Nerve Dysfunction Research Articles

Immune system perturbations in patients with severe long COVID

Abstract SARS-CoV-2 infections have different outcomes ranging from mild to severe acute infection as well as post-infectious multi-system inflammatory syndromes (MIS-C/A). Post-acute sequelae of COVID-19 (PASC) or long COVID is another outcome, which is poorly understood and range from mild to very severe persistent organ dysfunction and damages. To maximize our chances of identifying underlying mechanisms of long COVID we focus on the most severe cases with objective measures of disease such as lung damages, microvascular and autonomic nerve dysfunction. We are testing the following hypotheses that I) long COVID is a super-antigen mediated disease, II) an autoimmune condition driven by pathogenic autoantibodies, and/or III) a disease caused by viral persistence. A cohort of over 100 long COVID patients, 24 recovered long COVID patients as well as 9 COVID convalescent controls have been recruited thus far and blood samples analyzed for plasma proteome (Olink assays), immune cell composition and phenotypes (mass cytometry), T-cell repertoire (scTCR-seq), innate cell activation (circulating nucleosomes), and auto-antibody analyses (Luminex arrays) in order to understand immune perturbations in severe long COVID patients. Unlike children with hyperinflammatory MIS-C, we have not found any evidence of superantigen-mediated T-cell activation in long COVID, but instead substantial clonal expansion of memory T cell clones with effector memory states and shared clonality across patients. Additionally, cytokine perturbations such as elevated levels of IL8 and elevated levels of circulating nucleosomes indicate persistent activation of neutrophils in severe long COVID.

Early Diagnosis through Estimation of Inflammatory Biomarkers and the Neuroprotective Role of Metformin in Diabetic Peripheral Neuropathy

Purpose: Diabetic peripheral neuropathy (DPN), a chronic neurological complication of type 2 diabetes mellitus (T2DM) with signs and symptoms of peripheral nerve dysfunction such as numbness, tingling or burning sensation, paresthesias etc. Several lacunae exist in relation to the cause and effect of DPN. Therefore diagnosis, as well as treatment of DPN remains unsatisfactory. The involvement of chronic low-grade inflammation in DPN is a rapidly emerging concept and therefore the present study adds weight to it. We estimated some of the biomarkers of inflammation which may be the early markers of DPN. This study is the earliest of its kind to correlate the biomarker levels with metformin, a drug less reported in terms of its anti-inflammatory and neuroprotective activity. 
 Methods: After approval from the institutional human ethical committee, 90 patients attending the outpatient ward of a tertiary care hospital were included in the study. They were divided into two groups: M- group (patients on non metformin) and M+ group (patients on metformin). 5ml serum sample from each patient was processed for estimation of IL-1, IL-6, IL-8, TNF- α, INF- α, GMCSF and MCP-1 according to the manufacturer’s instructions on the commercially available ELISA kit. Metformin levels in the serum were estimated by HPLC. Data was put into statistical analysis. 
 Results: Results showed that IL-1, IL-2, IL-6 and TNF- α were significantly higher in the M- group. The difference was statistically significant between the two groups. The level of biomarkers showed a negative correlation with drug levels in the initial 2m treatment with the drug but was not statistically significant. However, after 6m treatment with metformin the correlation was found to be of statistical significance.
 Conclusion: we conclude that these biomarkers can be work tested for their clinical utility to be used as diagnostic tools for early detection of DPN and short-term metformin treatment greatly benefits DPN patients. Longitudinal studies may be more insightful as to the long term neuroprotective action of metformin.

PO-01-068 CRYOBALLOON ABLATION FOR ATRIAL FIBRILLATION WITH LEAD-FREE ZERO FLUOROSCOPY APPROACH INTEGRATING PULMONARY VEIN HEMODYNAMICS, INTRACARDIAC IMAGING, AND 3D MAPPING: A FOUR-YEAR SINGLE-CENTER EXPERIENCE

