著者

新堂 晃大 和田 英夫 冨本 秀和

出版者

一般社団法人 日本血栓止血学会

雑誌

日本血栓止血学会誌 (ISSN:09157441)

巻号頁・発行日

vol.25, no.3, pp.399-403, 2014 (Released:2014-07-01)

参考文献数

21

被引用文献数

2 2

著者

園生 雅弘 迫井 正深 渡辺 憲 冨本 秀和 安藤 哲朗 西山 和利 髙橋 良輔 戸田 達史 日本神経学会神経内科専門医基本領域化推進対策本部

出版者

日本神経学会

雑誌

臨床神経学 (ISSN:0009918X)

巻号頁・発行日

vol.60, no.8, pp.515-519, 2020 (Released:2020-08-07)

被引用文献数

1 1

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日本神経学会は2018年1月臨時社員総会において,神経内科専門医の基本領域化を目指すことを機関決定した.新専門医制度が大きく揺れる中,神経内科専門医基本領域化推進対策本部では,第60回学術大会において,専門医制度に関する緊急シンポジウムを開催した.本論文はその各演者の抄録を委員会報告としてまとめたものである.厚生労働省,日本医師会に所属する演者,及び,学会内の演者によって,基本領域化が必要な理由,特に地域医療との関係,実現するための手続き,克服すべき課題などが論じられた.これらを踏まえつつ,社員総会決定に従って,神経学会は今後も基本領域化を目指して関係各所との折衝を続ける.

著者

脇田 英明 冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.5, pp.491-494, 2018 (Released:2018-04-05)

参考文献数

10

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Dementia affects over 35 million people in the world with a rapidly increasing prevalence. Alzheimer's disease (AD) is the most common form of dementia. No fundamental treatment for AD has been established, and novel therapeutic strategies are under investigation. This progress has led to the development of numerous therapeutic strategies in the clinical testing. Immunotherapy against Aβ has been pursued extensively as a therapeutic approach to Alzheimer's disease, and several other promising trials are currently ongoing. In addition, new therapeutic strategies have been reported in Huntington's disease and frontotemporal dementia. This review overviews recent advances in basic and clinical research in dementia.

著者

冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.3, pp.188-192, 2017 (Released:2017-10-14)

参考文献数

19

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In recent years, outstanding progress has emerged in neuroimaging research of Alzheimer's disease (AD), which enables us to diagnose patients even in preclinical stages. However, it still remains uncertain to develop disease modifying therapy for AD. There are new concepts on the mechanism of tau and amyloid β accumulation, and its understanding may open an efficient way for therapeutic strategies for AD. This review focuses on the recent developments on the diagnosis and treatment of dementia.

著者

冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.39, no.3, pp.113-116, 2022 (Released:2022-11-22)

参考文献数

20

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Amyloid β (Aβ) is produced in the neurons and transported into the vessel walls and perivascular space through the extracellular space. These pathways are designated as intramural periarterial drainage (IPAD) pathway or glymphatic system in the brain. Overproduction of Aβ or alternatively, stagnation of Aβ transportation may lead to accumulation of amyloid fibrils in the vessel, thereby causing cerebral amyloid angiopathy (CAA). Spontaneous antibody production against Aβ occurs in patients with CAA, and induce CAA–related inflammation (CAA–ri). In terms of cellular mechanism and symptomatology, this entity is very close to amyloid–related imaging abnormalities (ARIA) which is often encountered in the patients during the course of amyloid vaccination treatment. This review overviews mechanisms of Aβ clearance in the brain and discuss on the Aβ antibody–related pathological conditions, including CAA–ri and ARIA.

著者

冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.37, no.5, pp.709-711, 2020 (Released:2021-07-21)

参考文献数

4

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It remains uncertain how brain circulation has effects on cognitive function in aging. Cerebral blood flow (CBF) decreases with advancing ages and in cognitive decline, apparently in vascular dementia and modestly in Alzheimer disease. Brain is an organ which requires enormous amount of CBF and metabolism compared to the other organs, and therefore, cerebral circulation is protected through autoregulation and subsequently, enhancement of oxygen extraction by neuronal structures even when CBF is decreased due to stenosis or obstruction of cerebral vessels.The damages in the grey matter is relatively mild, but the white matter becomes rarefied with gliosis and nerve fiber loss, if the decrease of CBF remains for a long duration at the level ranging from 50 to 70% of the baseline. In the long run, the patients may exhibit brain atrophy and cognitive decline. The mechanism of dementia in cerebrovascular disease, including small vessel dementia, is relatively straightforward, whereas in Alzheimer disease, it remains unclear how chronic cerebral hypoperfusion may lead to cognitive dysfunction and dementia. Apparently, chronic cerebral hypoperfusion induces neuro–inflammation, disintegration of blood–brain barrier (BBB) and altered excretion of amyloid beta via dysfunction of periarterial drainage pathway and glymphatic system. This review overviews the relationship between cerebral circulation disturbance and cognitive decline with advancing ages.

