Journal of Neurorestoratology最新文献

Brain trauma or traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. Along with the conventional therapeutic strategies, neurorestorative treatments for TBI have been developed in recent decades. However, missing standards and guidelines has become a growing issue both in clinical practice and fundamental research. Consequently, the Chinese Association of Neurorestoratology (Preparatory; CANR) and the China Committee of International Association of Neurorestoratology (IANR-China Committee) have reached a consensus to form and approve the Guideline of Clinical Neurorestorative Treatment for Brain Trauma. This guideline addresses the common issues in the evaluation and therapies of TBI patients within the scope of Neurorestoratology, offers recommendations based on state-of-art clinical evidences, and covers cell therapies, neural stimulation therapies, and pharmaceutical therapies. Hopefully, this guideline may provide references to clinical professionals during diagnosis and treatment, maximizing the neurorestorative therapeutic efficacy.

We present the case of a novel homozygous nonsense (c.4846C > T [p.R1616X]) mutation in the VPS13B in a Chinese boy with the primary symptoms of Cohen syndrome. This case presented with manifestations consistent with Cohen syndrome, including developmental delay, microcephaly, typical facial features, short stature, muscle hypotonia, neutropenia, and abnormal dental development; however, the patient did not have the typical findings of obesity, myopia, progressive retinal dystrophy, or epilepsy. The patient had a homozygous nonsense mutation (NM_017890: c.4846C > T [p.R1616X]). His brother, sister, and parents are heterozygous for the mutation. This locus variation has not been previously reported in Chinese children. Different mutation sites have different phenotypes. Cohen syndrome caused by a homozygous nonsense mutation of the VPS13B c.4846C > T (p.R1616X) does not present with obesity, ophthalmic abnormalities, or epilepsy, but has abnormal dental development. This may be related to the premature termination of peptide synthesis caused by nonsense mutations at this site.

Objective:

Deep brain stimulation (DBS) has promising outcomes in treatment-resistant depression (TRD). Several regions, including the subcallosal cingulate gyrus (SCG), nucleus accumbens, ventral capsule/ ventral striatum, and lateral habenula (LHb), can be targeted for TRD treatment. However, which target provides the best results remains controversial.

Methods:

We evaluated the antidepressant and antianxiety effects of DBS of the ventral medial prefrontal cortex (vmPFC) and LHb in stressed rats using the forced swimming test (FST) and open field test (OFT).

Results:

Bilateral high-frequency DBS of the vmPFC and LHb induced a significant decrease of the immobility time compared with that of controls (p < 0.05) in the FST. In the OFT, rats receiving vmPFC and LHb DBS showed no difference in the number of entries and time spent in the center area compared with those of control rats. However, vmPFC DBS provoked a significant decrease of these parameters compared with those of rats receiving LHb DBS (p < 0.05).

Conclusion:

These results suggested that vmPFC and LHb DBS had similar antidepressant effects, whereas LHb DBS was more effective in reducing anxiety-like behaviors. The results provide a reference for high-frequency DSB of SCG and LHb in TRD.

Spinal cord injury (SCI) is catastrophic damage for patients, their family, and society. Researchers and clinicians have been trying to find neurorestorative methods to recover their injured functions and structures. Cell therapy is one of the effective therapeutic strategies for SCI. And it can partially restore their neurological functions, which are once thought as permanent neurological deficits. Currently, cells being used therapeutically in clinic include olfactory ensheathing cells (OECs), mononuclear cells (MNCs), mesenchymal stromal cells (MSCs), Schwann cells, and hematopoietic stem cells, cell products differentiated from embryonic stem cells, mesenchymal stem cells, induced pluripotent stem cells, and neural stem cells as well as other kinds of cells. Real world data from these cell therapies showed some benefits in some patients with SCI. Due to being affected by many factors, the therapeutic results of some kinds of cells are contradictory and it is hard to compare effects among different types of cells. According to the data of cell therapies, OEC, MNC and MSC transplantation are applied for patients in majority percentage of cases, and OEC transplantation had a higher percentage of benefits. In next step, under the unified standard of cell preparation and quality control as well as the guidelines of clinical cell application, each kind of cells including OECs should be studied using prospective, multicenter, double-blind or observing-blind, placebo-control, randomized studies for SCI patients with different level of injury and chronicity.

