Regulatory T cells (Tregs) can eliminate autoreactive lymphocytes, induce self-tolerance, and suppress the inflammatory response. Mitochondria, as the energy factories of cells, are essential for regulating the survival, differentiation, and function of Tregs. Studies have shown that patients with autoimmune diseases of the central nervous system, such as multiple sclerosis, neuromyelitis optica spectrum disorder, and autoimmune encephalitis, have aberrant Tregs and mitochondrial damage. However, the role of mitochondrial-regulated Tregs in autoimmune diseases of the central nervous system remains inconclusive. Therefore, this study reviews the mitochondrial regulation of Tregs in autoimmune diseases of the central nervous system and investigates the possible mitochondrial therapeutic targets.
Obesity, a burgeoning global health issue, is increasingly recognized for its detrimental effects on the central nervous system, particularly concerning the integrity of the blood-brain barrier (BBB). This manuscript delves into the intricate relationship between obesity and BBB dysfunction, elucidating the underlying phenotypes and molecular mechanisms. We commence with an overview of the BBB's critical role in maintaining cerebral homeostasis and the pathological alterations induced by obesity. By employing a comprehensive literature review, we examine the structural and functional modifications of the BBB in the context of obesity, including increased permeability, altered transport mechanisms, and inflammatory responses. The manuscript highlights how obesity-induced systemic inflammation and metabolic dysregulation contribute to BBB disruption, thereby predisposing individuals to various neurological disorders. We further explore the potential pathways, such as oxidative stress and endothelial cell dysfunction, that mediate these changes. Our discussion culminates in the summary of current findings and the identification of knowledge gaps, paving the way for future research directions. This review underscores the significance of understanding BBB dysfunction in obesity, not only for its implications in neurodegenerative diseases but also for developing targeted therapeutic strategies to mitigate these effects.
Background: The previously approved botulinum toxin and nowadays promising calcitonin gene-related peptide (CGRP) monoclonal antibody have shown efficacy for preventing chronic migraine (CM). However, there is no direct evidence for their relative effectiveness and safety. In this study, we conducted an indirect treatment comparison to compare the efficacy and safety of CGRP monoclonal antibody with botulinum toxin for the preventive treatment of chronic migraine.Methods: Up to August 31, 2020, we systematically searched PubMed, Embase, and Cochrane Library Central Register of Controlled Trials (Central). Weighted mean difference (WMD) and relative risk (RR) were used to evaluate clinical outcomes. Indirect treatment comparison (ITC) software was used to conduct indirect treatment comparison.Results: Ten studies were pooled with 6,325 patients in our meta-analysis. Both botulinum toxin and CGRP monoclonal antibody demonstrated favorable efficacy in the change of migraine days, headache days, HIT-6 score, and 50% migraine responder rate compared with placebo. In indirect treatment comparison, CGRP monoclonal antibody was superior to botulinum toxin in the frequency of acute analgesics intake (WMD = −1.31, 95% CI: −3.394 to 0.774, p = 0.02113), the rate of treatment-related adverse events (AEs) (RR = 0.664, 95% CI: 0.469 to 0.939, p = 0.04047), and the rate of treatment-related serious adverse events (RR = 0.505, 95% CI: 0.005 to 46.98, p < 0.001).Conclusion: For chronic migraine patients, CGRP monoclonal antibody was slightly better than botulinum toxin in terms of efficacy and safety. In the future, head-to-head trials would be better to evaluate the efficacy and safety between different medications in the prevention of chronic migraine.
Objective To explore the effects of valproate on vestibular migraine(VM)symptom improvement and vestibular function.Methods The patients with VM treated in the Dizziness Diagnosis and Treatment Center of The Sec-ond Affiliated Hospital of Naval Medical University from September 1,2019 to May 1,2021 were randomly divided into Valproate group and Flunarizine group.The patients were treated with valproate or flunarizine for three months.Before and after the treatment,the frequency of VM as well as the scores of Visual Analogue Scale(VAS)and Dizziness Handi-cap Inventory(DHI)items were recorded.Vestibular function was compared in the Valproate group before and after treat-ment.Results The VM frequency,the total scores of VAS and DHI,and the scores of VAS and DHI items in both groups were significantly reduced after the treatment.The changes in VM frequency,VAS score,DHI-F score,DHI-P score,and total DHI score before and after treatment were significantly greater in the Valproate group than in the Flunari-zine group.There was no significant difference in the variation of DHI-E score before and after treatment between the two groups.Abnormal eye movement,gaze,and spontaneous nystagmus decreased significantly in the Valproate group after treatment.There were no significant differences in abnormal caloric test,c-VEMP,o-VEMP,saccade test,smooth pursuit test,and direction-changing positional nystagmus.Conclusion Valproate can significantly improve the symptoms of VM and reduce its frequency.Valproate is more efficient than flunarizine.
