Neurology in Japan

Neurology is a branch of medicine that focuses on the diagnosis and the treatment of diseases of the nervous system. The nervous system is a complex and sophisticated system that regulates and coordinates our body activities. It is divided into two major parts:

• The central nervous system: the brain and spinal cord
• The peripheral nervous system: all nerves branching out from the brain and spinal cord, and extend to other parts of the body, including organs and muscles.

Since the nervous system is complex, there are numerous subspecialties within the field of neurology, including:

• Neurodevelopmental disabilities
• Pediatric or child neurology
• Neuromuscular medicine
• Pain medicine
• Hospice and palliative care neurology
• Headache medicine
• Vascular Neurology (stroke care)
• Sleep medicine
• Autonomic disorders
• Brain injury medicine
• Neuropsychiatry
• Epilepsy
• Neurointensive care

A doctor who specializes in treating diseases of the nervous system is called a neurologist. Symptoms that often require a neurologist help may include coordination problems, muscle weakness, confusion, dizziness, and a change in sensation. People who are having problems with their senses, such as vision, touch, or smell, may also require to see a neurologist since problems with senses are sometimes caused by disorders of the nervous system.

A neurologist may also treat patients with:

• Stroke
• Seizure disorders, such as epilepsy
• Migraines and headaches
• Brain aneurysms
• Brain tumors
• Peripheral neuropathy
• Multiple sclerosis
• Infections of the nervous systems, such as meningitis, encephalitis, or brain abscesses
• Neuromuscular disorders, such as myasthenia gravis
• Neurodegenerative disorders, such as Alzheimer’s disease and Lou Gehrig’s disease
• Sleep disorders
• Spinal cord disorders, such as autoimmune and inflammatory disorders
• Speech and language disorders

Keep in mind that neurologist does not perform surgery. If you need surgery, you will be referred to a neurosurgeon.

What does Neurology Involve?

A wide variety of different tests and procedures are used to diagnose and treat neurological conditions. On your first appointment with a neurologist, a physical and neurological exam is likely to be performed. A neurological exam is done to test muscle strength, coordination, and reflexes.

Because different diseases can have similar symptoms, more than one testing may be required for your neurologist to make a diagnosis.

Some of the procedures that fall into the field of neurology may include:

Electromyography

Electromyography (EMG) is used to measure how well your muscles react to electrical stimulation from motor neurons, which are specific nerves controlling muscle movement. It can help neurologists diagnose general muscle or nerve dysfunction, as well as spinal cord disease.

During an EMG, small needles called electrodes are inserted into the muscle by a specially trained technician. The electrodes can measure the different electrical activity occurring in muscle tissue during periods of movement and rest.

Electroencephalogram

Electroencephalogram (EEG) is performed to assess and record electrical activity in your brain. Neurons in our brain communicate with other neurons through electrical impulses, which an EEG can record. Brain wave patterns can also be tracked by an EEG. It is used to help diagnose conditions of the brain, including tumors, inflammation, injuries, as well as psychiatric disorders, epilepsy, and seizures.

During an EEG, electrodes are placed on your head. The electrodes are connected to a computer, which converts electrical signals into patterns that can be seen from a screen or printed on a piece of paper.

Lumbar puncture

Lumbar puncture is done to test your spinal fluid. It involves inserting a needle into your spine after numbing it with an anesthetic. Using the needle, a sample of your spinal fluid is taken.

A lumbar puncture can help diagnose the following conditions:

• Meningitis
• Encephalitis
• Leukemia
• Myelitis
• Dementia
• Autoimmune diseases, such as multiple sclerosis (MS)
• Bleeding in the brain

The procedure can also be used to treat conditions affecting the spinal cord. Your neurologist may inject anesthetics, cancer treatments, or antibiotics using a lumbar puncture needle.

Tensilon test

To help diagnose myasthenia gravis, your neurologist may perform a tensilon test. It involves the injection of a medicine called Tensilon. Then, your neurologist observes how medicine affects your muscle movements.

Sleep study

Chronic sleep problems are diagnosed in a Sleep Study. Also known as a Polysomnogram (PSG), this procedure involves monitoring patients during sleep and physiological data is recorded electronically.

Other tests

Other types of tests may be used by your neurologist to make a diagnosis. These may include:

• Magnetic resonance imaging (MRI scan)
• Computed tomography (CT scan)
• Positron emission tomography (PET scan)
• Biopsy
• Genetic testing
• Angiography

Botox injections

Botox injections can be done to treat some neurological conditions, such as cerebral palsy, that can cause your limbs to pull in toward your center. Sometimes, these contracted muscles can be relaxed with Botox injections.

Botox injections involve injecting tiny amounts of botulinum toxin into your skin of muscles using a thin needle.

Brain tumor treatment

A range of treatments can be done to treat a brain tumor. If your neurologist believes that you need surgery, you will be referred to a neurosurgeon who will remove as much of the brain tumor as possible through surgery.

A brain tumor may also be treated with radiation therapy, which uses high-energy beams to kill tumor cells.

Brain tumor treatment may be integrated between the departments of neurology and oncology.

Brain rehabilitation therapy

Brain rehabilitation therapy is used to help you relearn functions that are lost as a result of a brain injury. Brain rehabilitation therapy is usually integrated between specialty teams in the departments of neurology, sports medicine, psychiatry and psychology, neuroradiology, and the vestibular/balance laboratory.

Deep brain stimulation

During deep brain stimulation, electrodes are implanted within certain areas of the brain. The electrodes generate electrical impulses that can regulate abnormal impulses. These electrical impulses may also affect certain chemicals and cells within the brain.

Deep brain stimulation can be done to treat numerous conditions, including dystonia, essential tremor, epilepsy, and Parkinson’s disease. It is also being studied as a potential treatment for multiple sclerosis and stroke recovery.

Spinal stenosis treatment

Spinal stenosis is a condition that occurs when the spinal canal narrows and pinches the nerves, leading to back and leg pain. Spinal stenosis may be treated with pain medications, physical therapy, steroid injections, decompression procedure, or surgery. Surgery is usually performed if other treatments have not helped.

How Long Should I Stay in Japan?

Your length of stay depends on the type of procedure you have, you may be allowed to leave the hospital on the same day or you will stay for several days. For diagnostic procedures, you should be allowed to leave the hospital on the same day. However, you should wait until the results of the test are ready before you can fly home, which may take as long as 7 days, sometimes even longer. If you undergo brain tumor treatments or other types of treatment, especially treatments that involve surgical intervention, you should aim to stay in Japan at least for 10 days.

What's the Recovery Time?

The recovery time can be different for each procedure. It may also depend on the reason why you are having the procedure and your overall health. Your neurologist and neurosurgeon will give you a recovery timeline for each procedure. The recovery period for diagnostic procedures is typically short and you may be able to resume your normal activities within a week or so. For surgical procedures, you may need to wait 4 weeks or months until you can go back to your daily routine, including work and exercise.

What About Aftercare?

A detailed aftercare instruction will be given to you following your procedure. While the instructions will be different for each procedure, they typically include a diet plan, exercise, restrictions, and wound care (if any surgical intervention is involved). You should follow these instructions carefully in order to have a speedy and smooth recovery.

You may also need to attend follow-up checkups to monitor your overall condition and healing. For brain tumors, you may need to attend regular checkups to ensure the tumor has not come back.

What's the Success Rate?

The field of neurology is constantly advancing. The success rate of each procedure is typically high, particularly when performed by highly skilled and experienced medical professionals. Still, some procedures may carry some risks, such as bleeding, infection, and nerve injury.

Are there Alternatives to Neurology?

Since neurology is the branch of medicine to diagnose and treat problems of the nervous system, there are no other alternatives. However, if your doctor found that your disease or illness is found to be caused by other problems unrelated to the nervous system, your doctor will recommend you to see the relevant doctor.

Neurology in and around Japan

About Japan

Japan is special in its own way; the culture, food, people, as well as technology are envied by the world over. With old Japan, comes the ancient tradition in the form of a geisha performance, onsen (hot spring) visit in the mountains, tea ceremony, or shrine visit. In contrast, there is modern Japan, full of smart systems and electronics, colorful advertisements and displays, and ultra-modern architecture. In recent years, Japan has become one of the top destinations in the world for oncology treatments and sees many tens of thousands of medical tourists each year. Many of these travel from within the region, including China and Korea, but they are unable to compete with the SE Asian nations with prices. Private hospitals are located across the country, with a particular focus in major cities like Tokyo, Kyoto, and Osaka. 25 of these facilities are JCI-accredited, with many offering Neurology procedures.

Popular Parts of Japan

Located in the Pacific Ocean, Japan is a stratovolcano archipelago. The four largest islands are Honshu, Hokkaido, Kyushu, and Shikoku. With a population of 127 million, 98% are ethnic Japanese. The country perfectly balances traditional with modern technology. Tourists will first see its exceptionally modern face, but after traveling around, they will find many opportunities to connect with the beautiful traditional culture.

• Tokyo is Japan’s capital, one of the 47 prefectures of Japan. It’s a huge metropolis that offers traditional arts and culture, futuristic infrastructures, and good restaurants. The cherry blossoms that bloom in Spring is one of the most popular sights. The soft pink petals are an icon of the country. There is an unlimited choice of shopping, many museums that cover every era of Japanese art history, and even a robot restaurant.
• Kyoto is made of religious architecture, with around 2000 temples and shrines. It moves at a slower pace than any other city in Japan. Filled with samurais, geishas, Zen gardens, and the torii gate, Kyoto is the spiritual center of Japan. The city is also known for its food, head to the Nishiki Market, a four-hundred-year-old local food market that offers a range of national cuisine to modern food from all over the world.
• Osaka, the second largest metropolitan area after Tokyo is known to be the most delicious city. The city is nicknamed “the nation’s kitchen.” Visit Dotonburi to experience the food culture of Osaka. Besides the food, there are numerous attractions that tourists should visit such as Universal Studios Japan, Cup Noodles Museum, Aquarium Kaiyukan, Osaka Castle, and Umeda Sky Building.
• Fukuoka has a welcoming feel with sunny weather and so much to do. It’s made up of two towns, the port city of Hakata and the former castle town of Fukuoka. Visit the impressive Fukuoka Castle, explore the Sumiyoshi-Jinja Shrine, learn history in Kyūshū National Museum, experience the ancient art of calligraphy and origami in Hakata Machiya Folk Museum, and enjoy a calming bath in one of the Onsen hot springs.
• Nagoya is the industrial center of Japan. It’s the birthplace of Toyota and a popular pinball-style game Pachinko. Although many of the historic buildings were destroyed in the air raids of 1945, tourists can still indulge in its culture and tradition. Visit the Nagoya Castle that was reconstructed in 1959, walk around the Atsuta Shrine, or see the history of the automobile in the Toyota Automobile Museum.

Weather and Climate in Japan

Japan has four distinct seasons.

1. Summer starts in June and lasts until August. The temperature can get very hot, up to 40 °C in some places, with high humidity. June is the rainy season where the farmers plant their rice. The rainy season is over in August but the typhoon season starts to peak.
2. Autumn starts in September and ends in November. September has the greatest risk of typhoons. The weather is generally mild. October is pleasantly warm with less humidity than in summer, making it a food time for traveling the country.
3. The temperature will drop in Winter. It lasts from December to February and is usually dry, pleasant, and sunny. The average temperature is around 2°C to 12°C, it rarely drops below 0°C. The northern island of Hokkaido, the Japan Alps, and the Japan Sea coast get a lot of snow while Tokyo gets very little snow.
4. Spring is said to be the best time to visit Japan because of its mild weather and cherry blossoms. The season starts in March and ends in May. The temperature will gradually increase during spring with little rainfall and clear sky.

Getting Around in Japan

The main airport for international tourists is the Narita International Airport. It is located around 60km east of central Tokyo. It serves both domestic and international flights to almost every major city around the globe. There are several budget airlines that operate flights from this airport, namely Jetstar Japan, Eastar Jet, and Peach. There are other international airports such as Kansai International Airport, New Chitose International Airport, and Kyushu Saga International Airport.

To get to Tokyo from Narita Airport, tourists can use the rail, bus, taxi, or car rental. The most affordable train line is the Keisei Line that connects with the Toei Asakusa Subway Line and the Yamanote Line, it costs around ¥1,190 to ¥1,230 ($10 to $11.3). There’s also the Sky Access Express train that offers better access to Tokyo, a trip to Asakusa will cost around ¥1,290 ($11.9) and take about 58 minutes. The quickest way to get to Tokyo will be by the Skyliner train, it takes just 36 minutes to Nippori and will cost around ¥2,470 ($22.7). The airport introduced N’EX Tokyo Round-Trip ticket for foreign passport holders that provides round-trip travel from Narita to Tokyo and back for ¥4,000 ($37) for adults and ¥2,000 ($18.4) for children.

A regular taxi from Narita to Tokyo is very expensive, usually over ¥20,000 ($184). The best option is the shared minibus that starts with ¥6,180 ($57) per person. Buses are usually more affordable, the Limousine Bus costs ¥2,880 ($26.5) and the Tokyo Shuttle costs around ¥900 ($8) to ¥1,000 ($9).

Getting around Japan is fairly easy because the country has excellent public transportation. It is recommended to get a Japan Rail Pass. Japan’s bullet train is fast but expensive. There are cheaper train options. Buses are less expensive but will take more time than trains.

Tourist Visas in Japan

Citizens of 68 countries and territories can enter and stay in Japan for up to 90 days without a visa. Citizens of Indonesia, Brunei, and Thailand are granted a 15-day visa-free trip to Japan. Citizens of the United Arab Emirates are allowed to stay for 30 days without a visa. It is advisable to contact the nearest Consular Section of the Embassy or Consulate General of Japan for more information.

Additional Information

1. Local Currency: Yen (¥) is the local currency. $1 will get you ¥11 ¥1,000 is worth approximately $9.
2. Money & Payments: ATMs are usually located in post offices and convenient stores. There are only a few branches of major Japanese banks that accept foreign-issued cards. Credit cards are accepted in major cities, but the rural area doesn’t. It’s best to always bring cash and bring a coin purse because everything below ¥500 is coins. Tipping is not mandatory, high-end hotels and restaurants usually add a 10% service fee to the bill.
3. Local Language: The official language is Japanese. English is common in major cities with many tourists such as Tokyo, Osaka, and Tokyo. Some restaurants write their menu in English and Japanese.
4. Local Culture and Religion: The dominant religion in Japan is Shinto and Buddhism. There’s a small group of Christians as well.
5. Public Holidays: Japan has sixteen national holidays each year, including Children’s Day, Constitution Memorial Day, and Marine Day. The country hosts numerous annual festivals such as Gion Matsuri in Kyoto, Awa Odori in Tokushima, and Yuki Matsuri Snow Festival in Sapporo.