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)

著者

平田 幸一

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.35, no.1, pp.3-6, 2018 (Released:2018-06-12)

参考文献数

21

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Tension type headache : TTH is regarded as an extremely common headache in the general medicine, and TTH is diagnosed in most by the headache not to be caused by alcohol and the common cold that are not serious.TTH is the most common headaches in a primary headache statistically, but the prevalence greatly varies by an investigation.Chronic TTH surely greatly reduce quality of life and are serious disease to cause severe disorder so that the comment of the tension–type headache in ICHD–3 beta has it. In addition, frequent episodic TTH will be to have possibilities to affect as the treatment with a sometimes expensive drug is required.However, Infrequent episodic TTH occurs in all most population, and when effect to give to an individual is very few things namely a physiological response.I would like to describe a personal opinion about the way of a diagnosis of TTH in ICHD–3 beta and the classification.

著者

齊藤 麻美 萩原 彰文 鎌形 康司 Andica Christina 青木 茂樹

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.3, pp.167-171, 2018 (Released:2018-12-25)

参考文献数

9

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Human brain MR imaging has made remarkable advances since the 1970s with many improvements in imaging technologies, such as shorter scanning methods and the use of higher magnetic fields.A quantitative MRI (qMRI) method with QRAPMASTER (quantification method using quantification of relaxation times and proton density by multi–echo acquisition of saturation–recovery using turbo spin–echo readout) pulse sequence, or well known as synthetic MRI (synthetic MR AB, Linköping, Sweden), enables simultaneous quantification of T1 and T2 relaxation rates, and proton density (PD) in a clinically acceptable time. Based on these quantitative values and with dedicated post–processing software, it is possible to obtain any contrast weighted images, such as T1–weighted, T2–weighted and inversion recovery images, automated brain segmentation and myelin measurement. In addition, axon volume fraction and g–ratio can also be estimated by combining this method and neurite orientation dispersion and density imaging (NODDI). Here, we provide an overview of synthetic MRI in brain diseases, such as Sturge–Weber syndrome and multiple sclerosis.Diffusion MRI has also shown many developments in the last 40 years since its development. One of the advanced diffusion MRI techniques called Oscillating gradient spin–echo (OGSE) was proposed recently. With OGSE it is possible to reduce the diffusion time compare to conventional diffusion MRI technique. Therefore, OGSE has the potential to distinguish between spatial and viscous restriction. In this article, we show the use of OGSE in epidermoid cyst and acute brain infarction cases.

著者

鈴木 圭輔

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.3, pp.152-159, 2019 (Released:2019-11-25)

参考文献数

57

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Sleep disorders are common in neurological diseases but are still underrecognized and undertreated. Different brain lesions related to neurological diseases result in altered sleep–wake rhythm and sleep structure. Additionally, insomnia is caused by sensorimotor symptoms related to neurological diseases, medication use and comorbid primary sleep disorders, such as sleep apnea syndrome, restless legs syndrome and rapid eye movement sleep behavior disorder. In headache disorders, headache can be caused by sleep disturbances. For further understanding of the relationship between neurological diseases and sleep disturbances, this review addresses 1) sleep and wakefulness disorders due to focal brain lesions, 2) sleep disturbances in Parkinson's disease and related disorders, 3) sleep disturbances in dementia disorders and 4) sleep disorders and headache disorders.

著者

安藤 利奈 多田 聡 宮上 紀之 矢部 勇人 野元 正弘 永井 将弘

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.3, pp.317-320, 2019 (Released:2019-11-25)

参考文献数

8

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Parkinson disease(PD)患者では日中の過度の眠気がみられることがあり,そのリスク因子としてPD治療薬の関与が報告されている.今回,PD患者の内服薬と眠気について調査するため,当科を受診したPD患者に対しEpworth Sleepiness Scale(ESS)を施行し,PD治療薬との関連について検討した.ESSスコアはPD治療薬総量,罹病期間,PD重症度と有意な正の相関を認めた.Dopamine agonist(DA)使用患者はESSスコアがDA未使用患者よりも高かった.原因としてDA使用患者はPD治療薬総量が多く,総量増加に伴うESSスコアの上昇が考えられた.また,突発的睡眠はDA使用患者,未使用患者共にみられ,突発的睡眠を認める患者でESSスコアが高い結果が得られたことから,全てのPD患者で突発的睡眠に注意が必要であり,ESSスコアが突発的睡眠の指標になることが示唆された.

著者

山口 智

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.445-449, 2018 (Released:2019-04-22)

参考文献数

13

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Acupuncture and moxibustion therapy are part of traditional oriental medicine, which has a history of more than 2000 years, and can have effects on many diseases and symptoms.Our department was established in 1984, and has been engaged in medical treatment and research/education in our university. We have received requests for acupuncture and moxibustion therapy from many departments, and have demonstrated the great effectiveness of acupuncture and moxibustion therapy in patients with intractable pain, paralysis or a series of unidentified complaints. Acupuncture treatment has also contributed to improvement in the physical and mental QOL of these patients, and it has objectively supported the idea of oriental medicine described in classic textbooks.Our department has also investigated the effects of acupuncture treatment on various organs, and has initiated the scientification of traditional medicine. As a result, it was suggested that acupuncture treatment contributed to alleviation of symptoms not only by mere local reactions but also through the central nervous system. Furthermore, the responses of the body to acupuncture treatment differ between individuals with diseases and symptoms and healthy people, suggesting the possibility of acupuncture treatment being involved in the recovery of the body's homeostasis. We believe that these normalizing effects of acupuncture treatment are characteristics of traditional medicine.Thus, the clinical practice and the research on the effect and mechanisms of acupuncture treatment on neurological disorder such as the primary headaches and stroke have been promoted in cooperation with neurology.From these results, we believe that traditional medicine, acupuncture and moxibustion therapy will be established as a new era of medicine by fusing with modern Western medicine by further developing medical collaboration.

著者

高松 直子 野寺 裕之 和泉 唯信

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.3, pp.176-182, 2019 (Released:2019-11-25)

参考文献数

11

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Neuromuscular ultrasound is useful complementary testing in conjunction with clinical evaluation and neurophysiological testing such as nerve conduction study and electromyography. Two kinds of probe frequencies are commonly used, higher frequency (15–18MHz) for the evaluation of surface regions such as nerve locating at the wrist, on the other hand, lower frequency (11–15MHz) is suitable for deeper structures such as nerve roots and sciatic nerves. To differentiate peripheral nerves from other structures, the color–Doppler technique is useful in identifying blood vessels, and also a long stretching structure can be recognized as a peripheral nerve. For quantitative evaluation, cross–sectional area (CSA) and fascicule diameter (FD) can be measured by the coronal view. In a suspected case of carpal tunnel syndrome, the ratio to compare the CSAs between at the wrist and the elbow. Evaluation of multiple nerves at the different sites enables differential diagnosis of focal vs. diffuse localization as well as axonal vs. demyelinating pathology.For evaluation of muscles, a linear–type probe is used to check echointensity, fiber arrangement, the presence of characteristic structures intramuscularly, and involuntary movements such as fasciculations and myokymia. Muscular high echointensity may suggest inflammation and fat reposition, that are further differentiated by observing muscle fiber arrangement. Other indications of muscle ultrasound include determination of optimal sites for muscle biopsy, identification of ALS, and other muscle diseases. Muscle ultrasound can detect fasciculation, especially in bulbar muscles at least at the equivalent sensitivity as needle electromyography.

著者

安藤 哲朗

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.352-356, 2016 (Released:2016-11-10)

参考文献数

28

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The first step in evaluating patients with spinal cord disease is to localize the lesion from the segmental sign. Cervical spondylosis, which can present as radiculopathy and myelopathy, is common in people over the age of 50. It is necessary to assess whether neurological symptoms result from cervical spondylosis or other neurological disorders. In order to avoid misdiagnosis, it is important to compare the levels of the lesions shown on imaging with the clinical findings. Differential diagnosis between amyotrophic lateral sclerosis and cervical spondylosis is an issue of major clinical importance. The cervical spinal cord MR images of spinal cord sarcoidosis sometimes mimics that of cervical spondylotic myelopathy.Spinal dural arteriovenous fistula is a treatable spinal cord disease, however it is still underdiagnosed.

著者

清水 利彦

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.36, no.3, pp.238-240, 2019 (Released:2019-11-25)

参考文献数

17

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Trigeminal autonomic cephalalgias includes cluster headache, paroxysmal hemicrania, short–lasting unilateral neuralgiform headache attacks and hemicrania continua. The trigeminal autonomic cephalalgias share the clinical features of unilateral headache and, usually, prominent cranial parasympathetic autonomic features, which are lateralized and ipsilateral to the headache. However, the responses to the treatment for the headaches are different in each trigeminal autonomic cephalalgias. The present review will discuss the recent findings of the treatments for the trigeminal autonomic cephalalgias.

著者

宮本 雅之

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.35, no.4, pp.556-560, 2018 (Released:2019-04-22)

参考文献数

38

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Both headache and sleep disturbance are common symptoms in clinical practice. When considering the relationship between headache and sleep disturbance, chronic daily headache, especially morning headache, is an indicator of nonspecific sleep disturbance.The relationship between sleep and headache is classified as follows : sleep–triggered or sleep–related headaches, sleep duration induced headache, sleep phase–related headaches, sleep–relieved headaches, dreams and headache and effects of headaches on sleep (Jennum & Jensen, 2002).Primary sleep disorders such as narcolepsy, parasomnia, restless legs syndrome may coexist in patients with migraine. Cluster headache suggests association with obstructive sleep apnea. Morning headache is important as a symptom of sleep apnea headache.Headache and sleep disorders are interrelated, both of which can adversely affect the quality of life of patients. Therefore, clinicians need to recognize the pathophysiology and interrelationship of headache and sleep disorders, respectively, and to evaluate and treat headache and sleep disorders properly.

著者

工藤 雅子

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.36, no.3, pp.233-237, 2019 (Released:2019-11-25)

参考文献数

11

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Tension type headache (TTH) is the most frequent headache among the primary headaches, and it is often encountered by a doctor in routine practice.The severity of tension type headache is mild to moderate. However, among patients with chronic or frequent episodic tension type headache it often disturbs their QOL (quality of life) in daily livings.The most important thing in managing TTH is correct diagnosis. In order to reach the proper treatment, it is important to exclude secondary headache, migraine and other primary headaches.The first line of acute treatment of TTH is administration of the abortive drugs such as NSAIDs and analgesics. However attention must be paid not to administer them loosely because these drugs sometimes induces medication overuse headache (MOH). As a preventive medication, antidepressants such as amitriptyline and muscle relaxants are recommended. It is also important to combine non–medication therapy such as psyco–behavioural therapy, relaxation or physical therapy. Understanding the stress and environmental factors of each case, and their management according to their condition are another important issues.

著者

高松 泰行 松田 直美 饗場 郁子

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.35, no.1, pp.33-37, 2018 (Released:2018-06-12)

参考文献数

17

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姿勢保持障害は進行性核上性麻痺(progressive supranuclear palsy:PSP)の主要症候であるが,その特徴について詳細に検討した報告は少ない.本研究では,PSP患者における静止立位時の重心動揺と姿勢保持障害の特徴について,健常高齢者と比較,検討した.対象はPSP患者21名,健常高齢者25名とした.年齢,性別,body mass index(BMI),静止立位時の重心動揺を評価した.PSPは,発症からの罹患期間,modified Rankin scale(mRS),進行性核上性麻痺評価尺度(PSP rating scale:PSPRS)項目V及びVI,pull testを評価した.重心動揺検査の結果,PSPと健常高齢者との間に有意差を認めた項目は,外周面積,単位面積軌跡長,前後方向動揺平均中心変位であった.PSPにおいて,pull testと相関を認めた項目は,罹患期間,mRS,PSPRS VI,外周面積であった.以上より,PSPは健常者に比べて,後方重心傾向が強く,静止立位バランスが不安定であり,単位面積軌跡長が低値であるという特徴が示された.また,pull testは疾患の進行度,機能自立度を反映しており,静止立位時のバランス能力が関係していることが示された.

