Award type：Award from international society, conference, symposium, etc. 

the Basic Scientist Summer School

Language：Japanese   Publisher：Journal of Neurology, Neurosurgery and Psychiatry  

Objectives To elucidate the phenotypes and pathophysiology of speech and voice disorders in Parkinson's disease (PD) with subthalamic nucleus deep brain stimulation (STN-DBS). Methods We conducted a cross-sectional study on 76 PD patients treated with bilateral STN-DBS (PD-DBS) and 33 medically treated PD patients (PD-Med). Speech and voice functions, electrode positions, motor function and cognitive function were comprehensively assessed. Moreover, speech and voice functions were compared between the on-stimulation and off-stimulation conditions in 42 PD-DBS patients. Results Speech and voice disorders in PD-DBS patients were significantly worse than those in PD-Med patients. Factor analysis and subsequent cluster analysis classified PD-DBS patients into five clusters: relatively good speech and voice function type, 25%; stuttering type, 24%; breathy voice type, 16%; strained voice type, 18%; and spastic dysarthria type, 17%. STN-DBS ameliorated voice tremor or low volume; however, it deteriorated the overall speech intelligibility in most patients. Breathy voice did not show significant changes and stuttering exhibited slight improvement after stopping stimulation. In contrast, patients with strained voice type or spastic dysarthria type showed a greater improvement after stopping stimulation. Spastic dysarthria type patients showed speech disorders similar to spastic dysarthria, which is associated with bilateral upper motor neuron involvement. Strained voice type and spastic dysarthria type appeared to be related to current diffusion to the corticobulbar fibres. Conclusions Stuttering and breathy voice can be aggravated by STN-DBS, but are mainly due to aging or PD itself. Strained voice and spastic dysarthria are considered corticobulbar side effects.

DOI： 10.1136/jnnp-2014-308043

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Neurosurgical Society  

Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for essential tremor (ET). However, its long-term outcomes and prognostic factors remain unclear. This study aimed to retrospectively investigate 38 patients with ET who underwent MRgFUS thalamotomy and were followed up for >2 years. The improvement in tremor was evaluated using the Clinical Rating Scale for Tremor (CRST). Adverse events were documented, and correlations with factors, such as skull density ratio (SDR), maximum mean temperature (T-max), and lesion size, were examined. Furthermore, the outcomes were compared between two groups, one that met the cutoff values, which was previously reported (preoperative CRST-B ≤ 25, T-max ≥ 52.5°C, anterior-posterior size of lesion ≥ 3.9 mm, superior-inferior [SI] size of lesion > 5.5 mm), and the other that did not. The improvement rate was 59.4% on average at the 2-year follow-up. Adverse events, such as numbness (15.8%), dysarthria (10.5%), and lower extremity weakness (2.6%), were observed even after 2 years, although these were mild. The factors correlated with tremor improvement were the T-max and SI size of the lesion (p < 0.05), whereas the SDR showed no significance. Patients who met the aforementioned cutoff values demonstrated a 69.8% improvement at the 2-year follow-up, whereas others showed a 43.6% improvement (p < 0.05). In conclusion, MRgFUS is effective even after 2 years. The higher the T-max and the larger the lesion size, the better the tremor control. Previously reported cutoff values clearly predict the 2-year prognosis, indicating the usefulness of MRgFUS.

DOI： 10.2176/jns-nmc.2023-0202

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CiNii Research

Language：English   Publisher：Parkinsonism and Related Disorders  

Introduction: Connector hubs are specialized brain regions that connect multiple brain networks and therefore have the potential to affect the functions of multiple systems. This study aims to examine the involvement of connector hub regions in essential tremor. Methods: We examined whole-brain functional connectivity alterations across multiple brain networks in 27 patients with essential tremor and 27 age- and sex-matched healthy controls to identify affected hub regions using a network metric called functional connectivity overlap ratio estimated from resting-state functional MRI. We also evaluated the relationships of affected hubs with cognitive and tremor scores in all patients and with motor function improvement scores in 15 patients who underwent postoperative follow-up evaluations after focused ultrasound thalamotomy. Results: We have identified affected connector hubs in the cerebellum and thalamus. Specifically, the dentate nucleus in the cerebellum and the dorsomedial thalamus exhibited more extensive connections with the sensorimotor network in patients. Moreover, the connections of the thalamic pulvinar with the visual network were also significantly widespread in the patient group. The connections of these connector hub regions with cognitive networks were negatively associated (FDR q < 0.05) with cognitive, tremor, and motor function improvement scores. Conclusion: In patients with essential tremor, connector hub regions within the cerebellum and thalamus exhibited widespread functional connections with sensorimotor and visual networks, leading to alternative pathways outside the classical tremor axis. Their connections with cognitive networks also affect patients’ cognitive function.

DOI： 10.1016/j.parkreldis.2024.106034

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DOI： 10.1101/2023.12.03.23299326

Language：Japanese   Publisher：THE JAPAN LARYNGOLOGICAL ASSOCIATION  

<p>Laryngectomy still plays an important role in the treatment of head and neck cancer. However, laryngectomized patients experience several difficulties in their lives because of the loss of their original voice. This study aimed to record the original voice before laryngectomy via a recording application or studio recording in patients who planned to undergo laryngectomy (Save the Voice project). In 2021, a multicenter prospective observational study was initiated for patients who planned to undergo laryngectomy in Japan. Before surgery, patients recorded their original voices using a voice recording application or in a recording studio. After laryngectomy, electrolarynx voices were obtained and stored in our database system. The study included 34 patients who were managed in three academic university hospitals (30 males, 4 females; median age at the time of surgery, 69 [range, 46–80] years). The tumor sites were the hypopharynx in 21 patients, esophagus in 6, larynx in 5, oropharynx in 1, and trachea in 1 patient. Among the 34 patients, the original voices were preoperatively recorded via a voice-recording application in 28 patients and via a recording studio in 6 patients. Preoperative recording of the patient’s original voice is essential to regenerate the voice after laryngectomy.</p>

DOI： 10.5426/larynx.35.142

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Language：English  

Sporadic inclusion body myositis (s-IBM) is an acquired degenerative inflammatory myopathy that leads to slowly progressive muscle weakness and atrophy of the limbs, face, and pharynx. Owing to the slow progression of the disease, the indications for surgical intervention remain unclear. Herein, we retrospectively reviewed the records of four patients with s-IBM who had undergone cricopharyngeal myotomy for severe dysphagia at our institution between 2016 and 2021. Among these, one patient underwent transcervical cricopharyngeal myotomy and laryngeal suspension, as videofluoroscopic examination of swallowing revealed poor laryngeal elevation. The remaining three patients underwent endoscopic cricopharyngeal myotomy using a curved rigid laryngoscope. Preoperatively, the mean Hyodo score was 8 points (range: 6-10) using a flexible endoscope. The mean surgical duration was 104 min, and no severe complications were observed. Postoperatively, all patients achieved improvement in swallowing function and food intake. Moreover, swallowing function was maintained in all four patients even 6-12 months postoperatively. Cricopharyngeal myotomy may be a safe surgical procedure with the potential to improve swallowing function, and a Hyodo score of 6 may be considered a surgical indication for cricopharyngeal myotomy in patients with s-IBM.

DOI： 10.18999/nagjms.85.4.866

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DOI： 10.1111/pcn.13578

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Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Language：English   Publishing type：Research paper (scientific journal)  

<h4>Introduction</h4>Patients with Parkinson's disease (PD) encounter a variety of speech-related problems, including dysarthria and language disorders. To elucidate the pathophysiological mechanisms for linguistic alteration in PD, we compared the utterance of patients and that of healthy controls (HC) using automated morphological analysis tools.<h4>Methods</h4>We enrolled 53 PD patients with normal cognitive function and 53 HC, and assessed their spontaneous speech using natural language processing. Machine learning algorithms were used to identify the characteristics of spontaneous conversation in each group. Thirty-seven features focused on part-of-speech and syntactic complexity were used in this analysis. A support-vector machine (SVM) model was trained with ten-fold cross-validation.<h4>Results</h4>PD patients were found to speak less morphemes on one sentence than the HC group. Compared to HC, the speech of PD patients had a higher rate of verbs, case particles (dispersion), and verb utterances, and a lower rate of common noun utterances, proper noun utterances, and filler utterances. Using these conversational changes, the respective discrimination rates for PD or HC were more than 80%.<h4>Conclusions</h4>Our results demonstrate the potential of natural language processing for linguistic analysis and diagnosis of PD.

DOI： 10.1016/j.parkreldis.2023.105411

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DOI： 10.1038/s41531-023-00507-y

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This study evaluated the safety of laryngeal closure and post-surgical changes in swallowing function of patients with amyotrophic lateral sclerosis (ALS) and proposed an appropriate surgical strategy for patients with ALS. Clinical and surgical data of 26 consecutive patients with ALS who underwent laryngeal closure at Nagoya University Hospital in Japan between 2003 and 2020 were retrospectively analyzed. Changes in swallowing functions were evaluated before and approximately 1 month post-surgery using Neuromuscular Disease Swallowing Status Scale (NdSSS), and Functional Oral Intake Scale (FOIS). The median operation time was 126 min (range, 51-163 min), and the median intraoperative blood loss was 20 mL (range, 0-88 mL). Among the 26 ALS patients who underwent laryngeal closure, grade 1 (mild) complications occurred in three patients (12%); however, no severe complications were observed. After surgery, 25 patients (96%) maintained the swallowing function and only one patient (4%) had deteriorating NdSSS and FOIS scores. No patients were referred to our hospital due to severe aspiration pneumonia after the surgery. Two patients did not require a feeding tube after the surgery and returned to oral intake. Laryngeal closure may be a safe surgical procedure for preventing chronic aspiration and may also maintain swallowing function of patients with ALS. Further multicenter prospective studies using the gold standard videofluoroscopic swallowing examination are required to support our findings.

