回复22楼 燕子
回复22楼 燕子:回复1楼 Andy
并不是只要是药就会导致DIP,目前我搜集的offending drugs(其实在我上面贴的文章里都有,估计没有多少人会认真看那么长的文字)
降压药及治头痛药中的钙离子通道阻滞剂、抗精神病药、抗抑郁或焦虑药、抗癫痫药、止吐和改变胃动力药物、氯贝胆碱和胆碱酯酶抑制剂、新斯的明等胆碱药物。
根据下列文章,临床是很难区分DIP和PD的(但我贴的第二篇文章(上海医生写的)从症状上对DIP和PD进行了一定的区分,至少可以作为怀疑DIP的初步依据)。只有在病人停药后逐步缓解并最终恢复的情况下,回过头来才能最终真正断定纯粹的DIP。
It is difficult to identify preclinical Parkinson’s disease in patients with DIP because the reversibility of parkinsonian features does not rule out preclinical Parkinson’s disease, nor does a clinically rapid resolution of parkinsonism preclude the later development of Parkinson’s disease. Moreover, a patient with DIP that is unrelated to Parkinson’s disease cannot be distinguished from a DIP patient who has subclinical Parkinson’s disease.15 However, as the prognosis and treatment strategies for DIP and Parkinson’s disease are different, it is important to be able to recognise subclinical Parkinson’s disease.
欣慰的是,"in our study, most of the patients with DIP (90%) had cardiac MIBG uptake within the normal range, suggesting that they did not have the sympathetic dysfunction seen in Parkinson’s disease, and that their DIP may be unrelated to Parkinson’s disease. "
你提到的止痛药,我比较粗的在网上查了一下,感觉并不会拮抗多巴氨受体,不太会导致DIP。
总结一下吧,如果病人具备下面列举的大多数条件,DIP的可能性非常大:
1,有服用offending drug史(单一长期用药、短期大量用药、联合用药等、甚至手术全身麻醉如果和offending drug同时进行的话,也可以视为联合用药);
2,症状的出现/缓解和服用/停用offending drug有直接关联性;
3,左旋多巴类药物作用不明显(明显的程度就是80%甚至全部症状在服用左旋多巴类药物后消失);
4,服用抗胆碱药物的症状有改善;
5,症状表现形式多为急性起病/双侧起病(部分一侧较重)/轻微震颤(部分药物会有特例)/无明显的晨僵和起步困难