Jet lag disorder occurs due to acute travel across time zones. Similar symptoms are evident when there exists a large discrepancy in the midpoint of sleep timing between free and work days. This difference is called social jetlag ; more than one or two hours of social jetlag is associated with both mental and physical health problems. A cross-sectional study in Germany showed that social jetlag peaked around 16-17 years to more than 3 hours. Therefore, social jetlag is an area of concern for adolescents. Social jetlag has been reported to be associated with poor academic performance, poor cognitive ability, obesity, long screen time, anxiety, sleepiness, irritability, poor sleep quality, less physical activity, breakfast skipping, and poor defecation habit among adolescents. This review introduces recent understanding on social jetlag, provides new insights on assumed problems linked to negative social jetlag, and raises current issues or future research direction on social jetlag.

  Objective: To evaluate the effectiveness and safety of ACTH therapy in patients with epileptic spasms (ES) after hypoxic encephalopathy. Methods: We conducted a retrospective nationwide study as a National Hospital Organization (NHO) Network research in Japan, and registered 342 patients with epileptic spasms treated by ACTH therapy. Among them, we selected patients with a history of hypoxic encephalopathy. Seizure outcome and adverse effects were evaluated about ACTH therapy. Short-term seizure outcome was evaluated at two months after the start of ACTH, and long-term seizure outcome at the final observation (over 6 months). We evaluated quantitative seizure outcome in terms of seizure-free period after ACTH therapy. Results: Forty-nine patients were recruited, one of whom had combined focal seizures with ES. In 48 patients with ES only, short-term seizure-free rate (SFR) was 71%, and long-term SFR was 33%. Median seizure-free period was 9.0 months (95% confidence interval, 20.6-53.1 months). Seizure-free period (SFP) corelated positively with epilepsy onset age, ES onset age, total dose of ACTH, and mean SFP in patients with epilepsy onset between 0-2 months was shorter than those in patients with epilepsy onset elder than 2 months. Mean SFP in patients with coadministration of valproic acid was longer than other patients. Adverse effects included irritability (69%), infection (38%), and hypertension (34%). Conclusion:ACTH therapy is effective for seizure control in patients with ES after hypoxic encephalopathy. The effectiveness depends on age, total dose of ACTH and coadministration of anti-seizure medication, and attention is required for the occurrence of infection.

  Disease modifying drugs (DMDs) were reportedly efficacious against multiple sclerosis (MS) in adults. However, there have been few reports on the efficacy of DMDs in the treatment of pediatric MS. The patient was a previously healthy girl, with a history of frequent falls since she was 12 years and 8 months old, blurred vision of the right eye when she was 13 years old, and right-sided upper extremity numbness when she was 13 years and 8 months old. She developed diplopia and numbness of the right upper and lower extremities at 14 years old. The initial neurologic examination findings suggested a pyramidal tract disorder, right upper extremity muscle weakness, and a positive Romberg sign. T2-weighted imaging of brain MRI sequences showed high signal intensities in the deep white matter of the bilateral centrum semiovale, white matter around the bilateral ventricles, and the right cerebellar peduncle. The cerebrospinal fluid examination revealed oligoclonal bands and elevated myelin basic protein levels. She was diagnosed with relapsing-remitting MS, based on the temporal and spatial multiplicity of two or more clinical symptoms and two or more demyelinating lesions presenting more than 1 month apart. She was hospitalized and treated with intravenous methylprednisolone, which resulted in remission. She then received oral prednisolone (PSL), but her disease relapsed 2 weeks upon tapering PSL. The short-term relapse was managed via daily oral administration of Fingolimod hydrochloride (FTY720) when the patient was 14 years and 6 months old. Remission was attained after 2 months, but FTY720 was discontinued due to lymphopenia. After the lymphocyte counts had improved, FTY720 was readministered every other day when the patient was 14 years and 9 months old. After 7 months, FTY720 therapy was given 5 days weekly, and the patient remained in remission for more than one year without needing a greater PSL dose. This case showed that FTY720 therapy was a viable treatment option in pediatric patients with highly active MS.

  Although patients with frontal lobe epilepsy are reported to exhibit cognitive dysfunction, no patients have been followed-up in regard to their detailed cognitive functioning for a long period after seizure termination. Here, we report on a Japanese boy who presented with cluster seizures at 12 years, 8 months of age, and was diagnosed with epilepsy with a likely frontal lobe focus. Approximately one year from the onset, his seizures were almost controlled. Another year later, he regained general intelligence and epileptic discharges disappeared from EEG. However, personality and behavior changes were observed following cluster seizures and he scored low on the Boston Qualitative Scoring System (BQSS) for the Rey-Osterrieth Complex Figure test. Approximately four years after onset, at 16 years, 8 months of age, his behaviors had largely recovered, with improvement of BQSS scores to the normal range. The BQSS is useful to evaluate visuoconstructional ability, visual memory performance, and in particular, the planning ability of frontal lobe functions based on the order in which elements are drawn. Patients with frontal lobe dysfunctions are known to perform poorly in drawing strategy and, therefore, this patient’s poor drawing strategy in the Rey-Osterrieth Complex Figure indicated by the low BQSS scores may be related to frontal lobe dysfunctions, poor planning ability in particular, associated with personality and behavior changes after cluster seizures.

  There are some reports of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) preceded by meningitis. Most of them show abnormal findings on T2-weighted and fluid-attenuated inversion recovery sequence brain magnetic resonance imaging (MRI), whereas only a few report entirely normal imaging findings. We report a case of MOGAD preceded by aseptic meningitis in a 4-year-old girl hospitalized for prolonged fever, headache, and vomiting. A cerebrospinal fluid test revealed an elevated cell count, but the brain MRI was unremarkable. After the diagnosis of subacute meningitis, she was unsuccessfully treated with antibiotics and anti-herpes drugs. Three weeks after the onset of subacute meningitis symptoms, she experienced hallucinations, and her EEG revealed an extensive slow waves. Brain MRI remained unremarkable. After a while, she developed spinal cord symptoms. Spinal cord MRI revealed a T2 high-signal lesion in the thoracic region. We diagnosed her with encephalomyelitis and initiated intravenous methylprednisolone pulse therapy (IVMP). Further testing revealed MOG antibody positivity, and she was diagnosed with MOGAD. She was treated with IVMP and intravenous immunoglobulin with a poor response ; thus, we initiated plasma exchange (PE) which improved her symptoms. Although acute disseminated encephalomyelitis often precedes MOGAD in children, MOGAD should be considered in the differential diagnosis of aseptic meningitis with unremarkable brain MRI.

  We reported a case of hereditary chorea where the patient’s life was improved following environmental adjustment. The patient was an 18-year-old female. She complained of headaches and expressed the willingness to commit suicide. The patient entered vocational school, but she dropped out due to problematic behavior. We changed her living conditions by incorporating volunteer work. We also secured an income for the patient using physical and mental disability certificates to claim a disability pension and employment transition support. The stage classification of the disease progress and the community chart were useful and effective in helping with the environmental adjustment. It is vital for specialized neuro-pediatric hospitals and rehabilitation facilities to cooperate in providing support.