Ondo W, Warrior D, Overby A, Calmes J, Hendersen N, Olson S, Jankovic J
Department of Neurlogy, Baylor College of Medicine, Houston, Texas, USA.
Arch Neurol. 2000 Oct;57(10):1464-9. doi: 10.1001/archneur.57.10.1464.
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder that is frequently mistaken for Parkinson's disease (PD) in its early stages.
To compare balance measures using computerized posturography in patients with early PSP and early PD.
We performed computerized posturography (SMART Balance Master; NeuroCom International, Inc, Clackamas, Ore) in 20 patients with clinically diagnosed mild to moderate PSP (ambulatory) and compared results with those from 20 patients with PD of similar age and disease duration who were not receiving medications, and from 20 healthy age- and sex-matched controls. Sensory organization testing (SOT), limits of stability (LOS), and toes-up perturbations (4 degrees at 50 degrees per second) were tested while receiving and not receiving a combination of oral carbidopa (25 mg) and levodopa (250 mg) in the PSP group. Clinical assessment included Unified Parkinson's Disease Rating Scale, Performance-oriented assessments, and functional reach.
When compared with the PD and control groups, total LOS time (P < .001) and path sway (P < .001) were significantly prolonged in PSP. Total SOT showed significantly worse scores in PSP compared with PD and control groups (F(2,57) = 29.6; P < .001). Univariate follow-up tests comparing PSP and PD showed differences in the following conditions: eyes open and visual sway (P = .003), eyes open and platform sway (P = .003), eyes closed and platform sway (P < .001), and eyes open and platform and visual sway (P < .001). Medium- and long-latency responses to perturbation were similar, but a larger number in the PSP group lacked short-latency responses (chi(2) = 11.3; P = .002). Levodopa administration did not significantly improve any aspect of posturography testing in PSP. In differentiating PSP from PD, LOS time and SOT condition of eyes open and platform and visual sway were nearly 100% sensitive and 100% specific (canonical correlation, 0.91).
Computerized posturography testing reliably differentiated early PSP from early PD and age-matched controls. The PSP group demonstrated severely contracted limits of stability with probable deficits in motor programming. Results of SOT in PSP suggested a vestibular pattern and overreliance on visual cues, even when incorrect. The absence of short-latency responses (monosynaptic reflex arch) suggests an additional disturbance in the spinal cord or peripheral nervous system. Arch Neurol. 2000;57:1464-1469
进行性核上性麻痹（PSP）是一种神经退行性疾病，在其早期阶段常被误诊为帕金森病（PD）。
比较早期PSP患者和早期PD患者使用计算机化姿势描记法进行平衡测量的结果。
我们对20例临床诊断为轻度至中度PSP（可行走）的患者进行了计算机化姿势描记法（SMART Balance Master；NeuroCom International，Inc，克拉卡马斯，俄勒冈州）检查，并将结果与20例年龄和病程相似且未接受药物治疗的PD患者以及20例年龄和性别匹配的健康对照者的结果进行比较。在PSP组中，分别在接受和未接受口服卡比多巴（25mg）和左旋多巴（250mg）联合用药的情况下，对感觉组织测试（SOT）、稳定极限（LOS）和足尖上抬扰动（每秒50度时4度）进行了测试。临床评估包括统一帕金森病评定量表、以表现为导向的评估和功能性伸展。
与PD组和对照组相比，PSP患者的总LOS时间（P<.001）和路径摆动（P<.001）显著延长。与PD组和对照组相比，PSP患者的总SOT得分显著更低（F(2,57)=29.6；P<.001）。比较PSP和PD的单因素随访测试显示，在以下情况下存在差异：睁眼和视觉摆动（P=.003）、睁眼和平台摆动（P=.003）、闭眼和平台摆动（P<.001）以及睁眼和平台及视觉摆动（P<.001）。对扰动的中、长潜伏期反应相似，但PSP组中更多患者缺乏短潜伏期反应（χ(2)=11.3；P=.002）。左旋多巴给药并未显著改善PSP患者姿势描记法测试的任何方面。在区分PSP和PD时，LOS时间以及睁眼和平台及视觉摆动的SOT情况的敏感性和特异性接近100%（典型相关性，0.91）。
计算机化姿势描记法测试能够可靠地将早期PSP与早期PD以及年龄匹配的对照者区分开来。PSP组表现出稳定极限严重受限，可能存在运动编程缺陷。PSP患者的SOT结果提示存在前庭模式以及对视觉线索的过度依赖，即使这些线索是错误的。缺乏短潜伏期反应（单突触反射弧）提示脊髓或周围神经系统存在额外的功能障碍。《神经病学文献》。2000年；57:1464 - 1469
