特发性震颤。

Q1 Medicine
Ludy C Shih
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引用次数: 0

摘要

目的:震颤是一种常见的表现,与广泛的潜在病因有关。本文综述了震颤的临床评价、特发性震颤的诊断、鉴别诊断和治疗方案。最新进展:虽然新的研究药物正在研究中,但除了心得安之外,还没有其他药物被美国食品和药物管理局(FDA)批准用于治疗原发性震颤。自1997年以来,丘脑深部脑刺激(DBS)已被批准使用,目前正在研究刺激目标的改进。聚焦超声丘脑切开术于2016年获得FDA批准,一些获得FDA批准的设备可以对正中神经和桡神经进行无创的传入模式刺激,以治疗原发性震颤。最后,注射肉毒杆菌毒素已经显示出治疗头部和声音震颤的潜在有效性,并且目前正在改进治疗上肢震颤的方法。要点:震颤是一种常见的神经系统症状,应与其他表面上类似震颤的运动障碍区分开来。此外,特发性震颤是一种由双侧上肢活动性震颤组成的原发性震颤障碍,常被误诊。仔细的病史和临床检查其他神经系统的发现,如运动迟缓、肌张力障碍或周围神经病变的证据,可以揭示潜在的其他震颤病因。在新发震颤患者中,应始终考虑药物性震颤和代谢紊乱。口服药物治疗,包括心得安和primidone,是主要的治疗方法,而DBS和聚焦超声丘脑切开术可以缓解致残,药物难治性震颤。新型口服药物,无创刺激震颤,注射肉毒杆菌毒素治疗手和头震颤需要进一步研究,但可能是未来潜在的治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Essential Tremor.

Objective: Tremor is a common presenting concern and is associated with a wide range of potential etiologies. This article reviews the approach to the clinical evaluation of tremor, the diagnosis of essential tremor, differential diagnoses, and management options.

Latest developments: Although new investigational drugs are being studied, no medication besides propranolol has been approved by the US Food and Drug Administration (FDA) as a treatment for essential tremor. Thalamic deep brain stimulation (DBS) has been approved for use since 1997, and refinement of the stimulation target is currently being investigated. Focused ultrasound thalamotomy was approved by the FDA in 2016, and some devices with FDA approval can administer noninvasive transcutaneous afferent patterned stimulation of the median and radial nerves to treat essential tremor. Finally, botulinum toxin injections have shown potential effectiveness for treating head and voice tremors, and methods are currently being refined for potential application in the treatment of upper limb tremors.

Essential points: Tremor is a common neurologic symptom and should be distinguished from other movement disorders that may superficially resemble tremor. In addition, essential tremor, a primary tremor disorder consisting of bilateral upper limb action tremor, is commonly misdiagnosed. A careful history and clinical examination for other neurologic findings, such as bradykinesia, dystonia, or evidence of peripheral neuropathy, can reveal potential alternative etiologies of tremor. Drug-induced tremor and metabolic disturbances should always be considered in patients with recent-onset tremor. Oral pharmacotherapies, including propranolol and primidone, are mainstays of treatment, whereas DBS and focused ultrasound thalamotomy can be offered to alleviate disabling, medication-refractory tremor. Novel oral pharmacologic agents, noninvasive stimulation for tremor, and botulinum toxin injections for hand and head tremor need further study but may serve as potential future treatment options.

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来源期刊
CiteScore
5.80
自引率
0.00%
发文量
175
期刊介绍: Continue your professional development on your own schedule with Continuum: Lifelong Learning in Neurology®, the American Academy of Neurology" self-study continuing medical education publication. Six times a year you"ll learn from neurology"s experts in a convenient format for home or office. Each issue includes diagnostic and treatment outlines, clinical case studies, a topic-relevant ethics case, detailed patient management problem, and a multiple-choice self-assessment examination.
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