,DING Y S,FOWLER J S,et al.Dopamine transporters decrease with age[J].J Nucl Med,1996,37(4):554-559.
• [21]李妍,朝娃,路敬叶,等.帕金森病轻度认知功能障碍[J].中国实用神经疾病杂志,2021,24(9):812-818.DOI:10.12083/SYSJ.2021.10.023.
• [22]TEIVE H A,TROIANO A R,GERMINIANI FM,et al.Flunarizineand cinnarizine-induced parkinsonism:a historical and clinical analysis[J].Parkinsonism Relat Disord,2004,10(4):243-245.DOI:10.1016/j.parkreldis,2003.12.004.
• [23]JEONG S,CHO H,KIM Y J,et al.Drug-induced Parkinsonism:A strong predictor of idiopathic Parkinson's disease[J].PLo S One,2021,16(3):e0247354.DOI:10.1371/journal.pone.0247354.
• [24]OLIVARES ROMERO J,ARJONA PADILLOA,BARRERO HERNANDEZ F J,et al.Utility of transcranial sonography in the diagnosis of drug-induced parkinsonism:a prospective study[J].Eur J Neurol,2013,20(11):1451-1458.DOI:10.1111/ene.12131.
• [25]BRIGO F,ERRO R,MARANGI A,et al.Differentiating drug-induced parkinsonism from Parkinson’s disease:an update on non-motor symptoms and investigations[J].Parkinsonism Relat Disord,2014,20(8):808-814.DOI:10.1016/j.parkreldis.2014.05.011.
• [26]YOMTOOB J,KOLOMS K,BEGA D.DAT-SPECT imaging in cases of drug-induced parkinsonism in a specialty movement disorders practice[J].Parkinsonism Relat Disord,2018,53:37-41.DOI:10.1016/j.parkreldis.2018.04.037.
• [27]WEARNE D,MCCARTHY M,ORR C.Differentiating Parkinson’s disease from drug-induced Parkinsonism[J].Aust N Z J Psychiatry,2019,53(9):923-924.DOI:10.1177/0004867419837751.
• [28]STEPHEN P J,WILLIAMSON J.Drug-induced parkinsonism in the elderly[J].Lancet,1984,2(8411):1082-1083.DOI:10.1016/s0140-6736(84)91516-2.
• [29]CHABOLLA DR,MARAGANORE DM,AHL-SKOG JE,et al.Drug-induced parkinsonism as a risk factor for Parkinson’s disease:a historical cohort study in Olmsted County,Minnesota[J].Mayo Clin Proc,1998,73 (8):724-727.DOI:10.4065/73.8.724.
• [30]OH S W,SHIN N Y,YOON U,et al.Shared functional neural substrates in Parkinson’s disease and drug-induced parkinsonism:association with dopaminergic depletion[J].Sci Rep,2020,10(1):11617.DOI:10.1038/s41598-020-68514-0.
• [31]BAEZ M A,AVERY J.Improvement in druginduced parkinsonism with electroconvulsive therapy[J].Am J Geriatr Pharmacother,2011,9(3):190-193.DOI:10.1016/j.amjopharm,2011.04.005.