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 2020. Atomoxetine improved orthostatic blood pressure changes as much as midodrine and was better in terms of ameliorating orthostatic hypotension symptoms. One meta–analysis provides low–quality evidence of a short–term improvement in orthostatic intolerance with increased salt intake. Another meta–analysis showed no significant effect to orthostatic hypotension of resistance exercise, electrical stimulation, and lower limb compression bandaging. Splanchnic venous compression alone did not improve tachycardia or symptoms, but the combination with propranolol was more effective in improving symptoms than either alone. Pharmacological norepinephrine transporter inhibition prevented severe vasovagal reactions and syncope induced by head up–tilt testing in patients with vasovagal syncope. Overactive bladder (OAB) symptoms were significantly improved in older adults with Parkinson's disease under fesoterodine fumarate treatment. One meta–analysis indicated that the safety and efficacy profile of mirabegron remains favorable compared with anti–muscarinics among older adults. Vibegron provided significant reductions in micturitions, urgency episodes and urge incontinence in patients with OAB. Daily consumption of sterilized probiotic containing L. helveticus with or without polydextrose alleviated constipation–related symptoms. Flaxseed flour was more effective at increasing defecation frequency than lactulose, patients with chronic functional constipation. Linaclotide significantly improved opioid–induced constipation symptoms. Electro–acupuncture could effectively improve bowel function, mental states and QOL of functional constipation patients. Plecanatide, tenapanor and minesapride were well–tolerated and effective treatment option for patients with constipation–predominant irritable bowel syndrome or functional constipation.