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Saito S, Hontsu S, Hiraoka J, Yamanaka A, Fujioka N, Shimada D, Okuda Y, Sugie K, Muro S. A Rare Case of Overlapping Durvalumab-induced Myositis, Takotsubo-like Morphological Changes Caused by Myocarditis, and Myasthenia Gravis. Intern Med 2024:3028-23. [PMID: 38658343 DOI: 10.2169/internalmedicine.3028-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Immune checkpoint inhibitors can cause a range of immune-related adverse events, including myositis, Takotsubo cardiomyopathy, and myasthenia gravis. We herein report a rare case of a 78-year-old man with concurrent durvalumab-induced myositis, Takotsubo-like morphological changes caused by myocarditis, and myasthenia gravis. The patient initially required invasive ventilation and exhibited symptoms of myasthenia gravis after treatment with high-dose steroids. However, he subsequently achieved successful recovery after the administration of intravenous immunoglobulin, plasmapheresis, and high-dose steroids. We advocate vigilant neurological monitoring of patients with immune checkpoint inhibitor-induced myositis, including the assessment of ptosis and other relevant signs, so that prompt treatment can be initiated at the time of emergence or progression of immune checkpoint inhibitor-induced myasthenia gravis.
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Affiliation(s)
- Shoichiro Saito
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Japan
| | - Shigeto Hontsu
- Department of Respiratory Medicine, Nara Medical University, Japan
| | - Junya Hiraoka
- Department of Respiratory Medicine, Nara Medical University, Japan
| | - Ai Yamanaka
- Department of Neurology, Nara Medical University, Japan
| | - Nobuhiro Fujioka
- Department of Respiratory Medicine, Nara Medical University, Japan
| | | | - Yosuke Okuda
- Department of Respiratory Medicine, Nara Medical University, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Japan
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Obayashi K, Saeki K, Tai Y, Yamagami Y, Esaki Y, Yoshikawa T, Sugie K, Kataoka H. Daily light exposure profiles and the association with objective sleep quality in patients with Parkinson's disease: The PHASE study. Sleep 2024:zsae036. [PMID: 38330229 DOI: 10.1093/sleep/zsae036] [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: 07/22/2023] [Indexed: 02/10/2024] Open
Abstract
STUDY OBJECTIVES Light information crucially influences the sleep initiation and continuity. The purpose of this study was to compare daily light exposure between patients with Parkinson's disease (PD) and non-PD older adults and evaluate the association of daily light exposure with objective sleep measures in patients with PD. METHODS In this cross-sectional study of 189 outpatients with PD and 1101 community dwelling older adults (controls), daily light exposure was measured using wrist light meters during the daytime and light meters set in the bedrooms during the nighttime, and objective sleep quality was measured by wrist actigraphy. RESULTS The median duration of exposure to ≥1000 lux light was significantly shorter in patients with PD than in controls. The median nighttime light intensity was higher in patients with PD than in controls. Among patients with PD, multivariable analysis suggested that the highest quartile of exposure to ≥1000 lux light during the daytime was linked to significantly higher sleep efficiency by 8.0% and shorter wake after sleep onset (WASO) by 36.9 min than the lowest quartile. During the nighttime, the highest quartile of mean light intensity had significantly lower sleep efficiency by 6.8%, longer WASO by 24.1 min, longer sleep onset latency, and higher fragmentation index, than the lowest quartile. Importantly, daytime and nighttime light levels were independently associated with objective sleep measures. CONCLUSION The present study illustrated that greater daytime light exposure and lower nighttime light exposure are significantly associated with better objective sleep measures in patients with PD.
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Affiliation(s)
- Kenji Obayashi
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Yoshiaki Tai
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Yuki Yamagami
- Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan
| | - Yuichi Esaki
- Department of Psychiatry, Fujita Medical University School of Medicine, Aichi, Japan
| | - Tadanobu Yoshikawa
- Department of Ophthalmology, Nara Medical University School of Medicine, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan
| | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan
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Mano T, Iguchi N, Eura N, Iwasa N, Yamada N, Horikawa H, Sugie K. Electromyography varies by stage in inclusion body myositis. Front Neurol 2024; 14:1295396. [PMID: 38249752 PMCID: PMC10797055 DOI: 10.3389/fneur.2023.1295396] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Inclusion body myositis (IBM) is a chronic inflammatory muscle disease that is characterized by mixed myogenic and neurogenic electromyography (EMG) findings. We investigated the association between EMG findings and the IBM stage. Methods We included consecutive patients diagnosed with IBM based on muscle biopsy and had needle EMG performed within 1 month of biopsy. Motor unit potential waveform (MUP) in EMG and pathological findings were compared between patients in early and late phases. Results In total, 30 patients with biopsy-confirmed IBM and 254 muscles were included. The rate of abnormal discharge did not differ according to disease stage. There was a difference in the frequency of occurrence between myogenic suggestive MUP and neurogenic of biceps and flexor digitorum profundus in the late phase. Abnormal MUP was observed even in muscles without muscle weakness, and myogenic changes were predominant in biceps and gastrocnemius with muscle weakness. The biopsy findings on the contralateral side of the muscle where electromyography was performed revealed a tendency for muscles that exhibited myogenic origin to have more inflammatory cells and RV; however, the difference was not significant. Conclusion The target muscles for EMG must be selected considering the disease stage as well. In the early stages of IBM, EMG results should be interpreted cautiously, as neurogenic suggestive pattern of MUP might also be exhibited. Contralateral electromyography findings may be helpful in selecting muscles for muscle biopsies, such as biceps and quadriceps.
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Affiliation(s)
- Tomoo Mano
- Department of Neurology, Nara Medical University, Kashihara, Japan
- Department of Rehabilitation Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Naohiko Iguchi
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Nobuyuki Eura
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Naoki Iwasa
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Nanami Yamada
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Hirosei Horikawa
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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Sakaguchi YM, Wiriyasermkul P, Matsubayashi M, Miyasaka M, Sakaguchi N, Sahara Y, Takasato M, Kinugawa K, Sugie K, Eriguchi M, Tsuruya K, Kuniyasu H, Nagamori S, Mori E. Identification of three distinct cell populations for urate excretion in human kidneys. J Physiol Sci 2024; 74:1. [PMID: 38166558 PMCID: PMC10763458 DOI: 10.1186/s12576-023-00894-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/26/2023] [Indexed: 01/04/2024]
Abstract
In humans, uric acid is an end-product of purine metabolism. Urate excretion from the human kidney is tightly regulated by reabsorption and secretion. At least eleven genes have been identified as human renal urate transporters. However, it remains unclear whether all renal tubular cells express the same set of urate transporters. Here, we show renal tubular cells are divided into three distinct cell populations for urate handling. Analysis of healthy human kidneys at single-cell resolution revealed that not all tubular cells expressed the same set of urate transporters. Only 32% of tubular cells were related to both reabsorption and secretion, while the remaining tubular cells were related to either reabsorption or secretion at 5% and 63%, respectively. These results provide physiological insight into the molecular function of the transporters and renal urate handling on single-cell units. Our findings suggest that three different cell populations cooperate to regulate urate excretion from the human kidney, and our proposed framework is a step forward in broadening the view from the molecular to the cellular level of transport capacity.
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Affiliation(s)
- Yoshihiko M Sakaguchi
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Nara, Japan
- Center for SI Medical Research, The Jikei University School of Medicine, Tokyo, Japan
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Pattama Wiriyasermkul
- Center for SI Medical Research, The Jikei University School of Medicine, Tokyo, Japan
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo, Japan
- Department of Biological Chemistry and Food Sciences, Faculty of Agriculture, Iwate University, Morioka, Iwate, Japan
| | - Masaya Matsubayashi
- Biological Research Department, Research Institute, Fuji Yakuhin Co., Ltd., Saitama, Japan
| | - Masaki Miyasaka
- Center for SI Medical Research, The Jikei University School of Medicine, Tokyo, Japan
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nau Sakaguchi
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshiki Sahara
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
- Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - Minoru Takasato
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
- Graduate School of Biostudies, Kyoto University, Kyoto, Japan
| | - Kaoru Kinugawa
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Nara, Japan
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroki Kuniyasu
- Department of Molecular Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Shushi Nagamori
- Center for SI Medical Research, The Jikei University School of Medicine, Tokyo, Japan.
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo, Japan.
- Department of Collaborative Research for Bio-Molecular Dynamics, Nara Medical University, Kashihara, Nara, Japan.
| | - Eiichiro Mori
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Nara, Japan.
- V-iCliniX Laboratory, Nara Medical University, Kashihara, Nara, Japan.
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5
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Isozumi N, Sugie K, Mori E. [Biological phase separation in neuromuscular diseases]. Rinsho Shinkeigaku 2023; 63:799-805. [PMID: 37989290 DOI: 10.5692/clinicalneurol.cn-001877] [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: 11/23/2023]
Abstract
Biological phase separation refers to the liquid-liquid phase separation of biomolecules such as proteins in cells. Phase separation is driven by low-complexity domains of phase-separating proteins and strictly controlled by regulatory factors. Phase separation has also been found to be disrupted by genetic abnormalities. Abnormal aggregates of causative proteins accumulate in many neuromuscular diseases. In recent years, it has become clear that phase separating proteins are associated with neuromuscular diseases, and that abnormalities in the regulation of phase separation leads to the formation of aggregates. Gains in our knowledge of biological phase separation is gradually elucidating the pathogenesis of neuromuscular diseases.
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Affiliation(s)
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University
| | - Eiichiro Mori
- Department of Future Basic Medicine, Nara Medical University
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Takeshima Y, Motoyama Y, Nakagawa I, Eura N, Saito K, Sugie K, Nakase H. Embolic stroke induced by rotational persistent 1st intersegmental artery compression. Br J Neurosurg 2023; 37:1835-1838. [PMID: 34180319 DOI: 10.1080/02688697.2021.1940854] [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] [Received: 03/13/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
A 45-year-old man suffered multiple cerebral infarctions in the vertebrobasilar artery territory, followed by second stroke against conservative treatment. Radiological examinations revealed intra-arterial defect in left persistent 1st intersegmental artery (PFIA) at C1 level, suggesting mural thrombus, and mechanical compression of left PFIA at the level with head rotation to the right clearly revealed by reconstructed 3-dimensional radiological images, but no findings of atlantoaxial instability. One month after the second stroke, posterior fixation was performed. Postoperative course was uneventful without subsequent stroke for 24 months. This unique case demonstrated that PFIA might associate with cerebral stroke as a clinical condition of bow hunter's stroke even in middle age. Reconstructed 3-dimensional radiological images might be useful for clear demonstration of the pathophysiology in this complex clinical entity.