Myasthenia gravis is an autoimmune disease,which is usually mediated by antibodies to acetylcholine re-ceptors at the neuromuscular junction.It is commonly treated with cholinesterase inhibitors such as pyridostigmine bro-mide.Although cardiovascular events with the drug are rare,it is very important to early recognize disease changes and be alert to potential cardiovascular events in patients with myasthenia gravis.Therefore,we report a case of an elderly female patient with myasthenia gravis developing acute myocardial infarction and then sudden cardiac death following anticholines-terase therapy,and discuss the possible causes of adverse cardiovascular events based on this case.
Objective To analyze the clinical features of patients with hepatolenticular degeneration(HLD)com-plicated by hepatic myelopathy(HM).Methods A retrospective analysis was performed on the clinical features,auxil-iary examinations,diagnosis and treatment,and outcomes of 5 patients diagnosed with HLD complicated by HM in our hospital from January 2018 to February 2023,and the relevant literature was reviewed.Results Among the 5 patients,4 were male and 1 was female;the age of onset of HM ranged from 16 to 32 years.All 5 patients had manifestations of de-compensated cirrhosis,and 3 patients had a history of transjugular intrahepatic portosystemic shunt(TIPS).The spinal MRI showed abnormal signals in the thoracic cord in 2 patients.Electromyography showed abnormalities in 3 patients,and electroencephalography showed significantly slower background brain waves in 4 patients.Two patients underwent liver transplantation,and 2 patients received endovascular treatment.One patient died of upper gastrointestinal bleeding;the other 4 patients had varying degrees of recovery.Conclusion The prevalence of HLD complicated by HM is very low.High copper status,hyperammonemia,TIPS,anemia,hypoproteinemia,and portal hypertension are directly associ-ated with HM.
Objective To explore the expression and role of Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)in the hippocampus of a rat model of post-traumatic stress disorder(PTSD)induced by single pro-longed stress(SPS).Methods Forty-five rats were randomly assigned into control group(n = 15)or PTSD group(n = 30;15 each were examined on days 4 and 7 after modeling,respectively).PTSD was induced by SPS,which was recog-nized internationally.The Morris water maze test was carried out to measure the spatial memory of the rats.The morpho-logical changes of the hippocampus were examined with Nissl staining.The expression of TLR4,MyD88,and downstream nuclear factor-kappa B(NF-κB)was determined by Western blot.Results Compared with the control group,the PTSD group showed a significantly prolonged mean escape latency(P<0.05);sparsely arranged and lightly stained neurons and a reduced number of Nissl bodies within cytoplasm in the hippocampus;and significantly increased protein expression of TLR4,MyD88,and NF-κB on days 4 and 7 after SPS stimulation(all P<0.05).Conclusion SPS can impair the spatial memory of rats,which may be associated with the up-regulation of TLR4/MyD88/NF-κB in the hippocampus.The activa-tion of TLR4/MyD88 signaling may be one of important molecular mechanisms in the development of SPS-induced PTSD.
Objective To investigate the risk factors for fatigue impairment in patients with multiple system atro-phy(MSA).Methods A total of 101 patients with MSA were enrolled,and according to the score of Fatigue Severity Scale(FSS),they were divided into non-fatigue group(<4 points)with 41 patients and fatigue group(≥4 points)with 60 patients.A binary logistic regression analysis was used to screen for the risk factors for fatigue in patients with MSA.Results There were significant differences in sex,course of disease,clinical classification,urinary retention,UMSARS-I,UMSARS-II,UMSARS-I+II,UMSARS-IV,bradykinesia,myotonia,ataxia,abnormal gait and posture,and ESS score be-tween the patients with different between fatigue levels(P<0.05).The binary logistic regression analysis showed that UMSARS-I and ESS scores were independent risk factors for fatigue in MSA patients(P<0.05).Conclusion Fatigue im-pairment in patients with MSA is caused by multiple factors,among which UMSARS-I and ESS scores are independent risk factors for fatigue in MSA.
