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題 名 | Successful Treatment of Rubral Tremor by High-dose Trihexyphenidyl: A Case Report=成功使用Trihexyphenidyl 控制紅核性顫抖:一病例報告 |
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作 者 | 劉立民; 施邦英; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 22:3 民95.03 |
頁 次 | 頁149-153 |
分類號 | 418.21 |
關鍵詞 | 紅核性顫抖; 藥物治療; Rubral tremor; Pharmacotherapy; Trihexyphenidyl; |
語 文 | 英文(English) |
中文摘要 | 一二十四歲男性於,西元 2001 年二月,發生急性右側肢體無力,構音困難,以及眼球轉動受限的情形。當時核磁共振攝影發現在左側丘腦區域有海棉靜脈竇血管瘤合併出血的情形。然而,在一個月之後,在右側肢體手腕部,手肘,肩膀,發現有些規律性,振幅較大的抖動。這些抖動在休息,運動,和維持姿勢時均會產生。而且,運動會引起更嚴重的抖動。它的頻率大概在二到三 Hz 左右。根據臨床上的表現,以及振動圖所顯現出的頻律,振幅,我們診斷為紅核性顫抖。在臨床上,紅核性顫抖並不是很少見,但是口服藥物通常比較沒有效果。最近的研究顯示,於視丘做深部腦刺激,腹內側丘腦開洞術,以及後腹側蒼白球開洞術是有效的。然而,這些手術是非常昂貴的,而且需要承擔手術的風險。這個案例,我們嘗試了valproate,clonazepam,verapamil。最後顫抖被單一高劑量的 trihexyphenidyl (38 mg/day)所控制。在這裡我們提出一個用單一口服藥物 trihexyphenidyl 治療紅核性顫抖成功的案例。 |
英文摘要 | A 24-year-old male suffered from acute-onset right-sided hemiparesis, dysarthria, and ophthalmoplegia in February 2001. Brain magnetic resonance imaging revealed a cavernous angioma with hemorrhage over the left thalamus. Moreover, some rhythmic, coarse, low-frequency (2–3 Hz) oscillation over the right wrist and elbow was noted 1 month later. Action tremor was more predominant than resting tremor. Rubral tremor was diagnosed on the basis of the clinical presentation and tremography analysis. Rubral tremor is not unusual, and pharmacotherapy is nearly always ineffective in clinical practice. Deep brain stimulation, thalamotomy, and pallidotomy are all considered effective according to recent research. However, they are either very expensive or invasive, and involve surgical risks. In our patient, we tried valproate, clonazepam, and verapamil one after another, but all in vain. Finally, titration of trihexyphenidyl provided significant benefit. The tremor was successfully controlled by a single high daily dose of trihexyphenidyl (38 mg) without severe or uncomfortable side effects. Here, we report a case of successful monotherapy of rubral tremor with high-dose trihexyphenidyl. |
本系統中英文摘要資訊取自各篇刊載內容。