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Idiopathic basal ganglia calcification (IBGC), also known as Fahr's disease or primary familial brain calcification, manifests as bilaterally symmetric calcifications in the brain. Clinical symptoms range from movement disorders to cognitive impairment and psychiatric symptoms. Since 2012, IBGC has been reported as an inherited disorder with several causative genes, including SLC20A2; however, the genotype-phenotype association remains unclear. Furthermore, longitudinal follow-up studies investigating the prognosis of neuropsychiatric symptoms in IBGC are lacking. A 36-year-old woman who experienced recurrent psychosis since the age of 30 years was admitted to our hospital. Her symptoms included delusions, hallucinations, disorganized speech, and grossly disorganized behavior. Cranial CT revealed calcification of the bilateral basal ganglia and dentate nucleus. The possibility of metabolic or endocrinological disorders causing secondary calcification was excluded via laboratory examinations. The genetic analysis revealed SLC20A2 mutation, and therefore, she was diagnosed with definite IBGC. At the age of 37, 42, and 43 years, similar psychosis recurred due to a decrease in medication. Each episode was relieved within one week with a low dose of risperidone (1.5-2 mg/day p.o.). Eventually, remission was maintained with risperidone (1.5 mg/day). To our knowledge, genetically confirmed case of IBGC with psychosis has been rarely reported. Recurrent psychosis can be the sole symptom of SLC20A2-associated IBGC and may be remitted with a low dose of risperidone. Literature review including eight case reports shows no superiority between medications. Although our case indicates that a low dose of antipsychotics can alleviate symptoms without any side effects and should be continued to prevent relapse in some patients with IBGC, there has been still shortage of the clinical evidence. Further longitudinal studies on genotype-phenotype associations may expedite personalized medicine for patients with IBGC.

To compare the energy efficiency of Wearable Power-Assist Locomotor (WPAL) with conventional knee-ankle-foot orthoses (MSH-KAFO) such as Hip and Ankle Linked Orthosis (HALO) or Primewalk.Cross over case-series.Chubu Rosai Hospital, Aichi, Japan, which is affiliated with the Japan Organization of Occupational Health and Safety.Six patients were trained with MSH-KAFO (either HALO or Primewalk) and WPAL. They underwent 6-minute walk tests with each orthosis. Energy efficiency was estimated using physiological cost index (PCI) as well as heart rate (HR) and modified Borg score. Trial energy efficiency with MSH-KAFO was compared with WPAL to assess if differences in PCI became greater between MSH-KAFO and WPAL as time goes on during the 6-minute walk. Spearman correlation coefficient of time (range: 0.5-6.0 minutes) with the difference was calculated. The same statistical procedures were repeated for HR and modified Borg score.Greater energy efficiency, representing a lower gait demand, was observed in trials with WPAL compared with MSH-KAFO (Spearman correlation coefficients for PCI, HR and modified Borg were 0.93, 0.90 and 0.97, respectively, all P 0.0001).WPAL is a practical and energy efficient type of robotics that may be used by patients with paraplegia.