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

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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.

著者

高橋 幸利 木水 友一 小池 敬義 堀野 朝子

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.33, no.1, pp.19-26, 2016 (Released:2016-05-20)

参考文献数

27

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A. Non–herpetic acute limbic encephalitis & anti–NMDAR encephalitis Non–herpetic acute limbic encephalitis is diagnosed with the characteristic onset symptom of limbic system and absence of herpes simplexes virus in CSF. Anti–NMDAR encephalitis is diagnosed with presence of antibodies to complex of NMDA–type GluR subunits by cell–based assay. Non–herpetic acute limbic encephalitis & anti–NMDAR encephalitis are causally related with antibodies to NMDA–type GluR, which internalize complex of NMDA–type GluR subunits on neural cell surface. Internalization may lead to protection from apoptosis by excitotoxicity related with increased glutamate and cytokines, and less phosphorylation of Akt in these encephalitides. Passive transfer of rabbit antibodies to n–terminal of human GluN2B into hippocampi of mice caused probable excited behavior and impairment of memory in behavioral analysis, and decreased expression of pam gene in microarray analyses and quantitative analyses of gene expression. In non–herpetic acute limbic encephalitis, factors including granzyme B, glutamate, etc., other than antibodies are causally related with neuronal cell death.B. Encephalitis mediated by antibodies to voltage–gated potassium channel (VGKC) In encephalitides mediated by antibodies to VGKC, patients with antibodies to leucine–rich glioma–inactivated 1 (LGI1) show characteristics of limbic encephalitis, and patients with antibodies to contactin–associate protein (Caspr) 2 show Morvan's syndrome with thymoma.C. Acute disseminated encephalomyelitis (ADEM) ADEM is the most common immune–mediated encephalitis, and its immune–mediated pathophysiology was not revealed. Recently, antibodies to myelin–oligodendrocyte glycoprotein were found in a few pediatric patients.

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.38, no.3, pp.356-359, 2021 (Released:2022-01-19)

参考文献数

11

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In the trials of more versus less statin, the RR per 1.0mmol/L further reduction in LDL cholesterol did not depend on the baseline LDL cholesterol concentration, with significant reductions of 23% in participants who had LDL cholesterol of 2.0–2.5mmol/L reduced further and of 29% in those who had LDL cholesterol lower than 2.0mmol/L (mean 1.71mmol/L) reduced further. “The lower, the better” relation was further confirmed with ezetimibe and PCSK9 inhibitors down to the range of 30mg/dL as the level of LDL–C after treatment. Based on the recent TST trial, target LDL–C level for the prevention of recurrent cardiovascular event may be set below 70mg/dL though Aisan, low body–weight patient, age older than 75 years old may not benefit from the strict control.

著者

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.38, no.3, pp.164-169, 2021 (Released:2022-01-19)

参考文献数

12

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We describe here our results of epidemiological survey for fatigue in Japan, and our recent findings found in chronic fatigue syndrome (CFS) patients. In 1999, our epidemiological survey of 3,015 Japanese people revealed that 35.6% of them had chronic fatigue and 16.8% had a deterioration of daily physical activities. Eight people (0.26%) were diagnosed as CFS according to CDC 1994 criteria. Our recent studies revealed that the existence of neuroinflammation in patients with CFS by the positron emission tomography. We also found that CFS patients exhibited significant differences in intermediate metabolite concentrations in the tricarboxylic acid and urea cycles, and that the identification of actin network proteins in circulating extracellular vesicles were useful as the blood biomarkers for CFS.

著者

森岡 周

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.4, pp.501-504, 2019 (Released:2020-04-24)

参考文献数

22

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This review explains the following : First, it demonstrates that functional impairment of the prefrontal cortex leads to chronic pain due to improper functioning of the descending pain modulatory system. In addition, patients with chronic pain often develop “learned–nonuse,” a condition in which affected limbs are not used because of misinterpretation (distorted cognition) that movements cause pain. When learned–nonuse occurs, cerebral cortical areas associated with the execution of movement and sensation are reduced in size, which leads to functional impairments associated with these areas. If nonuse of the affected limbs is prolonged, the self–perception of the body is decreased as in neglect–like symptoms, and this decrease in cognitive ability may result in chronic pain or pain exacerbation. Neglect–like symptoms associated with the development of chronic pain is caused by the collapse in the perception–movement loop, particularly by the disturbed mechanism of the comparator model. The comparator model is involved in the embodied brain system. In the end, this review explains the hypothesis for the mechanism of how functional disturbances can occur in the embodied–brain systems of patients with chronic pain at all levels, from sensorimotor representation to propositional representation and meta–representations.

