Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom.
Mov Disord. 2021 Mar;36(3):581-593. doi: 10.1002/mds.28415. Epub 2020 Dec 17.
Patients with movement disorders experience fluctuations unrelated to disease progression or treatment. Extrinsic factors that contribute to the variable expression of movement disorders are environment related. They influence the expression of movement disorders through sensory-motor interactions and include somatosensory, visual, and auditory stimuli. Examples of somatosensory effects are stimulus sensitivity of myoclonus on touch and sensory amelioration in dystonia but also some less-appreciated effects on parkinsonian tremor and gait. Changes in visual input may affect practically all types of movement disorders, either by loss of its compensatory role or by disease-related alterations in the pathways subserving visuomotor integration. The interaction between auditory input and motor function is reflected in simple protective reflexes and in complex behaviors such as singing or dancing. Various expressions range from the effect of music on parkinsonian bradykinesia to tics. Changes in body position affect muscle tone and may result in marked fluctuations of rigidity or may affect dystonic manifestations. Factors intrinsic to the patient are related to their voluntary activity and cognitive, motivational, and emotional states. Depending on the situation or disease, they may improve or worsen movement disorders. We discuss various factors that can influence the phenotypic variability of movement disorders, highlighting the potential mechanisms underlying these manifestations. We also describe how motor fluctuations can be provoked during the clinical assessment to help reach the diagnosis and appreciated to understand complaints that seem discrepant with objective findings. We summarize advice and interventions based on the variability of movement disorders that may improve patients' functioning in everyday life. © 2020 International Parkinson and Movement Disorder Society.
患有运动障碍的患者会经历与疾病进展或治疗无关的波动。导致运动障碍表现不同的外在因素与环境有关。它们通过感觉运动相互作用影响运动障碍的表达，包括躯体感觉、视觉和听觉刺激。躯体感觉效应的例子是触觉引起肌阵挛的刺激敏感性和肌张力障碍的感觉改善，但也有一些对帕金森震颤和步态的影响较小的效应。视觉输入的变化可能会影响几乎所有类型的运动障碍，要么是因为它失去了代偿作用，要么是因为疾病改变了参与视动整合的通路。听觉输入与运动功能的相互作用反映在简单的保护反射和复杂的行为中，如唱歌或跳舞。各种表现形式的范围从音乐对帕金森病运动迟缓的影响到抽动。体位变化会影响肌张力，可能导致僵硬明显波动，或影响肌张力障碍的表现。患者内在的因素与他们的主动活动以及认知、动机和情绪状态有关。根据情况或疾病的不同，它们可能会改善或恶化运动障碍。我们讨论了可能影响运动障碍表型变异性的各种因素，强调了这些表现背后的潜在机制。我们还描述了如何在临床评估过程中引发运动波动，以帮助做出诊断，并理解那些与客观发现不一致的抱怨。我们根据运动障碍的变异性总结了一些建议和干预措施，这些措施可能会改善患者日常生活中的功能。© 2020 国际帕金森病和运动障碍学会。
