帕金森病患者抗胆碱能药物诱发的口-颊不自主运动临床特点分析及文献复习

Clinical characteristics of orobuccal involuntary movements induced by anticholinergic agents in patients with Parkinson′s disease and literature review

目的探讨帕金森病患者抗胆碱能药物诱导的口-颊不自主运动的临床特点。方法回顾性收集2018年4月至2021年10月就诊于山东大学齐鲁医院(青岛)且在应用盐酸苯海索控制震颤的过程中出现的亚急性口-颊不自主运动的帕金森病患者, 汇总分析该类运动障碍的临床特点、潜伏期和相关危险因素, 结合国内外文献复习, 分析抗胆碱能药物诱导的口-颊不自主运动的临床特点。结果共收集7例帕金森病患者在应用盐酸苯海索的治疗过程中出现亚急性口-颊不自主运动, 均为老年患者, 其中女性6例, 男性1例。苯海索用量均为中小剂量(2~6 mg/d);3例未应用多巴胺能药物;4例合并应用多巴胺能药物, 剂量均为中小剂量(左旋多巴等效剂量200~550 mg);运动障碍表现为唇部不自主吸唇, 舌在口中不自主运动、舌不自主伸出口外, 不自主咬牙、咀嚼、舔舌噘唇, 均未见肢体及躯干异动。口-颊不自主运动出现的潜伏期为21~60 d, 减停药物后运动障碍的缓解时间为7~30 d。文献检索发现国外相似病例均为老年患者, 女性较男性多见(女性7例, 男性3例), 多数患者(8/10)仅表现为口-颊不自主运动, 当抗胆碱能药物剂量较大时合并肢体异动(2/10), 出现口-颊不自主运动的潜伏期为3~93 d, 减停抗胆碱能药物后症状缓解时间为2~60 d。结论抗胆碱能药物诱导的口-颊不自主运动在帕金森病患者的治疗过程中多为亚急性出现, 停药后可在短期内恢复, 与左旋多巴和抗胆碱能药物的剂量无关, 老年、女性、合并焦虑抑郁可能是其危险因素。

Objective To study the clinical characteristics of orobuccal involuntary movements(OB)induced by anticholinergic agents.Methods The clinical characteristics of patients with OB induced by anticholinergic agents in Qilu Hospital(Qingdao)from April 2018 to October 2021 and cases reported in the literature were analyzed in combination with literature review.Results Seven patients in Qilu Hospital(Qingdao)and 10 cases in the literature were analyzed.Of these 7 patients,6 were elderly female,with involuntary,repetitive,stereotypical movements of the lips,tongue,and sometimes of the jaw after intake of anticholinergic medication with the latency 21-60 days and the involuntary movements improved 7-30 days after discontinuation of anticholinergic medication.Of 10 cases reported in the literature,7 were elderly female and 8 only with OB and 2 patients had extremities dyskinesia plus OB.Involuntary movements appeared after latency of 3-93 days following the introduction of anticholinergic drugs and resolved after latency of 2-60 days following their withdrawal.Conclusions OB induced by anticholinergic agents mostly occur sub-acutely during the treatment of Parkinson′s disease,and can resolve in a short time after withdrawal,which is independent of the dose of levodopa and anticholinergic agents.The aging,female,and anxiety and depression may be the risk factors.