Politis Antonis M, Kokras Nikolaos, Pappa Dimitra, Siarkos Costantin, Katirtzoglou Everina, Papadimitriou George N, Kahn David A
POLITIS: Athens Medical School and John's Hopkins Medical School; KOKRAS, PAPPA, SIARKOS, KATIRTZOGLOU, and PAPADIMITRIOU: Athens Medical School; KAHN: Columbia University College of Physicians and Surgeons, New York.
J Psychiatr Pract. 2013 Sep;19(5):413-8. doi: 10.1097/01.pra.0000435041.13921.a8.
In elderly patients, exposure to antipsychotic medication and subsequent withdrawal may lead to the development of persistent extrapyramidal symptoms, possibly including a syndrome suggested to be tardive parkinsonism. We describe a case in which withdrawal of antipsychotics was unexpectedly associated with progressive deterioration, rather than improvement, of extrapyramidal parkinsonian symptoms. Abnormal imaging of presynaptic dopamine transporters (DaTs) using single-photon emission computed tomography (SPECT) with ioflupane I 123 (DaTscan) substantially contributed to the differential diagnosis, suggesting it was likely that the patient had an underlying neurodegenerative disorder that preceded the onset of medicationinduced parkinsonian symptoms. Our report illustrates how novel findings from DaTscan may assist with diagnosing the cause of persistent parkinsonian symptoms after antipsychotic withdrawal and provide insight into the controversial concept of tardive parkinsonism.
在老年患者中，使用抗精神病药物及随后停药可能会导致持续性锥体外系症状的出现，可能包括一种被认为是迟发性帕金森病的综合征。我们描述了一个病例，其中停用抗精神病药物意外地与锥体外系帕金森症状的进行性恶化而非改善相关。使用碘[I 123]氟哌啶（DaTscan）单光子发射计算机断层扫描（SPECT）对突触前多巴胺转运体（DaTs）进行异常成像，对鉴别诊断有很大帮助，提示患者可能在药物性帕金森症状出现之前就存在潜在的神经退行性疾病。我们的报告说明了DaTscan的新发现如何有助于诊断抗精神病药物停药后持续性帕金森症状的原因，并为迟发性帕金森病这一有争议的概念提供见解。