Chronic dizziness is a common clinical symptom with a complex etiology.With the updating of concepts and technological development in the diagnosis and treatment of dizziness and vertigo,the understanding of chronic dizzi-ness diseases is also constantly improving.Diagnostic standards for some common diseases have been published,and treat-ment methods supported by evidence-based medicine have been applied in clinical practice.This article takes the concept of chronic dizziness as a starting point,sorts out its underlying pathophysiological mechanisms and common causes,and attempts to establish an effective set of thoughts and methods for the diagnosis and treatment of chronic dizziness.It aims to make a preliminary exploration to improve the diagnosis and treatment level of dizziness diseases.
Objective To explore the research hotspots and development trend on vascular dizziness/vertigo based on visual analysis.Methods The Web of Science Core Collection Database was searched for papers on vascular dizziness/vertigo from January 2008 to March 2023.The CiteSpace 6.2.R2 software was used for visual analysis of the literature.Results There were a total of 1298 papers,with an increasing number of published papers from January 2008 to March 2023.A total of 424 institutions from 83 countries/regions had published relevant papers.The United States ranked first in terms of the number of published papers(331 papers)and betweenness centrality(0.25).Johns Hopkins University was the number one institution in terms of the number of published papers(56 papers),Newman-toker and David E were the most prolific authors.The most common keyword was ischemic stroke.According to keyword clustering,research in this field focused on early diagnosis of vascular dizziness/vertigo from risk factors and bedside examinations and infarction of the anterior inferior cerebellar artery supply area.In recent years,researchers had more interests in case reports,video electronystagmograms,and pathophysiological mechanisms in this field.Conclusion There are growing international studies on vascular dizziness/vertigo.Early diagnosis of vascular dizziness/vertigo through risk factors and bedside examinations in the emergency room is a research hotspot in this field.Researchers should focus on these topics in future studies.
Objective To quantitatively analyze the difference in the content of plasma exosome α-synuclein(α-syn)be-tween Parkinson disease(PD)and idiopathic rapid eye movement sleep behavior disorder(iRBD),and to identify predictable biological markers.Methods A total of 20 patients with iRBD(iRBD group),21 PD patients without RBD(PD-nRBD group),and 20 healthy controls matched for age and sex(HC group)were enrolled.Rapid-Eye-Movement Sleep Behavior Dis-order Questionnaire-Hong Kong(RBDQ-HK)was used to evaluate the nocturnal symptoms of all subjects,and the motor section of Unified Parkinson Disease Rating Scale Ⅲ(UPDRS Ⅲ)was used to evaluate motor impairment.ELISA was used to measure the content of plasma exosome α-syn,and the three groups were analyzed in terms of the content of plasma exosome α-syn and its correlation with RBDQ-HK score and UPDRS Ⅲ score.Results There was a significant difference in UPDRS Ⅲ score be-tween the iRBD group,the PD-nRBD group,and the HC group(P=0.000 1),with a significant difference between any two groups(P<0.05);there was also a significant difference in RBDQ-HK score between the three groups(P=0.000 1),and the iRBD group had a significantly higher score than the other two groups(P=0.000 1).The iRBD group and the PD-nRBD group had a significantly higher content of plasma exosome α-syn than the HC group(P=0.001),and the iRBD group had a lower con-tent of plasma exosome α-syn than the PD-nRBD group(P>0.05).In the iRBD group,plasma exosome α-syn was positively correlated with RBDQ-HK score(r=0.842,P=0.000 1),and in the PD-nRBD group,plasma exosome α-syn was positively cor-related with UPDRS Ⅲ score(r=0.817,P=0.000 1)and H-Y staging(r=0.592,P=0.005).Conclusion The presence of plasma exosome α-syn is observed in iRBD patients,which is similar to that in PD-nRBD patients,and the content of plasma exosome α-syn is associated with the motor score of PD-nRBD and the nocturnal symptom score of iRBD.Therefore,plasma exo-some α-syn is expected to become an early biomarker for predicting the conversion of iRBD to PD.
Objective To investigate the clinical characteristics of vestibular paroxysmia(VP):age distribution,triggers,accompanying symptoms,maximum frequency per day,nystagmus features during attacks,and neurovascular compression.Methods The clinical data of 70 patients with VP were collected to analyze their age distribution,triggers,accompanying symptoms,maximum frequency per day,nystagmus features during attacks,and neurovascular compres-sion by using descriptive statistical methods.Results Among the 70 patients with VP,30(42.86%)were elderly,23(32.86%)were young,and 17(24.29%)were middle-aged patients.The maximum frequency per day was 2-5 in 53 cases(75.71%),6-10 in 9 cases(12.86%),and>10 in 8 cases(11.43%).Thirty-six patients(51.43%)had triggers,including rapid walking,emotional excitement,driving,cycling,sexual intercourse,coughing or wheezing,speaking or chatting,bathing,defecation,drinking alcohol,and sound stimulation.Thirty-three patients(47.14%)had unilateral tin-nitus,bilateral tinnitus,and tinnitus with facial spasms;nystagmus during VP episodes met the characteristics of the head coordinate system,which was horizontal-torsional towards the affected side.Among 57 patients examined for the relation-ship between the vestibulocochlear nerve and vessels using magnetic resonance angiography,37 patients(64.91%)had contact between the vestibulocochlear nerve and the right anterior inferior cerebellar artery,15 patients(26.32%)had contact between the vestibulocochlear nerve and the left anterior inferior cerebellar artery,and 5 patients(8.77%)had contact between the vestibulocochlear nerve and the basilar artery.Conclusion VP is most prevalent in the elderly,then young and middle-aged people.Most patients with VP have a maximum frequency of 2-5 per day.VP can be triggered by anger,excitement,exercise,and various stimuli.VP attacks can be accompanied by tinnitus and facial spasms.Its nystag-mus is horizontal-torsional towards the affected side.The percentage of contact between the vestibulocochlear nerve and the right anterior inferior cerebellar artery is highest in patients with VP.
Persistent postural-perceptual dizziness(PPPD)is a common clinical chronic dizziness disease,with per-sistent dizziness,instability,or non-rotational vertigo as the main symptom.It may be aggravated by postural changes,ac-tive/passive movements,and exposure to complex visual environments.At present,it is believed that the occurrence of PPPD may be related to the failure of postural control readaptation and abnormal cortical multisensory integration,but the specific pathophysiological mechanism is not clear.In recent years,with the continuous application of neuroimaging tech-nology in the field of vertigo diseases,it has been found that in patients with PPPD,the brain structure,function,and con-nectivity related to vestibular multisensory and spatial orientation are decreased,while the function and connectivity re-lated to visual processing are enhanced.At the same time,various psychiatric factors(such as anxiety,depression,and neuroticism)as well as triggers may be involved in regulating the brain structure of people with PPPD,which helps explain the differences in outcomes between studies.The above neuroimaging findings are helpful for the early diagnosis and treat-ment of PPPD.Therefore,this paper reviews the neuroimaging studies of PPPD to provide a reference for explaining the pathophysiological mechanism of PPPD.
Electrical status epilepticus is a special electroencephalogram phenomenon,which means that the spike and slow waves are almost continuously emitted during the wake-sleep phases.Related concepts are epileptic encephalopa-thy with electrical status epilepticus during slow wave sleep,electrical status epilepticus in sleep,and subclinical electro-graphic seizures.The above related concepts are widely used in clinical practice,but there is a lack of unified criteria.There are abuses and misuses of these concepts.Clarifying related concepts is of great significance for scientific research and clinical practice.
Dizziness and vertigo are a major burden for the general population.Dizziness is a non-motion sensation of spatial disorientation,while vertigo is a false or distorted sensation of motion.Unlike vertigo,dizziness does not present with the typical sense of spinning,moving,rising,or falling.In a broad sense,dizziness includes vertigo.Anxiety and depression,public health burdens,are closely correlated negative states of cognition of self,environment,and future.Studies have shown that pa-tients with dizziness/vertigo are at higher risk for a variety of psychiatric disorders,especially anxiety and depression.Anxiety and depression greatly affect the prognosis and burden of patients with dizziness/vertigo,who often report multiple somatic symp-toms.This paper reviews domestic and international research on the association of dizziness/vertigo with anxiety and depression.
Orthostatic dizziness is a common type of dizziness or vertigo in the department of neurology.In the past,there was no expert consensus or diagnosis and treatment guideline for this disease due to the lack of diagnostic methods and standards.Based on the international criteria published by the Committee for the Classification of Vestibular Disorders of the Bárány Society in 2019 as well as our clinical experience,this article focuses on the possible mechanisms and diag-nosis and treatment suggestions on orthostatic dizziness/vertigo in the elderly,hoping to provide a reference for clinicians.
