摘要： Although many traits can be gained or lost over evolutionary time, it has long been unclear whether complex sensory processing structures, such as brain neuropils, can be regained after having been lost. Morris et al. show that a part of the brain once lost in butterflies, a macro-glomeruli complex (MGC) in the antennal lobe, is prevalent and has diversified in the Ithomiini tribe. This structure is sexually dimorphic in some species. This re-emergence of a complex sensory processing structure is likely driven by ecological factors.

关键词： Plasma exchange   Autoimmune Encephalitis   Multiple Sclerosis   Neuromyelitis Optica   Chronic Inflammatory Demyelinating Polyradiculoneuropathy   Myasthenia Gravis  

摘要： Autoimmune neurological disorders are commonly treated with immunosuppressive therapy. In patients with refractory conditions, standard immunosuppression is often insufficient for complete recovery or to prevent relapses. These patients rely on other treatments to manage their disease. While treatment of refractory cases differs between diseases, intravenous immunoglobulin, plasma exchange (PLEX), and immune-modulating treatments are commonly used. In this review, we focus on five autoimmune neurological disorders that were the themes of the 2018 Midlands Neurological Society meeting on PLEX in refractory neurology: Autoimmune Encephalitis (AE), Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum disorders (NMOSD), Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and Myasthenia Gravis (MG). The diagnosis of inflammatory neuropathies is often challenging, and while PLEX can be very effective in refractory autoimmune diseases, its ineffectiveness can be confounded by misdiagnosis. One example is POEMS syndrome (characterized by Polyneuropathy Qrganomegaly, Endocrinopathy, Myeloma protein, skin changes), which is often wrongly diagnosed as CIDP;and while CIDP responds well to PLEX, POEMS does not. Accurate diagnosis is therefore essential. Success rates can also differ within 'one' disease: e.g. response rates to PLEX are considerably higher in refractory relapsing remitting MS compared to primary or secondary progressive MS. When sufficient efforts are made to correctly pinpoint the diagnosis along with the type and subtype of refractory autoimmune disease, PLEX and other immunotherapies can play a valuable role in the patient management.

关键词： Coronavirus   COVID-19   SARS-CoV-2   Neurology   CNS   Animal study  

摘要： Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This virus, which was first identified in December 2019 in China, has resulted in a yet ongoing viral pandemic. Coronaviridae could potentially cause several disorders in a wide range of hosts such as birds and mammals. Although infections caused by this family of viruses are predominantly limited to the respiratory tract, Betacoronaviruses are potentially able to invade the central nervous system (CNS) as well as many other organs, thereby inducing neurological damage ranging from mild to lethal in both animals and humans. Over the past two decades, three novel CoVs, SARS-CoV-1, MERS-CoV, and SARS-CoV-2, emerging from animal reservoirs have exhibited neurotropic properties causing severe and even fatal neurological diseases. The pathobiology of these neuroinvasive viruses has yet to be fully known. Both clinical features of the previous CoV epidemics (SARS-CoV-1 and MERS-CoV) and lessons from animal models used in studying neurotropic CoVs, especially SARS and MERS, constitute beneficial tools in comprehending the exact mechanisms of virus implantation and in illustrating pathogenesis and virus dissemination pathways in the CNS. Here, we review the animal research which assessed CNS infections with previous more studied neurotropic CoVs to demonstrate how experimental studies with appliable animal models can provide scientists with a roadmap in the CNS impacts of SARS-CoV-2. Indeed, animal studies can finally help us discover the underlying mechanisms of damage to the nervous system in COVID-19 patients and find novel therapeutic agents in order to reduce mortality and morbidity associated with neurological complications of SARS-CoV-2 infection.

关键词： Neurosciences   Immunology   Pharmacology/Toxicology   Virology   Cell Biology  

关键词： Post-acute COVID-19   Cognitive impairment  

摘要： Central and peripheral nervous system involvement during acute COVID-19 is well known. Although many patients report some subjective symptoms months after the infection, the exact incidence of neurological and cognitive sequelae of COVID-19 remains to be determined. The aim of this study is to investigate if objective neurological or cognitive impairment is detectable four months after SARS-CoV-2 infection, in a group of patients who had mild-moderate COVID-19. A cohort of 120 health care workers previously affected by COVID-19 was examined 4 months after the diagnosis by means of neurological and extensive cognitive evaluation and compared to a group of 30 health care workers who did not have COVID-19 and were similar for age and co morbidities. At 4 month follow-up, 118/120 COVID-19 cases had normal neurological examination, two patients had neurological deficits. COVID-19 patients did not show general cognitive impairment at MMSE. In COVID-19 cases the number of impaired neuropsychological tests was not significantly different from non COVID-19 cases (mean 1.69 and 1 respectively, Mann-Whitney p = n.s.), as well as all the mean tests' scores. Anxiety, stress and depression scores resulted to be significantly higher in COVID-19 than in non COVID-19 cases. The results do not support the presence of neurological deficits or cognitive impairment in this selected population of mild-moderate COVID-19 patients four months after the diagnosis. Severe emotional disorders in patients who had COVID-19 in the past are confirmed.

关键词： COVID-19   neurological manifestations   SARS-CoV-2  

摘要： Background and purpose During acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry. Methods We analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results A total of 6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB;2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20-1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07-1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. Conclusion Our data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.

关键词： Functional neurological disorder   Conversion disorder   Neuropsychiatry   Formulation   Psychodynamic therapy   Cognitive behavioural therapy  

摘要： Background Functional Neurological Disorder (FND) is a complex neuropsychiatric condition with a multifactorial aetiology. The heterogeneity of patients with FND is rarely considered in psychotherapy trials, which may contribute to variable outcomes. Shared Individual Formulation Therapy (SIFT) is a new, brief (four session) psychotherapy that aims to accommodate heterogeneity by providing a personalised, trans-theoretical formulation of the person's difficulties and accompanying management plan. Methods An open-label, prospective trial of outpatient SIFT for adults with FND was conducted, using health-related quality of life (SF-12) as the principal outcome measure, with secondary measures of mental health, dissociation, health care use and attitude to the FND diagnosis. Measures were collected at baseline, end of treatment and 6- and 12-month follow-ups. Results Twenty-nine participants with various FND symptoms enrolled. Twenty-four completed all four sessions and 25 completed follow-up measures at 12 months. SF-12 scores improved significantly at end of treatment and were sustained throughout follow-up with moderate effect sizes (0.39-0.47;all p < 0.001). Most secondary outcomes also improved significantly at all time points. The intervention was highly acceptable and tolerable to patients and perceived as beneficial. Conclusion This trial provides preliminary evidence for initial and sustained benefit from SIFT for adults with FND. Further study is needed to validate these findings.

关键词： brain-derived neurotrophic factor (BDNF)   cognition   intellectual disability   intelligence quotient (IQ)   learning and memory   S100B  

摘要： Background Brain-derived neurotrophic factor (BDNF) and S100B are reported to play an important role in neurodevelopment and may contribute to developmental pathogenesis in neuropsychiatric diseases. In this study, we aimed to examine the possible roles of BDNF and S100B in the pathogenesis of nonsyndromic intellectual disability (NS-ID) and their relationship with cognitive performance. Methods Thirty-three patients with intellectual disability (ID) and 30 typically developing children were compared. BDNF and S100B serum levels were measured with ELISA. The Wechsler Intelligence Scale for Children-Revised Short form (WISC-R) and Leiter intelligence test were administered to determine the intelligence levels of subjects. Leiter intelligence test was applied to 10 participants (30.31%) in the ID group because they had speech and communication problems. All other participants underwent WISC-R. Results Brain-derived neurotrophic factor levels were found to be significantly low in the patient group (mean +/- SD, 67.43 +/- 29.74 pg/mL) compared with the control group (94.67 +/- 32.55 pg/mL) (P = 0.002). When S100B is assessed, there was no significant difference found between the patient group (335.05 +/- 279.89 pg/mL) and control group (295.30 +/- 146.55 pg/mL) (P = 0.901). There was a significant positive correlation between BDNF and performance IQ (r = 0.424 and P = 0.001) in all participants. In addition, positive correlations were found between BDNF levels and initiating speech time (r = -0.369 and P = 0.003). Conclusions Brain-derived neurotrophic factor deficiency is proposed to have a possible role in the pathology of NS-ID. High BDNF levels may be associated with better cognitive performance.

关键词： Brain injuries   Critical care   Cytokines   Immunosuppression   Infection  

摘要： Background Neurological injury can alter the systemic immune system, modifying the functional capacity of immune cells and causing a dysfunctional balance of cytokines, although mechanisms remain incompletely understood. The objective of this study was to assess the temporal relationship between changes in the activation status of circulating invariant natural killer T (iNKT) cells and the balance of plasma cytokines among critically ill patients with neurological injury. Methods We conducted an exploratory prospective observational study of adult (18 years or older) intensive care unit (ICU) patients with acute neurological injury (n = 20) compared with ICU patients without neurological injury (n = 22) and healthy controls (n = 10). Blood samples were collected on days 1, 2, 4, 7, 14, and 28 following ICU admission to analyze the activation status of circulating iNKT cells by flow cytometry and the plasma concentration of inflammation-relevant immune mediators, including T helper 1 (T(H)1) and T helper 2 (T(H)2) cytokines, by multiplex bead-based assay. Results Invariant natural killer T cells were activated in both ICU patient groups compared with healthy controls. Neurological patients had decreased levels of multiple immune mediators, including T(H)1 cytokines (interferon-gamma, tumor necrosis factor-alpha, and interleukin-12p70), indicative of immunosuppression. This led to a greater than twofold increase in the ratio of T(H)2/T(H)1 cytokines early after injury (days 1 - 2) compared with healthy controls, a shift that was also observed for ICU controls. Systemic T(H)2/T(H)1 cytokine ratios were positively associated with iNKT cell activation in the neurological patients and negatively associated in ICU controls. These relationships were strongest for the CD4(+) iNKT cell subset compared with the CD4(-) iNKT cell subset. The relationships to individual cytokines similarly differed between patient groups. Forty percent of the neurological patients developed an in

关键词： Diseases of the nervous system   Funding   Gene therapy   Life Sciences   general   Biotechnology   Biomedicine   Agriculture   Biomedical Engineering/Biotechnology   Bioinformatics