Marsala Sandro Zambito, Pistacchi Michele, Gioulis Manuela, Ferracci Franco, Capus Livio
Department of Neurology, Ospedale San Martino, Neurology Service, San Martino Hospital, Belluno, Italy.
Neurology Service, Santorso Hospital, Santorso, Italy.
Ann Indian Acad Neurol. 2017 Apr-Jun;20(2):138-141. doi: 10.4103/aian.AIAN_497_16.
Some patients present an unusual association of both action tremor (AT) and rest tremor (RT) making the differential diagnosis between essential tremor (ET) and Parkinson's disease (PD) difficult.
To investigate this particular clinical picture trying to focus on possible peculiar clinical inferences.
Twenty-three patients with atypical tremor syndrome were selected for the study. They underwent neurological examination, neuroimaging study, and brain DaTSCAN single-photon emission computed tomography.
Twenty-three patients were evaluated; 17 presented mixed-tremor syndrome, while six patients showed only isolated AT or RT. DaTSCAN was pathological in 19 patients and normal in 3 patients. The emerging statistical data highlighted a positive correlation between disease duration and DaTSCAN abnormalities; Fisher's exact test showed a marked difference in evolution toward a dysfunction of dopaminergic pathways in patients with both AT and RT phenotype.
The possible correlation between PD and ET has often been discussed without any clear findings. Are these patients suffering from ET prone to develop PD? Or are they the expression of a specific clinical phenotype? Our clinical survey has not led to absolute considerations; however, it seeks to highlight the clinical markers that might arouse the suspicion of extrapyramidal disease in patients with atypical tremor syndrome.
一些患者同时出现动作性震颤（AT）和静止性震颤（RT），这使得特发性震颤（ET）和帕金森病（PD）的鉴别诊断变得困难。
研究这种特殊的临床情况，试图关注可能的特殊临床推断。
选择23例非典型震颤综合征患者进行研究。他们接受了神经学检查、神经影像学研究和脑DaTSCAN单光子发射计算机断层扫描。
对23例患者进行了评估；17例表现为混合性震颤综合征，而6例患者仅表现为孤立的AT或RT。19例患者的DaTSCAN检查结果异常，3例正常。新出现的统计数据突出显示了病程与DaTSCAN异常之间的正相关；Fisher精确检验显示，具有AT和RT表型的患者在多巴胺能通路功能障碍的演变方面存在显著差异。
PD与ET之间可能的相关性经常被讨论，但尚无明确结果。这些患有ET的患者是否容易发展为PD？或者它们是一种特定临床表型的表现？我们的临床调查并未得出绝对结论；然而，它旨在突出可能引起对非典型震颤综合征患者锥体外系疾病怀疑的临床标志物。