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Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nobuyuki Eura
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kozue Saito
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kazuma Sugie
- Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
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7
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Ohira M, Yoshii K, Aso Y, Nakajima H, Yamashita T, Takahashi-Iwata I, Maeda N, Shindo K, Suenaga T, Matsuura T, Sugie K, Hamano T, Arai A, Furutani R, Suzuki Y, Kaneko C, Kobayashi Y, Campos-Alberto E, Harper LR, Edwards J, Bender C, Pilz A, Ito S, Angulo FJ, Erber W, Madhava H, Moïsi J, Jodar L, Mizusawa H, Takao M. First evidence of tick-borne encephalitis (TBE) outside of Hokkaido Island in Japan. Emerg Microbes Infect 2023; 12:2278898. [PMID: 37906509 PMCID: PMC10810618 DOI: 10.1080/22221751.2023.2278898] [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] [Received: 07/18/2023] [Accepted: 10/30/2023] [Indexed: 11/02/2023]
Abstract
Tick-borne encephalitis (TBE) is an infection of the central nervous system caused by the tick-borne encephalitis virus (TBEV). TBE is endemic in parts of Europe and Asia. TBEV is transmitted to humans primarily by Ixodes ticks. There have been 5 TBE cases identified in Japan, all on the northern island of Hokkaido. Rodents with TBEV antibodies and Ixodes ticks have been identified throughout Japan, indicating that TBEV infection might be undiagnosed in Japan. Residual serum and cerebrospinal fluid (CSF) collected in 2010-2021 from 520 patients ≥1 year-of-age previously hospitalized with encephalitis or meningitis of unknown etiology at 15 hospitals (including 13 hospitals outside of Hokkaido) were screened by ELISA for TBEV IgG and IgM antibodies; TBEV infection was confirmed by the gold standard neutralization test. Residual serum was available from 331 (63.6%) patients and CSF from 430 (82.6%) patients; both serum and CSF were available from 189 (36.3%). Two patients were TBE cases: a female aged 61 years hospitalized for 104 days in Oita (2000 km south of Hokkaido) and a male aged 24 years hospitalized for 11 days in Tokyo (1200 km south of Hokkaido). Retrospective testing also identified a previous TBEV infection in a female aged 45 years hospitalized for 12 days in Okayama (1700 km south of Hokkaido). TBEV infection should be considered as a potential cause of encephalitis or meningitis in Japan. TBE cases are likely undiagnosed in Japan, including outside of Hokkaido, due to limited clinical awareness and lack of availability of TBE diagnostic tests.
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Affiliation(s)
- Masayuki Ohira
- Department of Clinical Laboratory and Internal Medicine, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Kentaro Yoshii
- National Research Center for the Control and Prevention of Infectious Diseases, Nagasaki University, Nagasaki City, Japan
| | - Yasuhiro Aso
- Department of Neurology, Oita Prefectural Hospital, Oita, Japan
| | - Hideto Nakajima
- Department of Neurology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Toru Yamashita
- Department of Neurology, Okayama University Hospital, Okayama, Japan
| | | | - Norihisa Maeda
- Department of Neurology, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Katsuro Shindo
- Department or Neurology, Kurashiki Central Hospital, Okayama, Japan
| | | | - Tohru Matsuura
- Division of Neurology, Jichi Medical University Hospital, Tochigi, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University Hospital, Nara, Japan
| | - Tadanori Hamano
- Department of Neurology, University of Fukui Hospital, Fukui, Japan
| | - Akira Arai
- Aomori Prefectural Central Hospital, Aomori, Japan
| | - Rikiya Furutani
- Department of Neurology, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan
| | - Yasuhiro Suzuki
- Department of Neurology, National Hospital Organization Asahikawa Medical Center, Hokkaido, Japan
| | - Chikako Kaneko
- Department of Neurology, Southern Tohoku General Hospital, Fukushima, Japan
| | | | | | - Lisa R. Harper
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Juanita Edwards
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Cody Bender
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Andreas Pilz
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Vienna, Austria
| | - Shuhei Ito
- Vaccine Medical Affairs, Pfizer Japan Inc, Tokyo, Japan
| | - Frederick J. Angulo
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Wilhelm Erber
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Vienna, Austria
| | - Harish Madhava
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, London, UK
| | - Jennifer Moïsi
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Paris, France
| | - Luis Jodar
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Hidehiro Mizusawa
- Department of Neurology, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Masaki Takao
- Department of Clinical Laboratory and Internal Medicine, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
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Nakamura A, Matsumura T, Ogata K, Mori‐Yoshimura M, Takeshita E, Kimura K, Kawashima T, Tomo Y, Arahata H, Miyazaki D, Takeshima Y, Takahashi T, Ishigaki K, Kuru S, Wakisaka A, Awano H, Funato M, Sato T, Saito Y, Takada H, Sugie K, Kobayashi M, Ozasa S, Fujii T, Maegaki Y, Oi H, Tachimori H, Komaki H. Natural history of Becker muscular dystrophy: a multicenter study of 225 patients. Ann Clin Transl Neurol 2023; 10:2360-2372. [PMID: 37882106 PMCID: PMC10723226 DOI: 10.1002/acn3.51925] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Becker muscular dystrophy (BMD) is a milder variant of Duchenne muscular dystrophy (DMD), a lethal X-linked muscular disorder. Here, we aim to investigat the clinical involvement of skeletal, respiratory, cardiac, and central nervous systems in patients with BMD, as well as genotype-phenotype relationships. METHODS This nationwide cohort study investigated the clinical manifestations and genotype-phenotype relationships in 225 patients with BMD having in-frame deletion from 22 medical centers. The primary outcome was to elucidate the association of genotype with skeletal muscle, respiratory, cardiac, and central nervous system disorders. Descriptive statistics were used to analyze the data. RESULTS The average age of the subjects was 31.5 (range, 1-81) years. Initial symptoms of BMD were muscular (60%), followed by asymptomatic hypercreatine kinasemia (32.4%) and central nervous system disorders (5.3%). Gait disturbance was observed in 53.8% of patients and the average age at wheelchair introduction was 36.5 years. The ventilator introduction rate was 6.7% at an average age of 36.6 years. More than 30% of patients had an abnormal electrocardiogram and approximately 15% had heart failure symptoms. Cardiac function on echocardiography varied significantly among the patients. The frequencies of seizures and intellectual/developmental disability were 8.0% and 16.9%, respectively. Exon 45-47deletion (del) was the most common (22.6%), followed by exon 45-48del (13.1%). Patients with exon 45-49del patients demonstrated severe skeletal muscle damage. Patients with exon 45-47del and exon 45-55del patients did not require ventilator use. INTERPRETATION The study provides important prognostic information for patients and clinicians to establish therapy plans and to implement preventative medicine.
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Affiliation(s)
- Akinori Nakamura
- Department of NeurologyNHO Matsumoto Medical CenterMatsumotoJapan
| | | | - Katsuhisa Ogata
- Department of NeurologyNHO Higashisaitama National HospitalHasudaJapan
| | - Madoka Mori‐Yoshimura
- Department of NeurologyNational Center Hospital, National Center of Neurology and PsychiatryKodairaJapan
| | - Eri Takeshita
- Department of Child NeurologyNational Center Hospital, National Center of Neurology and PsychiatryKodairaJapan
| | - Koichi Kimura
- Department of Laboratory Medicine/CardiologyThe Institute of Medical Science, The University of TokyoMinato‐kuJapan
| | - Takahiro Kawashima
- Department of Information Medicine, National Center of Neurology and PsychiatryNational Institute of NeuroscienceKodairaJapan
| | - Yui Tomo
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and PsychiatryKodairaJapan
| | - Hajime Arahata
- Department of Neurology, Neuro‐Muscular CenterNHO Omuta National HospitalOmutaJapan
| | - Daigo Miyazaki
- Department of Medicine (Neurology and Rheumatology)Shinshu University School of MedicineMatsumotoJapan
| | - Yasuhiro Takeshima
- Department of PediatricsHyogo Medical University School of MedicineNishinomiyaJapan
| | | | - Keiko Ishigaki
- Department of PediatricsTokyo Women's Medical University School of MedicineShinjuku‐kuJapan
| | - Satoshi Kuru
- Department of NeurologyNHO Suzuka National HospitalSuzukaJapan
| | - Akiko Wakisaka
- Department of PediatricsNHO Iou National HospitalKanazawaJapan
| | - Hiroyuki Awano
- Research Initiative Center, Organization for Research Initiative and PromotionTottori UniversityYonagoJapan
| | - Michinori Funato
- Department of Pediatric NeurologyNHO Nagara Medical CenterNagaraJapan
| | - Tatsuharu Sato
- Department of PediatricsNagasaki University HospitalNagasakiJapan
| | - Yoshiaki Saito
- Department of PediatricsNational Rehabilitation Center for Children with DisabilitiesItabashiJapan
| | - Hiroto Takada
- Department of NeurologyNHO Aomori National HospitalAomoriJapan
| | - Kazuma Sugie
- Department of NeurologyNara Medical University School of MedicineKashiharaJapan
| | - Michio Kobayashi
- Department of NeurologyNHO Akita National HospitalYurihonjoJapan
| | - Shiro Ozasa
- Department of PediatricsKumamoto University HospitalKumamotoJapan
| | - Tatsuya Fujii
- Department of PediatricsShiga Medical Center for ChildrenMoriyamaJapan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of MedicineTottori UniversityYonagoJapan
| | - Hideki Oi
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and PsychiatryKodairaJapan
| | - Hisateru Tachimori
- Department of Information Medicine, National Center of Neurology and PsychiatryNational Institute of NeuroscienceKodairaJapan
- Endowed Course of Health System InnovationKeio University School of MedicineTokyoJapan
| | - Hirofumi Komaki
- Department of Child NeurologyNational Center Hospital, National Center of Neurology and PsychiatryKodairaJapan
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Yamashita S, Tawara N, Zhang Z, Nakane S, Sugie K, Suzuki N, Nishino I, Aoki M. Pathogenic role of anti-cN1A autoantibodies in sporadic inclusion body myositis. J Neurol Neurosurg Psychiatry 2023; 94:1018-1024. [PMID: 37451693 DOI: 10.1136/jnnp-2023-331474] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sporadic inclusion body myositis (sIBM) is an intractable muscle disease that frequently affects elderly people. Autoantibodies recognising cytosolic 5'-nucleotidase 1A (cN1A) were found in the sera of patients with sIBM. However, the pathogenic role of the autoantibodies remained unknown. This study investigated the pathogenic properties of the autoantibodies using active cN1A peptides immunisation. METHODS Wild-type C57BL6 mice were injected with three different mouse cN1A peptides corresponding to the previously reported epitope sequences of human cN1A. After confirming the production of autoantibodies to the corresponding cN1A peptides in each group, changes in body weight, exercise capacity by treadmill test and histological changes in mice injected with cN1A peptides or controls were investigated. RESULTS Autoantibodies against cN1A were detected in serum samples from mice injected with cN1A peptide. Some groups of mice injected with cN1A peptide showed significant weight loss and decreased motor activity. The number of myofibres with internal nuclei increased in all the peptide-injected groups, with surrounding or invading CD8-positive T cells into myofibres, abnormal protein aggregates and overexpression of p62 and LC3. CONCLUSIONS Active cN1A peptide immunisation partially reproduced the clinical and histological aspects of sIBM in wild-type mice. The murine model demonstrates the pathogenic properties of anti-cN1A autoantibodies to cause sIBM-like histological changes.
