免疫检查点抑制剂相关的神经肌肉事件的电生理学发现
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.
概括
免疫检查点抑制剂 (ICI) 治疗可能导致神经肌肉疾病. 肌炎在ICI相关的严重肌炎/肌炎中很常见,而在神经病变中则是典型的脱髓性多基隆性神经病变. 早期的电诊断评估至关重要.
科学领域:
- 神经学
- 免疫学
- 癌症学
背景情况:
- 免疫检查点抑制剂 (ICI) 是恢复抗瘤免疫力的重要癌症疗法,但可能导致罕见的,严重的免疫相关不良事件 (irAEs).
- 影响神经,神经肌肉结节 (NMJ) 和肌肉的神经肌肉疾病是最常见的,并带有最高的死亡风险.
- 及时识别这些ICI相关的神经肌肉并发症对于患者的治疗至关重要.
研究的目的:
- 描述ICI治疗患者的神经肌肉疾病的临床和电诊断结果.
- 区分ICI诱导的神经和神经肌肉结/肌肉表型.
主要方法:
- 在ICI治疗后进行电诊断评估的38名疑似n-irAEs患者的回顾性分析.
- 将其分为两种表型:ir-神经病 (头骨/外围神经病,骨干病) 和ir-MG/肌炎 (严重肌和/或肌炎).
- 使用运动/感觉传导研究,F波,针电磁图,单纤维电磁图,重复刺激,并唤起潜力.
主要成果:
- 这项研究包括38名患者:27名 (71%) 患有ir- MG/ myositis,11名 (29%) 患有ir- neuropathies.
- 在ir- MG/ myositis组中,表现出自发活动的肌肉炎是主要的模式.
- 在这些神经病症中,急性感官运动脱髓性多基隆性神经病是最常见的表现.
结论:
- 肌肉炎是最常见的IR-MG/肌肉炎模式,而非肌肉化多基隆性神经病则是IR-神经病的特征.
- 神经肌肉结位功能障碍经常与肌肉炎并存,在电生理学评估中可能会被忽视.
- 电诊断对于早期识别和有效管理ICI相关的神经肌肉并发症至关重要.
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