著者

近藤 夕騎 板東 杏太 有明 陽佑 勝田 若奈 小林 庸子 早乙女 貴子 髙橋 祐二

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.5, pp.628-632, 2018 (Released:2019-05-15)

参考文献数

18

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〔目的〕脊髄小脳変性症(spinocerebellar degeneration;SCD)患者に対する短期集中バランストレーニング介入が患者のバランス機能に及ぼす効果についてBalance Evaluation Systems Test(BESTest)を用いて検討した.〔方法〕Scale for the Assessment and Rating of Ataxia(SARA)歩行項目3点以下のSCD患者16名を対象とした.理学療法で1日2時間のバランストレーニング,作業療法または言語療法を1時間の計3時間を週5回実施する4週間の入院プログラムを実施し,入院1ヶ月前,プログラム開始時,プログラム終了時,退院1ヶ月後にSARA,BESTestを評価した.〔結果〕介入前後でBESTestの総得点,下位項目のsectionIII(予測的姿勢制御),sectionIV(反応的姿勢制御),sectionVI(歩行安定性),フォローアップで総得点,sectionIIIの得点が有意に改善していた.〔結論〕歩行可能なSCD患者では,BESTestを用いた評価により,課題となるバランス要素を抽出できた.またバランストレーニングの介入効果をBESTestの総得点,sectionIII,sectionIV,sectionVIで鋭敏に捉えられる可能性が示唆された.

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.40, no.6, pp.S199, 2023 (Released:2023-10-30)

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.6, pp.653-688, 2017 (Released:2017-04-30)

著者

端詰 勝敬 竹内 武昭 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.4, pp.671-674, 2020 (Released:2021-05-27)

参考文献数

10

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Central sensitization is a neurophysiological state in which the central nervous system is overexcited in response to stimuli. It is thought to be associated with painful diseases such as migraine and fibromyalgia, as well as conditions that cause functional physical symptoms. In our study, we found that those with chronic headache had higher central sensitization and higher levels of central sensitization have been shown to reduce quality of life.

著者

國枝 顕二郎 下畑 享良

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.31-33, 2022 (Released:2022-06-15)

参考文献数

6

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Nutritional impairment in multiple system atrophy (MSA) can be divided into early and advanced stages. In the early stage, nutritional impairment due to dysphagia can develop. In the advanced stage, body fat could accumulate after the introduction of a ventilator or the placement of a gastrostomy. Nutritional impairment may be progressive in MSA patients, even if body weight is maintained. The serum albumin level is a useful indicator of nutritional status. Leptin resistance due to autonomic neuropathy may be related to the accumulation of body fat. In the early stages, sufficient nutrition should be administered to prevent the progression of nutritional disorders. In the advanced stage, the amount of administered energy is reduced to prevent fat accumulation. Further research is needed to establish the evidence for the nutritional management of MSA.

著者

柏原 健一

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.34, no.3, pp.151-154, 2017 (Released:2017-10-14)

参考文献数

23

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Patients with Parkinson's disease (PD) may have impulsive–compulsive behaviors, such as impulse control disorder (ICD), dopamine dysregulation syndrome(DDS), and punding. ICD is a disorder characterized by impulsivity, i.e., a failure to resist temptation, urges, or impulses that may harm oneself or others. The ICDs frequently observed in patients with PD include pathological gambling, hypersexuality, binge eating, and compulsive shopping. Punding is a complex, prolonged, purposeless, and stereotyped behavior. The risk factors for developing such behaviors include a younger age of onset of PD and impulsive or novelty seeking characteristics. ICD may also be caused by dopamine agonists, with a higher risk associated with the dopamine D3 receptor subtype. Since behavioral disorders destroy the quality of life of patients with PD and their caregivers, early detection and appropriate management of symptoms are required. Changing or ceasing the use of dopamine agonists is recommended for improving ICD. In order to manage DDS, an improvement of “off” period is required, as well as limiting extra dosing of levodopa.

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.36, no.4, pp.341-344, 2019 (Released:2020-04-24)

参考文献数

3

被引用文献数

1

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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. We often recognize that patients with autoimmune encephalopathy are often misdiagnosed as functional psychogenic movement or somatoform disorders. We have reported 63 patients with autoimmune encephalopathy. Two–thirds of patients showed motor disturbance mostly with unsustained or give–way weakness. About 70% of patients showed sensory abnormalities that was not explainable anatomically. 27% of patients exhibited involuntary movements such as tremor entrainment, dystonia, or coarse involuntary movement. 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

五十嵐 久佳

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.229-232, 2019 (Released:2019-11-25)

参考文献数

24

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Both of chronic migraine (CM) and medication–overuse headache (MOH) are common neurological diseases. They have a great detrimental influence on a patient's life, with a severe impact on socioeconomic functioning and quality of life.One of the most common causes of migraine chronification is acute medication overuse. On the other hand, MOH is an interaction between a therapeutic agent used excessively and a susceptible patient. Among those with a previous primary headache diagnosis, about 80% of MOH patients have migraine.All patients with CM should be considered for pharmacological prophylaxis, and the behavioral aspects of therapy should be emphasized. The two prophylactic drugs with the best evidence for efficacy in CM are topiramate and onabotulinumtoxinA. But these therapies currently have not been covered by health insurance in Japan. The options to treat patients with CM are valproic acid, propranolol, lomerizine and amitriptyline. The treatment principles for MOH are : (1) discontinue the overused medication, (2) treat the headache after discontinuing the overused medication, and (3) administer prophylactic medications. Clinical evidence shows that the majority of patients with MOH improve after discontinuation of the overused medication, as does their responsiveness to preventative treatment. Simple advice on the causes and consequences of MOH is an essential part of its management and can be provided with success. Initiation of prophylactic medications at the time of withdrawal or even before withdrawal of overused medications is recommended. Since most of the MOH patients have migraine prior to MOH, valproic acid, lomerizine, propranolol, amitriptyline may be considered as prophylactic medications. As for prognosis, the relapse rate is approximately 30%. Even after discontinuation, patients should be given suitable counseling, and headache diary should be used to confirm the frequency of using triptans, ergotamine and analgesics.

