Journal of Clinical Neurology (Seoul, Korea)最新文献

{"title":"A Multinational, Multicenter, Randomized, Double-Blind, Active Comparator, Phase III Clinical Trial to Evaluate the Efficacy and Safety of Donepezil Transdermal Patch in Patients With Alzheimer's Disease.","authors":"Hyun Jeong Han,&nbsp;Mee Young Park,&nbsp;Kyung Won Park,&nbsp;Kee Hyung Park,&nbsp;Seong Hye Choi,&nbsp;Hee-Jin Kim,&nbsp;Dong Won Yang,&nbsp;Esther Gunaseli A/P M Ebenezer,&nbsp;Yuan-Han Yang,&nbsp;Gurudev M Kewalram,&nbsp;Seol-Heui Han","doi":"10.3988/jcn.2022.18.4.428","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.428","url":null,"abstract":"<p><strong>Background and purpose: </strong>Oral administration of cholinesterase inhibitors is often associated with adverse gastrointestinal effects, and so developing an alternative administration route, such as transdermal, is urgently needed. The primary objective of this study was to determine the efficacy and safety of the IPI-301 donepezil transdermal patch compared with donepezil tablets (control) in mild-to-moderate probable Alzheimer's disease (AD).</p><p><strong>Methods: </strong>This prospective, randomized, double-blind, double-dummy, two-arm parallel, multicenter trial included 399 patients, among whom 303 completed the trial. For randomization, the patients were stratified based on previous treatment and donepezil dose; patients in each stratum were randomized to the test and control groups at a 1:1 ratio.</p><p><strong>Results: </strong>The difference between the control group and the IPI-301 group, quantified as the Hodges-Lehmann estimate of location shift, was 0.00 (95% confidence interval: -1.00 to 1.33), with an upper limit of less than 2.02. The change in Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) score differed significantly between the IPI-301 and control groups (<i>p</i>=0.02). However, the changes in the full-itemized ADCS-ADL scores at week 24 did not differ significantly between the two groups. There were no differences between the two groups regarding the scores for the Clinician Interview-Based Impression of Change (<i>p</i>=0.9097), Mini-Mental State Examination (<i>p</i>=0.7018), Neuropsychiatric Inventory (<i>p</i>=0.7656), or Clinical Dementia Rating (<i>p</i>=0.9990). Adverse events, vital signs, and laboratory test results were comparable between the two groups.</p><p><strong>Conclusions: </strong>IPI-301 was safe and efficacious in improving cognitive function in patients with mild-to-moderate AD.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"428-436"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/c6/jcn-18-428.PMC9262446.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertrophic Pachymeningitis and Interstitial Lung Disease in IgG4-Related Disease.","authors":"So Hyun Yim,&nbsp;Jae Seob Yoon,&nbsp;Chang Hun Lee,&nbsp;Jiyoung Kim","doi":"10.3988/jcn.2022.18.4.481","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.481","url":null,"abstract":"Dear Editor, IgG4-related disease (IgG4-RD) is an immune-mediated inflammatory condition characterized by elevated serum IgG4 and affected organs being infiltrated by IgG4-positive plasma cells.1 This disease can affect multiple organs, but rarely involves the central nervous system (CNS).2 Here we report a case of IgG4-RD presenting as hypertrophic pachymeningitis (HP), which was confirmed in a lung biopsy. A 57-year-old female presented to our hospital with a throbbing headache that began 1 year previously. The pain persisted in the entire head and was more severe on the right side; the patient also had interstitial lung disease (ILD) (Fig. 1A). Although the patient did not present with joint tenderness, the presence of rheumatoid arthritis was supported by elevated C-reactive protein and an increased erythrocyte sedimentation rate. She had been prescribed methylprednisolone (2 mg/day) and tacrolimus (0.5 mg/day) for rheumatoid arthritis. Brain magnetic resonance imaging (MRI) performed in another hospital 5 months previously did not detect any structural lesions that could explain the headache symptoms (Fig. 1B). The patient had been diagnosed with chronic migraine at that time. Despite taking both acute and preventive migraine medications for 5 months, the headache became more severe and interfered with her daily physical activities and the quality of sleep at nighttime. Brain MRI performed upon admission to our hospital revealed pachymeningeal thickening with enhancement in the right hemisphere (Fig. 1C), which had not been found in the previous MRI. An examination of the CSF revealed slight elevation of the WBC count (12/μL, lymphocyte-dominant), whereas protein (37.2 mg/dL) and glucose (66.0 mg/dL) levels were within the normal ranges. Attributing the headaches to IgG4-RD