Rinshō shinkeigaku = Clinical neurology
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This paper consists of two parts. In part one, I show seven "objective" predictions of health care reform in Japan that will be enforced by Ministry of Health, Labor and Welfare, within a few years following the umbrella law of health care system reform that was enacted in 2006, with special reference to the reform of health care delivery system. ⋯ In part two, I propose my personal health care reform plan that will enhance health care quality preserving national health insurance system by increasing public health care expenditures. Finally, I emphasize three kinds of subtle evidences that may promote the reform in line with my proposal.
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The Creutzfeldt-Jakob Disease (CJD) Surveillance Committee, Japan, started in April 1999, and has identified 918 patients with prion diseases until March 2007, including 716 with sporadic CJD (78.0%), 128 with genetic prion diseases (14.0%), and 72 with environmentally acquired prion diseases (7.8%). Among atypical cases of sporadic CJD, most common was MM2 type including thalamic and cortical forms. ⋯ Taken together with the results by the previous surveillance systems, a total number of dCJD in Japan was 129. The vCJD patient had a history of short stay in the UK and presented with periodic electroencephalogram in the late stage, requiring revision of the vCJD case definition (WHO 2001).
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The introduction of deep brain stimulation (DBS) was a historical step forward for the treatment of advanced and medically intractable movement disorders that include Parkinson's disease, dystonias, essential tremor, and Holmes' tremor. DBS is able to modulate the target region electrically in a reversible and adjustable fashion in contrast to an irreversible and destructive lesioning procedure. ⋯ With the development of DBS technology and stereotactic neurosurgical techniques, its therapeutic efficacy has been increased while reducing surgical complications. DBS has become an established therapy for disabling movement disorders and is currently being used to treat neuropsychiatric disorders.
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Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by gait disturbance, dementia, and/or urinary incontinence without causative disorders, and ventricular enlargement due to disturbed CSF circulation. The diagnosis of iNPH in the elderly remains a substantial issue, and the treatment is not always adequately provided. Many patients with possibly curable INPH often are misdiagnosed as having AD or vascular dementia. ⋯ Here, some key clinical and neuroimaging features distinctive from other dementia are discussed. Also reviewed are the results of the recently completed prospective cohort study of iNPH (Study of iNPH on Neurological Improvement: SINPHONI). In SINPHONI, the MRI-based diagnosis (dilated ventricles associated with narrow dorsal subarrachnoid space) and ventriculoperitoneal shunt with Codman Hakim programmable valve shunt system were validated against 1-year post-surgery outcome.