[颤抖的手和更多:何时怀疑帕金森病]。

IF 0.7
Deutsche medizinische Wochenschrift (1946) Pub Date : 2025-09-01 Epub Date: 2025-08-29 DOI:10.1055/a-2514-0260
Kenan Steidel, David Pedrosa
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引用次数: 0

摘要

震颤是临床神经病学中最常见的运动障碍,严重影响患者的生活质量。在初级保健中,特别是在老年人中,区分震颤类型对于早期诊断和适当管理至关重要,特别是当怀疑患有帕金森病时。这篇综述提供了震颤分类和诊断策略的简要概述,重点是区分帕金森震颤与其他常见震颤综合征,如原发性震颤、肌张力障碍、功能性震颤、直立性震颤和继发性震颤。主要的临床特征,包括震颤类型(静止型、体位型、动态性、再发型)、频率、分布和相关的神经学症状,都被详细讨论。帕金森震颤的特征是一种不对称的静止性震颤,具有“药丸滚动”性质,并且在体位后可能再次出现,这是一个重要的诊断线索,特别是当伴有运动迟缓和非运动性前驱症状,如快速眼动睡眠行为障碍、便秘或低体温时。本文概述了一种实用的诊断途径,包括临床检查,结构化记忆,药物回顾,以及在必要时使用神经成像或DAT-SPECT。还讨论了治疗选择,从多巴胺能药物到高级干预措施,如深部脑刺激或聚焦超声治疗难治性震颤。该综述旨在支持非专家临床医生做出准确的早期诊断和开始治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Trembling hands and more: when to suspect Parkinson's disease].

Tremor is the most common movement disorder in clinical neurology and it significantly impacts patients' quality of life. In primary care, particularly among older adults, differentiating between tremor types is essential for early diagnosis and appropriate management, especially when Parkinson's disease is suspected. This review provides a concise overview of tremor classification and diagnostic strategies, with a focus on distinguishing Parkinsonian tremor from other common tremor syndromes such as essential, dystonic, functional, orthostatic, and secondary tremors.Key clinical characteristics, including tremor type (rest, postural, kinetic, re-emergent), frequency, distribution, and associated neurological signs, are discussed in detail. The hallmark of Parkinsonian tremor, an asymmetric resting tremor with a "pill-rolling" quality and possible re-emergence after postural, is highlighted as a critical diagnostic clue, particularly when accompanied by bradykinesia and non-motor prodromal symptoms such as REM sleep behaviour disorder, constipation, or hyposmia.The article outlines a pragmatic diagnostic pathway, including clinical examination, structured anamnesis, medication review, and the use of neuro-imaging or DAT-SPECT when indicated. Therapeutic options are also discussed, ranging from dopaminergic medication to advanced interventions like deep brain stimulation or focused ultrasound for refractory tremor. The review aims to support non-expert clinicians in making accurate early diagnoses and initiating therapy.

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