Tension type headache : TTH is regarded as an extremely common headache in the general medicine, and TTH is diagnosed in most by the headache not to be caused by alcohol and the common cold that are not serious.

TTH is the most common headaches in a primary headache statistically, but the prevalence greatly varies by an investigation.

Chronic TTH surely greatly reduce quality of life and are serious disease to cause severe disorder so that the comment of the tension–type headache in ICHD–3 beta has it. In addition, frequent episodic TTH will be to have possibilities to affect as the treatment with a sometimes expensive drug is required.

However, Infrequent episodic TTH occurs in all most population, and when effect to give to an individual is very few things namely a physiological response.

I would like to describe a personal opinion about the way of a diagnosis of TTH in ICHD–3 beta and the classification.

Overview of the board–certified systems for Neurology, Stroke Medicine, Epilepsy, Headache and Dementia research in Japan are described. Perspective of Japanese Society of Neurological Therapeutics is also commented.

This article describes Specialist System of The Japan Stroke Society.

The Japanese Headache Society (JHS), an Affiliate Member Society of the International Headache Society, started in 1973 as “the Headache Conference” and was founded in 1997.

JHS began to implement the accreditation of board–certified headache specialists in 2005. JHS has more than 2700 members and 902 board–certified headache specialists in 2017.

In this article, I described and discussed concerning the values and the carrier–path of board–certified headache specialists.

JES has certified the eligible members as clinical specialists of epilepsy since 1999, once they fulfill the qualification conditions and pass the examination (written– and oral part) that is currently done once a year in summer.

The Japanese Medical Specialty Board, formerly the Japanese Board of Medical Specialties, has approved it. Out of about 3000 JES members, a total of 633 members have been certified as clinical specialists of epilepsy until 2017. (http://square.umin.ac.jp/jes/en/clinical-sp.html)

In this paper, the accredited specialty board of Japan Society for Dementia Research was described.

A history and current issues of the board–certified neurologist in Japan are described.

A 62–year–old man suddenly developed right ocular pain and was diagnosed with scleritis. Serum immunological examination revealed elevated levels of myeloperoxidase anti–neutrophil cytoplasmic antibody (ANCA) and C–reactive protein. Thus, the patient was diagnosed with ANCA–related vasculitis. Although administration of prednisolone (PSL ; 30mg/day) resolved his symptoms, serum examination still revealed elevated levels of myeloperoxidase ANCA and C–reactive protein. His condition also deteriorated, including headache, left–side mixed hearing loss, left facial sensory loss, and interstitial pneumoniae. Increasing the PSL dose to 50mg/day resolved his symptoms, and PSL was then tapered stepwise. However, at 30mg/day PSL, the patient complained of deterioration of hearing loss and otalgia, and was diagnosed with bacterial otitis media. Further, after reduction of PSL to 27.5mg/day, the patient showed left–side facial nerve palsy and hoarseness. Administration of valaciclovir did not improve his symptoms, and he was consulted to our neurological service. Neurological examinations revealed otitis media and isolated left–side poly cranial neuropathy, involving cranial nerves V (1st and 2nd branches), VII, VIII, IX, X, and XI. Cranial gadolinium–enhanced T1–weighted magnetic resonance imaging revealed a massive granuloma located at the petrous portion of the carotid artery, cavernous sinus, and mastoid cells. Computed tomography showed left side otitis media with osteoclasia of mastoid cells. He was diagnosed with Garcin syndrome due to otitis media with ANCA–associated vasculitis. After intravenous gamma–globulin and methylprednisolone pulse therapies, his facial sensory disturbance and palsy resolved, and cranial magnetic resonance imaging revealed reduced granuloma size. Overall, neurologist should be aware that Garcin syndrome can be associated with OMAAV.

Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by supranuclear gaze palsy, postural instability with frequent falls, gait disturbance, pseudobulbar palsy, and dementia. Although postural instability is one of the cardinal features of PSP, there are few reports about the features in detail. In this study, we investigated the characteristics of body sway and postural instability in patients with PSP. The subjects were 21 patients with PSP whose mobility were above the level of assistance gait level (PSP) and 25 healthy elderly people (CON). Age, sex, body mass index, duration of disease from onset of initial symptoms, modified Rankin Scale (mRS), progressive supranuclear palsy rating scale (PSPRS), pull test and body sway during resting standing position were evaluated. Comparison between groups and relationship between the pull test and other evaluation items in PSP were analyzed. In PSP, area of body sway (cm²) wad larger and their center of gravity position (cm) was deviated backward during standing compared to CON. Furthermore, locus length per unit area (cm/cm²), which reflected postural adjustments controlled by the spinal proprioceptive reflexes of the lower limbs, was lower compared to CON. Patients with longer duration, more severe mobility, and worse clinical status of PSP had more severe postural instability. In addition, the postural instability was related to the degree of body sway in the static standing position in PSP.

Background : In patients with amyotrophic lateral sclerosis (ALS), various guidelines recommend to perform a diachronic pulmonary function test. Furthermore, we pay attention to the usefulness of measuring the vital capacity as percent of predicted (%VC), in addition to measuring the forced vital capacity as percent of predicted (%FVC) at our institute.

Methods : We measured VC and FVC every month. We also examined bulbar paralysis, physical function, and respiratory function based on the ALS usability test scale and their association with %VC and %FVC in 18 patients with ALS. Furthermore, we analyzed the correlation between the spare expiratory reserve volume, inspiratory capacity, and ALSFRS–R total score.

Results : For each ALSFRS–R item, physical function and bulbar paralysis correlated with %FVC and %VC ; however, respiratory function did not correlate with them. In patients with ALS, the diachronic pulmonary function test was useful for estimating physical function and bulbar paralysis. In addition, the inspiratory component of the pulmonary function test correlated with the ALSFRS–R total score.

Conclusion : Multidimensional evaluation of the pulmonary function test is important during follow–up for patients with ALS.