Objective:

This study aimed to explore the possibility and outcomes of surgical treatments for managing hereditary spinocerebellar ataxia (SCA).

Methods:

Three patients diagnosed with SCA and strongly willing to get surgical treatments were selected for surgery. Under general anesthesia, posterior cranial fossa decompression and extensive arachnoid resection were conducted. The bilateral occipital muscles flapped with arteries were anatomically separated, transferred, and adhered to the surface of the cerebellum. Then, clinical presentations pre- and post-operation were compared.

Results:

All symptoms of the three patients were significantly improved after surgery. In Case 1, after one day post-operation, bucking symptoms disappeared. Also, while standing and walking abilities gradually improved on the 6th day, self-care, speech, and normal handwriting abilities were recovered one month post-rehabilitation. However, during the 6-month follow-up, the patient was still in further recovery. In Case 2, the patient's handwriting function was restored on the 4th day after the operation. Moreover, the piebald skin on both lower limbs disappeared one week post-operation. One month later, the standing ability of the patient was also recovered. In Case 3, the four symptoms experienced were significantly recovered one day after surgery, including speech, bucking, lower limbs trembling, and unstable walking.

Conclusions:

Surgery is therefore a promising and brilliant option for treating hereditary SCA. After operations, neurological deficits improved fast, as shown evidently by recovery results, at a rate that was better than any other treatment way. Nevertheless, improvement mechanisms should further be explored.

Nanobiotechnology is an emerging field that has recently been explored for peripheral neural regeneration (PNR). Being a public-health problem, peripheral nerve injuries (PNIs) should be treated by the therapiesthat ensure swift functional recovery. The autologous nerve grafts (standard treatment for PNIs) are rarely available and also cause morbidity and neuroma formation at the harvest site, hence an alternative approach with minimum complications is required for the treatment of serious PNIs. Although nerve guidance conduits (NGCs) provide microenvironment for axonal regeneration but they are as yet imperfect solutions. Nanoparticles (e.g., metallic and metallic oxide nanoparticles) have properties which are interesting to include in biomaterials developed for peripheral nervous system regeneration including potential theranostic function. It is important to get an insight into the fundamental mechanisms of reconstruction of peripheral nerves for clinical translation of pre-clinical outcomes of the use of nanoparticles in PNR. Moreover, the combination of nanotechnological strategies is expected to provide transition from bed to bench-side and beyond to the patients, clinicians, and researchers.

Objective:

This study aimed to determine the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on anxiety and depression in Parkinson's disease (PD) patients.

Methods:

The clinical data of 57 patients with PD who underwent bilateral STN-DBS between March and December 2018, were retrospectively analyzed. Patient scores on the Unified Parkinson's Disease Rating Scale-Part III (UPDRS-Ⅲ), the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), and the Parkinson's Disease Questionnaire (PDQ-39) were evaluated.

Results:

Patient evaluations took place preoperatively and at 1, 3, and 6-month follow-ups. The average patient improvement rates for HAM-A and HAM-D scores at the 6-month follow-up were 41.7% [interquartile range (IQR) 34.9%] and 37.5% (IQR 33.4%), respectively (both p < 0.001). There were positive correlations between both the rate of improvement in HAM-A scores and the rate of improvement in PDQ-39 scores (r = 0.538, p < 0.001), and between the rate of improvement in HAM-D scores and the rate of improvement in PDQ-39 scores (r = 0.404, p = 0.002) at the 6-month follow-up. HAM-A and HAM-D scores were positively correlated with the Parkinson's Hoehn-Yahr disease stage (r = 0.296, p = 0.025; and r = 0.380, p = 0.004, respectively).

Conclusion:

Bilateral STN-DBS can improve symptoms of anxiety and depression in PD patients.

