著者

桂 研一郎

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.37, no.3, pp.351-352, 2020 (Released:2021-02-05)

参考文献数

3

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Most important factor to prevent stroke for the first time is hypertension. However, there are relatively few people who get normal blood pressure, although they aware their own hypertension. Recently that tendency was called “hypertension Paradox”. In Japan many people receive medical checkup which named “Ningen Dock” or “Brain Dock”. At those medical checkup, the measured blood pressures are often dissociated from the blood pressure of the usual daily life. Especially, people with 50 years old or higher have been spending tough and stressful days. The percentage of those stressful time part per day sometimes become very high. We should distinguish the difference of their life pattern to evaluate their blood pressure data at “Ningen dock”, or “Brain Dock”.

著者

波田野 琢 服部 信孝

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.4, pp.601-604, 2020 (Released:2021-05-27)

参考文献数

23

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Parkinson's disease is regarded as the second most prevalent neurodegenerative disorder after Alzheimer's disease. The characteristic pathological finding in cases of Parkinson's disease is dopaminergic neuronal degeneration with Lewy body. Braak et al hypothesized that Parkinson's disease might be distributed from peripheral autonomic neurons to the central nervous system. The progression of Parkinson's disease might be caused by prion–like dissemination of alpha–synuclein, which is known as the main component of Lewy body. Thus, it might be expected that prevention of alpha–synuclein aggregation is possible through disease–modifying therapy. Alpha–synuclein is associated with lipids and the perturbation of the association is caused by the aggregation of alpha–synuclein. Furthermore, genetic dysfunction of phospholipid and glucolipid enzymes, such as GBA mutation and PLA2G6 mutations, is associated with Parkinson's disease with Lewy body. Therefore, elucidation of the pathomechanisms in Parkinson's disease related to the perturbation of lipid metabolism might shed light on the development of disease–modifying therapy.

著者

小森 哲夫

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.1, pp.33-38, 2021 (Released:2021-07-28)

参考文献数

9

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Many patients with neuromuscular disease are involved in respiratory insufficiency. It becomes difficult problem especially in those patient with COVID–19. There are 7 important factors for the respiratory care in this condition. Those are risk of aerosol, care plan for non–invasive positive pressure ventilation and tracheostomy invasive positive pressure ventilation, tips of suction, oxygen therapy, mechanical clearance of tracheal air way and rehabilitation technique of respiratory care.The risk of aerosol might be the most important for every other 6 factors. I informed each factor precisely. It should be useful for daily clinical setting.

著者

蕨 陽子

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.1, pp.14-19, 2021 (Released:2021-07-28)

参考文献数

39

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Coronavirus disease 2019 (COVID–19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2). This review summarizes the knowledge about SARS–CoV–2 immunology and discusses the policy of clinical practice for neuroimmune diseases at the time of the SARS–CoV–2 pandemic. The human defense systems against SARS–CoV–2 infection begin to work through innate immunity. Most neuroimmune diseases are caused by impairment of adaptive immunity, which preserves the function of innate immunity. Therefore, patients with neuroimmune diseases are not typically susceptible to COVID–19 and will not experience severe symptoms. However, patients with multiple sclerosis are at risk if their score on the Expanded Disability Status Scale is high. In the context of the COVID–19 pandemic, various neuroimmune disease practice guidelines have been published assessing the risk COVID–19 poses with each immunotherapeutic agent. Some immunotherapeutics may reduce immunity to viral infections. In particular, B–cell depletion therapy (rituximab, ocrelizumab, and inebilizumab) should be avoided because it can cause severe COVID–19 outcomes and decrease immune response to vaccination. On the other hand, some immunotherapeutics such as dexamethasone and tocilizumab may prevent severe COVID–19 symtpoms by suppressing cytokine storms. In most neuroimmune diseases, infection is known as a risk factor for acute exacerbation, so there is a risk of exacerbation of neuroimmune diseases by SARS–CoV–2 infection. In diseases such as myasthenia gravis, where respiratory function is impaired, COVID–19 has a high risk of being fatal. In addition to treatment of viral infections, these patients should be carefully monitored with immunotherapy. The efficacy and safety of COVID–19 vaccines in patients with neuroimmune diseases is still unclear and awaits further study.

