Department of Neurology

This department has mainly 3 foci, movement disorders such as Parkinson's disease, neuroimmunologic disorders such as multiple sclerosis, and muscular disorders. We provide highly specialized diagnostic and medical care with collaboration of departments of neurolsugery, psychiatry and rehabilitation in our hospital, and also departments of institute of neuroscience NCNP. In order to develop the new treatment for the neuromuscular inractable disorders we actively apply clinical trials or methods, simultaneously, arrange the circumstance to receive the appropriate medical cares at home.

Department of Psychiatry

Department of Psychiatry provides evidence-based high levels of clinical diagnoses and treatment plans for patients with psychiatric disorders such as schizophrenia, mood disorders, anxiety disorders, epilepsy, sleep disorders, and dementia. Psychiatric rehabilitation and job assistance programs are provided at our day care center.
We have four hospital wards, consisting of 140 private rooms, which provide a variety of treatment programs such as a short-term admission program for acute psychoses, inspection admission programs for depression and epilepsy, a modified electroconvulsive therapy (m-ECT) program for intractable psychoses, emergency services for psychiatric patients having concurrent acute physical conditions, compensatory admissions ordered by the Governor of Tokyo, judicial psychiatric evaluation programs, and so on.
Near Infra-Red Spectroscopy (NIRS) is administered for depressed patients as an auxiliary differential diagnostic tool.
Approximately 1,100 patients are admitted to our psychiatric wards each year. The average length of hospital stay is less than 40 days.

1st Department(Department of Forensic Psychiatry)

The Department of Forensic Psychiatry is a core center of forensic psychiatry in Japan. We provide services to patients requiring psychiatric treatment for their social rehabilitation on both inpatient and outpatient basis under the Medical Treatment and Supervision Act (MTSA). Patients are mentally disordered offenders with court involuntary treatment order.
The facility consists of two Regional Secure Units with 33 beds respectively and one is the first Forensic Medical Psychiatry Unit in Japan, designated for managing medical and psychiatric comorbidity. A full range of psychiatric services is available through a multi-disciplinary team of medical, nursing and allied health professionals following guidelines by the Ministry of Health, Labour and Welfare. Since 2011, started outpatient services covering the neighborhood of Higashimurayama City and Kodaira City as a designated medical bureau for the outpatients.

Department of Child Neurology

Department of Child Neurology provides high levels of medical care for children suffering from various neurological disorders from not only all over Japan but also foreign countries. We offer highly specialized diagnostic systems for epilepsies, muscle disorders and many congenital brain disorders including brain malformations or genetic disorders. We also offer highly advanced treatment programs for these disorders.

Department of Neurosurgery

In this department, our activities are devoted to Functional neurosurgery. Above all, surgical treatment of intractable epilepsy and movement disorders is our main clinical target.
Epilepsy surgery; Resection, disconnection and neuromodulation procedures are performed based on the state of the art neuroimaging technique and advanced neurophysiological analysis. Against the harmful effect of seizures on the developing brain, early surgery with special expertise in children including catastrophic epilepsy of infants is a unique characteristic in our department. Comprehensive management and care of patients and their caregivers can be available in our Epilepsy center.
Deep brain stimulation; Highly precise and accurate, minimum invasive implantation of stimulation electrodes in the deep brain structures is performed by image-guided stereotactic surgery and intraoperative neurophysiological exploration for movement disorders such as Parkinson' s disease, dystonia, essential tremor, and Tourette's syndrome. All operations are carried out comfortably with the painless manner by special anesthetic technique.

Department of Internal Medicine

Department of General Medicine includes gastrointestinal medicine, cardiovascular medicine, and psychosomatic medicine. We treat hospitalized patients complicated with medical disease and outpatients.
The Department of Gastrointestinal Medicine provides medical treatment of overall digestive organ diseases. We carry out upper gastrointestinal endoscopy, colonoscopy, and abdominal ultrasonography as routine examinations. We also focus on gastrointestinal disorders conjunction with mental stress such as functional gastrointestinal disorders (functional dyspepsia, irritable bowel syndrome) and inflammatory bowel diseases (ulcerative colitis, Crohn's disease). We work on these diseases with speciality and provide clinical outcomes.
In Cardiovascular Medicine, we examine cardiac disease by electrocardiogram and echocardiography. We mainly treat hypertension, arrhythmia, and heart failure. Evaluation and management of cardiomyopathy associated with muscular dystrophy are important in our hospital.
Department of Psychosomatic Medicine provides care from both physical and psychosocial perspectives. Major target diseases are psychosomatic disorders, which are physical illnesses associated with psychosocial factors such as irritable bowel syndrome.

Department of General Surgery

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Department of Radiology

This Department is equipped with a number of modern diagnostic technologies including [computed radiography (CR), fluoroscopy, X-ray CT, ultrasound sonography (US), cerebral angiography, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomograpgy (PET)]. All data obtained are preserved and managed as digital images through a high-capacity image server. Cooperative efforts of the radiological technicians and the medical doctors make possible the evaluation of the disease status for psychiatric and neurological patients for early diagnosis and the selection of appropriate treatment modality.

Department of Clinical Laboratory

This Department performs all the clinical laboratory examinations on our patients. Neurophysiologic examinations are carried out to identify epileptic foci by using electroencephalogram, evoked potentials and magnetoencephalogram. We also evaluate cardio-pulmonary function for muscular dystrophy patients. The Pathology Section performs histopathological diagnoses on neurosurgical and postmortem tissue samples. The Genetic Analysis Laboratory carries out cutting-edge pathological, biochemical and genetic analyses on neuromusclular and neurodegenerative disorders.

Department of Physical Rehabilitation Medicine

We provide rehabilitation services, especially for neuromuscular diseases such as Parkinson's disease, muscular dystrophy and motor neuron diseases which are rare, intractable and progressive, with the aim of helping patients with various symptoms and prognoses. We cover all functional impairments, including movement disorders, deconditioning from any reasons (like pneumonia, bone fracture, surgery etc.), cognitive dysfunctions, swallowing difficulty, articulatory disorder, respiratory disorder due to respiratory muscle weakness or neurological symptom , and any troubles they have with of daily life activities. To improve those impairments as much as possible, we provide self-training programs, supportive exercises, speech and swallowing therapy, respiratory care and assistive devices such as orthosis, wheel chairs and communication aids.

Department of Psychiatric Rehabilitation

Clinical Psychology Division

Psychotherapists are assigned to three sections: Clinical Psychology Room, Day Care Section, and Forensic Psychiatry Section. The Clinical Psychology Room carries out a variety of psychological tests and provides a range of psychotherapy services under the cooperation with medical doctors. In the Day Care Section, psychotherapists run weekly rehabilitation programs and yearly events in collaboration with multi-disciplinary staffs. Through these social rehabilitation programs, understanding of own personal traits and acquisition of interpersonal skills of the users are promoted. Parallel to these group programs, programs to meet individual needs are also provided. In the Forensic Psychiatry Section, personalized therapies and various group programs are provided for the offenders with mental disorders, aiming their social reintegration.

Department of Clinical Psychology,Counseling and Social Services

This Department has three sections: Clinical Psychology Section (psychotherapy specialists) carries out a variety of psychological tests and provides a range of psychotherapy services. The Counseling Section (child counselors, child care specialists) is involved in mental care for patients with severe motor and intellectual disabilities. Other members strive to improve the quality of life (QOL) for patients with neuromuscular disorders. The Social Service Section offers assistance in adjusting to and coping with psychological and social challenges in dealing with various social welfare agencies.

Genetic Counseling Unit

Medical geneticists and genetic counselors provide genetic counseling for the patients with genetic disorders and their family members. Clients are individuals who concern about heredity and genetic testing of psychiatric and neuromuscular diseases: Duchenne/Becker muscular dystrophy, Fukuyama type congenital muscular dystrophy, myotonic dystrophy, spinal muscular atrophy, spinal and bulbar muscular atrophy, Huntington disease, spinocerebellar degeneration, mitochondrial diseases, schizophrenia, mental retardation, chromosomal abnormality, etc. Consultation day is every Monday and Thursday. Counseling fee is 10,500 yen for the first visit, and 5,250 yen for the following visits. Appointment by phone is necessary.

Department of Nursing

Our hospital has 13 nursing units including 4 psychiatric wards and one forensic psychiatry ward, 3 wards for neurological and muscular disorders, 2 wards for severe mental and intellectual disorders, one operation room for surgery, one outpatient clinic and one day-care unit. We provides with highly specialized and modern nursing care. Many professionals from other institutions visit and work with us to study and learn the highly specialized nursing models. Our hospital accepts students from colleges and schools of nursing for clinical educational in psychiatric and neurological diseases.

Department of Pharmacy

In addition to preparing regular prescribed medications, we make available chemical compounds which are not medicinal and no commercially available but may be alternative treatments. One example of such an agent is dichloroacetate in the treatment of mitochondrial disorders. To ensure that the medications are properly and safely utilized and administered, this Department stores their drugs and supplies them in prescribed doses. We provide our patients with full information about their medications.

