Neurological Sciences最新文献

Objective: This study investigated epidemiologic characteristics and analyzed postoperative complications on craniopharyngioma (CP) patients in China with an aim to provide a theoretical basis for the postoperative care of CP patients.

Methods: A total of 598 CP patients was divided into two groups based on the age and postoperative complications including visual impairment and endocrine dysregulation. The WISC IV scoring system was used to measure the cognitive functions of the pediatric patients. In addition, patients with two major CP types, the papillary and adamantinomatous CPs, were also compared with regard to postoperative complications.

Results: The Children group had a higher probability of developing severe visual impairment. Moreover, the Children group had a significantly higher occurrence rate of uremia and arginine vasopressin deficiency, thyroid disorder, dysregulated cortisol and growth hormones than the adult group. On the other hand, the mean time to the first recurrence was shorter in patients with the papillary CP than in those with the adamantinomatous CP. After secondary and more surgeries, 22.27% of patients developed amnesia. Patients with the adamantinomatous CP developed amnesia at a higher rate than patients with the papillary CP. Hypopituitarism did not correlate with patient age, gender, and disease duration, but correlated with the follow-up time. Statistically significant differences between the intracranial infection and the duration of surgery, and between intracranial hematoma and hydrocephalus, were observed.

Conclusions: Reduced operative time and enhanced postoperative follow-up can reduce the occurrence of postoperative complications in CP patients.

Purpose: We analyzed clinical features and predictors of outcome in adult patients with new-onset refractory status epilepticus(NORSE).

Methods: In this retrospective cohort, we analyzed the data of 72 patients with NORSE followed-up for two or more years. Outcome was assessed by Glasgow Outcome Scale(GOS) at discharge and latest follow-up.

Results: Mean age of the population was 35.13 ± 16.42 years and average follow-up was 60.34 ± 18.12 months. Average length of stay in hospital was 19.62 ± 14.68 days and mean ICU stay was14.43 ± 13.89 days. Of 72 patients with NORSE, 37(51.3%) patients progressed to super-refractory status epilepticus(SRSE). The most common etiology was cryptogenic(54%) followed by viral encephalitis(25%). Overall mortality was 27.8%. At discharge, 37 of 72 cases(51.4%) achieved a poor outcome (GOS 1-3). Among the survivors(n = 52), functional outcome improved over time and 84.6%(n = 44) achieved good outcome(GOS 4-5); however significant cognitive impairment was reported in 29(56%) and drug-resistant epilepsy in 31(60%). Although none of the factors predicted poor GOS outcome at discharge; etiology of viral encephalitis was associated with poor outcome at latest follow-up. Viral encephalitis, not able to achieve burst suppression on cEEG, medical complications and progression to SRSE predicted mortality during hospital stay.

Conclusion: Despite a prolonged clinical course and high mortality rate, more than 80% of adult survivors with NORSE attained a favourable functional outcome at long-term follow-up. None of the factors predicted the functional outcome at discharge; viral encephalitis was associated with poor outcome at latest follow-up. Significant cognitive impairment and drug-resistant epilepsy were reported in more than 50% of the survivors.

Parkinson's Disease (PD) is a chronic, neurodegenerative condition caused by a combination of ageing, environmental exposure and genetics, although the specifics remain unknown. Although historically considered a male-predominant condition, PD also affects a substantial proportion of women and intersex individuals whose experiences are often underrepresented. These populations have been overlooked in PD research, but recent findings have observed that multiple facets of the condition, including clinical presentation and treatment response may vary between sexes. However, there remains a 'one-size-fits-all' approach to diagnosis, management and treatment strategies, which has resulted in delayed diagnoses and adverse reactions to treatment, particularly in women. There has also been misuse of the terminology sex and gender, where sex should refer to biology and gender should relate to the impact of social norms, exclusive to the human experience. However, it is important to distinguish between the influence of biology and gender norms when discussing a multidimensional chronic condition such as PD. Considering how sex and gender can personalise an individual's experience living with PD will help improve the quality of research to inform and enhance standard care practices. This review will investigate the influence of sex and gender throughout an individual's journey with PD to identify important considerations in future prevention, diagnosis and care strategies. Comprehensively understanding the influence of sex and gender in PD will inform research and clinical strategies to refine current considerations for future implementation.

Objective: To observe the effect of bilateral cerebellar high-frequency rTMS on swallowing function and swallowing phase in patients with PSD.

Methods: 42 patients with PSD were randomly divided into bilateral cerebellar stimulation group and sham group (stimulating coil and scalp at a 90° angle). The rTMS stimulation parameters are 10 Hz,120% rMT, with 9 s intervals and 1 s stimulus, totaling 500 pulses. Before and after 3-week treatment, the MEPs amplitude of the suprahyoid muscles of the bilateral cerebral cortex was recorded as an index to quantify the excitability of the cerebral swallowing cortex. The VFSS was carried out for all patients before and after 3-week treatment, assessing the severity of dysphagia with FDS, assessing the risk of leakage and aspiration with PAS, and recording the swallowing phase.

Results: 40 patients were finally included for statistical analysis. After three weeks treatment, PAS and FDS scores improved, and the oral transit time (OTT) and Swallowing Reaction Time (SRT) were shorter in both groups. These indexes changed more significantly in the cerebellar stimulation group than the sham group. The MEP amplitudes of the cerebral swallowing cortex increased bilaterally, and the MEP amplitude of the contralateral cerebral swallowing cortex increased more significantly in the cerebellar stimulation group than that in the sham group.

Conclusion: To patients with PSD, bilateral cerebellar high-frequency rTMS can improve the swallowing function, increased the excitability of the contralesional cerebral swallowing cortex and shorten OTT and SRT.

Significance: Cerebellar rTMS may improve swallowing performance by regulating motor control.