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Purpose: Benign adult familial myoclonus epilepsy (BAFME) is an autosomal dominant disease representing tremulous myoclonus or cortical tremor and infrequent generalized seizures. We aimed to delineate detailed epidemiological backgrounds in patients with Japanese BAFME and to establish diagnostic criteria based on clinical and electrophysiological findings.Methods: After a previous survey on the current nationwide state of myoclonus epilepsy of adults in Japan, we conducted this survey to delineate the clinical characteristics of Japanese BAFME patients, using a questionnaire to obtain details for individual patients. Based on clinical diagnostic criteria, we analyzed demographic and clinical characteristics of 101 BAFME patients in 74 families.Results: BAFME patients were predominantly female and were widely distributed throughout Japan. Ninety-two patients (91.1%) showed signs of cortical tremor and 84 (83.2%) showed epileptic seizures. Epileptic seizures were infrequent in BAFME patients, but 22.6% of patients had more than one seizure per year at the maximum. Three patients (3.0%) showed cerebellar ataxia, eight (7.9%) showed cognitive impairment, and 13 (12.9%) had psychiatric symptoms. Brain MRI was normal in 74% of patients, and the remaining patients had non-specific abnormal findings. Sodium valproate and clonazepam were the primary drugs used for BAFME patients. The older patients showed significantly more severe and higher rates of abnormal electrophysiological results, which were suggestive of cortical hyperexcitability.Conclusion: Our study successfully delineated the overall clinical characteristics of Japanese BAFME. The correlation between the genetic, clinical, and electrophysiological results will be very important to further elucidate the pathophysiology and treatment of BAFME in the future. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To delineate long-term change of cortical excitability by measuring somatosensory evoked potentials (SEPs) in patients with Unverricht–Lundborg disease (ULD). Methods: SEPs to median nerve stimulation were repeatedly examined in two genetically proven ULD patients manifesting stable condition over 16years, namely disabling but non-progressive myoclonus and cessation of generalised tonic–clonic seizures. Results: In both patients, five sets of early cortical components were identified 16years ago: two tangential components of N20–P20 and P30–N30 and three radial components of P25, N35 and N40. Cortical SEPs were regarded as abnormally enhanced ‘giant’ based on the N35 amplitude (>mean+3 SD of normal controls). The bimodal negative peaks of N35 and N40 showed different spatial distribution: N35 maximum in the central area and N40 in the centro-parietal area. At present, N35 remained giant while N40 disappeared in both patients. Conclusions: It is possible that currently preserved giant SEPs at least at N35 reflect disabling cortical myoclonus and that disappearance of N40 might reflect a lesser degree of increased cortico-cortical connectivity and/or decreased cortical hyperexcitability in the association cortices. It might possibly have resulted in the disappearance of GTCSs. Significance: We delineated long-term change of giant SEP in ULD. [Copyright &y& Elsevier]

Abstract: General anesthesia is routinely used as a surgical procedure and its safety has been endorsed by clinical outcomes; however, its effects at the molecular level have not been elucidated. We previously showed that inhalation anesthesia affects the expression of 1.5% of 10,000 genes, which included so-called circadian genes. In the current study, we confirmed that inhalation of sevoflurane alters circadian gene expression, and investigated whether this alteration persists after awakening from anesthesia. Rats were anesthetized with 4.0% sevoflurane for 0 h, 2 h and 6 h (n =9 each group), before being sacrificed. Rats were also anesthetized for 6 h and allowed to recover after anesthesia, then sacrificed 2 h, 6 h and 24 h after awakening (n =9 each group). Anesthesia was started for each group so that all rats would be sacrificed at 13:00, and gene expression in the whole brain was examined using real-time RT–PCR. Expression of the genes encoding Per2, Dbp, Arc, Egr1, Krox20 and NGFI-B was suppressed during inhalation of sevoflurane for 2 h and 6 h. Although the suppression tended to be alleviated after awakening from anesthesia, the expression levels after a recovery period of 24 h remained significantly lower than the control levels of these genes, except for Krox20. We demonstrated that circadian gene expression is suppressed in whole brain during sevoflurane anesthesia, and the suppression continues for at least 24 h after termination of sevoflurane treatment. This suggests that sevoflurane anesthesia may have effects at the molecular level and that these effects are long lasting. [Copyright &y& Elsevier]

Background: Endoscopic submucosal dissection (ESD) has recently been developed for endoscopic treatment of GI tumors, which enables us to resect even large tumors en bloc. However, a considerable frequency of perforation has become another problem. The best way to prevent perforation is to create a sufficient submucosal fluid cushion (SFC). The aim of this study is to find out the feasibility of ESD by using a mixture of 1900 KDa hyaluronic acid (Suvenyl) and a 10% glycerin plus 5% fructose solution (Glyceol). Methods: Sixty-seven consecutive GI tumors in 54 patients who met indication criteria of ESD were enrolled. The mixing ratios of Suvenyl and Glyceol were 1:3 for esophageal/colorectal tumors and stomach tumors with scar, and 1:7 for stomach tumors without scar. After creation of SFCs, mucosal incision around the tumors and submucosal dissection under the tumors were made by cutting devices. The clinical outcomes were investigated. Results: Mean resected and tumor sizes were 38.6 and 25.6 mm, respectively. Perforation occurred in one colon tumor with severe fibrosis (1.5%), which was managed by endoscopic clipping without salvage surgery. No blood transfusion was performed. In one stomach and in one rectal tumor (3%), endoscopic hemostasis was necessary because of postoperative bleeding. Overall endoscopic and histologic en bloc resection rates were 94% (63/67) and 78% (52/67), respectively, and there was no recurrence after follow-up of 1 year. Conclusions: ESD when using a mixture of Suvenyl and Glyceol results in excellent outcomes, and this injection solution should be used for ESD. [Copyright &y& Elsevier]

Background: When choosing submucosal injection solutions for EMR, tissue damage should be considered, as well as the lesion-lifting ability. The objective of the study was to find out the potential tissue damage of submucosal injection solutions. Methods: The submucosal injection solutions examined were the following: normal saline solution (NS), 3.75% NaCl, 20% and 50% dextrose water (DW), a glycerin solution (Glyceol; 10% glycerin with 0.9% NaCl plus 5% fructose), and two hyaluronic acid (HA) solutions (0.25% 1900 kDa/NS solution and 0.125% 1900 kDa/ Glyceol solution). Furthermore, DW with different concentrations (5%, 10%, 15%, 30%, 40%) also was examined to find out the tolerable concentration without tissue damage. A total of 2 mL of each solution per stomach were injected by endoscopy into the submucosal layer at the separate sites of 4 living minipigs. Two minipigs were euthanized after 30 minutes of endoscopic observations, and the others were euthanized after additional endoscopic observations a week after injection. Results: There was no apparent tissue damage in NS, 5% and 10% DW, Glyceol, or two solutions of HA, whereas, hypertonic solutions, except Glyceol and 10% DW, have more or less potency of tissue damage. In 3.75% NaCl and DW with concentrations of ≥20%, considerable tissue damage was observed, which might affect resected EMR specimens and ulcer healing. Conclusions: Use of hypertonic solutions except Glyceol is not recommended with respect to tissue damage. A combination of HA and Glyceol is the most favorable submucosal injection solution, considering tissue damage and lesion-lifting ability. [Copyright &y& Elsevier]

• Ictal direct current shifts can be observed at a time constant of 2 s. • Two types of ictal direct current shifts were revealed by the waveform property. • Each type of direct current shift may be correlated with the corresponding pathology. To determine clinically ictal direct current (DC) shifts that can be identified by a time constant (TC) of 2 s and to delineate different types of DC shifts by different attenuation patterns between TC of 10 s and 2 s. Twenty-one patients who underwent subdural electrode implantation for epilepsy surgery were investigated. For habitual seizures, we compared (1) the peak amplitude and (2) peak latency of the earliest ictal DC shifts between TC of 10 s and 2 s. Cluster and logistic regression analyses were performed based on the attenuation rate of amplitude and peak latency with TC 10 s. Ictal DC shifts in 120 seizures were analyzed; 89.1% of which were appropriately depicted even by a TC of 2 s. Cluster and logistic regression analyses revealed two types of ictal DC shift. Namely, a rapid development pattern was defined as the ictal DC shifts with a shorter peak latency and they also showed smaller attenuation rate of amplitude (73/120 seizures). Slow development pattern was defined as the ictal DC shifts with crosscurrent of a rapid development pattern, i.e., a longer peak latency and larger attenuation rate of amplitude (47/120 seizures). Focal cortical dysplasia (FCD) 1A tended to show a rapid development pattern (22/29 seizures) and FCD2A tended to show a slow development pattern (13 /18 seizures), indicating there might be some correlations between two types of ictal DC shift and certain pathologies. Ictal DC shifts, especially rapid development pattern, can be recorded and identified by the AC amplifiers of TC of 2 s which is widely used in many institutes compared to that of TC of 10 s. Two types of ictal DC shifts were identified with possibility of corresponding pathology. Ictal DC shifts can be distinguished by their attenuation patterns. [ABSTRACT FROM AUTHOR]