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Affiliation(s)
- Satoshi Yamashita
- Department of Neurology, Kumamoto University, Kumamoto, Japan
- Department of Neurology, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Nozomu Tawara
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Ziwei Zhang
- Department of Neurology, Kumamoto University, Kumamoto, Japan
| | - Shunya Nakane
- Department of Neurology, Kumamoto University, Kumamoto, Japan
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Naoki Suzuki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
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10
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Kinugawa K, Mano T, Fujimura S, Takatani T, Miyasaka T, Sugie K. Bradykinesia and rigidity modulated by functional connectivity between the primary motor cortex and globus pallidus in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1537-1545. [PMID: 37612469 DOI: 10.1007/s00702-023-02688-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Abstract
The mechanisms underlying motor fluctuations in patients with Parkinson's disease (PD) are currently unclear. Regional brain stimulation reported the changing of motor symptoms, but the correlation with functional connectivity (FC) in the brain network is not fully understood. Hence, our study aimed to explore the relationship between motor symptom severity and FC using resting-state functional magnetic resonance imaging (rsfMRI) in the "on" and "off" states of PD. In 26 patients with sporadic PD, FC was assessed using rsfMRI, and clinical severity was analyzed using the motor part of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS Part III) in the on and off states. Correlations between FC values and MDS-UPDRS Part III scores were assessed using Pearson's correlation coefficient. The correlation between FC and motor symptoms differed in the on and off states. FC between the ipsilateral precentral gyrus (PreCG) and globus pallidus (GP) correlated with the total MDS-UPDRS Part III scores and those for bradykinesia/rigidity in the off state. Lateralization analysis indicated that FC between the PreCG and GP correlated with the contralateral total MDS-UPDRS Part III scores and those for bradykinesia/rigidity in the off state. Aberrant FC in cortico-striatal circuits correlated with the severity of motor symptoms in PD. Cortico-striatal hyperconnectivity, particularly in motor pathways involving PreCG and GP, is related to motor impairments in PD. These findings may facilitate our understanding of the mechanisms underlying motor symptoms in PD and aid in developing treatment strategies such as brain stimulation for motor impairment.
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Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
- Department of Rehabilitation Medicine, Nara Prefecture General Medical Center, Nara, Japan.
| | - Shigekazu Fujimura
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Kashihara, Japan
| | | | - Kazuma Sugie
- Department of Neurology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
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11
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Fukushima K, Yoshida T, Yamazaki H, Takamatsu N, Nagai T, Osaki Y, Harada M, Nishino I, Okiyama N, Sugie K, Izumi Y. A Case of Anti-NXP2 Antibody-positive Juvenile Dermatomyositis with Characteristic Fascial Thickening on Muscle Ultrasound and Improvement with Immunotherapy. Intern Med 2023:2720-23. [PMID: 37926535 DOI: 10.2169/internalmedicine.2720-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
We herein report a 12-year-old boy who presented with a fever, erythematous rash on the cheeks, back pain, and dysphagia. Blood tests revealed increased creatine kinase levels, and muscle ultrasonography (MUS) revealed characteristic fascial thickening in the lumbar paraspinal muscles, where myalgia was prominent. Sarcoplasmic expression of myxovirus-resistant protein A on a muscle biopsy and the presence of anti-nuclear matrix protein 2 (NXP2) antibodies confirmed the diagnosis of dermatomyositis. Prednisolone and intravenous immunoglobulin therapy improved the clinical and laboratory parameters as well as fascial thickening. MUS is useful for evaluating fasciitis associated with anti-NXP2 autoantibodies and monitoring therapeutic efficacy.
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Affiliation(s)
- Koji Fukushima
- Department of Neurology, Tokushima University Hospital, Japan
- Department of Neurology, Nara Medical University School of Medicine, Japan
| | | | - Hiroki Yamazaki
- Department of Neurology, Tokushima University Hospital, Japan
| | - Naoko Takamatsu
- Department of Neurology, Tokushima University Hospital, Japan
| | - Takashi Nagai
- Department of Pediatrics, Tokushima University Hospital, Japan
| | - Yusuke Osaki
- Department of Neurology, Tokushima University Hospital, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University Hospital, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Japan
| | - Naoko Okiyama
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University Hospital, Japan
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12
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Mano T, Yamanaka A, Akagi Y, Sugie K. Bilateral Striatal Hemorrhaging after Acute Carbon Monoxide Intoxication. Intern Med 2023; 62:3095-3096. [PMID: 36889714 PMCID: PMC10641183 DOI: 10.2169/internalmedicine.1063-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- Tomoo Mano
- Department of Neurology, Nara Medical University, Japan
| | - Ai Yamanaka
- Department of Neurology, Nara Medical University, Japan
| | - Yuzuki Akagi
- Department of Psychiatry, Nara Medical University, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Japan
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13
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Ozaki M, Mano T, Iwasa N, Yamamoto Y, Takatani T, Kido A, Sugie K. Presymptomatic myositis in patients with antisynthetase syndrome associated with interstitial lung disease: A prospective small case series clinical study. Int J Rheum Dis 2023; 26:2100-2103. [PMID: 37218544 DOI: 10.1111/1756-185x.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/22/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Maki Ozaki
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, Nara, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, Nara, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Nara, Japan
| | - Naoki Iwasa
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, Nara, Japan
| | - Yoshifumi Yamamoto
- Department of Respiratory Medicine, Nara Medical University School of Medicine Graduate School of Medicine, Nara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Nara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine Graduate School of Medicine, Nara, Japan
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14
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Sugata M, Kataoka H, Uchihara Y, Shimada D, Atagi K, Nakamura M, Hara M, Kawahara M, Sugie K. Lidocaine as a potential therapeutic option for super-refractory status epilepticus: A case report. J Cent Nerv Syst Dis 2023; 15:11795735231200740. [PMID: 37692459 PMCID: PMC10492485 DOI: 10.1177/11795735231200740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023] Open
Abstract
New-onset refractory status epilepticus (NORSE) is a rare and devastating condition and the prognosis is often poor, with half to two-thirds of survivors experiencing drug-resistant epilepsy, residual cognitive impairment, or functional disability, and the mortality rate is 16% to 27% for adults. We describe a patient with cryptogenic NORSE and favorable recovery from drug-resistant super-refractory SE after the use of intravenous lidocaine. The patient experienced fever and presented with refractory generalized tonic-clonic seizures. The cause was not found by performing extensive examinations, including cell surface autoantibodies and rat brain immunohistochemistry evaluations. The refractory SE with unresponsiveness to multiple anti-epileptic and prolonged sedative medications, which are necessary for prolonged mechanical ventilation, were ameliorated by additive treatment with intravenous lidocaine initiating at 1 mg/kg/h and maintaining at 2 mg/kg/h for 40 days, which led to freedom from intravenous sedative medication and mechanical ventilation. The patient was able to return to school. Lidocaine may be an optional treatment for cryptogenic NORSE.
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Affiliation(s)
- Mayu Sugata
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yuto Uchihara
- Department of Neurology, Nara Prefecture General Medical Center, Nara, Japan
| | - Daisuke Shimada
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Kazuaki Atagi
- Department of Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Michitaka Nakamura
- Department of Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Makoto Hara
- Department of Neurology, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Makoto Kawahara
- Department of Neurology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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15
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Uchihara Y, Saito K, Motoyama R, Ishibashi-Ueda H, Yamaguchi E, Hatakeyama K, Tanaka A, Kataoka H, Iihara K, Sugie K, Koga M, Toyoda K, Nagatsuka K, Ihara M. Neovascularization From the Carotid Artery Lumen Into the Carotid Plaque Confirmed by Contrast-Enhanced Ultrasound and Histology. Ultrasound Med Biol 2023; 49:1798-1803. [PMID: 37202244 DOI: 10.1016/j.ultrasmedbio.2023.04.002] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study was aimed at assessing intraplaque neovessels, focusing on neovascularization from the vascular luminal side using contrast-enhanced ultrasound (CEUS) and determining that this contrast effect indicates that the neovessel is connected to the vessel lumen histopathologically. Whether plaque vulnerability can be assessed more accurately was also investigated. METHODS We enrolled consecutive patients with internal carotid artery stenosis who underwent carotid endarterectomy (CEA) and pre-operative CEUS with perflubutane of the carotid arteries. We graded the contrast effect semi-quantitatively from the vascular luminal and adventitial sides. We compared the contrast effect with the pathological findings, especially the neovascularization of the CEA specimens. RESULTS In total, 68 carotid arterial atheromatous plaques (47 symptomatic) were analyzed. Symptomatic plaques were significantly correlated with stronger contrast effects from the luminal side than from the adventitial side (p = 0.0095). Microbubbles from the luminal side appeared to flow mainly into the plaque shoulder. The contrast effect value for the plaque shoulder and neovessel density were significantly correlated (ρ = 0.35, p = 0.031). Neovessel density was significantly higher in symptomatic than in asymptomatic plaques (56.2 ± 43.7/mm2 and 18.1 ± 15.2/mm2, respectively, p < 0.0001). Serial histological sections of CEA specimens in a symptomatic plaque with a strong contrast effect from the luminal side revealed multiple neovessels fenestrated to the vessel lumen with endothelial cells, consistent with the CEUS findings. CONCLUSION Contrast-enhanced ultrasound can be used to evaluate neovessels originating from the luminal side, histopathologically confirmed in serial sections. Symptomatic vulnerable plaque is correlated more significantly with intraplaque neovascularization from the luminal side than with neovascularization from the adventitia.
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Affiliation(s)
- Yuto Uchihara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Nara Medical University, Nara, Japan.
| | - Kozue Saito
- Department of Neurology, Nara Medical University, Nara, Japan; Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rie Motoyama
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | | | - Eriko Yamaguchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akito Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Nara Medical University, Nara, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuyuki Nagatsuka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
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16
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Mano T, Iguchi N, Iwasa N, Fujimura S, Takatani T, Sugie K. Challenges in evaluating forearm muscle activity based on the compound muscle action potential of the flexors of the whole forearm. Clin Neurophysiol Pract 2023; 8:132-136. [PMID: 37529160 PMCID: PMC10387516 DOI: 10.1016/j.cnp.2023.05.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/21/2023] [Accepted: 05/26/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Muscle strength, which correlates with the compound muscle action potential (CMAP), can also be estimated by measuring the CMAP. Therefore, we evaluated the CMAP of the flexor muscles of the whole forearm to identify their muscle strength. Methods Fourteen healthy volunteers were enrolled. The elbow was determined to be the stimulation point, and the recording site for the flexor muscles of the whole forearm was set at approximately 8 cm distal to the elbow. We prospectively evaluated the baseline-to-peak amplitude of the CMAP of the whole forearm flexor muscles (WFFM), including that obtained from the median nerve stimulation (WFFMm), ulnar nerve stimulation (WFFMu), and their sum (WFFMsum). Additionally, we analyzed the relationships between WFFMm and WFFMu amplitudes with other quantitative parameters, including grip strength and routine CMAP amplitudes. Results The CMAP's test-retest analysis revealed high reliability. Grip power was significantly correlated with WFFMm and WFFMsum and mildly correlated with WFFMu. Tip-pinch strength with WFFMm and flexor pollicis longus (FPL) measurements correlated significantly. Lateral-pinch strength was significantly correlated with the first dorsal interosseous muscle (FDI) measurements but not with WFFM. The abductor digiti minimi (ADM) and abductor pollicis brevis (APB) were not correlated with grip power or pinch strength. Conclusions By electrophysiology examination, this study demonstrated that WFFMm is involved in grip power and other pinch strengths. This method may serve as a novel tool for measurement of distal muscle strengths. Significance This is the first study to attempt to evaluate the muscle strength of forearm flexor muscles by measuring the CMAP.
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Affiliation(s)
- Tomoo Mano
- Department of Neurology, Nara Medical University, Kashihara, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Naohiko Iguchi
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Naoki Iwasa
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Shigekazu Fujimura
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenori Takatani
- Department of Operation Center, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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17
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Kataoka H, Obayashi K, Tai Y, Sugie K, Saeki K. Increased depressive symptoms in Parkinson’s disease during the COVID‐19 pandemic: preliminary findings from longitudinal analysis of the PHASE study. Clin Park Relat Disord 2023; 8:100194. [PMID: 36974118 PMCID: PMC10030263 DOI: 10.1016/j.prdoa.2023.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
Introduction The cumulative number of patients has increased through the four waves of the pandemic in Japan. Many people experienced mental stress due to the fear of infection, and restrictions of leaving the house and leisure activities. No longitudinal study has assessed the fluctuation of neuropsychiatric symptoms during the COVID-19 pandemic using the same scale. We examined changes in non-motor symptoms, and the scores of a Parkinson’s Disease (PD)-specific questionnaire between the early and later periods during the COVID-19 pandemic. Methods We conducted a questionnaire survey during the first wave (from February to April 2020) and the fourth wave of the COVID-19 pandemic (from March to April 2021). We compared the number of symptoms from the two periods. Results Compared with the first wave, the Geriatric Depression Scale score was significantly higher in the fourth wave of the pandemic (median score of GDS: 4.00 vs. 5.50, p = 0.022). Consistently, the scores of symptoms on MDS-UPDRS part 1 in the fourth wave were significantly higher in hygiene (p = 0.033), handwriting (p = 0.033), performing hobbies and other activities (p = 0.035), and turning in bed (p = 0.046) than in the first wave. Conclusions Our observation over a year between the early and later phases of the COVID-19 pandemic showed an increase in the severity of depression in patients with PD.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Nara, Japan
- Corresponding author at: Department of Neurology, Nara Medical University, 840 Shijocho, Kashiharashi, Nara 634-8521, Japan.
| | - Kenji Obayashi
- Department of Epidemiology, Nara Medical University, Nara, Japan
| | - Yoshiaki Tai
- Department of Epidemiology, Nara Medical University, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University, Nara, Japan
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18
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Iguchi N, Mano T, Iwasa N, Kikutsuji N, Saito K, Sugie K. An Ultrasonographic Evaluation for the Early Detection of Nerve Root Changes in Herpes Zoster-associated Motor Paresis. Intern Med 2023; 62:903-907. [PMID: 35989267 PMCID: PMC10076138 DOI: 10.2169/internalmedicine.0039-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/03/2022] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of herpes zoster complicated by right-arm paralysis, wherein cervical nerve root ultrasonography enabled the early diagnosis and a therapeutic efficacy evaluation. A 71-year-old man developed progressive weakness in the muscles innervated by the right C5-6 nerve root following the appearance of a painful rash. Cervical nerve root ultrasonography revealed C5-6 nerve root inflammatory swelling. Methylprednisolone pulse therapy and subsequent oral prednisolone therapy gradually improved the muscle weakness. At three weeks following admission, ultrasonography revealed C5-6 nerve root inflammatory swelling improvement. Ultrasonography may aid in the early detection of nerve root inflammatory swelling and help monitor treatment efficacy.
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Affiliation(s)
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Japan
| | - Naoki Iwasa
- Department of Neurology, Nara Medical University, Japan
| | | | - Kozue Saito
- Department of Neurology, Nara Medical University, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Japan
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19
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Takeuchi K, Izumi T, Nanaura H, Yamada N, Hayata Y, Obayashi C, Sugie K. Mitral Valve Replacement for Enlarged Libman-Sacks Endocarditis in a Patient with Persistent Primary Antiphospholipid Syndrome and Recurrent Stroke: A Case Report. Am J Case Rep 2023; 24:e938930. [PMID: 36740820 PMCID: PMC9909611 DOI: 10.12659/ajcr.938930] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Anticardiolipin antibodies in patients with Libman-Sacks endocarditis (LS) are indicative of comorbid antiphospholipid syndrome (APS) and can result in cerebral infarctions. We describe a case of LS and primary APS with recurrent cerebral infarctions despite anticoagulation treatment. The patient underwent surgery for enlarged LS vegetation with high titers of antiphospholipid antibodies. CASE REPORT A 41-year-old Japanese man was admitted to hospital for small cerebral infarction recurrence in a left parietal lesion. At age 35, the patient had suffered multiple cerebral infarctions. He was found to have high serum titers of all 3 antiphospholipid antibodies. Transesophageal echocardiography (TEE) findings were normal. Differential diagnosis ruled out other autoimmune diseases and a clinical diagnosis of primary APS was made. Warfarin anticoagulation was started. When cerebral infarction recurred 6 years after the first episode, serum titers of antiphospholipid antibodies remained high, and TEE showed a 7×8 mm area of mitral vegetation. A TEE results from his first admission revealed a 5×6 mm area of mitral vegetation, which was believed to be related to the current vegetation. As anticoagulation produced no improvement, the mitral valve was replaced with a mechanical valve. Examination of the excised vegetation found it to be consistent with LS. The patient made good progress within 3 years after surgery. CONCLUSIONS LS size can increase despite anticoagulation in cases with high titers of all 3 antiphospholipid antibodies and cerebral infarction. Such patients require ongoing TEE follow-up and surgical treatment should be considered.
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Affiliation(s)
- Katsuya Takeuchi
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Tesseki Izumi
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan,Corresponding Author: Tesseki Izumi, e-mail:
| | - Hitoki Nanaura
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Nanami Yamada
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshihiro Hayata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Chiho Obayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
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20
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Sugie K. Editorial commentary: Highlighting the ray of hope in Danon disease research after 40 years. Trends Cardiovasc Med 2023; 33:90-91. [PMID: 34863946 DOI: 10.1016/j.tcm.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
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21
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Kikutsuji N, Kataoka H, Kiriyama T, Sugie K. High-dose steroid-responsive COVID-19-related encephalopathy with a sudden onset of dysarthria mimicking stroke: a case report. J Cent Nerv Syst Dis 2022; 14:11795735221147218. [PMID: 36579076 PMCID: PMC9791002 DOI: 10.1177/11795735221147218] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
There has been limited research on encephalitis/encephalopathy, which is a less common coronavirus disease 2019 (COVID-19) neurological complication. The differentiation between stroke and encephalopathy with stroke mimickers is challenging in patients with COVID-19. Here, we describe a case of COVID-19-related encephalopathy mimicking stroke that was successfully treated with high-dose steroid pulse therapy. The patient suddenly experienced language disturbance with a left facial droop and symmetric numbness in his upper limbs. Magnetic resonance imaging (MRI) scans revealed hyperintensities in both the white matter and splenium. No pneumonia was observed. MRI abnormalities and neurological symptoms resolved after steroid pulse therapy and administration of remdesivir. High-dose steroid pulse treatment (for 3 days) might alleviate COVID-19-related encephalopathy.
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Affiliation(s)
- Naoya Kikutsuji
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Kashihara, Japan,Hiroshi Kataoka, MD, PhD, Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan.
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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22
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Mano T, Asada K, Suzuki S, Kasama S, Kinugawa K, Sugie K, Kasahara M, Kido A. Feasibility and acceptability of novel functional electronic stimulated rehabilitation application for treatment in patients with cerebrovascular disorders: the FRAT study protocol. Pilot Feasibility Stud 2022; 8:258. [PMCID: PMC9749168 DOI: 10.1186/s40814-022-01217-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
The prognosis of patients with cerebrovascular disorders is poor owing to their high residual rate of hemiplegia. Delayed withdrawal from synkinesis is a major cause of prolonged hemiplegia; however, effective rehabilitation has not been established. This single-arm, open-label study aims to evaluate the influence of a low-frequency treatment device on canceling synkinesis in patients with incomplete paralysis and cerebrovascular disorders.
Methods
Eligible participants will include patients aged 20 years or older with incomplete paralysis, defined as upper limb Brunnstrom stage (BRS) of 2–4, who are within 1 month of onset of a cerebrovascular disorder. Qualified patients will be assigned to the novel rehabilitation treatment with IVES+ for 4 weeks. The primary endpoint of the study is the change from baseline in the upper-limb Fugl-Meyer Assessment (FMA) 2 weeks after the start of treatment. The secondary endpoints are changes in the amount of Functional Independence Measure, changes in the amount of upper-limb BRS, and changes in the amount of Barthel Index (BI) compared to the pre-intervention value at weeks 2 and 4; changes in the upper-limb FMA scores at 1, 3, and 4 weeks; changes in grip strength compared to the pre-intervention values at 1, 2, 3, and 4 weeks; and changes in upper-limb strength (manual muscle test) compared to the pre-intervention values at 1, 2, 3, and 4 weeks.
Discussion
This study will explore the usefulness of IVES+ for recovery from motor paralysis in patients with cerebrovascular disorders.
