理学療法ジャーナル47巻12号

2013年12月発行

特集 神経筋疾患の治療と理学療法

パーキンソン病に対する深部脳刺激術と理学療法

著者： 堀場充哉¹ 岡雄一² 山下豊¹ 佐橋健斗¹ 田中照洋¹ 坪井理佳¹ 藤井園子¹ 清水陽子¹ 梅村淳³ 和田郁雄¹

所属機関： ¹名古屋市立大学病院リハビリテーション部 ²名古屋市立大学医学研究科脳神経外科学 ³順天堂大学医学部附属順天堂医院脳神経外科運動障害疾患病態研究・治療講座

ページ範囲：P.1069 - P.1077

パーキンソン病の概念

　パーキンソン病（Parkinson disease：PD）は，振戦，固縮，無動，姿勢反射障害を4徴候とする進行性の錐体外路系疾患である．黒質ドパミンニューロンの変性脱落は，運動症状発現の5～7年前から始まり，神経細胞数が40～60％まで減少すると運動症状が発現する^1,2）．

　近年，Braak仮説^3）が提唱され，PDの病理変化は嗅球から始まり，その進行は脳幹や延髄へ上行し，中脳黒質や視床下部，前脳へと広がり，新皮質に至るとされている．このように，迷走神経背側核，嗅球，縫線核や青斑核などの障害は黒質のドパミンニューロンの障害以前に出現することから，運動症状の出現以前に，慢性便秘，rapid eye movement（REM）睡眠行動異常，嗅覚障害，抑うつといった前駆症状，記憶，認知機能障害，情動障害，自律神経障害など多くの非運動症状も注目されている．

参考文献

1）Fearnley JM, et al：Ageing and Parkinson's disease：substantia nigra regional selectivity. Brain 114：2283-2301, 1991

2）Jankovic J：Progression of Parkinson disease：are we making progress in charting the course? Arch Neurol 62：351-352, 2005

3）Braak H, et al：Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging 24：197-211, 2003

4）Hely MA, et al：The Sydney multicenter study of Parkinson's disease：the inevitability of dementia at 20 years. Mov Disord 23：837-844, 2008

5）Ganga G, et al：Longitudinal study of levodopa in Parkinson's disease：effects of the advanced disease phase. Mov Disord 28：476-481, 2013

6）Fahn S, et al：Parkinson Study Group. Levodopa and the progression of Parkinson's disease. N Engl J Med 351：2498-2508, 2004

7）Calabresi P, et al：Levodopa-induced dyskinesias in patients with Parkinson's disease：filling the bench-to-bedside gap. Lancet Neurol 9：1106-1117, 2010

8）Ondo WG, et al：Selegiline orally disintegrating tablets in patients with Parkinson disease and“wearing off”symptoms. Clin Neuropharmacol 30：295-300, 2007

9）Crosby N, et al：Amantadine in Parkinson's disease. Cochrane Database Syst Rev：CD003468, 2003

10）Mallet N, et al：Cortical inputs and GABA interneurons imbalance projection neurons in the striatum of parkinsonian rats. J Neurosci 26：3875-3884, 2006

11）Moro E, et al：Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease. Mov Disord 25：578-586, 2010

12）Bejjani, BP, et al：Axial parkinsonian symptoms can be improved：the role of levodopa and bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 68：595-600, 2000

13）Yamada K, et al：Effect of bilateral subthalamic nucleus stimulation on levodopa-unresponsive axial symptoms in Parkinson's disease. Acta Neurochir（Wien）150：15-22, 2008

14）St George RJ, et al：A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD. Neurology 75：1292-1299, 2010

15）Umemura A, et al：Predictive factors affecting early deterioration of axial symptoms after subthalamic nucleus stimulation in Parkinson's disease. Parkinsonism Relat Disord 16：582-584, 2010

16）Fasano A, et al：Motor and cognitive outcome in patients with Parkinson's disease 8 years after subthalamic implants. Brain 133：2664-2676, 2010

17）Witt K, et al：Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson‘s disease：a randomised, multicentre study. Lancet Neurol 7：605-614, 2008

18）Yamanaka T, et al：Temporary deterioration of executive function after subthalamic deep brain stimulation in Parkinson's disease. Clin Neurol Neurosurg 114：347-351, 2012

19）Voon V, et al：Deep brain stimulation：neuropsychological and neuropsychiatric issues. Mov Disord 14：Suppl S305-27, 2006

20）Jankovic J, et al：Variable expression of Parkinson's disease：a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology 40：1529-1534, 1990

21）Michal/owska M, et al：Falls in Parkinson's disease. Causes and impact on patients' quality of life. Funct Neurol 20：163-168, 2005

22）Schaafsma JD, et al：Characterization of freezing of gait subtypes and the response of each to levodopa in Parkinson's disease. Eur J Neurol 10：391-398, 2003

