Pub Date : 2023-10-01DOI: 10.22141/2224-0713.19.5.2023.1014
Y.O. Palamarchuk
The article presents a clinical case of multiple sclerosis (MS) in a 10-year-old female patient, the use of one of the advanced magnetic resonance imaging (MRI) techniques, namely proton magnetic resonance spectroscopy (1H-MRS), in the diagnosis of MS. MRI is an integral part of the diagnostic algorithm for patients with multiple sclerosis according to the McDonald criteria, which were last updated in 2017. In addition, MRI allows assessing the course of the disease, serving as a criterion for confirming the aggravation of the pathological process. Although the McDonald criteria are applied in adults, they are also used to diagnose MS in children, and MS in children has its own particularities. The McDonald criteria include traditional (conventional) MRI sequences: T2-weighted images, T1-weighted images, post-contrast T1-weighted images. With the rapid development of MRI, cutting-edge (advanced) MRI techniques have emerged that allow for a better understanding of changes in the brain matter in MS: brain volumetry, magnetization transfer imaging, cortical imaging, diffusion tensor imaging, 1H-MRS, susceptibility-weighted imaging. In particular, 1H-MRS allows us to assess the degree of white matter integrity by detecting increased resonance of myelin breakdown metabolites. The studies have shown that changes in MS have their own specificity, but there is no consensus on this issue. Currently, there are no agreed guidelines that would include advanced MRI techniques, but we believe they will allow us to better understand the course of MS and to predict the development of the disease. This approach will improve the management of MS in both adults and children and quality of their life.
{"title":"Modern neuroimaging criteria for diagnosing multiple sclerosis in children","authors":"Y.O. Palamarchuk","doi":"10.22141/2224-0713.19.5.2023.1014","DOIUrl":"https://doi.org/10.22141/2224-0713.19.5.2023.1014","url":null,"abstract":"The article presents a clinical case of multiple sclerosis (MS) in a 10-year-old female patient, the use of one of the advanced magnetic resonance imaging (MRI) techniques, namely proton magnetic resonance spectroscopy (1H-MRS), in the diagnosis of MS. MRI is an integral part of the diagnostic algorithm for patients with multiple sclerosis according to the McDonald criteria, which were last updated in 2017. In addition, MRI allows assessing the course of the disease, serving as a criterion for confirming the aggravation of the pathological process. Although the McDonald criteria are applied in adults, they are also used to diagnose MS in children, and MS in children has its own particularities. The McDonald criteria include traditional (conventional) MRI sequences: T2-weighted images, T1-weighted images, post-contrast T1-weighted images. With the rapid development of MRI, cutting-edge (advanced) MRI techniques have emerged that allow for a better understanding of changes in the brain matter in MS: brain volumetry, magnetization transfer imaging, cortical imaging, diffusion tensor imaging, 1H-MRS, susceptibility-weighted imaging. In particular, 1H-MRS allows us to assess the degree of white matter integrity by detecting increased resonance of myelin breakdown metabolites. The studies have shown that changes in MS have their own specificity, but there is no consensus on this issue. Currently, there are no agreed guidelines that would include advanced MRI techniques, but we believe they will allow us to better understand the course of MS and to predict the development of the disease. This approach will improve the management of MS in both adults and children and quality of their life.","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135406779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.22141/2224-0713.19.5.2023.1015
Dipak Chaulagain, V. Smolanka, A. Smolanka, T. Havryliv
Glioblastoma (GBM) is the most common and malignant adult brain tumor. Despite substantial study and surgical advancements, the prognosis remains poor, demanding ongoing research of the current trends and potential surgical therapy. This abstract summarizes GBM surgical developments and future directions. GBM is treated with maximal safe resection, adjuvant radiation, and chemotherapy. Tumor penetration into eloquent brain areas often complicates surgical excision. Functional brain mapping and intraoperative imaging have increase safe resection. Awake craniotomy and intraoperative fluorescence-guided surgery may help remove more tumor. GBM surgery now incorporates molecular and genetic data. Molecular profiling helps discover mutations and genetic changes for tailored treatment. Immunotherapies and targeted therapies have the potential to enhance treatment outcomes for patients diagnosed with GBM. Precision medicine, which involves tailoring cancer treatments to each patient’s unique characteristics, is expected to play a pivotal role in future research endeavors. Nanotechnology and drug delivery devices offer the opportunity to optimize the delivery of anti-tumor drugs, potentially improving their efficacy. Artificial intelligence and machine learning in preoperative planning and intraoperative decision-making should improve surgical results. Current trends in GBM surgery include maximizing safe resection using advanced mapping and imaging techniques, incorporating molecular information for personalized treatment, and investigating targeted therapies and immunotherapies. The future of GBM surgery lies in the integration of precision medicine, nanotechnology, and artificial intelligence. By adopting these innovations, the surgical management of GBM may experience significant improvements, leading to better patient outcomes and an increase in life quality.
{"title":"Advancements in surgical management of glioblastoma: current trends and promising future directions","authors":"Dipak Chaulagain, V. Smolanka, A. Smolanka, T. Havryliv","doi":"10.22141/2224-0713.19.5.2023.1015","DOIUrl":"https://doi.org/10.22141/2224-0713.19.5.2023.1015","url":null,"abstract":"Glioblastoma (GBM) is the most common and malignant adult brain tumor. Despite substantial study and surgical advancements, the prognosis remains poor, demanding ongoing research of the current trends and potential surgical therapy. This abstract summarizes GBM surgical developments and future directions. GBM is treated with maximal safe resection, adjuvant radiation, and chemotherapy. Tumor penetration into eloquent brain areas often complicates surgical excision. Functional brain mapping and intraoperative imaging have increase safe resection. Awake craniotomy and intraoperative fluorescence-guided surgery may help remove more tumor. GBM surgery now incorporates molecular and genetic data. Molecular profiling helps discover mutations and genetic changes for tailored treatment. Immunotherapies and targeted therapies have the potential to enhance treatment outcomes for patients diagnosed with GBM. Precision medicine, which involves tailoring cancer treatments to each patient’s unique characteristics, is expected to play a pivotal role in future research endeavors. Nanotechnology and drug delivery devices offer the opportunity to optimize the delivery of anti-tumor drugs, potentially improving their efficacy. Artificial intelligence and machine learning in preoperative planning and intraoperative decision-making should improve surgical results. Current trends in GBM surgery include maximizing safe resection using advanced mapping and imaging techniques, incorporating molecular information for personalized treatment, and investigating targeted therapies and immunotherapies. The future of GBM surgery lies in the integration of precision medicine, nanotechnology, and artificial intelligence. By adopting these innovations, the surgical management of GBM may experience significant improvements, leading to better patient outcomes and an increase in life quality.","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135407371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.22141/2224-0713.19.5.2023.1013
K. Trinus
The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as a consequence of a blast injury, we have done present investigation. One hundred and ten patients were examined: 65 Anti-Terrorist Operation (ATO) participants with mild traumatic brain injury (mTBI), 44 non-ATO plus one patient with acromegaly was examined using posturography. Questionnaire “Types of Dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, showing that this complaint is not specific to mTBI. Objective vertigo (sensation of the subjects moving around the patient) was detected in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. Thus, we have two different qualitative groups. So, these complaints are specific to the patients, who survived blast injury. Complaints of subjective vertigo are also typical for those with blast injury. Complaints of pseudovertigo are specific to the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific to the people with blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) have been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not typical for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been revealed in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients; this complaint is not specific to mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is detected in 20 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. It is also an interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific to the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control). The results are discussed from the point of view of a severe vestibular disorder due to the blast injury. The tallness correlated with drop attacks (R29.6 according to ICD-10, the nosology is missing in the Ukrainian translation), it is suggested that growth hormone might cause the fluctuation of vestibular function. Conclusions. 1. ATO participants have pronounced vestibular disorders. 2.
{"title":"Vestibular disorders in blast injuries. The role of growth hormone","authors":"K. Trinus","doi":"10.22141/2224-0713.19.5.2023.1013","DOIUrl":"https://doi.org/10.22141/2224-0713.19.5.2023.1013","url":null,"abstract":"The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as a consequence of a blast injury, we have done present investigation. One hundred and ten patients were examined: 65 Anti-Terrorist Operation (ATO) participants with mild traumatic brain injury (mTBI), 44 non-ATO plus one patient with acromegaly was examined using posturography. Questionnaire “Types of Dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, showing that this complaint is not specific to mTBI. Objective vertigo (sensation of the subjects moving around the patient) was detected in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. Thus, we have two different qualitative groups. So, these complaints are specific to the patients, who survived blast injury. Complaints of subjective vertigo are also typical for those with blast injury. Complaints of pseudovertigo are specific to the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific to the people with blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) have been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not typical for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been revealed in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients; this complaint is not specific to mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is detected in 20 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. It is also an interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific to the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control). The results are discussed from the point of view of a severe vestibular disorder due to the blast injury. The tallness correlated with drop attacks (R29.6 according to ICD-10, the nosology is missing in the Ukrainian translation), it is suggested that growth hormone might cause the fluctuation of vestibular function. Conclusions. 1. ATO participants have pronounced vestibular disorders. 2.","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135407535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-08DOI: 10.22141/2224-0713.19.4.2023.1010
I. Labunets, T. Panteleymonova, N. Utko, Vitalii Kyryk, S. Savosko, Z.L. Litochenko
Background. Oxidative stress and immune cell (T-lymphocytes, macrophages) products are important for the development of morpho-functional disorders of the nervous system in Parkinson’s disease. Connection of Parkinson’s disease with age and functioning of the major histocompatibility complex genes are also shown. The purpose was to assess changes in the brain of T-lymphocytes, macrophages, malondialdehyde (MDA) contents, the activity of antioxidant enzymes, the structure of brain and spinal cord neurons, as well as behavior in adult and aging mice with different H-2 haplotypes and toxic model of parkinsonism. Materials and methods. Adult and aging female mice of FVB/N (genotype H-2q) and 129/Sv (genotype H-2b) strains were once injected with the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) at the dose of 30 mg/kg. Contents of CD3+, CD3–CD11b+, CD3+CD11b+ cells, MDA and the activity of antioxidant enzymes in the brain were evaluated. The structure of neurons of the substantia nigra, lumbar spine, behavior in the open field test, as well as in rigidity and rotarod performance tests were studied. Results. In adult mice of both strains, motor and non-motor (spatial-exploratory, emotional) activity is impaired under the influence of MPTP. At the same time, linear differences in behavior changes were revealed in their directions and expressiveness. In aging FVB/N experimental mice, motor behavior disorders prevailed and were combined with non-motor changes in 129/Sv mice. Violations in the structure of substantia nigra neurons after MPTP administration were more severe in FVB/N mice while those in the lumbar spinal cord neurons were more pronounced in the 129/Sv mice. In aging experimental mice of both strains, the percentage of damaged neurons in the brain and spinal cord was significantly lower than in adult animals. After MPTP administration to adult mice, the direction of changes in the brain T-lymphocytes and macrophages (increase or decrease) depended on their strains. In aging experimental mice, the linear heterogeneity of changes was preserved for the T-lymphocyte content, while the macrophage level was increased regardless of the animal strains. Under MPTP influence, the MDA content increased in the brain of mice of all experimental groups. The direction of changes in superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase activities (decrease or increase) depended on the strains of animals and their age. Conclusions. MPTP-induced changes (directions, expressiveness) in T-lymphocyte, macrophage contents, antioxidant enzymes activity, the structure of neurons of the substantia nigra and lumbar spine, as well as behavioral reactions largely depended on the adult mice H-2 haplotype. There were age-related effects of the neurotoxin on changes in the studied indicators in mice of different strains. At the same time, dependence of changes in most above indicators on the H-2 haplotype preserved.
{"title":"Changes in the number of macrophages, T-lymphocytes, activity of antioxidant enzymes in the brain, behavior and structure of the central nervous system neurons in adult and aging mice of different strains with the MPTP-induced model of parkinsonism","authors":"I. Labunets, T. Panteleymonova, N. Utko, Vitalii Kyryk, S. Savosko, Z.L. Litochenko","doi":"10.22141/2224-0713.19.4.2023.1010","DOIUrl":"https://doi.org/10.22141/2224-0713.19.4.2023.1010","url":null,"abstract":"Background. Oxidative stress and immune cell (T-lymphocytes, macrophages) products are important for the development of morpho-functional disorders of the nervous system in Parkinson’s disease. Connection of Parkinson’s disease with age and functioning of the major histocompatibility complex genes are also shown. The purpose was to assess changes in the brain of T-lymphocytes, macrophages, malondialdehyde (MDA) contents, the activity of antioxidant enzymes, the structure of brain and spinal cord neurons, as well as behavior in adult and aging mice with different H-2 haplotypes and toxic model of parkinsonism. Materials and methods. Adult and aging female mice of FVB/N (genotype H-2q) and 129/Sv (genotype H-2b) strains were once injected with the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) at the dose of 30 mg/kg. Contents of CD3+, CD3–CD11b+, CD3+CD11b+ cells, MDA and the activity of antioxidant enzymes in the brain were evaluated. The structure of neurons of the substantia nigra, lumbar spine, behavior in the open field test, as well as in rigidity and rotarod performance tests were studied. Results. In adult mice of both strains, motor and non-motor (spatial-exploratory, emotional) activity is impaired under the influence of MPTP. At the same time, linear differences in behavior changes were revealed in their directions and expressiveness. In aging FVB/N experimental mice, motor behavior disorders prevailed and were combined with non-motor changes in 129/Sv mice. Violations in the structure of substantia nigra neurons after MPTP administration were more severe in FVB/N mice while those in the lumbar spinal cord neurons were more pronounced in the 129/Sv mice. In aging experimental mice of both strains, the percentage of damaged neurons in the brain and spinal cord was significantly lower than in adult animals. After MPTP administration to adult mice, the direction of changes in the brain T-lymphocytes and macrophages (increase or decrease) depended on their strains. In aging experimental mice, the linear heterogeneity of changes was preserved for the T-lymphocyte content, while the macrophage level was increased regardless of the animal strains. Under MPTP influence, the MDA content increased in the brain of mice of all experimental groups. The direction of changes in superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase activities (decrease or increase) depended on the strains of animals and their age. Conclusions. MPTP-induced changes (directions, expressiveness) in T-lymphocyte, macrophage contents, antioxidant enzymes activity, the structure of neurons of the substantia nigra and lumbar spine, as well as behavioral reactions largely depended on the adult mice H-2 haplotype. There were age-related effects of the neurotoxin on changes in the studied indicators in mice of different strains. At the same time, dependence of changes in most above indicators on the H-2 haplotype preserved.","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88105008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-08DOI: 10.22141/2224-0713.19.4.2023.1006
K. Trinus
The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as the consequence of blast injury, we have done present investigation. One hundred and nine patients were examined: 65 Anti-Terroristic Operation (ATO) participants, who survived mild and moderate blast injury without cranial trauma, and 44 non-ATO patients (rhinitis, pharyngitis, otitis). Questionnaire “Types of dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, thus, showing that this complaint is not specific for mild traumatic brain injury (mTBI). Objective vertigo (sensation of subjects moving around the patient) met in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. So, we have two different qualitative groups. Тhese complaints are specific for the patients, who survived blast injury. Complaints of vertigo are also typical for the patients, who survived blast injury. Complaints of giddiness are specific for the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific for the patients, who survived blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) has been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not specific for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been detected in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients. This complaint is not specific for mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is met in 20.00 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. This is also interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific for the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control. It has been shown that among other signs, there is a positive correlation with age, imbalance, ascendophobia and dyspnea). The results are discussed from the point of view of the severe vestibular impairment due to the blast injury. Conclusions. 1. MBTI from blast injury is accompanied by severe stress, objective and subjective vertigo, giddiness an
{"title":"Mild blast injury: vertigo complaints analysis","authors":"K. Trinus","doi":"10.22141/2224-0713.19.4.2023.1006","DOIUrl":"https://doi.org/10.22141/2224-0713.19.4.2023.1006","url":null,"abstract":"The data about vestibular disorders resulting from blast injury are contradictory. To disclose the problem of vestibular disorder as the consequence of blast injury, we have done present investigation. One hundred and nine patients were examined: 65 Anti-Terroristic Operation (ATO) participants, who survived mild and moderate blast injury without cranial trauma, and 44 non-ATO patients (rhinitis, pharyngitis, otitis). Questionnaire “Types of dizziness” has been used according to the International Clinical Protocol on Vestibular Disorders (Dizziness). Complaints of dizziness (distortion of perception of space, movement and time) have been revealed in 70.77 % (46) ATO and 43.18 % (19) non-ATO patients: F-test = 0.51, T-test = 0.004, thus, showing that this complaint is not specific for mild traumatic brain injury (mTBI). Objective vertigo (sensation of subjects moving around the patient) met in 26.15 % (17) ATO and 11.56 % (5) non-ATO patients: F-test = 0.027, T-test = 0.046. So, we have two different qualitative groups. Тhese complaints are specific for the patients, who survived blast injury. Complaints of vertigo are also typical for the patients, who survived blast injury. Complaints of giddiness are specific for the patients, who survived blast injury. Imbalance and drop attacks are not typical for ATO patients. Complaints of kinetosis are specific for the patients, who survived blast injury. Orthostatics (discomfort sensations that appear after sudden standing up) has been revealed in 76.92 % (50) ATO and 47.73 % (21) non-ATO patients, this complaint is not specific for mTBI. Vestibular system organizes space orientation tetrad: vestibular, somatosensory, visual and hearing information to percept, orient and interact with environment. Acro-, nycto- and ascendophobia have appeared to be of no importance. Agoraphobia (Greek αγωρα — market, supermarket syndrome, discomfort in open, public places or crowds) has been detected in 33.85 % (22) ATO and 15.91 % (7) non-ATO patients. This complaint is not specific for mTBI. Claustrophobia (discomfort appearing in small, closed spaces) is met in 20.00 % (13) ATO and 9.09 % (4) non-ATO patients: F-test = 0.024, T-test = 0.10. Thus, we have two different qualitative groups. This is also interesting case, when we reveal qualitative difference without quantitative one. This is the argument to use F-test in our study. So, complaints of claustrophobia are specific for the patients, who survived blast injury. The same situation is with descendophobia (discomfort during walking down the hill or descending the staircase, patients note the necessity of visual control. It has been shown that among other signs, there is a positive correlation with age, imbalance, ascendophobia and dyspnea). The results are discussed from the point of view of the severe vestibular impairment due to the blast injury. Conclusions. 1. MBTI from blast injury is accompanied by severe stress, objective and subjective vertigo, giddiness an","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85348310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-08DOI: 10.22141/2224-0713.19.4.2023.1007
