Noboru Imai

Clinical features of probable medication-overuse headache: a retrospective study in Japan.

This study examined the clinical picture of probable medication-overuse headache (MOH) and the presence of any features peculiar to Japan. In a retrospective study of 47 patients, type of primary headache, type of medicine overused, method and result of withdrawal were investigated. Among the 47 patients, 80.9% had migraine only, and 85.1% overused combination medications. While 36 patients (76.6%) succeeded in withdrawal, five patients (10.6%) failed. One patient (2.1%) had not improved by 2 months after withdrawal and was diagnosed with chronic migraine and chronic tension-type headache without MOH. The remaining five patients (10.6%) dropped out. All dropout patients were recommended abrupt inpatient withdrawal, but chose abrupt outpatient withdrawal. As features peculiar to Japan, many patients with probable MOH overused combination analgesics, particularly females.

Relapse of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome without increased level of vascular endothelial growth factor following successful autologous peripheral blood stem cell transplantation.

We report a patient with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome who experienced relapse after successful treatment with autologous peripheral blood stem cell transplantation (auto-PBSCT). Interestingly, although vascular endothelial growth factor (VEGF) levels were positively correlated with disease activity before and after auto-PBSCT, as expected, levels did not increase at the time of relapse. The patient was treated with doxorubicin, dexamethasone, and diuretics, followed by thalidomide, and remains clinically stable at one year after treatment. This case suggests that VEGF level may not always be indicative of relapse of POEMS syndrome, and that thalidomide is both useful and safe for patients with relapse following successful treatment with auto-PBSCT.

Clinical profile of cluster headaches in Japan: low prevalence of chronic cluster headache, and uncoupling of sense and behaviour of restlessness.

Introduction: This study examined the clinical profile of cluster headaches in Japan and the potential presence of features peculiar to Japan. Most previous studies of cluster headaches have focused on Caucasian populations. Methods: Subjects comprised 86 consecutive new cluster headache patients (68 males, 18 females; mean age, 38.4 ± 12.2 years; range, 17–73 years). Mean age at onset was 31.0 years and the ratio of males to females was 3.8:1. Results: Chronic cluster headache was observed in 3.5% of patients. More than half of patients (68.9%) reported feelings of restlessness during headache episodes and 42.9% reported restless behaviour. Patients with uncoupling of feelings of restlessness and restless behaviour forced themselves to keep still. Similar findings were reported in a Taiwanese study. Conclusion: Japanese patients in this study showed a relatively low prevalence of chronic cluster headaches, and uncoupling of a sense of restlessness and restless behaviour. These features of cluster headache may be more common in Japanese and Taiwanese patients than in Caucasian patients.

Kinetics Differ Between Copper-Zinc and Manganese Superoxide Dismutase Activity With Acute Ischemic Stroke

This study aimed to clarify the kinetics of copper-zinc (CuZn) and manganese (Mn) superoxide dismutase (SOD) activity in acute ischemic stroke victims. Using the nitrite method, we investigated sequential changes in CuZn and Mn SOD activity in the cerebrospinal fluid (CSF) of 8 patients with acute ischemic stroke. SOD activity in each patient was measured at 36 hours and 3, 7, 14, and 28 days after stroke. CuZn SOD activity in CSF peaked 3 days after stroke, with values gradually decreasing after 7 days. In contrast, Mn SOD activity remained significantly lower in the stroke group than in controls throughout the study. These findings may reflect differences between the 2 isoenzymes in terms of the distribution, role, and method of synthesis in brain tissue.

Superoxide dismutase activity of CSF in patients with multiple infarction.

CTにて多発性脳梗塞と診断された24例の髄液superoxide dismutase (SOD) 活性と脳萎縮・PVLおよびMMST検査結果との関係について検討を行った.髄液SOD活性は亜硝酸法 (大柳変法) でtotal SOD, Mn SOD, Cu-Zn SODを測定し, 脳萎縮の程度はCTscanによる二次元法でbrain-atrophy index (BAI), ventricular area index (VAI), PVL area index (PAI) を求め評価した.その結果, total SODはVAIと負の相関 (p<0.01) を, Mn SODはBAIと正の相関 (p<0.01) を, Cu-Zn SODはVAIと負の相関 (p<0.02) を示した.PAI, MMSTと各SOD活性では, 有意な相関は認められなかった.以上より多発性脳梗塞患者においては脳萎縮が強いほど髄液SOD活性は低下することが示された.