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1.
PLoS One ; 15(2): e0228671, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053652

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics. METHODS: We conducted a retrospective study covering 2005-2014 at 5 pediatric centers in 3 U.S. regions. Possible AFM cases aged ≤18 years were identified by searching discharge ICD-9 codes and spinal cord MRI reports (>37,000). Neuroradiologists assessed MR images, and medical charts were reviewed; possible cases were classified as AFM, not AFM, or indeterminate. RESULTS: At 5 sites combined, 26 AFM cases were identified from 2005-2013 (average annual number, 3 [2.4 cases/100,000 pediatric hospitalizations]) and 18 from 2014 (12.6 cases/100,000 hospitalizations; Poisson exact p<0.0001). A cluster of 13 cases was identified in September-October 2014 (temporal scan p = 0.0001). No other temporal or seasonal trend was observed. Compared with cases from January 2005-July 2014 (n = 29), cases from August-December 2014 (n = 15) were younger (p = 0.002), more frequently had a preceding respiratory/febrile illness (p = 0.03), had only upper extremities involved (p = 0.008), and had upper extremity monoplegia (p = 0.03). The cases had higher WBC counts in cerebrospinal fluid (p = 0.013). CONCLUSION: Our data support emergence of AFM in 2014 in the United States, and those cases demonstrated distinctive features compared with preceding sporadic cases.


Assuntos
Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/epidemiologia , Surtos de Doenças , Mielite/diagnóstico , Mielite/epidemiologia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia , Adolescente , Fatores Etários , Viroses do Sistema Nervoso Central/líquido cefalorraquidiano , Viroses do Sistema Nervoso Central/terapia , Criança , Pré-Escolar , Enterovirus Humano D , Feminino , Hospitalização , Hospitais Pediátricos , Humanos , Lactente , Classificação Internacional de Doenças , Imagem por Ressonância Magnética , Masculino , Mielite/líquido cefalorraquidiano , Mielite/terapia , Doenças Neuromusculares/líquido cefalorraquidiano , Doenças Neuromusculares/terapia , Estudos Retrospectivos , Estações do Ano , Estados Unidos
2.
BMC Infect Dis ; 20(1): 125, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046658

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM) are reported to be associated with enterovirus D68 infection. Though an increasing number of AFM cases were reported with EV-D68 infection in the US, few such cases have been found in China. CASE PRESENTATION: A 6-year-old boy presented with acute flaccid myelitis (AFM) involving left arm after fever and respiratory symptoms for 6 days. Computed Tomography (CT) revealed inflammation in both lungs and magnetic resonance imaging (MRI) of the brain and spine showed swelling in the left frontal lobe and brain stem. The patient was diagnosed with meningomyelitis. EV-D68 was detected from pharyngeal samples 36 days after the onset of the disease. CONCLUSION: We report the first EV-D68 infection in case of AFM in mainland China. AFM surveillance systems is recommended to be established in China to guide diagnosis, case reporting, and specimen collection and testing for better understanding its etiologies.


Assuntos
Viroses do Sistema Nervoso Central/virologia , Enterovirus Humano D/patogenicidade , Infecções por Enterovirus/etiologia , Mielite/virologia , Doenças Neuromusculares/virologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/virologia , Viroses do Sistema Nervoso Central/diagnóstico por imagem , Viroses do Sistema Nervoso Central/etiologia , Viroses do Sistema Nervoso Central/terapia , Criança , China , Encefalite Viral/diagnóstico por imagem , Encefalite Viral/virologia , Enterovirus Humano D/genética , Enterovirus Humano D/isolamento & purificação , Infecções por Enterovirus/diagnóstico por imagem , Infecções por Enterovirus/terapia , Infecções por Enterovirus/virologia , Humanos , Imagem por Ressonância Magnética , Masculino , Mielite/diagnóstico por imagem , Mielite/etiologia , Mielite/terapia , Doenças Neuromusculares/diagnóstico por imagem , Doenças Neuromusculares/etiologia , Doenças Neuromusculares/terapia , Faringe/virologia , Filogenia , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/virologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Coluna Vertebral/virologia , Tomografia Computadorizada por Raios X
3.
Muscle Nerve ; 61(1): 17-25, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31531874

RESUMO

While traditional immunosuppressive and immunomodulatory therapies remain the cornerstone of immune-mediated neuromuscular disease management, new and novel agents including antigen-specific, monoclonal antibody drugs, have emerged as important treatment options. This article is the second of a two-part series that reviews immune-based therapies in neuromuscular diseases. The first article provides an update on the use of traditional immune-based therapies such as corticosteroids, plasma exchange, steroid-sparing immunosuppressive drugs, and intravenous immunoglobulin G. This second article focuses on new and novel immune-based therapies, including eculizumab, a complement inhibitor approved for acetylcholine receptor antibody-positive myasthenia gravis; rituximab, a B-cell depletion therapy with evolving indications in neuromuscular diseases; and the subcutaneous formulation of immunoglobulin G that gained approval for use in chronic inflammatory demyelinating polyradiculoneuropathy in 2018. Finally, several novel antigen-specific drugs at different stages of investigation in neuromuscular disease are also reviewed.


