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司徒醫生，俄勒岡/加州
司徒醫生手記：手抖與帕金森氏病
在神經內科，手抖和帕金森病很常見。
帕金森病，很常見，但不簡單
但它的原因，到今天也沒有搞清楚。有些人有家族史，但很多人並沒有。
這個病，診斷既容易，也不容易。
早年歐洲做過研究：就算是經驗很好的神經內科醫生，診斷準確率大概也隻有70%。
為什麽容易誤判？
1.手抖 不等於帕金森
但臨床上要問的第一件事是：是靜止時抖？還是拿東西、舉手時才抖？
2. 早期症狀，往往不典型
帕金森的典型表現包括：一側為主的震顫，動作變慢，走路變小步、身體前傾，寫字越來越小（小字症）。不是每個人一開始就有全部症狀。
3. 病人描述，常會“偏”
有的患者怕得帕金森 就盡量輕描淡寫，也有的人怕被漏診 ，反而誇大症狀。所以，醫生聽到的“故事”，不一定完全等於真實情況。
近十年來，有一個檢查：多巴胺轉運體掃描（DaTscan）。 大概敏感度90%；特異性 90%。 也就是說仍有約10%真正帕金森的檢查是陰性。 也有陽性的，但對藥物反應很差。所以Datscan是輔助工具，不是“判官”。
我在臨床上遵循這樣的程序：
第一條：不要急著確實。有些病，需要時間來顯示自己。
第二條：看“組合”，不是看單點症狀
如果一個人有手抖（而且一側明顯），走路變慢，寫字變小和動作變笨。診斷的把握就大很多。
第三條：盡量客觀化
我常建議：
1. 做 finger tapping（手指敲擊）速度記錄: “用拇指和食指，盡量張大，然後盡量快地把它們合在一起敲擊。每一下都要做大一點，不要做小動作。”
2. 錄像記錄走路姿態
3. 過段時間再對比
第四條：看藥物反應。如果對 左旋多巴（Levodopa） 有明顯反應：診斷的可信度可以大大提高（接近95%）
五、不隻是手抖
帕金森不隻是運動問題，還可能包括：便秘，頭暈，血壓不穩定，排尿問題，睡眠問題。通常需看別的專科醫生。
六、治療簡單說一句： 目前最核心的治療，仍然是多巴胺補充治療（如左旋多巴）。另外：腦深部電刺激（DBS），部分患者的手術選擇。這些通常在疾病中期才考慮，效果不太確定。
(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.