The term “micro-entrapment syndrome of nerves innervating the face (MESNIF)” is a relatively new concept. It refers to the micro-entrapment of facial nerve (trigeminal nerve and facial nerve) terminals for various reasons, resulting in one-side facial discomfort, subjective sensory abnormalities, or stiffness, and in certain cases, localized micro muscle movement abnormalities and motor disharmony. It is frequently caused by facial paralysis or chronic trigeminal neuritis or injury, and is prevalent in clinical practice. Peripheral facial paralysis affects 60%-70% of people. Both men and women are susceptible to it. It is most common in young and middle-aged women. At the moment, there are two types of therapy options for this disease: nonsurgical treatments and surgical treatments. Among surgical treatments, pulsed radiofrequency has good curative results. This paper describes two typical situations that had good curative effects.

Alzheimer’s disease (AD) is a neurodegenerative disease dominated by progressive cognitive dysfunction causing significant social, economic, and medical crises. Cell therapy has demonstrated favorable effects for AD. This pilot study examined the safety and neurorestorative effects of the olfactory ensheathing cell (OEC), olfactory neuron (ON), and Schwann cell (SC) on patients with AD. Seven patients with AD were enrolled in this two-center, randomized, double-blind, and placebo- controlled cell therapy study with a subsequent 12-month follow-up. We randomly assigned one or two participants in OEC, ON, and SC therapy or OEC combined with ON and placebo control. All enrolled patients were injected cells or medium into the olfactory sub-mucosa. They got an assessment of Mini-Mental State Examination, Montreal Cognitive Assessment, and Clinical Dementia Rating before treatment and 1, 3, 6, 12 months after treatment. We performed MRI or CT scans before treatment and 12 months after treatment. After integrating the results from the three evaluation methods, all cell types showed better results than a placebo control. ON and SC seem to exhibit more vital potential neurorestorative ability to enhance or convert the neurological functions of patients with AD, and OEC may help AD patients keep neurological functions stable. In this pilot study, there was no adverse or side-effect event. The results of this study strongly suggest conducting a phase II clinical trial of ON, SC, and OEC therapy to prove their neurorestorative effect on patients with AD.

Objective:

To analyze the risk factors of delayed encephalopathy in patients with acute carbon monoxide poisoning (DEACMP) and to investigate the clinical significance and clinical value.

Methods:

The baseline data from 68 patients admitted in the 981st Hospital of Chinese People’s Liberation Army Joint Logistics Support Force were collected, including sex, age, Glasgow Coma Scale (GCS), history of smoking/drinking, history of DEACMP. Laboratory examination records including cranial CT/MRI, cervical vascular color ultrasonography, cardiac color ultrasonography, blood biochemical markers, blood routine, and blood coagulation function were also collected. Additionally, patients were followed-up visited at 1 month and 6 months. Patients were divided into either the DEACMP group or the NDEACMP group according to the occurrence of DEACMP. The risk factors of DEACMP were identified by univariate and logistic regression analyses. The area under the curve (AUC), sensitivity, and specificity of each index were compared by the receiver operating characteristic (ROC) curve.

Results:

Among the 68 patients, 13 patients suffered from DEACMP with an incidence of 19.1%. Univariate analysis indicated that there were statistically significant differences in patients’ age, blood glucose, blood glucose/potassium, GCS scores, abnormal cranial CT/MRI, and coma time more than 4 h (P < 0.05). Logistic regression analysis showed that B, SE, Wald, df, P, Exp (B) of GCS score were -0.489, 0.208, 5.55, 1, 0.018 and 0.634, respectively. Overall, GCS score is correlated with DEACMP’s occurrence. ROC curve analysis showed that the sensitivity, specificity, and the AUC of GCS scores were 0.769, 0.873 and 0.843, respectively. The AUC of the indices in descending order are: GCS score, blood glucose, blood glucose/potassium and age.

Conclusion:

GCS score, blood glucose, blood glucose/potassium, and age are useful predictive factors for the occurrence of DEACMP. Among these, GCS score is the most significant predictive factor.