The terminology used to describe epileptic falls has been a matter of controversy: a number of descriptions from the lowest level of fits (Jackson, 1886), to motor seizures with falling (Gastaut 1982), the distinctions between them being rather arbitrary.
The reason for the uncertainty encountered is the fact that all the events related to the falls take place very suddenly and end in a fraction of second, and therefore there are unavoidable technical limitations in documentation. With the advent of the CCTV-EEG, we can record and analyze epileptic falls more precisely.
In our study dealing with 48 falls in 15 patients with Lennox-Gastaut syndrome, a fall was defined as a complete loss of the maintenance of either standing or sitting posture, which took place within 1 second. Through precise analysis, it was possible to classify them into the following 4 types: a) tonic type, b) flexor-spasms type, c) myoclonic-atonic type, and d) atonic type. In contrast to the generally accepted view, it was found that atonic or myoclonic-atonic falls were rather exceptional. The patients whose falls were categorized as the flexor spasms type, which is remniscent of infantile spasms, in fact experienced in their past history West syndrome before it evolved to Lennox-Gastaut syndrome. The extreme pathophysiological complexity of epileptic falls is stressed.

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Platelet agreggation was studied by the turbidimetric method using Lumi-aggregometer in 368 patients with cerebrovascular diseases and 124 adult controls. Platelet aggregability in response to adenosine diphosphate (ADP) was defined as the threshold concentration of ADP to cause secondary aggregation. The threshold concentration of ADP was greater than 4μM in 4 (8%), 1 or 2μM in 36 (74%), 1/2μM in 8 (16%), and 1/4μM in 1 (2%) of 49 adult healthy controls, whose ages ranged from 18 to 49 years. The degree of aggregability was defined as normal when the threshold concentration of ADP was 1 or 2μM, borderline when 1/2μM, increased when less than 1/4μM and decreased when greater than 4μM. The threshold ADP concentration was 4μM in 5 (7%), 1 or 2μM in 30 (40%), 1/2μM in 25 (33%), 1/8 or 1/4μM in 15 (20%) of 75 elderly control subjects, whose ages ranged from 50 to 91 years. This suggests that the ADP threshold concentration was increased in elderly controls.
The increased platelet aggregation was seen in 30% of patients with TIA, 21% of patients with non-embolic cerebral infarction, 13% of patients with cerebral hemorrhage and 9% of patients with cerebral embolism. These results may indicate that patients with ischemic cerebrovascular disease have platelet hyperaggregability. In the patients with cerebral infarction, there were no relationships between platelet aggregability and the following factors: age, sex and the presence of hypertension or diabetes mellitus. Patients with increased platelet aggregation were slightly fewer in the first week after the onset than in other weeks. In addition, we showed that the platelet aggregability by the threshold concentrations of ADP in non-embolic cerebral infarction was useful for judgement of validity of antiplatelet drugs, such as ticlopidine.

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Short leg prosthesis is considered to be efficient for stroke patients. Since studies on biomaterials and biomechanics have been developed, structures of prosthesis has become stronger and more effective. The nature of stroke hemiplegia is spastic, so that a use of spring mechanism is not recommended for prosthesis. However, we applied spring mechanism, and plastic foot mould was added to the new device. Walking patterns were analyzed by using forceplate recorders (Kesler Co.) Improvement of forces and duration were shown by the application of new prosthesis. Among those patients, new spring prosthesis were considered to be convenient for daily activities. Clinical data were discussed in this paper.
Further studies will be necessary to obtain ideal short leg prosthesis.

