摘要
帕金森药源性异动症为左旋多巴治疗后常见并发症,临床表现复杂。我院收治了1例确诊为帕金森药源性异动症误诊为癫痫的患者。患者为男性,69岁,因"行动迟缓15年,反复发作性四肢抽动伴憋气6个月余,突发意识丧失10 min"于2018年5月2日至我院就诊。患者长期服用多巴丝肼片并出现明显药物并发症。于2017年7月加用雷沙吉兰后稍有好转,于2017年11月开始出现反复四肢抽动,发作时间自数分钟至1 h不等,并逐渐出现抽动时伴明显憋气,2018年5月1日再次四肢抽动后意识丧失后送至我院急诊。患者由于合并有长期服用激素病史,安定类药物和抗癫痫药物对病情控制有一定疗效,故一开始被误诊为癫痫,随着药物的调整和病情的变化,最终确诊为帕金森药源性异动症。该症临床表现多样包括剂峰异动症,双相异动症和肌张力障碍。发病机制尚不完全明确,临床表现多样,而以发作性憋气伴低氧血症导致意识丧失为异动症表现的帕金森病国内外鲜有报道。因此,合并帕金森病患者如要诊断癫痫,首先应排除异动症可能。药物的合理使用在帕金森病中晚期也就显得尤为重要。
Parkinson′s drug-induced dyskinesia is a common complication after levodopa treatment, and its clinical manifestations are complex. A case of Parkinson′s L-dopa-induced dyskinesia misdiagnosed as epilepsy in our hospital is reported. The patient, a 69-year-old male, was hospitalized on May 2, 2018 due to "15 years of retardation, recurrent limb twitching with breathing for more than 6 months, sudden loss of consciousess for 10 minutes". The patient took madopar for a long time and had obvious drug complications. In July 2017, the use of rasagiline improved manifestations slightly. In November 2017, repeated limb twitches began to occur. The onset time ranged from several minutes to one hour, and there was a gradual occurrence of twitching accompanied by obvious breathing. On May 1, 2018, the patient was sent to our hospital for emergency treatment after limb twitching again. Due to the long-term history of hormone use, and tranquilizers and antiepileptic drugs were used to control the condition of the patient, the patient was misdiagnosed as epilepsy at first. With the adjustment of drugs and the change of condition, the patient was finally diagnosed as Parkinson′s L-dopa-induced dyskinesia. The clinical manifestations of the disease include peak dyskinesia, bipolar dyskinesia and dystonia. The pathogenesis of Parkinson′s disease is not completely clear and its clinical manifestations are diverse. However, there are few reports of Parkinson′s disease, whose manifestation is loss of consciousness due to paroxysmal breath holding and hypoxemia. Therefore, in order to diagnose epilepsy in patients with Parkinson′s disease, the possibility of dyskinesia should be excluded first. Therefore, the rational use of drugs is particularly important in the middle and late period of Parkinson′s disease.
作者
杨雪莲
蔡丽瑛
来小音
江梅
Yang Xuelian;Cai Liying;Lai Xiaoyin;Jiang Mei(Department of Neurology,Gongli Hospital,Pudong New District,Shanghai 200135,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2019年第8期646-649,共4页
Chinese Journal of Neurology
基金
上海市浦东新区卫生和计划生育委员会学科带头人培养计划(PWRd2017-10).
关键词
帕金森病
运动障碍
癫痫
Parkinson disease
Movement disorders
Epilepsy
