Abstract:Functional movement disorders (FMDs) are a type of conversion (dissociative) disorders and are of an important branch of movement disorders. However, many neurologists and psychiatrists are still not aware of these disorders. We reviewed the clinical manifestations, auxiliary examinations, diagnosis and differential diagnosis, treatments and prognosis of FMDs in this consensus paper. The purpose of this review was to improve our understandings in the mechanisms of FMDs and increase the accuracy in the diagnosis of FMDs. We also aim to help clinicians provide propriate treatments for the FMD patients.

Abstract:With the development of antibiotics, the threat generated by infectious diseases has been successfully relieved. Clinicians could lock the criminal pathogen and apply corresponding treatment under the help of current testing methods like NGS and drug sensitive test. The central nervous system has been one of the commonest sites where intensive or refractory infections occur due to its special anatomic and physiologic characters. Among all the CNS infections, the perimeningeal infections which happens to or around the dura are thought to related with peripheral infections most closely as for their special etiology and pathophysiology. Although perimeningeal infections are usually caused by some anteceded infections, but their insidious course and unspecific manifestations make them hard to be diagnosed in time. Once perimeningeal infections begin to show apparent symptoms, serious damage could have been done to the CNS, which could not be cured by simple antibiotic therapies. Therefore, early recognition and diagnosis of perimeningeal infections with corresponding antibacterial treatment is the most important way to avoid poor prognosis caused by these curable neurological disorders, and at the same time, it can reduce the damage of unnecessary surgical intervention to the body.

Abstract:As one of the most common neurological diseases in the world, epilepsy has numerous neurobiological, cognitive and psychosocial consequences. Timely diagnosis of epilepsy and appropriate treatment is of great significance to improve patient outcomes. As science and technology advances, diagnosis of epilepsy is being increasingly improved. This article will start with aspects of neuroimaging, nerve electrophysiology, genetics, body fluid examination, neuropsychology, immunology and artificial intelligence, review advances in the diagnosis of epilepsy and look forward to the future. We are trying to explain the status and progress of clinical diagnosis of epilepsy.

Abstract:Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common chronic immune-mediated peripheral neuropathy. Early and accurate diagnosis is crucial for treatment and prevention of irreversible nerve damage. This article reviews recent progresses in clinical types, diagnosis and treatment of CIDP. The discovery of specific IgG4 antibodies against nodal and paranodal proteins, as well as nerve/nerve root enlargement revealed by nerve ultrasound and MRI, could be effective supplemental tools for diagnosis.

Abstract:The clinical manifestations of autoimmune encephalitis (AE) consist of acute or sub-acute memory loss, mental-behavior disorders and seizures. Clinical diagnostic criteria for AE, published by Lancet Neurology in 2016, and Expert Consensus on Diagnosis and Treatment of Chinese Autoimmune Encephalitis in 2017 are of great importance for the standardized diagnosis and treatment. In this article, we will review the common types of AE and the clinical features of the newly-found AE antibodies related syndromes.

Abstract:Schizophrenia is a group of severe mental disorders with unknown etiology. Since there are no biological markers to diagnose so far, the diagnosis of schizophrenia is mainly based on symptomatology. This article describes the diagnostic criteria and classification changes of schizophrenia in International Statistical Classification of Disease and Health Problem (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic systems, in order to increase the understanding of the content of each diagnostic system by clinicians.

Abstract:Dizziness is the commonest chief complaints, and it often presents a significant challenge to the physician, not only because dizziness involves multiple disciplines but also the patient's description are unclear and unreliable usually. Diagnosis of dizziness must be based on a thorough and detailed history and key physical examinations, the classification established in 1972 was more useful than Bárány criteria, which was traditionally divided into four categories: vertigo, dizziness, disequilibrium, and presyncope. Patients have difficulty describing their symptoms accurately but can consistently identify the timing and triggers. The key physical examination include spontaneous nystagmus, positional provoked test, head impulse test, hearing and focal neurological deficits. Satisfactory results can be achieved only by choosing auxiliary examinations reasonably according to the diagnostic criteria of dizziness, gradually establishing hierarchical diagnosis ideas, and comprehensively evaluating and giving comprehensive treatment.