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Questionnaries were sent to 219 subjects who had been discharged from the Department of Rehabilitation Medicine during 1976-1981. There were 136 responders. Sixty-three subjects (46%) died, 73 were alive. Among these 73, 54 were with their families, 12 were in hospitals, 2 in nursing homes, and 5 were living alone. Seventy-six per cent of the subjects were under medical care including 8 bedridden subjects.
Among the deceased, the cause was cerebral infarction in the majority of the cases. As to complications and symptoms, there was not much difference between the alive group and the deceased. Sufficient medical care would be necessary to the deceased group.
We analyzed the time interval from discharge to death, and it was within 4 years in 68.2% of the cases, and within 6 years in 80%. Therefore, we should expand follow-up care for at least 4 years, hopefully, for 6 years.

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Patients with motor dysfunction accompanied with disturbance of consciousness are often encountered among those with central nervous diseases.
Patients with disturbance of consciousness usually lack the will to recover, spontaneity and the ability to communicate. Particularly in those with severely disturbed consciousness (consciousness level of two or three digits according to the Japan Coma Scale established by the Japan Neurosurgical Society), self-directed movements also disappear and prognosis is poor in many cases.
In such patients, life-saving treatment including the following procedures are required: intubation feeding, tracheotomy, oxygen inhalation, intravenous drip, balloon insertion, use of diaper, etc. When too much time are required for the treatment, irretrievable secondary complications may occur, possibly leading to delayted rehabilitation including maintenance therapy.
We performed rehabilitation in patients with dyskinesia as a main complaint accompanied with disturbance of consciousness using not only conventional maintenance therapy but also providing assistance to the patient in getting up and sitting, maintaining a sitting position, balancing, transferring to a wheel chair, standing up, etc. Multiple sensory stimulation was also applied to induce reflex movements. We performed such rehabilitation in 21 patients (14 males and 7 females, mean age 54 years) with encephalitic central nervous diseases for 4 years.
The following results were obtained: (1) Twelve patients (57%) had severe degree of disturbance of consciousness (two or three digit level of consciousness) when rehabilitation was started, but the level returned to zero in all cases. (2) All patients were eventually able to leave their sickbed. (3) According to the stage established by the 2nd Tokyo National Hospital, all patients showed severe disturbance of under 2 at the initiation of rehabilitation, but 11 (52%) showed a recovery to over 7, the level at which it was possible for patients to walk, by the end of rehabilitation.
Early rehabilitation seemed to induce more favorable results.

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It is well known that severely handicapped subjects are often suffered from rickets.
Serum levels of 25-hydroxyvitamin D (25-OH-D) were measured in normal controls and severely handicapped subjects who had been hospitalized for several years. Serum levels of 25-OH-D in severely handicapped subjects were significantly low as compared with normal controls. Long-term anticonvulsants therapy had no significant effects on serum levels of 25-OH-D in severely handicapped subjects.
The cause of low serum levels of 25-OH-D in severely handicapped subjects might be a low amount of daily sunlight exposure. Therefore, it is important for severely handicapped, hospitalized subjects to bathe in the sun.

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We tried to make a developmental scale to evaluate developmental profiles of children with very poor responses to various sensory stimulations due to severe brain damage. It's usually hard to evaluate their developmental changes with other conventional scales.
The aim of this scale was to estimate diversity of patients' responses and it consisted of 17 visual, 35 auditory, and 17 superficial sensation tests.
Twelve patients were examined with this scale. They all had tetraplegia and very few responses except eye-fixation, eye-pursuit and auditory orientation.
With this scale we could assess patients' developmental profiles by evaluating diversity of their responses to various stimuli.

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1) Multi-institutional study in 16 national mental hospitals on aging of chronic psychiatric inpatients from 1983 to 1984 was compared with the former study done in 1973.
2) A total number of inpatients was 4, 727 and aged psychiatric inpatients over 60 years old increased from 13.6% to 22.0% during a period of 10 years.
3) There were 783 chronic aged inpatiens who were over 60 years old and had been hospitalized for more than 3 years. The percentage of number of patients with schizophrenia among these patients remarkably increased from 36.7% to 61.9%. Most of them were hebephrenic type.
4) They had various physical complications including circulatory, digestive and respiratory diseases. There was a great shortage of physicians, other than psychiatrists, who could deal with these physical complications of the aged patients.
5) Main reasons for a long stay in hospital were rejection from their families, disability of ADL and severity of disorders.
6) Proper places for aged patients were nursing homes for the aged or geriatric hospitals; 38.8% and 19.8% respectively.

