著者

竹島 多賀夫

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.35, no.3, pp.307-312, 2018 (Released:2018-12-25)

参考文献数

27

---

Neuromodulation is focused as a new therapy for primary headache disorders.Non–invasive neuromodulation devices are free from surgical risks and those costs are practical ranges in primary care settings. It is also important most of these devices are self–applicable after the appropriate introductions.Transcutaneous supraorbital trigeminal neurostimulation (Cefaly) is widely used in Europe and United States, and clinical evidence for migraine management have been accumulated. I demonstrated our preliminary favorable results of Cefaly devices for Japanese migraine sufferers. Non–invasive vagus nerve stimulation (nVNS) has been approved in United States. Single–pulse transcranial magnetic stimulation (sTMS) is also expected to be a new device for chronic pain including migraine headache.These non–invasive neuromodulation devices will open new avenues on the management of primary headaches including migraine.

著者

小野寺 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.38, no.6, pp.S110, 2021 (Released:2021-10-10)

著者

関 守信

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.37, no.2, pp.146-151, 2020 (Released:2020-08-31)

参考文献数

26

---

Immune check point inhibitors have shown remarkable benefit in the treatment of a range of cancer types. As cancer treatment with these drugs has become more common, the safety management of immune–related adverse events (irAEs) due to cancer immunotherapy has become more important. Myositis is one of the representative neuromuscular irAEs. A variety of studies have demonstrated that myositis as an irAE is often accompanied by ocular muscle symptoms, which physicians have often termed “myasthenia-like” or “pseudo-myasthenic” symptoms. Physicians often recognize the unique clinical manifestations of irAE myositis and may hesitate to diagnose these patients as pre–existing myositis alone. To comprehensively characterize the inflammatory myopathy associated with programmed cell death 1 inhibitors (PD–1 myopathy), we studied 19 Japanese patients with PD–1 myopathy. PD–1 myopathy occurred 29 days on average after the first administration of PD–1 inhibitor. The initial manifestation of muscle weakness was ptosis in 10 patients. 15 patients had ptosis, 13 diplopia, 8 facial muscle weakness, 10 bulbar symptoms, 13 limb weakness, 14 neck weakness, 4 cardiac involvement, 6 respiratory involvement and 16 myalgia. Ocular, facial, cardiac and respiratory muscle involvement and myalgia were frequently observed. Serum creatine kinase was increased to 5,247 IU/L on average. Autoantibodies related to inflammatory myopathy were negative, while anti–striational antibodies were found in 13 (68%) patients. HLA–C*12:02 alleles were more frequently detected than healthy controls. Muscle pathology was characterized by multifocal necrotic myofibers with endomysial inflammation and expression of MHC class I. There are guidelines for the treatment of neuromuscular irAEs. For all but the minimum symptoms, therapy with PD–1 inhibitors should be withheld. Immunosuppressive therapy with corticosteroids was generally effective for muscle weakness. PD–1 inhibitor induced myositis and myasthenia gravis may share the same pathophysiology, suggesting an emerging clinical entity. Based on our clinical, histological and immunological findings, PD–1 myopathy is a discrete subset of inflammatory myopathy.

著者

入谷 修司

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.409-412, 2016 (Released:2016-11-10)

参考文献数

8

---

When the patient's chief complaints were not explained in a rational manner based on usual medical examinations, usually those patients tend to be transfer to the psychiatry as being suspicious diagnosed somatoform disorder or psychogenic disease. But the treating these unexplainable clinical conditions in psychiatric category might to be lead to the mind–body dualism in clinical settings. Prominent clinical attitude based on only EBM (evidence based medicine) under ever–improving medical sciences would be attentive mainly to the biomedical model, not on the bio–psycho–social medical model. It has been unknown the precise neural mechanism of psychosomatic correlation even now. Nowadays, we clinicians should confront the patient's complaints with mind–body identity theory and explore their cause of disease as whole–patient approach.

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.5, pp.619-634, 2019 (Released:2020-06-02)

著者

森田 昭彦 石原 正樹 亀井 聡

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.262-264, 2019 (Released:2019-11-25)

参考文献数

5

---

A detailed survey to investigate the prevalence, clinical features, associated outcomes, and prognostic factors in adult patients with influenza–associated acute encephalopathy was performed. The estimated annual incidence of adult IAE was 0.98/1,000,000 population in Japan. Baseline patient characteristics were 50% male, median age at onset of 54.5 years, and median hospital stay of 15 days. As initial symptoms, 93% of patients showed disturbance of consciousness. Convulsions and delirious behavior were shown in 26% and 40% of patients, respectively. 65% of patients received pulse corticosteroid therapy with methylprednisolone and 21% of patients received intravenous gamma–globulin therapy. Additionally, 21% of patients required mechanical ventilation. 63% of patients achieved a good recovery, but 7% died. Plasma glucose level was significantly associated with poor outcome. Hyperglycemia might be an independent predictor of poor prognosis in IAE patients and reflect systemic hypercytokinemia in IAE pathogenesis.

