Self-Supporting Hybrid Supercapacitor Electrodes Based on Carbon Nanotube and Activated Carbons

Self-supporting AC (activated carbon)-FWCNT (few-wall carbon nanotubes) hybrid electrodes were fabricated by mixing of ACs with high specific surface area (SSA) and sub-millimeter-long FWCNTs. In order to fabricate the hybrid electrodes, AC and FWCNT were mixed in a weight ratio of 9:1, dispersed by bath-sonication and vacuum-filtrated on a membrane filter. The addition of FWCNTs gives conductivity and mechanical strength, and replace metallic current collectors in thick (0.1 mm) electrodes. For making an electrode, three different ACs that derived from walnut shell (WS), that from apricot stones (AS), and that commercially used for capacitors (YP-80F, Kuraray Chemical Co., Osaka Japan), were used with FWCNT in weight ratio of AC:FWCNT = 9:1. An electrode based only on FWCNT was also prepared as a reference for comparison. Electrochemical properties of the obtained electrodes were investigated by the cyclic voltammetry method (CV). Electrochemical characteristics were measured using the three-electrode cell contained of YP80F-FWCNT, AS-FWCNT, WS-FWCNT as a working electrode, a YP-80F-FWCNT counter electrode and a Ag/AgCl reference electrode with an electrolyte of 1 M Na2SO4 aqueous solution. Also, the morphological properties of obtained electrodes were studied using scanning electron microscope (SEM), the SSA was investigated by the Brunauer-Emmett-Teller analysis. SSA, conductivity, and resistivity of AS-FWCNT and WS-FWCNT electrodes were summarized. Both the AS-FWCNT and WS-FWCNT hybrid electrodes showed specific capacitances of about 140 F/g at 1 mV/s and about 100 F/g at 100 mV/s, which are similar or even better than the AC-CNT hybrid electrode made of commercialized AC (YP-80F).

Clinical, pathologic and genetic studies on autosomal recessive early-onset parkinsonism with diurnal fluctuation

To clarify the genetic mode and clinical characteristics of familial early-onset parkinsonism with diurnal fluctuation, we studied 43 patients from 22 families. The estimated segregation ratio (0.2963) and absence of gender preponderance indicated autosomal recessive inheritance. Clinical features included the average age at onset of 26.1 years, parkinsonism with marked diurnal fluctuation, remarkable effect of levodopa, dyskinesias, dystonia, hyperreflexia, absence of dementia, and a benign course; autonomic symptoms were only mild if present. Autopsy study in one of our patients disclosed neuronal loss without Lewy bodies and the presence of melanin-poor neurons in the substantia nigra. Linkage analysis on 16 families mapped the disease gene to chromosome 6q25.2-27.

Clinical features of non-hypertensive lobar intracerebral hemorrhage related to cerebral amyloid angiopathy

BACKGROUND AND PURPOSE

The present study aims to clarify the clinical features of non-hypertensive cerebral amyloid angiopathy-related lobar intracerebral hemorrhage (CAA-L-ICH).

METHODS

We investigated clinical, laboratory, and neuroimaging findings in 41 patients (30, women; 11, men) with pathologically supported CAA-L-ICH from 303 non-hypertensive Japanese patients aged >OR=55, identified via a nationwide survey as symptomatic CAA-L-ICH.

RESULTS

The mean age of patients at onset of CAA-L-ICH was 73.2 +/- 7.4 years; the number of patients increased with age. The corrected female-to-male ratio for the population was 2.2, with significant female predominance. At onset, 7.3% of patients received anti-platelet therapy. In brain imaging studies, the actual frequency of CAA-L-ICHs was higher in the frontal and parietal lobes; however, after correcting for the estimated cortical volume, the parietal lobe was found to be the most frequently affected. CAA-L-ICH recurred in 31.7% of patients during the average 35.3-month follow-up period. The mean interval between intracerebral hemorrhages (ICHs) was 11.3 months. The case fatality rate was 12.2% at 1 month and 19.5% at 12 months after initial ICH. In 97.1% of patients, neurosurgical procedures were performed without uncontrollable intraoperative or post-operative hemorrhage.

CONCLUSIONS

Our study revealed the clinical features of non-hypertensive CAA-L-ICH, including its parietal predilection, which will require further study with a larger number of patients with different ethnic backgrounds.

Positron-emission tomography of brain regions activated by recognition of familiar music

BACKGROUND AND PURPOSE

We can easily recognize familiar music by listening to only one or 2 of its opening bars, but the brain regions that participate in this cognitive processing remain undetermined. We used positron-emission tomography (PET) to study changes in regional cerebral blood flow (rCBF) that occur during listening to familiar music.

METHODS

We used a PET subtraction technique to elucidate the brain regions associated with the recognition of familiar melodies such as well-known nursery tunes. Nonmusicians performed 2 kinds of musical tasks: judging the familiarity of musical pieces (familiarity task) and detecting deliberately altered notes in the pieces (alteration-detecting task).

RESULTS

During the familiarity task, bilateral anterior portions of bilateral temporal lobes, superior temporal regions, and parahippocampal gyri were activated. The alteration-detecting task bilaterally activated regions in the precunei, superior/inferior parietal lobules, and lateral surface of frontal lobes, which seemed to show a correlation with the analysis of music.

