著者
飯塚 高浩
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.35, no.3, pp.231-236, 2018 (Released:2018-12-25)
参考文献数
24

After the discovery of new class of autoantibodies against neuronal cell surface antigens and synaptic proteins (NSA–antibodies), the concept of encephalitis has dramatically changed. Encephalitis can be divided into infectious and autoimmune (non–infectious) groups. Autoimmune encephalitis (AE) may have autoantibodies against intracellular onconeuronal antigens (e.g. Hu, Yo, Ri, CV2/CRMP5, Ma2, amphiphysin) or NSA (e.g. NMDAR, AMAPAR, GABAaR, GABAbR, DPPX). Most of the former antibodies are not pathogenic but are used as a biomarker of classical paraneoplastic neurological syndromes, whereas IgG NSA–antibodies are more likely pathogenic, and the presence of the antibodies implies that patients may respond to immunotherapy. With infectious etiologies in mind previous diagnostic criteria for encephalitis has been made based on fever, mental status changes, inflammatory CSF, and brain MRI and EEG abnormalities ; however, these abnormalities may not be present in patients with NSA antibody–positive AE. Although early initiation of immunotherapy is often emphasized in AE, antibody testing is not readily accessible in most situation, thus initiation of immunotherapy may be delayed. Therefore, in 2016, a practical diagnostic approach to AE was proposed to achieve prompt immunotherapy at 3 levels of evidence for AE (possible, probable, and definite) with several new diagnostic criteria. A recent study showed that diffuse brain atrophy in anti–NMDAR encephalitis can be reversible and does not imply a poor clinical outcome. In contrast, cerebellar atrophy was irreversible and associated with a poor outcome. First–line immunotherapy can be started depending on the severity of patients with possible AE at early stage while excluding alternative diagnosis, but the second–line immunotherapy should be carefully used after confirming the NMDAR–antibodies in CSF with appropriate testing.In this lecture, I focus on anti–NMDAR encephalitis and talk about a potential pitfall in clinical diagnosis of the disease.

言及状況

外部データベース (DOI)

Twitter (2 users, 6 posts, 4 favorites)

#自己免疫性脳炎 飯塚 高浩先生 頭部MRIで #脱髄病変 を認める非典型例では #抗NMDAR脳炎 #脱髄重複症候群 である可能性があるため #抗MOG抗体 あるいは #AQP4抗体 を測定する必要がある 引用元… https://t.co/famGuRf70b
#自己免疫性脳炎 早期診断と早期治療の重要性 飯塚高浩先生 #海外で推奨されている治療薬 は本邦では #未承認 #適応外治療薬 であり施設毎に個別対応の現状 本邦でも有効治療薬が早期から適切に使用できるように切に希望する 引用… https://t.co/OyNvVceWRA
#自己免疫性脳炎 における早期診断と早期治療の重要性 飯塚高浩先生 最も遭遇する頻度の高い #抗NMDAR 脳炎に焦点を絞り診断と治療戦略について述べたが本邦では本疾患に対して #保険適応のある治療薬 はない 引用元… https://t.co/8m7U3Pu756
#自己免疫性脳炎 における早期診断と早期治療の重要性 飯塚 高浩先生 北里大学医学部神経内科学 #抗NMDAR脳炎 高度な意識障害が遷延するが, 腫瘍の早期切除と強力な #免疫療法 を併用することにより改善し得る疾患である 18… https://t.co/qhwXSD4cBJ

収集済み URL リスト