23）Giladi N, et al：Freezing phenomenon in patients with parkinsonian syndromes. Mov Disord 12：302-305, 1997

24）Mitoma H, et al：24-hour recording of parkinsonian gait using a portable gait rhythmogram. Intern Med 49：2401-2408, 2010

25）Utsumi H, et al：. Quantitative assessment of gait bradykinesia in Parkinson's disease using a portable gait rhythmogram. Acta Med Okayama 66：31-40, 2012

26）Horak FB, et al：The Balance Evaluation Systems Test（BESTest）to differentiate balance deficits. Phys Ther 89：484-498, 2009

27）Bloch F, et al：Parkinson's disease with camptocormia. J Neurol Neurosurg Psychiatry 77：1223-1228, 2006

28）Furusawa Y, et al：Role of the external oblique muscle in upper camptocormia for patients with Parkinson's disease. Mov Disord 27：802-803, 2012

29）Takakusaki K, et al：Role of basal ganglia-brainstem pathways in the control of motor behaviors. Neurosci Res 50：137-151, 2004

30）Karachi C, et al：Cholinergic mesencephalic neurons are involved in gait and postural disorders in Parkinson disease. J Clin Invest 120：2745-2754, 2010

31）高草木薫，他：運動下行路―網様体脊髄路．Clin Neurosci 27：752-756，2009

32）Giladi N, et al：Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord 6：165-170, 2000

33）日本神経学会ホームページ：パーキンソン病治療ガイドライン2011　http://www.neurology-jp.org/guidelinem/pdgl/sinkei_pdgl_2011_12.pdf（2013年9月15日アクセス）

34）Nieuwboer A, et al：Cueing training in the home improves gait-related mobility in Parkinson's disease：the RESCUE trial. J Neurol Neurosurg Psychiatry 78：134-140, 2007

35）Arias P, et al：Effect of rhythmic auditory stimulation on gait in parkinsonian patients with and without freezing of gait. PLoS One 5：e9675, 2010

36）Frazzitta G, et al：Rehabilitation treatment of gait in patients with Parkinson's disease with freezing：a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training. Mov Disord 24：1139-1143, 2009

37）Cubo E, et al：Short-term and practice effects of metronome pacing in Parkinson's disease patients with gait freezing while in the 'on' state：randomized single blind evaluation. Parkinsonism Relat Disord 10：507-510, 2004

38）Vandenbossche J, et al：Freezing of gait in Parkinson disease is associated with impaired conflict resolution. Neurorehabil Neural Repair 25：765-773, 2011

39）Doherty KM, et al：Postural deformities in Parkinson's disease. Lancet Neurol 10：538-549, 2011

40）Wunderlich S, et al：Camptocormia in Parkinson's disease mimicked by focal myositis of the paraspinal muscles. Mov Disord 17：598-600, 2002

41）Furusawa Y, et al：Role of the external oblique muscle in upper camptocormia for patients with Parkinson's disease. Mov Disord 27：802-803, 2012

42）Azher SN, et al：Camptocormia：pathogenesis, classification, and response to therapy. Neurology 65：355-359, 2005

43）von Coelln R, et al：Ultrasound-guided injection of the iliopsoas muscle with botulinum toxin in camptocormia. Mov Disord 23：889-892, 2008

44）Tassorelli C, et al：Pisa syndrome in Parkinson's disease：clinical, electromyographic, and radiological characterization. Mov Disord 27：227-235, 2012

45）Vitale C, et al：Vestibular impairment and adaptive postural imbalance in parkinsonian patients with lateral trunk flexion. Mov Disord 26：1458-1463, 2011

46）Santamato A, et al：Botulinum toxin type A and a rehabilitation program in the treatment of Pisa syndrome in Parkinson's disease. J Neurol 257：139-141, 2010

47）Wright WG, et al：Axial kinesthesia is impaired in Parkinson's disease：effects of levodopa. Exp Neurol 225：202-209, 2010

48）Smania N, et al：Effect of balance training on postural instability in patients with idiopathic Parkinson's disease. Neurorehabil Neural Repair 24：826-834, 2010

49）Mak MK, et al：Cued task-specific training is better than exercise in improving sit-to-stand in patients with Parkinson's disease：A randomized controlled trial. Mov Disord 23：501-509, 2008

50）Cakit BD, et al：The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease. Clin Rehabil 21：698-705, 2007

51）Protas EJ, et al：Gait and step training to reduce falls in Parkinson's disease. NeuroRehabilitation 20：183-190, 2005

52）Li F, et al：Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med 366：511-519, 2012

53）Reuter I, et al：Effects of a flexibility and relaxation program, walking, and Nordic walking on Parkinson's disease. J Aging Res：232473, 2011

54）Allen NE, et al：Balance and falls in Parkinson's disease：a meta-analysis of the effect of exercise and motor training. Mov Disord 26：1605-1615, 2011