Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- bradicinesia
- tremor de repouso
- rigidez
- instabilidade postural
Outros fatores diagnósticos
- hipomimia
- hipofonia
- disartria hipocinética
- micrografia
- postura encurvada
- marcha arrastada
- distúrbios do olhar conjugado
- fadiga
- constipação
- depressão
- ansiedade
- demência
- exposição a antipsicóticos ou antieméticos
- características do parkinsonismo atípico
- hiposmia/anosmia
- distúrbios do sono
Fatores de risco
- idade mais avançada
- história de doença de Parkinson (DP) familiar na doença de início mais precoce
- mutação no gene que codifica a glucocerebrosidase
- exposição a 1-metil-4-fenil-1,2,3,6-tetra-hidropiridina (MPTP)
- exposição crônica a metais
- sexo masculino
- fatores adicionais de risco genético
- trauma cranioencefálico
- influência geográfica
- exposição a toxinas
- profissão
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- estudo do agente dopaminérgico
Investigações a serem consideradas
- ressonância nuclear magnética (RNM) cranioencefálica
- neuroimagem funcional (imagem do transportador de dopamina como tomografia computadorizada por emissão de fóton único [SPECT] com beta-CIT [2beta-carbometoxi-3-beta(4-iodofenil) tropano] ou FP-CIT [fluoropropil-carbometoxi-3 beta-(4-iodofenil) tropano], ou tomografia por emissão de pósitrons [PET] de fluorodopa)
- exame olfativo
- teste genético
- teste neuropsicométrico
- ceruloplasmina sérica
- cobre urinário de 24 horas
- inervação simpática cardíaca usando iodo-123 metaiodobenzilguanidina (MIBG)
- patologia do cérebro (post mortem)
Novos exames
- biópsia de pele
Algoritmo de tratamento
parkinsonismo leve
parkinsonismo moderado
parkinsonismo avançado
Colaboradores
Autores
Delaram Safarpour, MD, MSCE
Assistant Professor of Neurology
Department of Neurology
School of Medicine
Oregon Health & Science University
Portland
OR
Declarações
DS has received honoraria for participation in advisory boards for Boston Scientific (the manufacturer of Deep Brain Stimulation device) and Abbvie (the manufacturer of Duopa). She has received consultation fees from Abbott (the manufacturer of Deep Brain Stimulation device). DS has received an institutional grant and has received an honorarium for lectures from Parkinson Study Group.
Marian L. Dale, MD, MCR
Assistant Professor of Neurology
Department of Neurology
Oregon Health & Science University
Staff Neurologist
Portland VA Medical Center
Portland
OR
Declarações
MLD has received consulting honoraria from Synergic Medical Technologies and UCB, and has received grant funding from the NIH and the Collins Medical Trust.
Lauren S. Talman, MD
Assistant Professor of Neurology
Department of Neurology
School of Medicine
Oregon Health & Science University
Portland
OR
Declarações
LST declares that she has no competing interests.
Agradecimentos
Dr Delaram Safarpour, Dr Marian L. Dale, and Dr Lauren S. Talman would like to gratefully acknowledge Dr Avram Fraint, Dr Danny Bega, Dr Meredith Spindler, Dr Jayne R. Wilkinson, and Dr Andrew D. Siderowf, the previous contributors to this topic.
Declarações
DB served on the speaker's bureau for Teva Pharmaceuticals, and ACADIA Pharmaceutical, Inc; he has received consultancy fees from US WorldMeds and grant support from the Parkinson Foundation; he was on the board of directors for Rock Steady Boxing Windy City. AF, MS, JRW, and ADS declare that they have no competing interests.
Revisores
Graham A. Glass, MD
Assistant Clinical Professor
Department of Neurology
UCSF Medical Center
Parkinson's Disease Research
Education and Clinical Center
San Francisco
CA
Declarações
GAG declares that he has no competing interests.
Daniel Kremens, MD, JD
Assistant Professor of Neurology
Jefferson Medical College
Thomas Jefferson University
Philadelphia
PA
Declarações
DK declares that he has no competing interests.
Donald Grosset, BSc (Honours), MB, ChB, MD, FRCP
Consultant Neurologist / Honorary Senior Lecturer
Institute of Neurological Sciences
Southern General Hospital / University of Glasgow
Glasgow
UK
Declarações
DG is an author of a reference cited in this topic.
Patricia Dowsey Limousin, MD, PhD
Reader in Clinical Neurology
Honorary Consultant
Institute of Neurology
National Hospital for Neurology and Neurosurgery
London
UK
Declarações
PDL declares that she has no competing interests.
Nikolaus McFarland, MD, PhD
Assistant Professor
Department of Neurology
University of Florida College of Medicine
Gainesville
FL
Declarações
NM declares that he has no competing interests.
Diagnósticos diferenciais
- Tremor essencial
- Paralisia supranuclear progressiva (PSP)
- Atrofia de múltiplos sistemas (AMS; AMS-A, anteriormente denominada síndrome de Shy-Drager; AMS-P, degeneração nigroestriatal; AMS-C, atrofia olivopontocerebelar)
Mais Diagnósticos diferenciaisDiretrizes
- European Academy of Neurology/Movement Disorder Society - European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies
- Physical therapist management of Parkinson disease: a clinical practice guideline from the American Physical Therapy Association
Mais DiretrizesFolhetos informativos para os pacientes
Doença de Parkinson: o que é?
Doença de Parkinson: quais tratamentos funcionam?
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal