ABSTRACT
[Introduction] We report a case of patient with migraine that improved after acupuncture and additional treatment for comorbidities of dry eye.[Case presentation] Subject was a 59-year-old female patient who was 156 cm tall and 49 kg in weight (BMI: 20.1). Her blood pressure was 122/69 mmHg, and her pulse was 70 beats per minute. She had suffered from headaches for about ten years and had been previously diagnosed with migraine. Due to the worsening of the headaches, she began acupuncture treatments. Since the onset of the headaches, she was also diagnosed with dry eye.[Treatment] At the initial visit, the subject's Headache Impact Test (HIT-6) score was 65. Manual acupuncture in her back and neck area and C2 peripheral nerve field stimulation with electroacupuncture were performed for migraine. At week four of treatment, the HIT-6 score was 60 and the headaches appeared 14 times a month, which improved to 48 and 7, respectively, at week 12. However, her headaches worsened after treatment interruption. At week 40, the HIT-6 score and headache frequency worsened and increased to 60 and 13, respectively. Acupuncture treatment for migraine was resumed, and treatment for comorbidities of dry eye, that included manual acupuncture around the orbits and self-care, was also performed. Subsequently, her headaches ameliorated significantly. At week 56, the HIT-6 score was 48 and the headaches appeared only five times a month. Migraine relief persisted and the symptoms of dry eye also improved.[Discussion and Conclusion] The additional dry eye treatment had a positive effect in improving the symptoms of migraine. It has been speculated that the pathogenesis of both diseases is related to central sensitization of the optical and trigeminal nervous systems. If so, the improvement of dry eye symptoms may have had an effect on migraine relief as well.
ABSTRACT
Anti-N-methyl-D-aspartate（NMDA）receptor（NMDAR）encephalitis is an autoimmune disorder typically involving ovarian teratomas and a severe neuropsychiatric disorder involving prominent memory and behavioral deficits. The purpose of this study was to evaluate the clinical symptoms and outcomes of six patients（one male, five female；age：20 to 47 years）with autoantibody-associated NMDAR encephalitis, who underwent comprehensive rehabilitation in our hospital. The five female patients underwent ovarian teratoma removal. At the beginning of rehabilitation, the mean score on the Rivermead Behavioural Memory Test was 16.7, and prospective memory was preserved in two patients and was recovered in two patients. The mean Wechsler Memory Scale-Revised score of the six patients significantly increased after rehabilitation, which suggested good recovery, compared to that in the patients with herpes encephalitis. However, in the chronic state, two patients showed persistent short-term memory disturbances that required a compensatory approach and employment assistance. Four patients who were treated with convalescent cognitive rehabilitation 4.5 months after onset improved in 4 months and showed good prognoses. Three returned to work, one returned to school, and two lived independently. Patients with anti-NMDAR encephalitis respond to immunotherapy, but they exhibit persistent cognitive deficits that are related to the distribution and functional role of NMDARs in the human brain. Early intervention for the short-term memory disturbances in convalescent rehabilitation, chronic interventions for the persistent memory disturbances, and preservation of perceptive memory are important to facilitate future employment.