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司徒医生
司徒医生手记：手抖与帕金森氏病
在神经内科，手抖和帕金森病很常见。
帕金森病，很常见，但不简单
但它的原因，到今天也没有搞清楚。有些人有家族史，但很多人并没有。
这个病，诊断既容易，也不容易。
早年欧洲做过研究：就算是经验很好的神经内科医生，诊断准确率大概也只有70%。
为什么容易误判？
1.手抖 不等于帕金森
但临床上要问的第一件事是：是静止时抖？还是拿东西、举手时才抖？
2. 早期症状，往往不典型
帕金森的典型表现包括：一侧为主的震颤，动作变慢，走路变小步、身体前倾，写字越来越小（小字症）。不是每个人一开始就有全部症状。
3. 病人描述，常会“偏”
有的患者怕得帕金森 就尽量轻描淡写，也有的人怕被漏诊 ，反而夸大症状。所以，医生听到的“故事”，不一定完全等于真实情况。
近十年来，有一个检查：多巴胺转运体扫描（DaTscan）。 大概敏感度90%；特异性 90%。 也就是说仍有约10%真正帕金森的检查是阴性。 也有阳性的，但对药物反应很差。所以Datscan是辅助工具，不是“判官”。
我在临床上遵循这样的程序：
第一条：不要急着确实。有些病，需要时间来显示自己。
第二条：看“组合”，不是看单点症状
如果一个人有手抖（而且一侧明显），走路变慢，写字变小和动作变笨。诊断的把握就大很多。
第三条：尽量客观化
我常建议：
1. 做 finger tapping（手指敲击）速度记录: “用拇指和食指，尽量张大，然后尽量快地把它们合在一起敲击。每一下都要做大一点，不要做小动作。”
2. 录像记录走路姿态
3. 过段时间再对比
第四条：看药物反应。如果对 左旋多巴（Levodopa） 有明显反应：诊断的可信度可以大大提高（接近95%）
五、不只是手抖
帕金森不只是运动问题，还可能包括：便秘，头晕，血压不稳定，排尿问题，睡眠问题。通常需看别的专科医生。
六、治疗简单说一句： 目前最核心的治疗，仍然是多巴胺补充治疗（如左旋多巴）。另外：脑深部电刺激（DBS），部分患者的手术选择。这些通常在疾病中期才考虑，效果不太确定。
(2026-04-10)
In neurology, tremor and Parkinson’s disease are very common.
Parkinson’s disease is common—but not simple.
Its cause is still not fully understood. Some people have a family history, but many do not.
This disease is not easy to diagnose.
An earlier European study showed that even experienced neurologists had only about a 70% diagnostic accuracy.
Why is it often misdiagnosed?
1. Tremor ≠ Parkinson’s disease
The first clinical question is:
Is the tremor present at rest? Or only when holding or lifting something?
2. Early symptoms are often atypical
Typical Parkinson’s features include:
Unilateral tremor
Slowness of movement
Small-step gait, forward posture
Handwriting becoming smaller (micrographia)
But not everyone presents with all symptoms at the beginning.
3. Patient descriptions can be biased
Some patients fear Parkinson’s and minimize symptoms. Others fear missing a diagnosis and exaggerate symptoms. So the “story” the doctor hears is not always fully accurate.
About DaTscan
In the past decade, a test called dopamine transporter imaging (DaTscan) has been used.
Sensitivity: ~90%
Specificity: ~90%
This means: About 10% of true Parkinson’s cases can still test negative. Some positive cases may respond poorly to medication
So DaTscan is a supporting tool, not a final judge.
My Clinical Approach
1. Don’t rush the diagnosis
Some diseases need time to reveal themselves.
2. Look at the pattern, not a single symptom
If a patient has:
Tremor (especially unilateral)
Slower walking
Smaller handwriting
Clumsiness
Then diagnostic confidence increases significantly.
3. Try to make things objective
I often recommend:
1. Finger tapping test
“Use your thumb and index finger. Open as wide as possible, then tap them together as fast as possible. Make each movement large—don’t make small motions.”
2. Video recording of gait
3. Compare over time
4. Look at medication response
If there is a clear response to Levodopa, diagnostic confidence increases significantly (approaching ~95%).
5. It’s not just tremor
Parkinson’s is not only a motor disorder. It may also include:
Constipation
Dizziness
Blood pressure instability
Urinary issues
Sleep problems
Often requires involvement of other specialties.
6. Treatment (briefly)
The core treatment remains dopamine replacement therapy (e.g., Levodopa).
Additionally: Deep Brain Stimulation (DBS) and surgery may be considered in selected patients. These are usually considered in the mid-stage of the disease, and outcomes can vary.