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A case of arachnoiditis ossificans is presented.
A 46-year-old man was admitted to the hospital in January 1983, with complaints of weakness in his left leg and gait disturbance. He had a history of meningitis thirty-six years previously, when he was ten years of age, and recovered uneventfully. In 1970, he first noted numbness and weakness of the right leg. In 1975, he underwent a laminectomy of L₁ and L₂ under the diagnosis of adhesive arachnoiditis. Postoperative course was relatively fair. The symptoms had been gradually aggravating for one year prior to admission.
On examination there was muscle atrophy in both legs, especially in the left. Muscle weakness was dominant in the left, and EHL and TA were grade 1. All deep tendon reflexes in lower limbs were absent, there was a loss of sensation below the twelfth thoracic level bilaterally and urinary retention.
Myelographic examinations showed an advanced picture of arachnoiditis. A descending myelogram revealed complete block at T₁₁. An ascending one showed narrowing of the column like a string to L₂.
In 1983 a T₁₀ to T₁₂ laminectomy was done. On opening the dura, arachnoid was thick and opaque and adhered to the spinal cord. At the T₁₀ level, there was a bony plaque buried in the thickened arachnoid membrane. It was resected and arachnoid was removed as much as possible.
Three years after the operation paraplegia worsened, but he was working as a chauffeur.
It is likely that in the present case meningitis at his years of ten was responsible for adhesive arachnoiditis and ossification developed in its process.

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A case of cerebral tuberculoma was reported. A 36-year-old male visited our hospital because of several focal epileptic seizures in the left face in June, 1984. He had no neurological deficit. However, computerized tomography (CT) scans showed a small low density area with a high density spot in the right motor area. On April 6, 1985, he had a general epileptic seizure with loss of consciousness. He was admitted to our hospital with complaints of paresthesia in the left face and tongue on April 15, 1985. CT scans with contrast administration showed an irregular and nodular enhancement with perifocal edema in the right frontal and parietal lobe. Right carotid angiography showed no abnormal vessel or increased vascularity. On the 16th hospital day, craniotomy was made over the right parietal region for a presumed low grade astrocytoma. During the operation malignant hyperthermia occurred. We performed only external decompression because of marked brain swelling. The patient made an uneventful recovery after intravenous injection of dantrolene sodium. On the 39th hospital day a second craniotomy was made under neuroleptalalgesia. The surface of the parietal lobe was edematous and the convolutions appeared slightly distended. There was a grayish-white, elastic, hard, poorly vascularized and finger-tip-sized nodule in the subcortex. It was partially removed. Histology verified tuberculoma. Postoperative course was uneventful. The antituberculous therapy was started soon after the operation. He was in good health without neurological deficits about six months later. CT scans showed that the nodule was markedly reduced in size.

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We present a case of acute cerebellar infarction with excellent recovery by surgical treatment. The patient was a 33-year-old female who was admitted to another hospital complaining of sudden onset of headache and weakness. On the following day, her level of consciousness deteriorated rapidly and she was transferred to our hospital.
She was semicomatose. The right pupil was slightly larger than the left and the reaction to light was bilaterally brisk. A CT scan revealed a low density area in the left cerebellar hemisphere, disappearance of the fourth ventricle and hydrocephalus. A bilateral brachial angiogram demonstrated a hypovascular mass lesion in the posterior fossa.
The left posterior inferior cerebellar artery was not visualized. We diagnosed as a cerebellar infarction with severe brain edema. She became comatose after angiography. Suboccipital craniectomy was immediately performed and the infarcted cerebellar hemisphere was partially resected. She awoke and was able to respond to some orders on the first postoperative day. Four months later she was discharged home with slight diplopia and ataxia. At preset (three years after surgery) she is in good health without neurologic deficits.
Cerebellar infarction is sometimes fatal due to brainstem compression. Suboccipital decompression is effective for these cases. Even if the patient is comatose before sugery, good operative results can be expected. Surgical treatment is recommended for acute cerebellar infarction with brainstem compression,

