Neuropsychologic status in multiple sclerosis after treatment with glatiramer

BACKGROUND: Glatiramer acetate (Copaxone) therapy reduces clinical disease activity in relapsing-remitting multiple sclerosis (MS). OBJECTIVE: To study the effect of glatiramer therapy on neuropsychologic function as part of a randomized, placebo-controlled, multicenter trial. METHODS: Two hundred forty-eight patients with relapsing-remitting MS and mild to moderate disability (Expanded Disability Status Scale score, <5.0) were tested before and 12 and 24 months after randomization to administration of glatiramer acetate, 20 mg/d, or matching placebo. Neuropsychologic tests examined 5 cognitive domains most often disrupted in patients with MS: sustained attention, perceptual processing, verbal and visuospatial memory, and semantic retrieval. RESULTS: Baseline neuropsychologic test performance was similar in both treatment groups and was within normal range, except for impaired semantic retrieval. Mean neuropsychologic test scores were higher at 12 and 24 months than at baseline, and no differences were detected between treatment groups over time. No significant interactions were detected between treatment and either time or baseline impairment. CONCLUSIONS: Our 2-year longitudinal study showed no effect of glatiramer therapy on cognitive function in relapsing-remitting MS. Although it is possible that glatiramer therapy has no effect on cognitive function, the lack of measurable decline in cognitive function in both patient groups for 2 years limits the opportunity for glatiramer to demonstrate a therapeutic effect by minimizing such decline. Emerging treatments for MS should continue to be examined for their effect on cognitive impairment because it can be a critical determinant of disability. A greater understanding of the natural history of cognitive decline in MS is essential for a rational design of these drug trials.     

长春西汀治疗血管性痴呆的临床疗效观察

目的:探讨长春西汀对血管性痴呆(VD)疗效和作用机制。方法:96例VD患者随机分成长春西汀治疗组和胞二磷胆碱对照组,分别在治疗第10、21d进行简易精神状态评分(MMSE)和长谷川评分(1DS),同时测定与记忆有关的乙酰胆碱酯酶(AchE)的活性。结果:长春西汀治疗组患者第21d的MMSE和IDS评分均高于治疗前和一般治疗组(P＜0．01),且长春西汀治疗组VD患者的乙酰胆碱酯酶(AchE)活性降低和血浆乙酰胆(Ach)含量升高(P＜0．05)。结论:长春西汀治疗VD疗效肯定,其机制可能与胆碱能神经系统功能增强有关。     

偏头痛病人发作期血浆TXB_2和6-keto-PGF_(1α)含量的改变

用放免法测定了偏头痛病人发作期血浆TXB_2和6—keto—PGF_(1α)的含量,结果显示;偏头痛发作期血浆TXB_2的含量稍高于对照组(P<0.01);6—keto—PGF_(1α)的含量稍高于对照组,但无统计学差异(P>0.05)。因此,偏头痛发作期存在血浆TXB_2和6—keto—PGF_(1α)的失衡,以血浆TXB_2的改变为主。     

新型隐球菌脑膜炎18例临床治疗分析及文献复习

目的探讨新型隐球菌脑膜炎(CNM)的治疗及转归。方法对18例CNM患者的临床资料进行回顾性分析并文献复习。结果18例患者均经病原学确诊。单用氟康唑治疗6例,随访观察治愈、好转者3例,死亡3例;两性霉素B(Am B)和氟康唑(FCZ)序贯治疗12例,随访观察治愈、好转者10例,死亡2例。结论联合用药抗真菌效果较好,脑室引流能较快缓解症状、改善预后。     

新型隐球菌脑膜炎的诊断探讨及文献复习

目的:探讨新型隐球菌脑膜炎(CNM)的临床特点及诊断方法。方法:对18例CNM患者的临床资料进行回顾性分析并文献复习。结果:18例患者均经病原学确诊。大部分CNM患者为亚急性起病,临床表现无特异性,误诊率高,首诊误诊率为72％,其中误诊为结核性脑膜炎的占69％。结论:脑脊液中找到新型隐球菌是诊断该病的重要依据,多种快速检测手段结合可提高早期诊断率。     

80岁以上高龄患者急性脑梗塞的临床特点分析

目的:探讨超过80岁的高龄急性脑梗塞患者的临床特点。方法:58例高龄(均≥80岁)急性脑梗塞患者,大多数行头颅MRI平扫加弥散加权成像(DWl),少数行CT检查。依影像学结果按梗塞病灶的大小分为两组:大面积梗塞(直径>1.5cm)及小面积梗塞(直径≤1.5cm,主要为腔隙性梗塞)组。回顾比较两组间发病特点;糖尿病、高血压、颈动脉硬化、冠心病、房颤的发生率;治疗方法、平均住院时间、30天病死率、日常生活活动能力(ADL)等临床指标。结果:大面积梗塞组占16例(27.6%),小面积梗塞组占42例(72.4%)。首发症状中大面积梗塞组以意识障碍(87.5%vs23.8%;P=0.018)、严重偏瘫(93.8%vs28.6%;P=0.012)、头痛(43.8%vs14.3%;P=0.026)、言语障碍等症状为主,小面积梗塞以以肢体无力、行走不稳(64.3%vs6.3%;P=0.001)、头昏、眩晕(52.4%vs25.0%;P=0.028)、言语不清、感觉障碍等症状为主。大面积梗塞组房颤高发(43,8%vs14.3%;P=0.030),小面积梗塞组高血压(88.1%vs56.3%;P=0.041)、糖尿病(54.8%vs18.8%;P=0.021)高发。在大面积梗塞组急性期用低分子肝素抗凝较多(75.0%vs40,5%;P=0.035),两组均以口服抗血小板药物为主。大面积梗塞组的并发症较多,平均住院日为小面积梗塞组的近二倍,死亡率较后者明显增高(25.0%vs4.8%;P=0.035)。结论:高龄急性脑梗塞患者以较小面积的腔隙性脑梗塞多见。小面积梗塞组高血压、糖尿病的发生较高。大面积梗塞组房颤的发生较高,有较高的死亡率,预后较差,需要更积极的综合诊治管理。常规尽早行头颅MRI加DWI有助于急性脑梗塞的早期诊断治疗。     

