Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Lower Motor Weakness and Complex Regional Pain Syndrome of Lower Limb in the Patient of Frontotemporal Dementia: A Case Report

이마관자엽 치매 환자에서 나타난 하지 근력 저하와 복합부위 통증증후군에 대한 증례 보고

  • Lee, Kwang Min (Department of Rehabilitation Medicine, Wonkwang University School of Medicine) ;
  • Noh, Se Eung (Department of Rehabilitation Medicine, Wonkwang University School of Medicine) ;
  • Joo, Min Cheol (Department of Rehabilitation Medicine, Wonkwang University School of Medicine) ;
  • Hwang, Yong (Department of Emergency Medicine, Wonkwang University School of Medicine) ;
  • Kim, Ji Hee (Department of Rehabilitation Medicine, Wonkwang University School of Medicine)
  • 이광민 (원광대학교 의과대학 재활의학과교실) ;
  • 노세응 (원광대학교 의과대학 재활의학과교실) ;
  • 주민철 (원광대학교 의과대학 재활의학과교실) ;
  • 황용 (원광대학교 의과대학 응급의학과교실) ;
  • 김지희 (원광대학교 의과대학 재활의학과교실)
  • Received : 2017.09.11
  • Accepted : 2017.12.08
  • Published : 2017.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Frontotemporal dementia, the second most common cause of early onset dementia, is a neurodegenerative clinical syndrome characterized by progressive deficits in behavior, executive function and language. Although motor symptoms in frontotemporal dementia are represented by motor neuron disease, parkinsonism and progressive supranuclear palsy syndrome, there have been no reports of motor weakness caused by the direct involvement of central motor nervous systems in frontotemporal dementia. Moreover, no association between clinical dementia groups and complex regional pain syndrome has been reported. We diagnosed a rare case with motor weakness and complex regional pain syndrome of lower limbs due to central nervous system lesion in a patient with frontotemporal dementia by magnetic resonance imaging, electrodiagnostic study and three phase bone scan. Following steroid therapy for complex regional pain syndrome, pain was improved. Functional improvement was noted after rehabilitation therapy, including functional electrical stimulation, muscle strengthening exercise and gait training during hospitalization. This case report suggests that rehabilitation therapy for motor weakness in frontotemporal dementia could be effective for improving overall function.

이마관자엽 치매는 조기 발현형 치매 중 두 번째로 흔한 형태로 행동, 언어, 인지 장애를 보이는 신경퇴행성 질환이다. 이마관자엽 치매에서 운동 기능 이상이 동반되는 경우는 운동 신경원 질환과 파킨슨증, 진행성 핵상 마비 등으로 대표되나, 다른 동반 질환 없이 이마관자엽 치매가 중추신경계의 운동신경영역을 직접 침범하여 나타난 운동 기능 이상은 보고된 바가 없다. 또한, 임상적 치매 집단과 복합부위 통증 증후군 사이의 연관성은 보고된 바가 없다. 저자들은 이마관자엽 치매환자에서 나타난 중추신경계 원인의 하지 근력 저하를 뇌 자기공명영상과 전기진단학적 검사를 통해 진단하였고, 동반된 복합부위 통증증후군을 삼상 골주사 검사를 통해 진단하였으며, 이에 따른 임상적 치료를 시행하였다. 스테로이드를 이용한 복합부위 통증증후군 치료 후에 환자의 통증은 호전되었고, 입원 상태에서 하지 근육에 대한 기능적 전기 자극 치료, 근력 강화 운동 및 보행 훈련을 포함한 포괄적 재활치료를 시행한 후에 저명한 기능적 호전을 보였다. 이마관자엽 치매에서 관찰된 중추신경계 원인의 근력 저하에 대한 재활 치료는 전반적 기능의 향상에 효과적일 것으로 추정된다.

