Brown Fraser S, Rowe James B, Passamonti Luca, Rittman Timothy
Department of Clinical Neurosciences Cambridge University Hospitals Cambridge United Kingdom.
Department of Clinical Neurosciences University of Cambridge Cambridge United Kingdom.
Mov Disord Clin Pract. 2019 Dec 19;7(1):16-24. doi: 10.1002/mdc3.12879. eCollection 2020 Jan.
Despite falls being an almost universal clinical feature and central to the presentation and diagnostic criteria of progressive supranuclear palsy, our understanding of falls is surprisingly limited and there are few effective treatment options.
To provide an overview of the topic of the impact, assessment, mechanism, and management of falls in progressive supranuclear palsy.
We performed a literature search for "falls" and "progressive supranuclear palsy" and included additional relevant literature known to us. We synthesized this literature with experience from clinical practice.
We review current understanding of the pathophysiology of falls, highlighting the roles of the indirect pathway and the pedunculopontine nucleus. We go on to identify shortcomings in commonly used assessments to measure falls. We discuss medical and nonmedical fall prevention strategies, and finally we discuss balancing falls risk against promoting independence.
Falls are central to progressive supranuclear palsy presentation and diagnosis. Indirect locomotor and pedunculopontine nucleus dysfunction are thought to be the neural substrate of falls in this condition. Attempts to measure and prevent falls, by medical and nonmedical means, are currently limited. A personalized approach is advocated in the management of falls.
尽管跌倒几乎是进行性核上性麻痹普遍存在的临床特征，也是其临床表现和诊断标准的核心，但我们对跌倒的了解却出奇地有限，且有效的治疗选择很少。
概述进行性核上性麻痹中跌倒的影响、评估、机制及管理这一主题。
我们对“跌倒”和“进行性核上性麻痹”进行了文献检索，并纳入了我们已知的其他相关文献。我们将这些文献与临床实践经验相结合。
我们回顾了目前对跌倒病理生理学的认识，强调了间接通路和脚桥核的作用。我们接着指出了常用跌倒评估方法的不足之处。我们讨论了预防跌倒的医学和非医学策略，最后讨论了如何在降低跌倒风险与促进独立性之间取得平衡。
跌倒在进行性核上性麻痹的表现和诊断中至关重要。间接运动功能和脚桥核功能障碍被认为是这种情况下跌倒的神经基础。目前，通过医学和非医学手段测量和预防跌倒的尝试有限。在跌倒管理中提倡采用个性化方法。
