[Neurology in the 21st century--the era of preventive neurology utilizing new diagnostic and therapeutic techniques].
The aims of neurology in Japan in the 21st Century should include establishment of therapeutic measures for neurological diseases, training clinical neurologists to cover both static and dynamic aspects of neurology, and application of gene therapy and neurogenesis to clinical neurology. It is also important to note that once any neurological disease develops, remaining sequelae are usually not curable, so the problem of how to prevent the onset of neurological diseases, that is preventive neurology, will become increasingly important. The key target for prevention in neurology is cerebro-vascular disease, since it is very common. Many risk factors are known for ischemic CVD. However, even for the management of hypertension, the so-called number needed to treat (NNT) is 29-118/5 years for primary prevention and 14-23/5 years for secondary prevention. It is also important to consider genetic factors that influence CVD, including abnormal plasminogen, Lp (a), ACT Isehara 1 gene, apolipoprotein E and so on, since these congenital factors reinforce known acquired risk factors, such as hypertension. In addition, the presence of asymptomatic cerebral infarction, as well as PVH and DSWMH, in MRI T2-weighted images is an important predictor of future symptomatic CVD. Finally, storage of one's own bone marrow cells might be useful, since in the event of onset of CVD, dementia or other neurological diseases, autotransplantation with cytokine might become available for neurogenesis. The results of our recent experiments indicate that this idea may be feasible.
Shinohara
Yukito
Y
Department of Neurology, Tokai University School of Medicine.
D000818:Animals; D016026:Bone Marrow Transplantation; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005544:Forecasting; D015316:Genetic Therapy / Q000379:methods; D017228:Hepatocyte Growth Factor / Q000008:administration & dosage; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D017270:Lipoprotein(a) / Q000235:genetics; D008279:Magnetic Resonance Imaging; D039902:Multipotent Stem Cells / Q000637:transplantation; D009154:Mutation; D009462:Neurology / Q000639:trends*; D010958:Plasminogen / Q000235:genetics; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011794:Quercetin / Q000008:administration & dosage; D012307:Risk Factors; D014182:Transplantation, Autologous; D000514:alpha 1-Antichymotrypsin / Q000235:genetics
D017270:Lipoprotein(a); D010975:Platelet Aggregation Inhibitors; D000514:alpha 1-Antichymotrypsin; D017228:Hepatocyte Growth Factor; D010958:Plasminogen; D011794:Quercetin