著者
髙畑 克徳 髙嶋 博
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.1, pp.9-18, 2016 (Released:2016-05-20)
参考文献数
19
被引用文献数
1

Autoimmune encephalopathies are clinically and immunologically heterogeneous disorders. Over time, many different types of autoimmune encephalopathy have been discovered. In such clinical situations, we often recognize that patients with autoimmune encephalopathy are often misdiagnosed as exhibiting functional psychogenic movement, conversion, or somatoform disorders. We clinically analyzed 63 patients (14 males and 49 females; age range, 15–79 years) diagnosed with autoimmune encephalopathy in our hospital from 2013 to 2015. Throughout this period we diagnosed almost no conversion disorders in our department. These patients were diagnosed using the diagnostic criteria for each disease, following clinical features showing neurological symptoms of brain origin, responsiveness to immunosuppressive therapy, the existence of known pathological antibodies, and/or history of human papilloma virus (HPV) vaccination. Fourty–two patients showed motor disturbance (weakness, paresis of extremities, or slower pinching) and 35/42 (83.3%) patients showed give–way weakness, indicating disruption of continuous muscle contraction. Fourty–four patients showed sensory abnormalities such as strong pain, deep muscle pain, dysesthesia, paresthesia, or fast neurologic pain. Surprisingly, most pain was distributed in manner that was not explainable anatomically, while some patients also showed patchy, stocking–glove, or localized pain. Seventeen patients exhibited involuntary movements such as tremor entrainment, dystonia, or coarse involuntary movement. In most patients, such motor, sensory, or involuntary movements were markedly improved with immunosuppressive therapies such as prednisolone, azathioprine, or immune adsorption therapy. We observed memory loss, PNES (psychogenic non–epileptic seizure), dissociative amnesia, hyperventilation, opsoclonus, epilepsy, or autonomic symptoms amongst our patients. Although give–way weakness, anatomically unexplainable pain/abnormal sensation, and strange involuntary movements were thought to be psychogenic, the presence of one of these three symptoms was indicative of autoimmune encephalopathy. As autoimmune encephalitis exhibits diffuse involvement with the whole brain, these symptoms were entirely understandable. Except for the presence of organic disease, most patients were classified into somatoform disorders (DSM–IV, ICD–10) or functional movement disorders. Without first excluding autoimmune encephalopathy, we propose that physicians should not diagnose somatoform disorders. Since autoimmune encephalopathy patients often possess so–called psychogenic signs, it is possible that such signs might be generated by autoimmune encephalopathy instead of somatoform disorders. In conclusion, we propose that give–way weakness and anatomically unexplainable pain/abnormal sensation are key symptoms of autoimmune encephalopathy. We hope that many patients with autoimmune encephalopathy will now be identifiable using our new neurological examination and that each patient can be given an exact diagnosis and therefore be administered with the appropriate treatments.
著者
髙嶋 博
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.35, no.4, pp.536-542, 2018 (Released:2019-04-22)
参考文献数
24

Many patients present with extremely serious problems such as headache, photophobia, acoustic hyperresponsiveness, severe pain, menstrual disorders, various sleep disorders, and POTS after human papillomavirus vaccination (HPV vaccine). In addition, patients exhibit various neurological symptoms such as movement disorders, walking disturbance, involuntary movement, abnormal sensation, memory disturbance, and so on. However, these symptoms are variable and have been considered to be symptoms of hysteria (somatoform disorder, somatic symptoms). Immunosuppressive treatments were not administered because many cases were considered to be of neurological origin. In such cases, the disease condition is objectively evaluated to diagnose and treat patients with neurological symptoms. In conclusion, the wide–ranging symptoms of the central nervous system include those caused by disseminated autoimmune encephalitis and also symptoms of the peripheral small fibers. Thus, according to the obtained findings, the neurological symptoms caused by HPV vaccination are related to immunological diseases, and not psychogenic diseases. In addition, the cause of misdiagnosis has also been described.
著者
池田 修一
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.1, pp.32-39, 2016 (Released:2016-05-20)
参考文献数
25
被引用文献数
2

