Acta neurologica Taiwanica最新文献

Purpose: Because of the COVID-19 pandemic and resulting widespread vaccination, many related neurological disorders, including autoimmune encephalopathy, have emerged. The pathophysiological mechanism underlying the COVID-19 vaccination and autoimmune encephalopathy remains unclear; more case reports and further investigation are required.

Case report: We report a clinical case of a 38-year-old woman who presented with acute-onset amnesia, language disturbance, and seizure. We suspected autoimmune encephalopathy triggered by the ChAdOx1 nCoV-19 vaccine. Brain magnetic resonance imaging revealed a subacute infarction at the right internal capsule and irregular vascular contour, which indicated a vasculopathy, such as vasculitis. Cerebrospinal fluid analysis revealed inflammation without pleocytosis, and electroencephalography detected diffuse background slowing with sharp transients at the right temporal region. Although autoantibody tests were negative, we initiated steroid pulse therapy. The patient's symptoms improved rapidly. The patient was discharged without neurological deficit or sequelae.

Conclusion: Clinicians should be mindful of postvaccinal encephalopathy and suspect this condition in patients with acute onset of psychosis or mental change, higher cortical dysfunction, and seizure within 2 weeks of vaccination. Early diagnosis is key, and immune treatment, such as steroid pulse therapy or immunosuppressants, may dramatically improve patients'symptoms.

The Taiwan Headache Society published its guidelines for acute migraine treatment in 2017. Since then, emerging drugs and treatment options have developed rapidly. The migraine-specific drugs gepants and ditans and several noninvasive neuromodulation devices have been approved for use in Europe and the United States. Although not all emerging drugs and treatment options have been approved for use in Taiwan, keeping pace with international trends and updating treatment guidelines are imperative. Therefore, the Treatment Guideline Subcommittee of the Taiwan Headache Society reviewed the quality of recent trials, evaluated the corresponding grade of evidence, and appraised the reported clinical efficacy to reach a new consensus. To ensure that the updated Taiwan guidelines are appropriate and feasible, the subcommittee also referred to the guidelines from the United States, Europe, Canada, and other countries concerning the main roles, recommendation levels, clinical efficacy, and adverse reactions of drugs for the acute migraine treatment. Several types of drugs are currently available for acute migraine treatment in Taiwan. These drugs can be categorized into migraine-specific and migraine-non-specific. Among them, migraine-specific triptans (oral or nasal spray formulations) and migraine-nonspecific acetaminophen and NSAIDs (diclofenac, ibuprofen, naproxen) are highly recommended because they are supported by strong evidence and demonstrate high efficacy. Prochlorperazine injection has been upgraded to a highly recommended level because of the rich clinical experience for this treatment. Ergotamine/caffeine remains a second-line drug because of its lower specificity and efficacy compared with triptans. High-dose aspirin was downgraded to rescue treatment because of potential gastrointestinal side effects. Although evidence supports the combination of oral tramadol and acetaminophen, this combination should be used as a rescue treatment due to concerns about dependence. Evidence supporting the use of intravenous tramadol or morphine is insufficient; therefore, their use is not recommended. As for non-pharmacological approaches, there are only limited controlled data. The choice of treatment for acute migraine attacks should follow the concept of "stratified care." For mild to moderate migraine attacks, oral NSAIDs are the first choice, with combination analgesics, intravenous/intramuscular NSAIDs as alternatives. For moderate to severe attacks, oral or nasal spray triptans and ergotamine/caffeine compounds are recommended and should be administered in the early stage of migraine attacks. Antiemetics can be used as supplements to alleviate nausea and vomiting. Other emerging migraine-specific drugs, such as gepants or ditans, may also have a role in the future. Notably, a combination of a triptan and a NSAID yielded a better efficacy compared with either therapy alone. Parenteral steroids and fluid supply are the first-line treatment for stat

This review addresses recent developments in the analyses of plasma amyloid beta (Aβ) and total tau (t-tau) protein levels as biomarkers for discriminating amnestic mild cognitive impairment (aMCI) from Alzheimer disease (AD), using immunomagnetic reduction (IMR). Recent studies have focused on the differential diagnosis of normal controls (NCs) with aMCI or AD. Results of 15 clinical studies have demonstrated decrease in plasma Aβ1-40 and increase in plasma Aβ1-42 and t-tau levels in patients with aMCI and AD. For a given biomarker, effect size is determined by comparing the mean ratios of biomarker levels between two diagnostic groups. Effect sizes are less than 1 for Aβ1-40 (0.606-1.032) but >1 for Aβ1-42 (1.018-2.167) and t-tau (1.030-4.147) in aMCI and AD compared with NCs. The effect size of the plasma tau significantly increases the most as aMCI progresses to AD. Studies into the application of IMR to determine plasma Aβ and tau levels as biomarkers for aMCI or AD have recently progressed. Future investigations should validate recently published results, preferably in patients with pathologically confirmed AD. In addition, effort should be directed toward standardizing the design of such studies and data analysis. Keywords: amyloid beta, plasma tau, Alzheimer disease, biomarker, mild cognitive impairment.

Purpose: Guillain-Barre syndrome (GBS) is an immune-mediated disease of the peripheral nerves and could be fatal and has severe neurologic complications. This study herein reports the clinical course of the first patient of GBS after SARS-CoV-2 Oxford/AstraZeneca vaccination in Taiwan.

Case report: A 38-year-old woman who presented with progressive numbness and weakness of both upper and lower limbs over 1 week. Ascending patterns was noted, and bilateral leg were more severe with diffused absence of deep tendon reflex. Clinical examination and investigation findings confirmed with the diagnosis of GBS. Deterioration of muscle power and respiratory failure had developed during the hospitalization. She had no common GBS predisposing history, but she had received her first SARS-CoV-2 Oxford/AstraZeneca vaccination intramuscularly 10 days prior to her symptoms. Clinical symptoms had much improved after double filtration plasmapheresis.

Conclusion: Our case is the first case of GBS developed after AstraZeneca vaccine injection in Taiwan, presenting with atypical manifestation of early facial and bulbar involvement. The vaccination associated GBS should be closely monitored as other safety profile, since it may result in respiratory failure and severe neurologic complications. Keyword: Guillain-Barre Syndrome, SARS-CoV-2 Vaccination.

Exosomes are believed to be secreted from multivesicular endosomes and containing proteins and nucleic acids, including mRNA and microRNAs, which have been implicated to play a role in neurodegenerative diseases. Neuron-derived exosomes at the circulation provide a unique potential as biomarkers towards assessment of Alzheimer's disease (AD), even at the pre-clinical stage. This review briefly discusses their biogenesis and transport, exosomal protein verses soluble protein, evidence for their role in AD, isolation of exosomes, and challenges and future directions to realize reliable blood-based biomarkers to meet phenomenal unmet clinical and pre-clinical need of AD.

Objective: Neurofibromatosis is one of the most common dominantly inherited genetic disorders. This study aimed to study the demographic and clinical profile of neurofibromatosis patients.

Methods: This study is cross-sectional conducted in 2020 on the population of patients with neurofibromatosis. Patients who are members of the Neurofibromatosis Association answered the online demographic and clinical information questionnaire.

Results: 446 patients with neurofibromatosis participated in this study with a mean age of 33.39 plus or minus 12.87 years. 297 patients (66.6%) were women and 378 (84.8%) patients had type 1 neurofibromatosis. The disease visibility was reported to be moderate in 254 patients (54.9%) and the severity of the disease was mild in 238 (53.4%) patients. The type of neurofibromatosis was not significantly related to gender, age groups, parental education, and ethnicity. The relationship between severity and age (p is equal to less than 0.001) and gender (p is equal to 0.042) was significant and the relationship between visibility and age (p is equal to less than 0.001) was significant but despite the fact that the disease was more visible in men than women, it was not significantly related to gender.

Conclusions: The study results showed that the most common complication in the study population was Cafe au lait spot. In addition, visibility and severity of the disease were mild and moderate, respectively. Keyword: Neurofibromatosis, Demographic information, Clinical Information.

Purpose: Posterior reversible encephalopathy syndrome (PRES) displayed various acute neurological symptoms. PRES is a rare presentation of hypercalcemia. Here we present a case with ectopic secretion of parathyroid hormone from neuroendocrine carcinoma of the endometrium presenting as hypercalcemia-related PRES.

Case report: A 67-year-old woman presented with acute generalized tonic-clonic seizure followed by post-ictal confusion and neuropsychiatric behaviors. The diagnosis is PRES. Investigations showed uterine cervical region with multiple liver metastasis complicated with hypercalcemia, elevated intact parathyroid hormone. Further pathology concluded as a poorly differentiated adenocarcinoma of the endometrium with neuroendocrine differentiation and immunoreactive for PTH. The patient's neurologic manifestations had resolved. Serum free calcium level and intact-PTH had declined after first course of definitive chemoradiation.

