特集 神経疾患治療の進歩 2017
自律神経疾患の治療の進歩
キーワード:
orthostatic hypotension,
postural tachycardia syndrome,
urinary disturbance,
constipatioin,
ahidrosis
2018 年 35 巻 5 号 p. 624-627
詳細
2018 年 35 巻 5 号 p. 624-627
Article on novel development of neurological treatment published in 2017 were reviewed.
Neurogenic orthostatic hypotension (OH) and postprandial hypotension (PH) : According to the Grading of Recommendations Assessment, Development and Evaluation (GRADE), abdominal binder, midodrine and droxidopa were assessed as strong recommendation for OH, and acarbose as strong recommendation for PH.
Postural tachycardia syndrome (PoTS) : Ivabradine showed a possibility of effectiveness for PoTS, but.droxidopa did not improve significantly.
Vasovagal syncope : Fluoxetine improved vasovagal syncope in patients with anxiety. Dual–Chamber pacing significantly reduced the recurrence of vasovagal syncope.
Urinary disturbance : Solifenacine increased maximum cystometric capacity, and injection of onabotulinum toxin A reduced frequency of urinary incontinence.
Chronic constipation : Lubiprostone increased spontaneous bowel movements in diabetic patients with constipation. Low dose linaclotide improved chronic idiopathic constipation. The phase II trial suggest that a clinically optimal dose of elobixibat is 10mg/day for Japanese patients with chronic constipation. Naldemedine significantly increased spontaneous bowel movements in patients with opioid–induced constipation.
Anhidrosis : Degranulation and shrinkage of dark cells in eccrine glands and elevated serum carcinoembryonic antigen were seen in patients with acquired idiopathic generalized anhidrosis (AIGA). The Japanese guideline of AIGA was revised in 2017.
Hyperhidrosis : Percutaneous and oral oxybutynin administration improved hyperhidrosis.