CONCLUSION

We hypothesize that during the familiarity task, activated brain regions participate in retrieval from long-term memory and verbal and emotional processing of familiar melodies. Our results reinforced the hypothesis reported in the literature as a result of group and case studies, that temporal lobe regions participate in the recognition of familiar melodies.

Dysferlin mutations in Japanese Miyoshi myopathy: relationship to phenotype

OBJECTIVE

To study dysferlin gene mutations and genotype-phenotype correlations in Japanese patients with Miyoshi myopathy (MM).

BACKGROUND

MM is an autosomal recessive distal muscular dystrophy that arises from mutations in the dysferlin gene. This gene is also mutated in families with limb girdle muscular dystrophy 2B.

METHODS

The authors examined 25 Japanese patients with MM. Genomic DNA was extracted from the peripheral lymphocytes of the patients. The PCR products of each of 55 exons were screened by single strand conformation polymorphism or direct sequencing from the PCR fragments.

RESULTS

The authors identified 16 different mutations in 20 patients with MM; 10 were novel. Mutations in Japanese patients are distributed along the entire length of the gene.

CONCLUSIONS

Four mutations (C1939G, G3370T, 3746delG, and 4870delT) are relatively more prevalent in this population, accounting for 60% of the mutations in this study. This study revealed that the G3370T mutation was associated with milder forms of MM and the G3510A mutation was associated with a more severe form.

Influence of metallic chlorides on the formation of PCDD/Fs during low-temperature oxidation of carbon

Experimental study was conducted to clarify the formation behavior of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) from carbonaceous materials through a de novo synthesis route. Samples were prepared by changing mixing method and composite state of metallic chloride in graphite powder in order to simulate the texture of "unburned carbonaceous particles", i.e., soot, formed in thermal processes. Reagents of KCl, CaCl2. 2H2O, FeCl3 x 6H2O, and CuCl2 x 2H2O were used as chlorine sources and were added to graphite powder with different methods. The composite state of metallic chloride was varied by preliminary treatments: hand-mixing, mixed-grinding using a high-intensity ball mill, and preheating at different temperatures between 500 and 1100 degrees C. In the de novo experiment, reaction temperature and oxygen concentration of flowed gas were set at 300 degrees C and 2.5 mol %, respectively. During the experiment, formation rates of CO and CO2 and the formed amounts of organic chlorine and PCDD/Fs were measured. The results show a reasonable relation between the amount of formed organic chlorine and oxidation rate of carbon, and the order of the activity of metallic chlorines was obtained as KCl < CaCl2 < FeCl3 << CuCl2. Furthermore, it was found that the effect of the composite state of metallic chloride on the formation of PCDD/Fs significantly depends on the kind of metal. The results will give useful information to examine the formation mechanism of PCDD/Fs from unburned carbon particles in thermal processes.

Early-onset, rapidly progressive familial tauopathy with R406W mutation

An early-onset and rapidly progressive familial tauopathy with R406W mutation is described. The patient was a 47-year-old man who first presented with psychiatric symptoms followed by overt dementia at age 52 and died 1 year later. Postmortem study revealed tangle-associated neuronal degeneration, accentuated in the medial temporal lobe. R406W mutation was determined by sequence analysis and immunocytochemically with anti-mutant tau antibody.

[Neurological and neuropathological studies of amyotrophic lateral sclerosis/parkinsonism-dementia complex in the Kii Peninsula of Japan]

Hohara and Kozagawa in the Kii peninsula of Japan are reported to be high-incidence foci of amyotrophic lateral sclerosis (Kii ALS) and parkinsonism-dementia complex (Kii PDC). During the period between 1996 and 1999, three Kii ALS patients and 19 Kii PDC patients were confirmed neurologically in Hohara among which, one Kii ALS patient and two Kii PDC patients were examined neuropathologically. The ratio of positive family history where ALS or PDC occurred within the fourth degree of the relatives was 33.3% in the patients with Kii ALS, 78.9% in those with Kii PDC, and 72.7% in total. The ages of onset were between 57 years and 63 years (mean age: 60.0 years) in the patients with Kii ALS and between 53 years and 74 years (mean age: 66.5 years) in those with Kii PDC. All of the Kii ALS patients were female, and the male to female ratio of the Kii PDC patients was 1:1.7. The clinical features of Kii ALS were basically similar to those of classical ALS. The core clinical features of Kii PDC consisted of dementia and parkinsonism, frequently accompanied by motor neuron symptoms. The cardinal neuropathological features of Kii ALS/PDC included many neurofibrillary tangles (NFTs) associated with loss of nerve cells in the cerebral cortex and the brain stem, as well as morphological alterations diagnostic of ALS. Ultrastructurally, NFTs consisted of paired helical filaments. When we compared the clinical features of these Kii ALS patients with those that had been surveyed in 1969, the male to female ratio changed from male dominance to female dominance and the mean age of the onset of the disease was delayed by approximately 10 years. The most frequent initial symptom had been weakness of the lower limbs in the survey in 1969 and was bulbar palsy in this study. As to Kii PDC, this is the first report of the clinical features of many cases.

