Junichi Furusho

A comparison survey of seizures and other symptoms of Pokemon phenomenon

On 16 December 1997, many Japanese children developed neurologic problems while watching the animated television series Pokemon. This study included children who visited the outpatient departments of 14 pediatric clinics for other reasons within 2 months after this incident. Volunteering children and parents or guardians were asked to complete questionnaires. We obtained 1,373 replies (including 800 males, 558 females, and 15 children without information on sex; mean age, 6.8 +/- 3.5 years). The majority of children included in this study (80%) watched this program, and 67 (6.1%; 40 males, 27 females) were affected by the program. There were 10 patients with seizures (0.9%; four males and six females). Fifty-seven patients developed other symptoms. Compared with nonaffected children, significantly more affected children reported that they concentrated on watching this program, watched it at a short distance from the screen, and did not watch this program in a brightly lit room. Seizures tended to occur in older children (average = 10.8 years) and in children with a high rate of familial histories of seizures. Symptoms other than seizures occurred more frequently, and autonomic and psychologic factors, such as motion sickness, could be considered possible mechanisms. Children who developed symptoms seemed to have problems in viewing conditions.

Simultaneous study of interictal EEG and near-infrared spectroscopy in a boy with epilepsy

Abstract Near-infrared spectroscopy (NIRS) is a useful non-invasive method for the diagnosis of the cerebral metabolism with epileptic foci in cases of intractable epilepsy. We examined the cerebral metabolic state of epilepsy at the interictal state using a simultaneous measurement of electroencephalograph (EEG) and an NIR system in a boy with epilepsy. The subject was a 9-year-old boy with temporal lobe epilepsy. Oxy-hemoglobin (oxy-Hb), deoxy-hemoglobin (deoxy-Hb) and regional cerebral blood volume (rCBV) were estimated using a multi-channel functional NIR (fNIR) system with 24 channels (Hitachi Medical), after obtaining informed consent. Spikes on the EEG were frequently seen on the left parietal and middle temporal area during photo stimulation at the drowsy stage. On the opposite side, spikes were occasionally seen during photo stimulation. Functional NIR findings at the same time were the following: the increase of deoxy-Hb and the slight decrease of oxy-Hb and rCBV firstly from the left middle/post-temporal surfaces, and delaying response at the opposite sides. Besides, the changes of deoxy-Hb, oxy-Hb and rCBF showed the relatively small amplitude. The appearance of the abnormal metabolic state was consistent with the EEG, as spikes became less and less frequent, we then came to the conclusion that NIRS could evaluate the real-time cerebral metabolic state of the epileptic foci, even if the clinical seizure did not occur.

Early Diagnosis of Herpes Encephalopathy Using Fluid-Attenuated Inversion Recovery Pulse Sequence

This study describes the usefulness of fluid-attenuated inversion recovery (FLAIR) pulse sequence for early diagnosis and treatment of herpes encephalitis. An 8-year-old boy with suspected herpes simplex encephalitis was examined by magnetic resonance imaging at 3 days post-symptom onset. Lesions in the right thalamus and insular cortex were detected by conventional T2-weighted images and images from FLAIR pulse sequence. Bilateral temporal lesions, however, were only detected by FLAIR images.

Alleviation of sleep disturbance and repetitive behavior by a selective serotonin re-uptake inhibitor in a boy with Asperger's syndrome

An 8 year-old boy with Aspergers syndrome had difficulties in communicating with his teachers and classmates. He occasionally stole out of the classroom. He could not sleep at night recalling his awful experience and kept crying every night and refused to go to school. The treatment with fluvoxamine was started at the dose of 25 mg daily. Four weeks after the treatment, his repetitive behavior and hyperactivity decreased and night crying diminished. Although he still has difficulties in communicating with others, he is now able to attend extra-curricular classes in a private school. Fluvoxamine, a selective serotonin re-uptake inhibitor that has been mainly used for patients with depression and obsessive-compulsive disorder, might be effective for compulsive symptoms and sleep disturbance of patients with pervasive developmental disorders.

West syndrome with periventricular leukomalacia: a morphometric MRI study

A morphometric magnetic resonance imaging study was performed, and the results were compared among three groups (group 1, periventricular leukomalacia patients with West syndrome; group 2, periventricular leukomalacia patients without West syndrome; and group 3, control patients) to clarify the characteristics and cause of West syndrome. This study included 21 infants (11 males and 10 females, 7 months to 2 years 8 months old) born at 24-32 weeks of gestation and weighing 625-1,908 gm. The Evans ratio, ratio of the posterior horns, Cella media index, width of the third ventricle, and the areas of the midbrain, pons, and medulla oblongata were measured and compared among the three groups. There were no differences of gestation or birth weight among the three groups. The Evans ratio, ratio of the posterior horns, Cella media index, and width of the third ventricle were larger in group 1 than in groups 2 and 3. The ratio of the posterior horns and Cella media index were larger in group 2 than in group 3, although the width of the third ventricle was not. Myelination was delayed in all patients in group 1 and in two patients in group 2. In group 1 the areas of the midbrain and pons were smaller than in groups 2 and 3 and the medulla oblongata was smaller than in group 3, although there were no differences in midbrain, pons, and medulla oblongata between groups 2 and 3. Although the infants with periventricular leukomalacia and West syndrome frequently demonstrated marked ventricular dilatation and delayed myelination, the atrophy of midbrain and pons was the most characteristic, and the damage may cause West syndrome.

