手机版
帕金森病 Parkinson's disease
帕站首页 专题讨论 帕金森病 放心医生 中医与帕 病友故事 留言交流 脑起搏器 专家解答
 
第 1 94 95 96 97 98 99 100 101 102 103 108 页 (第98页,共1073条)
兰州患者家属:回复961楼 章华  邮箱:22800269@QQ.COM  IP:117.156.2.95  日期:2014-12-17 [回复971楼]

  回复961楼 章华
  回复961楼 章华:回复960楼 兰州患者家属
  
  章医生:加了贴片效果不明显,因父亲前列腺肥大没办法吃金刚烷胺,请问泰舒达是缓释片,每次半粒可以吗?贴片怎么撤药?逐渐减贴片加泰舒达吗? 

:回复1楼 章华  邮箱:446384320@qq.co m  IP:112.94.158.220  日期:2014-12-18 [回复972楼]

  回复1楼 章华
  回复1楼 章华:临床应用Zonisamide(唑尼沙胺)治疗帕金森症的最新机制解释
  
  章医生你好,非常希望可以得到你的帮助,妈妈今年才52岁,最近由于左手发抖,肌张力高去了两家医院均被诊断为帕金森,同时妈妈脊髓受压,左手的神经被压到,可是些骨科医生就说脊髓受压会导致肌张力高,但是神经内科的医生就说不会导致肌张力高,妈妈这样的情况真的是帕金森吗?因为妈妈还那么年轻,她一向坚强,因为这件事还哭了几次,作为女儿又什么都不懂,感觉心里很难过,麻烦章医生百忙之中可以帮忙分析下,谢谢! 

章华:回复971楼 兰州患者家属  邮箱:drcheunghk@gmail.com  IP:124.217.139.49  日期:2014-12-19 [回复973楼]

  回复971楼 兰州患者家属
  回复971楼 兰州患者家属:回复961楼 章华
  
  
  贴片每周减1mg。
  泰舒达可以每次先半片,如果情况可以的话可以等贴片减完再加泰舒达,否则贴片减至每天4mg就可以加泰舒达。 

章华:回复972楼 w̳  邮箱:drcheunghk@gmail.com  IP:124.217.139.49  日期:2014-12-19 [回复974楼]

  回复972楼 w̳
  回复972楼 w̳:回复1楼 章华
  
  
  
  脊髓受压当然会出现肌张力高的情况,可以去理疗科做做牵引,看看是否会改善。骨科疾病导致的肢体问题与帕金森病需要鉴别。。
  但肌张力高不是确诊帕金森病的主要因素,要参考运动状况,另外有一些神经系统体检。
  女性有几个发病高危期,一是产后,二是绝经后,三是曾经有子宫和卵巢切除的,这几种情况下2-3年内出现类帕金森症症状,除了一些特别的因素,都是需要高度怀疑原发性帕金森病。 

美丽的云:关于如何调药的问题请教章医生  邮箱:yunleihly2006@163.com  IP:218.244.198.4  日期:2014-12-19 [回复975楼]

  关于如何调药的问题请教章医生
   我母亲以前一直吃美多巴,原来每天2次,每次半片,金刚烷胺每天2次,也是每次半片,已吃1年了,雷沙吉兰每天1次,每次1粒,辅酶Q10,每天6粒,每粒200mg,因为今年十一以后病情有些加重,爱流口水,经常迷糊,浑身发紧,所以住院调养了半个月,有所好转,于是我让她中午增加了一次美多巴(半片),增加了一个管脑梗的药,因为她有腔隙型脑梗,现我想给她增加森福罗(德国产的0.25mg),从每次0.125mg,每天3次开始,您看可以么?我看过该药的说明,而且我也阅读了薛老师的帖子,所以我想把美多巴减量,金刚烷胺停掉,我比较纠结的就是如何减量美多巴,和怎样停掉金刚烷胺,因为我觉得用药太多会产生冲突或毒性,而且从薛老师的帖子里获知,金刚烷胺突然停掉会有很多副作用。
  您看我母亲这种情况,以您的经验判断应该如何调药呢?
  
   

章华:回复974楼 章华  邮箱:drcheunghk@gmail.com  IP:124.217.139.49  日期:2014-12-19 [回复976楼]

  回复974楼 章华
  回复974楼 章华
  
  长期使用多巴类或者激动剂导致的精神症状,包括幻觉幻听,神志迷糊甚至出现精神错乱。
  临床上有二个选择,一是选择减多巴类或者激动剂药量,但这样会减弱运动状况。二是不减药量,加精神科药物,但可能会出现其他副作用。
  这是一个剂末并发精神症状(幻觉幻听、精神恍惚)的严重病例,方法只是添加唑尼沙胺,结果是令人满意的。一个月后精神状况稳定,运动状况改善。六个月后关期明显改善,生活自理可以参与家庭活动。十个月后日常可以骑自行车外出。
  作者的观点,在这个病例的药物安排从而改善症状上,唑尼沙胺的添加就是Key(关键)。
  
  CASE REPORT
  Effectiveness of zonisamide in a patient with Parkinson’s disease and various levodopa-induced psychotic symptoms
  Ichiro Yabe,1 Midori Ohta,2 Toshiaki Egashira,3 Kazunori Sato,1 Takahiro Kano,1 Makoto Hirotani,1 Yasuyuki Kunieda4 and Hidenao Sasaki1
  1Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, 2Rehabilitation Center, Departments of 3 Psychiatry, and 4 Internal Medicine, Wakkanai City Hospital, Wakkanai, Japan
  Key words
  dopamine agonists, levodopa, Parkinson’s disease, psychotic symptoms, zonisamide.
  Accepted for publication 18 August 2014.
  Correspondence
  Ichiro Yabe
  Department of Neurology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan. Email: yabe@med.hokudai.ac.jp
  Abstract
  Levodopa and dopamine agonists are useful as Parkinson’s disease medications. However, they often induce persistent psychotic symptoms and motor complica- tions, which make Parkinson’s disease treatment difficult. This is a case report of a patient with advanced Parkinson’s disease accompanied by exacerbation of motor symptoms and psychotic symptoms derived from prolonged use of conventional anti-Parkinson’s disease drugs, and in whom adjunctive therapy with a new anti- Parkinson’s disease drug, zonisamide, was shown to improve motor symptoms with no exacerbation of psychotic symptoms.
  As medication for Parkinson’s disease (PD), levodopa (L-dopa) and dopamine agonists (DA) are used as the first- line of treatment for PD to activate dopamine neurons. How- ever, they often induce persistent psychotic symptoms includ- ing hallucinations and delusions. In addition, after long-term use of L-dopa, some patients experience motor complications, such as wearing-off and the on-off phenomenon, and involun- tary movement. In view of these facts, particular caution should be taken in the selection of drugs for the treatment of advanced PD. Zonisamide has been developed as a new anti- PD drug in Japan, and is considered to have various effects on PD. We report a case of an advanced PD patient with exacerbation of psychotic symptoms, and in whom adjunctive therapy with zonisamide proved to be effective.
  Case report
  A 47-year-old man was diagnosed with early-onset PD with a duration of 19 years. He reported no remarkable family histories.
  An overview of clinical symptoms and the medication his- tory of the patient is presented in Figure 1. He noticed gait disturbance as a first symptom 19 years before zonisamide ini- tiation. Four years later, he was diagnosed with early-onset PD and started treatment. After receiving 7 years of treatment with L-dopa and DA, he manifested psychotic symptoms including hallucinations and delusions. Over the next 7 years, although he was treated with L-dopa/carbidopa, DA, anticho- linergics and antipsychotics, he was in and out of hospital nine times because of the manifestation and exacerbation of
  psychotic symptoms (delusions, visual and auditory hallucina- tions, wandering, gambling problems, emotional disturbance), motor complications and gait disturbance.
  He first visited the Department of Neurology, Wakkanai City Hospital in Wakkanai City, Japan, for treatment of his motor symptoms. His main symptoms were muscle rigidity of the left limbs, bradykinesia and freezing of gait, which were severe enough to require wheelchair confinement. No neuro- logical abnormalities were found in the cranial nerves, the cer- ebellum or the sensory system. Brain magnetic resonance imaging also showed no significant abnormalities.
  Although the patient seemed to require an increased dose of anti-PD drugs, increasing the L-dopa dose was deemed inappropriate, as he was already suffering from psychotic symptoms. Instead we initiated adjunctive therapy with 25 mg/day zonisamide, in addition to 300 mg/day L-dopa and 4 mg/day ropinirole. As a result, a marked improvement was achieved in freezing gait, and he could walk by himself within a month of initiation of treatment with zonisamide. Meanwhile, his psychotic symptoms remained stable without aggravation. Six months later, the “off-time” periods were reduced. The patient’s daily life improved dramatically to the extent that he could engage in recreational activities with his family. Ten months after zonisamide initiation, improvement of gait freezing persisted, and he could go out on his bicycle during the day. His Unified Parkinson’s Disease Rating Scale scores markedly improved .
   

:回复972楼 w̳  邮箱:446384320@qq.co m  IP:58.250.163.3  日期:2014-12-19 [回复977楼]

  回复972楼 w̳
  回复972楼 w̳:回复1楼 章华
  
  非常谢谢医生,妈妈今年52岁,目前月经很久才偶尔有来,有更年期症状,加上脊髓受压,现在主要表现就是左手有点静止性震颤还有肌张力高,这样的情况是不是帕金森呢?如何才可以鉴别,之前吃骨科的中药手抖有缓解就是反复,如果帕金森也是这样吗?心里很着急不知道如何是好,麻烦医生给个建议,谢谢 

兰州患者家属:回复973楼 章华  邮箱:22800269@QQ.COM  IP:117.156.2.94  日期:2014-12-20 [回复978楼]

  回复973楼 章华
  回复973楼 章华:回复971楼 兰州患者家属
  
  万分感谢章医生! 

:回复974楼 章华  邮箱:446384320@qq.co m  IP:117.136.40.199  日期:2014-12-20 [回复979楼]

  回复974楼 章华
  回复974楼 章华:回复972楼 w̳
  
  章医生,我想问下如果是因为绝经期引起的类帕金森症状可以缓解回来吗?应该怎么办?谢谢 

:回复974楼 章华  邮箱:446384320@qq.co m  IP:117.136.33.65  日期:2014-12-22 [回复980楼]

  回复974楼 章华
  回复974楼 章华:回复972楼 w̳
  
  非常谢谢医生,妈妈今年52岁,目前月经很久才偶尔有来,有更年期症状,加上脊髓受压,现在主要表现就是左手有点静止性震颤还有肌张力高,这样的情况是不是帕金森呢?如何才可以鉴别,之前吃骨科的中药手抖有缓解就是反复,如果帕金森也是这样吗?心里很着急不知道如何是好,麻烦医生给个建议,谢谢  

输1-2个字  第 1 94 95 96 97 98 99 100 101 102 103 108 页(共1073条)