Electrophysiologists have for years been plagued with the dangers of prolonged radiation exposure and associated long-term use of lead aprons. Patients also are exposed to significant amounts of radiation during fluoroscopy-guided catheter ablations. As such, efforts are being made to pioneer techniques which do not require fluoroscopy without sacrificing efficacy, safety, and patient outcomes. To evaluate the acute safety and efficacy of zero fluoroscopy cryoballoon ablation (ZFC) for atrial fibrillation (AF) with guidance from intracardiac echocardiography (ICE), pulmonary vein (PV) hemodynamics, and 3-dimensional (3D) mapping. Contiguous patients in a single center underwent ZFC for AF with ICE guidance, PV occlusion monitoring using hemodynamics, and 3D mapping. The superior vena cava was visualized with ICE, transseptal puncture was performed and LA sheath placement was confirmed with ICE. ICE catheter was then advanced into the LA through the same transseptal puncture. 3D mapping of the LA was performed, cryoballoon was advanced into the PV antrum, and seal was confirmed with ICE, color-flow dopper, and PV pressure waveform monitoring. Wide antral circumferential ablation was performed along all PVs. During ablation of right PVs, the phrenic nerve was monitored using palpation, liver capsule excursion noted on ICE, and pulsed wave doppler of the liver capsule. 3D mapping was used to ascertain entrance and exit blocks and circumferential antral isolation. A retrospective analysis of patients undergoing ZFC for treatment of AF from November 2018 to September 2022 was completed. The sample included 433 patients (219 women [50.6%] with a mean age of 66.5±11.6 years). Mean total procedure time was 49.3±12.0 minutes, mean LA dwell time was 36.5±10.3 minutes, and mean duration of cryoballoon application was 15.9±4.0 minutes. Procedural complication rates were 0.6% for effusions, 1.3% for phrenic nerve dysfunction, 0.8% for phrenic nerve palsy, 0.1% for vascular complications, 0% for esophageal injury, and 0.5% for all-cause mortality. Our single center experience demonstrates the feasibility of safely and effectively completing cryoballoon ablations for atrial fibrillation with a lead-free zero fluoroscopy approach. Additional multi-center studies are needed to ascertain the wide-scale applicability of this approach. The center acknowledges the learning curve associated with this skill set.

Hard to see: Systemic lupus erythematous presenting as cranial nerve six palsy: A Case Report

Systemic Lupus Erythematous (SLE) is an autoimmune disease that can affect multiple organs and can have a wide variety of symptomatic presentations. One rare presenting symptom is oculomotor nerve dysfunction, the following case report is of a 41-year-old female with a past medical history of hypertension and asthma, who was admitted for ocular dysfunction. On physical examination, the patient had an ocular palsy, but the rest of the neurological exam was unremarkable. Imaging modalities such as computed tomography (CT) scan head without contrast, brain magnetic resonance imaging, and computed tomography angiography (CTA) of the head and neck revealed no acute pathology. After a neurological etiology was excluded an autoimmune diagnosis was pursued. Lab results were positive for Anti-Smith, ANA, and Anti-DsDNA. The patient also at this time was also diagnosed with an acute kidney injury and a kidney biopsy that was done later revealed focal lupus nephritis. After starting immunosuppressive therapy, her symptoms improved.

Etiology of Trauma-Related Acute Compartment Syndrome of the Hand: A Systematic Review.

Hand compartment syndrome is a limb-threatening emergency. Although it is a relatively uncommon condition, early diagnosis, and urgent fasciotomy can prevent irreversible ischemia, myonecrosis, nerve dysfunction, and subsequently permanent loss of hand functions. The occurrence of hand compartment syndrome is relatively infrequent, resulting in a limited amount of literature on its causes. As a result, we conducted a systematic review to provide the most comprehensive data regarding the etiology of traumatic hand compartment syndrome. This systematic review was conducted and reported in light of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We searched among Medline, and EBSCO Database, with no restriction on the dates (last date of the systematic search was done on April 28, 2022). We included all studies containing data regarding traumatic hand compartment syndrome. A total of 29 articles with 129 patients constituted the basis of this review. The etiology of traumatic hand compartment syndrome was classified into three groups: soft tissue injury-related, fracture-related, and vascular injury-related causes. The most common etiology of hand compartment was related to soft tissue injuries which constituted 86.8% of all etiologies, followed by fracture-related (5.4%), then vascular injury-related (1.5%). Further, burns were the most likely injury to lead to hand compartment syndrome which made up 63.4% of soft-tissue injuries, followed by animal bites (8.9%). Hand compartment syndrome can be caused by multiple etiologies that affect people of different ages. Therefore, identifying the most prevalent causes can help in early detection of compartment syndrome by frequent assessment of patients that present with the most prevalent causes like burn among soft tissue injuries and metacarpal bone fracture among fractures.

