关键词： Neurological disorders   Music therapy   Therapeutic   Emotion   Social   Cognitive   Psychosocial   Behavioral   Motor  

摘要： Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

关键词： Cardiopulmonary resuscitation   Favourable neurological outcome   Out-of-hospital cardiac arrest   Shenfu injection   Survival  

摘要： Aim We aimed to assess the effects of Shenfu injection (SFI) in combination with epinephrine during cardiac arrest on survival and neurological outcome after out-of-hospital cardiac arrest (OHCA).Methods In this randomised, assessor-blind controlled trial, Utstein-style data were collected from 1233 OHCA patients treated at the Beijing Emergency Medical Center between January 2013 and June 2016. The patients were randomised into either a treatment group that received a combination of SFI and standard treatment with epinephrine or a control group that received standard treatment with epinephrine alone. The primary outcome was survival to hospital admission. The secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital discharge, favourable neurological outcome at discharge, survival to one year, and favourable neurological outcome at one-year *** In both groups, the survival to hospital admission, ROSC, survival to hospital discharge, and one-year survival rate after discharge from the hospital did not differ significantly. However, SFI achieved favourable neurological outcome at discharge in comparison with the standard treatment with an odds ratio (OR) of 2.72 at a 95% confidence interval (CI; 1.00-8.53). Meanwhile, unlike with epinephrine alone, the combination of SFI and epinephrine achieved a better cerebral performance category (CPC) score (1-2) after one-year survival (OR: 5.08, 95% CI: 1.07-47.80).Conclusion The combination of SFI and epinephrine had favourable neurological outcomes after OHCA compared with those with epinephrine alone, whereas the survival to admission was not significantly altered.

关键词： glutamic acid decarboxylase   GAD65 autoimmunity   neuronal antibodies   paraneoplastic neurological syndromes   limbic encephalitis   autoimmune epilepsy   cerebellar ataxia   stiff-person syndrome  

摘要： Glutamic acid decarboxylase (GAD) is an intracellular enzyme whose physiologic function is the decarboxylation of glutamate to gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter within the central nervous system. GAD antibodies (Ab) have been associated with multiple neurological syndromes, including stiff-person syndrome, cerebellar ataxia, and limbic encephalitis, which are all considered to result from reduced GABAergic transmission. The pathogenic role of GAD Ab is still debated, and some evidence suggests that GAD autoimmunity might primarily be cell-mediated. Diagnosis relies on the detection of high titers of GAD Ab in serum and/or in the detection of GAD Ab in the cerebrospinal fluid. Due to the relative rarity of these syndromes, treatment schemes and predictors of response are poorly defined, highlighting the unmet need for multicentric prospective trials in this population. Here, we reviewed the main clinical characteristics of neurological syndromes associated with GAD Ab, focusing on pathophysiologic mechanisms.

关键词： Brain ischemia   Reperfusion   Inflammation   Metalloproteinases 1 and 2  

摘要： Ischemic stroke represents a major cause of adult death and severe neurological disability worldwide. Reperfusion following brain ischemia produces an inflammatory cascade that increases brain damage. In this context, matrix metalloproteinases (MMPs) play an important role as pro-inflammatory mediators. The MMP 2 up-regulation seems to promote matrix degradation, blood-brain barrier (BBB) disruption and facilitates the influx of peripheral inflammatory cells to the brain after stroke. However, there are not studies about MMP-1 in this condition. The aim of this study is to evaluate the association of brain damage, inflammatory response and the immunostaining profile of matrix metalloproteinases 1 and 2 after transient global cerebral ischemia. Mice were submitted to bilateral common carotid arterial occlusion (BCCAo) during 25 min. After three days of reperfusion, the neurological deficit score was evaluated and the animals were euthanized. Brain samples were collected in order to analyze the histopathological damage, MMPs 1 and 2 immunostaining and cytokines and chemokines levels. Ischemic group showed neurological deficits associated with brain lesions, characterized by necrotic core and penumbra zone three days after reperfusion. Higher brain immunostaining of MMP-1 and MMP-2 was observed in BCCAo samples than in sham samples. Ischemic group also exhibited increased brain levels of the cytokines tumoral necrosis factor (TNF) and interleukin 1 beta (IL-1 beta), chemokine (C-X-C motif) ligand 1 (CXCL1), and chemokine (C-C motif) ligand 5 (CCL5) in comparison to sham group. Our results suggest that the MMP-1 and MMP-2 raise, associated with the up-regulation of inflammatory mediators, contributes to brain damage and neurological deficits after global brain ischemia followed by three days of reperfusion in mice.

