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SUMMARY: Intracranial aneurysm is a common cerebrovascular disease with high mortality. Neurosurgical clipping for the treatment of intracranial aneurysms can easily lead to serious postoperative complications. Studies have shown that intraoperative monitoring of the degree of cerebral ischemia is extremely important to ensure the safety of operation and improve the prognosis of patients. Aim of this study was to probe the application value of combined monitoring of intraoperative neurophysiological monitoring (IONM)-intracranial pressure (ICP)-cerebral perfusion pressure (CPP) in craniotomy clipping of intracranial aneurysms. From January 2020 to December 2022, 126 patients in our hospital with intracranial aneurysms who underwent neurosurgical clipping were randomly divided into two groups. One group received IONM monitoring during neurosurgical clipping (control group, n=63), and the other group received IONM-ICP-CPP monitoring during neurosurgical clipping (monitoring group, n=63). The aneurysm clipping and new neurological deficits at 1 day after operation were compared between the two groups. Glasgow coma scale (GCS) score and national institutes of health stroke scale (NIHSS) score were compared before operation, at 1 day and 3 months after operation. Glasgow outcome scale (GOS) and modified Rankin scale (mRS) were compared at 3 months after operation. All aneurysms were clipped completely. Rate of new neurological deficit at 1 day after operation in monitoring group was 3.17 % (2/63), which was markedly lower than that in control group of 11.11 % (7/30) (P0.05). Combined monitoring of IONM-ICP-CPP can monitor the cerebral blood flow of patients in real time during neurosurgical clipping, according to the monitoring results, timely intervention measures can improve the consciousness state of patients in early postoperative period and reduce the occurrence of early postoperative neurological deficits.
El aneurisma intracraneal es una enfermedad cerebrovascular común con alta mortalidad. El clipaje neuroquirúrgico para el tratamiento de aneurismas intracraneales puede provocar complicaciones posoperatorias graves. Los estudios han demostrado que la monitorización intraoperatoria del grado de isquemia cerebral es extremadamente importante para garantizar la seguridad de la operación y mejorar el pronóstico de los pacientes. El objetivo de este estudio fue probar el valor de la aplicación de la monitorización combinada de la monitorización neurofisiológica intraoperatoria (IONM), la presión intracraneal (PIC) y la presión de perfusión cerebral (CPP) en el clipaje de craneotomía de aneurismas intracraneales. Desde enero de 2020 hasta diciembre de 2022, 126 pacientes de nuestro hospital con aneurismas intracraneales que se sometieron a clipaje neuroquirúrgico se dividieron aleatoriamente en dos grupos. Un grupo recibió monitorización IONM durante el clipaje neuroquirúrgico (grupo de control, n=63) y el otro grupo recibió monitorización IONM-ICP-CPP durante el clipaje neuroquirúrgico (grupo de monitorización, n=63). Se compararon entre los dos grupos el recorte del aneurisma y los nuevos déficits neurológicos un día después de la operación. La puntuación de la escala de coma de Glasgow (GCS) y la puntuación de la escala de accidentes cerebrovasculares de los institutos nacionales de salud (NIHSS) se compararon antes de la operación, 1 día y 3 meses después de la operación. La escala de resultados de Glasgow (GOS) y la escala de Rankin modificada (mRS) se compararon 3 meses después de la operación. Todos los aneurismas fueron cortados por completo. La tasa de nuevo déficit neurológico 1 día después de la operación en el grupo de seguimiento fue del 3,17 % (2/63), que fue notablemente inferior a la del grupo de control del 11,11 % (7/30) (P 0,05). La monitorización combinada de IONM-ICP-CPP puede controlar el flujo sanguíneo cerebral de los pacientes en tiempo real durante el corte neuroquirúrgico; de acuerdo con los resultados de la monitorización, las medidas de intervención oportunas pueden mejorar el estado de conciencia de los pacientes en el período postoperatorio temprano y reducir la aparición de problemas postoperatorios tempranos y déficits neurológicos.
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ObjectiveTo investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia. MethodsSixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device. ResultsAfter treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R2 > 0.804, P < 0.001). ConclusionThe combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.
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The diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy relies on clinical features, demyelinating changes on motor and sensory nerve conduction studies, elevated cerebrospinal fluid protein, peripheral nerve image, nerve pathology, and response to immune therapy. Each diagnostic proof should be interpreted in light of clinical background and other findings, to avoid misdiagnosis or overdiagnosis, treatment delay or unnecessary treatment with immunotherapy.
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Epilepsy is a common neurological disease, which is caused by transient brain dysfunction due to sudden abnormal discharges of neurons.Repetitive transcranial magnetic stimulation (rTMS) is a neuroelectrophysiological technique developed based on transcranial magnetic stimulation that regulates the excitability of the cerebral cortex, presenting the advantages of painless, non-invasiveness, good safety and less adverse events.In addition, rTMS is widely used in experimental research and clinical treatment, which has a high efficacy on the treatment of central nervous system diseases, and important value for the detection and treatment of pediatric epilepsy.This paper reviews the principle, mechanism, application and safety of rTMS in the treatment of pediatric epilepsy.
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OBJECTIVE: To explore the characteristics of peripheral nerve injury caused by occupational acute trimethyltin chloride(TMT) poisoning. METHODS: The clinical manifestations and test data of neurotic electrophysiology, pure tone hearing threshold and acoustic immittance in 16 patients with occupational acute TMT poisoning were retrospectively analyzed. The patients were followed up after 6 months of discharge. RESULTS: Among the 16 cases of occupational acute TMT poisoning, 6, 4 and 6 cases were with mild, moderate and severe poisoning, respectively. For the firstly appeared symptoms, 7 cases had abnormal mental behavior and memory loss, 5 cases had tinnitus and hearing loss, 5 cases had decreased visual acuity, 2 cases had diplopia and 2 cases had binocular pain. The main clinical manifestations included 8 cases of disturbance of consciousness, and 6 cases of abnormal orientation and aggressive behavior. After correction of hypokalemia, 7 cases of patients had limb muscle weakness, hypomyotonia and weakened tendinous reflect, 9 cases had decreased tactile sensation below the groin in the lower limbs, and 6 cases had instability of walking. The main manifestations of neuroelectrophysiological detection were: 9 patients(accounting for 56.3%) showed abnormal neuroelectromyography, 4 cases of severe poisoning had damaged motor nerve, sensory nerve axon and myelin sheath, and the proximal nerve was also partially damaged. There were 2 cases of moderate poisoning showing abnormal symptoms, the axon and myelin sheath of sensory nerve were damaged, one common peroneal nerve was demyelinated. Three cases of mild poisoning had one common peroneal nerve axon damaged, one proximal tibial nerve damaged, and the axon and myelin sheath of sensory nerve were damaged. Brainstem auditory evoked potential I wave and visual evoked potential P100 latency prolonged and amplitude decreased in some of the patients with mild, moderate and severe poisoning. The sensorineural hearing loss occurred in 81.3% of patients. CONCLUSION: Occupational acute TMT poisoning can cause damage to motor nerve, sensory nerve axon and myelin sheath of extremities. Both distal and proximal nerves might be involved. It can also damage cochlear hair cells and optic nerve. Attention should be paid to the early treatment of peripheral nerve damage, cochlear hair cell and optic nerve damage caused by TMT.
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Objective:To evaluate peripheral nerve injury in convalescent patients with peripheral paralysis after stroke, and explore the correlation between injured nerve and upper limb motor function. Methods:From December, 2015 to October, 2019, 77 stroke patients were examined motor nerve conduction, F wave, skin sympathetic response (SSR) and electromyography (EMG) on the affected side upper limbs. They were divided into the normal group and the injured group, according to motor nerve conduction. They were assessed with simplified Fugl-Meyer Assessment-Upper Extremities (FMA-UE), and the correlation between the neuroelectrophysiological parameters and FMA-UE score was analyzed. Results:There were 41 patients (53.25%) with peripheral nerve injury (injured group). FMA-UE score was less in the injured group than in the normal group (t = 2.193, P < 0.05), with lower amplitude and occurrence rate of F wave (t > 2.002, P < 0.05), and lower amplitude and shorter latency of SSR (t > 3.140, P < 0.01), although the occurrence rate of F wave and latency of SSR was in the reference range. There was correlation between numbers of injured nerves and FMA-UE score (r = -0.858, P < 0.001). Multivariate linear regression analysis showed that the amplitudes of ulnar, radial and musculocutaneous nerves affected the FMA-UE score (B > 0.317, P < 0.05). Conclusion:There may be peripheral nerves injury for patients with upper limb peripheral paralysis after stroke, which may impair the outcome of motor recovery, and need to be avoided and treated.
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BACKGROUND: Three-dimensional (3D) printing technology can be used to prepare bioscaffolds to meet the requirements of shape, size and surface morphology of spinal cord implantation. OBJECTIVE: To investigate the effect of 3D printed collagen/chitosan scaffolds on the recovery of neurological function in rats with spinal cord injury. METHODS: The collagen/chitosan scaffolds were prepared by freeze-drying method with a mass ratio of 2:1. The 3D printed collagen/chitosan scaffolds were prepared by 3D printer. The porosity and elastic modulus of the scaffolds were measured, and the morphology of the scaffolds was observed by electron microscope. Neural stem cells were co-cultured with 3D printed collagen/chitosan scaffold, and common collagen/chitosan scaffold, respectively, for scanning electron microscope and cell counting kit-8 assay. Forty female Sprague-Dawley rats (provided by Academy of Military Sciences of PLA) were randomly divided into four groups: sham-operated, spinal cord injury, common collagen/chitosan scaffold, and 3D printed collagen/chitosan scaffold groups. The rats in the latter three groups were used to prepare complete spinal cord transected injury model, followed by filled with the corresponding scaffold materials. Basso, Beattie, Bresnahan scores of the posterior limb, slope test, neuroelectrophysiological detection and MRI were conducted at each time point after surgery. The study was approved by the Animal Ethics Committee of Tianjin Key Laboratory of Traumatic Brain Injury. RESULTS AND CONCLUSION: (1) Scanning electron microscope showed that 3D printed collagen/chitosan scaffolds had interconnected porous structure, and the internal structure of common collagen/chitosan scaffolds was disordered. (2) Neural stem cells grew well on the surface of scaffolds and fully extended. The activity of neural stem cells on the surface of 3D printed collagen/chitosan scaffolds was significantly higher than that of the common collagen/chitosan scaffold group (P < 0.05). (3) The porosity and modulus of elasticity in the 3D printed collagen/chitosan scaffold group were higher than those in the common collagen/chitosan scaffold group (P < 0.05). (4) The Basso, Beattie, Bresnahan score in the 3D printed collagen/chitosan scaffold group was higher than that in the spinal cord injury and common collagen/chitosan scaffold groups (P < 0.05) at 3-8 weeks after surgery, and the angle of slope experiment at 4, 6 and 8 weeks after surgery was higher than that in the spinal cord injury and common collagen/chitosan scaffold groups (P < 0.05). (5) The amplitude of motor evoked potential and somatosensory evoked potential in the 3D printed collagen/chitosan scaffold group were higher than those in the spinal cord injury and common collagen/chitosan scaffold groups (P < 0.05), and the latency of motor evoked potential and somatosensory evoked potential were shorter than those in the spinal cord injury and common collagen/chitosan scaffold groups (P < 0.05). (6) MRI plain scan showed that the amplitude of motor evoked potential and somatosensory evoked potential in the 3D printed collagen/chitosan scaffold group were higher than those in the spinal cord injury and common collagen/chitosan scaffold groups (P < 0.05). 3D printed collagen/chitosan scaffold group had good continuity and more nerve fiber bundles passing through the injury site. (7) The results imply that 3D printed collagen/chitosan scaffolds can promote the repair of nerve function in the spinal cord injury rats.
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Insomnia is one of the common sleep disorders. Despite of wide recognition that patients with insomnia subjectively experience impaired daytime functioning, there is little consistent objective evidence of neurobehavioural performance deficits. However, evidences of potential cognitive impairment in insomnia patients have been found in neuroimaging, neurobiochemistry and neuroelectrophysiology. This paper describes the characteristics of cognitive impairment in insomnia patients, then introduces the evidence of potential cognitive impairment found in neuroimaging, neurobiochemistry and neuroelectrophysiology, and finally analyzes the possible causes of this phenomenon.
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@#Objective To analyze the neuroelectrophysiological characteristics of peripheral neuropathy after chronic obstructive pulmonary disease. Methods From January to December, 2016, a total of 60 patients of chronic obstructive pulmonary disease with peripheral neuropathy were reviewed the motor conduction velocity and compound muscle action potential amplitude of median, ulnar, tibial, peroneal nerves; the sensory conduction velocity and sensory nerve action potential amplitude of median, ulnar, tibial, superficial peroneal nerves; and the skin sympathetic response of limbs. Results The incidence of abnormalities was higher in amplitude than in conduction velocity of motor nerve and sensory nerves (χ2=190.026, P<0.001). The incidence of abnormal conduction velocity was similar in motor nerve and sensory nerves (χ2=1.538, P>0.05), as well as the abnormal action potential amplitude (χ2=2.839, P>0.05). The incidence of abnormal conduction was similar with abnormal skin sympathetic response (χ2=0.001, P>0.05). The incidence of abnormalities of nerve conduction study (χ2=81.114, P<0.001) and abnormal skin sympathetic response (χ2=5.689, P<0.05) was more in lower limbs than in upper limbs. Conclusion The peripheral neuropathy after chronic obstructive pulmonary disease characters mainly as motor-sensory multiple neuropathy, involving motor, sensory and autonomic nerve. The axonal damage is significant, with the similar severity between motor and sensory nerves, as well as between the large and small nerves.
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Objective The change of thyroid hormones affects male sexual function, but the underlying physiological mechanism is not yet clear.The aim of this study was to explore the association of thyroid hormones with abnormal penile neuro-electrophysiology in patients with premature ejaculation (PE).Methods This retrospective study included 52 acquired PE (APE) patients aged 35.36 ± 8.39 years and 24 healthy males aged 32.87±7.45 years.We measured the levels of thyroid hormones in all the subjects and, based on the latency time of penile sympathetic skin responses (PSSR), classified the APE patients into a normal (n=31) and an abnormal PSSR type (n=31).Results The concentration of total tetraiodothyronine (TT4) in the serum was significantly higher in the APE patients than in the normal control ([102.81±18.37] vs [92.68±11.56] nmol/L, P=0.018).The levels of serum TT4 and free tetraiodothyronine (FT4) were both markedly increased in the APE patients of the abnormal PSSR type as compared with those of the normal PSSR type ([113.28±20.89] vs [95.72±12.42] nmol/L, P<0.001 and [12.02±0.88] vs [10.81±1.63] nmol/L, P=0.003).The FT4 concentration was correlated negatively with the latency time of PSSR (r=-0.363, P=0.008) and positively with the Premature Ejaculation Diagnostic Tool (PEDT) scores (r=0.455, P=0.001).Conclusion Abnormal PSSR may be associated with elevated levels of thyroid hormones in APE patients, and regulation of thyroid hormone levels may help improve the symptoms of PE with abnormal PSSR.
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In recent years, neuro-electrophysiological techniques, as objective evaluation methods, have been gradually used in func-tional evaluation, guiding clinical rehabilitation programs and judging prognosis after stroke. They were proved to judge the integrity of cen-tral nervous system and conduction function and evaluate neuromuscular function. Nerve conduction, needle electromyography, H reflex, F wave, sympathetic skin response, motor-evoked potentials, somatosensory-evoked potentials, brain stem auditory-evoked potentials and sur-face electromyography were reviewed in this article.
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Brainstem infarction accounts for about 9% to 21.9% of all cerebral infarctions. This article reviews the etiology of brainstem infarction and its pathogenesis,clinical manifestation,diagnosis,and treatment.
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Objective To investigate the clinical characteristics of diabetes complicated with peripheral neu- ropathy and increase the cognition of diabetic peripheral neuropathy in clinical work.Methods The clinical data of 160 diabetic patients were analyzed with retrospective analysis.Results 118 diabetic patients had different levels neuroelectrophysiologic abnormality,and the incidence rate was 73.8 %.The cure rate of diabetic peripheral neuropa- thy was 11.0%.Conclusion The incidence of peripheral neuropathy is high in diabetic patients,neuroelec- trophysiologic examination is a sensitive index in diagnosis of diabetic peripheral neuropathy,and the therapeutic ef- fect of diabetic peripheral neuropathy is poor.
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Objective:To analyze the clinical characteristics,neuroelectrophysiological changes and prognosis in children with Acute Flaccid Paralysis(AFP) caused by non-poliovirus(NPV) infections,and to explore it’s possible pathogenesis. Methods: Clinical observation,EV-antibody(EV-Ab) detection in blood serum,creatase detection in blood serum,cerebrospinal fluid(CSF) check-up and electrophysiologic study(EPS) were done in 32 AFP cases by NPV infections;and the result were compared. Results:(1)Children at every age were involved,mostly at age of 1~3 years;it occurred in every season,mostly in summer and autumn;Before palsy,most of them were affected by viral infections in respiratory tract or digestive tract;29 cases had AFP in one side of lower extremity with 3~4 grade muscle force,only 3 cases presented dissymmetrical AFP in both lower extremities,all cases had weakened tendon reflex,and none had sensory disorder.(2)Of 32 cases,10 presented Coxsackie virus antibody(CBV-IgM)(+) and 12 ECHOV-IgM(+) in blood serum,2 presented CBV-IgM(+) and slightly increased protein in CSF,and the rest were normal;2 cases had slightly increased CK in blood serum during climax,and presented normal in convalescent period. (3)Electrophysiologic changes included the following 29 cases had cutdowned compound muscle action potential(CMAP) wave amplitude in motor nerves,especially in the distal amplitude,even disappeared,and had normal nerve conduction velocity(NCV) in motor nerves,the present rate of F-wave was decreased,all cases had normal sensory nerve action potential(SNAP),and normal sensory nerve conduction velocity(SCV),electromyogram of 26 cases indicated neurogenic lesion,and only 3 cases had no obvious changes.(4)Majority of 32 cases recovered in two weeks,and the prognosis was good. Conclusion:The possible mechanism of AFP in children with NPV infections is that the induced immune reaction from NPV infections leaded to the motor nerve’s axonal slight degeneration,especially in its distal amplitude.
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ObjectiveTo explore the relationship between the changes of neuro-electrophysiology and prognosis in children with Guillain-Barr? syndrome(GBS).MethodsThirty-eight children with GBS were divided into group A(rapid recovery,n=16) and group B(slow recovery,n=22) according to the time required for podosoma motor function recovery,at the same time,they were divided into the better prognosis group(n=22) and the worse prognosis group(n=16),for analyzing the difference between group A and B in terms of age,preceding infections,maximal Hughes grades and neuro-electrophysiology including motor conduction velocity(MCV),distal complex muscle action potential(dCMAP) and F wave,and investigating the related factors with the prognosis of GBS.Results1.MCV of tibial nerve was(40.2?2.53) m/s and(33.4?2.46) m/s in group A and group B,respectively;MCV of peroneal nerve was(45.2?3.23) m/s and(38.3?2.16) m/s in group A and group B,respectively,and the difference between group A and group B was significant(Pa0.05);abnormal rate of F wave(68.42%) was higher than abnormal rate of MCV(42.11%) and dCMAP(42.11%)(Pa