Effects of cerebellar transcranial alternating current stimulation in cerebellar ataxia: study protocol for a randomised controlled trial.

Cerebellar ataxia (CA) is a movement disorder that can affect balance and gait, limb movement, oculomotor control, and cognition. Multiple system atrophy-cerebellar type (MSA-C) and spinocerebellar ataxia type 3 (SCA3) are the most common forms of CA, for which no effective treatment is currently available. Transcranial alternating current stimulation (tACS) is a non-invasive method of brain stimulation supposed to alter cortical excitability and brain electrical activity, modulating functional connectivity within the brain. The cerebellar tACS can modulate the cerebellar outflow and cerebellum-linked behavior and it is a proven safe technique for humans. Therefore, the aim of this study is to 1) examine whether cerebellar tACS improves ataxia severity and various non-motor symptoms in a homogeneous cohort of CA patients consisting of MSA-C and SCA3, 2) explore the time course of these effects, and 3) assess the safety and tolerance of cerebellar tACS in all participants. This is a 2-week, triple-blind, randomised, sham-controlled study. 164 patients (MSA-C: 84, SCA3: 80) will be recruited and randomly assigned to either active cerebellar tACS or sham cerebellar tACS, in a 1:1 ratio. Patients, investigators, and outcome assessors are unaware of treatment allocation. Cerebellar tACS (40 min, 2 mA, ramp-up and down periods of 10s each) will be delivered over 10 sessions, distributed in two groups of five consecutive days with a two-day break in between. Outcomes are assessed after the tenth stimulation (T1), and after 1 month (T2) and 3 months (T3). The primary outcome measure is the difference between the active and sham groups in the proportion of patients with an improvement of 1.5 points in the Scale for the Assessment and Rating of Ataxia (SARA) score after 2 weeks of treatment. In addition, effects on a variety of non-motor symptoms, quality of life, and autonomic nerve dysfunctions are assessed via relative scales. Gait imbalance, dysarthria, and finger dexterity are objectively valued via relative tools. Finally, functional magnetic resonance imaging is performed to explore the possible mechanism of treatment effects. The results of this study will inform whether repeated sessions of active cerebellar tACS benefit CA patients and whether this form of non-invasive stimulation might be a novel therapeutic approach to consider in a neuro-rehabilitation setting.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05557786; https://www.clinicaltrials.gov/ct2/show/NCT05557786.

Caspr2 Antibody-Mediated Ataxia, Parkinsonism, and Epilepsy: A Case for Escalating Immunotherapy. (P13-11.007)

<h3>Objective:</h3> To report a rare presentation of anti-Caspr2 syndrome treated successfully with rituximab. <h3>Background:</h3> Anti-Caspr2 syndrome has a variety of clinical phenotypes including encephalopathy, seizure, psychiatric disturbances, respiratory failure, dysautonomia, peripheral nerve dysfunction, as well as ataxia of a constant or episodic nature.¹ In many of the cases with ataxia, there is associated limbic encephalitis.² Anti-Caspr2 syndrome with ataxia, parkinsonism and seizure has only been reported once in the literature.³ This symptomatology can be easily mistaken for an atypical parkinsonism like cerebellar multiple systems atrophy, or spinocerebellar ataxia type 2 but this treatable cause is an important consideration. <h3>Design/Methods:</h3> To report a case of anti-Caspr2 syndrome presenting with pure ataxia, then progressing to parkinsonism, and epilepsy; its successful treatment; and accompanying video examinations. <h3>Results:</h3> A 71 year-old man was referred for 8 months of progressive, generalized ataxia and dysarthria. Immune-mediated ataxia was considered given the subacute course with rapid progression. He was found to have a Caspr2 antibody titer of 1:100. Evaluation for malignancy was unremarkable. Lumbar puncture revealed Caspr2 antibody positivity. The patient was treated with 4 days of intravenous steroids and immunoglobulins with significant improvement. He relapsed four months later with lower extremity weakness and ataxia. Despite maintenance intravenous immunoglobulin, his ataxia continued to progress. He then developed focal seizures with impaired awareness and left sided parkinsonism. He was started on rituximab immunotherapy for ongoing disease activity. His ataxia and parkinsonism significantly improved to near-baseline with continued stability 6 months later. <h3>Conclusions:</h3> This case illustrates an example of an autoimmune-mediated cerebellar ataxia of subacute onset with progression to parkinsonism and epilepsy. Special consideration for anti-Caspr2 syndrome should be taken in cases of progressive ataxia with accompanying neurologic features of parkinsonism and seizure. Escalation to rituximab can be considered for patients who continue to progress despite preliminary immunotherapy. <b>Disclosure:</b> Dr. Sugar has nothing to disclose. Dr. Witek has nothing to disclose.

