In June 2016, American Heart Association (AHA)/American Stroke Association (ASA) released the first guideline for adult stroke rehabilitation—AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery (2016 GASRR). This paper aims to compare the 2016 GASRR with Chinese Adult Stroke Rehabilitation Guideline in 2011 (2011 CASRG) and Consensus of Rehabilitation Experts on Acute Cerebral Infarction in 2016 (2016 CREACI) to provide references for rehabilitation therapy of stroke in China. The 2016 GASRR, 2011 CASRG and 2016 CREACI all suggest that early rehabilitation during acute stage is essential for optimal outcomes, but do not provide the specified timing of intervention. Suggestions on rehabilitation methods are mentioned given specific training programs can prevent pressure sore, joint contracture, deep venous thrombosis (DVT), lung infection and urinary tract infection. The 2016 GASRR gives more detailed information on rehabilitation methods, level of rehabilitation activities, rehabilitation schedule, and the interventions to prevent pro-stroke complications. Furthermore, different approaches are suggested in the 2016 GASRR, 2011 CASRG and 2016 CREACI on prevention of DVT and post-stroke central pain and the psychological intervention. The 2016 GASRR also has covered recommendations for improvement of activities of daily living (ADL) and instrumental activities of daily living (IDAL) which are specified to leisure activities and occupational treatments. As compared with the criteria of stroke rehabilitation abroad, there is still a long way to go for the development of stroke rehabilitation in China. In the future, more researches are needed to be done in China in order to standardize the post-stroke rehabilitation.

Objective: To investigate the clinical and imaging characteristics of superficial siderosis of central nervous system (SSCNS) and improve the understanding of SSCNS in the clinical practice. Methods: The clinical diagnosis and treatment of a patient with SSCNS were reported. Neurology and imaging experts were invited to discuss the clinical and imaging characteristics of SSCNS based on literature review. Results: The patient presented with progressively evolving gait ataxia, pyramidal dysfunction, sensory abnormalities and sphincter dysfunction. Cerebrospinal fluid (CSF) examination showed immunoglobulin G (IgG) oligoclonal bands. Magnetic resonance imaging (MRI) revealed hemosiderin deposition on surface of brainstem, cerebellar vermis and spinal cord. The symptoms were controlled with treatment of deferiprone. Conclusion: The clinical manifestations of SSCNS are complex and diverse. The imaging and CSF characteristics contribute to the early diagnosis of SSCNS. Early diagnosis and treatment can help prevent further development of the disease. In addition, the demonstration of CSF-oligoclonal bands implies that inflammation might be involved in the pathogenesis of SSCNS. The mechanism remains to be confirmed by further studies.

With the increasing incidence of ischemic stroke and the younger age of onset, active and effective recanalization of blood vessels and recovery of blood supply are important in super-early treatment of stroke and the functional rehabilitation in the late stage. At present, the main methods of vascular recanalization are intravenous thrombolysis, arterial thrombolysis, mechanical recanalization and bridging therapy. This paper introduces the current internationally accepted super-early recanalization methods in ischemic stroke, and discusses some controversial points in the clinical practice.

Rehabilitation of stroke is an indispensable process in the management of stroke; however, there is no consensus on timing and the specific strategies for early rehabilitation intervention. During 1994-2013, American Heart Association/American Stroke Association (AHA/ASA) successively released six versions of guideline for the early management of patients with acute ischemic stroke. The recommendation on early rehabilitation intervention was first proposed in the guideline of 2003, recommending that the patients with acute ischemic stroke should be managed in comprehensive specialized stroke care units which incorporates rehabilitation personnels. Moreover, the prevention of subacute complications through early rehabilitation intervention was emphasized, and the passive and full-range-of-motion exercises for paralyzed limbs can be started during the first 24 hours, while avoiding falls. The enteral nutrition through nasogastric gavage and the use of percutaneous endoscopic gastrostomy (PEG) to sustain nutrition in patients with swallowing dysfunction were also primarily mentioned in the guideline. In the guideline of 2007, assessment of swallowing before starting eating or drinking was recommended, and the patients who cannot take food and fluids orally should receive nasogastric gavage or PEG. Early mobilization for less severely affected patients and measures to prevent subacute complications of stroke in specialized stroke care units were recommended in the guideline of 2013, and the assessment of swallowing and the appropriate choice to sustain nutrition were stressed on again. However, the final results of a very early rehabilitation trial (AVERT), which was a randomised controlled trial to evaluate the efficacy and safety of very early mobilization within 24 h of stroke onset, could not give a definite conclusion on the benefits in very early rehabilitation for patients with acute ischemic stroke. No similar large-sample clinical trials have been done in China. Therefore, there is no consensus on the optimal timing of rehabilitation intervention for ischemic stroke, and how soon should it begin is still unknown. In principle, the timing of rehabilitation should be based on the premise that not to aggravate the underlying conditions, and the early rehabilitation for acute ischemic stroke is recommended to implement in specialized stroke units.

With the increasing incidence of dementia, more and more attention has been given to this disease. It has already been a clinical difficult problem threatening the health of mankind, especially for the aged people. After Alzheimer's disease, vascular dementia (VaD) is the second leading cause of senile dementia, including ischemic or hemorrhagic cerebrovascular diseases or a variety of clinical dementia due to low blood flow induced by heart and circulatory disorders. VaD is a promising disease for prevention and treatment, and it has been a hot topic in recent years. Therefore, this article summarizes the recent advances in molecular and genetic mechanism of VaD.

Brain heart syndrome (BHS) refers to the secondary heart damage caused by acute-phase stroke, manifested as cardiac dysfunction and changes in cardiac electrical activity, leading to the aggravating conditions. The treatment of BHS has become more complex, or even contradictory, severely affects the prognosis of the patients. This paper discusses the advances in clinical examinations, pathogenesis and treatment of BHS, particularly pointing out that the laboratory results of heart damage and the electrocardiogram abnormalities are related to stroke type and the part of lesion in stroke. Meanwhile, it is pointed out that the primary disease should be treated first in the treatment of patients with BHS. The dynamic monitoring of electrocardiogram and laboratory tests for heart damage should be conducted while correcting arrhythmia and myocardial ischemia in time, which can determine the heart damage in real time and effectively, so as to give targeted treatment and rehabilitation.

Parkinson’s disease is a common neurological disease. It belongs to the “tremor syndrome” in traditional Chinese medicine. Parkinson’s disease is mostly treated from liver, spleen or kidney based on the theory of traditional Chinese medicine. The relationship between lung and Parkinson’s disease is rarely mentioned. Using the treatment to tonifying lung in the early stage of Parkinson’s disease has certain curative efficacy to prevent or slow down its progression. Based on the theory of traditional Chinese medicine, the lung opens at nose, governs Qi and breathing, regulates water passage, and has internal and external relations with the Large Intestine Meridian. Its physiological function also affects the transporting of Qi and blood through the whole body. So the lung is the key organ of Parkinson’s disease. In this paper, the discussion on the relationship between the lung and Parkinson’s disease through aspects of etiology, pathogenesis and non-motor symptoms demonstrates that the early treatment of Parkinson’s disease from lung is necessary and feasible.

Objective: To investigate the clinical value of circular RNA hsa_circ_0133159 in diagnosis and prognostic evaluation of glioma. Methods: The relative expressions of hsa_circ_0133159 in 10 normal brain tissue samples and 38 glioma tissue samples were detected by real-time fluorescence-based quantitative reverse transcription-polymerase chain reaction (qRT-PCR), and its relationship with clinicopathological characteristics was analyzed. The clinical value of hsa_circ_0133159 in diagnosis of glioma was evaluated by using the receiver operating characteristic (ROC) curve. The survival analysis was conducted using Kaplan-Meier method, and the univariate analysis of prognostic factors was conducted by using log-rank test. The multivariate analysis was conducted by using COX regression analysis. Results: Compared with normal brain tissues, the relative expressions of hsa_circ_0133159 in low-grade and high-grade glioma were increased significantly (P = 0.026, P = 0.007). The area under curve (AUC) of hsa_circ_0133159 in ROC curve was 0.887 and its sensitivity and specificity for the diagnosis of glioma were 86.8% and 80.0%, respectively with the cut-off value of 4.32. The progression-free survival (PFS) and overall survival (OS) of glioma patients with low expression of hsa_circ_0133159 (≤4.32, n = 17) were significantly prolonged as compared with those of glioma patients with high expression of hsa_circ_0133159 (> 4.32, n = 21). The result of univariate analysis showed that the Karnofsky performance status (KPS) score, number of tumor lesions, pathologic grade, recurrence and the relative espression of hsa_circ_0133159 were significantly associated with PFS and OS of patients with glioma (P < 0.05)。Multivariate analysis revealed that relative expression of hsa_circ_0133159 was an independent prognostic factor of glioma [PFS: relative risk = 1.268 (95% confidence interval: 1.007-3.459), P = 0.001; OS: relative risk = 1.252 (95% confidence interval: 1.103-2.422), P = 0.001]. Conclusion: hsa_circ_0133159 may be used as a new biomarker for the diagnosis and prognostic evaluation of glioma.

This paper reviews the progress in traditional Chinese medicine and western medicine research on the relationship of diabetes mellitus and small brain lesions, and puts forward the hypothesis of nourishing Yin and truncating lesion method for the treatment of small brain lesions related to diabetes mellitus in stroke prevention based on traditional Chinese medicine theory of collaterals disease and torsion and truncation, in order to further improve and clear the traditional Chinese medicine theory of nourishing Yin and truncating lesion and preventive treatment of disease, providing references for preventing stroke related to diabetic mellitus in traditional Chinese medicine.

Cerebral small vessel disease (CSVD) is a common disease accompanied by aging and is also usually concomitant with neurodegeneration diseases, exacerbating cognitive impairment and physical disability. The lack of consistency of terminology, definition, image acquisition and scientific report of CSVD hampers the further understanding of effects of CSVD on pathophysiological and clinical features of common neurodegenerative diseases. A working group of global research specialists made a comprehensive review of neuroimaging markers of CSVD. The standard of interpretation of terminology and definition of six neuroimaging markers indicating key characteristic manifestations of CSVD, minimum standard for image acquisition and analysis, agreement on scientific reporting of neuroimaging features of CSVD, and new imaging methods for early detection of CSVD, were developed in 2012. These six neuroimaging markers include recent small subcortical infarcts, lacune of presumed vascular origin, white matter hyperintensities of presumed vascular origin, perivascular space, cerebral microbleeds and brain atrophy. The new standard should not be applied only to research work but also to the clinical practice, in order to improve the standardization of interpretation, acquisition and reporting of neuroimaging features of CSVD.

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of central nervous system and remains one of the major causes of disability in young adults. Conventional therapeutics can only prolong the remission duration, but do not cure it. Induced pluripotent stem cells (iPSCs) with the same totipotent differentiation as the stem cells have a broad prospect for application of cell replacement therapy in MS. Somatic cell reprogramming and transdifferentiating can shorten the time for generating oligodendrocyte cell lineage, as compared with the traditional method with iPSCs, which provides a new idea for the treatment of MS. With the improved efficiency and quality in obtaining neural stem cells and oligodendrocytes, it is possible to have a big achievement in cell therapy for MS.

The choice of therapies for neurological disorders is limited and the effectiveness is poor. Stem cells are a group of cells that are immortal and have unlimited renewal abilities. Stem cell transplantation is expected to be an important choice for treating neurological diseases. The types of stem cells usually used in registered clinical trials include multipotent stem cells, hematopoietic stem cells and mesenchymal stem cells, which are usually used to treat stroke, spinal cord injury, Parkinson’s disease, multiple sclerosis, neuromyelitis optica spectrum disorders, amyotrophic lateral sclerosis, brain tumors, cerebral palsy, hypoxic ischaemic encephalopathy, etc. The majority of these clinical trials are early small-scale trials and the results of completed clinical studies suggest that stem cell therapies are safe and well tolerated. However, large-scale randomized controlled clinical trials to study the effectiveness of stem cell therapies for neurological disorders are still lacking.

Pneumonia is one of the most common complications of stroke. Understanding of the pathogenesis, clinical manifestations, laboratory and imaging findings and the risk factors related to stroke-associated pneumonia may contribute to the early identification of high-risk patients and taking strategies for prevention in early-stage after the onset of stroke, so as to reduce the incidence rate of stroke-associated pneumonia. Early identification of stroke-associated pneumonia and effective treatment can improve the success rate of treatment in patients with stroke. This paper summarizes the pathogenesis, diagnostic criteria, pathogen characteristics, risk assessment and prediction, and prevention measures of stroke-associated pneumonia in recent years, in order to provide clinical guidance on diagnosis, prevention and treatment of stroke-associated pneumonia.

On October 16, 2017, the Neurocritical Care Society (NCS) released an evidence-based guideline: The Implementation of Targeted Temperature Management (TTM) (hereinafter referred to as the 2017 NCS guideline). Based on population-intervention-comparison-outcome (PICO) frame, the editorial committee for this guide line has addressed and discussed 16 clinical problems related to the 3 aspects of implementation of TTM in neurocritical care practice, including TTM’s induction and maintenance, shivering and complications. The 2017 NCS guideline is designed to assist the clinicians in neurocritical care who use TTM to carry out TTM better. Based on the interpretation of the 2017 NCS guideline, the similarities and differences in TTM application among the 2017 NCS guideline, 2017 guidelines for TTM in the intensive care unit (ICU) from France, 2015 guidelines for the use of TTM (therapeutic hypothermia) after cardiac arrest from Canada, 2016 China expert consensus on TTM after cardiac arrest and 2015 China expert consensus on hypothermia in neurocritical care are analyzed and compared, in order to help clinicians better understand the TTM application in neurocritical care.

In November 2020, Myasthenia Gravis Foundation of America (MGFA) released International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update online. In addition to retaining seven topics for myasthenia gravis, two new topics (ocular myasthenia gravis and immune checkpoint inhibitor-associated myasthenia gravis) were included in this guideline. Furthermore, the previous recommendations for thymectomy were updated, and the new recommendations were developed for the use of rituximab, eculizumab, and methotrexate in the topic of myasthenia gravis and immunosuppression therapy. This paper summarizes the updated recommendations and new contents in this guideline.

Objective: Through the analysis and summary of the clinical features of neurosyphilis, this study aims to give references for reducing the clinical misdiagnosis of neurosyphilis. Methods: A retrospective analysis of the clinical data of 24 cases of neurosyphilis in Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to January 2017 was conducted. Results: Of 24 cases of neurosyphilis, 21 cases were males, 3 were females; the median age was 55 years (range: 28 to 75 years); 3 cases had the first clinical manifestation of epilepsy, 3 cases had paralytic dementia, 5 cases had cerebral vascular disease-like attack, and 5 cases had spinal cord symptoms. Twenty-four cases had positive results of serum treponema pallidum particle agglutination test (TPPA) and toluidine red unheated serum test (TRUST) as well as cerebrospinal fluid TPPA. There were 21 cases had abnormal count of cerebrospinal fluid cells and 20 cases had increased protein content. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) showed 10 cases had lacunar infarction, 3 cases had acute cerebral infarction, 1 case had cerebral hemorrhage, 5 cases had vascular stenosis, thinning and absence, 1 case had nucleus abnormal signal, 1 case had spinal cord infectious granuloma, 1 case had spinal cord abnormal signal, 2 cases had brain lobe abnormal signal, 2 cases had brain atrophy and hippocampal atrophy, and 4 cases had no abnormal intracranial findings. All the patients received penicillin treatment immediately after the diagnosis of neurosyphilis was confirmed, and the symptoms were relieved after treatment. Conclusion: Combination of clinical manifestations with laboratory and imaging could help to reduce the misdiagnosis of neurosyphilis.

The evidence-based guideline of diagnostic approach to pauci- or asymptomatic hyperCKemia developed and released by European Federation of Neurological Societies (EFNS) has provided the definition, clinical manifestation, diagnostic procedure and prognosis of this disease. Pauci- or asymptomatic hyperCKemia is defined as a condition that creatine kinase (CK) value beyond 1.5 times the upper limit of normal with no muscular signs. For the etiology searching, collection of the related family history is essential and the non-neuromuscular conditions that might contribute to hyperCKemia are needed to be excluded before further investigation. A muscle biopsy is preferred if one or more of the following are present: the serum CK value is ≥3 times the normal, the electromyogram suggests myopathic condition, the patient is < 25 years of age or there is a clue of exercise intolerance. The long-term prognosis of pauci- or asymptomatic hyperCKemia is generally quite favorable.

Cerebral blood vessel has the ability to automatically adjust the blood flow to the brain and against the damage of acute or chronic cerebral perfusion pressure alteration to meet the needs of brain metabolism during the occurrence of ischemic stroke. Through this physiological mechanism which is named as cerebrovascular reserve (CVR), the brain can get through the crisis. As a milestone of the research in the pathophysiology of ischemic stroke, however, CVR has not been widely recognized, which restricts the clinical application of CVR in further use as a routine reference index for the treatment of ischemic stroke. In this paper, the definition of CVR and its physiological mechanism, evaluation and intervention, and the progress in clinical application are systematically reviewed.

Accumulating data has supported an autoimmune basis in patients with drug-resistant epilepsy (DRE). Neural-specific autoantibodies targeting both intracellular and plasma membrane antigens promote epilepsy through different mechanisms. Semeiology of epileptic seizure, neural-specific autoantibodies, inflammatory cerebrospinal fluid (CSF) findings, magnetic resonance imaging (MRI) and electroencephalograph (EEG) contribute to make diagnosis of autoimmune epilepsy. Immunomodulatory treatment may be a prospective effective therapy for autoimmune epilepsy, such as corticosteroids, immunoglobulins, plasmapheresis, cyclophosphamide, rituximab and azathioprine. Recent studies have indicated that cyclosporine A, FK-506 and rapamycin are effective for autoimmune epilepsy. In addition, plasma exchange is also one of the treatment options in acute phase. Prompt diagnosis and early treatment with immunotherapy and maintenance treatment in stable stage may lead to better outcomes. This review summarizes and analyzes the progress in pathophysiology, clinical presentation, diagnosis and management of autoimmune epilepsy.

In recent years, with the continuous improvement of the level of medical technology, the mortality of stroke has decreased with years. However, the prevalence rate and disability rate of stroke have increased. Cognitive dysfunction after stroke is one of the common complications of stroke, and the cognitive dysfunction significantly affects the prognosis of stroke. Music therapy is one of the new techniques of rehabilitation therapy. It aims to regulate the nerve excitability and the inner circulation of the human body by music, so as to help the recovery of cognitive function. In this paper, the mechanism of music affecting cognitive function, the development of music therapy in china and abroad, the clinical application of music therapy in the rehabilitation of stroke patients and the existing problems are reviewed.

