著者

目崎 高広

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.51, no.7, pp.465-470, 2011 (Released:2011-07-21)

参考文献数

38

被引用文献数

3 4

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ジストニアは,中枢性の持続的な筋緊張を特徴とする運動異常症の一症候群である.その臨床特徴として,定型性,動作特異性,感覚トリック,オーバーフロー現象,早朝効果,フリップフロップ現象,共収縮,陰性ジストニア(仮称)などがあり,これらを参考に診断する.通常,局所性ジストニアの治療はボツリヌス毒素の筋肉内注射が第一選択である.一次性ジストニアで,より広範な身体部位を侵すばあいには,定位脳手術を考慮する.二次性ジストニアにおける定位脳手術の成績は一般に劣るが,遅発性ジストニアでは効果が高い.内服治療は,有効率が通常低く,一方,副作用の頻度は高いため,特殊な病型以外では補助療法としての位置づけに留まる.

著者

目崎 高広

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.52, no.11, pp.1068-1070, 2012 (Released:2012-11-29)

参考文献数

10

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Primary dystonia is believed to be rare, and its estimated prevalence is roughly around 10-20 per 100,000 in the general population. In middle-aged or elderly people, the prevalence is much higher, reported to be over 700 per 100,000. Dystonia also occurs secondarily in various conditions, as drug-induced (acute or tardive) dystonia or in association with neurological disorders. Reported prevalence values may be underestimate. The diagnosis of dystonia tends to be delayed for several years after the onset of symptoms, or the symptoms may be left unrecognized or misinterpreted. "Dry eye" is common in the modern society and is a frequent misdiagnosis of blepharospasm. "Stiff sensation of the neck", a ubiquitous symptom among Japanese, may actually be a phenotype of cervical dystonia. A subset of "essential tremor" and tremor in SWEDDs (Scans Without Evidence of Dopaminergic Deficits) reportedly have similar pathophysiology to dystonia. Occupational dystonia is common within a specific population. About 1% of musicians may suffer from musician's dystonia, and about one-third of professional or highly skilled golfers may have "yips", possibly a representation of dystonia. Dystonia is common against a general belief, and should be included among the differential diagnosis in patients with muscular hyperactivity and impaired voluntary movements.

著者

目崎 高広

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.4, pp.359-362, 2018 (Released:2018-02-20)

参考文献数

20

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Botulinum toxin has been widely applied to therapeutic and cosmetic uses since 1980's. In Japan two formulations, one type A and one type B, are available under strict official regulations. Off–label use is prohibited, and the reimbursement of national insurance is too much restrictive to encourage clinicians of the next generation to launch the practice of this highly effective treatment. Moreover, many of the doctors in Japan are too busy to learn and perform this relatively time–consuming but financially unrewarded procedure. These hardships may regrettably result in the future decline, both quantitative and qualitative, of practice in the clinical setting, as far as Japan is concerned.For injection, the author prefers 27–30 gauge thin needles to thicker ones, to minimize patient's agony, and whenever possible tries to accurately identify target muscles under the monitoring with electromyography, electrical stimulation, or ultrasonography, for the treatment of the limb or deep cervical muscles. Especially for the obliquus capitis inferior and semispinalis cervicis muscles, the ultrasound is superior to other monitoring techniques.In spasticity many patients have anticoagulant or antiplatelet drugs for the secondary prevention of cardio– or cerebro–vascular diseases, and special care should be taken to avoid massive intramuscular bleeding in these patients. The consensus about the adequate use of these drugs still remains to be confirmed.Antitoxin antibody may abolish the toxin effect, but significant number of patients may show apparent secondary resistance to the therapy due to another reasons than neutralizing antibody. Target sites, dose, and technical issues should be re–assessed before abandoning treatment whenever the toxin effect appears to have diminished.

著者

木村 淳 目崎 高広 梶 龍兒

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.83, no.9, pp.1655-1659, 1994-09-10 (Released:2008-06-12)

参考文献数

10

著者

目崎高広

出版者

診断と治療社

雑誌

ジストニアとボツリヌス治療

巻号頁・発行日

pp.169-187, 2005

被引用文献数

1

著者

目崎高広

雑誌

Clinical Neuroscience

巻号頁・発行日

vol.25, pp.716-717, 2007

被引用文献数

1