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Naito R, Watanabe Y, Naito A, Sugasawa K, Nakata Y, Kamiyama T, Okiyama R, Yokochi F, Isozaki E, Yamasoba T, Takahashi K. Visual fixation suppression of caloric nystagmus in progressive supranuclear palsy - A comparison with Parkinson's disease. J Vestib Res 2023; 33:385-401. [PMID: 37599554 DOI: 10.3233/ves-210147] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Impairment of visual fixation suppression (VS) in progressive supranuclear palsy (PSP) is not well documented. OBJECTIVE To evaluate the usefulness of impaired VS of caloric nystagmus as an index for differential diagnosis between PSP and Parkinson's disease (PD), which is often difficult, especially in the early stage. METHODS Subjects comprised 26 PSP patients and 26 PD patients clinically diagnosed at Tokyo Metropolitan Neurological Hospital. We retrospectively investigated VS of caloric nystagmus, horizontal pursuit, saccades, and horizontal optokinetic nystagmus recorded on direct-current-electronystagmography, and neuroradiological findings. RESULTS The median of the average VS% was 0% and 50.0% in PSP and PD patients, respectively. In PSP, VS was impaired even in the early stage of disease. We found a significant correlation between VS and velocity of saccades or maximum slow phase velocity of optokinetic nystagmus only in PSP patients. PSP patients with atrophy of the subthalamic nucleus or with decreased blood flow in the frontal lobe showed significantly more severe impairment of VS. CONCLUSIONS VS may be a useful biomarker to differentiate patients with PSP from those with PD. Cerebellar networks that connect with the cerebral cortex and basal ganglia may contribute to impaired VS of caloric nystagmus in PSP.
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Affiliation(s)
- Rie Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yuki Watanabe
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Akira Naito
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Neuro-Otology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yasuhiro Nakata
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tsutomu Kamiyama
- Department of Neuro-Radiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Ryoichi Okiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicines, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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2
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Ochiai Y, Bandoh M, Sunami Y, Miyakoshi N, Kiyokawa Y, Isozaki E. [Case Report: Broca's Aphasia in a Left-Handed Patient with a Right Brain Infarction and Early Stage Aphonia]. Brain Nerve 2022; 74:393-399. [PMID: 35437292 DOI: 10.11477/mf.1416202050] [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: 06/14/2023]
Abstract
We report a case of Broca's aphasia in a left-handed patient with a right brain infarction. The patient's speech is consistent with a particular type of aphemia, that is, without vocalization except for a few phonemes or words. The patient presented with aphonia in an early stage. The lack of speech could be due to the impairment of the phonological-speech process or speech initialization. This type of aphemia has been reported to involve the right inferior precentral gyrus or right middle and inferior frontal gyri. Our patient had both lesions. The symptom and the lesion of this type of aphemia could differ from those of another type of aphemia corresponding to apraxia of speech, and the speech of Broca's aphasia could have multiple mechanisms. Our case shows Alexander's anomalous type with atypical lateralization and distribution of the lesion. Verbal intrahemispheric dissociation apraxia was suspected in our patient. The coexistence of aphasia, anosodiaphoria of hemiplegia is a dual symptom in which bilateral hemispheric functions exist in a unilateral hemisphere. (Received 1 December, 2021; Accepted 1 February, 2022; Published 1 April, 2022).
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Affiliation(s)
- Yukiko Ochiai
- Department of neurology, Tokyo Metropolitan Neurological Hospital
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3
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Kawazoe T, Tobisawa S, Sugaya K, Uruha A, Miyamoto K, Komori T, Goto YI, Nishino I, Yoshihashi H, Mizuguchi T, Matsumoto N, Egawa N, Kawata A, Isozaki E. Myoclonic Epilepsy with Ragged-red Fibers with Intranuclear Inclusions. Intern Med 2022; 61:547-552. [PMID: 34433719 PMCID: PMC8907771 DOI: 10.2169/internalmedicine.7767-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We herein report a case of myoclonic epilepsy with ragged-red fibers (MERRF) harboring a novel variant in mitochondrial cysteine transfer RNA (MT-TC). A 68-year-old woman presented with progressive myoclonic epilepsy with optic atrophy and peripheral neuropathy. A skin biopsy revealed p62-positive intranuclear inclusions. No mutations were found in the causative genes for diseases known to be related to intranuclear inclusions; however, a novel variant in MT-TC was found. The association between intranuclear inclusions and this newly identified MERRF-associated variant is unclear; however, the rare complication of intranuclear inclusions in a patient with typical MERRF symptoms should be noted for future studies.
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Affiliation(s)
- Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Japan
| | - Shinsuke Tobisawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Japan
| | - Akinori Uruha
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Japan
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Germany
| | - Kazuhito Miyamoto
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), TMNH, Japan
| | - Yu-Ichi Goto
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Japan
- Medical Genome Center, NCNP, Japan
| | - Ichizo Nishino
- Medical Genome Center, NCNP, Japan
- Department of Neuromuscular Research, National Institute of Neuroscience, NCNP, Japan
| | - Hiroshi Yoshihashi
- Department of Clinical Genetics, Tokyo Metropolitan Children's Medical Center, Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Naohiro Egawa
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital (TMNH), Japan
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4
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Ikezawa J, Yokochi F, Okiyama R, Kumada S, Tojima M, Kamiyama T, Hanakawa T, Matsuda H, Tanaka F, Nakata Y, Isozaki E. Is Generalized and Segmental Dystonia Accompanied by Impairments in the Dopaminergic System? Front Neurol 2021; 12:751434. [PMID: 34867735 PMCID: PMC8638468 DOI: 10.3389/fneur.2021.751434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/01/2021] [Accepted: 10/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background: The pathogenesis of dystonia is remarkably diverse. Some types of dystonia, such as DYT5 (DYT-GCH1) and tardive dystonia, are related to dysfunction of the dopaminergic system. Furthermore, on pathological examination, cell loss in the substantia nigra (SN) of patients with dystonia has been reported, suggesting that impaired dopamine production may be involved in DYT5 and in other types of dystonia. Objectives: To investigate functional dopaminergic impairments, we compared patients with dystonia and those with Parkinson's disease (PD) with normal controls using neuromelanin-sensitive magnetic resonance imaging (NM-MRI) and dopamine transporter single photon emission computed tomography (DAT SPECT). Methods: A total of 18, 18, and 27 patients with generalized or segmental dystonia, patients with PD, and healthy controls, respectively, were examined using NM-MRI. The mean area corresponding to NM in the SN (NM-SN) was blindly quantified. DAT SPECT was performed on 17 and eight patients with dystonia and PD, respectively. The imaging data of DAT SPECT were harmonized with the Japanese database using striatum phantom calibration. These imaging data were compared between patients with dystonia or PD and controls from the Japanese database in 256 healthy volunteers using the calibrated specific binding ratio (cSBR). The symptoms of dystonia were evaluated using the Fahn–Marsden Dystonia Rating Scale (FMDRS), and the correlation between the results of imaging data and FMDRS was examined. Results: The mean areas corresponding to NM in the SN (NM-SN) were 31 ± 4.2, 28 ± 3.8, and 43 ± 3.8 pixels in patients with dystonia, PD, and in healthy controls, respectively. The mean cSBRs were 5 ± 0.2, 2.8 ± 0.2, 9.2 (predictive) in patients with dystonia, PD, and in healthy controls, respectively. The NM-SN area (r = −0.49, p < 0.05) and the cSBR (r = −0.54, p < 0.05) were inversely correlated with the FMDRS. There was no significant difference between the dystonia and PD groups regarding NM-SN (p = 0.28). In contrast, the cSBR was lower in patients with PD than in those with dystonia (p < 0.5 × 10−6). Conclusions: Impairments of the dopaminergic system may be involved in developing generalized and segmental dystonia. SN abnormalities in patients with dystonia were supposed to be different from degeneration in PD.
