25 September 2018, Volume 14 Issue 3

    

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Expert Perspective
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  The application of therapeutic plasma exchange in neuroimmunological disorders

  YAO Xiaoying, GUAN Yangtai

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 117-125. https://doi.org/10.12022/jnnr.2018-0079

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  Plasma exchange is a method of blood purification, which can remove the pathogenic components of the blood circulation and achieve the aim of immunological modulation and treatment of diseases. Recently, plasma exchange has been more and more frequently used in the treatment of neuroimmunological disorders, and achieved satisfactory therapeutic effects. The most recent American Society for Apheresis (ASFA) guideline, updated in 2016, listed the indications for plasma exchange. According to this guideline, this paper summarizes the plasma exchange therapy for neuroimmunological disorders in combination with relevant literature, with a view to providing relevant treatment recommendations for clinicians. Plasma exchange plays an important role in the treatment of neuroimmunological disorders, but more high-quality clinical studies are needed to confirm its efficacy and to formulate optimal treatment options.
Original Research
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  Association of carotid plaque characteristics with cerebral ischemic lesion determined by high resolution-magnetic resonance imaging

  YU Shoufen1, ZHAO Huilin2, LI Yansheng3

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 126-134. https://doi.org/10.12022/jnnr.2018-0065

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  Objective: To evaluate the relationship between carotid plaque characteristics and acute intracranial infarction lesions by analyze the carotid plaque load and composition of patients with acute intracranial infarction determined by high resolution-magnetic resonance imaging (HR-RMI).
  
  Methods: A total of 115 eligible patients with acute cerebral infarction who were hospitalized in the Department of Neurology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2010 to 2011 were enrolled. The load and composition of carotid atherosclerotic plaque and the location and volume of cerebral infarction lesions were analyzed. Logistic regression analysis was used to analyze the relationship between the load and components of carotid plaque and cerebral infarction.
  
  Results: After adjusting for common vascular risk factors, carotid atherosclerotic plaque load was positively correlated with the risk and volume of cerebral infarction in the ipsilateral internal carotid artery supply area (P < 0.05). Mean lumen area (mean LA), mean wall area (mean WA), percent wall volume (PWV), maximum wall thickness (max WT) and minimum lumen area (min LA) were all correlated with the volume of cerebral infarction lesions. Mean WA, PWV and max WT representing plaque load were positively correlated with the volume of the infarction lesions, and the mean LA and the min LA representing the degree of carotid artery stenosis were negatively correlated with the volume of the infarction lesions. The volumes of lipid-rich necrotic core, intraplaque hemorrhage and intraplaque calcification in carotid plaque were positively correlated with the volume of cerebral infarction lesion in internal carotid artery supply area (P < 0.01).
  
  Conclusion: The load and composition of carotid atherosclerotic plaque are related to the risk and volume of intracranial infarction. HR-MRI can be used as a good tool to identify high-risk plaques and help to assess the risk of cerebral infarction.
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  Effect of synchronized bionic electrical stimulation in hyperbaric oxygen chamber on patients with cerebral infarction in convalescent period

  DUAN Qian, LIU Wenying, JIN Wei, SHEN Jie

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 135-140. https://doi.org/10.12022/jnnr.2018-0047

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  Objective: To explore the effect of bionic electrical stimulation synchronized with intrachamber hyperbaric oxygen on patients with cerebral infarction in convalescent period.
  
  Methods: From August 1, 2016 to October 30, 2017, 68 patients with cerebral infarction in convalescent period who received rehabilitation treatment in the Department of Rehabilitation Medicine of Shanghai Eighth People’s Hospital met the criteria for case selection. These 68 patients were randomly divided into study group (34 cases) and control group (34 cases) treated with hyperbaric oxygen synchronized with intrachamber bionic electrical stimulation and hyperbaric oxygen combined with bionic electrical stimulation nonsynchronously, respectively. Neurological impairment and activity of daily living were assessed by the National Institute of Health Stroke Scale (NIHSS) and modified Barthel index before treatment, 20 days after the start of treatment, and 1 month and 3 months after the end of treatment. The clinical effective rates of the 2 groups were evaluated 20 days after the start of treatment and 1 month and 3 months after the end of treatment.
  
  Results: Thirty-three patients in the study group and 31 patients in the control group were included in the final statistical analysis. Before treatment, there was no significant difference in the NIHSS score and the modified Barthel index between the 2 groups (P > 0.05). At 20 days after the start of treatment and 1 month and 3 months after the end of treatment, the NIHSS scores of the two groups were significantly lower and the modified Barthel index were significantly higher than those before treatment (P < 0.05); the NIHSS scores of the study group were significantly lower than those of the control group (P < 0.05), and the modified Barthel index were significantly higher than those of the control group (P < 0.05); the clinical effective rate of the study group was also significantly higher than that of the control group (P < 0.05).
  
  Conclusion: Hyperbaric oxygen synchronized with intrachamber bionic electrical stimulation and hyperbaric oxygen combined with bionic electrical stimulation nonsynchronously can both improve the functional impairment of the patients with cerebral infarction in convalescent period, especially hyperbaric oxygen synchronized with intracabin bionic electrical stimulation is more effective.
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  Efficiency of suspension training for balance function in patients with lumbar spinal cord injury

  HAN Dong, XIA Wenguang, ZHENG Chanjuan, ZHANG Yangpu, HUA Qiang

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 141-146. https://doi.org/10.12022/jnnr.2018-0057

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  Objective: To evaluate the effects of suspension training on balance function in patients with lumbar spinal cord injury.
  
  Methods: Thirty-five eligible patients with lumbar spinal cord injury were enrolled from June 2014 to September 2015 and treated in Department of Rehabilitation Medicine of Hubei Provincial Hospital of Integrated Chinese and Western Medicine. All these patients had received surgical operation for lumbar spinal cord injury. The 35 patients were randomly divided into suspension training group (n = 17, treated with routine neurotrophic therapy, routine rehabilitation and suspension training for 12 weeks) and routine rehabilitation group (n = 18, treated with routine neurotrophic therapy and routine rehabilitation for 12 weeks). The balance function of the two groups was assessed by time up and go test (TUG) and Berg balance scale before rehabilitation treatment and at the 4th, 8th and 12th week of rehabilitation treatment. The changes of balance function between the two groups before and after rehabilitation treatment and between the two groups were compared.
  
  Results: The TUG scores of suspension training group and routine rehabilitation group were significantly lower at the 8th and 12th week of rehabilitation treatment than before rehabilitation (P < 0.01), and the Berg balance scale scores at the 4th, 8th and 12th week were significantly higher than before rehabilitation (P < 0.01). At the 8th and 12th week of rehabilitation treatment, the TUG scores of the suspension training group were significantly lower than those of the routine rehabilitation group (P < 0.05); at the 12th week of rehabilitation treatment, the Berg balance scale score of the suspension training group was significantly higher than that of the routine rehabilitation group (P < 0.01).
  
  Conclusion: Suspension training combined with routine rehabilitation has a significant effect on balance function of patients with lumbar spinal cord injury.
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  Efficacy of Nao-Xue-Shu Oral Liquid on hematoma absorption in patients with hypertensive intracerebral hemorrhage

  HAO Yong1, WAN Wenbin1, ZHOU Hang2, HUANG Xinxin3, WANG Yishu1, YANG Xiao1, GUAN Yangtai1

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 147-153. https://doi.org/10.12022/jnnr.2018-0075

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  Objective: To retrospectively analyze the effect of Nao-Xue-Shu Oral Liquid (NXS) on the absorption of intracerebral hematoma in patients with hypertensive intracerebral hemorrhage.
  
  Methods: The medical records of eighty-four patients with hypertensive cerebral hemorrhage were retrospectively collected. The patients were divided into NXS group (n = 41) and basic treatment group (n = 43). Both groups received oxygen inhalation, hemostasis, dehydration, blood pressure control, basic disease treatment and symptomatic and supportive treatment. The patients in the NXS group received NXS orally or by nasal feeding within 72 hours since the disease onset. Both groups were treated for 10 days. Before treatment and 10 days after treatment, the volume of intracerebral hematoma was observed and calculated by computed tomography (CT), and the use of dehydration and antihypertensive drugs during treatment was recorded.
  
  Results: There was no significant difference in gender, systolic blood pressure, diastolic blood pressure and intracerebral hematoma volume between the two groups before treatment (P > 0.05), but there was significant difference in age (P = 0.005). There was no significant difference in the use rate of dehydration and antihypertensive drugs between the two groups during treatment (P = 0.529, P = 0.898); after 10 days of treatment, the volumes of intracerebral hematoma of the two groups were smaller than those before treatment, but only the change of volume of intracerebral hematoma in the NXS group had statistical significance (P = 0.001). The volume of intracerebral hematoma in the NXS group after treatment for 10 d was significantly smaller than that in the basic treatment group (P = 0.046). Multiple linear regression analysis showed that age and blood pressure had no significant correlation with the volume of intracerebral hematoma before and after treatment and the absorption of intracerebral hematoma (P > 0.05).
  
  Conclusion: NXS can reduce the intracerebral hematoma and promote the absorption of intracerebral hematoma in patients with hypertensive cerebral hemorrhage, but has no obvious effect on the use of dehydration and antihypertensive drugs.
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  Effects of Chinese medicine for reinforcing Qi and activating blood circulation on nerve conduction velocity and oxidative stress in patients with diabetic peripheral neuropathy

  QIN Baofeng1, WENG Weili1, ZHU Xuying1, ZHANG Liqiong2, ZHANG Hongzhi1

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 154-160. https://doi.org/10.12022/jnnr.2018-0026

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  Objective: To observe the effects of Chinese medicine for reinforcing Qi and activating blood circulation on nerve conduction velocity and serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels of patients with diabetic peripheral neuropathy.
  
  Methods: Sixty diabetic peripheral neuropathy patients with Qi deficiency and blood stasis syndrome were randomly divided into two groups: Chinese medicine for reinforcing Qi and activating blood circulation group (30 cases, diabetes basic treatment combined with Chinese medicine for reinforcing Qi and activating blood circulation for 12 weeks) and control group (30 cases, diabetes basic treatment for 12 weeks). The changes of common peroneal nerve conduction velocity and serum SOD and MDA levels were compared between the two groups before and after treatment, and the clinical efficacy of the two groups was compared.
  
  Results: The conduction velocities of the common peroneal nerve in the two groups after 12 weeks of treatment were significantly faster than those before treatment (P < 0.05); the conduction velocity of the sensory nerve in the Chinese medicine for reinforcing Qi and activating blood circulation group after treatment was significantly faster than that in the control group (P < 0.05), but there was no significant difference in the motor nerve conduction velocity (P > 0.05). After 12 weeks of treatment, serum SOD levels in both groups were significantly higher than those before treatment (P < 0.05), and the serum MDA levels were significantly lower (P < 0.05). After 12 weeks of treatment, the clinical effective rate of the Chinese medicine for reinforcing Qi and activating blood circulation group was 93.3%, significantly higher than 76.7% of the control group (P = 0.001).
  
  Conclusion: Chinese medicine for reinforcing Qi and activating blood circulation can significantly improve the nerve conduction velocity in patients with diabetic peripheral neuropathy, and its mechanism may be related to antioxidant stress.
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  Effect of modified air pressure therapy on upper extremity motor function in patients with stageⅠ shoulder-hands syndrome after stroke

  ZHANG Dandan1, 2, CAO Feng1, 2, ZHAN Qing1, 2

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 161-166. https://doi.org/10.12022/jnnr.2018-0046

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  Objective: To evaluate the effect of modified air pressure therapy on upper extremity motor unction and the range of motor (ROM) of shoulder joint in patients with stageⅠ shoulderhands syndrome (SHS) after stroke.
  
  Methods: Sixty patients with stageⅠ SHS after stroke were randomly divided into two groups: the modified air pressure therapy group (n = 30) and the traditional air pressure therapy group (n = 30). The Fulg-Meyer assessment score of upper extremity motor function and ROM of shoulder joint were compared between the two groups before treatment and 4 weeks after treatment, and the therapeutic efficacy was compared between the two groups after 4 weeks.
  
  Results: After 4 weeks of treatment, Fugl-Meyer assessment scores of upper extremity motor function were significantly increased in both groups (P < 0.05), and the improvement in the modified air pressure therapy group was more significant than that in the air pressure therapy group (P < 0.05). After 4 weeks of treatment, the ROM of shoulder joint of the two groups were both improved significantly (P < 0.05), and the improvements in flexion, abduction and rotation mobility of the modified air pressure therapy group were more significant than those of the traditional air pressure therapy group (P < 0.05, P < 0.01, P <0.05). After 4 weeks of treatment, the response rate of modified air pressure therapy group was significantly higher than that of the traditional air pressure therapy group (83.3% vs 56.7%, P < 0.01).
  
  Conclusion: Compared with the traditional air pressure therapy, the modified air pressure therapy can significantly improve the upper extremity motor function and ROM of shoulder joint in patients with stageⅠ SHS after stroke, which is worthy of clinical application.
Review
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  Progress in nucleocytoplasmic transportin pathogenesis of amyotrophic lateral sclerosis and frontotemporal dementia

  XIONG Jianmei, CUI Fang

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 167-171. https://doi.org/10.12022/jnnr.2018-0031

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  Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are neurodegenerative diseases characterized by selective and progressive loss of neurons in the central nervous system, bring heavy burden to society and family. More and more evidences have shown that ALS and FTD overlap in clinical manifestations, pathological changes and genetic characters. Compared with ALS or FTD, ALS-FTD has faster disease progression and shorter survival time. At present, the etiology and pathogenesis of ALS and FTD are unclear. Many studies have revealed that there is a common pathological basis for ALS and FTD:
  TDP-43 (transactivation response DNA-binding protein 43 kDa)-positive inclusion bodies exist in the remnant neurons and glial cells of the nervous system. Studies have shown that TDP-43 protein in the central nervous system of patients with ALS-FTD loses normal nuclear localization and aggregates in the cytoplasm to form inclusion bodies. It is speculated that the loss of normal function and acquired neurotoxicity of TDP-43 may be one of the initiating factors of ALS-FTD. This paper reviews the latest research progress in the pathogenesis of ALS-FTD.
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  Research progress in poststroke depression

  JIANG Dudu1, 2, LIU Yigang3, SONG Haoming1, ZHAN Qing2

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 172-177. https://doi.org/10.12022/jnnr.2018-0073

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  Poststroke depression (PSD) is the most common emotional disorder after stroke. PSD is one of the factors affecting the quality of life of stroke patients, which can affect the recovery of daily living ability and nerve function impairment, and cause the protracted course of stroke. The pathophysiological mechanism of PSD has not been fully elucidated, and may involve biological, behavioral and social factors. This paper reviews the pathogenesis, diagnosis and treatment of PSD.
Case Report
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  Sjögren’s syndrome manifesting myelopathy: one case eport and literature review

  BAI Shuwei, JIANG Xianguo, GUAN Yangtai

  Journal of Neurology and Neurorehabilitation. 2018, 14(3): 178-184. https://doi.org/10.12022/jnnr.2018-0078

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  Objective: To improve the understanding of clinical manifestations and imaging features of Sjögren’s syndrome myelopathy (SSM).
  
  Methods: A case of SSM was reported. The clinical manifestations, etiology, imaging features and treatment principles of SSM were discussed with literature review.
  
  Results: One elderly male patient complained mainly of limb weakness and diuresis difficulty; magnetic resonance imaging showed myelitis, and serum anti-nuclear antibody screening, ophthalmic dry keratoconjunctivitis and lip biopsy pathology confirmed SSM. The patient was transferred to department of rheumatology for treatment with glucocorticoid and rituximab, and the symptoms were relieved. 
  
  Conclusion: Instead of the typical symptoms of dry mouth and dry eyes, the neuropathy included peripheral and central nervous system is often observed as the early manifestation in many Sjögren’s syndrome patients. Therefore, for the clinical diagnosis of Sjögren’s syndrome, attention should also be paid to the possible concomitant neuropathy. The incidence of SSM is not high, and it is easy to be misdiagnosed or missed. Therefore, differential diagnosis should be made between SSM and myelopathy, optic neuromyelitis spectrum disease and multiple sclerosis, so as to make a correct diagnosis as soon as possible, and give appropriate individual treatment.