DOI： 10.1007/s00455-022-10454-0

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<h4>Objective</h4>The efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) ablation for essential tremor (ET) is well known; however, no prognostic factors have been established. The authors aimed to retrospectively investigate MRgFUS ablation outcomes and associated factors and to define the cutoff values for each prognostic factor.<h4>Methods</h4>Sixty-four Japanese patients who underwent unilateral ventral intermediate nucleus thalamotomy with MRgFUS for ET were included. Follow-up evaluations were performed at 1 week and 1, 3, 6, 12, and 24 months postoperatively. Tremor suppression was evaluated using the Clinical Rating Scale for Tremor (CRST), and adverse effects were recorded postoperatively. Outcome-associated factors were examined preoperatively, intraoperatively, and postoperatively using multivariate analyses. The cutoff values for the prognostic factors were calculated using receiver operating characteristics.<h4>Results</h4>Percentage improvements in the CRST scores of the affected upper limb were 82.4%, 72.2%, 68.6%, and 65.9% at 1, 3, 6, and 12 months, respectively. Preoperatively, a high skull density ratio (SDR) (p ≤ 0.047), low CRST part B score (used to assess tremors during several tasks) (cutoff value 25, p ≤ 0.041), and nonoccurrence of resting tremors (p = 0.027) were significantly associated with improved tremor control. An intraoperatively high maximum mean temperature (cutoff value 52.5°C, p ≤ 0.047), postoperatively large lesion (cutoff value 3.9 mm in the anterior-posterior direction, p ≤ 0.002; cutoff value 5.0-5.55 mm in the superior-inferior direction, p ≤ 0.026), and small transducer focus correction (p ≤ 0.015) were also associated with improved tremor control. No valid cutoff value was found for SDR. Adverse effects (limb weakness, sensory disturbance, ataxia/walking disturbance, dysgeusia, dysarthria, and facial swelling) occurred transiently and were associated with high SDR, high temperature, high number of sonication sessions, large lesion, and occurrence of resting tremor. Patients who developed leg weakness experienced greater percentage improvement in tremors at 3 months postoperatively than those who did not.<h4>Conclusions</h4>MRgFUS ablation could be used to achieve good tremor control with acceptable adverse effects in Japanese patients with ET. The relatively low SDR in Asian ethnic groups as compared with that of Western populations makes treatment difficult; however, the cutoff values obtained in this study may be useful for achieving good treatment outcomes even in such patients. Clinical trial registration no.: UMIN000026952 (University Hospital Medical Information Network).<h4>Abbreviations</h4>ACPC = anterior commissure-posterior commissure; AP = anterior to posterior; CRST = Clinical Rating Scale for Tremor; ET = essential tremor; MRgFUS = magnetic resonance-guided focused ultrasound; PC = posterior commissure; PSA = posterior subthalamic area; RL = right to left; ROC = receiver operating characteristic; SDR = skull density ratio; SI = superior to inferior; T2WI = T2-weighted imaging; VIM = ventral intermediate nucleus.

DOI： 10.3171/2022.3.JNS212460

DOI： 10.3171/2022.3.JNS212460

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Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)/zona incerta (Zi), and the other with the aim of targeting the Vim/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo/Raprl and Vim/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.

DOI： 10.3389/fnhum.2022.1065459

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Societas Neurologica Japonica  

We present a 71-year-old woman with an eight-year history of Parkinson's disease (PD). She began to experience wearing-off at the age of 66 and subsequently developed dyskinesia. She had worsened dyskinesias for three days, followed by a high fever, and she was subsequently hospitalized. On admission, severe dyskinesia, hyperpyrexia, and elevation of serum creatine kinase were observed. Severe dyskinesia without rigidity continued throughout the day and she was diagnosed with dyskinesia-hyperpyrexia syndrome (DHS). She was treated with standard medical care and anti-parkinsonian medications were reduced drastically. Dyskinesia started to wane three days after admission and almost disappeared on day twelve. Prior to admission, the patient reported she had been taking two to three times the dose prescribed of istradefylline, which was the suspected to be a trigger of DHS. Because DHS is a rare but potentially life-threatening complication, early recognition and diagnosis is vital. A proper treatment strategy for DHS may include standard medical care together with reduced anti-parkinsonian medications.

DOI： 10.5692/clinicalneurol.cn-001740

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CiNii Research

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DOI： 10.1111/1346-8138.16399

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<h4>Objective</h4>Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy ameliorates symptoms in patients with essential tremor (ET). How this treatment affects canonical brain networks has not been elucidated. The purpose of this study was to clarify changes of brain networks after MRgFUS thalamotomy in ET patients by analyzing resting-state networks (RSNs).<h4>Methods</h4>Fifteen patients with ET were included in this study. Left MRgFUS thalamotomy was performed in all cases, and MR images, including resting-state functional MRI (rsfMRI), were taken before and after surgery. MR images of 15 age- and sex-matched healthy controls (HCs) were also used for analysis. Using rsfMRI data, canonical RSNs were extracted by performing dual regression analysis, and the functional connectivity (FC) within respective networks was compared among pre-MRgFUS patients, post-MRgFUS patients, and HCs. The severity of tremor was evaluated using the Clinical Rating Scale for Tremor (CRST) score pre- and postoperatively, and its correlation with RSNs was examined.<h4>Results</h4>Preoperatively, ET patients showed a significant decrease in FC in the sensorimotor network (SMN), primary visual network (VN), and visuospatial network (VSN) compared with HCs. The decrease in FC in the SMN correlated with the severity of tremor. After MRgFUS thalamotomy, ET patients still exhibited a significant decrease in FC in a small area of the SMN, but they exhibited an increase in the cerebellar network (CN). In comparison between pre- and post-MRgFUS patients, the FC in the SMN and the VSN significantly increased after treatment. Quantitative evaluation of the FCs in these three groups showed that the SMN and VSN increased postoperatively and demonstrated a trend toward those of HCs.<h4>Conclusions</h4>The SMN and CN, which are considered to be associated with the cerebello-thalamo-cortical loop, exhibited increased connectivity after MRgFUS thalamotomy. In addition, the FC of the visual network, which declined in ET patients compared with HCs, tended to normalize postoperatively. This could be related to the hypothesis that visual feedback is involved in tremor severity in ET patients. Overall, the analysis of the RSNs by rsfMRI reflected the pathophysiology with the intervention of MRgFUS thalamotomy in ET patients and demonstrated a possibility of a biomarker for successful treatment.

DOI： 10.3171/2022.5.JNS22411

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Language：English   Publishing type：Research paper (scientific journal)  

Holmes Tremor (HT) is an irregular, slow-frequency (<4.5 Hz) tremor characterized by a combination of resting, postural, and action tremors mostly of the upper extremities. Symptoms of HT typically emerge 4 weeks to 2 years after a brain injury caused by a spectrum of etiologies. HT pathophysiology is thought to result from aberrant collateral axonal sprouting and synaptic dysfunction following neuronal damage. To date, the dopaminergic nigrostriatal system, cerebello-thalamo-cortical pathway, and dentate-rubro-olivary pathway have all been implicated in the clinical manifestations of HT. The diversity of HT etiologies usually requires a personalized treatment plan. Current treatment options include carbidopa-levodopa, levetiracetam, and trihexyphenidyl, and surgical management such as deep brain stimulation in selected medication-refractory patients. In this review we discuss the pathophysiology, etiology, neuroimaging, and the latest clinical guidelines for care and management of HT.

DOI： 10.5334/tohm.683

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Parkinsonism and Related Disorders  

Introduction: The impact of deep brain stimulation (DBS) on speech rhythm and its mechanism remains unclear. We investigated speech rhythm characteristics of patients with Parkinson's disease (PD) treated with subthalamic nucleus (STN) DBS to understand the underlying pathophysiology better. Methods: We enrolled a total of 105 participants and evaluated speech rhythm performances among patients with PD who had undergone STN-DBS (the PD-DBS group), patients with PD treated only with medication (the PD-Med group), patients with cerebellar ataxia (the CA group), and healthy controls (the HC group). Each participant was asked to repeat the syllable/pa/at a comfortable self-chosen steady pace. A widely-used software (the Motor Speech Profile) program performed an acoustic analysis. Results: Compared to the PD-Med and HC groups, speech rate instability (DDKjit) was significantly higher in the PD-DBS and CA groups (p < 0.01). However, after DBS was turned off, the DDKjit of the PD-DBS group improved to a level comparable to that of the PD-Med and HC groups. In contrast to the significantly higher variability of speech volume (DDKcvi) in the CA group, the PD-DBS group showed similar DDKcvi to the PD-Med and HC groups. Conclusions: STN-DBS affects the speech rate stability of patients with PD. Speech rhythm disorders caused by STN-DBS were phenotypically similar to that in CA in terms of interval variability but different regarding amplitude variability. Further studies are warranted to elucidate the underlying pathophysiology of speech rhythm disorders in PD patients treated with DBS.

DOI： 10.1016/j.parkreldis.2021.10.029

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Language：Japanese   Publisher：(一社)日本神経学会  

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/brain/awab192

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Frontiers in Neurology  

Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting. Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies. Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, p < 0.0001), posteriorly [slope (β) = 0.04, p < 0.05], and dorsally (β = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, p = 0.053). Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.

