MovementDisorders：运动障碍.ppt

Movement Disorders Mary Quiceno, M.D. Neurology Hypokinetic HyperkineticMovement Disorders Parkinson’s disease Parkinson’s Plus Syndromes PSP MSA SND OPCA CBD AD w/Lewy bodies LBD Tremor Dystonia Myoclonus Chorea Tics Akathisia Stereotypy RLS Basal Ganglia What is Parkinsons Disease? Parkinsonism is the name given to a collection of symptoms and signs consisting of: Tremor Rigidity Bradykinesia Unsteady gait Parkinsonism Many neurological disorders have features of parkinsonism. When parkinsonism occurs without any other neurological abnormalities, and there is no recognizable cause of it, the disorder is termed Parkinsons disease after the English physician who first described it fully in 1817. Evaluation by a neurologist is important for several reasons: All tremors are not Parkinson’s disease. There are many causes of tremor. It should not be assumed that someone has PD unless the tremor has all the features of the tremor that is known to occur in PD and other causes of tremor have been excluded. Parkinsonism is a symptom of many disorders. There are a variety of disorders in which parkinsonism occurs without obvious cause, but these disorders usually have additional features that distinguish them from classic PD. Such a distinction is important because the long-term outlook may differ and the treatment options may be different. Parkinsonism Exclusion criteria for PD Neuroleptics Toxin exposure (MPTP, CO, Mn, Methanol) Encephalitis Stroke Head injuries Early and severe dementia or autonomic dysfunction Levodopa non-responder Drug-induced Parkinsonism More common in elderly and women Symmetric onset of bradykinesia, tremor, and/or rigidity Onset within a few days to 3 months in 90% of affected patients Stop drug, try anticholingeric therapy New and Old Antipsychotics Risperdal Haldol Benzamides Reglan Phenothiazines Compazine Phenergan Others causing mainly postural tremors: Lithium Depakote Amiodarone How is Parkinsons Disease Treated? A n