Hisashi Kumashiro

Clinical Features of Autistic Children with Setback Course in Their Infancy

Abstract: This study examines the incidence rate of setback in 80 autistic children, the correlation between the type of onset and clinical features, developmental level and prognosis based on an originally developed questionnaire. Moreover, this study seeks to investigate the possibility that infantile autism might be classified into subgroups by the type of onset.

The epidemiological study of autism in Fukushima-ken.

Abstract: A survey of children aged under 18 years in Fukushima‐ken (prefecture) in Japan showed that 2.33 per 10,000 children suffered from early infantile autism. The average of prevalence rates of autistic children born between 1968 and 1974 was 4.96 per 10,000 children. Based on a comparison between cities and rural districts, the prevalence rates of the former were significantly higher than those of the latter. Autistic boys outnumbered autistic girls with a sex ratio of 9: 1. Psychiatric illnesses; were very rare among the relatives of autistic children. The rate of prenatal and perinatal complications was higher than the national norm among autistic children. Parents of autistic children had a significantly higher education than the national norm. There were more nuclear families in the autistic group than in the national norm.

Spike‐Wave Stupor

Five cases of spike‐wave stupor are presented. One case occurred in association with cerebrovascular disease and another in association with the Vogt‐Koyanagi syndrome. A third case had repeated episode of spike‐wave stupor as the only sign of a seizure disorder. A fourth case was characterized by behavior quite similar to catatonic schizophrenia and was so diagnosed. These atypical cases are contrasted with a case more typical of petit mal status as reported in the literature. Thus while spike‐wave stupor is usually superimposed on a chronic centrencephalic seizure disorder, it must be recognized as a syndrome that can arise from a variety of etiological mechanisms. Detailed clinical and EEG investigation is necessary for an understanding of the mechanisms involved in any individual case.

Teratogenicity of Antiepileptic Drugs: Is the Prevention Possible?

Abstract: To assess the relative contribution of antiepileptic drugs (AEDs) toward the occurrence of congenital malformation, two prospective studies (previous and present) were compared. In the present subjects of 145 cases, the total daily dose of AEDs (drug score) in each case was decreased as much as possible, and polypharmacy was changed to monopharmacy before conception where it was possible. The incidence of malformations significantly decreased from 13.5% to 6.2% (p = 0.031) by the change in drug regimen. The drug score, number of AEDs, maternal age at delivery, seizure type, and etiology of epilepsy were statistically different between the two study groups. Even after the correction of the data by the last three factors, the difference in the incidence of malformation did not disappear, while it disappeared if data were corrected either by the drug score or number of AEDs. These results suggest that the possibility of prevention of AED related malformations is possible by an improvement in AED therapy.

“Sleep Apnoea” and Sleep Regulating Mechanism –A case effectively treated with monochlorimipramine–

The patient was a 69‐year old male, with apnoea‐tonic convulsion in sleep as the chief complaint. Over the period of 17 years prior to his admission to our clinic he had been treated as a case of night epilepsy, without improvement but aggravation. Satisfactory results of our treatment are briefly summarized as follows.

A Case of Temporal Lobe Astrocytoma Associated with Epileptic Seizures and Schizophrenia-Like Psychosis

Abstract: The clinical pictures of a left temporal lobe astrocytoma involving the hippocampal region showed a period of 27 years from ages 12 to 38 by epileptic sehres and a period of 9 years from 14 to 22 by schizophrenia‐like symptoms and the following aggressive behavior during 16 years from ages 23 to 38. After a resection of the temporal lobe tumor sparing the hippocampus, transient delusions and aggressive behavior were observed. It might be considered that the hippocampus has the most suspectable relation ship with the schizophrenia‐like symptoms.

