[Nationwide questionnaire study in "the Model Core Curriculum" and current status for the undergraduate education in neurology].

To investigate the current state of education for undergraduates, the subcommittee of the Japanese Society of Neurology for undergraduate education sent a questionnaire on the 2001-version of Model Core Curriculum to the department of neurology in 80 medical universities and their 7 associate medical institutes throughout Japan. Answers were obtained from 56 out of those 87 institutes (64.4%). According to the answers, the Core Curriculum was introduced to the program of undergraduate education in 93% of those 56 universities. For the revision of neurology part in the current Core Curriculum, there are number of requests for improving the description on the neurological examination, list of common symptoms and disorders, and addition of therapeutics. Despite application of the Model Core Curriculum in medical education, the present study disclosed that there were considerable difference in the number and content of the lectures, and the duration of clinical clerkship in neurology ward. These differences of the curriculum and training program depends on not only the number of staffs, but also whether they are working as staffs in a department of neurology or as a small group of neurologists within a department other than neurology.

Exercise training enhances in vivo tuberculosis purified protein derivative response in the elderly.

We investigated the effect of 25 wk of exercise training on in vivo immune measures that depend on T helper 1 (Th1) and T helper 2 (Th2) immune responses in the elderly as a substudy of a randomized controlled trial to investigate health benefits of regular exercise training for the elderly. Sixty-five healthy elderly volunteers were randomly assigned to either an exercise training group (n = 32) or a sedentary control group (n = 33). The area of skin reaction to purified protein derivative (PPD) of tuberculin that depends on Th1 activation and the concentrations of serum IgG subclasses and IgE were evaluated before and after 25-wk intervention. All participants completed 25 wk of training. Thirty-one participants of the exercise group and all control group underwent immunological analyses, but only 30 from the exercise group and 21 from the control group had the PPD skin reaction assessment. Repeated-measures ANOVA revealed a significant interaction between time and exercise intervention, which appeared as an enhanced skin reaction to tuberculin PPD (P < 0.05) and a reduced serum IgG4 concentration, the production of which depends on Th2-dependent class switching (P < 0.05), in the exercise group after 25 wk. No immune variables changed in the control group. These result supports the hypothesis that exercise training favors in vivo Th1 immune response in elderly persons.

[Occupational dystonia associated with production line work and PC work].

It is considered that occupational dystonia is associated with fixed abnormal postures or repetitive skilled movements. In our country, occupational dystonia seems to be frequent to production line workers or visual display terminal (VDT) workers. Most of patients with occupational cervical dystonia start with symptoms of stiffness in the neck or shoulder portions. In the occupational health scene, dystonia is treated as cervicobrachial disorder. As for most occupational health staffs, dystonia is an unknown disorder, therefore the patients may not receive appropriate treatments.

Unilateral positive-negative myoclonus in Creutzfeldt-Jakob disease.

We report a patient with Creutzfeldt-Jakob disease who presented asymmetric myoclonus. Positive-negative myoclonus was seen only in the right extremities in association with periodic synchronous discharges (PSDs) on the electroencephalogram, although pure positive myoclonus was rarely seen in the left extremities, independently in PSDs. The duration of the silent period recorded in the right-hand muscle produced by transcranial magnetic stimulation was much longer than that in the left-hand muscle or that in normal subjects. Brain MRI diffusion-weighted images showed signal hyperintensities in the putamen and cerebral cortex, including the motor cortex, predominantly on the left side.

Rhythmic EMG and EEG activity during voluntary movement in posthypoxic cortical action myoclonus.

A patient with posthypoxic cortical action myoclonus was studied using polygraphic EEG-EMG recording techniques and transcranial magnetic stimulation. The myoclonic jerks were not stimulus-sensitive, and were not associated with enhancement of the somatosensory evoked potential (SEP). The most prominent electrophysiological finding was that rhythmic EMG activity was produced when the patient attempted rapid voluntary movement. EEG-EMG polygraph indicated that the rhythmic EMG activity was preceded by rhythmic activity in the EEG recorded overlying the contralateral central region. The frequency of both EEG and EMG activity was the same (approximately 50 Hz). Treatment using a combination of clonazepam, carbamazepine and primidone diminished the action myoclonus, concomitant with the disappearance of the rhythmic EEG and EMG activity. In the sensorimotor cortex of the normal monkey and humans, oscillatory activity ranging between 20-50 Hz has been recorded in the local field potential. Our findings suggest that cortical hyperoscillation may produce this characteristic rhythmic EEG and EMG activity and may, in turn, be related to cortical action myoclonus.

Effects of exercise training on physical activity in older people: a randomized controlled trial.

BACKGROUND: Recent randomized controlled trials indicated that exercise training for elderly significantly increased their physical fitness. However, very few studies have examined changes in physical activity after exercise training. The purpose of this study was to investigate whether six-month exercise training for older adults can increase and maintain their physical activity in daily life. METHODS: Sixty-two men and women aged 60 to 81 years (mean age 67.1 years), living in communities, were randomly allocated into an exercise group (n = 32) or a control group (n = 33). The intervention started in April 1998 and lasted for 25 weeks. The exercise regimen consisted of endurance training and resistance exercises in a two-hour class conducted at least twice a week. The subjects completed a physical activity diary at each pre-intervention (March 1998), post-intervention (September 1998) and follow-up (April 1999) measurement of physical activity. Physical activity, expressed as total daily energy expenditure, was calculated by multiplying the amount of time spent in each activity and the corresponding METs. RESULTS: Total daily energy expenditure significantly increased from 40.8 kcal/kg/day to 43.5 kcal/kg/day in the exercise group (p = 0.03), but did not change in the control group. At the follow-up measurement, the mean total daily energy expenditure in the exercise group remained significantly higher, by 1.7 kcal/kg/day, than that at the pre-intervention (p = 0.05). CONCLUSIONS: This randomized controlled trial indicated that exercise training for elderly was effective in increasing physical activity in daily life.