Mañon-Espaillat R, Mandel S
Department of Neurology, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Clin Podiatr Med Surg. 1999 Jan;16(1):67-79.
Neuromuscular disorders can impose significant disability in patients by virtue of weakness, pain, and sensory and autonomic symptoms and deficits. For all of these disorders, supportive measures, appropriate physical therapy, and respiratory support are beneficial. Pain management can be accomplished by the use of antiepileptic medications, such as carbamazepine, phenytoin, valproic, and gabapentin. Tricyclic antidepressants can also be helpful for pain management and depression. Benzodiazepines and baclofen are helpful for management of spasticity. No specific treatment exists yet for the motor neuron disorders. In peripheral neuropathies, identifying and treating the cause is most important. In other neuropathies, such as in acute or chronic inflammatory demyelinating neuropathies, immunosuppression is indicated. Myasthenia gravis can be treated with cholinesterase inhibitors and immunosuppression. A specific treatment does not exist yet for muscular dystrophies. Immunosuppression is helpful in patients with inflammatory myopathies. Toxic myopathies can be treated by removing the causative agent and by supportive measures. Endocrine myopathies will respond to treatment of the primary endocrinopathy.
神经肌肉疾病可因肌无力、疼痛以及感觉和自主神经症状及功能障碍而给患者带来严重残疾。对于所有这些疾病，支持性措施、适当的物理治疗和呼吸支持都有益处。疼痛管理可通过使用抗癫痫药物来实现，如卡马西平、苯妥英、丙戊酸和加巴喷丁。三环类抗抑郁药对疼痛管理和抑郁症也有帮助。苯二氮䓬类药物和巴氯芬有助于治疗痉挛。目前尚无针对运动神经元疾病的特异性治疗方法。在周围神经病变中，识别并治疗病因最为重要。在其他神经病变中，如急性或慢性炎症性脱髓鞘性多发性神经病，则需要进行免疫抑制治疗。重症肌无力可用胆碱酯酶抑制剂和免疫抑制治疗。目前尚无针对肌肉萎缩症的特异性治疗方法。免疫抑制对炎性肌病患者有帮助。中毒性肌病可通过去除致病因素和采取支持性措施来治疗。内分泌性肌病对原发性内分泌疾病的治疗有反应。