著者

石川 英洋 新堂 晃大 冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.39, no.3, pp.346-349, 2022 (Released:2022-11-22)

参考文献数

14

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Kelch–like protein 11 (KLHL11)–associated paraneoplastic syndrome (PNS) has been newly categorized as PNS. The corresponding syndromes are cerebellar and/or brainstem involvement, and in the fewer cases, limbic encephalitis. Hearing loss or tinnitus often precedes other symptoms. Findings of cerebrospinal fluid show inflammatory (protein 50mg/dL or greater and leukocyte counts exceeding 5 cells/µL) with oligoclonal bands in over 80% cases. The most common associated tumor is testicular germ cell tumor, especially seminoma. The primary testicular tumor is often spontaneously regressed with or without metastasis in lymph nodes, called a burned–out testicular tumor. Ultrasonography of testis is useful for such cases because it can detect the suggestive findings of burned–out tumors such as fibrosis and microlithiasis as hypoechoic area. The principles for management are treatment of underlying cancer and immunotherapy. KLHL11–PNS may have a more refractory course than PNS associated with antibodies against neural cell surface antigens since KLHL11 antibodies are targeting intracellular autoantigens and cause cytotoxic T–cell–mediated pathogenesis. A recent paper published by Autoimmune Encephalitis Alliance Clinicians Network recommends that tumor treatment and intravenous methylprednisolone followed by short oral taper should be performed as first–line therapy. If there is no improvement cyclophosphamide can be the next option. Then experimental therapy like IL–6 inhibitor or bortezomib can be considered in non–responded cases.

著者

冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.38, no.3, pp.337-342, 2021 (Released:2022-01-19)

参考文献数

15

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The number of dementia patients is rapidly increasing worldwide, however, in some cohorts in western countries the number shows a decreasing trend oppositely. The initial trial for disease modifying drug has started in 1999 by Schenk et al., but in vail for a long duration. The obstacles to be overcome appear to be an accurate diagnosis of dementia other than Alzheimer's disease, as well as autoimmune encephalitis and a similar but milder condition named amyloid–related imaging abnormalities (ARIA). When the diagnosis of Alzheimer's disease is delayed, accumulated fibrillary amyloid may be degraded and result in ARIA as a perivascular edema and microhemorrhages after administration of anti–amyloid β (Aβ) antibodies. Therefore, an early diagnosis of Alzheimer's disease is pivotal for safe and efficient strategies for disease modifying drugs.At present, amyloid PET study and cerebrospinal fluid (CSF) Aβ42 levels are an established biomarker for early diagnosis of Alzheimer's disease. These biomarkers still have drawbacks because of high cost and invasiveness, respectively. However, more recently, peripheral blood biomarkers have been introduced. Moreover, novel findings on aggregation mechanism of anti Aβ has been revealed, thereby accelerating development of disease modifying drug for Alzheimer's disease.

著者

冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.2, pp.194-198, 2016 (Released:2016-08-10)

参考文献数

22

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Cerebral small vessels have a pivotal role in maintaining exchange of energy and metabolites in the brain. Hypertension and amyloid β deposition may affect these small vessels, resulting in hypertensive small vessel disease and cerebral amyloid angiopathy (CAA), respectively, and are collectively related to the pathogenesis of microvascular lesions and dementing illness. This review focuses on the significance of cerebral microvascular lesions in cognitive impairment, and further, the relationship between cerebral microcirculation disturbance and perturbation of amyloid β clearance in Alzheimer's disease.

著者

冨本 秀和

出版者

一般社団法人 日本脳卒中学会

雑誌

脳卒中 (ISSN:09120726)

巻号頁・発行日

vol.35, no.2, pp.128-132, 2013-03-20 (Released:2013-03-25)

参考文献数

7

被引用文献数

2 1

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要旨:脳小血管病は小血管の病理変化,またはその結果生じる微小病変を意味し,それらに起因する比較的均質な病理・臨床像を包摂する病態である.その大部分は,1型の高血圧性小血管病と2型のアミロイド血管症に分類される.前者はラクナ梗塞,白質病変,脳出血が主体で,認知症を来す場合は皮質下血管性認知症と呼称される.後者は皮質下出血や白質病変の原因となり,ほとんどのアルツハイマー病患者で合併がみられる.本稿ではそれぞれの病態や臨床症候について概説し,さらに両型の相互の関連についても述べる.

著者

脇田 英明 冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.4, pp.506-509, 2017 (Released:2017-02-28)

参考文献数

16

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Dementia affects over 35 million people in the world with a rapidly increasing prevalence. Alzheimer's disease (AD) is the most common form of dementia.No fundamental treatment for AD has been established, and novel therapeutic strategies are pursued extensively. This progress has led to the development of numerous therapeutic strategies in the clinical testing. A long–term randomized controlled trial suggested the beneficial effects of multidomain lifestyle–based interventions to maintain cognitive functioning, Although humanized monoclonal antibodies that bind amyloid b failed to improve cognition in patients with AD, several other promising trials are currently ongoing. In patients with dementia with Lewy bodies, it has been reported that lack of interferon–β signaling causes α–synuclein pathology. In addition, new therapeutic strategies have been reported in prion disease and Huntington disease. This review overviews recent advances in basic and clinical research in dementia.