著者

入谷 修司

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.409-412, 2016

---

<p>When the patient's chief complaints were not explained in a rational manner based on usual medical examinations, usually those patients tend to be transfer to the psychiatry as being suspicious diagnosed somatoform disorder or psychogenic disease. But the treating these unexplainable clinical conditions in psychiatric category might to be lead to the mind–body dualism in clinical settings. Prominent clinical attitude based on only EBM (evidence based medicine) under ever–improving medical sciences would be attentive mainly to the biomedical model, not on the bio–psycho–social medical model. It has been unknown the precise neural mechanism of psychosomatic correlation even now. Nowadays, we clinicians should confront the patient's complaints with mind–body identity theory and explore their cause of disease as whole–patient approach.</p>

著者

飯塚 高浩

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.231-236, 2018 (Released:2018-12-25)

参考文献数

24

---

After the discovery of new class of autoantibodies against neuronal cell surface antigens and synaptic proteins (NSA–antibodies), the concept of encephalitis has dramatically changed. Encephalitis can be divided into infectious and autoimmune (non–infectious) groups. Autoimmune encephalitis (AE) may have autoantibodies against intracellular onconeuronal antigens (e.g. Hu, Yo, Ri, CV2/CRMP5, Ma2, amphiphysin) or NSA (e.g. NMDAR, AMAPAR, GABAaR, GABAbR, DPPX). Most of the former antibodies are not pathogenic but are used as a biomarker of classical paraneoplastic neurological syndromes, whereas IgG NSA–antibodies are more likely pathogenic, and the presence of the antibodies implies that patients may respond to immunotherapy. With infectious etiologies in mind previous diagnostic criteria for encephalitis has been made based on fever, mental status changes, inflammatory CSF, and brain MRI and EEG abnormalities ; however, these abnormalities may not be present in patients with NSA antibody–positive AE. Although early initiation of immunotherapy is often emphasized in AE, antibody testing is not readily accessible in most situation, thus initiation of immunotherapy may be delayed. Therefore, in 2016, a practical diagnostic approach to AE was proposed to achieve prompt immunotherapy at 3 levels of evidence for AE (possible, probable, and definite) with several new diagnostic criteria. A recent study showed that diffuse brain atrophy in anti–NMDAR encephalitis can be reversible and does not imply a poor clinical outcome. In contrast, cerebellar atrophy was irreversible and associated with a poor outcome. First–line immunotherapy can be started depending on the severity of patients with possible AE at early stage while excluding alternative diagnosis, but the second–line immunotherapy should be carefully used after confirming the NMDAR–antibodies in CSF with appropriate testing.In this lecture, I focus on anti–NMDAR encephalitis and talk about a potential pitfall in clinical diagnosis of the disease.

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.616-616, 2016 (Released:2017-02-28)

著者

荒木 信夫

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.33, no.1, pp.5-6, 2016

---

The Japanese Society of Neurological Therapeutics is pleased to announce the launch of an electronic version of the Societys journal. Beginning in 2016, the Societys journal will be open access and all manuscripts will be accessible in both PDF and HTML (XML) format on J–STAGE (Japan Science and Technology Information Aggregator, Electronic). Each manuscript will have a unique digital object identifier (doi) that provides a permanent link to the manuscript and facilitates citation by researchers anywhere in the world. Members of the Japanese Society of Neurological Therapeutics will receive regular emails that include the table of contents of new issues as well as other important information about the journal.

著者

伊藤 義彰

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.4, pp.435-438, 2022 (Released:2022-12-27)

参考文献数

16

---

Stroke prevention constitutes antithrombotic treatments and risk control. Atherothrombosis may be treated with dual platelet therapy in the acute phase followed by single therapy with additional cilostazol in high risk group. Cardioembolism and paradoxical embolism should be treated with anticoagulants. Direct oral anticoagulants with dose based on age, renal function and body weight has fewer intracranial hemorrhages than warfarin and is recommended as first choice.

著者

山村 隆

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.40, no.6, pp.S201, 2023 (Released:2023-10-30)

著者

福武 敏夫

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.40, no.6, pp.S200, 2023 (Released:2023-10-30)

著者

星山 栄成

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.508-512, 2020 (Released:2021-05-27)

参考文献数

28

---

Post–stroke epilepsy (PSE) is divided into two categories. Early seizures (ES) typically occur within one week after stroke onset and are also termed ‘acute symptomatic seizures’, whereas late seizures (LS) have a peak within 6–12 months with a higher recurrence rate. PSE is about 10% as a stroke complication, but its rate is as high as 30 to 40% in the cause of elderly–onset epilepsy. Although there is no evidence for the treatment of post–stroke epilepsy, antiepileptic drug treatment should be considered in the event of an unprovoked first seizure. We hope that new antiepileptic drugs will be effective as the evidence accumulates. This review provides a comprehensive perspective of PSE, including the definition, diagnostic criteria, examination tool, and treatment of PSE.

