Holmes震颤的临床特征及短期预后  

Clinical features and short-term prognosis of Holmes'tremor

作　　者：刘志勤 万志荣[2] 贾晓涛 杨学志[3] 方晓霞[4] 张志勇[5] Liu Zhiqin;Wan Zhirong;Jia Xiaotao;Yang Xuezhi;Fang Xiaoxia;Zhang Zhiyong(Department of Neurology,Xi'an Central Hospital,Xi'an Jiaotong University School of Medicine,Xi'an 710003,China;Department of Neurology,Aerospace Central Hospital,Beijing 100049,China;Department of Neurology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Departmentof Neurology,the Affiliated Taihe Hospital of Hubei University of Medicine,Shiyan 442000,China;Departmentof Neurology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]西安交通大学医学院附属西安市中心医院神经内科,西安710003 [2]航天中心医院神经内科,北京100049 [3]温州医科大学附属第一医院神经内科,温州325000 [4]湖北医药学院附属太和医院神经内科,十堰442000 [5]中日友好医院神经科,北京100029

出　　处：《中华医学杂志》2019年第11期801-805,共5页National Medical Journal of China

基　　金：陕西省科技发展计划(2014K11-02-03).

摘　　要：目的探讨Holmes震颤(HT)患者的临床特点及短期预后。方法回顾性分析2014年1月至2018年1月在5家医院神经内科住院的HT患者的临床及影像资料,并利用Fahn-Tolosa-Marin震颤评定量表(TRS)比较不同的病变类型组间(孤立病变组与多发病变组;中脑受累组与非中脑受累组)临床症状严重程度及短期预后的差异。结果(1)本研究共纳入23例患者,HT出现距原发疾病的时间为2d至20个月(中位时间29d),最常见的病因是脑血管病(18例,78.3%)。(2)影像上原发病损部位依次为中脑(65.2%)、丘脑(47.8%)及小脑(30.4%)。表现为孤立病变12例(52.2%)、多发病变11例(47.8%);中脑受累15例(65.2%)、非中脑受累8例(34.8%)。研究显示孤立病变组与多发病变组TRS总分比较差异无统计学意义(P=0.57),而中脑受累组的TRS总分较非中脑受累组显著升高(P=0.00)。(3)深部脑电刺激术有效治疗1例;单纯药物治疗22例,其中以左旋多巴联合氯硝西泮(7/12)与左旋多巴单药(9/20)较有效。(4)出院3个月随访时,手术治疗者预后良好,而药物治疗者中良好结局者仅8例(36.4%)。孤立病变组与多发病变组预后不良者占比差异无统计学意义(P=0.40),而中脑受累组预后不良者占比显著高于非中脑受累组(P=0.02)。结论HT最常见的病因是脑血管病,常见的原发病损部位为中脑、丘脑及小脑。单纯药物治疗的HT仅部分有效且短期预后不佳,原发中脑受累者震颤程度更重且预后更差。Objective To explore the clinical characteristics and short-term prognosis of Holmes′tremor(HT)patients.Methods The clinical and imaging data of HT patients in 5 teaching hospitals between January 2014 and January 2018 were retrospectively analyzed,and Fahn-Tolosa-Marin Tremor Rating Scale(TRS)was used to compare the clinical severity and short-term prognosis between the different subtypes.Results(1)The time from primary disease to tremor onset was 2 days to 20 months(median time 29 d)in 23 patients with HT enrolled,and the most common cause of HT was cerebrovascular disease(78.3%).(2)The most common involved locations were midbrain(65.2%),thalamus(47.8%)and cerebellum(30.4%).No significant difference in total TRS scores between the isolated lesion group(12 cases)and multiple lesions group(11 cases)(P=0.57),while the scores of the mesencephalic group(15 cases)was significantly higher than the non-mesencephalic group(8 cases)(P=0.00).(3)One case was treated with deep brain stimulation(DBS),while 22 cases were treated with medical therapy.Levodopa combined with clonazepam(7/12)and single levodopa(9/20)were partially effective.(4)At the 3-month follow-up after discharge,patients received DBS had good prognosis.Among the 22 patients treated with medicine,only 8(36.4%)patients had good outcomes.The short-term prognosis was not significantly different between the isolated and multiple lesion groups(P=0.40),while it was worse in the mesencephalic group than the non-mesencephalic group(P=0.02).ConclusionThe most common cause of HT is cerebrovascular disease,and primary lesions are midbrain,thalamus,and cerebellum.The pharmacologic agents are partially valid for disease control of HT and the short-term prognosis is poor,while the patients with mesencephalic involvement have more severe tremor and worse prognosis.

关 键 词：Holmes震颤 中脑 脑血管病 左旋多巴 深部电刺激术 

分 类 号：R742[医药卫生—神经病学与精神病学]