By using cortico-cortical evoked potentials [CCEP: early negative (N1) and late negative (N2) components], we aimed to clarify high frequency oscillation (HFO) correlates of CCEPs and its relation to human epileptogenesis. We recruited 12 patients with intractable partial epilepsy who underwent invasive presurgical evaluation with chronic implantation of subdural electrodes. Repetitive single-pulse electrical stimulation (1Hz) was applied to (1) the seizure onset zone (SOZ) and (2) the control cortex (nSOZ), and CCEPs were recorded from the surrounding cortices within SOZ and nSOZ, respectively. We applied short-time Fourier transform to obtain induced responses at the timing of N1 (HFO N1) and N2 (HFO N2) and analyzed the logarithmic power change of HFO N1 and HFO N2 in reference to the baseline activity for ripple (120–200Hz) and fast ripple (>200Hz) bands. Seventeen clear CCEP responses were recorded for both SOZ and nSOZ across patients. In both SOZ and nSOZ stimulation, HFO N1 generally showed power increase and HFO N2 power decrease across the 2 frequency bands. HFO N1 power at SOZ increased more significantly than that at nSOZ in FR band. The present study suggests HFO correlates of CCEPs could be a surrogate marker of abnormally enhanced cortical excitability in human epileptic focus. [Copyright &y& Elsevier]

Tacrolimus ointment is prescribed for patients with atopic dermatitis, although it is known to cause transient burning sensations and hot flashes in the applied skin. The aim of this study was to evaluate the effects of olopatadine hydrochloride (olopatadine), an antiallergic agent with a histamine H1 receptor (H1R) antagonistic activity, on the incidence of hot flashes induced by topical treatment with tacrolimus ointment in rats. Consequently, the skin temperature was increased by the topical application of tacrolimus ointment in rats, and the rise in skin temperature was inhibited by pretreatment with olopatadine in a dose-dependent manner. Inhibitory effect of olopatadine on tacrolimus-induced skin temperature elevation was significantly more potent than that of cetirizine hydrochloride, other antiallergic agent with H1R antagonistic activity, at doses in which both agents exhibit comparable H1R antagonistic activity in rats. These results suggest that H1R antagonistic activity-independent mechanism contribute to the inhibitory effect of olopatadine on tacrolimus-induced skin temperature elevation. Olopatadine also significantly inhibited increases in vascular permeability and nerve growth factor production in the skin induced by topical tacrolimus treatment. Thus, the onset of hot flashes in rats is quantitatively determined by measuring the skin temperature and olopatadine attenuates hot flashes induced by topical tacrolimus ointment in rats, suggesting that the combination application with olopatadine and tacrolimus ointment is useful for improving medication adherence with tacrolimus ointment treatment in patients with atopic dermatitis. [ABSTRACT FROM AUTHOR]

Introduction. Although low-dose perampanel (PER) is reportedly effective on cortical myoclonus in a limited number of patients, its underlying mechanisms remain unclear. We aimed to extract and elaborate the clinical effects of PER on refractory cortical myoclonus for dose, etiology and also somatosensory-evoked potential (SEP) findings. Method. We examined 18 epilepsy patients with seizure and cortical myoclonus (10 males; mean age, 48.4 ± 16.2 years; Unverricht-Lundborg disease = 7, benign adult familial myoclonus epilepsy = 6, dentatorubral-pallidoluysian atrophy = 2, Gaucher disease = 1, and Lance-Adams syndrome = 2). Based on data accumulated before and after PER treatment, activities of daily life [ADL]), short latency, cortical components of SEP, and PER blood concentration were analyzed. Results. PER (mean dose: 3.2 ± 2.1 mg/day) significantly improved seizure frequency, myoclonus and ADL scores. It also significantly decreased the amplitude of and prolonged correlate with clinical scores among all patients. In contrast, the degree of P25 prolongation ms) significantly correlated with improved ADL score (p = 0.019) and blood PER concentration (p = 0.011). The degree of N33 prolongation (32.1 ± 4.0 to 33.7 ± 3.4 ms) was positively correlated with ADL score and blood PER concentration (p = 0.025 and p = 0.025, respectively). Conclusion. Low-dose PER markedly improved myoclonus and ADL in patients with refractory cortical myoclonus. SEP, especially P25 latency, is a potentially good biomarker to assess the objective effects of PER on intractable cortical myoclonus. (https://doi.org/10.1016/j.clinph.2019.07.006). [ABSTRACT FROM AUTHOR]

