パーキンソン病

The Diagnosis and Indication for Surgical Treatment in Parkinson's Disease

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・パーキンソン病は振戦，筋強剛，無動・寡動，姿勢反射障害などの運動症状と，多様な非運動症状を呈する疾患である．

・2015年にMDS（International Parkinson and Movement Disorder Society）から新たな診断基準が提唱され，支持的基準の項目にMIBG心筋シンチグラフィと嗅覚検査が挙げられている．

・薬物治療は症状出現早期から開始することが推奨され，患者背景を考慮した薬剤選択が必要とされている．

・外科的治療のタイミングはwearing offやジスキネジアなどの運動合併症が出現し，かつon時のADLが保たれている時期が効果的である．

　Parkinson's disease（PD）, a neurodegenerative disorder is caused due to damage in the dopaminergic neurons of the substantia nigra, a part of the midbrain. The disease is characterized by motor symptoms such as tremor, rigidity, akinesia, and bradykinesia. PD is a systemic disease associated with non-motor manifestations such as autonomic neuropathy, depression, behavioral disorders, sleep disorders, cognitive dysfunction, and sensory disorders. Diagnosis of PD was based on the UK Parkinson's Disease Society Brain Bank clinical diagnostic criteria. However, new diagnostic criteria were recently proposed by the International Parkinson and Movement Disorder Society in 2015. This paper describes the diagnosis and drug therapies in Parkinson's disease and discusses the criteria and timing of surgical treatment for the advanced stage of Parkinson's disease.