著者

大坪 孝一

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.37, no.6, pp.S81, 2020

著者

吉田 眞理

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.373-377, 2016 (Released:2016-11-10)

参考文献数

5

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Diagnostic neuropathology of central nervous system leading to treatment is divided into two domains. One is brain biopsy and the other is autopsy proven pathological diagnosis. Brain biopsy is useful in difficult cases, in which less invasive measures have been unable to yield a definitive diagnosis, especially associated with space occupying lesions of white matter on imaging studies. These lesions include primary central nervous system lymphoma (PCNSL), tumefactive demyelinating lesions (TDL), progressive multifocal leukoencephalopathy (PML), and amyloid β–related angiitis (ABRA). Brain biopsies lead to early pathological diagnosis and suitable treatment. As brain biopsies often consist of small pieces of tissue, sampling error might occur. Preoperative discussion among neurologists, neurosurgeons, neuroradiologists, and pathologists is very important about differential diagnosis and biopsy regions. Furthermore, preoperative steroid or immunosuppressive therapy often obscure or obliterate pathological findings from naive inflammatory reaction. Therefore, it is recommended to plan a brain biopsy before steroid or immunosuppressive therapy.In neurodegenerative disorders or dementias, correct pathological diagnosis is obtained in autopsy. The worldwide decrease of autopsy rate has been reported, which make correct pathological diagnosis difficult. The characteristic pathological findings of neurodegenerative disorders consist of disease specific inclusions in neurons and glia composed of abnormally aggregated disease specific proteins. Alzheimer's disease has neurofibrillary tangle with tau aggregation and senile plaques with amyloid β fibrils. Parkinson disease and dementia with Lewy bodies shows α–synuclein positive Lewy bodies and Lewy neurites. In multiple system atrophy α–synuclein positive glial cytoplasmic inclusions in oligodendroglia are pathological hallmark. Major tauopathies consist of Pick disease with Pick bodies composed of 3 repeat tau, progressive supranuclear palsy and corticobasal degeneration with glioneuronal inclusions composed of 4 repeat tau. Amyotrophic lateral sclerosis and frontotemporal lobar degeneration present TDP–43 proteinopathies. In elderly overlapping of several neurodegenerative diseases is not uncommon. Pathological confirmations contribute the verification and understanding of clinical and neuroradiological findings, and treatment.

著者

伊藤 恒 山本 一徹 福武 滋 山口 敏雄 平 孝臣 亀井 徹正

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.37, no.1, pp.43-46, 2020 (Released:2020-07-21)

参考文献数

13

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薬剤抵抗性の本態性振戦(essential tremor:ET)10例(男性8例,女性2例,67.1±17.5歳,全例右利き)に対してMRガイド下集束超音波(MR–guided focused ultrasound:MRgFUS)による左視床中間腹側核(ventral intermediate nucleus:Vim)破壊術を行い,12か月後までの有効性と安全性を検討した.治療直後から全例で右上肢の振戦が改善し,2例で振戦が再増悪したものの,右上肢のClinical Rating Scale for Tremorの平均値は12か月後まで約60%の低下が持続した.しかし,Quality of Life in Essential Tremor QuestionnaireのGlobal Impression Scoreの平均値は有意な改善を認めなかった.有害事象の大部分は軽微かつ一過性であり,治療から6か月後以降に新規の有害事象は生じなかった.MRgFUSによる片側Vim破壊術は薬剤抵抗性のETに対する治療選択肢の1つであるが,振戦の改善効果を高めるとともに,より多数例を長期に検討する必要がある.

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

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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.

著者

矢部 一郎 佐々木 秀直

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.346-349, 2018 (Released:2018-02-20)

参考文献数

17

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We reviewed the recent advances in syringomelia based on nationwide survey on the epidemiology of syringomyelia in Japan. The estimated prevalence of ambulatory syringomyelia patients in Japan was 1.94 per 100,000. The proportion of asymptomatic syringomyelia patients was 22.7%. Chiari type I malformations and idiopathic syringomyelia were the first and second most common etiologies. Approximately 70% patients were performed foramen magnum decompression (FMD) with dural patch grafting and/or dural dissection. Several pedigrees with familial syringomyelia were observed. The progress of genetic analysis study is expected.

