Introduction Narcolepsy type 1 (NT1) is a chronic neurological disorder characterised by excessive daytime sleepiness, cataplexy and disturbed nocturnal sleep. Current pharmacological treatments often have limited efficacy, significant side effects or potential for abuse. Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique that has shown promise in regulating sleep–wake cycles and neural network activity. Preliminary evidence from our prior study on Transcutaneous Auricular Vagus Nerve Stimulation in patients with NT1 (TARGET-NT1 study) suggests potential benefits of taVNS for NT1. The TARGET-2 trial aims to evaluate the efficacy and safety of bilateral taVNS compared with unilateral taVNS and sham stimulation in patients with NT1.Methods and analysis TARGET-2 is a randomised double-blind trial. A total of 153 participants with NT1 will be recruited from four centres in China. Participants will be randomly allocated (1:1:1) to receive either (1) bilateral taVNS (active stimulation on both ears), (2) unilateral taVNS (active stimulation on the left ear only) or (3) sham taVNS (minimal intensity stimulation on both ears). Participants and outcome assessors are blinded. The intervention will be administered twice daily for 30 min per session over 12 weeks. The primary outcome is the change in the Epworth Sleepiness Scale (ESS) score from baseline to the 12-week endpoint. Secondary outcomes are changes in the narcolepsy severity scale score, Pittsburgh Sleep Quality Index, fatigue severity scale score, 14-item Hamilton Anxiety Rating Scale score and 17-item Hamilton Depression Rating Scale score, as well as responder rates (proportion with ≥25% ESS reduction) from baseline to week 12. Safety will be assessed by monitoring adverse events.Ethics and dissemination Ethical approval has been granted by the Medical Ethical Committee of Xijing Hospital (Approval Number: XJLL-KY-20252403). Written informed consent will be obtained from all participants before initiating any study-specific procedures. The results will be submitted for publication in a peer-reviewed journal. The anticipated completion date for reporting of the study results is 31 March 2027.Trial registration Chinese Clinical Trial Registry, ChiCTR2500110531 (registered on 15 October 2025).

BackgroundMajor depression disorder (MDD) forms a common psychiatric comorbidity among patients with narcolepsy type 1 (NT1), yet its impact on patients with NT1 is often overlooked by neurologists. Currently, there is a lack of effective methods for accurately predicting MDD in patients with NT1.ObjectiveThis study utilized machine learning (ML) algorithms to identify critical variables and developed the prediction model for predicting MDD in patients with NT1.MethodsThe study included 267 NT1 patients from four sleep centers. The diagnosis of comorbid MDD was based on Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). ML models, including six full models and six compact models, were developed using a training set. The performance of these models was compared in the testing set, and the optimal model was evaluated in the testing set. Various evaluation metrics, such as Area under the receiver operating curve (AUC), precision-recall (PR) curve and calibration curve were employed to assess and compare the performance of the ML models. Model interpretability was demonstrated using SHAP.ResultIn the testing set, the logistic regression (LG) model demonstrated superior performance compared to other ML models based on evaluation metrics such as AUC, PR curve, and calibration curve. The top eight features used in the LG model, ranked by feature importance, included social impact scale (SIS) score, narcolepsy severity scale (NSS) score, total sleep time, body mass index (BMI), education years, age of onset, sleep efficiency, sleep latency.ConclusionThe study yielded a straightforward and practical ML model for the early identification of MDD in patients with NT1. A web-based tool for clinical applications was developed, which deserves further verification in diverse clinical settings.

