Brain and Nerve最新文献

Amyloid PET plays a crucial role in the early diagnosis of Alzheimer's disease and the determination of the feasibility of disease-modifying therapies. It offers several advantages, including high sensitivity and specificity, minimal invasiveness, and the ability to provide spatial evaluation, all of which contribute to the optimization of dementia care. However, proper use and interpretation of the results require a thorough understanding of their limitations. Although careful consideration is necessary when using scans on asymptomatic individuals, clinical applications could broaden if preemptive treatments and high-precision individual risk assessments for the preclinical stage are developed.

Several characteristic radiographic signs associated with various diseases are useful in neuroradiological practice; however, their clinical usefulness varies widely. This article presents some common signs and the associated pathological features, particularly those observed on computed tomography and magnetic resonance imaging or pathognomonic signs that are useful for accurate diagnosis, even in patients with rare diseases.

The advent of lecanemab is a hope not only for people with dementia and their families but also for society as a whole. However, the effectiveness of lecanemab is limited, and the need to inform patients of their dementia may emphasize negative aspects more than ever as "early diagnosis leads to early despair." In this situation, it is important to provide post-diagnostic support to make the "time spent living with dementia," which is prolonged by lecanemab, as meaningful as possible. In this review, the authors introduce the "Peer Support Activities for people with mild dementia and their families," a post-diagnosis support program for those diagnosed early in the course of the disease.

Headache is the most common condition encountered in neurological practice. However, despite the burden to patients, migraine, a typical primary headache, is not life-threatening, and evaluation shows no abnormalities; therefore, it is often treated using analgesics. Moreover, patients often do not visit hospitals and clinics because over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs are easily available. However, many patients continue to experience headaches. Migraine therapy has progressed remarkably following the advent of calcitonin gene-related peptide antibody drugs in recent years. Many patients with migraine do not visit hospitals and clinics and do not receive appropriate treatment. Therefore, in the future, neurologists will need to play a key role in patient education and in training physicians to enable accurate diagnosis of headaches.

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.

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.

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.