Clinical Research Unit

This section is mainly involved in managing clinical trials of newly developed drugs, which aims to gain approval from PMDA and MHLW. Recently, this section has expanded its operation to include support to the clinical intervention trials, which are not necessarily linked to approval. Fourteen clinical research coordinators (CRCs) including 3 full-time staffs (3 pharmacist, 2 clinical laboratory technicians, and 4 nurses) work with the attending doctors to evaluate the safety and effectiveness of new drugs and / or specific treatments, paying close attention to patients' privacy and safety, as well as their human rights.

Nutrition Control Unit

A well balanced diet is essential for maintaining normal life activities. Since regular meals are essential for reducing the life stresses our psychiatric patients face and to enable them to enjoy a full life, we always pay special attention to the arrangement of table place settings and make sure that their food is served at the appropriate temperature. For patients with neurological disorders, we prepare their food by making allowance for any chewing or swallowing difficulties they may have.

Medical and Welfare Consultation Unit

Diseases cause not only mental and physical disabilities but also affect their life style, social role and interpersonal relationships. In particular, most of the patients who are treated in our hospital have chronic psychiatric, neurological and muscular disorders with occasional severe emotional crises requiring support for the patient's family as they deal with their activities of daily living. Medical specialists in this section help to solve and reduce the various stresses and problems our patients and their family face.

Department of Neurosurgery

In this department, our activities are devoted to Functional neurosurgery. Abobe all, surgical treatment of intractable epilepsy and movement disorders is our main clinical target.
Epilepsy surgery;
Resection, disconnection and neuromodulation procedures are performed based on the state of the art neuroimaging technique and advanced neurophysiological analysis. Against the harmful effect of seizures on the developing brain, early surgery with special expertise in children including catastrophic epilepsy of infants is a unique characteristic in our department. Comprehensive management and care of patients and their caregivers can be available in our Epilepsy center.
Deep brain stimulation;
Highly precise and accurate, minimum invasive implantation of stimulation electrodes in the deep brain structures is performed by image-guided stereotactic surgery and intraoperative neurophysiological exploration for movement disorders such as Parkinson' s disease, dystonia, essential tremor, and Tourette's syndrome. All operations are carried out comfortably with the painless manner by special anesthetic technique.

Epilepsy Center

National Center of Neurology and Psychiatry has one of the largest comprehensive epilepsy program in Japan. Diagnostic facilities such as video-EEG monitoring, 3T-MRI, PET, SPECT and MEG are utilized for evaluation and surgical procedures including intracranial EEG monitoring, temporal and extra-temporal resection, multilobar disconnection, hemispherotomy, callosotomy, VNS and stereotactic thermocoagulation are performed both for children and adults.

The Sleep Disorders Center was established in 2012. The Center seeks to fulfill its goal of improving the health by serving three key functions: clinical care, education, and research. Sleep disorders span many medical fields, requiring multidisciplinary approaches not only to treatment, but also to basic research. The center works with psychiatrists, neurologists, pulmonologists, dentists, psychologists, neuroscientists, cellular and molecular biologists. The Center strives to provide outstanding clinical care for all patients with a wide variety of sleep disorders, as well as education for patients and their families, other physicians and physicians-in-training. The physicians are also involved in numerous research studies to improve our understanding of the mechanisms, diagnosis and treatments for sleep disorders.

We will:
1. Provide comprehensive and advanced medical care for the full range of muscular diseases.
2. Be engaged in promoting clinical research/studies to overcome muscular diseases.
3. Contribute to progress in medical treatment for muscular diseases by collaborating with institutions both within and outside of Japan.

We are working as a multidisciplinary team providing medical care and conducting research to offer comprehensive care for muscular diseases. The National Center of Neurology and Psychiatry has been involved in medical care and research for muscular diseases over several decades. It has also been a leading member of the Muscular Dystrophy Research Group which has a history of more than 40 years. Based on these experiences and collaboration among departments, the Muscular Disease Center aims to contribute to progress in medical treatment for muscular diseases.

Diagnosis and Treatment

We establish a diagnosis for patients with possible muscular disease and/or treat patients with documented muscular disease, with application of the latest findings.

