Josephs Keith A, Whitwell Jennifer L, Parisi Joseph E, Lapid Maria I
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
J Neurol. 2016 May;263(5):1008-1014. doi: 10.1007/s00415-016-8096-1. Epub 2016 Mar 26.
We report on the unusual behavior of coprophagia (eating one's own feces) in neurologic disorders. The Mayo Clinic Health Sciences-computerized clinical database was queried for all patients evaluated at our institution between 1995 and 2015 in which coprophagia was documented in the medical records. Twenty-six patients were identified of which 17 had coprophagia. Of the 17 patients, five were excluded due to age at onset less than 10 years, leaving 12 adult patients for this study. The median age at onset of coprophagia in the 12 patients was 55 years (range 20-88 years), and half were female. Additional behaviors were common including scatolia (fecal smearing), hypersexuality, aggression, and pica (eating objects of any kind). Coprophagia was associated with neurodegenerative dementia in six patients, developmental delay in two, and one each with seizures, steroid psychosis, frontal lobe tumor, and schizoaffective disorder. Brain imaging in the six patients with dementia showed moderate-to-severe medial temporal lobe atrophy, as well as mild frontal lobe atrophy. Autopsy examination was performed in one patient and revealed frontotemporal lobar degeneration pathology. Many different behavioral and pharmacologic therapies were implemented, yet only haloperidol was associated with discontinuation of the behavior. Coprophagia is associated with different neurologic disorders, particularly neurodegenerative dementias. The behavior may be related to medial temporal lobe atrophy, similar to the Klüver-Bucy syndrome. Haloperidol appears to be effective in treating the behavior, at least in some patients.
我们报告了神经系统疾病中异食癖（吞食自己粪便）的异常行为。对梅奥诊所健康科学计算机化临床数据库进行查询，以获取1995年至2015年期间在我们机构接受评估且病历中有异食癖记录的所有患者。共识别出26例患者，其中17例有异食癖。在这17例患者中，5例因发病年龄小于10岁被排除，剩余12例成年患者纳入本研究。这12例患者异食癖的发病年龄中位数为55岁（范围20 - 88岁），其中一半为女性。其他常见行为包括粪便涂抹、性欲亢进、攻击行为和异食癖（吞食任何物品）。6例患者的异食癖与神经退行性痴呆相关，2例与发育迟缓相关，1例分别与癫痫、类固醇精神病、额叶肿瘤和分裂情感性障碍相关。6例痴呆患者的脑部影像学检查显示中重度颞叶内侧萎缩以及轻度额叶萎缩。对1例患者进行了尸检，显示额颞叶变性病理改变。实施了许多不同的行为和药物治疗，但只有氟哌啶醇与该行为的停止相关。异食癖与不同的神经系统疾病相关，尤其是神经退行性痴呆。这种行为可能与颞叶内侧萎缩有关，类似于克吕弗 - 布西综合征。氟哌啶醇似乎对治疗这种行为有效，至少对一些患者有效。
