Answer to FAQ
For Children
Q1 Is there limitation in exercise of gymnastics in school?
A1 In the paediatric period, children develop usually ischemic symptoms. Thus, bypass surgery is generally recommended bilaterally. After the surgical anaestomoses, it is usually no limitation in exercise in school when the clinical symptoms become stable. However, football, judo, and boxing are not recommended because head trauma is a high possibility and hyperventilation is not good for brain circulation in moyamoya disease.
Q2 Is there limitation in music exercise in school?
A2 In the paediatric period, children develop usually ischaemic symptoms. Thus, bypass surgery is generally recommended bilaterally. After the surgical anastomoses, it is usually no limitation in music lesson at school when the clinical symptoms become stable. However, instruments which requires hyperventilation are not recommended. In such cases, change to another instrument is recommended at school.
Q3 Is there limitation in running or summer camp?
A3 Running at the patients' pace is okay. They may run and take rests, and then run. It is no problem to join the summer camp. There is usually no limitation for swimming.
Q4@ Is poor performance at school attributable to moyamoya disease?
A4 Your child may be doing his or her best. It is the best to observe him or her without intervening their study. Parents are requested to take care for the children not to make the circumstances to hate school.
Q5 Does speech disturbance improve?
A5 Contrary to the adults, it is often experienced that speech disturbance in children dramatically improve. It depends of course upon the territory of the cerebral ischemia, long term observation is necessary especially for paediatric moyamoya patients.
Q6 Crying often causes ischemic episodes. What should we do?
A6 Before bypass surgery, crying is not good for the brain. Early bypass surgery is recommended. However, after surgical intervention, crying does not necessarily cause serious ischaemic complication. Although loud crying is not good, it is also not good for the children that the parents do not get angry to them for fear of inducing ischaemic phenomena.
Q7 Do Moyamoya patients who were diagnosed moyamoya disease during childhood develop haemorrhage when they grow up?
A7 In the medical literature, such cases have been reported. It doesn't follow that all children with initial ischemic symptoms develop hemorrhagic complications in the future. The fact is that no detailed data are available.
Q8 Does my child have to undergo bypass surgery?
A8 It is generally accepted that bypass surgery is effective for the patients with ischemic symptoms. Such bypass surgery is recommended before the patients develop irreversible brain infarction. Without surgical intervention, some of the patients develop brain infarction during the follow-up.
For Adults
Q1 I have got married. Is it safe to be pregnant?
A1 There are many female moyamoya patients who have children. It is better to talk with neurosurgeons and obstetricians when you are going to have a baby. Detailed information is available to the separate page.
Q2 Is it possible to return to the original work?
A2 In adults with brain hemorrhage or infarction, returning to the original work depends upon the degree of the brain damage. It means that some return to the original work, and some can not. The latter may require a long term for rehabilitation.
Q3 In my childhood, I have experienced mild ischaemic episodes similar to the typical symptoms in moyamoya disease. Although I have not been to the hospital for examination and I have no such episodes today, should I undergo the examination of moyamoya disease?
A3 If your symptoms in childhood were similar to those of moyamoya disease, you'd better undergo MR (magnetic resonance) examination. MR examination is risk free and if you have moyamoya disease, it will show the disease correctly.
Q4 Have anticonvulsants adverse effects on the fetus?
A4 For men (fathers with anticonvulsants), no. But, for women (mothers with anticonvulsants), yes. See the page on anticonvulsants and pregnancy.
For both children and adults
Q1 Although I have no ischemic episodes, headache continues. What should I do?
A1 It is common for the moyamoya patients to experience headache, which is occasionally severe. If it is preoperative, bypass surgery is recommended because headache is often the sign of ischemia. Even after bypass surgery, the moyamoya patients may experience headache. Analgesics is the first choice. When analgesics is not effective, minor tranquilizer or anti-calcium channel blocker is occasionally effective to headache.
Q2 Even after the bypass surgery, I sometimes experience ischemic episodes. What can I do?
A2 It is believed by many Japanese neurosurgeons that direct anaestomosis becomes effective earlier than indirect anastomosis. Depend upon the patients, it requires weeks or months that the bypass surgery becomes effective. It requires occasionally more than 1 year that ischemic episodes subside gradually. In the case of unsuccessful bypass surgery, ischemic episodes continue. Thus, it is better to consult to the neurosurgeons or neurologists when the ischemic episode continues.
Q3 How often should I have MRI examination? How about electroencephalogram?
A3 If clinically stable, MRI may be required once per year or two years. When you have no seizure episodes, you may not require electroencephalograms.
Q4 Which is the better surgical method between direct and indirect anastomosis? What is the best surgical method?
A4 You may look at the page on treatment. There is no consensus among Japanese neurosurgeons what the best treatment is. We prefer direct anastomosis when feasible even for the children. It is true that some neurosurgeons believe that indirect anastomosis is also effective like direct one. You may consult to your neurosurgeons for the possible surgical treatment.
Q5 Is it necessary to be prescribed with anti-convulsants or aspirin? How long?
A5 If generalised convulsion (seizure) does occasionally occur, you require anti-convulsants. Otherwise you may not require anti-convulsants except for the some postoperative periods. It is not proved that aspirin is effective for moyamoya patients. You should consult to your doctor.
Q6 Is cerebral angiography really required for the diagnosis and treatment of moyamoya disease?
A6 Only for the diagnosis, MR angiography is sufficient, but for surgical planning, many neurosurgeons believe that the angiography is necessary. Angiography is not risk free, but it does not necessarily carry high risk. It should be balanced between the merits and demerits of the catheter angiography.
Q7 Is moyamoya disease hereditary?
A7 Since the aetiology of moyamoya disease is unknown, it is not clear that moyamoya disease is hereditary. About 10% of familial occurrence of moyamoya disease indicates some involvement of hereditary factor in moyamoya disease.
Q8 Is moyamoya disease infectious? How to prevent it.
A8 The etiology of moyamoya disease is unknown. In 70's and 80', it was believed that the preceding infection (either bacterial or viral) might be related to moyamoya disease. However, this was not proven. Now, it is believed that moyamoya disease is not infectious, thus it is unnecessary to care about it. You should not think that moyamoya disease is infectious and dangerous because it is not so.