理学療法ジャーナル47巻12号

2013年12月発行

特集 神経筋疾患の治療と理学療法

筋疾患に対する治療と理学療法

著者： 若杉樹史¹ 山内真哉¹ 眞渕敏¹ 竹林崇¹ 児玉典彦¹ 道免和久²

所属機関： ¹兵庫医科大学病院リハビリテーション部 ²兵庫医科大学リハビリテーション医学教室

ページ範囲：P.1079 - P.1086

はじめに

　近年の筋疾患に対する新たな知見や治療方法の進歩はめざましい．われわれはそのような治療の変化に対応しながら，理学療法を展開していく必要がある．本稿では，神経筋接合部疾患の代表疾患である重症筋無力症（myasthenia gravis：MG），ランバート・イートン筋無力症候群（Lambert-Eaton myasthenic syndrome：LEMS）と，炎症性ミオパチーの代表疾患である多発性筋炎（polymyositis：PM），皮膚筋炎（dermatomyositis：DM）に対する治療を概説する．そのうえで，個々の疾患に出現する機能障害や，理学療法を実施していくうえでの運動負荷，留意点について解説する．

参考文献

1）Bennett RL, et al：Overwork weakness in partially denervated skeletal muscle. Clin Orthop 12：22-29, 1958

2）Peach PE：Overwork weakness with evidence of muscle damage in a patient with residual paralysis from polio. Arch Phys Med Rehabil 71：248-250, 1990

3）K Ming Chan, et al：Randomized controlled trial of strength training in post-polio patients. Muscle Nerve 27：332-338, 2003

4）Cup EH, et al：Exercise therapy and other types of physical therapy for patients with neuromuscular diseases：A systematic review. Arch Phys Med Rehabil 88：1452-1464, 2007

5）van der Kooi EL, et al：Strength training and aerobic exercise training for muscle disease. Cochrane Database Syst Rev. CD003907, 2005

6）Voet NB, et al：Strength training and aerobic exercise training for muscle disease. Cochrane Database Syst Rev. CD003907, 2013

7）Cejudo P, et al：Exercise training in mitochondrial myopathy：a randomized controlled trial. Muscle Nerve 32：342-350, 2005

8）van der Kooi EL, et al：Strength training and albuterol in facioscapulohumeral muscular dystrophy. Neurology 63：702-708, 2004

9）Lindeman E, et al：Strength training in patients with myotonic dystrophy and hereditary motor and sensory neuropathy：a randomized clinical trail. Arch Phys Med Rehabil 76：612-620, 1995

10）Benatar M, et al：Medical and surgical treatment for ocular myasthenia. Cochrane Database Syst Rev. CD005081, 2012

11）越智博文，他：2006年重症筋無力症全国臨床疫学調査．厚生労働省精神神経疾患委託研究，免疫性神経疾患報告集，pp139-143，2006

12）Vincent A, et al：Myasthenia gravis. Lancet 357：2122-2128, 2001

13）日本神経治療学会・日本神経免疫学会合同　神経免疫疾患治療ガイドライン委員会：神経免疫疾患治療ガイドライン，協和企画，2004

14）Skeie GO, et al：Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol 17：893-902, 2010

15）Gronseth GS, et al：Practice parameter：Thymectomy for autoimmune myasthenia gravis（an evidence-based review）：Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 55：7-15, 2000

16）Thymectory and Myasthenia Gravis, A Clinical Challenge（MGTX）.　https://mgtx.soph.uab.edu/MGTX/

17）Nagane Y, et al：Early aggressive treatment strategy against myasthenia gravis. Eur Neurol 65：16-22, 2011

18）Lambert EH, et al：Defect of neuromuscular conduction associated with malignant neoplasms. Am J Physiol 187：612-613, 1956

19）Eaton LM, et al：Electromyography and electric stimulation of nerves in disease of motor unit：observations on myasthenic syndrome associated with malignant tumors. J Am Med Assoc 163：1117-1124, 1957

20）Mareska M, et al：Lambert-Eaton myasthenic syndrome. Neurology 24：149-153, 2004

21）若杉樹史，他：Lambert-Eaton筋無力症候群患者の1症例．臨床理学療法研究28：83-85，2011

22）Maddison P, et al：Favourable prognosis in Lambert-Eaton myasthenic syndrome and small-cell lung carcinoma. Lancet 353：117-118, 1999

23）本村政勝，他：Lambert-Eaton筋無力症候群．Brain Medical 16：76-82，2004

24）Keogh M, et al：Treatment for Lambert-Eaton myasthenic syndrome. Cochrane Database Syst Rev. CD003279, 2011

