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乳腺癌所致抗Yo抗体阳性副肿瘤性小脑变性患者的康复治疗:1例报告及文献复习

Rehabilitation for a patient with anti-Yo antibody-positive paraneoplastic cerebellar degeneration caused by breast cancer: A case report and literature review.

作者信息

Kato Naoki, Hashida Goichi, Konaka Kuni

机构信息

Department of Rehabilitation, Osaka University Medical Hospital Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

出版信息

Medicine (Baltimore). 2017 Nov;96(44):e8468. doi: 10.1097/MD.0000000000008468.

Abstract

RATIONALE

Rehabilitation for paraneoplastic cerebellar degeneration (PCD) has been indicated as necessary. However, there are only a few reports on rehabilitation in PCD. We describe the course of physical and cognitive functions and activities of daily living (ADL) in a patient with PCD and examine the effect of rehabilitation, along with a review of relevant literature.

PATIENT CONCERNS

A 42-year-old woman experienced rapid deterioration in cerebellar symptoms and was unable to walk. The cerebellar symptoms improved after mastectomy, which was performed 3 months after the onset of symptoms. However, the cerebellar symptoms exacerbated 11 months after the onset of symptoms. She underwent immunotherapy because the level of anti-Yo antibodies was high, and anti-glutamic acid decarboxylase antibodies were detected.

DIAGNOSES

She was diagnosed with anti-Yo antibody-positive PCD caused by breast cancer.

INTERVENTIONS

Rehabilitation was performed preoperatively, postoperatively, and at 1 year after the onset of symptoms.

OUTCOMES

Her physical function and ADL improved after the surgery and at 1 year after the onset of symptoms. Finally, she regained the ability to walk between parallel bars supported with one hand and a walking frame.

LESSONS

Given the results of this case and the relevant literature, it appears that rehabilitation improves physical function and ADL after oncotherapy. Particularly, initiating treatment within three months of onset of symptoms may enable patients to walk without assistance.

摘要

理论依据

副肿瘤性小脑变性(PCD)的康复治疗已被认为是必要的。然而,关于PCD康复治疗的报道却很少。我们描述了一名PCD患者的身体和认知功能以及日常生活活动(ADL)的病程,并研究了康复治疗的效果,同时回顾了相关文献。

患者情况

一名42岁女性小脑症状迅速恶化,无法行走。症状出现3个月后进行了乳房切除术,术后小脑症状有所改善。然而,症状出现11个月后小脑症状再次加重。由于抗Yo抗体水平较高且检测到抗谷氨酸脱羧酶抗体,她接受了免疫治疗。

诊断

她被诊断为乳腺癌引起的抗Yo抗体阳性PCD。

干预措施

在症状出现前、术后以及症状出现后1年进行了康复治疗。

结果

手术后以及症状出现后1年,她的身体功能和ADL得到了改善。最终,她恢复了单手支撑在双杠间行走以及使用助行架行走的能力。

经验教训

根据该病例的结果和相关文献,康复治疗似乎能改善肿瘤治疗后的身体功能和ADL。特别是在症状出现后三个月内开始治疗可能使患者能够独立行走。

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Guidelines for treatment of immune-mediated cerebellar ataxias.免疫介导性小脑共济失调的治疗指南。
Cerebellum Ataxias. 2015 Nov 10;2:14. doi: 10.1186/s40673-015-0034-y. eCollection 2015.
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Inpatient rehabilitation performance of patients with paraneoplastic cerebellar degeneration.副肿瘤性小脑变性患者的住院康复表现
Arch Phys Med Rehabil. 2014 Dec;95(12):2496-9. doi: 10.1016/j.apmr.2014.07.003. Epub 2014 Jul 19.
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The cerebellum: an overview.小脑:概述
Trends Cogn Sci. 1998 Sep 1;2(9):305-6. doi: 10.1016/s1364-6613(98)01224-8.

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