Ungureanu Larisa, Irincu Laura, Diaconu Stefania, Oprițoiu Bianca, Chaudhuri K Ray, Falup-Pecurariu Cristian
Department of Neurology, County Clinic Hospital, 500365 Brașov, Romania.
Faculty of Medicine, Transilvania University, 500036 Brașov, Romania.
J Pers Med. 2024 Feb 29;14(3):270. doi: 10.3390/jpm14030270.
Although the reported frequency of diplopia is between 10 to 40% of patients with Parkinson's disease (PD) and other movement disorders, it remains one of the most undiagnosed non-motor symptoms. Furthermore, it has a major impact on the quality of life of these patients. The aim of this study is to systematically review the literature regarding the frequency, causes, and implications of diplopia in movement disorders.
An electronic search was conducted in March and June 2023 using the PubMed database in order to identify appropriate studies. Studies that were written in English, that represented observational, analytical studies, and case reports, and that provided information regarding diplopia in movement disorders were included in the systematic review.
A total of 686 articles were identified out of which 43 met the inclusion criteria. The studies included in the systematic review ranged from descriptive studies (case reports and case series) to analytical-observational studies (cross-sectional studies, prospective and retrospective cohort studies, and case-control studies). In Parkinson's disease, the incidence of diplopia ranged from 10 to 38%. In these patients, diplopia was linked to the presence of visual hallucinations and cognitive decline but also to convergence insufficiency and the presence of motor fluctuations. Cases of diplopia secondary to deep brain stimulation were also reported. Diplopia was associated with longer disease duration and worse motor and non-motor scores. Diplopia was also reported in other movement disorders such as multiple system atrophy (frequency as high as 18%) and progressive supranuclear palsy (frequency as high as 39%) and was associated with increased mortality and shorter duration in life span.
Diplopia occurs in up to 38% of patients with movement disorders and has a negative impact on their health-related quality of life. Treating physicians should actively ask about diplopia and other ophthalmological symptoms, as many patients do not spontaneously report them. The pathophysiology of diplopia is complex, and it involves heterogeneous peripheral and central mechanisms. The management of these patients should involve a multidisciplinary team of health professionals in order to provide appropriate, tailored management.
尽管据报道，帕金森病（PD）和其他运动障碍患者中复视的发生率在10%至40%之间，但它仍然是最未被诊断出的非运动症状之一。此外，它对这些患者的生活质量有重大影响。本研究的目的是系统回顾关于运动障碍中复视的发生率、病因及影响的文献。
于2023年3月和6月使用PubMed数据库进行电子检索，以确定合适的研究。纳入系统评价的研究需为英文撰写，为观察性、分析性研究及病例报告，且提供有关运动障碍中复视的信息。
共识别出686篇文章，其中43篇符合纳入标准。纳入系统评价的研究范围从描述性研究（病例报告和病例系列）到分析性观察研究（横断面研究、前瞻性和回顾性队列研究以及病例对照研究）。在帕金森病中，复视的发生率在10%至38%之间。在这些患者中，复视与视幻觉和认知衰退的存在有关，但也与集合不足和运动波动的存在有关。也有关于深部脑刺激继发复视的病例报告。复视与疾病持续时间较长以及运动和非运动评分较差有关。在其他运动障碍中也有复视的报道，如多系统萎缩（发生率高达18%）和进行性核上性麻痹（发生率高达39%），且与死亡率增加和寿命缩短有关。
高达38%的运动障碍患者会出现复视，这对他们与健康相关的生活质量有负面影响。治疗医生应积极询问复视及其他眼科症状，因为许多患者不会主动报告这些症状。复视的病理生理学很复杂，涉及多种外周和中枢机制。对这些患者的管理应包括多学科的健康专业人员团队，以便提供适当的、量身定制的管理。
