Min Young Gi, Hong Yoon-Ho
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Department of Neurology, Seoul National University College of Medicine, Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul National, Republic of Korea, University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
eNeurologicalSci. 2020 Jan 30;18:100224. doi: 10.1016/j.ensci.2020.100224. eCollection 2020 Mar.
Treatment-related fluctuation (TRF), only defined in Guillain-Barre syndrome (GBS), refer to the deterioration of symptoms following treatment-induced improvement, and implies disease activity lasting beyond the effect of immunotherapy. Here, we first propose the concept of TRF in subacute inflammatory demyelinating polyneuropathy (SIDP) with description of a corresponding case. A 27-year-old female presented with acute flaccid paralysis, and experienced two sequential episodes of TRF, the latter occurring around 8 weeks from disease onset. She eventually recovered through intravenous immunoglobulin treatment, and has not experienced any further deterioration over the next four years. The concept of SIDP-TRF would resolve the gap between GBS-TRF and acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and help to decide the optimal treatment strategy in a spectrum of idiopathic immune-mediated polyneuropathies.
治疗相关波动（TRF）仅在吉兰-巴雷综合征（GBS）中有所定义，指治疗诱导症状改善后症状恶化，意味着疾病活动持续超过免疫治疗的效果。在此，我们首次提出亚急性炎性脱髓鞘性多发性神经病（SIDP）中TRF的概念并描述了一个相应病例。一名27岁女性出现急性弛缓性麻痹，并经历了两次连续的TRF发作，后者发生在疾病发作约8周时。她最终通过静脉注射免疫球蛋白治疗康复，并且在接下来的四年中未再出现任何进一步恶化。SIDP-TRF的概念将弥合GBS-TRF与急性起病慢性炎性脱髓鞘性多发性神经根神经病（CIDP）之间的差距，并有助于在一系列特发性免疫介导性多发性神经病中确定最佳治疗策略。
