| Journal of Neurology ¹6 2009
Obukhova A.V., Artemyev D.V. The experience of specialized neurological care for outpatients with parkinsonism The paper reviews the experience concerning specialized neurological care for outpatients with extrapyramidal disorders. The data collected for 264 patients who consulted a neurologist within a year are included in the analysis. Parkinsonism was detected in 214 subjects including 84% cases of Parkinson’s disease (PD), 5% patients with parkinsonism associated with other neurodegenerative diseases and 7% cases of secondary parkinsonism. The typical diagnostic pitfalls detected in the course management of patients with extrapyramidal disorders are discussed. In 30% of the subjects referred to a neurologist their "directional diagnosis’ was changed. The most typical pitfall is overdiagnosis of parkinsonism in patients with essential tremor. Special attention is given to the cases comprising the combination of parkinsonism and cerebrovascular pathology. Besides, it has been detected that young age at the onset of the disease and female sex are associated with slower progression of the disease. Particular issues concerning antiparkinsonian therapy at different stages of PD are considered. Key Words: parkinsonism REFERENCES 1. Àðòåìüåâ Ä. Â., Îáóõîâà À. Â. Ñîâðåìåííûå ïîäõîäû ê ëå÷åíèþ ðàííèõ ñòàäèé áîëåçíè Ïàðêèíñîíà // Consilium medicum. — 2008. — Ò. 10. — Ñ. 89—92. 2. Àðòåìüåâ Ä. Â. Äîôàìèíåðãè÷åñêàÿ òåðàïèÿ ïîçäíèõ ñòàäèé áîëåçíè Ïàðêèíñîíà // Consilium medicum. — 2009. — Ò. 11. — Ñ. 34—38. 3. Ëåâèí Î. Ñ., Äîêàäèíà Ë. Â. Ýïèäåìèîëîãèÿ ïàðêèíñîíèçìà è áîëåçíè Ïàðêèíñîíà // Íåâðîë. æóðí. — 2005. — Ò. 10, ¹ 5. — Ñ. 41—49. 4. Ëåâèí Î. Ñ. Êàê ëå÷èòü ïàðêèíñîíèçì íå ïðè áîëåçíè Ïàðêèíñîíà? // Òðóäíûé ïàöèåíò. — 2008. — ¹ 5—6. 5. Íîäåëü Ì. Ð., ßõíî Í. Í. Äâèãàòåëüíûå ôëóêòóàöèè è äèñêèíåçèè ïðè áîëåçíè Ïàðêèíñîíà: íîâûå âîçìîæíîñòè òåðàïèè // Íåâðîë. æóðí. — 2007. — Ò. 12, ¹2. — Ñ. 26—33. 6. Ïðîòîêîë âåäåíèÿ ïàöèåíòîâ ñ áîëåçíüþ Ïàðêèíñîíà. — Ì., 2006. 7. Øòîê Â. Ï., Èâàíîâà-Ñìîëåíñêàÿ È. À., Ëåâèí Î. Ñ. Ýêñòðàïèðàìèäíûå ðàññòðîéñòâà. Ðóêîâîäñòâî ïî äèàãíîñòèêå è ëå÷åíèþ. — Ì., "ÌÅÄïðåññ-èíôîðì". — 2002. 8. ßõíî Í. Í., Õàòèàøâèëè È. Ò. Ïàðêèíñîíèçì: êëèíèêà, äèàãíîç äèôôåðåíöèàëüíûé äèàãíîç // Ðóñ. ìåä. æóðí. — 2002. — Ò. 8, ¹ 10. — Ñ. 418—425. 9. Cleeves L., Findley L. J., Koller W. Lack of association between essential tremor and Parkinson’s disease // Ann. Neurol. — 1988. — Vol. 24, N 1. — P. 23—26. 10. Diederich N. J. Parkinson disease with old-age onset: a comparative study with subjects with middle-age onset // Arch. Neurol. — 2003. — Vol. 60, N 4. — P. 529—533. 11. Ferguson L. W., Rajput M. L., Muhajarine N. Clinical features at first visit and rapid disease progression in Parkinson’s disease // Parkinsonism Relat. Disord. — 2008. — Vol. 14, N 5. — P. 431—435. 12. Pahwa R., Koller W. C. Is there relationship Parkinson’s disease and essential tremor? // Clin. Neuropharmacol. — 1993. — Vol. 16, N 1. — P. 30—35. 13. Rajput A. H., Birdi S. Epidemiology of Parkinson’s disease // Parkinsonism Relat. Disord. — 1997. — Vol. 3, N 4. — P. 175—186. 14. Shahed J., Jankovic J. Exploring the relationship between essential tremor and Parkinson’s disease // Parkinsonism Relat. Disord. — 2007. — Vol. 13, N 2. — P. 67—76. 15. Shulman L. M. Gender differences in Parkinson’s disease // Gend. Med. — 2007. — Vol. 4, N 1. — P. 8—18. 16. Tan E. K., Lee S. S., Fook-Chong S., Lum S. Y. Evidence of increased odds of essential tremor in Parkinson’s disease // Mov. Disord. — 2008. — Vol. 23, N 7. — P. 993—997. 17. Walters A. S. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group // Mov. Disord. — 1995. — Vol. 10, N 5. — P. 634—642. |