帕金森病丘脑底核深部脑刺激术后的功能性运动障碍：三例报告
Functional Dyskinesias following Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A Report of Three Cases.
作者信息
Maciel Ricardo, Zúñiga-Ramírez Carlos, Munhoz Renato P, Zurowski Mateusz, Fasano Alfonso
机构信息
Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre Toronto Western Hospital, UHN Toronto Ontario Canada.
Movement Disorders Unit, Hospital das Clínicas Federal University of Minas Gerais Belo Horizonte Brazil.
出版信息
Mov Disord Clin Pract. 2020 Dec 2;8(1):114-117. doi: 10.1002/mdc3.13111. eCollection 2021 Jan.
BACKGROUND
Functional (psychogenic) dyskinesias in patients with Parkinson's disease (PD) are exceedingly rare.
CASES
Herein we report three patients with PD who presented with functional dyskinesias in the first 3 months after subthalamic nucleus deep brain stimulation (DBS). All patients presented with chorea mimicking levodopa or stimulation-induced dyskinesias in the first 24 hours following stimulation adjustment. Two patients had generalized chorea and one, hemichorea. In all patients the abnormal movements could be induced or resolved with placebo/nocebo changes to the stimulation parameters. Following the diagnosis of a functional movement disorder (FMD), all patients improved with appropriate management.
CONCLUSIONS
Functional chorea following DBS might mimic organic dyskinesias in PD but can be accurately diagnosed using suggestibility and placebo responses to sham stimulation adjustments. Recognizing the presence of FMD following DBS is important for proper management of these patients.
背景
帕金森病（PD）患者中功能性（心理性）运动障碍极为罕见。
病例
在此，我们报告3例PD患者，他们在丘脑底核深部脑刺激（DBS）后的前3个月出现功能性运动障碍。所有患者在刺激参数调整后的最初24小时内均出现类似左旋多巴或刺激诱发的舞蹈症。2例患者出现全身性舞蹈症，1例出现偏侧舞蹈症。在所有患者中，通过对刺激参数进行安慰剂/反安慰剂改变可诱发或缓解异常运动。在诊断为功能性运动障碍（FMD）后，所有患者经适当治疗均有改善。
结论
DBS后的功能性舞蹈症可能模仿PD中的器质性运动障碍，但可通过对假刺激调整的暗示性和安慰剂反应进行准确诊断。认识到DBS后FMD的存在对于这些患者的正确管理很重要。
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