常见震颤的诊断和治疗.pptVIP

**Figure1Schematicandsimplifiedsynopsisofthebrainregionsandpathwaysinvolvedintremorogenesis.Seetextfordetails.(D1,Dopaminereceptortype1;D2,dopaminereceptortype2;exc.,excitatory;GABA,g-aminobutyricacid;Glu,glutamate;GPe,externalglobuspallidus;GPi,internalglobuspallidus;ICP,inferiorcerebellarpeduncle;inh.,inhibitory;SCP,superiorcerebellarpeduncle;SNc,substantianigra,parscompacta;SNr,substantianigraparsreticulata;STN,subthalamicnucleus;VIM,ventrointermediatenucleusofthalamus.)**Reemergingtremor，再现性震颤：部分PD患者手臂保持向外伸展姿势数秒后震颤再次出现，这也被认为是一种静止性震颤，因为身体的这一部分在这一阶段保持一个姿势不动。********β肾上腺素受体激动剂：特布他林、奥西那林、异他林、肾上腺素抗抑郁药：安非他酮、锂剂、三环类抗抑郁药神经安定药：氟哌啶醇抗惊厥药：丙戊酸钠多巴胺受体激动剂：苯丙胺重金属：水银、铅、砷、铋黄嘌呤类或诱导药：咖啡、茶、茶碱、环孢菌素********蓝斑去甲肾上腺素能细胞—浦肯野细胞树突（GABA细胞，对齿状核细胞起到抑制作用）。这一机制与SCA2严重的动作性震颤是类似的，其病理学改变就是选择性的浦肯野细胞变性。小脑齿状核细胞的传出纤维也投射到丘脑的腹内侧核。神经变性病如PD患者的亲属ET发病率更高，这提示ET可能也是一种变性病。*****Figure2ComplexnatureoftremoratrestinParkinson’sdisease(PD).Electrophysiologicsurfacerecordingstudy.Thesurfaceelectromyography(EMG)recordingsofa67-year-oldmanwithPDrevealarhythmicactivitywithafrequencyof5Hzinallmusclesstudied.Allrecordingsshownwereperformedsimultaneously.Theantagonists,anteriortibialandgastrocnemiusmuscles,areactivatedinshiftedphases,andaslightelectricalactivitywasdetectedinthequadricepsmusculatureonthesameside.Thefrequencyintheelectrophysiologicactivityontheleftandontherightsidediffersslightly,with13activationsintheleftanteriortibialmuscle,butonly12intherightsideduringtheperiodrepresentedinthefigure.Thisindicatesthattremorsoriginateinseparatecircuitsintheleftandrightsides,andtheoverallpictureunderscoresthecentraloriginandcomplexnatureofparkinsoniantremor.**特发性震颤治疗：没有禁忌症的情况下，普萘洛尔（40-240mg/天）和扑米酮作为一线推荐；普萘洛尔的剂量为40-240mg/天，用药前先做心电图以评估心动过缓的风险；同时也要了解存在体位性低血压的风险；扑米酮的使用要谨慎，从12.5m