Dear 素,
For your information.
Clinical Manifestations
Cardinal features of Parkinson's disease include
1. Resting tremor generally of one hand or foot, often unilateral, which ceases with movement. Tremor also may be noted in the lips, chin, and tongue.
2. Rigidity, manifested by increased resistance to passive range of motion. Cog-wheel rigidity often can be elicited in the wrists and elbows.
3. Akinesia and bradykinesia.
4. Disturbances of gait. Festination is a quickened gait with the body propelled forward.
Patients with Parkinson's disease also may have
1. Loss of righting reflexes
2. Postural changes
3. Masked facial expressions and delayed ability to demonstrate facial expressions (hypomimia)
4. Decreased blinking
5. Hypophonia/dysarthria
6. Micrographia
7. Depression
8. Dementia
9. Constipation
10. Seborrhea
11. Impotence
12. Urinary incontinence
13. Myalgia
14. Sleep disturbances (Kennedy-Malone & Loftus-Fader, in press).
Diagnostic Evaluation
1. Diagnosis requires finding two of the three cardinal signs: bradykinesia, resting tremor, or rigidity.
2. There are no histologic indicators for Parkinson's disease.
3. Magnetic resonance imaging (MRI) may be ordered to rule out suspected brain lesions or abnormalities such as normal pressure hydrocephalus.
4. A clinical response to carbidopa/levodopa provides a strong indication of Parkinson's disease.
5. Positron emission tomography (PET) scanning has been used in the evaluation of levodopa uptake and conversion to dopamine in the corpus striatum. Clinicians use PET scans to confirm the diagnosis of Parkinson's disease before surgery.
Differential Diagnosis
1. Essential benign familial tremor is characterized by involuntary rhythmic shaking or tremor, usually involving the hands, head, voice, or other body parts. Essential tremor, which is 10 to 20 times more prevalent than Parkinson's disease, is an action tremor. It can be postural or kinetic in nature. This tremor is more prominent with voluntary movement such as eating or drinking.
2. Huntington's disease is clearly genetic in origin. It is an autosomal dominant inherited neuropsychiatric disorder that presents in adult life (usually in patients younger than 40 years). Symptoms include personality and mood changes, chorea, clumsiness, and cognitive decline. Apathy, irritability, and depression are common. Huntington's disease is a deteriorating illness that ultimately results in death after a 15- to 20-year duration of the disease.
3. Shy-Drager syndrome is a neurodegenerative disorder characterized by bradykinesia, rigidity, minimal tremor, and poor response to dopamine. Shy-Drager displays early and prominent autonomic nervous system dysfunction.
4. Progressive supranuclear palsy signs and symptoms include early gait disturbances characterized by falls and axial rigidity, with nuchal dystopia, facial spasticity, and supranuclear gaze abnormalities. Cognitive and behavioral abnormalities are present.
5. Creutzfeldt-Jakob disease is a rare neurodegenerative disease. In 10% of the cases, it is inherited in an autosomal dominant fashion. Creutzfeldt-Jakob disease has been transmitted by accidental inoculation through contaminated corneal transplants, dural grafts, intracerebral electrodes, and human growth hormone preparations. Symptoms include malaise, impaired sleep, altered eating patterns, and rapid progressive syndrome of mental deterioration associated with extrapyramidal, pyramidal, cerebellar, visual changes, lead-pipe rigidity, and myoclonus. The cognitive deficits in Creutzfeldt-Jakob disease present as cortical dementia with aphasia, agnosia, amnesia, apraxia, hallucinations, and delusions.
6. Normal-pressure hydrocephalus, also known as symptomatic hydrocephalus, presents with gait apraxia, urinary incontinence, and dementia (Aminoff, 1997).
(以上摘自Lippincott's Primary Care Practice Vol.3(2)1999 pp 169-173)
以上這篇文章第一段是提到Parkinson's Disease 臨床表徵有；靜坐不能﹙休息時不自主顫動）、僵直、運動不能、運動遲緩...等等
第二段是提到如何診斷，第三段則是鑑別診斷。
我想說的是；有〝輕微振動〞的徵兆並不一定是Parkinson's Disease ，建議您找專科醫師協助，解決您的疑惑與問題。
>【 在 素 的大作中提到: 】
>謝謝你們的答覆
>因為我的母親已經有輕微振動徵兆出現
>很擔心她已有類似的症狀
>身為女兒已嫁出無法在旁協助
>只好求助於各位可否有預防的方法
>除了吃西藥中醫ㄋ
>或有更溫和的嗎
>
>
>>【 在 James1215 的大作中提到: 】
>>(ㄧ）
>>巴金森氏症是種慢性退化性疾病,原因不明.典型症狀是振顫,僵直及動作遲緩.並非所有病人都會有這三種症狀.在發病早期通常只有一或兩種症狀較顯著.除了巴金森氏症外,有許多疾病亦有類似表徵,如老年性振顫,假性延髓麻痺,威爾森氏症及其他錐體外疾病.故巴金森氏症之診斷不易,須詳細作鑑別診斷.治療方面,仍以藥物為主.近20年來的發展,已使我們能有效減輕其症狀並使病人有正常的期望壽命.Anticholinergics 可用在輕微的患者,特別是以振顫為主要症狀的病人.Amantadine 用在以僵直及行動遲緩為主的病人,但連續使用6至12個月後效果會下降.Levodopa是目前控制巴金森氏症的主要藥物,有80% 的病人可因之得到緩解,但效果在連續使用3至5年後會降低. 若與dopa去醯𢶷抑制劑合用,可減少周圍神經系統的副作用 .Bromocriptine可在Levodopa效果下降時與之合用,或在發病早期即合併使用以延長Levodopa的有效期間.總之巴金森氏症對許多藥物皆有反應,且未來將可望有更多的新療法出現.
>>
>>﹙二）
>>巴金森氏症是一種漸進性腦黑質紋狀體多巴胺神經元細胞退化,導致神經傳導物質Dopamine 減少所造成的中樞神經系統疾病.本文內容概述目前使用於巴金森氏症治療的藥物,簡單介紹各藥物之使用時間及使用方法:(1)Levodopa: Dopamine之前驅物,經由酵素Dopa decarboxylase作用而轉化成Dopamine,補充Dopamine之缺乏;(2)Dopamine催動劑:直接刺激Dopamine接受器;(3)Selegiline:降低 Dopamine代謝速率;(4)抗Muscarine藥:通常使用於症狀較輕微的年輕患者;(5) Amantadine:促進Dopamine的合成、釋放,並減緩Dopamine的再吸收;(6) Apomorphine:為一種D1及D2 Dopamine催動劑,可以間歇性或連續性皮下注射方式給予,不適於口服.
>>
>> ﹙以上兩篇文章摘自科技簡訊）
>>Dear 素,
>>
>>帕金森氏症的症狀氏可以改善的，在發病初期時，藥物治療的效果
>>可以顯著地改善症狀﹙一般來說，藥物治療仍是首選的治療方式），不過隨著病程的進展﹙到目前為止，帕金森氏症是“進行性”疾病，無法根治，只能延緩病程的進行），幾年後人體將對藥物產生“耐受性”藥量須漸漸增加，如何延緩人體對藥物的“耐受性”呢？ 這需要與治療病人的專科醫師討論，調整用藥方式及劑量，並與醫師密切合作，才能延長藥物的效果。
>>建議您可以看看前幾期的康健雜誌，其中有一篇報導李泰祥得帕金森氏症的心路歷程，我想蠻有參考價值的！
>>
>>
>>
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>>>【 在 素 的大作中提到: 】
>>>我急於需要這方面的常識
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