was considered based on the HP revealed by brain MRI and the ILD comorbidity. We investigated the patient’s serum for subclasses of IgG, and found elevated IgG4 (186.4 mg/dL, reference range: 3.9–86.4 mg/dL). A lung biopsy was performed to confirm the diagnosis, because it is safer and easier than a meningeal biopsy. The lung biopsy revealed obliteration of venular vessels and storiform fibrosis with infiltration by lymphoplasma cells (Fig. 1E and F). IgG and IgG4 were found in plasma cells by immunohistochemistry (Fig. 1G and H). Based on the clinical and radiological features observed and the serological and pathological findings, the patient was diagnosed with IgG4-RD.3 She was treated with a high dose of prednisolone (1,000 mg/day for 5 days), followed by rituximab (375 mg/m2). Subsequent MRI revealed decreased pachymeningeal enhancement (Fig. 1D). IgG4-RD can affect various organs, and in this case two organs were involved: the lungs and the brain. The most commonly affected body parts include the pancreas, salivary and lacrimal glands, biliary tract, thyroid, kidney, and lung, while the CNS is rarely involved.4 Diseases that can affect each of these organs are type ","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"481-483"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/1b/jcn-18-481.PMC9262458.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Metabolic Changes Influencing Three-Dimensional Perception in Parkinson's Disease.","authors":"Yoonah Park,&nbsp;Kun-Woo Park,&nbsp;Chan-Nyoung Lee","doi":"10.3988/jcn.2022.18.4.447","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.447","url":null,"abstract":"<p><strong>Background and purpose: </strong>Stereopsis refers to the perception of depth and awareness of the distance of an object from the observer that results from the brain receiving visual stimuli from both eyes in combination. Patients with idiopathic Parkinson's disease (PD patients) typically experience problems with vision, eyeball movements, and visual perception due to degeneration of the cells that generate dopamine in the brain. We therefore hypothesized that stereopsis is affected more by visual cortical dysfunction in idiopathic PD than by retina and subcortical structural dysfunction.</p><p><strong>Methods: </strong>We analyzed stereopsis in 12 PD patients and 7 healthy controls using a three-dimensional (3D) television (TV). Before allowing patients to watch TV, we examined their visual acuity and strabismus using the Titmus Stereo Fly Test, and evaluated their cognitive function using cognitive tests. The patients watched 3D and two-dimensional (2D) versions of a movie with an approximate duration of 17 minutes, and then completed a questionnaire about stereopsis. All subjects underwent brain F-18 fluorodeoxyglucose (FDG) positron-emission tomography after watching the 3D version of the movie. One week later, subjects watched the 2D version of the same movie under the same conditions. Each scan was analyzed using statistical parametric mapping (version 8) software.</p><p><strong>Results: </strong>The visual cortex was activated less in the PD patients than in the healthy controls when watching the 2D or 3D movie. However, there was no significant difference between watching 2D and 3D movies in the PD patients or healthy controls.</p><p><strong>Conclusions: </strong>The lower activation of the primary visual cortex in PD patients suggests the presence of dysfunction of the visual cortex. In addition, there was less activation of the visual association cortex in PD patients when watching a 3D movie than in controls under the same conditions. This might be one reason why PD patients do not recognize real and dynamic stereopsis. These findings have clinical significance since they suggest that safety needs to be considered when making devices or programs using 3D or virtual reality for use by patients with various cerebral degenerative diseases.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"447-452"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/b8/jcn-18-447.PMC9262454.