Marialuisa Gandolfi , Christian Geroin , Gabriele Imbalzano , Serena Camozzi , Zoe Menaspà , Michele Tinazzi , Carlo Alberto Artusi
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引用次数: 0
摘要
轴性姿势异常(PA)是帕金森病(PD)或不典型帕金森病患者经常出现的、致残率高且药物难治的运动并发症。在过去几年中,帕金森病的诊断、评估和病理生理机制都取得了进展。然而,对这些患者的管理仍然是一项挑战,医护人员通常会忽视这些障碍,从而可能导致其恶化并影响患者的残疾。从基于共识的评估和诊断标准来看,PA 需要基于其复杂性和多因素致病机理进行跨学科管理。在此背景下,我们进行了一项系统性文献综述,根据基于专家的帕金森病轴性 PA 新分类,分析了帕金森病 PA 可用的药物和非药物治疗方案。根据PA的类型和严重程度,不同的多学科方法,包括多巴胺能治疗调整、物理治疗、肉毒毒素注射和脑深部刺激,可改善PA。建议帕金森病患者尽早采用跨学科方法来控制 PA。
Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions
Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson’s disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients’ disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA.