This paper reports the diagnosis and management of a 65-year-old male patient with thrombotic thrombocytopenic purpura (TTP) presenting with neurological symptoms. The onset of the disease was sudden, presenting with cerebral manifestations including aphasia, limb numb and weakness. The symptoms observed were variable and fluctuant. After admission, this patient had a fever. The laboratory examination revealed anemia, peripheral thrombocytopenia, moderate renal involvement, schistocytosis, a severe functional deficiency in ADAMTS13 and positive anti-ADAMTS13 antibodies. Clinical and biological anomalies ascertained the diagnosis of idiopathic TTP. With the rapid diagnosis and therapeutical plasma exchange immediately performed, the patient reached a complete recovery.

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.

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.

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.

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.

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.

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.

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.

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.

Dysphagia in Parkinson’s disease (PD) is characterized by high incidence rate, hidden early symptoms, and low recognition rate, which can easily lead to complications such as aspiration pneumonia and malnutrition, affecting patients’ quality of life. The use of effective screening tools and objective instrument examinations is helpful for early identification of swallowing damage patterns, and provides the basis for individualized treatment including drug therapy, surgery and rehabilitation for dysphagia in PD. Based on the theory of holism, syndrome differentiation and disease differentiation, and meridian and acupoint theory, traditional Chinese medicine has certain advantages in the treatment of dysphagia in PD. Comprehensive rehabilitation and traditional Chinese medicine therapy are combined to optimize the treatment. This paper reviews the diagnosis, evaluation, treatment and rehabilitation of dysphagia in PD and the progress in treatment with traditional Chinese medicine, in order to provide help for neurologists, speech and swallowing therapist and other clinicians in the management of dysphagia in PD in clinical practice.

Acute ischemic stroke is the most common type of stroke, accounting for 60%-80% of all strokes. The management of acute ischemic stroke emphasizes early diagnosis, early treatment, early rehabilitation and early prevention of recurrence. Under the guidance of the principles of evidence-based medicine, stroke organizations at home and abroad have developed guidelines for the prevention and treatment of cerebrovascular diseases in different countries. Cerebrovascular Disease Group of the Neurology Branch of the Chinese Medical Association has revised the guidelines for the prevention and treatment of acute ischemic stroke in China since 2002 and stressed the importance of antithrombotic therapy. With the deepening of stroke prevention and treatment and the development of medical technology, the understanding of the mechanism of ischemic stroke thrombosis and accurate antiplatelet therapy is increasing, which provides a new opportunity for accurate antithrombotic therapy. In this paper, the form of thrombosis and the latest progress in antithrombotic therapy in acute ischemic stroke are reviewed, which provide therapeutic references for clinical prevention and treatment of acute ischemic stroke.

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.

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.

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.

Post-stroke spasm is an important cause of high disability rate after stroke. Spastic paralysis after stroke has become a difficult clinical problem because of its “difficult to identify and treat”. If spasm is not treated promptly and effectively, it will not only cause limb pain, but also lead to muscle atrophy and joint contracture and deformation, which will restrict joint movement, affect the effectiveness of rehabilitation training, and even aggravate the condition. Therefore, effective prevention and treatment of spastic paralysis after stroke is an important measure to improve the quality of life of patients. This paper reviews the possible pathogenesis, evaluation methods and rehabilitation treatment of post-stroke spastic paralysis, in order to provide references for the prevention and treatment of poststroke spastic paralysis.

This paper reports one adult case presenting with headache and diplopia as initial symptoms of hemophagocytic syndrome (HPS), describing the diagnostic process and treatment outcomes, in order to improve the understanding of HPS complicated by nervous system involvement. A 55-year-old female adult case presented with headache and diplopia as initial symptoms followed by high fever was hospitalized in Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Admission laboratory tests revealed pancytopenia, abnormal liver function (elevated serum levels of alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase), hypertriglyceridemia, hypofibrinogenemia and hyperferritinaemia. The results of bone marrow aspiration and biopsy showed decreased proliferation of nucleated bone marrow cells, reduction of all three hematopoietic cell lines, and hemophagocytosis of neutrophils and platelets, indicating the diagnosis of HPS. This case report suggests that when a patient presenting with headache, diplopia, fever, and reduction of peripheral whole blood cells should be highly suspected for the possibility of secondary HPS, and the early bone marrow aspiration and biopsy is the key to make a definite diagnosis.

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.

