• 제목/요약/키워드: atypical Parkinsonism

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Metabolic Topography of Parkinsonism

  • 김재승
    • Nuclear Medicine and Molecular Imaging
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    • 제41권2호
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    • pp.141-151
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    • 2007
  • 파킨슨병은 노년층에 가장 흔한 퇴행성 뇌질환 중의 하나로 진행성핵상마비, 다중계 위축, 루이체 치매 등과 같은 비전형 파킨슨병과 임상적으로 감별이 어려울 수 있다. 파킨슨병과 비전형 파킨슨병의 감별은 치료방침 결정과 예후평가뿐만 아니라 파킨슨병의 원인과 병태생리를 연구하고 새로운 치료법 개발에 있어서도 매우 중요하다. 파킨슨병과 비전형 파킨슨병과 같이 파킨슨 증후군을 유발하는 질환은 선조체내 도파민 신경의 퇴행성 변화를 흔히 동반하지만 병태생리학적으로 서로 다른 뇌피질 및 피질하 구조물에서의 신경세포 소실을 동반하고 있다. 따라서 국소 시냅스 활성도와 신경 및 시냅스의 손상, 그리고 원발병변과 기능적으로 연결된 원격부위의 기능이상 등을 대변하는 뇌포도당 대사를 F-18FDG PET으로 평가하는 것은 파킨슨 병의 감별진단과 병태생리를 평가하는데 유용하다.

Risperidone으로 유발된 것으로 의심된 약물유발성 이상운동증에 대한 의심약물 중단 및 억간산가진피반하와 GB34(陽陵泉) 전침치료를 통한 외래기반 관리 : 증례보고 (Drug-Induced Dyskinesia Outpatient Suspected to be Induced by Risperidone Management with Yigan-san with Citri Pericarpium and Pinelliae Rhizoma (modified Yigan-san, Yokukan-san Kachimpihang), Electro-Acupuncture at GB34 (陽陵泉), and Stopping Suspected Medication: A Case Report)

  • 노민영;장승원;김현호;한양희;임정태
    • 대한한방내과학회지
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    • 제40권6호
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    • pp.1303-1310
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    • 2019
  • Objectives: Drug-induced Parkinsonism has similar symptoms to Parkinson's disease, but each has different causes. Drug-induced Parkinsonism accounts for the largest proportion of secondary Parkinsonism We report a outpatient case of drug-induced Parkinsonism after taking Risperidone, an atypical antipsychotic. Method: With discontinuing of antipsychotic drug, modified Yigan-san extract was administered for 12 weeks, and acupuncture and electroacupuncture procedures were performed 20 times. Results: Abnormal Involuntary Movement Scale (AIMS) score decreased from 23 to 3 during 59 days of treatment period without adverse events and worsening of depression. The Patient was highly satisfied. Conclusion: Modified Yigan-san and electroacupuncture (GB34) can be used as an treatment option in patients with drug-induced Parkinsonism.

파킨슨 증후군 환자의 자세 불안정과 보행장애에 대한 한의치료의 효과: 후향적 연구 (Effects of Korean Medicine on Postural Instability and Gait Difficulty in Patient with Parkinsonism: Retrospective Study)

  • 양승보;김연진;이형민;이상화;조승연;박정미;고창남;박성욱
    • 대한한의학회지
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    • 제38권3호
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    • pp.96-102
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    • 2017
  • Objectives: The purpose of this study was to investigate the effects of Korean Medicine on postural instability and gait difficulty(PIGD) in patient with parkinsonism. Methods: We reviewed the charts of patients with parkinsonism who were admitted to the department of Korean internal medicine, stroke and neurological disorders center, Kyung Hee University Hospital at Gangdong from October 2009 to May 2017. We analyzed the data of UPDRS (Unified Parkinson's disease rating scale) and calculated PIGD related UPDRS before and after the admission. Results: The average of PIGD score for the 23 patients of Parkinsonism significantly decreased from $8.35{\pm}5.13$ to $4.52{\pm}3.68$ after treatment. The average of PIGD score for the 16 patients of idiopathic parkinson's disease and 7 patients of atypical Parkinsonism decreased from $9.13{\pm}4.46$ to $4.63{\pm}4.15$ and from $6.57{\pm}6.45$ to $4.29{\pm}2.56$ after treatment, respectively. Conclusions: These results provide that Korean Medicine has an effect on the motor function of patients who suffer from Parkinsonism with Postural Instability and Gait Difficulty. Furthermore it could be effective for improving activities of daily life.

