25 December 2016, Volume 12 Issue 4

    

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Expert Perspective
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  Diagnosis and treatment of botulism

  JIN Lingjing, PAN Lizhen, WANG Lin, WAN Xinhua

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 173-180. https://doi.org/10.12022/jnnr.2016-0054

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  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.
Youth Forum
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  Rehabilitation of hand and upper extremity function in post-stroke patients under the guidance of person-environment-occupation model

  ZHOU Huanxia, YU Xiaoming, LIU Qianwen, WANG Honglin, WANG Chuan, WU Ping, ZHAN Qing

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 181-185. https://doi.org/10.12022/jnnr.2016-0053

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  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.
Original Research
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  Associations of smoking and plasma homocysteine level with main cardiac-cerebral vascular events in male patients with hypertension

  QIU Mingjing, ZHANG Qi, JIN Aiping, WANG Wenxie, FANG Min, TAN Yan, LIU Xueyuan

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 186-190. https://doi.org/10.12022/jnnr.2016-0057

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  Objective: To investigate the relationships between smoking and plasma homocysteine (Hcy) level with main cardiac-cerebral vascular events (MCCVEs) in male patients with hypertension.Methods: Three hundred and fifty-five male patients with hypertension were recruited in this study and divided into smoking group (n = 166) and non-smoking group (n = 189). The information of clinical records was collected. The plasma Hcy level was detected by velocity method. The relationships between smoking and plasma Hcy level with MCCVEs in male patients with hypertension were evaluated. The risk factors related to MCCVEs were examined using logistic regression analysis.Results: Plasma Hcy level in smoking group [(17.74±12.64) μmol/L] was higher than that in non-smoking group [(15.37±5.37) μmol/L] (P < 0.05). The incidence rate of MCCVEs in smoking group (57.83%) was higher than that in non-smoking group (44.44%) (χ² = 9.324, P < 0.05). Logistic regression analysis showed that age, course of hypertension, smoking and plasma Hcy level were independent risk factors of MCCVEs (all P < 0.05). The odds ratio of smoking was 1.786 (95% confidence interval: 1.131-2.820) and the odds ratio of plasma Hcy level was 1.035 (95% confidence interval: 1.004-1.073).Conclusion: Smoking is associated with increased level of plasma Hcy and higher incidence rate of MCCVEs in patients with hypertension. The age, course of hypertension, smoking and plasma Hcy level are independent risk factors of MCCVEs.
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  Effectiveness of rehabilitation with movement imagery therapy under the guidance of mirror training on upper limb function of hemiplegic patients after acute ischemic stroke

  SHE Junhui, LUO Juan, LIN Dawei, LIN Yiwen, YOU Hua

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 191-196. https://doi.org/10.12022/jnnr.2016-0042

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  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.
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  Early hemorrhagic cerebrospinal fluid drainage after interventional embolization for ruptured intracranial aneurysm

  YIN Xiaoming, WANG Donglei, HUI Lusheng

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 197-201. https://doi.org/10.12022/jnnr.2016-0061

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  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.
Epidemiologic Research
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  Prevalence of chronic diseases and community health service in Huli District, Xiamen, 2013

  CHEN Lixin, SHEN Xuehui

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 202-207. https://doi.org/10.12022/jnnr.2016-0046

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  Objective: Huli District in Xiamen is a national reform pilot area for chronic disease prevention and treatment. The purpose of this study is to investigate the prevalence of hypertension, diabetes, hyperlipidemia and obesity which are the risk factors related to cardiovascular diseases, and explore the appropriate corresponding modes of community health management in permanent residents living in Huli District, Xiamen.Methods: Using proportional stratified random sampling method, the prevalence of hypertension, diabetes, hyperlipidemia and obesity and the status of community health management in the residents more than 18 years of age living in Huli District, Xiamen for more than six months were investigated.Results: This survey was conducted in July 2013, and a total of 3 300 cases were included in this study, and 3 240 eligible questionnaires were obtained from 1 583 males (48.86%) and 1 657 females (51.14%); the effective response rate was 98.18%. The overall prevalence rates of hypertension, diabetes, hyperlipidemia and obesity were 21.36%, 5.31%, 4.48% and 10.74%, respectively. The prevalence rates of hypertension, diabetes, hyperlipidemia and obesity were 22.30%, 6.51%, 7.08% and 8.09%, respectively in males, and 20.46%, 4.16%, 1.99% and 13.28% in females, respectively. In this sample, the proportion of chronic disease patients received at least one intervention of health management was 9.26% (300/3 240).Conclusion: The prevalence rates of chronic diseases in residents in Huli District, Xiamen are higher than the average level in China, which indicates that the risk factors of cardiovascular diseases have a certain prevalence in the residents in Huli District. The implementation of community health management can help to prevent and treat the chronic diseases, improve the rehabilitation efficacy for patients, and reduce the economic and family burden.
Review
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  Pathogenesis of glioma-associated epilepsy and its therapy

  WANG Xinxin, LU Qinchi

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 208-214. https://doi.org/10.12022/jnnr.2016-0058

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  Epilepsy can be developed in 30%-50% of the patients with glioma, which is the most common form of brain tumors. The seizures induced by glioma are still remained after resection of glioma lesions, therefore it is essential and meaningful to explore the pathogenesis and the related treatment of glioma-associated epilepsy. This paper discusses the pathogenic mechanisms involved in the development of glioma-associated epilepsy, including the alteration of glutamate and its transporters, the dysregulation of intracellular chloride (Cl)^-, the alteration of gamma-amino butyric acid (GABA) signal pathway-mediated inhibitory effect, and the abnormalities in mammalian target of rapamycin (mTOR) signal pathway. The related drugs based on the pathogenic mechanisms of glioma-associated epilepsy are summarized, such as sulfasalazine—the blocker of cystine-glutamate transporter (xCT), bumetanide—the regulator for Cl^-, and rapamycin which is an inhibitor of mTOR, in order to provide effective treatment strategies for glioma-associated epilepsy. Finally, the guidance about the use of anti-epileptic drugs (AEDs) in controlling the glioma-associated seizures is also summarized.
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  Advances in pathogenesis of secondary brain insults after hypertensive intracerebral hemorrhage and the prevention and treatment strategies of Western medicine and traditional Chinese medicine

  SUN Chuanhe, LIAO Weilong, GAO Penglin, JIANG Wenfei, PAN Weidong

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 215-220. https://doi.org/10.12022/jnnr.2016-0052

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  The hypertensive intracranial hemorrhage (HICH) is a critical neurological condition which has a high morbidity and mortality. When HICH is complicated by secondary brain insults, it will lead to more severe outcomes and a high mortality. This paper aims to completely explore the pathogenesis of secondary brain insults after HICH according to different views from Western medicine and traditional Chinese medicine, involved in definition, etiology and pathogenesis; the prevention and treatment strategies of Western medicine, traditional Chinese medicine and integrative medicine for secondary brain insults after HICH are also summarized.
Case Report
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  Comprehensive rehabilitation for peripheral hypoglossal nerve palsy after carotid endarterectomy: One case report and literature review

  WANG Xue, WAN Chunxiao

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 221-227. https://doi.org/10.12022/jnnr.2016-0055

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  Objective: The diagnosis and treatment rates of peripheral hypoglossal nerve palsy are low, and a considerable number of patients fail to get timely and appropriate rehabilitation treatment. The purpose of this paper is to report the comprehensive rehabilitation therapy of peripheral hypoglossal nerve paralysis caused by carotid endarterectomy and its effectiveness.Methods: One case of peripheral hypoglossal nerve palsy caused by carotid endarterectomy was admitted in Department of Rehabilitation Medicine, Tianjin Medical University General Hospital in March 1st, 2016. This patient received oral administration of neurotrophic drugs and were treated with comprehensive rehabilitation treatment including tongue muscle training, neuromuscular electrical stimulation therapy and far infrared therapy for 15 days. Retrospective analysis of the diagnosis and treatment process was performed, and the relevant literature was reviewed.Results: After comprehensive rehabilitation treatment for 15 days, the muscle of the tongue was more flexible, and the articulation was more clear, also showing an improved ability to control and mix the food bolus; while the tongue was still slightly right-skewed, but the deflection angle of tongue median groove was decreased by 17.5 degrees; the wrinkles on the right side surface of the tongue were reduced, and the tongue looked plump and ruddy; the tip of the tongue could touch the upper lip, with less difficulty in licking the left side of the mouth; the tension of the neck muscles was decreased significantly when stuck out the tongue to the right; when curled the tip of the tongue inside the mouth, it could touch the edge of the soft palate. The therapeutic effect of rehabilitation was satisfying.Conclusion: The treatment of peripheral hypoglossal nerve paralysis has been rarely reported. On the basis of oral neurotrophic drugs, the application of rehabilitation therapy including tongue muscle training, neuromuscular electrical stimulation therapy and far infrared therapy, can effectively improve the patient’s tongue muscle function and tongue muscle atrophy, which has become a safe and effective rehabilitation therapy to relieve the peripheral hypoglossal nerve palsy.
Medical Writing
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  Requirements on case report writing

  HUANG Wenhua

  Journal of Neurology and Neurorehabilitation. 2016, 12(4): 228-232. https://doi.org/10.12022/jnnr.2016-0067

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  Case report is a common type of medical paper, and it is also one of the most popular types of paper for clinicians. Through vivid description of the diagnosis and treatment process about one or two cases or the case series, case report can provide perceptual first-hand information for clinicians, not only has a guiding significance in clinical diagnosis, treatment and follow-up, and cultivates clinical thinking, but also has educational significance for the whole society, to provide references for government decision-making. However, in many of the medical journals, the writing requirement on case report is less or even absent. This phenomenon exists in both domestic and foreign journals, especially in domestic journals. Due to the lack of the corresponding writing instruction, the quality of the case report is uneven, leading to the reduced acceptance rate of the case report. This paper introduces the related writing requirement on case report in Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals which is proposed by the International Committee of Medical Journal Editors (ICMJE) and the CARE Checklist—2016: Information for writing a case report, in order to help the authors to improve the level of case report writing.