摘要： The possible entry of SARS‐CoV‐2 to reach the brain via cribriform plate (B) or after systemic circulatory dissemination following infection of the lung (C), in early or late phases of COVID‐19 may result in loss of involuntary control of breathing resulting in acute respiratory insufficiency requiring assisted ventilation (D) The clinicians throughout the world in general, and Wuhan, China, in particular, are getting the firsthand to study and report the real‐time clinical presentations of the patients affected by COVID‐19. The prognostic and diagnostic significance of neurological sign and symptoms in COVID‐19 patients can be gauged by fact that the protocol designed to investigate the First Few X cases (FFX) and their close contacts by the World Health Organization (WHO), includes a separate section for “other neurological signs” in addition to separate columns for respiratory symptoms. 3 Additionally, reports of COVID‐19‐affected individuals experiencing convulsions in prevalent areas is alarming and need to be distinguished from febrile convolution that is expected to occur with high‐grade fever in patients with COVID‐19. Studies believe that direct SARS‐CoV infection of the human CNS does occur in some patients. 8 It is also important to mention here that the neurological signs and symptoms observed in the COVID‐19 cases could be a manifestation of hypoxia, respiratory, and metabolic acidosis at an advanced stage of the disease, but reasonably, a differential diagnosis of these cases is needed, which could prove lifesaving.

关键词： Brain death   Ancillary testing   Death by neurological criteria   Cerebral blood flow study   EEG  

摘要： Keywords: Brain death; Ancillary testing; Death by neurological criteria; Cerebral blood flow study; EEG EN Brain death Ancillary testing Death by neurological criteria Cerebral blood flow study EEG 68 69 2 04/11/20 20200501 NES 200501 Introduction Death by neurological criteria (DNC) or brain death, defined as the irreversible loss of all functions of the brain including the brainstem, occurs in 21% of deaths in pediatric intensive care units.[1] DNC is diagnosed clinically by the presence of coma, absence of brainstem reflexes, and apnea after a carbon dioxide challenge on two separate examinations.[2] Ancillary tests can assist in DNC diagnosis primarily when components of the examination or apnea testing cannot be completed safely or when uncertainty exists about the reliability of the neurological examination.[2] SP , sp [3] Physicians perform ancillary tests for a variety of reasons, not always as recommended by published guidelines.[4] Our study objective was to determine the incidence of and indications for ancillary testing in DNC evaluation in children. Indications for ancillary testing were coded per the pediatric guidelines.[2] At our institution, an electroencephalography (EEG) was required for children aged <=12 months (2013 to 2017) and <=30 days (2017 to 2018). The patient was subsequently declared DNC with two unequivocal examinations and apnea tests. [Extracted from the article]

关键词： Traveller   neurological complications   Plasmodium falciparum  

摘要： Highlight (<50 words). A 53 years-old Israeli, working in Liberia, received initial treatment for severe cerebral falciparum malaria and evacuated to Israel. Following regain of consciousness, and cessation of seizures, the patient developed chaotic ocular movements, consistent with opsoclonus, accompanied by myoclonus. This may represent a rare manifestation of Post Malaria Neurological Syndrome. [ABSTRACT FROM AUTHOR]

摘要： Expanding use of immune-checkpoint inhibitors (ICIs) underscores the importance of accurate diagnosis and timely management of neurological immune-related adverse events (irAE-N). We evaluate the real-world frequency, phenotypes, co-occurring immune-related adverse events (irAEs), and long-term outcomes of severe, grade III to V irAE-N at a tertiary care center over 6?years. We analyze how our experience supports published literature and professional society guidelines. We also discuss these data with regard to common clinical scenarios, such as combination therapy, ICI rechallenge and risk of relapse of irAE-N, and corticosteroid taper, which are not specifically addressed by current guidelines and/or have limited data. Recommendations for management and future irAE-N reporting are outlined. ANN NEUROL 2020;87:659669

