Clinical and EEG characteristics analysis of autoimmune encephalitis in children with positive and negative anti-N-methyl- D-aspartate receptor antibodies.

BACKGROUND: Autoimmune encephalitis is complex and varied, but it is a curable disease. However, the diagnosis and treatment of children with Autoimmune encephalitis remains challenging. Therefore, we conducted this study to analyze the clinical features, electroencephalogram (EEG) characteristics, treatment and prognosis of autoimmune encephalitis in children with negative and positive anti-N-methyl-D-aspartate receptor (NMDAR) antibody. METHODS: From January 2015 to January 2017, 28 child patients with autoimmune encephalitis were hospitalized in the Neural Ward of the Children's Medical Center, Qilu Hospital of Shandong University. Inclusion criteria were based on the diagnostic criteria for autoimmune encephalitis published in Lancet Neurology in 2016. The clinical, EEG and imaging data were summarized. The clinical features, treatment regimen, follow-up and prognosis were also analyzed. RESULTS: Among these 28 child patients, 10 patients had positive anti-NMDAR antibody, while 18 patients had negative anti-NMDAR antibody. The clinical manifestations, EEG findings and seizures were similar (P>0.05) between these two groups. All 28 child patients were treated with methylprednisolone shock and human immunoglobulin. The response to immunotherapy was similar between these two groups (P>0.05). CONCLUSIONS: The clinical manifestation of autoimmune encephalitis is complex and varied, but it is a curable disease. Immunotherapy should be considered as soon as possible, with or without autoantibodies. Most of the child patients had a good prognosis, while some of them had the sequelae of epilepsy, mild mental symptoms, and dyskinesia. It is necessary to improve the understanding of autoimmune encephalitis with/without positive antibodies, and make diagnosis and treatment as soon as possible, in order to improve the prognosis.

Application of parallel stent placement in the treatment of unruptured vertebrobasilar fusiform aneurysms.

OBJECTIVE Large vertebrobasilar fusiform aneurysms (VFAs) represent a small subset of intracranial aneurysms and are often among the most difficult to treat. Current surgical and endovascular techniques fail to achieve a complete or acceptable result because of complications, including late-onset basilar artery thrombosis and perforator infarction. The parallel-stent placement technique was established in the authors' department, and this study reports the application of this technique in the treatment of unruptured VFAs. METHODS Eight patients with 8 unruptured VFAs who underwent parallel stent placement between April 2011 and August 2012 were included. The diameters of the VFAs ranged from 7.9 to 14.0 mm, and the lengths from 27.5 to 54.4 mm. Of the 8 patients with unruptured VFAs, 3 received double or triple parallel stents and 5 patients received a series-connected stent with another 1 or 2 stents deployed parallel to them. Outcomes for these patients were tabulated, based on the modified Rankin Scale (mRS) score and angiographic results. RESULTS All of the 25 stents were successfully placed without any treatment-related complications. During follow-up, 5 patients had decreased mRS scores, 2 were unchanged, and 1 was increased for subarachnoid hemorrhage. Immediate and follow-up clinical outcome was completely or partially recovered in most patients. Follow-up angiograms revealed 2 aneurysms were reduced in size and 6 were unchanged after stent placement. No in-stent stenosis, occlusion of the posterior inferior cerebellar artery, or perforators jailed by the stent occurred in any of the aneurysms. CONCLUSIONS These results provide encouraging support for the parallel-stent placement technique, which can be envisaged as an alternative strategy against unruptured VFAs. However, testing in more patients is needed.

Maternal immune activation increases seizure susceptibility in juvenile rat offspring.

Epidemiological data suggest a relationship between maternal infection and a high incidence of childhood epilepsy in offspring. However, there is little experimental evidence that links maternal infection with later seizure susceptibility in juvenile offspring. Here, we asked whether maternal immune challenge during pregnancy can alter seizure susceptibility and seizure-associated brain damage in adolescence. Pregnant Sprague-Dawley rats were treated with lipopolysaccharide (LPS) or normal saline (NS) on gestational days 15 and 16. At postnatal day 21, seizure susceptibility to kainic acid (KA) was evaluated in male offspring. Four groups were studied, including normal control (NS-NS), prenatal infection (LPS-NS), juvenile seizure (NS-KA), and "two-hit" (LPS-KA) groups. Our results demonstrated that maternal LPS exposure caused long-term reactive astrogliosis and increased seizure susceptibility in juvenile rat offspring. Compared to the juvenile seizure group, animals in the "two-hit" group showed exaggerated astrogliosis, followed by worsened spatial learning ability in adulthood. In addition, prenatal immune challenge alone led to spatial learning impairment in offspring but had no effect on anxiety. These data suggest that prenatal immune challenge causes a long-term increase in juvenile seizure susceptibility and exacerbates seizure-induced brain injury, possibly by priming astroglia.