Drug-induced psychotic symptoms in Parkinson's disease. Problems, management and dilemma

Psychotic symptoms develop in 20-30% of patients with Parkinson's disease (PD) receiving chronic anti-PD medications, and visual hallucinations with or without delirium and paranoid delusions are the most frequent symptoms. Psychotic symptoms disturb ADL and QOL of PD patients and tax caregivers far more than the motor disabilities do, and good management of drug-induced psychotic symptoms is potentially important. Withdrawal of anti-PD drugs relieves the patients from psychotic side effects, but worsens the parkinsonian motor symptoms. The first step of treatment is to eliminate triggering factors other than anti-PD drugs, such as infections, metabolic disorders, subdural hematoma, and hallucinogenic drugs. The second step is to eliminate anti-PD drugs in the following order; first anticholinergics, amantadine and selegiline, second dopamine agonists, and finally levodopa/carbidopa. Anti-PD medications should be reduced to the point of improving psychotic side effects without drastically worsening parkinsonian motor symptoms. When the above adjustments fail to sufficiently alleviate psychotic side effects, the third step is consideration of antipsychotic drugs although they have potential capacity to antagonize dopamine D2 receptors and worsen parkinsonism. Atypical antipsychotics such as clozapine and olanzapine are recommended, though the former is not available in Japan.

Large-scale, multicenter study of cerebrospinal fluid tau protein phosphorylated at serine 199 for the antemortem diagnosis of Alzheimer's disease

We surveyed a total of 570 cerebrospinal fluid (CSF) samples from a variety of diseases, including Alzheimer's disease (AD; n = 236), non-AD-demented and nondemented diseases (n = 239), and normal controls (n = 95) to quantitate levels of tau protein phosphorylated at serine 199 (CSF/phospho-tau199) by a recently established sandwich ELISA. The CSF/phospho-tau199 levels in the AD group were significantly elevated compared to those in all the other non-AD groups. Receiver operating characteristics curves showed that the diagnostic sensitivity and specificity for the AD group vs all the other non-AD groups using the CSF/phospho-tau199 were 85.2% and 85.0%, respectively. Furthermore, there was a significant positive correlation between CSF/phospho-tau199 and CSF/total-tau levels in the AD group. Elevated CSF/phospho-tau199 in the AD group was noted irrespective of age, gender, dementia severity, and number of apolipoprotein E4 alleles. Thus, we suggest that CSF/phospho-tau199 may be a novel and logical biomarker in supporting antemortem diagnosis of AD.

Activated brain regions in musicians during an ensemble: a PET study

As in visual processing, we speculated that, in music processing, different brain regions would activate according to the mode of music listening. Using motets by a famous composer, we studied changes in regional cerebral blood flow (rCBF) with positron emission tomography associated with concentrating on the alto-part within the harmony (alto-part-listening condition) compared to listening to the harmony as a whole (harmony-listening condition). The alto-part-listening condition was associated with bilateral increases of rCBF in superior parietal lobules, precunei, premotor areas and orbital frontal cortices. Superior parietal lobules are likely to be responsible for auditory selective attention to the alto part within the harmony and the analysis of tone pitch on a mental score. The precuneus possibly participated in writing tones of the alto part on a mental score. Based on our findings, we propose that both auditory selective attention and analytic processing play an important role in concentrating on a certain vocal part within a harmony. During the harmony-listening condition, temporal poles, the anterior portion of the cingulate gyrus, occipital cortex and the medial surface of the cerebellum were bilaterally activated. Further studies are necessary to clarify the difference in music processing between musicians and nonmusicians.

[A case of sarcoidosis with simultaneous involvement of the lower brainstem and the whole cervical cord and the extraocular muscles]

We report a 63-year-old woman with sarcoidosis which involved the spinal cord, lower brainstem and extraocular muscules simultaneously. In this patient, uveitis developed in 1991 and the skin lesion in 1992. A biopsy of the skin lesion showed changes consistent with sarcoidosis. The ocular and dermal symptoms improved with oral corticosteroid. In October 1997, she noted the left blepharoptosis and numbness of the hands. The MRI showed diffuse swelling of the lower brainstem and the cervical and upper thoracic cord. These lesions showed high intensity signal on T2WI and low intensity signal on T1WI. T1WI with contrast enhancement revealed localized enhancement within the spinal lesion at the C4/5 level. The ocular MRI showed swelling of the left superior rectus muscle and upper levator palpebral muscle. The steroid pulse therapy and subsequent oral administration of prednisolone markedly improved the clinical symptoms. MRI after treatment showed marked improvement of both the spinal cord and ocular muscle lesions. To our knowledge, the simultaneous occurrence of myelopathy and symptomatic extraocular musculopathy in the condition has not been reported previously.

Familial amyotrophic lateral sclerosis and parkinsonism-dementia complex of the Kii Peninsula of Japan: clinical and neuropathological study and tau analysis

We report the first case of neuropathologically verified parkinsonism-dementia complex of the Kii peninsula, together with the patient's brother, who had amyotrophic lateral sclerosis. The propositus woman developed parkinsonism and dementia at 63 years of age and died at 70 without displaying clinical features of amyotrophic lateral sclerosis. The brain exhibited marked atrophy of the frontal and temporal lobes. Microscopically, there were many neurofibrillary tangles in the central nervous system, most markedly in the mesial temporal lobe and deep nuclei, as well as changes of amyotrophic lateral sclerosis but no senile plaques or Lewy bodies. Neurofibrillary tangles exhibited twisted tubule structures on electon microscopic examination, and an analysis of insoluble tau protein extracted from the fresh brain revealed a 60-, 64-, 68-kD triplet. The tau gene exhibited no mutations. Her brother developed progressive bulbar palsy-type amyotrophic lateral sclerosis at 45 years of age and died at 49 without presenting with dementia or parkinsonism. Neuropathological examination revealed not only pathologic features of amyotrophic lateral sclerosis but also a moderate number of neurofibrillary tangles in the temporal cortex and deep nuclei. The siblings were neuropathologically similar despite their different clinical manifestations. These findings suggest that amyotrophic lateral sclerosis and parkinsonism-dementia complex of this family may be phenotypic variants of a tauopathy caused by genetic abnormalities.