Trial registration
Japanese Clinical Registry, jRCTs052180226. Date of registration: February 1, 2022
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Kataoka H, Sugie K. Persistent intolerable abdominal pain in patients with Parkinson's disease. Clin Neurol Neurosurg 2022; 224:107558. [PMID: 36565687 DOI: 10.1016/j.clineuro.2022.107558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES In Parkinson's disease (PD), pain is common, increases motor disability, and makes daily life unpleasant. Few patients reportedly have a low prevalence of abdominal pain. The pathophysiology of such abdominal pain has not been confirmed. We clinically studied patients with PD and persistent intolerable abdominal pain to determine the pathophysiology and effective therapy. MATERIALS AND METHODS We obtained detailed clinical information from medical records, including the disease course before and after the onset of abdominal pain. The maximal thickness of the rectus muscle at the L4 and L5 corpus vertebral level of the abdomen on axial computed tomography was calculated, and the relative muscle thickness ratio was calculated by dividing the maximal thickness by the distance from the fascia between the bilateral rectus muscles of the abdomen and the dorsal part of the corpus vertebrae. RESULTS In six patients with PD (three men, age range 71-85 years), the Hoehn-Yahr stage, disease duration, and daily levodopa equivalent dose were 3.1 ± 0.7, 107 ± 44 months, and 636.7 ± 451.4 mg/day, respectively. The pain occurred daily and often during the night and was not related to the timing of food intake. The pain in two patients was related to wearing-off. One patient showed constant hypertonic activity in the rectus abdominis on surface electromyography. The rectus abdominis showed that the maximal thickness and relative muscle thickness ratio of patients with abdominal pain were significantly higher than those of patients without pain. Therapeutic usefulness of antiparkinsonian medications was short and limited. CONCLUSIONS Although intolerable abdominal pain is likely to be infrequent, it alleviates the quality of life of patients with PD. The pathophysiology seems to vary, and our observations found wearing-off of related pain and muscle contraction, suggesting dystonia. Among persistent abdominal pain, organic abnormalities, such as the precursor state of megacolon, may be lurking.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Nara, Japan.
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara, Japan
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Kinugawa K, Mano T, Nakagawa Y, Hotta N, Sugie K. Case report: Unilateral masticatory atrophy caused by pure trigeminal motor neuropathy. Radiol Case Rep 2022; 17:4542-4545. [PMID: 36189157 PMCID: PMC9520091 DOI: 10.1016/j.radcr.2022.09.031] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, Kashihara, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
- Corresponding author.
| | - Yosuke Nakagawa
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Naoki Hotta
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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Shobatake R, Ota H, Takahashi N, Ueno S, Sugie K, Takasawa S. The Impact of Intermittent Hypoxia on Metabolism and Cognition. Int J Mol Sci 2022; 23:12957. [PMID: 36361741 PMCID: PMC9654766 DOI: 10.3390/ijms232112957] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/15/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022] Open
Abstract
Intermittent hypoxia (IH), one of the primary pathologies of sleep apnea syndrome (SAS), exposes cells throughout the body to repeated cycles of hypoxia/normoxia that result in oxidative stress and systemic inflammation. Since SAS is epidemiologically strongly correlated with type 2 diabetes/insulin resistance, obesity, hypertension, and dyslipidemia included in metabolic syndrome, the effects of IH on gene expression in the corresponding cells of each organ have been studied intensively to clarify the molecular mechanism of the association between SAS and metabolic syndrome. Dementia has recently been recognized as a serious health problem due to its increasing incidence, and a large body of evidence has shown its strong correlation with SAS and metabolic disorders. In this narrative review, we first outline the effects of IH on the expression of genes related to metabolism in neuronal cells, pancreatic β cells, hepatocytes, adipocytes, myocytes, and renal cells (mainly based on the results of our experiments). Next, we discuss the literature regarding the mechanisms by which metabolic disorders and IH develop dementia to understand how IH directly and indirectly leads to the development of dementia.
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Affiliation(s)
- Ryogo Shobatake
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan
- Department of Neurology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara 630-8305, Japan
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan
| | - Hiroyo Ota
- Department Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan
| | - Nobuyuki Takahashi
- Department of Neurology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara 630-8305, Japan
| | - Satoshi Ueno
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan
| | - Shin Takasawa
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan
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Ohashi T, Mano T, Iguchi N, Nanaura H, Kiriyama T, Sugie K. [A case of Guillain-Barré syndrome with unilateral diaphragmatic nerve palsy that was longitudinally evaluated using multiple examinations]. Rinsho Shinkeigaku 2022; 62:805-809. [PMID: 36184413 DOI: 10.5692/clinicalneurol.cn-001765] [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: 06/16/2023]
Abstract
The patient, a 50-year-old woman, presented with fever and diarrhea in early July, X. One week later, she noticed muscle weakness in both lower extremities, which upon examination was found to be dominant in the distal muscles, with associated loss of tendon reflexes. We diagnosed the case as Guillain-Barré syndrome. After admission, the patient experienced decreased oxygenation, and a chest X-ray indicated elevation of the left hemidiaphragm. The phrenic nerve conduction studies revealed laterality of the amplitude of compound muscle action potential, and diaphragmatic ultrasonographic examination revealed decreased left diaphragmatic wall motion. We diagnosed the patient with unilateral diaphragmatic nerve palsy and initiated intravenous immunoglobulin and methylprednisolone treatment. After 2 weeks, the patient demonstrated good clinical recovery, increased diaphragmatic nerve amplitude, and improved diaphragmatic movement. We evaluated the longitudinal clinical course of unilateral diaphragmatic nerve palsy in the patient using nerve conduction tests and diaphragmatic echocardiography. The longitudinal evaluation allowed us to assess the pathological condition more sensitively so that the prognosis could be predicted accurately.
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Affiliation(s)
| | - Tomoo Mano
- Department of Neurology, Nara Medical University
- Department of Rehabilitation Medicine, Nara Medical University
| | | | | | | | - Kazuma Sugie
- Department of Neurology, Nara Medical University
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27
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Yamanaka A, Eura N, Shiota T, Yamaoka M, Nishimori Y, Iguchi N, Ozaki M, Nanaura H, Iwasa N, Kiriyama T, Izumi T, Kataoka H, Sugie K. VP.48 Clinicopathological characteristics of 105 patients with idiopathic inflammatory myopathy based on muscle specific antibodies. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.179] [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: 11/05/2022]
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28
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Soyama S, Mano T, Yamada N, Iguchi N, Iwasa N, Sugie K. [A case of the palatal tremor that disappeared during swallowing, thought to be caused by microbleeds of bilateral dentate nucleus]. Rinsho Shinkeigaku 2022; 62:744-747. [PMID: 36031373 DOI: 10.5692/clinicalneurol.cn-001678] [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: 06/15/2023]
Abstract
A 72-year-old female presented with slowly progressive dysphonia, which was a syllable-separated utterance, for three years. She had the rhythmic continues contraction of palatal and uvula muscles during speech with a frequency of about 2 Hz. The videoendoscopy showed that the rhythmic contraction, which synchronized in the nasopharynx and the larynx, did not disappear during vocalization. The swallowing videofluorography showed that the rhythmic contraction disappeared transiently during the swallowing reflex, and there was no aspiration. The MRI revealed olivary pseudohypertrophy and multiple microbleedings including the bilateral dentate nucleus. The degeneration of olivary nucleus secondary to the bilateral asymptomatic dentate nucleus microbleedings within the dentato-rubro-olivary pathway was thought to be a cause of palatal tremor. This is a first report that a dynamic relation between vocalization and swallowing in palatal tremor.
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Affiliation(s)
- Shigeto Soyama
- Department of Medical Technology Center, Nara Medical University Hospital
| | - Tomoo Mano
- Department of Neurology, Nara Medical University
- Department of Rehabilitation Medicine, Nara Medical University
| | | | | | - Naoki Iwasa
- Department of Neurology, Nara Medical University
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University
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Shimizu H, Hatakeyama K, Saito K, Shobatake R, Takahashi N, Deguchi J, Tokunaga H, Shimada K, Nakagawa I, Myochin K, Sakai K, Kubo M, Yamashita A, Obayashi C, Sugie K, Matsumoto M. Age and composition of the thrombus retrieved by mechanical thrombectomy from patients with acute ischemic stroke are associated with revascularization and clinical outcomes. Thromb Res 2022; 219:60-69. [PMID: 36126564 DOI: 10.1016/j.thromres.2022.09.004] [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: 06/01/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Understanding the composition of stroke thrombi retrieved by mechanical thrombectomy is essential to clarify the pathogenesis of stroke. However, it is difficult to evaluate thrombus composition precisely and objectively. Immunohistochemical staining was used to evaluate thrombus composition and age. MATERIALS AND METHODS Consecutive thrombi (n = 108) retrieved from patients who underwent mechanical thrombectomy for acute large-vessel ischemic stroke were retrospectively analyzed. Lytic features of granulocytes and CD163 were estimated as indicators of the age of the cardioembolic (CE) thrombus. RESULTS The stroke subtypes were as follows: CE, 74 cases; large artery atherosclerosis, 11; undetermined etiology, 12; and other determined etiology, 11. There were no statistical differences in thrombi composition according to stroke subtypes. The fibrin area was positively correlated with the red blood cell (RBC) and platelet areas. The following analysis was performed using CE only. Regarding age, the thrombus was judged as fresh in 30.0 % and older in 70.0 % based on the lytic features. The RBC areas of older thrombi were smaller than those of fresh thrombi. The puncture-to-reperfusion time of older thrombi was longer than that of fresh thrombi. Platelet-rich thrombi were associated with a greater number of maneuvers, a smaller prevalence of TICI 3, and unfavorable functional outcomes compared to platelet-poor thrombi. The number of CD163 positive cells in thrombi with anticoagulants was higher than in those without anticoagulants. CONCLUSION Thrombus composition correlated with revascularization and clinical outcomes. The composition of an acute ischemic thrombus may reflect the pathophysiology of stroke and influence treatment efficacy.
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Affiliation(s)
- Hisao Shimizu
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kozue Saito
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | | | | | - Jun Deguchi
- Department of Neurosurgery, Nara City Hospital, Nara, Japan
| | | | - Keiji Shimada
- Department of Pathology, Nara City Hospital, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kaoru Myochin
- Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Japan
| | - Kazuya Sakai
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Masayuki Kubo
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Atsushi Yamashita
- Department of Pathology, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Chiho Obayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan.
