Rinshō shinkeigaku = Clinical neurology
-
[123I] Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy has been used to evaluate postganglionic cardiac sympathetic innervation in heart diseases and some neurological disorders. To see clinical usefulness of MIBG myocardial scintigraphy to differentiate Parkinson's disease (PD) and dementia with Lewy bodies (DLB) from related movement disorders and Alzheimer disease (AD), we performed MIBG myocardial scintigraphy in patients with these disorders. Cardiac uptake of MIBG is specifically reduced in PD and DLB, and this imaging approach is a sensitive diagnostic tool that possibly differentiates PD and DLB from related movement disorders and AD. ⋯ We found that (1) alpha-synuclein aggregates in the epicardial nerve fascicles, namely the distal axons of the cardiac sympathetic nerve, were much more abundant in ILBD with preserved TH-ir axons than in ILBD with decreased TH-ir axons and PD; (2) alpha-synuclein aggregates in the epicardial nerve fascicles were closely related to the disappearance of TH-ir axons; (3) in ILBD with preserved TH-ir axons, alpha-synuclein aggregates were consistently more abundant in the epicardial nerve fascicles than in the paravertebral sympathetic ganglia (pSG); and (4) this distal-dominant accumulation of alpha-synuclein aggregates was reversed in ILBD with decreased TH-ir axons and PD, which both showed decreased or depleted TH-ir axons but more abundant alpha-synuclein aggregates in the pSG. These findings indicate that accumulation of alpha-synuclein aggregates in the distal axons of the cardiac sympathetic nervous system precedes that of neuronal somata or neurites in the pSG and that heralds centripetal degeneration of the cardiac sympathetic nerve in PD. This chronological and dynamic relationship between alpha-synuclein aggregates and distal-dominant degeneration of the cardiac sympathetic nervous system may represent the pathological mechanism underlying a common degenerative process in PD.
-
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.
-
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).
-
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.