Cerebral atrophy and convulsive seizures after recovery from cerebral edema and coma in a patient with fulminant hepatitis B

We report a 48-year-old woman who developed convulsive seizures and cerebral atrophy after recovery from fulminant hepatitis B with coma and cerebral edema at the acute stage. Neurological disturbances and cerebral signs are rare sequelae of fulminant hepatic failure (FHF); only a few cases have reported in the literature. Cortical laminar necrosis secondary to cerebral edema or delayed neuronal death due to toxic substances may have caused delayed brain atrophy and epileptogenesis.

A novelCLCN1 mutation: P480T in a Japanese family with Thomsen's myotonia congenita

At least 50 disease-causing mutations in the skeletal muscle voltage-gated chloride channel gene (CLCN1), almost all of which originate from Caucasian families, have been identified. We investigated a Japanese family with Thomsen's myotonia congenita that included 16 affected individuals (8 men and 8 women) through five generations. Polymerase chain reaction (PCR)-single-strand conformation polymorphism (SSCP) screening of 11 members showed an aberrant conformer in exon 13 of CLCN1 complementary DNA (cDNA) in 8 affected and 1 unaffected members. By sequence analysis, we identified a C-to-A transition at nucleotide position 1438, resulting in a substitution of proline for threonine at amino acid position 480 (P480T), the same position of the original mutation (P480L) in Thomsen's disease. The P480T mutation was novel and absent in 100 normal controls. Seven of the 8 affected individuals were heterozygous; another, from affected parents, was homozygous. Clinically, myotonia in the homozygous patient was more severe than that in heterozygous patients, probably due to the gene dosage effect. On a long-train nerve-stimulation test at a rate of 3 Hz, M-wave responses in the homozygous patient showed marked decrement followed by recovery. In contrast, the heterozygous patients showed just a slight decrement or no changes, and none of 2 patients with myotonic muscular dystrophy or 2 normal controls revealed any decrement. Thus, the long-train nerve-stimulation test at a low stimulus frequency may be a useful tool to assess the disease-severity/genotype relationship in myotonia congenita.

Geographical distribution of amyotrophic lateral sclerosis with neurofibrillary tangles in the Kii Peninsula of Japan

Between 1984 and 1996 we histopathologically examined 26 autopsy cases of amyotrophic lateral sclerosis (ALS) from the Mie Prefecture in eastern and southern Kii Peninsula, which includes the Hohara ALS focus. Four of the individuals had a moderate number of neurofibrillary tangles in the locus coeruleus, substantia nigra, raphe nucleus, periaqueductal grey and hippocampus in addition to the histological changes of ALS. All four came from the vicinity of Hohara; symptoms of ALS developed in 1979, 1987, 1991 and 1993. Two had family history of ALS, and one, of parkinsonism-dementia. These findings confirm that Kii type ALS occurs continuously in and near the Hohara focus.

[Changes of autonomic functions by endoscopic upper thoracic sympathectomy on idiopathic hyperhidrosis]

Changes of autonomic functions before and after bilateral endoscopic upper thoracic sympathectomy (EUTS) were evaluated in 13 patients with idiopathic hyperhidrosis, with the sympathetic skin response, coefficient of variation of R-R intervals, mean heart rate, thermography, and non-invasive Valsalva test of the tonometry method. EUTS electronically destructs the upper thoracic sympathetic ganglions which innervate the upper extremities, and partially the heart. The decrement of mean heart rate, and persistent inhibition of the vascular contraction and hidrosis of the hands appeared after EUTS. These manifestations were effect produced by the abortion of sympathetic activity by EUTS. In 10 of the 12 cases, the baroreceptor sensitivity index II of Valsalva test which reflects the sympathetic autonomic nervous function of the heart showed normal pattern after EUTS. Four cases revealed reincrement of both the blood pressure and heart rate at the latter half phase of the second stage of the Valsalva test. The sympathetic dysfunction of the heart was limited to the decrement of mean heart rate although EUTS partially destroys sympathetic fibers innervating the heart. A long-term study is necessary to evaluate the effect of EUTS on the cardiac function.

[Essential points to differentiate various diseases causing parkinsonism]

This review article deals with the cardinal features to differentiate various conditions which present with parkinsonism, other than Parkinson's disease, Lewy body disease, progressive supranuclear palsy and corticobasal degeneration. Special attention is paid to the distinctive clinical features, laboratory data and neuroimaging findings of frequent diseases as well as important ones including multiple system atrophies(MSA), drug-induced parkinsonism, vascular pseudo-parkinsonism and manganese intoxication due to parenteral nutrition. MRI is useful to diagnose MSA, vascular pseudo-parkinsonism and manganese intoxication. Benzamide derivatives including sulpiride, tiapride, metoclopramide and cisapride are the main causes of drug-induced parkinsonism in recent years in Japan.