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Takatani T, Hayashi H, Park YS, Mano T, Sugie K, Nakase H, Kawaguchi M. WE-231. Application of tetanic stimulation to the pudendal nerve prior to transcranial stimulation for augmentation of motor-evoked potential. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.275] [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: 11/29/2022]
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31
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Ohara H, Yamanaka M, Tsuchida Y, Masumoto M, Shimizu H, Iguchi N, Sugie K, Kinoshita M. WE-128. Utility of American clinical neurophysiology society’s standardized critical care EEG terminology 2021 for diagnosis of anti-glutamic acid decarboxylase antibody-associated-disorders. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.172] [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: 11/03/2022]
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32
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Iwasa N, Iguchi N, Mano T, Naoya K, Sugie K. WE-162. Challenging the nerve conduction study of flexor digitorum profundus (FDP). Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.206] [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: 11/28/2022]
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Kaito S, Ida M, Kimura K, Kawanishi H, Onodera H, Kiriyama T, Sugie K, Kawaguchi M. Effects of a False Window on the Change of Cognitive Function in Patients Admitted to a Neurological Ward. Hosp Top 2022:1-6. [PMID: 35762657 DOI: 10.1080/00185868.2022.2091498] [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] [Indexed: 10/17/2022]
Abstract
False windows can display a variety of outdoor scenery in rooms without real windows. We aimed to assess the effects of three different hospital beds on the change in the frontal assessment battery scores in patients aged ≥ 20-year-old admitted in our neurological ward. We included 24 patients on the window side, 12 patients on the aisle side with a false window, and 12 patients on the aisle side without a false window. There were no statistical differences in the change of cognitive function among the three hospital beds. Only the length of hospital stay was a significant associated factor.
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Affiliation(s)
- Shinobu Kaito
- Department of Nursing, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Keiko Kimura
- Department of Nursing, Nara Medical University Hospital, Kashihara, Nara, Japan
| | - Hideaki Kawanishi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroki Onodera
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
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Kataoka H, Nanaura H, Kiriyama T, Sugie K. Prognostic Factor for Subacute Encephalitis with First-Episode Psychosis. Eur Neurol 2022; 85:446-452. [DOI: 10.1159/000524975] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Although symptomatic manifestations in encephalitis vary, they typically include seizures, memory deficit(s), and altered consciousness. Psychosis also occurs as an initial manifestation. In clinical practice, clinicians often encounter the question of whether first-episode psychosis (FEP) originates from encephalitis itself or if encephalitis presenting with FEP develops concurrently. The prognosis of FEP among patients with overall encephalitis, including autoimmune encephalitis, remains uncertain. <b><i>Methods:</i></b> We examined a prognostic factor in patients with encephalitis who had both FEP and CSF pleocytosis. A total of 36 patients who presented with FEP were enrolled. A score of ≥3 and ≤2 on the modified Rankin scale were defined as poor and good outcomes, respectively. A total of 13 independent variables were analyzed by the multivariate logistic regression analysis. <b><i>Results:</i></b> Significant variables on univariate logistic regression analysis included female sex (OR 5.571, 95% CI: 1.297–23.934; <i>p</i> = 0.021) and the use of mechanical ventilation during the acute stage (OR 7.286, 95% CI: 1.508–35.211; <i>p</i> = 0.013). On multivariate logistic regression analysis, the use of mechanical ventilation during the acute stage (OR 5.446, 95% CI: 1.044–28.615; <i>p</i> = 0.044) was significantly associated with poor outcomes. <b><i>Conclusions:</i></b> The use of mechanical ventilation is a poor prognostic factor of subacute encephalitis with FEP, and female sex may be a risk factor for unfavorable development of the disease.
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Shiota T, Eura N, Hasegawa A, Kiriyama T, Sugie K. Pathological features of inflammatory myopathy as a manifestation of chronic graft-versus-host disease after allogeneic bone marrow transplantation. Neuropathology 2022; 42:309-314. [PMID: 35508303 DOI: 10.1111/neup.12816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/23/2022] [Revised: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is the most important complication resulting in the death of bone marrow transplantation (BMT) survivors. It is also a relatively rare cause of inflammatory myopathy (IM). We report the case of a 46-year-old woman who developed severe cGVHD-related IM after BMT for myelodysplastic syndrome. She presented with severe muscle pain and weakness with cGVHD-related symptoms in other organs. Myopathological analysis showed moderate cell infiltration with remarkable necrotic and regenerative fibers. Sarcoplasm and capillaries expressed C5b9 and myxovirus resistance protein 1. Non-necrotic fibers in perifascicular regions expressed MHC-II. Steroid therapy did not sufficiently control cGVHD-related IM, and the patient was concurrently treated with an immunosuppressant. Our findings show that IM is a key manifestation of cGVHD and that the expression of interferon-inducible proteins in muscle pathology is useful for identifying cGVHD-related IM.
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Affiliation(s)
- Tomo Shiota
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nobuyuki Eura
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Atsushi Hasegawa
- Department of Hematology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
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Sugie K. [Treatment of Dermatomyositis and Immune-Mediated Necrotizing Myopathy with Poor Muscle Recovery with Steroids and IVIg: Intractable Dermatomyositis and Immune-Mediated Necrotizing Myopathy]. Brain Nerve 2022; 74:537-544. [PMID: 35589644 DOI: 10.11477/mf.1416202077] [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: 06/15/2023]
Abstract
Among idiopathic inflammatory myopathies, dermatomyositis and immune-mediated necrotizing myopathy are distinguished by their different clinicopathological features. Corticosteroids are administered as the first-line treatment for both, and immunosuppressive agents and intravenous immunoglobulin important second-line treatments. Since some patients show resistance to these therapies, it is necessary to considering additional treatment based on muscle pathology, muscle imaging, and systemic complications such as malignancy and interstitial lung disease, in addition to the careful evaluation of muscle strength. However, more effective therapeutic strategies are not yet well-established for refractory cases because the available therapeutic agents are limited. Therefore, the development of novel therapies is required in the future.
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Affiliation(s)
- Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine
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37
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Kinugawa K, Mano T, Takatani T, Kido A, Sugie K. Electroencephalographic-Based Functional Connectivity Networks of Visual Hallucinations and Visuospatial Dysfunctions in Parkinson's Disease. Eur Neurol 2022; 85:404-409. [PMID: 35483334 DOI: 10.1159/000524365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
Visual dysfunction is an important nonmotor symptom of Parkinson's disease (PD). Visual hallucinations (VHs) and visuospatial dysfunctions (VSDs) are common visual dysfunctions in PD; however, the underlying mechanisms remain unclear. Our study aimed to evaluate neuronal synchronization between patients with PD with and without VH or VSD using electroencephalographic (EEG) coherence analysis. Twenty-four patients with sporadic PD were evaluated for the presence of VH and VSD, and were divided into VH-negative and VH-positive groups, and these groups were further subdivided by VSD status. Coherence analysis was performed on EEG data. Whole-brain and regional coherences were calculated and compared between the groups. There was a significant difference in frontal-frontal coherence between the VH+ VSD- and VH+ VSD+ groups (p = 0.026). Our findings suggest that reduced EEG coherence in frontal regions might be involved in VSD in patients with PD. Reduced neuronal synchronization between the frontal lobes may contribute to the disruption of visual processing in PD.
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Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University, Kashihara, Japan,
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, Kashihara, Japan.,Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Kashihara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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38
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Inatomi S, Izumi T, Eura N, Sato I, Tasaki M, Muro S, Sugie K. Electroencephalographic findings after convulsive seizures due to cerebral arterial air embolism secondary to lung cancer: a case report. J Med Case Rep 2022; 16:137. [PMID: 35346360 PMCID: PMC8962241 DOI: 10.1186/s13256-022-03300-2] [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] [Received: 11/27/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cerebral arterial air embolism is often associated with an invasive iatrogenic etiology and a high rate of convulsive seizures. There are only a few descriptions of electroencephalogram findings in convulsive seizures due to cerebral arterial air embolism of noniatrogenic etiology. Herein, we describe the case of a patient with lung cancer and convulsive seizures with abnormalities detected on electroencephalogram caused by cerebral arterial air embolism of noniatrogenic etiology. Case presentation A 55-year-old Japanese man underwent radiotherapy and chemotherapy for cancer in the hilum of the left lung that was diagnosed after hemoptysis. One year after the diagnosis, he developed fever and chest pain that required hospitalization. At admission, he was in shock, and chest computed tomography revealed invasion of the left atrium and left main bronchus by the hilar cancer. Chest and abdominal computed tomography revealed small low-density areas within the tumor and around the intestinal membrane, which were interpreted as the presence of air due to invasion of the lung cancer. He was diagnosed with septic shock due to necrotic infection secondary to cancer invasion into the left atrium. The following day, he complained of difficulty in speaking and weakness in the left side of his body. A head computed tomography scan revealed multiple small low-density areas in the right cortex and bilateral subcortex, which were interpreted as air emboli. On day 3, he experienced generalized tonic–clonic seizures for approximately 1 minute, followed by myoclonus-like convulsions in the left lower limb and a right-sided gaze. The electroencephalogram findings after the convulsive seizures revealed partial epilepsy-like waves with intermittent spikes in the bilateral cerebral hemispheres and a diffuse slow wave in the left frontal lobe. He recovered from sepsis without recurrence of convulsive seizures; however, he died of hemoptysis on day 50 after discharge. Conclusions Electroencephalogram findings of focal spike activities and diffuse slow waves were detected in early seizures due to cerebral arterial air embolism of noniatrogenic etiology associated with lung cancer. Additional case descriptions are warranted to establish patterns in electroencephalogram findings specific to cerebral arterial air embolism.
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Iguchi N, Mano T, Iwasa N, Ozaki M, Yamada N, Kikutsuji N, Kido A, Sugie K. Thoracic Excursion Is a Biomarker for Evaluating Respiratory Function in Amyotrophic Lateral Sclerosis. Front Neurol 2022; 13:853469. [PMID: 35401409 PMCID: PMC8984343 DOI: 10.3389/fneur.2022.853469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo evaluate the usefulness of thoracic excursion as a biomarker in patients with amyotrophic lateral sclerosis (ALS).MethodsWe measured the forced the vital capacity (FVC), thoracic excursion, baseline-to-peak diaphragmatic compound muscle action potential (DCMAP) amplitude, diaphragm thickness at full inspiration (DTfi), Medical Research Council (MRC) sum score for muscle strength, and arterial partial pressures of oxygen and carbon dioxide and administered the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) and modified Medical Research Council (mMRC) Dyspnea Scale. The test–retest reliability of thoracic excursion was determined.Results and ConclusionsThirty-four patients with ALS and 26 age- and sex-matched healthy participants were enrolled. Thoracic excursion measurement had excellent test–retest reliability (intraclass coefficient: 0.974). Thoracic excursion was more strongly correlated with FVC (r = 0.678, p < 0.001) than DCMAP amplitude (r = 0.501, p = 0.003) and DTfi (r = 0.597, p < 0.001). It was also correlated with ALSFRS-R score (r = 0.610, p < 0.001), MRC sum score (r = 0.470, p = 0.005), and mMRC Dyspnea Scale score (r = −0.446, p = 0.008) and was the most sensitive parameter for assessing dyspnea and FVC. Thoracic excursion decreased as FVC declined in the early and late stages, there were no differences in DCMAP amplitude and DTfi between the early and late stages, and ALSFRS-R score and MRC sum score decreased only in the late stage. Thoracic excursion was well correlated with respiratory function and is useful for predicting respiratory and general dysfunction in patients with ALS regardless of stage.