Objective: To explore the effectiveness of modified Wendan Decoction combined with lidocaine in integrative medical treatment of Lermoyez syndrome. Methods: Twenty patients with Lermoyez's syndrome received intravenous injection with lidocaine for 3 days and oral modified Wendan Decoction for 2 weeks. Before treatment and after 4-week follow-up, the severities of vertigo, low-tone hearing loss, tinnitus and the sensation of ear fullness were evaluated. Results: Of 20 patients, the low-tone hearing was obviously improved in 3 (15%) patients, moderately improved in 9 (45%) patients, and not improved in 8 (40%) patients. The sensation of ear fullness and tinnitus were relieved in 16 (80%) and 17 (85%) patients, respectively, and not relieved in 4 (20%) and 3 (15%) patients. The overall disease control rate of vertigo was 100% including 65% (13/20) achieving full control and 35% (7/20) achieving almost control. Conclusion: The integrative medical treatment with modified Wendan Decoction combined with lidocaine for Lermoyez syndrome can get good efficacy, which provides clinical evidence for further investigation of potential therapeutic methods for this disease.

Objective: Intravenous thrombolysis is the most effective therapy that guidelines have recommended for treating acute ischemic stroke. This study aims to evaluate the factors related to the clinical outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis. Methods: This study recruited 136 patients with acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator (rt-PA). The demography, vascular risk factors and the characteristics of acute ischemic stroke were recorded. The early improvement which was defined as complete resolution of the neurologic deficit or an improvement from baseline in the score on the National Institute of Health Stroke Scale (NIHSS) 24 hours after intravenous thrombolysis and the independent functional outcomes which was defined as a score of 0 or 1 on the modified Rankin scale (mRS) three months after the onset of stroke were evaluated. The factors related to early improvement and late independent functional outcomes were examined by univariate and multivariate analyses. Results: Sixty-six patients (48.5%) achieved early improvement and 64 patients (47.1%) achieved late independent functional outcomes. The early efficacy 2 hours, 24 hours and 7 days after intravenous thrombolysis had relevance to the later prognosis (all P < 0.05). Lower systolic pressure was independently associated with better early improvement (P < 0.05). Conclusion: Decrease in systolic blood pressure before intravenous thrombolysis may promote the early improvement in patients with acute ischemic stroke. The early response to intravenous thrombolysis may predict the late outcomes.

Objective: To report the diagnosis and treatment of a patient with acute ischemic stroke caused by traumatic internal carotid artery occlusion, and review the related literatures. Methods: The clinical diagnosis and treatment of a patient with acute ischemic stroke caused by traumatic internal carotid artery occlusion was reported. The clinical characteristics of traumatic internal carotid artery occlusion and the related progress in diagnosis and treatment of this disease were reviewed. Results: A patients with acute ischemic stroke caused by traumatic internal carotid artery occlusion received intravenous thrombolysis. After 2-week treatment, the right limb function was recovered, only leaving moderate motor aphasia, and the National Institute of Health Stroke Scale (NIHSS) score was 2. After 6-week treatment, the carotid artery computed tomography angiography (CTA) suggested the proximal stenosis of left common carotid artery and the distal common carotid artery occlusion extending to the bifurcation of the common carotid artery. Then the left carotid endarterectomy was performed with embolectomy and carotid angioplasty and stenting. After operation, the patient was followed-up, and the prognosis was good. Conclusion: For patients with acute ischemic stroke caused by traumatic internal carotid artery occlusion, individualized treatment is recommended on the basis of guidelines. The thrombolytic therapy in time window can improve the prognosis of the patients.

Neuromyelitis optica (NMO) is an idiopathic inflammatory central nervous system (CNS) syndrome distinct from multiple sclerosis (MS). The discovery of highly specific antiaquaporin-4 antibody as a diagnostic biomarker for NMO has enabled recognition of NMO and expanded the concept of neuromyelitis optica spectrum disorders (NMOSD). The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria of NMOSD—International Consensus Diagnostic Criteria for NMOSD, 2015. In this new nomenclature, the individual definition of NMO is cancelled and classified into unified term NMOSD, which is stratified further by serologic testing (AQP4-immunoglobulin G-positive or -negative). One of the core clinical characteristics is necessarily required for patients with AQP4-immunoglobulin G-positive NMOSD. More stringent clinical criteria, with additional neuroimaging findings, is required for diagnosis of AQP4-immunoglobulin G-negative NMOSD or when serologic testing is unavailable. This paper presents the highlights of International Consensus Diagnostic Criteria for NMOSD, 2015, and gives some comments.

Objective: To improve the understanding of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode (MELAS) symdrom in clinical practice. Methods: The clinical manifestations, diagnosis and treatment of one case with MELAS syndrome were reported. The pathogenesis, clinical manifestations, diagnosis and treatment of MELAS syndrome were discussed based on literature review. Results: MELAS syndrome is a type of mitochondrial disease that mainly involves brain and muscle tissues and is associated with stroke-like episodes. It should be clinically differentiated from encephalitis and cerebral infarction. Early diagnosis and treatment can help prevent further development of the disease. Conclusion: The clinical manifestations of MELAS syndrome are complex and diverse. The long-term prognosis is poor and the mortality rate is high. Therefore, early diagnosis and treatment are of important clinical significance for improving the prognosis and quality of life of the patients with MELAS syndrome.

Motor dysfunction after stroke is a major problem for neurologists, and it is of important clinical significance that the stroke patients with upper limb dysfunction should need rehabilitation treatment, while the upper limb rehabilitation robots are important tools to solve this problem. This paper introduces the structures of ontology of upper limb rehabilitation robots, human-computer interaction technology of rehabilitation robots based on biological signals including myoelectric signal and electroencephalogram, the control system of rehabilitation robot technology based on the position and force, and the evaluation methods for the efficacy of upper limb rehabilitation training, in order to explore the developing prospects of upper limb rehabilitation robots.

Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder that includes motor symptoms and non-motor symptoms. At present, there is no effective treatment method for PD and its progression, and only motor symptoms (including tremor, rigidity and being slow, etc.) can be treated with symptomatic treatment, but there is almost no reliable and effective treatment for non-motor symptoms. Tai Ji Quan has certain curative effect in the treatment of motor symptoms and non-motor symptoms of PD. The purpose of this paper is to review the progress in the role of Tai Ji Quan in motor symptoms and non-motor symptoms of PD.

Objective: To evaluate the effectiveness of Biodex dynamic and static balance testing and training system for balance recovery in patients with Parkinson’s disease. Methods: Forty-two eligible patients with Parkinson’s disease were randomly divided into general balance training group (control group, n = 21) and the Biodex dynamic and static balance testing and training group (study group, n = 21), and received the general balance training and Biodex dynamic and static balance training for 6 weeks, respectively. The dynamic and static balance function was evaluated before training and six weeks after training. The Berg Balance Scale was also used to examine the patients’ balance function. Results: As compared with before training, the static balance score of the study group was obviously improved after training for 6 weeks (P < 0.05); in the control group, the balance function score of forward and backward adjustment was not remarkably improved after training (P > 0.05). After training for 6 weeks, the balance function scores of overall, forward, front-left and front-right adjustments of the study group were significantly improved than those before training and those of the control group after training (all P < 0.05), but the scores of left and right adjustments were not significantly improved as compared with those of the control group after training (both P > 0.05); in the control group, only the scores of left and right adjustments were significantly improved after training (both P < 0.05). The Berg Balance Scale score of the study group was also obviously improved as compared with that before training and that of the control group after training (both P < 0.05). Conclusion: Biodex dynamic and static balance testing and training system is superior to the general balance training in improving the balance function of the patients with Parkinson’s disease, especially in forward, left, right, front-left and front-right adjustments.

A report on revised terminology and concepts for organization of seizures and epilepsies proposed by International League Against Epilepsy (ILAE) Commission on Classification and Terminology in 2010 has revised concepts, terminology, and approaches for classifying seizures and epilepsy, aiming to establish the international consensus on classification and terminology, reflect the fundamental relation between the classification and the terminology, and provide guidance on making appropriate treatment protocols in clinical practice. Generalized seizures and focal seizures are redefined for seizures as occurring in bilaterally distributed networks (generalized) and within networks limited to one hemisphere (focal), respectively. Furthermore, genetic, structural-metabolic and unknown which represent modified concepts are used to replace idiopathic, symptomatic, and cryptogenic categories. Organization of forms of epilepsy is first described by specificity: electroclinical syndromes, constellation, and epileptic encephalopathies. This paper interprets the key changes in terminology and concepts for organization of seizures and epilepsies in the revised terminology and concepts for organization of seizures and epilepsies of the ILAE.

Objective: To evaluate the effectiveness of early hemorrhagic cerebrospinal fluid drainage after interventional embolization for ruptured intracranial aneurysm.Methods: From January 2007 to July 2016, a total of 40 patients with aneurysmal subarachnoid hemorrhage (aSAH) were admitted in Department of Neurosurgery, Aoyang Hospital Affiliated to Jiangsu University, and treated with intervention therapy including lumbar puncture and drainage and/or external ventricular drainage. The treatment outcomes were retrospectively evaluated.Results: Of 40 patients, 12 patients (30.0%) developed cerebral vasospasm during 2-7 days after onset of aneurysm rupture, and were relieved after symptomatic treatment. Three patients (7.5%) developed hydrocephalus 1-2 months after discharge. The modified Rankin scale evaluation showed that 37 patients (grade 1) recovered well, 2 patients (grade 2) had mild disability, and 1 patient (grade 6) had poor outcome (the family abandoned the treatment, and the patient died of lung infection). At the end of follow-up, 37 patients (94.9%) were cured or improved, and the intelligence of 2 patients (5.1%) was decreased, and no patients developed severe sequelaes such as hemiplegia, aphasia and limb dysfunction.Conclusion: Early hemorrhagic cerebrospinal fluid drainage after interventional embolization for ruptured intracranial aneurysm can release the hemorrhagic cerebrospinal fluid to obviously reduce the incidence of complications and shorten the recovery time, so it is a simple, safe, inexpensive and effective treatment therapy.

This paper expounds the clinical therapeutic efficacy of extracts from Gastrodia elata Blume on anticonvulsant and neuroprotective effects. The studies based on pharmacology and molecular level have shown that the extracts from Gastrodia elata Blume has a variety of effects. In this paper, the research progress in bioactive constituents in the extracts from Gastrodia elata Blume and its anticonvulsant and neuroprotective are reviewed.

Infection is one of the most common serious complications in stroke patients. The incidence rate of stroke-associated pneumonia (SAP) is high after stroke. SAP can aggravate the patient’s condition and is closely related to the prognosis. It is also one of the main causes of death. Understanding the risk factors of SAP, early identifying SAP, and timely providing effective rehabilitation with traditional Chinese and Western medicine can promote the absorption of inflammation, shorten the hospitalization duration, improve the quality of life, and benefits the prognosis of patients. This paper reviews the progress in SAP rehabilitation with traditional Chinese and Western medicine.

Epilepsy is a chronic brain disease caused by a variety of reasons. It is a kind of repetitive, episodic and transient central nervous system dysfunction which is caused by the excessive discharge of neurons in the brain. Epilepsy is one of the common diseases of nervous system. There are about fifty million persons with epilepsy in the world. In China, there are about six million patients with active epilepsy, and the treatment gap is up to 63%. Recurrent seizures will seriously affect the quality of life of patients. The majority of patients can reach effective control of the seizures through reasonable medication treatment, whereas a part of patients with refractory epilepsy need non-drug therapy. This article summarizes the progress in treatment of epilepsy from two aspects of western medicine and traditional Chinese medicine.

With the publicity of the concept of precision medicine, some researchers or doctors have proposed that the precision medicine is the same as the concept of treatment based on syndrome differentiation of traditional Chinese medicine according to the same individual treatment methods. This paper summarizes what the individual treatment is and indicates the similarity and differentiation between the two concepts from microscopic and macroscopic points of view. Integrative neurology needs the dynamic integration of the two individual and precision methods. This integrated way may decrease the rates of misdiagnosis and therapeutic errors and improve the neurologic clinical effects.

Induced pluripotent stem (iPS) cells can be directly generated from differentiated somatic cells by transduction, which is a great revolution in life sciences. iPS cells are similar to embryonic stem cells and have the potential to differentiate into mature cells, but the former can avoid immunological rejection and medical ethics which exists in the study of embryonic stem cells. Therefore, iPS cells have shown a good prospect in the field of basic and clinical research. This paper reviews the 10-year development course of iPS cells research, the use of iPS cells in many kinds of diseases and clinical drug monitoring, and the problems in the study, especially focusing on the application of iPS cells in nervous system diseases.

Objective: Empty sella has been defined as the herniation of the subarachnoid space into the sella turcica through the defected sellar diaphragm. Primary empty sella (PES) is not related to any known previous diseases of pituitary gland, but is considered to be caused by increased intracranial pressure (ICP), in association with defects of the sellar diaphragm. This case report aims to report the empty sella induced by chronic ICP. Methods: Two cases of empty sella related to chronic intracranial hypertension caused by cerebral venous sinus thrombosis (CVST) were reported. Results: In the present two cases, headache was the main clinical symptom; increased ICP was revealed by lumbar puncture; head magnetic resonance venography (MRV) showed the filling defects of the venous sinuses which implied CVST. The headache in the two cases was relieved gradually after the anticoagulant therapy. The degree of empty sella was aggravated on the head magnetic resonance imaging (MRI) images in one case during follow-up; in another case, the empty sella appeared during follow-up. Conclusion: The empty sella can be caused and aggravated by chronic ICP.

Parkinson’s disease (PD) is a neurodegenerative disorder, which affects central nervous system (CNS). Dancing therapy has been suggested to give benefits to emotional, physical, spiritual and cognitive functions and the interpersonal integration. Dancing therapy can also improve the coordination of limbs of patients with PD, improve their gait and movement fluency, and improve the balance, cognitive ability and self-efficacy. In 2001, the Dance for Parkinson’s Disease? training classes were developed by Mark Morris Dance Group and New York Brooklyn Parkinson Group. They incorporated the music and dance into the rehabilitation treatment of PD. This paper expounds the role of dancing therapy in rehabilitation treatment of PD, and introduces its development status domestic and abroad.

Objective: To evaluate the effectiveness of rehabilitation with movement imagery therapy under the guidance of mirror training on upper limb function and viability of hemiplegic patients after acute ischemic stroke .Methods: Seventy-six hemiplegic patients after acute ischemic stroke eligible for the case inclusion criteria were included in this study from January 1st, 2014 to June 30th, 2016. They were randomly divided into two groups: group of movement imagery therapy under the guidance of mirror training (n = 38) and the group of movement imagery therapy alone (n = 38); based on the routine rehabilitation, the patients in these two groups were received movement imagery therapy under the guidance of mirror training and the movement imagery therapy alone for 4 weeks, respectively. The National Institute of Health Stroke Scale (NIHSS) score, Barthel index, Action Research Arm Test (ARAT) score and Fugl-Meyer upper limb motor function score were evaluated before rehabilitation and after 4-week rehabilitation, and were compared between the two groups.Results: The NIHSS score, Barthel index, ARAT score and Fugl-Meyer upper limb motor function score of two groups were significantly improved after 4-week rehabilitation as compared with those before rehabilitation (all P < 0.05). After rehabilitation, these measurements were improved more obviously in the group of movement imagery therapy under the guidance of mirror training as compared with those in the group of movement imagery therapy alone (all P < 0.05).Conclusion: Rehabilitation with movement imagery therapy under the guidance of mirror training can better improve the upper limb function and daily living ability of hemiplegic patients after acute ischemic stroke.

Objective: The purpose of this study is to investigate the relationship between the cognitive state of patients with cerebral small vessel disease (CSVD) and the location and number of lacunar infarcts, the white matter lesion (WML) and medial temporal lobe atrophy (MTA). Methods: This study recruited 59 patients with CSVD who had a recent symptomatic ischemic stroke history > 3 months and were registered in the secondary prevention clinic of cerebrovascular disease in Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine. According to the detailed neuropsychological assessment results, 59 patients were divided into no cognitive impairment (NCI) group (n = 24), mild cognitive impairment (MCI) group (n = 22) and vascular dementia (VaD) group (n = 13). The magnetic resonance imaging (MRI) of brain with multiple sequences and oblique coronal reconstruction was used for counting the number of lacunar infarcts and grading WML and MTA. Results: Cognitive impairment in patients with CSVD was associated with the number of lacunar infarcts (P = 0.004), and the number of lacunar infarcts in the subcortical white matter parts was significantly different among three groups (P = 0.001). The patients had more lacunar infarcts in thalamus in MCI and VaD groups than in NCI group, but it did not reach significant difference (P = 0.058). The majority of WLMs were located in the frontal and parietal occipital lobes, and there were less lesions in the temporal lobes and basal ganglia. There were significant differences in WML score of bilateral frontal lobes (P = 0.003) and basal ganglia (P = 0.009) among three groups. Of the 59 patients, MRI oblique coronal reconstruction was performed in 43 patients. It showed that MTA almost developed synchronously in both sides, and there were statistically significant differences in left and right MTA scores among three groups (both P < 0.001). In 13 patients whose left MTA scores were ≥2, 11 patients were in NCI and MCI groups. All the patients in VaD group had MTA, and the average left and right MTA scores of 6 patients were ≥2. The result of multivariate analysis showed that the number of subcortical WML [odds ratio: 2.39 (95% confidence interval: 1.19-5.80), P = 0.005] and the left MTA score [odds ratio: 10.21 (95% confidence interval: 2.02-51.75), P = 0.003] were the independent risk factors of cognitive impairment of patients with CSVD. Conclusion: The degree of cognitive impairment in patients with CSVD is associated with the number of subcortical WML and left MTA score.

Severe hemorrhagic transformation is a most dangerous complication during thrombolytic therapy for acute ischemic stroke. This paper summarizes the definition, clinical manifestations, imaging characteristics, and the related risk factors of thrombolysis-associated severe hemorrhagic transformation. In acute ischemic stroke patients with high risk of severe hemorrhagic transformation, thrombolytic therapy with a low dose of recombinant tissue plasminogen activator (rtPA) may reduce the risk of symptomatic intracerebral hemorrhage.