Shanina Elena, Liao Bing, Smith Robert Glenn
Department of Neurology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
Methodist Neurological Institute, Houston Methodist Hospital, 6560 Fannin St., Houston, TX, 77030, USA.
Curr Treat Options Neurol. 2019 Apr 27;21(5):24. doi: 10.1007/s11940-019-0562-5.
Brachial plexopathies (BPs) are a heterogeneous group of diseases which can profoundly affect person's function and quality of life. This review targets current approaches to treatment of different BP types.
Although there are multiple BP etiologies, non-traumatic causes are particularly unrecognized by clinicians, leading to misdiagnoses and delay in appropriate therapies. Recent data suggests that idiopathic neuralgic amyotrophy may be 50-fold more common than previously thought, with poorer outcomes than reported unless rapid diagnosis is followed by a multidisciplinary approach to treatment, including surgery for refractory cases. Advances in diagnostic imaging reduce time to treatment, if proper recognition by primary providers leads to rapid referral to neurologists. Due to rarity, heterogeneity, and overlap of different BP syndromes, development of treatment strategies is still based on case series and retrospective studies. Despite advances in surgical therapies, there are no randomized trials to guide optimal approaches to treatment in either traumatic or non-traumatic cases. Recent advances in imaging and surgical therapies may significantly improve clinical outcomes for patients with BPs, if rapid diagnosis of these often under-recognized conditions can be substantially improved to optimize approach to management. Controlled trials are still needed to optimize therapeutic strategies.
臂丛神经病（BPs）是一组异质性疾病，可严重影响患者的功能和生活质量。本综述旨在探讨当前针对不同类型臂丛神经病的治疗方法。
尽管臂丛神经病有多种病因，但非创伤性病因尤其容易被临床医生忽视，从而导致误诊和适当治疗的延误。最新数据表明，特发性神经性肌萎缩的发病率可能比之前认为的高50倍，若不进行快速诊断并采取多学科治疗方法（包括对难治性病例进行手术），其预后比报道的更差。如果初级医疗人员能够正确识别并迅速转诊至神经科医生，诊断成像技术的进步可缩短治疗时间。由于不同臂丛神经综合征罕见、异质性强且相互重叠，治疗策略的制定仍基于病例系列研究和回顾性研究。尽管手术治疗取得了进展，但尚无随机试验来指导创伤性或非创伤性病例的最佳治疗方法。如果能够大幅改善对这些常被忽视疾病的快速诊断，以优化管理方法，那么成像和手术治疗方面的最新进展可能会显著改善臂丛神经病患者的临床预后。仍需要进行对照试验以优化治疗策略。