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Affiliation(s)
- Naohiko Iguchi
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, Kashihara, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
- *Correspondence: Tomoo Mano
| | - Naoki Iwasa
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Maki Ozaki
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Nanami Yamada
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Naoya Kikutsuji
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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Shiota T, Nagata R, Kikuchi S, Nanaura H, Matsubayashi M, Nakanishi M, Kobashigawa S, Isozumi N, Kiriyama T, Nagayama K, Sugie K, Yamashiro Y, Mori E. C9orf72-Derived Proline:Arginine Poly-Dipeptides Modulate Cytoskeleton and Mechanical Stress Response. Front Cell Dev Biol 2022; 10:750829. [PMID: 35399536 PMCID: PMC8983821 DOI: 10.3389/fcell.2022.750829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022] Open
Abstract
Proline:arginine (PR) poly-dipeptides from the GGGGCC repeat expansion in C9orf72 have cytotoxicity and bind intermediate filaments (IFs). However, it remains unknown how PR poly-dipeptides affect cytoskeletal organization and focal adhesion (FA) formation. Here, we show that changes to the cytoskeleton and FA by PR poly-dipeptides result in the alteration of cell stiffness and mechanical stress response. PR poly-dipeptides increased the junctions and branches of the IF network and increased cell stiffness. They also changed the distribution of actin filaments and increased the size of FA and intracellular calcium concentration. PR poly-dipeptides or an inhibitor of IF organization prevented cell detachment. Furthermore, PR poly-dipeptides induced upregulation of mechanical stress response factors and led to a maladaptive response to cyclic stretch. These results suggest that the effects of PR poly-dipeptides on mechanical properties and mechanical stress response may serve as a pathogenesis of C9orf72-related neurodegeneration.
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Affiliation(s)
- Tomo Shiota
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Riko Nagata
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Japan
| | - Sotaro Kikuchi
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Japan
| | - Hitoki Nanaura
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Masaya Matsubayashi
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Japan
| | - Mari Nakanishi
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Japan
| | - Shinko Kobashigawa
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Japan
| | - Noriyoshi Isozumi
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Japan
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Kazuaki Nagayama
- Micro-Nano Biomechanics Laboratory, Department of Mechanical Systems Engineering, Ibaraki University, Hitachi, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yoshito Yamashiro
- Life Science Center for Survival Dynamics, Tsukuba Advanced Research Alliance, Tsukuba, Japan
- *Correspondence: Yoshito Yamashiro, ; Eiichiro Mori,
| | - Eiichiro Mori
- Department of Future Basic Medicine, Nara Medical University, Kashihara, Japan
- V-iCliniX Laboratory, Nara Medical University, Kashihara, Japan
- *Correspondence: Yoshito Yamashiro, ; Eiichiro Mori,
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Mano T, Kinugawa K, Ozaki M, Kataoka H, Sugie K. Neural synchronization analysis of electroencephalography coherence in patients with Parkinson's disease-related mild cognitive impairment. Clin Park Relat Disord 2022; 6:100140. [PMID: 35308256 PMCID: PMC8928128 DOI: 10.1016/j.prdoa.2022.100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/02/2021] [Revised: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
We studied brain functional connectivity in 20 patients with PD-MCI and 10 MCI patients without Parkinsonism. Cognitive impairment was related to decreased coherence in the alpha range [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. Regional coherence in left FP had a higher correlation with cognitive function. Differences in EEG coherence may reflect a compensatory response to PD-MCI.
Introduction The underlying pathophysiology of slight cognitive dysfunction in Parkinson’s disease-related mild cognitive impairment (PD-MCI) is yet to be elucidated. Our study aimed to evaluate the association between cognitive function and brain functional connectivity (FC) in patients with PD-MCI. Methods Twenty patients with sporadic PD-MCI were evaluated for FC in the brain network. Further, electroencephalography (EEG) coherence analysis in the whole-brain and quantified regional coherence using phase coupling were performed for each frequency, and motor and cognitive function were assessed in the whole-brain. Results The degree of cognitive impairment was related to a decrease in the coherence in the alpha ranges. The regional coherence in the left frontal-left parietal region rather than the right frontal-right parietal region showed a higher correlation with the cognitive function scores. Conclusion The differences in EEG coherence across different types of cognitive dysfunction reflect a compensatory response to the heterogeneous and complex clinical presentation of PD-MCI. Our findings indicate decreased brain efficiency and impaired neural synchronization in PD-MCI; these results may be crucial in elucidating the pathological exacerbation of PD-MCI.
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Key Words
- Coherence analysis
- EEG, electroencephalography
- Electroencephalography
- FAB, Frontal Assessment Battery
- FC, functional connectivity
- FF, frontal-frontal
- FP, frontal-parietal
- FPL, left frontal-left parietal
- FPR, right frontal-right parietal
- FT, frontal-temporal
- HDS-R, Revised Hasegawa Dementia Score
- LEDD, levodopa-equivalent daily dose
- MCI, Mild Cognitive Impairment
- MCI, mild cognitive impairment
- MDS-UPDRS, Movement Disorder Society Unified Parkinson's Disease Rating Scale
- MMSE, Mini-Mental State Examination
- Mild cognitive impairment
- PD, Parkinson’s disease
- PO, parietal-occipital
- PT, parietal-temporal
- Parkinson's disease
- RBD, rapid eye movement sleep behavior disorder
- TT, temporal-temporal
- Time–frequency analysis
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Affiliation(s)
- Tomoo Mano
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.,Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Kaoru Kinugawa
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Maki Ozaki
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
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Ozaki M, Mano T, Iwasa N, Iguchi N, Kido A, Sugie K. HP42: EMG is a potential biomarker for myositis in patients with antisynthetase syndrome without muscle symptoms. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2021.11.040] [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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Kinugawa K, Mano T, Takatani T, Kataoka H, Kido A, Sugie K. HP18: Analysis of functional connectivity in non-motor symptoms in Parkinson’s Disease. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2021.11.021] [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: 11/03/2022]
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Kataoka H, Okada Y, Kiriyama T, Kita Y, Nakamura J, Shomoto K, Sugie K. Effect of galvanic vestibular stimulation on axial symptoms in Parkinson’s disease. J Cent Nerv Syst Dis 2022; 14:11795735221081599. [PMID: 35237093 PMCID: PMC8883401 DOI: 10.1177/11795735221081599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/28/2022] [Indexed: 11/15/2022] Open
Abstract
Postural imbalance, abnormal axial posture, and axial rigidity are the characteristic features of Parkinson’s disease (PD), and they are referred to as axial symptoms. The symptoms are difficult to manage since they are often resistant to both L-DOPA and deep brain stimulation. Hence, other treatments that can improve Parkinsonian axial symptoms without adverse effects are required. Vestibular dysfunction occurs in PD since neuropathological changes and reflex abnormalities are involved in the vestibular nucleus complex. Galvanic vestibular stimulation (GVS), which activates the vestibular system, is a noninvasive method. This review aimed to assess the clinical effect of GVS on axial symptoms in PD. To date, studies on the effects of GVS on postural instability, anterior bending posture, lateral bending posture, and trunk rigidity and akinesia in PD had yielded interesting data, and none of the patients presented with severe adverse events, and the others had mild reactions. GVS indicated a possible novel therapy. However, most included a small number of patients, and the sample sizes were not similar in some studies that included controls. In addition, there was only one randomized controlled clinical trial, and it did not perform an objective evaluation of axial symptoms. In this type of research, vestibular contributions to balance should be distinguished from others such as proprioceptive inputs or nonmotor symptoms of PD.
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Affiliation(s)
- Hiroshi Kataoka
- The Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yohei Okada
- Graduate School of Health Science, Kio University, Kashiba, Nara, Japan
| | - Takao Kiriyama
- The Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yorihiro Kita
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Junji Nakamura
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Koji Shomoto
- Graduate School of Health Science, Kio University, Kashiba, Nara, Japan
| | - Kazuma Sugie
- The Department of Neurology, Nara Medical University, Kashihara, Japan
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Onishi T, Shimonishi N, Takeyama M, Furukawa S, Ogiwara K, Nakajima Y, Kasahara K, Nishio K, Yoshimoto K, Inoue S, Kawaguchi M, Fukushima H, Saito Y, Yoshiji H, Muro S, Tsuruya K, Okada S, Sugie K, Kawaguchi R, Nishikubo T, Yamazaki M, Oda Y, Kawabe T, Onishi K, Nishio T, Nogami K. The balance of comprehensive coagulation and fibrinolytic potential is disrupted in patients with moderate to severe COVID-19. Int J Hematol 2022; 115:826-837. [PMID: 35171446 PMCID: PMC8852977 DOI: 10.1007/s12185-022-03308-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 12/19/2022]
Abstract
Coagulation and fibrinolytic mechanisms are enhanced in patients with coronavirus (COVID-19), but disturbances in the balance of both functions in COVID-19 patients remain unclear. We assessed global coagulation and fibrinolysis in plasma from 167 COVID-19 patients (mild/moderate/severe: 62/88/17, respectively) on admission using clot-fibrinolysis waveform analysis (CFWA). Maximum coagulation velocity (|min1|) and maximum fibrinolysis velocity (|FL-min1|) were expressed as ratios relative to normal plasma. Ten patients (6.0%) developed thrombosis, 5 (3.0%) had bleeding tendency, and 13 (7.8%) died during admission. FDP levels increased with severity of COVID-19 symptoms (mild/moderate/severe; median 2.7/4.9/9.9 μg/mL, respectively). The |min1| ratios were elevated in all categories (1.27/1.61/1.58) in keeping with enhanced coagulation potential, with significant differences between mild cases and moderate to severe cases. The |FL-min1| ratios were also elevated in all groups (1.19/1.39/1.40), reflecting enhanced fibrinolytic potential. These data identified coagulation dominance in moderate to severe cases, but balanced coagulation and fibrinolysis in mild cases. There were significant differences in FDP and TAT, but no significant differences in |min1| or |FL-min1| ratios, between patients with and without thrombosis. CFWA monitoring of coagulation and fibrinolysis dynamics could provide valuable data for understanding hemostatic changes and disease status in COVID-19 patients.