Autosomal recessive early-onset parkinsonism with diurnal fluctuation: clinicopathologic characteristics and molecular genetic identification

Autosomal recessive early-onset parkinsonism with diurnal fluctuation (AR-EPDF, syn. autosomal recessive juvenile parkinsonism, PARK2) is one of the hereditary parkinsonian syndromes. We examined subjects consisting of 43 patients from 22 families with AR-EPDF. The clinical features were relatively homogeneous, including the average age at onset of 26.1 years, beginning with dystonic gait disturbance, diurnal fluctuation of the symptoms (sleep benefit) unrelated to medication, dystonia (mainly foot dystonia), hyperactive tendon reflex, remarkable effect of levodopa and other antiparkinsonism drugs, susceptibility to dopa-induced dyskinesia, mild autonomic symptoms, absence of dementia, and slow progression of disease. Some patients had hysteric character or psychic symptoms provoked by medication. Pathologic study revealed neuronal loss in the substantia nigra pars compacta and locus coeruleus without Lewy body formation. We performed extensive molecular genetic analysis of the parkin gene in 16 families to identify a total of six different deletional mutations. In AR-EPDF loss of newly discovered 'Parkin' protein is responsible for selective degeneration of the pigmented neurons in the substantia nigra and locus coeruleus. Compared with autosomal dominant Parkinson's disease, AR-EPDF appears to be more prevalent and present in several ethnic groups.

Widespread expression of alpha-synuclein and tau immunoreactivity in Hallervorden-Spatz syndrome with protracted clinical course

Hallervorden-Spatz syndrome (HSS) is a rare autosomal recessive disorder clinically characterized by extrapyramidal signs and progressive dementia. In a typical case, the clinical symptoms become apparent during late childhood, and usually the course is protracted over a decade or more. We recently had an opportunity to study the brains of two cases of HSS with a clinical course of over 30 years. Case 1 was a 44-year-old female and case 2 was a 37-year-old male. Grossly, the brains showed severe fronto-temporal lobar atrophy with abundant spheroids and mild iron deposits in the globus pallidus, associated with features of motor neuron disease. In addition, there was diffuse sponginess in the atrophic cortex as well as widespread Alzheimer's neurofibrillary tangles (NFTs) and Lewy bodies (LBs) in the cortical and subcortical regions, including the spinal cord. Ultrastructurally, NFTs were composed of paired helical filaments, and LBs of central dense cores with radiating fibrils. Discrete immunostaining was demonstrated in NFTs and neuropil threads with various antibodies against phosphorylated tau, and in LBs with antibody against alpha-synuclein. In addition, diffuse, overlapping immunoreactivity of alpha-synuclein and phosphorylated tau was seen within the cytoplasm of many neurons. However, when LBs and NFTs coexisted within the same neurons, they were clearly segregated. The findings of our present cases as well as those reported in the literature may indicate that simultaneous and extensive occurrence of abnormal phosphorylation of tau and accumulation of alpha-synuclein may constitute cardinal pathological features of HSS with protracted clinical course.

[A 59-year-old woman with recurrent convulsive seizures, cerebral infarctions, dementia, and intracranial calcifications]

A 59-year-old woman with recurrent seizures and progressive dementia is reported. Her past history and familial history were unremarkable. She became short-tempered at 56 years old (Oct. 1991). She had the first seizure attack and was admitted to a hospital at March 4, 1993, with prolonged disturbance of consciousness and subsequent mental deterioration. Her brain CT showed multiple small calcifications in the subcortical white matter and pons. The laboratory data including blood count, serum chemistry, serological studies and CSF was normal. MRI and digital subtraction angiography of the cranial vessels were unremarkable. There was a decrease in accumulation in the right cerebral hemisphere on 123I IMP SPECT. Despite anti-convulsant therapy, she had recurrent seizures several times, with gradual worsening of her mental state. She had the latest seizure attack and was transferred to Matsusaka Chuo Hospital, on August 29, 1993. After the attack she had been in the apallic state, and died on Nov. 13, 1995. This case was discussed in a neurological CPC. The discussants suggested that the isolated angiitis of the central nervous system caused secondary seizures and cerebral infarctions. Post-mortem examination revealed the CNS findings of vasculitis at various stages, calcification or mineralization mainly in the subcortical white matter and pons, massive cerebral infarctions with massive exudate, fresh and old small bleedings and exudate around the inflamed or calcified vessels. The white matter degeneration resembled that of Binswanger leukoencephalopathy. The final pathological diagnosis was isolated angiitis of the central nervous system since there was no inflammatory changes or atherosclerotic change of the blood vessels in the extracranial organs.