著者

木多 眞也

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.311, 2016 (Released:2016-11-10)

著者

渡辺 宏久 勝野 雅央 祖父江 元

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.186-190, 2016 (Released:2016-08-10)

参考文献数

22

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The development of large data sets and more powerful computers over the last decade have made it possible to reveal the fundamental principles of complex functional and anatomical brain networks using several techniques. Resting state functional magnetic resonance imaging (rsfMRI), a non–invasive tool to assess functional abnormalities of the brain without specific motor or cognitive tasks, has provided important insight into the pathophysiology of normal aging and neurodegenerative disorders. Results of our preliminary analysis of 200 aged healthy subjects indicate that brain atrophy with aging is observed mainly in limbic and premotor areas. Diffusion tract imaging showed anatomical network disruption surrounding the lateral ventricle. However, rsfMRI showed that an increase of resting connectivity across multiple cortical areas was observed more frequently than a decrease. These results may reflect a compensatory phenomenon of functional brain networks against the progression of brain atrophy and disruption of anatomical brain networks with aging. The IMAGEN group demonstrated that dozens of genes linked to ion channel activity and synaptic function support connectivity functional resting state networks. These molecular components may become new targets for disease modifying therapy. In addition, rsfMRI revealed that replacement therapy, deep brain stimulation, and rehabilitation may assist the normalization or amelioration of abnormal functional network connectivities and improve symptoms in neurodegenerative disorders. Analysis of brain functional connectivity may play an important clinical role as an early diagnostic and biomarker tool.

著者

川口 淳

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.229-234, 2017 (Released:2017-10-14)

参考文献数

30

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Meta–analysis plays an important role in systematic review. It allows strong evidence to be obtained through combining the results (the differences between groups) from several related research studies. The method by which results are combined in meta–analysis has been developed in the statistics framework. On the other hand, imaging analysis has been applied in many studies of brain diseases. Meta–analysis of brain imaging studies is necessary mainly because of the small sample size typically used in individual brain imaging studies because of the acquisition cost. Meta–analyses have already been published for studies of neurological diseases, such as Alzheimer's disease and Parkinson's disease. Many methods have been developed and are reviewed in this article. One of the most popular methods is coordinate–based meta–analysis (CBMA), which combines coordinates obtained as the statistical results of each brain imaging study on the standard brain template. Since the coordinate represents only one of the regions (the peak), the original spatial map needs to be reconstructed for each study. The reconstructed spatial maps represented by multiple neighborhood coordinates are combined for several studies. Inferential statistical analysis is then applied to these maps to produce the final output of the meta–analysis, using permutation tests ; this is a similar approach to that used to create the statistical parametric map (SPM) in individual studies. This procedure is called an activation likelihood estimate (ALE) and there exist similar approaches such as kernel density analysis (KDA) and signed differential mapping (SDM). This article introduces the software that allows the implementation of these techniques, and also the database for the output of the brain imaging data analysis. Further development of the CMBA methodology, such as with the bias correction used in traditional meta–analysis, would be desirable. In conclusion, meta–analysis of brain imaging analysis would be helpful to obtain more credible evidence. The methodology is already established and available for implementation.

著者

楠 進

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.36, no.1, pp.3-5, 2019 (Released:2019-07-10)

参考文献数

9

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Proteoglycans (PGs) consist of a core protein and glycosaminoglycans (GAGs). They are components of the extracellular matrices of the central nervous system (CNS) and also are present in the peripheral nervous system. They have been reported to be axon regenerating inhibitors in the CNS. They may therefore affect the pathogenetic mechanisms of the neurological diseases, but their roles have rarely been studied so far. Recently we investigated experimental autoimmune encephalomyelitis (EAE) induced in the mice deficient in glycosyltransferases involved in the synthesis of GAGs and found that modification of the carbohydrate residue of PGs have major effects on the pathogenesis of EAE. About half of the patients with IgM paraproteinemic neuropathy (IgM–N), IgM M–proteins are known to recognize HNK–1 epitope of myelin–associated glycoprotein (MAG). Phosphacan is a proteoglycan, which also has HNK–1 epitope. We studied binding specificities of such IgM M–proteins and found that they were heterogeneous. The ratio of the binding activity to phosphacan divided by that to MAG (P/M ratio) was related with the clinical severity of IgM–N. Further investigation on the roles of PGs in the neurological diseases may lead to the understanding of the pathogenesis and the development of novel therapies of neurological diseases.

著者

林 英治

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.6, pp.S84, 2020 (Released:2020-10-05)

著者

上原 孝一

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.37, no.6, pp.S83, 2020 (Released:2020-10-05)

著者

柳町 かんな

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.6, pp.S82, 2020 (Released:2020-10-05)

著者

大坪 孝一

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.37, no.6, pp.S81, 2020 (Released:2020-10-05)

著者

清塚 鉄人

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.37, no.6, pp.S80, 2020 (Released:2020-10-05)

著者

織茂 智之

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.6, pp.S78, 2020 (Released:2020-10-05)

著者

太田 雅也

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.6, pp.S77, 2020 (Released:2020-10-05)