Shigenobu Ishida

Photosensitive Seizures Provoked While Viewing “Pocket Monsters,” a Made-for-Televison Animation Program in Japan

Summary: Purpose: To describe the recent epidemic of photosensitive seizure that occurred in relation to an episode of the television animation program “Pocket Monsters,” we report four patients who experienced seizures while watching the episode in question. We also report some technical aspects of the program episode.

Intracranial EEG Recording from Intravascular Electrodes in Patients with Temporal Lobe Epilepsy

Purpose: As part of a presurgical extracranial study, we performed intracranial electroencephalographic (EEG) recording by using micro‐guidewires as active intravascular electrodes in two patients with temporal lobe epilepsy in combination with the Wada test. In one case, there was good agreement among information derived from the non‐invasive assessments, such as ictal semiology, interictal and ictal data from long‐term EEG and video monitoring, magnetic resonance imaging (MRI) findings, single photon emission computed tomography (SPECT) findings, and neuropsychological studies, that consistently pointed to one temporal lobe as the epileptogenic region. The other case showed no definite information about the laterality of the epileptogenic region. The interictal scalp EEG for the two cases showed independent, bilateral, anterior to midtemporal spike foci. The ictal EEGs with sphenoidal electrodes showed no apparent changes initially and during simple partial seizures.

Efficacy and tolerability of levetiracetam as adjunctive therapy in Japanese patients with uncontrolled partial-onset seizures.

The aim of this study was to confirm the efficacy and safety of adjunctive levetiracetam in adult Japanese patients with uncontrolled partial‐onset seizures.

Gender difference in QTc prolongation of people with mental disorders.

BackgroundWe examined gender difference in QTc interval distribution and its related factors in people with mental disorders.MethodsWe retrospectively reviewed medical charts of patients discharged from a university psychiatric unit between November 1997 and December 2000. Subjects were 328 patients (145 males and 183 females) taking psychotropics at their admission. We examined patient characteristics, medical history, diagnosis, and medication before admission.ResultsMean QTc interval was 0.408 (SD = 0.036). QTc intervals in females were significantly longer than those in males. QTc of females without comorbidity was significantly longer than that of males.ConclusionThe influence of gender difference on QTc prolongation in people with mental disorders merits further research.

Mianserin suppositories in the treatment of post-operative delirium

Mianserin suppositories (10–90 mg) were administered at bedtime to 16 patients with post‐operative delirium (mean age 69·5 years). By the Delirium Rating Scale (DRS: Trzepacz et al., 1988), the average score decreased from 21·2 prior to administration to 14·5 on the first day of treatment and to 7·1 on the seventh day. Improvement was observed in all cases (marked in 85 per cent and slight in 15 per cent). The plasma concentration of mianserin was 65 ng/ml on day 1, 93 ng/ml on day 3 and 65 ng/ml on day 5, having reached therapeutic levels within 24 h of beginning treatment. Decreases in the free‐3‐methoxy‐4‐hydroxyphenyl(ethylene)glycol (MHPG) concentrations in plasma were observed after drug administration, but free‐homovanillic acid (HVA) concentrations in plasma showed no significant change with the drug treatment. We consider mianserin suppositories to be an effective treatment for post‐operative delirium.

Prognosis of epilepsy withdrawn from antiepileptic drugs

Abstract Antiepileptic drugs (AED) were discontinued in 55 epileptics who had been free from seizures treated with AED, in accordance with the following criteria and procedures. (i) A reduction in AED commences when patients have been free from seizures for at least 2 years and epileptic discharges have also disappeared in repeated electroencephalogram (EEG) recordings during that period. (ii) AED are gradually reduced if no relapse is seen in clinical seizures and epileptic discharges in EEG. (iii) As a rule at least 2 years are required as the interval from the onset of a reduction to the withdrawal of AED. Forty‐three patients were followed up by a questionnaire and/or by telephone and the follow‐up period from the withdrawal of AED to the survey ranged from 0.9 to 8.8 years; in 38 patients (88.4%) the period was longer than 2 years. No relapse of seizures was found in any of the 43 patients. The severity of epilepsy judged by the total number and frequency of seizures, the presence of neuropsychiatric complications, the combination of different types of seizures, and the duration of epilepsy from the seizure onset to the last seizure appeared not to be risk factors for the recurrence of seizure. Normal EEG was, however, considered to be an important prerequisite for a good prognosis.

