Risk factors of elevated blood ammonia level in epilepsy patients treated with lamotrigine.

AbstractThe aim of this study was to explore the effect of lamotrigine (LTG) on blood ammonia level in patients with epilepsy and identify risk factors affecting blood ammonia level. This study included 91 epilepsy patients who were treated with LTG at Department of Neurology, Zhongshan Hospital, Xiamen University from January 2011 to April 2016, and were followed up for 3 years. Blood samples were taken during the interictal state and analyzed for blood LTG and ammonia levels. Total of 46.1% of the samples exceeded the median blood ammonia level, and 2.1% of patients had hyperammonemia. Blood ammonia level was positively correlated with LTG blood concentration. LTG combined with valproic acid therapy, seizure within 1 year, and elevated neutrophils affected blood ammonia level. Blood ammonia level was significantly correlated with plasma concentration of LTG. LTG combined with valproic acid therapy, seizure within 1 year, and elevated neutrophils may be risk factors for elevated blood ammonia level in epilepsy patients treated with LTG.

Comparison of Electroencephalography in Patients With Seizures Caused by Neurosyphilis and Viral Encephalitis.

Background: Neurosyphilis (NS) lacks specificity in clinical and imaging features, and patients are frequently misdiagnosed as viral encephalitis when they present with seizures. This study aimed to compare electroencephalography (EEG) in patients with seizures resulting from the two diseases and provide guidance for differential diagnosis. Methods: A retrospective study on patients diagnosed with neurosyphilis and viral encephalitis with seizures in the Department of Neurology, Zhongshan Hospital, Xiamen University from 2012 to 2020. Results: A total of 39 patients with seizures caused by neurosyphilis and 40 patients with seizures caused by viral encephalitis were included. Chi-square test analysis showed that compared with patients with viral encephalitis, patients with neurosyphilis mainly developed in middle-aged and elderly people (p < 0.001), were more likely to have temporal epileptiform discharges (p < 0.001), and less likely to have status epilepticus (SE) (p = 0.029). There was difference between two groups in the EEG performance of lateralized periodic discharges (LPDs) (p = 0.085). The two groups were matched for age and sex by case-control matching, and 25 cases in each group were successfully matched. Patients with neurosyphilis were more likely to have temporal epileptiform discharges than those with viral encephalitis (p = 0.002), and there were no significant differences in LPDs (p = 0.077) and SE (p = 0.088) between two groups. Conclusion: When EEG shows temporal epileptiform discharges, especially in the form of LPDs, we should consider the possibility of neurosyphilis.

Phenobarbital versus valproate for generalized convulsive status epilepticus in adults (2): A multicenter prospective randomized controlled trial in China (China 2-P vs. V).

OBJECTIVE: A multicenter study of phenobarbital versus valproate (i.e., the China 2-P vs. V study) was conducted to compare the efficacy and safety of phenobarbital and valproate for generalized convulsive status epilepticus (SE) in a multicenter trial design. METHODS: Three improvements (uniform intravenous pumping, pump speed adjustment according to adverse events and blood drug level monitoring) over a previous study were made regarding an intravenous regimen of phenobarbital and valproate in a multicenter, prospective, randomized, controlled study. Long-term electroencephalography (EEG) monitoring was performed after initial drug treatment. Termination, relapse, adverse event and poor prognosis rates in patients with generalized convulsive status epilepticus (GCSE) were compared. RESULTS: The rate of GCSE termination within one hour were significantly higher in the phenobarbital group (33 cases) than in the valproate group (36 cases) (84.8 % vs. 63.9 %, P = 0.048), but the rates of nontermination of EEG epileptic discharge within one hour were similar between the two groups (12.1 % vs. 8.3 %, P = 0.702). The relapse and adverse event rates were not significantly different between groups, but 3 hypoventilation events and 1 hypotension event occurred in the phenobarbital group compared to 0 in the valproate group. There were no cases of epileptiform EEG discharge relapse in the phenobarbital group, compared to 1 case in the valproate group. CONCLUSIONS: The phenobarbital regimen evaluated in this study has a higher GCSE termination rate than the valproate regimen, indicating that the former is suitable for countries, regions and individuals with limited access to new antiepileptic drugs or limited economic means.

Long noncoding RNA MALAT1 and its target microRNA-125b are potential biomarkers for Alzheimer's disease management via interactions with FOXQ1, PTGS2 and CDK5.

This study aimed to investigate the intercorrelation among long noncoding RNA MALAT1 (lnc-MALAT1), microRNA-125b (miR-125b), FOXQ1, PTGS2 and CDK5, as well as their correlations with disease risk, severity and progression of Alzheimer's disease (AD). In total, 120 AD patients, 120 Parkinson's disease (PD) patients and 120 controls were enrolled. Cerebrospinal fluid (CSF) samples were collected from 50 AD patients, 50 PD patients and 50 controls; plasma samples were obtained from all participants. Lnc-MALAT1, miR-125b, FOXQ1, PTGS2 and CDK5 were detected by RT-qPCR. CSF lnc-MALAT1/FOXQ1 and plasma lnc-MALAT1 were downregulated, while CSF miR-125b/PTGS2/CDK5 and plasma miR-125b/PTGS2 were upregulated in AD patients compared to PD patients and controls, which differentiated AD patients from PD patients and controls, as demonstrated by ROC curve analyses. In AD patients, CSF/plasma lnc-MALAT1 negatively correlated with miR-125b and PTGS2 but positively correlated with FOXQ1; CSF/plasma miR-125b negatively correlated with FOXQ1 but positively correlated with PTGS2/CDK5. In addition, CSF/plasma lnc-MALAT1 and FOXQ1 correlated with alleviated disease severity, while miR-125b, PTGS2 and CDK5 correlated with exacerbated disease severity, which were manifested by their correlations with MMSE score, Aß42, t-tau and p-tau in AD patients. However, their correlations with MMSE score, Aß42, t-tau and p-tau were weak in PD patients and controls. Notably, CSF but not plasma lnc-MALAT1 and miR-125b could predict the MMSE score decline at 1 year, 2 years and 3 years in AD patients. In conclusion, lnc-MALAT1 and its target miR-125b are potential biomarkers for AD management via their intercorrelation with FOXQ1, PTGS2 and CDK5.

High Stress Hyperglycemia Ratio Predicts Poor Outcome after Mechanical Thrombectomy for Ischemic Stroke.

OBJECTIVE: The present study aimed to evaluate the association between stress hyperglycemia ratio (SHR) and outcome at 3 months after mechanical thrombectomy (MT) for acute occlusion in the anterior circulation. METHODS: Data from 160 consecutive patients with large vessel occlusion in the anterior circulation who underwent MT from May 2013 to March 2018 were retrospectively reviewed. SHR was calculated as the fasting glucose concentration divided by the estimated average glucose concentration (derived from the glycosylated hemoglobin level). Patients were dichotomized into 2 groups in accordance with the median SHR. Univariate and multivariate analyses were used to identify predictors of functional outcome. Good and poor outcomes were defined as modified Rankin Scale scores of 0-2 and 3-6, respectively. RESULTS: patients with unfavorable outcome had significantly higher levels of SHR than those with favorable outcome (median in SHR = 1.02 versus .84, P = .000). The median SHR was .96. Univariate analysis showed that significantly more patients with a poor outcome had SHR ≥ .96 compared with those with a good outcome (65.2% versus 31.0%, P = .000). After adjusting for potential covariates, Increased SHR (odds ratio [OR] 6.97, 95% confidence intervals [CI] 1.22-39.65, P = .029, for continuous SHR levels) and SHR ≥ .96 (OR 3.12, 95% CI 1.39-6.96, P = .006) remained independent predictors of poor outcome. CONCLUSIONS: Increased SHR is strongly correlated with poor outcome at 3 months after MT for proximal artery occlusion in the anterior circulation.

Intensive Statin Therapy for Acute Ischemic Stroke to Reduce the Number of Microemboli: A Preliminary, Randomized Controlled Study.

BACKGROUND: To assess whether intensive statin therapy reduces the occurrence of microemboli in patients with acute ischemic stroke. METHODS: Patients with acute ischemic stroke within 72 h of onset were randomized to the intensive statin (atorvastatin 60 mg/day, adjusted to 20 mg/day after 7 days) and control (atorvastatin 20 mg/day) groups. Combined aspirin and clopidogrel were used for antiplatelet therapy. Microemboli were monitored by transcranial Doppler on days 1 (pre-treatment), 3, and 7. Metalloproteinase-9 (MMP-9), high-sensitivity C-reactive protein (hs-CRP), and National Institutes of Health Stroke Scale (NIHSS) score were assessed on days 1 and 7. The modified Rankin scale (mRS) was used on day 90. The primary outcome was the proportion of patients with microemboli on day 3. RESULTS: There were 35 (58.3%) and 30 (52.6%) patients with microemboli in the intensive statin (n = 60) and control (n = 57) groups, respectively, on day 1 (p = 0.342). On day 3, there were significantly less microemboli in the intensive statin group (n = 9; 15.0%) compared with controls (n = 16; 28.1%; p = 0.002). No difference was observed in MMP-9 and hs-CRP levels on day 1, but on day 7, MMP-9 (median 79.3 vs. 95.9 µg/L; p = 0.004) and hs-CRP (median 2.01 vs. 3.60 mg/L; p = 0.020) levels were lower in the intensive statin group compared with controls. There were no differences in NIHSS scores on days 1 and 7. There was no difference in mRS on day 90. CONCLUSION: Intensive atorvastatin therapy in patients with acute ischemic stroke reduces the occurrence of microemboli and inflammation, with no overt adverse events.

A hydrogel biosensor for high selective and sensitive detection of amyloid-beta oligomers.

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive cognitive and memory impairment. It is the most common neurological disease that causes dementia. Soluble amyloid-beta oligomers (AßO) in blood or cerebrospinal fluid (CSF) are the pathogenic biomarker correlated with AD. METHODS: A simple electrochemical biosensor using graphene oxide/gold nanoparticles (GNPs) hydrogel electrode was developed in this study. Thiolated cellular prion protein (PrPC) peptide probe was immobilized on GNPs of the hydrogel electrode to construct an AßO biosensor. Electrochemical impedance spectroscopy was utilized for AßO analysis. RESULTS: The specific binding between AßO and PrPC probes on the hydrogel electrode resulted in an increase in the electron-transfer resistance. The biosensor showed high specificity and sensitivity for AßO detection. It could selectively differentiate AßO from amyloid-beta (Aß) monomers or fibrils. Meanwhile, it was highly sensitive to detect as low as 0.1 pM AßO in artificial CSF or blood plasma. The linear range for AßO detection is from 0.1 pM to 10 nM. CONCLUSION: This biosensor could be used as a cost-effective tool for early diagnosis of AD due to its high electrochemical performance and bionic structure.

Relationship of plasma matrix metalloproteinase-9 and hematoma expansion in acute hypertensive cerebral hemorrhage.

In the present study, we aimed to investigate the relationship of plasma matrix metalloproteinase-9 (MMP-9) and hematoma expansion (HE) in acute hypertensive cerebral hemorrhage (AHCH) (HE-in-AHCH). Patients with hypertensive cerebral hemorrhage, confirmed by head computed tomography (CT) within 12 h of onset, were prospectively collected. Venous blood was sampled within 4 h of the confirmation to determine the serum MMP-9 concentration. The blood pressure and National Institute of Health Stroke Score of the patients were recorded on hospital admission. CT re-scanning was performed within 42-54 h of the first head CT examination or immediately after worsening of the patients' consciousness disorder. The relationship between MMP-9 level and HE was analyzed. A total of 186 patients were included. Of these patients, 41 had HE (22.0%). Multivariate logistic regression analysis showed that, in addition to the short interval between onset and the first CT examination, and the irregularity of hematoma shape, increasing MMP-9 level was an independent risk factor for HE-in-AHCH (OR value = 15.65, 95% CI: 5.30-46.15). Moreover, increasing plasma MMP-9 level was identified as an independent risk factor in patients with HE-in-AHCH.

Association of the Apolipoprotein E polymorphism with migraine: a meta-analysis.

BACKGROUND: Apolipoprotein E (ApoE) gene has been reported to be associated with migraine and tension-type headache (TTH), but the results are conflicting. This study aimed to evaluate the association of ApoE with migraine by a meta-analysis. METHODS: MEDLINE, ISI Web of Knowledge, The Cochrane Central Register of Controlled Trials, and EMBASE databases were searched to identify eligible studies published in English from 2000 to 2014. Data were extracted using standardized forms. The association was assessed by relative risk (RR) with 95% confidence intervals (CIs) using a fixed or random effects model. RESULTS: Four studies, comprising 649 migraineurs, 229 TTH subjects and 975 controls, met all the criteria and were included in the meta-analysis. No significant difference was found comparing genotypic and allelic frequencies in the case of migraineurs versus controls and TTH subjects versus controls. Only when migraineurs and TTH subjects were considered as a whole group, ApoE4 was found to increase the relative risk of headache by 1.48 (95% CI 1.16, 1.90; P = 0.002), compared to controls. CONCLUSIONS: ApoE ε4 allele is not associated with migraine susceptibility, but is positively related to headache (including migraine and TTH).

Retrospective analysis of bevacizumab in combination with fotemustine in chinese patients with recurrent glioblastoma multiforme.

The aim of this study was to assess the activity and safety of bevacizumab (BEV) and fotemustine (FTM) for the treatment of recurrent glioblastoma multiforme (GBM) patients and explore the potential prognostic parameters on survival. This study retrospectively analyzed all patients with GBM who were treated with at least one cycle of BEV and FTM from July 2010 to October 2012. A total of 176 patients with recurrent GBM were enrolled. The response rate and disease control rate were 46.6% and 90.9%, respectively. A 6-month PFS rate of 33.3% (95% CI: 26.5%-40.3%) and a median PFS of 5.0 (95% CI: 2.4-7.5) months were observed. The median OS was 8.0 (95% CI: 6.7-9.2) months. Multivariate analysis showed that risk factors with a significant influence on the PFS of all patients were Karnofsky Performance Status (KPS) (≥70 versus <70, HR = 0.53, 95% CI: 0.39-0.73, and P = 0.01) and MGMT status (methylated versus unmethylated, HR = 0.69, 95% CI: 0.52-0.97, and P = 0.04). The most common treatment-related adverse events were fatigue, proteinuria, hypophonia, hypertension, thrombocytopenia, anemia, and neutropenia. In conclusion, combination of BEV with FTM is well tolerated and may derive some clinical benefits in recurrent GBM patients. Higher KPS and MGMT promoter hypermethylation were suggested to be associated with prolonged survival.