Multiple sclerosis (MS) is an autoimmune demyelinating disease in the central nervous system (CNS), and the currently approved disease-modifying therapy drugs (MTD) can inhibit the peripheral immune attack in MS, but still fail to prevent the disease process in patients with progressive MS or severe neurodegeneration. Microglia, as inherent immune cells in CNS, play a role in immune defense, regulate the proliferation and development of neurons and glial cells, and remove apoptotic cells, exerting the neural protective effect. In recent years, many existing clinical drugs for MS have been found to have regulatory effects on microglia, and various preclinical studies have confirmed that therapeutic strategies targeting microglia show great potential in the treatment of MS. In this paper, the role of microglia in the pathogenesis of MS and its potential therapeutic targets are reviewed.

Inefficient glutamate receptor A2 (GluA2) Q/R site-RNA editing and related downregulation of adenosine deaminase acting on RNA2 (ADAR2) expression as well as pathological transactivation response DNA-binding protein 43-kD (TDP-43) can simultaneously occur in the same motor neurons in patients with amyotrophic lateral sclerosis (ALS), suggesting that there may be an association among these molecular abnormalities in ALS patients. The animal experiment has found that after knock-down of ADAR2 gene, the motor neurons of the rats showed a chronic death. The abnormal mislocalization and aggregation of TDP-43 fragments induced by ADAR2 difficiency results in nerve cell toxicity, then accelerating the degeneration and death of the motor neurons. This paper summarizes the role of inefficient GluA2 Q/R site-RNA editing and TDP-43 pathology in sporadic ALS, and discusses the possible influencing factors associated with inefficient RNA editing mediated by ADAR2, hoping to provide useful information to develop a novel therapeutic strategy for ALS.

Sirtuin 5 (SIRT5) is a nicotinamide adenine dinucleotide (NAD+)-dependent desuccinylase. It is mainly located in the mitochondrial matrix and is closely related to mitochondrial metabolism and redox process. In recent years, great progress has been made on the role of SIRT5 in cardiovascular and cerebrovascular diseases, neurodegenerative diseases and tumorigenesis. This review summarizes the latest progress in desuccinylation of SIRT5 and its mechanism in nervous system diseases.

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.

Music therapy is one of the treatment methods for stroke, which is performed by listening, singing, playing or cooperating with music rhythm. With music stimulation, music therapy can accelerate the nerve repair in patients with stroke, improve the blood flow of brain, the cognitive level and the motor function, and help to alleviate the dysfunction caused by stroke. Compared with the conventional drug therapy, music therapy can also prevent the potential mental disorders and treat the existing mental disorders in patients with stroke, so as to improve the patients’ psychology, effectively supplement the deficiency of psychological intervention, and help the patients to recover better. This paper reviews the latest progress in music therapy for stroke, and looks forward to the future development of music therapy.

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.

Botulinum neurotoxin (BoNT) produced by Clostridium botulinum selectively cleaves soluble N-ethyl-maleimide-sensitive factor attachment protein receptor (SNARE) complex protein and thus inhibits neurotransmitter release and causes chemodenervation. BoNT has been used in many fields such as clinical diagnosis and treatment and cosmetic surgery. Botulism is a neuroparalytic disease caused by over-dose of BoNT. Iatrogenic botulism is most commonly observed after injection of neurotoxin with poor quality or not following usage rules. The symptoms of botulism commonly present as acute symmetrical descending flaccid paralysis. In some severe cases, respiratory failure may happen, which can even cause death. Once botulism happens, early administration of antitoxin is the most effective therapy, thus early diagnosis is essential. The diagnosis of botulism is mainly based on medical history and physical examination because toxin detection and Clostridium botulinum culture are both time-consuming. Nerve electrophysiological tests may be helpful in differential diagnosis. This paper reviews the researches on botulism, which may provide a basis for the diagnosis and treatment of botulism.

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.

Parkinson’s disease (PD) is a common neurodegenerative disease, and its prevalence increases with age. At present, patients with PD in China mainly receive rehabilitation training in community rehabilitation centers or pension institutions, but due to the limitations of objective conditions, they often do not get timely and effective continuous rehabilitation treatment. Under the trend of “internet plus medical care”, in order to better guide rehabilitation training for patients with PD at home, it is necessary to develop an application software (APP) for rehabilitation training for patients with PD at home. This paper discusses the modules and function design of APP from five aspects of health education, rehabilitation training, home renovation, medical record and others, hoping to provide references for the design of related rehabilitation APP.

Physical disability is common in stroke survivors. Sarcopenia after stroke has a strong impact on the decision and efficiency of rehabilitation and it may lead to the delayed recovery of patients. The pathogenesis of sarcopenia has not been investigated in details. “Stroke-related sarcopenia” was proposed in 2013 and several factors have been well known to contribute to sarcopenia, such as immobilization, impaired feeding and the activation of ubiquitin proteasome pathway. This paper reviews the recent studies on pathogenesis of stroke-related sarcopenia and distinguishes it from sarcopenia induced by other diseases, providing a basis for the prevention and therapy of sarcopenia after stroke.

Neurorestoratology has been formally proposed as a complete discipline concept for more than 10 years. At present, more and more colleagues are enthusiastic about neurorestoratology, and more scholars support and pay attention to the development of neurorestoratology. In order to better promote the development of neurorestoratology, this paper reviews the development history and achievements of neurorestoratology, and puts forward some strategies to promote the development of neurorestoratology in China.

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.

Biological phenotype refers to the observable characteristics or combinations of characteristics of an organism, including its morphology or physical form and structure, development process, biochemical and physiological characteristics, behavior and the results of behavior. The concept of phenotype is no longer limited to genetic research, especially after its introduction into autoimmune diseases, that is, not only to find the “origin” of the disease, but also to recognize specific disease entities according to clinical manifestations, to carry out interventions and evaluate the prognosis. In this paper, the scope and significance of clinical core phenotype, intermediate phenotype and endophenotype of neuroimmunological diseases and the approach to understand phenotype of neuroimmunological diseases in depth are discussed.

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.

Atherosclerosis is a major risk factor for cardiovascular and cerebrovascular diseases. The mechanism of atherosclerosis is not clear in modern medicine. According to traditional Chinese medicine, atherosclerosis is closely related to pathological products such as turbid phlegm and static blood. Turbid phlegm and static blood are caused by dysfunction of viscera and organs and obstruction of transfusion of Qi, blood and body fluid. There is correlation and independence between turbid phlegm and static blood. Qi can move blood, and circulation of blood depends on Qi flow; the stagnation of Qi leads to blood stasis, while the smoothness of Qi causes the turbid phlegm to disappear; the insufficient Qi reasults in the formation of turbid phlegm. Therefore, turbid phlegm and static blood often stick to each other for disease. Modern medicine has different limitations in the prevention and treatment of atherosclerosis. Traditional Chinese medicine has the characteristics of omni-directional and multi-target action, which can affect the occurrence and development of atherosclerosis in all aspects, thus providing a more comprehensive way for the prevention and treatment of atherosclerosis.

Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune central nervous system disease with low incidence and involving spinal cord and optic nerve. The clinical manifestations of NMOSD are various, thus，it needs to distinguish from different diseases and poses challenges on diagnosis and differential diagnosis. This paper discusses the diagnosis and imaging differential diagnosis of NMOSD, focusing on the neuroimaging features, in order to improve the clinicians’ understanding of NMOSD and other related diseases, and improve the abilities of diagnosis and differential diagnosis.

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.

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.

Stroke has become a major disease endangering human health due to its high morbidity, high disability rate and high mortality. After the acute ischemic stroke, the blood-brain barrier is destroyed. A large number of immune cells enter the central nervous system and interact with the central immune cells, which is able to further amplify the inflammatory response and aggravate ischemic brain damage. The immune inflammatory response runs through the process of injury and repair of ischemic stroke, in which microglia plays an important role. This paper summarizes the mechanism of inflammatory injury in acute ischemic stroke, introduces the current clinical trials of interventions in stroke patients with immunomodulators, presents the problems faced by clinical trials of stroke, as well as looks forward to the future of stroke immunotherapy.

Antibody-related encephalitis refers to an autoimmune inflammatory brain disease associated with antibodies against neuronal cell-surface or intracellular antigens, which takes neuropsychiatric symptoms as the main clinical manifestations. According to the antigen location, the pathogenicity of antibody and the response to immunotherapy, antibody-related encephalitis can be roughly divided into autoimmune encephalitis (AE) and paraneoplastic syndrome (PS). This review highlights the immunological pathogenesis of antibody-related encephalitis, including the causes of onset, failure of immunologic tolerance, the generation and damaging effects of pathogenic antibodies, and the destruction of blood-brain barrier, and aims to further understand the differences in pathogenesis treatment principles between AE and PS to provide evidences for further treatment optimization.

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.

Hemiplegia is a typical dysfunction induced by stroke. The dysfunction of hand and upper extremity can severely influence the occupational performance and restrict the living ability of the patients. Based on person-environment-occupation (PEO) model, this paper discusses the rehabilitation of hand and upper extremity function from several aspects including factors related to person, environment and occupation, in order to improve the understanding of occupational therapy in China, improve the behavior performance, decrease the degree of function limitation and raise the living ability in routine life, ultimately resulting in the improved quality of life.