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特集 傍腫瘍性神経筋疾患update
抗NMDA受容体脳炎に関する最新の知見
著者： 飯塚高浩1 坂井文彦2 望月秀樹1
所属機関： 1北里大学医学部神経内科学 2国際頭痛センター新百合ヶ丘
ページ範囲：P.331 - P.338
文献概要
はじめに
近年，voltage-gated potassium channel（VGKC），N-methyl-D-aspartic acid（NMDA）受容体，α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid（AMPA）受容体，γ-aminobutyric acid (GABA) B受容体など各種神経細胞表面抗原に対する抗体を介して発症する新しいカテゴリーの自己免疫性脳炎が提唱されている1－5）。抗NMDA受容体脳炎はその代表的な疾患であり，現在では本邦でも稀な疾患ではないと考えられている6）。本疾患の臨床症状，検査所見，病態，治療については本誌の60巻9号7）に既に述べているが，本稿ではこの1年間に報告された新しい知見を含め最新情報を述べる。
近年，voltage-gated potassium channel（VGKC），N-methyl-D-aspartic acid（NMDA）受容体，α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid（AMPA）受容体，γ-aminobutyric acid (GABA) B受容体など各種神経細胞表面抗原に対する抗体を介して発症する新しいカテゴリーの自己免疫性脳炎が提唱されている1－5）。抗NMDA受容体脳炎はその代表的な疾患であり，現在では本邦でも稀な疾患ではないと考えられている6）。本疾患の臨床症状，検査所見，病態，治療については本誌の60巻9号7）に既に述べているが，本稿ではこの1年間に報告された新しい知見を含め最新情報を述べる。
参考文献
1) Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, et al: Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 61: 25-36, 2007
2) Tüzün E, Dalmau J: Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist 13: 261-271, 2007
3) Graus F, Saiz A, Lai M, Bruna J, López F, et al: Neuronal surface antigen antibodies in limbic encephalitis: clinical-immunologic associations. Neurology 71: 930-936, 2008
4) Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, et al: AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol 65: 424-434, 2009
5) Lancaster E, Lai M, Peng X, Hughes E, Constantinescu R, et al: Antibodies to the GABA (B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol 9: 67-76, 2009
6) 飯塚高浩: 臨床症候からみた抗NMDA受容体脳炎の病態. 最新医学64: 1536-1544, 2009
7) 飯塚高浩, 坂井文彦: 抗NMDA受容体脳炎―臨床徴候とその病態生理. Brain Nerve 60: 1047-1060, 2008
8) Nokura K, Yamamoto H, Okawara Y, Koga H, Osawa H, et al: Reversible limbic encephalitis caused by ovarian teratoma. Acta Neurol Scand 95: 367-373, 1997
9) Okamura H, Oomori N, Uchitomi Y: An acutely confused 15-year-old girl. Lancet 350: 488, 1997
10) Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, et al: Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol 58:594-604, 2005
11) Kawaguchi K, Kishida S, Okeda R, Funata N, Koike M: Encephalomyeloneuritis with mediastinal germ cell tumor. A paraneoplastic condition? Acta Pathol Jpn 38: 351-359, 1988
12) Iizuka T, Sakai F, Ide T, Monzen T, Yoshii S, et al: Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal. Neurology 70: 504-511, 2008
13) Ishiura H, Matsuda S, Higashihara M, Hasegawa M, Hida A, et al: Response of anti-NMDA receptor encephalitis without tumor to immunotherapy including rituximab. Neurology 71: 1921-1923, 2008
14) Novillo-López ME, Rossi JE, Dalmau J, Masjuan J: Treatment-responsive subacute limbic encephalitis and NMDA receptor antibodies in a man. Neurology 70: 728-729, 2008
15) Wilder-Smith EP, Ng ES: The writing on the wall. Lancet 372: 344, 2008
16) Eker A, Saka E, Dalmau J, Kurne A, Bilen C, et al: Testicular teratoma and anti-N-methyl-D-aspartate receptor-associated encephalitis. J Neurol Neurosurg Psychiatry 79: 1082-1083, 2008
17) 亀井 聡: 若年女性に好発する急性非ヘルペス性脳炎（Acute juvenile female non-herpetic encephalitis: AJFNHE). 神経進歩48: 827-836, 2004
18) 飯塚礼二, 小林義康: 急性瀰漫性リンパ球髄膜脳炎および脳症の病理. 神経進歩8: 417-426, 1964
19) Kamei S, Kuzuhara S, Ishihara M, Morita A, Taira N, et al: Nationwide survey of acute juvenile female non-herpetic encephalitis in Japan: relationship to anti-N-methyl-d-aspartate receptor encephalitis. Intern Med 48: 673-679, 2009
20) Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, et al: Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 7: 1091-1098, 2008
21) Tower J, Malkin M, Rathke S, Novoa-Takara L, Ho Khang-cheng: Fatal anti-NMDA receptor paraneoplastic encephalitis due to microscopic ovarian teratoma. Neurology 72(Suppl 3): A26, 2009
22) Florance NR, Davis RL, Lam C, Szperka C, Zhou L, et al: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 66: 11-18, 2009
23) Niehusmann P, Dalmau J, Rudlowski C, Vincent A, Elger CE, et al: Diagnostic value of N-methyl-D-aspartate receptor antibodies in women with new-onset epilepsy. Arch Neurol 66: 458-464, 2009
24) Lee A, Glick DB, Dinwiddie SH: Electroconvulsive therapy in a pediatric patient with malignant catatonia and paraneoplastic limbic encephalitis. J ECT 22: 267-270, 2006
25) Kleinig TJ, Thompson PD, Matar W, Duggins A, Kimber TE, et al: The distinctive movement disorder of ovarian teratoma-associated encephalitis. Mov Disord 23: 1256-1261, 2008
26) 飯塚高浩: 抗NMDA受容体脳炎の異常運動. Brain Medical 20: 243-255, 2008
27) Seki M, Suzuki S, Iizuka T, Shimizu T, Nihei Y, et al: Neurological response to early removal of ovarian teratoma in anti-NMDAR encephalitis. J Neurol Neurosurg Psychiatry 79: 324-326, 2008
28) Iizuka T, Yoshii S, Ide T, Hamada J, Kan S, et al: Reversible brain atrophy in anti-NMDA receptor encephalitis: a long-term observational study. Neurology 72(Suppl 3): A27-A28, 2009
29) Stone JM, Morrison PD, Pilowsky LS: Glutamate and dopamine dysregulation in schizophrenia--a synthesis and selective review. J Psychopharmacol 21: 440-452, 2007
30) Gardoni F, Picconi B, Ghiglieri V, Polli F, Bagetta V et al: A critical interaction between NR2B and MAGUK in L-DOPA induced dyskinesia. J Neurosci 26: 2914-2922, 2006
31) Konitsiotis S, Tsironis C, Kiortsis DN, Evangelou A: Effects of N-methyl-D-aspartate receptor antagonism on neuroleptic-induced orofacial dyskinesias. Psychopharmacology (Berl) 185: 369-377, 2006
32) Nash JE, Ravenscroft P, McGuire S, Crossman AR, Menniti FS, et al: The NR2B-selective NMDA receptor antagonist CP-101,606 exacerbates L-DOPA-induced dyskinesia and provides mild potentiation of anti-parkinsonian effects of L-DOPA in the MPTP-lesioned marmoset model of Parkinson's disease. Exp Neurol 188: 471-479, 2004
33) 内野彰子, 飯塚高浩, 浦野義章, 由井進太郎, 濱田潤一, 他: 発症早期に腫瘍切除した抗NMDA受容体脳炎の1例. Neuroinfection 14: 157(abstract), 2009
34) Sansing LH, Tüzün E, Ko MW, Baccon J, Lynch DR, et al: A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol 3: 291-296, 2007
35) Tüzün E, Zhou L, Baehring JM, Bannykh S, Rosenfeld MR, et al: Evidence for antibody-mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratoma. Acta Neuropathol August 14 2009［Epub ahead of print］
36) Ishiura H, Matsuda S, Higashihara M, Hasegawa M, Hida A, et al: Response of anti-NMDA receptor encephalitis without tumor to immunotherapy including rituximab. Neurology 71: 1921-1923, 2008
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