RESUMO
Parkinsonism is a rare feature of immunological diseases. We describe a 67-year-old man with Caplan's syndrome (CS) and parkinsonism. CS is an immunologic disease characterised by the presence of rheumatoid arthritis associated with a specific form of pneumoconiosis. Parkinsonism as a manifestation of involvement of the central nervous system in this condition has never been reported. Following immunosuppressive treatment both the CS and the parkinsonian signs and symptoms showed a marked improvement. The role of immune mechanisms in these parkinsonian syndromes is discussed.
Assuntos
Encéfalo/patologia , Encéfalo/fisiopatologia , Síndrome de Caplan/complicações , Síndrome de Caplan/imunologia , Encefalite/imunologia , Doença de Parkinson/imunologia , Idoso , Anti-Inflamatórios/uso terapêutico , Atrofia/diagnóstico , Atrofia/imunologia , Atrofia/fisiopatologia , Encéfalo/imunologia , Síndrome de Caplan/tratamento farmacológico , Encefalite/tratamento farmacológico , Encefalite/fisiopatologia , Humanos , Imunossupressores/uso terapêutico , Pulmão/imunologia , Pulmão/patologia , Pulmão/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Silicose/complicações , Resultado do TratamentoRESUMO
The aim of the study was to determine the clinical frequency and features of REM sleep behaviour disorder (RBD) in a large population of Parkinson's disease (PD) patients using defined diagnostic criteria both for RBD and PD. Six trained neurologists used a semistructured questionnaire based on ICSD-R diagnostic criteria for RBD to evaluate 200 PD patients and their caregivers. Interobserver reliability for the diagnosis of RBD was "substantial" (Kappa 0.65). Five patients were excluded from the study because of an MMSE lower than 25. The demographic and PD clinical features were compared in the clinically defined RBD group and in those without RBD (NRBD). Then the RBD features during the last year were analysed in the affected group. Out of 195 patients, 66 fulfilled the ICSD-R criteria for RBD; 62 patients reported RBD during the last year (frequency 31.8%). RBD features: two or more episodes per week in 35.5%; upper limb movements in 87%; lower limb movements in 79%; vocalisations during events in 85%. RBD onset was before PD in 27% of patients; 69% of the RBD group had injured themselves or their caregivers during sleep. According to multivariate analysis, RBD was associated with male gender, age and PD duration. Brief training and the use of a semistructured questionnaire may help the neurologist in dealing with sleep disturbances in PD patients. The search for RBD symptoms in PD is highly recommended, especially in patients with a long disease duration, the risk of sleep-related injuries being high.
