Anouti A, Koller W C
Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City 66160-7314, USA.
West J Med. 1995 Jun;162(6):510-3.
Tremor is commonly encountered in medical practice, but can be difficult to diagnose and manage. It is an involuntary rhythmic oscillation of a body part produced by reciprocally innervated antagonist muscles. Tremors vary in frequency and amplitude and are influenced by physiologic and psychological factors and drugs. Categorization is based on position, posture, and the movement necessary to elicit the tremor. A resting tremor occurs when the body part is in repose. A postural tremor occurs with maintained posture and kinetic tremor with movement. Various pathologic conditions are associated with tremors. Essential tremor, which is the most common, is postural and kinetic, with a frequency between 4 and 8 Hz, and involves mainly the upper extremities and head. Essential tremor responds to treatment with primidone, beta-blockers, and benzodiazepines. Parkinson's disease causes a 4- to 6-Hz resting tremor in the arms and legs that responds to the use of anticholinergics and a combination of carbidopa and levodopa. Tremor can also be a manifestation of Wilson's disease, lesions of the cerebellum and midbrain, peripheral neuropathy, trauma, alcohol, and conversion disorders. Treatment should be directed to the underlying condition. Stereotactic thalamotomy of thalamic stimulation is a last resort.
震颤在医疗实践中很常见，但可能难以诊断和处理。它是由相互支配的拮抗肌产生的身体部位的不自主节律性振荡。震颤在频率和幅度上有所不同，并受生理、心理因素及药物影响。分类基于位置、姿势以及引发震颤所需的动作。静止性震颤在身体部位静止时出现。姿势性震颤在保持姿势时出现，动作性震颤在运动时出现。多种病理状况与震颤相关。最常见的特发性震颤是姿势性和动作性的，频率在4至8赫兹之间，主要累及上肢和头部。特发性震颤对扑米酮、β受体阻滞剂和苯二氮䓬类药物治疗有反应。帕金森病会导致手臂和腿部出现4至6赫兹的静止性震颤，对抗胆碱能药物以及卡比多巴和左旋多巴的联合使用有反应。震颤也可能是威尔逊病、小脑和中脑病变、周围神经病变、创伤、酒精以及转换障碍的表现。治疗应针对潜在病因。丘脑立体定向切开术或丘脑刺激是最后的手段。
