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Sakiyama Y, Kanda N, Higuchi Y, Yoshimura M, Wakaguri H, Takata Y, Watanabe O, Yuan J, Tashiro Y, Saigo R, Nozuma S, Yoshimura A, Arishima S, Ikeda K, Shinohara K, Arata H, Michizono K, Higashi K, Hashiguchi A, Okamoto Y, Hirano R, Shiraishi T, Matsuura E, Okubo R, Higuchi I, Goto M, Hirano H, Sano A, Iwasaki T, Matsuda F, Izumo S, Takashima H. New type of encephalomyelitis responsive to trimethoprim/sulfamethoxazole treatment in Japan. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e143. [PMID: 26309903 PMCID: PMC4537311 DOI: 10.1212/nxi.0000000000000143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 07/06/2015] [Indexed: 12/18/2022]
Abstract
Objective: To determine the causative pathogen and investigate the effective treatment of a new type of encephalomyelitis with an unknown pathogen in Japan and report the preliminary ultrastructural and genomic characterization of the causative agent. Methods: From 2005 to 2012, we treated 4 Japanese patients with geographic clustering and comparable clinical features, serum/CSF cytology, and radiologic findings. Brain biopsy was conducted in all patients to analyze neuropathologic changes by histology, and electron microscopy was applied to reveal the features of the putative pathogen. Genomic DNA was obtained from the affected brain tissues and CSF, and an unbiased high-throughput sequencing approach was used to screen for specific genomic sequences indicative of the pathogen origin. Results: All patients exhibited progressive dementia with involuntary tongue movements. Cytologic examination of CSF revealed elevated mononuclear cells. Abnormal MRI signals were observed in temporal lobes, subcortical white matter, and spinal cord. Biopsied brain tissue exhibited aggregated periodic acid-Schiff–positive macrophages and 2–7 μm diameter round/oval bodies without nuclei or cell walls scattered around the vessels. Unbiased high-throughput sequencing identified more than 100 archaea-specific DNA fragments. All patients were responsive to trimethoprim/sulfamethoxazole (TMP-SMX) plus corticosteroid therapy. Conclusions: We report 4 cases of encephalomyelitis due to an unknown pathogen. On the basis of ultrastructural and genomic studies, we propose a new disease entity resulting from a causative pathogen having archaeal features. TMP-SMX therapy was effective against this new type of encephalomyelitis.
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Affiliation(s)
- Yusuke Sakiyama
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Naoaki Kanda
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Yujiro Higuchi
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Michiyoshi Yoshimura
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Hiroyuki Wakaguri
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Yoshiharu Takata
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Osamu Watanabe
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Junhui Yuan
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Yuichi Tashiro
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Ryuji Saigo
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Satoshi Nozuma
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Akiko Yoshimura
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Shiho Arishima
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Kenichi Ikeda
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Kazuya Shinohara
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Hitoshi Arata
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Kumiko Michizono
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Keiko Higashi
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Akihiro Hashiguchi
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Yuji Okamoto
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Ryuki Hirano
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Tadafumi Shiraishi
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Eiji Matsuura
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Ryuichi Okubo
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Itsuro Higuchi
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Masamichi Goto
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Hirofumi Hirano
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Akira Sano
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Takuya Iwasaki
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Fumihiko Matsuda
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Shuji Izumo
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan
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