柏金遜綜合症
| 柏金遜綜合症 Parkinsonism | |
|---|---|
 | |
| 病因 | |
| 分類和外部資源 | |
| 醫學專科 | 神經學 |
| ICD-11 | 8A00 |
| ICD-10 | G21、G22 |
| DiseasesDB | 24212 |
| MedlinePlus | 000759 |
| Orphanet | 68402 |
柏金遜綜合症（Parkinsonism）是和運動機能相關的臨床綜合症，其特徵是顫抖、運動功能減退、僵硬及平衡障礙[1][2]。在柏金遜氏症（PD）患者身上會有類似徵狀（此綜合症因此而得名），而路易氏體腦退化症（DLB）、柏金遜症性腦退化症（PDD）等疾病也會有此徵狀。這類綜合症的病因範圍很廣，包括神經退化障礙疾病、藥物、毒素、代謝疾病，或是柏金遜氏症以外的神經性疾病[3]。
病因
[編輯]藥物引起
[編輯]有柏金遜綜合症的人當中，約有7%是因為藥物的副作用而造成的，主要是因為抗精神病藥，特別是吩噻嗪（例如perphenazine及氯丙嗪）、噻噸（例如三氟噻噸及珠氯噻醇）及丁酰苯（例如氟哌啶醇），偶爾也有因為抗憂鬱藥物而造成。藥物引起柏金遜綜合症的盛行率會隨年齡而上昇。藥物引起的柏金遜綜合症一但出現，多半會維持原有的程度，不像柏金遜氏症會漸漸惡化[4]。
毒素
[編輯]有發現殺蟲劑或除草劑暴露程度和柏金遜氏症之間的關聯性。若暴露在百草枯或錳乃浦/鋅錳乃浦下，風險是原來的兩倍[5]。
已證實慢性錳（Mn）暴露會造成類似柏金遜綜合症的疾病，其特徵是運動障礙，此徵狀無法用典型的柏金遜症治療方式來治療，因此推測除了典型黑質內多巴胺能損失外，包括有其他的致病途徑[6]。錳會在基底核內累積，因此造成運動障礙[7]有一種和SLC30A10基因（錳外流轉運蛋白，減少細胞內錳所必需的蛋白）有關的變異和這種類似柏金遜綜合症疾病有關[8]。在這疾病中看不到柏金遜氏症中典型的路易體[7]。
診斷
[編輯]許多疾病會造成柏金遜綜合症。
- 皮質基底核退化症[9]
- 路易氏體腦退化症[9]
- 額顳腦退化症（匹克氏病）[10]
- 格斯特曼–斯特勞斯勒–申克綜合症[9]
- 亨丁頓舞蹈症[9]
- Lytico-bodig症（ALS complex of Guam）[9]
- 多系統萎縮（Shy–Drager綜合症）[9]
- 神經吞噬作用[9]
- 神經元蠟樣脂褐質儲積症[9]
- 少腦橋小腦萎縮[9]
- 泛酸鹽激活酵素關聯之神經退化性疾病，也稱為具有腦部鐵質積聚的神經變性（neurodegeneration with brain iron accumulation）[9]
- 帕金突變（遺傳性青少年肌張力障礙）[9]
- 柏金遜氏症[9]
- 柏金遜氏症性腦退化症[11]
- 進行性上眼神經核麻痺症[9]
- 肝豆狀核變性[9]
- X連鎖性肌張力障礙柏金遜症（Lubag綜合症）[9]
- 藥物引發（偽柏金遜綜合症）
- 感染
- 毒素
- 番荔枝科[16]
- 一氧化碳[9]
- 二硫化碳[9]
- 氰化物[9]
- 乙醇[9]
- 己烷[17]
- 錳乃浦/鋅錳乃浦[5]
- 錳[9][6]
- 汞[9]
- 甲醇[9]
- MPTP[9][18]
- 百草枯[19][5]
- 魚藤酮[19]
- 甲苯[20]（吸入濫用）[21]
- 創傷
- 血管的
- Binswanger病（皮質下白質腦病）[9]
- 血管性腦退化症（多發梗塞性）[9]
- 其他
- 腦幹受損（特別是黑質的多巴胺能核）[22][23]或是基底核（特別是蒼白球）[24]或丘腦的受損[25]
- 甲狀腺機能低下症[9]
- 站立性顫抖症[26]
- 腫瘤伴隨綜合症：因為癌症產生的抗體引發的神經性徵狀[27]
- 快速發作的肌張力障礙性柏金遜症[28]
- 常染色體隱性遺傳性少年柏金遜症[29]
原發性震顫
[編輯]根據2018年的回顧性研究，還不確定柏金遜綜合症和原發性震顫是否有關[30]。
參考資料
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