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Neurology：美国神经协会更新迟发性运动障碍治疗指南

2013-08-05 sunight dxy

美国神经协会迟发性运动障碍指南
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迟发性运动障碍是一种特殊而持久的锥体外系反应，主要见于长期服用大剂量抗精神病药的患者，减量或停服后最易发生。一般认为长期阻断纹状体多巴胺能受体后，多巴胺受体反应超敏所致，也可能与基底节GABA功能受损有关。 为了更好的对包括迟发型运动障碍在内的迟发性综合征进行循证学管理，重点对以下五个问题进行解释：1、停止使用多巴胺受体阻滞剂是不是能有效治疗迟发性综合征？2、典型多巴胺受体阻滞剂改为非典型多巴胺

迟发性运动障碍是一种特殊而持久的锥体外系反应，主要见于长期服用大剂量抗精神病药的患者，减量或停服后最易发生。一般认为长期阻断纹状体多巴胺能受体后，多巴胺受体反应超敏所致，也可能与基底节GABA功能受损有关。【原文下载】

为了更好的对包括迟发型运动障碍在内的迟发性综合征进行循证学管理，重点对以下五个问题进行解释：1、停止使用多巴胺受体阻滞剂是不是能有效治疗迟发性综合征？2、典型多巴胺受体阻滞剂改为非典型多巴胺受体阻滞剂是否可减轻迟发性综合征症状？3、治疗迟发性综合征的有效药物是什么？4、使用肉毒素进行化学去神经支配对迟发性综合征是否有效？5、手术治疗是否对迟发性综合征有效？

搜索1966年至2011年PsycINFO、Ovid MEDLINE、EMBASE、科学网站和Cochrane数据库，将文献根据证据等级进行4级分层，根据证据等级进行推荐。氯硝西泮或可改善迟发性运动障碍症状，银杏或可改善迟发型综合征症状（均为B级证据）。氯硝西泮和银杏可被推荐为治疗药物。利培酮可能改善迟发型综合征但是不被推荐为一线治疗，因为抗精神病药物尽管可以掩盖症状但是可能造成迟发性综合征。金刚烷胺和丁苯那嗪可作为迟发型综合征的治疗药物（C级证据）。不推荐地尔硫卓作为迟发性运动障碍的治疗药物（B级证据）。不推荐加兰他敏和二十碳五烯酸作为治疗药物（C级证据）。乙酰唑胺，溴隐亭，巴氯芬，维生素B1，维生素E，维生素B6，司来吉兰，氯氮平，奥氮平，褪黑素，硝苯地平，氟甲呱臻苯二氮革，舒必利，氟哌噻吨，醋酸奋乃静，氟哌啶醇，左乙拉西坦，喹硫平，齐拉西酮，舍吲哚，阿立哌唑，丁螺环酮，yi-gan san，比哌立登，A型肉毒毒素，电休克治疗，α-甲基多巴，利血平，苍白球深部脑刺激等方式治疗迟发性综合征的临床数据不足，尚不能支持或拒绝这些治疗方式（U级证据）。停用致病的药物或将典型多巴胺受体抑制剂改换成非典型多巴胺受体阻滞剂的临床数据不足，尚不能采用或拒绝使用（U级证据）。

【原文下载】Bhidayasiri R, Fahn S, Weiner WJ, Gronseth GS, Sullivan KL, Zesiewicz TA.Evidence-based guideline: Treatment of tardive syndromes: Report of the Guideline Development Subcommittee of the American Academy of Neurology.Neurology. 2013 Jul 30;81(5):463-469.

PMID:
23897874

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    2014-06-06 yinhl1978

    #Neurol#

    0

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    2013-12-15 经常头晕

    #迟发性#

    0

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    2013-11-08 w984445tii

    #治疗指南#

    0

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    2013-08-07 FukaiBao

    #运动障碍#

    0

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    2013-08-07 xlxchina

    #迟发性运动障碍#

    0

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