Many patients present with extremely serious problems such as headache, photophobia, acoustic hyperresponsiveness, severe pain, menstrual disorders, various sleep disorders, and POTS after human papillomavirus vaccination (HPV vaccine). In addition, patients exhibit various neurological symptoms such as movement disorders, walking disturbance, involuntary movement, abnormal sensation, memory disturbance, and so on. However, these symptoms are variable and have been considered to be symptoms of hysteria (somatoform disorder, somatic symptoms). Immunosuppressive treatments were not administered because many cases were considered to be of neurological origin. In such cases, the disease condition is objectively evaluated to diagnose and treat patients with neurological symptoms. In conclusion, the wide–ranging symptoms of the central nervous system include those caused by disseminated autoimmune encephalitis and also symptoms of the peripheral small fibers. Thus, according to the obtained findings, the neurological symptoms caused by HPV vaccination are related to immunological diseases, and not psychogenic diseases. In addition, the cause of misdiagnosis has also been described.

Sleep disturbance has been recognized as an important non–motor symptom of Parkinson's disease, which can impair the quality of life of patients. However, adequate screening and management of sleep disturbances coexisting with Parkinson's disease are still challenging issues. The causes of sleep disturbances include disease–related pathological changes in the brainstem and hypothalamus, which modulate REM / non–REM sleep and sleep–wake cycle, the effects of nighttime motor / non–motor symptoms including restlessness of the limbs and REM sleep behavior disorder, and the co–occurrence of other sleep disorders, such as sleep apnea syndrome. We provide an updated review of sleep disturbances in patients with Parkinson's disease and related disorders.

Both headache and sleep disturbance are common symptoms in clinical practice. When considering the relationship between headache and sleep disturbance, chronic daily headache, especially morning headache, is an indicator of nonspecific sleep disturbance.

The relationship between sleep and headache is classified as follows : sleep–triggered or sleep–related headaches, sleep duration induced headache, sleep phase–related headaches, sleep–relieved headaches, dreams and headache and effects of headaches on sleep (Jennum & Jensen, 2002).

Primary sleep disorders such as narcolepsy, parasomnia, restless legs syndrome may coexist in patients with migraine. Cluster headache suggests association with obstructive sleep apnea. Morning headache is important as a symptom of sleep apnea headache.

Headache and sleep disorders are interrelated, both of which can adversely affect the quality of life of patients. Therefore, clinicians need to recognize the pathophysiology and interrelationship of headache and sleep disorders, respectively, and to evaluate and treat headache and sleep disorders properly.

筋ジストロフィー病棟入院患者データベースでは，1999年から毎年10月1日時点の全国27筋ジストロフィー専門施設入院患者の臨床情報を収集している．本報告では，筋強直性ジストロフィー（myotonic dystrophy：DM）の検討を行った．1999年には331例あったDM入院例数は2005年まで増加傾向，その後370例前後で推移した．年齢層は40～50歳代が中心であったが，60歳代以上高齢層が徐々に増加した．1999年に19.9％であった人工呼吸療法施行率は経年的に上昇し，2009年以降は50%以上となった．また，1999年に86.1％であった経口摂取率は低下傾向で，2013年には50%台となった．2000年から2013年までの14年間に602死亡例が報告された．死因の30～50%を呼吸器関連死が，20～30%を心臓関連死が占め，これらは死因全体の50～80%に相当した．死亡時平均年齢は，2000年で57.6歳であったが，徐々に上昇し，2013年には59.6歳になった．筋ジストロフィー専門施設入院中のDM患者は高齢化，重症化しており，その対策も検討する必要がある．

薬剤抵抗性の本態性振戦（essential tremor：ET）10例（男性8例，女性2例，67.1±17.5歳，全例右利き）に対してMRガイド下集束超音波（MR–guided focused ultrasound：MRgFUS）による左視床中間腹側核（ventral intermediate nucleus：Vim）破壊術を施行し，施行から6ヶ月間の有効性と安全性を検討した．治療直後から全例で右上肢の振戦が改善したが，2例で振戦が再増悪した．有害事象として，超音波照射中には頭痛や浮動感などが，照射後には右手指と顔面の感覚障害や歩行時の不安定性などが，それぞれ生じた．MRgFUSによる片側Vim破壊術は薬剤抵抗性のETに対する治療選択肢になりうると考えられたが，長期的な有効性・安全性の評価が必要である．

抗筋特異的受容体型チロシンキナーゼ抗体陽性重症無力症（anti–muscle–specific receptor tyrosine kinase antibody–positive myasthenia gravis：抗MuSK–MG）は球麻痺のため誤嚥や窒息の危険性があるが，嚥下造影検査（video fluoroscopic examination of swallowing：VF）などの客観的評価の報告は1例にとどまる．症例は46歳男性，抗MuSK抗体陽性MGとして外来通院中であった．むせのない嚥下困難感，著明な開鼻声が出現したため入院となった．VFにて咳反射の消失した不顕性誤嚥が認められ，絶食の上，免疫グロブリン大量静注療法を施行した．VF所見の改善が不十分であったためステロイドパルス療法を追加したところ，症状および所見は著明に改善した．VFにより食事中止や再開，食形態だけでなく治療方針も決定することができ，本例は肺炎や窒息をおこすことなく回復した．MGを含む重度嚥下障害を来たす疾患の治療評価にはVFが有用である．