We report five cases of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Five women (27-38 years), Who-presented with psychiatric symptoms, neurological complications, and decreased consciousness, were diagnosed with anti-NMDAR encephalitis after testing positive for serum anti-NMDAR antibodies. The mean（±SD）for hospitalization duration was 272.4（±144.8)days. All patients presented with respiratory failure due to central hypoventilation and required mechanical ventilation for 50.2（±13.1）days on average. Four patients showed no abnormal findings upon brain MRI, one showed high intensity lesions in the right temporal cortex and bilaterally in the hippocampus on T2 weighted images. Higher brain function assessment revealed an overall decrease in intelligence, attention, memory, and executive function in all patients. Temporal assessments revealed progressive improvement in these dysfunctions over several years. Four patients presented with deep venous thrombosis, articular contracture, ectopic ossification, and compression paralysis during the first immobility episode. Two had severely impaired communication and ability to perform activities of daily living when admitted for rehabilitation. However, eventually all the patients attained a premorbid state.
　Anti-NMDAR encephalitis possibly results from reversible synaptic dysfunction；therefore, it has a better functional prognosis compared with classical limbic encephalitis and other paraneoplastic neurologic syndromes. Previous studies found abnormalities in the limbic area on MRI in about 25％ of patients, although other findings were non-specific. Prevention of disuse syndrome due to prolonged immobility is important in acute phase rehabilitation. Our study shows that long-term temporal assessments of higher brain function are necessary and useful in the chronic stage.

The aim of the present study is to characterize the burden of parents who care for their children with disabilities with the use of a Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) that has been successfully used to quantify the caregiver burden for caring for the disabled elderly. We performed a survey in which questionnaires including the J-ZBI (adapted for the subjects of this study) were given to 135 parents of children in a school for the physically challenged. We obtained 69 valid responses. For the parents, the mean J-ZBI score was 25.6 points and the mean CES-D score was 10.8 points. A lowered QOL for these parents was suggested by the finding that the mean SF-36 score was lower than for other persons of the same year and age in Japan. The parents reported physical strain more frequently than mental stress as the main caregiver burden. According to the parent group's mean J-ZBI score, we classified them into either a heavier or a lighter burden group. The parents who were in a state of depression as judged by the CES-D were more frequently found in the heavier burden group, while those with children who showed complete or modified independence in more items of FIM were more frequent in the lighter burden group. Services to support the physical aspects of parents caring for children with disabilities would reduce their caregiver burden effectively.

Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV) -aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.

Few case reports have documented patients with respiratory muscle paralysis due to spinal cord infarction or the need for ventilation. Objective：Herein, we report a case of non-invasive positive pressure ventilation (NPPV)-aided respiratory management. Patients：A 46-year-old man experienced sudden breathing difficulty, and, owing to respiratory failure, underwent tracheostomy and mechanical ventilation following tracheal intubation. The patient exhibited complete limb paralysis and was diagnosed with spinal cord infarction. Methods：Ventilator weaning was challenging, and necessitated patient transfer to our hospital. Results：Upon admission, the patient exhibited a forced vital capacity of 250 mL and required complete assistance. The ventilator settings were adjusted to a tidal volume of 20 mL/kg of the ideal body weight and positive end expiratory pressure off. One month post-admission, the patient was transferred for all day respiratory management with NPPV. One year after the onset, the patient's vital capacity improved to 1960 mL. The patient engaged in activities involving changes in body position or transfer training, gait training, and activities of daily living training with NPPV. Following training, the patient could independently propel a wheelchair and walk 40 m using a walker. The patient could also eat, brush his teeth using a self-help device, and independently wipe their face.Conclusion：Respiratory dysfunction in this case was a ventilatory impairment resulting from respiratory muscle paralysis. Pulmonary rehabilitation for cervical spinal cord injury facilitates respiratory management with NPPV, improves respiratory condition, and reduces the amount of assistance.