BRAIN and NERVE－神経研究の進歩74巻5号

2022年05月発行

増大特集 次の一手—神経筋疾患難治例をどのように治療するか

ステロイドパルス・IVIgで回復が思わしくない抗NMDAR脳炎—セカンドライン免疫療法と予後予測

著者： 木村暁夫¹

所属機関： ¹岐阜大学大学院医学系研究科脳神経内科学分野

ページ範囲：P.443 - P.448

文献概要

多くの抗NMDAR脳炎患者では，ステロイドパルス療法，免疫グロブリン大量静注療法，血漿交換療法といったファーストライン免疫療法と，卵巣奇形腫合併例では腫瘍切除により，症状は緩徐に改善する。一方，リツキシマブやシクロホスファミドといったセカンドライン免疫療法の追加が必要となる患者も少なからず存在する。本論では，主にどのような患者に対して，どのタイミングでセカンドライン免疫療法を考慮すべきか，文献とわれわれの治療経験に基づき考察する。

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