Parkinson Disease: Kikuchi S

Miziuno Y, Okuma Y, Kikuchi S, Kuno S, Hashimoto T, Hasegawa K, Mano Y, Miwa H, Murata M, Yamamoto M, Yokochi F, Okiyama R, Kanazawa A, Shinpo K, Chuma T, Higashi T, Maruyama T, Mizuta E, Yamazaki S, Anonymous00188. · Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan · Rinsho Shinkeigaku. · Pubmed #12708433 No free full text.

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Kikuchi S. · Department of Neurology, Hokkaido University Graduate School of Medicine. · Nippon Rinsho. · Pubmed #15462388 No free full text.

Abstract: Ad hoc committee of Japanese Neurological Society made a guideline for the treatment of Parkinson's disease in 2002. Based on the chapter of treatment for early Parkinson's disease, starting drugs were discussed in this article. Three points should be considered in initiating the drug treatment, that is, neuroprotection, motor complications, and side effects. In order to demonstrate neuroprotection of dopamine agonists by using neuroimaging techniques, CALM-PD CIT study (pramipexole) and REAL-PET study (ropinirole) were done. There are, however, many controversies concerning neuroprotection and no definite conclusion was drawn. On the contrary, the inhibitory effects of dopamine agonists on the appearance of motor complications were clearly elucidated by several large-scale studies. For the present, although the side effects were reported more frequently in those treated by dopamine agonists than by levodopa, starting the treatment by dopamine agonists were recommended except in patients with dementia and in elderly patients, for whom levodopa should be used first.

Kikuchi S, Tashiro K. · Department of Neurology, Hokkaido University School of Medicine. · Nippon Rinsho. · Pubmed #11808268 No free full text.

This publication has no abstract.

Kikuchi S, Moriwaka F, Tashiro K. · Department of Neurology, Hokkaido University School of Medicine. · Nippon Rinsho. · Pubmed #11068442 No free full text.

Abstract: Diagnostic criteria for Parkinson's disease is used in all clinical studies concerning this disease. For supplying meaningful data to the evidence-based medicine, the diagnostic criteria must be clearly defined in such studies. In the setting and usage of diagnostic criteria, it is indispensable to clarify the aim and the population for which the criteria is used. Then, as for the contents of the criteria, 1) additional criteria, 2) exclusion criteria, and 3) levels of confidence must be considered. For the future re-evaluation, diagnostic criteria must be logic. Final references are also necessary for judging the accuracy of the criteria.

Tamura I, Kikuchi S, Otsuki M, Kitagawa M, Tashiro K. · Department of Communication Disorders, School of Psychological Science, Health Sciences University of Hokkaido, 2-5 Ainosato, Kitaku, Hokkaido, 002-8072, Sapporo, Japan. · J Neurol Sci. · Pubmed #12686397 No free full text.

Abstract: Using the dual task paradigm, previous studies have suggested that working memory (WM) deficit is due to depleted attention resources in patients with Parkinson's disease (PD). The aim of this study is to establish whether the WM problems in PD are due to reduced attentional set-shifting resources rather than depletion of attention resources. The task design attempts to eliminate confounding of the deficits in dealing with novel material, a problem documented in PD, by concentrating on WM tasks of mental calculation that are familiar to subjects in daily living. We also administered attention tasks, the Trail Making Test (TMT) that relies primarily on attentional set-shifting and the Kana (Japanese syllabogram) Pick-out Test instead primarily depending on depleted attention resources for allocation. A total of 24 patients with PD and 24 normal controls participated in this study.The PD group showed deficits in mental calculation span and in attentional set-shifting in the TMT-b.Considering the common deficits in alternating processing of mental calculation and TMT-b in PD, the results suggested that the central executive dysfunction in PD during mental calculations was due to reduced attentional set-shifting resources for rapidly alternating operations, rather than the depletion of attentional resources.

Murata J, Kitagawa M, Uesugi H, Saito H, Iwasaki Y, Kikuchi S, Sawamura Y. · Sapporo Azabu Neurosurgical Hospital, Japan. · No Shinkei Geka. · Pubmed #17424967 No free full text.

Abstract: Tremor in the proximal arm muscle, trunk, or legs is often resistant to the standard stereotactic surgery of the thalamic ventrointermediate nucleus. We have performed deep brain stimulation (DBS) of the posterior subthalamic area for those intractable tremors. The white matter area between the red nucleus and the subthalamic nucleus was targeted on the T2-weighted MR-CT fused image. Inhibitory effect on the tremor was tested with macrostimulation. The somatosensory-evoked potential recorded through DBS contacts demonstrated characteristic biphasic pattern. Eight cases with severe essential tremor and 18 of tremor-dominant Parkinson disease were treated with unilateral DBS of the area including the zona incerta and the prelemniscal radiation (Zi/Raprl). Tremors including the proximal part have been well controlled for 24 months after the operation. The stimulation parameters have been almost stable during the follow-up period. There was no obvious adverse effect of stimulation. We conclude that Zi/Raprl-DBS is a safe and effective treatment on Parkinsonian and essential tremor.

Hamaue N, Ogata A, Terado M, Ohno K, Kikuchi S, Sasaki H, Tashiro K, Hirafuji M, Minami M. · Department of Pharmacology, Health Sciences University of Hokkaido, Ishikari-Tobetsu, 061-0293, Hokkaido, Japan. · Neurochem Res. · Pubmed #17103330 No free full text.

Abstract: We analyzed two disease model groups with rats infected by Japanese encephalitis virus (JEV), a 90-day group and a 180-day group after JEV infection. The time measured by the modified pole test showed that motor activities in these two groups were slower than those of age-matched control groups. Striatal dopamine (DA) levels were significantly decreased in all JEV-infected rats. Norepinephrine concentration in brain regions in the 180-day group was significantly decreased in the medulla oblongata and hypothalamus as compared with the control and 90-day group. Tyrosine hydroxylase-positive neurons were significantly decreased in both JEV-infected rat groups. These results suggest that DA decrease and pathological changes in JEV-infected model rats persist for a long time, at least up to 180 days, and this model will be useful for the evaluation of new anti-parkinsonian agents.

Mito Y, Yoshida K, Yabe I, Makino K, Tashiro K, Kikuchi S, Sasaki H. · Neurology, Asahikawa Red Cross Hospital, Asahikawa 070-8530, Japan. · Hokkaido Igaku Zasshi. · Pubmed #16528976 No free full text.

Abstract: OBJECTIVE: The aim of the present study is to investigate the association of symptoms in Parkinson's disease (PD) with cerebral perfusion on single photon emission computed tomography (SPECT). The clinical features of PD were compared with SPECT images of the brain obtained by three-dimensional stereotactic surface projection (3D-SSP) analysis. PATIENTS AND METHODS: Thirty-eight patients who had PD without dementia (17 men and 21 women with a mean age of 68.6 +/- 4.7 years) were enrolled in this study. Their symptoms were rated using the unified Parkinson's disease rating scale (UPDRS). Within a week, all patients were examined by SPECT with 1-123, and reconstructed images were analyzed with 3D-SSP using an image-analysis software, iSSP ver. 3.5. Data on brain surface perfusion extracted by 3D-SSP analysis were compared between the PD patients and the normal control group. The same comparisons were made for subgroups of PD patients with severe symptoms, such as tremor, gait disturbance, bradykinesia, and the UPDRS motor score. RESULTS: Cerebral perfusion was decreased at the anterior cingulate cortex and occipital lobe of the PD patients compared with the normal controls. In the subgroups with severe gait disturbance and severe bradykinesia, additional hypoperfusion was seen at the lateral frontal association and lateral temporal association and the medial frontal gyrus, and by the pixel-by-pixel comparison, perfusion was significantly decreased (p < 0.05) at the medial frontal gyrus and anterior cingulate cortex compared with the normal control group. CONCLUSION: In PD patients, severe gait disturbance and bradykinesia may be correlated with hypoperfusion of the medial aspect of the frontal lobe. This suggests that functional disturbance of the supplementary motor area and other parts of the frontal lobe are involved in the development of gait disturbance and bradykinesia in PD.

Mito Y, Yoshida K, Yabe I, Makino K, Tashiro K, Kikuchi S, Sasaki H. · Department of Neurology, Asahikawa Red Cross Hospital, 1-1, Akebono, Asahikawa, Hokkaido, 070-8530, Japan. · J Neurol Sci. · Pubmed #16352310 No free full text.

Abstract: OBJECTIVES: We hypothesize that the regional pattern of blood flow reduction in the brain is different between tremor-dominant Parkinson's disease (PD) and postural instability gait difficulty (PIGD)-dominant PD. We therefore investigated the association of phenotypes in untreated PD with brain perfusion on SPECT using three-dimensional stereotactic surface projection (3D-SSP) technique. PATIENTS AND METHODS: Thirty-three patients who had PD without dementia (12 men and 21 women with a mean age of 67.1+/-6.4 years) were included in this study. Their symptoms were rated using the Unified Parkinson's Disease Rating Scale (UPDRS). Patients were grouped in two phenotypes: tremor and PIGD-dominant groups based on UPDRS components. Around the same time, all patients were examined by N-isopropyl-p[123I] iodoamphetamine single photon emission computed tomography (123I-IMP SPECT), and obtained images were analyzed with 3D-SSP using an image-analysis software, NEUROSTAT. Data on brain surface perfusion extracted by 3D-SSP analysis were compared between the PD patients and the normal control group. The same comparisons were made for subgroups of PD patients. RESULTS: Cerebral perfusion was decreased at the anterior cingulate cortex and primary visual cortex of the PD patients, and especially by the pixel-by-pixel comparison, perfusion was significantly decreased at the right anterior cingulate cortex compared with the normal controls. In the PIGD-dominant group, more severe hypoperfusion was seen at the same regions. In the tremor-dominant group, significant hypoperfusion was not seen compared with the normal controls. CONCLUSIONS: The regional pattern of blood flow reduction in the brain was found to be different between tremor-dominant PD and PIGD-dominant PD. These regional differences were considered to suggest different and disease-specific combinations of underlying pathophysiological and neurochemical processes.

Mito Y, Yoshida K, Yabe I, Makino K, Hirotani M, Tashiro K, Kikuchi S, Sasaki H. · Department of Neurology, Asahikawa Red Cross Hospital,1-1, Akebono, Asahikawa, Hokkaido 070-8530, Japan. · Clin Neurol Neurosurg. · Pubmed #16023534 No free full text.

Abstract: OBJECTIVES: Cerebral blood flow was compared among patients with dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Parkinson's disease without dementia (PD), and Alzheimer's disease (AD) using three-dimensional stereotactic surface projection (3D-SSP) analysis. PURPOSE: We attempt to clarify the difference of reduction pattern on SPECT among patients having DLB, PDD, PD, AD. PATIENTS AND METHODS: Six patients with DLB, 7 patients with PDD who were matched with the DLB patients for age, unified Parkinson's disease rating scale-III (UPDRS-III) score, and degree of cognitive function disorders, 21 patients with PD who were matched with the DLB patients for age, UPDRS-III score, 12 patients with AD who were matched with the DLB patients for age and degree of cognitive function disorders, and 12 control subjects. All patients were examined by N-isopropyl-p[123I] iodoamphetamine single photon emission computed tomography (123I-IMP SPECT), and obtained images were analyzed with 3D-SSP using an image-analysis software, iSSP ver. 3.5. RESULTS: Although DLB and PDD showed similar cerebral perfusion reduction pattern at the lateral parietal association and lateral temporal association and precuneus on SPECT by the pixel-by-pixel comparison, greater perfusion reduction was observed in DLB than in PDD. Cerebral perfusion was decreased at the occipital lobe of the DLB patients compared with the AD patients. CONCLUSIONS: The regional pattern of blood flow reduction in the brain was found to be different among DLB, PD, and AD. Greater blood flow reduction was observed in DLB, although DLB and PDD showed similar reduction pattern. These regional differences were considered to suggest different and disease-specific combinations of underlying pathological and neurochemical processes.

