Emina Ogawa

HOW TO MANAGE OVERACTIVE BLADDER IN ELDERLY INDIVIDUALS WITH DEMENTIA? A COMBINED USE OF DONEPEZIL, A CENTRAL ACETYLCHOLINESTERASE INHIBITOR, AND PROPIVERINE, A PERIPHERAL MUSCARINE RECEPTOR ANTAGONIST

routine CSF analysis, and electroencephalography. Our case is highly unusual, with early neuroimaging abnormalities and near-normal routine CSF findings. PCR confirmed HSE the same day. This case emphasizes the importance of early neuroimaging in elderly patients suspected of having HSE without CSF abnormalities. PCR detection of HSV DNA in CSF is presently considered to be the reference standard but may be negative during the first 24 to 48 hours after onset of symptoms. Also, PCR sensitivity can diminish 5 to 7 days after commencing antiviral treatment. EEGs show temporal lobe involvement as well as characteristic PLEDs and are fairly sensitive, particularly during the first 48 hours, although lacking specificity. Several publications have recently reported on the diagnostic value of diffusion-weighted MRI, suggesting that it is more sensitive than conventional T2weighted sequences in the early detection of HSE, although conclusive studies have not yet been performed. CT scans typically reveal hypodensities in the temporal lobes and frontal lobes (unior bilaterally), rarely with hemorrhagic components, and show gadolinium enhancement only during later stages of the disease. T2-weighted and MRI imaging studies, as well as fluid attenuated inversion recovery and diffusion-weighted sequences, commonly show more-extensive abnormalities corresponding to tissue edema, often including the inferior frontal and medial temporal lobes, and insular cortex and often sparing the basal ganglia. The neuroradiological findings in this patient are typical for HSE, although they appeared unusually early. Diagnostic tools are evolving but presently do not offer high enough sensitivity to exclude the presence of HSV in the early stages of the disease. Our case report suggests that conventional MRI should be performed early in the absence of other diagnostic clues. The efficacy of acyclovir 10 mg/kg given every 8 hours for 21 days has been proven in two randomized clinical trials. The effect of dexamethasone as an adjuvant treatment on survival and neurological sequelae of HSE in adults is being studied in the German trial of Acyclovir and Corticosteroids in Herpes Simplex Encephalitis, which is planned to conclude in 2011. In our patient, early acyclovir treatmentFbefore a pleocytosis appearedFdid not have a significant effect on outcome.

Vascular incontinence: incontinence in the elderly due to ischemic white matter changes

This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD). The concept is based on the original observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normal-pressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.

Correlation of right frontal hypoperfusion and urinary dysfunction in iNPH: A SPECT study

To elucidate the pathophysiology of urinary dysfunction in idiopathic normal‐pressure hydrocephalus (iNPH) by single‐photon emission computed tomography (SPECT) and statistical brain mapping.

Sensitivity and specificity of metaiodobenzylguanidine (MIBG) myocardial accumulation in the diagnosis of Lewy body diseases in a movement disorder clinic

Cardiac scintigraphy with metaiodobenzylguanidine (MIBG), an analog of norepinephrine (NE), is now widely performed in Lewy body diseases (Parkinson’s disease (PD), dementia with Lewy bodies (DLB), pure autonomic failure (PAF), and REM sleep-related behavioral disorder (RBD)) to assess function of the sympathetic nerve endings in the heart. Monitoring of this function is considered important because cardiac sympathetic denervation has been documented in Lewy body diseases by scintigraphy as well as by pathology [1]. However, sensitivity and specificity of MIBG myocardial scintigraphy in the diagnosis of Lewy body diseases has not fully been established. The objective of this study was to determine sensitivity and specificity of MIBG myocardial scintigraphy in the diagnosis of Lewy body diseases in a movement disorder clinic. The study enrolled 182 new patients who visited our movement disorder clinic in a period of 15 months, most of whom were referred patients. They comprised Lewy body diseases in 127 (90 PD, 34 DLB, one PAF, and 2 RBD; 53 men, 74 women; mean age 73 years (range 51–85 years); mean disease duration 6.0 years (range 1–18 years); median Hohen Yahr stage 3 (range 1–4) in PD, DLB), and neurologic diseases control in 62 (parkinsonian gait disorder, cognitive decline, or autonomic dysfunction; including 21 Alzheimer’s disease [AD], 9 progressive supranuclear palsy [PSP], etc.) (Fig. 1). All patients fulfilled the ‘probable’ diagnostic consensus criteria for degenerative neurological disorders, which were confirmed again during a 3-year follow-up period. In order to confirm the diagnosis, in addition to standard neurological and cognitive examination, we performed brain magnetic resonance imaging (MRI) and brain single-photon emission computed tomography (SPECT) imaging using 99mTclabeled L,L-ethyl cysteinate dimer (ECD) in all patients. The methods of MIBG scintigraphy are based on evidence that NE and MIBG have the same mechanisms for uptake, storage, and release. The cut-off value of delayed images of the heart versus mediastinum (HM) ratio was 2.0. Statistical analysis was

Real-time measurement of oxyhemoglobin concentration changes in the frontal micturition area: an fNIRS study

To explore brain activity in the frontal micturition area during natural bladder behavior.

Pathogenesis of reduced or increased bladder sensation

Pathogenesis of reduced or increased bladder sensation is not well known. Hence, we systematically investigated the frequency of reduced or increased bladder sensation in neurologic/mental diseases.

VGCC antibody-positive paraneoplastic cerebellar degeneration presenting with positioning vertigo

A 70-year-old woman developed paraneoplastic cerebellar degeneration (PCD) due to P/Q-type and N-type voltage-gated calcium channel antibodies and small cell lung cancer, the main clinical manifestations of which were severe positioning vertigo and vomiting. Loss of the visual suppression of caloric nystagmus, spontaneous downbeat nystagmus, periodic alternating nystagmus, and positioning vertigo in our patient most probably corresponds to the cerebellar flocculus/paraflocculus lesion caused by PCD.

Constipation and Metaiodobenzylguanidine Myocardial Scintigraphy Abnormality

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Constipation triggered the malignant syndrome in Parkinson's disease

A 69-year-old, chronically constipated patient with Parkinson’s disease developed fecal impaction and the malignant syndrome simultaneously, even while the patient was taking anti-parkinsonian drugs as prescribed. Administration of intravenous levodopa and oral Dai-kenchu-tou, an herbal medicine with serotonergic 5-HT3 receptor agonistic property successfully ameliorated his clinical symptoms. Constipation may trigger worsening of Parkinson’s disease and occurrence of the malignant syndrome by affecting levodopa absorption. Further, improved bowel motility may prevent worsening of Parkinson’s disease and occurrence of the malignant syndrome.

Influence of Body Position on Defecation in Humans

Objectives: To compare three positions for defecation by measuring abdominal pressure and the anorectal angle simultaneously.