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Affiliation(s)
- Jun Ikezawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Ryoichi Okiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Satoko Kumada
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Maya Tojima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.,Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Takashi Hanakawa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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5
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Kawazoe T, Inoue T, Tobisawa S, Sugaya K, Shimizu T, Miyamoto K, Goto M, Yokogawa N, Azuma S, Itagaki S, Nishida K, Morita Y, Nagao M, Isozaki E. Immunoglobulin G4-related Disease Accompanied by Peripheral Neuropathy: A Report of Two Cases. Intern Med 2021; 60:1941-1947. [PMID: 33456044 PMCID: PMC8263177 DOI: 10.2169/internalmedicine.6461-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Due to its rarity and the limited literature, the clinicopathological characteristics of peripheral nerve involvement in immunoglobulin G4 (IgG4)-related disease are unknown. We present two cases of IgG4-related disease, accompanied by peripheral neuropathy, presenting as unilateral ptosis (case 1) and sclerosing cholangitis (case 2), respectively. In both cases, sural nerve biopsy indicated vasculitis as the underlying pathophysiology; the peripheral neuropathy was refractory to corticosteroid therapy. In contrast to the previously proposed pathomechanism of IgG4-related neuropathy (direct lymphoplasmacytic infiltration), the pathological findings in our cases suggest that vasculitis occurs secondary to systemic autoimmune conditions.
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Affiliation(s)
- Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Tomoyuki Inoue
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Shinsuke Tobisawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Kazuhito Miyamoto
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Manaka Goto
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Japan
| | - Naoto Yokogawa
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Japan
| | - Sanami Azuma
- Department of Otolaryngology-Head and Neck Surgery, Tokyo Metropolitan Tama Medical Center, Japan
| | - Shingo Itagaki
- Department of Pathology, Tokyo Metropolitan Tama Medical Center, Japan
| | - Kenji Nishida
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Japan
| | - Masahiro Nagao
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
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Homma T, Mochizuki Y, Tobisawa S, Komori T, Isozaki E. Cerebral white matter tau-positive granular glial pathology as a characteristic pathological feature in long survivors of multiple system atrophy. J Neurol Sci 2020; 416:117010. [PMID: 32652361 DOI: 10.1016/j.jns.2020.117010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/03/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION It is unclear whether tau-positive granular glial pathology is a characteristic feature of MSA. We aimed to analyse the prevalence and significance of tau-positive granular glial pathology in MSA. METHODS Fourteen MSA cases were clinicopathologically investigated, focusing on tau-positive granular glial pathology in the frontal and temporal white matter and putamen. RESULTS In five MSA cases, the temporal white matter showed AT8-positive granular glial pathology; this pathology was detected in the frontal white matter in three cases. AT8-positive granular glia in the white matter were associated with long disease duration with long-term tube feeding and/or long-term tracheotomy. Alpha-synuclein-positive glial cytoplasmic inclusion intensity was not associated with AT8-positive granular glial pathology. The tau isoform of AT8-positive granular glia in the cerebral white matter exhibited three-repeat, not four-repeat, tau. Ten MSA patients showed tau-positive granular glial pathology in the putamen; the tau isoform was predominantly three-repeat tau and four-repeat tau in cases with disease duration ≥13 years and < 13 years, respectively. CONCLUSIONS Tau-positive granular glia in the putamen is a characteristic pathological feature of MSA. Tau-positive granular glia appear in the cerebral white matter in MSA patients and are associated with long disease duration with long-term tube feeding and/or long-term tracheotomy.
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Affiliation(s)
- Taku Homma
- Department of Neuropathology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan; Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Itabashi, Tokyo, Japan.
| | - Yoko Mochizuki
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Itabashi, Tokyo, Japan; Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, Kita, Tokyo, Japan
| | - Shinsuke Tobisawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Takashi Komori
- Department of Neuropathology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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7
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Norioka R, Kumada S, Tobisawa S, Tsuyusaki Y, Isozaki E. Clinical characteristics of children and adults with anti-N-methyl-D-aspartate receptor encephalitis. Clin Neurol Neurosurg 2020; 196:106015. [PMID: 32574966 DOI: 10.1016/j.clineuro.2020.106015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/13/2019] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the clinical characteristics of children and adults with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. METHODS Patients who tested positive for the anti-NMDAR antibody (by a cell-based assay) in the cerebrospinal fluid were enrolled. They were divided into two groups based on age (<16 years or older). RESULTS Three children (two males and one female) and four adults (one male and three females) were examined. The age at onset was 3.0 ± 1.41 years (range: 2-5 years) for the children and 31.8 ± 6.80 years (range: 20-36 years) for the adults. The follow-up duration was 82.7 ± 23.80 months (range: 52-110 months) for the children and 61.5 ± 12.54 months (range: 43-78 months) for the adults. Prodromal symptoms such as fever and headache were observed in three adults. Two children received influenza vaccination before the onset of encephalitis. Brain magnetic resonance imaging abnormalities were observed in three children and one adult. Basal ganglia lesions were observed in two children and one adult, and the two children showed dystonia. Two children and one adult without neoplasms experienced recurrences. The modified Rankin Scale scores at the final follow-up tended to be worse in children than in adults. CONCLUSION Three patients had basal ganglia lesions, and two of them showed dystonia. Dystonia with basal ganglia lesions has been rarely reported in anti-NMDAR encephalitis but should be noted as a significant symptom, which severely affects the activities of daily life.
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Affiliation(s)
- Ryohei Norioka
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
| | - Satoko Kumada
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Shinsuke Tobisawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yu Tsuyusaki
- Department of Neuropediatrics, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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8
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Norioka R, Warabi Y, Matayoshi H, Isozaki E. The Successful Treatment of Severe Trigeminal Neuralgia by a Single Mandibular Nerve Block and Subsequent Natalizumab Administration in a Patient with Multiple Sclerosis. Cureus 2020; 12:e7646. [PMID: 32411548 PMCID: PMC7217241 DOI: 10.7759/cureus.7646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report the case of a middle-aged woman who developed trigeminal neuralgia as a sequela of multiple sclerosis (MS). The trigeminal neuralgia was refractory to medications and persisted for two years. Eventually, it was resolved by a mandibular nerve block followed by natalizumab administration. The pain was controlled for 23 months, and additional nerve blocks were not required during this period. It has been previously reported that natalizumab therapy improves the Expanded Disability Status Scale (EDSS) scores and health-related quality of life in patients with MS. In the present case, natalizumab may have prolonged the effect of the mandibular nerve block and consequently improved the patient’s quality of life.
