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肌张力障碍

最后审阅: 10 Nov 2024
最后更新: 27 Jan 2023

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 主动肌和拮抗肌的同时收缩
  • 肌肉疼痛
  • 运动可诱发或加重是肌张力障碍普遍特征
  • 眼睑痉挛
  • 斜颈
  • 手痉挛
  • 足痉挛
  • 急性发病(服用抗多巴胺类药物后的 5 天内)
  • 之前存在的全身性肌张力障碍急剧恶化
完整详情

其他诊断因素

  • 受累身体部位的扭转
  • 行为拮抗(感觉假象)
  • 扩散到其他身体部位
  • 帕金森氏病
  • 肌阵挛
  • 震颤、无力或痉挛
  • 裂隙灯检查中的 Kayser-Fleischer 环
完整详情

危险因素

  • 肌张力障碍家族史
  • 受累部位的重复性运动
  • 出生创伤和儿童发育迟缓
  • 服用抗多巴胺类药物
  • 创伤
  • 基因突变
  • 德系犹太人族群
  • 基底神经节的结构性损伤
  • 帕金森综合征
完整详情

诊断性检查

首要检查

  • 左旋多巴反应性
完整详情

需考虑的检查

  • 头颅磁共振成像
  • 血清铜蓝蛋白水平
  • 24 小时尿铜
  • TOR1A(也称为 DYT1)基因检测
  • GCH1 基因检测
完整详情

治疗流程

急症处理

急性肌张力障碍反应

持续性治疗

全身性肌张力障碍

局部性肌张力障碍:除了成人孤立性足肌张力障碍

成人孤立性足肌张力障碍

撰稿人

作者

Ludy C. Shih, MD, MMSc

Associate Professor of Neurology

Department of Neurology

Boston University School of Medicine

Boston

MA

利益声明

LCS has been reimbursed by Medtronic, Praxis Precision Medicines, and WCG-Medavante for consulting services. LCS has received research grant funding from the National Institutes of Health, Abbott, and Praxis Precision Medicines.

鸣谢

Dr Ludy C. Shih would like to gratefully acknowledge Dr Samuel Frank, Dr David K. Simon, and Dr Daniel Tarsy, previous contributors to this topic.

利益声明

SF is employed by the Beth Israel Deaconess Medical Center, which has received funding from Allergan to support partial fellowship training. DKS has received consulting fees from the Gerson Lehrman Group. DKS is an author of a reference cited in this topic. DT has received an unrestricted grant from Allergan and Medtronic being used for education. He received unrestricted funds for patient education from Allergan, Boehringer Ingelheim, Valeant, and Teva Neurosciences. He has received research funds from Solvay and Neurogen. DT is an author of a number of references cited in this topic.

同行评议者

Patricia Dowsey Limousin, MD, PhD

Reader in Clinical Neurology

Honorary Consultant

Institute of Neurology

National Hospital for Neurology and Neurosurgery

London

UK

利益声明

PDL declares that she has no competing interests.

Zhigoa Huang, MD, PhD

Assistant Professor

Director

Movement Disorder Center

Dept of Neurology

University of Florida

Tampa

FL

利益声明

ZH has been a consultant for Allergan and a speaker for Novartis and TEVA.

  • 肌张力障碍 images
  • 鉴别诊断

    • 手足徐动症型或痉挛型脑瘫
    • Huntington 病(HD)
    • 帕金森病(PD)或非典型的帕金森病
    更多 鉴别诊断
  • 指南

    • 临床实践指南更新总结:肉毒毒素用于治疗睑痉挛、颈部张力障碍、成人痉挛状态和头痛。
    • EFNS 原发性肌张力障碍诊断和治疗指南
    更多 指南
  • padlock-locked登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

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