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The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study.This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes.In 2020, the frequency of outpatient EEG studies (-10.7%, p0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.

Two terpenes; cneorubin X (1), (-)-gymnomitr-3(15)-en-4β-ol (2) as well as one benzoic compound; caffeic acid (3) were isolated from Bazzania harpago collected from Mt. Trus Madi, Sabah, Malaysia. The structures of these secondary metabolites were elucidated based on spectroscopic data (Infra-Red (IR), 1D and 2D Nuclear Magnetic Resonance (NMR), and Mass Spectrum (MS)). This is the first record that cneorubin X (1) was isolated from non-vascular plants and it exhibited active anti-fungal activity against Haliphthoros sabahensis and Haliphthoros milfordensis. Chemosystematics finding suggests that the Marchantiophyta (liverworts) genus Bazzania might have a closer chemical relationship to its sister group Bryophyta (mosses) genus Brachythecium, Kindbergia and Mnium, as well as Anthocerophyta (hornworts) genus Anthocerosin their evolutionary history.

BACKGROUND Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a newly identified low-grade brain tumor with frequent epileptic presentation. Despite the facilitated use of invasive electroencephalography owing to the growing availability of stereo-electroencephalography (SEEG), intracranial features of tumor-related seizures are still scarcely described. This report provides the first description of SEEG-recorded seizures in PLNTY to provide an insight into its surgical strategy. OBSERVATIONS Spontaneous clinical seizures were recorded with SEEG in a young adult patient with drug-resistant epilepsy associated with a PLNTY in the left lateral temporal cortex. The seizure onset was characterized by low-voltage fast activity (LVFA) and showed eccentric localization with respect to the tumor: LVFA was localized in the anterior portion of the tumor and spread toward the adjacent polar cortex. The language risks associated with the resection of the posterior temporal cortex could thus be minimized. LESSONS PLNTY can show a focal and eccentric seizure-onset zone around the tumor. The present findings serve to improve the functional and seizure outcomes using the staged invasive approach in PLNTY.

BACKGROUND Frontal disconnection surgery is a useful surgical option for patients with frontal epilepsy whose seizure onset zones are exceedingly large and thus are not amenable to conventional resective surgery. While it has the advantage of avoiding sequelae stemming from a large resection cavity, the impact of radical anatomofunctional disconnection of such a vast frontal region is not fully understood. OBSERVATIONS The authors have identified secondary degeneration in the striatum ipsilateral to the frontal disconnection surgery in two adult patients who had otherwise favorable postoperative outcomes following the surgery. On serial postoperative magnetic resonance imaging, the striatum showed transient restricted diffusion in the caudate head and rostral putamen around several weeks postoperatively and subsequent atrophy in the caudate head. The affected striatal regions (i.e., the anterior portion of the striatum) were congruent with the known fronto-striatal connectivity corresponding to the disconnected frontal regions anterior to the primary and supplementary motor areas. Both patients achieved 1-year seizure freedom without apparent disability related to the surgery. LESSONS The benign postoperative course despite the marked degenerative changes in the ipsilateral striatum supports the feasibility of the frontal disconnection surgery in otherwise inoperable patients with broad frontal epileptogenicity.

Abstract New bioactive 13-epi-neoverrucosane diterpenoid, 5β-acetoxy-13-epi-neoverrucosanic acid (1) along with three known secondary metabolites, 13-epi-neoverrucosan-5β-ol (2), chelodane (3) and (E)-β-farnesene (4) were isolated from the MeOH extract of east Malaysia’s liverwort Pleurozia subinflata. The chemical structure of new compound was elucidated by the analyses of its spectroscopic data (FTIR, NMR and HR-ESI-MS). These epi-neoverrucosane-type compounds seem to be notable chemosystematic markers for P. subinflata in Borneo. Compound 3 was widespread in marine sponges however this is the first record for 3 to be found in liverwort. These metabolites were tested for their antifungal potentials against selected fungi from the marine environment. Compound 1 exhibited effective antifungal activity against Lagenidium thermophilum. Graphic Abstract

A new lobane-type diterpenoid, loba-8,10,13(15)-triene-14,17,18-triol 17-acetate (1), and 5 known compounds, lobatriene (2), (17 R)-loba-8,10,13(15)-triene-17,18-diol (3), loba-8,10,13(15)-triene-14,17,18-triol 14,17-diacetate (4), loba-8,10,13(15)-triene-14,17,18-triol 14-acetate (5), and lobatrienetriol (6), were isolated from a population of Okinawan soft coral Lobophytum sp. The structures of these compounds were elucidated by spectroscopy, including nuclear magnetic resonance and high-resolution mass spectrometry. The cytotoxicity and genotoxicity of these compounds were tested using human lymphoblastoid TK6 cells.

OBJECTIVE To identify the risk factors for psychological distress in electroencephalography (EEG) technicians during the coronavirus disease 2019 (COVID-19) pandemic. METHOD In this national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan), which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES), a questionnaire was administered to 173 technicians engaged in EEG at four clinics specializing in epilepsy care and 20 hospitals accredited as (quasi-) epilepsy centers or epilepsy training facilities in Japan from March 1 to April 30, 2021. We collected data on participants' profiles, information about work, and psychological distress outcome measurements, such as the K-6 and Tokyo Metropolitan Distress Scale for Pandemic (TMDP). Linear regression analysis was used to identify the risk factors for psychological distress. Factors that were significantly associated with psychological distress in the univariate analysis were subjected to multivariate analysis. RESULTS Among the 142 respondents (response rate: 82%), 128 were included in the final analysis. As many as 35.2% of EEG technicians have been under psychological distress. In multivariate linear regression analysis for K-6, female sex, examination for patients (suspected) with COVID-19, and change in salary or bonus were independent associated factors for psychological distress. Contrastingly, in multivariate linear regression analysis for TMDP, female sex, presence of cohabitants who had to be separated from the respondent due to this pandemic, and change in salary or bonus were independent associated factors for psychological distress. CONCLUSION We successfully identified the risk factors associated with psychological distress in EEG technicians during the COVID-19 pandemic. Our results may help in understanding the psychological stress in EEG technicians during the COVID-19 pandemic and improving the work environment, which is necessary to maintain the mental health of EEG technicians.

The red alga Laurencia nipponica comprises various chemical races distributed relative to the ocean current in Japanese coastal areas. We investigated the chemical compositions and chemical races of L. nipponica distributed from the Kunashiri and Etorofu Islands, the confluence of the Soya warm current and Oya-shio cold current. Two new halogenated secondary metabolites, deacetylneonipponallene (1) and neopacifenol (2), along with four known compounds, deoxyprepacifenol (3), pacifenol (4), halo-chamigrene diether (5), and isolaurallene (6) were isolated from L. nipponica collected at Chikappunai, Kunashiri Island, while Zaimokuiwa (Kunashiri Island) and Sana (Etorofu Island) populations contained 3, 7-hydroxylaurene (7), 2,10-dibromo-3-chloro-9-hydroxy-α-chamigrene (8), and (3Z)-laurefucin (9). The structures of 1 and 2 were established using spectroscopic methods. The chemical races of L. nipponica distributed in this area were divided into 6- and 9-producing races. Interestingly, both races contained 4 as an additional race-index, as well as its derivatives, 2 and 5. To the best of our knowledge, this is the first example of a race comprising a mixture of two race-index compounds, suggesting that the convergence of two currents causes the production of new and diverse chemical races in this species.

Red algae of the genus Laurencia have been known to produce a wide array of bioactive secondary metabolites. Here, we report the isolation of two new halogenated chamigrenes, lauremantanones A (1) and B (2), along with seven known compounds, dendroidiol (3), (+)-elatol (4), cartilagineol (5), obtusol (6), (+)-laurencenone B (7), 2-chloro-3-hydroxy-α-chamigren-9-one (8), and puertitol A (9), from a population of Laurencia majuscula (Harvey) Lucas from Mantanani Island (North Borneo). The structures of the two new metabolites were determined based on spectroscopic data (IR, 1D and 2D NMR, and MS). Compounds isolated from this alga exhibited potent cytotoxic (HeLa, MCF-7, P-388) and antibacterial (against antibiotic-resistant clinical bacteria) activities. The major metabolite of this population has significant importance in the geographical distribution of this species globally.