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Homma T, Mochizuki Y, Hara M, Kamei S, Mizutani T, Takubo H, Isozaki E, Takahashi M, Komori T, Hao H. Gradient subthalamic neurodegeneration and tau pathology in the hypoglossal nucleus as essential pathological markers of progressive supranuclear palsy - Richardson syndrome. Rev Neurol (Paris) 2020; 176:353-360. [PMID: 32247606 DOI: 10.1016/j.neurol.2019.09.010] [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: 06/03/2019] [Revised: 08/07/2019] [Accepted: 09/12/2019] [Indexed: 10/24/2022]
Abstract
Progressive supranuclear palsy - Richardson syndrome (PSP-RS) was first described in 1964 by Steele et al. Tau pathology has not been reported in the hypoglossal nuclei of PSP-RS patients, whereas Steele et al. described gliosis with no remarkable neuronal losses in the hypoglossal nucleus. This study aimed to investigate the distribution and degree of tau pathology-associated neurodegeneration, with an emphasis on the hypoglossal nucleus, in patients with PSP-RS. Six clinicopathologically proven PSP-RS cases were included in this study. All patients were clinicopathologically and immunohistochemically re-evaluated. This study confirmed the following neuropathological characteristics of PSP-RS: (1) neurodegeneration usually affects the striatonigral system and cerebellar dentate nucleus; (2) the cerebellar afferent system in PSP-RS is affected by absent-to-mild neurodegeneration; and (3) the extent of tau distribution throughout the central nervous system is greater than the extent of neurodegeneration. Furthermore, we found that subthalamic neurodegeneration was more prominent in the ventromedial region than in the dorsolateral region. Nevertheless, the tau pathology showed no remarkable differences between these two sites. Interestingly, the tau pathology was frequently observed in the hypoglossal nuclei of PSP-RS patients. Gradient neurodegeneration of the subthalamus and tau pathology in the hypoglossal nucleus could be regarded as essential pathological features of PSP-RS.
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Affiliation(s)
- T Homma
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan; Department of Pathology, Ebara Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan; Department of Neuropathology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
| | - Y Mochizuki
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan; Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, Tokyo, Japan
| | - M Hara
- Department of Neurology, Nihon University School of Medicine, Tokyo, Japan
| | - S Kamei
- Department of Neurology, Nihon University School of Medicine, Tokyo, Japan
| | | | - H Takubo
- Department of Neurology, Ebara Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan; Cyofu Keijinkai Clinic, Tokyo, Japan
| | - E Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - M Takahashi
- Department of Pathology, Ebara Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - T Komori
- Department of Neuropathology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - H Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
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10
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Shimazaki R, Uruha A, Kimura H, Nagaoka U, Kawazoe T, Yamashita S, Komori T, Miyamoto K, Matsubara S, Sugaya K, Nagao M, Isozaki E. Rimmed Vacuoles in Myositis Associated with Antimitochondrial Antibody. J Clin Neurol 2020; 16:510-512. [PMID: 32657078 PMCID: PMC7354972 DOI: 10.3988/jcn.2020.16.3.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rui Shimazaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
| | - Akinori Uruha
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.,Department of Neuropathology, Charité-Universitätsmedizin, Berlin, Germany
| | - Hideki Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Utako Nagaoka
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Satoshi Yamashita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kazuhito Miyamoto
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Shiro Matsubara
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masahiro Nagao
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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11
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Shimizu T, Nakayama Y, Funai A, Morishima R, Hayashi K, Bokuda K, Nakata Y, Isozaki E. Progressive deterioration of sensory cortex excitability in advanced amyotrophic lateral sclerosis with invasive ventilation. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:147-149. [PMID: 31852262 DOI: 10.1080/21678421.2019.1704015] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We describe a patient with sporadic amyotrophic lateral sclerosis (ALS) who showed progressive deterioration of sensory cortex excitability at the advanced stage, while using invasive ventilation. At the time of diagnosis, the patient showed enlarged N20 of the median nerve somatosensory evoked potential (SEP). Following ventilator use through tracheostomy, the patient gradually fell into a totally locked-in state for four years and the N20 showed progressive deterioration in the amplitude, which finally led to its loss. Magnetic resonance imaging (MRI) showed frontotemporal and mild parietal cortex atrophy, subcortical white matter hyperintensity and brainstem atrophy suggesting the involvement of the central sensory pathways. MRI and flash visual evoked potentials revealed that the occipital lobe was well-preserved throughout the course of the disease. This is the first case report of a physiological demonstration of multisystem neurodegeneration involving the central sensory pathway in a patient with advanced ALS and invasive ventilation use.
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Affiliation(s)
- Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan, and
| | - Asuka Funai
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Nishigori R, Warabi Y, Shishido-Hara Y, Nakamichi K, Nakata Y, Komori T, Isozaki E. Inflammatory Cerebellar PML with a CD4/CD8 Ratio of 2.9 Showed a Favorable Prognosis in a Patient with Rheumatoid Arthritis. Intern Med 2019; 58:3323-3329. [PMID: 31366796 PMCID: PMC6911754 DOI: 10.2169/internalmedicine.3038-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The patient was a 74-year-old woman with rheumatoid arthritis who developed ataxia. MRI revealed T2-hyperintense lesions predominantly in the left middle cerebellar peduncle. Punctate or linear Gd enhancement was also observed on T1-weighted images. A brain biopsy was conducted and the pathology revealed a mild demyelinated lesion. Polymerase chain reaction (PCR) of biopsied brain tissues revealed the presence of JC virus (JCV) DNA, but JCV-infected oligodendroglia-like cells were not apparent on immunohistochemistry. Sensitive in-situ hybridization, however, detected three JCV-positive cells and the infiltration of CD4+ and CD8+ T cells and plasma cells was also observed. Immunosuppressants were tapered off and mirtazapine and mefloquine administered, resulting in a favorable outcome.
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Affiliation(s)
- Ryusei Nishigori
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
- Department of Neurology, Kyoto University Graduate School of Medicine, Japan
| | - Yoko Warabi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Yukiko Shishido-Hara
- Department of Anatomic Pathology, Tokyo Medical University, Japan
- Department of Pathology and Applied Neurobiology, Kyoto Prefectural University of Medicine, Japan
| | - Kazuo Nakamichi
- Department of Virology 1, National Institute of Infectious Diseases, Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
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Morishima R, Bandoh M, Sunami Y, Isozaki E. [Progressive supranuclear palsy-Richardson syndrome with visual attention disturbance (Holmes and Horrax) and ataxie optique (Garcin): a case report]. Rinsho Shinkeigaku 2019; 59:730-735. [PMID: 31656263 DOI: 10.5692/clinicalneurol.cn-001273] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
[Background] Supranuclear extraorbital muscle palsy is the core feature of progressive supranuclear palsy (PSP), and ordinarily presents as spontaneous vertical gaze constriction. However, higher visual function associated with visuospatial cognition in PSP patients was not previously considered. [Case presentation] We present a 72-year old right-handed man with PSP- Richardson syndrome (PSP-RS) and abnormal higher visual function. His symptoms began 2 years previously and included the use of small steps while walking, forgetfulness, and postural instability. Neurological examination revealed supranuclear vertical gaze limitation, akinesia, and lead-pipe rigidity without laterality. Neuro-ophthalmological examination showed abnormal ocular movement consistent with PSP, and no visual abnormality was observed. General cognitive functions, including attention and prominent visuospatial orientation and visual attention disturbances, were assessed using neuropsychological tests and concomitant spatial agraphia and impaired configuration using figure copying. Although he presented with mildly decreased and monotonous speech with palilalia, he showed no apparent aphasia, apraxia, visual object agnosia, or Bálint's 'optische Ataxie' i.e. visual ataxia under fixation. Brain MRI revealed atrophy of the mesencephalic tegmentum, bilateral frontal lobe, and bilateral hippocampus. N-isopropyl-p-(iodine-123)-iodoamphetamine single photon emission computed tomography revealed decreased cerebral blood flow in the bilateral frontal lobe, lateral temporal lobe, and basal ganglia. Dopamine transporter single photon emission CT revealed uptake attenuation in the bilateral striatum. 123I-metaiodobenzyl-guanidine myocardium scintigraphy results were normal. [Discussion] The patient's symptoms indicated classical PSP-RS accompanied with a combination of disturbances in spatial orientation and visual attention as noted by Holmes and Horrax and 'ataxie optique' by Garcin. Thus, as observed in this patient, many clinically diagnosed PSP patients with undiagnosed higher visual dysfunction, masked by limited eye movement may exist. These symptoms may further our understanding about posterior cortical atrophy and tauopathy including not only PSP but also corticobasal syndrome and Alzheimer disease.
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Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Mitsuaki Bandoh
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Yoko Sunami
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
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Warabi Y, Takahashi T, Isozaki E. Dimethyl Fumarate Was Ineffective but Not Harmful for a Patient with Myelin Oligodendrocyte Glycoprotein Antibody Disease. Cureus 2019; 11:e6040. [PMID: 31824807 PMCID: PMC6886657 DOI: 10.7759/cureus.6040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/06/2022] Open
Abstract
We treated a myelin oligodendrocyte glycoprotein (MOG) antibody disease patient who had been prescribed dimethyl fumarate because she was thought to have been suffering from multiple sclerosis (MS). Mild optic neuritis relapsed at one year and four months after the administration of dimethyl fumarate. Therefore, dimethyl fumarate was ineffective for preventing relapse of MOG antibody disease. However, dimethyl fumarate for MOG antibody disease was not harmful compared with when disease-modifying drugs (DMDs) of MS were used for anti-aquaporin-4 antibody-positive neuromyelitis optica. If MS patients repeat relapses even after the start of DMDs, a differential diagnosis including MOG antibody disease should be made.
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Affiliation(s)
- Yoko Warabi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, JPN
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine and National Hospital Organization Yonezawa National Hospital, Sendai, JPN
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, JPN
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15
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Morishima R, Shimizu T, Nishida H, Mashimo H, Arisaka A, Kumada S, Isozaki E. P2-17-05. Ultrasound evaluation of the cervical root in pediatric chronic inflammatory demyelinating polyradiculoneuropathy. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Funai A, Kimura H, Shimizu T, Morishima R, Bokuda K, Kamiyama T, Shinodsuka K, Ishizaka A, Koike K, Miyamoto K, Isozaki E. W1-5. A case of vasculitic neuropathy with marked demyelinating features in the nerve conduction study. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.06.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Bokuda K, Shimizu T, Kimura H, Morishima R, Kamiyama T, Kawata A, Nakayama Y, Isozaki E. Relationship between EMG-detected and ultrasound-detected fasciculations in amyotrophic lateral sclerosis: A prospective cohort study. Clin Neurophysiol 2019; 131:259-264. [PMID: 31506234 DOI: 10.1016/j.clinph.2019.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Fasciculation potentials (FP) are an important consideration in the electrophysiological diagnosis of ALS. Muscle ultrasonography (MUS) has a higher sensitivity in detecting fasciculations than electromyography (EMG), while in some cases, it is unable to detect EMG-detected fasciculations. We aimed to investigate the differences of FP between the muscles with and without MUS-detected fasciculations (MUS-fas). METHODS Thirty-one consecutive patients with sporadic ALS were prospectively recruited and in those, both needle EMG and MUS were performed. Analyses of the amplitude, duration, and number of phases of EMG-detected FPs were performed for seven muscles per patient, and results were compared between the muscles with and without MUS-fas in the total cohort. RESULTS The mean amplitude and phase number of FP were significantly lower in patients with EMG-detected FP alone (0.39 ± 0.25 mV and 3.21 ± 0.88, respectively) than in those with both FP and MUS-fas (1.22 ± 0.92 mV and 3.74 ± 1.39, respectively; p < 0.0001 and p = 0.017, Welch's t-test). CONCLUSION Small FP may be undetectable with MUS. MUS cannot replace EMG in the diagnostic approach for ALS. SIGNIFICANCE Clinicians should use a combination of EMG and MUS for the detection and quantitative analysis of fasciculation in ALS.
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Affiliation(s)
- Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hideki Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Murayama A, Sugaya K, Shimizu T, Sunami Y, Tobisawa S, Isozaki E. Central nervous system involvement in patients with critical illness polyneuropathy. J Neurol Sci 2019; 396:216-218. [DOI: 10.1016/j.jns.2018.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 01/08/2023]
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19
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Morishima R, Shimizu T, Isozaki E. O-1-06. Relationships between sympathetic skin responses and 123I-etaiodobenzylguanidine myocardial scintigraphy in neurological disorders. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Based on the hypothesis that autoimmunity plays a role in the pathogenesis of neuralgic amyotrophy (NA), immunotherapy is sometimes administered. Early intervention is recommended for a good prognosis. We herein report the case of a 55-year-old man who presented with neuralgia, weakness, and muscle atrophy in his right shoulder girdle and upper arm, which progressed for ten months following a marine sports accident. The patient was diagnosed with NA. His neurological deficits gradually improved after several courses of immunotherapy, suggesting that in addition to being effective for treating early-stage disease, immunotherapy may be effective for treating chronic cases.
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Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Utako Nagaoka
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Masahiro Nagao
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
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Shimizu T, Bokuda K, Kimura H, Kamiyama T, Nakayama Y, Kawata A, Isozaki E, Ugawa Y. Sensory cortex hyperexcitability predicts short survival in amyotrophic lateral sclerosis. Neurology 2018; 90:e1578-e1587. [PMID: 29602913 DOI: 10.1212/wnl.0000000000005424] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/01/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate somatosensory cortex excitability and its relationship to survival prognosis in patients with amyotrophic lateral sclerosis (ALS). METHODS A total of 145 patients with sporadic ALS and 73 healthy control participants were studied. We recorded compound muscle action potential and sensory nerve action potential of the median nerve and the median nerve somatosensory evoked potential (SEP), and we measured parameters, including onset-to-peak amplitude of N13 and N20 and peak-to-peak amplitude between N20 and P25 (N20p-P25p). Clinical prognostic factors, including ALS Functional Rating Scale-Revised, were evaluated. We followed up patients until the endpoints (death or tracheostomy) and analyzed factors associated with survival using multivariate analysis in the Cox proportional hazard model. RESULTS Compared to controls, patients with ALS showed a larger amplitude of N20p-P25p in the median nerve SEP. Median survival time after examination was shorter in patients with N20p-P25p ≥8 μV (0.82 years) than in those with N20p-P25p <8 μV (1.68 years, p = 0.0002, log-rank test). Multivariate analysis identified a larger N20p-P25p amplitude as a factor that was independently associated with shorter survival (p = 0.002). CONCLUSION Sensory cortex hyperexcitability predicts short survival in patients with ALS.
