Deep brain stimulation for generalised dystonia and spasmodic torticollis.

Dystonia appears distinct from the other tremulous disorders in that improvement following deep brain stimulation frequently appears in a delayed and progressive manner. The rate of this improvement and the point at which no further progress can be expected are presently unknown. The establishment of these parameters is important in the provision of accurate and relevant prognostic information to these patients, their carers, and their treating physicians. We studied 12 consecutive patients with generalised dystonia (n=6) and spasmodic torticollis (n=6) who underwent bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) and were followed up for a minimum of 2 years postoperatively. Standard rating scales were used to quantify their neurological improvement. Both groups experienced a statistically significant improvement in their rating scores at both one and two years following surgery. At 2 years follow-up, the spasmodic torticollis group exhibited a 59% improvement in their total Toronto Western Spasmodic Torticoilis Rating Scale (TWSTRS) rating score and the generalised dystonia group attained a 46% improvement in their overall Burke, Fahn and Marsden Dystonia Rating Scale (BFMDRS) evaluation. Ninety-five percent of the final improvement was attained by 6.4 months in the generalised dystonia group and by 6.6 months in those with spasmodic torticollis. There was no significant improvement after one year postoperatively. These findings add further support to GPi DBS as an effective treatment for generalised dystonia and spasmodic torticollis, and furnish important information as to the expected rate of improvement and the point at which no further gains can be reasonably anticipated.     

Neurophysiologic Intervention in Deep Brain Stimulation Treatment for Movement Disorders: A Practical Framework

Clinical neurophysiology has always played an important interventional role throughout the perioperative stages in functional neurosurgery. On the one hand, some neurophysiologic procedures have become an integrated part of neurosurgery. On the other hand, in deep brain stimulation, although the surgical electrode implantation is an essential step, the therapeutic effects are actually produced by electrically modulating the physiologic activity of the brain. We review the topic of neurophysiologic intervention in the deep brain stimulation for movement disorders by presenting the evidence derived from our own experiences based on an integrated group located at two hospitals in London and Oxford, UK, and mainly covering tremor caused by multiple sclerosis, Parkinson's disease and dystonia.     

Effects of vision and arm position on amplitude of arm postural tremor in patients with multiple sclerosis

Feys P, Helsen WF, Liu X, Lavrysen A, Nuttin B, Ketelaer P. Effects of vision and arm position on amplitude of arm postural tremor in patients with multiple sclerosis. Arch Phys Med Rehabil 2004;85:1031-3.

Objectives

To quantify the effects of vision and arm position on arm postural tremor, comparisons were made between flexed and extended arm positions performed with the eyes open and closed.

Design

Case-control study.

Setting

National multiple sclerosis (MS) center in Belgium.

Participants

Sixteen patients (32 arms) with MS who had intention tremor and 16 healthy controls (32 arms).

Interventions

Not applicable.

Main outcome measure

The amplitude of postural tremor was assessed by a magnetic position sensor attached to the index finger.

Results

The amplitude of postural tremor was not influenced by changes in visual condition or different arm positions. Both healthy controls and MS patients made more directional changes in the flexed, compared with the extended arm position.

Conclusions

The amplitude of the arm postural tremor in MS is independent of vision and arm position. Selecting 1 arm position is sufficient to assess postural tremor amplitude.     

Statins,plasma cholesterol,and risk of Parkinson's disease: A prospective study

Previous findings on the association of statins, plasma lipids, and Parkinson's disease (PD) are confounded by the fact that statins also affect lipid profiles. We prospectively examined plasma lipids and statin use in relation to PD in the Atherosclerosis Risk in Communities (ARIC) Study. Statin use and plasma lipids were assessed at baseline (visit 1, 1987‐89) and at three triennial visits thereafter (visits 2‐4) until 1998. Potential PD cases were identified from multiple sources and validated where possible. The primary analysis was limited to incident PD cases diagnosed between 1998 and 2008. Odds ratios and 95% confidence intervals were derived from multivariate logistic regression models. Statin use was rare at baseline (0.57%) but increased to 11.2% at visit 4. During this time frame, total‐cholesterol levels decreased, particularly among statin users. Fifty‐six PD cases were identified after 1998. Statin use before 1998 was associated with significantly higher PD risk after 1998 (odds ratio = 2.39, 95% confidence interval 1.11‐5.13) after adjusting for total cholesterol and other confounders. Conversely, higher total cholesterol was associated with lower risk for PD after adjustment for statin usage and confounders. Compared with the lowest tertile of average total cholesterol, the odds ratios for PD were 0.56 (0.30‐1.04) for the second and 0.43 (0.22‐0.87) for the third tertile (P_trend = 0.02). Statin use may be associated with a higher PD risk, whereas higher total cholesterol may be associated with lower risk. These data are inconsistent with the hypothesis that statins are protective against PD. © 2015 International Parkinson and Movement Disorder Society     

Caffeine intake, smoking, and risk of Parkinson disease in men and women

The authors prospectively examined whether caffeine intake was associated with lower risk of Parkinson disease (PD) in both men and women among 304,980 participants in the National Institutes of Health-AARP Diet and Health Study and whether smoking affected this relation. Multivariate odds ratios and 95% confidence intervals were derived from logistic regression models. Higher caffeine intake as assessed in 1995-1996 was monotonically associated with lower PD risk (diagnosed in 2000-2006) in both men and women. After adjustment for age, race, and physical activity, the odds ratio comparing the highest quintile of caffeine intake with the lowest was 0.75 (95% confidence interval: 0.60, 0.94; P(trend) = 0.005) for men and 0.60 (95% confidence interval: 0.39, 0.91; P(trend) = 0.005) for women. Further adjustment for duration of smoking and analyses carried out among never smokers showed similar results. A joint analysis with smoking suggested that smoking and caffeine may act independently in relation to PD risk. Finally, the authors conducted a meta-analysis of prospective studies and confirmed that caffeine intake was inversely associated with PD risk in both men and women. These findings suggest no gender difference in the relation between caffeine and PD.     