A new cembrane-type diterpenoid, sinulaflexiolide P (1), along with three known derivatives: sinulaflexiolide H (2), 11-epi-sinulariolide acetate (3), and (1S*,3S*,4S*,7E,11E)-3,4-epoxy-13-oxo-3,7,11,15-cembratriene (4), was isolated from a population of Bornean soft coral Sinularia flexibilis. The structures of these metabolites were elucidated based on spectroscopic data including NMR and HR-ESI-MS. In addition, these compounds were tested against six strains of marine fungi.

Background and objectives Meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is an effective tool for distinguishing Parkinson's disease (PD) from other diseases accompanied by parkinsonism. Unlike other Parkinsonian diseases, in PD, MIBG accumulation in the heart tends to decrease. However, previous studies have reported that a decrease in MIBG accumulation also occurs in progressive supranuclear palsy (PSP). Thus, we analyzed the relationship between the degree of MIBG accumulation decrease, clinical symptoms, and brainstem atrophy in PSP. Methods We retrospectively collected data from patients who underwent MIBG myocardial scintigraphy and compared MIBG indices (heart to mediastinum [H/M] ratio, washout rate) between subjects with PSP and other diseases including PD. In addition, we evaluated the relationship between clinical characteristics, MIBG accumulation, and brainstem atrophy in patients with PSP. Results Patients with PSP had a significantly lower early H/M ratio compared with multiple system atrophy with predominant parkinsonism (MSA-P) patients, and a control group. In PSP patients there was a correlation between the decrease in delay H/M ratio, atrophy of the pons, and clinical severity as evaluated by Hoehn and Yahr score. Conclusion Unlike in PD, PSP patients exhibited a mild decrease in MIBG accumulation in MIBG myocardial scintigraphy, which may be related to brainstem atrophy.

Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by episodic involuntary movement attacks triggered by sudden movements, acceleration, or intention to move. We ascertained two Japanese familial cases with PKD. The proband is a 22-year-old woman who had noted sudden brief (30 s) of involuntary movements provoked by kinesigenic trigger such as starting to run, getting on a train, picking up a telephone receiver and so on at the age of 14. Interictal brain single photon emission computed tomography (SPECT) showed hyperperfusion in the left thalamus. A 46-year-old woman, the mother of the proband was also suffering from brief attacks triggered by starting to run in her high school days. On neurological examination, both showed no abnormality. Whole exome sequencing combined with rigorous filtering revealed two heterozygous nonsynonymous variants (NM_001447: c.8976GC [p.Gln2992His] in FAT2 and NM_015678: c.8596CT [p.Arg2866Trp] in NBEA). Real time quantitative PCR analysis of Nbea mRNA levels in the developing rat brain revealed peak at postnatal day 28 and decline at postnatal day 56. This result might match the most common clinical course of PKD from the point of view of the most common age at remission. NBEA has been reported to be responsible for neurodevelopmental disease accompanied by epilepsy. We concluded the variant in NBEA most likely to be responsible for our familial cases of PKD.

Two new nardosinane-type sesquiterpenoids, paralemnolin V (1) and paralemnolin W (2), along with five known sesquiterpenoids (3–7), were isolated from a population of Bornean soft coral Lemnalia sp. The structures of these metabolites were elucidated based on their NMR and HR-ESI-MS spectral data. These compounds were subjected to antibacterial and antifungal tests against eight bacterial and seven fungal strains.

Four scalarane sesterterpenoids, scalarolide acetate (1), scalarolide (2), 12-O-deacetyl-12-epi-19-O-methylscalarin (3) and methyl 18-hydroxy-19-norscalar-16-en-20-carboxylate (4) were isolated from the Bornean spongeSpongiasp. The distinction between 12 a -OAc and 12 b -OAc, and 19-olide and 20-olide in sesterterpenes were revealed as well as previously not assigned relative configuration at 18-OH of4is reported herein for the first time. In addition, compounds1-3showed strong cytotoxic activities against adult T-cell leukemia (ATL), S1T cells. This is the first record of scalarane sesterterpenes from the Bornean sponge.

