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首页> 外文期刊>BMC Psychiatry >Possible multiple system atrophy with predominant parkinsonism in a patient with chronic schizophrenia: a case report
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Possible multiple system atrophy with predominant parkinsonism in a patient with chronic schizophrenia: a case report

机译：慢性精神分裂症患者可能以多发性帕金森综合症萎缩：一例

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Multiple system atrophy (MSA) is an adult-onset, rare, and progressive neurodegenerative disorder characterized by a varying combination of autonomic failure, cerebellar ataxia, and parkinsonism. MSA is categorized as MSA-P with predominant parkinsonism, and as MSA-C with predominant cerebellar features. The prevalence of MSA has been reported to be between 1.86 and 4.9 cases per 100,000 individuals. In contrast, approximately 1% of the population is affected by schizophrenia during their lifetime; therefore, MSA-P comorbidity is very rare in schizophrenic patients. However, when the exacerbation or progression of parkinsonism occurs in patients with schizophrenia treated with antipsychotics, it is necessary to consider rare neurodegenerative disorders, including MSA-P, in the differential diagnosis of parkinsonism. A 60-year-old female patient with chronic schizophrenia developed possible MSA-P. She had been treated mainly with typical antipsychotics, and presented with urinary incontinence, nocturnal polyuria, and dysarthria around 2011. In 2014, she developed worsening parkinsonian symptoms and autonomic dysfunction. Although her antipsychotic medication was switched to an atypical antipsychotic and the dose reduced, her parkinsonism was not improved. In 2015, modified electroconvulsive therapy produced slight improvements in the symptoms; however, she shortly returned to her symptomatic state. A combination of cardiac 123I-meta-iodobenzylguanidine scintigraphy and 123I-FP-CIT single-photon emission computed tomography imaging, in addition to brain magnetic resonance imaging findings, helped to discriminate MSA-P from other sources of parkinsonism. L-dopa had been prescribed, but she responded poorly and died in the spring of 2016. This case report highlights the importance of considering MSA-P in the differential diagnosis for parkinsonism in a patient being treated with antipsychotics for chronic schizophrenia. MSA-P should be considered in patients presenting with worsening and progressing parkinsonism, especially when accompanied by autonomic dysfunction or cerebellar ataxia. Although a definite diagnosis of MSA-P requires autopsy confirmation, a combination of brain magnetic resonance imaging and nuclear medicine scans may help to differentiate suspected MSA-P from the other parkinsonian syndromes. This case also demonstrates that MSA with parkinsonism that is poorly responsive to L-dopa may improve shortly after modified electroconvulsive therapy without worsening psychiatric symptoms.
机译：多系统萎缩症（MSA）是一种成人发作，罕见和进行性神经退行性疾病，其特征是自主神经功能衰竭，小脑性共济失调和帕金森综合症的不同组合。 MSA被归类为具有主要帕金森综合症的MSA-P，以及具有主要小脑特征的MSA-C。据报道，MSA的患病率为每10万人1.86至4.9例。相比之下，大约1％的人口在一生中会受到精神分裂症的影响;因此，MSA-P合并症在精神分裂症患者中非常罕见。但是，当抗精神病药治疗的精神分裂症患者发生帕金森病恶化或发展时，在鉴别帕金森病时必须考虑罕见的神经退行性疾病，包括MSA-P。一名60岁的慢性精神分裂症女性患者出现了MSA-P。在2011年前后，她主要接受了典型的抗精神病药物治疗，并出现尿失禁，夜间多尿和构音障碍。2014年，她出现了帕金森病症状加重和植物神经功能异常。尽管她的抗精神病药改用非典型抗精神病药并且剂量减少了，但帕金森病并没有得到改善。 2015年，改良的电抽搐疗法使症状略有改善;但是，她很快又回到了症状状态。心脏123I-间碘碘苄胍显像和123I-FP-CIT单光子发射计算机断层显像相结合，除了脑磁共振成像发现，还有助于将MSA-P与其他帕金森氏病源区分开。 L-多巴已开出处方，但她反应较差并于2016年春季死亡。该病例报告强调了在接受慢性精神分裂症抗精神病药物治疗的帕金森病鉴别诊断中考虑使用MSA-P的重要性。帕金森病恶化和进展的患者应考虑使用MSA-P，尤其是伴有自主神经功能障碍或小脑性共济失调的患者。尽管对MSA-P进行明确诊断需要尸检确认，但脑磁共振成像和核医学扫描相结合可能有助于将可疑的MSA-P与其他帕金森综合症区分开来。该病例还表明，对L-多巴反应较差的帕金森病MSA可能在改良的电惊厥治疗后不久改善，而不会恶化精神症状。

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