Immunosuppressive drug therapy in myasthenia gravis

We reviewed the records of 37 patients with myasthenia gravis treated with azathioprine (n = 10) or cyclophosphamide (n = 27). All patients had received prednisone and anticholinesterase therapy, and most had undergone thymectomy prior to immunosuppressive therapy. Thirty patients (81%) responded to treatment. Both azathioprine and cyclophosphamide were found to be effective in the treatment of myasthenia gravis. The degree of improvement was more pronounced in patients with thymoma.     

Immunosuppressive treatment of rippling muscles in patients with myasthenia gravis

Rippling muscle disease is a rare autosomal dominant disorder that may occur sporadically. In this report two patients presenting with rippling muscles followed by myasthenia gravis are described. Our first patient developed rippling muscles about 1 month after infection with Yersinia enterocolitica. Two years later myasthenia gravis appeared. Our second patient had a 2-year history of asthma prior to the onset of rippling muscles which preceded the myasthenic symptoms by 4–8 weeks. Acetylcholine receptor and anti-skeletal muscle antibody titers were positive in both patients. In both patients the rippling phenomena worsened with pyridostigmine treatment but markedly improved after immunosuppression with azathioprine.     

The significance and management of persistent primary insomnia: the past, present and future of behavioral insomnia therapies

Persistent primary insomnia (PPI) is a prevalent and potentially serious condition that compromises the functioning, health status, and quality of lives of millions of individuals around the world. This condition is typically perpetuated by a host of psychological and behavioral mechanisms that often require behavioral interventions. Nonetheless, all too commonly, practitioners underestimate the seriousness of this condition or rely too heavily on symptom focused sedative hypnotic therapy for its treatment. Herein we briefly review the epidemiology of PPI and consider the inadequacies of sedative hypnotics for treating this disorder. Subsequently, we provide rationale for the use of behavioral interventions with this condition and we describe the gradual evolution of the currently available behavioral insomnia treatments and consider promising recent developments such as the emergence of cognitive-behavioral and specially tailored, patient-specific approaches. In closing, we consider the potential usefulness of a combined pharmacological/behavioral intervention for PPI and present a number of important research questions to address in future studies of the behavioral insomnia therapies.     

Recent clinical trials and future therapies

Journal of Neurology - Immunotherapy for multiple sclerosis (MS) has developed extremely successfully during the past decade and a number of new strategies were developed for the treatment of the...     

Oral corticosteroid therapy and present disease status in myasthenia gravis

Introduction: The aim of this study was to elucidate the effectiveness of oral prednisolone (PSL) according to dosing regimen in 472 patients with myasthenia gravis (MG). Methods: We compared the clinical characteristics and PSL treatment between 226 patients who achieved minimal manifestations (MM) or better and 246 patients who remained improved (I) or worsened, according to the MG Foundation of America postintervention status. Results: Achievement of MM or better at peak PSL dose (odds ratio 12.25, P < 0.0001) and combined use of plasma exchange/plasmapheresis (PE/PP) and/or intravenous immunoglobulin (IVIg) (odds ratio 1.92, P = 0.04) were associated positively, and total PSL dose during the past year (odds ratio 0.17, P = 0.03) was associated negatively with present MM or better status. Conclusions: Higher PSL dose and longer PSL treatment do not ensure better outcome. In the absence of a good response, the PSL dose should be decreased by combining with modalities such as PE/PP or IVIg. Muscle Nerve 51 :692–696, 2015     

The present and the future of sleep research in Asia

Abstract In recent years, recognition of the importance of sleep, not only as a health problem but also as a social problem, has brought about worldwide growing interest in sleep and sleep research. In Asian countries, the number of sleep researchers is increasing rapidly and as a result the Asian Sleep Research Society (ASRS) was founded in 1994. This paper reviews the main topics of basic and clinical sleep research which have been investigated recently in Japan and in Asian countries. The subjects of sleep research in Asia in the future will be, in principle, similar to those in other countries of the world. However, the author suggests several subjects which are more or less specific to Asia and which should be studied in association, such as epidemiological longitudinal study of sleep disorders in developing countries, characteristics of sleep and dreaming in oriental culture and philosophy, etc. The roles of ASRS in dissemination of information, promotion of training and education, and enlightenment of public and government were also emphasized.     

Neurologists in the United States--past, present, and future

Neurologists in the United States were enumerated for each year from 1935 to 1984 on two bases: board certification (including Child Neurology and Psychiatry and Neurology) and completion of PG4 neurology residency training. The annual incidence of new neurologists was calculated at less than 200 until 1970; then it rose steadily to 380 in 1980, and plateaued thereafter at 385. The estimated number of neurologists present at one time (prevalence) was 1,500 in 1950, 2,400 in 1970, 4,600 in 1980, 8,100 in 1990, and 11,000 in 2000. These numbers for total neurologists will plateau at 12,200 by about 2010, at which time the number of certified neurologists will also plateau at 9,900. Both numbers are notably less than our prior estimate of needs: 16,500 neurologists by 1990, 19,100 in 2010.     

Pediatric neurosurgery in the Middle East: present and future

The Middle East is the term used for more than ten countries with populations characterized by different ethnic roots and religions and with diverse political and economic power. It is probably the most unstable part of the whole world, having spent centuries struggling for a settled situation. Reflecting this political turmoil, the health problems and priorities in these countries are very different than in western countries. Medical associations, including neurosurgical associations, in most of these countries have very little communication with international societies compared with such associations in other parts of the world. Although one or two neurosurgeons in almost every country in the region enjoy some prominence in the international neurosurgical arena, almost no society-based relationships have been established among Middle East countries. Pediatric neurosurgery has been regarded as a subspecialty in the Middle East countries for the last two decades. Although it is not well organized except in Turkey and Israel, most of the countries in this region now have neurosurgeons who give special attention to pediatric neurosurgery within their general neurosurgical practice. Practicing neurosurgeons are few and and far between; there are certainly not enough of them to allow specialization in specific fields of neurosurgery in most countries in the Middle East. Moreover, owing to political and economic problems, most countries in the region are behind the standard neurosurgical agenda. Nonetheless, the flow rate of papers submitted to Child's Nervous System from several countries in the region has been slowly but progressively increasing. Hopefully, political stabilization in the near future will activate progress in pediatric neurosurgery along with neurosurgery in this region.     

帕金森病诊断的过去、现在和将来

健康是人类幸福生活的基石,健康的体魄是人们所追求与向往的目标,因此,人类在诞生之初便同疾病做着不屈不挠的斗争.帕金森病(Parkinson's disease, PD)是一种常见于中老年人的神经系统变性疾病,其相关症状在数千年前的<黄帝内经>中已有描述.作为一种影响多个系统的慢性神经变性疾病,PD只有当中脑多巴胺(DA)能神经元减少50%、纹状体DA递质降低70%以上时才表现出临床症状.