The red algal genus Laurencia is a prolific producer of halogenated secondary metabolites. A new tricyclic dibrominated diterpenoid, neoiriepentaol (1) and chlorinated C15-acetogenin, nangenyne (2), along with two known terpenoids, neoirietetraol (3) and dactyloxene A (4), were isolated from methanol crude extract of red alga Laurencia nangii. The structures were established based on one- and two-dimensional nuclear magnetic resonance (NMR), Fourier-transform infrared (FTIR), and high-resolution electrospray ionization mass spectrometry (HRESIMS) data. These compounds were screened against seven species of marine fungi. Compounds 1–3 exhibited activity against Lagenidium thermophilum and Haliphthoros sabahensis. Potent activity was showed by 1 with L. thermophilum hyphal inhibition at MIC value of 12.5 μg mL−1 and hyphal motility was observed at 50 μg mL−1 within 24 h.

The red alga genus Laurencia (Rhodomelaceae, Ceramiales) is known to produce and contain a rich diversity of halogenated secondary metabolites. These compounds are dominated by two major biosynthetic groups: terpenes (sesquiterpenes, diterpenes, and triterpenes) and C15-acetogenins. In the course of our investigation on red algae genus Laurencia from North Borneo Island, three new halogenated chamigranes, 7-aldehydelaurencenone B (1), 2-chloro-3-methoxy-α-chamigren-9-one (2), and laureborneone (3) along with five known halogenated derivatives such as [1(15)Z,2Z,4R,8S,9R]-8,15-dibromochamigra-1(15),2,11(12)-trien-9-ol (4), [1(15)E,2Z,4R,8S,9R]-8,15-dibromochamigra-1(15),2,11(12)-trien-9-ol (5), ma’ilion (6), laurencenone B (7), and 2-chloro-3-hydroxy-α-chamigren-9-one (8) were isolated from Laurencia majuscula. The structures of these compounds were determined based on spectroscopic data which consisted of infrared (FT-IR), H1-NMR, C13-NMR, H1-H1-COSY, HSQC, HMBC, and NOESY. In addition, high-resolution electrospray ionization mass spectrometry (HRESIMS) was done to calculate their molecular formula and unsaturation index. The anticancer potentials of these compounds were tested against three cancer cell lines, and their IC50 values were determined.

The medicinal plant, Syzygium leucoxylon or commonly known as Obah found in North Borneo was considered as traditional medicine by local committee. Two new phenolics, leucoxenols A (1) and B (2) were isolated and identified as major secondary metabolites from the leaves of S. leucoxylon. Their chemical structures were elucidated based on spectroscopic data such as NMR and HRESIMS. Furthermore, these compounds were active against selected strains of fungi.

The antifungal activity of two Bornean medicinal wild gingers Plagiostachys megacarpa and Zingiber phillippsiae were examined against Lagenidium thermophilum. The most active extract was P. megacarpa at concentration of 320 µg/mL inhibiting both hyphal growth and zoospore production of L. thermophilum in 24 h. Toxicity tests were conducted using mud crab (Scylla tranquebarica) larva. Bath treatment of P. megacarpa at concentrations of 320 and 640 µg/mL for 24 h were highly effective against hyphae and zoospores of the strain and it is non-toxic to mud crab larva. Therefore, crude extracts P. megacarpa may be used as alternative treatment for marine Oomycete infection of mud crab.

There are no specific radiologic features in MOG-Ab (autoantibodies directed against myelin oligodendrocyte glycoprotein)-associated diseases. We present two MOG-Ab-positive patients with symmetrical lesions in the bilateral cingulate cortex of the frontal and parietal lobes. Those lesions showed hyperperfusion in acute phase and hypoperfusion in chronic phase on brain SPECT. In both patients, steroid therapy was effective in acute phase and for prevention of recurrence. High signal in the bilateral cingulate cortex on MR T2-weighted and FLAIR images might to be one of the unique findings considered MOG-Ab associated diseases.