Posterior circulation ischemia is an ischemic cerebrovascular disease frequently seen in clinical practice,which includes transient ischemic attack and cerebral infarction of the posterior circulation.The clinical manifestations of patients with posterior circulation infarction are complex and varied,and diagnosis is mainly based on clinical manifesta-tions and imaging.Transient ischemic attacks in the posterior circulation have neither obvious positive signs nor typical im-aging manifestations during the interictal period,making the diagnosis difficult.Brainstem auditory evoked potentials re-flect the electrophysiological functioning of the auditory nerves and brainstem auditory conduction pathway.The use of brainstem auditory evoked potentials,especially brainstem auditory evoked potentials at high stimulation rates,in diagnos-ing posterior circulation ischemia expands and enriches diagnostic methods,which is of great significance for the early diag-nosis of the disease.However,there are still many problems worth considering.
Objective To examine the risk factors for increased burden of cerebral small vessel diseases(CSVD)in middle-aged and elderly patients with sudden sensorineural hearing loss(SSNHL).Methods The data were retrospec-tively collected from middle-aged and elderly patients who were admitted to the hospital due to SSNHL between May 2019 and May 2023.The patients were analyzed for their clinical manifestations,hearing test results,and radiological features.All enrolled patients were assessed for total CSVD burden,and patients with varying degrees of burdens(0,1,2,and≥3 points)were compared for their differences in the clinical features and hearing features.Ordinal logistic regression was conducted to identify the independent risk factors for increased total CSVD burden in middle-aged and elderly patients with SSNHL.Results A total of 206 patients with SSNHL were enrolled,including 94 males and 112 females,with an average age of(58.70±7.98)years.The numbers of patients with a total CSVD burden of 0、1、2,and≥3 points were 108(52.4%),54(26.2%),29(14.0%),and 15(7.2%),respectively.Univariate analysis showed significant differences between different CSVD burden groups in age,hypertension status,history of drinking,low-density lipoprotein>3.1 mmol/L,and presence of dizziness at the onset of disease(P<0.05).Logistic regression analysis demonstrated that aging(OR=1.050;95%CI 1.023-1.077),hypertension(OR=1.584;95%CI 1.036-2.422),history of drinking(OR=2.304;95%CI 1.415-3.754),and presence of dizziness at the onset of disease(OR=1.691;95%CI 1.085-2.637)were independent risk factors for in-creased CSVD burden in SSNHL patients aged 45 years and above.Conclusion Aging,hypertension,history of drink-ing,and dizziness at the onset of disease are independent risk factors for increased CSVD burden in middle-aged and el-derly patients with SSNHL.Clinicians should conduct radiological evaluations on these patients to identify pa-tients with CSVD at an early stage.
Objective This study aims to explore the clinical characteristics of common mutation sites in the SOD1 gene and provide assistance for the early identification,diagnosis,and course evaluation of amyotrophic lateral sclerosis(ALS).Methods The clinical data and genetic testing results of a patient with ALS caused by the c.131A>G:p.H44R muta-tion in the second exon of the SOD1 gene were retrospectively analyzed and discussed in conjunction with the literature.Results The patient presented with pain and weakness in the right lower limb accompanied by muscle atrophy.No posi-tive signs were observed in the sensory system.The electromyogram revealed subclinical neurogenic changes in the unaf-fected limbs.Whole-exome sequencing identified a rare mutation in exon c.131A>G:p.H44R of the SOD1 gene.Conclusion Early diagnosis of ALS is challenging,and the clinical manifestations vary depending on the gene site muta-tions.Genetic testing can assist in diagnosis and has significant identification value in the early stages of the disease.
Arginine vasopressin(AVP),also known as antidiuretic hormone,is a highly conserved neuropeptide se-creted by the supraoptic or paraventricular nucleus of the hypothalamus and has complex physiological functions.This ar-ticle reviews the physiological properties of AVP and elaborates on the possible involvement of AVP in sleep-arousal regula-tion via the hypothalamic orexinergic and noradrenergic systems and the role of AVP in maintaining circadian homeostasis by facilitating intercellular coupling of suprachiasmatic nucleus neurons,as well as the potential role of AVP in the regula-tion of anxiety and depression.