Incidence and Possible Predictive Factors of Facial Nerve Paralysis after Superficial Parotidectomy for Benign Tumours: Our Experience.

Salivary gland tumors represent 3-10% of all head and neck neoplasms. Most of the tumours are benign with parotid gland being most commonly affected. Surgical intervention in the form of parotidectomy forms the mainstay of treatment. Among the various postoperative complications that may occur after parotidectomy, facial nerve weakness is the most dreaded one for both the surgeon as well as the patient. In the literature, the incidence of transient facial weakness after parotid surgery ranges from 10 to 68%, and long-term dysfunction ranges from 0 to 19%. Apart from injury mechanisms such as nerve division, stretch, thermal injuries, ischemia, several other risk factors such as tumour size, disease duration etc. have also been identified for post parotidectomy facial nerve dysfunction which vary considerably from study to study. Thus, facial nerve injury despite being a common and dreaded complication is also a preventable one. We in our institute conducted a retrospective study from January 2018 to December 2021to evaluate the incidence of facial nerve weakness and possible predictive factors among 60 patients who underwent superficial parotidectomy for benign tumours and found that when it comes to benign tumours surgical technique rather than tumour factors are more important in preventing nerve injury. Undertaking this study was important in order to emphasize the importance of extensive preoperative planning and better surgical practices among budding head and neck surgeons in our country.

The Characteristics and Duration of Mechanical Ventilator Use on Patient with Neuromuscular Paralysis Diseases in Intensive Care Unit (ICU) Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar in December 2019 - December 2022

Background: Amyotrophic Lateral Sclerosis (ALS), Guillain-Barre Syndrome (GBS), and Myasthenia Gravis (MG) are neuromuscular diseases which involved the dysfunction of peripheral nerves or muscles. Respiratory muscle weakness often happens in neuromuscular diseases, where it leads to the requirement of mechanical ventilation or even death from respiratory failure. This study aims to determine the characteristics and duration of mechanical ventilator usage in patients with neuromuscular paralysis diseases at Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar. Results: From December 2019 to December 2022, there were 5 GBS patients (20%), 19 MG crisis patients (76%), and 1 ALS patient (4%). The mean of age was 40.8 years and the majority was female. The average duration of ventilator use in GBS patients was 25.8 days, in MG crisis was 26.2 days, and in ALS was 30 days, therefore all of them were prolonged. The outcomes were 3 GBS patients (12%) lived and 2 GBS patients (8%) died; 14 MG crisis patients (56%) lived and 5 MG crisis patients (20%) died; and 1 ALS patient (4%) died. The ICU diagnosis which complicated the patients were electrolyte disturbances, hypoalbuminemia, and community or ventilator acquired pneumonia. Conclusion: Neuromuscular disease mostly causes respiratory muscle weakness and results in increased mortality and morbidity requiring mechanical ventilation. Risk factors affecting the prolonged duration of ventilator use were electrolyte disturbances, hypoalbuminemia, and pneumonia. Keywords: length of ventilator usage, neuromuscular paralysis disease, amyotrophic lateral sclerosis, Guillain-Barre syndrome, myasthenia gravis, intensive care unit, Bali

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation.