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Affiliation(s)
- Tomoko Onishi
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Naruto Shimonishi
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiro Takeyama
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Shoko Furukawa
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenichi Ogiwara
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yuto Nakajima
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University, Kashihara, Japan
| | - Kiyomi Yoshimoto
- Department of General Medicine, Nara Medical University, Kashihara, Japan
| | - Satoki Inoue
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | | | - Hidetada Fukushima
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Ryuji Kawaguchi
- Department of Obstetrics and Gynecology, Nara Medical University, Kashihara, Japan
| | - Toshiya Nishikubo
- Neonatal Intensive Care Unit, Nara Medical University, Kashihara, Japan
| | - Masaharu Yamazaki
- Central Clinical Laboratory, Nara Medical University Hospital, Kashihara, Japan
| | - Yukio Oda
- SEKISUI MEDICAL CO., LTD, Tokyo, Japan
| | | | | | | | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Kinugawa K, Mano T, Yamatani Y, Miyasaka T, Kataoka H, Sugie K. Pain-Related Abnormal Neuronal Synchronization of the Nucleus Accumbens in Parkinson’s Disease. Brain Sci 2022; 12:brainsci12010084. [PMID: 35053828 PMCID: PMC8773786 DOI: 10.3390/brainsci12010084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with Parkinson’s disease (PD) often experience pain, which fluctuates in “on” and “off” states, but the underlying mechanism is unclear. The nucleus accumbens (NAc) is a central component of the mesolimbic dopaminergic pathway involved in pain processing. We conducted resting-state functional magnetic resonance imaging (rsfMRI) analysis to explore the relationship between the neuronal synchronization of NAc with pain-related brain regions and pain intensity in “on” and “off” states. We assessed 23 patients with sporadic PD based on rsfMRI and pain intensity using the revised Short-Form McGill Pain Questionnaire. Patients with PD displayed higher pain intensity scores in the “off” state than in the “on” state. The pain intensity in the “off” state was substantially correlated with the functional connectivity (FC) between the NAc and primary motor/sensory cortices and contralateral NAc. Changes in pain intensity from the “on” to “off” state displayed correlations with those between the right (rNA) and left NAc (lNAc) and the right precentral gyrus (rPreCG) /right insular cortex (rIC) from the “off” to “on” state. Aberrant bilateral NAc and rNAc–rPreCG/rIC FC in the “off” state were closely related to pain symptoms developed from the “on” to “off” states. These results suggest that the NAc in the mesolimbic pathway is related to pain in PD and may help understand the mechanism of pain development in patients with PD.
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Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan; (K.K.); (H.K.); (K.S.)
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan; (K.K.); (H.K.); (K.S.)
- Correspondence: ; Tel.: +81-744-22-3051
| | - Yuya Yamatani
- Division of Central Radiology, Nara Medical University Hospital, 840 Shijo-cho, Kashihara 634-8521, Japan;
| | - Toshiteru Miyasaka
- Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan;
| | - Hiroshi Kataoka
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan; (K.K.); (H.K.); (K.S.)
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan; (K.K.); (H.K.); (K.S.)
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Kataoka H, Isogawa M, Inoue T, Hasebe M, Takashima R, Kasama S, Nanaura H, Kiriyama T, Kasahara M, Sugie K. Zonisamide for the Efficacy of Sleep Abnormality in Parkinson's Disease (ZEAL Study): A Protocol for Randomized Controlled Trials. Front Neurol 2022; 12:741307. [PMID: 34970203 PMCID: PMC8713296 DOI: 10.3389/fneur.2021.741307] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Sleep disorders are one of the most frequent non-motor symptoms of Parkinson's disease (PD), and the efficacy of dopaminergic agents remains controversial. Clinical randomized control trials for the treatment of sleep disorders in PD are limited. Zonisamide (1,2-benzisoxazole-3-methanesulfonamide) improved motor symptoms and wearing-off in patients with PD. Patients with PD were reported to have dream-enacting behavior that was resolved after treatment with zonisamide. This study aimed to verify the safety and efficacy of zonisamide for sleep disorders and rapid eye movement (REM) sleep behavioral disorders using a mobile two-channel electroencephalography (EEG)/electrooculography (EOG) recording system. Methods and Analysis: The present study is a randomized placebo-controlled trial to determine the efficacy of zonisamide for sleep disorders in patients with PD. This study was designed to be single-blind, but the subject allocation is randomized by an independent allocation manager via computer-generated block randomization. The subjects in the treatment group took zonisamide (25 mg per day) before bedtime for 28 days. The sleep index is analyzed using a portable EEG/EOG recording system collected on two consecutive nights within 7 days prior to the intervention and reobtained on one night within 2 days after the 28-day administration of zonisamide. The amount of change in sleep efficiency before and after the 28-day administration will be compared between the zonisamide treatment group and placebo group concerning the primary endpoint. As for the secondary endpoint, the change in the ratio of other sleep parameters, including REM sleep without atonia, or sleep architecture will be evaluated. Ethics and Dissemination: The protocol was approved by the Nara Medical University Certified Review Board (CRB5200002). The trial was notified and registered with the Japan Registry of Clinical Trials (jRCTs051200160). Written informed consent will be obtained from every participant using informed consent approved by the CRB. The results of this trial will be disseminated through peer-reviewed scientific journals.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Masahiro Isogawa
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Miyoko Hasebe
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Ryuzo Takashima
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Shu Kasama
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Hitoki Nanaura
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Masato Kasahara
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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Izumi T, Nanaura H, Iguchi N, Ozaki M, Sugie K. Serum Alkaline Phosphatase in Cryptogenic Stroke Cases with Active Cancer. Intern Med 2022; 61:639-646. [PMID: 35228475 PMCID: PMC8943387 DOI: 10.2169/internalmedicine.7550-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective We assessed the relationship between the levels of serum alkaline phosphatase, which is often increased with biliary obstruction and bone metastasis, and active cancer in patients with cryptogenic stroke. Methods Serum alkaline phosphatase levels in patients with cryptogenic stroke sampled upon admission were measured using the Japan Society of Clinical Chemistry method used in Japan. Active cancer was defined as a new diagnosis, treatment, progression, or recurrence within six months before admission or metastatic cancer. Multivariate logistic regression analyses were performed to explore the relationship between serum alkaline phosphatase and active cancer in these patients. Results Among the 249 patients classified as having cryptogenic stroke, 64 had active cancer. Patients with cryptogenic stroke with active cancer had significantly higher serum alkaline phosphatase levels (486±497 vs. 259±88.2 U/L; p<0.001) than those without cancer. Multivariate logistic analysis revealed that serum alkaline phosphatase levels ≥286 U/L were associated with cryptogenic stroke with active cancer [odds ratio (OR), 2.669, 95% confidence interval (CI), 1.291-5.517; p=0.008] independent of age ≤70 years old (OR, 3.303, 95% CI, 1.569-6.994; p=0.002), male sex (OR, 0.806, 95% CI, 0.380-1.710; p=0.573), and serum D-dimer levels ≥2.6 μg/mL (OR, 18.78, 95% CI, 8.130-43.40; p<0.001). Conclusion In patients with cryptogenic stroke, high serum alkaline phosphatase levels may be related to active cancer.
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Affiliation(s)
- Tesseki Izumi
- Department of Neurology, Nara Medical University, Japan
| | | | | | - Maki Ozaki
- Department of Neurology, Nara Medical University, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Japan
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Shobatake R, Ota H, Takahashi N, Ueno S, Sugie K, Takasawa S. Anorexigenic Effects of Intermittent Hypoxia on the Gut-Brain Axis in Sleep Apnea Syndrome. Int J Mol Sci 2021; 23:364. [PMID: 35008784 PMCID: PMC8745445 DOI: 10.3390/ijms23010364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/07/2023] Open
Abstract
Sleep apnea syndrome (SAS) is a breathing disorder characterized by recurrent episodes of upper-airway collapse, resulting in intermittent hypoxia (IH) during sleep. Experimental studies with animals and cellular models have indicated that IH leads to attenuation of glucose-induced insulin secretion from pancreatic β cells and to enhancement of insulin resistance in peripheral tissues and cells, such as the liver (hepatocytes), adipose tissue (adipocytes), and skeletal muscles (myocytes), both of which could lead to obesity. Although obesity is widely recognized as a major factor in SAS, it is controversial whether the development of SAS could contribute directly to obesity, and the effect of IH on the expression of appetite regulatory genes remains elusive. Appetite is regulated appropriately by both the hypothalamus and the gut as a gut-brain axis driven by differential neural and hormonal signals. In this review, we summarized the recent epidemiological findings on the relationship between SAS and feeding behavior and focused on the anorexigenic effects of IH on the gut-brain axis by the IH-induced up-regulation of proopiomelanocortin and cocaine- and amphetamine-regulated transcript in neuronal cells and the IH-induced up-regulation of peptide YY, glucagon-like peptide-1 and neurotensin in enteroendocrine cells and their molecular mechanisms.
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Affiliation(s)
- Ryogo Shobatake
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan; (S.U.); (K.S.)
- Department of Neurology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara 630-8305, Japan;
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan;
| | - Hiroyo Ota
- Department Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan;
| | - Nobuyuki Takahashi
- Department of Neurology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara 630-8305, Japan;
| | - Satoshi Ueno
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan; (S.U.); (K.S.)
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan; (S.U.); (K.S.)
| | - Shin Takasawa
- Department of Biochemistry, Nara Medical University, 840 Shijo-cho, Kashihara 634-8521, Japan;
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50
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Nishimori Y, Iida A, Ogasawara M, Okubo M, Yonenobu Y, Kinoshita M, Sugie K, Noguchi S, Nishino I. TNNI1 Mutated in Autosomal Dominant Proximal Arthrogryposis. Neurol Genet 2021; 8:e649. [PMID: 34934811 PMCID: PMC8682965 DOI: 10.1212/nxg.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
Objectives The main objective of this case report is to identify a gene associated with a Japanese family with autosomal dominant arthrogryposis. Methods We performed clinicopathologic diagnosis and genomic analysis using trio-based exome sequencing. Results A 14-year-old boy had contractures in the proximal joints, and the serum creatine kinase level was elevated. Muscle biopsy demonstrated a moth-eaten appearance in some type 1 fibers, and electron microscopic analysis revealed that type 1 fibers had Z disk streaming. We identified a heterozygous nonsense variant, c.523A>T (p.K175*), in TNNI1 in the family. Discussion The altered amino acid residue is within the tropomyosin-binding site near the C-terminus, in a region homologous to the variational hotspot of Troponin I2 (TNNI2), which is associated with distal arthrogryposis type 1 and 2b. Compared with patients with TNNI2 variants, our patient had a milder phenotype and proximal arthrogryposis. We report here a case of proximal arthrogryposis associated with a TNNI1 nonsense variant, which expands the genetic and clinical spectrum of this disease. Further functional and genetic studies are required to clarify the role of TNNI1 in the disease.
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Affiliation(s)
- Yukako Nishimori
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aritoshi Iida
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masashi Ogasawara
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mariko Okubo
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Yonenobu
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Kinoshita
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuma Sugie
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoru Noguchi
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research (Y.N., M.O., M.O., S.N., I.N.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan; Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Tokyo, Japan (Y.N., A.I., I.N.); Department of Neurology (Y.N., K.S.), Nara Medical University, Nara, Japan; Department of Neurology (Y.Y., M.K.), Osaka University Graduate School of Medicine, Osaka, Japan
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