若年性パーキンソン病を合併した統合失調症患者の1例—123I-MIBG心筋シンチグラフィー(心筋MIBG)・123I-Ioflupane SPECT(DaTSCAN)の検討

A Patient of Schizophrenia with Juvenile Parkinson's Disease.: The evaluation of 123I-MIBG myocardial scintigrapy and 123I-Ioflupane SPECT(DaTSCAN)image

抄録　統合失調症の治療は現在もドパミンD₂受容体遮断作用を有する薬剤が主体で，精神科領域でのパーキンソニズムは一般的な神経症状である。パーキンソン病(PD)は，65歳以上の有病率は約1%と言われており，初老期以降の統合失調症患者でPDの合併に注意が必要である。一方若年性PDの有病率は40歳以前で0.00001%以下ときわめて低いため，成人早期の統合失調症患者に合併した際に，PDの診断・治療が遅れる恐れがある。今回，発症から約10年の経過を経て心筋MIBG，DaTSCANでのPDの診断が確定し，ドパミン補充療法にて精神・運動症状の顕著な改善を認めた43歳の統合失調症症例を経験した。その症状・経過とともに黒質線条体神経系の変性に関連のあるPD様症状も検討した。

　Schizophrenic patients are generally treated with the medication that has the effect of dopamine D2-receptor blockade. Parkinsonism is deemed a most common neurological complication in the psychiatric field. Furthermore, it is estimated that the prevalence of Parkinson's disease(PD)onset over 65 years is about 1%. Therefore, we should pay attention to the co-existence of schizophrenia and PD. Conversely, the prevalence of juvenile PD onset under 40 years is very low, which is under 0.00001%. Consequently, the diagnosis and the treatment for schizophrenic patients with juvenile PD might be delayed. I recently experienced a 43-year-oldr schizophrenic patient who suffered from parkinsonism over about ten years. ¹²³I-MIBG myocardial scintigrapy and ¹²³I-Ioflupne SPECT(DaTSCAN)imaging disclosed PD. I treated with dopamine supplement therapy. As a result, the patient made a remarkable recovery from psychiatric and motor symptoms. In this paper, I described the symptoms and clinical course of a case of schizophrenic patient with juvenile PD, including the evaluation of parkinsonism related with degeneration of the nigro-striatal system.