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promising Blood Biomarkers for Clinical Use in Alzheimer's Disease: A Focused Update.","authors":"Sun Ah Park,&nbsp;Yu Jung Jang,&nbsp;Min Kyoung Kim,&nbsp;Sun Min Lee,&nbsp;So Young Moon","doi":"10.3988/jcn.2022.18.4.401","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.401","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is the most-common cause of neurodegenerative dementia, and it is characterized by abnormal amyloid and tau accumulation, which indicates neurodegeneration. AD has mostly been diagnosed clinically. However, ligand-specific positron emission tomography (PET) imaging, such as amyloid PET, and cerebrospinal fluid (CSF) biomarkers are needed to accurately diagnose AD, since they supplement the shortcomings of clinical diagnoses. Using biomarkers that represent the pathology of AD is essential (particularly when disease-modifying treatment is available) to identify the corresponding pathology of targeted therapy and for monitoring the treatment response. Although imaging and CSF biomarkers are useful, their widespread use is restricted by their high cost and the discomfort during the lumbar puncture, respectively. Recent advances in AD blood biomarkers shed light on their future use for clinical purposes. The amyloid β (Aβ)42/Aβ40 ratio and the concentrations of phosphorylated tau at threonine 181 and at threonine 217, and of neurofilament light in the blood were found to represent the pathology of Aβ, tau, and neurodegeneration in the brain when using automatic electrochemiluminescence technologies, single-molecule arrays, immunoprecipitation coupled with mass spectrometry, etc. These blood biomarkers are imminently expected to be incorporated into clinical practice to predict, diagnose, and determine the stage of AD. In this review we focus on advancements in the measurement technologies for blood biomarkers and the promising biomarkers that are approaching clinical application. We also discuss the current limitations, the needed further investigations, and the perspectives on their use.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"401-409"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/92/0b/jcn-18-401.PMC9262460.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40477650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolyl Isomerase Pin1 Expression in the Spinal Motor Neurons of Patients With Sporadic Amyotrophic Lateral Sclerosis.","authors":"Haruhisa Kato,&nbsp;Makiko Naito,&nbsp;Tomoko Saito,&nbsp;Takuto Hideyama,&nbsp;Yasuhiro Suzuki,&nbsp;Takashi Kimura,&nbsp;Shin Kwak,&nbsp;Hitoshi Aizawa","doi":"10.3988/jcn.2022.18.4.463","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.463","url":null,"abstract":"<p><strong>Background and purpose: </strong>Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease. Selective deficiency of edited adenosine deaminase acting on RNA 2 (ADAR2), a key molecule in the acquisition of Ca²⁺ resistance in motor neurons, has been reported in sporadic ALS (sALS) spinal motor neurons. Since ADAR2 activity is positively regulated by prolyl isomerase Protein never in mitosis gene A interacting-1 (Pin1), a known phosphorylation-dependent peptidyl-prolyl cis/trans isomerase, we investigated Pin1 expression in spinal motor neurons in sALS.</p><p><strong>Methods: </strong>Specimens of the spinal cord were obtained from the lumbar region in eight sALS patients and age-matched five controls after postmortem examinations. The specimens were double stained with anti-Pin1 and anti-TAR DNA-binding protein of 43 kDa (TDP-43) antibodies, and examined under a fluorescence microscope.</p><p><strong>Results: </strong>This study analyzed 254 and 422 spinal motor neurons from 8 sALS patients and 5 control subjects, respectively. The frequency of motor neurons with high cytoplasmic Pin1 expression from the spinal cord did not differ significantly between sALS specimens without cytoplasmic TDP-43 inclusions and control specimens. However, in sALS specimens, neurons for which the Pin1 immunoluminescence intensity in the cytoplasm was at least twice that in the background were more common in specimens with cytoplasmic TDP-43 inclusions (<i>p</i><0.05 in χ² test).</p><p><strong>Conclusions: </strong>In sALS, neurons with higher expression levels of Pin1 levels had more TDP-43 inclusions. Despite the feedback mechanism between Pin1 and ADAR2 being unclear, since Pin1 positively regulates ADAR2, our results suggest that higher Pin1 expression levels in motor neurons with TDP-43 pathology from sALS patients represent a compensatory mechanism.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"463-469"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/ad/jcn-18-463.PMC9262457.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin-Induced Immune-Mediated Necrotizing Myopathy Does Not Always Present With Immediate or Severe Symptoms.","authors":"Minsung Kang,&nbsp;Young-Eun Park,&nbsp;Jin-Hong Shin,&nbsp;Hung Youl Seok","doi":"10.3988/jcn.2022.18.4.489","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.489","url":null,"abstract":"Statins are 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) inhibitors that can cause myalgia or muscle weakness due to their myotoxic effect. These symptoms usually occur within a few weeks of statin initiation. 1-3 Immune-mediated necrotizing myopathy (IMNM) is characterized by severe muscle weakness and marked elevation of creatine kinase (CK), with anti-signal recognition particle or anti-HMGCR antibodies in 88%–90% of patients. 