1．Diagnosis: Diagnostic procedures such as electrophysiological testing, imaging, muscle pathology and genetic testing are used to make a correct diagnosis and provide informative data for subsequent treatment. Especially, muscle pathology meets the highest world standards both qualitatively and quantitatively, with more than 12,000 cases being diagnosed since 1978. Furthermore, detailed analyses employing more than 20 types of immunohistochemical staining are performed in all patients (Department of Neuromuscular Research). In addition, we serve as an important base for genetic diagnosis, particularly of facioscapulohumeral muscular dystrophy (FSHD), because our center is the only institution at which genetic diagnosis of FSHD is available in Japan and there are very few of these institutions worldwide (Section of Molecular Diagnosis and Department of Laboratory Medicine).

2．Genetic counseling: Clinical specialists in this field and certified genetic counselors provide genetic counseling. When a genetic diagnosis is made, an attending physician and the Genetic Counseling Unit　work together closely to assure that due consideration is also given to patient's psychological state. The Department of Outpatient Genetic Counseling Clinic is also available for consultation regarding carrier detection and prenatal diagnosis.

3．Treatment: We administer medications (e.g., steroids), ventilation therapy, treatment for cardiomyopathy and other therapies. As a leading member of the Muscular Dystrophy Research Group, we are committed to improving and standardizing treatment modalities.

4．We have specialized outpatient clinics (Department of Child Neurology, Department of Neurology, Department of Orthopedics, Department of Rehabilitation Medicine). We are among the hospitals most frequently treating muscular diseases in Japan; patients have been referred to us from around the country.

5．We have organized a public symposium for muscular dystrophy ever year, which has been attended by more than 150 participants annually in recent years. As of July 2013, a total of 10 symposiums had been held. Details of the next symposium are available on our website (http://www.ncnp.go.jp/). We endeavor to provide information about treatments for muscular diseases through lectures within and outside of Japan, publications, our website, and so on.

6．How to visit the Outpatient Clinic: Advance reservation only. If you would like to have an outpatient consultation, please first make an appointment for a new patient at the Department of Child Neurology or the Department of Neurology by calling the Outpatient Reservation Service (TEL: 042-346-2190, Reception hours: 9:00-15:00 on weekdays). At this time, you need to inform the operator, for example, that the patient being brought in is suspected to have a muscular disease or has already been diagnosed with a muscular disease. Hospitalization without an outpatient consultation may be arranged depending on the situation, if you live far from our center and require inpatient examination and/or treatment. Such requests should be directed to us by the patient's attending physician.

Rehabilitation and Care

Definitive treatments are not available for most muscular diseases. However, continuation of periodic examinations/assessments and appropriate care have improved the life circumstances and outcomes of patients. We provide multidisciplinary care with the aim of achieving an improved quality of life, etc.

1．With an eye to the future, we offer rehabilitation appropriate for the stage of disease. Patients with insufficient expectoration of sputum and other respiratory disorder symptoms may receive pulmonary rehabilitation and home mechanical ventilation. We conduct a consultation aimed at devising a support system for achieving better home care. We currently support operation of the Family Association for Muscular Dystrophy, consisting mainly of families of patients seen in our center.

2．Medical care at each department
A)Dental care is provided for misalignment of teeth, poor oral hygiene, etc.
B)Nutritional consultation is conducted by registered dieticians. along with objective evaluation.
C)The Dysphagia Research Clinic provides assessment and treatment to patients with muscular disease who have difficulty in eating and drinking. The clinic is run by the medical team consisting of a neurologist, dentists, nurses and speech and language therapists, all experts in dysphasia.
D)Gastrostomy is available with management of the gastrostomy site for patients, as an example, who find it difficult to maintain their physical conditions with oral feeding alone.
E)The Department of Orthopedics, which has a good understanding of muscular diseases, is involved in medical care.
F)There are certain key points to consider when anesthetizing patients with muscular diseases. The Department of Anesthesiology uses special care and an appropriate anesthetic in such patients.

Promotion of Advanced Medical Treatment

Definitive treatments are not available for most muscular diseases. Since all muscular diseases are rare (i.e., the number of affected patients is limited), many challenges are faced in the collection of patient information and in conducting clinical studies. To move beyond the status quo, it is essential to develop a system which allows the application of research findings to clinical practice as quickly as possible, establishment of an international network, and active involvement in the network. We are committed to developing advanced diagnostics and treatments for muscular diseases in cooperation with other countries throughout the world.

