帕金森症候群
帕金森症候群 Parkinsonism | |
---|---|
病因 | |
分类和外部资源 | |
醫學專科 | 神經學 |
ICD-11 | 8A00 |
ICD-10 | G21、G22 |
DiseasesDB | 24212 |
MedlinePlus | 000759 |
Orphanet | 68402 |
帕金森症候群(Parkinsonism)是和運動機能相關的臨床症候群,其特徵是顫抖、運動功能減退、僵硬及平衡障礙[1][2]。在帕金森氏症(PD)患者身上會有類似症狀(此症候群因此而得名),而路易氏體失智症(DLB)、帕金森病性失智症(PDD)等疾病也會有此症狀。這類症候群的病因範圍很廣,包括神經退化障礙疾病、藥物、毒素、代謝疾病,或是帕金森氏症以外的神經性疾病[3]。
病因
藥物引起
有帕金森症候群的人當中,約有7%是因為藥物的副作用而造成的,主要是因為抗精神病药,特別是吩噻嗪(例如perphenazine及氯丙嗪)、噻噸(例如三氟噻噸及珠氯噻醇)及丁酰苯(例如氟哌啶醇),偶爾也有因為抗憂鬱藥物而造成。藥物引起帕金森症候群的盛行率會隨年齡而上昇。藥物引起的帕金森症候群一但出現,多半會維持原有的程度,不像帕金森氏症會漸漸惡化[4]。
毒素
有發現殺蟲劑或除草劑暴露程度和帕金森氏症之間的關聯性。若暴露在百草枯或錳乃浦/鋅錳乃浦下,風險是原來的兩倍[5]。
已證實慢性锰(Mn)暴露會造成類似帕金森症候群的疾病,其特徵是運動障礙,此症狀無法用典型的帕金森症治療方式來治療,因此推測除了典型黑质內多巴胺能損失外,包括有其他的致病途徑[6]。锰會在基底核內累積,因此造成運動障礙[7]有一種和SLC30A10基因(錳外流轉運蛋白,減少細胞內錳所必需的蛋白)有關的變異和這種類似帕金森症候群疾病有關[8]。在這疾病中看不到帕金森氏症中典型的路易體[7]。
診斷
許多疾病會造成帕金森症候群。
- 皮質基底核退化症[9]
- 路易氏體失智症[9]
- 額顳失智症(匹克氏病)[10]
- 格斯特曼–斯特劳斯勒–申克综合征[9]
- 亨丁頓舞蹈症[9]
- Lytico-bodig症(ALS complex of Guam)[9]
- 多系統萎縮(Shy–Drager症候群)[9]
- 神經吞噬作用[9]
- 神經元蠟樣脂褐質儲積症[9]
- 少腦橋小腦萎縮[9]
- 泛酸鹽激活酵素關聯之神經退化性疾病,也稱為具有腦部鐵質積聚的神經變性(neurodegeneration with brain iron accumulation)[9]
- 帕金突變(遺傳性青少年肌張力障礙)[9]
- 帕金森氏症[9]
- 帕金森氏症性失智症[11]
- 進行性上眼神經核麻痺症[9]
- 肝豆狀核變性[9]
- X連鎖性肌張力障礙帕金森症(Lubag症候群)[9]
- 藥物引發(偽帕金森症候群)
- 感染
- 毒素
- 番荔枝科[16]
- 一氧化碳[9]
- 二硫化碳[9]
- 氰化物[9]
- 乙醇[9]
- 己烷[17]
- 錳乃浦/鋅錳乃浦[5]
- 锰[9][6]
- 汞[9]
- 甲醇[9]
- MPTP[9][18]
- 百草枯[19][5]
- 魚藤酮[19]
- 甲苯[20](吸入濫用)[21]
- 創傷
- 血管的
- Binswanger病(皮質下白質腦病)[9]
- 血管性痴呆(多發梗塞性)[9]
- 其他
- 腦幹受損(特別是黑質的多巴胺能核)[22][23]或是基底核(特別是蒼白球)[24]或丘脑的受損[25]
- 甲狀腺機能低下症[9]
- 站立性顫抖症[26]
- 腫瘤伴隨症候群:因為癌症產生的抗體引發的神經性症狀[27]
- 快速發作的肌張力障礙性帕金森病[28]
- 常染色體隱性遺傳性少年帕金森病[29]
原發性震顫
根據2018年的回顧性研究,還不確定帕金森症候群和原發性震顫是否有關[30]。
參考資料
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