DOI： 10.3389/fneur.2021.679918

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Language：English   Publisher：Frontiers in Human Neuroscience  

Background: Freezing of gait (FOG) is a common symptom in Parkinson’s disease (PD) and can be difficult to treat with dopaminergic medications or with deep brain stimulation (DBS). Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation (BCDBS) delivers current in various frequencies of bursts (e.g., 4, 10, or 15 Hz), while maintaining an intra-burst frequency identical to conventional DBS. Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG. Methods: Ten PD subjects with STN or GPi DBS and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state. Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS. Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy.

DOI： 10.3389/fnhum.2021.651168

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

<h4>Background and purpose</h4>Deep brain stimulation (DBS) is the most common surgical treatment for essential tremor (ET), yet there is variation in outcome and stimulation targets. This study seeks to consolidate proposed stimulation "sweet spots," as well as assess the value of structural connectivity in predicting treatment outcomes.<h4>Materials and methods</h4>Ninety-seven ET individuals with unilateral thalamic DBS were retrospectively included. Using normative brain connectomes, structural connectivity measures were correlated with the percentage improvement in contralateral tremor, based on the Fahn-Tolosa-Marin tremor rating scale (TRS), after parameter optimization (range 3.1-12.9 months) using a leave-one-out cross-validation in 83 individuals. The predictive feature map was used for cross-validation in a separate cohort of 14 ET individuals treated at another center. Lastly, estimated volumes of tissue activated (VTA) were used to assess a treatment "sweet spot," which was compared to seven previously reported stimulation sweet spots and their relationship to the tract identified by the predictive feature map.<h4>Results</h4>In the training cohort, structural connectivity between the VTA and dentato-rubro-thalamic tract (DRTT) correlated with contralateral tremor improvement (R = 0.41; p < 0.0001). The same connectivity profile predicted outcomes in a separate validation cohort (R = 0.59; p = 0.028). The predictive feature map represented the anatomical course of the DRTT, and all seven analyzed sweet spots overlapped the predictive tract (DRTT).<h4>Conclusions</h4>Our results strongly support the possibility that structural connectivity is a predictor of contralateral tremor improvement in ET DBS. The results suggest the future potential for a patient-specific functionally based surgical target. Finally, the results showed convergence in "sweet spots" suggesting the importance of the DRTT to the outcome.

DOI： 10.1016/j.nicl.2021.102846

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media {LLC}  

INTRODUCTION: The globus pallidus internus (GPi) region has evolved as a potential target for deep brain stimulation (DBS) in Parkinson's disease (PD). DBS of the GPi (GPi DBS) is an established, safe and effective method for addressing many of the motor symptoms associated with advanced PD. It is important that clinicians fully understand this target when considering GPi DBS for individual patients. METHODS: The literature on GPi DBS in PD has been comprehensively reviewed, including the anatomy, physiology and potential pitfalls that may be encountered during surgical targeting and post-operative management. Here, we review and address the implications of lead location on GPi DBS outcomes. Additionally, we provide a summary of randomized controlled clinical trials conducted on DBS in PD, together with expert commentary on potential applications of the GPi as target. Finally, we highlight future technologies that will likely impact GPi DBS, including closed-loop adaptive approaches (e.g. sensing-stimulating capabilities), advanced methods for image-based targeting and advances in DBS programming, including directional leads and pulse shaping. RESULTS: There are important disease characteristics and factors to consider prior to selecting the GPi as the DBS target of PD surgery. Prior to and during implantation of the leads it is critical to consider the neuroanatomy, which can be defined through the combination of image-based targeting and intraoperative microelectrode recording strategies. There is an increasing body of literature on GPi DBS in patients with PD suggesting both short- and long-term benefits. Understanding the GPi target can be useful in choosing between the subthalamic (STN), GPi and ventralis intermedius nucleus as lead locations to address the motor symptoms and complications of PD. CONCLUSION: GPi DBS can be effectively used in select cases of PD. As the ongoing DBS target debate continues (GPi vs. STN as DBS target), clinicians should keep in mind that GPi DBS has been shown to be an effective treatment strategy for a variety of symptoms, including bradykinesia, rigidity and tremor control. GPi DBS also has an important, direct anti-dyskinetic effect. GPi DBS is easier to program in the outpatient setting and will allow for more flexibility in medication adjustments (e.g. levodopa). Emerging technologies, including GPi closed-loop systems, advanced tractography-based targeting and enhanced programming strategies, will likely be future areas of GPi DBS expansion. We conclude that although the GPi as DBS target may not be appropriate for all PD patients, it has specific clinical advantages.

DOI： 10.1007/s40120-020-00220-5

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: The role of the cerebellum in Parkinson's disease (PD) has attracted increasing attention; however, the role of functional connectivity (FC) between the basal ganglia and particular cerebellar subregions remains to be elucidated. We aimed to clarify the FC and its contribution to motor and cognitive performances in patients with PD. METHODS: We included 99 patients with PD and 99 age- and sex-matched healthy controls in this study. We created a cerebellar functional parcellation by performing cerebellum-only independent component analysis. Using the functional parcellation map, we performed seed-based connectivity analysis using each region as a seed and extracted the mean correlation coefficients within the thalamus and basal ganglia, including the caudate, pallidum, putamen and subthalamic nucleus. We examined the group differences and correlations with the motor and general cognitive scores. In addition, we conducted a mediation analysis to clarify the relationship among FC, motor severity, and cognition. RESULTS: The PD group showed decreased FC between a wide range of cerebellar subregions and the basal ganglia. Motor severity was correlated with FC between the subthalamic nucleus and posterior Crus I/II, and general cognitive performance scores correlated with FC between the caudate nucleus and medial-posterior part of the Crus I/II (p < 0.05, corrected for multiple comparisons). The cerebello-caudate network had a direct effect on cognitive performance (p = 9.0 × 10-3), although partially mediated by motor performance (p = 8.2 × 10-3). CONCLUSION: FC between cerebellar Crus I/II and divergent basal ganglia related to motor and cognitive performance in PD.

DOI： 10.1016/j.parkreldis.2020.09.005

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PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Few studies have reported long-term outcomes of globus pallidus internus (GPi) deep brain stimulation (DBS) in Parkinson's disease (PD). The authors aimed to investigate long-term outcomes of bilateral GPi DBS for 5 years and beyond for PD patients. METHODS: The authors retrospectively analyzed the clinical outcomes in 65 PD patients treated with bilateral GPi DBS at a single center. The outcome measures of motor symptoms and health-related quality of life (HRQoL) included the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39). Scores at baseline were compared with those at 1, 3, 5, and 6-8 years after implantation using Wilcoxon signed-rank tests with α correction. RESULTS: GPi DBS significantly improved the off-medication UPDRS III total scores, UPDRS IV, and dyskinesia score at 1 year when compared with baseline (all p < 0.001). The off- and on-medication tremor scores, UPDRS IV, and dyskinesia scores showed moderate and sustained improvement (the ranges of the mean percentage improvement at each time point were 61%-75%, 30%-80%, 29%-40%, and 40%-65%, respectively) despite lacking statistical significance at long-term follow-up with diminishing sample sizes. The off-medication UPDRS III total scores did not show significant improvement at 5 years or later, primarily because of worsening in rigidity, akinesia, speech, gait, and postural stability scores. The on-medication UPDRS III total scores also worsened over time, with a significant worsening at 6-8 years when compared with baseline (p = 0.008). The HRQoL analyses based on the PDQ-39 revealed significant improvement in the activities of daily living and discomfort domains at 1 year (p = 0.003 and 0.006, respectively); however, all the domains showed gradual worsening at the later time points without reaching statistical significance. At 3 years, the communication domain showed significant worsening compared with baseline scores (p = 0.002). CONCLUSIONS: GPi DBS in PD patients in this single-center cohort was associated with sustained long-term benefits in the off- and on-medication tremor score and motor complications. HRQoL and the cardinal motor symptoms other than tremor may worsen gradually in the long term. When counseling patients, it is important to recognize that benefits in tremor and dyskinesia are expected to be most persistent following bilateral GPi DBS implantation.

DOI： 10.3171/2020.6.JNS20617

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3174/ajnr.A6693

Web of Science

Scopus

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Dystonic tremor (DT) is defined as the tremor in body parts affected by dystonia. Although deep brain stimulation (DBS) has been used to manage medically-refractory DT patients, its efficacy has not been well established. The objective of this study is to provide an up-to-date systematic review of DBS outcomes for DT patients. We conducted a literature search using Medline, Embase, and Cochrane Library databases in February 2020 according to the PRISMA guidelines. From 858 publications, we identified 30 articles involving 89 DT patients who received DBS of different targets. Thalamic DBS was the most common (n = 39) and improved tremor by 40-50% potentially in the long-term over five years with variable effects on dystonic symptoms. Globus pallidus internus (GPi), subthalamic, and subthalamic nucleus (STN) DBS improved both tremor and dystonic symptoms; however, data were limited. A few studies have reported better tremor and dystonia outcomes with combinations of different targets. Concerning adverse effects, gait/balance disorders, and ataxia seemed to be more common among patients treated with thalamic or subthalamic DBS, whereas parkinsonian adverse effects were observed only in patients treated with subthalamic or GPi DBS. Comparative benefits and limitations of these targets remain unclear because of the lack of randomized controlled trials. In conclusion, DBS of these targets may improve tremor with a variable effect on dystonia with different adverse effect profiles. The shortcomings in the literature include long-term motor outcomes, quality of life outcomes, optimal DBS targeting, and DBS programming strategy.

DOI： 10.1016/j.parkreldis.2020.06.008

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Scopus

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Objective: To reveal clinical characteristics of suboptimal responses to deep brain stimulation (DBS) in a multi-country DYT1 dystonia cohort. Methods: In this multi-country multi-center retrospective study, we analyzed the clinical data of DYT1 patients who experienced suboptimal responses to DBS defined as <30% improvement in dystonia scales at the last follow-up compared with baseline. We used a literature-driven historical cohort of 112 DYT1 patients for comparison. Results: Approximately 8% of our study cohort (11 out of 132) experienced suboptimal responses to DBS. Compared with the historical cohort, the multi-country cohort with suboptimal responses had a significantly younger age at onset (mean, 7.0 vs. 8.4 years; p = 0.025) and younger age at DBS (mean, 12.0 vs. 18.6 years; p = 0.019). Additionally, cranial involvement was more common in the multi-country cohort (before DBS, 64% vs. 45%, p = 0.074; before or after DBS, 91% vs. 47%, p = 0.001). Mean motor improvement at the last follow-up from baseline were 0% and 66% for the multi-country and historical cohorts, respectively. All 11 patients of the multi-country cohort had generalization of dystonia within 2.5 years after disease onset. All patients experienced dystonia improvement of >30% postoperatively; however, secondary worsening of dystonia commenced between 6 months and 3 years following DBS. The improvement at the last follow-up was less than 30% despite optimally-placed leads, a trial of multiple programming settings, and additional DBS surgeries in all patients. The on-/off-stimulation comparison at the long-term follow-up demonstrated beneficial effects of DBS despite missing the threshold of 30% improvement over baseline. Conclusion: Approximately 8% of patients represent a more aggressive phenotype of DYT1 dystonia characterized by younger age at onset, faster disease progression, and cranial involvement, which seems to be associated with long-term suboptimal responses to DBS (e.g., secondary worsening). This information could be useful for both clinicians and patients in clinical decision making and patient counseling before and following DBS implantations. Patients with this phenotype may have different neuroplasticity, neurogenetics, or possibly distinct neurophysiology.

DOI： 10.3389/fnhum.2020.00242

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Scopus

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: We aimed to explore the differences in motor symptoms and quality of life (QOL) outcomes following bilateral globus pallidus internus deep brain stimulation (GPi DBS), across well-defined motor subtypes of Parkinson's disease (PD), to improve clinical decision making. METHODS: This single-center retrospective study investigated bilateral GPi DBS outcomes in 65 PD patients. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS) and Parkinson's Disease Questionnaire (PDQ-39) before and one year after surgery. Outcomes were compared between the tremor-dominant (TD) and postural instability and gait difficulty (PIGD) subtypes and between the TD and akinetic-rigid (AR) subtypes. RESULTS: For the entire cohort, motor function (UPDRS III) in the Off-medication state, motor complications (UPDRS IV), activities of daily living (ADL, UPDRS II), and the ADL and discomfort domains of PDQ-39 significantly improved one year following GPi implantation compared to baseline (effect size = 1.32, 1.15, 0.25, 0.45, and 0.34, respectively). GPi DBS improved the Off-medication UPDRS III scores regardless of the motor subtypes. However, compared to the PIGD and AR patients, the TD patients showed greater improvement in overall UPDRS III postoperatively primarily due to greater tremor improvement in the Off-medication state. The outcomes in akinesia, rigidity, axial symptoms and QOL were similar among all subtypes. CONCLUSION: Bilateral GPi DBS was effective for advanced PD patients regardless of motor subtypes. Greater tremor improvement in the TD patients accounted for greater Off-medication motor improvement. Longer-term GPi DBS outcomes across different motor subtypes and brain targets should be further studied.

DOI： 10.1016/j.parkreldis.2020.05.004

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Scopus

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.clineuro.2020.105764

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Scopus

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media {LLC}  

OBJECTIVE: To analyze deep brain stimulation (DBS) outcomes in patients with cervical dystonia (CD), the relationships between motor and disability/pain outcomes, and the differences in outcomes between globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS, and to identify potential outcome predictors. METHODS: A systematic literature search identified individual patient data of CD patients who underwent DBS and whose outcomes were assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Then, we performed a pooled meta-analysis on this cohort. RESULTS: A review of 39 papers yielded 208 patients with individual TWSTRS scores and demographic information. At a mean follow-up period of 23.3 months after either GPi or STN DBS, the TWSTRS total (58.8%), severity (53.9%), disability (61.3%), and pain (46.6%) scores significantly improved compared to baseline status (all p < 0.001). There were no significant outcome differences between short-term (< 23.3 months) and long-term (≥ 23.3 months). The TWSTRS outcomes after GPi and STN DBS were comparable, whereas these two targets showed different adverse effect profiles. The rates of responders to DBS according to the TWSTRS total and severity (defined as ≥ 25% improvement) were both 89%. Regression analyses demonstrated motor benefits associated with disability improvement more than pain relief (R2 = 0.345 and 0.195, respectively). No clinically meaningful predictors for DBS outcomes were identified. CONCLUSION: DBS improves motor symptoms, disability, and pain in CD patients and may provide sustained benefits over 2 years. GPi and STN appear to be equally effective targets with different adverse effect profiles.

DOI： 10.1007/s00415-020-09703-9

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Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: The present study aimed to survey the prevalence of prodromal symptoms of Parkinson's disease (PD) in Japanese health checkup examinees, for identifying at-risk subjects. METHODS: We conducted a questionnaire survey of annual health checkup examinees without neurological symptoms using the following self-reported questionnaires: Japanese version of the Scale for Outcomes in Parkinson's disease for Autonomic Symptoms (SCOPA-AUT); Self-administered Odor Question (SAOQ); REM Sleep Behavior Disorder Screening Scale (RBDSQ); Beck Depression Inventory-Second Edition (BDI-II); Epworth Sleepiness Scale (ESS); and Physical Activity Scale for the Elderly (PASE). The presence of prodromal symptoms was determined using the 90th percentile threshold of each questionnaire. Subjects ≥ 50 years of age with ≥ 2 core prodromal symptoms (dysautonomia, hyposmia, and RBD), were classified as at risk. RESULTS: Between March 2017 and March 2018, 4,953 participants sufficiently answered the questionnaires. Among 2,726 subjects ≥ 50 years of age, 155 were classified as at risk. These subjects had worse values of BDI-II (12.0 ± 8.3 vs. 4.4 ± 3.8, p < 0.001) and ESS (9.6 ± 5.0 vs. 6.3 ± 3.2, p < 0.001), in addition to SCOPA-AUT, SAOQ, and RBDSQ. Male at-risk subjects showed lower values of hemoglobin (14.8 ± 1.3 vs. 15.0 ± 1.1, p = 0.032) and low density lipoprotein cholesterol (114.5 ± 30.3 vs. 123.0 ± 28.9, p = 0.004) than the examinees reporting no prodromal symptoms. CONCLUSION: Approximately 6% of the population aged 50 years or older was at risk for PD. Male at-risk subjects had mild hematological and metabolic changes relevant to PD.

DOI： 10.1007/s00415-020-09714-6

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Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Society of Neuroradiology ({ASNR})  

DOI： 10.3174/ajnr.A6429

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

Management of patients with Parkinson disease (PD) during inpatient hospital stays is complex and poses unique challenges for physicians and ancillary staff. Patients with PD have a high risk of complications, encephalopathy, and prolonged hospital stay. Early recognition of complications and implementation of rehabilitation strategies along with appropriate management of medications are critical to improve outcomes. Patients with PD can exhibit worsening mobility and balance, insomnia, orthostatic hypotension, multiple neuropsychiatric symptoms, and gastrointestinal dysfunction while hospitalized. This review summarizes the specific in-hospital concerns observed in patients with PD and discusses potential treatment approaches.

DOI： 10.1016/j.cger.2019.09.009

PubMed

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

Dystonia is an incurable movement disorder which can cause not only physical but also mental problems, leading to impaired health-related quality of life (HRQoL). For patients with dystonia refractory to medical treatment, deep brain stimulation (DBS) is a well-established surgical treatment. The objective of this systematic review is to provide a better understanding of HRQoL outcomes after DBS for dystonia. A search of the literature was conducted using Medline (PubMed), Embase, and Cochrane Library databases in May 2019. HRQoL outcomes after DBS along with motor outcomes were reported in a total of 36 articles involving 610 patients: 21 articles on inherited or idiopathic isolated dystonia, 5 on tardive dystonia, 3 on cerebral palsy, 2 on myoclonus-dystonia, 1 on X-linked dystonia-parkinsonism, and 3 on mixed cohorts of different dystonia subtypes. DBS improved motor symptoms in various subtypes of dystonia. Most studies on patients with inherited or idiopathic isolated dystonia showed significant improvement in physical QoL, whereas gains in mental QoL were less robust and likely related to the complexity of associated neuropsychiatric problems. HRQoL outcomes beyond 5 years remain scarce. Although the studies on patients with other subtypes of dystonia also demonstrated improvement in HRQoL after DBS, the interpretation is difficult because of a limited number of articles with small cohorts. Most articles employed generic measures (e.g. Short Form Health Survey-36) and this highlights the critical need to develop and to utilize sensitive and disease-specific HRQoL measures. Finally, long-term HRQoL outcomes and predictors of HRQoL should also be clarified.

DOI： 10.1016/j.parkreldis.2019.11.016

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Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although earlier studies reported variable speech changes following subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients, the effects of globus pallidus internus (GPi) DBS on speech performance in PD remain largely unknown. OBJECTIVE: We aimed to characterize speech changes following PD GPi-DBS. METHODS: We retrospectively analyzed clinical and speech outcomes of 25 PD patients treated with bilateral GPi-DBS at a single center. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), speech subsystem domains (respiratory, laryngeal, resonance, orofacial, rate, prosody, rhythm, and naturalness), and overall speech intelligibility. Scores at baseline were compared with those at 6 months, 1 year, and the longest clinical follow-up available. RESULTS: In the off-medication state, activities of daily living and motor function based on UPDRS II and III significantly improved postoperatively. We observed unique patterns of speech changes in patients with PD following GPi-DBS in the short- (n = 25) and longer-term (n = 8) follow-up periods. Velopharyngeal (resonance), laryngeal components, and prosody worsened after bilateral GPi-DBS (p < 0.015). Speech intelligibility did not worsen after GPi-DBS in the short-term, but there was a trend to deteriorate at long-term follow-up (e.g., one year and beyond). We observed worsening of hypokinetic dysarthria in individual patients. Also, a minority of patients developed stuttering, spastic dysarthria, or ataxic dysarthria. CONCLUSION: Bilateral GPi-DBS worsened several modalities of parkinsonian speech without compromising overall speech intelligibility. GPi-DBS can potentially worsen or induce hypokinetic dysarthria, stuttering, spastic dysarthria, or ataxic dysarthria. GPi-DBS may have different and variable effects on speech function when compared to STN-DBS.

DOI： 10.3233/JPD-202246

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Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Speech disorders are among the most common adverse effects after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) patients. However, longitudinal speech changes after STN-DBS are not fully understood. OBJECTIVE: We performed a two-year prospective study on PD patients who underwent STN-DBS and analyzed changes in speech function to clarify factors predicting for speech deterioration. METHODS: Twenty-five PD patients were assessed before and up to two years after STN implantation. Speech function was evaluated in the on-stimulation condition and 30 min after stimulation cessation using auditory-perceptual assessment. Patients who experienced overall worsening in speech intelligibility or naturalness ≥1 point during follow-up were classified into a deteriorated group (n = 16), with the remaining subjects being classified into a stable group (n = 9). Cognitive and motor functions were also assessed. RESULTS: The stable group had significantly better values of low volume, monoloudness, and asthenic voice subscores of the auditory-perceptual assessment in the on-stimulation condition compared with the off-stimulation condition. Imprecise consonants, excess loudness variation, and strained voice subscores were improved via cessation of stimulation in both groups. Before surgery, the deteriorated group had significantly lower scores in the Stroop Color-Word Test and Digit Span compared to the stable group. CONCLUSIONS: During follow-up, some subscores showed significant worsening in the on-stimulation condition in both groups. However, beneficial effects of STN-DBS on speech appeared to counterbalance negative effects of STN-DBS on speech function only in the stable group. Worse cognitive function may be a potential predictor for speech deterioration after STN-DBS in PD patients.

DOI： 10.3233/JPD-191798

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Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Objective: To examine the short- and long-term clinical outcomes of the bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) on gait and axial symptoms in Parkinson's disease (PD) patients. Available data have been inconsistent and mostly short-term regarding the effect of both brain targets on gait and axial symptoms. We aimed to identify potential target specific differences at 3-year follow-up from a large single-center experience. Methods: We retrospectively reviewed short-term (6-month follow-up) and long-term (36-month follow-up) changes in the Unified Parkinson's Disease Rating Scale (UPDRS) Part II and III total scores of 72 PD patients (53 with bilateral STN-DBS and 19 with bilateral GPi-DBS). An interdisciplinary team made target-specific decisions for each DBS patient. We analyzed changes in gait and axial subscores derived from UPDRS II and III. Results: In both the STN- and GPi-DBS cohorts, we observed no significant differences in gait and axial UPDRS derived subscores in the off-med/on stimulation state at long-term follow-up when compared to baseline. On-med axial scores remained similar in the short-term but worsened in both groups (STN, 2.23 ± 3.43, p < 0.001; GPi, 2.53 ± 2.37, p < 0.01) in the long-term possibly due to disease progression. At long-term follow-up, the UPDRS III off-med/on stimulation scores worsened but were persistently improved from baseline in both groups (-9.07 ± 13.9, p < 0.001). Conclusions: The study showed that long-term both STN- and GPi-DBS had a similar effect on gait and axial symptoms in UPDRS derived subscores at 36-month follow-up despite potential baseline differences in criteria for selection of each target. More sophisticated measures of gait and balance beyond the categorical UPDRS score will be needed for future studies.

DOI： 10.3389/fnhum.2020.00001

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Long-term efficacy of deep brain stimulation (DBS) on health-related quality-of-life (HRQoL) for isolated dystonia is not well established. This study aims to determine the long-term impact of DBS on HRQoL outcomes and identify clinical predictors. METHODS: We retrospectively investigated 16 inherited or idiopathic isolated dystonia patients treated with bilateral globus pallidus internus DBS who were followed beyond 9 years at our center. The cohort consisted of 9 males, 7 females; 10 generalized, 6 segmental; mean (range) age at implantation, 37.0 (8-67) years; mean follow-up duration after implantation, 10.9 (9-13) years. We employed the Unified Dystonia Rating Scale for motor and Short Form Health Survey for HRQoL assessments to monitor the change longitudinally. We analyzed the changes in motor and HRQoL at 1-2 years (short-term) and ≥9 years (long-term) follow-up as compared to baseline with a Wilcoxon signed-rank test. We assessed the factors that predicted motor and HRQoL improvement with univariate regression analyses. RESULTS: Motor (41.6%; p = 0.004) and HRQoL (total score, p = 0.039) improvements remained significant at long-term follow-up and, in the regression analysis, change in HRQoL outcomes correlated significantly with change in motor outcomes (R2 = 0.384, p = 0.010). Additionally, short-term motor and HRQoL improvements predicted the long-term motor (R2 = 0.384, p = 0.010) and HRQoL (total score, R2 = 0.594, p < 0.001) outcomes, respectively. CONCLUSION: Motor and HRQoL improvements with DBS in isolated dystonia remain sustained for nearly a decade and may largely be predictable by the short-term response to DBS.

DOI： 10.1016/j.parkreldis.2019.04.024

PubMed

Publishing type：Research paper (scientific journal)  

OBJECTIVES: This study aimed to explore clinical correlates of repetitive speech disorders in patients with Parkinson's disease (PD). METHODS: This study investigated speech function (Assessment of Motor Speech for Dysarthria and Stuttering Severity Instrument-3), motor function (Unified Parkinson's Disease Rating Scale III [UPDRS-III] and UPDRS-IV), cognitive function (Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA], Stroop color-word test, verbal fluency, digit span tests, and line orientation), and activities of daily living of 113 PD patients. Comparison between groups (independent t-tests, Mann-Whitney U tests, or χ2 test) and linear regression analyses were performed to determine clinical correlates of repetitive speech disorders. RESULTS: Totally, 65 patients (57.5%) had repetitive speech disorders. Patients with repetitive speech disorders had significantly worse UPDRS-III (P = .049), MoCA (P = .030), and speech function and higher levodopa equivalent daily dose (LEDD; P = .031) than those without repetitive speech disorders. Males were significantly predominant in patients with repetitive speech disorders (64.6%) compared to those without repetitive speech disorders (18.7%; P < .001). The univariate and subsequent multiple linear regression analyses revealed that the severity of repetitive speech disorders significantly correlated with gender (P < .001), MoCA (P = .006), and speech variables (abnormal rate, P = .007; imprecise consonants, P = .043), independent from disease duration, UPDRS III, and LEDD. CONCLUSIONS: PD patients with repetitive speech disorders had worse motor, cognitive, and speech functions than those without repetitive speech disorders. The most influential factor for repetitive speech disorders might be male gender.

DOI： 10.1016/j.jns.2019.04.012

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Scopus

PubMed

DOI： 10.7916/tohm.v0.685

PubMed

Authorship：Lead author,　Corresponding author   Publishing type：Part of collection (book)   Publisher：Springer International Publishing  

DOI： 10.1007/978-3-319-56015-1_223-1

Publisher：三輪書店  

DOI： 10.11477/mf.5002201012

CiNii Research

Language：English   Publisher：(一社)日本神経学会  

Publishing type：Research paper (scientific journal)  

OBJECTIVE: We examined the anatomical involvement related to cognitive impairment in patients with multiple system atrophy (MSA). METHODS: We examined 30 patients with probable MSA and 15 healthy controls. All MSA patients were assessed by the Unified MSA-Rating scale and Addenbrooke's Cognitive Examination-Revised (ACE-R). We classified 15 MSA patients with ACE-R scores > 88 as having normal cognition (MSA-NC) and 15 with scores ≤ 88 as having cognitive impairment (MSA-CI). All subjects underwent 3 T MRI scanning and were investigated using voxel-based morphometry and diffusion tensor imaging. RESULTS: Both the MSA-NC and MSA-CI patients exhibited cerebellar but not cerebral atrophy in voxel-based morphometry compared to controls. In contrast, tract-based spatial statistics revealed widespread and significantly decreased fractional anisotropy (FA) values, as well as increased mean diffusivity, radial diffusivity, and axial diffusivity in both the cerebrum and cerebellum in MSA-CI patients compared to controls. MSA-NC patients also exhibited similar involvement of the cerebellum but less extensive involvement of the cerebrum compared with the MSA-CI patients. In particular, FA values in MSA-CI patients were significantly decreased in the anterior part of the left corpus callosum compared with those in MSA-NC patients. The mean FA values in the left anterior part of the corpus callosum were significantly correlated with total ACE-R scores and subscores (memory, fluency, and language) in MSA patients. CONCLUSIONS: Decreased FA values in the anterior corpus callosum showed a significant correlation with cognitive impairment in MSA.

DOI： 10.1007/s00415-018-8923-7

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Scopus

PubMed

Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

OBJECTIVE: To identify a candidate biomarker reflecting biological changes during the preclinical progression of spinal and bulbar muscular atrophy (SBMA). METHODS: We analyzed longitudinal changes in biochemical parameters obtained during health examinations before and after the diagnosis of SBMA. We estimated trajectories of clinical markers across years from the onset of weakness using linear mixed models and compared these trajectories with those estimated for male healthy controls and patients with amyotrophic lateral sclerosis (ALS) and Parkinson disease (PD). Moreover, we examined the relationship between serum creatinine level and the onset of symptoms using Kaplan-Meier curves. RESULTS: Between October 2014 and October 2017, we enrolled 40 patients with genetically confirmed SBMA, 48 healthy controls, 25 patients with ALS, and 20 patients with PD. In patients with SBMA, we evaluated the patients' data for a period of 17.3 ± 7.5 years, including 11.4 ± 7.1 years of preclinical phase. Decreases in serum creatinine occurred >10 years before the onset. The mean serum creatinine concentration was 0.56 mg/dL at the onset of weakness in patients with SBMA compared to 0.88 ± 0.10 mg/dL on final evaluation in healthy controls. Serum levels of alanine transaminase and aspartate transaminase showed tendencies to increase in preclinical SBMA. These preclinical changes of biomarkers were not observed in either ALS or PD. CONCLUSIONS: Our findings suggest that serum creatinine begins to decrease before the onset of clinical symptoms and is a biomarker for disease progression and the efficacy of therapeutics in preclinical SBMA.

DOI： 10.1212/WNL.0000000000005360

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Scopus

PubMed

Publishing type：Research paper (scientific journal)   Publisher：Springer Nature  

Cognitive deficits in Parkinson's disease (PD) are heterogeneous entities, but a relationship between the heterogeneity of cognitive deficits and resting-state network (RSN) changes remains elusive. In this study, we examined five sub-domain scores according to Addenbrooke's Cognitive Examination-Revised (ACE-R) for the cognitive evaluation and classification of 72 non-demented patients with PD. Twenty-eight patients were classified as PD with normal cognition (PD-NC). The remaining 44 were subdivided into the following 2 groups using a hierarchical cluster analysis: 20 with a predominant decrease in memory (PD with amnestic cognitive deficits: PD-A) and 24 with good memory who exhibited a decrease in other sub-domains (PD with non-amnestic cognitive deficits: PD-NA). We used an independent component analysis of RS-fMRI data to investigate the inter-group differences of RSN. Compared to the controls, the PD-A showed lower FC within the ventral default mode network (vDMN) and the visuospatial network. On the other hand, the PD-NA showed lower FC within the visual networks and the cerebellum-brainstem network. Significant differences in the FC within the vDMN and cerebellum-brainstem network were observed between the PD-A and PD-NA, which provided a good discrimination between PD-A and PD-NA using a support vector machine. Distinct patterns of cognitive deficits correspond to different RSN changes.

DOI： 10.1007/s00415-018-8755-5

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Scopus

PubMed

Publishing type：Research paper (scientific journal)   Publisher：Wiley-Blackwell  

DOI： 10.1111/ncn3.12176

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Publishing type：Research paper (scientific journal)   Publisher：Wiley-Blackwell  

DOI： 10.1111/ncn3.12183

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Publishing type：Research paper (scientific journal)  

OBJECTIVE: Severe hyposmia is a risk factor of dementia in Parkinson's disease (PD), while the underlying functional connectivity (FC) and brain volume alterations in PD patients with severe hyposmia (PD-SH) are unclear. METHODS: We examined voxel-based morphometric and resting state functional magnetic resonance imaging findings in 15 cognitively normal PD-SH, 15 cognitively normal patients with PD with no/mild hyposmia (PD-N/MH), and 15 healthy controls (HCs). RESULTS: Decreased gray matter volume (GMV) was observed in the bilateral cuneus, right associative visual area, precuneus, and some areas in anterior temporal lobes in PD-SH group compared to HCs. Both the PD-SH and PD-N/MH groups showed increased GMV in the bilateral posterior insula and its surrounding regions. A widespread significant decrease in amygdala FC beyond the decreased GMV areas and olfactory cortices were found in the PD-SH group compared with the HCs. Above all, decreased amygdala FC with the inferior parietal lobule, lingual gyrus, and fusiform gyrus was significantly correlated with both reduction of Addenbrooke's Cognitive Examination-Revised scores and severity of hyposmia in all participants. Canonical resting state networks exhibited decreased FC in the precuneus and left executive control networks but increased FC in the primary and high visual networks of patients with PD compared with HCs. Canonical network FC to other brain regions was enhanced in the executive control, salience, primary visual, and visuospatial networks of the PD-SH. CONCLUSION: PD-SH showed extensive decreased amygdala FC. Particularly, decreased FC between the amygdala and inferior parietal lobule, lingual gyrus, and fusiform gyrus were associated with the severity of hyposmia and cognitive performance. In contrast, relatively preserved canonical networks in combination with increased FC to brain regions outside of canonical networks may be related to compensatory mechanisms, and preservation of brain function.

DOI： 10.1371/journal.pone.0190072

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PubMed

Publishing type：Research paper (scientific journal)   Publisher：Springer Nature  

We previously reported that Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) had distinct phenotypes of speech and voice disorders: hypokinetic dysarthria, stuttering, breathy voice, strained voice, and spastic dysarthria. However, changes over time remain unclear. In the present study, 32 consecutive PD patients were assessed before and up to 1 year after surgery (PD-DBS). Eleven medically treated PD patients were also assessed (PD-Med). Speech, voice, motor, and cognitive functions were evaluated. At baseline, the incidence of hypokinetic dysarthria (63% of PD-DBS vs. 82% of PD-Med), stuttering (50% vs. 45%), breathy voice (66% vs. 73%), and strained voice (3% vs. 9%) was similar between groups. At 1 year, a slight but significant deterioration in speech intelligibility (p < 0.001) and grade of dysphonia (p = 0.001) were observed only in PD-DBS group compared with baseline. During the follow-up, stuttering (9% vs. 18%) and breathy voice (13% vs. 9%) emerged in PD-DBS and PD-Med, but strained voice (28%) and spastic dysarthria (44%) emerged only in PD-DBS. After the stimulation was stopped, strained voice and spastic dysarthria improved in most patients, while stuttering and breathy voice improved in a minority of patients. These findings indicate that the most common DBS-induced speech and voice disorders are strained voice and spastic dysarthria and that STN-DBS potentially aggravates stuttering and breathy voice. An improved understanding of these types of disorders may help detect speech and voice deteriorations during the early phase and lead to appropriate treatments.

DOI： 10.1007/s00702-017-1804-x

Web of Science

Scopus

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jns.2017.08.730

Web of Science

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jns.2017.08.389

Web of Science

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jns.2017.08.018

Web of Science

Scopus

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jns.2017.08.2924

Web of Science

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jns.2017.08.2943

Web of Science

Language：Japanese   Publisher：Society of Allied Health Sciences  

<p><b>ABSTRACT: </b>Following the Lee Silverman Voice Treatment® program, multiple treatment options became available to address dysphonia, secondary to Parkinson's disease (PD). One of the treatment methods, developed by Elandary and colleagues of the Parkinson Voice Project (a speech clinic solely specialized for PD) in the U.S., takes a unique, two-layer approach. The program starts with a series of one-on-one therapy sessions (SPEAK OUT!®) followed by a group therapy program designed to maintain speech improvements (LOUD Crowd®). With its catchphrase, “Speak with Intent,” the SPEAK OUT!®/LOUD Crowd® program's aim is to activate the pyramidal system that is relatively intact with PD. Two of the authors (YT and NT) recently participated in the SPEAK OUT!®/LOUD Crowd® workshop for clinicians to learn about this new treatment approach. The present report provides the overview of the program as well as a brief summary of other methods that address speech issues for individuals with PD.</p>

DOI： 10.15563/jalliedhealthsci.8.80

CiNii Research

Language：Japanese   Publisher：Nagoya Journal of Medical Science  

Voxel-based analysis (VBA) of diffusion tensor images (DTI) and voxel-based morphometry (VBM) in patients with multiple sclerosis (MS) can sensitively detect occult tissue damage that underlies pathological changes in the brain. In the present study, both at the start of fingolimod and post-four months clinical remission, we assessed four patients with MS who were evaluated with VBA of DTI, VBM, and fluid-attenuated inversion recovery (FLAIR). DTI images for all four patients showed widespread areas of increased mean diffusivity (MD) and decreased fractional anisotropy (FA) that were beyond the highintensity signal areas across images. After four months of continuous fingolimod therapy, DTI abnormalities progressed; in particular, MD was significantly increased, while brain volume and high-intensity signals were unchanged. These findings suggest that VBA of DTI (e.g., MD) may help assess MS demyelination as neuroinflammatory conditions, even though clinical manifestations of MS appear to be in complete remission during fingolimod.

DOI： 10.18999/nagjms.78.4.455

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Journal of Parkinson's Disease  

Background: Voice and speech disorders are one of the most important issues after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) patients. However, articulation features in this patient population remain unclear. Objective: We studied the articulation features of PD patients with STN-DBS. Methods: Participants were 56 PD patients treated with STN-DBS (STN-DBS group) and 41 patients treated only with medical therapy (medical-therapy-alone group). Articulation function was evaluated with acoustic and auditory-perceptual analyses. The vowel space area (VSA) was calculated using the formant frequency data of three vowels (/a/, /i/, and /u/) from sustained phonation task. The VSA reportedly reflects the distance of mouth/jaw and tongue movements during speech and phonation. Correlations between acoustic and auditory-perceptual measurements were also assessed. Results: The VSA did not significantly differ between the medical-therapy-alone group and the STN-DBS group in the off-stimulation condition. In the STN-DBS group, the VSA was larger in the on-stimulation condition than in the off-stimulation condition. However, individual analysis showed the VSA changes after stopping stimulation were heterogeneous. In total, 89.8 of the STN-DBS group showed a large VSA size in the on- than in the off-stimulation condition. In contrast, the VSA of the remaining patients in that group was smaller in the on- than the off-stimulation condition. Conclusions: STN-DBS may resolve hypokinesia of the articulation structures, including the mouth/jaw and tongue, and improve maximal vowel articulation. However, in the on-stimulation condition, the VSA was not significantly correlated with speech intelligibility. This may be because STN-DBS potentially affects other speech processes such as voice and/or respiratory process.

