Self‐mutilation in chorea–acanthocytosis: Manifestation of movement disorder or psychopathology?
Self‐mutilation in chorea–acanthocytosis: Manifestation of movement disorder or psychopathology?
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DOI：
10.1002/mds.21156
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发表时间：
2006-12
影响因子：
8.6
通讯作者：
R. Walker;Qinyue Liu;M. Ichiba;S. Muroya;M. Nakamura;A. Sano;C. Kennedy;G. Sclar
中科院分区：
文献类型：
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作者：
R. Walker;Qinyue Liu;M. Ichiba;S. Muroya;M. Nakamura;A. Sano;C. Kennedy;G. Sclar
我们感谢阿尔维斯及其同事对我们的文件提出的中肯意见。[1]在他们的文章[2]中，他们描述了一名患有接种后帕金森综合征的儿童，该儿童与我们的患者有一些共同的特征，即在治疗的几周内发生左旋多巴诱导的运动波动和运动障碍。然而，这两种情况之间有几个不同之处。在我们的病例中，Vim丘脑切开术和左旋多巴停药后恢复良好且稳定，与Alves及其同事的患者的不良结局形成对比。这可能是由于各种因素。在我们的病例中，双侧炎性病变明显比一个孤立的中脑病变对孩子的大脑造成更大的伤害。正如阿尔维斯和他的同事们所指出的那样，儿童的大脑可能更容易受到伤害，导致其自然修复或补偿损伤的能力丧失。另一方面，除了对震颤的影响外，Vim丘脑切开术还改善了患者的僵硬和运动功能减退，这并不令人惊讶。这种作用在经典的立体定向文献中已被普遍报道3，有些人甚至假设Vim丘脑切开术可以减缓帕金森病（PD）的进展。[4]总之，尽管这两份报告存在不同，但都表明中脑病变引起的帕金森综合征可能对左旋多巴有反应。运动波动和运动障碍也可能与特发性PD相似。黑质病变的程度是否是决定左旋多巴引起的运动并发症的主要因素还有待证实。
We thank Alves and colleagues for their pertinent comments to our paper. 1 In their article2 they describe a child with postvaccinal Parkinsonism that shares some traits with our patient, namely, levodopa-induced motor fluctuations and dyskinesias occurring within a few weeks of treatment. However, there are several differences between the two cases. Good and stable recovery following Vim thalamotomy and levodopa withdrawal in our case contrasts with the poorer outcome of Alves and colleagues’ patient. It may be due to various factors. Bilateral inflammatory lesions obviously produced more harm to the child’s brain than one isolated midbrain lesion in our case. As Alves and colleagues suggest, children’s brain might be more vulnerable to the insults that led to the loss of its natural capacity to repair or compensate for the lesion. On the other hand, we do not find it so much surprising that beside the effect on tremor, Vim thalamotomy in our patient improved also her rigidity and hypokinesia. Such an effect had been commonly reported in classical stereotactic literature3 and some even hypothesized that Vim thalamotomy can slow down the progression of Parkinson’s disease (PD). 4 In conclusion, despite various differences in the two reports, both demonstrate that Parkinsonism produced by midbrain lesions may respond to levodopa. Motor fluctuations and dyskinesias can also develop similarly to idiopathic PD. It remains to be proven if the extent of lesion to the substantia nigra is the main factor that determines the appearance of levodopa-induced motor complications.