新量表ESSENI在预测脑梗死复发方面的探索性研究

目的用量表预测脑梗死复发是一直以来临床医师关注的课题,ESSEN评分是国际公认的预测量表,但其中未包括影像学等重要因素,预测效度有限。方法本研究选择北京大学人民医院2005至2007年住院的非心源性脑梗死患者,应用电话随访结合电子病例查询调查方法,确定为单发组或复发组,并对其进行各个临床和影像特点的电子表格录入。应用Cox regression筛选脑梗死5年复发的独立危险因素,并根据B值对其进行赋分;结合ESSEN评分制订新的评分量表ESSENI,应用ROC分析比较两种评分的曲线下面积(AUC);应用生存分析计算5年复发率。结果 Cox regression得出,糖尿病、MRI上脑白质病、脑梗死灶多于1个和不同系统梗死灶是脑梗死复发的独立危险因素;根据B值对其分别赋分1、2、6和1.5分,建立ESSENI评分系统,即在ESSEN的9分基础上加上3项影像学因素,共18.5分。并得出≥10分为高危人群,其5年复发率为(68±0.05)%;应用ROC分析,其ESSENI的AUC为0.789;>ESSEN的AUC为0.65。结论新的评分系统ESSENI结合影像学和临床特点,能够更好地提高其长期的脑梗死复发预测度。     

胃粘膜肠上皮化生CST-Л的表达及其与H.pylori相关性研究

目的探讨GST-Л在胃癌发生过程中表达,及在肠化阶段以GST-Л为代表的人体对致癌物解毒系统与H.pylori致毒作用间的相互作用.方法利用S-P法对219例胃粘膜活检标本进行GST-Л单克隆抗体的检测:利用HID-AbpH2.5-PAS粘蛋白组化学技术对171例肠化粘膜进行分型;利用HE及H.pylori-DNA PCR及ELISA方法对正常胃粘膜和肠化粘膜进行H.pylori的检测.对80例H.pylori阳性患者进行H.pylori根除治疗三个月后进行H.pylori、GST-Л的检测.结果正常胃粘膜未见GST-Л的表达,肠化粘膜GST-Л阳性率为69.6%,胃癌GST-Л阳性率为44.4%,高于正常胃粘膜(P＜0.01),低于肠化粘膜(P＜0.05).H.pylori阴性组SGT-Л阳性率高于H.pylori阳性组(P＜0.05).H.pylori根除治疗后,根除组GST-Л表达高于未根除组(P＜0.05).结论正常胃粘膜→肠化粘膜→胃癌组织GST-Л表达由无→高→低,GST-Л弱阳性或阴性的Ⅲ型肠化与胃癌关系密切;肠化粘膜中GST-Л弱阳性或阴性表达如合并H.pylori感染者,胃癌发生的危险性增加,提示在肠化阶段H.pylori的致毒作用与机体对致癌物的解毒作用彼此相互拮抗.     

复方贞术调脂方对HepG2细胞胰岛素抵抗的作用及机制研究

目的 观察复方贞术调脂方（FTZ）对胰岛素抵抗（IR） HepG2细胞的作用,为开拓FTZ的治疗范围,阐明FTZ调节糖脂代谢的机制提供实验依据.方法 用高浓度胰岛素诱导HepG2细胞使其产生胰岛素抵抗,用高、中、低3个剂量的FTZ干预后,葡萄糖氧化酶法检测HepG2细胞培养液上清液中葡萄糖的含量,实时荧光定量PCR检测HepG2细胞胰岛素信号PI-3Kp85 mRNA的表达,Western blot检测HepG2细胞胰岛素信号转导蛋白IRS1表达.结果 模型细胞培养基上清液中葡萄糖含量高于正常细胞（P＜0.05）.给予FTZ（1、25、100μg/mL）后,HepG2细胞培养基上清液中葡萄糖含量均低于模型细胞葡萄糖含量（P＜0.05）.胰岛素抵抗细胞与正常细胞相比PI-3Kp85 mRNA和IRS1的蛋白表达显著降低（P＜0.05）.给予FTZ干预后,与胰岛素抵抗细胞相比PI-3Kp85 mRNA和IRS1的蛋白表达显著增加（P＜0.05）.结论 FTZ可改善胰岛素抵抗HepG2细胞对葡萄糖的摄取.其改善胰岛素抵抗的作用机制之一可能是通过上调胰岛素信号PI-3Kp85 mRNA和IRSl蛋白质在胰岛素抵抗HepG2细胞的表达.