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Affiliation(s)
- Toshio Shimizu
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan.
| | - Kota Bokuda
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Hideki Kimura
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Tsutomu Kamiyama
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Yuki Nakayama
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Akihiro Kawata
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Eiji Isozaki
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
| | - Yoshikazu Ugawa
- From the Department of Neurology (T.S., K.B., H.K., T.K., A.K., E.I.), Tokyo Metropolitan Neurological Hospital; Department of Neurology (T.S., Y.U.), Fukushima Medical University School of Medicine; ALS Nursing Care Project (Y.N.), Tokyo Metropolitan Institute of Medical Science; and Advanced Clinical Research Center (Y.U.), Fukushima Global Medical Science Center, Japan
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Nakayama Y, Shimizu T, Matsuda C, Haraguchi M, Hayashi K, Mochizuki Y, Nagao M, Kawata A, Isozaki E. Non-motor manifestations in ALS patients with tracheostomy and invasive ventilation. Muscle Nerve 2017; 57:735-741. [PMID: 29105161 DOI: 10.1002/mus.26004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/13/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION This study aimed to investigate non-motor manifestations in amyotrophic lateral sclerosis (ALS) patients with tracheostomy and invasive ventilation (TIV) and their relevance to disease progression. METHODS Sixty-seven ALS patients with TIV were enrolled, and followed-up prospectively. The patients were classified at the final evaluation into two subgroups according to the duration of TIV use or disease stage measured by communication impairment. We identified non-motor manifestations and investigated their frequencies and differences across the stages. RESULTS The non-motor manifestations were macroglossia (22.4%), unstable blood pressure (38.8%), hypothermia (26.9%), dysuria (50.7%), and hyperglycemia (12.1%). These manifestations occurred significantly more frequently in patients with TIV ≥5 years than in patients with TIV <5 years, and more in patients with severe communication impairment than in those with preserved communication ability. DISCUSSION Non-motor manifestations are observed at a high rate in ALS patients with TIV, and are possibly related to disease progression. Muscle Nerve 57: 735-741, 2018.
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Affiliation(s)
- Yuki Nakayama
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Chiharu Matsuda
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Michiko Haraguchi
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yoko Mochizuki
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, Tokyo, Japan
| | - Masahiro Nagao
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Sakamoto Y, Shimizu T, Tobisawa S, Isozaki E. Chronic demyelinating neuropathy with anti-myelin-associated glycoprotein antibody without any detectable M-protein. Neurol Sci 2017; 38:2165-2169. [DOI: 10.1007/s10072-017-3133-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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24
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Hayashi K, Mochizuki Y, Nakahara A, Kakita A, Komori T, Isozaki E. Histopathological characteristics of the inferior olivary nucleus in patients with amyotrophic lateral sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Sugaya K, Inoue T, Nakata Y, Isozaki E. Independent loss of melanin-containing neurons between the locus coeruleus and substantia nigra in Parkinson’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Shimizu T, Bokuda K, Kimura H, Nakayama Y, Kawata A, Isozaki E, Ugawa Y. Sensory cortical excitability and survival prognosis in patients with amyotrophic lateral sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Nakayama Y, Shimizu T, Matsuda C, Haraguchi M, Hayashi K, Bokuta K, Nagao M, Kawata A, Isozaki E. Non-motor symptoms during disease progression in ALS patients with tracheostomy and invasive ventilation. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Bokuda K, Toshio S, Kimura H, Kamiyama T, Yamazaki T, Morishima R, Kawata A, Isozaki E. Slowing of peripheral motor nerve conduction in amyotrophic lateral sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Tojima M, Masui K, Kimura H, Warabi Y, Sugaya K, Hasegawa M, Isozaki E, Komori T. A case of atypical tauopathy in a patient with the clinical diagnosis of progressive supranuclear palsy. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Uchihara T, Sango M, Takubo H, Komori T, Yoshimura N, Nohara C, Homma T, Wada A, Kodama M, Orimo S, Isozaki E, Kitagawa M, Hirokawa K, Toru S. Reduced MIBG uptake under relative preservation of cardiac sympathetic nerve in four autopsy patients of CBD-tau without lewy pathology. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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31
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Morishima R, Shimizu T, Isozaki E. Relationships between sympathetic skin responses and 123I-metaiodobenzyl-guanidine myocardium scintigraphy in neurological disorders. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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32
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Bokuda K, Shimizu T, Imamura K, Kawata A, Watabe K, Hayashi M, Nakayama Y, Isozaki E, Nakano I. Predictive factors for prognosis following unsedated percutaneous endoscopic gastrostomy in ALS patients. Muscle Nerve 2017; 54:277-83. [PMID: 26799526 DOI: 10.1002/mus.25051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 04/30/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION This study aimed to determine the prognostic factors and the values that predict survival after percutaneous endoscopic gastrostomy (PEG) tube placement in patients with amyotrophic lateral sclerosis (ALS). METHODS We retrospectively analyzed the correlations for 97 consecutive patients with ALS between clinical parameters and survival following PEG tube placement using the log-rank test and Cox proportional-hazards models. RESULTS The log-rank test showed that an arterial carbon dioxide pressure (PaCO2 ) of ≤ 40 mmHg (P = 0.0054), a forced vital capacity (FVC) of ≥ 38% of predicted (P = 0.0003), and bulbar-onset (P = 0.0121) were significantly associated with better post-PEG survival. Multivariate analysis showed that the FVC and PaCO2 were associated with better post-PEG survival (P = 0.0081 and P = 0.0265, respectively). CONCLUSIONS PEG tube placement in ALS is recommended when FVC is ≥ 38% of predicted and when PaCO2 is normal. Muscle Nerve 54: 277-283, 2016.
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Affiliation(s)
- Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042
| | - Kazuhiro Imamura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042
| | - Kazuhiko Watabe
- ALS/Neuropathy Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masaharu Hayashi
- Mental Development Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yuki Nakayama
- Laboratory of Nursing Research for Intractable Disease, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042
| | - Imaharu Nakano
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042
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Hayashi K, Mochizuki Y, Takeuchi R, Shimizu T, Nagao M, Watabe K, Arai N, Oyanagi K, Onodera O, Hayashi M, Takahashi H, Kakita A, Isozaki E. Clinicopathological characteristics of patients with amyotrophic lateral sclerosis resulting in a totally locked-in state (communication Stage V). Acta Neuropathol Commun 2016; 4:107. [PMID: 27716404 PMCID: PMC5045653 DOI: 10.1186/s40478-016-0379-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/22/2016] [Indexed: 12/12/2022] Open
Abstract
In the present study, we performed a comprehensive analysis to clarify the clinicopathological characteristics of patients with amyotrophic lateral sclerosis (ALS) that had progressed to result in a totally locked-in state (communication Stage V), in which all voluntary movements are lost and communication is impossible. In 11 patients, six had phosphorylated TAR DNA-binding protein 43 (pTDP-43)-immunoreactive (ir) neuronal cytoplasmic inclusions (NCI), two had fused in sarcoma (FUS)-ir NCI, and three had copper/zinc superoxide dismutase (SOD1)-ir NCI. The time from ALS onset to the need for tracheostomy invasive ventilation was less than 24 months in ten patients. Regardless of accumulated protein, all the patients showed common lesions in the pallido–nigro–luysian system, brainstem reticular formation, and cerebellar efferent system, in addition to motor neurons. In patients with pTDP-43-ir NCI, patients with NCI in the hippocampal dentate granule neurons (DG) showed a neuronal loss in the cerebral cortex, and patients without NCI in DG showed a preserved cerebral cortex. By contrast, in patients with FUS-ir NCI, patients with NCI in DG showed a preserved cerebral cortex and patients without NCI in DG showed marked cerebral degeneration. The cerebral cortex of patients with SOD1-ir NCI was preserved. Together, these findings suggest that lesions of the cerebrum are probably not necessary for progression to Stage V. In conclusion, patients with ALS that had progressed to result in communication Stage V showed rapidly-progressed symptoms, and their common lesions could cause the manifestations of communication Stage V.