Prognosis of Epilepsy: The Second Interim Report of A Multi-Institutional Study in Japan

1 This is the second interim report of the multi‐institutional study on the long‐term prognosis of epilepsy started in 1975 in Japan. The number of institutions joining the investigation increased from 10 to 16 (11 psychiatric, three pediatric and two neurosurgical clinics) during the second year of the study. The outcome of epileptic seizures and EEG findings 10 years after the onset (10‐year‐outcome study, subjects: onset of illness later than 1959, first visit between 1964 and 19661, five years after the onset (5‐year‐outcome study, subjects: onset later than 1964, first visit between 1969 and 1971) were investigated in September 1976. 2 The rate of successful follow‐ups including those by means of inquiry by mail or telephone ranged from 15.4% to 45.8% in the adult 10‐year‐outcome study (483 cases in total), 13.6% to 53.376 in the adult 5‐year‐outcome study (287 cases), and 46.0% to 70.5% in the child 5‐year‐outcome study (747 cases). 3 In the adult 10‐year‐outcome study, the seizures disappeared in 73% of the cases with absence seizures, 67% of generalized tonic‐clonic seizures, 69% of partial seizures with elementary motor symptoms and 3576 of partial seizures with secondarily generalized seizures. In the partial seizures with complex symptomatology, the seizures disappeared in 57% of psychomotor seizures, but only in 33% of psychomotor cases with secondarily generalized convulsive seizures. The outcome of seizures was almost similar in the adult 5‐year‐outcome study as in the 10‐year‐outcome study. In the child cases, the rate of complete remission was higher than that of adult cases in almost all types of seizures. 4 As for the clinico‐electroencephalographic correlations, about half of the adult and approximately 70% of the child cases showed a parallel change in clinical seizure frequency and EEG pictures. In most of the non‐parallel cases, aggravation of EEG abnormalities was observed despite clinical improvement.

Serial changes of n-isopropyl-p-iodoamphetamine single photon emission computed tomography in two epileptic psychotics

Abstract: Serial changes of single photon emission computed tomography (SPECT) in two epileptic psychotics are reported. One patient had a decreased blood flow of the left temporal lobe with schizophrenia‐like symptoms, and the other patient had a decreased blood flow of the right temporal lobe with depressive symptoms. In each case, these abnormal findings disappeared following recovery from a psychotic state. It might be suggested that the psychotic state of an epileptic patient influences the SPECT findings.

Clinical and Pathological Studies of Myoclonus Epilepsy

The authors reported the clinical picture of myoclonus epilepsy occurred in three siblings of one family. In Case 1 the illness began at 14 years, and she is now still alive. In Case 2 the disease began at 7 years and death occurred at the age of 14 after the clinical course of about 7 years. In Case 3 (autopsy case), the onset of the disease was 6 years of age, and death occurred at 11 after the clinical history of 5 years. Autopsy revealed the degenerative lesions of the dentate and the olivary nucleus associated with gliosis of the pallidum due to a perinatal anoxic damage.

Morphological Alteration in Hippocampus after Status Epilepticus Induced by Intra‐amygdaloid Injection of Dibutyryl‐CAMP in Rats

Granule cell axons or mossy fibers, which normally innervate neurons in the hilus and CA3 field of the hippocampus, are a major excitatory link in the circuitry of the hippocampus. In the mammalian hippocampal formation, mossy fibers show a normal variation in their distribution and several types of morphological reorganizationq2 Such reorganization includes supragranular sprouting of mossy fibers following partial deafferentation of the dentate gyrus induced by lesions of the perforant path. Some studies have demonstrated that more extensive supragranular sprouting occurred following a kainic acid treatment.6 An intracerebral or systemic injection of kainic acid caused a selective loss of neurons in the hilus and CA3 and CA4 fields, which presumably produced partial deafferentation of the molecular layer that could serve as a stimulus for mossy fiber sprouting. However, recent studies revealed that mossy fiber sprouting occurred in the absence of overt morphological damage in kindled animals. These observations have led to the suggestion that epileptic activity could cause structural reorganization of