髓鞘糖蛋白抗體神經病變：病例報告

多發性神經病變在復健科是很常見的疾病。病患的症狀包括：肢體末端的感覺缺失，穿鞋子容易掉，手腳麻木像戴手套穿腳襪一般，拿小東西會掉，走路不穩；做肌肉神經電學檢查時會發現多條神經病變，且從遠端開始。感覺神經較先侵犯，若嚴重時，運動神經也會影響，甚至會造成肌肉萎縮。多發性神經病變的病因很多，治療方式也不同，我們報告一個罕見的病例，病因是髓鞘糖蛋白抗體造成的多發性神經病變。這是一位88歲男性榮民，主述因雙下肢無力，手腳麻，至神經內科求診，診斷為髓鞘糖蛋白抗體神經病變，做過血漿置換術及免疫球蛋白治療，但效果不顯著。最近因走路不穩，穿衣時扣鈕釦困難，而被安排於復健科住院。入院後身體檢查發現上肢肌力為4分，但兩手握力為3分，手部小肌肉明顯萎縮，下肢肌力為4分，深部肌腱反射上肢皆為1+，下肢皆敲不出，四肢末端感覺都缺損，為典型的多發性神經病變。病人在接受行走、平衡訓練及職能訓練後，步態有改善，加上輔具的協助，手部的精細動作也有進步，積極的復健治療確實能改善其生活品質。

關鍵字

多發性神經病變；抗髓鞘糖蛋白抗體

並列摘要

Polyneuropathy is common in the field of rehabilitation medicine. Its symptoms include sensory impairment in the distal limbs, ataxia, tremor, and pinch weakness. Electrophysiology will show multiple neuropathies with distal involvement first. Sensory nerve impairment usually appears earlier than motor nerve impairment. In severe cases, muscle atrophy can also be seen. Due to the multiple etiologies of polyneuropathy, the treatments vary. We report a rare case of anti-MAG neuropathy. The patient is a 88-year-old retired veteran, who complained of bilateral lower leg weakness and numbness in the distal part of all limbs. He visited the neurology OPD and was diagnosed with anti-MAG neuropathy in 1995. Plasma phoresis replacement and an intravenous injection of immunoglobulin were given but in vain. Recently, he had difficulty in dressing, and an unsteady gait was also noted. Thus, he was admitted on June 23, 2002 for comprehensive rehabilitation. Physical examination revealed muscle power in the upper limbs, as grade 4, bilateral hand grasp as grade 3, lower limbs as grade 4, and atrophy of the intrinsic muscles of both hands. Deep tendon reflex was absent in the bilateral legs. All sensory tests were impaired in the distal parts of the four limbs. The patient underwent balance and ambulation training, and the gait pattern then improved progressively. With support by an upper arm orthosis, hand function improved.

並列關鍵字

neuropathy ； anti-myelin-associated glycoprotein antibody

國際替代計量

髓鞘糖蛋白抗體神經病變：病例報告

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