Association of HLA-A*31:01 Screening With the Incidence of Carbamazepine-Induced Cutaneous Adverse Reactions in a Japanese Population

Importance Carbamazepine, a commonly used antiepileptic drug, is one of the most common causes of cutaneous adverse drug reactions (cADRs) worldwide. The allele HLA-A*31:01 is reportedly associated with carbamazepine-induced cADRs in Japanese and European populations; however, the clinical utility of HLA-A*31:01 has not been evaluated. Objective To assess the use of HLA-A*31:01 genetic screening to identify Japanese individuals at risk of carbamazepine-induced cADRs. Design, Setting, and Participants This cohort study was conducted across 36 hospitals in Japan from January 2012 to November 2014 among 1202 patients who had been deemed suitable to start treatment with carbamazepine. Preemptive HLA-A*31:01 genetic screening was performed for 1187 participants. Patients who did not start treatment with carbamazepine or alternative drugs were excluded. Participants were interviewed once weekly for 8 weeks to monitor the development of cADRs. Data analysis was performed from June 8, 2015, to December 27, 2016. Exposures Neuropsychiatrists were asked to prescribe carbamazepine for patients who tested negative for HLA-A*31:01 and alternative drugs for those who tested positive for HLA-A*31:01. Main Outcomes and Measures Incidence of carbamazepine-induced cADRs. Results Of the 1130 included patients who were prescribed carbamazepine or alternative drugs, the mean (range) age was 37.4 (0-95) years, 614 (54.3%) were men, and 198 (17.5%) were positive for HLA-A*31:01. Expert dermatologists identified 23 patients (2.0%) who had carbamazepine-induced cADRs, of which 4 patients required hospitalization. Drug-induced hypersensitivity syndrome was observed for 3 patients, maculopapular eruption for 9 patients, erythema multiforme for 5 patients, and an undetermined type of cADR for 6 patients. No patient developed Stevens-Johnson syndrome or toxic epidermal necrolysis. Compared with historical controls, the incidence of carbamazepine-induced cADRs was significantly decreased (for BioBank Japan data: incidence, 3.4%; odds ratio, 0.60; 95% CI, 0.36-1.00; P = .048; for the Japan Medical Data Centre claims database: incidence, 5.1%; odds ratio, 0.39; 95% CI, 0.26-0.59; P < .001). Conclusions and Relevance Preemptive HLA-A*31:01 genetic screening significantly decreased the incidence of carbamazepine-induced cADRs among Japanese patients, which suggests that it may be warranted in routine clinical practice.

Antiepileptic drugs and bone atrophy. A 3-year follow-up study.

われわれは同一精薄施設の長期入所者87例 (うち62例はAED服用群) を対象と, て, 抗てんかん薬 (AED) と骨萎縮性病変の発生状況および, 1α-OH-D3 (VD) の骨萎縮性病変に対する効果について, MD法, MD/MS法を用いて3年間の追跡調査を行い, 以下の結果を得た。初回 (1986年) のMD法で正常であった57例は, VDを投与しなかったところ, 徐々にMD法で異常が出現し悪化した。なかでもAED服用群 (42例) に悪化傾向が強かった。初回のMD法で異常を認めた30例は, VDを投与したところ, 骨皮質の骨塩量 (GS max) の増加を主体に改善傾向を示し, 3年間投与, てもVDの効果の減弱や1副作用は認められなかった。なかでもAED服用群 (20例) の方が未服用群 (10例) よりも平均骨塩量 (ΣGS/D) と断面2次モーメント (I) が増加した。以上のことから, 特にAEDの投与中に認められた骨萎縮性病変には, VDの投与が有効であった。今回の対象とした精薄施設の入所者は全体的に特異なレーダーチャートを示したが, それは主に骨の横径発達の遅滞に関連, ていると思われた。