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Bokuda K, Shimizu T, Kimura H, Yamazaki T, Kamiyama T, Watabe K, Kawata A, Hayashi M, Isozaki E. Quantitative analysis of the features of fasciculation potentials and their relation with muscle strength in amyotrophic lateral sclerosis. Neurol Sci 2016; 37:1939-1945. [PMID: 27541300 DOI: 10.1007/s10072-016-2692-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/11/2016] [Accepted: 08/16/2016] [Indexed: 12/26/2022]
Abstract
This study aimed to quantitatively analyze fasciculation potentials (FPs) and to investigate their relationship with muscle strength in amyotrophic lateral sclerosis (ALS). Fifty-one patients with sporadic ALS or progressive muscular atrophy (25 men, 26 women, mean age of 68 years) underwent needle EMG. We determined the duration, phase number, and amplitude of FPs from three muscles (upper trapezius, biceps brachii, and tibialis anterior) and examined their relations with muscle strength. In total, 878 FPs were analyzed. FP duration displayed a significant negative relation with the strength of all three muscles; the weaker muscles showed longer durations of FPs than the muscles with normal strength. The amplitude and phase number were not related with muscle strength, but there were significant correlations between the duration and amplitude of FPs in the trapezius and tibialis anterior muscles. The longer duration of FPs in muscles with weak strength suggests that the morphological changes of FPs were caused by temporal dispersion through progressively degenerating and/or immature reinnervating motor branches, and were observed uniformly in different muscles along with disease progression.
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Affiliation(s)
- Kota Bokuda
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.,Mental Development Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Hideki Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Toshihiro Yamazaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Kazuhiko Watabe
- ALS and Neuropathy Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Medical Technology (Neuropathology), Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
| | - Masaharu Hayashi
- Mental Development Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan
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Yasui T, Warabi Y, Nagao M, Isozaki E. Myelomalacia at the posterior funiculus related to a ventral longitudinal intraspinal fluid collection. BMJ Case Rep 2016; 2016:bcr-2016-214791. [PMID: 27335357 DOI: 10.1136/bcr-2016-214791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Toshio Yasui
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yoko Warabi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Masahiro Nagao
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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36
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Toru S, Uchihara T, Isozaki E, Orimo S. [A Case of Inspiration Stridor in Dementia with Lewy Bodies]. Brain Nerve 2016; 68:667-77. [PMID: 27279166 DOI: 10.11477/mf.1416200460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Shuta Toru
- Department of Neurology, Nitobe Memorial Nakano General Hospital
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Goto Y, Warabi Y, Sunami Y, Isozaki E. Dopa-responsive acute disseminated encephalomyelitis with marked atrophy of the striate body. BMJ Case Rep 2016; 2016:bcr-2016-215859. [PMID: 27256998 DOI: 10.1136/bcr-2016-215859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yuya Goto
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yoko Warabi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yoko Sunami
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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Hayashi K, Mochizuki Y, Koide R, Kawata A, Homma T, Shimizu T, Komori T, Isozaki E. A Japanese familial ALS patient with autonomic failure and a p.Cys146Arg mutation in the gene for SOD1 (SOD1). Neuropathology 2016; 36:551-555. [PMID: 27090969 DOI: 10.1111/neup.12303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/22/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 12/13/2022]
Abstract
We describe a Japanese man with familial amyotrophic lateral sclerosis (ALS) associated with a p.Cys146Arg mutation in the copper/zinc superoxide dismutase gene (SOD1). The patient developed bulbar signs followed by rapidly progressive limb muscle weakness. The prominent clinical feature was orthostatic hypotension due to autonomic failure, which occurred after he underwent tracheostomy 1 year and 3 months after the onset. Thereafter, he required mechanical ventilation and progressed to communication stage V (totally locked-in state) 7 years after the onset. Neuropathology showed ALS with posterior column degeneration and multiple system degeneration. Severe neuronal loss in the intermediolateral nucleus was also observed. Two previously reported cases of ALS patients with autonomic failure showed severe neuronal loss in the intermediolateral nucleus in addition to degeneration of the motor neurons. Thus, autonomic failure due to neuronal loss in the intermediolateral nucleus could present in patients with ALS associated with certain mutations in SOD1.
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Affiliation(s)
- Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Yoko Mochizuki
- Department of Pathology, Tokyo Metropolitan Neurological Hospital.,Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation center for the disabled
| | - Reiji Koide
- Department of Neurology, Tokyo Metropolitan Neurological Hospital.,Division of Neurology, Department of Medicine, Jichi Medical University School of Medicine
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Taku Homma
- Department of Pathology, Tokyo Metropolitan Neurological Hospital.,Department of Pathology, Nihon University School of Medicine
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Takashi Komori
- Department of Pathology, Tokyo Metropolitan Neurological Hospital
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
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Homma T, Mochizuki Y, Komori T, Isozaki E. Frequent globular neuronal cytoplasmic inclusions in the medial temporal region as a possible characteristic feature in multiple system atrophy with dementia. Neuropathology 2016; 36:421-431. [DOI: 10.1111/neup.12289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/03/2016] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Taku Homma
- Department of Pathology; Tokyo Metropolitan Neurological Hospital; Fuchu Tokyo Japan
- Department of Pathology; Nihon University School of Medicine; Itabashi Tokyo Japan
| | - Yoko Mochizuki
- Department of Pathology; Tokyo Metropolitan Neurological Hospital; Fuchu Tokyo Japan
- Department of Neurology; Tokyo Metropolitan Kita Medical and Rehabilitation Centre for the Disabled; Kita-ku Tokyo Japan
| | - Takashi Komori
- Department of Pathology; Tokyo Metropolitan Neurological Hospital; Fuchu Tokyo Japan
| | - Eiji Isozaki
- Department of Neurology; Tokyo Metropolitan Neurological Hospital, Tokyo Metropolitan Neurological Hospital; Fuchu-shi Tokyo Japan
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40
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Mochizuki Y, Hayashi K, Nakayama Y, Shimizu T, Kamide M, Ogino M, Komori T, Hasegawa M, Isozaki E, Nakano I. ALS patients with ability to communicate after long-term mechanical ventilation have confined degeneration to the motor neuron system. J Neurol Sci 2016; 363:245-8. [PMID: 27000258 DOI: 10.1016/j.jns.2016.02.068] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/27/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To clarify the position in the amyotrophic lateral sclerosis (ALS) spectrum, of a subgroup of patients who maintained the ability to communicate after long-term mechanical ventilation (LTMV) by tracheostomy. METHODS We undertook a clinicopathological investigation of sporadic ALS in three patients who maintained the ability to communicate after approximately 30-year survival on LTMV by tracheostomy. RESULTS The age of onset and duration of disease was 48 years and 31 years in patient 1, 55 years and 29 years in patient 2, and 31 years and 33 years in patient 3, respectively. Each patient displayed slow disease progression. In all patients, both upper and lower motor neurons were markedly degenerated, while other neuronal systems and the brainstem tegmentum were spared. A few normal-looking motor neurons remained in the anterior horn of the spinal cord. There were no TAR DNA-binding protein 43-immunoreactive inclusions in the lower motor neurons in any patient and only occasional inclusions in the cerebral cortex of one patient. CONCLUSION The clinicopathological findings of these three patients suggest that there is a distinct subgroup of ALS patients characterized by the above-mentioned features.
