Существует ли анти-NMDA-рецепторный энцефалит? II. Проблемы терапии

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Аннотация

В первой части обзора авторы подвергли сомнению диагностическую концепцию анти-NMDA-рецепторного энцефалита (ANMDARE). Вторая часть посвящена анализу ныне существующих подходов к его терапии. Показано, что использование антипсихотиков или иммуносупрессоров чревато развитием тяжёлых осложнений, вплоть до летальных исходов, в ближайшей или в отдалённой перспективе. Сопоставление клинических и нейробиологических эффектов, ассоциируемых с антителами к GluN1-субъединице глутаматных N-метил-D-аспартатных рецепторов (NMDAR1-AB) и введением субанестетических доз неконкурентного антагониста NMDA-рецепторов кетамина с высокой степенью вероятности указывает на нейропротективную, саногенную роль NMDAR1-AB, которую нужно не подавлять, а потенцировать. Средствами выбора в терапии острых полиморфных гиперкинетических психозов остаются бензодиазепины и электросудорожная терапия.

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Евгений Владимирович Снедков

Психиатрическая больница Св. Николая Чудотворца

Email: esnedkov@mail.ru
ORCID iD: 0000-0002-1438-1890
SPIN-код: 4353-6428

д-р мед. наук, профессор

Россия, Санкт-Петербург

Игорь Анатольевич Волчек

Российский биотехнологический университет; Научно-исследовательский центр иммунологии и аллергологии

Email: igor.volchek@gmail.com
ORCID iD: 0009-0000-1451-6145
SPIN-код: 6743-2105

д-р мед. наук, профессор; главный научный сотрудник научно-исследовательского центра иммунологии и аллергологии

Россия, Москва; Москва

Илья Владимирович Лемешев

Психиатрическая больница Св. Николая Чудотворца; Северо-Западный государственный медицинский университет им. И.И. Мечникова

Автор, ответственный за переписку.
Email: ilya.lemeshev@gmail.com
ORCID iD: 0009-0002-0491-6545
SPIN-код: 7635-4548

зав. дневным стационаром, врач-психиатр; ассистент кафедры

Россия, Санкт-Петербург; Санкт-Петербург

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