DOI： 10.3233/JPD-160838

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Journal of Neural Transmission  

Speech and voice disorders are one of the most common adverse effects in Parkinson’s disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS). However, the pathophysiology of voice and laryngeal dysfunction after STN-DBS remains unclear. We assessed 47 PD patients (22 treated with bilateral STN-DBS (PD-DBS) and 25 treated medically (PD-Med); all patients in both groups matched by age, sex, disease duration, and motor and cognitive function) using the objective and subjective voice assessment batteries (GRBAS scale and Voice Handicap Index), and laryngoscopy. Laryngoscopic examinations revealed that PD-DBS patients showed a significantly higher incidence of incomplete glottal closure (77 vs 48 %; p = 0.039), hyperadduction of the false vocal folds (73 vs 44 %; p = 0.047), anteroposterior hypercompression (50 vs 20 %; p = 0.030) and asymmetrical glottal movement (50 vs 16 %; p = 0.002) than PD-Med patients. On- and off-stimulation assessment revealed that STN-DBS could induce or aggravate incomplete glottal closure, hyperadduction of the false vocal folds, anteroposterior hypercompression, and asymmetrical glottal movement. Incomplete glottal closure and hyperadduction of the false vocal folds significantly correlated with breathiness and strained voice, respectively (r = 0.590 and 0.539). We should adjust patients’ DBS settings in consideration of voice and laryngeal functions as well as motor function.

DOI： 10.1007/s00702-015-1436-y

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Journal of Neurology  

Voice and speech disorders are one of the most important issues after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease patients; however, their characteristics remain unclear. We performed a comprehensive voice evaluation including the multi-dimensional voice program for acoustic analysis, the GRBAS scale for perceptual analysis, and the evaluation of the voice handicap index (VHI) for psychosocial analysis. In total, 68 patients who had undergone STN-DBS (37 assessed in the on- and off-stimulation conditions) and 40 who had been treated with medical therapy alone were evaluated. Further, we performed laryngoscopic examinations in 13 STN-DBS and 19 medical-therapy-alone patients. The STN-DBS group, especially females, showed widespread impairment of voice parameters and significantly poorer VHI scores than the medical-therapy-alone group. The degree of voiceless (DUV) and strained voice were the most impaired factors in the STN-DBS group; and DUV significantly improved after stopping stimulation. Furthermore strained voice, breathiness, and asthenia improved after stopping stimulation. Laryngoscopic examination showed that abnormal laryngeal muscle contraction and incomplete glottal closure were more prominent in the STN-DBS group than in the medical-therapy-alone group. We demonstrated that (1) more widespread voice impairment in females, (2) poorer voice-related QOL, (3) worse DUV and strained voice, and (4) abnormal laryngeal muscle contraction were the characteristic voice and laryngeal findings in the STN-DBS group compared with those in the medical-therapy-alone group.

DOI： 10.1007/s00415-015-7681-z

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Parkinsonism and Related Disorders  

Objectives: We assessed the usefulness of differential diagnosis of parkinsonism by evaluating lesions of the decussation of the superior cerebellar peduncle (SCP) in patients with progressive supranuclear palsy (PSP) using a new MRI procedure known as readout segmentation of long variable echo-trains (RESOLVE). Methods: We evaluated 100 cases, consisting of 20 with PSP, 24 with Parkinson's disease (PD), 13 with multiple system atrophy with predominant parkinsonism (MSA-P), 18 with multiple system atrophy with predominant cerebellar ataxia (MSA-C), and 24 controls. All patients were scored on the Unified Parkinson's Disease Rating Scale Part III and the Scale for the Assessment and Rating Scale of Ataxia, and MRI using RESOLVE was conducted. Results: Images acquired by this MRI procedure clearly showed high intensity areas corresponding to the decussation of the SCP in all controls, PD, and MSA patients. In contrast, ten of the 20 PSP patients exhibited abnormal iso intensities of the decussation of the SCP, while the other 10 showed high intensity signals. Among the PSP patients, there were no differences in clinical features between those with and those without visualization of the decussation of the SCP. Iso intensity signals had a sensitivity of 50% and a specificity of 100% for differentiating PSP from PD, MSA, and controls. Conclusion: This MRI procedure (RESOLVE) shows a potential for detecting the involvement of the decussation of the SCP in PSP, and can be used for discriminating PSP from PD and MSA-P. © 2013 Elsevier Ltd.

DOI： 10.1016/j.parkreldis.2013.10.007

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Movement Disorders  

Background: The aim of this study was to investigate the cortical and subcortical brain structures in Parkinson's disease (PD) with visual hallucination (VH), and to elucidate the association between the proposed hypothesis of VH in PD and regional brain volume changes. Methods: We used 3T magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) to investigate the brain structures of PD patients with VH (PD-VH; n=13) and PD patients without VH (PD-C; n=13). Results: The PD-VH patients showed significant cortical atrophy compared to the PD-C patients in the bilateral dorsolateral prefrontal cortex, left rostral region of the prefrontal cortex, left ventral section of the cingulate cortex, bilateral primary visual cortex, and secondary visual cortex including the left inferior occipital gyrus, right lingual cortex, right supramarginal gyrus, and left fusiform gyrus. Significant subcortical atrophic changes were observed in the white matter of the right parahippocampal gyrus, the bilateral posterior part of the cingulate gyrus, the left lingual gyrus, and the right middle occipital gyrus. Conclusions: VH in PD can occur due to distinctive neuroanatomical involvement. © 2013 Movement Disorder Society.

DOI： 10.1002/mds.25641

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Scopus

PubMed

Language：Japanese   Publisher：Societas Neurologica Japonica  

This symposium discusses the utility of the different MR techniques in the diagnosis and management of spinocerebellar degeneration (SCD). Conventional MRI is widely used and can show characteristic signal abnormalities such as putaminal hyperintensity, hyperintense putaminal rim, putaminal hypointensity, hot cross bun sign in the pontine base, and hyperintensity in the middle cerebellar peduncles strengthening a diagnosis of multiple system atrophy (MSA). However, the diagnostic utility of these signal abnormalities in early MSA remains restricted. In addition, it should be considered that different magnetic field strengths and sequences could be influenced on the findings resulting false negative. On the other hand, proton magnetic resonance spectroscopy, diffusion weighted imaging (DWI), diffusion tensor imaging (DTI) and voxel based morphometry (VBM) in the pontine base, cerebellum, and putamen will be informative in the early diagnosis of MSA and other SCD prior to conventional MRI changes and even before any clinical manifestation of symptoms. Particularly, DWI, DTI, and VBM are expected to have potential as surrogate markers of disease progression. Further prospective and large studies including earlier disease stages will be needed to clarify whether these novel MR techniques will aid in the future sets of diagnostic criteria and therapeutic trials.

DOI： 10.5692/clinicalneurol.53.1087

Scopus

PubMed

CiNii Research

Language：Japanese   Publisher：Journal of the Neurological Sciences  

We investigated the magnetic resonance imaging (MRI) findings of 32 multiple sclerosis (MS) patients using voxel-based morphometry (VBM) and voxel-based analysis of white matter fluid-attenuated inversion recovery image (FLAIR) high-intensity lesions and diffusion tensor imaging (DTI). Compared with 18 healthy controls, MS patients showed gray matter volume reduction in the thalamus, hypothalamus, caudate, limbic lobe, and frontal lobe. A marked volume reduction of white matter was evident along the ventriculus lateralis and corpus callosum. FLAIR high-intensity lesions were observed beside the ventriculus lateralis. DTI revealed reduced fractional anisotropy areas similar to those of the FLAIR high-intensity lesions. Changes in the volume of increased mean diffusivity (MD) were the most widespread and extended to normal-appearing white matter (p < 0.001). Multiple regression analysis revealed that MD values were significantly correlated with both disease duration (r = 0.381, p = 0.032) and expanded disability status scale scores (EDSS) (r = 0.393, p = 0.026). This study demonstrated that combined voxel-based analysis for volumetry, FLAIR high-intensity lesions, and DTI could reveal widespread brain abnormalities in MS patients. Furthermore, DTI, especially MD, showed far more widespread brain degeneration than other MRI parameters, and was significantly correlated with both severity and disease duration. © 2012 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jns.2012.04.019

Web of Science

Scopus

PubMed

Language：Japanese

＜文献概要＞はじめに 首下がり症候群は,体幹に比して頸部が異常に前屈した状態を呈する疾患群を指す(図1).高橋は,「いくつかの基礎疾患に伴ってみられる症候としての首下がり」を首下がり症候群とした.首下がり症候群は,神経筋疾患が原因となる場合,神経変性疾患が原因となる場合,さらには脊椎・脊髄病変が原因となる場合に大別される(図1).一方,"首下がり"は,神経学用語集改訂第3版において,「三浦謹之助が詳述した項部筋不全麻痺による首下がりを主徴とする病態.当初地方病[Gerlier病]とされたが諸原因による」との記載がある.三浦の報告した「Kubisagari」で認めた頸部の前屈は,発作性,麻痺性,再発性で,しばしば家族性であるなど,現在,われわれが診療している首下がり症候群とは臨床像が大きく異なる.このため,目崎は,その総説の中で,dropped headを首下がりと訳すことに対して異を唱えている.この過度の頸部の前屈が,錐体外路疾患において注目されるようになったのは比較的最近であり,用語についてもその成因をジストニアと考えたことに由来するdisproportionate anterocollisや,筋力低下と考えたことに由来するdropped head syndrome(首下がり症候群)が用いられてきた.本レビューでは,錐体外路疾患におけるdisproportionate anterocollis(antecollis)・首下がり症候群の病態,分類,治療について整理したい.

