帕金森病诊断北京协和医院.pptxVIP

帕金森病诊断北京协和医院第1页/共42页 良性震颤特征 家庭史 饮酒 求医发病年龄震颤类型分布病程ARP 常阴性可疑早期中年静止手、双下肢进行性可以出现阳性占50%震颤明显减轻晚期童年、中年、老年姿势、运动引起的手、头、声音缓慢进行性; 静止相当长时期, 永不出现 治疗 Levodopa Propranolol primidone有效可减轻震颤无效 无效有效有效帕金森病 良性震颤 Goetz CG, et al.1995;1(4):47第2页/共42页 Final Neurological Evaluation in Beijing, Xian, Shanghai, 2001 Non-PD Parkinsonism N=132?N=9 N=117? N=6Parkinsonism excluded N=665N=643 N=7 N =15Parkinson’s Disease N=272+1Non-Parkinsonism N=1,839Initial Evaluation in 1997Non-PD Parkinsonism N=130Lost243Died 276Parkinsonism excludedN=8,205Re-study N=12,401+2Re-study N=1,188Negative symptom questionnaire N=27,213 Response N=29,454Parkinson’s Disease N=277* N=17 N=6 N=252* N=2Positive symptom questionnaire N=2,241Parkinsonism excluded N=27,212Eligible N=31,318Non-response N=1,864Neurological exam N=2,241Neurological exam N=27,212+1Lost3,323Died 873Follow_up Survey? For Non-PD Parkinsonism non-follow-up n=49, traced=62.3 %* For PD non-follow-up n=75 traced=72.5 %94%64.4%45.6%33.8%43.7%56.3%66.2%第3页/共42页 临床诊断的准确性22年中，65例尸检，59例神经病理检查。生前临床最初诊断PD43例，随访11.7年，临床最后诊断PD41例死后病理证实31(76%)。(Rajput,et al. 1991)第4页/共42页 病理检查确认 临床误诊为PD的原因第5页/共42页 神经病理诊断59例第6页/共42页 疑似特发性帕金森病的 主要的特发性帕金森综合症第7页/共42页 Clinical Diagnosis of IPD: difficult, particularly in early casesBetween IPD and other parkinsonian syndrome.Clinically diagnosed IPD: 100 casesPathologically confirmed: 76 cases(Hughes AJ, et al. 1992)第8页/共42页 Clinical Features of IPD: particularly in early casesThe highest positive predictive values:tremorasymmetry of symptoms at onsetgood clinical response to L-dopa第9页/共42页 Clinical Features of IPD:  particularly in early casesAt the onset of the symptomatic phase, the clinical response to L-dopa is not yet availableA sufficient dosage (1000 mg/day), [withdrawing levodopa over 1-2 days] an improvedment in the motor score of 30% or more indicates “dopa-sensitivity”第10页/共42页 Clinical Features of IPD: