Korea health care system and public welfare system have been changed slowly and developed step by step. It makes efforts to promote the welfare of the people, but does not provide good benefits for geriatric patients. In 2008, it was incompletely set up the long term care system in Korea. And the Law on Long-Term Care Insurance for Elderly was officially announced in Nov. 2011 and the law for dementia, Dementia Management Act, was drafted in Feb. 2012. Though there were many laws, the concept of long-term care hospital and geriatric care facility is still obscure. In long-term care hospital, there are big expansion of the number of beds and institutions in Korea. Over a half of the patients in long-term care hospitals are suffered from mixed neurological diseases. Especially, dementia is the comorbid state with other chronic geriatric diseases. In view of the aging population, the role of neurologist will continue to grow. So neurologists need more special training for the needed skills and competencies, and the specific care settings program in long-term care hospital. In this review, the history and current state of long-term care hospital, related laws, and the role of neurologist will be discussed.
Aged ; Aging ; Delivery of Health Care ; Dementia ; Humans ; Insurance, Long-Term Care ; Jurisprudence ; Korea ; Long-Term Care*

BACKGROUND AND PURPOSE: Unstable carotid atherosclerotic plaques are characterized by cap rupture, leading to thromboembolism and stroke. Matrix metalloproteinases (MMPs) have been implicated in the progression of atherosclerosis and plaque rupture. The aim of this study was to assess the relationship between the expressions of MMP-2 and MMP-9 and carotid plaque instability. METHODS: Eighty atherosclerotic plaques were collected from 74 patients undergoing carotid endarterectomy. Clinical information was obtained from each patient, and plaque morphology was examined at the macroscopic and microscopic levels. The immunohistochemical expressions of MMPs were graded using semiquantitative scales. RESULTS: Macroscopic ulceration (84.6% versus 63.4%, p=0.042) and microscopic cap rupture (79.5% versus 51.2%, p=0.010) were more common in symptomatic than in asymptomatic patients. Immunoreactivities of MMP-2 and MMP-9 were increased in 40 and 36 atheromatous plaques, respectively. Macroscopic ulceration was strongly correlated with the expressions of MMP-2 (p<0.001) and MMP-9 (p=0.001). There were significant correlations between increased MMP-2 expression and cap rupture (p=0.002), intraplaque hemorrhage (p=0.039), and a thin fibrous cap (p=0.002), and between increased MMP-9 expression and cap rupture (p=0.010) and a large lipid core (p=0.013). CONCLUSIONS: Plaque rupture was significantly associated with the development of vascular events in carotid atherosclerotic disease. MMP-2 and MMP-9 are strongly correlated with plaque instability.
Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases ; Endarterectomy, Carotid ; Hemorrhage ; Humans ; Matrix Metalloproteinases ; Plaque, Atherosclerotic ; Rupture ; Stroke ; Thromboembolism ; Ulcer

Endothelins (ETs), which were originally found to be potent vasoactive transmitters, were known to be implicated in nervous system, but the mode of mechanism remains unclear. ETs (ET-1, ET-2, and ET-3) were added to HN33 (mouse hippocampal neuron chi neuroblastoma) cells. Among the three types of ET, only ET-1 increased the intracellular calcium levels in a PLC dependent manner with the induction of ERK 1/2 activation. As the result of ET-1 exposure, the survival rate of HN33 cells and the PKCalpha translocation into the plasma membrane were increased. We suggest that ET-1 participated in the neuroprotective effect involving the calcium-PKCalpha-ERK1/2 pathway.
Animals ; Apoptosis/*drug effects ; Calcium/*metabolism ; Cell Line ; Cell Survival/drug effects ; Cytosol/drug effects/metabolism ; Endothelin-1/*pharmacology ; Endothelin-2/pharmacology ; Endothelin-3/pharmacology ; Estrenes/pharmacology ; Extracellular Signal-Regulated MAP Kinases/*metabolism ; Immunoblotting ; Mice ; Mitogen-Activated Protein Kinase 1/metabolism ; Mitogen-Activated Protein Kinase 3/metabolism ; Neurons/*cytology/drug effects/*enzymology ; Neuroprotective Agents/pharmacology ; Phosphoproteins/metabolism ; Protein Kinase C-alpha/*metabolism ; Protein Transport/drug effects ; Pyrrolidinones/pharmacology ; Serum

Hepatic myelopathy is a rare neurological complication of chronic liver disease, and is characterized by a progressing spastic paraparesis without any sensory loss. However, a few recent reports suggest that involvement of the sensory system is also possible in hepatic myelopathy. We present a patient with hepatic myelopathy, who had impaired proprioception and a delayed cortical response of somatosensory evoked potentials. This supports the hypothesis that hepatic myelopathy may involve the sensory system as well as the motor system.
Evoked Potentials, Somatosensory ; Humans ; Liver Diseases ; Paraparesis, Spastic ; Proprioception ; Spinal Cord Diseases

