2016/11/17 帕金森疾病之診斷及用藥

Diagnosis and Pharmacological Treatment of Parkinson Disease

Cheng Hsien Lu Professor of Neurology Chang Gung Memorial Hospital-Kaohsiung and Chang Gung University

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Overview of Parkinson’s disease (PD) The Diagnosis of PD Pharmacological treatment of PD

Overview of Parkinson’s disease (PD) 西元1817年，英國醫師詹姆斯.巴金森發表了《關於震顫麻痹的研究》， 雖然震顫麻痹以前也有人提過，但因為以前研究化石時精確分類的習慣， 帕金森認為以前對震顫麻痹的說法太含糊了。他主要描述了靜止性震顫 及其逐漸進展的特點，伴有慌張步態，他稱之為“paralysis agitans”。雖然 只有六個病例，但他的觀察和描寫非常詳細，有的病例是他在街上一瞥 而過的。對其中一個特殊病例他描寫到：“他也是在街上見到的，是一 個約65歲的男性，體格健壯，肢體、頭部及整個身體都抖動得很厲害，都 不能僅僅用震顫來形容。他幾乎不能行走，身體彎的像弓一樣，頭向前 傾，只能連續小跑，每五六步就得用拐杖用力支撐以使身體保持直立。 他說自己以前是一個航海員，他抱怨說現在生病都是因為以前在西班牙 的一個狹小的監獄裏禁閉了幾個月，在那裏他只能躺在潮濕的地上睡 覺”。為了紀念詹姆斯.巴金森的卓越觀察, 就把這種疾病命名為巴金森氏 病

Overview of Parkinson’s disease (PD)

2nd most common neurodegenerative disease.

Affects 1-2% of population over 60 years of age.

Long-term consequences of early loss of critical neurons after developmental damage.

DA, dopaminergic. The impact of early developmental damage is not immediately evident but produces disease years or decades later as the number of neurons decreases with advancing age.

In Human’s brain, the Dopamine/acetylcholine system is balanced. Both neurotransmitter have excitatory and inhibitory actions.

Dopamine is a catecholamine within the metabolic pathways: Tyrosine Dopa Dopamine Noradrenaline Adrenaline Dopamine excess Chorea Dopamine depletion Parkinsonism

Clinical features Resting tremor Rigidity Bradykinesia Postural instability Flexion of upper and low extremity Freezing and motor block

Stages of Parkinson’s Disease Hoehn and Yahr Staging Scale of PD

Stage I

Description Unilateral symptoms of disease

II

Bilateral symptoms of disease

III

All of above, plus postural instability

IV

All of above, plus patient need assistance

V

patient cannot function independently

Current drugs used to treat PD