Matsue Miyasaka

Epidemiological survey of dementia and depression among the aged living in the community in Japan

Abstract: The authors surveyed the prevalence of depression and dementia in the elderly in Ohira town in Japan from 1989 to 1990. The total population of this town was 26,712, with 2,778 people aged 65 and above, constituting 10.4% of the total population. The prevalence of dementia (n=128) was 6.1% and that of major depression (n=9) was 0.4%, according to the DSM‐III‐R criteria. The prevalence of a depressive state which did not fulfill the criteria for major depression (n=55) was 2.4%. The patients with multi‐infarct dementia (n=49) suffered from depression (42.8%) more frequently than those with dementia of the Alzheimer type (11.1%). The rate of depression coexisting with dementia increased with aging, while the rate of depression without dementia did not change in all the age groups.

Treatment of tardive dyskinesia with ceruletide: A double-blind, placebo-controlled study

The effectiveness of a once-weekly i.m. injection of ceruletide (0.8 microgram/kg) in suppressing the symptoms of neuroleptic-induced tardive dyskinesia (TD) was evaluated in a double-blind, placebo-controlled, matched-pairs study. Global evaluation of the severity of TD symptoms over the 8-week study period revealed a significant improvement with ceruletide as compared with placebo. Analysis of the therapeutic response to ceruletide over the course of treatment revealed a slow, but long-lasting improvement of TD symptoms. Side effects, which were mild and transient, consisted mainly of nausea and epigastric discomfort. The incidence of side effects did not differ between the ceruletide- and placebo-treated groups. Ceruletide appears to be a novel and practical treatment that can substantially alleviate the symptoms of dyskinesia.

A Double-Blind Comparison of Sulpiride with Chlordiazepoxide in Neurosis

The therapeutic effectiveness of sulpiride on various types of neurosis was compared with that of chlordiazepoxide on a double‐blind basis.

Symposium: Temporal Lobe Epilepsy

Temporal lobe epilepsy (TLE), in which the seizures result from epileptic discharges in mesial temporal limbic structures, has been the main refractory epilepsy in adults. Quality-of-life (QOL) in patients with TLE may be impaired by complex partial seizures, side effects of anticonvulsants and interictal behavioral disorders.’ QOL is a subjective concept and based on individual psychosocial problems. However, a neuropathological dysfunction or lesion of epileptic disorder’, a chronic neurological disease of the brain, may produce a cognitive dysfunction in some patients with TLE, which may compose a biological vulnerability to psychosocial stressors. To improve the QOL issues, it seems indispensable to clarify a long-term course of TLE of childhood onset, a possible relationship of mesial temporal pathology in TLE to both interictal behavioral disorders and to intractability of the seizures, a change in patient’s social functioning after epileptic surgery, and the clinical significance of mesial temporal sclerosis (MTS). For these reasons, six speakers were nominated to discuss these issues in this symposium. Dr. Hashimoto examined the seizure outcome, drug compliance, marital condition,

Multi-institutional Study on Possibility of Prediction of Long-term Prognosis in Temporal Lobe Epilepsy.

側頭葉てんかんの長期予後予測の可能性を検討するため, 一定期間に受診し, その後, 10～20年間の治療, 経過観察をなしえた76例を対象として多施設共同研究を行った。治療開始後2年目の時点の臨床所見と長期予後との関係をみたところ, 治療開始後2年目に月1回以上の頻度で発作があり, しかも神経精神医学的合併症状がみられた11例では, 調査時点で全例が発作を有していたが, とくに, そのうちの7例は月1回以上の発作を示していた。これに対して, 治療開始後2年目の1年間に発作がみられず, その時点で神経精神医学的異常所見を示していなかった18例では, 16例 (89%) が発作抑制状態にあった。以上の結果から, 治療開始後2年目の臨床所見から長期予後の良否を予測することが, 少なくとも一部の例については, かなりの程度可能であるものと考えた。長期予後予測の治療的意義について若干の考察を加えた。

Propagation of the Epileptic Discharge: Transverse or Longitudinal?

In order to establish the strategy of comprehensive treatment of epilepsy, it will be most necessary to understand the clinical manifestations produced by the propagation of epileptic discharge which spread intracerebrally from the cortex to the periphery via the spinal cord. The president of this meeting, Prof. J. Mukawa had asked us, the authors, to organize and also to take the chair of the symposium as titles. His strongest interests were based on whether the transverse propagation or the longitudinal propagation will play a major role, even if both mechanisms will intermingle with each other, in the actual seizures. The authors had requested to let contributions to this planning by two foreign investigators and seven domestic researchers. They were very cooperative and well responded to our requests.

Comparing “Absence Status” to Tomplex Partial Status“

According to the report by Celesia G. and coworkers ( 1976) ,? they observed 2,290 epileptic cases, and of them 60 cases (2.6%) presented status epilepticus, consisting of 45 convulsive status and I5 nonconvulsive status. Among the 15 nonconvulsive status, there were 13 cases of absence status and 2 cases of psychomotor status. According to the report by Forster C. and others (1969), among 100 cases of status epilepticus, there were 35 cases of nonconvulsive status, which constituted 33 petit ma1 status and 2 cases of psychomotor status. Ballenger C. and others’ report that until 1983 in the literature, there were reports of approximately 400 cases of absence status, while as for the reports of partial complex status (CPS status), there were only 17 cases with positive EEG records. I have experienced only 3 cases of absence status and none of the cases of CPS status.” At our daily clinic, we experience far more patients with complex partial seizure than those with absence, and yet we observe less fewer complex partial status than absence status. The situation is paradoxical. Why? Through my experience in animal experiments, the limbic seizure activities have a very high amplitude and a very high frequency, and their recovery was very late in comparison with thalomo-neocortical seizures (Fig. 1 ) .‘I We suppose the rarity of complex partial status (limbic seizure status) will depend on the difference of the seizure activity between the limbic structure and neocortical structure. I would like to ask the symposists their opinion regarding the reason