Conclusion: Immunostaining of the tumor tissue can be used to estimate the ectopic PTH production within the tumor cells. Early detection and appropriate clinical treatment hold the potential to improve the prognosis of refractory hypercalcemia and hypercalcemia related PRES. Keyword: Posterior reversible encephalopathy syndrome; hypercalcemia; intact-parathyroid hormone; parathyroid hormone-related peptide; neuroendocrine carcinoma of endometrium.

Purpose: Cefepime is a widely used antibiotic which was known to have neurotoxicity resulted from its ability to cross the blood-brain barrier and a wide variety of symptoms had been documented. Here we reported a case of Cefepime induced neurotoxicity with rare presentation. The aim of this study was to improve the knowledge of this condition.

Case report: A 89-year-old female with a history of ESRD (end stage renal disease) and superimposed acute cholecystitis was treated with Cefepime. She developed the symptoms of global aphasia, right hemiplegia, leftward eye deviation and abnormal plantar reflex at right foot, which resembled acute ischemic stroke at left MCA (middle cerebral artery), on the fourth day of Cefepime treatment. There was no evidence of acute infarction in MRI (magnetic resonance imaging) of brain and EEG (electroencephalography) revealed NCSE (nonconvulsive status epilepticus). NCSE was suspected to be attributed to Cefepime-induced neurotoxicity. The patient's main risk factors were decreased renal clearance and incorrect dosing. Conslusion: Cefepime-induced neurotoxicity should be suspected in patients who developed neurologic symptoms after the administration of Cefepime. Emergent image study for excluding more commonly seen or critical etiologies and further evaluation with EEG were necessary. For those patients who have risk factors for Cefepime neurotoxicity, such as ESRD, TDM (therapeutic drug monitoring) may be useful in providing close monitoring and preventing adverse effects associated with Cefepime treatment. Keyword: Cefepime, acute ischemic stroke, aphaia, nonconvulsive status epilepticus.

Purpose: Quality of life (QoL) is considered as an important criterion for therapeutic effectiveness. Therefore, the present study aimed to validate the Persian version of the Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS) for use in Iranian people with MS.

Methods: In a cross-sectional study, 158 people with MS were selected through the census sampling method. The construct validity of the Persian version of HAQUAMS was first evaluated by a confirmatory factor analysis (CFA) in AMOS-22 software, and then the internal consistency reliability and the item-total score correlations were calculated for each subscale by the SPSS-22.

Results: The CFA and output results indicated that the HAQUAMS with a five-factor structure among the Iranian MS patients had a good construct validity if an item was eliminated and a number of covariance errors between items were released (RMSEA is euqal to 0.069). The internal consistency of HAQUAMS subscales was acceptable to excellent (alpha is euqal to 0.81 to 0.91). The analysis of item-total score correlation for determining the construct validity of HAQUAMS indicated that all items of the questionnaire had a moderate to strong positive correlation with their subscales (P less than 0.0001, r is euqal to 0.41 to 0.89). The correlation of total scores of HAQUAMS and the Beck Depression Inventory-short form (BDI-13) was equal to 0.74 (P less than 0.0001), indicating good concurrent criterion validity.

Conclusion: The Persian version of the HAQUAMS with a five-factor construct had acceptable validity and reliability and could be used for measurement of the health related QoL in Iranian people with MS.

Background: Multiple sclerosis (MS) is an autoimmune and multi-factorial (e.g. environmental, genetic) disease. We conducted a case-control study of month and season of birth (MOB and SOB) and multiple sclerosis (MS) risk in the east of Iran.

Methods: The MS patients registered in Mashhad and Torbat Heydariyeh MS Society until 20 March 2018 was compared with the MOB and SOB in the healthy population during 1988 to 2018. Case group was matched for age, sex and place of residence with the control group. Differences in the distributions of MOB and SOB between the patients and the control groups were assessed using the chi-square test.

Results: There were 2,160 MS patients in case group and 2,245 in control group. There was a significant relationship between MOB ans SOB with the risk of MS (P less than 0.05). Analysis showed a significant (p less than 0.01) peak in the MOB during Mar-Apr (OR is equal to 1.60), May-Jun (OR is equal to 1.30) and Aug-Sep (OR is equal to 2.42).

Conclusion: The findings show a relationship between MOB and SOB as risk factor for MS in Northeast Iran. Further studies are needed to confirm this result. Keyword: Multiple sclerosis, Month of Birth, seasonality, case-control, Iran.