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

Transcranial Magnetic Stimulation in the Differential Diagnosis of Unilateral Peripheral Facial Nerve Palsy

(1) Background: This study aims to assess the diagnostic accuracy of parameters based on a combination of transcranial magnetic stimulation (TMS) and electrical stimulation (ES) in the differentiation between idiopathic and secondary facial palsy in a large cohort of patients. (2) Methods: Patients with unilateral facial palsy ≤7 days after symptom onset were included. Compound muscle action potential (CMAP) amplitudes were measured after stimulation of both facial nerves at (A) the internal acoustic meatus using TMS, CMAP-TMS, and (B) at the stylomastoid foramen using electrical stimulation, CMAP-ES. To express the degree of nerve dysfunction in the facial canal specifically, the amplitude reduction of the CMAP-TMS in relation to CMAP-ES was calculated and expressed as a percentage (amplitude reduction over the facial canal, ARFC). Receiver Operating Characteristic (ROC) curves were constructed to assess the diagnostic accuracy of ARFC as a marker to discriminate between patients with idiopathic and secondary facial palsy. (3) Results: Data from 498 patient records were analyzed. Idiopathic facial palsy was diagnosed in 424 patients, and secondary facial palsy in 74 patients. The area under the ROC curve for ARFC was 0.398. (4) Conclusions: The overall diagnostic accuracy of this method to differentiate secondary from idiopathic facial palsy is low.

Importance of Combination of Intravitreal Bevacizumab and Panretinal Photocoagulation in Proliferative Diabetic Retinopathy

Introduction: Diabetic retinopathy is a vascular condition of the retina that develops due to diabetes mellitus (DM). This study aimed to compare intravitreal bevacizumab, pan-retinal photocoagulation or a combination of both in proliferative diabetic retinopathy.&#x0D; Method: In this prospective, randomized interventional study, 180 patients with PDR were enrolled and divided into three equal groups, i.e., Group A patients treated with laser alone and group B- patients treated with anti-VEGF alone and Group C- patients treated with anti-VEGF and laser. The patient’s detailed history and clinical and demographical data were recorded and compared. The examination was done, including visual acuity assessment with Snellen’s chart, slit-lamp biomicroscopic examination, Intraocular pressure and pupillary assessment for optic nerve dysfunction.&#x0D; Results: The mean age of group-A, B and C were 57.13 ± 6.88, 55.62 ± 5.97 and 54.86 ± 4.98 were comparable. At the same&#x0D; &#x0D; time, most of the patients were between the age group of 58–66 years [25(41.67%)]. Majority of the patients were male in all three groups. A significant difference was observed in mean FBS and duration of diabetes. In group A and C, most patients affected eye was left [35(58.33%)] and [34(56.67)], respectively, while in group B right eye was affected [33(55.00%)]. The mean VA Log MAR was found to be significant among the three groups. Mean SNELLENS and IOP were insignificant among the groups. At first, follow up the mean VA LOG MAR, SNELLENS, FFA and OCT were found to significant among the groups. At second follow-up, the mean VA LOG MAR was significant. Intragroup analysis between the treatment of the eye was found insignificant, while the rest of the parameters and characteristics were found significant. Conclusion: The present study suggests that the anti-VEGF + PRP were the best treatment regime, followed by anti-VEGF, and PRP was the least effective.

Rhinocerebral Mucormycosis Following COVID-19 Infection in Iran.

Mucormycosis (also called black fungus) is an opportunistic serious fungal infection caused by mucormycetes. It can occur in diabetes mellitus patients and other immunosuppressive conditions with recent predisposing factors such as maxillofacial surgery and corticosteroid usage. In this study, 14 patients were referred to the otorhinolaryngology or ophthalmology ward of Shafa Hospital (Kerman, Iran) with primary symptoms of nasal fullness and facial nerve dysfunction; they were admitted to the hospital to rule out the fungal infection. An endoscopic biopsy was taken from facial sinuses or orbit, and a microscopic evaluation was performed using hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining methods to rule out mucormycosis. In the histopathological examination, broad-based nonseptate branching fungal hyphae were found in nasal sinuses through the endoscopic biopsy. Most of the patients had diabetes mellitus with a primary symptom of facial nerve palsy; also, most of them received corticosteroids (intravenous [IV] or intramuscular [IM] injection). All patients have recently been infected with COVID-19 (less than 1 month ago). COVID-19 infection might be a predisposing factor for many opportunistic infections, such as fungal elements); thus, the physician should be aware of the dosage and duration of corticosteroid therapy to prevent the development of these infections.

Tension-free thyroidectomy (TFT, medial thyroidectomy) — a prospective study: surgical technique and results of 259 operations

BACKGROUND: One of the most important tasks in thyroid surgery is to prevent the development of specific complications — laryngeal nerve dysfunction and hypoparathyroidism. A significant number of technical solutions introduced into clinical practice in recent years are aimed at solving this problem.AIM: Тo evaluate the results of an alternative technique of thyroid surgery — medial thyroidectomy.MATERIALS AND METHODS: 270 patients with thyroid diseases were operated on using tension free thyroidectomy technique in the volume of hemi- or thyroidectomy with or without cervical lymphadenectomy. The selection of patients was continuous. All patients underwent ultrasound or videolaryngoscopy before the operation and on the 1st postoperative day. Patients who underwent thyroidectomy underwent blood analysis for parathormone and blood analysis for ionized calcium.RESULTS: For hemithyroidectomy the duration of surgery did not change. In the group of patients with nodes up to 30 mm the duration of surgery increased. An increase in the operation time was also noted for thyroidectomy. Unilateral laryngeal paresis was registered in 6 (2.3%) patients or 1.7% of the number of recurrent laryngeal nerves in the risk area. The risk of parathyroid gland (PTG) removal was 0.39% of the number of operations and 0.14% of the number of PTG in the risk area. Decrease in the level of parathormone in the first day after surgery was noted in 11.5% of patients. The development of postoperative hematoma was noted in 1 patient (0.39%).CONCLUSION: The technique of thyroid surgery with medial access to the recurrent laryngeal nerve and parathyroid glands is feasible in the vast majority of patients with thyroid diseases requiring surgical treatment and shows high safety and a number of advantages over the traditional method of thyroid surgery.

Application of two kinds of electrophysiological monitoring techniques for the prediction of facial nerve outcomes after vestibular Schwannoma surgery

Objective: To investigate the application of transcranial facial nerve motor evoked potential (FNMEP) and direct nerve electrical stimulation (DNES) for the prediction of facial nerve function after vestibular schwannoma surgery. Methods: The clinical data of 106 patients who underwent vestibular schwannoma surgery under electrophysiological monitoring of facial nerve between 2017 and 2021 were retrospectively examined, and there were 57 males and 49 females, with a mean age of (51±11) years. Neuroelectrophysiological monitoring was performed in all patients during the operation. After the tumor was removed, FNMEP and DNES were used for electrophysiological evaluation of facial nerve function. The amplitude ratios of FNMEP to baseline (M1) and the brainstem segment to the internal auditory canal segment of DNES (M2) were recorded after the tumor was removed, respectively. The correlation between these two ratios and facial nerve function at 1 day, 1 month and 3 months after the operation were compared. According to the House-Brackmann (HB) scale, Grade Ⅰ-Ⅱ refers to good facial nerve function, and grade Ⅲ-Ⅵ refers to moderate and severe facial nerve dysfunction. Non-parameter Spearman correlation coefficient was used to evaluate the correlation between M1 and M2 and facial nerve function at 1 day, 1 month and 3 months after operation, and the receiver operating characteristic (ROC) curves were plotted to verify the diagnostic efficacy of M1 and M2 for predicting the prognosis of postoperative facial nerve function. Results: Among 106 patients, 102 cases (96.3%) underwent total tumor resection, 4 patients (3.7%) underwent subtotal resection, 104 patients (98.1%) had anatomical preservation of facial nerves, and there were no deaths reported. All patients could evoke reliable FNMEP and 2 patients could not evoke DNES in the brainstem segment of the facial nerve. There were 81 (76.4%), 99 (93.4%) and 103 patients (97.2%) with satisfactory function of facial nerve at 1 day, 1 month and 3 months after surgery, respectively. M1 had large absolute values of Spearman correlation coefficient at 1 day (ρ=|-0.648|) and 1 month (ρ=|-0.552|) after surgery (both P<0.001), while M2 showed a greater absolute value of Spearman correlation coefficient at 3 months (ρ=|-0.395|) than that of M1 (ρ=|-0.378|) (P<0.001). Cut-off value of M1 was 0.58 (sensitivity=0.92, specificity=0.64), and that of M2 was 0.36 (sensitivity=0.64, specificity=1.00). Meanwhile, M1<0.58 or M2<0.36 suggested moderate and severe impairment of facial nerve function. Conclusions: Both FNMEP and DNES during vestibular schwannoma surgery can effectively evaluate the postoperative facial nerve function. FNMEP is better than DNES in predicting the early postoperative facial nerve function, but DNES is better for predicting the long-term postoperative facial nerve function.

