关键词： Epilepsy surgery   Elderly   Neuropsychology   HRQoL   Outcome  

摘要： Introduction: Health related quality of life (HRQoL) has become a pivotal outcome parameter after surgery for drug-resistant epilepsy. The aim of the study was to investigate HRQoL and its relationship to seizure outcome, neurological deficits and anxiety after epilepsy surgery in a specific subpopulation of elderly patients. Methods: A total of 85 elderly patients (older than 50 years) answered a standardized HRQoL questionnaire one year after epilepsy surgery. The questionnaire addressed the present self-assessed HRQoL in four subdomains (physical function, cognitive function, mood, social interaction). The questionnaire was based on the "Epilepsy Surgery Inventory-55", adapted for use in German speaking patients and validated by the QOLIE - 10 and Beck Depression Inventory. Results: A total of 51 patients (60%) were completely seizure free (ILAE1) at last available outcome (LAO). Permanent neurological deficits were observed in 8 patients (7%). Correlation analysis confirmed significant association between seizure outcome and overall HRQoL (r = - 0.368, p < .001). New permanent neurological deficits showed impact on both HRQoL and the "cognitive function" subdomain. Anxiety and subjective assessment of postoperative status were strongly correlated with overall HRQoL (r = 0.692, p <.001 and r = 0.591, p <.001 respectively) and remained as independent prognostic factors in a multivariate regression analysis. Conclusion: Surgery for drug-resistant epilepsy in elderly improves patients HRQoL. Both seizure freedom and new neurological deficits influence overall HRQoL. Interestingly, anxiety and patients' subjective assessment of postoperative status showed the highest impact on HRQoL in this subpopulation of epilepsy patients. (C) 2020 Elsevier Inc. All rights reserved.

关键词： tremor   essential tremor   ataxia   finger–   nose–   finger test  

摘要： In this paper, we introduce a simple method based on image analysis and deep learning that can be used in the objective assessment and measurement of tremors. A tremor is a neurological disorder that causes involuntary and rhythmic movements in a human body part or parts. There are many types of tremors, depending on their amplitude and frequency type. Appropriate treatment is only possible when there is an accurate diagnosis. Thus, a need exists for a technique to analyze tremors. In this paper, we propose a hybrid approach using imaging technology and machine learning techniques for quantification and extraction of the parameters associated with tremors. These extracted parameters are used to classify the tremor for subsequent identification of the disease. In particular, we focus on essential tremor and cerebellar disorders by monitoring the finger-nose-finger test. First of all, test results obtained from both patients and healthy individuals are analyzed using image processing techniques. Next, data were grouped in order to determine classes of typical responses. A machine learning method using a support vector machine is used to perform an unsupervised clustering. Experimental results showed the highest internal evaluation for distribution into three clusters, which could be used to differentiate the responses of healthy subjects, patients with essential tremor and patients with cerebellar disorders.

关键词： EMBRYONIC physiology   EGGS   ANALYSIS of variance   ANIMAL experimentation   CELLULAR signal transduction   CORRELATION (Statistics)   ESTROGEN   FACTOR analysis   FISHER exact test   FOLLICLE-stimulating hormone   GENOMES   GONADS   OVARIAN follicle   HUMAN growth   MULTIDIMENSIONAL scaling   POLYMERASE chain reaction   REPTILES   RESEARCH funding   RNA   STATISTICS   T-test (Statistics)   TRANSCRIPTION factors   WATER pollution   PHENOTYPES   DATA analysis   ENVIRONMENTAL exposure   ENDOCRINE system   ONTOLOGIES (Information retrieval)   GENE expression profiling   SEQUENCE analysis   ONE-way analysis of variance  

