UMIN Clinical Trials Registry: UMIN000011495.

Background and purpose The effect of a sociability‐based fitness approach on parkinsonian disability in patients with Parkinson's disease (PD) was assessed. Methods Eighty patients diagnosed with PD were randomly assigned to either the group‐based rehabilitation (GBR) group (n = 40) or the individual‐based rehabilitation (IBR) group (n = 40). The primary outcome was the difference between the two groups in the mean change from baseline to post‐training in the total score on the Unified Parkinson's Disease Rating Scale (UPDRS). The secondary outcomes included the change in mental status and the difference in the mean change from baseline to month 3 and month 6 in the total score on the UPDRS. Results The mean (±SD) UPDRS scores were 72.0 ± 21.0 in the GBR group and 72.1 ± 18.6 in the IBR group. The UPDRS scores from baseline to post‐training were 22.8 ± 13.5 in the GBR group and 10.9 ± 8.8 in the IBR group (difference 11.8 points; 95% confidence interval [CI] 5.0–18.6; p = 0.001). The difference between the groups from baseline to month 3 (difference 10.06 points; 95% CI 3.3–16.8) and the difference between the groups from baseline to month 6 (difference 11.7 points; 95% CI 4.9–18.5) were also significant (p = 0.004 and p = 0.001, respectively). The scores of cognitive function and depression had not changed significantly. Conclusions Patients receiving GBR demonstrated significant improvements in parkinsonian symptoms, suggesting that the sociability‐based fitness can be applied to clinical treatment by sustaining the motivation in PD.

An 80-year-old woman with a 7-year history of progressive supranuclear palsy had periodic dyspnea attacks that lasted for several hours. During these attacks, she involuntarily groaned because she could barely exhale but could inhale (video 1 on the Neurology ® Web site at Neurology.org). When she was instructed to pronounce words, she could do this voluntarily and phonation enabled her to exhale. Laryngoscopy revealed that her vocal cords opened during inspiration but closed during expiration (video 2). This was a case of laryngeal dystonia 1,2 and may be a rare example of respiratory disorders resulting from adductor laryngeal exhaling dystonia (appendix e-1).

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A successful delivery in a 26-year-old Japanese womanwith essential athrombia was reported. A diagnosis of essential athrombia was made by clinical and laboratory features including bleeding tendency, prolonged bleeding time, normal platelet count, normal clot retraction and impaired platelet aggregation induced by ADP.Since the presentation was a frank breech at the end of the 39th week of pregnancy, cesarean section delivery was performed under good hemostatic control with transfusion of 7.3 X 1011 platelets. No hemorrhagic complication was observed during the puerperium.