Postoperative changes in nonspecific low back pain after atlantoaxial stabilization surgery

Objectives: Posterior atlantoaxial stabilization can be technically challenging. Postoperative C2 nerve dysfunction occurs as a complication of this procedure or when a lateral mass is exposed and sacrificed for screw placement. Patients with cervical pathology sometimes complain of low back pain simultaneously. In this study, we aimed to investigate the results of C1-C2 posterior stabilization and C2 nerve root sacrifice on postoperative lumbar complaints. Methods: Twenty-six patients who underwent multicentric posterior C1-C2 stabilization due to atlantoaxial dislocation were retrospectively included in the study. Those that were not sacrificed the C2 nerve root during stabilization were considered group 1 (n = 12), and those that were sacrificed the C2 nerve root were considered group 2 (n = 14). A visual Analogue Scale (VAS) was used for the neck, arm, low back, and leg pain. The EQ-5D Index was used as the overall quality of life scale. Results: Six months postoperatively, both groups showed significant (p &amp;lt; 0.01) improvement in VAS neck, arm, and low back scores between preoperative and postoperative. In addition, there was no significant improvement in the VAS leg and EQ-5D score in either of the groups. While no significant decrease was found in occipital neuralgia in group 1, it showed significant (p &amp;lt; 0.01) improvement in occipital neuralgia in group 2. Conclusions: Although the exact pathophysiology is unknown, cervical stabilization surgery and sacrification of the C2 nerve root in this surgery can, directly and indirectly, improve low back pain.

Vertebrobasilar dolichoectasia and other arterial abnormalities leading to abducens nerve palsy

IntroductionDolichoectatic vessels can cause cranial nerve dysfunction by either direct compression or ischemia. Abducens nerve palsy due to neurovascular compression by elongated, enlarged, tortuous or dilated arteries is an uncommon but important cause. AimTo highlight neurovascular compression as a cause of abducens nerve palsy and discuss various diagnostic techniques. MethodsManuscripts were identified using the National Institutes of Health PubMed literature search system. Search terms included abducens nerve palsy, neurovascular compression, dolichoectasia and arterial compression. Inclusion criteria required that the articles were written in English. ResultsThe literature search identified 21 case reports where abducens nerve palsy was due to vascular compression. Out of these 18 patients were male and the mean age was 54 years. Eight patients had unilateral right abducens nerve involvement; eleven patients had unilateral left nerve involvement and two patients had bilateral involvement. The arteries causing the compression were basilar, vertebral and anterior inferior cerebellar arteries. A compressed abducens nerve is not usually clearly detected on CT (Computed Tomography) or MRI (Magnetic Resonance Imaging). MRA (Magnetic Resonance Angiography), Heavy T2- WI (weighted imaging), CISS (constructive interference in steady state) and FIESTA (Fast Imaging Employing Steady-state Acquisition) are essential to demonstrate vascular compression of the abducens nerve. The various treatment options included controlling hypertension, glasses with prisms, muscle resection and microvascular decompression.

Abstract Number ‐ 13: Endovascular BCI to Restore Motor Control for the Command of Digital Devices in Severe Quadriparesis