A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. Approximately 2 minutes after an intravenous line was established by an anesthesia resident, severe hypoxia and bradycardia developed, and she lost consciousness. Cardiopulmonary resuscitation was initiated immediately, and after 1 minute, she regained consciousness, and her breathing and circulation recovered. After admission to the intensive care unit, emergency coronary angiography was performed. The blood flow in all the coronary arteries was normal. However, a decrease in the apical left ventricular wall motion and an increase in the basal wall motion were observed. Based on these findings, Takotsubo cardiomyopathy was diagnosed. The wall motion gradually improved and the patient was discharged from the hospital on postoperative day 15. The respiratory depression and bradycardia were thought to be due to an inadvertent bolus of remifentanil. We surmised that the patient had received a slight amount of retained medication when the anesthesia resident established the intravenous line, which caused severe respiratory depression. It is important to note that adverse effects such as severe respiratory depression and bradycardia can be caused by even small doses of remifentanil. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: There are circadian genes whose expressions were affected by sevoflurane. We hypothesized that propofol and dexmedetomidine also have influences on the expressions of circadian genes. Materials and methods: Seven-week-old rats were cannulated and propofol (600μg/kg/min, 1ml/h, n =6: group P6H), dexmedetomidine (1μg/kg/min, 1ml/h, n =6: group D6H), 10% lipid (1ml/h, n =6: group L) and normal saline (1ml/h, n =6: group N) were infused intravenously for 6h; rats were decapitated soon or 24h after awakening from anesthesia (groups P24H n =6 and D24H n =6). Real time reverse transcription-polymerase chain reaction was performed using rat whole brain and the expressions of circadian genes were measured. Results: In the P6H group and the P24H group, the whole expressions of seven genes were changed significantly compared with the L group. In the D6H group, the whole expression of seven genes was changed significantly compared with the N group. In the P6H group, all gene expressions except for Tef (thyrotroph embryonic factor) were changed significantly compared with the L group. In this group, the expression of Dbp (D site albumin promoter binding protein) was increased, and the others were decreased. In the D6H group, all gene expressions except for Dbp and Tef were decreased significantly compared with the N group. For the two anesthetics, the expression patterns were different only in Dbp. Conclusion: We showed that propofol and dexmedetomidine have influences on the circadian gene expressions. [Copyright &y& Elsevier]

Abstract: Due to the broad anti-inflammatory and immunomodulatory actions of phosphodiesterase (PDE) 4 inhibitors, it has been proposed that PDE4 inhibitors might be efficacious for skin disorders such as atopic dermatitis. KF66490 is a newly developed PDE4 inhibitor that inhibits PDE4B (IC50 =220 nM) and the production of tumor necrosis factor (TNF)-α by mouse peritoneal exudated cells stimulated with lipopolysaccharide (IC50 =855 nM). To evaluate efficacy of KF66490 in atopic dermatitis (AD) models, on skin inflammation induced by repeated application of 2,4,6-trinitro-1-chlorobenzene (TNCB) on ear in BALB/c mice and on spontaneously AD-like skin diseases in NC/Nga mice. BALB/c mice were sensitized with 0.3% w/v TNCB applied to the ear on day-7, followed by application three times a week from days 0 to 21. NC/Nga mice spontaneously developed dermatitis symptoms under conventional conditions. Test compounds were administered orally once daily during experiments. In the TNCB-induced dermatitis model, KF66490 significantly inhibited the increase in ear thickness and interleukin (IL)-4 and IL-1β levels in the ear. Histopathological and immunohistochemical analysis revealed that KF66490 significantly inhibited the proliferation of fibroblasts and CD3-positive T cells infiltration into the ear. In addition, KF66490 significantly suppressed the development of dermatitis in NC/Nga mice on all observation days, except for 5 and 6 weeks after the first dose. Furthermore, KF66490 produced less potent emetic effects than the first generation PDE4 inhibitor, rolipram. The present results suggest that KF66490 has excellent potential as an oral medicine for the treatment of atopic dermatitis. [Copyright &y& Elsevier]