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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.


Tachibana N.,Okaya City Hospital | Kinoshita M.,Shinshu University | Saito Y.,National Center Hospital of Neurology and Psychiatry | Ikeda S.-I.,Shinshu University
Tohoku Journal of Experimental Medicine | Year: 2013

N-methyl-D-aspartate receptors (NMDARs) are one type of ionotropic glutamate receptors (GluRs) and are heterotetrametric cation channels composed of NMDAR1 (NR1), NMDAR2 (NR2A, 2B, 2C or 2D) and NMDAR3 (NR3A or NR3B) subunits. The main subunits are NR1 and NR2 and their combinations are classified into several diverse forms including NR1/NR1/NR2A/NR2A, NR1/NR1/NR2B/NR2B and NR1/ NR1/NR2A/NR2B. NMDARs are physiologically related to synapse development and synaptic plasticity in the central nervous system. Anti-NMDAR encephalitis is a form of autoimmune limbic encephalitis mainly affecting young women, with various manifestations including initial psychiatric symptoms, subsequent unresponsiveness, intractable generalized seizure, dysautonomia and orofacial dyskinesia. This disorder is often accompanied by ovarian teratoma that is originated from oocytes. Anti-neural antibody for the NR1/ NR2 heteromer of NMDAR has been identified as a disease-specific hallmark. It has been emphasized that neural components in ovarian teratoma act as a trigger to produce anti-NMDAR antibodies, although about half of the patients with anti-NMDAR encephalitis are not associated with ovarian teratoma. To identify NMDAR-related epitopes located outside of the brain, we performed immunohistochemical examinations of normal human ovary and testis using specific antibodies against NR1, NR2A and NR2B, respectively, and found expression of the NR2B epitope in the cytoplasm of oocytes. In contrast, the testis showed no immunohistochemical reactivity. Therefore, oocytes contain NMDAR-related epitopes including NR2B. The NMDAR-related epitopes in normal oocytes may cause an antigen-antibody reaction in certain pathological conditions. The presence of NR2B immunoreactivity in oocytes may account for the fact that anti-NMDAR encephalitis predominantly affects young females. © 2013 Tohoku University Medical Press.


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.


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.


Yamamoto T.,National Center Hospital of Neurology and Psychiatry | Kobayashi Y.,National Center Hospital of Neurology and Psychiatry | Murata M.,National Center Hospital of Neurology and Psychiatry
Parkinsonism and Related Disorders | Year: 2010

Objective: We investigated the time course of pneumonia onset and duration of continued oral intake following videofluorography (VFG) in patients with Lewy body disease. Patients and Methods: Subjects were 90 patients with idiopathic Parkinson's disease (IPD) and 45 with Lewy body dementia (LBD). We performed a follow-up study of the time from VFG until onset of pneumonia or discontinuation of oral intake, up to a maximum of 24 months, and determined the associated risk factors. We evaluated the cumulative rates of pneumonia onset and continued oral intake over 24 months for each disease. Results: Among patients with Lewy body disease, 53 developed pneumonia and 21 discontinued oral intake; patients with aspiration fared significantly worse [hazard ratio (HR) = 26.62, 3.21, p < 0.01, = 0.05]. Hoehn-Yahr (HY) stage during VFG was also a risk factor for discontinuation of oral intake. The cumulative rate of pneumonia onset was significantly higher in the aspiration group for both IPD and LBD (p < 0.01, <0.01). The cumulative rate of continued oral intake tended to be lower in the aspiration group for IPD, and was significantly lower for LBD (p = 0.07, <0.01). Conclusion: Aspiration during VFG was a risk factor for pneumonia onset in patients with Lewy body disease. Aspiration and HY stage during VFG were risk factors for discontinuing oral intake. The cumulative rate of continued oral intake up to 24 months after VFG was poorest for LBD patients with aspiration. © 2010.


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.