Patient background of the Pokemon phenomenon: Questionnaire studies in multiple pediatric clinics

Many children in Japan developed various neuropsychological problems, including seizures, while watching the program Pocket Monster, televised on 16 December 1997. To examine the basis for this incident, we have performed a survey of volunteering children and their parents who visited our pediatric clinics for other reasons from 8 January to 28 February 1998. Children and their parents filled out questionnaires. Among the total of 662 children surveyed, the great majority (603, 91.1%) was found to have watched the Pocket Monster program and 30 individuals (5.0% of viewers) complained of variable degrees of neuropsychological abnormalities. These included seizures (two cases), headache (nine cases), nausea (eight cases), blurred vision (four cases), vertigo (two cases), dysthymia (two cases) and vomiting (one case). Nearly half (14) of these children developed symptoms during or immediately after watching the program, while the remainder did so later. Representative cases are reported and other statistical aspects are discussed.

Study of Psychiatric Symptoms after Discontinuation of Antiepileptic Drugs

Summary: We studied 23 patients with epilepsy and a hallucinatory delusional state (group A) or other psychotic symptoms (group B) in whom antiepileptic drugs (AEDs) were successfully discontinued. Patients in group A had an earlier age at onset of both epilepsy and psychotic symptoms than those in group B. Both groups had similar seizure frequency and duration of AED therapy. The psychotic symptoms in group A patients started at the age 20.8 years and lasted longer than in group B patients; and antipsychotic drug treatment was generally effective, but the social adaptation (work/personal life) of the patients was poor. We considered that group A patients had schizophrenia rather than mere recurrence of epileptic psychosis.

MRI lesions masked by brain development: a case of infant-onset focal epilepsy

A 3-month-old male presented with right-side-dominant focal seizures. Focal spikes were observed on the left side of an electroencephalogram obtained at the time of onset. The immature development in the left middle temporal lobe was observed by initial magnetic resonance imaging (MRI). The hypoperfusion in the left temporal lobe observed with single-photon computed tomography was consistent with MRI findings. These MRI findings were not observed in a second MRI at 11 months of age. This observation may explain one of the causes of infant-onset focal epilepsy.

The first Japanese pediatric case of obsessive–compulsive disorder who responded to a selective serotonin re‐uptake inhibitor

psychiatric condition and it has been reported that over 80% of patients with OCD had their onset before the age of 18 years.1 According to epidemiological studies,2 the prevalence of OCD among adolescents is 1–2%; consequently, it is considered that more than a few children and adolescents have suffered from OCD.3 The pharmacological management of OCD in children and adolescents has so far been with clomipramine, bromazepam and haloperidol, but the outcomes have been variable from a psychiatric viewpoint.4 The usefulness of selective serotonin re-uptake inhibitors (SSRIs) for OCD has been reported repeatedly; and SSRIs are gradually replacing tricyclic antidepressants as firstchoice drugs in the treatment of OCD because of their minimal adverse effects.1–9 In Japan, fluvoxamine, a type of SSRI, has been available since May 1999. Because meticulous care in the administration of SSRIs is recommended in the pediatric field, no report of their use in children has so far been published in Japan. In the present paper, we describe a case of an adolescent patient in whom a good outcome was obtained by using fluvoxamine.

Isoproterenol continuous inhalation therapy in an infant with severe bronchiolitis lifesaving therapy

A 46-day-old infant weighing 4.8 kg was admited to Showa University Hospital Emergency Center, with symptoms of tachypnea and not crying. On admission, he was cyanotic with a respiratory rate of 120 breaths/min, heart rate of 220 beats/min and a temperature of 37°C. Poor breath sounds were noted over both lungs. There were no other remarkable findings. Hematology showed negative C-reactive protein and white blood cells at 11 000/mm3 (lymphocytes 72%, neutrophils 24%, monocytes 2%, basophils 2%). The respiratory syncytial virus titer was 32 by paired serum test. The parainfluenza virus and adeno titers were both negative. Arterial blood gas analysis showed pH 7.406, PCO2 5 8mmHg, PO 2 74 mmHg and HCO3 32.0 mEq/L, oxygen saturation 84%, breathing room air. A chest X-ray showed hyperinflation, tram lines and thickening of the bronchial airways, but not atelectasis. Immediately, we gave salbutamol, 0.1 mL in 2 mL saline, by nebulizer, but it was not effective. A cardiac echogram did not show cardiac diseases, such as heart failure or heart deformities. Therefore, a diagnosis of respiratory syncytial virus-induced bronchiolitis was made and oxygen and nebulized L-isoproterenol, 0.02 mg (L-isoprenarine hydrochloride; Nikken Chemical Co. Ltd, Tokyo, Japan) in 3 mL saline was started immediately with rapid infusion of fluids. While preparations for mechanical ventilation were underway, his respiratory condition quickly improved and as the L-isoproterenol therapy was clearly sufficient, mechanical ventilation did not proceed. He was put in an oxygen head box and given nebulized L-isoproterenol continuously from a Inspiron Nebulizer (Fig. 1, Rusch Manufacturing, Armagh, Ireland). L-Isoproterenol (1.0mg of 0.2 mg/kg) was mixed with 500 mL saline and nebulized at an oxygen flow of 10 L/min. After 1 h therapy, his respiratory condition had improved further and arterial blood gas analysis showed PCO2 of 46 mmHg. Also, oxygen saturation by pulse oxymeter showed that the patient maintained >98% O2 saturation, allowing the oxygen concentration to be reduced slowly. Electrocardiogram did not show abnormal findings, such as any arrhythmia and creatine phosphokinase did not increase during inhalation. Pediatrics International (1999) 41, 94–96