免疫チェックポイント阻害剤に関連する神経筋疾患における電気生理学的発見
E Lainez1, A Llauradó2, M Gratacòs-Viñola1
1Department of Clinical Neurophysiology. Vall d'Hebron University Hospital. Passeig de la Vall d'Hebron, 119 Barcelona, Spain.
まとめ
免疫チェックポイント阻害剤 (ICI) 治療は神経筋疾患を引き起こす可能性があります. 骨髄炎はICIに関連する骨髄症/骨髄炎で一般的であり,骨髄病では非骨髄性ポリラジキュロネウロパシーが典型的である. 早期の電気診断は 極めて重要です
科学分野:
- 神経学
- 免疫学
- 腫瘍学
背景:
- 免疫チェックポイント阻害剤 (ICI) は,抗腫瘍免疫を回復する重要ながん治療法ですが,希少で重度の免疫関連の有害事象 (irAEs) を引き起こします.
- 神経学的IRA (n- IRA),特に神経,神経筋結節 (NMJ),および筋肉に影響を与える神経筋疾患は,最も頻繁であり,死亡リスクが最も高い.
- ICIに関連した神経筋肉の合併症の迅速な認識は,患者の管理に不可欠です.
研究 の 目的:
- ICIで治療された患者の神経筋疾患の臨床および電気診断の発見を特徴づける.
- ICI誘発のn-irAEsの神経疾患と神経筋結合/筋肉のフェノタイプを区別する.
主な方法:
- ICI治療後に電気診断評価を受けている,疑われるn- irAEsの38人の患者の遡及分析.
- 2つのフェノタイプに分類される: ir-神経病 (頭蓋骨/外周神経病,根性病) と ir-MG/筋炎 (筋症および/または筋炎).
- モーター/センサリー伝導の研究,F波,針のEMG,単一ファイバーのEMG,繰り返し刺激,および誘発的ポテンシャルを使用しました.
主要な成果:
- この研究では,27人 (71%) がIRMG/ myositis,11人 (29%) がIRNeuropathiesと診断されました.
- 自発的な活動を示す筋炎は,IR-MG/筋炎のグループ内で圧倒的なパターンでした.
- 急性感覚運動脱ミエリン性ポリラジキュロネウロパシーは,神経疾患の中で最も一般的であった.
結論:
- 筋炎は最も頻繁なIR-MG/筋炎パターンであり,脱ミエリン性ポリラジキュロネウロパシーがIR-ニューロパシーの特徴である.
- 神経筋結節機能障害はしばしば筋炎と共存し,電気生理学的評価では見過ごされることがあります.
- 電気診断は,ICIに関連する神経筋肉合併症の早期発見と効果的な管理に不可欠です.
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