Keywords

References

  1. J. Bang, S. Spina, B. L. Miller, Frontotemporal dementia. Lancet, vol. 386, no. 10004, pp. 1672-1682, 2015. DOI: http://dx.doi.org/10.1016/s0140-6736(15)00461-4
  2. M. J. Barad, T. Ueno, J. Younger, N. Chatterjee, S. Mackey, Complex regional pain syndrome is associated with structural abnormalities in pain-related regions of the human brain, J Pain, vol. 15, no. 2, pp. 197-203, 2014. DOI: http://dx.doi.org/10.1016/j.jpain.2013.10.011
  3. S. Bruehl, Complex regional pain syndrome, Bmj, vol. 351, pp. h2730, 2015. DOI: http://dx.doi.org/10.1136/bmj.h2730
  4. J. R. Burrell, M. C. Kiernan, S. Vucic, J. R. Hodges. Motor neuron dysfunction in frontotemporal dementia. Brain, vol. 134, no. Pt 9, pp. 2582-2594, 2011. DOI: http://dx.doi.org/10.1093/brain/awr195
  5. J. R. Daube, Electrodiagnostic studies in amyotrophic lateral sclerosis and other motor neuron disorders, Muscle Nerve, vol. 23, no. 10, pp. 1488-1502, 2000. DOI: https://doi.org/10.1002/1097-4598(200010)23:10<1488::AID-MUS4>3.0.CO;2-E
  6. F. Di Pietro, J. H. McAuley, L. Parkitny, M. Lotze, B.M. Wand, G. L. Moseley, T.R. Stanton. Primary motor cortex function in complex regional pain syndrome: a systematic review and meta-analysis. J Pain, vol. 14, no. 11, pp. 1270-1288, 2013. DOI: http://dx.doi.org/10.1016/j.jpain.2013.07.004
  7. F. Di Pietro, J. H. McAuley, L. Parkitny, M. Lotze, B.M. Wand, G. L. Moseley, T. R. Stanton. Primary somatosensory cortex function in complex regional pain syndrome: a systematic review and meta-analysis. J Pain, vol. 14, no. 10, pp. 1001-1018, 2013. DOI: http://dx.doi.org/10.1016/j.jpain.2013.04.001
  8. W. Janig, R. Baron, Complex regional pain syndrome is a disease of the central nervous system, Clin Auton Res, vol. 12, no. 3, pp. 150-164, 2002. DOI: https://doi.org/10.1007/s10286-002-0022-1
  9. W. Janig, R. Baron, Complex regional pain syndrome: mystery explained? Lancet Neurol, vol. 2, no. 11, pp. 687-697, 2003. DOI: https://doi.org/10.1016/S1474-4422(03)00557-X
  10. K. A. Josephs, J. E. Parisi, D. S. Knopman, B. F. Boeve, R.C. Petersen, D.W. Dickson, Clinically undetected motor neuron disease in pathologically proven frontotemporal lobar degeneration with motor neuron disease, Arch Neurol, vol. 63, no. 4, pp. 506-512, 2006. DOI: http://dx.doi.org/10.1001/archneur.63.4.506
  11. I. Le Ber, E. Guedj, A. Gabelle, P. Verpillat, M. Volteau, C. Thomas-Anterion, M. Decousus, D. Hannequin, P. Vera, L. Lacomblez, A. Camuzat, M. Didic, M. Puel, J. A. Lotterie, V. Golfier, A. M. Bernard, M. Vercelletto, C. Magne, F. Sellal, I. Namer, B.F. Michel, J. Pasquier, F. Salachas, J. Bochet, A. Brice, M. O. Habert, B. Dubois, Demographic, neurological and behavioural characteristics and brain perfusion SPECT in frontal variant of frontotemporal dementia. Brain, vol. 129, no. Pt 11, pp. 3051-3065, 2006. DOI: http://dx.doi.org/10.1093/brain/awl288
  12. I. Litvan, Y. Agid, D. Calne, G. Campbell, B. Dubois, R. C. Duvoisin, C.G. Goetz, L. I. Golbe, J. Grafman, J.H. Growdon, M. Hallett, J. Jankovic, N. P. Quinn, E. Tolosa, D. S. Zee, Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDSSPSP international workshop, Neurology, vol. 47, no. 1, pp. 1-9, 1996. DOI: https://doi.org/10.1212/WNL.47.1.1
  13. J. Marinus, G. L. Moseley, F. Birklein, R. Baron, C. Maihofner, W.S. Kingery, J. J. van Hilten, Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol, vol. 10, no. 7, pp. 637-648, 2011. DOI: http://dx.doi.org/10.1016/s1474-4422(11)70106-5
  14. H. J. Rosen, M. L. Gorno-Tempini, W. P. Goldman, R. J. Perry, N. Schuff, M. Weiner, R. Feiwell, J. H. Kramer, B. L. Miller, Patterns of brain atrophy in frontotemporal dementia and semantic dementia. Neurology, vol. 58, no. 2, pp. 198-208, 2002. DOI: https://doi.org/10.1212/WNL.58.2.198
  15. R. J. Schwartzman, T. L. McLellan, Reflex sympathetic dystrophy. A review, Arch Neurol, vol. 44, no. 5, pp. 555-561, 1987. DOI: https://doi.org/10.1001/archneur.1987.00520170081028
  16. W.W. Seeley, R. Crawford, K. Rascovsky, J. H. Kramer, M. Weiner, B. L. Miller, M. L. Gorno-Tempini, Frontal paralimbic network atrophy in very mild behavioral variant frontotemporal dementia, Arch Neurol, vol. 65, no. 2, pp. 249-255, 2008. DOI: http://dx.doi.org/10.1001/archneurol.2007.38
  17. R. T. Vieira, L. Caixeta, S. Machado, A. C. Silva, A. E. Nardi, O. Arias-Carrion, M. G. Carta, Epidemiology of early-onset dementia: a review of the literature, Clin Pract Epidemiol Ment Health, vol. 9, pp. 88-95, 2013. DOI: http://dx.doi.org/10.2174/1745017901309010088