Abstract:Dizziness and vertigo are the most common clinical complaint symptoms. However, clinical diagnosis and treatment are often difficult due to the non-specific symptoms. Detailed medical history collection and systematic physical examination are helpful to determine the location of the lesion, so that the corresponding auxiliary examination can be selected more specifically, the cause of the disease can be identified more effectively, and the correct treatment strategy can be made more quickly. Based on the author's rich clinical experience in the diagnosis and treatment of dizziness/vertigo cases, this article briefly explains the diagnosis and treatment of dizziness and vertigo from the aspects of history taking and physical examination.

Abstract:Headache is one of the most common clinical complaints, with complex clinical manifestations and diverse causes. Correct clinical reasoning and methods are very important. Therefore, it is necessary to grasp the diagnostic classification of headaches and identify the clinical characteristics of common headache diseases. Firstly, a detailed medical history inquiry is required to understand the nature and type of headache, duration, accompanying symptoms and related medical history in clinical practice. Secondly, relevant physical examinations and targeted auxiliary examinations should be carried out, and indiscriminate auxiliary examinations can’t contribute to diagnosis. Based on the above process, the etiological diagnosis of different headache diseases can be completed. This article intends to combine the diagnostic criteria of The International Classification of Headache Disorders, 3rd Edition to explain how to make a diagnosis of headache diseases through medical history inquiry, physical examination and auxiliary examinations.

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Abstract:With the development of brain project in China, brain bank work will play an important role in the project. Neurodegenerative diseases contribute an important part in brain bank diseases, and it is of great significance to make a strict neuropathological diagnosis. In this article, combined with the author's working experience in brain bank, this paper focuses on summarizing the pathological characteristics of common neurodegenerative diseases, and introduces the pathological diagnosis progress of Alzheimer's disease, primary aging-related tauopathy and other diseases introduced in recent years, trying to establish a standardized procedure for pathological diagnosis of neurodegenerative diseases in brain bank.

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Abstract:Nowadays, the number of non-communicable diseases (NCDs) sufferers has increased dramatically surpassing that of infectious diseases, and NCDs have become the most important factor threatening the human health. This leads to heavy burdens on families and the society. Therefore, it is meaningful to early diagnose NCDs. However, it cannot be accomplished clinically at present, so a novel NCDs diagnosis method is necessary. Most NCDs like cardiovascular diseases, cancers and diabetes, can affect the nervous system and cause changes in nerve electrical signals. The state-of-the-art method for early diagnosing NCDs could be accomplished through neuroelectrophysiological methods. Considering the diversity and complication of neural signals, the widely-applied machine learning methods can be combined together with neuroelectrophysiological approaches to quantify the relationships between NCDs and neural signals. This paper generally and systematically review the neuroelectrophysiology incorporated with machine learning in the diagnosis of non-communicable diseases.

Abstract:Mental disorders, with complex mechanisms, are characterized by high recurrence and high disability rate, while cortical excitation-inhibition imbalance is often present. It is important to develop noninvasive, in-vivo and quantified measures of cortical activity for discovering the underlying mechanism of mental disorders and improving the clinical diagnostic accuracy. Transcranial magnetic stimulation (TMS), combined with neurophysiology, has been well established to evaluate cortical excitability and inhibition. We have reviewed new progresses in the measures of cortical activity by TMS, as well as their clinical utility in evaluating cortical function and therapeutic effects of mental disorders.

Abstract:Nowadays various types of genetic tests including single gene testing, Panel testing, whole-exome sequencing and wholegenome sequencing, have been widely used in the diagnosis of neurogenetic diseases. With the advances in genetic testing, physicians are able to reach a rapid and precise diagnosis of diseases with vast genetic heterogeneity and complex phenotypes. This overview of genetic testing strategies aims to help physicians to select the test that is most appropriate for their practice setting.

Abstract:Clinical genetic testing in the patients with Alzheimer's disease (AD) and related cognitive impairments offers a precise molecular diagnosis, and could help members of an affected family to determine personal risk. Patients with dementia should be offered a full diagnostic assessment to determine their likely clinical diagnosis. We recommend gene panel testing for all patients with AD and a strong family history or early-onset disease (<60 years), all patients with behavioral variant frontotemporal dementia (bvFTD) or frontotemporal dementia-amyotrophic lateral sclerosis (FTD-ALS), and patients with primary progressive aphasia (PPA) or a corticobasal syndrome (CBS) and a positive family history. Patients with amyotrophic lateral sclerosis and frontotemporal dementia are recommended to perform C9orf72 repeat testing additionally. Patients with Huntington disease (HD) or prion disease phenotypes should undergo a single-gene test first and, if this test is negative, whole-exome sequencing (WES) or whole-genome sequencing (WGS) should be performed. WES and WGS become financially feasible but raise complex issues such as variants of uncertain significance. The American College of Medical Genetics and Genomics and the Association of Molecular Pathology (ACMGAMP) guidelines for the classification of single nucleotide polymorphisms are designed to combine several pieces of evidence to classify that a variant is pathogenic or benign.