Assuntos
Fatores Imunológicos/uso terapêutico , Imunoterapia/métodos , Doenças Neuromusculares/terapia , Anticorpos Monoclonais/uso terapêutico , Humanos , Imunização Passiva/métodos , Imunossupressores/uso terapêutico , Doenças Neuromusculares/tratamento farmacológico
4.
Tumori ; 105(6): NP75-NP78, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31600120

RESUMO

This study reports a case series of patients with upper limb neuromotor deficits following pediatric central nervous system tumor and treated with rehabilitative therapy according to action observation therapy (AOT). AOT is based on the "mirror neurons" system and had positive results in various non-oncologic neurologic pathologies. This study is the first experience in the oncology field, and included 6 patients, 4 of whom were fully evaluated at 6-month follow-up. In all patients, therapy showed improvement in all assessment tests. These promising results lead to further studies to confirm their effectiveness.


Assuntos
Neoplasias do Sistema Nervoso Central/complicações , Reabilitação Neurológica , Doenças Neuromusculares/etiologia , Doenças Neuromusculares/reabilitação , Extremidade Superior/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Reabilitação Neurológica/métodos , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/terapia , Resultado do Tratamento , Adulto Jovem
6.
Muscle Nerve ; 60(5): 528-537, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31443119

RESUMO

INTRODUCTION: Although intravenous immune globulin (IVIg) is used to treat patients in the outpatient setting, there is limited documentation addressing the safety of this practice. METHODS: Retrospective analysis of 438 patients with neuromuscular diseases receiving IVIg in an outpatient setting. RESULTS: Adverse events (AE) overall occurred in 16.9% of patients. Headache was the most common AE, noted in 11.6% of patients. Serious AEs occurred in 0.91% of patients; aseptic meningitis was the only one noted. Multivariate analyses identified the following risk factors for AEs: first-lifetime course of IVIg, higher dose per course of IVIg, diagnosis of myasthenia gravis, women, and younger age. DISCUSSION: Intravenous immune globulin is generally safe to administer in an outpatient setting. Women, myasthenia gravis patients, and those receiving their first course or a higher total dose of IVIg are at an increased risk of experiencing an AE.


Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Doenças Neuromusculares/terapia , Adulto , Fatores Etários , Idoso , Assistência Ambulatorial , Exantema/induzido quimicamente , Feminino , Cefaleia/induzido quimicamente , Humanos , Hipertensão/induzido quimicamente , Infusões Intravenosas , Masculino , Meningite Asséptica/induzido quimicamente , Pessoa de Meia-Idade , Análise Multivariada , Miastenia Gravis/terapia , Miosite/terapia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
7.
EBioMedicine ; 45: 630-645, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31257147

RESUMO

Duchenne muscular dystrophy (DMD) is an X-linked disorder characterized by progressive muscle degeneration, caused by the absence of dystrophin. Exon skipping by antisense oligonucleotides (ASOs) has recently gained recognition as therapeutic approach in DMD. Conjugation of a peptide to the phosphorodiamidate morpholino backbone (PMO) of ASOs generated the peptide-conjugated PMOs (PPMOs) that exhibit a dramatically improved pharmacokinetic profile. When tested in animal models, PPMOs demonstrate effective exon skipping in target muscles and prolonged duration of dystrophin restoration after a treatment regime. Herein we summarize the main pathophysiological features of DMD and the emergence of PPMOs as promising exon skipping agents aiming to rescue defective gene expression in DMD and other neuromuscular diseases. The listed PPMO laboratory findings correspond to latest trends in the field and highlight the obstacles that must be overcome prior to translating the animal-based research into clinical trials tailored to the needs of patients suffering from neuromuscular diseases.