[Encephalomyelopathy demonstrated on MRI in a case of chronic toluene intoxication]

Myelopathy in chronic toluene intoxication is rare. We present obvious lesions of the spinal cord on MRI in a 30-year-old Japanese man with chronic toluene intoxication. He had abused toluene for more than 10 years, and developed visual impairment, horizontal nystagmus, pyramidal tract signs, postural tremor, Romberg's sign, and sensory disturbance below the level of Th 2 dermatome. Anti-HTLV-1 antibody titer and vitamin B12 level in the serum were within normal limits. Biochemical analysis showed no increase of very long chain fatty acids. Cerebrospinal fluid showed no abnormal findings. Auditory brainstem response showed delay of I-V interpeak latency. Somatosensory evoked potential with the median nerve stimulation showed delay of N13-N20 central conduction time, which was later followed by absence of N14-N20 components. On MRI in T2 weighted image, marked high intensity was demonstrated in the posterior limbs of the internal capsule, and in the posterior columns and lateral tracts from the cervical through the upper thoracic cord. Cerebral lesions probably reflect demyelination and axonal degeneration produced by chronic toluene abuse. Spinal cord lesions seem to be secondary to nerve fiber changes more proximal to the nerve cell bodies.

[Complex visual hallucination in the quadrantanopsic field in a patient with a medial temporal hematoma following left putaminal hemorrhage]

A 56-year-old man with a left medial temporal lobe hematoma from the left putaminal hemorrhage presented with complex visual hallucinations in the right quadrantanopsic field. In the right superior quadrantanopsic field, he saw colored and formed hallucinations of plants, bamboo thickets and a stature of bodhisattva. Most of these hallucinations were what he had actually seen before. The visual hallucinations disappeared when he gazed them with saccadic eye movements. EEG showed no epileptic discharges. MRI revealed hematoma from the lower putamen to the medial temporal lobe including amygdala on the left. 123I-IMP SPECT showed hypoperfusion in the left temporal lobe and in the left occipital and parietal lobes. We speculate that the hallucinations of the present case were produced by the dysfunctions not only of the temporooccipital and temporoparietal regions but also of the posterior inferotemporal cortex which has strong interactions with amygdala and works as the visual memory center.

[Phase 1 clinical study of 123I-FP-CIT, a new radioligand for evaluating dopamine transporter by SPECT (II): Tracer kinetics in the brain]

The kinetics of 123I-FP-CIT in the brain for healthy subjects were studied. Twelve dynamic SPECT data sets (0- to 6-hr after an intravenous injection) from a Phase 1 clinical trial of 123I-FP-CIT were analyzed. Tracer concentrations in the striatum, midbrain, cerebellum and cerebral cortex were measured on the SPECT images co-registered with the corresponding MR images. High tracer accumulation was observed in the striatum, which peaked at 60 min post-injection, followed by slow elimination (3%/hr). The kinetics were similar both in the cerebellum and in the cerebral cortex, which peaked at 15 min post-injection, followed by rapid elimination. Tracer accumulation in the midbrain was higher than in the cerebellum and cerebral cortex. The striatal specific/nonspecific binding ratio ((striatal-occipital)/occipital concentration ratio) was stable at 3-hr post-injection and later at a value of 3, suggesting that the specific binding of 123I-FP-CIT could be evaluated from a single SPECT image at 3- to 6-hr post-injection. The specific/nonspecific binding ratio at 4-hr post-injection showed a negative correlation with aging (r = -0.70, p = 0.01), with a decrease rate of 11%/decade (95% confidence interval: 3%-19%/decade).

Apolipoprotein E phenotypes in healthy normal controls and demented subjects with Alzheimer's disease and vascular dementia in Mie Prefecture of Japan

In order to clarify the association between apolipoprotein E4 (ApoE4) and the pathogenesis of Alzheimer's disease (AD), we analyzed the distribution of the apolipoprotein E (ApoE) phenotypes and the frequency of the apo E alleles epsilon2, epsilon3, and epsilon4 in Japanese healthy controls (n = 1090, an average age of 51.2+/-12.6 years) and demented patients (n=103, mean age of 73.6+/-9.2 years). Demented subjects were divided into three subgroups: early-onset AD group (EOAD; n=25, mean age 63.0+/-6.2 years), late-onset AD group (LOAD; n=33, mean age 79.3+/-5.1 years), and vascular dementia group (VD; n=45, mean age 75.3+/-8.0 years). The apolipoprotein E phenotype was determined by isoelectric focusing and immunoblotting. There were no significant differences in the distribution of the apo E phenotypes by gender or age, and the estimated frequencies of epsilon2, epsilon3 and epsilon4 were 0.05, 0.86 and 0.09, respectively, in the normal controls. There was a significant difference in the distribution of the apo E phenotypes between LOAD and elderly controls aged more than 65 years (P<0.0001). The distribution of the apo E phenotypes in EOAD was the same as that in LOAD. The frequency of the epsilon4 allele was significantly higher in LOAD (0.35, P<0.0001) and EOAD (0.28, P<0.0001) than that in the control subjects (0.07), but not in VD (0.12, P=0.1630). The present findings suggest that ApoE4 is related with both EOAD and LOAD, but not with VD, and support the hypothesis that it is a genetic risk factor of AD.

Accumulation of neurofilaments and SOD1-immunoreactive products in a patient with familial amyotrophic lateral sclerosis with I113T SOD1 mutation

OBJECTIVE

To report neuropathologic features of argyrophilic inclusions in the anterior horn cells, motor cortex Betz cells, and neurons of the medullary reticular formation, spinal posterior horn, and Clarke column in a Japanese case of familial amyotrophic lateral sclerosis with I113T substitution in exon 4 of the copper-zinc superoxide dismutase (SOD1) gene.