4 Some IMNM subtypes, particularly anti-HMGCR-positive IMNM, can be triggered by statins. 4 We report a case of statin-induced IMNM with an unusually mild presentation and delayed symptom onset that responded well to steroid monotherapy. 68-year-old of proximal both upper and lower extremities and CK U/L. med-ication our not his muscle A neurological examination revealed slight weakness in shoulder abduction (Medical Re-search Council [MRC] grade 4+) and hip flexion (MRC grade 4) but no other abnormal findings, including for the sensory system, deep tendon reflexes, and coordination. Serum 440 U/L (normal range <190 U/L), the findings of other routine labo-ratory tests normal, of thyroid function. Autoimmune profiling for various negative. Anti-HMGCR antibody a line immunoassay positive at 106 U (positive >10 U). Nerve conduc-tion studies and needle electromyography revealed polyphasic motor-unit po-tentials with","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"489-491"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/65/50/jcn-18-489.PMC9262459.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Optic Neuropathy as the Prominent Manifestation of Wilson's Disease.","authors":"Shilin Yang,&nbsp;Shenyi Kuang,&nbsp;Yiqin Xiao,&nbsp;Xiang Han","doi":"10.3988/jcn.2022.18.4.492","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.492","url":null,"abstract":"","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"492-494"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/31/jcn-18-492.PMC9262453.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40488321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease Course and Outcomes in Patients With the Limited Form of Neuromyelitis Optica Spectrum Disorders and Negative AQP4-IgG Serology at Disease Onset: A Prospective Cohort Study.","authors":"Xiaodong Chen,&nbsp;Jing Zhou,&nbsp;Rui Li,&nbsp;Bingjun Zhang,&nbsp;Yuge Wang,&nbsp;Xiaonan Zhong,&nbsp;Yaqing Shu,&nbsp;Yanyu Chang,&nbsp;Wei Qiu","doi":"10.3988/jcn.2022.18.4.453","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.453","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients presenting with clinical characteristics that are strongly suggestive of neuromyelitis optica spectrum disorders (NMOSD) have a high risk of developing definite NMOSD in the future. Little is known about the clinical course, treatment, and prognosis of these patients with likely NMOSD at disease onset.</p><p><strong>Methods: </strong>This study prospectively recruited and visited 24 patients with the limited form of NMOSD (LF-NMOSD) at disease onset from November 2012 to June 2021. Their demographics, clinical course, longitudinal aquaporin-4 immunoglobulin G (AQP4-IgG) serology, MRI, therapeutic management, and outcome data were collected and analyzed.</p><p><strong>Results: </strong>The onset age of the cohort was 38.1±12.0 years (mean±standard deviation). The median disease duration was 73.5 months (interquartile range=44.3-117.0 months), and the follow-up period was 54.2±23.8 months. At the end of the last visit, the final diagnosis was categorized into AQP4-IgG-seronegative NMOSD (<i>n</i>=16, 66.7%), AQP4-IgG-seropositive NMOSD (<i>n</i>=7, 29.2%), or multiple sclerosis (<i>n</i>=1, 4.2%). Seven of the 24 patients (29.2%) experienced conversion to AQP4-IgG seropositivity, and the interval from onset to this serological conversion was 37.9±21.9 months. Isolated/mixed area postrema syndrome (APS) was the predominant onset phenotype (37.5%). The patients with isolated/mixed APS onset showed a predilection for conversion to AQP4-IgG seropositivity. All patients experienced a multiphasic disease course, with immunosuppressive therapy reducing the incidence rates of clinical relapse and residual functional disability.</p><p><strong>Conclusions: </strong>Definite NMOSD may be preceded by LF-NMOSD, particularly isolated/mixed APS. Intensive long-term follow-up and attack-prevention immunotherapeutic management is recommended in patients with LF-NMOSD.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"453-462"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/71/jcn-18-453.PMC9262456.