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Tang A, Yoshida K, Lahey H, Wilcox DR, Guan H, Costenbader K, Solomon D, Miyawaki EK, Bhattacharyya S. Herpes Simplex Virus Encephalitis in Patients With Autoimmune Conditions or Exposure to Immunomodulatory Medications. Neurology 2024; 102:e209297. [PMID: 38696733 DOI: 10.1212/wnl.0000000000209297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Among infectious etiologies of encephalitis, herpes simplex virus type 1 (HSV-1) is most common, accounting for ∼15%-40% of adult encephalitis diagnoses. We aim to investigate the association between immune status and HSV encephalitis (HSVE). Using a US Medicaid database of 75.6 million persons, we evaluated the association between HSVE and autoimmune conditions, exposure to immunosuppressive and immunomodulatory medications, and other medical comorbidities. METHODS We used the US Medicaid Analytic eXtract data between 2007 and 2010 from the 29 most populated American states. We first examined the crude incidence of HSVE in the population. We then age and sex-matched adult cases of HSVE with a sufficient enrollment period (12 months before HSVE diagnosis) to a larger control population without HSVE. In a case-control analysis, we examined the association between HSVE and exposure to both autoimmune disease and immunosuppressive/immunomodulatory medications. Analyses were conducted with conditional logistic regression progressively adjusting for sociodemographic factors, Charlson Comorbidity Index, and non-autoimmune comorbidities. RESULTS Incidence of HSVE was ∼3.01 per 105 person-years among adults. A total of 951 HSVE cases and 95,100 age and sex-matched controls were compared. The HSVE population had higher rates of medical comorbidities than the control population. The association of HSVE and autoimmune conditions was strong (adjusted odds ratio (OR) 2.6; 95% CI 2.2-3.2). The association of HSVE and immunomodulating medications had an OR of 2.2 (CI 1.9-2.6), also after covariate adjustment. When both exposures were included in regression models, the associations remained robust: OR 2.3 (CI 1.9-2.7) for autoimmune disease and 2.0 (CI 1.7-2.3) for immunosuppressive and immunomodulatory medications. DISCUSSION In a large, national population, HSVE is strongly associated with preexisting autoimmune disease and exposure to immunosuppressive and immunomodulatory medications. The role of antecedent immune-related dysregulation may have been underestimated to date.
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Affiliation(s)
- Alice Tang
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Kazuki Yoshida
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Hannah Lahey
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Douglas R Wilcox
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Hongshu Guan
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Karen Costenbader
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Daniel Solomon
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Edison K Miyawaki
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
| | - Shamik Bhattacharyya
- From the Division of Rheumatology, Inflammation and Immunity (K.Y., H.G., K.C., D.S.), and Department of Neurology (A.T., D.R.W., E.K.M., S.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Frank H. Netter MD School of Medicine at Quinnipiac University (H.L.), North Haven, CT; and Department of Neurology, Neuroimmunology and Neuro-Infectious Diseases Division (D.R.W.), Massachusetts General Hospital
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Davalos D, Miyawaki EK. Editorial: The neurology and psychology of time perception. Front Neurol 2023; 14:1282635. [PMID: 37799284 PMCID: PMC10548369 DOI: 10.3389/fneur.2023.1282635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Deana Davalos
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | - Edison K. Miyawaki
- Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA, United States
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Wang Y, Pines AR, Yoon JY, Frandsen SB, Miyawaki EK, Siddiqi SH. Focal Lesion in the Intraparietal Sulcus: A Case for Network-Dependent Release Hallucinations. J Neuropsychiatry Clin Neurosci 2023; 36:74-76. [PMID: 37727058 DOI: 10.1176/appi.neuropsych.20220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Yidi Wang
- Department of Medicine, Harvard Medical School, Boston (Wang); Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Pines, Siddiqi); Department of Neurology (Yoon, Miyawaki) and Center for Brain Circuit Therapeutics (Pines, Frandsen, Siddiqi), Mass General Brigham, Harvard Medical School, Boston; Department of Neurosurgery, Mount Sinai Hospital, New York (Yoon)
| | - Andrew R Pines
- Department of Medicine, Harvard Medical School, Boston (Wang); Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Pines, Siddiqi); Department of Neurology (Yoon, Miyawaki) and Center for Brain Circuit Therapeutics (Pines, Frandsen, Siddiqi), Mass General Brigham, Harvard Medical School, Boston; Department of Neurosurgery, Mount Sinai Hospital, New York (Yoon)
| | - Joseph Y Yoon
- Department of Medicine, Harvard Medical School, Boston (Wang); Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Pines, Siddiqi); Department of Neurology (Yoon, Miyawaki) and Center for Brain Circuit Therapeutics (Pines, Frandsen, Siddiqi), Mass General Brigham, Harvard Medical School, Boston; Department of Neurosurgery, Mount Sinai Hospital, New York (Yoon)
| | - Summer B Frandsen
- Department of Medicine, Harvard Medical School, Boston (Wang); Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Pines, Siddiqi); Department of Neurology (Yoon, Miyawaki) and Center for Brain Circuit Therapeutics (Pines, Frandsen, Siddiqi), Mass General Brigham, Harvard Medical School, Boston; Department of Neurosurgery, Mount Sinai Hospital, New York (Yoon)
| | - Edison K Miyawaki
- Department of Medicine, Harvard Medical School, Boston (Wang); Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Pines, Siddiqi); Department of Neurology (Yoon, Miyawaki) and Center for Brain Circuit Therapeutics (Pines, Frandsen, Siddiqi), Mass General Brigham, Harvard Medical School, Boston; Department of Neurosurgery, Mount Sinai Hospital, New York (Yoon)
| | - Shan H Siddiqi
- Department of Medicine, Harvard Medical School, Boston (Wang); Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Pines, Siddiqi); Department of Neurology (Yoon, Miyawaki) and Center for Brain Circuit Therapeutics (Pines, Frandsen, Siddiqi), Mass General Brigham, Harvard Medical School, Boston; Department of Neurosurgery, Mount Sinai Hospital, New York (Yoon)
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Miyawaki EK, Bhattacharyya S, Torre M. Revisiting a Telencephalic Extent of the Ascending Reticular Activating System. Cell Mol Neurobiol 2023:10.1007/s10571-023-01339-3. [PMID: 36964874 DOI: 10.1007/s10571-023-01339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023]
Abstract
Is the cerebrum involved in its own activation to states of attention or arousal? "Telencephalon" is a term borrowed from embryology to identify not only the cerebral hemispheres of the forebrain, but also the basal forebrain. We review a generally undercited literature that describes nucleus basalis of Meynert, located within the substantia innominata of the ventrobasal forebrain, as a telencephalic extension of the ascending reticular activating formation. Although that formation's precise anatomical definition and localization have proven elusive over more than 70 years, a careful reading of sources reveals that there are histological features common to certain brainstem neurons and those of the nucleus basalis, and that a largely common dendritic architecture may be a morphological aspect that helps to define non-telencephalic structures of the ascending reticular activating formation (e.g., in brainstem) as well as those parts of the formation that are telencephalic and themselves responsible for cortical activation. We draw attention to a pattern of dendritic arborization described as "isodendritic," a uniform (isos-) branching in which distal dendrite branches are significantly longer than proximal ones. Isodendritic neurons also differ from other morphological types based on their heterogeneous, rather than specific afferentation. References reviewed here are consistent in their descriptions of histology, particularly in studies of locales rich in cholinergic neurons. We discuss the therapeutic implications of a basal forebrain site that may activate cortex. Interventions that specifically target nucleus basalis and, especially, the survival of its constituent neurons may benefit afflictions in which higher cortical function is compromised due to disturbed arousal or attentiveness, including not only coma and related syndromes, but also conditions colloquially described as states of cognitive "fog" or of "long-haul" mental compromise.
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Affiliation(s)
- Edison K Miyawaki
- Department of Neurology, Brigham and Women's Hospital, Mass General Brigham, 60 Fenwood Rd., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital, Mass General Brigham, 60 Fenwood Rd., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Matthew Torre
- Department of Pathology, Mass General Brigham, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Miyawaki EK. Review: Subjective Time Perception, Dopamine Signaling, and Parkinsonian Slowness. Front Neurol 2022; 13:927160. [PMID: 35899266 PMCID: PMC9311331 DOI: 10.3389/fneur.2022.927160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
The association between idiopathic Parkinson's disease, a paradigmatic dopamine-deficiency syndrome, and problems in the estimation of time has been studied experimentally for decades. I review that literature, which raises a question about whether and if dopamine deficiency relates not only to the motor slowness that is an objective and cardinal parkinsonian sign, but also to a compromised neural substrate for time perception. Why does a clinically (motorically) significant deficiency in dopamine play a role in the subjective perception of time's passage? After a discussion of a classical conception of basal ganglionic control of movement under the influence of dopamine, I describe recent work in healthy mice using optogenetics; the methodology visualizes dopaminergic neuronal firing in very short time intervals, then allows for correlation with motor behaviors in trained tasks. Moment-to-moment neuronal activity is both highly dynamic and variable, as assessed by photometry of genetically defined dopaminergic neurons. I use those animal data as context to review a large experimental experience in humans, spanning decades, that has examined subjective time perception mainly in Parkinson's disease, but also in other movement disorders. Although the human data are mixed in their findings, I argue that loss of dynamic variability in dopaminergic neuronal activity over very short intervals may be a fundamental sensory aspect in the pathophysiology of parkinsonism. An important implication is that therapeutic response in Parkinson's disease needs to be understood in terms of short-term alterations in dynamic neuronal firing, as has already been examined in novel ways—for example, in the study of real-time changes in neuronal network oscillations across very short time intervals. A finer analysis of a treatment's network effects might aid in any effort to augment clinical response to either medications or functional neurosurgical interventions in Parkinson's disease.
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Affiliation(s)
- Edison K. Miyawaki
- Department of Neurology, Mass General Brigham, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Edison K. Miyawaki
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Miyawaki EK, Wilcox DR, Kraft AW, Guenette JP. Dysarthria-Facial Paresis and Rostral Pontine Ischemic Stroke. Case Rep Neurol 2022; 14:104-110. [PMID: 35431875 PMCID: PMC8958628 DOI: 10.1159/000522283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 11/19/2022] Open
Abstract
We describe an acute, postoperative dysarthria-facial paresis. While the rare stroke syndrome has been described previously, we present an under-described clinical nuance to its presentation with a particularly clear imaging correlation. A 78-year-old, right-handed man with a past medical history of aortic stenosis presented after a transcatheter aortic valve replacement. Immediately postoperatively, no neurological deficits were noted. That evening, he described his speech as “drunken.” He was later noted to have a right lower facial droop in addition to the speech change. His speech exhibited labial, lingual, and (to a lesser degree) guttural dysarthria. At the patient's request due to claustrophobia, he received 2 mg of oral lorazepam prior to cranial imaging. Afterwards, he was sleepy but arousable, yet was unable to put pen to paper when asked to write. Right lower facial paresis persisted, but he now demonstrated a right pronator drift, which resolved after 14 h without other evolution to his clinical examination. Brainstem lesions above the level of the pontine facial nucleus may present with central facial paresis contralateral to the lesion. An associated dysarthria may have both labial and lingual features in the absence of tongue or pharyngeal weakness. Our review of reported cases of dysarthria in isolation, dysarthria in combination with facial paresis, and facial paresis finds that all presentations may result from cortical, subcortical, or brainstem involvement. Stroke mechanisms are most commonly thromboembolic or small-vessel-ischemic in either the anterior or posterior circulations.
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Affiliation(s)
- Edison K. Miyawaki
- Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA
- *Edison K. Miyawaki,
| | - Douglas R. Wilcox
- Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew W. Kraft
- Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey P. Guenette
- Department of Radiology, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA
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Mishra S, Suh CH, Bergmark RW, Jo VY, Miyawaki EK, Schoenfeld JD, Uppaluri R, Guenette JP. Imaging features, therapies, and outcomes of fibrosing inflammatory pseudotumor of the nasopharynx: A systematic review. J Neuroimaging 2021; 32:223-229. [PMID: 34879175 DOI: 10.1111/jon.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Fibrosing inflammatory pseudotumor (FIP) of the nasopharynx is a rare nonneoplastic inflammatory lesion that is frequently mistaken for malignancy or infection. It is often misdiagnosed by radiologists as nasopharyngeal carcinoma or lymphoma, resulting in multiple biopsies and delays in diagnosis. The purpose is to understand trends in clinical presentation, imaging findings, treatment modalities, and patient outcomes of nasopharyngeal FIP. METHODS MEDLINE and EMBASE databases were queried for articles related to FIP of the nasopharynx. Articles that described cases of FIP involving the nasopharynx were selected. Studies that described inflammatory pseudotumor of the nasopharynx associated with known distinct pathologic entities were excluded. RESULTS A total of 19 articles describing 37 patients were included. MRI findings were reported in 32 patients. All cases demonstrated avid gadolinium enhancement. T2-weighted imaging characteristics were described or displayed for 21 patients: 95% demonstrated hypointensity compared to surrounding mucosa. Fluorodeoxyglucose (FDG) PET/CT findings were reported for 6 patients, all demonstrating mild FDG avidity. CONCLUSIONS Nasopharyngeal FIP is a histological diagnosis of exclusion that presents with facial pain and, often, cranial neuropathies. Relatively low T2-weighted MRI signal should inform the interpreting neuroradiologist to include FIP as a differential consideration for both the ordering provider and pathologist. Corticosteroid therapy is the most frequently employed therapy and results in partial or complete response in most patients. Radiation therapy and anti-inflammatory medications have also been reported to have potential therapeutic roles.