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Remarkable progress of cytogenetic study and technique provided an information on the contribution of detectable structural abnormalities of X-chromosome.
In particular, cases of female Ducheinne muscular dystrophy with X-autosome translocation were increasingly reported both from abroad and at home. More than 16 cases have been reported so far.
We report here an additional case of DMD (or BMD) in a female carrier of an apparently balanced translocation t (x; 2) (p21.2; q21.1) and studied comparatively 17 cases including present cases and discussed the significance of X-A T in female DMD.

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We experienced a parkinsonian patient with severe disturbance of gait mainly due to freezing gait resistant to levodopa therapy but improved in walking with two canes.
The patient was a 71-year-old male and had 2-year history of parkinsonism secondary to cerebrovascular accident. On admission, he had difficulty in walking by himself because of freezing phenomenon. He could walk but slowly and step by step with a cane. Mild muscular rigidity was present in the neck and four extremities. Neither resting tremor nor involuntary movement was noted. He received amantadine, 200mg/day and levodopa in gradually increasing dosage. With the therapy, rigidity was completely relieved but freezing remained unchanged. Therefore, we tried to make him walk with two canes on both sides. He held two canes in each hand and brought each cane forwardly alternatively followed by opposite-side foot. An average time of walk by this method was significantly decreased than that of conventional walk with a cane.
Freezing phenomenon is one of the most troublesome problems in the treatment of parkinsonism and frequently rather worsens with increasing doses of levodopa. Recently, it is reported that L-threo-DOPS, precursor of noradrenaline, was effective for freezing symptoms. Though it has been tried in some institutions, its usage is not yet popularized. The patient was severely difficult in walking, whereas he was easy to walk when crossing over the obstacles or going up stairs. This curious phenomenon is termed “kinésie paradoxale” and has been utilized in rehabilitation of parkinsonism. Walk with two canes is just to be practical utilization of “kinésie paradoxale” in daily activities. This method should be tried in patients with severe disturbance of gait resistant to levodopa therapy, and additionally patients with long-term levodopa therapy and elderly patients who are prone to have adverse reactions with increasing doses of levodopa.

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A case was reported of 27-year-old right-handed amnesic aphasia without speech-motor-disturbance. He could retrieve words by letter better than by voice. His retrieval ability was examined by detailed tests by voice and letter against commonly used objects in daily life, names of well-known areas in Japan and daily time orientations.
The major findings were as follows:
1) This case showed dissociation between retrieval by voice and retrieval by letter. He could retrieve the words by letter that could not retrieve by voice.
2) He could retrieve words by voice after the word retrieval by letter.
3) Different words were retrieved by voice and by letter.

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West syndrome is often incurable and mental conditions of most of the patients are severely impaired. Thus early diagnosis and treatment are important.
We report a case in which a large quantity of vitamin B₆ was dramatically effective. The patient was a 5-month-old girl. From July 19, 1986, she started a series of seizures once a day consisting of about 10 spasms, each of which was about 10 seconds' duration and about 10 seconds apart. Her seizures were characterized by sudden foward bending of her head and her arms being flexed and stiff. On July 29 she visited our hospital for the first time, at which time her electroencephalogram (EEG) showed hypsarhythmia. Oral administration of 200 miligrams of activated vitamin B₆ per day was started. Next day seizures disappeared. Her EEG which was taken 4 days later showed no epileptic wave. Thereafter she has been showing normal development without further episodes of seizure on vitamin B₆ treatment alone.

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