比较不同方式移植的人间充质干细胞在大鼠失神经支配的骨骼肌的分布及对坐骨神经损伤的影响

目的:探讨干细胞治疗神经肌肉疾病的更为可能而有效的给药途径及对坐骨神经损伤后修复的影响.方法:体外分离培养人间充质干细胞,经鉴定标记后备用.将54只SD大鼠随机分为肌肉注射干细胞组(肌注组)、静脉注射干细胞组(静脉组)和肌肉注射生理盐水组(对照组),每组18只.所有大鼠均建立坐骨神经损伤模型,3天之后,将106个干细胞通过肌肉注射和静脉注射分别移植到损伤大鼠模型中,于移植后3、7、14、21、28、60 d,观察坐骨神经功能指数、电生理指标和肌肉病理结果.结果:三组大鼠在观察期间均呈不同程度的失神经和神经再生现象.肌注组的腓肠肌肌电图自发电位减少,且动作电位出现的时间早于静脉组和对照组.移植后14 d开始,肌注组大鼠的传导速度明显快于静脉组和对照组[分别为(32.27±7.42) m/s,(22.92±7.34) m/s和(17.67±5.52) m/s; F=5.661,P=0.042],60 d时,三组的传导速度差异无统计学意义(P＞0.05),而波幅改变肌注组为(12.50±2.06) mV,静脉组为(1.50±0.20) mV,对照组为(10.13±4.04) mV,差异仍有统计学意义(F=6.347, P=0.033).肌注组至少在3周内均可见干细胞的存活,其在光镜下呈幼稚状态,大部分在肌细胞周边,少数散在肌细胞内.静脉组在腓肠肌中未见标记细胞.60 d时肌注组腓肠肌的萎缩程度比静脉组和对照组轻,三组肌纤维直径的差异有统计学意义(F=4.537,P=0.021).结论:肌肉注射人间充质干细胞对大鼠坐骨神经损伤和腓肠肌失神经萎缩具有促修复作用;肌肉注射是比较有效的一个给药途径.     

早期康复治疗对幕上大量脑出血患者预后影响的研究

目的:研究早期康复治疗对幕上大量脑出血患者运动功能和日常生活活动能力的影响,以及对预防和减少幕上大量脑出血患者肩痛和肺炎的影响.方法:将97例40～80岁确诊为幕上脑出血的病人随机分为3组,早期康复组(35例)、对照组(32例)和后期康复组(30例).采用FMA(Fugl-Meyer)评定及MBI(modify barthel index)法对患者运动功能和日常生活能力评定.肩痛是以患者静止或活动时出现疼痛为阳性,肺感染依据症状、体征及胸片可诊断. 结果:康复2月后早期康复组患者的各项评分明显改善,肩痛及肺感染发生率较其他两组低(P<0.05),后期康复组与对照组间差异无统计学意义(P>0.05).结论:早期康复可以改善患者的运动功能及日常生活活动能力,减少肺感染及肩痛的发生率.     

氟桂利嗪联合普奈洛尔治疗偏头痛的观察

目的观察氟桂利嗪联合普奈洛尔治疗无先兆偏头痛的疗效，探讨两药联合应用能否增强疗效。方法146例无先兆偏头痛患者随机分为3组，Ⅰ组50例，氟桂利嗪每晚睡前5mg一次口服，普夸洛尔每次10mg，每日3次口服；Ⅱ组49例，氟桂利嗪每晚睡前5mg一次口服；Ⅲ组47例，普奈洛尔每次10mg，每日3次口服。3组均以90d为疗程，观察3组治疗前后平均每月头痛发作次数、程度的变化及副作用。结果治疗后Ⅰ组总有效率92．0％，Ⅱ组总有效率69．4％，Ⅲ组总有效率63．8％，联合治疗组疗效明显优于单一用药组，v值分别为2．64、3．45，均P〈0．01，3组副作用无明显差异。结论氟桂利嗪与普奈洛尔联合应用能提高治疗无先兆偏头痛的疗效，副作用无增加。     

Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study

Background/ObjectiveOccurrence of post-dural puncture headache (PDPH) after diagnostic lumbar puncture (LP) for idiopathic intracranial hypertension (IIH) may seem very unlikely in clinical practice. Nevertheless, it has been suggested by several studies, mainly in sub-group analyses. We aimed to evaluate the prevalence of PDPH in an IIH population and determine any eventual predictive factors of PDPH occurrence.MethodsWe conducted a retrospective multiple-center observational study. All newly diagnosed IIH patients who met the International Classification of Headache Disorders (ICHD-3) or the Dandy modified criteria were included from three different French hospitals. They all underwent LP following the same process with the same type of needle. We recorded PDPH occurring within five days after LP, as defined by ICHD-3 criteria.ResultsSeventy-four IIH patients were recruited, of whom 23 (31%) presented with PDPH. Neither classical risk factors for PDPH such as body mass index, age or gender, nor cerebrospinal fluid opening pressure, or specific IIH features were associated with occurrence of PDPH.ConclusionPDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients.