Home Table of Contents

25 June 2018, Volume 14 Issue 2
    

  • Select all
    |
    Comment on Guideline
  • ZHANG Ying, GUAN Yangtai
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 57-61. https://doi.org/10.12022/jnnr.2018-0041
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    The European Committee of Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Academy of Neurology (EAN) have joined to develop an up-to-date and evidence-based clinical practice guideline for the pharmacological treatment of people with multiple sclerosis (MS) to guide healthcare professionals in the decision-making process. This guideline focuses on disease-modifying treatment (DMT) for the adult patients with confirmed MS and clinically isolated syndrome (CIS) and a total of 20 recommendations have been agreed, encompassing treatment efficacy, monitoring of treatment response, strategies for inadequate treatment response, treatment discontinuation and/or switch, as well as treatment in special situations (such as pregnancy). This paper presents the highlights of the guideline and gives some comments.
  • Expert Perspective
  • TIAN Jun, PAN Weidong
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 62-66. https://doi.org/10.12022/jnnr.2018-0033
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    According to the stigma of mental and psychological diseases, those patients are preferred to be treated in general hospitals or integrated traditional Chinese and western medicine hospitals. Patients not only with mental and psychological diseases, but also with internal diseases mostly chose to be treated in department of neurology at first. At present, there are fewer neurologic doctors have the experiences in diagnosis and treatment of mental and psychological diseases in general hospitals. At the same time, the diagnosis and treatment of the patients with internal diseases and mental disorders are more complicated. Doctors in mental health centers or department of psychiatry in general hospitals have limited ability to diagnose and treat patients with internal diseases and mental disorders. This paper reviews the current situation of diagnosis and treatment of mental and psychological diseases in general hospitals or integrated traditional Chinese and western medicine hospitals in China, and propose how to improve it.
  • Original Research
  • WANG Zhiying, XU Qun, CHEN Gang, YU Ling
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 67-74. https://doi.org/10.12022/jnnr.2018-0032
    Abstract ( ) Download PDF ( )   Knowledge map   Save

    Objective: To explore the predictive value of baseline cognitive score and olfactory function in conversion from mild cognitive impairment (MCI) to dementia.

    Methods: The subjects were 57 patients initially diagnosed of MCI in Memory Disorder Outpatient Department affiliated to the Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from March 2011 to September 2012. The cognitive function-related neuropsychological tests including Mini-mental State Examination (MMSE), Instrumental Activity of Daily Living (IADL), Montreal cognitive assessment (MoCA), Neuropsychiatric Inventory (NPI) and 12-item Cross-Cultural Smell Identification Test were used. Prospective follow-up was performed for 2 years. During 2 years, the regular neuropsychological tests and olfactory assessment were conducted. Within 2 years, MCI patients who converted to dementia were classified into MCI conversion group, and those who did not convert to dementia were classified into MCI stable group. Logistic regression analysis was used to analyze the independent predictors of conversion of MCI to dementia within 2 years.

    Results: There were no significant differences in baseline age, sex, years of education and body mass index (BMI) between the MCI transformation group and the MCI stable group (P > 0.05). The baseline MMSE score, MoCA score, IADL score and olfactory score in the MCI conversion group were all lower than those of the MCI stable group, and the difference was statistically significant (P < 0.001); the NPI score was also lower than that of the MCI stable group, but the difference was not statistically significant (P = 0.364). During the follow-up period of 2 years, 18 of the 57 MCI patients were converted to dementia, and the
    conversion rate was 31.6%. The MMSE score, MoCA score, IADL score and olfactory score of the MCI group were still lower than those of the MCI stable group in the second year of follow-up, and the difference was statistically significant (P < 0.001). Logistic regression analysis showed that age, BMI, years of education, MMSE score, IADL score, MoCA score, NPI score, and olfactory score were not independent predictors of conversion from MCI to dementia (P > 0.05).

    Conclusion: Neuropsychological tests and olfactory assessment may be potential predictors of conversion from MCI to dementia in patients with MCI, but it is still necessary to expand the sample size for further validation.
  • Journal of Neurology and Neurorehabilitation. 2018, 14(2): 75-80. https://doi.org/10.12022/jnnr.2018-0030
    Abstract ( ) Download PDF ( )   Knowledge map   Save

    Objective: To investigate the time of onset, etiology, related risk factors, clinical manifestations and prognosis of cerebrovascular diseases during pregnancy and puerperium.

    Methods: Retrospective analysis of the clinical data of 20 patients with cerebrovascular diseases during pregnancy and puerperium, who were admitted in Renji Hospital, Shanghai Jiao Tong University School of Medicine between January 2013 and May 2017, was conducted.

    Results: Of the 20 patients with cerebrovascular diseases during pregnancy and puerperium, 12 patients developed cerebral hemorrhage due to cerebral vascular malformation, venous sinus thrombosis, lupus erythematosus complication, hemorrhage of pituitary tumor, acoustic neuroma, cavernous hemangioma and Moyamoya disease; 2 patients developed subarachnoid hemorrhage due to aneurysm rupture; 6 patients developed cerebral infarction due to cerebral embolism caused by atrial fibrillation (rheumatic heart disease), anti-cardiolipin antibody syndrome and venous sinus thrombosis formation. Of 20 patients, 18 survived, and 2 died; 8 patients successfully delivered the fetus, but 1 patient died and the other 7 patients recovered well.

    Conclusion: The risk factors of pregnancy and the cerebrovascular diseases interact to increase the risk of cerebrovascular diseases, especially the risk of cerebral hemorrhage is increased during late pregnancy. When pregnant women present with acute/subacute headache, vomiting, disturbance of consciousness, weakness of the limbs, and other nervous system focal signs, they must be alert to the occurrence of cerebrovascular diseases. Imaging examinations can promptly confirm the diagnosis and find the cause. Timely multidisciplinary combination therapy can help improve the prognosis.
  • LI Zhong, SUN Liming, GU Jinghui, LI Hui
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 81-85. https://doi.org/10.12022/jnnr.2018-0029
    Abstract ( ) Download PDF ( )   Knowledge map   Save

    Objective: To explore the clinical characteristics of cerebral infarction caused by closed traumatic brain injury in elderly patients.

    Methods: The clinical data of 11 elderly patients with traumatic cerebral infarction caused by closed traumatic brain injury in Department of Encephalopathy, Beijing First Hospital of Integrated Chinese and Western Medicine from January 2011 to October 2017 were retrospectively analyzed.

    Results: Among 11 eligible elderly patients, 6 were males and 5 were females. The average age was 78.9 (range: 61-95) years old. The average interval between closed traumatic brain injury and posttraumatic cerebral infarction was 30 (range: 2-69) hours. The Glasgow Coma Scale score was 3-8 points in 2 patients, 9-12 points in 3 patients, and 13-15 points in 6 patients. The Glasgow Outcome Scale score was 1 point in 3 patients, 2 points in 1 patient, 3 points in 3 patients, 4 points in 1 patient, and 5 points in 3 patients. The incidence rate of moderate to severe disability was 45.5% (5/11), and the incidence rate of death and moderate to severe disability was 72.7% (8/11). 

    Conclusion: The elderly patients are prone to traumatic cerebral infarction after closed traumatic brain injury, with severe clinical symptoms, high disability and mortality, and lack of specific and effective treatment. To fully understand the clinical characteristics of traumatic cerebral infarction caused by closed traumatic brain injury in elderly patients is of great significance for the prevention and timely diagnosis of this disease and the improvement of its prognosis.
  • YU Min, JIANG Dudu, HUANG Chunhong, GU Qin, ZHAN Qing
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 86-92. https://doi.org/10.12022/jnnr.2018-0042
    Abstract ( ) Download PDF ( )   Knowledge map   Save

    Objective:
    To investigate the value of electromyography (EMG) combined with somatosensory evoked potential (SEP) in evaluation of diabetic neurologic complications. 

    Methods: One hundred and thirty-five diabetic patients were grouped according to the course of diabetes (< 1 year, 1-10 years, > 10 years), diabetic perilpheral neuropathy (DPN) (yes or no), ischemic stroke (yes or no), and the locus of cerebral stroke (anterior circulation infarction or posterior circulation infarction). The age, glycosylated hemoglobin level, nerve conduction velocity (NCV), SEP, DPN and ischemic stroke were retrospectively analyzed and compared.

    Results: Of the 135 diabetic patients, 50 (37.0%) were diagnosed of DPN, 32 (23.7%) with ischemic stroke, 56 (41.5%) with NCV abnormality, 16 (11.9%) with F wave abnormality, and 27 (20.0%) with SEP abnormality (20%). The rate of NCV abnormality, the proportion of DPN and the proportion of ischemic stroke in diabetes course 1-10-year and >10-year groups were significantly higher than those in the diabetes course < 1 year group (P < 0.05). The rate of NCV abnormality (P < 0.01), the rate of F wave abnormality (P < 0.01) and the rate of SEP abnormality (P < 0.01) in patients with DPN symptoms and signs were significantly higher than those in patients without DPN symptoms and signs. The age of diabetic patients with ischemic stroke was older than those without ischemic stroke (P < 0.01), and the course of diabetes was longer (P = 0.01) with a higher rate of SEP abnormality (P = 0.02). Spearman correlation analysis showed that NCV abnormality (r = 0.26, P < 0.01) and ischemic stroke (r = 0.22, P < 0.01) were positively correlated with the course of diabetes; DPN was positively correlated with the course of diabetes (r = 0.21, P < 0.05), age (r = 0.19, P < 0.05), glycosylated hemoglobin level (r = 0.24, P < 0.01), NCV abnormality (r = 0.75, P < 0.01), and F wave abnormality (r = 0.22, P < 0.01); NCV abnormality (r = 0.28, P < 0.01) and F wave abnormality (r = 0.30, P < 0.01) were both positively correlated with glycosylated hemoglobin level; SEP abnormality was positively correlated with F wave abnormality (r = 0.62, P < 0.01), ischemic stroke (r = 0.20, P < 0.05) and the difference in National Institute of Health stroke scale (NIHSS) score before and after hospitalization (duration: 7-14 d) (r = 0.43, P < 0.05). 

    Conclusion: EMG is an important method for screening and diagnosing DPN. EMG combined with SEP can screen early DPN, which helps to improve the detection rate of subclinical DPN, and has a certain value in the assessment of central system damage and prognosis of diabetes.

  • Expert Comments on Neuroimaging
  • WAN Wenbin1, HAO Yong1, XU Qun1, CHEN Ying1, CHEN Zengai2, GUAN Yangtai1
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 93-99. https://doi.org/10.12022/jnnr.2018-0053
    Abstract ( ) Download PDF ( )   Knowledge map   Save

    Objective:
    To investigate the clinical and imaging characteristics of transverse spinal cord infarction (SCI) induced by aortic atherosclerosis combined with aneurysm, so as to improve the understanding of the disease in clinical practice.

    Methods: One case of transverse SCI induced by aortic atherosclerosis combined with aneurysm and its clinical diagnosis and treatment process were reported. Neurological and imaging specialists were invited to discuss the clinical manifestations and imaging features of the disease based on the relevant literature review. 

    Results: The clinical manifestations of a case of transverse SCI induced by aortic atherosclerosis combined with aneurysm were repeated numbness and weakness of the lower extremities with progressive aggravation. Magnetic resonance imaging (MRI) revealed an abnormal signal and slight swelling of the lower thoracic and lumbar spinal cord. Computed tomography angiography (CTA) showed dilated outer wall of the aortic arch, aortic atherosclerosis of aorta, and multiple ulcers in the inner wall of the aortic arch with mural thrombus; atherosclerotic plaques at both sides of the carotid bifurcation and the origin of the internal carotid artery with the stenosis of vascular cavity; dissecting changes in left common iliac artery, and localized mural thrombus in left internal iliac artery with obvious stenosis of vascular cavity. After definitive diagnosis, this case was transferred to interventional surgery for aortic aneurysm.

    Conclusion: The incidence rate of SCI is much lower than that of cerebral infarction. Aortic disease is one of the common causes of SCI. Acute onset and rapid progression to its peak are the characteristics of SCI. By combining cerebrospinal fluid and MRI examinations, most patients can be definitely diagnosed. However, its etiology still depends on CTA and digital substraction angiography (DSA) examination. There is no effective treatment for SCI. At present, only a few treatment methods have been proposed for etiology.
  • Review
  • LIU Yigang1, JIANG Dudu2, JIN Lingjing1
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 100-105. https://doi.org/10.12022/jnnr.2018-0018
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Parkinson’s disease (PD) is a disabling neurodegenerative disorder characterized clinically by static tremor, rigidity, bradykinesia and postural instability, and pathologically by the extensive loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). The precise etiology of PD is mostly unknown and the pathogenesis is related to several factors such as hereditary and environmental factors. Current studies have found that mitochondrial dysfunction and oxidative stress play important roles in the pathogenesis of PD. This paper aims to elucidate the mechanism of mitochondrial dysfunction in the pathogenesis of PD and the protective effect of neurotrophic factors on mitochondria.
  • WU Yuyao1, WU Jin2
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 106-110. https://doi.org/10.12022/jnnr.2018-0027
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Parkinson’s disease is a common degenerative disease of the central nervous system. It is characterized by muscle rigidity, static tremor, bradykinesia and other non-motor symptoms such as hyposmia, constipation and depression, and it brings inconvenience to patients’ lives. Exercise therapy plays an irreplaceable role in enhancing the living ability and quality of life of patients with Parkinson’s disease. Constraint-induced movement therapy as one of the progressively movement therapies can alter the disuse-induced enhancement process of the injured limbs and improve the physical function with repeated and intensive training. This paper discusses the origin and possible mechanism in constraint-induced movement therapy, then expounds the application of constraint-induced movement therapy in Parkinson’s disease.
  • YANG Tong, LIN Li
    Journal of Neurology and Neurorehabilitation. 2018, 14(2): 111-116. https://doi.org/10.12022/jnnr.2018-0019
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Myasthenia gravis (MG) is a kind of refractory autoimmune disease. In recent years, with the development of medical level at home and abroad, the therapeutic methods of MG have been improved. The treatment of MG by single traditional Chinese medicine or western medicine may be difficult to achieve significant effect. The combination of traditional Chinese and Western medicine can give their own advantages to improve the prognosis and the quality of life of the patients with MG. This paper expounds the progress in treatment of MG from aspects of traditional Chinese medicine, western medicine and integrated traditional Chinese and western medicine.