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Affiliation(s)
- Shruti Mishra
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Regan W Bergmark
- Division of Otolaryngology-Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vickie Y Jo
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edison K Miyawaki
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham & Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham & Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Miyawaki EK, Hsu L, Bhattacharyya S, O'Hare MJ, Roy A, Kett L, Caplan RA, Dattilo LW, Jo VY, Guenette JP. Fibrosing Inflammatory Pseudotumor Presenting as Cranial Neuropathy. Case Rep Neurol 2020; 12:247-254. [PMID: 32774282 PMCID: PMC7383149 DOI: 10.1159/000507920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 12/27/2022] Open
Abstract
We report two cases of biopsy-corroborated “fibrosing inflammatory pseudotumor” to illustrate that the entity, rarely described in the neurological literature, should be included in the differential diagnosis of either a cranial mononeuropathy or, certainly, in the case of progressive cranial neuropathies. A broad differential diagnosis arises in certain contexts. Early steroid treatment can be effective, and perhaps later-generation immune-modulating agents may confer further options, although there is no known definitive treatment.
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Affiliation(s)
- Edison K Miyawaki
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liangge Hsu
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meabh J O'Hare
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexis Roy
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Kett
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel A Caplan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Koller WC, Wilkinson S, Pahwa R, Miyawaki EK. Surgical treatment options in Parkinson's disease. Neurosurg Clin N Am 1998; 9:295-306. [PMID: 9495892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgical treatment of Parkinson's disease has become an important mode of therapy for advanced disease. Both ablative lesions and, more recently, deep brain stimulation have been employed. Various brain areas, including the thalamus, globus pallidus, and subthalamus, have been target sites.
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Affiliation(s)
- W C Koller
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas 66160-7314, USA
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Tarsy D, Miyawaki EK. Stiff-man syndrome. Report of a case. Arch Intern Med 1994; 154:1285-8. [PMID: 8203996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Stiff-man syndrome is a well-described, but rare and often overlooked, neuromuscular syndrome of rigidity, spasm, and gait abnormality that is associated with several endocrinologic and autoimmune disorders. A patient exhibiting many typical features of stiff-man syndrome had intermittent symptoms for 22 years before the correct diagnosis was made. Similar to many described patients, she was diabetic, hyperthyroid, and had elevated islet cell, antithyroid, and glutamic acid decarboxylase antibody levels. The high frequency of diabetes mellitus among patients with stiff-man syndrome is emphasized, as is increasing evidence to suggest that elaboration of anti-glutamic acid decarboxylase and anti-islet cell antibodies may play a role in the pathophysiologic state of the disorder.
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Affiliation(s)
- D Tarsy
- Division of Neurology, New England Deaconess Hospital, Boston, Mass
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Abstract
Current evidence suggests that anxiety has a neurobiologic basis. It is thought to be caused by dysfunction of one or more neurotransmitters and their receptors. Most data, which are derived from study of the benzodiazepine-gamma-aminobutyric acid receptor complex, indicate that alteration of the influx of chloride ions within this receptor complex is associated with the development of anxiety. The primary therapeutic effect of benzodiazepines occurs at this receptor complex. All clinically available benzodiazepines are active at this receptor complex, producing therapeutic results and side effects. Subtypes of benzodiazepine receptors as well as endogenous benzodiazepine ligands also have been identified. These may play a role in the pathogenesis of anxiety. Benzodiazepines also modulate the production of neuroactive steroids in the central nervous system. In the future, drugs that affect these varying benzodiazepine functions may play a role in the treatment of anxiety. Other neurotransmitters also have been implicated in the genesis of anxiety. Drugs affecting the noradrenergic beta receptor and the 5-hydroxytryptamine (serotonin) receptors have anxiolytic properties. New evidence also suggests a role for adenosine and cholecystokinin in the development of anxiety; drugs interacting with these neurotransmitters also may have anxiolytic properties.
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Affiliation(s)
- C Salzman
- Consolidated Department of Psychiatry, Harvard Medical School, Boston, Mass., USA
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Salzman C, Miyawaki EK, Soloman D. Use of benzodiazepines. Hosp Community Psychiatry 1990; 41:334. [PMID: 2179102 DOI: 10.1176/ps.41.3.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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