Kitagawa M, Murata J, Uesugi H, Kikuchi S, Saito H, Tashiro K, Sawamura Y. · Sapporo Azabu Neurosurgical Hospital, Hokkaido, Japan. · Neurosurgery. · Pubmed #15670376 No free full text.

Abstract: OBJECTIVE: To determine the efficacy and safety of unilateral deep brain stimulation on the posterior subthalamic white matter, including the zona incerta (ZI) and the prelemniscal radiation (PRL), for tremor-dominant parkinsonian patients and to determine the exact location of electrodes that were most effective. METHODS: Eight parkinsonian patients with severe resting tremor underwent unilateral stimulation of the ZI/PRL by use of stereotactic guidance. Electrophysiological targeting was obtained by macrostimulation and by somatosensory evoked potentials recorded directly through a quadripolar deep brain stimulation lead. Postoperative computed tomographic scans and magnetic resonance images were performed to confirm anatomic location of the electrode. Parkinsonian motor disabilities were evaluated by use of the Unified Parkinson's Disease Rating Scale in the medication-off state before surgery and every 6 months after electrode implantations. RESULTS: The mean location of the clinically effective contacts was in the posterior subthalamic white matter, including the ZI and the PRL (mean, 5.6 +/- 1.2 mm posterior to the midcommissural point, 3.2 +/- 1.1 mm inferior to the anterior commissure-posterior commissure line, and 10.5 +/- 1.2 mm lateral to the midline). At 24 months after operation, ZI/PRL stimulation resulted in significant improvement in mean Unified Parkinson's Disease Rating Scale motor score by 44.3%, contralateral tremor by 78.3%, contralateral rigidity by 92.7%, and contralateral akinesia by 65.7% above the "off-stimulation" scores. Handwriting, posture, and gait were also improved. There were no or only mild adverse events. CONCLUSION: Unilateral ZI/PRL stimulation is a reliable and long-term therapeutic modality and can be considered another surgical target for the treatment of tremor-dominant Parkinson's disease.

Yanagisawa N, Yamamoto M, Kikuchi S, Murata M, Ohkuma Y. · Kanto Rosai Hospital. · J Neurol. · Pubmed #15505751 No free full text.

This publication has no abstract.

Tamura I, Kikuchi S, Kitagawa M, Otsuki M, Tashiro K. · Department of Communication Disorders, School of Psychological Science, Health Sciences University of Hokkaido, 2-5 Ainosato, Kita-ku, Sapporo 002-8072, Japan. · No To Shinkei. · Pubmed #12755037 No free full text.