目的 探讨基于脑电图(Electroencephalogram,EEG)信号的卷积神经网络在癫痫检测中的应用价值.方法 本研究使用了来自癫痫EEG信号数据CHB-MIT数据库中的8例患者的EEG信号;EEG信号分为3类:发作间期、发作前期(发作前持续时间至10 min)和癫痫发作期状态;开发了一种基于迁移学习和功率谱密度能量图的深度卷积神经网络(Deep convolutional neural network,DCNN)的癫痫EEG信号分类方法(EEG signal classification method,EEGC),并对癫痫状态进行分类;将在线硬示例挖掘(Online hard exam-ple mining,OHEM)损失函数集成到EEGC方法中以获得较高的分类准确率.结果 本研究提出的EEGC方法对癫痫状态分类的准确度较高,但发作前期没有像其他两种状态那样准确分类;当将O H EM损失函数集成到EEGC方法中时发作前期的分类准确度提高了3％,并且它对3种癫痫状态(发作间期、发作前期和癫痫发作)的分类具有很高的敏感度(97.8％、93.6％ 和95.8％)和特异度(99.2％、97.1％ 和99.3％).结论 本研究提出的EEGC方法具有较高的癫痫状态分类准确率,可辅助临床医生了解患者癫痫状态的类别,从而有效地预防和治疗癫痫.

Objective:To discuss the clinical and electrophysiological characteristics of propriospinal myoclonus (PSM).Methods:The clinical and electrophysiological characteristics of four patients diagnosed as PSM in the Electroencephalography Monitoring Center, Department of Neurology, Xijing Hospital, the Air Force Military Medical University from April 2018 to July 2019 were studied. All patients were accorded with diagnostic criteria of PSM that international classification of sleep disorders-3 edition recommended and were followed up.Results:There were three males and one female in the four patients. The age of onset was ranged from 43 to 55 years. The course was from eight months to three years, and the follow-up time was from three months to one year. The clinical features of the four patients were characteristically paroxysmal tic or shaking of the neck, trunk or limbs, with short duration and great frequency. All patients accepted 24-hour video electroencephalography monitoring. No epileptic discharge was recorded during the monitoring. The burst activity of deltoid, quadriceps or rectus abdominis muscle was monitored by surface electromyography at the onset of myoclonus. All patients were treated with clonazepam. Three patients had an obvious curative effect and one patient had no effect.Conclusions:The clinical manifestation of PSM is similar to seizures. There is no epileptic discharge, and only the burst activity of muscles is monitored at the onset. Most patients have significant effect on clonazepam.

目的 探讨丁苯酞联合依达拉奉治疗急性脑梗死(ACI)的效果及对患者神经功能的影响.方法 选取2015年5月至2018年7月于本院接受治疗的ACI患者148例,按照序贯随机法将其分为对照组与观察组,各74例.对照组采用依达拉奉注射液治疗,观察组在对照组的基础上采用丁苯酞口服治疗.比较两组日常生活能力、神经功能缺损情况、脑梗死面积、6-酮-前列腺素F1α、血清血栓素B2水平、治疗效果与不良反应发生情况.结果 治疗后,两组BI评分明显高于治疗前,NIHSS评分明显低于治疗前,脑梗死面积明显小于治疗前,且观察组优于对照组,差异具有统计学意义(P<0.05).治疗后,两组6-酮-前列腺素F1α水平明显高于治疗前,血清血栓素B2水平明显低于治疗前,且观察组优于对照组,差异具有统计学意义(P<0.05).观察组治疗总有效率高于对照组,差异具有统计学意义(P<0.05).观察组不良反应总发生率与对照组比较,差异无统计学意义(P>0.05).结论 丁苯酞与依达拉奉联合治疗可有效改善ACI患者预后,减轻神经功能损伤程度,值得推广使用.

Objective To study the effect on different doses of venlafaxine in the treatment of acute anxiety disorder after stroke.Methods 86 patients with acute anxiety disorder after stroke in our hospital were selected as the subjects.The patients were randomly divided into observation group and control group.Two groups were given routine drug in the treatment of stroke.The observation group was given a large dose of venlafaxine 150mg/d,while the control group was treated with small dose of 75mg/d for 8 weeks.All the patients were treated for 8 weeks.The two groups of Hamilton Anxiety Scale (HAMA) score,the National Institutes of Health Stroke Scale (NIHSS) score,the daily living ability scale (ADL) score and the incidence of adverse reactions were recorded.Results After treatment,the scores of somatization,anxiety and HAMA in the observation group were lower than those before treatment (P＜0.05).After treatment for 2 weeks,the scores of the control group were lower than those before treatment (P＜0.05).The observation group was significantly lower than the control group at the end of 1 and 2 weeks (P ＜ 0.05).Compared with before treatment,NIHSS and ADL scores of the two groups after treatment were significantly improved (P ＜ 0.05).The NIHSS score of the observation group was lower than that of the control group after treatment,and the ADL score was higher than that of the control group (P ＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion Different doses of venlafaxine in the treatment of acute post-stroke anxiety disorder can significantly improve the patient's stroke,anxiety symptoms,but the effect of large dose is better than small dose.Large dose adverse reactions did not increase significantly and it has better application prospect.