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Affiliation(s)
- Yoko Mochizuki
- Department of Pathology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, Tokyo, Japan.
| | - Kentaro Hayashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yuki Nakayama
- Laboratory of Nursing Research for Intractable Disease, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masayuki Kamide
- Emergency Department of Atsugi City Hospital, Kanagawa, Japan
| | - Mieko Ogino
- Division of Integrated Care and Whole Person Care, Department of Comprehensive Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takashi Komori
- Department of Pathology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masato Hasegawa
- Department of Dementia and Higher Brain Function, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Imaharu Nakano
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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Yamaguchi M, Komori T, Nakata Y, Yagishita A, Morino M, Isozaki E. Multinodular and vacuolating neuronal tumor affecting amygdala and hippocampus: A quasi-tumor? Pathol Int 2015; 66:34-41. [DOI: 10.1111/pin.12366] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Maki Yamaguchi
- Department of Laboratory Medicine and Pathology (Neuropathology); Tokyo Metropolitan Neurological Hospital; Tokyo Japan
- Department of Diagnostic Pathology; Kyoto University Hospital; Kyoto Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology); Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Akira Yagishita
- Department of Neuroradiology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Michiharu Morino
- Department of Neurosurgery; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Eiji Isozaki
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
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Abstract
We report two cases of neuromyelitis optica patients with progressive cerebral atrophy. The patients exhibited characteristic clinical features, including elderly onset, secondary progressive tetraparesis and cognitive impairment, abnormally elevated CSF protein and myelin basic protein levels, and extremely highly elevated serum anti-AQP-4 antibody titer. Because neuromyelitis optica pathology cannot switch from an inflammatory phase to the degenerative phase until the terminal phase, neuromyelitis optica rarely appears as a secondary progressive clinical course caused by axonal degeneration. However, severe intrathecal inflammation and massive destruction of neuroglia could cause a secondary progressive clinical course associated with cerebral atrophy in neuromyelitis optica patients.
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Affiliation(s)
- Yoko Warabi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan Department of Neurology, National Yonezawa Hospital, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
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Nakayama Y, Shimizu T, Mochizuki Y, Hayashi K, Matsuda C, Nagao M, Watabe K, Kawata A, Oyanagi K, Isozaki E, Nakano I. Predictors of impaired communication in amyotrophic lateral sclerosis patients with tracheostomy-invasive ventilation. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:38-46. [PMID: 26121169 DOI: 10.3109/21678421.2015.1055276] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Predictors of communication impairment in patients with amyotrophic lateral sclerosis (ALS) using tracheostomy-invasive ventilation (TIV) were investigated. Seventy-six ALS patients using TIV were enrolled and classified into three subgroups of communication ability: patients who could communicate with communication devices (Stage I), patients who had difficulty with communication (Stage II, III, or IV), and patients who could not communicate by any means (Stage V). Predictors of communication impairment were analysed by the Cox proportional hazard model. Results demonstrated that there were no significant differences in disease duration between subgroups. Within 24 months after disease onset, patients who needed TIV and tube feeding, developed oculomotor impairment or became totally quadriplegic and progressed from Stage I to II and V significantly earlier. Multivariate analyses revealed that within 24 months from onset, the need for TIV and progression to total quadriplegia were significant events in patients who progressed to Stage II, whereas the development of oculomotor limitation was significant in patients who progressed to Stage V. In conclusion, TIV, impaired oculomotor movement and total quadriplegia are predictors of severe communication impairment. Rapid disease progression might indicate future communication impairment after the use of TIV. We highly recommend early detection of impaired communication and identification of the best methods of communication.
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Affiliation(s)
- Yuki Nakayama
- a Laboratory of Nursing Research for Intractable Disease, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
| | - Toshio Shimizu
- b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan
| | - Yoko Mochizuki
- c Department of Pathology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan.,d Department of Neurology , Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled
| | - Kentaro Hayashi
- b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan
| | - Chiharu Matsuda
- a Laboratory of Nursing Research for Intractable Disease, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
| | - Masahiro Nagao
- b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan
| | - Kazuhiko Watabe
- e ALS and Neuropathy Project, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
| | - Akihiro Kawata
- b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan
| | - Kiyomitsu Oyanagi
- f Department of Brain Disease Research , Shinshu University School of Medicine , Nagano , Japan
| | - Eiji Isozaki
- b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan
| | - Imaharu Nakano
- b Department of Neurology , Tokyo Metropolitan Neurological Hospital , Tokyo , Japan
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Aoki Y, Mochizuki Y, Isozaki E, Bando M, Oyanagi K, Mizutani T. [An autopsy case of frontotemporal lobar degeneration with motor neuron disease associated with numerous diffuse plaques, pretangles and neuropil threads]. Rinsho Shinkeigaku 2015; 55:362-3. [PMID: 26028203 DOI: 10.5692/clinicalneurol.cn-000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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45
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Aoki Y, Mochizuki Y, Isozaki E, Bando M, Oyanagi K, Mizutani T. [Autopsy case of frontotemporal lobar degeneration with motor neuron disease associated with numerous diffuse plaques, pretangles and neuropil threads]. Rinsho Shinkeigaku 2015; 54:325-9. [PMID: 24807277 DOI: 10.5692/clinicalneurol.54.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report an autopsy case of dementia associated with amyotrophic lateral sclerosis (ALS) in a 73-year-old female. She developed memory impairment at the age of 68 years. Atrophy of her hand muscles was noted at the age of 71 years. She was not aware of her memory impairment or muscle weakness, and was loquacious and euphoric. She was clinically diagnosed as having Alzheimer disease (AD) complicated by ALS with dementia/frontotemporal lobar degeneration with motor neuron disease (ALS-D/FTLD-MND). A neuropathological study confirmed the presence of features of sporadic ALS. Furthermore, severe neuronal loss involving the subiculum and the rostral portion of the medial side of the temporal pole cortex was detected, and TAR DNA-binding protein-43-positive-neuronal cytoplasmic inclusions were identified in the granule cells of the dentate gyrus. These findings were compatible with the pathological features of ALS-D/FTLD-MND. Although many pretangles, neuropil threads and senile plaques were revealed in the degenerated areas, there were few neurofibrillary tangles and typical plaques (Braak stage III, C). Further discussion is required to determine whether AD with ALS-D/FTLD-MND is different from typical AD. This case might be helpful for diagnosing similar cases in the future.
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Affiliation(s)
- Yasuko Aoki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
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Koh K, Kobayashi F, Miwa M, Shindo K, Isozaki E, Ishiura H, Tsuji S, Takiyama Y. Novel mutations in the PNPLA6 gene in Boucher-Neuhäuser syndrome. J Hum Genet 2015; 60:217-20. [PMID: 25631098 DOI: 10.1038/jhg.2015.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 01/24/2023]
Abstract
On whole-exome sequencing, a novel compound heterozygous mutation (c.2923A>G/c.3523_3524insTGTCCG, p.T975A/p.1175_1176insVS) and a novel homozygous one (c.3534G>C, p.W1178C) in the PNPLA6 gene were identified in sporadic and familial Japanese patients with Boucher-Neuhäuser syndrome (BNS), respectively. However, we did not find any mutations in the PNPLA6 gene in 88 patients with autosomal recessive hereditary spastic paraplegia (ARHSP). Our study confirmed the earlier report that a PNPLA6 mutation causes BNS. This is the first report on PNPLA6 mutations in non-Caucasian patients. Meanwhile, PNPLA6 mutations might be extremely rare in Japanese ARHSP patients. Moreover, we first found hypersegmented neutrophils in two BNS patients with PNPLA6 mutations.
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Affiliation(s)
- Kishin Koh
- Department of Neurology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Fumikazu Kobayashi
- Department of Neurology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Michiaki Miwa
- Department of Neurology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Kazumasa Shindo
- Department of Neurology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihisa Takiyama
- Department of Neurology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
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Ota M, Shimizu T, Yoshida H, Kawata A, Kinoshita M, Nakano S, Isozaki E, Matsubara S. Clinical features and therapeutic responses of idiopathic orbital myositis. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ncn3.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Makiko Ota
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
- Department of Neurology; Osaka City General Hospital; Osaka Japan
| | - Toshio Shimizu
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Hiroshi Yoshida
- Department of Neuro-ophthalmology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Akihiro Kawata
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Masako Kinoshita
- Department of Neurology; Utano National Hospital; National Hospital Organization; Kyoto Japan
| | - Satoshi Nakano
- Department of Neurology; Osaka City General Hospital; Osaka Japan
| | - Eiji Isozaki
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
| | - Shiro Matsubara
- Department of Neurology; Tokyo Metropolitan Neurological Hospital; Tokyo Japan
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Yasui K, Yabe I, Yoshida K, Kanai K, Arai K, Ito M, Onodera O, Koyano S, Isozaki E, Sawai S, Adachi Y, Sasaki H, Kuwabara S, Hattori T, Sobue G, Mizusawa H, Tsuji S, Nishizawa M, Nakashima K. A 3-year cohort study of the natural history of spinocerebellar ataxia type 6 in Japan. Orphanet J Rare Dis 2014; 9:118. [PMID: 25053188 PMCID: PMC4223818 DOI: 10.1186/s13023-014-0118-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Only a few prospective studies have determined which clinical symptoms and factors are associated with the disease severity of spinocerebellar ataxia type 6 (SCA6). A multicenter longitudinal cohort study was conducted to clarify both the natural history of SCA6 in Japan and the factors influencing disease progression. METHODS Patients were consecutively recruited between 2007 and 2008. Scores from the Scale for the Assessment and Rating of Ataxia (SARA) and Barthel Index (BI) were collected prospectively each year. Additionally, data from the Japan intractable diseases research (IDR) registry were collected both retrospectively, from 2003 to 2006, and prospectively, from 2007 to 2010. As a result, we were able to collect 3 years of retrospective data and 4 years of prospective data during the course of 3 yearly visits. RESULTS Forty-six patients were registered. The follow-up rate of the third year was 93%. The SARA scores worsened significantly each year. Over 3 years, the decline of the SARA scores was 1.33 ± 1.40 points/year. The results of multivariate analysis of the decline of the SARA score were not significant. The IDR scores correlated well with the SARA and BI scores. Kaplan-Meier curves of 7 years of data from the IDR registry illustrated the correlation between the ability to walk and the time course of the disease. CONCLUSIONS Information regarding the progression of ataxia and the decline in the activities of daily living (ADL) in patients with SCA6 was obtained by a 3-year cohort study and a 7-year IDR study. The decline of the SARA score of patients with SCA6 was 1.33 ± 1.40 points/year. The results elucidate the natural history of SCA6, factors influencing disease severity, and utility of data from the IDR registry of Japan.
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Asada T, Takeda K, Okiyama R, Isozaki E, Fukuyama H. The role of the thalamus in recovery from tactile extinction and crossed tactile extinction. Neurocase 2014; 20:37-41. [PMID: 23075220 DOI: 10.1080/13554794.2012.732082] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 68-year-old man had a cerebral infarction affecting the right parietal lobe, right insula, and the left prefrontal region. On admission, left hand tactile extinction was noted when the hands were placed both in anatomical and crossed positions, but was noted only in crossed positions from day 20 and later. Five months later, the patient developed another cerebral infarction in the right thalamus, and left hand tactile extinction was again seen both in the anatomical and crossed positions. Our findings suggest that the thalamus was involved in the recovery from the tactile extinction in anatomical positions.
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Affiliation(s)
- Tomohiko Asada
- a Department of Brain Functional Imaging, Human Brain Research Center , Kyoto University Graduate School of Medicine , Kyoto , Japan
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Mochizuki Y, Isozaki E, Takao M, Hashimoto T, Shibuya M, Arai M, Hosokawa M, Kawata A, Oyanagi K, Mihara B, Mizutani T. Familial ALS with FUS P525L mutation: two Japanese sisters with multiple systems involvement. J Neurol Sci 2012; 323:85-92. [PMID: 22980027 DOI: 10.1016/j.jns.2012.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/15/2012] [Accepted: 08/20/2012] [Indexed: 12/13/2022]
Abstract
We evaluated the clinicopathological features of familial amyotrophic lateral sclerosis (ALS) with the fused in sarcoma (FUS) P525L mutation. Two sisters and their mother had a similar clinical course, which was characterized by the development of limb weakness at a young age with rapid disease progression. An elder sister, patient 1, progressed into a totally locked-in state requiring mechanical ventilation and died 26 years after the onset of the disease. In contrast, the younger sister, patient 2, died in the early stages of the disease. The patients had neuropathological findings that indicated a very active degeneration of motor neurons and multiple system degeneration, which led to marked brain and spinal cord atrophy in the long term clinical outcome. The multiple system degeneration included the frontal lobe, the basal ganglia and substantia nigra, cerebellum and related area. Compared with previously reported ALS cases, the severe degeneration of the frontal lobe and the striatum were the characteristic features in the patient 1 in this case study. The degeneration spread over multiple systems might be caused not only by the appearance of the FUS immunoreactive neuronal cytoplasmic inclusions but also by the degeneration of neuronal connections from the primary motor cortex and related areas.
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Affiliation(s)
- Yoko Mochizuki
- Department of Pathology, Tokyo Metropolitan Neurological Hospital, Tokyo 183-0042, Japan.
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