帕金森病“关”状态的研究进展：40 多年来我们学到了什么？

The spectrum of "off" in Parkinson's disease: What have we learned over 40 years?

机构信息

Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.

Department of Neurology, Duke University Medical Center, Durham, NC, USA.

出版信息

Parkinsonism Relat Disord. 2018 Jun;51:9-16. doi: 10.1016/j.parkreldis.2018.02.001. Epub 2018 Feb 2.

DOI:10.1016/j.parkreldis.2018.02.001

PMID:29456046

Abstract

The terms "on" and "off" were used by Marsden and his contemporaries over 40 years ago to describe times when Parkinson's disease patients experienced good motor function ("on") and immobility ("off"). Yet there remains no published consensus definition of "off", leading clinicians and patients to develop individualized impressions of "off" determinations. In this paper, we first discuss the evolution of the terminology and understanding of "off" states since Marsden's time, which now include non-motor as well as motor symptoms. We then review pathophysiology and risk factors for the development of "off" states as well as tools to detect the "off" state, before proposing a practical definition of "off" for consideration. A common, practical definition of the "off" state could improve clinical recognition of "off" symptoms and lead to significant benefit for patients.

摘要

“开”和“关”这两个术语是由 Marsden 及其同时代的人在 40 多年前用来描述帕金森病患者体验到良好运动功能（“开”）和运动不能（“关”）的时候。然而，目前还没有关于“关”的公开共识定义，导致临床医生和患者对“关”的确定产生了个性化的印象。在本文中，我们首先讨论了自 Marsden 时代以来，“关”状态的术语和理解的演变，现在包括非运动和运动症状。然后，我们回顾了“关”状态的发病机制和危险因素以及检测“关”状态的工具，最后提出了一个实用的“关”定义供考虑。一个常见的、实用的“关”状态定义可以提高对“关”症状的临床认识，并为患者带来显著的益处。