Assuntos
Distrofia Muscular de Duchenne/terapia , Doenças Neuromusculares/terapia , Oligonucleotídeos Antissenso/uso terapêutico , Peptídeos/uso terapêutico , Animais , Modelos Animais de Doenças , Distrofina , Éxons/genética , Terapia Genética , Humanos , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/patologia , Distrofia Muscular de Duchenne/genética , Doenças Neuromusculares/genética , Oligonucleotídeos Antissenso/genética , Peptídeos/genética
8.
Nervenarzt ; 90(8): 809-816, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31286145

RESUMO

BACKGROUND: For a long time the treatment of neuromuscular diseases was considered to be purely symptomatic. Due to new technologies in recent years novel causal forms of treatment could be developed. Gene therapies for spinal muscular atrophy, Duchenne muscular dystrophy, limb-girdle muscular dystrophy, myotubular myopathy and hereditary motor and sensory neuropathy type 1A are currently being evaluated in clinical trials. Initial preliminary results are promising and the first preparation onasemnogene abeparvovec-xioi (Zolgensma®) for the treatment of spinal muscular atrophy has recently been approved by the U.S. Food and Drug Administration (FDA). OBJECTIVE: This review describes the principles of gene therapy, summarizes the interim results published so far and provides an overview of currently active or soon to be initiated gene therapy trials. CONCLUSION: Gene therapies have the potential to significantly influence the course of neuromuscular diseases. First positive intermediate results have been published and the first treatment has recently been approved in the USA. Long-term data on sustained effects and toxicity of gene therapies are not yet available. These novel treatment options will present new challenges for the healthcare systems concerning diagnosis, treatment and reimbursement.


Assuntos
Terapia Genética , Doenças Neuromusculares , Terapia Genética/tendências , Humanos , Doenças Neuromusculares/terapia
9.
Eur J Pediatr ; 178(9): 1305-1315, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31338675

RESUMO

Acute flaccid myelitis is characterized by the combination of acute flaccid paralysis and a spinal cord lesion largely restricted to the gray matter on magnetic resonance imaging. The term acute flaccid myelitis was introduced in 2014 after the upsurge of pediatric cases in the USA with enterovirus D68 infection. Since then, an increasing number of cases have been reported worldwide. Whereas the terminology is new, the clinical syndrome has been recognized in the past in association with several other neurotropic viruses such as poliovirus.Conclusion: This review presents the current knowledge on acute flaccid myelitis with respect to the clinical presentation and its differential diagnosis with Guillain-Barré syndrome and acute transverse myelitis. We also discuss the association with enterovirus D68 and the presumed pathophysiological mechanism of this infection causing anterior horn cell damage. Sharing clinical knowledge and insights from basic research is needed to make progress in diagnosis, treatment, and prevention of this new polio-like disease. What is Known: • Acute flaccid myelitis (AFM) is a polio-like condition characterized by rapid progressive asymmetric weakness, together with specific findings on MRI • AFM has been related to different viral agents, but recent outbreaks are predominantly associated with enterovirus D68. What is New: • Improving knowledge on AFM must increase early recognition and adequate diagnostic procedures by clinicians. • The increasing incidence of AFM urges cooperation between pediatricians, neurologists, and microbiologists for the development of treatment and preventive options.


Assuntos
Viroses do Sistema Nervoso Central/diagnóstico , Enterovirus Humano D , Infecções por Enterovirus/diagnóstico , Mielite/diagnóstico , Doenças Neuromusculares/diagnóstico , Viroses do Sistema Nervoso Central/epidemiologia , Viroses do Sistema Nervoso Central/terapia , Viroses do Sistema Nervoso Central/virologia , Diagnóstico Diferencial , Infecções por Enterovirus/complicações , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/terapia , Saúde Global , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/virologia , Humanos , Mielite/epidemiologia , Mielite/terapia , Mielite/virologia , Mielite Transversa/diagnóstico , Mielite Transversa/virologia , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/terapia , Doenças Neuromusculares/virologia , Prognóstico
10.
Expert Rev Clin Pharmacol ; 12(8): 757-770, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220956

RESUMO

Introduction: Genetic neuromuscular diseases (NMDs) constitute a heterogeneous group of rare conditions, including some of the most disabling conditions in childhood. Recently, advanced technologies have greatly expanded preclinical and clinical research, and specific therapies have been developed. Area covered: We provide an overview of novel pharmacological approaches to the main NMDs, including Duchenne muscular dystrophy (DMD), spina muscular atrophy (SMA), X-linked myotubular myopathy, Pompe disease (PD), and myotonic dystrophy type 1, with attention to both achievements and unresolved therapeutic challenges. We conducted a selected review of relevant publications in the last five years identified through PubMed and Scopus. Additional information was derived from the website of clinicaltrials.gov and from the authors' direct knowledge of research activities. Expert Opinion: For the first time, targeted therapies have received conditional regulatory approval and have been introduced into clinical care: enzyme replacement therapy for PD, gene expression modulation for DMD and SMA, and gene therapy for SMA. Though not curative, these treatments can improve functioning and increase survival. Issues still to be addressed include: early recognition, definition of new emerging phenotypes, development of more sensitive outcome measures, long-term risk-benefit estimates, high costs sustainability, and criteria for therapy initiation and discontinuation.


