Rinshō shinkeigaku = Clinical neurology
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Intracerebral hemorrhage (ICH) is a common stroke subtype in Japan. Hypertension is the leading cause. Perindopril Protection Against Recurrent Stroke Study (PROGRESS) revealed that blood pressure (BP) lowering could reduce stroke recurrence by 28% (ICH recurrence by 49%). ⋯ Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) showed the feasibility and safety of early rapid BP lowering to 140 mm Hg. INTERACT2 and ATACH II are the randomized trials to compare the guideline-based control (<180 mm Hg) and strict control (<140 mm Hg). We have just started to enroll patients to ATACH II from Japan on February 2012.
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Secondary encephalitis (encephalopathy) causally related with immune response induced by infection, etc., includes encephalitis mediated by innate immunity and adaptive immunity. In the latter, encephalitis mediated by antibodies to molecules at cell-surface of neuron seems to have relatively better outcome. In patients with encephalitis mediated by antibodies to NMDA-type glutamate receptors (NR), mean onset age is 26.5 years old, and the major initial symptoms are limbic symptoms including abnormal behavior, etc. ⋯ In patients with encephalitis mediated by antibodies to voltage-gated potassium channel (VGKC), predominant affection of males are observed, and antibodies to leucine-rich glioma-inactivated 1 (LGI1) and contactin-associate protein (CASR) 2 are found as major epitopes. Patients with Hashimoto encephalitis mediated by antibodies to n-terminal of α-enolase (NAE) have broad spectra of clinical characteristics. Antibodies to TPO can be the marker for diagnosis, and thereafter, confirmation of antibodies to NAE is necessary for definitive diagnosis.
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The success of chronic deep brain stimulation (DBS) and electrical neuro-network modulation (ENM) to address neurological and neuropsychiatric disorders has led the Food and Drug Administration (FDA), and also other worldwide regulatory agencies to grant approval for the use of DBS in specific disorders. In the United States, DBS is FDA approved for the treatment of advanced Parkinson's disease (PD), essential tremor (ET), obsessive compulsive disorder (OCD), and for dystonia. OCD and dystonia have been approved under a mechanism referred to as a humanitarian device exemption (HDE). ⋯ Based on a specific symptom profile, a strategic and personalized medicine approach can be undertaken. The personalized approach will take into consideration the brain target, a unilateral versus a bilateral procedure, and the potential for use of more than one DBS lead per brain hemisphere. Additionally, a personalized approach to DBS will also facilitate improved pre-operative medication adjustments, as well as optimal post-operative medication, behavioral, and device management.
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Using clinical information, it was investigated whether lesions in sporadic amyotrophic lateral sclerosis (sALS) spread contiguously from an onset site to the another regions in domino-like manner as hypothesized by prion-like propagation of pathogenic proteins. First, the data from medical records of 53 sALS patients with bulbar or lower limb onset showed that the symptom has noncontiguously spread from the bulbar region to the lower limbs or vice versa, skipping the upper limbs, in 18.9% of the patients. ⋯ The two parameters should be positively correlated, if the lesion propagates contiguously from an initially affected motoneuron to the neighbouring ones within the same motoneuron pool (local progression) and then propagates to the another motoneuron pools (regional spread). However, the statistically significant correlation was not found, suggesting that there may be the different mechanisms between local progression and regional spread of ALS lesions.
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While triptans, the 5-HT1B/1D agonists, are effective and generally well-tolerated in many patients up to one-third of migraine patients either may not respond well to triptans, may not tolerate their side effects, or may have contraindications that preclude their use. Recurrence, triptan-related side effects, and cardiovascular constriction effects are demerits for acute migraine treatment. CGRP receptor antagonists, the so-called gepants, were clearely designed and expected to be better than triptans. ⋯ A small number of patients taking olcegepant showed marked elevation in liver transaminase levels. It was decided to discontinue development of olcegepant. New CGRP receptor antagonists would be expected for acute migraine treatment.