Parkinsonian syndromes.
Parkinsonian syndromes.
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DOI：
10.1212/01.con.0000436152.24038.e0
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发表时间：
2013-10-01
期刊：
影响因子：
--
通讯作者：
Litvan, Irene
中科院分区：
文献类型：
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作者：
Williams, David R;Litvan, Irene
综述的目的：不同的帕金森病在临床上的分离可能是具有挑战性的。本文着重介绍帕金森病(PD)、进行性核上性麻痹(PSP)、多系统萎缩(MSA)和皮质基底膜变性(CBD)的重要临床特征。治疗和疾病管理的策略也被讨论。研究结果：在过去的十年里，人们越来越认识到帕金森氏症的神经退行性形式的广泛的临床表现。这些疾病的非运动症状，包括精神、认知、自主神经和胃肠道功能障碍，似乎对生活质量和残疾有重大影响。PSP和CBD现在被认为是病理诊断，具有几种不同和不同的临床表型，与帕金森病和额颞痴呆综合征重叠和共享特征。帕金森病的特点是对多巴胺能药物的良好反应持续多年，与MSA和PSP患者的反应相反。对CBD提出了新的诊断标准。目前还没有出现针对PSP、MSA或CBD的新的治疗措施。注射疗法和脑深部刺激手术是治疗晚期PD的公认疗法。总结：“帕金森综合征”包括一些根据共同的临床特征归类在一起，但又根据不同的病理基础分开的病因学实体。总体而言，考虑临床症状、发病方式和疾病进展的性质对于做出及时和明确的诊断都是重要的。
PURPOSE OF REVIEW: The different parkinsonian conditions can be challenging to separate clinically. This review highlights the important clinical features that guide the diagnosis of Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD). Strategies for treatment and disease management are also discussed.RECENT FINDINGS: Over the past decade there has been an increasing recognition of the broad clinical presentations of the neurodegenerative forms of parkinsonism. Nonmotor symptoms in these diseases, including psychiatric, cognitive, autonomic, and gastrointestinal dysfunction, appear to have a major impact on quality of life and disability. PSP and CBD are now considered pathologic diagnoses, with several different and varied clinical phenotypes, that overlap and share features with PD and frontotemporal dementia syndromes. PD is distinguished by its excellent response to dopaminergic medications that is maintained over many years, in contrast to the response seen in patients with MSA and PSP. New diagnostic criteria have been proposed for CBD. No new therapeutic interventions have emerged for PSP, MSA, or CBD. Infusional therapies and deep brain stimulation surgery are established therapies for advanced PD.SUMMARY: The "parkinsonian syndromes" encompass a number of nosologic entities that are grouped together on the basis of their shared clinical features but are separated on the basis of their different pathologies. Overall, the consideration of clinical signs, mode of disease onset, and nature of disease progression are all important to make a timely and definitive diagnosis.