10
the possible spread of their influence on neighboring motor neurons, as well as
complement keeping immune complexes in the neuromuscular synapses. The
autoimmune nature of the disease is often reinforced by the concomitant autoimmune
disease of the thyroid gland and paraproteinemia. Unsuccessful attempts to use
immunosuppressive therapy does not rule out the genesis of autoimmune disease
[Smith RG et al., 1996].
According to some reports in the genesis of the disease may play a role and
exogenous factors. For example, one of the spread of disease endemic areas in Guam
(New Guinea) patients showed high concentrations of aluminum and manganese, with
reduced calcium. In motor neurons we detected accumulation of hydroxyapatite
aluminum. Due to lysis of infected cells there can be a formation of antibodies to the
nerve fibers. Metal complexes in neurons may be found for many years, and then for
unknown reasons signs develop of amyotrophic lateral sclerosis or Parkinson's disease
with dementia syndrome. In the cerebrospinal fluid also showed increase of glutamate
and aspartate, which may damage the motor neurons [Popova L.M., 1998]. Given the
widespread use of aluminum-containing tap water purification reagents, such a
possibility is not excluded in our cities, which underlines the need for the use of a variety
of household water filters and efferent therapy, able to promptly withdraw excessive
amounts of aluminum and other potentially harmful metals to prevent such disorders.
And reports appeared on the successful use of plasmapheresis treatments at intervals
of 1-2 months for 12 years, which provided a stable condition of the patient.
Morvan fibrillary chorea is characterized by generalized myokymia (pseudo
fasciculations), pain, hyperhidrosis, weight loss, insomnia, and hallucinations. The
disease develops as idiopathic and due to mercury intoxication, chrysotherapy
(treatment with salts of gold) and thymoma. The pathogenesis of the primary forms of
the disease remains unclear, although by analogy with similar diseases that are
accompanied by increased muscle activity not to be excluded is autoimmune nature of
the disease. An indirect confirmation of this view is the highest reported case of
repeated sessions of plasmapheresis that stops the main manifestations of the disease
[Madrid A. et al., 1996].
Acute encephalitis is also described caused by antibodies to called anti-N-methyl-
D-aspartate receptor, at which developing convulsions, stupor, dysphagia and
hypoventilation, until malignant catatonia. The use of high-dose prednisone does not
give effect and signs of the disease have been cropped by a course of plasma
exchange on the background of the rapid reduction of these autoantibodies [Schimmel
M. et al., 2009].
Stiff-man syndrome (progressive encephalomyelitis with muscular rigidity)
–
a
rare but serious autoimmune disease, with increasing bulbar hyper contracture,
diplopia, dysphagia, pain in areas of the spastic muscle contractions. For these patients
typical thing is hyperlordosis. Diazepam is used in the treatment, significantly reducing
11
motor activity, as well as baclofen and hlonazepam. It is hypothesized that this
syndrome is the result of an imbalance between inhibitors of γ
-aminebutyl acid
-motor
neurons. There are signs that the autoantibodies of patients Stiff-man syndrome,
cerebellar ataxia and diabetes mellitus type 1 react with glutamic acid decarboxylase,
the synthesizing enzyme, which is localized in the corresponding neurons [Saiz A. et al.,
1997; Abele M. et al., 1999; Tuomi T. et al., 1999]. Plasmapheresis, reducing the titer of
antibodies, reduces extraceptive reflexes, decrease in muscle motor activity and
provides significant clinical improvement [Brashear HR, Phillips LH, 1991; Shariatmadar
S., Noto TA, 2001; Schröder A. et al., 2009]. L. Fogan (1994) also noted that the use of
plasmapheresis with subsequent courses of corticosteroid therapy resulted in a
significant improvement and long-term remission.
Acquired neuromyotoniya - as the previous pathology, it is a rare disease of
unknown etiology in which hyperexcitability of peripheral motor nerves leads to
involuntary muscle twitching, painful spasms and weakness. Given the possible
mechanism of autoimmune disease, S. Sinha et al. (1991) after 7 years of ineffective
drug therapy, using plasmapheresis, which each time resulted in the almost complete
disappearance of the symptoms for 2-3 weeks with a very pronounced decline recorded
electromyographic neyro myotonic disorders. Over the next few weeks, the symptoms
slowly returned.
Rasmussen's encephalitis - a rare syndrome of progressive unilateral brain
disfunction with limited seizures. Usually occurs in childhood (6-8 years old), with a
gradual progression, resulting in hemiparesis and dementia. Revealed are signs of
inflammation with perivascular accumulations of lymphocytes. The autoimmune nature
is proved by detection of autoantibodies. In some cases, improvement was reached with
the use of corticosteroids and immunoglobulins. However, resulting in a significant
improvement was a course of plasmapheresis (5-6 sessions of up to 1 circulating
plasma volume each). In this case, convulsions stopped, there was improvement in
speech and motor activity [Andrews PI et al., 1996].
Autoimmune autonomic gangliopathy accompanied by a lesion of both the nerve
fibers and ganglion. As of intravenous immunoglobulin therapy and plasma exchange
offer improvement of the clinical picture of lesions [Iodice V. et al., 2009].
Fatal familial insomnia is a rare but severe genetically determined disorder
characterized by a significant shortening of sleep time and is accompanied by
increasing weakness, impaired autonomic functions, ataxia, dysarthria, hallucinations,
delirium and myoclonus. Starting at the age of 25-60 years, continues from 7 to 33
months, with the imminent deaths [Gambetti P., Parch P., 1999].
This disease is a kind of "prion" diseases. Prions are proteins that are normally
soluble in detergents, have the form of
-helix and are protease-destroyed. Pathological
-isoforms have a flattened shape, insoluble and resistant to proteases. With their
accumulation there is possible development of such pathological insomnia. Thus there