Tomoda Akemi, Nomura Keiko, Shiraishi Seiji, Miike Teruhisa, Hamada Akinobu, Hosoya Mitsuaki
Department of Child Development, Kumamoto University School of Medicine, Kumamoto.
No To Hattatsu. 2003 Jul;35(4):321-6.
A survey was made on 10 patients with subacute sclerosing panencephalitis (SSPE) during the last four years from the viewpoint of clinical safety of ribavirin therapy in Japan. Although the age of onset, latent period, and effectiveness were variable among the cases, they were treated safely with intraventricular ribavirin combined with high doses of interferon (IFN). Their clinical stages on admission ranged from the first to fourth of Jabbour's classification, and those on the beginning of ribavirin therapy also ranged from the first to fourth. Seven of them were first treated with intraventricular IFN-alpha monotherapy, however, the combination of intraventricular IFN-alpha and ribavirin was started after clinical worsening. Although 5 patients showed slow progression, seven responded to the therapy with clinical improvement or decreased measles antibody titers in the CSF. Especially, one patient showed improvement to Jabbour's first stage and no further progression during the following 3 years. Ribavirin therapy caused no severe effects. Lip swelling (50%), sleepiness (40%), and headache (30%) were noted. Although we were unable to perform a double-blinded clinical study for ethical reasons, our results suggest that treatment with intraventricular ribavirin and high doses of IFN may be effective for SSPE. Early administration of intraventricular ribavirin and IFN might be considered especially to IFN in non-responders. To establish this combination therapy as a safe and effective treatment of SSPE, further studies are necessary on the role of ribavirin in the pathogenesis as well as its effects in the central nervous system.
在过去四年中，从日本利巴韦林治疗的临床安全性角度，对10例亚急性硬化性全脑炎（SSPE）患者进行了一项调查。尽管各病例的发病年龄、潜伏期和疗效各不相同，但他们通过脑室内注射利巴韦林联合高剂量干扰素（IFN）进行了安全治疗。他们入院时的临床分期从贾布尔分类的第一期到第四期不等，利巴韦林治疗开始时的分期也从第一期到第四期。其中7例最初接受脑室内α-干扰素单一疗法治疗，然而，在临床病情恶化后开始联合使用脑室内α-干扰素和利巴韦林。尽管5例患者病情进展缓慢，但7例患者对治疗有反应，临床症状改善或脑脊液中麻疹抗体滴度降低。特别是，1例患者改善至贾布尔第一期，在接下来的3年中未进一步进展。利巴韦林治疗未引起严重不良反应。观察到有唇部肿胀（50%）、嗜睡（40%）和头痛（30%）。尽管由于伦理原因我们无法进行双盲临床研究，但我们的结果表明，脑室内注射利巴韦林和高剂量干扰素治疗可能对SSPE有效。对于无反应者，尤其可以考虑早期给予脑室内利巴韦林和干扰素。为了将这种联合治疗确立为SSPE的安全有效治疗方法，有必要进一步研究利巴韦林在发病机制中的作用及其在中枢神经系统中的作用。