Murata M.,National Center Hospital of Neurology and Psychiatry
Clinical Neurology | Year: 2010

We serendipitously found that zonisamide (ZNS), an antiepileptic agent, has beneficial effects on Parkinson disease. A 25 mg once a day of ZNS (200-600 mg/day for epilepsy), significantly improves motor function of advanced patients with Parkinson disease. Its effects maintained at least one year even in patients with advanced stage. It was finally approved as an anti parkinsonian agent in Japan on January 2009. As the mechanism of anti-parkinsonian effects of ZNS, we showed that ZNS increases dopamine contents in the striatum by activating dopamine synthesis through increasing the levels of tyrosine hydroxylase (TH) mRNA and TH protein. It moderately inhibits monoamine oxydase (MAO) activity. ZNS shows significant inhibition on T-type Ca ++ channel. It may also affect the beneficial effects of ZNS on Parkinson disease. ZNS also showed neuroprotective effects on several parkinsonian models. It markedly inhibited quinoprotein formation and increased the level of glutathione by enhancing the astroglial cystine transport system and/or astroglial proliferation through S100β. We will verify the neuroprotective effects of ZNS on patients with Parkinson disease and study the factors responsible for the individual difference of the effects of ZNS by using genome wide association study (GWAS) in the near feature.


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.


Asanuma M.,Okayama University of Science | Miyazaki I.,Okayama University of Science | Diaz-Corrales F.J.,Okayama University of Science | Diaz-Corrales F.J.,Centro Andaluz Of Biologia Molecular Y Medicina Regenerativa Cabimer | And 5 more authors.
Annals of Neurology | Year: 2010

Objective: Recent double-blind, controlled trials in Japan showed that the antiepileptic agent zonisamide (ZNS) improves the cardinal symptoms of Parkinson's disease. Glutathione (GSH) exerts antioxidative activity through quenching reactive oxygen species and dopamine quinone. GSH depletion within dopaminergic neurons impairs mitochondrial complex I activity, followed by age-dependent nigrostriatal neurodegeneration. This study examined changes in GSH and GSH synthesis-related molecules, and the neuroprotective effects of ZNS on dopaminergic neurodegeneration using 6-hydroxydopamine-injected hemiparkinsonian mice brain and cultured neurons or astrocytes. Methods and Results: ZNS increased both the cell number and GSH levels in astroglial C6 cells, but not in dopaminergic neuronal CATH.a cells. Repeated injections of ZNS (30mg/kg intraperitoneally) for 14 days also significantly increased GSH levels and S100β-positive astrocytes in mouse basal ganglia. Repeated ZNS injections (30mg/kg) for 7 days in the hemiparkinsonian mice increased the expression of cystine/glutamate exchange transporter xCT in activated astrocytes, which supply cysteine to neurons for GSH synthesis. Treatment of these mice with ZNS also increased GSH levels and completely suppressed striatal levodopa-induced quinone formation. Reduction of nigrostriatal dopamine neurons in the lesioned side of hemiparkinsonian mice was significantly abrogated by repeated injections of ZNS with or without adjunctive levodopa starting 3 weeks after 6-hydroxydopamine lesioning. Interpretation: These results provide new pharmacological evidence for the effects of ZNS. ZNS markedly increased GSH levels by enhancing the astroglial cystine transport system and/or astroglial proliferation via S100β production or secretion. ZNS acts as a neuroprotectant against oxidative stress and progressive dopaminergic neurodegeneration. © 2010 American Neurological Association.


Kobayashi O.,National Center Hospital of Neurology and Psychiatry
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica | Year: 2010

Drug addiction in Japan is a field of clinical psychiatry that occasionally poses questions concerning legal status of the patients abusing illicit drugs. In other countries, continuing care perspective and harm reduction policy is gradually becoming the main current of the addiction psychiatry. There are several clinical projects in Japanese psychiatric hospitals and public health centers attempting to motivate and treat drug dependent patients through outpatient group therapy. SMARPP is one of such projects with promising results concerning the efficacy on treatment retention.

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