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.
Although there are some shortcomings in both modern medicine and traditional Chinese medicine, the rightness of medicine should not be judged solely by modern scientific theory. No matter which theoretical system is based on, as long as the pathogenesis can be explained with the theory that patients can understand and accept, the “pain” of patients can be relieved, and the life span of patients with high quality of life can be prolonged, it is good medicine. Nowadays, western medicine has begun to introduce various kinds of traditional medicine, including traditional Chinese medicine, to treat various chronic diseases and emotional disorders. The author advocates that modern medicine should focus on patients’ symptoms and carry out comprehensive treatment with integrative medicine (combined with drug therapy, psychotherapy, emotional therapy and other therapies) to better relieve patients’ pain and establish a perfect integrative medicine system.
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.
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.
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.
The primary angiitis of the central nervous system (PACNS) is a rare vascular inflammatory disease that involving the brain and spinal cord. Currently, the diagnosis of PACNS is mainly dependent on clinical manifestations and signs, imaging, cerebrospinal fluid examination and brain biopsy. The magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) are employed in PACNS to assess the vascular lesions. Pathological diagnosis can be confirmed by brain biopsy. Retrospective studies have shown that cyclophosphamide combined with glucocorticoids can be used as a therapeutic regimen in the induction phase of PACNS, while immunosuppressive agents such as azathioprine can be used as maintaining therapy. In addition, the therapeutic benefits of biological agents such as rituximab, an anti-CD20 monoclonal antibody, have also been reported. However, due to the rarity and heterogeneity of PACNS, there is no definite clinical evidence related to diagnosis and treatment strategies, so the diagnosis and treatment of PACNS is still very challenging in clinical practice. Therefore, It is urgent to explore the pathogenesis of PACNS in order to provide scientific basis for early diagnosis and improvement of therapeutic effect.
Autoimmune encephalitis (AE) is a relatively new category of immune-mediated disease involving the central nervous system. AE-related antibodies can be divided into two groups: antibodies targeting intracellular neuronal antigens and antibodies targeting cell-surface neuronal antigens. Central nervous system idiopathic inflammatorydemyelinating diseases (CNS-IIDDs) is an immune-related group of inflammatory demyelination diseases especially occurring in the brain (including the optic nerve) and/or spinal cord. It is related to several autoantibodies (including anti-aquaporin 4 antibodies and anti-myelin oligodendrocyte glycoprotein antibodies). AE may co-exist with CNS-IIDDs. In this paper, the characteristics of AE, CNS-IIDDs and AE co-existing with CNS-IIDDs were reviewed in combination with relevant literature, in order to provide relevant diagnosis and treatment recommendations for clinicians. However, more high-quality studies are needed to confirm its pathogenesis and clinical features.
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are common demyelinating diseases of central nervous system (CNS). In recent years, the development of magnetic resonance imaging (MRI) techniques and the progress in autoimmune antibody detection have gradually deepened the clinical understanding of these diseases. Many diagnostic criteria and guidelines for MRI provide important basis for clinical identification of MS and NMOSD. Distinct autoimmune antibodies and neuroimaging features make myelin oligodendrocyte glycoprotein-immunoglobulin G-associated encephalomyelitis (MOG-EM) a novel and isolate group of diseases separated from MS and NMOSD. Therefore, how to distinguish MOG-EM from MS and NMOSD by using MRI technique, and how to achive early diagnosis, guide treatment and predict prognosis by using MRI technology, have become hot issues in the current research on demyelinating diseases of CNS. This paper aims to review and discuss the progress in the utility of MRI in the clinical diagnosis of common demyelinating diseases of CNS.
Objective: To investigate the efficacy of local intramuscular injection of botulinum toxin A (BTX-A) guided by electromyography (EMG) in the treatment of limb spasm after stroke.
Methods: The subjects were 96 patients with spastic hemiplegia after stroke. According to the results of the Fugl-Meyer Assessment (FMA) scale of upper limbs or lower limbs with severer spasticity, these 96 patients were divided into upper limbs group A (n = 26, score ≥51), group B (n = 21, score 34-50) and group C (n = 9, score ≤33), and lower limbs group A (n = 25, score ≥23), group B (n = 12, score 17-22) and group C (n = 3, score ≤16). Local intramuscular injection of BTX-A (a multi-point injection, the total dose of each patient ≤400 U) was performed under the guidance of EMG, and combined with limb function training. One month, three months and six months after treatment, the efficacy was evaluated by Modified Ashworth Scale, FMA scale, Modified Barthel Index, World Health Organization Quality of Life Assessment Instrument, Self-rating Depression Scale, Self-rating Anxiety Scale and EMG.
Results: One month, three months and six months after treatment, the FAM scale scores of upper limbs groups A and B were 60.35±1.51, 62.35±3.01 and 64.10±2.56, and 39.10±2.23, 42.12±2.34 and 43.09±1.89, respectively; the FAM scale scores of lower limbs groups A and B were 33.16±1.06, 33.45±2.14 and 33.89±2.08, and 20.95±3.75, 23.45±2.20 and 24.12±1.89, respectively. The scores of FAM scale in group A and group B were significantly improved after treatment (P < 0.05), but there was no significant difference in the score of FAM scale in group C after treatment as compared with that before treatment (P > 0.05). One month after treatment, there were significant differences in total marked efficiency and total effective rate among group A, group B and group C (P < 0.05), but there were no significant differences in total marked efficiency and total effective rate among group A, group B and group C after 3 months and 6 months of treatment (P > 0.05). The Modified Barthel Index scores of 96 patients at 1, 3 and 6 months after treatment were not significantly improved compared with those before treatment (P > 0.05); besides environmental score, the physiological, psychological and social relationship scores of the World Health Organization Quality of Life Assessment Instrument were significantly increased compared with those before treatment (P < 0.05); the scores of Self-rating Depression Scale and Self-rating Anxiety Scale were significantly decreased compared with those before treatment (P < 0.05). The activities of spontaneous potential at rest in group A and group B were significantly lower than those before treatment, but there was no significant change in group C compared with that before treatment.
Conclusion: Local intramuscular injection of BTX-A has a remarkable effect on limb spasm after stroke. Combined with effective rehabilitation training, muscle spasm can be quickly alleviated or eliminated, and the quality of life and the mood can be improved.
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.