Total pages：冊   Language：Japanese

CiNii Books

Language：Japanese

Total pages：xi, 451p   Language：Japanese

CiNii Books

Language：Japanese

パーキンソン病(PD)に対する言語療法はLee Silverman Voice Treatmentが嚆矢となり,その後に病態解明や治療法の開発が進んできた.本稿では,米国のParkinson Voice Project(PD専門の言語治療クリニック)で行われている治療法を中心に紹介する.本施設ではPDにより低下した発声・発話機能の回復を目的とした個別療法と,改善した発声・発話機能の維持を目的とした集団療法の2つの治療プログラムが提供されている.いずれの治療法においてもPD患者が日常生活で良好な発話が保てるよう緻密に構想化されたアプローチのみならず,患者のモチベーションを高めるための創意工夫が随所に施されていた.(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J06406&link_issn=&doc_id=20170411330011&doc_link_id=%2Fem9allhe%2F2017%2F000801%2F011%2F0080-0088%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem9allhe%2F2017%2F000801%2F011%2F0080-0088%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese

Language：Japanese

視床下核脳深部刺激療法(STN-DBS)後、長期治療中に再増悪した運動合併症に対し、ロピエロール徐放錠が有効であった2例を経験した。症例1は56歳女で、44歳時に両上肢静止時振戦で発症した。薬物療法の調整は困難と判断し、52歳時に両側STN-DBSを施行した。刺激の調整による運動症状のロントロールは、刺激部位の変更や刺激強度の変更により、ジスキネジアの増悪、複視、手足のしびれなどが出現した。ロピニロール徐放錠へと切り替えたところ、ジスキネジアの増悪を伴うことなく軽度改善した。症例2は54歳女で、38歳時に両上肢静止時振戦で発症した。47歳時に左STN-DBSを施行した。左側への側前屈が増悪したため、ロピニロール徐放錠へと切り替えた。直後は動きの悪化を訴えたが、姿勢異常の軽度から中等度改善を認めた。

Language：Japanese

Language：Japanese

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：中部リウマチ学会  

Language：Japanese   Publisher：(一社)日本定位・機能神経外科学会  

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞COVID-19パンデミックは人類と社会に大きなインパクトを与えたが,パンデミック前と比べた最も大きな変化の1つが,オンライン会議システムの普及と活用である。その影響を受けているのは医学も例外ではなく,オンライン診療と並んでオンライン教育の試みも進んでいる。本稿では,東海国立大学機構(名古屋大学と岐阜大学)における脳神経内科領域の合同オンライン臨床実習の試みを紹介する。

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経治療学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

症例は71歳女性.63歳でパーキンソン病を発症し,66歳からウェアリングオフ,その後ジスキネジアも出現した.3日前からジスキネジアの増悪,前日から発熱あり,高クレアチンキナーゼ血症を認め入院.筋強剛を伴わず覚醒中に持続する重度ジスキネジアを認め,dyskinesia-hyperpyrexia syndrome(DHS)と診断した.全身管理と抗パーキンソン病薬の大幅な減量を行い,2週間で改善した.イストラデフィリンの過量服薬がDHSの誘因と考えられた.DHSは稀ではあるが致死的となり得る合併症であり,早期の診断が求められる.治療として,全身管理とともに抗パーキンソン病薬の減量が重要である.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01550&link_issn=&doc_id=20220817430006&doc_link_id=10.5692%2Fclinicalneurol.cn-001740&url=https%3A%2F%2Fdoi.org%2F10.5692%2Fclinicalneurol.cn-001740&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)Neuroscience Laboratory Japan  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本神経治療学会  

Language：Japanese   Publisher：(一社)日本認知症学会  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

J-GLOBAL

Language：Japanese   Publisher：(株)三輪書店  

＜文献概要＞はじめに 首下がり症候群は,体幹に比して頸部が異常に前屈した状態を呈する疾患群を指す(図1).高橋は,「いくつかの基礎疾患に伴ってみられる症候としての首下がり」を首下がり症候群とした.首下がり症候群は,神経筋疾患が原因となる場合,神経変性疾患が原因となる場合,さらには脊椎・脊髄病変が原因となる場合に大別される(図1).一方,"首下がり"は,神経学用語集改訂第3版において,「三浦謹之助が詳述した項部筋不全麻痺による首下がりを主徴とする病態.当初地方病[Gerlier病]とされたが諸原因による」との記載がある.三浦の報告した「Kubisagari」で認めた頸部の前屈は,発作性,麻痺性,再発性で,しばしば家族性であるなど,現在,われわれが診療している首下がり症候群とは臨床像が大きく異なる.このため,目崎は,その総説の中で,dropped headを首下がりと訳すことに対して異を唱えている.この過度の頸部の前屈が,錐体外路疾患において注目されるようになったのは比較的最近であり,用語についてもその成因をジストニアと考えたことに由来するdisproportionate anterocollisや,筋力低下と考えたことに由来するdropped head syndrome(首下がり症候群)が用いられてきた.本レビューでは,錐体外路疾患におけるdisproportionate anterocollis(antecollis)・首下がり症候群の病態,分類,治療について整理したい.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J02317&link_issn=&doc_id=20181206110006&doc_link_id=10.11477%2Fmf.5002201012&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.5002201012&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：English   Publisher：(一社)日本神経学会  

Language：English   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経治療学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(株)中外医学社  

Language：Japanese   Publisher：(一社)日本総合健診医学会  

J-GLOBAL

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本認知症学会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY  

Web of Science

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY  

Web of Science

Language：Japanese   Publisher：保健医療学学会  

パーキンソン病(PD)に対する言語療法はLee Silverman Voice Treatmentが嚆矢となり,その後に病態解明や治療法の開発が進んできた.本稿では,米国のParkinson Voice Project(PD専門の言語治療クリニック)で行われている治療法を中心に紹介する.本施設ではPDにより低下した発声・発話機能の回復を目的とした個別療法と,改善した発声・発話機能の維持を目的とした集団療法の2つの治療プログラムが提供されている.いずれの治療法においてもPD患者が日常生活で良好な発話が保てるよう緻密に構想化されたアプローチのみならず,患者のモチベーションを高めるための創意工夫が随所に施されていた.(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J06406&link_issn=&doc_id=20170411330011&doc_link_id=%2Fem9allhe%2F2017%2F000801%2F011%2F0080-0088%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem9allhe%2F2017%2F000801%2F011%2F0080-0088%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：English   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

Language：Japanese   Publisher：日本音声言語医学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本神経治療学会  

Language：Japanese   Publisher：(一社)日本神経治療学会  

Language：Japanese   Publisher：(一社)日本神経治療学会  

J-GLOBAL

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：Movement Disorder Society of Japan (MDSJ)  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04306&link_issn=&doc_id=20141006020247&doc_link_id=10.11477%2Fmf.6001200003&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.6001200003&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04306&link_issn=&doc_id=20141006020055&doc_link_id=10.11477%2Fmf.6001200003&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.6001200003&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(有)科学評論社  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：日本音声言語医学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J04306&link_issn=&doc_id=20131007180222&doc_link_id=10.11477%2Fmf.6001100379&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.6001100379&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(株)メディカルレビュー社  

視床下核脳深部刺激療法(STN-DBS)後、長期治療中に再増悪した運動合併症に対し、ロピエロール徐放錠が有効であった2例を経験した。症例1は56歳女で、44歳時に両上肢静止時振戦で発症した。薬物療法の調整は困難と判断し、52歳時に両側STN-DBSを施行した。刺激の調整による運動症状のロントロールは、刺激部位の変更や刺激強度の変更により、ジスキネジアの増悪、複視、手足のしびれなどが出現した。ロピニロール徐放錠へと切り替えたところ、ジスキネジアの増悪を伴うことなく軽度改善した。症例2は54歳女で、38歳時に両上肢静止時振戦で発症した。47歳時に左STN-DBSを施行した。左側への側前屈が増悪したため、ロピニロール徐放錠へと切り替えた。直後は動きの悪化を訴えたが、姿勢異常の軽度から中等度改善を認めた。

Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J04306&link_issn=&doc_id=20131007180053&doc_link_id=10.11477%2Fmf.6001100379&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.6001100379&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：(株)三輪書店  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経治療学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(有)科学評論社  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Language：Japanese   Publisher：(一社)日本神経学会  

Event date： 2023.3

Language：English   Presentation type：Poster presentation  

Event date： 2021.9

Language：English   Presentation type：Poster presentation  

Event date： 2020.9

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Language：English   Presentation type：Poster presentation  

Language：English   Presentation type：Oral presentation (general)  

岐阜大学とのジョイントプログラム．反転学習

文系学生に対する医学の講義

医学部4年生に対する臨床講義

看護師特定行為研修

看護師特定行為研修

医学部5，6年生に対する講義，実習

岐阜大学とのジョイントプログラム．反転学習

医学部4年生に対する臨床講義