L. Kyrylova, O. Yuzva, O. Miroshnikov, O. Berehela
Background. The development and availability of genetic research open both new possibilities in the diagnosis of epileptic encephalopathies and require the search for correlations between detected pathological mutation and the clinical and instrumental examination of a child. In particular, seizure disorders in children in whom SCN1A has been detected cover a spectrum that varies from simple febrile seizures and mild generalized epilepsy with febrile seizures plus, which was first described in 2003, to severe myoclonic epilepsy in infancy (more commonly known as Dravet syndrome) or severe intractable childhood epilepsy with generalized tonic-clonic seizures. Materials and methods. In our study, we examined 4 children (2 boys and 2 girls) with clinical and instrumental signs of epileptic encephalopathy with resistant seizures who were treated in the psychoneurology department for children with perinatal pathology and orphan diseases of the SI “Lukyanova Institute of Pediatrics, Obstetrics and Gynecology named of the National Academy of Medical Sciences of Ukraine”. The average age of patients was 2.20 ± 1.55 years. In addition to the laboratory and instrumental examination, all children underwent a medical genetic analysis (whole exome sequencing or next-generation sequencing) and the mutation of the SCN1A gene was detected. Subsequently, the relationship between the obtained laboratory instrumental and clinical anamnestic data was analyzed using statistical research methods. Results. It should be noted that the onset of genetic disorders caused by SCN1A occurs at the age of 5.5–6 months. During the onset, focal clonic seizures predominate, mainly against the background of hyperthermia, which are later modified into generalized tonic-clonic, myoclonic ones, and even absences. In three of four cases, the epileptiform activity was focal, with a predominant localization in the fronto-central regions followed by generalization. In all children, taking into account the focal onset of attacks, therapy was started with the use of carbamazepine, which is contraindicated in children with this mutation. After analyzing our cases, we saw that the course of the disease and the resistance of attacks were more severe in girls. The study of this phenomenon requires observation of a larger number of children. Conclusions. In children with genetically determined epileptic encephalopathy caused by the SCN1A mutation, the onset of the disease occurs in the first half of life and is usually manifested itself by focal seizures. In children with SCN1A mutation, frontal localization of epileptiform activity prevails. Considering this feature of the disease and based on our own long-term observation of children with epileptic encephalopathies of early age, we would like to warn against the use of carbamazepines in this age group. The course of SCN1A epileptic encephalopathy (Dravet syndrome) is difficult, given the resistance of attacks and regression in the development
{"title":"Features of epileptic encephalopathy caused by SCN1A mutation","authors":"L. Kyrylova, O. Yuzva, O. Miroshnikov, O. Berehela","doi":"10.22141/2224-0713.19.4.2023.1007","DOIUrl":"https://doi.org/10.22141/2224-0713.19.4.2023.1007","url":null,"abstract":"Background. The development and availability of genetic research open both new possibilities in the diagnosis of epileptic encephalopathies and require the search for correlations between detected pathological mutation and the clinical and instrumental examination of a child. In particular, seizure disorders in children in whom SCN1A has been detected cover a spectrum that varies from simple febrile seizures and mild generalized epilepsy with febrile seizures plus, which was first described in 2003, to severe myoclonic epilepsy in infancy (more commonly known as Dravet syndrome) or severe intractable childhood epilepsy with generalized tonic-clonic seizures. Materials and methods. In our study, we examined 4 children (2 boys and 2 girls) with clinical and instrumental signs of epileptic encephalopathy with resistant seizures who were treated in the psychoneurology department for children with perinatal pathology and orphan diseases of the SI “Lukyanova Institute of Pediatrics, Obstetrics and Gynecology named of the National Academy of Medical Sciences of Ukraine”. The average age of patients was 2.20 ± 1.55 years. In addition to the laboratory and instrumental examination, all children underwent a medical genetic analysis (whole exome sequencing or next-generation sequencing) and the mutation of the SCN1A gene was detected. Subsequently, the relationship between the obtained laboratory instrumental and clinical anamnestic data was analyzed using statistical research methods. Results. It should be noted that the onset of genetic disorders caused by SCN1A occurs at the age of 5.5–6 months. During the onset, focal clonic seizures predominate, mainly against the background of hyperthermia, which are later modified into generalized tonic-clonic, myoclonic ones, and even absences. In three of four cases, the epileptiform activity was focal, with a predominant localization in the fronto-central regions followed by generalization. In all children, taking into account the focal onset of attacks, therapy was started with the use of carbamazepine, which is contraindicated in children with this mutation. After analyzing our cases, we saw that the course of the disease and the resistance of attacks were more severe in girls. The study of this phenomenon requires observation of a larger number of children. Conclusions. In children with genetically determined epileptic encephalopathy caused by the SCN1A mutation, the onset of the disease occurs in the first half of life and is usually manifested itself by focal seizures. In children with SCN1A mutation, frontal localization of epileptiform activity prevails. Considering this feature of the disease and based on our own long-term observation of children with epileptic encephalopathies of early age, we would like to warn against the use of carbamazepines in this age group. The course of SCN1A epileptic encephalopathy (Dravet syndrome) is difficult, given the resistance of attacks and regression in the development ","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89093797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-08DOI: 10.22141/2224-0713.19.4.2023.1009
A. Zhezher, N. Zhezher
Background. The problem of effective prolonged epidural analgesia (PEA) in case of hypotonic labor, which allows minimal intervention in the process of labor activity while providing adequate analgesia, remains unresolved. A study was conducted to increase the effectiveness of PEA use during the first state of childbirth in women with hypotonic labor. The purpose: to increase the effectiveness of prolonged epidural analgesia in case of hypotonic labor during vaginal childbirth. Materials and methods. We performed analgesia to 60 women with a diagnosis of stage 1 hypotonic labor who were divided in 2 groups: the main one (n = 35) and the controls (n = 25). ASA status in both groups was I–II. In both groups, the epidural space was punctured at L1-L2. A test 4-ml dose of 2% lidocaine solution was administered and 5 minutes after, the epidural catheter was inserted. Then, in the main group, 1 ml of fentanyl solution and 6 ml of 0.9% NaCl were injected into the epidural space; in the control group, 6–8 ml of 0.125% bupivacaine solution. The effectiveness was evaluated according to the visual analogue scale, hemodynamic changes and the outcome of childbirth (conservative or operative). The condition of the fetus was assessed according to cardiotocography data. Statistical processing of the material was carried out using Excel. Results. The use of fentanyl in 69 % of cases allowed finishing the birth conservatively, the condition of the fetus and newborn was considered satisfactory. In the control group, 72 % of births resulted in cesarean section. Indications for surgery were hypotonic labor and fetal distress. Conclusions. The use of the narcotic analgesic fentanyl for prolonged epidural analgesia in hypotonic labor effectively relieves pain and increases the likelihood of conservative childbirth. It is safe for mother, fetus and newborn.
{"title":"Use of the narcotic analgesic fentanyl to correct violations of the autonomic regulation of childbirth","authors":"A. Zhezher, N. Zhezher","doi":"10.22141/2224-0713.19.4.2023.1009","DOIUrl":"https://doi.org/10.22141/2224-0713.19.4.2023.1009","url":null,"abstract":"Background. The problem of effective prolonged epidural analgesia (PEA) in case of hypotonic labor, which allows minimal intervention in the process of labor activity while providing adequate analgesia, remains unresolved. A study was conducted to increase the effectiveness of PEA use during the first state of childbirth in women with hypotonic labor. The purpose: to increase the effectiveness of prolonged epidural analgesia in case of hypotonic labor during vaginal childbirth. Materials and methods. We performed analgesia to 60 women with a diagnosis of stage 1 hypotonic labor who were divided in 2 groups: the main one (n = 35) and the controls (n = 25). ASA status in both groups was I–II. In both groups, the epidural space was punctured at L1-L2. A test 4-ml dose of 2% lidocaine solution was administered and 5 minutes after, the epidural catheter was inserted. Then, in the main group, 1 ml of fentanyl solution and 6 ml of 0.9% NaCl were injected into the epidural space; in the control group, 6–8 ml of 0.125% bupivacaine solution. The effectiveness was evaluated according to the visual analogue scale, hemodynamic changes and the outcome of childbirth (conservative or operative). The condition of the fetus was assessed according to cardiotocography data. Statistical processing of the material was carried out using Excel. Results. The use of fentanyl in 69 % of cases allowed finishing the birth conservatively, the condition of the fetus and newborn was considered satisfactory. In the control group, 72 % of births resulted in cesarean section. Indications for surgery were hypotonic labor and fetal distress. Conclusions. The use of the narcotic analgesic fentanyl for prolonged epidural analgesia in hypotonic labor effectively relieves pain and increases the likelihood of conservative childbirth. It is safe for mother, fetus and newborn.","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80833164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-08DOI: 10.22141/2224-0713.19.4.2023.1008
T. Petriv, Raft Mohammad Daoud Almhairat, M. M. Tatarchuk, B. M. Luzan, J.V. Tsymbaliuk, V.I. Tsymbaliuk
Background. Limb damage dominates in the structure of combat trauma, making up to 75 % in modern wars and the number of wounded with peripheral nerve injuries of the limbs can be up to 25 %. The degree of disability of patients is 65–70 %, which makes the problem of restoring peripheral nerves extremely actual. The purpose of the study was to determine the effect of long-term invasive electrical stimulation on the functional restoration of the neuromuscular complex in experiment. Materials and methods. The study was performed on 29 white outbred rabbits (2500 ± 250 g, 5–6 months) according to all norms of bioethics. Animals were divided into the following experimental groups: group 1 (n = 8, controls) — epineural suture of the sciatic nerve and implantation of a non-working antenna of the electrical stimulation device; group 2 (n = 7): similar operation of epineural suture of the sciatic nerve with implantation of the electric stimulator antenna and stimulation on beginning at the 2nd day after the operation; group 3 (n = 7): a similar operation of the sciatic nerve epineural suture with implantation of an electric stimulator antenna and the start of stimulation after 2 weeks, when the initial signs of nerve regeneration were observed; group 4 (n = 7): autografting of the sciatic nerve and implantation of an electrical stimulator and the beginning of stimulation at a time point that will coincide with the signs of nerve regeneration. Results. Therefore, in group 2, where electrical stimulation was started the day after the operation, the indicators of functional recovery of the neuromuscular complex were better than in its absence, as well as under the conditions of starting the stimulation in the period when the initial signs of regeneration were observed. Therefore, it can be assumed that the invasive electrical stimulation of the peripheral nerve, started in the acute period after the injury, has a positive effect on the regeneration of the peripheral nerves, as well as on the results of the functional restoration of the neuromuscular complex. The positive effect of electrical stimulation on the functional state of muscles is indirectly evidenced by the larger amplitude of the compound muscle action potential (CMAP) in the group where the stimulation was started faster. A larger amplitude of the CMAP during the observation indicates a greater number of axons that reached the muscle during 8 weeks. Given that the growth cone of the regenerating nerve contains a certain number of axons that first grow to the effector organ, in this case the muscle, with a relatively unchanged action potential latency, it can be assumed that direct electrical stimulation of the peripheral nerve leads to an increase speed of axons sprouting, with their relatively unchanged number. The absence of a significant difference in the action potential latency in the groups where autografting and suture were performed under the same conditions of stimulation indicates a p
{"title":"Long-term invasive electrical stimulation of peripheral nerve in the functional recovery of neuromuscular complex in experiment","authors":"T. Petriv, Raft Mohammad Daoud Almhairat, M. M. Tatarchuk, B. M. Luzan, J.V. Tsymbaliuk, V.I. Tsymbaliuk","doi":"10.22141/2224-0713.19.4.2023.1008","DOIUrl":"https://doi.org/10.22141/2224-0713.19.4.2023.1008","url":null,"abstract":"Background. Limb damage dominates in the structure of combat trauma, making up to 75 % in modern wars and the number of wounded with peripheral nerve injuries of the limbs can be up to 25 %. The degree of disability of patients is 65–70 %, which makes the problem of restoring peripheral nerves extremely actual. The purpose of the study was to determine the effect of long-term invasive electrical stimulation on the functional restoration of the neuromuscular complex in experiment. Materials and methods. The study was performed on 29 white outbred rabbits (2500 ± 250 g, 5–6 months) according to all norms of bioethics. Animals were divided into the following experimental groups: group 1 (n = 8, controls) — epineural suture of the sciatic nerve and implantation of a non-working antenna of the electrical stimulation device; group 2 (n = 7): similar operation of epineural suture of the sciatic nerve with implantation of the electric stimulator antenna and stimulation on beginning at the 2nd day after the operation; group 3 (n = 7): a similar operation of the sciatic nerve epineural suture with implantation of an electric stimulator antenna and the start of stimulation after 2 weeks, when the initial signs of nerve regeneration were observed; group 4 (n = 7): autografting of the sciatic nerve and implantation of an electrical stimulator and the beginning of stimulation at a time point that will coincide with the signs of nerve regeneration. Results. Therefore, in group 2, where electrical stimulation was started the day after the operation, the indicators of functional recovery of the neuromuscular complex were better than in its absence, as well as under the conditions of starting the stimulation in the period when the initial signs of regeneration were observed. Therefore, it can be assumed that the invasive electrical stimulation of the peripheral nerve, started in the acute period after the injury, has a positive effect on the regeneration of the peripheral nerves, as well as on the results of the functional restoration of the neuromuscular complex. The positive effect of electrical stimulation on the functional state of muscles is indirectly evidenced by the larger amplitude of the compound muscle action potential (CMAP) in the group where the stimulation was started faster. A larger amplitude of the CMAP during the observation indicates a greater number of axons that reached the muscle during 8 weeks. Given that the growth cone of the regenerating nerve contains a certain number of axons that first grow to the effector organ, in this case the muscle, with a relatively unchanged action potential latency, it can be assumed that direct electrical stimulation of the peripheral nerve leads to an increase speed of axons sprouting, with their relatively unchanged number. The absence of a significant difference in the action potential latency in the groups where autografting and suture were performed under the same conditions of stimulation indicates a p","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78261907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-08DOI: 10.22141/2224-0713.19.4.2023.1005
V.M. Dubynetska
This article deals with the topical issue of today — ischemic strokes in young people. Currently, there are more than 150 identified causes of ischemic stroke, the most common of them are antiphospholipid syndrome, Fabry disease, genetic mutations, acquired and congenital thrombophilia, heart defects, a number of infectious agents, comorbid nosologies (migraine), and the use of narcotic agents. Special attention was paid to the monogenic disorders, which begin from an ischemic stroke or in which this type of stroke is one of the leading characteristics. The article shows in detail the characteristic features of each pathology, methods of diagnosis and ways of treatment, which is necessary in the work of a neuropathologist and doctors of other specialties.
{"title":"The main etiopathogenetic factors, features of the clinical course, diagnosis and treatment of ischemic stroke in young people","authors":"V.M. Dubynetska","doi":"10.22141/2224-0713.19.4.2023.1005","DOIUrl":"https://doi.org/10.22141/2224-0713.19.4.2023.1005","url":null,"abstract":"This article deals with the topical issue of today — ischemic strokes in young people. Currently, there are more than 150 identified causes of ischemic stroke, the most common of them are antiphospholipid syndrome, Fabry disease, genetic mutations, acquired and congenital thrombophilia, heart defects, a number of infectious agents, comorbid nosologies (migraine), and the use of narcotic agents. Special attention was paid to the monogenic disorders, which begin from an ischemic stroke or in which this type of stroke is one of the leading characteristics. The article shows in detail the characteristic features of each pathology, methods of diagnosis and ways of treatment, which is necessary in the work of a neuropathologist and doctors of other specialties.","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84398905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-09DOI: 10.22141/2224-0713.19.3.2023.1000
O. Semonova, L. Myronyak
Background. The growing number of patients with dementia in aging population of developed countries significantly increases the relevance of differential diagnosis of cognitive impairment and age-associated cognitive disorders. The purpose of the study was to determine the criteria for physiological changes in cognitive status and diffusion processes in brain’s white matter in healthy middle-aged and elderly people. Material and methods. Thirty-nine healthy middle-aged (45–59 years, n = 19) and elderly patients (60–75 years, n = 20) were examined. Neuropsychological testing was performed using the following scales: Montreal Cognitive Assessment, Mini-Mental State Examination, Frontal Assessment Battery, Semantic Verbal Fluency (SVF) and Phonemic Verbal Fluency (PVF). Molecular diffusion in brain’s white matter was investigated by diffusion tensor imaging (Ingenia 3.0T, Philips). Results. Moderate positive correlations were found between age and the Frontal Assessment Battery score (rs = –0.443), memory (rs = –0.444) and executive function (rs = –0.542). Cognitive functions in middle-aged and elderly patients didn’t differ in cognitive domains of naming (II), memory (III), language (VIII), delayed reproduction (X), orientation (XI), semantic and phonemic verbal fluency. At the same time, differences in attention (IV, VI, AIS: p = 0.038; 0.043; < 0.001), language (VII, LIS: p < 0.001), abstraction (IX: p = 0.008) and visuospatial function (VIS: p = 0.002) were significant. Physiolo-gical age-related changes of molecular diffusion in the white matter of the cerebral hemispheres are characterized by a decrease of 21.0–37.0 % (p = 0.02 — < 0.001) in anisotropic and an increase of 16.3–29.5 % (p < 0.001) in free diffusion of water molecules in the conductive tracts and beyond them.
{"title":"The state of cognitive functions and diffusion processes in the white matter of the cerebral hemispheres in healthy middle-aged and elderly people","authors":"O. Semonova, L. Myronyak","doi":"10.22141/2224-0713.19.3.2023.1000","DOIUrl":"https://doi.org/10.22141/2224-0713.19.3.2023.1000","url":null,"abstract":"Background. The growing number of patients with dementia in aging population of developed countries significantly increases the relevance of differential diagnosis of cognitive impairment and age-associated cognitive disorders. The purpose of the study was to determine the criteria for physiological changes in cognitive status and diffusion processes in brain’s white matter in healthy middle-aged and elderly people. Material and methods. Thirty-nine healthy middle-aged (45–59 years, n = 19) and elderly patients (60–75 years, n = 20) were examined. Neuropsychological testing was performed using the following scales: Montreal Cognitive Assessment, Mini-Mental State Examination, Frontal Assessment Battery, Semantic Verbal Fluency (SVF) and Phonemic Verbal Fluency (PVF). Molecular diffusion in brain’s white matter was investigated by diffusion tensor imaging (Ingenia 3.0T, Philips). Results. Moderate positive correlations were found between age and the Frontal Assessment Battery score (rs = –0.443), memory (rs = –0.444) and executive function (rs = –0.542). Cognitive functions in middle-aged and elderly patients didn’t differ in cognitive domains of naming (II), memory (III), language (VIII), delayed reproduction (X), orientation (XI), semantic and phonemic verbal fluency. At the same time, differences in attention (IV, VI, AIS: p = 0.038; 0.043; < 0.001), language (VII, LIS: p < 0.001), abstraction (IX: p = 0.008) and visuospatial function (VIS: p = 0.002) were significant. Physiolo-gical age-related changes of molecular diffusion in the white matter of the cerebral hemispheres are characterized by a decrease of 21.0–37.0 % (p = 0.02 — < 0.001) in anisotropic and an increase of 16.3–29.5 % (p < 0.001) in free diffusion of water molecules in the conductive tracts and beyond them.","PeriodicalId":14476,"journal":{"name":"INTERNATIONAL NEUROLOGICAL JOURNAL","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74010497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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