Understanding drug-induced parkinsonism
Understanding drug-induced parkinsonism
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了解药物引起的帕金森病
作者：
M. Alvarez;V. Evidente
1817年，詹姆斯·帕金森（James Parkinson）描述了震颤性麻痹，现在被称为帕金森病（PD）。对帕金森病的描述不断发展，直到现在“帕金森病”一词指的是一种以震颤、僵硬和运动迟缓为特征的综合征，此外还有姿势反射丧失和冻结。帕金森氏症最常见的病因是PD。然而，对于任何帕金森患者，必须获得仔细的医疗和用药史，因为药物性帕金森病（DIP）通常是可逆的，特别是如果早期停用致病药物。
In 1817, James Parkinson described the shaking palsy now known as Parkinson disease (PD). Descriptions evolved until the term “parkinsonism” now refers to a syndrome characterized by the presence of tremor, rigidity, and bradykinesia in addition to loss of postural reflexes and freezing. The most common cause of parkinsonism is PD. However, in any parkinsonian patient, one must obtain a careful medical and medication history, as drug-induced parkinsonism (DIP) is often reversible, especially if the offending drug is discontinued early.
A 46-year-old man developed upper limb tremors 2 weeks after initiating perphenazine for mood disorder. Perphenazine was promptly changed to quetiapine, though his tremor persisted. He had a history of hypertension, hypercholesterolemia, and chronic nausea. His medications include verapamil, lovastatin, and metoclopramide.
Motor, sensory, and cerebellar testing were normal. Although mildly stooped, he had normal gait and postural reflexes. Extrapyramidal examination revealed a mild chin tremor, moderate symmetric 3 to 4 Hz resting tremor of the upper and lower limbs, and faster frequency postural tremor of both arms. Finger tapping was moderately irregular bilaterally.
Many patients with DIP are often misdiagnosed …