Endothelial damage and blood brain barrier disruption contribute to ischemic stroke and brain injury. Gliptins are a novel class of treatment agents for diabetes, and recent studies have linked the use of gliptins to neuroprotection. Alogliptin is a type of orally available gliptin that was approved for clinical use by the FDA in 2013. In this study, we investigated the neurovascular protective effects of alogliptin both in vivo and in vitro. In a murine middle cerebral artery occlusion (MCAO) stroke model, administration of alogliptin ameliorated cerebral infarction and disruption of brain vascular permeability, and restored expression of the endothelial tight junction proteins occludin and zona occludens 1 (ZO-1). In brain vascular endothelial cells exposed to oxygen and glucose deprivation/reperfusion (OGD/R), alogliptin prevented OGD/R-induced high permeability of the endothelial monolayer. Alogliptin treatment recovered the reduction in occludin and ZO-1 induced by OGD/R. Moreover, alogliptin treatment prevented OGD/R-induced induction of metalloproteinase (MMP)-2 and MMP-9, and restored expression of tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2. Collectively, our data indicate that alogliptin can improve neurovascular integrity and exerts neuroprotective effects.

Basal ganglia cerebral infarction can cause cerebral vascular dementia, which seriously influence patient’s quality of life. Thus, early prevention and treatment are extremely important. At present, the common methods used for treatment include drug therapy, acupuncture therapy, and rehabilitation treatment, etc. Research found that acupuncture-medicine therapy can significantly improve patient’s prognosis and quality of life. This study applied acupuncture-medicine therapy to treat patients with basal ganglia cerebral infarction, and used functional magnetic resonance imaging (fMRI) technology to observe its clinical curative effect. A total of 80 basal ganglia cerebral infarction patients were randomly divided into four groups. All of the four groups received cerebral infarction drug therapy, including anti-atherosclerosis, lipid regulation, cranial nerve nutrition, and improve cerebral circulation. Group D, as the control group, received routine drug treatment for cerebral infarction. Group A, B, and C were given acupuncture therapy, rehabilitation therapy, and acupuncture plus rehabilitation therapy on the basis of control group. Degree of nervous functional defects (NIHSS), motor function, and activity of daily life were compared. fMRI was performed to observe cerebral cortex activation area under the same stimuli. Four groups showed statistical difference on NIHSS score, clinical efficacy score, Barthel Index score, and SM1 region activation area (P<0.05). Acupuncture-medicine therapy has prominence effect for the treatment of patients with basal ganglia cerebral infarction. fMRI can objectively indicate the cortex recovery, suggesting that it can track functional recovery after treatment and provide a new direction for clinical diagnosis, treatment, and prognosis.

Objective:To investigate the relationship between different types of epilepsy and the onset time after stroke,and observe the characteristics of video EEG in various types of patients.Methods:A total of 82 patients with post-stroke epilepsy admitted in our hospital from February 2015 to February 2021 were enrolled in this study.The types of stroke,type of epilepsy and the onset of epileptic seizures were recorded.The video EEG features in various types of patients were compared.Results:The incidence of early onset epilepsy after ischemic stroke was 37.21％,which was lower than that in patients with hemorrhagic stroke (84.62％),and the incidence of delayed epilepsy was higher than that of hemorrhagic stroke (P＜ 0.05).The incidence of delayed epilepsy was 73.33％,which was higher than that of partial secondary seizures (12.50％) and systemic seizures (20.69％) (P＜0.05).The EEG showed that 42 cases (51.22％) had epilepsy-like discharges,23 cases (28.05％) had localized slow wave activity,14 cases (17.07％) had asymmetric amplitude on both sides,and 9 cases (10.98％) had partial lead voltage change.Conclusion:There were differences in epilepsy onset time of patients with different epilepsy types after stroke.Partial seizures were mainly tardive epilepsy,and generalized seizures were early-onset epilepsy.Clinical epileptic seizures could be evaluated by observing EEG characteristics.

目的 探讨银杏提取物联合氟西汀治疗急性脑梗塞后抑郁的临床疗效.方法 130例急性脑梗塞后抑郁的患者被随机分为观察组和对照组,每组65例;对照组患者仅服用氟西汀;观察组在对照组治疗的基础上,采用银杏提取物对患者进行治疗.使用汉密尔顿抑郁量表(HAMD)评价疗效.结果 治疗前两组患者的HAMD评分无显著性差异(P＞0.05);治疗后4周、治疗后6周和治疗后8周,观察组患者的HAMD评分明显低于对照组,两组间评分比较显著性差异(P＜0.05);对两组患者的临床疗效进行统计分析,发现观察组和对照组的总有效率分别为81.54％和66.15％,观察组的总有效率明显高于对照组,两组间总有效率差异显著(P＜0.05).结论 银杏提取物联合氟西汀治疗急性脑梗塞后抑郁的作用显著,效果明显优于单一使用氟西汀的治疗疗效.

目的：应用TCD发泡试验（c‐TCD）研究晕厥患者右向左分流的发生率，分析RLS分流量与晕厥的关系。方法：将256例确诊为晕厥的患者分为晕厥组，120例健康志愿者分为对照组，均行TCD发泡试验，评估RLS发生情况及分流量大小。结果：晕厥组与对照组比较年龄、性别无统计学意义（P＞0．05），两组RLS阳性率分别为45．7％、25．8％，大量分流率分别为23．4％、4．2％，大量分流率、阳性率分别为51．2％、16．1％，晕厥组显著高于对照组（ P＜0．05）。两组小量分流率分别为22．3％、21．7％，比较无统计学意义。结论：右向左大量分流是导致晕厥的原因之一。

目的 观察蛭蛇通络胶囊治疗缺血性中风恢复期患者的有效性及安全性.方法 选择我院2012年6月～2014年6月门诊中风病中经络(恢复期)患者350例,采用随机分组的方法,治疗组184例用蛭蛇通络胶囊,对照组166例用消栓通络片,观察两组患者的临床疗效及用药的安全性.结果 两组对患者的神经功能缺损状况、日常生活能力评定(Barthel指数)均能明显改善,并且疗效相近.两组间临床疗效比较总有效率无显著性差异(P＞0.05),总愈显率有显著性差异(P＜0.05),说明治疗组和对照组疗效相近,但愈显率明显高于对照组.结论 蛭蛇通络胶囊临床用于治疗缺血性中风恢复期安全有效.

Objective To evaluate the safety and efficacy of multi-mode CT guided arterial thrombolysis and intravenous thrombolysis with rt-PA in treatment of acute cerebral infarction.Methods The carotid artery system in patients with acute cerebral infarction 65 cases were randomly divided into arterial thrombolysis group of 35 patients and intravenous thrombolytic group of 30 patients,record the NIHSS score and living ability status before thrombolysis and after thrombolysis 2h,24h,7d and 30d.Determine the efficacy of thrombolysis after 30 days.Results Arterial thrombolysis group average NIHSS score results were significantly lower than the intravenous thrombolysis group.Two groups total effective rate were 74.29% and 46.67% respectively.Conclusion Intra-arterial thrombolysis and venous thrombolysis guided by multi-mode CT are safe,effective in treatment of acute cerebral infarction,clinical efficacy of the former is superior to the latter.