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herpes-Zoster-Mediated Radiculitis After Thoracic Spine Surgery.","authors":"Hyo Sae Ahn,&nbsp;Doo Hyuk Kwon","doi":"10.3988/jcn.2022.18.4.484","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.484","url":null,"abstract":"Dear Editor, Varicella zoster virus (VZV) primarily infects children and reactivates in adulthood, causing herpes zoster (also called shingles). Herpes zoster induces pain along the skin dermatome that is accompanied by characteristic band-shaped blisters. Known risk factors include infection with human immunodeficiency virus, bone marrow transplantation, leukemia, lymphoma, receiving immunosuppressors including chemotherapy or steroids, various autoimmune diseases, old age, trauma, female sex, asthma, diabetes, and chronic obstructive pulmonary disease.1,2 In cases of spinal diseases, VZV can be reactivated after interventions including injection therapy or various surgical treatments, including spinal surgery.3-5 However, herpes zoster is quite rare in clinical neurology. A 53-year-old male patient visited the emergency room with a chief complaint of weakness in both legs that started 3 days prior without any history of trauma. He had liver cirrhosis. On neurological examination, the strength of both lower limbs was Medical Research Council scale grade 1, and there was no sensation at all. On thoracolumbar spine magnetic resonance imaging revealed right T1–T2 paracentral disc herniation with cord compression and cord signal change (Fig. 1A and B). The patient was diagnosed with thoracic myelopathy. The following surgical treatment was performed immediately: T1 total laminectomy, C7 and T2 dome laminoplasty, T1–T2 discectomy, and T1–T2 postfusion with a pedicle screw (Fig. 1C and D). After surgical treatment, the muscle strength and sensation in the lower limbs gradually improved. However, 10 days after the operation, the patient complained of a stinging sensation on the right chest wall and upper arm associated with vesicular skin rashes (Fig. 1E and F) that had developed along the right T1 dermatome, which were compatible with herpes zoster viral infection. Valacyclovir (1 g) was administered orally three times a day for 7 days, and the stinging symptoms and skin rash subsequently improved. In this case, herpes zoster occurred in the related segment (T1 dermatome) after surgical treatment for thoracic myelopathy caused by right T1–T2 paracentral disc herniation. The exact mechanism of VZV reactivation remains unknown. Reactivation of the VZV under reduced virus-specific cell-mediated immune responses induces widespread cell-to-cell proliferation, strong local inflammatory responses, and widespread necrosis of neuroglial cells and neurons within the ganglion. VZV spreads down the sensory nerve and is then released from the nerve endings in the skin, causing a cutaneous dermatomal rash.6 Although it is unclear how local surgical trauma can reactivate VZV in the ganglion,6,7 we hypothesized that the reactivation was due to a decline in VZV-specific cell-mediated immunity and disruption of cutaneous immunity caused by stimulating the sensory nerve. General anesthesia and surgeryrelated stress can reduce virus-specific cell-mediated immune response","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"484-486"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/e5/jcn-18-484.PMC9262449.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40478047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Intraoperative Neurophysiology During Microvascular Decompression Surgery for Hemifacial Spasm.","authors":"Byung-Euk Joo,&nbsp;Jun-Soon Kim,&nbsp;Vedran Deletis,&nbsp;Kyung Seok Park","doi":"10.3988/jcn.2022.18.4.410","DOIUrl":"https://doi.org/10.3988/jcn.2022.18.4.410","url":null,"abstract":"<p><p>Microvascular decompression (MVD) is a widely used surgical intervention to relieve the abnormal compression of a facial nerve caused by an artery or vein that results in hemifacial spasm (HFS). Various intraoperative neurophysiologic monitoring (ION) and mapping methodologies have been used since the 1980s, including brainstem auditory evoked potentials, lateral-spread responses, Z-L responses, facial corticobulbar motor evoked potentials, and blink reflexes. These methods have been applied to detect neuronal damage, to optimize the successful decompression of a facial nerve, to predict clinical outcomes, and to identify changes in the excitability of a facial nerve and its nucleus during MVD. This has resulted in multiple studies continuously investigating the clinical application of ION during MVD in patients with HFS. In this study we aimed to review the specific advances in methodologies and clinical research related to ION techniques used in MVD surgery for HFS over the last decade. These advances have enabled clinicians to improve the efficacy and surgical outcomes of MVD, and they provide deeper insight into the pathophysiology of the disease.</p>","PeriodicalId":324902,"journal":{"name":"Journal of Clinical Neurology (Seoul, Korea)","volume":" ","pages":"410-420"},"PeriodicalIF":3.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/be/jcn-18-410.PMC9262452.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40477616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}