原发性进行性冻结步态的临床及磁共振研究  

Clinical study of MRI features on primary progressive freezing gait

作　　者：李蒙燕[1] 胡蓉[1] 余健敏[1] 

机构地区：[1]广州市第一人民医院神经科,广州510180

出　　处：《中国实用神经疾病杂志》2017年第8期1-4,共4页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨原发性进行性冻结步态(primary progressive freezing gait,PPFG)的临床、诊断及MRI特点。方法对已随访2~4a的6例疑诊PPFG老年患者的临床资料进行分析总结。结果 6例患者年龄(78±1.2)岁,均以反复发作的下肢冻结步态为突出症状,症状逐年加重,病程中均伴有程度较轻的非运动症状,如焦虑、抑郁、大汗、便秘、尿频、白天嗜睡,认知功能无影响;头部MRI表现基本一致,提示不同程度的"脑室旁白质脱髓鞘改变、脑萎缩";治疗困难,大剂量的复方左旋多巴药物治疗效果欠佳,减量并加用司来吉兰、DA受体激动剂、金刚烷胺或屈昔多巴不同组合联合治疗,显示部分有效。结论 6例患者的临床表现基本符合PPFG的诊断标准,但均伴有轻微的非运动症状,与既往文献报道不符,头部MRI改变一致,为该病病因的研究可能起提示作用,但最终诊断需要长期的随访观察或病理检查。Objective To explore the clinical characteristics,diagnosis and MRI features of primary progressive freezing gait （PPFG）. Methods The clinical data of six patients with suspected PPFG who had been followed up for 2 to 4 years were analyzed in detail. Results The age of included patients was （78.5 ± 1.2） years. Recurrent freezing gait was the prominent symptom and worsened year by year. Other positive signs of non-motor symptoms,such as anxiety,depression, sweating, constipation, pollakis- uria and somnolence,were involved in disease process. With accordant manifestations, brain MRI showed different degrees of de- mye]inating in the white matter of ventricle and encephalanalosis. Patients did not respond to large doses of compound levodopa. However,some combination therapy with selegiline,DA agonists,amantadine or droxidopa was effective. Conclusion The clinical manifestations of 6 patients conform to diagnostic criteria of PPFG, but manifestations with slight non-motor symptoms are out of accord with other reports. The imaging of MRI has similar performance,which may improve the study of disease etiology. Howev- er,to make a final diagnosis of PPFG,long-term follow-up observation or pathological examination would be necessary.

关 键 词：冻结步态 磁共振 非运动症状 

分 类 号：R741[医药卫生—神经病学与精神病学]