ABSTRACT
Objective:To explore the relationship between seizure cluster of temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and cortisol (COR) rhythm, and understand its mechanism from the perspective of neuroendocrine.Methods:Fifty-seven patients with unilateral TLE-HS were recruited from the Qinghai Provincial People′s Hospital from May 1st 2012 to December 31st 2020. According to the history of seizure clusters one month before admission, 27 patients were enrolled in seizure clusters group (SC group), 30 patients were included in without seizures cluster group (NSC group). The clinical characteristics were systematically analyzed and compared between the SC and NSC groups. Plasma COR levels were measured at 8:00, 16:00 and 24:00 (COR8, COR16 and COR0) on the same day, and bilateral magnetic resonance spectroscopy (MRS) diagnosis was performed in two groups. Independent sample t test, chi-square test, repeated analysis of variance, covariance analysis, and multivariate Logistic regression were used for statistical analysis. Results:Time effect, grouping effect and the interaction effect of the time and grouping in the level of COR were statistically significant. Covariance analysis excluded age as an influential factor, COR16, COR0 and the slope of COR8-16 in the SC group [(126.22±19.98) μg/L, (51.63±21.43) μg/L, -7.78±4.54] were higher than the NSC group [(97.70±18.55) μg/L, (31.90±10.73) μg/L, -12.40±4.16], and the difference was statistically significant ( F=5.587, 4.320, 4.013, all P<0.05). The slope of COR0-8 in the SC group (17.11±6.32) was lower than that in the NSC group (20.62±6.54), and the difference was statistically significant ( F=-2.065, P<0.05). There was no significant difference in lateralization of hippocampal sclerosis between the two groups, and there was no significant difference in the ratio of N-acetyl aspartic acid(NAA)/[choline(Cho)+creatinine(Cr)] in the unilateral hippocampal sclerosis zone of the two groups, but the NAA/(Cho±Cr) ratio of the contralateral hippocampus in the SC group (0.71±0.03) was lower than that in the NSC group (0.76±0.06),and the difference was statistically significant ( t=4.999, P=0.029). Multivariate Logistic regression analysis showed that COR16 ( OR=1.328, 95% CI 1.073-1.642, P=0.009), COR8-16 ( OR=3.657, 95% CI 1.404-9.525, P=0.008) were independent risk factors of seizure clusters in TLE-HS. Conclusion:COR rhythm disturbance may be the neuroendocrine basis of seizure clusters in patients with TLE-HS.
ABSTRACT
Objective:To analyze the risk factors for early neurological deterioration(END)in elderly patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods:Clinical data of 118 patients with AIS who had received thrombolysis were collected retrospectively.According to the occurrence of END, cases were divided into the END group(n=28)and the non-END group(n=90). Univariate analysis was used to compare general characteristics, clinical data, laboratory test results, TOAST classification, infarct location, and degree of culprit vessel stenosis between the two groups.Multivariate Logistic regression analysis was used to analyze the related factors for END.Results:Univariate analysis showed that the proportion of patients with diabetes mellitus and previous cerebral infarction was higher in the END group than in the non-END group( χ2=4.000 and 8.056, P=0.046 and 0.005). There were significant differences in National Institutes of Health Stroke Scale(NIHSS)score, time from onset to thrombolysis, thrombolysis time, swallowing dysfunction, albumin, leukocyte count, neutrophil count, lymphocyte count, glycosylated hemoglobin(HbA1c), creatinine, total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)and lipoprotein(a)levels between the two groups(all P<0.05). There were also significant differences between the two groups in TOAST classification, infarct location and degree of culprit vessel stenosis( χ2=13.109 and 9.509, Z=2.912, P=0.004, 0.023 and 0.004). Multivariate Logistic regression analysis showed that NIHSS score, HbA1c, cardiogenic stroke, degree of culprit vessel stenosis and leukocyte count on admission were independent risk factors for END( OR=1.122, 2.131, 1.965, 1.876 and 1.563, P=0.036, 0.024, 0.028, 0.030 and 0.041). Conclusions:NIHSS score, HbA1c, cardiogenic stroke, degree of culprit vascular stenosis and leukocyte count on admission are independent risk factors for END, which should be closely monitored and managed with well formulated preventive measures in order to improve the prognosis of AIS patients.