Department of Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
J Neurol Neurosurg Psychiatry. 2010 Nov;81(11):1223-8. doi: 10.1136/jnnp.2009.193391. Epub 2010 Jun 14.
This study examines the clinical accuracy of movement disorder specialists in distinguishing tremor dominant Parkinson's disease (TDPD) from other tremulous movement disorders by the use of standardised patient videos.
Two movement disorder specialists were asked to distinguish TDPD from patients with atypical tremor and dystonic tremor, who had no evidence of presynaptic dopaminergic deficit (subjects without evidence of dopaminergic deficit (SWEDDs)) according to (123)I-N-ω-fluoro-propyl- 2β-carbomethoxy-3β-(4-iodophenyl) nortropane ([(123)I] FP-CIT) single photon emission computed tomography (SPECT), by 'blinded' video analysis in 38 patients. A diagnosis of parkinsonism was made if the step 1 criteria of the Queen Square Brain Bank criteria for Parkinson's disease were fulfilled. The reviewer diagnosis was compared with the working clinical diagnosis drawn from the medical history, SPECT scan result, long term follow-up and in some cases the known response to dopaminergic medications. This comparison allowed a calculation for false positive and false negative rate of diagnosis of PD.
High false positive (17.4-26.1%) and negative (6.7-20%) rates were found for the diagnosis of PD. The diagnostic distinction of TDPD from dystonic tremor was reduced by the presence of dystonic features in treated and untreated PD patients.
Clinical distinction of TDPD from atypical tremor, monosymptomatic rest tremor and dystonic tremor can be difficult due to the presence of parkinsonian features in tremulous SWEDD patients. The diagnosis of bradykinesia was particularly challenging. This study highlights the difficulty of differentiation of some cases of SWEDD from PD.
本研究通过使用标准化患者视频，考察运动障碍专家在区分震颤为主型帕金森病（TDPD）与其他震颤性运动障碍方面的临床准确性。
要求两位运动障碍专家根据（123）I-N-ω-氟丙基-2β-羧基-3β-（4-碘苯基）-nortropane([（123）I] FP-CIT)单光子发射计算机断层扫描（SPECT），通过“盲法”视频分析，将震颤为主型帕金森病与不伴有多巴胺能缺陷的非典型性震颤和肌张力障碍性震颤患者（无多巴胺能缺陷的受试者（SWEDD））区分开来。如果满足了 Queen Square 脑库帕金森病诊断标准的第 1 步标准，则诊断为帕金森病。将审查者诊断与从病史、SPECT 扫描结果、长期随访以及在某些情况下已知对多巴胺能药物的反应中得出的临床工作诊断进行比较。这种比较可以计算出 PD 诊断的假阳性和假阴性率。
发现 PD 的诊断存在较高的假阳性（17.4%-26.1%）和假阴性（6.7%-20%）率。在存在肌张力障碍特征的情况下，TDPD 与肌张力障碍性震颤的诊断区别会减小。
由于震颤性 SWEDD 患者存在帕金森特征，因此难以从非典型性震颤、单纯性静止性震颤和肌张力障碍性震颤中临床区分 TDPD。诊断运动迟缓特别具有挑战性。本研究强调了一些 SWEDD 病例与 PD 之间难以区分的问题。