우울증으로 내원한 진행성 핵상 마비 환자 1례 (A Case of a Depressed Patient With Progressive Supranuclear Palsy)

  • 한서윤 ;장진구 ;이수영
    • 대한불안의학회지
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    • 제19권2호
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    • pp.56-60
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    • 2023
  • Progressive supranuclear palsy (PSP) is rare atypical Parkinsonism accompanied by various psycho-behavioural problems. In this case report, we describe the diagnostic and treatment progress of a 65-year-old PSP patient who visited the psychiatric clinic with a depressed mood and lumbar pain resulting in a suicide attempt. Over the course of 30 months of treatment, typical characteristics of PSP, such as postural instability, dyskinesia, cognitive dysfunction and supranuclear gaze palsy, became prominent, and magnetic resonance imaging and the F-18 FP-CIT positron emission tomography revealed midbrain atrophy and reduced dopamine uptake in the basal ganglia. When treating elderly patients with depression, parkinsonism symptoms such as gait disturbances, frequent falls, tremors, and rigidity should be closely examined.

3차원 보행분석기를 통해 보행장애의 호전이 확인된 비정형 파킨슨증후군 환자 한방치험 1례 (A Case Report of Korean Medical Treatment on Atypical Parkinsonism Patient Complaining of Gait Disturbance Using 3-Demensional Gait Analysis System)

  • 허혜민;이경화;허경화;황예채;조승연;박정미;고창남;박성욱
    • 대한중풍순환신경학회지
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    • 제24권1호
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    • pp.13-24
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    • 2023
  • ■Objectives This case study is to report the effects of Korean medicine on parkinsonism patient's Gait Disturbance. ■Methods During 12 days of hospitalization, the patient was treated by acupuncture, pharmaco-acupuncture, moxibustion, herbal medicine, especially Cheongsimyeonjatang-gamibang. In order to assess the change of symptoms, we used a 3-Dimensional(3D) gait analysis system, Unified Parkinson's Disease Rating Scale(UPDRS), analysis of gait video and self-evaluation of discomfort. ■Results After treatment, The improvements of walking pattern were observed in both objective analysis results of gait analysis system and subjective video analysis. And the UPDRS score decreased, especially Part III score decreased more than minimal clinically important difference(MCID). In addition, There was improvement in self assessment of the patient. ■Conclusion This study suggests that Korean medical treatment might be effective in motor disorder of parkinsonism patient.

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Salivary Gland Uptake on 18F-FP-CIT PET as a New Biomarker in Patients With Parkinsonism

  • Seo Young Kang;Ji Young Yun;Yeon-Koo Kang;Byung Seok Moon;Hai-Jeon Yoon;Min Young Yoo;Bom Sahn Kim
    • Korean Journal of Radiology
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    • 제24권7호
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    • pp.690-697
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    • 2023
  • Objective: 18F-FP-CIT positron emission tomography (PET) is known for its high sensitivity and specificity for evaluating striatal dopamine transporter (DAT) binding. Recently, for the early diagnose of Parkinson's disease, many researchers focused on the diagnosis of synucleinopathy in organs involved in non-motor symptoms of Parkinson's disease. We investigated the feasibility of salivary gland uptake on 18F-FP-CIT PET as a new biomarker in patients with parkinsonism. Materials and Methods: A total of 219 participants with confirmed or presumed parkinsonism, including 54 clinically diagnosed idiopathic Parkinson's disease (IPD), 59 suspected and yet undiagnosed, and 106 with secondary parkinsonism, were enrolled. The standardized uptake value ratio (SUVR) of the salivary glands was measured on both early and delayed 18F-FP-CIT PET scans using the cerebellum as the reference region. Additionally, the delayed-to-early ratio (DE_ratio) of salivary gland was obtained. The results were compared between patients with different PET patterns. Results: The SUVR in early 18F-FP-CIT PET scan was significantly higher in patients with IPD pattern compared that in the non-dopaminergic degradation group (0.5 ± 0.19 vs. 0.6 ± 0.21, P < 0.001). Compared with the non-dopaminergic degradation group, the DE_ratio was significantly lower in patients with IPD (5.05 ± 1.7 vs. 4.0 ± 1.31, P < 0.001) or atypical parkinsonism patterns (5.05 ± 1.7 vs. 3.76 ± 0.96, P < 0.05). The DE_ratio was moderately and positively correlated with striatal DAT availability in both the whole striatum (r = 0.37, P < 0.001) and posterior putamen (r = 0.36, P < 0.001). Conclusion: Parkinsonism patients with an IPD pattern exhibited a significant increase in uptake on early 18F-FP-CIT PET and a decrease in the DE_ratio in the salivary gland. Our findings suggest that salivary gland uptake of dual-phase 18F-FP-CIT PET can provide diagnostic information on DAT availability in patients with Parkinson's disease.

Antipsychotics for patients with pain

  • Shin, Sang Wook;Lee, Jin Seong;Abdi, Salahadin;Lee, Su Jung;Kim, Kyung Hoon
    • The Korean Journal of Pain
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    • 제32권1호
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    • pp.3-11
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    • 2019
  • Going back to basics prior to mentioning the use of antipsychotics in patients with pain, the International Association for the Study of Pain (IASP) definition of pain can be summarized as an unpleasant experience, composed of sensory experience caused by actual tissue damage and/or emotional experience caused by potential tissue damage. Less used than antidepressants, antipsychotics have also been used for treating this unpleasant experience as adjuvant analgesics without sufficient evidence from research. Because recently developed atypical antipsychotics reduce the adverse reactions of extrapyramidal symptoms, such as acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia caused by typical antipsychotics, they are expected to be used more frequently in various painful conditions, while increasing the risk of metabolic syndromes (weight gain, diabetes, and dyslipidemia). Various antipsychotics have different neurotransmitter receptor affinities for dopamine (D), 5-hydroxytryptamine (5-HT), adrenergic (${\alpha}$), histamine (H), and muscarinic (M) receptors. Atypical antipsychotics antagonize transient, weak $D_2$ receptor bindings with strong binding to the $5-HT_{2A}$ receptor, while typical antipsychotics block long-lasting, tight $D_2$ receptor binding. On the contrary, antidepressants in the field of pain management also block the reuptake of similar receptors, mainly on the 5-HT and, next, on the norepinephrine, but rarely on the D receptors. Antipsychotics have been used for treating positive symptoms, such as delusion, hallucination, disorganized thought and behavior, perception disturbance, and inappropriate emotion, rather than the negative, cognitive, and affective symptoms of psychosis. Therefore, an antipsychotic may be prescribed in pain patients with positive symptoms of psychosis during or after controlling all sensory components.

파킨슨병의 자기공명영상 소견: 흑질선조체 변성의 영상학적 평가 (MRI Findings in Parkinson's Disease: Radiologic Assessment of Nigrostriatal Degeneration)

  • 배윤정;김종민;최병세;송요성;남윤호;조세진;김재형;김상은
    • 대한영상의학회지
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    • 제83권3호
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    • pp.508-526
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    • 2022
  • 파킨슨병은 중뇌 흑질에 위치한 도파민성 신경세포의 퇴행성 소실로 인해 발생하는 이상운동질환이다. 최근 다양한 자기공명영상기법의 발전으로 파킨슨병에서 일어나는 병리생태학적인 변화를 반영하는 여러 영상 소견들이 보고되었다. 여러 연구에서 이러한 영상 소견들은 파킨슨병의 진단 및 비정형 파킨슨증과의 감별 등에 유의미한 도움을 줄 수 있는 것이 밝혀졌다. 본 종설에서는, 파킨슨병에서 일어나는 흑질선조체 변성의 병태생리를 나타낼 수 있는 나이그로좀 영상 및 뉴로멜라닌 영상 등을 포함한 자기공명영상기법들과 각 영상에서 나타나는 소견에 대하여 자세히 다루었다.