Surgical outcomes of focal cortical dysplasia patients with "difficult to locate" intractable epilepsy and their influencing factors / 中华神经医学杂志

Objective:To explore the surgical outcomes of focal cortical dysplasia (FCD) patients with "difficult to locate" intractable epilepsy and their influencing factors.Methods:Thirty-five FCD patients with "difficult to locate" intractable epilepsy, underwent surgical treatment after intracranial electroencephalogram (iEEG) evaluation in our hospital from January 2011 to December 2018, were chosen in our study. Engel grading was used to evaluate the surgical efficacies of these patients, and they were divided into a satisfied efficacy group (Engel grading I) and an incomplete satisfied efficacy group (Engel grading II-IV). The clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was performed to explore the influencing factors for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy.Results:Of these 35 patients, 26 patients (74.3%) achieved satisfied efficacy, and 4 had incomplete satisfied efficacy. As compared with those in the satisfied efficacy group, patients in the incomplete satisfied efficacy group had significantly lower total resection rate of epileptogenic foci ( P<0.05). Multivariate Logistic regression analysis showed that incomplete resection of epileptogenic foci was the influencing factor for surgical outcomes of FCD patients with "difficult to locate" intractable epilepsy ( P=0.014, OR=0.050, 95%CI: 0.005-0.547). Conclusion:The FCD patients with "difficult to locate" intractable epilepsy can achieve satisfactory results by surgical resection of epileptogenic zones after iEEG monitoring; these FCD patients with "difficult to locate" intractable epilepsy with incomplete resection of epileptogenic foci often have poor surgical outcomes.

Application of intracranial lead reconstruction in deep brain stimulation therapy in patients with Parkinson's disease / 南方医科大学学报

OBJECTIVE@#To evaluate the feasibility of applying intracranial lead reconstruction in deep brain stimulation (DBS) therapy for Parkinsonism.@*METHODS@#We retrospectively collected the clinical data from 27 patients with Parkinson's disease (PD), who received bilateral subthalamic nucleus (STN) DBS therapy between January, 2016 and December, 2017. According to the position of the selected optimal stimulating contact of the implanted leads, the patients were divided into group A with the stimulating contacts of the bilateral leads in the STN, group B with unilateral stimulating contacts in the STN, and group C with bilateral stimulating contacts outside the STN. All the patients were assessed for improvement using Hoehn-Yahr stage, the third part of United Parkinson's Disease Rating Scale (UPDRS Ⅲ), Schwab and England Activities of Daily Living (SE-ADL), and L-dopa equivalent daily dose (LEDD). The consistency between the optimal stimulating contact selected by lead reconstruction and that by standard postoperative programming procedure was also evaluated.@*RESULTS@#The patients in all the 3 groups showed postoperative improvements in Hoehn-Yahr stage, UPDRS Ⅲ score, SE-ADL score, and LEDD in the medication-off state. But at 12 months of the follow-up, such improvements were maintained only in the patients of group A. The optimal stimulating contacts selected by lead reconstruction and standard postoperative programming procedure had a matching rate of up to 77.78% (42/54), and the coordinates of the optimal contacts selected by the two methods showed no significant difference.@*CONCLUSIONS@#Intracranial lead reconstruction facilitates the study of the association between the implant site of the leads and the clinical outcome of DBS therapy for PD and allows the precise selection of the optimal contact of the implanted leads in postoperative programming of DBS.

Expressions of brain derived neurotrophic factor and tropomyosin-related kinase B and their significances in rats with early brain injury after subarachnoid hemorrhage / 中华神经医学杂志

Objective To observe the expressions of brain derived neurotrophic factor (BDNF) and tropomyosin-related kinase B (TrkB) in rats with early brain injury (EBI) after subarachnoid hemorrhage,and study the neuroprotective effects of BDNF and TrkB on EBI.Methods Male Sprague-Dawley rats (n=56),weighing 280-320 g,were randomly divided into sham-operated group and SAH group;SAH models were established by endovascular perforation ofinternal carotid artery.At 24 and 72 h after modeling,neurological scale scores were recorded;brain water content was measured;immunohistochemical staining and ELISA were used to observe the dynamical expressions of BDNF and TrkB in the brain.Results At 24 and 72 h after modeling,the neurological function scores and brain water content of SAH rats were higher than those of sham-operated group.The expression scores of BDNF in the SAH rats were 1.33±0.52 and 1.67±0.52,and the expression levels were (12.11±0.44) mg/mL and (15.82±0.89) mg/mL;the expression scores of TrkB were 1.17±0.75 and 2.00±0.00,and the expression levels were (18.89±0.38) mg/mL and (25.18±0.68) mg/mL.The expression scores of BDNF in the sham-operated group were 0.33±0.52 and 0.17±0.41,and the expression levels of BDNF in the sham-operated group was (4.92±0.16) mg/mL and (4.93±0.20) mg/mL;the expression scores of TrkB were 0.17±0.41 and 0.33±0.52,and the expression levels were (8.52±0.41) mg/mL and (8.08±0.34) mg/mL.There were significant differences in BDNF and TrkB expressions between the two groups at 24 and 72 h after modeling (P＜0.05).Conclusion The expressions of BDNF and TrkB increase significantly after SAH,and BDNF and TrkB play protective effect on EBI after SAH.

Prognostic influence factors of ruptured intracranial aneurysms under keyhole clipping / 中华神经医学杂志

Objective To investigate the changes of perioperative blood glucose in patients with ruptured intracranial aneurysms under keyhole clipping and their prognostic influence factors.Methods Totally, 147 patients with ruptured intracranial aneurysms, admitted to our hospital from July 2010 to July 2012, were selected.The changes of serum glucose on admission and at non-fasting state every day at the hospital, random blood sugar before operation and one day after the operation were analyzed;modified Rankin scale (mRS) was performed to evaluate short-term prognosis of the patients 14 day after the operation;Logistic regression analysis was used to analyze the prognostic influence factors of ruptured intracranial aneurysms under keyhole clipping.Results In the 147 patients with ruptured intracranial aneurysms, 57 (38.8％) had preoperative increased blood glucose and 99 (67.3％) had postoperative increased blood glucose;77 patients had ratio of postoperative/preoperative blood glucose＜1.2, 38 had ratio=1.2-1.5, and 32 had ratio ≥ 1.5.Seventy-eight patients had a good prognosis, while 69 patients gained a poor prognosis.As compared with the good prognosis group, the poor prognosis group had significantly larger percentage of patients with age elder than 60 or with postoperative blood glucose＞7.0 mmol/L, higher Hunt-Hess scale scores and ratio of postoperative/preoperative blood glucose, with significant differences (P＜0.05);multi-factor unconditional Logistic regression analysis indicated that age, postoperative and preoperative blood glucose ratio, postoperative blood glucose and Hunt-Hess scale scores were the independent factors of prognosis.Conclusion In patients with age＞60, Hunt-Hess scale Ⅳ or Ⅴ, postoperative blood glucose＞7.0 mmol/L and postoperative/preoperative blood glucose ratio ≥ 1.5, poor prognosis can be predictive.

Effect of butylphthalide injection on serum neuron specific enolase, C-reactive protein and fatty acid binding protein levels in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage / 中国生化药物杂志

To investigate influence of butylphthalide injection on serum neuron specific enolase, C-reactive protein and fatty acid binding protein levels in patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage.Methods Ninety patients with cerebral vasospasm were admitted to The First Affiliated Hospital of Fujian Medical University, then the patients were divided into two groups: The control group (45 patients) was treated with nimodipine and triple-H therapy after surgery;in addition to nimodipine and triple-H therapy, butylphthalide injection was administered to the experimental group(45 patients).Transcranial doppler(TCD)was used for the evaluating cerebral artery blood flow velocity, and the serum neuron specific enolase(NSE), C-reactive protein(CRP) and fatty acid binding protein(FABP) levels in patients with cerebral vasospasm were measured. Results The experimental group improved significantly more than the control group, a significant decrease in cerebral blood flow velocity of the middle cerebral artery in the experimental group as measured by TCD (P<0.05).The serum levels of NSE, CRP and FABP in the patients in the experimental group decreased more significantly (P<0.05).And the incidence of cerebral infarction in experimental group was lower than that in control group (P<0.05).Conclusion The serum levels of NSE, CRP and FABP in the patients with cerebral vasospasm following aneurysmal subarachnoid hemorrhage could be significantly reduced by administration of butylphthalide injection, which also could improve cerebral blood supply.Therefore, administration of butylphthalide injection is an effective treatment for cerebral vasospasm.

The primary application of intra-operative evoked potentials monitoring in microsurgery of intracranial aneurysms / 中国神经精神疾病杂志

Background Although remarkable progress has been made in microsurgery, surgery of intracranial aneurysm still encounters various complications. Cerebral ischemia and postoperative disorders of nervous system could be induced by various specific operation procedures. To improve the outcomes in intracranial aneurysm surgery and to minimize the occurrence of postoperative ischemic complications, it is necessary to perform real-time monitoring on ischemic damages for the corresponding functional areas. To elevate the sensitivity of Eps changes for the detection of cerebral ischemia induced by operation, we monitored Motion Evoked Potential ( MEPs), Somatosensory Evoked Potential (SSEPs)and Brainstem Auditory Evoked Potential (BAEPs) in microsurgical operations of intracranial aneurysms. And then the correlation between Eps changes and clinical outcome was investigated.Methods MEPs, SSEPs, and BAEPs were recorded intra-operatively for 25 cases in intracranial aneurysms. Monitored results and clinical outcome were analyzed in a prospective observational design.Results The MEPs in 5 of 21 cases, the SSEPs in 5 of 25 cases and the BAEPs in 1 of 3 cases showed inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels. 3 patients developed advanced weakness, which showed abnormal SSEPs in only one patient while showed abnormal MEPs in all 3 cases.Conclusions The MEPs is more sensitive than SSEPs in monitoring the motor ischemic impairments. The monitoring results were correlated to the clinical outcome closely. Monitoring Eps in keyhole microsurgery of intracranial aneurysms could improve the sensitivity in detecting insufficient distal collateral flow. And then successful completion of potentially hazardous maneuvers would be attained.