Abstract:Cerebrovascular disease is the leading cause of mortality and disability in China, and assessing the imaging diagnosis accurately, especially in patients with acute ischemic stroke (AIS), is of great importance in formulating treatment program and improving prognosis. Neuroimaging has been developing rapidly in recent years, and new techniques have emerged to help clinicians in assessing the infarct size, evaluating the ischemic penumbra, and identifying responsible vessels in patients with AIS, these measures provide useful information for individualized clinical treatment. In this paper, we briefly summarized the new technologies and applications of computerized tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis and treatment of cerebrovascular diseases, in order to provide reference for clinical imaging applications in cerebrovascular diseases.

Abstract:The aging of the population has led to a significant increase in the incidence and prevalence rate of dementia, especially Alzheimer's disease (AD). Positron emission tomography (PET) is one of the most advanced molecular imaging diagnostic techniques in recent years. In the field of dementia, based on neuropathology, radio-labeled molecular probes of amyloid and tau tracer can objectively detect the distribution of abnormal protein deposition in the brain, which can be widely used in the early diagnosis and differential diagnosis of AD, disease progression and prognosis assessment. This paper focuses on the development and clinical research status of molecular probes for amyloid and tau protein.

Abstract:Corticobasal degeneration (CBD) is a neurodegenerative disease characterized by asymmetric motor symptoms and cerebral cortical dysfunction, with pathological diagnosis as gold standard. Due to the heterogeneity of clinical features and the overlapping with other neurodegenerative diseases in symptoms and pathology, the diagnosis of CBD is difficult. The correct rate of current diagnostic criteria is low and the imaging is excluded. In this paper, we give a review of the progress in imaging of CBD in recent decades, including computed tomography (CT), magnetic resonance imaging (MRI), radionuclide imaging, and their contributions in identification of CBD with other diseases.

Abstract:Objective: To explore the diagnostic value of the absence of "swallow tail" appearance at 3.0 T susceptibility weighted imaging (SWI) in Parkinson's disease (PD) and analyze the correlation between visualization of nigrosome-1 and clinical data of PD patients. Methods: We enrolled 50 PD patients and 57 sex-and age-matched non-PD patients from the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University from September 2017 to November 2019.All subjects underwent 3.0 T SWI. Bilateral "swallow tail" appearance on the SWI images were evaluated by two clinicians blinded to the clinical data and diagnosis. The absence of "swallow tail" on one side was diagnosed as PD. Then, the sensitivity, specificity, accuracy and predictive values of the absence of "swallow tail" appearance in the diagnosis of PD were calculated. The correlation between visualization of nigrosome-1 and clinical data was also assessed. Results: Taking clinical diagnosis as the gold standard, and the absence of "swallow tail" on one side as the image diagnosis standard for PD, 45 patients were diagnosed correctly. Inter-rater agreement was excellent (k=0.963, P=0.000). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of discriminating PD patients from non-PD patients with the absence of "swallow tail" appearance were 90.0%, 91.2%, 90.7%, 90.0% and 91.2%, respectively. The clinical symptoms of 44 PD patients were asymmetrical, among which 32 cases of nigrosome-1 visualization were asymmetrical. There was no significant difference between poorly visualized nigrosome-1 and clinical symptoms in PD patients (χ²=5.756, P=0.056). Bilateral nigrosome-1 absence occurred in 11 PD patients, which were "total absence group", and the rest of PD patients were "non-total absence group". There was a significant difference in the hamilton depression rating Scale score between "total absence group" and "non-total absence group" (U=126.500, P=0.038), while, there were no significant differences in the duration, modified Hoehn-Yahr stage, the Unified Parkinson's disease rating scale part Ⅲ score, the mini mental state examination score and the Montreal cognitive assessment score between two groups (P=0.768, P=0.140, P=0.839, P=0.054, P=0.067). Conclusion: The absence of "swallow tail" appearance at 3.0 T SWI has a high accuracy in the diagnosis of PD and the degree of absence may be related to the depression degree of PD patients, and has certain reference value for the diagnosis of PD.

