脆性X染色体相关震颤与共济失调综合征的诊断难点
- 作者: Krasakov I.V.1,2, Litvinenko I.V.2, Dyskin D.E.2
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隶属关系:
- Nikiforov All-Russian Center of Emergency and Radiation Medicine
- Military Medical Academy
- 期: 卷 43, 编号 4 (2024)
- 页面: 481-487
- 栏目: Discussion
- URL: https://ogarev-online.ru/RMMArep/article/view/275790
- DOI: https://doi.org/10.17816/rmmar636637
- ID: 275790
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全文:
详细
脆性X染色体相关震颤与共济失调综合征(FXTAS)是一种近期文献中描述的神经退行性疾病,由于医生对该病的认知不足,患者的检出率较低。其临床表现具有高度的表型变异性,并与其他更常见的运动障碍症状相似,因此患者常被长期误诊。本文探讨了FXTAS与特发性震颤、帕金森病、多系统萎缩、小脑脊髓性共济失调及进行性核上性麻痹的鉴别诊断问题。
为了展示诊断该疾病的复杂性,文章描述了一例基因确诊的FXTAS病例。该病例的临床表现包括:不对称的致残性姿势-运动性手部震颤、轻微的静止性震颤、中度小脑性共济失调、不对称的中度左旋多巴反应性帕金森综合征、轻度认知障碍及精神病性障碍。本文不仅详细描述了疾病的临床表现,还记录了患者的遗传史,包括其女儿的基因检测结果(FMR1基因前突变携带者)以及患有马丁-贝尔综合征的孙子。
本病例的特点在于患者长期被误诊为“帕金森病”,并接受了高剂量左旋多巴/卡比多巴(250 + 25毫克, 每天最多6片)的治疗。在查阅国内现有文献后,未发现其他已报道的FXTAS病例。
作者简介
Igor' V. Krasakov
Nikiforov All-Russian Center of Emergency and Radiation Medicine; Military Medical Academy
编辑信件的主要联系方式.
Email: krasakoviv@yandex.ru
ORCID iD: 0000-0001-6092-0659
SPIN 代码: 9891-8300
Scopus 作者 ID: 26642102200
Researcher ID: I-8865-2016
MD, Cand. Sci. (Medicine)
俄罗斯联邦, Saint Petersburg; Saint PetersburgIgor' V. Litvinenko
Military Medical Academy
Email: litvinenkoiv@rambler.ru
ORCID iD: 0000-0001-8988-3011
SPIN 代码: 6112-2792
Scopus 作者 ID: 35734354000
Researcher ID: F-9120-2013
MD, Dr. Sci. (Medicine), Professor
俄罗斯联邦, Saint PetersburgDmitriy E. Dyskin
Military Medical Academy
Email: drabovsk@mail.ru
ORCID iD: 0000-0002-2855-2953
SPIN 代码: 6662-9481
Scopus 作者 ID: 6602481680
Researcher ID: J-3336-2016
MD, Dr. Sci. (Medicine), Associate Professor
俄罗斯联邦, Saint Petersburg参考
- Hagerman RJ, Leehey M, Heinrichs W, et al. Intention tremor, parkinsonism, and generalized brain atrophy in male carriers of fragile X. Neurology. 2001;57(1):127–130. doi: 10.1212/wnl.57.1.127
- Hall DA, Berry-Kravis E, Jacquemont S, et al. Initial diagnoses given to persons with the fragile X associated tremor/ataxia syndrome (FXTAS). Neurology. 2005;65(2):299–301. doi: 10.1212/01.wnl.0000168900.86323.9c
- Gamisoniya AM. Sindrom lomkoj X-hromosomy. GENOKARTA Geneticheskaya enciklopediya 2019. Available from: https://www.genokarta.ru/disease/Sindrom_lomkoj_X_hromosomy (In Russ.)
- Hagerman PJ, Hagerman RJ. Fragile X-associated tremor/ataxia syndrome — an older face of the fragile X gene. Nat Clin Pract Neurol. 2007;3(2):107–112. doi: 10.1038/ncpneuro0373
- Johnson K, Herring J, Richstein J. Fragile X Premutation Associated Conditions (FXPAC). Front Pediatr. 2020;8:266. doi: 10.3389/fped.2020.00266
- Pereverzeva DS, Tyushkevich SA, Gorbachevskaia NL, et al. Heterogeneity of clinical characteristics of FMR1-related disorders. S.S. Korsakov Journal of Neurology and Psychiatry. 2019;119(7): 103–111. EDN: CHAHKE doi: 10.17116/jnevro2019119071103
- Cabal-Herrera AM, Tassanakijpanich N, Salcedo-Arellano MJ, Hagerman RJ. Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): Pathophysiology and Clinical Implications. Int J Mol Sci. 2020;21(12):4391. doi: 10.3390/ijms21124391
- Orsucci D, Lorenzetti L, Baldinotti F, et al. Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): A Gender Perspective. J Clin Med. 2022 Feb 15;11(4):1002. doi: 10.3390/jcm11041002
- Salcedo-Arellano MJ, Cabal-Herrera AM, Tassanakijpanich N, et al. Ataxia as the Major Manifestation of Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): Case Series. Biomedicines. 2020;8(5):136. doi: 10.3390/biomedicines8050136
- Islam F, Lee W. A Case of Generalized Chorea Presenting as an Early Feature of Fragile-X Associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract. 2020;7(4):464–466. doi: 10.1002/mdc3.12944
- Gaillard F, Campos A, Hacking C, et al. Fragile X-associated tremor/ataxia syndrome. Reference article. Radiopaedia.org (Accessed on 21 Sep 2024). doi: 10.53347/rID-1359
- Robertson EE, Hall DA, McAsey AR, O’Keefe JA. Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders. Clin Neuropsychol. 2016;30(6):849–900. doi: 10.1080/13854046.2016.1202239
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