El Otmani H, Raji L, El Moutaouakil B, Rafai M A, Slassi I
Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc.
Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc.
Encephale. 2015 Apr;41(2):190-3. doi: 10.1016/j.encep.2013.03.013. Epub 2013 Oct 2.
Punding is a stereotypical behavior characterized by an intense fascination with repetitive handling and examining of mechanical devices or arranging common objects. This condition, which is different from both obsessive-compulsive disorder and mania, is still underestimated in patients with Parkinson's disease and may have deleterious social consequences on patients and their families.
We report the case of severe punding in a 23-year-old parkinsonian woman, who presented, a few days following a rise in the dose of pergolide up to 2,5 mg/(d), frequent and daily unusual repetitive behavior, characterized by ceaseless sewing, disassembly and reassembly of phones, and coloring of drawings. These behaviors were associated with a common peak of dose dyskinesia and were responsible for a considerable reduction in duration of sleep with negative impact on the quality of life of her parents. These symptoms significantly improved immediately after switching pergolide to an equivalent dose of ropinirole (12 mg/(d).
Punding has only recently come to the attention of physicians through the first report in a parkinsonian patient, triggered by dopaminergic replacement therapy. The phenomenon was thought to be related to excessive dopaminergic stimulation of the limbic and associative pathways. The current mainstay of treatment is the reduction in the dose of dopaminergic medication or changing the presumed responsible drug, often a dopaminergic agonist. In this article, the authors review the epidemiology, pathophysiology and management of this curious phenomenon.
刻板行为是一种刻板的行为，其特征是对机械装置的重复操作和检查或整理常见物品有着强烈的痴迷。这种情况与强迫症和躁狂症均不同，在帕金森病患者中仍未得到充分认识，可能会对患者及其家庭产生有害的社会影响。
我们报告了一名23岁帕金森病女性患者出现严重刻板行为的病例。在培高利特剂量增加至2.5毫克/（天）后的几天里，她频繁出现日常异常重复行为，表现为不停地缝纫、拆卸和重新组装手机以及给图画上色。这些行为与剂量异动症的共同峰值相关，导致睡眠时间大幅减少，对其父母的生活质量产生负面影响。在将培高利特换用等效剂量的罗匹尼罗（12毫克/（天））后，这些症状立即显著改善。
刻板行为直到最近才通过帕金森病患者的首例报告引起医生的关注，该报告由多巴胺能替代疗法引发。这种现象被认为与多巴胺能对边缘系统和联合通路的过度刺激有关。目前的主要治疗方法是减少多巴胺能药物的剂量或更换可能相关的药物，通常是多巴胺能激动剂。在本文中，作者回顾了这种奇特现象的流行病学、病理生理学和管理方法。
