手のふるえをおこす病気

2015年8月18日号

高安奈津子(高安クリニック)

 手がふるえるという症状は日常的に見るものではないため、怖い病気ではないかと不安になる方も多いと思います。
 脳卒中ではないかと心配されて受診される方がいらっしゃいますが、脳卒中の症状として手のふるえが出てくることもありうる(小脳や中脳、視床などが病巣の場合)ものの、通常は強いめまいや複視などほかの症状をともないます。症状が手のふるえのみであれば脳卒中をおこしていることは非常に稀です。手がふるえる症状でもっとも多いと思われるものは、本態性振戦です。ある種の遺伝的素因で発症すると考えられています。原因は成人期から発症しますが高齢になるとふるえが顕著になり、手や首、声などがふるえます。発症時期を本人も覚えていないことが多いです。わずらわしい症状ですが、日常生活に大きな支障がなければ薬を服用する必要がない場合もあります。処方は降圧薬であるβ遮断薬のほか、抗てんかん薬、抗不安薬などを用いるほか、重症の場合手術療法も考慮されます。
 次に、パーキンソン病という病気があります。中脳の黒質細胞の変性と脱落が主な病理学的所見です。脳の錐体外路系に障害がおきるため、運動の調節が困難になります。パーキンソン病のふるえはほぼ右左どちらかに強く、下肢のふるえも見られますが、特徴的な表情や歩き方などが見られれば比較的容易に診断できます。最近認知度が高まってきたレビー小体型認知症はパーキンソン病と症状が似ており、手のふるえもみられますが、認知症と幻視をともなうのが特徴です。ほかに、パーキンソン病ではないものの同様の症状がでるものをパーキンソン症候群と呼んでいます。脳血管障害によるものや薬剤によるものなどがあります。その他、手のふるえを起こす疾患としては甲状腺機能亢進症、社会不安障害、その他の不随意運動などさまざまな疾患があります。

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 ちなみに、漢方でもふるえに対する処方が色々あります。日本の場合例えば「抑肝散加厚朴芍薬」などが有名です。半側顔面けいれんなどにも応用されます。