Continuum (Minneap Minn). 2024 Aug 1;30(4):1226-1258. doi: 10.1212/CON.0000000000001463.
Autoimmune neurologic disorders encompass a broad category of diseases characterized by immune system attack of the central, peripheral, or autonomic nervous systems. This article provides information on both acute and maintenance immunotherapy used to treat autoimmune neurologic disorders as well as a review of symptomatic management and special considerations when caring for patients with these diseases.
Over the past 20 years, more than 50 antibodies have been identified and associated with autoimmune neurologic disorders. Although advances in diagnostic testing have allowed for more rapid diagnosis, the therapeutic approach to these disorders has largely continued to rely on expert opinion, case series, and case reports. With US Food and Drug Administration (FDA) approval of biologic agents to treat neuromyelitis optica spectrum disorder (NMOSD) and myasthenia gravis as well as ongoing clinical trials for the treatment of autoimmune encephalitis, the landscape of immunotherapy options continues to expand. Consideration of the unique pathogenesis of individual autoimmune neurologic disorders as well as the mechanism of action of the diverse range of treatment options can help guide treatment decisions today while evidence from clinical trials informs new therapeutics in the future.
Recognizing patients who have a clinical history and examination findings concerning for autoimmune neurologic disorders and conducting a thorough and directed imaging and laboratory evaluation aimed at ruling out mimics, identifying specific autoimmune syndromes, and screening for factors that may have an impact on immunotherapy choices early in the clinical course are essential to providing optimal care for these patients. Providers must consider immunotherapy, symptomatic treatment, and a multidisciplinary approach that addresses each patient's unique needs when treating patients with autoimmune neurologic disorders.
自身免疫性神经疾病涵盖了一大类疾病，其特征为免疫系统攻击中枢、周围或自主神经系统。本文提供了用于治疗自身免疫性神经疾病的急性和维持免疫疗法的信息，以及对这些疾病患者的症状管理和特殊护理注意事项的回顾。
在过去的 20 年中，已经鉴定出 50 多种与自身免疫性神经疾病相关的抗体。尽管诊断检测的进步使诊断速度更快，但这些疾病的治疗方法在很大程度上仍然依赖于专家意见、病例系列和病例报告。随着美国食品和药物管理局（FDA）批准生物制剂用于治疗视神经脊髓炎谱系障碍（NMOSD）和重症肌无力，以及正在进行的自身免疫性脑炎治疗临床试验，免疫治疗选择的范围继续扩大。考虑到个体自身免疫性神经疾病的独特发病机制以及各种治疗选择的作用机制，可以帮助指导当前的治疗决策，而临床试验的证据则为未来的新疗法提供信息。
认识到具有自身免疫性神经疾病临床病史和检查结果的患者，并进行全面、有针对性的影像学和实验室评估，旨在排除类似疾病、确定特定的自身免疫综合征，并筛查可能影响免疫治疗选择的因素，这些对于为这些患者提供最佳护理至关重要。在治疗自身免疫性神经疾病患者时，提供者必须考虑免疫疗法、对症治疗和多学科方法，以满足每个患者的独特需求。
