Brain and nerve = Shinkei kenkyū no shinpo
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Review Case Reports
[Anti-nMDA receptor encephalitis--clinical manifestations and pathophysiology].
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a new category of treatment-responsive encephalitis associated with "anti-NMDAR antibodies", which are antibodies to the NR1/NR2 heteromers of NMDAR. The antibodies are detected in the CSF/serum of young women with ovarian teratoma, who typically develop schizophrenia-like psychiatric symptoms, usually preceded by fever, headache, or viral infection-like illness. After reaching the peak of psychosis, most patients developed seizures followed by an unresponsive/catatonic state, decreased level of consciousness, central hypoventilation frequently requiring mechanical ventilation, orofacial-limb dyskinesias, and autonomic symptoms. ⋯ Although recovery occurs without the need for tumor removal, the severity and extended duration of symptoms support tumor removal. Combined therapy including tumor resection and immunotherapy is recommended. In this review, we also discuss the relationship between anti-NMDAR encephalitis and related disorders, including acute diffuse lymphocytic meningoencephalitis and acute juvenile female non-herpetic encephalitis (AJFNHE).
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The limbic system (comprising the amygdala and the anterior cingulate cortex) and the prefrontal cortex (the orbital and dorsolateral prefrontal cortices) have been implicated in emotional and behavioral control. Selective lesion studies in rodents suggest that the basolateral nucleus of the amygdala, which is a critical subnucleus within the amygdala, plays a critical role in appetitive instrumental behaviors. On the other hand, the central nucleus of the amygdala directly receives afferents from the lateral nucleus of the amygdala. ⋯ The dorsolateral prefrontal cortex is involved in predicting of the outcome of own action, and the evaluation of the outcome for guiding optimal behaviors is based on its close reciprocal connections with the limbic system. These 4 regions of the brain interact with each other and work complementarily. In the present review, the abovementioned functions of the limbic system and prefrontal cortex in primates are discussed with regard to the findings of previous neurophysiological studies in which neuronal responses in these brain regions were analyzed in monkeys and rats.