Ryo Tomioka

Efficacy of intravenous methylprednisolone pulse therapy in patients with multiple sclerosis and neuromyelitis optica

Background: No large-scale studies have compared the efficacy of intravenous methylprednisolone pulse therapy (IVMP) for multiple sclerosis (MS) and neuromyelitis optica (NMO). Objective: To explain differences in treatment responses of MS and NMO patients to IVMP. Methods: Changes in neurological symptoms/signs and Expanded Disability Status Scale (EDSS) scores before and within 1 week of IVMP completion were obtained in 2010 at 28 institutions, and retrospectively collated from 271 MS (478 courses) and 73 NMO (118 courses) cases. Results: In MS patients, decreased EDSS score was significant after the first (−0.8 ± 0.9), second (−0.7 ± 0.9), and third (−0.7 ± 0.8) courses (p < 0.05), but not after the fourth (−0.3 ± 0.7) and fifth (−0.5 ± 0.6). However, decreased EDSS score was only significant after the first course (−0.5 ± 1.5, p < 0.05) in NMO patients. EDSS score was significantly decreased in MS compared with NMO patients at the first course (p < 0.05), but not thereafter. Model analysis for EDSS score improvement at the first course, adjusting for covariates, showed significantly greater decreases in MS compared with NMO patients (p < 0.05). Conclusion: IVMP is effective in MS from the first to third courses, and in NMO at the first course. Additionally, IVMP is more efficacious in MS than NMO patients, even at the first course.

Efficacy of methylprednisolone pulse therapy for acute relapse in Japanese patients with multiple sclerosis and neuromyelitis optica: A multicenter retrospective analysis – 1. Whole group analysis

There has been no large‐scale study of methylprednisolone pulse therapy in Asian patients with multiple sclerosis (MS) or neuromyelitis optica (NMO), despite it being widely used for acute relapse. We aimed to clarify treatment response of MS and NMO patients to methylprednisolone pulse therapy and post‐pulse oral corticosteroids in real clinical practice in a multicenter study in Japan.

Dysphagia as a result of ossification of the anterior longitudinal ligament in a patient with myotonic dystrophy

A 61‐year‐old man with myotonic dystrophy (dystrophia myotonica [DM]) complained of dysphagia. Videofluoroscopy suggested impairment of swallowing attributable to weakness of the oropharyngoesophageal muscles. To manage this problem, percutaneous endoscopic gastrostomy was attempted, but the endoscopy showed the upper esophagus was obstructed. Computed tomography (CT) of the neck showed ossification of the anterior longitudinal ligament (OALL) compressing the esophagus. In the serum, 1,25‐dihydroxycholecalciferol was elevated; head CT suggested hyperostosis of the calvarium; and dual‐energy X‐ray absorptiometry at lumbar segments yielded a bone mineral density of 1.092 g/cm2, corresponding to 113% of the age‐matched, Asian male controls. Systemic abnormal calcium metabolism could underlie this patient, which might have, directly or indirectly, contributed to OALL, resulting in dysphagia. The issue of abnormal calcium metabolism in DM deserves further exploration, as it can manifest with diverse, unexpected clinical symptoms, such as dysphagia as a result of OALL, as in the present case.