著者

井上 雄一

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.5, pp.S102, 2016 (Released:2016-10-31)

著者

古和 久典

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.3, pp.194-197, 2019 (Released:2019-11-25)

参考文献数

12

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What should we do if the patient complains of a headache?In general, it is essential to first check the vital signs, evaluate the level of consciousness, and decide whether or not it is in an emergency. Headache diagnosis will be followed without medical emergent situation. First of all, you should confirm whether it is “a headache that he/she has never experienced before” or “it is a headache that he/she always repeat”. If it is the former, there is a higher probability of a “secondary headache” which has other causes of headache, and if it is the latter, it may be a chronic headache of “primary headache” as the headache itself is a disease.If you think of a secondary headache, you have to make sure that you don't miss a headache due to an urgent or progressive disease that can not be postponed. According to “Clinical Practice Guideline for Chronic Headache 2013”, in the following cases : (1) headache with sudden onset, (2) headache never experienced before, (3) headache different from the customary headache, (4) headache that has increased in frequency and intensity, (5) headache begins after age 50, (6) headache with neurological deficit, (7) headache in a patient with cancer or immunodeficiency, (8) headache in a patient with psychiatric symptoms, (9) headache in a patient with fever, neck stiffness or meningeal irritation, it is recommended that an aggressive search is necessary in doubt of secondary headache. It is important to keep in mind the characteristics and accompanying symptoms of headaches to search.When considering primary headache that is a disease itself such as migraine, tension–type headache, and trigeminal autonomic cephalalgias, you should be clear whether the diagnosis is migraine, and if it is migraine, how the influence on daily life is.One of the most difficult issues at present in daily practice of migraine headaches is to respond chronic headaches. It is necessary to search for chronification promoting factors that can be intervened and to treat migraine with considering the prevention against it.Although everyone has experienced headaches at least once due to colds, lack of sleep, or hangovers, and headaches are one of the common complaints often encountered in daily practice, there is always the possibility that secondary headaches or severe migraine headaches are included in it. It is hoped that many headache patients will be able to spend their smiles as medical workers deal with appropriate headaches.

著者

神林 崇 今西 彩 佐川 洋平 筒井 幸 竹島 正浩 大森 佑貴 高橋 裕哉 小野 太輔 佐藤 雅俊 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.33, no.5, pp.S101, 2016 (Released:2016-10-31)

著者

藤岡 俊樹

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.3, pp.198-202, 2018 (Released:2018-12-25)

参考文献数

29

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CIDP (chronic inflammatory demyelinating polyneuritis) is the most common immune–mediated chronic polyneuropathy that comprises typical CIDP (symmetrical demyelinating sensory–motor neuropathy) and several subtypes ; i.e., MADSAM (multifocal acquired demyelinating sensory and motor) neuropathy (Lewis Sumner Syndrome), DADS (distal acquired demyelinating symmetric) neuropathy and multifocal motor neuropathy (MMN). Typical CIDP is usually treated by either intravenous immunoglobulin (IVIg), corticosteroid (CS) or plasma exchange (PLEX). These three therapies are thought as a first line therapy (FLT). Among FLT, IVIg and CS are very often employed because of their simplicity during treatment, however, the efficacy is almost same in three modalities of FLT. If one treatment of FLT failed to lead a good response, other treatment of FLT should be tried. Finally, FLT results in remission in more than 80% of typical CIDP cases. Second line treatment for FLT–resistant cases is still vague although numerous experiences especially about immunosuppressive agents (ISA) have been reported. Among ISA, cyclophosphamide (intravenous pulse) and rituximab seem to be effective although randomized controlled trial is required. IVIg treatment requires maintenance treatment (IVIg every three weeks). Recently efficacy of subcutaneous immunoglobulin treatment (SCIg) in maintenance treatment was proven although it is not approved in Japan. Merit of SCIg is that it can be done by patients in their home. Moreover, SCIg is proven effective as an initial treatment for typical CIDP. This may help patients suffering from CIDP reduce economical, physical or time burden during treatment.The standard treatment for MADSAM neuropathy is still vague. FLT in typical CIDP should be tried as well. IVIg–responding case needs to adhere maintenance IVIg or SCIg although later is not approved in Japan.MMN responds to IVIg well, however, delayed diagnosis or treatment results in poor response.Recently, neuropathy with antibodies against proteins localized in paranode of peripheral nerve is discovered, called as “paranodopathy”.Most of these cases have IgG4 antibodies against Neurofascin 155, 140, 186, contactin–1, or contactin–associated protein 1 (Caspr). They present unique signs compared to typical CIDP, i.e., relatively rapid progression, remarkable ataxia or tremor. Most of these cases present poor response for IVIg. Rituximab seems to be a hopeful therapeutical candidate in the future although strong evidence is not available at this moment.

著者

柴田 護

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.6, pp.S99, 2018 (Released:2018-11-12)

著者

鈴木 圭輔

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.6, pp.S124, 2018 (Released:2018-11-12)

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.