No abstract available.
Hemianopsia* ; Isoniazid ; Tuberculosis

The spinocerebellar ataxia type 2 (SCA 2) is an autosomal dominant cerebellar ataxia that commonly presents with cerebellar ataxia, hyporeflexia, and slow saccades. Recent clinical series described movement disorder in the SCA 2 such as Parkinsonism or dystonia. Dystonia can be observed in and even be the presenting feature of the SCA 2. We report two patients with genetically confirmed SCA 2 displaying a slowly progressive syndrome combined with cerebellar ataxia and craniocervical segmental dystonia.
Cerebellar Ataxia ; Dystonia* ; Humans ; Movement Disorders ; Parkinsonian Disorders ; Reflex, Abnormal ; Saccades ; Spinocerebellar Ataxias*

A few patients with Parkinson's disease (PD) crave large amounts of levodopa therapy far beyond those needed to alleviate their symptoms, even in the state of overdose complication. Such harmful pattern of compulsive dopaminergic drug use is called as dopamine dysregulation syndrome (DDS). We report a chronic stage PD patient presenting with high fever and altered mentality, who had the DDS as well as the Parkinsonism hyperpyrexia syndrome (PHS).
Dopamine* ; Fever ; Humans ; Levodopa ; Parkinson Disease ; Parkinsonian Disorders*

BACKGROUND: Based on a recent study showing that the reactivation of HSV-1 may be one of the possible pathogenesis of idiopathic facial mononeuropathy, antiviral therapy has been suggested as a good treatment modality. However, the efficacy of antiviral therapy is still controversial. This argument may be caused by the absence of a reliable system of grading facial nerve paralysis. We performed this study to investigate the therapeutic effects of an antiviral agent and possible prognostic factors using the Sunnybrook scale. METHODS: Patients with idiopathic facial mononeuropathy were divided as two groups according to the treatment regimens (Acyclovir & Steroid vs. Steroid only). Clinical efficacy was evaluated using the House-Brackmann grading system and Sunnybrook scale. Electrodiagnostic studies including the blink reflex, facial nerve conduction study, and facial nerve excitability test were performed. The clinical improvement rate between the two groups and the usefulness of the electrodiagnostic studies as prognostic factors were analyzed. RESULTS: No significant differences of the clinical improvement rate was revealed with a 70% improvement rate for the Acyclovir treatment group and 84% for the steroid only group. Among electrodiagnostic studies, the compound muscle gamma action potential (CMAP) amplitude (=0.637, p=0.000) and nerve excitability =0.688, gamma test (p=0.000) on 2 weeks showed significant correlations to the final Sunnybrook score. There is good correlation between the two facial nerve grading systems. CONCLUSIONS: Acyclovir may not be effective in the recovery of idiopathic facial mononeuropathy. CMAP amplitude and nerve excitability tests on 2 weeks may provide valuable prognostic factors. The Sunnybrook scale may be useful as a facial grading system.
Action Potentials ; Acyclovir* ; Blinking ; Facial Nerve ; Herpesvirus 1, Human ; Humans ; Mononeuropathies* ; Paralysis

Relapsing polychondritis (RP) is a rare multisystem autoimmune disease of unknown origin characterized by recurrent episodes of inflammation and progressive destruction of cartilaginous tissues. We present a patient diagnosed with meningoencephalitis associated with RP whose initial symptoms included chronic headache with memory disturbance and disorientation. After treatment of meningoencephalitis, the patient had frequent bilateral auricular swelling, polyarthralgia, and sensory neural hearing loss. Although RP is an extremely rare disease, it should be considered as a possible cause of chronic meningoencephalitis.
Arthralgia ; Autoimmune Diseases ; Headache Disorders ; Hearing Loss ; Humans ; Inflammation ; Memory ; Meningoencephalitis* ; Polychondritis, Relapsing* ; Rare Diseases

BACKGROUND: Foot Scan System (RS scan international cooperation) measuring the plantar pressure distribution is simple and inexpensive tool for gait analysis. The analysis of plantar pressure distribution of the feet during gait maybe helps the assessment of motor symptoms or gait stability of Idiopathic Parkinson's disease (IPD). METHODS: We compared the parameters of foot scan system between 34 normal controls and 23 IPD patients before and after levodopa administration. Data of plantar force distribution and time of stance phase were collected using pressure-sensitive insoles as parts of the Foot Scan System. RESULTS:There were significant difference between normal controls and IPD patients in fore foot peak pressure/rear foot peak pressure ratio, time percentage of heel strike phase, mid stance phase, propulsion phase in stance phase. But in these parameters there were no significant difference between IPD patients before dopamine with after dopamine medication. CONCLUSIONS: Using the Foot Scan System (RS scan international cooperation) measuring the plantar pressure distribution, we showed that F/R ratio and time percentage of propulsion phase are reduced significantly in patients with IPD, which enables us to understand the features of gait in IPD patients more easily.
Dopamine ; Foot* ; Gait ; Heel ; Humans ; Levodopa ; Parkinson Disease* ; Strikes, Employee