針刺療法合併西醫診治泛視神經脊髓炎之病例報告

Acupuncture Combined with Western Medicine for Treating Neuromyelitis Optica Spectrum Disorder: A Case Report

視神經脊髓炎是一種罕見的去髓鞘疾病，過去台灣很少發表過中西醫聯合治療此疾病之報導。我們報告一位34歲女性，最初以腹部脹痛為表現至急診就診，入院後陸續出現癲癇、急性呼吸衰竭、四肢無力等症狀，轉入加護病房觀察，經插管治療，並根據臨床表現追蹤脊髓磁振造影與AQP4抗體，確診為泛視神經脊髓炎的個案。經給予類固醇、血漿置換術與免疫抑制劑療法兩周後，情況轉趨穩定，但四肢肌力仍差且無法脫離呼吸器。經會診中醫施行針刺療法近兩個月療程中，病患順利拔管且四肢肌力進步甚多，半年後追蹤影像學檢查亦有顯著的改善。由此可見，針刺療法介入罕見的神經性疾病，亦可獲得滿意療效，藉此也希望未來台灣醫療環境可提供更寬廣的中西醫合併診療平台。

Neuromyelitis optica (NMO) is a rare demyelinating disease of central nervous system. There has seldomly been reported in Taiwan that its treatment with acupuncture combined with Western Medicine. We encountered a case of 34-year-old woman with abdominal pain, followed by seizure attack, acute respiratory failure, and quadriplegia. She received endotracheal intubation in the Intensive Care Unit (ICU). Neuromyelitis optica spectrum disorder (NMOSD) was diagnosed based on clinical manifestations, a contiguous spinal cord lesion on MRI extending more than three segments, and seropositivity for aquaporin-4 (AQP4) autoantibodies. Her condition was stabilized within two weeks after glucocorticoids administration, plasmapheresis, and systemic immunosuppression. However, there was not any apparent improvement on muscle strength and she was still ventilator-dependent. During approximately two-month period of acupuncture therapy, the patient received endotracheal extubation and four limbs muscle strength markedly improved. The six-month follow-up MRI image also demonstrated significant interval change. We observed satisfactory therapeutic response to treat such rare neurological disease with acupuncture. Hope that we can create a better medical care environment to combine Traditional Chinese Medicine and Western Medicine in Taiwan in the future.