Brain and Nerve最新文献

The prevalence of peripheral neuropathies has increased over the years, and novel treatments for management of several neuropathies have emerged over the past decade. Following a literature search of the ICHUSHI database, we observed that recent literature on peripheral neuropathy most frequently includes reports from the orthopedic specialty, followed by studies reported by the neurology service. Notably, the number of studies reported by the neurology departments has increased over the past decade. However, most patients with common peripheral neuropathies do not visit the neurology department. Therefore, it is necessary to highlight the role of neurologists for comprehensive evaluation and management of neuromuscular disorders. This may result in acknowledgement of neurology as the primary gatekeeper of peripheral neurological diseases.

Tumefactive demyelinating lesions (TDL), defined as inflammatory demyelinating lesions, may develop either during treatment for multiple sclerosis and related disorders or as the first demyelinating episode without any past medical history suggesting demyelination. If the latter, it would be so delicate to diagnose as demyelination. Especially in such situations, biopsy is often necessary in addition to neuroimaging for distinction TDL with tumorous or infectious diseases. In this article, we will review about concept, epidemiology, diagnosis, and treatment of TDL.

Neurologists have played an important role in the treatment of adult epilepsy for more than 60 years since the establishment of the Japanese Society of Neurology. The terminology used in epileptology in Japan is adopted from that used by the International League Against Epilepsy. The terminology for seizures observed in temporal lobe epilepsy has transitioned from psychomotor to complex partial and currently to focal impaired awareness seizures. Second- and third-generation anti-seizure medications (ASM) are currently available, and several new first-line agents have emerged in clinical practice. ASM that are relatively safe for the fetus during pregnancy are currently available, and advances have been made in research and treatment of epilepsy in the elderly population. Although surgical treatment for epilepsy is advancing, it is not widely performed in Japan. We hope that neurologists continue to contribute to epilepsy care.

Determination of indications for acute reperfusion therapy (intravenous recombinant tissue plasminogen activator administration and mechanical thrombectomy) and identification of stroke mimics and chameleons are essential components of effective stroke treatment. Moreover, neurologists select the appropriate medications and manage the patient's general condition. Therefore, a neurologist's solid diagnostic skills based on neurological symptomatology and an internist's broad knowledge and insight play key roles clinically.

Vertigo and dizziness are among the most common chief complaints in the neurology and emergency departments. Benign, self-limiting peripheral causes such as benign positional paroxysmal vertigo or vestibular neuropathy, Ménière's disease are the majority, but dangerous underlying conditions such as cerebrovascular or cardiovascular diseases are still overlooked. In this paper, the anatomy of the vestibular network from peripheral to central and the classification based on "triggers and timing" rather than the analysis of patient's word (rotational versus dizzy) are presented. Based on these, I classify various causes of vertigo and dizziness into three groups, i.e. highly dangerous, less dangerous but cautionary, and benign self-limiting ones, and explain them focusing on isolated vertigo or isolated vestibular syndrome.

The September 2013 issue of this journal contains an article titled "The Role of Neurologists in Dementia Practice" in which I have highlighted the contributions of neurologists to dementia care. I have emphasized the importance of proactive leadership within interdisciplinary teams that include general practitioners and psychiatrists. Following the implementation of the Basic Act on Dementia to Promote an Inclusive Society and advances in medical science, such as introduction of the anti-Alzheimer drug lecanemab, neurologists are expected to play a more active role in dementia management and require more specialized skills. The emergence of lecanemab has led to more direct involvement of neurologists in dementia practice, which has resulted in the emergence of "novice" dementia specialists. However, a shortage of neurologists who specialize in behavioral neurology remains a significant concern in Japan. This challenge is compounded by the inadequate education of general neurologists in this domain, because dementia management requires deep knowledge and skills in behavioral neurology. The most important and urgent issue is to promptly address this shortage. Although neurologists' involvement in dementia practice is attributable to the introduction of lecanemab, I sincerely look forward to neurologists transitioning from "novice" to "real" experts in dementia. I reiterate this call as a recommendation to fellow neurologists, emphasizing the need to evolve into true specialists in the field.

Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder characterized by progressive axial muscle stiffness, central nervous system hyperexcitability, and painful stimulus-sensitive muscle spasms. A nationwide survey performed in 2018 showed the estimated prevalence of SPS was 0.2 per 100,000 population. Most patients with SPS had antibodies against glutamic acid decarboxylase 65, followed by antibodies to the glycine receptor α-subunit. Usually, patients with SPS showed favorable outcomes; however, some studies have reported intractable SPS. Early diagnosis and aggressive immunotherapy are necessary for management of patients with SPS.

Hyperscanning functional magnetic resonance imaging (fMRI) was developed to gain deeper insight into the neural basis of social cognition. Simultaneous imaging of brain activity in multiple subjects facilitates analysis of the neural basis of real-time interactions and communication. This method reveals the neural basis of social interactions, including inter-individual synchronization as a phenomenon that cannot be reduced to individuals. This modality enables research into the neural mechanisms underlying social interactions that are integral to many aspects of our lives. I will outline the background, current status, and prospects of development of hyperscanning fMRI, which may be an important methodology in the shift from "first-person" neuroscience (which refers to the interaction between individuals and the environment) to "second-person" neuroscience (which refers to the application of neuroscientific methods to investigate inter-individual associations).

Two-photon excitation microscopy enables in vivo deep-tissue imaging within organisms. This technique is based on two-photon excitation, a nonlinear optical process that uses near-infrared light for excitation, resulting in high tissue permeability. Notably, two-photon excitation occurs only near the focal plane; therefore, minimally invasive tomographic images can be obtained. Owing to these features, two-photon excitation microscopy is currently widely used in medical and life-science research, particularly in the domain of neuroscience for in vivo visualization of deep tissues. However, the use of long-wavelength excitation light in two-photon excitation microscopy has resulted in a larger focused spot size and relatively low spatial resolution, which is a limitation of this technique for further applications. Recent studies have described super-resolution microscopy techniques applied to two-photon excitation microscopy in an attempt to observe living organisms "as they are in their natural state" with high spatial resolution. We have also addressed this topic using an optical approach (two-photon stimulated emission depletion microscopy) and an image analysis approach (two-photon super-resolution radial fluctuation). Here, we describe these approaches together with a discussion of our recent accomplishments.

Accurate identification of regions that show activity changes in response to functional expression is necessary to understand the mechanisms underlying functional expression in the brain. Quantitative activity-induced manganese-enhanced magnetic resonance imaging (qAIM-MRI) is a noninvasive whole-brain activity history imaging method used for this purpose. Notably, qAIM-MRI is a pseudo-Ca²⁺ imaging method that uses Mn²⁺ as a surrogate marker for Ca²⁺. In this paper, I describe the principles, applications, and limitations of qAIM-MRI.