title: New type of encephalomyelitis responsive to trimethoprim/sulfamethoxazole treatment in Japan.
abstract: OBJECTIVE
  To determine the causative pathogen and investigate the effective treatment of a new type of encephalomyelitis with an unknown pathogen in Japan and report the preliminary ultrastructural and genomic characterization of the causative agent.
  
  
  METHODS
  From 2005 to 2012, we treated 4 Japanese patients with geographic clustering and comparable clinical features, serum/CSF cytology, and radiologic findings. Brain biopsy was conducted in all patients to analyze neuropathologic changes by histology, and electron microscopy was applied to reveal the features of the putative pathogen. Genomic DNA was obtained from the affected brain tissues and CSF, and an unbiased high-throughput sequencing approach was used to screen for specific genomic sequences indicative of the pathogen origin.
  
  
  RESULTS
  All patients exhibited progressive dementia with involuntary tongue movements. Cytologic examination of CSF revealed elevated mononuclear cells. Abnormal MRI signals were observed in temporal lobes, subcortical white matter, and spinal cord. Biopsied brain tissue exhibited aggregated periodic acid-Schiff-positive macrophages and 2-7 μm diameter round/oval bodies without nuclei or cell walls scattered around the vessels. Unbiased high-throughput sequencing identified more than 100 archaea-specific DNA fragments. All patients were responsive to trimethoprim/sulfamethoxazole (TMP-SMX) plus corticosteroid therapy.
  
  
  CONCLUSIONS
  We report 4 cases of encephalomyelitis due to an unknown pathogen. On the basis of ultrastructural and genomic studies, we propose a new disease entity resulting from a causative pathogen having archaeal features. TMP-SMX therapy was effective against this new type of encephalomyelitis.
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Yusuke
authors: Y
authors: Sakiyama
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Naoaki
authors: N
authors: Kanda
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Yujiro
authors: Y
authors: Higuchi
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Michiyoshi
authors: M
authors: Yoshimura
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Hiroyuki
authors: H
authors: Wakaguri
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Yoshiharu
authors: Y
authors: Takata
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Osamu
authors: O
authors: Watanabe
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Junhui
authors: J
authors: Yuan
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Yuichi
authors: Y
authors: Tashiro
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Ryuji
authors: R
authors: Saigo
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Satoshi
authors: S
authors: Nozuma
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Akiko
authors: A
authors: Yoshimura
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Shiho
authors: S
authors: Arishima
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Kenichi
authors: K
authors: Ikeda
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Kazuya
authors: K
authors: Shinohara
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Hitoshi
authors: H
authors: Arata
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Kumiko
authors: K
authors: Michizono
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Keiko
authors: K
authors: Higashi
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Akihiro
authors: A
authors: Hashiguchi
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Yuji
authors: Y
authors: Okamoto
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Ryuki
authors: R
authors: Hirano
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Tadafumi
authors: T
authors: Shiraishi
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Eiji
authors: E
authors: Matsuura
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Ryuichi
authors: R
authors: Okubo
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Itsuro
authors: I
authors: Higuchi
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Masamichi
authors: M
authors: Goto
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Hirofumi
authors: H
authors: Hirano
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Akira
authors: A
authors: Sano
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Takuya
authors: T
authors: Iwasaki
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Fumihiko
authors: F
authors: Matsuda
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Shuji
authors: S
authors: Izumo
authors: Department of Neurology and Geriatrics (Y.S., N.K., Y.H., M.Y., Y. Takata, O.W., J.Y., Y. Tashiro, R.S., S.N., A.Y., K.I., K.S., H.A., K.M., K.H., A.H., Y.O., R.H., T.S., E.M., R.O., I.H., T.I., H.T.), Center for Chronic Viral Diseases (S.A., S.I.), Department of Neurosurgery (H.H.), and Department of Psychiatry (A.S.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Center for Genomic Medicine (H.W., F.M.), Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurology (Y. Tashiro, R.S.), Fujimoto Hayasuzu Hospital, Miyazaki, Japan; and National Sanatorium Hoshizuka Keiaien (M.G.), Kagoshima, Japan.
authors: Hiroshi
authors: H
authors: Takashima