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摘要


震顫(tremor)是最常見的不自主運動障礙。它可以是單一存在的症狀或是其他運動障礙疾病的症狀之一。例如:肌張力不全症(dystonia disorder),帕金森式症(Parkinson disease),脊髓小腦步態失調症(spinocerebellal ataxia)…等。震顫的特點是:不自主且有節奏的肌肉收縮,引起身體特定部位或數個部位的來回振動現象。震顫之命名,最常用的方式是依據身體在何種姿態發生震顫而命名,如:靜態性震顫(rest tremor),姿態性震顫(postural tremor),或動態性震顫(kinetic tremor)。震顫的分類,常依不同之臨床特徵和病因加以區分,包括原發性震顫(essential tremor)、帕金森式震顫(Parkinsonian tremor)、小腦震顫(cerebellar tremor)、肌張力不全震顫(dystonic tremor)、身體直立性震顫(orthostatic tremor)、生理性震顫(Physiologic tremor)及精神性震顫(psychogenic tremor)。震顫的診斷必需要有詳實的病史(包括家族遺傳、藥物使用,或飲酒成癮或戒斷史)、完整的神經檢查及必要之實驗室檢驗以確定診斷。臨床上也可使用肌電圖或表面肌電圖(surface EMG)記錄震顫的頻率及振幅來協助震顫之分類。震顫之治療,依震顫分類而採不同的治療方針,可依序使用藥物,肉毒桿菌毒素(botulinum toxin),外科燒灼手術,或深部大腦電刺激(deep brain stimulation, DBS)治療等。

並列摘要


Tremor is the most common involuntary movement disorder. It can be an isolated symptom or a symptom of another neurological disorder, such as dystonia, Parkinson disease, spinocerebellar ataxia et al. It is an unintentional, somewhat rhythmic, muscle movement involving to-and-fro movements of one or more parts of the body. It can affect the hands, arms, head, vocal cord, jaw, chin, and legs. Most tremors occur in the hands. Clinically, the most useful way to categorized tremor is whether it occurs mainly at rest, on postural, or during movement (kinetic tremor). Tremor is most common classified by different clinical features and cause or origin; include essential tremor, Parkinsonian tremor, cerebellar tremor, dystonic tremor, orthostatic tremor, physiologic tremor, and psychogenic tremor. Diagnosis need a detail history (include familial inheritance, drugs exposure, alcohol consumption or withdraw); complete physical examination and laboratory tests. Electromyography is also a simple and quick method with which to calculate tremor frequency and amplitude for assisting diagnosis. Treatment for majority of tremor syndrome is purely symptomatic, and is similar regardless of the underlying cause of the tremor. There are different medicines to try in order propranolol, clonazepam, primidome and gabapentin for limb tremors, or trihexyphenidyl for dystonic tremor. Focal botulinum toxin injection may be help in focal tremor. Neurosurgery is only indicated in severe tremor, such as deep brain stimulation (DBS) of subthalamic nucleus for primary or secondary parkinsonian tremor.

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