关键词： Cryptogenic   Patent foramen ovale   Ischemic stroke or cerebrovascular accident   Transient ischemic attack   Paradoxical embolism  

摘要： Background: Randomized-controlled trials (RCTs) reported a finding on the safety and efficacy of percutaneous patent foramen ovale (PFO) closure to prevent stroke recurrence. It showed that the Amplatzer (AMP) device appears to be superior to medical therapy (MT) in preventing strokes and episodes of atrial fibrillation (AF), than other devices. We performed a network meta-analysis (NMA) to evaluate the closure of PFO in preventing subsequent neurological events while investigating the results obtained by specific devices. Methods: We searched 3 databases (MEDLINE, EMBASE, CENTRAL/CCTR) and identified 6 RCTs until March 2019. We performed an NMA and used pooled ORs. Analyses were done in NetMetaXL1.6-WinBUGS1.4. Results: Six RCTs with 3,560 patients (mean age 45.2-46.2 years) were included in the present NMA. Depending on the device, 4 groups of patients were compared with MT: 1,889 patients undergoing PFO closure were significantly less likely to experience a stroke than 1,671 patients treated with MT (ORs 0.41;95% Cr.I. 0.27-0.60 with fixed-effects model and ORs 0.22;95% Cr.I. 0.05-0.70 with random-effects model). The patients with AMP showed a similar risk than those treated with Helex/Cardioform (HLX/CF) or with a group of 11 multiple devices. This suggests the equality between the 2 most currently used devices. When assessing TIA and, for the safety analysis, major bleeding, both models confirm no significant difference between any devices and MT. PFO closure increased the risk of new-onset AF: MT induces AF significantly less than all the devices. In favor of the AMP, there is a reduced number of cases of AF versus MT;however, no device superiority has been established in comparing HLX/CF and other devices in a random effect model. Conclusions: Our NMA provides evidence in favor of PFO closure with all the devices currently in use. We can conclude that these devices are better than MT, but not that 1 device is better than the rest in reducing stroke recurrence

关键词： Anterior column reconstruction   Corpectomy   Decompression   Short-segment posterior fixation   Thoracolumbar burst fracture  

摘要： Background: Thoracolumbar burst fractures (TLBFs) are the most common spinal trauma;however, their appropriate management has not yet been determined. In this study, we aimed to compare the clinical and radiological results of percutaneous pedicle screw fixation (PPSF) following posterior decompression technique versus anterior corpectomy and fusion technique for the treatment of TLBFs. Methods: A total of 46 patients (2002-2015) with TLBFs were included in this study. The inclusion criteria were a single-level Magerl type A3 burst fracture of the thoracolumbar junctional spine (T12-L2). The patients were divided into two groups;Group A (22 patients) underwent anterior corpectomy and fusion, and Group B (24 patients) underwent PPSF after posterior decompression. Anterior corpectomy and fusion surgery were performed in 22 cases before April 2009, and PPSF following posterior decompression technique was used in 24 cases since then. For radiological assessment, the kyphosis angle was measured preoperatively, early postoperatively, and at the last follow-up using the Cobb angle. Mean correction of the Cobb angle after surgery, and loss of correction between the immediate postoperative and final Cobb angle were calculated accordingly. All neurological deficits were identified in the initial evaluation and graded using the American Spinal Injury Association (ASIA) grading system. Perioperative parameters including operation time, amount of blood loss, and mean hospital stay were also evaluated. Results: The patients comprised 17 males and 5 females in Group A and 13 males and 11 females in Group B. In terms of the involved levels, there were three cases of T12, twelve Ll , and seven L2 in Group A and one case of T12, thirteen Ll , and ten L2 in Group B. The mean follow-up duration was 44.9 months in Group A and 14.7 months in Group B. The kyphotic angle was significantly corrected after surgery by 6.4 degrees in Group A (p = 0.001) and 9.2 degrees in Group B (p < 0.001).