Abstract:Objective: To detect iron content in deep grey matter nucleus of brain by susceptibility weighted imaging (SWI) and to assess the correlation between iron deposition and motor symptoms of Parkinson's disease (PD). Methods: This study enrolled 35 PD patients and 41 age-and sex-matched healthy controls who completed SWI examination on 3 T MRI. The phase value of each nucleus was measured in the phase images. The clinical data such as Hoehn-Yahr stage, scores of the Unified Parkinson's Disease Rating Scale (UPDRS) partⅠ, Ⅱ, Ⅲ and total score were collected. According to the Hoehn-Yahr classification, the PD group was divided into the early group (≤2 grade) and the mid-late group (>2 grade), and in the early group (Hoehn-Yahr classification≤1.5 grade) was divided into the ipsilateral and contralateral groups according to the asymmetry of their motor symptoms, and the distribution of iron content. The differences of phase value of each nucleus in each group were compared, and the correlation between phase value and iron content, UPDRS score and so on were analyzed. Results: The phase value of each nucleus in the control group had a negative linear correlation with the iron content of normal human brain reported in the literature (r=-0.809, P=0.028). The phase value of substantia nigra pars compactac (SNc) in the PD group was significantly lower than that of the control group (P=0.011), and the phase value of SNc portion in the mid-late PD group was significantly lower than that of the control group (P=0.014). The SNc phase value of the ipsilateral and contralateral group in the early PD group was significantly different (P<0.001), and the SNc phase value of the contralateral group was significantly lower than that of the control group (P=0.032). The phase value of SNc of PD group showed a negatively linear correlation with UPDRS-Ⅱscore (r=-0.364, P=0.032). Conclusion: The iron content of SNc gradually increase during the progression of PD, mainly in the middle and late stages. The asymmetric distribution of SNc iron deposits in early PD is related to the asymmetry of motor symptoms. Iron deposition in SNc of PD patients is positively linear correlated with motor symptoms, indicating that it may function as a biomarker for monitoring PD progression.

Abstract:Objective: To investigate the abnormality of degree centrality of brain network in patients with early migraine compared with healthy subjects using resting-state functional magnetic resonance imaging (fMRI). Methods: A total of 44 patients with early migraine and 45 healthy controls were included, and the resting-state fMRI scanning for each subject was performed. The MRI data were pre-processed using DPARSFA software. The degree centrality (DC) based on graph theory analysis was calculated for both patients with early migraine and healthy controls. The comparison was performed by independent-sample t-test, and the spearman correlation analysis was used to evaluate the correlation between DC value of significant brain areas and the mini-mental state examination (MMSE), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) scores. Results: For the patients with early migraine, the DC values in the thalamus, the superior temporal gyrus, the medial frontal gyrus, the frontal lobe, the limbic lobe, the posterior central gyrus, the anterior central gyrus and the paracentral lobule were significantly different compared to the healthy subjects (P<0.05, the Cluster>20, TFCE, permutation times>5 000), but there was no correlation between the DC values and clinical scores (P>0.05). Conclusion: The changes of DC values in patients with early migraine are mainly located in the area of pain recognition and processing, which provides a new discovery for further exploring the pathological and neurophysiological mechanisms of migraine.

Abstract:Objective: To evaluate the effectiveness of acupuncture combined with donepezil for Alzheimer's disease (AD). Methods: China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese BioMedical Literature Database (CBM), PubMed and Web of Science were searched for relevant randomized controlled trials (RCTs) from inception to February 17, 2021.The score data of cognitive scale and daily living ability scale were extracted from the selected literature, and the difference and standard deviation of each scale before and after treatment were calculated, and the data were analyzed by RevMan 5.4 software. Results: In total, 7 RCTs involving 425 participants were included in the study, 212 in observation group and 213 in control group. Meta-analysis showed that acupuncture plus donepezil therapy was superior to donepezil alone in improving MMSE (MD=0.52, 95%CI=0.18 to 0.86) and ADAS-Cog (MD=-1.78, 95%CI=-2.47 to-1.10) scores of AD patients. On the basis of GRADE system, scores of MMSE and ADAS-Cog were evaluated as low-quality while those of MoCA and ADL were critically low-quality. Conclusion: Current RCTs evidence indicates that combination of acupunc ture and donepezil may perform better on improving cognitive function of AD patients than donepezil alone. Further largesample RCTs, however, are still in desperate need to be carried.