著者

白石 眞

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.203-207, 2019 (Released:2019-11-25)

参考文献数

17

---

Involuntary movements, a collective term for movements occurring without volition, are the hallmark of hyperkinetic movement disorders. The main types of hyperkinetic movement disorders comprise restless leg syndrome, tremor, chorea, dystonia, myoclonus, and tics, along with other symptoms including akathisia, hemifacial spasm, myokymia, stereotypies, periodic limb movement disorder, hyperekplexia, and alien hand syndrome. Variations in movement symptoms termed dyskinesia are often observed in clinical practice in response to levodopa and dopamine agonist treatment. Despite falling outside the narrow definition of involuntary movements, psychogenic involuntary movements that can be temporarily voluntarily suppressed and involuntary movements caused by adverse drug effects also require attention. Most involuntary movements can be diagnosed through observation of clinical characteristics. However, it is important to begin by accurately noting the observed movements without trying to fit them into an existing diagnostic category. The initial focus of observation should be temporal patterns of occurrence, specifically whether movements are irregular or have a constant or periodically recurrent rhythm. Tremors are characterized by constant rhythmic oscillations in contrast with the irregular pattern presented by other types of involuntary movement. In cases where it is difficult to differentiate between tremors and other movement disorders, skin palpation and surface electromyography are useful for diagnosis. The choice of drug therapy among the many available types should be based on the pathophysiology of the hyperkinetic (involuntary) movements or underlying disorder.

著者

鈴木 圭輔 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.4, pp.545-552, 2018 (Released:2019-04-22)

参考文献数

50

---

Sleep disturbance has been recognized as an important non–motor symptom of Parkinson's disease, which can impair the quality of life of patients. However, adequate screening and management of sleep disturbances coexisting with Parkinson's disease are still challenging issues. The causes of sleep disturbances include disease–related pathological changes in the brainstem and hypothalamus, which modulate REM / non–REM sleep and sleep–wake cycle, the effects of nighttime motor / non–motor symptoms including restlessness of the limbs and REM sleep behavior disorder, and the co–occurrence of other sleep disorders, such as sleep apnea syndrome. We provide an updated review of sleep disturbances in patients with Parkinson's disease and related disorders.

著者

佐々木 祐典 本望 修

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.314, 2020 (Released:2021-02-05)

著者

永田 栄一郎

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.3, pp.303-306, 2018 (Released:2018-12-25)

参考文献数

3

---

Migraine is a chronic, disabling, and recurrent neurological disorder. The guideline published by Japanese Headache Society, based on evidence–based medicine data, is a useful source of guidance, especially for acute and preventive therapies of migraine (Japanese Clinical Practice Guideline for Chronic Headache 2013). At present, migraine therapy can be classed as acute therapy and preventive therapy. In acute therapy, we give migraineurs NSAIDs or triptans for abortive medicines. We have five triptans (sumatriptan, zolmitriptan, eletriptan, rizatriptan, and naratriptan) in Japan. Notably, sumatripotan has three dosage forms (oral tablet, inhalant, and injection). They are used appropriately by the type of migraine attacks. In general, we firstly give an oral tablet. However, when patients have nausea and vomiting, they cannot take oral medicines. At that time, we use inhalant or injection, especially using injection for a severe attack. It's best timing to take a triptan just after the attack to get the most effective treatment. On the other hand, we usually use calcium blockers, anti–epileptic drugs, anti–depressants, and β–blockers for preventive therapy. Among them, lomerizine, verapamil, valproic acid, amitriptyrine, and propranolol have insurance adaptation in Japan. In preventive therapy, you should not change another preventive drug at least two months. Moreover, you should choose appropriate preventive drug with individual patients. As for the trick of acute treatment, we sometimes give a migraineur both triptan and NSAIDs when a migarineur has a severe attack.

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.36, no.1, pp.28-29, 2019 (Released:2019-07-10)

著者

樋口 雄二郎 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.5, pp.773-777, 2022 (Released:2023-01-20)

参考文献数

15

---

We would like to review the recent therapeutic advances of spinocerebellar degeneration (SCD) that were published in 2021. Currently, SCD treatment is limited only to symptomatic mitigation, and no therapy is available to stop or delay the disease progression. Various pre–clinical and clinical trials were carried out in 2021. Some interesting trials have been reported, and further developments are expected. This article introduces the outline of therapies with rovatirelin, riluzole/troriluzole, leriglitazone, sodium valproate, CRISPR/Cas9 gene editing, antisense oligonucleotides (ASOs), mesenchymal stem cells (MSCs), and cerebello–spinal transcranial direct current stimulation (tDCS). We expect that these treatments will benefit the patients with SCD.