摘要： BACKGROUND: Only a limited number of neuroimaging studies have explored the effects of ambient air pollution in adults. The prior studies have investigated only cortical volume, and they have reported mixed findings, particularly for gray matter. Furthermore, the association between nitrogen dioxide (NO2) and neuroimaging markers has been little studied in adults. OBJECTIVES: We investigated the association between long-term exposure to air pollutants (NO2, particulate matter (PM) with aerodynamic diameters of <= 10 lm (PM10) and <= 2.5 mu m (PM2.5), and neuroimaging markers. METHODS: The study included 427 men and 530 women dwelling in four cities in the Republic of Korea. Long-term concentrations of PM10, NO2, and PM2.5 at residential addresses were estimated. Neuroimaging markers (cortical thickness and subcortical volume) were obtained from brain magnetic resonance images. A generalized linear model was used, adjusting for potential confounders. RESULTS: A 10-lg/m3 increase in PM10 was associated with reduced thicknesses in the frontal [-0.02 mm (95% CI: -0.03, -0.01)] and temporal lobes [-0.06 mm (95% CI: -0.07, -0.04)]. A 10-lg/m3 increase in PM2.5 was associated with a thinner temporal cortex [-0.18 mm (95% CI: -0.27, - 0.08)]. A 10-ppb increase in NO2 was associated with reduced thicknesses in the global [-0.01 mm (95% CI: -0.01, 0.00)], frontal [-0.02 mm (95% CI: -0.03, -0.01)], parietal [-0.02 mm (95% CI: -0.03, -0.01)], temporal [-0.04 mm (95% CI: -0.05, -0.03)], and insular lobes [-0.01 mm (95% CI: - 0.02, 0.00)]. The air pollutants were also associated with increased thicknesses in the occipital and cingulate lobes. Subcortical structures associated with the air pollutants included the thalamus, caudate, pallidum, hippocampus, amygdala, and nucleus accumbens. DISCUSSION: The findings suggest that long-term exposure to high ambient air pollution may lead to cortical thinning and reduced subcortical volume in adults.

关键词： Epidemiology   Older adults   Alzheimer's disease   Aging   Neurological diseases  

摘要： Neurological diseases refer to the diseases that target the nervous system (brain, spine or nerves). They are the second leading cause of death, and the first cause of severe long-term disability in the world. The prevalence of most neurological diseases increases sharply with age, and age also modulates the impact of risk factors, clinical presentation and the natural course of these diseases. Longitudinal population-based studies provide useful insights for a better understanding of the specificities of neurological diseases in older adults by assessment of a wide range of risk factors. Rapid population aging, especially in low-income countries, presents challenges in terms of health and social care. A multidisciplinary approach is necessary to find solutions to tackle the burden of neurological diseases in older adults. (C) 2020 Elsevier Masson SAS. All rights reserved.

关键词： Stroke   Thrombectomy   Leukoaraiosis   Earlier neurological outcome  

摘要： Background and purpose. - The aim of the study was to evaluate whether leukoaraiosis (LA) severity is associated with earlier neurological outcome in acute stroke patients undergoing mechanical thrombectomy. Materials and methods. - In this retrospective multicenter study, we evaluated 273 acute stroke patients treated with mechanical thrombectomy. LA severity was graded as 0-2 (absent-to-moderate) versus 3-4 (severe) according to the van Swieten scale. The main clinical outcome was the proportion of early neurological improvement and early neurological deterioration. Early neurological improvement was defined as a decrease of >= 4 points on the NIHSS, or an NIHSS score of zero 24 hours after baseline assessment. Early neurological deterioration was defined as an increase of >= 4 points on the NIHSS 24 hours after baseline assessment. Results. - There was a significantly lower early neurological improvement rate (17.1% versus 39.2%;P = 0.006) and non-significantly higher early neurological deterioration rate (29.3% versus 17.7%;13= 0.084) in patients with severe LA ( sLA) compared with patients with absent-to-moderate LA. In multivariable analysis, sLA was inversely associated with early neurological improvement (OR, 0.31;95% CI, 0.13-0.78;P=0.012). There was no significant association of sLA with early neurological deterioration. However, in patients without symptomatic intracranial hemorrhage, sLA was an independent predictor of early neurological deterioration (OR, 2.65;95% CI, 1.09-6.45;P= 0.032). Conclusions. - sLA is a significant negative predictor of early neurological improvement and is an independent predictor of early neurological deterioration in patients without symptomatic intracranial hemorrhage. (C) 2020 Elsevier Masson SAS. All rights reserved.

