著者

蕨 陽子 林 健太郎 森島 亮 井上 智之 清水 俊夫 高橋 一司

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.39, no.5, pp.799-802, 2022 (Released:2023-01-20)

参考文献数

8

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【目的】高齢COVID–19患者の回復期の摂食機能療法の効果と社会的意義について検討する.【方法】高齢者施設を感染経路とし,急性期治療後に当院へ転入院したCOVID–19連続14例の経過を後方視的に検討した.摂食機能療法は医師と看護師,理学療法士で開始し,隔離解除後に言語聴覚士が携わった.【結果】14例は年齢86±7(mean±SD, range 72–95)歳で,8例は認知症,2例は神経変性疾患を有した.COVID–19は86%で肺炎像を呈し,64%で酸素吸入を要した.発症から18.2±5.6(11–33)日経過した当院入院時,9例(63%)が摂食不能であった.入院後,5例は体力や意欲,認知機能が回復し摂食が回復したが,神経変性疾患2例は摂食嚥下機能が回復せず,認知症1例は先行期の問題が回復せず,残る1例は死亡した.【結論】神経変性疾患以外でCOVID–19から回復した高齢者の83%は摂食嚥下機能が回復した.神経難病診療を生かした隔離下での嚥下評価と摂食機能療法が高齢COVID–19患者の摂食嚥下機能回復に寄与し,予後の改善につながった.

著者

蕨 陽子

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.38, no.1, pp.14-19, 2021 (Released:2021-07-28)

参考文献数

39

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Coronavirus disease 2019 (COVID–19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2). This review summarizes the knowledge about SARS–CoV–2 immunology and discusses the policy of clinical practice for neuroimmune diseases at the time of the SARS–CoV–2 pandemic. The human defense systems against SARS–CoV–2 infection begin to work through innate immunity. Most neuroimmune diseases are caused by impairment of adaptive immunity, which preserves the function of innate immunity. Therefore, patients with neuroimmune diseases are not typically susceptible to COVID–19 and will not experience severe symptoms. However, patients with multiple sclerosis are at risk if their score on the Expanded Disability Status Scale is high. In the context of the COVID–19 pandemic, various neuroimmune disease practice guidelines have been published assessing the risk COVID–19 poses with each immunotherapeutic agent. Some immunotherapeutics may reduce immunity to viral infections. In particular, B–cell depletion therapy (rituximab, ocrelizumab, and inebilizumab) should be avoided because it can cause severe COVID–19 outcomes and decrease immune response to vaccination. On the other hand, some immunotherapeutics such as dexamethasone and tocilizumab may prevent severe COVID–19 symtpoms by suppressing cytokine storms. In most neuroimmune diseases, infection is known as a risk factor for acute exacerbation, so there is a risk of exacerbation of neuroimmune diseases by SARS–CoV–2 infection. In diseases such as myasthenia gravis, where respiratory function is impaired, COVID–19 has a high risk of being fatal. In addition to treatment of viral infections, these patients should be carefully monitored with immunotherapy. The efficacy and safety of COVID–19 vaccines in patients with neuroimmune diseases is still unclear and awaits further study.