Abstract:Objective: To investigate the correlation between the susceptibility of rs1372525 and rs3822086 polymorphisms of αsynuclein gene (SNCA) and Parkinson's disease in Xinjiang. Methods: A case-control study was conducted to collect the peripheral blood of 225 outpatients with Parkinson's disease from the Affiliated Hospitals of Xinjiang Medical University and 231 healthy subjects matched with age, gender and place of birth. The patients were divided as the case group and the control group. The peripheral blood of two groups of participants were collected, and the polymorphism of SNCA rs1372525 and rs3822086 loci were analyzed by deoxyribonucleic acid (DNA) amplification and polymerase chain reaction (PCR). Results: The SNCA rs1372525 loci of the case group and the control group were respectively detected in 161 and 164 cases of AA type, 54 and 61 cases of AG type, and 10 and 6 cases of GG type. The frequency of allele A was 83.6% and 84.2% respectively, and the frequency of allele G was 16.4% and 15.8%. There was no significant difference in the distribution frequency of genotypes and alleles between the case group and the control group (P>0.05). There were 47 and 73 cases of CC type, 115 and 113 cases of CT type and 63 and 45 cases of TT type detected at rs3822086 locus in case group and control group, respectively. The frequency of allele C was 46.4% and 56.1%, and the frequency of allele T was 53.6% and 43.9%, respectively. There was no significant difference in rs3822086 CC genotype and allele C between the two groups (P>0.05). However, there were significant differences in the distribution frequency of CT and TT genotypes and allele T between the two groups (P<0.05). Conclusion: There is no correlation between SNCA rs1372525 locus polymorphism and the incidence of Parkinson's disease, and rs3822086 locus is considered as one of the susceptible sites in the occurrence and development of Parkinson's disease.

Abstract:Objective: To explore the clinical features, imaging features and treatment of spinal dural arteriovenous fistula (SDAVF), in order to improve the early identification and diagnosis of SDAVF. Methods: The clinical features, imaging features and treatment of 6 patients with SDAVF admitted to the Department of Neurosurgery in Shanghai Putuo District People's Hospital were retrospectively analyzed. Results: Of the 6 patients with SDAVF, 5 were males and 1 was female. The age of diagnosis ranged from 22 to 74 years old. The course of the disease ranged from 2 months to 2 years. Legs weakness was involved in 5 patients, legs or limbs sensory disorder in 6 patients, and bowel and/or bladder dysfunction in 4 patients, among which 2 patients required indwelling catheter. Magnetic resonance (MR) examination of spinal cord was performed in 5 patients before surgery. The results showed spinal cord long T1 and long T2 signals, and there was vascular flow void signal change on the surface of spinal cord, and enhancement was seen after contrastenhanced MR scan. Digital subtraction angiography (DSA) showed that fistula occurred in the thoracic segment in 5 patients, one patient had 3 times of DSA and no fistulas were found, and the fistula was found during the operation. Fistulas were excised during the surgery in the 5 patients, and all recovered well after the operations. Conclusion: SDAVF has its clinical features and imaging characteristics. Spinal MR can be used for preliminary diagnosis. DSA is the gold standard for diagnosis, surgery is an effective treatment method, and early diagnosis and early treatment can help to improve the prognosis of patients.

Abstract:Objective: To explore the effect of role-playing education model on improving the awareness of senile dementia in study partners. Methods: Totally 50 study partners were given role-playing education once a week for 6 weeks by clinic convenience sampling. Paired sample t-test was used to statistically analyze the changes of knowledge and attitudes toward dementia. Results: The score of senile dementia knowledge assessment scale (25.58±4.56) after role-playing was higher than that before (17.54±2.68), with statistical significance (P<0.01). The score of the dementia attitude scale (109.84±10.82) after role-playing was higher than that before (104.74±11.04), with statistical significance (P<0.05). Conclusion: Role-playing can effectively help study partners understand dementia knowledge and comprehend the patient behavior patterns.

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