閉じ込め症候群を呈した浸透圧性脱髄症候群に対するリハビリテーション治療の経験

Experience of Rehabilitation Treatment for Osmotic Demyelination Syndrome with Locked-in Syndrome

はじめに

　浸透圧性脱髄症候群（osmotic demyelination syndrome：ODS）は，電解質異常やその急速な補正などにより，仮性球麻痺，四肢麻痺，意識障害などが生じる病態であり，閉じ込め症候群を呈することもある．確立された治療法はなく，ステロイドパルス療法や血漿交換療法などの対症療法を実施するが，33〜55 ％に機能障害が残存すると報告されている．そのため，早期から病状に合わせた適切なリハビリテーション治療を実施し，二次障害を予防することが重要である．

　症例は47歳男性で，低ナトリウム（Na）血症を契機にODSを発症し，一時閉じ込め症候群を呈した．ステロイドパルス療法の後，急性期から各フェーズにおいて目標を設定したリハビリテーション治療を実施し，発症1年後には後遺症を遺さず，社会復帰できた．文献的考察を含め報告する．

　本症例報告に際し，患者本人および家族に書面にて説明を行い，同意を得た．

Abstract　Osmotic demyelination syndrome is a pathological condition that leads to electrolyte imbalances and rapid correction, resulting in pseudobulbar palsy, quadriplegia, and altered consciousness. Approximately 33-55％ of affected patients experience residual functional impairment. Herein, we describe a case of a patient with osmotic demyelination syndrome who developed locked-in syndrome during the disease course, underwent rehabilitation treatment, and achieved complete remission without sequelae.

The patient was a 47-year-old man who was admitted to hospital A owing to weakness in the lower extremities and dysarthria. He had severe hyponatremia and received sodium correction. However, on hospital day 9, dysarthria redeveloped and involuntary finger movements were noted. Osmotic demyelination syndrome was suspected based on the findings of magnetic resonance imaging of the head and clinical course, leading to his transfer to hospital B. Steroid pulse and rehabilitation therapies were initiated at hospital B. By the 19th day of symptom onset, his limb and facial muscle paralysis progressed, leading to locked-in syndrome. Thereafter, the patient was transferred to hospital C, where he received physiotherapy, occupational therapy, and eating training, markedly improving his physical functions. He was discharged from hospital C, 4 months after the symptom onset, with limited range of motion of the fingers and weakness of the extremities and continued to receive outpatient rehabilitation treatment. His symptoms improved further, and 1 year after the onset of symptoms, he returned to work without any sequelae.