[Influence of ketogenic diet on the clinical effects and electroencephalogram features in 31 children with pharmacoresistant epileptic encephalopathy].

OBJECTIVE: To investigate the effect of ketogenic diet (KD) on the clinical and electroencephalogram features in children with pharmacoresistant epileptic encephalopathy. METHOD: Thirty-one children (19 boys, 12 girls) aged 7 months to 7 years (mean 2 years 5 month) with epilepsy refractory to conventional antiepileptic drugs (AEDs) were included in this study. In addition to their original AED treatment, the children were assigned to different ketogenic diets based on their age. The prospective electro-clinical assessment was performed prior to the KD and then one week, one month and again 3 months after the initiation of therapy, respectively. RESULT: The reduction of seizure frequency in 52%, 68% and 71% of all patients exceeded 50% one week, one month and three months after KD treatment respectively. KD is particularly effective in myoclonic astatic epilepsy (MAE; Doose Syndrome) and West syndrome with 100% and 81.25% of the patients having a greater than 50% seizure reduction, respectively. After 3 months of KD treatment, more than 2/3 patients experienced a reduction in interictal epileptiform discharges (IEDs) and improvement in EEG background. CONCLUSION: The clinical and electroencephalographic improvement confirms that KD is beneficial in children with refractory epilepsy.

[Chemical constituents of Camellia sinensis var. assamica].

To study the chemical constituents of Camellia sinensis var. assamica. The compounds were isolated by NKA Macroporous resin silica gel, Sephadex LH-20, RP-C18 column chromatographies and semi-preparative HPLC,and their structures were elucidated by physicochemical properties and spectral analysis. Thirteen compounds were isolated and identified as caffeine (1), theobromine (2), gallic acid (3), (+)-catechin (4), ampelopsin (5), (-)-epicatechin (6), (-)-epiafzelechin (7), (-)-epicatechin-3-O-gallate (8), (-)-epiafzelechin-3-O-gallate (9) , (+)-catechin-3-O-gallate (10) , (+)-afzelechin-3-O-gallate (11), quemefin-3-O-alpha-L-arabinopyranosid (12), and (-)-epicatechin-3-O-p-hydroxybenzoate (13). Compounds 2, 5, 10-13 were isolated from this plant for the first time, and compound 11 is a new natural product.

Prenatal immune challenge in rats increases susceptibility to seizure-induced brain injury in adulthood.

Maternal infection during pregnancy is associated with an increased risk of neurodevelopmental injury. Our aim was to investigate whether prenatal immune challenge could alter susceptibility to seizure-induced brain injury in adulthood. Pregnant Wistar rats were injected intraperitoneally with lipopolysaccharide (LPS) or normal saline (NS) at days 15 and 16 of gestation. At postnatal day 45, seizure susceptibility was assessed in response to lithium-pilocarpine (LiPC) in adult offspring. Four groups were studied, including normal control (NS-NS), prenatal inflammation (LPS-NS), adult seizure (NS-LiPC), and "two-hit" (LPS-LiPC) groups. Our results demonstrated that adult rat offspring of LPS-exposed dams showed significantly greater susceptibility to LiPC-induced seizures, as well as enhanced hippocampal neuronal injury after seizures. Furthermore, animals in the "two-hit" group performed significantly worse than those from the NS-LiPC group in the open field test and Morris water maze. Our findings suggest that prenatal immune activation can cause a long-lasting increase in seizure susceptibility and predispose the brain to the damaging effect of seizures later in life.

[Risk factors in carotid angioplasty and stenting for extracranial carotid stenosis of elderly patients].

