Résumé
Objective To study the effects of repeated transcranial magnetic stimulation(rTMS)on Parkinson's plus syndrome(PPS).Methods Fifteen in-patients with PPS were studied between 2005 and 2008.The patients received 1 Hz rTMS at an intensity 30%over the threshold.The rTMS was applied on the hand representive area of the bilateral first motor cortex,50 stimulations on each side,5 arrays,for 5 min,once daily for 15 d.Hamilton's depression scale(HAMD),Hamilton's anxiety scale(HAMA),the unified Parkinson's disease rating scale(UPDRS,which can be subdivided into UPDRS Ⅰ,UPDRS Ⅱ and UPDRS Ⅲ),an activities of daily living scale(ADL),the mini-mental state examination(MMSE)and motor evoked potential(MEP)were assessed before and immediately after 15 d of rTMS treatment. Results Average HAMD,HAMA,UPDRS,UPDRS Ⅱ and UPDRS Ⅲ scores all decreased,and ADL scores increased significantly after treatment,while UPDRSⅠand MMSE scores were unchanged before and after treatment.No significant changes in resting motor threshold or central motor conduction time of the MEP were observed after rTMS treatment. Conclusion Clinical symptoms of PPS patients improved after rTMS treatment and side effects were few.Depression,anxiety,motor function and ability in the activities of daily living improved greatly.Repeated transcranial magnetic stimulation is a potential treatment for PPS patients.There may be no correlation between the effective mechanism of rTMS and cortex excitation.
Résumé
Introducción: Se presenta el caso de un paciente de 73 años, con diagnóstico de parálisis supranuclear progresiva (PSP), quien ingresa a la unidad de salud mental por presencia de síntomas psicóticos con poca respuesta al uso de antipsicóticos y medicación antiparkinsoniana. Objetivo: Revisar las principales alteraciones clínicas de los pacientes con este diagnóstico, las teorías etiopatológicas y las conductas que se deben seguir frente a esta entidad. Método: Reporte de caso. Desarrollo y conclusión: La PSP, aunque poco común, es de interés psiquiátrico, ya que cursa a menudo con síntomas psicóticos y es frecuentemente diagnosticada como una enfermedad psiquiátrica.
Introduction: This is a case report of a 73 year old man, with a diagnosis of progressive supranuclear palsy (PSP) who is admitted to a mental health unit with psychotic symptoms with little response to antipsychotic and antiparkinsonian medication. Objective: This case report emphasizes the clinical symptoms of patients with this diagnosis, the etiopathological theories and the most accurate treatment for this disease. Design: Case report. Development and conclusion: PSP, though rare, is of interest to psychiatry because of the common occurrence of psychiatric symptoms and the frequent misdiagnosis with psychiatric illness.
Résumé
Parkinson plus syndrome was first described in 1997 and it is accounted for 10 per cant of parkisonian patients. In Thailand there was no such case documented. We thus reported th first three patients with Parkinson plus syndrome in Thailand. Two patients (60 years old man and 51 years old woman) presented with classical parkinsonism which few years later developed cerebellar and brainstem signs (dysarthria, nystagmus, dysdiadocholinesia and progressivedysphagia).Computed brain scanning showed marked atrophy of brainstem and cerebellum. They were both diagnosed as olivopontocerebellar atrophy variety of Parkinson plus syndrome. The first patient was deteriorated in the neurological deficits that needed to be confined in bed six years later but his intellectual function was still preserved. The third patient, a 51 years old man presented with parkinsonism that was not responsed to levodopa therapy, then 2 years later he developed myoclonus of the left arm, progressive dysarthria, gait difficulty and deterioration of his intellectual function. Magnetic resonance imaging of the brain showed marked atrophy of brainstem, cerebellum, basal ganglia and cerebral cortex. Single photon emission tomography showed bilateral decreased perfusion of both parietal lobes and basal ganglia. Multiple system atrophy category of Parkinson plus syndrome was diagnosed. He was still survived at his fifth years of illness but in a dependent state at home. Patient with Parkinson plus syndrome must be diagnosed from parkinsonism because it has differ natural history treatment and prognosis.