Association of auditory Charles Bonnet syndrome with increased blood flow in the nondominant Brodmann area 22

Abstract Aim Auditory Charles Bonnet syndrome (aCBS) is characterized by musical hallucinations (MHs) that accompany acquired hearing impairments. This hallucination is the acoustic perception of music, sounds, or songs in the absence of an outside stimulus, and it may be associated with hyperactivity of the superior temporal lobes. Some studies have reported the possibility of improving MH with antiepileptics. To elucidate in detail the brain regions responsible for aCBS, we analyzed the regions that changed functionally after treatment. Methods Before and after treatment with carbamazepine (four cases), clonazepam (one case), and a hearing aid (one case), cerebral perfusion single‐photon emission computed tomography (SPECT) and the Auditory Hallucination Rating Scale (AHRS) were applied to six patients with hearing‐loss–associated MHs. Results Cerebral blood flow analysis using SPECT revealed hyperperfusion in Brodmann area (BA) 22—the posterior region of the superior temporal gyrus—in the nondominant hemisphere in all six patients in the pretreatment phase. After treatment, the hyperperfusion region improved in all patients. The area percentages with hyperperfusion in the nondominant BA22 were strongly positively correlated with the AHRS score. Conclusion The results suggest that aCBS, which was treatable with antiepileptics or hearing aids, was involved in hyperexcitement in BA22, and that MH strength was correlated with degree of excitement

Bias in spontaneous reporting of adverse drug reactions in Japan.

Attitudes of healthcare professionals regarding spontaneous reporting of adverse drug reactions (ADRs) in Japan are not well known, and Japan's unique system of surveillance, called early post-marketing phase vigilance (EPPV), may affect these reporting attitudes. Our objectives were to describe potential effects of EPPV and to test whether ADR seriousness, prominence, and frequency are related to changes in reporting over time.A manufacturer's database of spontaneous ADR reports was used to extract data from individual case safety reports for 5 drugs subject to EPPV. The trend of reporting and the time lag between ADR onset and reporting to the manufacturer were examined. The following indices for ADRs occurring with each drug were calculated and analyzed to assess reporting trends: Serious:Non-serious ratio, High prominence:Low prominence ratio, and High frequency:Low frequency ratio.For all 5 drugs, the time lag between ADR onset and reporting to the manufacturer was shorter in the EPPV period than in the post-EPPV period. All drugs showed higher Serious:Non-serious ratios in the post-EPPV period. No specific patterns were observed for the High prominence:Low prominence ratio. The High frequency:Low frequency ratio for peginterferon alpha-2a and sevelamer hydrochloride decreased steadily throughout the study period.Healthcare professionals may be more likely to report serious ADRs than to report non-serious ADRs, but the effect of event prominence on reporting trends is still unclear. Factors associated with ADR reporting attitude in Japan might be different from those in other countries because of EPPV and the involvement of medical representatives in the spontaneous reporting process. Pharmacovigilance specialists should therefore be cautious when comparing data between different time periods or different countries. Further studies are needed to elucidate the underlying mechanism of spontaneous ADR reporting in Japan

The 5 Drugs Studied.

<p>*ADR: adverse drug reaction, EPPV: early post-marketing phase vigilance.</p><p>The 5 Drugs Studied.</p

High prominence:Low prominence ratios over time.

<p>(A) capecitabine, (B) eldecalcitol, (C) epoetin beta pegol, (D) peginterferon alfa-2a, and (E) sevelamer hydrochloride.</p

Adverse drug reaction reporting trend for 5 drugs.

<p>Total number of individual case safety reports for (A) capecitabine, (B) eldecalcitol, (C) epoetin beta pegol, (D) peginterferon alfa-2a, and (E) sevelamer hydrochloride.</p

High frequency:Low frequency ratios over time.

<p>(A) capecitabine, (B) eldecalcitol, (C) epoetin beta pegol, (D) peginterferon alfa-2a, and (E) sevelamer hydrochloride.</p