1．We have conducted clinical studies for muscular dystrophy; as of the end of August, 2013, 4 studies are ongoing.
2．We make a unique diagnosis which would not be practical at other institutions by applying new findings, obtained in various Institutes, to carry out diagnostic procedures as quickly as possible.
3．Institutes and Hospitals work together closely to establish a system for developing advanced medical treatments, including clinical studies on muscular diseases.
A)Prior to conducting clinical studies, we created a patient registry system for muscular dystrophy as a member of the Muscular Dystrophy Study Group. The Registry of Muscular Dystrophy is responsible for the management and operation of this system (Remudy: http://www.remudy.jp/).
B)The Muscular Dystrophy Clinical Trial Network has been established, with the aim of promoting clinical studies on muscular dystrophy in Japan. The administrative office is based at our center (http://www.mdctn.jp/).
C)We are working as a full member of the Cooperative International Neuromuscular Research Group (CINRG: http://www.cinrgresearch.org/), a clinical research group for muscular dystrophy led by the Children's National Medical Center in the United States. In addition, we collaborate with Translational Research in Europe-Assessment and Treatment of Neuromuscular Diseases (TREAT-NMD: http://www.treat-nmd.eu/), a clinical research group for neuromuscular diseases in Europe, in organizing a patient registry and conducting global studies.
D)As a leading member of the Asian and Oceanian Myology Center as well as the World Muscle Society, we are actively exchanging information about advanced medical treatments.
E)In addition to facilitate exchange of views between Institutes and Hospitals, we are actively communicating with external parties including regulatory authorities (i.e., organizations responsible for the authorization of medications such as the Ministry of Health, Labour and Welfare and the Pharmaceuticals and Medical Devices Agency) and pharmaceutical companies.

Relevant Departments and Core Members of the Muscular Disease Center

Director of Center: Hirofumi Komaki
Department of Child Neurology: Akihiko Ishiyama, Hirofumi Komaki, Masayuki Sasaki
Department of Neurology: Yasushi Oya, Madoka Mori, Miho Murata
Department of Rehabilitation Medicine: Yoko Kobayashi, Yasuyuki Iwata
Department of Surgery: Takeshi Miyama
Department of Dentistry: Yutaka Fukumoto
Department of Anesthesiology: Tetsuji Nakai
The Dysphasia Research Clinic: Toshiyuki Yamamoto
Department of Clinical Research Unit: Akemi Tamaura
Section of Molecular Diagnosis and Department of Laboratory Medicine, Genetic Counseling Unit: Yukiko Sato, Eri Takeshita, Yu-ichi Goto
Translational Medical Center: Reiko Shimizu, En Kimura, Shin'ichi Takeda
Department of Neuromuscular Research, National Institute of Neuroscience: Ichizo Nishino

Many other staff members are also involved in medical care/research for muscular diseases.

Contact person for inquiries about the Muscular Disease Center: Hirofumi Komaki

E-mail medical consultation for patients is not available.

Links, Websites that are helpful for obtaining information about muscular diseases

Translational Research in Europe - Assessment and Treatment of Neuromuscular Diseases (TREAT-NMD)
http://www.treat-nmd.eu/
The organization's aim is to facilitate medical care, patient registry, and research for neuromuscular diseases mainly in Europe.

Cooperative International Neuromuscular Research Group (CINRG)
http://www.cinrgresearch.org/
This research group for muscular diseases is led by the Children's National Medical Center in the United States. The National Center of Neurology and Psychiatry is a full member of the group.

Parkison's Disease might be the most popular disease in the neurodegenerative disorders from the view point of the numbers of patiens or possible remedies and their researches. Accurate diagnosis and proper treatments are well requested to each patient. On this account we investigate clinical or basical researches together with reserach divisions, It is also important to announce our outcome both for the patiens to associate with the disease and for the medical specialis to supply services of high quality. Accordingly, some symposiums, lectures or training course are held. Rehabilittion course or periodical and digignated examination course are developed, which are well received by the patients.In addition to Parkison's Disease, our target includes such diseases presenting Parkisonism or Spinocereller degenetraion, movement disorders as Dystonia or Chorea.

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Early Detection and Intervention Center for Schizophrenia will be established during 2013. Our aim is to promote early detection of patients with schizophrenia, to offer appropriate clinical care for those in the early phase of illness, which is called the "critical period," and to assist clinical and basic research to improve our understanding of diagnosis and intervention. We provide appropriate care based on detailed examinations, implementing "shared decision making" and multidisciplinary approaches at our specialty outpatient clinic. The center also manages a registration system for patients in the critical period, which supports good relationship between the registered patients and the center staff, even if patients receive regular outpatient treatment at different hospitals. Our center supports various bidirectional relations, such as patients - center staff, local psychiatric service - center staff, and researchers - center staff, to improve better outcome of patients with schizophrenia.

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