Assuntos
Terapia Genética/métodos , Terapia de Alvo Molecular , Doenças Neuromusculares/terapia , Animais , Criança , Desenho de Fármacos , Humanos , Doenças Neuromusculares/genética , Doenças Neuromusculares/fisiopatologia
11.
mBio ; 10(2)2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940708

RESUMO

Since 2014, acute flaccid myelitis (AFM), a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes, has been reemerging globally in epidemic form. This unanticipated reemergence is ironic, given that polioviruses, once the major causes of AFM, are now at the very threshold of global eradication and cannot therefore explain any aspect of AFM reemergence. Instead, the new AFM epidemic has been temporally associated with reemergences of nonpolio enteroviruses such as EV-D68, until recently thought to be an obscure virus of extremely low endemicity. This perspective reviews the enigmatic epidemiologic, virologic, and diagnostic aspects of epidemic AFM reemergence; examines current options for clinical management; discusses future research needs; and suggests that the AFM epidemic offers important clues to mechanisms of viral disease emergence.


Assuntos
Viroses do Sistema Nervoso Central/epidemiologia , Doenças Transmissíveis Emergentes/epidemiologia , Gerenciamento Clínico , Mielite/epidemiologia , Doenças Neuromusculares/epidemiologia , Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/etiologia , Viroses do Sistema Nervoso Central/terapia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/etiologia , Doenças Transmissíveis Emergentes/terapia , Saúde Global , Humanos , Mielite/diagnóstico , Mielite/etiologia , Mielite/terapia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/etiologia , Doenças Neuromusculares/terapia
14.
J Rehabil Med ; 51(4): 237-243, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30834452

RESUMO

OBJECTIVE: This systematic review aimed to assess the clinical impact of neuromuscular electrical stimulation as a treatment modality for patients with oedema. DATA SOURCES AND STUDY SELECTION: PubMed was searched up to July 2018 for randomized and non-randomized clinical trials comparing neuromuscular electrical stimulation vs no stimulation following the formation of oedema. A modified Downs and Black checklist was used to evaluate the quality of the evidence. DATA SYNTHESIS: Initial searches yielded 150 results. Removal of duplicates reduced this number to 97 results. Seventy-five studies were excluded following a review of titles and abstracts. Full-text screening eliminated 15 studies. A final total of 7 studies met the inclusion criteria. Six studies supported the use of neuromuscular electrical stimulation for oedema reduction, and one study did not find an effect, but reported inter-group variance. CONCLUSION: The results of this systematic review support the use of neuromuscular electrical stimulation for ameliorating the abnormal accumulation of interstitial fluid, which is clinically shown as oedema. Neuromuscular electrical stimulation is effective in a number of rehabilitation settings and patient groups, for treatment of both upper and lower limb oedema. However, further trials are needed to reinforce these findings.


Assuntos
Edema/terapia , Terapia por Estimulação Elétrica/métodos , Doenças Neuromusculares/terapia , Humanos
15.
Am J Occup Ther ; 73(1): 7301205150p1-7301205150p11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30839270

RESUMO

This systematic review examines the efficacy of yoga as a neuromuscular intervention for community-dwelling populations at risk for falls to determine its utility for use in occupational therapy intervention. Populations included older adults and adults with traumatic brain injury (TBI), cerebrovascular accident (CVA), dementia and Alzheimer's disease (AD)-type dementia, multiple sclerosis (MS), and Parkinson's disease (PD). Benefits of yoga include improved posture control, improved flexibility of mind and body, relaxation, and decreased anxiety and stress. A systematic review of the literature was conducted to understand the salutary benefits of yoga for clients who are at risk for falls because of neuromuscular issues. Moderate evidence supports the use of yoga to decrease the risk for falls for community-dwelling older adults and people with CVA, dementia and AD-type dementia, and MS. Studies involving people with TBI and PD did not include strong enough evidence to be able to make a clear classification.


