Hassin-Baer S, Sirota P, Korczyn A D, Treves T A, Epstein B, Shabtai H, Martin T, Litvinjuk Y, Giladi N
Department of Neurology, Tel-Aviv Medical Center, Israel.
J Neural Transm (Vienna). 2001;108(11):1299-308. doi: 10.1007/s007020100006.
In order to characterize the clinical spectrum of neuroleptic-induced parkinsonism (NIP), we studied a population of consecutive psychiatric in-patients treated with neuroleptics for at least two weeks, who were diagnosed by their psychiatrist as having parkinsonism. Parkinsonism was confirmed by a movement disorders specialist who performed neurological assessment including the motor examination and the activities of daily living (ADL) sections of the Unified Parkinson's Disease Rating Scale (UPDRS), and the Hoehn and Yahr (H&Y) staging. Seventy-five patients (54 males), aged 46 +/- 13 years (range 21 to 73 years) were included in the analysis. The mean duration of neuroleptic therapy was 15 +/- 12 years, while 61% were treated for more than 10 years. Most of the patients (n = 66, 88%) were scored as H&Y stage 2.5 or less. Rest tremor was present in 44% of the patients, and usually persisted in action. Forty-one patients (61%) had symmetrical involvement. Parkinsonian signs were significantly more common and pronounced in the upper in comparison with the lower limbs (p = 0.0001). Gait disturbances were mild and freezing of gait was very rare (n = 2). Neither age nor duration of therapy or their interaction affected the total motor score or any of the motor sub-scores. In conclusion, NIP differs from PD for more bilateral involvement with relative symmetry, and by affecting upper limbs more often than the lower ones. NIP tends to be associated with the triad of bradykinesia, tremor and rigidity while PD tends to involve gait and posture more often. NIP develops unrelated to duration of neuroleptic treatment or age of the patient, suggesting an individual predisposition to blockage of the dopaminergic receptors.
为了描述抗精神病药物所致帕金森综合征（NIP）的临床谱，我们研究了一组连续的接受抗精神病药物治疗至少两周的精神科住院患者，这些患者被精神科医生诊断为患有帕金森综合征。帕金森综合征由一名运动障碍专家确诊，该专家进行了神经学评估，包括统一帕金森病评定量表（UPDRS）的运动检查和日常生活活动（ADL）部分，以及霍恩和雅尔（H&Y）分期。分析纳入了75例患者（54例男性），年龄为46±13岁（范围21至73岁）。抗精神病药物治疗的平均时长为15±12年，其中61%的患者接受治疗超过10年。大多数患者（n = 66，88%）的H&Y分期为2.5期或更低。44%的患者存在静止性震颤，且通常在动作时持续存在。41例患者（61%）双侧受累。与下肢相比，帕金森体征在上肢明显更常见且更明显（p = 0.0001）。步态障碍较轻，步态冻结非常罕见（n = 2）。年龄、治疗时长及其相互作用均未影响总运动评分或任何运动子评分。总之，NIP与帕金森病（PD）不同，其双侧受累更为常见且相对对称，上肢受累比下肢更频繁。NIP往往与运动迟缓、震颤和强直三联征相关，而PD往往更常累及步态和姿势。NIP的发生与抗精神病药物治疗时长或患者年龄无关，提示个体对多巴胺能受体阻滞存在易感性。
