[A report from neurological practice].

It was one of the great pleasures to have fulfilled my long-held dream in 1986, newly opened the Kitasato University East Hospital (KUEH). In 1965, I served at chronic ward of Baltimore City Hospitals as a resident of neurology, where most of the patients were relaxed and enjoyed their hospital life. Since then, my dream had been growing that chronic ward for neurological diseases was necessary in Japan, good for chronic cares as well as clinical research. KUEH include 89 beds for neurological diseases, uniquely enough, of which 15 beds specially prepared for the patients with respiratory distress suffering from intractable neurological diseases. KUEH gave us a lot of medical informations, developed to clinical research. Some of them will be introduced briefly as follows; firstly, in three patients with Guillain-Barré syndrome (GBS) we found high titers of serum IgM and IgG antibodies associated with acute cytomegalovirus (CMV) infections. They also had high titers of IgM and IgG anti-GM2 antibodies. The titers of anti-GM2 antibodies decreased on absorption with CMV-infected cells. These new findings suggested that anti-GM2 antibodies are associated with acute CMV infections in GBS patients. Secondly, we have patients with autosomal dominant familial Parkinsonism in Sagamihara, Kanagawa. Their clinical features are not essentially different from solitary Parkinson disease, and they respond well to levodopa treatment. Three autopsied cases, however, revealed neuropathological findings much different from those of classical Parkinson disease, such as rather mild to moderate loss of melanin-containing cells, well-maintained locus ceruleus neurons in number and no Lewy bodies detected at all. There are no reports in literatures of familial Parkinsonism from clinical and neuropathological points of view. Thirty-eight years have passed since establishment of the Japan Neurological Society, meanwhile the expertise neurologists come out. Neurology is, however, still minor in medical practice. This is my opinion that neurologist should take leadership in clinical medicine as well as in academic fields. We need tell people our work, how our neurologic expertise can help them treat various disorders such as stroke, pain, sleep, and headache, epilepsy as well as physical and mental rehabilitation for the establishment of our identity.