METHODS AND RESULTS

These inclusions were stained pale pink on the hematoxylin-eosin stain and dark on the Bielschowsky stain. They were positive for antibodies to phosphorylated neurofilaments, ubiquitin, and SOD1. On electron microscopy, they consisted of abundant intermediate filaments of 10 to 20 nm in diameter with disordered array indicating neurofilaments.

CONCLUSION

These findings suggest that the I113T mutation induces accumulation of neurofilaments and SOD1 in the central nervous system neurons.

Novel chloride channel gene mutations in two unrelated Japanese families with Becker's autosomal recessive generalized myotonia

We investigated the skeletal muscle voltage-gated chloride channel gene (CLCN1) in two unrelated Japanese patients with Becker's myotonia congenita. The non-myotonic parents of each patient were consanguineous. The proband of each family shares generalized myotonia, transient weakness after rest, and leg muscle hypertrophy. However, the disease severity related to the degree of myotonia differed, even in view of the response to long train nerve stimulation tests. CLCN1 gene analysis revealed a novel Ala659Val missense mutation identified to be homozygous in the more severe patient, while a novel Gln445Stop nonsense mutation was present in the other patient. Both mutations were absent in 90 Japanese normal controls. This is the first report of Japanese cases of Becker's myotonia congenita with CLCN1 gene mutations.

[Phase 1 clinical study of 123I-FP-CIT, a new radioligand for evaluating dopamine transporter with SPECT (I): Biodistribution and absorbed dose]

A Phase 1 clinical study of 123I-FP-CIT, N-(3-fluoropropyl)-2 beta-carbomethoxy-3 beta-(4-iodophenyl)nortropane (123I), developed for evaluation of dopamine transporter (DA-T) by single photon emission computed tomography (SPECT), was performed in 12 healthy male volunteers. No adverse reactions to 123I-FP-CIT (167 MBq) injection were observed. In sequential whole-body images after intravenous injection, the radioactivity was distributed mainly in the liver, abdomen, lungs and brain, and it decreased gradually with time. The radioactivity was excreted mainly in the urine and no prolonged retention of radioactivity was observed in any organs at 2 days post-injection. The radiation absorbed dose of 123I-FP-CIT, calculated on the basis of the pharmacokinetics, was equal to or less than those of other brain diagnostic imaging agents. These results suggest that i.v. injection of 123I-FP-CIT causes no significant problems in terms of its safety, biodistribution or absorbed dose.

Input-output organization of the foot motor area in humans

OBJECTIVE

A well-organized input-output relation similar to that of the monkey motor cortex has been demonstrated in the human hand motor area (Terao Y, Ugawa Y, Uesaka Y, Hanajima R, Gemba-Shimizu K, Ohki Y, Kanazawa I. Input-output organization in the hand area of the human motor cortex, Electroenceph clin Neurophysiol 1995;97:375-381). The aim of this study is to investigate the input-output organization of the human foot motor area.

METHODS

We studied the effect of tactile stimuli given to the toe tip on the sizes of following responses; motor evoked potentials (MEPs) elicited by transcranial magnetic or electrical stimulation (TMS or TES) over the motor cortex and magnetic stimulation at the foramen magnum level.

RESULTS

Air stimuli applied to the toe tip facilitated magnetically evoked MEPs of mainly the muscle attached to that toe, although a less prominent facilitation was also noted in muscles attached to the adjacent toes. Neither responses evoked by TES, nor those by stimulation at the foramen magnum level, were affected by air stimuli. These results suggest that the observed facilitatory effect occurs at the cortical level.

CONCLUSION

A fairly well-organized input-output relation is present also in the foot motor area in humans, although the facilitatory effect is not so topographically restricted as is noted for the hand motor area.

A novel mutation in the gene for the adult skeletal muscle sodium channel alpha-subunit (SCN4A) that causes paramyotonia congenita of von Eulenburg

BACKGROUND

Paramyotonia congenita (PMC) of von Eulenburg is an autosomal dominant muscular disease characterized by exercise- and cold-induced myotonia and weakness. To date, 18 missense mutations in the adult skeletal muscle sodium channel alpha-subunit (SCN4A) gene have been identified to cause a spectrum of muscular diseases, including PMC of von Eulenburg, PMC without cold paralysis, potassium-aggravating myotonia, and hyperkalemic periodic paralysis. However, no obvious correlations can be made between the location or nature of amino acid substitutions in SCN4A and its clinical phenotypes.

OBJECTIVE

To describe clinical and genetic features of a family with PMC of von Eulenburg.

RESULTS

A Japanese family with cold-induced myotonia and weakness was diagnosed as having PMC of von Eulenburg. This phenotype was identified to be caused by a novel mutation that substituted a glutamic acid residue for a highly conserved glycine residue in the fourth transmembrane segment (S4) of domain IV. This predicted a decrease in positive charge specific for the S4.

CONCLUSION

In addition to the G1456E identified in this study, 4 mutations that cause a decrease in positive charge in the S4/D4 are associated with the phenotype of PMC of von Eulenburg. This provides an important genotype-phenotype correlation in sodium channelopathies.

