Doença de Parkinson
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
Disclosures
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
Disclosures
NM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015 Oct;30(12):1591-601. Abstract
Internation Parkinson and Movement Disorder Society. MDS position paper: diagnosis of Parkinson's disease. Mar 2023 [internet publication].Full text
Pringsheim T, Day GS, Smith DB, et al; Guideline Subcommittee of the AAN. Dopaminergic therapy for motor symptoms in early Parkinson disease practice guideline summary: a report of the AAN Guideline Subcommittee. Neurology. 2021 Nov 16;97(20):942-57.Full text Abstract
Seppi K, Ray Chaudhuri K, Coelho M, et al. Update on treatments for nonmotor symptoms of Parkinson's disease - an evidence-based medicine review. Mov Disord. 2019 Feb;34(2):180-98.Full text Abstract
Fox SH, Katzenschlager R, Lim SY, et al. International Parkinson and Movement Disorder Society evidence-based medicine review: update on treatments for the motor symptoms of Parkinson's disease. Mov Disord. 2018 Aug;33(8):1248-66.Full text Abstract
Rughani A, Schwalb JM, Sidiropoulos C, et al. Congress of Neurological Surgeons systematic review and evidence-based guideline on subthalamic nucleus and globus pallidus internus deep brain stimulation for the treatment of patients with Parkinson's disease: executive summary. Neurosurgery. 2018 Jun 1;82(6):753-6.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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)
More DifferentialsDiretrizes
- Suspected neurological conditions: recognition and referral
- European Academy of Neurology/Movement Disorder Society - European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies
More DiretrizesFolhetos informativos para os pacientes
Doença de Parkinson: o que é?
Doença de Parkinson: quais são as opções de tratamento?
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