Objective To observe the cerebral edema occurrence,evolution and prognosis of intra-arterial thrombolytic recanalization in patients with acute ischemic stroke.Methods From October 2010to October 2012,36patients who underwent the intraarterial thrombolytic therapy were cerebral recanalization.They were randomly divided into two groups:1-3hgroup and>3-6h group.The alteration of brain edema was observed by cranial CT.Their mRS.NHISS and BI were scaled and recorded before and after intra-arterial thrombolytic therapy.Results After intra-arterial thrombolytic therapy,the occurrence rate of cerebral edema was 94%,appeared at the onset of more than 1hours in all patients.Long-term follow-up showed,cerebral edema location appeared obvious cerebromalacia.Cerebral edema and clinical outcome had not significant difference between 1-3hgroup and 3-6hgroup.Conclusion Cerebral edema and loss of cerebral tissue occurred almost inevitability in patients who received intra-artery thrombolysis and recanalized their cerebral artery.It indicates that good local circulation and general condition may be favorable factors that can gradually reduce brain edema.

Objective To explore clinical efficacy of early treatment for post cerebral concussion syndrome.Methods To- tally 187cases of the patients with mild,moderate cerebral concussion in our hospital were selected and were divided into three groups randomly,treated with energy mixture,nimodipine and intravenous injection of erigeron breviscapus.Treatment effects of the three groups at 7d,21dafter the treatment were compared.After three months of follow-up,the recurrence of the three groups was analyzed.Results At 7d,21dafter the start of treatment,the treatment efficacy of erigeron breviscapus group(87.50%,96.88%),was significantly higher than them of nimodipine(72.13%,80.33%)and energy mixture group(58.06%,61.29%,P<0.05).At the following 3months after injury,the ocurrence rate of post-concussion syndrome in the erigeron breviscapus group(4.69%)was significantly lower than that of nimodipine group(22.95%)and energy mixture group(38.71%,P<0.05).Conclusion It is important for improving initial symptoms and inhibitions of post-traumatic syn- drome to early select effective medicine on cerebral concussion symptoms

抽动秽语综合征又称慢性多发性抽动,由Itard在1825年首先报道,是一种起病于儿童期,以运动性和发声性抽动,伴行为异常为特征的慢性神经/精神障碍性疾病,有30％ ～60％伴发注意力缺陷多动症.流行病学资料显示,患病率为0.005‰～0.8‰[1].传统治疗首选氟哌啶醇,伴有注意力缺陷多动症或疗效欠佳者合用可乐定,但因其副作用大,患儿难以耐受,依从性差,治疗效果欠佳.总结2010年3月至2012年8月收治的8例患儿利用利培酮与匹莫林配伍治疗成功的6岁以上抽动秽语综合症合并注意力缺陷多动症患儿的临床资料,报告如下.

目的 研究遗传性痉挛性截瘫的临床表现和遗传特点.方法 回顾性分析12例患者的临床资料.结果 本组起病年龄为10～ 52岁,平均年龄22岁；35岁以下11例,35岁以上1例；单纯型9例,复杂型3例；3个家族有阳性家族史,共7例患者,散发病例5例.结论 本组遗传性痉挛性截瘫患者多于青少年或青年发病,男性多于女性,单纯性较复杂型多见,遗传方式以常染色体显性遗传多见.

目的:探讨奥扎格雷钠针联合阿托伐他汀钙治疗急性脑梗死的临床疗效。方法:回顾性分析我科收治的162例急性脑梗死患者,分为治疗组和对照组,两组均应用拜阿司匹林、苦碟子和吡拉西坦治疗,治疗组加用阿托伐他汀钙和奥扎格雷钠。结果:治疗组的总有效率明显高于对照组的76.25%,治疗组神经功能的缺损程度轻于对照组,且在治疗过程中未发生不良反应。结论:奥扎格雷钠针联合阿托伐他汀钙治疗急性脑梗死,有助于神经功能恢复。

脑静脉窦血栓形成(cerebral venous thrombosis,CVT)是颅内静脉系统,包括静脉窦、大脑深静脉、浅静脉的一种血栓栓塞性疾病.CVT是由多种原因所致的脑静脉回流受阻的一组血管疾病.该病少见但却是卒中的重要病因.

盐酸法舒地尔(fasudil hydrochloride,FSD)是一种新型异喹啉磺胺衍生物.作为一种新型高效的血管扩张药,FSD可以有效缓解脑血管痉挛,改善蛛网膜下腔出血(SHA)患者的预后,防治迟发性脑血管痉挛(CVS).近年来,其临床应用逐渐受到关注.