A relatively high incidence of chronic limb pain, frequently complicated by violent, tremulous involuntary movements, has been noted in Japanese girls following human papillomavirus (HPV) vaccination. The average incubation period after the first dose of the vaccine was 5.47±5.00 months. Frequent manifestations included headaches, general fatigue, coldness of the legs, limb pain and weakness. The skin temperature examined in the girls with limb symptoms exhibited a slight decrease in the fingers and a moderate decrease in the toes. Digital plethysmograms revealed a reduced height of the waves, especially in the toes. The limb symptoms of the affected girls were compatible with the diagnostic criteria for complex regional pain syndrome (CRPS). The Schellong test identified a significant number of patients with orthostatic hypotension and a few patients with postural orthostatic tachycardia syndrome. Electron–microscopic examinations of the intradermal nerves showed an abnormal pathology in the unmyelinated fibers in two of the three girls examined. The symptoms observed in this study can be explained by abnormal peripheral sympathetic responses. The most common previous diagnosis in the studied girls was psychosomatic disease. Additionally delayed manifestation of cognitive dysfunction in the post–vaccinated girls has been paid much attention: memory loss, difficulty in reading textbooks and/or calculation.
著者
髙嶋 博
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.472-473, 2018 (Released:2018-02-20)
参考文献数
15
著者
渡邊 恭良 倉恒 弘彦
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.1, pp.40-45, 2016 (Released:2016-05-20)
参考文献数
16

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disease characterized by chronic, profound, disabling, and unexplained fatigue. Although it is hypothesized that inflammation in the CNS is involved in the pathophysiology of CFS/ME, there were no direct evidence of neuroinflammation in patients with CFS/ME. Activation of microglia and/or astrocytes is related to neuroinflammation. Our recent PET study successfully demonstrated that neuroinflammation (activation of microglia and astrocytes) is present in widespread brain regions in patients with CFS/ME, and is associated with the severity of neuropsychological symptoms. Evaluation of neuroinflammation in patients with CFS/ME may be essential for understanding the core pathophysiology, as well as for developing the objective diagnostic criteria and effective medical treatments for CFS/ME. We here describe related pathophysiological findings and topics, and mention the diagnostic and therapeutic attempts through these findings in Japan.

73 0 0 0 OA Letter to the Editor

著者
上田 豊 木村 正
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.471-471, 2018 (Released:2018-02-20)
参考文献数
12
著者
平田 幸一 鈴木 圭輔 春山 康夫 小橋 元 佐伯 吉規 細井 昌子 福土 審 柳原 万理子 井上 雄一 西原 真理 西須 大徳 森岡 周 西上 智彦 團野 大介 竹島 多賀夫 端詰 勝敬 橋本 和明
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.2, pp.166-179, 2020 (Released:2020-08-31)
参考文献数
51

難治性の疾患における持続中枢神経感作と言われる病態の疫学,基礎・臨床的な位置付けさらには患者のケアにむけての研究をまとめた.本総説は厚生労働研究班の各員の研究結果を示したものなので,必ずしもまとまりがない点に限界があるが,今までは疾患縦断的に診断治療がおこなわれてきた難治性疾患における中枢神経感作の役割を横断的にみたという意味でもわれわれの研究の結果は一部ではあるが解明したものといえる.結果として,中枢神経感作は種々の疾患,特に難治性のもので明らかに何らかの役割を呈していることが示せた.さらにその治療法の解明には至らぬまでも,患者ケアに繋がる方略を示せたものと考えられ,今後の研究の基盤となることが望まれる.
著者
髙嶋 博
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.160-162, 2017 (Released:2017-10-14)
参考文献数
5

Autoimmune encephalopathies are clinically and immunologically heterogeneous disorders. Many different types of autoimmune encephalopathy have been discovered, and most common type may be Hashimoto encephalopathy in it. In clinical situations, we often recognize that patients with autoimmune encephalopathy are often misdiagnosed as exhibiting functional psychogenic movement, conversion, or somatoform disorders. We clinically analyzed 63 patients with autoimmune encephalopathy. Two–thirds of patients showed motor disturbance mostly with give–way weakness. About 70% of patients showed sensory abnormalities such as strong pain, deep muscle pain, dysesthesia, paresthesia, or fast neurologic pain. Most pain was distributed in manner that was not explainable anatomically. 27% of patients exhibited involuntary movements such as tremor entrainment, dystonia, or coarse involuntary movement. We observed memory loss, PNES (psychogenic non–epileptic seizure), dissociative amnesia, hyperventilation, opsoclonus, epilepsy, or autonomic symptoms amongst our patients. Although give–way weakness, anatomically unexplainable pain, and strange involuntary movements were thought to be psychogenic, the presence of one of these three symptoms was indicative of autoimmune encephalopathy. As autoimmune encephalitis exhibits diffuse involvement with the whole brain, these symptoms were entirely understandable. Except for the presence of organic disease, most patients were classified into somatoform disorders or functional movement disorders. Without first excluding autoimmune encephalopathy, physicians should not diagnose somatoform disorders.
著者
朝比奈 正人
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.3, pp.368-372, 2016 (Released:2016-11-10)
参考文献数
14

