25 March 2016, Volume 12 Issue 1

    

• Select all
  |

Editorial
• Select
  Timing and strategies for early management and rehabilitation of acute ischemic stroke

  ZHAN Qing, WANG Lijing

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 1-7. https://doi.org/10.12022/jnnr.2016-0014

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  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.
• Select
  Integrative medicine and Chinese integrative neurology

  PAN Weidong

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 8-11. https://doi.org/10.12022/jnnr.2016-0003

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  The concept of traditional Chinese medicine (TCM) combined with Western medicine initiated from the 1950s in order to develop TCM by means of the modern technology or Western medicine. With the passage of time, the concept of TCM combined with Western medicine has been changed as integrative medicine (IM). It includes any methods which can help people improving health or treating diseases. Although all kinds of diseases of Chinese integrative neurology may not be found in TCM area, but the diseases in integrative neurology area can be treated and the symptoms of these diseases can be relieved by using symptomatic treatment and dialectical therapy from TCM. The integrative treatment has indicated superiority in treating diseases of integrative neurology by combining TCM methods. The integrative therapy may improve the treatment methods for some major refractory diseases of neurology.
Comment on Guideline
• Select
  Comment on international consensus diagnostic criteria for neuromyelitis optica spectrum disorders, 2015

  ZHANG Ying, GUAN Yangtai

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 12-16. https://doi.org/10.12022/jnnr.2016-0020

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  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.
• Select
  New standard of neuroimaging markers of cerebral small vessel disease

  XU Qun

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 17-23. https://doi.org/10.12022/jnnr.2016-0009

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  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.
Review
• Select
  Advances in treatment with induced pluripotent stem cells and somatic cell transdifferentiation for multiple sclerosis

  LI Mei, XIE Chong, GUAN Yangtai

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 24-28. https://doi.org/10.12022/jnnr.2016-0026

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  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.
• Select
  Advances in stroke-associated pneumonia

  WANG Qinying, ZHAN Qing

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 29-35. https://doi.org/10.12022/jnnr.2016-0019

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  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.
• Select
  Antiepileptic drugs and risk factors of cardiovascular disease

  WANG Xinxin, LU Qinchi

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 36-40. https://doi.org/10.12022/jnnr.2016-0021

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  There is a reciprocal causal relationship between epilepsy and cardiovascular disease (CVD), which means that epilepsy may increase the incidence rate and mortality of CVD, while the CVD may induce the sudden unexpected death in epilepsy. Different antiepileptic drugs have different effects on the risk factors of CVD including body weight, insulin resistance, metabolic syndrome, serum uric acid level, carotid artery intima-media thickness and markers of oxidative stress. In view of the fact that some antiepileptic drugs may increase or reduce the risk of occurrence of CVD, therefore, in individualized antiepileptic therapy, appropriate antiepileptic drugs should be selected for patients with high risk of CVD, meanwhile, the rational use of drugs which can reduce the risk of CVD is recommended.
• Select
  Neuroinflammation in ischemic stroke

  ZHI Nan, XU Qun

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 41-46. https://doi.org/10.12022/jnnr.2016-0010

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  Neuroinflammation plays an important role in pathological injury after ischemic stroke. Increasing evidence suggests that neuroinflammation is a double-edged sword, as it not only exacerbates secondary brain injury in the acute stage of stroke, but also beneficially contributes to brain recovery after stroke. This paper reviews the key factors involved in neuroinflammation after ischemic stroke, including inflammatory cells, inflammatory mediators and adhesion molecules, describing their possible detrimental and protective effects in stroke. This review also briefly introduces recently studies about the advances and future perspectives in neuroinflammation after ischemic stroke.
• Select
  Advances in MRI in diagnosis of early-stage Alzheimer’s disease

  ZHAO Jiangmin, ZHAN Qing

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 47-51. https://doi.org/10.12022/jnnr.2016-0015

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  With the aging of global population, the incidence of Alzheimer’s disease (AD) shows a significant upward trend. So far, there is still a lack of effective treatment for AD, and diagnosis, prevention and treatment in early stage of AD is the only effective way to delay the progression of AD. Currently, the diagnosis of AD still mainly relies on the exclusive method and clinical neuropsychological scales with poor repeatability and being absent of objective evidence, lacking sensitive and accurate methods for early diagnosis of AD. With the development of medical imaging technology, "medical imaging⁺" transdisciplinary research has become the new norm, the interdisciplinary neuroimaging techniques can clearly show the finer structures and lesions in the brain, which provides a basis for the early diagnosis of AD. Due to the loss of neurons in brain tissues of patients with AD, cerebral atrophy is developed, so the AD can be observed by measuring the degree of cerebral atrophy. This paper summarizes the research progress in measurement of hippocampal volume, entorhinal cortex thickness and the change of amygdale through magnetic resonance imaging (MRI), the application of double inversion recovery (DIR) sequence in diagnosis of AD, and the role of diffusion tensor imaging (DTI) in the assessment of injury in white matter related to hippocampus.
Case Report
• Select
  Headache and diplopia as initial symptoms of hemophagocytic syndrome: A case report and literature review

  GAO Meichun, CHEN Gang, WANG Zhiying, LU Qinchi

  Journal of Neurology and Neurorehabilitation. 2016, 12(1): 52-56. https://doi.org/10.12022/jnnr.2016-0007

  Abstract ( ) Download PDF ( ) HTML ( )   Knowledge map   Save

  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.