OBJECTIVE To determine the characteristics of olfactory dysfunction in patients with temporal lobe epilepsy (TLE). METHODS Odor identification was assessed using the odor stick identification test for Japanese (OSIT-J, full score 12 points) in 65 patients with TLE and in 74 controls. RESULTS The mean OSIT-J score was significantly lower in patients with TLE (mean ± SD = 8.1 ± 2.8; median = 9) than in the control subjects (mean ± SD = 10.6 ± 1.1; median = 11) (P

The chemical composition of three Laurencia spp., Laurencia sp., L. okamurae and L. saitoi, which were collected from the Seto Inland Sea of Japan, has been examined. Laurencia sp. collected from the coast of Matoba Park, Takehara, Hiroshima Prefecture, contained a brominated chamigrane-type sesquiterpene (1), named matobol, as the main metabolite. The structure of matobol was determined as (+)-(2R,3R,6R,10S)-2,10-dibromochamigr-7(14)-en-3-ol (1). This is the first time that the optically active 1 has been isolated from Laurencia. On the other hand, L. okamurae from the coast of Ikunoshima Island, Hiroshima Prefecture, produced laurinterol (2) that is a known cyclolaurane-type sesquiterpene characteristic to this species in Japan. L. saitoi from the coast of Matoba Park contained a known bromoallenic C15-acetogenin, neolaurallene (3).

A new sesquiterpene, capgermacrene H (1) was isolated together with 7 other compounds, capgermacrenes A-G (2-8), from a population of soft coral Capnella imbricata collected from Mantanani Island, Sabah, Malaysia. The structure of this metabolite was elucidated based on spectroscopic data such as nuclear magnetic resonance and high-resolution electrospray ionization mass spectrometry. Capgermacrene A (2) showed potent cytotoxicity against adult T-cell leukemia, S1T cells at half-maximal inhibitory concentration of 0.79 µg/mL., 論文

We describe a 60-year-old woman with combined central and peripheral demyelination who presented with obstinate constipation, weakness in the lower limbs, and a bilateral sensory disturbance below her chest followed by girdle sensation in the right region of the abdomen, which was responsive to steroid therapy and plasmapheresis. Serum anti-lactosylceramide antibody was positive without anti-neurofascin 155 antibody or anti-galactocerebroside antibody positivity. Two months later, the patient had a first relapse that was responsive to steroid treatment. A nerve conduction study confirmed reversible conduction failure (RCF) in both episodes. Our case is unique in that she had an RCF episode as well as some similarities to encephalomyeloradiculoneuropathy.

One new cembrane diterpene, 16-hydroxycembra-1,3,7,11-tetraene (1), along with three known compounds, 15-hydroxycembra-1,3,7,11-tetraene (2), sarcophine (3) and sarcophytoxide (4) were isolated from Sarcophyton sp. collected from Karah Island, Terengganu, West Malaysia. Their structures were elucidated based on spectroscopic data. Activities of these compounds against antibacterial resistant clinical bacteria are reported. Only 1 exhibited inhibition against Staphylococcus aureus.

Two new C15-acetogenins, 4-epi-isolaurallene (1) and 4-epi-itomanallene A (2) were isolated from a population of marine red alga Laurencia nangii Masuda from Carrington Reef. The structures of these compounds were determined intensively by NMR and HRESIMS data. Their configurations were elucidated by detailed comparison of chemical shifts, germinal protons splitting and NOE correlations with known and synthesized analogues. In addition, antibacterial activities of these compounds were evaluated. These compounds would serve as diastereomeric models for future reference. Since the isolaurallene, neolaurallene, 9-acetoxy-1,10,12-tribromo-4,7:6,13-bisepoxypentadeca-1,2-diene, itomanallene A and laurendecumallene A were isolated, compounds 1 and 2 were the sixth example of C15-acetogenin with dioxabicyclo[7.3.0]dodecene skeleton.