Clinically it is very important to diagnose and treat autonomic symptoms such as syncope, urinary problems and sweat abnormalities. Vasovagal syncope, the most common syncopal disorder, usually develops under 40 years old. As the sensitivity of head–up tilt test is low, history taking is more important for the diagnosis. Carotid sinus syncope usually develops over 60 years old and its diagnosis is confirmed based on the evidence of bradycardia and hypotension induced by stimulation to the carotid sinus. Orthostatic hypotension is defined as a sustained reduction of systolic blood pressure of at least 20mmHg or diastolic blood pressure of 10mmHg within 3 minutes of standing or during head–up tilt test. Non–pharmacological management is important : salt supplementation, fluid intake and avoiding precipitating factors such as high carbohydrate meals, hot environments, alcohol and vasodilator drugs. Vasopressor drugs, which are used for treatment of orthostatic hypotension, can cause or aggravate recumbent hypertension. Urinary dysfunction is classified into storage and voiding symptoms. Anticholinergic drugs, which are used for treatment of storage symptoms, may exacerbate cognitive impairment. In regard to impaired voiding, clean intermittent selfcatheterization is preferred in patients having over 100ml of residual urine. Sudomotor abnormalities include hyperhidrosis and hypo/anhidrosis. For focal hyperhidrosis such as palmoplantar hyperhidrosis treatment like aluminium chloride application, tap water iontophoresis and thoracic sympathectomy may be performed. For acquired idiopathic generalized anhidrosis corticosteroid therapy is often effective.
著者
橋本 洋一郎
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.35, no.4, pp.416-421, 2018 (Released:2019-04-22)
参考文献数
13

RCVS comprise a group of disorders characterized by prolonged but reversible vasoconstriction of the cerebral arteries, usually associated with acute–onset, severe, recurrent headaches, with or without additional neurologic symptoms and signs. Recurrent thunderclap headaches, seizures, transient ischemic attacks, brain infarctions, brain hemorrhages and non–aneurysmal subarachnoid hemorrhages can all reveal RCVS.Stroke can occur a few days after initial normal imaging, and cerebral vasoconstriction is at a maximum on angiograms 2–3 weeks after clinical onset. Segmental constrictions of cerebral arteries resolve within 3 months. RCVS is supposedly due to a transient disturbance in the control of cerebrovascular tone.
著者
神林 崇 大森 佑貴 今西 彩 高木 学 佐川 洋平 筒井 幸 竹島 正浩 小野 太輔 塩見 利明 清水 徹男
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.406-410, 2018 (Released:2018-02-20)
参考文献数
6

Delayed sleep phase disorder (DSPD) comprises a persistent or recurrent pattern of sleep disturbances, sleep disruption that leads to insomnia and/or excessive daytime sleepiness, and impaired functioning in social, occupational, or other spheres. Three techniques are typically used to treat DSPD : chronotherapy, phototherapy, and exogenous melatonin administration. Antipsychotics have not been reported in the treatment of DSPD, aripiprazole (APZ), which is a second generation antipsychotic, manifests a novel mechanism of action by serving as a partial agonist of D2 receptors. Depression is reported to be the most common psychopathology associated with DSPD, and APZ is reported to be effective in major depressive disorder as adjunctive therapy. Therefore, we speculated that APZ might be effective to treat DSPD, and we observed how APZ works for the treatment of DSPD.Methods : 18 subjects (including 7 women) who are 14–48–year–old (the average is 31.6) were included. The patients were prescribed 0.75–4.5mg APZ at once a day.Results : We prescribed 1.5–3.0mg/day of APZ, all subject reduced total sleep time (9.6 +/− 2.3h → 7.8 +/− 2.0h, p=0.03), many cases got up earlier (9.1 +/− 1.9h → 6.7 +/− 1.4h, p=0.005) in the morning and advanced their sleep phase within one week. The sleep onset was not significantly changed (23.5 +/− 2.0h → 22.9 +/− 1.9h, n.s.).Conclusion : Low dose of APZ would reduce nocturnal sleep time in the subjects who had prolonged sleep time and DSPD symptoms. The mechanism of action would be dopaminergic up regulation due to dopamine D3 agonistic activity. Since it is difficult for physicians to treat prolonged sleep time and DSPD symptoms, this medication would become a new therapeutic tool for these patients.
著者
井上 雄吉
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.228-233, 2016 (Released:2016-08-10)
参考文献数
40

