Inflammatory brain lesions preceding primary central nervous system lymphoma: a case report and genetic analysis.

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is an aggressive extranodal lymphoma exclusively occurring within the central nervous system. Inflammatory brain lesions as "sentinel lesions" of PCNSL are very rare. We present a rare case of PCNSL with preceding inflammatory lesions in an immunocompetent patient who underwent two biopsies, one craniotomy and two genetic testing. CASE REPORT: A 66-year-old male patient presented with left limb weakness and ataxia. Brain magnetic resonance imaging showed a contrast-enhancing lesion with perifocal brain edema in the near midline of right frontal lobe. Histological examination of a brain biopsy specimen revealed inflammatory lesion characteristics with infiltration of T-cell dominant lymphocytes and few B-cell. Given that the patient developed cerebral hematoma after biopsy, lesion resection by craniotomy was performed. An excised sample demonstrated mixed T-cell and B-cell infiltrating inflammatory lesions. Four months after total resection of the right frontal lobe lesion, another lesion appeared in the left frontal parietal lobe, which was diagnosed as diffuse large B-cell lymphoma by biopsy. In addition, genetic testing of the lesions at two different locations was performed, and the results showed that the inflammatory lesions had the same three gene (RELN, PCLO, and CREBBP) mutations as PCNSL. Interestingly, the three mutated genes are associated with tumor. CONCLUSION: Our present case is the first to demonstrate inflammatory brain lesions heralding PCNSL from genetic and pathological perspectives. This may help clinicians to select new auxiliary diagnostic methods for timely diagnosis of patients with suspected PCNSL.

An alternative therapy for drug-resistant epilepsy: transcutaneous auricular vagus nerve stimulation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies demonstrated that vagus nerve stimulation (VNS) is an effective therapy for drug-resistant epilepsy. Acupuncture is also used to treat epilepsy. This study was designed to examine the safety and effectiveness of transcutaneous auricular vagus nerve stimulation (ta-VNS) for patients with drug-resistant epilepsy.</p><p><b>METHODS</b>A total of 50 volunteer patients with drug-resistant epilepsy were selected for a random clinical trial to observe the therapeutic effect of ta-VNS. The seizure frequency, quality of life, and severity were assessed in weeks 8, 16, and 24 of the treatment according to the percentage of seizure frequency reduction.</p><p><b>RESULTS</b>In the pilot study, 47 of the 50 epilepsy patients completed the 24-week treatment; three dropped off. After 8-week treatment, six of the 47 patients (12%) were seizure free and 12 (24%) had a reduction in seizure frequency. In week 16 of the continuous treatment, six of the 47 patients (12%) were seizure free; 17 (34%) had a reduction in seizure frequency. After 24 weeks' treatment, eight patients (16%) were seizure free; 19 (38%) had reduced seizure frequency.</p><p><b>CONCLUSION</b>Similar to the therapeutic effect of VNS, ta-VNS can suppress epileptic seizures and is a safe, effective, economical, and widely applicable treatment option for drug-resistant epilepsy. (ChiCTR-TRC-10001023).</p>

Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Refractory Epileptic Seizures / 世界科学技术-中医药现代化

This study was aimed to examine whether transcutaneous auricular vagus nerve electrical stimulation (ta-VNS) at auricular concha area was an effective approach for patients with refractory seizures. Double-blind transcu-taneous nerve electrical stimulation was applied in this study. A pilot study was conducted firstly on 50 patients with refractory seizures to preliminarily observe the therapeutic effect of ta-VNS. Then, a randomized controlled trial (RCT) was conducted on another 144 epilepsy patients who were randomly assigned to the ta-VNS group (n = 98), and the transcutaneous non-auricular vagus nerve electrical stimulation (tn-VNS) control group (n = 46). The treat-ment was performed twice a day for 24 weeks. Patients who were neither in the ta-VNS group nor the tn-VNS group accepted medication at the same time. The seizure frequency and severity were assessed in the 8-week, 16-week and 24-week of the treatment according to the modified Engel scale. The results showed that in the pilot study, after 8-week treatment, 6 out of 50 epilepsy patients were seizure free; and 12 cases had a 50%-89% reduction in seizure frequency. After 24-week treatment, 8 cases were seizure free; 2 cases had a more than 90% reduction in seizure frequency; and 9 cases had a 50%-89% reduction in seizure frequency. In the RCT study of 144 epilepsy patients, after 8-week treatment, 10 out of 98 patients in the ta-VNS group were seizure free; 6 cases had a more than 90% reduction in seizure frequency; and 25 cases had a 50%-89% reduction in seizure frequency. After 24-week treatment, 15 cases were seizure free; 6 cases had a more than 90% reduction in seizure frequency; and 26 cases had a 50%-89% reduction in seizure frequency. After 8-week treatment, in the tn-VNS control group, only 3 out of 46 patients were seizure free; 2 cases had a more than 90% reduction in seizure frequency; and 9 cases had a 50%-89% reduction in seizure frequency. After an additional 16-week treatment of ta-VNS, 7 out of 46 patients were seizure free; 14 had a 50%-89% reduction in seizure frequency. There were significant differences in seizure frequency reduction among groups (P< 0.05). It was concluded that ta-VNS, which had similar therapeutic effect as VNS, was able to suppress epileptic seizures. It is a safe, effective, economic, and applicable treatment option for the treatment of refractory epilepsy.