自律神経疾患の治療の進歩

抄録

We reviewed articles on the novel development of treatment for autonomic disorders published in 2021. Thigh–length elastic pressure socks may prevent orthostatic hypotension (OH) that could develop after spinal surgery. A randomized double–blind and controlled study indicated that ampreloxetine improved OH. A meta–analysis revealed that commonly prescribed drugs causing sympathetic inhibition were associated with significantly increased odds of OH. Caffeine might be a treatment option for OH if other evidence–based treatments are ineffective. Abdominal and lower body compression, high dietary sodium intake, and ivabradine reduced heart rate and improved symptoms during standing in adult patients with postural orthostatic tachycardia syndrome. Acarbose may avoid the occurrence of postprandial hypotension. For patients with recurrent vasovagal syncope (VVS), there is a possibility that yoga exercise improves postural symptoms and QOL. Increased salt and water intake may reduce syncope recurrence rates in pediatric patients with VVS. Tibial nerve stimulation may be as effective as anticholinergic drugs for overactive bladder (OBA) and more tolerable. Transcutaneous tibial nerve stimulation may be as effective as percutaneous tibial nerve stimulation for OAB. Sacral neuromodulation may be effective as well as onabotulinumtoxin A for OAB, and safety. A randomized double–blind and controlled study indicated that vibegron (75mg/day) was more effective for OAB than tolterodine (4mg/day). Treatment with a cinnamon patch might improve OAB. Tenapanor may improve irritable bowel syndrome with constipation symptoms. A randomized double–blind and controlled study showed that plecanatide relieved the symptoms of chronic idiopathic constipation with a relatively low incidence of diarrhea. Probiotics treatment may be effective for constipation in patients with Parkinson disease. Rhubarb, a Chinese traditional medicine, may be effective for chronic idiopathic constipation.