著者

清水 優子

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.6, pp.S206, 2018 (Released:2018-11-12)

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.35, no.3, pp.222-225, 2018 (Released:2018-12-25)

参考文献数

20

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Autonomic dysfunction presents several symptoms and signs, such as constipation, urinary problems and sweat abnormalities. Fainting (syncope) or swooning (presyncope) is one of the more common autonomic symptoms, and medical staff require to obtain knowledge and skill to manage syncope. Vasovagal syncope and orthostatic hypotension are representative of diseases which can cause syncope. This review will outline the current understanding of diagnosis, pathophysiology and management of vasovagal syncope and orthostatic hypotension for medical staff.

著者

野村 哲志

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.6, pp.S141, 2017 (Released:2017-11-14)

著者

長谷川 一子

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.33, no.2, pp.110-114, 2016 (Released:2016-08-10)

参考文献数

6

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How to diagnose and manage for involuntary movement is one of the attractive issues in neurology. In this issue I provide how to make a diagnosis on abnormal involuntary movement. Abnormal involuntary movements are consist of tremor, dystonia, chorea myoclonus, tic and so on. They are frequently observed in neurology clinic. It is important to diagnose of them by history taking, inspection, neurological examination, and confirmed with both imaging such as MRI and electrophysiological examination. Electrophysiological examination consist of the surface electromyography, the evoked potentials (auditory, visual, spinal and so on), and equilibrium function tests. I hope this issue encourage your practice on movement disorders.

著者

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.37, no.3, pp.225-231, 2020 (Released:2021-02-05)

参考文献数

18

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Encephalitis/Encephalopathy is a life–threatening disease with many causes. In the last 15 years the continual discovery of newly identified forms of autoimmune encephalitis (AE) associated with antibodies to cell–surface or synaptic proteins has changed the paradigms for diagnosing and treating disorders. AE is one of the most common causes of non–infectious encephalitis. It can be triggered by tumors, infections, or it may be cryptogenic. These disorders can occur in patients with or without cancer―often children or young adults who develop psychosis, catatonic or autistic features, memory problems, abnormal movements, or seizures that were previously considered idiopathic. We review here the process of discovery, the symptoms, and the target antigens of AE including our previous published research data. Anti–N–methyl–D–Aspartate receptor (NMDAR) encephalitis, several subtypes of limbic encephalitis, and other AEs that result in psychosis, seizures, or abnormal movements are described. We also discussed their recent diagnostic approach and treatment in AE.This recent advances in AE research led to the identification of syndromes and biomarkers. Existing criteria for AE are too reliant on antibody testing. Since antibody test results are not available at onset, a practical, syndrome–based diagnostic approach is required. It is possible to proceed through a logical differential diagnosis of AE using criteria based on conventional clinical neurological assessment and standard diagnostic tests (MRI, EEG, and CSF studies). Through this approach, levels of evidence of probable and definite AE can be achieved early and therapies implemented quickly, with the possibility of fine–tuning the diagnosis and treatment when antibody results become available. Notably, most treatment recommendations in AE are based on the experience of experts in the field. However, there is a need for clinical trials to identify clinically meaningful cut–off values of autoantibody titres which provide a clear indication for immunotherapy and to compare the efficacy of different immunotherapeutic strategies more objectively. A task for the future is moving these strategies to the clinics.

著者

大槻 美佳

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.374-380, 2018 (Released:2018-02-20)

参考文献数

13

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We need to understand aphasia in terms of two points of view. One is the viewpoint of system of language, and the other is the viewpoint of brain function. Language systems are hierarchically constructed, for instance, acoustic system (hearing and speech), phonetic system (discrimination of language sounds and articulation control), phonemic system and lexical/semantic system. Language impairments can be developed of each system as language symptoms. And there are corresponding lesion sites in the brain for each elementary language symptoms such as anarthrie/apraxia of speech, impairment of discrimination of language sound (word deafness), phonemic paraphasia, word comprehension impairment, word retrieval impairment and so on. Classical aphasia classification are vascular syndromes and can be explained as the syndromes made of the elementary symptoms.

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.37, no.4, pp.636-639, 2020 (Released:2021-05-27)

参考文献数

5

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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 misdiagnosed as exhibiting functional psychogenic movement, conversion, or somatoform disorders. Most patients with autoimmune encephalopathy showed motor disturbance mostly with unsustained and/or give–way weakness. About 70% of patients showed sensory abnormalities that was not explainable anatomically. One–fourth of patients exhibited involuntary movements such as tremor entrainment, dystonia, or coarse involuntary movement. 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.