OBJECTIVES: To evaluate the risk factors and safety of carotid angioplasty and stenting(CAS) for extracranial carotid stenosis in elderly patients and summarize CAS on the indication of elderly patients and the prevention of complications. METHODS: The population characteristics, clinical features and vascular data of 60 elderly patients (≥ 75 years) treated between June 2001 and December 2010 were retrospectively analyzed. There were 57 male and 3 female. The median age of the patients was 78.8 years (range, 75 - 93 years ). The mean case history was 2.5 months with a range of 1 to 6 months. To summarize the prognosis of CAS according to the reduction of stenosis, NIHSS score, the incidence of early postoperative, 30 days adverse events and the follow-up status. Using χ(2) test as the statistical method. RESULTS: The mean stenosis was reduced from 81% ± 17% preoperative to 18% ± 9% postoperative. NIHSS score was reduced from preoperative 22 ± 8 to postoperative 10 ± 4. The average follow-up period was 1.5 years (range from 3 months to 3 years), and the results showed no procedure-related death occurred. Ipsilateral stroke occurred in 1 case (1.7%) and restenosis (≥ 50%) occurred in 2 patients (3.3%). Diabetes (χ(2) = 23.96, P < 0.01)and cardiac insufficiency (χ(2) = 6.446, P < 0.05)had a respectively significant impact on the incidence of early postoperative complications. CONCLUSIONS: CAS can be effective in restoring carotid artery stenosis of elderly patients and preventing the occurrence of stroke. The elderly, diabetes, cardiac insufficiency are more likely to increase the postoperative risk of adverse events.

[Stenting treatment of venous sinus stenosis for intractable pulsatile tinnitus].

OBJECTIVE: To evaluate the application, effectiveness and safety of stenting in venous sinus stenosis for intractable pulsatile tinnitus via endovascular treatment. METHODS: From January 2010 to July 2011, 12 cases with intractable pulsatile tinnitus originating from cerebral venous sinus stenosis underwent stenting treatment. All of them were diagnosed by digital subtraction angiography (DSA). There was ipsilateral stenosis in junction segment of sigmoid and transverse sinuses. The diverticulum of sigmoid sinus was found in 6 cases. Eleven patients underwent stenting placement and angioplasty for venous sinus stenosis. RESULTS: All pulsatile tinnitus symptoms disappeared immediately after stenting. No related complication was found during stenting and over a follow-up period of 3 - 22 months. There was no recurrence of pulsatile tinnitus. CONCLUSIONS: Stent placement is a safe and effective procedure for pulsatile tinnitus with cerebral venous sinus stenosis.

Overexpression of actin-depolymerizing factor blocks oxidized low-density lipoprotein-induced mouse brain microvascular endothelial cell barrier dysfunction.

The aim of present work was to elucidate the role of actin-depolymerizing factor (ADF), an important regulator of actin cytoskeleton, in the oxidized low-density lipoprotein (ox-LDL)-induced blood-brain barrier (BBB) disruption. The primary mouse brain microvascular endothelial cells (MBMECs) were exposed to ox-LDL. Treatment with LDL served as control. It was found that ADF mRNA level and protein expression were decreased when exposed to ox-LDL in MBMECs. Then, we investigated the influence of ADF overexpression on ox-LDL-treated MBMECs. Structurally, overexpression of ADF inhibited ox-LDL-induced F-actin formation. Functionally, overexpression of ADF attenuated ox-LDL-induced disruption of endothelial barrier marked by restoration of transendothelial electrical resistance, permeability of Evans Blue and expression of tight junction-associated proteins including ZO-1 and occludin, and blocked ox-LDL-induced oxidative stress marked by inhibition of reactive oxygen species (ROS) formation and activity of NADPH oxidase and Nox2 expression. However, overexpression of ADF in control cells had no significant effect on endothelial permeability and ROS formation. In conclusion, overexpression of ADF blocks ox-LDL-induced disruption of endothelial barrier. In addition, siRNA-mediated downregulation of ADF expression aggravated ox-LDL-induced disruption of endothelial barrier and ROS formation. These findings identify ADF as a key signaling molecule in the regulation of BBB integrity and suggest that ADF might be used as a target to modulate diseases accompanied by ox-LDL-induced BBB compromise.

Revascularization for complex cerebral aneurysms.

BACKGROUND AND PURPOSE: Complex cerebral aneurysms may require indirect treatment with revascularization. This manuscript describes various surgical revascularization techniques together with clinical outcomes. METHODS: Thirty-two consecutive patients with complex cerebral aneurysm were managed from November 2005 to October 2008. Techniques used for revascularization were high-flow bypass, low-flow bypass, branch artery reimplantion, and primary reanastomosis. Physiologic and anatomic monitoring technologies, including electroencephalography, somatosensory evoked potential monitoring, microvascular doppler ultrasonography, and/or indocyanine green videoangiography were used intraoperatively to assess both brain physiology and vascular anatomy. Patient outcome was determined using the Glasgow Outcome Scale at discharge and at a mean of 12 months post operation (range 6-25 months). RESULTS: Two cervical carotid aneurysms (6%) were resected followed by primary reanastomosis, 21 aneurysms (66%) were trapped following saphenous vein high-flow bypasses, five (16%) were clipped after superficial temporal or occipital artery low-flow bypasses, and four (12%) middle cerebral branch arteries were reimplanted. Of the 32 patients at discharge, 29 (91%) had a Glasgow Outcome Scale of four or five, two (6%) had severe disability, and one (3%) died. CONCLUSION: Cerebral revascularization remains an effective and reliable procedure for treatment of complex cerebral aneurysms. Low morbidity and mortality rates reflect the maturity of patient selection and surgical technique in the management of these lesions.

[Evaluation of carotid angiography and stenting for patients with contralateral carotid occlusion].

OBJECTIVE: To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion. METHODS: From January 2001 to January 2010, 56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases. RESULTS: The technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and post-procedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent. CONCLUSIONS: CAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous post procedure general management can decrease the rate of complication.

[Embolization combined with endovascular stenting for treatment of intracranial pseudoaneurysms].

OBJECTIVE: To evaluate the therapeutic effect of embolization combined with endovascular stenting in the for treatment of intracranial pseudoaneurysms. METHODS: Seventeen patients with intracranial pseudoaneurysms received endovascular treatment with coil placement, NBCA glue embolization and endovascular stenting, and the therapeutic effect was evaluated according to the findings in immediate postoperative and follow-up angiography. RESULTS: Fatal aneurysm rupture occurred in 1 case during embolization, and the surgical procedures were carried out smoothly in the remaining 16 cases. The aneurysm cavity dense coil packing ratio was 50% in coil embolization group and 42.9% in stent-assisted coil embolization group. In the follow-up for 3 months to 2 years, 2 patients in coil embolization group experienced pseudoaneurysm recurrence and were managed successfully with additional embolization with coils and stent. Aneurysms were not found postoperatively in stent-assisted coil embolization group. CONCLUSION: Embolization combined with endovascular stenting is a safe and effective treatment of intracranial pseudoaneurysms with minimized risk of recurrence.

[Clinical study on endovascular treatment for symptomatic atherosclerotic stenosis of basilar artery].

OBJECTIVE: To study the feasibility, safety and validity of percutaneous angioplasty and stenting (PTAS) for symptomatic atherosclerotic stenosis of basilar artery. METHODS: The results of treatment and follow-up of 40 cases with symptomatic atherosclerotic stenosis of basilar artery performed PTAS from August 2003 to December 2009 were studied retrospectively, who had either recurrent transient ischemic attacks (TIAs) or obvious ischemic symptoms and resistant to medical therapy. RESULTS: PTAS were successfully performed in all the 40 cases and the post-operative average residual stenosis descended to 14% ± 11% from pre-operative 82% ± 14%. After operation the patients were administrated with antiplatelet drugs. After procedure the clinic symptoms and signs of ischemia were improved obviously in 38 cases and deteriorated in 2 cases whose CT scanning showed that the range of infarction in brain stem enlarged. The symptoms improved after treatment but 2 patients had neurological deficit. No hemorrhagic complications occurred in the group. During the follow-up for 2 months to 7 years, transcranial doppler ultrasonography in 26 cases demonstrated the blood flow was faster than normal in 2 cases, and digital subtraction angiography (DSA) in 6 cases showed restenosis in-stent in 1 case. The second stent was implanted because of the symptomatic restenosis. In another case the follow-up DSA showed occlusion of basilar artery in-stent but there was no ischemia of post circulation because the generation of anastomoses. CONCLUSIONS: PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic atherosclerotic stenosis of basilar artery. Further study in large number of patients is needed for long-term outcome.

[The analysis of intracranial aneurysms undergoing surgical treatment].

OBJECTIVE: To study the surgical principles and treatment options of intracranial aneurysms. METHODS: One hundred and thirty nine patients with intracranial aneurysms were retrospectively studied, including 80 open-surgery cases and 59 endovascular-treated cases from January to December in 2009. Open surgical methods included clipping, trapping or wrapping and interventional methods included simple coiling or stent-assisted coiling. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring were regularly used. Microvascular doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels. RESULTS: Seventy-three aneurysms were directly clipped, 6 were trapped and 1 was wrapped. Thirty-three aneurysms were coiled and 26 were coiled assisted with stents. At discharge, 71 of the 80(88.8%) surgical treated patients had Glasgow Outcome Scale score of 4 or 5 points, 3 points in 6 patients (7.5%), 2 points in 1 patient (1.2%), and 1 point in 2 patients (2.5%). Fifty-four out of 59 cases underwent endovascular treatment scored 4 or 5 points (91.5%) and 3 points in 5 patients (8.5%). CONCLUSIONS: Surgical clipping and endovascular coiling are two major treatment choices for intracranial aneurysms. The treatment option should be individualized based on the patients' specific conditions, which could have a safe, effective and durable outcome.

[Reconstructive endovascular treatment for symptomatic giant and fusiform aneurysm of vertebrobasilar artery with self-expandable stents].

OBJECTIVE: To reconstruct and affix symptomatic giant and fusiform aneurysms of vertebrobasilar artery by using self-expandable stents in 5 cases with an average volume 5.5 mm × 5.0 mm × 60.0 mm. METHODS: The clinical data of 5 patients who were suffered from giant and fusiform aneurysms of vertebrobasilar artery between October 2007 and October 2009 were retrospectively analyzed. Under instructing of digital subtraction angiography (DSA) images deployed the LEO and Neuroform stents for reconstructing and affixing the deferent 5 giant fusiform aneurysms of vertebrobasilar artery. And assisted embolized with 3 Orbit coils for a ruptured aneurysm to stop bleeding at the same time. RESULTS: The operative procedures were succeeded in all five cases. The damaged signs and symptoms of posterior group of cranial nerves disappeared in 3 cases by following 3 to 26 months. Trigeminal neuralgia in one case was markedly improved but a hemiparesis. One case with subarachnoid hemorrhage (SAH) showed no relapse evidence. Follow up DSA images in 3 cases demonstrated one case with a more rule modality in the part of aneurysm affixed by stent and proximal part of aneurysm in which no covering by stent revealed a mild to expand after 26 months review. And the images of postoperative DSA following 1 month and 4 months in another 2 cases displayed the imaging enlargement of part of the original aneurysm body shrink and shape the rules than the previous view. CONCLUSIONS: The treatment of symptomatic huge fusiform vertebrobasilar aneurysms by using self-expandable stents is feasible, aneurysm growth is under control, short-term effects are positive.

Microsurgical management of large and giant paraclinoid aneurysms.

BACKGROUND: Because of the complex topographic anatomical relationship between vascular, dural and bone structures, paraclinoid aneurysms, especially those of larger size, remain a great challenge for vascular neurosurgeons. We present our microneurosurgical experience of 51 consecutive patients with large and giant paraclinoid aneurysms to scrutinize our personal strategies related to surgical treatment. METHODS: Fifty-one patients with large or giant paraclinoid underwent micorneurosurgical aneurysm treatment. Operative strategies were planned according to preoperative state-of-the-art imaging studies, and a pterional-transsylvian approach was routinely used. Proximal control of the internal carotid artery (ICA) was achieved by exposure of the cervical portion of the vessel. Intraoperative electroencephalogram and somatosensory evoked potential monitoring, indocyanine green (ICG) videoangiography and/or microvascular Doppler ultrasonography (MDU) were regularly used. A postoperative digital subtraction angiography or computed tomography angiography was performed to verify the efficacy of treatment. RESULTS: Forty-three large and giant paraclinoid aneurysm necks (84%) were directly clipped, seven unclippable aneurysms (14%) were trapped with extra-intracranial high-flow revascularization, and one aneurysm (2%) was treated with only ICA proximal Hunterian ligation. Two patients (4%) died in the early postoperative period. In 84% of the patients, the Glasgow Outcome Scale score was 4 or 5 at discharge. At the 6-month follow-up examination, the Rankin Outcome Scale score was 0-2 in 90% of patients. CONCLUSIONS: Temporary parent vessel occlusion, retrograde suction decompression, endoaneurysmectomy, parent vessel clip reconstruction, and bypass vascular anastomosis are essential techniques to treat complex paraclinoid aneurysms. The combined use of electrophysiological monitoring, MDU, intraoperative ICG videoangiography, and endoscopy can substantially improve microsurgical outcome.

