25 September 2020, Volume 16 Issue 3

    

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Expert Lecture
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  Diagnosis and imaging differential diagnosis of neuromyelitis optica spectrum disorders

  DING Jie, GUAN Yangtai

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 91-99. https://doi.org/10.12022/jnnr.2020-0046

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  Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune central nervous system disease with low incidence and involving spinal cord and optic nerve. The clinical manifestations of NMOSD are various, thus，it needs to distinguish from different diseases and poses challenges on diagnosis and differential diagnosis. This paper discusses the diagnosis and imaging differential diagnosis of NMOSD, focusing on the neuroimaging features, in order to improve the clinicians’ understanding of NMOSD and other related diseases, and improve the abilities of diagnosis and differential diagnosis.
Original Research
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  Diagnostic value of intravoxel incoherent motion magnetic resonance imaging in crossed cerebellar diaschisis after ischemic stroke

  PAN Lijun, WANG Juan, ZU Jinyan, LI Lei, ZHAO Yixu, ZHOU Bin, SHEN Fei, LI Zhiyong, CHEN Zengai

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 100-107. https://doi.org/10.12022/jnnr.2020-0020

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  Objective: Crossed cerebellar diaschisis (CCD) after ischemic stroke plays an important role in the evaluation of neurological function and clinical outcome. The aim of this study was to investigate the value of magnetic resonance (MR) intravoxel incoherent motion (IVIM) quantitative parameters in detecting CCD after subacute ischemic stroke.
  
  Methods: The medical records of 56 patients with subacute ischemic stroke were collected and analyzed retrospectively from January 2015 to December 2017. Of 56 patients, 39 patients met the criteria of case selection. All patients underwent routine MR imaging (MRI), IVIM sequence on 3.0T MR and three-dimensional arterial spin labeling (ASL). The cerebral blood flow (CBF) and asymmetric index (AI) of CBF (AI_CBF) of bilateral cerebellar hemisphere were detected on ASL perfusion MRI. AI_CBF > 10% was considered as CCD positive. The IVIM derived parameters (D , D﹡, f and ADC ) and the corresponding asymmetric indexes (AI_D , AI_D﹡, AI_f and AI_ADC ) were measured. Paired t test was used to compare the differences in parameters of cerebellar hemispheres. Pearson correlation analysis was used to evaluate the correlation between IVIM parameters values and CBF. Receiver operating characteristics (ROC) curve was used to evaluate the diagnostic accuracy of the statistical significant IVIM parameters in detecting CCD.
  
  Results: Among 39 patients, 15 (38.5%) were CCD positive and 24 (61.5%) were CCD negative. The National Institute of Health Stroke Scale (NIHSS) scores at admission and discharge of the CCD positive group were higher than those of the CCD negative group (P > 0.05). The values of D﹡ and f of the CCD positive group showed statistically significant differences between the bilateral cerebellar hemispheres (P < 0.001), and the D﹡ values of the healthy side decreased compared with the affected side, while the f values increased. There was a positive correlation between AI_D﹡ and AI_CBF (r = 0.502，P = 0.001), and a negative correlation between AI_f and AI_CBF (r = －0.347，P = 0.003). The parameters AI_D﹡ and AI_f showed high accuracy for detecting CCD with the areas under the curve of 0.744 and 0.717, respectively.
  
  Conclusion: IVIM-derived quantitative parameters are useful to detect CCD after supratentorial ischemic stroke.
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  Improving the medication adherence of patients with Alzheimer’s disease through subjective factors: A pilot study

  HE Minchao

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 108-114. https://doi.org/10.12022/jnnr.2020-0044

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  Objective: To investigate the effect of improving the subjective factors on medication adherence of patients with Alzheimer’s disease (AD).
  
  Methods: Thirty patients with AD who met the criteria of case selection from December 2014 to October 2017 were prospectively enrolled. One of them dropped out during the study period, and the remaining 29 patients completed the 9-month study. The measures to improve the subjective factors related to medication adherence included publicizing and educating patients, increasing the number of interviews and telephone visits, establishing patient files; the pharmacist was responsible for drug distribution and take-back; improving the attention and cooperation of caregivers on medication adherence, recording medication cards and supervising medication. The medication adherence was calculated by pill counts. The average medication adherence of the study was compared with those reported in literatures from United States, Netherlands, Australia, India, South Korea and Taiwan of China, as well as the standard good (80%) and excellent (90%) medication adherence.
  
  Results: In this study, the average medication adherence rate was 92.3% ± 13.9%, and the good and excellent medication adherence rates were 88.9% and 79.5%, respectively in the study period of 9 months; the average medication adherence rate was 92.1% ± 13.2%, and the good and excellent rates were 84.6% and 80.8%, respectively at the end of the 9th month. The average medication adherence rate in the study period of 9 months was significantly higher than those reported in other literatures (P < 0.001). The average medication adherence rate at the end of the 9th month was also higher than those reported in other literatures except Taiwan of China (P < 0.001). The medication compliance rate was significantly higher than the standard good medication adherence (P < 0.001), but had no significant difference as compared with the standard excellent medication adherence (P > 0.05).
  
  Conclusion: The medication adherence of patients can be enhanced by improving the subjective factors of healthcare providers and caregivers.
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  Rehabilitation of Jiawei Xinglou Chengqi Decoction on hiccups in patients with phlegm-heat and fu-viscera excess syndrome caused by cerebral infarction

  WANG Heng, NI Jianli, HUANG Meiqin, WANG Jing

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 115-120. https://doi.org/10.12022/jnnr.2020-0050

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  Objective: To explore the rehabilitation effect and mechanism of Jiawei Xinglou Chengqi Decoction on hiccup in patients with phlegm-heat and fu-viscera excess syndrome caused by cerebral infarction.
  
  Methods: In a randomized controlled trial, 80 patients with hiccup after cerebral infarction with phlegm-heat and fu-viscera excess syndrome were randomly divided into Jiawei Xinglou Chengqi Decoction group (n = 40) and control group (n = 40). On the basis of conventional western medicine treatment, Jiawei Xinglou Chengqi Decoction group was treated with Jiawei Xinglou Chengqi Decoction for 10 days. At the end of 10-day treatment, the therapeutic effect for hiccup was evaluated. The frequency and duration of each hiccup, the concentrations of Ca^2＋, Mg^2＋ and Na^＋ in peripheral blood and serum motilin level were compared before treatment, at the end of 10-day treatment and 30 days after treatment.
  
  Results: At the end of 10-day treatment, hiccups in both groups were relieved, and the response rate of Jiawei Xinglou Chengqi Decoction group (92.1%) was significantly higher than that of the control group (82.1%) (P < 0.05). The frequency of hiccup and the duration of each hiccup after treatment in both groups were significantly lower than those before treatment (P < 0.01). The frequency of hiccup and the duration of each hiccup in Jiawei Xinglou Chengqi Decoction group were significantly lower than those in the control group at the end of 10-day treatment and 30 days after treatment (P < 0.05, P < 0.01). After treatment,
  the concentrations of Ca^2＋, Mg^2＋ and Na^2＋ in peripheral blood in both groups were higher than those before treatment, but the differences were not statistically significant (P > 0.05); the serum motilin levels were significantly increased (P < 0.05), but there was no significant difference between the two groups (P > 0.05).
  
  Conclusion: Jiawei Xinglou Chengqi Decoction has significant curative effect on hiccup after cerebral infarction with phlegm-heat and fu-viscera excess syndrome, and there are less adverse reactions during the treatment, but the mechanism of treatment is not clear.
Review
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  Progress in traditional Chinese medicine and rehabilitation for dysphagia in Parkinson’s disease

  CHEN Miao, HUANG Jianping

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 121-128. https://doi.org/10.12022/jnnr.2020-0040

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  Dysphagia in Parkinson’s disease (PD) is characterized by high incidence rate, hidden early symptoms, and low recognition rate, which can easily lead to complications such as aspiration pneumonia and malnutrition, affecting patients’ quality of life. The use of effective screening tools and objective instrument examinations is helpful for early identification of swallowing damage patterns, and provides the basis for individualized treatment including drug therapy, surgery and rehabilitation for dysphagia in PD. Based on the theory of holism, syndrome differentiation and disease differentiation, and meridian and acupoint theory, traditional Chinese medicine has certain advantages in the treatment of dysphagia in PD. Comprehensive rehabilitation and traditional Chinese medicine therapy are combined to optimize the treatment. This paper reviews the diagnosis, evaluation, treatment and rehabilitation of dysphagia in PD and the progress in treatment with traditional Chinese medicine, in order to provide help for neurologists, speech and swallowing therapist and other clinicians in the management of dysphagia in PD in clinical practice.
Case Report
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  Integrative traditional Chinese and western medicine for severe carbon monoxide encephalopathy: One case report

  QIAN Yijia, WANG Qiang

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 129-133. https://doi.org/10.12022/jnnr.2020-0011

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  Objective: To improve the knowledge of carbon monoxide (CO) encephalopathy among the masses and medical staff in rural areas and coal-burning areas.
  
  Methods: The clinical diagnosis and treatment of one elderly male patient with severe CO encephalopathy were described, and the clinical features, diagnosis, treatment and prognosis of this patient were summarized.
  
  Results: The main clinical manifestations of this patient with severe CO encephalopathy were paralysis, cognitive decline and secondary epilepsy. After the treatment of integrated traditional Chinese and western medicine and rehabilitation training, the patient’s paralysis and cognitive ability gradually improved, and there was no epileptic seizure.
  
  Conclusion: CO encephalopathy is a kind of delayed encephalopathy after acute CO poisoning. When treating patients with acute CO poisoning, the risk of neurological sequelae must be considered and effective intervention measures should be given as soon as possible to improve the prognosis.
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  Balance training combined with psychological counselling in the treatment of balance dysfunction after traffic accident: One case report

  SUN Chaolei, LU Liang, HUANG Liming

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 134-137. https://doi.org/10.12022/jnnr.2020-0037

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  Objective: To evaluate the effect of balance training combined with psychological counselling on patients with balance dysfunction after traffic accident.
  
  Methods: One patient after traffic accident was diagnosed of balance dysfunction, posttraumatic stress disorder, mild depression and anxiety after excluding organic injury. The patient was given balance training combined with psychological counselling, and the therapeutic response was evaluated by mental psychological scales.
  
  Results: After 20 times of balance training, the patient recovered from balance dysfunction and was able to cross the road alone, and the post-traumatic stress disorder was gradually relieved. The scores of Berg Balance Scale, Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were significantly improved.
  
  Conclusion: For the balance dysfunction mainly caused by post-traumatic stress disorder, anxiety and depression, routine rehabilitation training combined with psychotherapy may be an effective treatment strategy.
Teaching Research
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  Using subtypes of the disease of western medicine in the basic teaching of traditional Chinese medicine centered on syndrome differentiation and treatment for foreign students

  RONG Jingfeng, SCHR?DER Joana, CHI Hao, SIMA Dandan, ZHENG Xuanlu, PAN Weidong

  Journal of Neurology and Neurorehabilitation. 2020, 16(3): 138-142. https://doi.org/10.12022/jnnr.2020-0081

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  Foreign students who have not received the basic education of traditional Chinese culture tend to have doubts about traditional Chinese medicine when they are studying the traditional Chinese medicine centered on syndrome differentiation and treatment. They even think that the individualized diagnosis and treatment system of traditional Chinese medicine centered on symptoms is nonsense. By trying to make the subtypes of disease in western medicine correspond to the syndrome differentiation and treatment of traditional Chinese medicine centered on syndrome, the problem-based learning (PBL) is used to carry out the teaching of traditional Chinese medicine for foreign students, which can stimulate their interests in learning traditional Chinese medicine, promote them to deeply understand the theory of traditional Chinese medicine, and make the teaching of integrated Chinese and western medicine more feasible. This teaching method is also applicable to education for doctors of western medicine learning traditional Chinese medicine.