Assuntos
Acidentes por Quedas/prevenção & controle , Doenças Neuromusculares/terapia , Equilíbrio Postural , Ioga , Humanos , Vida Independente
16.
Neurology ; 92(15): e1773-e1785, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30850441

RESUMO

OBJECTIVE: The aim of this phase 2 trial was to ascertain the feasibility and effect of community-based aerobic exercise training for people with 2 of the more common neuromuscular diseases: Charcot-Marie-Tooth disease type 1A (CMT) and inclusion body myositis (IBM). METHODS: A randomized single-blinded crossover trial design was used to compare a 12-week aerobic training program using recombinant exercise bicycles compared to a control period. The training occurred 3 times per week in community gyms local to the participants. Support was available from trained gym staff and a research physiotherapist. The 2 disease groups were analyzed separately. The primary outcome measure was peak oxygen uptake (VO2 peak) during a maximal exercise test, with secondary measures of muscle strength, function, and patient-reported measures. RESULTS: Data from 23 people with CMT and 17 people with IBM were included in the analysis. Both disease groups had high levels of participation and demonstrated improvements in VO2 peak, with a moderate effect size in the CMT participants (Cohen d = 0.53) and a strong effect size in the IBM group (Cohen d = 1.72). No major changes were observed in the secondary outcome measures. Qualitative interviews revealed that participants valued the support of gym instructors and the research physiotherapists in overcoming challenges to participation. CONCLUSION: Twelve weeks of aerobic training in community gyms was feasible, safe, and improved aerobic capacity in people with CMT and IBM. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with CMT type 1A and IBM, an aerobic training program increases aerobic capacity.


Assuntos
Serviços de Saúde Comunitária , Terapia por Exercício/organização & administração , Exercício Físico , Doenças Neuromusculares/terapia , Adulto , Limiar Anaeróbio , Doença de Charcot-Marie-Tooth/terapia , Estudos Cross-Over , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Miosite de Corpos de Inclusão/terapia , Doenças Neuromusculares/metabolismo , Método Simples-Cego , Resultado do Tratamento
17.
Neurology ; 92(14): 663-674, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30850443

RESUMO

Neuromuscular adverse events following cancer treatment with anti-programmed cell death protein 1 (PD-1) monoclonal antibodies are relatively rare, yet potentially fatal. We performed a systematic review to characterize the clinical presentation, diagnostic workup, and management of neuromuscular disorders (NMDs) in patients treated with nivolumab or pembrolizumab monotherapy or concurrent with other immunologic agents, such as ipilimumab. Sixty-one publications on 85 patients (mean age 66.9 years [range 34-86]; male/female 2.6:1; 59% metastatic melanoma) were identified from selected indexing databases until June 2018. Forty-eight patients had received nivolumab and 39 pembrolizumab. The mean number of PD-1 inhibitor treatment cycles prior to onset of symptoms was 3.6 (range 1-28). Symptoms included oculomotor (47%), respiratory (43%), bulbar (35%), and proximal weakness (35%), as well as muscle pain (28%). Diagnoses were categorized as myasthenia gravis (27%), neuropathy (23%), myopathy (34%), or a combination of these (16%). After a critical review of the data, however, evidence did not support the stated NMD diagnosis in 13% of cases, while up to 25% of patients had signs of additional NMDs. Cardiac complications occurred in more than 30% of patients diagnosed with myasthenia gravis or myositis. Mortality was high in these patients, despite adequate treatment strategies including corticosteroid, IV immunoglobulins, and plasma exchange. The clinical presentation of NMDs associated with PD-1 inhibitors is often atypical, with considerable overlap between myasthenia gravis and myopathy, and cardiac/respiratory complications are common.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Doenças Neuromusculares/induzido quimicamente , Nivolumabe/efeitos adversos , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Corticosteroides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Doenças Musculares/induzido quimicamente , Doenças Musculares/terapia , Miastenia Gravis/induzido quimicamente , Miastenia Gravis/terapia , Miosite/induzido quimicamente , Miosite/terapia , Doenças Neuromusculares/terapia , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/terapia , Troca Plasmática
20.
Semin Neurol ; 39(1): 115-124, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30743297

RESUMO

Neuromuscular emergencies may be defined as disorders or exacerbation of diseases of the peripheral nervous system that are rapidly progressive and potentially life-threatening. Such disorders can affect any level of the peripheral nervous system, from the muscle to the anterior horn cell. While their clinical manifestations may vary, severe morbidity and mortality is most frequently the result of neuromuscular respiratory failure. Some disorders, such as Guillain-Barré syndrome, provide the additional threat of severe, and potentially irreversible, nerve loss. Others, such as rhabdomyolysis and malignant hyperthermia, may produce serious medical complications. This article reviews neuromuscular emergencies by localization in the peripheral nervous system of the underlying disorder, as well as the identification and management of neuromuscular respiratory failure.


Assuntos
Emergências , Doenças Neuromusculares , Doença Aguda , Humanos , Doenças Neuromusculares/complicações , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/terapia
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