Coon Elizabeth A, Low Phillip A
Department of Neurology, Mayo Clinic, Rochester, MN, United States.
Department of Neurology, Mayo Clinic, Rochester, MN, United States.
Handb Clin Neurol. 2018;157:715-725. doi: 10.1016/B978-0-444-64074-1.00043-4.
Autonomic dysfunction in Parkinson disease encompasses thermoregulatory symptoms and was first noted by Gowers in the late 19th century when he described abnormal temperature sensation and sweating in Parkinson disease patients. These thermoregulatory symptoms became more recognized in the postlevodopa era when Parkinson disease patients were more readily tested with objective autonomic function tests. Objective thermoregulatory testing in Parkinson disease reveals deficits of sweating and vasomotor tone which often correlate with the severity of other autonomic deficits. Tests of thermoregulatory function can also be used to differentiate Parkinson disease from other neurodegenerative disorders. The pathophysiology of thermoregulatory dysfunction in Parkinson disease encompasses both central and peripheral mechanisms; involvement of the brainstem and hypothalamus with alpha-synuclein pathology is well recognized with increasing evidence of peripheral neuropathy in Parkinson disease that influences thermoregulation. Medications used to treat Parkinson disease also affect thermoregulatory symptoms. Disorders of thermoregulation significantly affect the quality of life for patients and their caregivers and can be severe and even life threatening, such as in the parkinsonism-hyperpyrexia syndrome.
帕金森病中的自主神经功能障碍包括体温调节症状，最早由高尔在19世纪末发现，当时他描述了帕金森病患者的异常温度感觉和出汗情况。在左旋多巴时代，当帕金森病患者更容易接受客观自主神经功能测试时，这些体温调节症状得到了更多的认识。帕金森病的客观体温调节测试显示出汗和血管舒缩张力缺陷，这通常与其他自主神经缺陷的严重程度相关。体温调节功能测试也可用于区分帕金森病与其他神经退行性疾病。帕金森病中体温调节功能障碍的病理生理学包括中枢和外周机制；脑干和下丘脑与α-突触核蛋白病理的关联已得到充分认识，同时越来越多的证据表明帕金森病中的周围神经病变会影响体温调节。用于治疗帕金森病的药物也会影响体温调节症状。体温调节障碍显著影响患者及其照顾者的生活质量，可能很严重甚至危及生命，如在帕金森综合征-高热综合征中。