Introduction Brain‐computer interfaces (BCIs), functioning as motor neuroprostheses, have the potential to restore the transmission of neural signal from the cerebral cortex to control digital devices and improve functional independence in patients with severe paralysis due to brain, spinal cord, peripheral nerve or muscle dysfunction. Methods COMMAND is an FDA‐approved, NIH‐funded single arm, open‐label, prospective early feasibility study designed to enroll 6 patients with severe quadriparesis to receive an endovascular implantable motor neuroprosthesis (Stentrode, Synchron Inc, Brooklyn, NY). The primary outcome measures include treatment related serious adverse events within 12‐month after device implantation. Secondary outcome measures include restoration of neural signal from the cerebral cortex utilized for neuromuscular control of digital devices, resulting in the successful execution of non‐mechanical digital commands, e.g., for the control of personal computers. The study device comprises of three parts: 1) Endovascular electrode array and lead (StentrodeTM), implanted percutaneously via the jugular vein in the superior sagittal sinus adjacent to the motor cortex using endovascular approach; 2) Implantable Receiver Transmitter Unit (IRTU) implanted in the pectoral region; and 3) Controller, including an External Receiver Transmitter Unit (ERTU), Signal Control Unit (SCU) and Software Application. Results A 67 year‐old patient with complete quadriplegia from amyotrophic lateral sclerosis (ALS) enrolled into the study and completed a screening process, which included CTV and MRV to ascertain normal venous sinus anatomy, with two patent jugular veins and bilateral patent transverse sinuses. Using a right internal jugular vein access, the investigational endovascular Stentrode BCI was implanted in the superior sagittal sinus adjacent to primary motor cortex. Co‐registration to enable accurate anatomical targeting was achieved by fusing structural MRI data with intra‐procedurally acquired 3D‐volume (3D‐DSA). A sub‐clavicular subcutaneous pocket was created to place the IRTU. Then, the lead was tunneled to the pocket and connected to the IRTU. Before closure of the wound, impedance measurement was taken which confirmed functionality of the system. The patient tolerated the procedure very well, was successfully extubated after the procedure and remained neurologically at his baseline. The patient was started on dual antiplatelet therapy 2 weeks prior to the surgery and will be continued on this regimen for 3 months.The participant will undergo machine‐learning‐assisted training to use wirelessly transmitted electrocorticography signals associated with attempted movements to control multiple mouse‐click actions, including zoom and left‐click. Used in combination with an eye‐tracker for cursor navigation, the patient will practice controlling a computer to conduct instrumental activities of daily living (IADL) tasks. Conclusions We describe the first US in‐human experience of a minimally invasive, fully implanted, wireless motor neuroprosthesis using an endovascular stent‐electrode array to transmit electrocorticography signals from the motor cortex for multiple command control of digital devices.

Latest Findings on the Interaction Mechanism Between Depressive Disorder and Intestinal Permeability

The intestinal barrier, a complex structure consisting of multiple layers of defense barriers, blocks the transfer of intestinal and foreign bacteria and their metabolites into the internal environment of the human body. Intestinal permeability can be used to evaluate the integrity of the intestinal barrier. Increased intestinal permeability has been observed in patients with depressive disorder. Some studies have reported an interaction between depressive disorder and intestinal barrier. Herein, we reviewed reported findings on the mechanisms of how systematic low-grade inflammation, vagal nerve dysfunction, and hypothalamic-pituitary-adrenal axis dysfunction cause changes in intestinal permeability in patients with depressive disorder and the pathogenic mechanism of how bacterial translocation caused by damaged intestinal barrier leads to depressive disorder. In addition, the potential mechanisms of how antidepressants improve intestinal permeability and how probiotics improve depressive disorder have been discussed.

CASE REPORT ON NON-FUNCTIONING PITUITARY ADENOMA PRESENTING WITH SHORT STATURE, DELAYED PUBERTY AND PRIMARY AMENORRHEA

Delayed puberty in girls is dened as lack of secondary sexual characteristics by the age of 13 years and absence of menarche by the age of 16 years or 5 years after onset of puberty indicates pubertal delay. Constitutional delay of growth and puberty (CDGP) is the most commonly encountered cause of delayed puberty in girls. Pituitary tumors are not very common in childhood and adolescence, and prevalence of up to 1 per million children has been reported. Non-functioning pituitary adenomas (NFPAs) are benign adenohypophyseal tumors not associated with clinical evidence of hormonal hypersecretion. Patients with NFPAs usually come to medical attention as a result of “mass effects” symptoms like headaches, visual disturbances, and/or cranial nerve dysfunction caused by lesions large enough to mechanically compress and damage surrounding structures. Other manifestations are hypopituitarism as a result of mass effect by the compression of the normal anterior pituitary, and hyperprolactinemia due to pituitary stalk deviation can also be present. Here is a case of 16 year old female adolescent with pituitary adenoma presenting with delayed puberty and primary amenorrhea with short stature.