Abstract: The purpose of this study was to investigate the age-related working memory(WM) decline in patients with Parkinson's disease(PD) using Baddeley's WM model. This model consists of the central executive (CE) and two slave systems, the phonological loop (PL) for the storage of verbal materials, and the visuospatial sketchpad(VSSP) for the storage of visuospatial information. The participants of this study were 22 PD, 11 old (age of 68-78, mean age, 70.5) and age of onset, duration of illness, medication time, and Yahr stage, global cognitive status-matched 11 young(age of 39-58, mean age, 51.5) PD, age- and educational years, global cognitive status-matched 22 normal control (NC), 11 old(age of 65-78, mean age, 70.4) and 11 young(age of 45-57, mean age, 52.4). Mental calculation span of digit sequences, digit forward and backward span, visual memory span were carried out. Age related decline of WM was found in both groups, but processing related differences were revealed between the two groups. NC group showed significant decline with aging in digit backward span. In contrast, in mental calculation span, PD groups showed significant deficit revealed in young PD group and declined significantly with aging and significant decline was not found in digit backward span. In term of the processing and difficulty of WM tasks, digit backward span that needs maintenance of digit sequences and re-ordering, was more difficult than mental calculation that needs maintenance of digit sequences, summation of the digit and updating of the results. There were not significant differences between four groups in digit forward span, visual memory span. The results indicated that the WM span in normal aging declined as task difficulty increased. Their performance decline may be caused by the CE dysfunction. On the other hand, PD showed a characteristic CE deficit observed in mental calculation even in young age and decline with aging. Such decline may be caused by peculiar processing related dysfunction of CE that assumes to be essential deficit of PD.

Kikuchi S, Shinpo K, Tsuji S, Takeuchi M, Yamagishi S, Makita Z, Niino M, Yabe I, Tashiro K. · Department of Neurology, Hokkaido University School of Medicine, Kita 15, Nishi 7, Kita-ku, Hokkaido, Sapporo, Japan. · Brain Res. · Pubmed #12576183 No free full text.

Abstract: Proteasomal dysfunction has been implicated in the pathogenesis of Parkinson's disease (PD). We examined the effect of a selective proteasomal inhibitor, epoxomicin, on primary cultured mesencephalic neurons. Exposing rat cultured mesencephalic neurons to epoxomicin for 24 h resulted in neurotoxicity in a dose-dependent manner. Epoxomicin caused mitochondrial dysfunction, reduction in reduced glutathione (GSH), and increased generation of free radicals. Neuronal damage was significantly blocked by antioxidative/GSH-augmenting agents. Epoxomicin also increased the expression of Bax and decreased that of Bcl-2, which may cause mitochondrial dysfunction and release of free radicals. Dopaminergic neurons were preferentially resistant to the toxicity of epoxomicin. Inhibiting the synthesis of tetrahydrobiopterin (BH(4)), which has been reported to have antioxidative function, increased the susceptibility of dopaminergic neurons, whereas increasing BH(4) levels protected non-dopaminergic neurons. These findings suggest that BH(4) is at least in part a contributing factor to grand the resistance to dopaminergic neurons against epoxomicin neurotoxicity. Our results suggest that proteasome inhibition causes the neurotoxicity in mesencephalic neurons, but that is not sufficient to reproduce the selective damage to dopaminergic neurons, such as that seen in PD.

Murata J, Sawamura Y, Kitagawa M, Saito H, Kikuchi S, Tashiro K. · Sapporo Azabu Neurosurgical Hospital. · No To Shinkei. · Pubmed #11424357 No free full text.

Abstract: Image-guided stereotactic surgery of the ventralis intermedius nucleus of the thalamus, globus pallidus, and subthalamic nucleus is a prevailing modality as a treatment of movement disorders. This technical note describes a method of minimally-invasive stereotactic functional surgery for patients with parkinsonian symptom or various tremors. Patients were administered propofol, an intravenous anesthetic, during placement of a burr hole and a stereotactic frame, but not the period when the patients were necessary to be awake. The intravenous anesthesia was very beneficial to relieve local pain and mental stress of the patients. Radionics ImageFusion and AtlasPlan were used for defining the target localization without an intraoperative ventriculography. ImageFusion efficiently fused high-resolution MR images on CT images. AtlasPlan accurately corrected the localization of the tentative target point after measurements from the midpoint of the anterior commissure-posterior commissure line on the modified MRI, and enabled us to reduce the degree of an intraoperative correction to fix a final target. Stereotactic functional surgery has been thought to be less-invasive, however further modifications of surgical procedure and intraoperative medication can make this type of surgery much more less-invasive.