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震颤治疗的技巧和窍门。

Tips and tricks in tremor treatment.

机构信息

Department of Neurology, Neurologische Klinik und Poliklinik mit Friedrich Baur Institut, Ludwig-Maximilians University, Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany.

Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

J Neural Transm (Vienna). 2024 Oct;131(10):1229-1246. doi: 10.1007/s00702-024-02806-x. Epub 2024 Jul 24.

Abstract

Tremor, whether arising from neurological diseases, other conditions, or medication side effects, significantly impacts patients' lives. Treatment complexities necessitate clear algorithms and strategies. Levodopa remains pivotal for Parkinson's tremor, though response variability exists. Some dopamine agonists offer notable tremor reduction targeting D2 receptors. Propranolol effectively manages essential tremor and essential tremor plus (ET/ET +), sometimes with primidone for added benefits, albeit dose-dependent side effects. As reserve medications anticholinergics and clozapine are used for treatment of parkinsonian tremor, 1-Octanol and certain anticonvulsant drugs for tremor of other orign, especially ET. Therapies such as invasive deep brain stimulation and lesional focused ultrasound serve for resistant cases. A medication review is crucial for all forms of tremor, but it is particularly important if medication may have triggered the tremor. Sensor-based detection and non-drug interventions like wristbands and physical therapy broaden diagnostic and therapeutic horizons, promising future tremor care enhancements. Understanding treatment nuances is a key for tailored tremor management respecting patient needs and tolerability. Successful strategies integrate pharmacological, non-invasive, and technological modalities, aiming for optimal symptom control and improved quality of life.

摘要

震颤无论是由神经疾病、其他疾病还是药物副作用引起,都会对患者的生活产生重大影响。治疗的复杂性需要明确的算法和策略。左旋多巴仍然是帕金森病震颤的关键治疗药物,但存在反应变异性。一些多巴胺激动剂针对 D2 受体,可显著减轻震颤。普萘洛尔可有效治疗特发性震颤和特发性震颤伴发(ET/ET+),有时加用丙戊酸可获得额外益处,但存在剂量依赖性副作用。作为储备药物,抗胆碱能药物和氯氮平用于治疗帕金森震颤,1-辛醇和某些抗惊厥药物用于治疗其他来源的震颤,特别是 ET。对于耐药病例,可采用侵入性脑深部刺激和病灶聚焦超声等治疗方法。对于所有形式的震颤,药物审查都很重要,但如果药物可能引发震颤,审查就尤为重要。基于传感器的检测和非药物干预,如腕带和物理疗法,拓宽了诊断和治疗范围,有望为未来的震颤治疗提供更好的效果。了解治疗细节是制定个体化震颤管理方案的关键,需要尊重患者的需求和耐受性。成功的策略整合了药物治疗、非侵入性和技术手段,旨在实现最佳症状控制和提高生活质量。

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