自律神経疾患の治療の進歩

抄録

We reviewed articles on novel development of neurological treatment published in 2018. Treatment algorism of orthostatic hypotension was indicated in a JACC State–of–the–Art Review. In regard to cardiovascular autonomic dysfunction, consensus statement on the definition of neurogenic supine hypertension in autonomic failure was proposed by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS). It was reported that propranolol, bisoprolol and a combination of pyridostigmine and propranolol or bisoprolol showed effectiveness for postural tachycardia syndrome. Therapy for vasovagal syncope was also updated. For over active bladder, effectiveness of gabapentin and phytomedicine extracts were reported, and several confirmative studies were also performed. Safety and efficacy of elobixibat and linaclotide for chronic idiopathic constipation were shown by the phase 3 trials. Safety and efficacy of plecanatide (unapproved in Japan), a guanylate cyclase agonist, for irritable bowel syndrome was also shown by the phase 3 trial. A meta–analysis showed efficacy of naldemedine and naloxone for the treatment of opioid–induced constipation. Topical botulinum toxin type A liposomal cream significantly was reported to improve axillary hyperhidrosis. It was reported that a combination of topical agents and oxybutynin reduced focal hyperhidrosis. Percutaneous radiofrequency thoracic sympathectomy was reported to improve palmar hyperhidrosis.