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Neurological Surgery No Shinkei Geka Volume 23, Issue 2 （February 1995）

Neurological Surgery 脳神経外科 23巻2号（1995年2月発行）

Japanese English

研究

アドリアマイシンを用いた神経ブロック療法 Treatment of Intractable Post-Herpetic Neuralgia and Blepharospasm:Intraneural injection of adriamycin 斉木雅章 ¹ , 近藤明悳 ^1,3 , 絹田祐司 ¹ , 岩崎孝一 ¹ , 小畑仁司 ¹ , 長谷川浩一 ¹ , 沈正樹 ¹ , 中野伊知郎 ¹ , 山本悌司 ² Masaaki SAIKI ¹ , Akinori KONDO ^1,3 , Yuji KINUTA ¹ , Koichi IWASAKI ¹ , Hitoshi KOBATA ¹ , Koichi HASEGAWA ¹ , Masaki CHIN ¹ , Ichiro NAKANO ¹ , Teiji YAMAMOTO ² ¹北野病院神経センター脳神経外科 ²福島医科大学神経内科 ³北野病院脳神経外科 ¹Department of Neurosurgery, Kitano Medical Research Institute and Hospital ²Department of Neurology, Fukushima Medical College キーワード： Post-herpetic neuralgia , Blepharospasm , Adriamycin , Intraneural injection Keyword: Post-herpetic neuralgia , Blepharospasm , Adriamycin , Intraneural injection pp.125-130

発行日 1995年2月10日 Published Date 1995/2/10

DOI https://doi.org/10.11477/mf.1436900975

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Abstract 文献概要
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Ι．はじめに

　帯状ヘルペス後神経痛や眼瞼けいれん等は古くより難治性として知られている疾患であり，神経減圧術が効を奏する三叉神経痛や顔面けいれんなどと異なり現在まで有効な治療法は確立されていない．

　一方，抗腫瘍薬として広く知られているadriamycin（以下ADM）はDNA依存性のRNA合成を阻害するため，これを神経線維に注人すると薬剤がretrograde ax—oplasmic transportにより神経核に取り込まれ，その神経細胞をdegenerationに陥らせることが実験的に証明されている^2,9）．そこでわれわれは，帯状ヘルペス後神経痛や眼瞼けいれんなどの疾患に対する治療を目的として，このADMによる神経細胞変性作用を臨床的に応用した神経ブロック療法（chemical rhizotomy）を施行したので，その結果と用性について報告する．

Adriamycin, an anthracycline antineoplastic agent, can swiftly be transported to the sensory or somatic motor neurons by way of axoplasmic transport when injected into the subepineurium of the trigeminal nerveor sciatic nerve in experimental animals, and is conse-quently able to induce degeneration of the neurons without any systemic side effects.

Intraneural injection of this agent was carried out for the treatment of a total of 22 patients presenting with intractable neural dysfunction (12 with neuralgia, in-cluding 7 with post-herpetic neuralgia and 10 with fa-cial clystonia). The nerve which innervated the affected site was exposed under local anesthesia and approximately 10-60μl of 1-20% adriamycin was in-jected into the subepineurium.

Results of the treatment after average follow-up periods of 21.5 months were as follows : Out of 12 pa-tients with neuralgia, good results were obtained in 2 cases (16.7%), fair results in 6 cases (50.0%) (overall effective rate 67.7%). There were no changes in symp-toms in 4 cases (33.3%). Out of 10 patients with facialdystonia, good results were obtained in 2 cases (20.0%), fair in 2 cases (20.0%) (overall effective rate 40.0%), and no changes in symptoms in 6 cases (60.0%). No major complications were encountered during these procedures and, once symptoms had dis-appeared after the treatment, no recurrence of symp-toms was experienced. This method clearly differs from other various kinds of simple peripheral neurotomy, since transection of the peripheral nerve does not cause any destructive changes in the sensory ganglion or motor nucleus and, hence, symptoms may recur.

It is concluded that this method of chemical rhizo-tomy using adriamycin is effective and safe for intract-able neural dysfunction, such as post-herpetic neuralgia and blepharospasm.