The diagnosis of Pappa requires three steps:

The first step: clear support standards;

The second step: warning "ten small red flags";

Step 3: Distinguish nine exclusion criteria.

We have talked about four supporting standards and ten warning signs. Today, Sister Fu Xiao will talk about nine exclusion criteria for diagnosing Pappa.

The so-called exclusion criterion means that if there is Parkinson's disease, it can be excluded. Because these nine manifestations are specific signs in the diagnosis of other diseases, they are not consistent with the diagnosis of Parkinson's disease.

Play the nine exclusion criteria one by one:

first

The dose and duration of dopamine receptor blockers or dopamine exhausters in the treatment of induced Parkinson's syndrome are consistent with those of drug-induced Parkinson's syndrome. This indicates that drugs induce Parkinson's syndrome.

second

Parkinson-like symptoms still confined to the lower limbs after 3 years of onset suggest secondary Parkinson's syndrome, such as vascular Parkinson's syndrome.

essay

The downward vertical supranuclear gaze paralysis, or the downward vertical saccade is selectively slowed down, suggesting progressive supranuclear paralysis (PSP).

This is an uncommon but not uncommon Parkinson's syndrome, which may be similar to the early Parkinson's disease.

Paralysis of ocular muscles in the vertical nucleus is a sign of PSP. Other common clinical features include dysarthria, dysphagia, myotonia, abnormal cognitive function of frontal lobe and sleep disorder.

Article 4

Clear signs of cerebellar abnormalities, such as cerebellar gait, limb ataxia or abnormal cerebellar eye movements, such as nystagmus induced by persistent gaze, huge square wave jerky, and high-rhythm saccade. This indicates cerebellar lesions.

Article 5

Within five years after the onset, he was diagnosed with highly suspected behavioral variation frontotemporal dementia or primary progressive aphasia.

What needs to be emphasized here is that not all dementia is an absolute exclusion standard. Dementia in this standard refers to frontotemporal dementia.

Article 6

Although the severity of the disease is moderate, there is no significant therapeutic response to high-dose levodopa treatment. Patients who meet the exclusion criteria refer to patients who must use a sufficiently high daily dose of levodopa (≥600 mg/d).

For untreated patients, or patients with levodopa dose less than 600mg/d, this exclusion standard is not applicable.

Lack of treatment response should be clearly recorded by patients (or reliable witnesses), or continuous objective examination (such as MDS-UPDRS III score increased by 3 points).

Article 7

Molecular neuroimaging showed that the presynaptic dopaminergic system was functioning normally.

This shows that there is no imaging evidence of dopaminergic deficiency: there are relatively isolated upper limb rest and postural tremor similar to early Parkinson's disease, but they will not develop into more extensive Parkinson's disease with time.

Unlike typical Pappa patients, there is no evidence of dopamine deficiency in substantia nigra striatum on dopamine transporter imaging in these patients.

Article 8

Clear cortical compound sensory loss (skin writing perception and entity discrimination perception damage), clear limb concept apraxia or progressive aphasia suggest cortical basal ganglia degeneration.

Article 9

There are other diseases that can definitely lead to Parkinson's disease or are suspected to be related to the patient's symptoms, or professional doctors may judge that it is other syndromes based on comprehensive diagnosis and evaluation, not papaya.

Did you get Pam's nine exclusion criteria?

Author: Wu Yufu

Xiao Pa He Jie Image Design: Zhao Haokai

Author introduction: Wu Yufu, chief physician.

Mainly engaged in clinical and research work of neuromotor disorders and cerebrovascular diseases for 20 years. He is good at the diagnosis and treatment of Parkinson's disease, Parkinson's syndrome and cerebrovascular diseases (cerebral infarction, cerebral hemorrhage, cerebral arteriosclerosis, cerebral blood supply deficiency, etc.). ) and various neuromotor disorders, cognitive disorders, anxiety, depression, neurasthenia, peripheral neuropathy, etc. He has presided over or participated in many scientific research projects, published many first author's papers in core journals, and edited or edited many monographs.

Visiting hours: Monday, Wednesday and Friday morning.

(Neurology Department Dyskinesia Clinic)