Creutzfeldt-Jakob disease with florid-type plaques after cadaveric dura mater grafting

BACKGROUND

Many reported cases of iatrogenic Creutzfeldt-Jakob disease (CJD) developed after grafting cadaveric dura mater contaminated with CJD prions (dura-associated CJD). They are known to be clinicopathologically similar to sporadic CJD. We report herein 2 autopsy cases of dura-associated CJD with atypical clinicopathological features.

PATIENTS

Two patients presented with progressive ataxia and mental deterioration 10 or 11 years after neurosurgical treatment with cadaveric dural grafting, which led to their deaths at 8 and 17 months, respectively, after onset.

RESULTS

The cases were clinically atypical in exhibiting no or late occurrence of myoclonus and periodic synchronous discharges on electroencephalographic studies. They were pathologically unique in several aspects. The most striking feature was the presence of many prion protein (PrP) plaques in multiple areas in the brain. Some of them were the "florid" type surrounded by a zone of spongiform changes known to be a hallmark for the new variant CJD. The distribution of spongiform degeneration was also unique in that it was intense in the thalamus, basal ganglia, and the dentate nuclei of the cerebellum but milder in the cerebrum. There were no mutations in the PrP gene of the patients. There was no major difference in the size and glycoform pattern between the abnormal isoform of PrP extracted from the brain tissue from the dura-associated cases of CJD and that from a sporadic case of CJD.

CONCLUSIONS

These 2 cases are clinicopathologically distinct from typical dura-associated cases of CJD. They may be a subtype with florid-type plaques in dura-associated CJD.

Molecular genetic analysis of a novel Parkin gene in Japanese families with autosomal recessive juvenile parkinsonism: evidence for variable homozygous deletions in the Parkin gene in affected individuals

Autosomal recessive juvenile parkinsonism (AR-JP) is a distinct clinical and genetic entity characterized by selective degeneration of nigral dopaminergic neurons and young-onset parkinsonism with remarkable response to levodopa. Recently, we mapped the gene locus for AR-JP to chromosome 6q25.2-q27 by linkage analysis and we identified a novel large gene, Parkin, consisting of 12 exons from this region; mutations of this gene were found to be the cause of AR-JP in two families. Now we report results of extensive molecular analysis on 34 affected individuals from 18 unrelated families with AR-JP. We found four different homozygous intragenic deletional mutations, involving exons 3 to 4, exon 3, exon 4, and exon 5 in 10 families (17 affected individuals). In addition to the exonic deletions, we identified a novel one-base deletion involving exon 5 in two families (2 affected individuals). All mutations so far found were deletional types in which large exonic deletion accounted for 50% (17 of 34) and the one-base deletion accounted for 6% (2/34); in the remaining, no homozygous mutations were found in the coding regions. Our findings indicate that loss of function of the Parkin protein results in the clinical phenotype of AR-JP and that subregions between introns 2 and 5 of the Parkin gene are mutational hot spots.

Significant decreased insulin secretion in a diabetic patient with clinically probable multiple sclerosis

A 39-year-old man with chief complaints of aphasia, disorientation and acalculia was admitted to our hospital. He was diagnosed as a clinically probable case of multiple sclerosis (MS) and his symptoms improved while on steroid pulse therapy. The patient had been diagnosed as having diabetes mellitus 16 years before the onset of MS and his insulin secretion further decreased with time. Slight insulin resistance was observed during a euglycemic hyperinsulinemic clamp study. These results suggested that this patient developed diabetes mellitus mainly due to the decrease of insulin secretion.

[Sinus bradycardia induced by talipexole hydrochloride in a patient with Parkinson disease]

We report sinus bradycardia induced by talipexole hydrochloride in a 65-year-old man with Parkinson disease. Approximately four hours after he had taken 0.8 mg of talipexole hydrochloride, he acutely developed sleepiness, delusion, akinesia, and faintness associated with hypotension and sinus bradycardia. Another similar episode occurred when he had taken talipexole hydrochloride 1.2 mg/day in combination with a daily dose of 200 mg of levodopa and 20 mg of carbidopa. These symptoms persisted for 12 hours and diminished gradually without any specific treatments. Talipexole hydrochloride, a stimulator of both the D2 and alpha 2 receptors probably induced bradycardia and hypotension in the present case.

Autosomal recessive juvenile parkinsonism maps to 6q25.2-q27 in four ethnic groups: detailed genetic mapping of the linked region

Parkinson disease (PD) is a common neurodegenerative condition associated with degeneration of dopaminergic neurons in the zona compacta of the substantia nigra. There is increasing evidence that genetic factors play a role in the etiology of PD, although genetic heterogeneity is likely. An autosomal dominant syndrome with many similarities to sporadic PD has been mapped to 4q21-22 in a large Italian pedigree and has been found to be due to mutation of the alpha-synuclein gene. However, this gene appears to account for only a minority of PD, and a susceptibility locus for autosomal dominant parkinsonism has recently been mapped, on 2p13. Autosomal recessive juvenile parkinsonism (JP), which shows marked clinical similarity to PD, maps to 6q25.2-q27. We found linkage to this region in a group of 15 families from four distinct ethnic backgrounds. A full genomic screen excluded other candidate regions. We have constructed a detailed genetic map of the linked region and have mapped the position of the manganese superoxide dismutase gene (SOD2). Recombination events restricted the JP locus to a 6.9-cM region and excluded SOD2. The apparent homozygosity for null alleles at D6S955 in one family suggested a deletion and finer localization of the JP locus.