Shuhei Kasama

Cerebral blood flow in Parkinson's disease, dementia with Lewy bodies, and alzheimer's disease according to three-dimensional stereotactic surface projection imaging

Regional brain perfusion was analyzed using single-photon emission computed tomography with three-dimensional stereotactic surface projections (3D-SSP) in 69 patients with Parkinson’s disease (PD), 16 patients with dementia with Lewy bodies (DLB) and 15 patients with Alzheimer’s disease (AD), and compared with that in 24 age-equivalent normal subjects. Nondemented PD patients revealed less parietal and frontal flow than controls. With mental impairment, flow reduction extended to other areas including occipital regions. PD with dementia and DLB showed similar reduction patterns, although frontal flow showed a greater reduction in DLB. AD showed little occipital reduction, but a severe parieto-temporal reduction. Thus, 3D-SSP appears to be useful in the detection of cortical lesions and the differential diagnosis of patients with cognitive impairment.

Therapeutic efficacy of double filtration plasmapheresis in patients with anti-aquaporin-4 antibody-positive multiple sclerosis

Multiple sclerosis (MS) in Asian countries, including Japan, is classified into two types: conventional MS (C-MS), characterized mainly by cerebral lesions, and opticospinal MS (OS-MS) or neuromyelitis optica (NMO), characterized by selective involvement of the optic nerve and spinal cord. Recently, a serum immunoglobulin-G-antibody was discovered in patients with NMO that targets aquaporin-4 (AQP4). The existence of the anti-AQP4 antibody shows the pathogenetic role of humoral immune factors in OS-MS/NMO. We treated eight patients with anti-AQP4 antibody-positive MS with double filtration plasmapheresis (DFPP) to remove the antibody. Improvement of vision was observed in two patients. Motion improvement was seen in seven patients. Sensory improvement was observed in four patients. In total, six out of eight patients (75%) showed therapeutic improvement after DFPP treatment. We propose that DFPP might be an effective therapeutic option for patients with anti-AQP4 antibody-positive MS.

Decreased chloride levels of cerebrospinal fluid in patients with amyotrophic lateral sclerosis

Recent studies have suggested that the elevation of intracellular chloride contributes to excitotoxic cell death in motor neuron and can be related to the pathogenesis of amyotrophic lateral sclerosis (ALS). We investigated whether chloride levels in cerebrospinal fluid (CSF) and serum were lower in ALS patients than in control patients with other neurological diseases (OND). We also examined the relationship between chloride levels and clinical ALS phenotypes. We measured chloride levels (CSF and serum) in 27 ALS patients and 33 age- and gender-matched OND controls admitted to our hospital for diagnosis. The CSF chloride levels were lower in ALS patients (117 [range 102-130] mmol/L) than in OND controls (126 [range 114-134] mmol/L) (P<0.0001). However, no significant difference was found in their serum chloride levels (P>0.05). There was no significant difference in CSF chloride levels among the sub-groups of ALS patients classified according to their age, gender, duration of illness, clinical state and type of onset (P>0.05). CSF chloride levels already significantly decreased in ALS patients at the time of diagnosis. We conclude that the elevation of intracellular chloride would cause the reduction of chloride in CSF and be related to the pathogenesis of ALS.

Cerebral blood flow and cognitive function in Parkinson's disease

To evaluate visual cognitive and memory function in patients with Parkinsons disease (PD), we performed the Rey–Osterrieth complex figure (ROCF) test in 24 patients with PD and 12 normal control subjects. In the ROCF test, the copy score (copy0) was used to evaluate visuospatial constructive function; the recall score (recall30) 30 min after copying the ROCF and the percentage recall score (%recall30=100×{1−[copy0–recall30]/copy0}) was used to evaluate visuospatial memory function. Regional cerebral blood flow (rCBF) in the PD patients was measured using single-photon emission computed tomography (SPECT) and 123I-iodoamphetamine as a tracer. Measurement of rCBF was performed semiquantitatively using the RI count ratio to the cerebellar region. The recall30 and %recall30 scores were significantly lower in the PD patients than the normal controls. The copy0 score was correlated with rCBF in the lateral and medial prefrontal cortex. Both the recall30 score and the %recall30 score were correlated with rCBF in the posterior parietal cortex. In addition, the %recall30 score was correlated with the lateral occipital cortex. The present study suggests that the impairment of visuospatial constructive function in PD patients may be related to a reduction in rCBF in the frontal cortex, while impairment of visuospatial memory function may be related to a reduction in rCBF in the posterior parietal and occipital cortex.

A comparative SPECT study of regional brain perfusion in patients with Alzheimer's disease, progressive supranuclear palsy, and corticobasal degeneration

Abstract To investigate the underlying mechanism of dementing illnesses that comprise tauopathy, we evaluated the regional cerebral blood flow (rCBF) of patients with Alzheimers disease (AD), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP), and of normal control subjects using single-photon emission computed tomography (SPECT) with 123I-iodoamphetamine as the tracer. rCBF was evaluated semiquantitatively by using the ratio of the RI count to the occipital region count, and the asymmetry index. Compared with the normal controls, AD patients showed significantly decreased rCBF in the inferior and lateral prefrontal, temporal, and posterior parietal cortices, while CBD patients showed significant rCBF reduction in the inferior prefrontal, anterior cingulate, medial premotor, temporal, posterior parietal, and sensorimotor cortices, thalamus, and basal ganglia. PSP patients showed no rCBF reduction in any region. Compared with PSP patients, CBD patients showed significant rCBF reduction in the sensorimotor cortex. Compared with CBD patients, AD patients showed significant rCBF reduction in the posterior parietal cortex, while rCBF in the sensorimotor cortex of the CBD patients was significantly decreased compared to the AD patients. Asymmetry of rCBF was observed in the lateral prefrontal and posterior parietal cortices of the AD patients and in the inferior prefrontal and sensorimotor cortices of the CBD patients. In conclusion, AD patients were characterized by reduced rCBF in the temporoparietal cortex. Although the magnitude of the rCBF reduction was mild in CBD, the decreases extended widely over the subcortical/cortical areas.

Cerebral blood flow and depression in Parkinson's disease

Abstract To clarify the responsible lesion of depression in patients with Parkinsons disease (PD), regional cerebral blood flow (rCBF) was determined and depression was evaluated in 26 patients with PD and 12 normal control subjects. Measurement of rCBF was performed by single-photon emission computed tomography (SPECT) using N -isopropyl- p [ 123 I] iodoamphetamine ( 123 I-IMP) as a tracer. Tracer activity was determined in 13 pairs of cerebellar, cortical and subcortical regions, and expressed as the ratio in each region under consideration to the mean counting rate over the cerebellar region. Assessment of the depression scale was based on the subjects performance on Zungs self-rating depression scale (SDS). There were significant differences in both the SDS and Mini-Mental State Examination (MMSE) scores between the patient and the control groups, although no correlation was noted between both scores. The SDS score in PD patients was significantly correlated with the tracer activity in the left medial and left inferior frontal cortex. Present results suggest that depression in PD may be associated with the left frontal rCBF reduction.