López-Sendón Moreno Jose L, Alonso-Cánovas Araceli, Buisán Catevilla Javier, García Barragán Nuria, Corral Corral Iñigo, de Felipe Mimbrera Alicia, Matute Lozano María Consuelo, Masjuan Vallejo Jaime, Martínez-Castrillo Juan Carlos
Movement Disorders Center Department of Neurology Hospital Universitario Ramón y Cajal Madrid Spain.
Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Madrid Spain.
Mov Disord Clin Pract. 2015 Dec 18;3(3):268-274. doi: 10.1002/mdc3.12281. eCollection 2016 May-Jun.
Response to drug withdrawal in patients with suspected drug-induced parkinsonism (DIP) is of prognostic and therapeutic importance, but cannot be predicted solely on clinical information. The aim of this study was to validate SN hyperechogenicity (SN+) assessed by transcranial sonography as a predictor of response to drug withdrawal in this group of patients.
Patients were diagnosed according to previously published criteria and prospectively included in the study. All patients were followed until complete recovery of parkinsonian symptoms or at least for 6 months after discontinuation of the offending drug and then diagnosed as DIP or parkinsonism following neuroleptic exposure (PFNE). Transcranial sonography (TCS) findings were compared with the clinical diagnosis.
Sixty patients comprised the group for the final analysis. Sixteen patients were classified as PFNE and 44 as DIP. The area of SN echogenicity was significantly increased in the PFNE group (0.23 cm; standard deviation [SD]: 0.04), compared to the DIP group (0.14 cm; SD, 0.05; one-way analysis of variance; < 0.001). Normal SN was significantly associated with complete recovery after withdrawal of the parkinsonism-inducing drug ( < 0.0005). Accuracy of SN+ to distinguish PFNE from DIP was: sensitivity 81.2%; specificity 84.1%; positive predictive value 47.4%; and negative predictive value 96.2%.
We believe that SN+ assessed with TCS is a valid prognostic marker in the setting of suspected DIP. It is a nonexpensive, feasible technique that can be implemented for proper counseling and guidance of treatment decisions.
疑似药物性帕金森综合征（DIP）患者对撤药的反应具有预后和治疗意义，但仅根据临床信息无法预测。本研究的目的是验证经颅超声评估的黑质高回声（SN+）作为该组患者撤药反应预测指标的有效性。
根据先前发表的标准对患者进行诊断，并前瞻性纳入研究。所有患者均随访至帕金森症状完全恢复或在停用致病药物后至少随访6个月，然后诊断为DIP或抗精神病药物暴露后帕金森综合征（PFNE）。将经颅超声（TCS）检查结果与临床诊断进行比较。
最终分析纳入60例患者。16例患者被分类为PFNE，44例为DIP。与DIP组（0.14 cm；标准差[SD]：0.05）相比，PFNE组黑质回声面积显著增加（0.23 cm；SD：0.04；单因素方差分析；P<0.001）。正常黑质与停用致帕金森药物后完全恢复显著相关（P<0.0005）。SN+区分PFNE与DIP的准确性为：敏感性81.2%；特异性84.1%；阳性预测值47.4%；阴性预测值96.2%。
我们认为，经颅超声评估的SN+在疑似DIP情况下是一个有效的预后指标。它是一种廉价、可行的技术，可用于适当的咨询和治疗决策指导。
