Distinguishing progressive supranuclear palsy from other forms of Parkinson's disease: evaluation of new signs.
Distinguishing progressive supranuclear palsy from other forms of Parkinson's disease: evaluation of new signs.
复制标题
区分进行性核上性麻痹与其他形式的帕金森病：新体征的评估。
DOI：
10.1111/j.1749-6632.2002.tb02862.x
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发表时间：
2002
影响因子：
5.2
通讯作者：
Leigh,RJohn
中科院分区：
文献类型：
--
作者：
Kuniyoshi,Sandra;Riley,DavidE;Zee,DavidS;Reich,StephenG;Whitney,Christina;Leigh,RJohn
区分进行性核上性麻痹（PSP）与其他帕金森综合征可能是困难的，特别是在疾病的早期阶段。根据神经病理学标准，部分PSP病患者被误诊。1特征性眼动异常可能被遗漏或延迟至PSP病程后期。2因此，有必要确定其他的临床体征，可能有助于早期，可靠的诊断。本研究的目的是确定典型PSP或帕金森病（PD）患者三种临床体征的频率。我们使用目前公认的临床标准来诊断PSP 3和PD。4例患者在进入研究前由运动障碍专家诊断。其他神经科医生事先没有被告知诊断结果，他们进行了研究测试。我们研究了12例PSP患者（7例男性），他们的年龄范围为68至80岁（中位数75），诊断的疾病持续时间范围为1个月至11年（中位数4年），教育水平范围为8至20年（中位数16）。我们还研究了28例PD患者（15例男性）;他们的年龄范围为47至80岁（中位数70岁），病程范围为4个月至20年（中位数6年），教育水平范围为8至20年（中位数15年）。PSP和PD患者在病程或受教育程度方面无显著差异。我们试图对所有患者进行三项临床测试，尽管少数患者无法配合某些测试。第一个实验包括尝试通过以1-2 Hz的频率向一只睁开的眼睛重复闪烁笔光来诱导眨眼反应。异常反应被定义为在超过七次连续闪光刺激后缺乏习惯性（持续眨眼）。第二个测试包括在办公椅上单向旋转45秒;异常反应包括持续的头部偏离。第三个测试要求患者拍手，
Distinguishing progressive supranuclear palsy (PSP) from other parkinsonian syndromes may be difficult, especially in the early stages of disease. Based on neuropathological criteria, some patients with PSP disease are misdiagnosed. 1 Characteristic eye movement abnormalities may be missed or delayed until late in the course of PSP. 2 Therefore, there is a need to identify additional clinical signs that may aid early, reliable diagnosis. The goal of this study was to determine the frequency of three clinical signs in patients with classic PSP or Parkinson’s disease (PD). We used currently accepted, clinical criteria to diagnose PSP3 and PD. 4 Patients were diagnosed before entry into the study by a movement disorders specialist. Other neurologists, who were not informed of the diagnosis beforehand, conducted the study tests. We studied 12 patients (7 male) with PSP; their ages ranged from 68 to 80 years (median 75), duration of diagnosed illness ranged from 1 month to 11 years (median 4 years), and educational level ranged from 8 to 20 years (median 16). We also studied 28 patients (15 male) with PD; their ages ranged from 47 to 80 years (median 70), duration of illness ranged from 4 months to 20 years (median 6), and educational level ranged from 8 to 20 years (median 15). There were no significant differences in the duration of illness or educational level between PSP and PD patients.We attempted to evaluate three clinical tests on all patients, although a few patients were unable to cooperate for some tests. The first consisted of attempting to induce a blink response by flashing a pen light repetitively into one open eye at 1–2 Hz. An abnormal response was defined as lack of habituation (continued blinking) after more than seven consecutive flash stimuli. The second test consisted of unidirectional rotation in an office chair for 45 seconds; an abnormal response consisted of a sustained head deviation. 5 For the third test, patients were requested to clap