Background and PurposeThis study aimed to determine the subjective and objective improvements in sleep quality after treatment with gamma-aminobutyric acid (GABA; 300 mg daily) extracted from unpolished rice germ.MethodsThis study was a prospective, randomized, double-blind, and placebo-controlled trial. In total, 40 patients who complained of insomnia symptoms were enrolled and randomly assigned to the GABA treatment group (n=30) or the placebo group (n=10). Polysomnography was performed, and sleep questionnaires were administered before treatment and after 4 weeks of treatment.ResultsAfter 4 weeks of treatment the sleep latency had decreased [13.4±15.7 min at pretreatment vs. 5.7±6.2 min at posttreatment (mean±SD), p=0.001] and the sleep efficacy had increased (79.4±12.9% vs. 86.1±10.5%, p=0.018) only in the GABA treatment group. Adverse events occurred in four subjects (10%).ConclusionsThis study shows that treatment with unpolished-rice-germ-derived GABA improved not only the subjective sleep quality but also the objective sleep efficacy without severe adverse events.

BackgroundCervical artery dissection is one of the most important causes of ischemic stroke in young age patients. However, multiple cervical artery dissection simultaneously involving the anterior and posterior circulation is uncommon. Here, we would like to report a case of a patient with bilateral vertebral artery (VA) and internal carotid artery dissection (ICA) after a use of systemic steroid due to peripheral facial palsy.Case presentationA 44-year-old man with hypertension visited emergency department due to recurrent vertigo. He was receiving methyl prednisolone for two weeks for the treatment of right peripheral type facial palsy which occurred after retro-orbital headache. Neurologic examination revealed severe ataxia at left side. Sensory for pain and temperature was declined in the right arm and leg. Diffusion-weighted image showed an acute ischemic lesion at the whole territory of posterior-inferior cerebellar artery. Severe stenosis was observed from bilateral VAs and ICAs on conventional magnetic resonance angiography. Intramural hematoma and intimal flap was observed from the high-resolution MRI.ConclusionsPeripheral type facial palsy is an unusual presentation of carotid dissection. Steroids aggravate arterial dissection by increasing blood pressure and blood vessel fragility by its negative effect on connective tissue strength. Use of steroid in patients with peripheral type facial palsy with severe headache may need caution.

Gamma-aminobutyric acid (GABA) has potential benefits in counteracting the sleep disruption and potential therapeutic effects on blood pressure, stress, cancer, and inflammatory diseases. Recently, High-dose GABA can be extracted from fermented rice germ using lactic acid bacteria. This study aimed to evaluate the effects of GABA natural extracts from fermented rice-germ on sleep latency, subjective sleep quality and insomnia symptoms. Methods: This was a prospective randomized double-blind placebo-controlled trial performed at Kyung-Hee University hospital at Gangdong from June 2013 to October 2013. Adult (age≥30) patients who was diagnosed of insomnia according to DSM-IV criteria was enrolled. They were randomized into three groups: high dose treatment group 300 mg; low-dose treatment group, 100 mg; and placebo group. Questionnaires including Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), WHO-5 Well-Being Index were performed, and 1-week actigraphy was recorded before and 1 week after the treatment. Results: Total of 114 patients were randomized into 3 groups: high-dose treatment (n=37), low-dose treatment (n=38), and placebo treatment group (n=39). At 1 week after the treatment, PSQI total score and C2 (sleep latency) score significantly decreased in low-dose and high-dose treatment group than the placebo groups [Repeated measures analysis of variance (ANOVA), p=0.017, 0.004 respectively]. ISI score also decreased in the two groups in dose-dependent manner (Repeated measures ANOVA, p=0.037). There were five (4.4%) patients who reported medication adverse events. Conclusions: This study suggests that treatment of low and high-dose GABA from unpolished rice-germ decreases sleep latency and improve insomnia severity without severe adverse events.

Creutzfeldt-Jakob disease (CJD) is the most common prion disease in humans. Once formed by unknown cause, PrP sc can make the normal cellular PrP (PrP c) transform into the pathogenic PrP sc in a cascade. Consequent extensive neuronal loss causes dementia, involuntary movement, psychosis, and incoordination. The criteria for clinical diagnosis include cerebrospinal fluid (CSF) biomarkers (e.g., 14-3-3 protein and t-tau), specific magnetic resonance image (MRI) finding, electroencephalography (EEG), and clinical symptoms. 1 Recently, in vitro protein misfolding amplification system, the real-time quakinginduced conversion assay (RT-QuIC), for the detection of PrP sc in CSF was developed and showed ultra-high sensitivity and specificity, amending the diagnostic criteria. 2 Here, we report the case of a patient without obvious clinical symptoms of sporadic Creutzfeldt-Jakob disease (sCJD) except rapidly progressive cognitive decline and a positive RT-QuIC assay who was not CJD. An age 54 Korean female visited the clinic with progressive cognitive decline for 2 months. Her daughter noticed this when the patient, who is a storekeeper, had problems with calculations at the register. She also misplaced things and spent time searching for them. Also, she had difficulty verbally expressing herself and sometimes could not understand what others were saying. She graduated from high school in 12 years. Her medical history was unremarkable. A month ago, she was admitted to a university hospital for evaluation. On neuropsychological evaluation, visual and verbal memory, frontal/executive function and calculation impairment were noted. Her Mini-Mental State Examination was 23, Clinical Dementia Rating scale 1 (sum of box 4). Brain MRI did not show any lesion even on diffusionweighted images (DWIs) (Fig. 1A). EEG showed mild cerebral dysfunction but no periodic sharp wave complexes. CSF analysis showed five white blood cells with normal chemistry. Autoimmune antibodies and tumor markers were negative. CSF 14-3-3 protein was weakly positive; and total tau (t-tau) level was elevated to 1,206 pg/mL. Additionally, RT-QuIC assay tested positive. Flutemetamol (18F) positron emission tomography showed elevated cortical amyloid uptake (Fig. 1B). She was discharged with a diagnosis of sCJD with superimposed Alzheimer's disease. Donepezil 5 mg was started. However, a month after discharge, she was stable without signs of aggravation. For a second opinion, she visited Asan Medical Center. EEG, and brain MRI DWI did not show abnormal findings. In CSF analysis, 14-3-3 protein was weakly positive, t-tau level increased to 1,336 pg/mL, p-tau to 144.7 pg/mL, and amyloid