25）若杉樹史，他：重症筋無力症クリーゼ症例の筋力改善の経過に着目した1症例．臨床理学療法研究29：61-63，2012

26）畑中裕己，他：神経反復刺激試験．臨床神経生理学39：169-176，2011

27）Symonette CJ, et al：Muscle strength and fatigue in patients with generalized myasthenia gravis. Muscle Nerve 41：362-369, 2010

28）Oh SJ, et al：Electrophysiological diagnostic criteria of Lambert-Eaton myasthenic syndrome. Muscle Nerve 32：515-520, 2005

29）Hatanaka Y, et al：Ten-second exercise is superior to 30-second exercise for post-exercise facilitation in diagnosing Lambert-Eaton myasthenic syndrome. Muscle Nerve 37：572-575, 2008

30）Strommen JA, et al：Neuromuscular rehabilitation and electrodiagnosis. 3. Diseases of muscles and neuromuscular junction. Arch Phys Med Rehabil 86：18-27, 2005

31）小野寺宏：重症筋無力症の治療とリハビリテーション．臨床リハ14：628-635，2005

32）Fregonezi GA, et al：Effects of 8-week, interval-based inspiratory muscle training and Breathing retraining in patients with generalized myasthenia gravis. Chest 128：1524-1530, 2005

33）Lohi EL, et al：Physical training effects in myasthenia gravis. Arch Phys Med Rehabil 74, 1993

34）Lucia A, et al：Double trouble（Mcardle's disease and myasthenia gravis）：how can exercise help? Muscle Nerve 35：125-128, 2007

35）Hafer-Macko CE：Multi-modal Exercise program for chronic stable myasthenia gravis　http://clinicaltrials.gov/show/NCT01047761

36）Berrouschot J, et al：Therapy of myasthenic crisis. Crit Care Med 25：1228-1235, 1997

37）Marino L（原著），稲田英一（監訳）：ICUブック，第3版，メディカル・サイエンス・インターナショナル，2008

38）Mier-Jedrzejowics AK, et al：Respiratory muscle function in myasthenia gravis. Am Rev Respir Dis 138：867-873, 1988

39）Schweickert WD, et al：Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest 140：1612-1617, 2011

40）千住秀明，他（監修）：呼吸理学療法標準手技，医学書院，2008

41）Wirtz PW, et al：Difference in distribution of muscle weakness between myasthenia gravis and the Lambert-Eaton myasthenic syndrome. J Neurol Neurosurg Psychiatry 73：766-768, 2002

42）Bohan A, et al：Polymyositis and dermatomyositis（first of two parts）. N Engl J Med 292：344-347, 1975

43）谷本潔昭，他：皮膚筋炎　多発性筋炎の改訂診断基準．厚生省特定疾患自己免疫疾患調査研究班平成4年度研究報告書，pp25-8，1993

44）山内真哉，他：亜急性期の筋炎患者に対する運動療法効果と運動負荷量の検討．理学療法学40：116-117，2013．

45）山内真哉，他：亜急性期の皮膚筋炎患者に対する運動療法における運動負荷量の検討．理学療法学38：114-120，2011

46）Schakman O, et al：Mechanisms of glucocorticoid-induced myopathy. J Endocrinol 197：1-10, 2008

47）Pereira RM, et al：Glucocorticoid-induced myopathy. Joint Bone Spine 78：41-44, 2011

48）Hicks JE, et al：Isometric exercise increases strength and does not produce sustained creatinine phosphokinase increases in a patient with polymyositis. J Rheumatol 20：1399-1401, 1993

49）Escalante A, et al：Resistive exercise in the rehabilitation of polymyositis/dermatomyositis. J Rheumatol 20：1340-1344, 1993

50）Wiesinger GF, et al：Benefit of 6 months long-term physical training in polymyositis/dermatomyositis patients. Br J Rheumatol 37：1338-1342, 1998

51）Wiesinger GF, et al：Improvement of physical fitness and muscle strength in polymyositis/dermatomyositis patients by a training programme. Br J Rheumatol 37：196-200, 1998

52）Alexanderson H, et al：Safety of a home exercise programme in patients with polymyositis and dermatomyositis：a pilot study. Rheumatology 38：608-611, 1999

53）Alexanderson H, et al：The safety of a resistive home exercise program in patients with recent onset active polymyositis or dermatomyositis. Scand J Rheumatol 29：295-301, 2000

54）Varjú C, et al：The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis. Clin Rehabil 17：83-87, 2003

55）Alexanderson H, et al：Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Arthritis Rheum 57：768-777, 2007

56）Chung YL, et al：Creatine supplements in patients with idiopathic inflammatory myopathies who are clinically weak after conventional pharmacologic treatment：Six-month, double-blind, randomized, placebo-controlled trial. Arthritis Rheum 57：694-702, 2007