Repetitive transcranial magnetic stimulation (rTMS) has the potentials to change brain excitability, inducing plasticity. In recent years, the use of rTMS has been increased for basic research and clinical applications, such as post–stroke complicatons, including hemiparesis, aphasia or unilateral spatial neglect.rTMS is classified into inhibitory low–frequency (≦1Hz) and facilitatory high–frequency rTMS (≧5Hz), totally named as conventional rTMS (c–rTMS), in which stimulation pattern is regular. In contrast, patterned rTMS (p–rTMS) has irregularly modified stimulation pattern. The after–effect of rTMS, lasting beyond stimulation time, depends on the number, intensity and frequency of stimulation pulses, contributing to clinical efficacy of rTMS. Lastly, p–rTMS is used much often than c–rTMS, because the after–effect of the former is more than the latter in duration and magnitude of the effect. The author and collegue use theta burst stimulation (TBS) (Huang et al, 2005) among various p–rTMS. TBS is classified into inhibitory continuous TBS (cTBS) and facilitatory intermittent TBS (iTBS). In this report, in addition to c–rTMS, the efficacies of cTBS are described for unilateral spatial neglect (USN) or non–fluent aphasia, stimulating over posterior parietal cortex or Brodmann area 45 (BA45) on unaffected hemisphere, respectively. Also, in recent, we have reported the effect for post–stroke ataxia of hybrid therapy of iTBS over the motor cortex on affected hemisphere combined with integrated volitional control electrical stimulation (IVES).rTMS (in particular, TBS) is expected a promising useful therapy for rehabilitation.
著者
髙嶋 博
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.1, pp.3-6, 2022 (Released:2022-06-15)
参考文献数
13

Medical scientists are asked to make various judgments when new diseases emerge, such as COVID–19, but even for these experts, their judgments are often incorrect. Experts always attempt to convince the public using a term “science–based evidence” but, in many cases, without real solid evidence. There are massive of unexplained diseases and pathogenicity in neurology. In order to discover and elucidate new diseases and their pathophysiological conditions, it is important to carefully examine and investigate each patient, followed by a persistent tracing sincerely and deeply. Medicine is still developing, and to make the neurology more practical and useful for the world, I would like to expect flexibility, innovation, and conscience from doctors with neurological expertise.
著者
犬塚 貴 木村 暁夫 林 祐一
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.94-98, 2016 (Released:2016-08-10)
参考文献数
20
被引用文献数
2

Several autoantibodies are associated with autoimmune encephalitis. Some of these antibodies are directed against intracellular neuronal antigens such as Hu and Ma2, which are strongly associated with paraneoplatic syndrome. In the past 10 years, various antibodies were identified that recognize neuronal cell–surface or synaptic proteins in patients associated with or without malignancy. Some of these antibodies are able to directly access receptors of neurotransmitters or channels and are responsible for causing neurological syndromes. Autoimmune encephalopathy with these antibodies generally responds to immunotherapies, such as steroids, plasmapheresis, and intravenous immunoglobulin as well as immunosuppressant and anti–cancer treatments in cases of paraneoplastic syndrome.Patients with N–methyl–D–aspartate (NMDA) receptor antibodies, which are the most common in autoimmune encephalopathy, often cause psychiatric manifestation, memory impairment, seizures, dyskinesia, catatonia, autonomic instability and respiratory failures. Although 86% of patients become worse at the stage of mRS5, almost 80% of all patients recover to the stage of less than mRS2 with immunomodulatory therapy and careful management for their general condition. Detection of those antibodies in both serum and CSF using cell–based assays is important for definite diagnosis. Availability of screening systems of antibodies and covering health insurance for immunomodulatory therapy for autoimmune encephalitis are highly expected.
著者
横田 隆徳 仁科 一隆 桑原 宏哉
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.3, pp.303-306, 2016 (Released:2016-11-10)
参考文献数
22

Two major types of oligonucleotide drugs for gene silencing, short interfering RNA (siRNA) and RNase H active antisense oligonucleotides (ASOs), microRNA (miRNA) and Aptamer are being developed as therapeutic platforms orthogonal to small molecule and protein therapeutic. We outlined these oligonucleotide drugs. Despite progress in the design of new oligonucleotide chemical modifications, methods which improve potency of oligonucleotide drugs in animals are highly desirable. The insufficient delivery, poor cellular uptake and their inefficient access to target RNA during intracellular trafficking are major impediments to in vivo silencing by conventional oligonucleotide drugs. Here we developed a short DNA/RNA heteroduplex oligonucleotide (HDO) with a structure different from siRNA of double–stranded RNA and ASO of single–stranded DNA. When the DNA strand was used as 13–mer locked nucleotide acid (LNA) gapmer ASO and RNA strand was conjugated with vitamin E (α–tocopherol) (Toc–HDO), it achieved the most efficacious gene silencing in yet reported ASOs.