[Cause and treatment for intracranial hemorrhage during the perioperative period of carotid artery stenting].

OBJECTIVES: To discuss the possible cause of intracranial hemorrhage and treatment after carotid artery stenting (CAS) in patients with carotid artery stenosis. METHODS: From January 2003 to August 2009, 403 patients with carotid artery stenosis that were performed CAS, intracranial hemorrhage occurred in 5 cases after the procedure. We analyzed the feature of these cases and perioperative management retrospectively to summarize the possible cause of intracranial hemorrhage and preventive measure. RESULTS: Cerebral hemorrhage were found 30 min after CAS in 2 cases, 5 days in 2 cases and 3 days in 1 case. One patient was treated conservatively whose hemorrhage was about 2 ml, one was performed draining of ventricle and the other three cases were all performed craniotomy to remove the hematoma and to depress. The position of hemorrhage were all in the side of carotid artery stenosis, and in 2 cases of them the hemorrhage were at the region of previous cerebral infarction. One patient was cured conservatively, the one who was performed draining of ventricle died. Among the other three cases performed craniotomy, one recovered with light neurological deficit and two died of multiple organ failure. CONCLUSION: Intracranial hemorrhage is the most serious complication of CAS of carotid artery, and general measure should be taken to prevent it from occurring.

Effects of antiepileptic drugs on mRNA levels of BDNF and NT-3 and cell neogenesis in the developing rat brain.

Epilepsy is a common neurological disorder that occurs more frequently in childhood than in adulthood. Antiepileptic drugs (AEDs) which are used to treat seizures in pregnant women, infants, and young children may cause cognitive impairment or other uncertain injury. However, the exact mechanisms responsible for adverse effects of AEDs in the developing brain are still not clear. In the present study, we investigate the effects of AEDs on mRNA levels of brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), cell neogenesis and mossy fiber sprouting (MFS) in the developing rat brain. Long-term treatment with Phenobarbital (40mg/kg), valproate (100mg/kg) and topiramate (40mg/kg) reduces BDNF and NT-3 mRNA expression in the developing brain, while lamotrigine reduces mRNA expression only at high dose level (80mg/kg). Cell neogenesis only increases in the rats treated with valproate and lamotrigine. And no differences are observed between the control group and the AEDs-treated groups in the Timm scores of the CA3 region and supragranular region. Our findings present some possible mechanisms to explain why different AEDs cause different cognitive impairment.

[The recognition and endovascular treatment of subclavian steal syndrome].

OBJECTIVE: To investigate and evaluate the effectiveness and safety of the percutaneous transluminal angioplasty (PTA) and stent placement (SP) in the treatment of left subclavian steal syndrome (SSS). METHODS: From January 2007 to December 2009, 32 patients with left SSS were selected and the digital subtracted angiography (DSA) were used to evaluate before PTA and SP. Anticoagulation and antiplatelet therapy before and after interventional treatment were taken. Then the therapeutic effect was evaluated after the procedure immediately, in the third month and the sixth month post-operatively by transcranial doppler sonography (TCD). RESULTS: DSA was used to evaluate therapeutic effect after PTA and SP, the stenosis degree in average lumens diameter of the patients descended from 87.5% to 15.0%. The stenosis of subclavian steal artery was obviously improved and the contraflow of vertebral artery was disappeared without the stent's recovery and displacement by TCD. The mean systolic blood pressure difference between left and right upper limb was obvious lower than that before therapy [51.6 mmHg (1 mmHg = 0.133 kPa) vs 10 mmHg after 3 months]. No embolism and death was found. CONCLUSIONS: PTA and SP are effective in the treatment of SSS. Anticoagulation and antiplatelet therapy after interventional treatment has a good therapeutic effect. TCD is a cheap, sensitive and non-invasive method for evaluating SSS.