Time filter

Source Type

Watanabe Y.,National Center Hospital of Neurology and Psychiatry
Journal of the Japan Epilepsy Society | Year: 2013

The number of adult epilepsy patients is several times larger than that of pediatric epilepsy patients. In Japan, since there are few specialists who care for adult epilepsy patients, pediatricians not only care for children but also a proportion of adult patients. Although it is anticipated that the number of neurologists who specialize in epilepsy will increase and will be responsible for the care of most of the adult epilepsy patients, treatment for epilepsy patients with psychiatric symptoms require collaboration between psychiatrist and neurologist. The number of elderly onset epilepsy continues to increase accompanying aging of the Japanese population. The symptoms and treatment of epilepsy in the elderly differ in some aspects from those of epilepsy in younger patients. Onset of epilepsy in the elderly may be misdiagnosed as dementia, and this aspect requires attention. Epilepsy patients with psychiatric symptoms often take a combination of antiepileptic and antipsychotic drugs. Since these drugs interact with each other to affect the pharmacological actions and blood concentrations, these interactions should be considered during combined use of these agents. Source

Sugai K.,National Center Hospital of Neurology and Psychiatry
Brain and Development | Year: 2010

Febrile seizures (FS) require both acute and chronic management. Acute management includes the treatment and differential diagnosis of FS and depend on the presence of seizures and a patient's level of consciousness upon arrival at hospital: a patient may be discharged after physical examination if there are no seizures and no alteration of consciousness; close observation and laboratory examinations may be indicated in cases when there are no seizures but the patient exhibits altered consciousness; and intravenous diazepam (DZP) is indicated if seizures persist. Central nervous system infections should be ruled out: if the patient has signs of meningeal irritation or increased intracranial pressure, disturbed consciousness for >1 h, atypical seizures (partial seizures, seizures for >15 min, or recurrent seizures within 24 h), cerebrospinal fluid examinations and/or computed tomography/magnetic resonance imaging are warranted. Chronic management includes the prevention of recurrent FS, counseling parents, and vaccination. Japanese guideline for the prevention of recurrent FS defines two types of warning factors (WF) for selecting patients who should be monitored carefully: factors related to the onset of epilepsy (EP factors) and recurrence of FS (FS factors). The EP factors consist of neurological or developmental abnormalities prior to the onset of FS, atypical seizures, and history of epilepsy in parents or siblings. The FS factors include the onset of FS before 1 year of age and a history of FS in one or both parents. The guideline recommends no medication for children with two or fewer past episodes of FS without WF; prophylactic DZP for children with prolonged FS exceeding 15 min, or two or more episodes of FS with two or more WF; and daily administration of phenobarbital or valproate for children in whom FS occur under 38 °C or who have prolonged FS despite prophylactic DZP. To reduce parents' anxiety, the natural history of FS should be explained. A child can be given all current vaccinations 2-3 months after the last episode of FS by his/her family doctor with information provided to the parents as to how to cope with fever and convulsions. © 2009 Elsevier B.V. All rights reserved. Source

Kobayashi O.,National Center Hospital of Neurology and Psychiatry
Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence | Year: 2010

Assessment of the degree of motivation for change in drug abusers is important in determining the optimal treatment modality for each patient. The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is a 19 item instrument designed by Miller and Tonigan to provide quantitative assessment of the motivation for change in substance abusers. The object of the present study is to examine the factor structure and validity of the Japanese version of SOCRATES-8D (version 8 for drug abusers). One hundred and five adolescent delinquents (81 male and 24 female) in a detention home were included in the study. The most frequently abused drug was cannabis in 43 percent of the delinquents, followed by methamphetamine in 20 percent and organic solvent in 18 percent. Exploratory factor analysis and validity analysis was performed to determine the factor structure and criterion-related validity. The two factor structure of the 13 item Japanese version was confirmed, namely 6 item "Ambivalence" and 7 item "Taking steps". Internal consistency was acceptable with the value of a over 0.85. Criterion-related validity was confirmed with significant negative correlation between the Self-Efficacy Scale (Morita et al.) and "Ambivalence" factor, and significant positive correlation with "Taking steps" factor. Also, there was significant positive correlation between the Japanese version of the Drug Abuse Screening Test (Skinner) and "Ambivalence" factor. The external validity of "Recognition" factor was not confirmed. Presumably the factor related to the recognition of oneself as an addict was absorbed in "Ambivalence" factor, due to the relatively less severe degree of drug dependence that is characteristic of the juvenile delinquents in detention homes. The 13 item Japanese version of the SOCRATES-8D is valid and applicable to the substance abusing juvenile delinquents in detention homes. Further research with the inclusion of adult samples from addiction clinics is necessary to confirm the generalizability of the version. Source

Uchino A.,Saitama University | Kamiya K.,National Center Hospital of Neurology and Psychiatry
Surgical and Radiologic Anatomy | Year: 2013

Extremely rarely, a posterior communicating artery (PCoA) of "duplicate origin" occurs when two branches of the PCoA arise separately from the supraclinoid segment of the internal carotid artery (ICA) and quickly fuse to form an arterial ring. Three such cases previously reported were described as "fenestration." We report the case of this rare variation diagnosed by magnetic resonance angiography and discuss the differentiation of PCoA of duplicate origin from PCoA fenestration, supraclinoid ICA fenestration, and hyperplastic anterior choroidal artery. © 2013 Springer-Verlag France. Source

Sakamoto T.,National Center Hospital of Neurology and Psychiatry
Clinical Neurology | Year: 2012

Botulinum toxin acts on the neuromuscular injections to block the neural transmission, resulting in the relief of hypercontraction of the muscles injected. For the treatment of spasticity, larger muscles in the extremitires are the targets of injection. Accurate injections are necessary for the effective botulinum therapy, using electromyogrphy for the precise approach and ultrasonography for the precise detection of muscles in layer. Recent report showed botulinum toxin is delivered via synapse vesicles, which suggests the more acetylcholine release response to the more botulinum toxin. Concerning antibody formation, the less moleculer weighted botulinum toxin can be available for the more dosage to treat larger muscles. The diffusion into the muscles or vessels, nerves nearby should be carefully avoided. FDA warning revealed severe respiratory complications including dead cases during usual botulinum toxin therapy. A2, not Al, toxin has a unique character not being tranported through axon, which can supply more safer treatment. Source

Discover hidden collaborations