ENS 2009:巴金森氏症的第一個病徵經常與運動無關


  July 1, 2009(義大利米蘭)-專家們報告,在開始有巴金森氏症運動的病徵好幾年前,病患可能就有症狀。研究者們於第19屆歐洲神經學學會會議上強調,有一些看似無關的症狀,可能確實就是巴金森氏症的第一個病徵。
  
  西班牙巴塞隆納大學的Eduardo Tolosa醫師在會議中表示,來自臨床、神經顯像、與病理的研究結果告訴我們,嗅覺異常、自主神經障礙、或是情緒與睡眠異常會發生在典型運動症狀發生好幾年前,甚至是幾十年前。
  
  這些數據顯示,至少在部分病例身上,巴金森氏症可能從腦幹下方、嗅覺腦部構造、或是周邊自律神經叢開始,之後影響到黑質,他表示,目前並不清楚這些構造何時牽涉到神經退化過程。
  
  雖然巴金森氏症常見於老年病患,但某些病患可能在40歲時、甚至更早前就會發病。來自瑞士Zurich大學醫院的Claudio Bassetti醫師提出有關醫師過度依賴多巴胺激性藥物的擔憂。
  
  他指出,我們越來越常注意到,某些巴金森氏症與不寧腿症候群病患使用了比實際需要的還要多的多巴胺激性藥物。在回饋機制中牽涉到多巴胺系統以及之後成癮的神經生化學解釋了過度使用這些藥物。
  
  Bassetti醫師與其研究團隊研究巴金森氏症的夢遊行為。透過問卷,他們詢問417位病患有關他們的睡眠品質與睡眠異常。
  
  【夢遊、衝動行為與自殺】
  Bassetti的團隊發現,罹患巴金森氏症的病患比較可能有夢遊的問題,且容易有睡眠障礙的經驗。整體看來,9%病患表示有夢遊的問題。這些病患的罹病時間顯著較長(P=0.035),且比較可能有幻想與做噩夢的現象(P=0.004與P=0.003)。
  
  研究者們表示,夢遊,顯然是巴金森氏症的一個晚期表徵。
  
  根據發表者表示,目前越來越重視巴金森氏症病患的某些衝動行為。Bassetti醫師在一項新聞稿中表示,這些衝動行為,如病理性賭博、過度的性衝動、衝動性購物、衝動性暴飲暴食或是衝動型過度使用多巴胺激性藥物,這些會導致巴金森氏症病患散盡家財,或是惡化這些病患的社會問題。
  
  來自捷克共和國Brno大學研究者們的結論是,必須要考慮年輕巴金森氏症病患與治療有關的病理性賭博,以及可能的臨床與社會預後。
  
  這項小型研究以愛荷華賭博任務小組的電子化版本比較20位病患與20位控制組受試者。他們發現巴金森氏症病患分數顯著較低,且比較可能做出不好的選擇。
  
  另一項來自塞爾維亞Belgrade神經學機構的研究,探索巴金森氏症病患的自殺行為。研究者們追蹤102位病患長達8年。他們發現這些病患因為自殺特定的死亡率高出5倍(95% CI為2.1-12.7)。整體來看,有近四分之一的巴金森氏症病患死亡或是有自殺的想法,這可能顯著地影響生活品質。
  
  Bassetti醫師表示,巴金森氏症非運動相關的病徵是個重要的新挑戰,且在診斷與治療這個疾病上,逐漸被認為是個重要特徵。
  
  研究者們表示沒有相關資金上的往來。
  

ENS 2009: First Signs of Parkinson's Often Not Motor-Related

By Allison Gandey
Medscape Medical News

July 1, 2009 (Milan, Italy) — Patients may have symptoms years before they experience the motor manifestations of Parkinson's disease, report experts. Presenting here at the 19th Meeting of the European Neurological Society, researchers emphasized that an array of seemingly unrelated symptoms may actually be the first signs of Parkinson's.

"Evidence is accumulating from clinical, neuroimaging, and pathological studies that olfactory dysfunction, dysautonomia, or mood and sleep disorders can occur years and perhaps even decades before the classical motor symptoms arise," Eduardo Tolosa, MD, from the University of Barcelona, in Spain, said at the meeting.

"These data suggest that, at least in some cases, Parkinson's disease may start in the lower brain stem, olfactory structures, or the peripheral autonomic plexuses, reaching the substantia nigra only later," he noted. "It is unclear when these structures become involved in the neurodegenerative process."

Although Parkinson’s disease is most common in elderly patients, some may be affected in their 40s or even younger. Claudio Bassetti, MD, from the University Hospital of Zurich, in Switzerland, voiced concern about doctors relying too heavily on dopaminergic medications.

"We increasingly notice that some patients with Parkinson's disease and restless-legs syndrome take more dopamine than they really need to," he said. "The involvement of the dopamine system in reward mechanisms and eventually in the neurobiology of addiction may explain this overuse."

Dr. Bassetti and his research team studied sleep walking in patients with Parkinson's disease. Using a questionnaire, they asked 417 patients about their sleep quality and sleep disorders.

Sleep Walking, Compulsive Behavior, and Suicide

Dr. Bassetti's group found that patients with Parkinson's disease were more likely to sleep walk and experience other sleep disturbances. In all, 9% of patients reported sleep walking. These patients had significantly longer disease duration (P = .035) and were more likely to have hallucinations and nightmares (P = .004 and P = .003).

Sleep walking, the researchers suggest, appears to be a late manifestation of Parkinson's disease.

According to presenters, there is also increasing awareness about compulsive behavior in some patients with Parkinson's disease. "These impulse-control disorders such as pathological gambling, hypersexuality, compulsive shopping, compulsive eating, or compulsive overuse of dopaminergic drugs can lead to monetary losses or worsen the social handicap of Parkinson's patients," Dr. Bassetti added in a news release.

"It is necessary to consider pathological gambling in young Parkinson's disease patients with regard to their treatment and possible clinical and sociological outcomes," conclude researchers from the University of Brno, in the Czech Republic.

Their small study compared 20 patients and 20 controls using a computerized version of the Iowa Gambling Task. They found that Parkinson's patients had significantly lower scores and were more likely to make bad choices.

Another study, from the Institute of Neurology in Belgrade, Serbia, explored the risk for suicide in patients with Parkinson's disease. Investigators followed 102 patients for 8 years. They found that suicide-specific mortality was more than 5 times higher (95% CI, 2.1 – 12.7). In all, almost a quarter of the Parkinson's patients either died or experienced suicidal ideation, which may significantly influence quality of life.

"Nonmotor manifestations of Parkinson's disease are an important new challenge and increasingly recognized as an important feature in the diagnosis and treatment of this disorder," Dr. Bassetti said.

The researchers have disclosed no relevant financial relationships.

19th Meeting of the European Neurological Society: Abstracts 17, O38, O39, P408. Presented June 20-24, 2009.

    
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