关键词： Neuronal plasticity   Short-term plasticity   Long-term potentiation   Neurodegenerative diseases   AMPAR   NMDAR  

摘要： Stimuli from stressful events, attention in the classroom, and many other experiences affect the functionality of the brain by changing the structure or reorganizing the connections between neurons and their communication. Modification of the synaptic transmission is a vital mechanism for generating neural activity via internal or external stimuli. Neuronal plasticity is an important driving force in neuroscience research, as it is the basic process underlying learning and memory and is involved in many other functions including brain development and homeostasis, sensorial training, and recovery from brain injury. Indeed, neuronal plasticity has been explored in numerous studies, but it is still not clear how neuronal plasticity affects the physiology and morphology of the brain. Thus, unraveling the molecular mechanisms of neuronal plasticity is essential for understanding the operation of brain functions. In this timeline review, we discuss the molecular mechanisms underlying different forms of synaptic plasticity and their association with neurodegenerative/neurological disorders as a consequence of alterations in neuronal plasticity.

关键词： hearing loss   immunotherapy   melanoma   neurological immune-related adverse events   ototoxicity  

摘要： Background Recurrent immunotherapy-induced audiovestibular toxicity despite cessation of therapy has not been reported. Methods We report the first case of recurrent audiovestibular toxicity following immune-checkpoint inhibitor (ICI) therapy. The patient was seen with sudden bilateral hearing loss and disequilibrium. After ruling out other etiologies, he was diagnosed with audiovestibular and neurological immune-related adverse events (irAEs). He received systemic steroids, with significant hearing and balance recovery. Over the following 4 months, he experienced two other episodes of sudden bilateral hearing loss despite ICIs cessation. The second episode was treated with oral steroids, and hearing improved. On the third episode, he received oral and intratympanic steroids, and he was started on infliximab. Results Audiogram 8 months following the last recurrence showed hearing improvement and stability. Conclusion Immunotherapy-induced ototoxicity may recur despite therapy cessation. High dose steroids remain the mainstay of treatment. If audiovestibular irAEs recur despite multiple courses of steroids, immunosuppressive agents may be considered.

关键词： Benign spinal tumors   Spinal schwannoma   Spinal neurinoma   Spinal surgery   Spinal neuro-oncology   Functional outcome   Neurosurgery  

摘要： Introduction: Spinal schwannoma (SS) is the most frequently diagnosed benign spinal tumor, constituting approximately 25 % of all intradural tumors. Aim of our study was to identify factors that potentially affect immediate postoperative neurological outcome, and the rate of functional recovery within 12 months. Methods: Screening of our institutional database yielded 90 consecutive patients (mean age 57.1 years, 39 women [43.3 %]) with newly diagnosed SS between March 1997 and October 2018. We pre- and postoperatively reviewed patient charts, surgical reports, radiographic data, use of IOM, duration of symptoms, histopathology, co-morbidities, radiographic extension, surgical strategy, neurological performance (Japanese Orthopedic Association Score [JOA score] and Frankel Grade Classification). Results: Mean duration of preoperative symptoms was 3.6 +/- 1.6 months. Most common symptoms were local pain (n = 77, 85.6 %). Macroscopic complete resection was achieved in 84 patients (93.3 %). During follow-up, complete recovery from local pain was documented for 41 patients (59.7 %), from radiating pain for 41 (69.5 %;p < 0.001). Postoperatively, 25 (27.7 %) patients developed a new neurological deficit (motor deficits n = 3 and sensory deficits n = 23;one patient developed both);after 12 months, however, motor deficits had abated in all patients, and 16 (69.5 %) patients had completely recovered from sensory deficits. Use of intraoperative monitoring (IOM) was a significant predictor for good functional outcome (p < 0.001). Conclusion: Resection of SS accompanied by IOM whenever feasible should be advocated. We achieved a high number of complete resections with a low rate of morbidity. New postoperative motor or sensory deficits had a very high rate of complete recovery within 12 months.