四肢感覚障害を呈した傍腫瘍性神経症侯群の2症例に対するリハビリテーションの経験

Paraneoplastic Syndrome with Sensory Polyneuropathy : A Report on Rehabilitation in Two Cases

はじめに

　傍腫瘍性神経症侯群は，悪性腫瘍患者にみられる神経症候であり，腫瘍の直接浸潤や転移，代謝障害，抗腫瘍療法の副作用などを除外したもので「腫瘍の遠隔効果」として知られている．神経症候としては中枢神経，末梢神経，神経筋接合部，筋を傷害する様々なものが報告されている^1）．肺小細胞癌，血液腫瘍，婦人科腫瘍などで傍腫瘍性神経症侯群の頻度が高いとされている^2）．

　傍腫瘍性神経症侯群における末梢神経障害様式のひとつに，感覚性ニューロパチーがある^3）．傍腫瘍性神経症侯群の報告は多いが，リハビリテーション（以下，リハ）過程を含めた長期経過の報告は，ほとんど見当たらない．我々は後根神経節の障害によると考えられる感覚障害を呈した傍腫瘍性神経症候群の2症例を経験したので，リハ経過を含めて報告する．

Abstract : We report two cases of paraneoplastic syndrome with sensory polyneuropathy. Case one showed numbness of the upper and lower extremities before a diagnosis of small cell carcinoma was made. Case two showed the same symptoms coincidentally with a recurrence of ovarian cancer. In both cases, Romberg's sign was positive, ataxic gait was noted, and the patient's skill movement was disturbed. Sensory nerve action potentials were not evoked in any of the nerves. Compound muscle action potential and motor conduction velocity were at the lower limits of normal. The neurological abnormalities did not resolve in spite of medical treatments. In these two cases, the loss of sensory neurons due to a lesion of the dorsal root ganglia was suggested. The loss of sensory feedback might lead to muscle weakness and fatigue, so they tend to be disused. For long-term rehabilitation management in these two cases, we suggested a regular exercise program to prevent muscle weakness.