Diagnosis and Management of Tremor.
Diagnosis and Management of Tremor.
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DOI：
10.1212/con.0000000000000346
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发表时间：
2016-08-01
期刊：
影响因子：
--
通讯作者：
Louis, Elan D
中科院分区：
文献类型：
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作者：
Louis, Elan D
回顾目的：震颤是身体部位的有节奏的振动，是最常见的不自主运动之一。节律振荡可以通过多种方式表现出来。因此，震颤具有丰富的临床现象。因此，诊断震颤疾病可能特别具有挑战性。本文的目的是为读者提供一种简单的方法来诊断和治疗震颤患者。 最新发现：近年来，随着广泛的神经影像学方法和严格的、受控的尸检研究的使用，对震颤疾病病理生理学基础的科学认识有了很大的发展。基底神经节和小脑是似乎发挥着重要作用的结构。总结：震颤疾病的诊断具有挑战性。震颤的治疗方法涉及病史和神经学检查，重点关注震颤现象学的细微差别，其中有很多。评估应从震颤病史和重点神经系统检查开始。检查应关注震颤现象学的许多微妙之处。除其他外，病史和检查用于确定震颤的主要类型是动作性震颤（即姿势性震颤、运动性震颤或意向性震颤）还是静止性震颤。然后，临床医生应制定两组鉴别诊断：以动作性震颤为主要震颤的疾病与以静息性震颤为主要震颤的疾病。前一种类型中最常见的是原发性震颤、增强性生理性震颤、药物性震颤、肌张力障碍性震颤、直立性震颤和小脑性震颤。帕金森病是最常见的静止性震颤，还有药物引起的静止性震颤。本文详细介绍了每种震颤疾病以及其他震颤疾病的临床特征。
PURPOSE OF REVIEW: Tremor, which is a rhythmic oscillation of a body part, is among the most common involuntary movements. Rhythmic oscillations may manifest in a variety of ways; as a result, a rich clinical phenomenology surrounds tremor. For this reason, diagnosing tremor disorders can be particularly challenging. The aim of this article is to provide the reader with a straightforward approach to the diagnosis and management of patients with tremor.RECENT FINDINGS: Scientific understanding of the pathophysiologic basis of tremor disorders has grown considerably in recent years with the use of a broad range of neuroimaging approaches and rigorous, controlled postmortem studies. The basal ganglia and cerebellum are structures that seem to play a prominent role.SUMMARY: The diagnosis of tremor disorders is challenging. The approach to tremor involves a history and a neurologic examination that is focused on the nuances of tremor phenomenology, of which there are many. The evaluation should begin with a tremor history and a focused neurologic examination. The examination should attend to the many subtleties of tremor phenomenology. Among other things, the history and examination are used to establish whether the main type of tremor is an action tremor (ie, postural, kinetic, or intention tremor) or a resting tremor. The clinician should then formulate two sets of differential diagnoses: disorders in which action tremor is the predominant tremor versus those in which resting tremor is the main tremor. Among the most common of the former type are essential tremor, enhanced physiologic tremor, drug-induced tremor, dystonic tremor, orthostatic tremor, and cerebellar tremor. Parkinson disease is the most common form of resting tremor, along with drug-induced resting tremor. This article details the clinical features of each of these as well as other tremor disorders.