Neurological Perspective Research Articles

Neurological explanations of decision making in humans: A review

The present review paper focuses on neurological perspective of decision making which plays a major role in our daily life. Our success or failure heavily depends up on the decision we make. So, there is a strong connection between decision making and successful life. Decision making is one of the cognitive aspects that give high load to our brain. In processing decisions, neurons and blood oxygen levels play major role. The author tried to explore various brain regions that involved in decision making process in the light of previous research findings. The author has reviewed 50 research papers/dissertations/documents/ review reports and other sources. Most of the researches used brain mapping techniques to explain possible reasons behind decision making. The conceptual understandings of the review have been presented in the following sections. The author came across various types of decision making such as perceptual decision making, social decision making, economic decision making in relation to different brain regions like parietal cortex, medial premotor cortex. These aspects have been discussed and highlighted in the upcoming sections.

Epilepsy in Norrie disease

The insight into the Norrie disease viewed from neurology perspective and clinical case of refractory epilepsy relevant to the disease are considered. Epilepsy rarely accompanies Norrie disease. The dynamics of changes in electroencephalograms (EEG) and types of epileptic seizures during the disease progression as well as depending on the therapy received in the clinical case is analyzed. It is relevant for patients with Norrie disease to regularly undergo video-EEG monitoring to detect epileptiform activity, ictal patterns for timely diagnostics of epilepsy followed by prescribing proper therapy to improve quality of life.

Prediction in the Aging Brain: Merging Cognitive, Neurological, and Evolutionary Perspectives.

Although the aging brain is typically characterized by declines in a variety of cognitive functions, there has been growing attention to cognitive functions that may stabilize or improve with age. We integrate evidence from behavioral, computational, and neurological domains under the hypothesis that over the life span the brain becomes more effective at predicting (i.e., utilizing knowledge) compared to learning. Moving beyond mere description of the empirical literature-with the aim of arriving at a deeper understanding of cognitive aging-we provide potential explanations for a learning-to-prediction shift based on evolutionary models and principles of senescence and plasticity. The proposed explanations explore whether the occurrence of a learning-to-prediction shift can be explained by (changes in) the fitness effects of learning and prediction over the life span. Prediction may optimize (a) the allocation of limited resources across the life span, and/or (b) late-life knowledge transfer (social learning). Alternatively, late-life prediction may reflect a slower decline in prediction compared to learning. By discussing these hypotheses, we aim to provide a foundation for an integrative neurocognitive-evolutionary perspective on aging and to stimulate further theoretical and empirical work.

Familial cold autoinflammatory syndrome and multiple sclerosis

AbstractBackgroundCryopyrin‐associated periodic syndrome (CAPS) is an autoinflammatory disorder with a spectrum ranging from the milder familial cold auto‐inflammatory syndrome (FCAS) phenotype to the more severe Muckle–Wells Syndrome. Although headaches are the most common neurological symptoms, neuroinflammatory diseases such as multiple sclerosis (MS) have only been reported in the more severe phenotypes.Case PresentationWe describe a 43‐year‐old male diagnosed with relapse‐remitting MS who developed cold‐induced arthralgias and urticaria. He initially presented with facial numbness and arthralgias in his late teenage years, and brain magnetic resonance imaging (MRI) demonstrated multiple lesions with periventricular white matter extension. Oligoclonal bands were detected in the cerebrospinal fluid (CSF). Symptoms gradually improved, and a decade later he presented with numbness at upper limbs and tongue. Brain and spine MRI showed new lesions, but CSF was unremarkable. He was started on interferon β‐1a with symptomatic improvement until another flare around 13 years later. Treatment was changed to dimethyl fumarate. During this hospitalization, urticaria was problematic and particularly associated with cold temperatures. This raised suspicion for possible CAPS and subsequently confirmed with an A439V mutation in the NLRP3 gene, consistent with FCAS. Anakinra was started but was not tolerated because of localized reactions despite desensitization. His serum amyloid A was mildly elevated at 9 mg/L (reference range 0–6). He remains stable from a neurological perspective, including imaging, and continues dimethyl fumarate.ConclusionsTo date, FCAS and possible association with MS has not been described. The case raises challenges in the diagnosis of concurrent disease processes. It also highlights that neurological sequelae should be considered in all spectrums of CAPS, and distinctions with MS should be made where possible.

APPLICATION OF SHOCK WAVE THERAPY IN NEUROREHABILITATION (LITERATURE REVIEW)

The review presents current literature data on the use of shock wave therapy (SWT) in neurorehabilitation. In recent years, the development of this method is progressing. The uniqueness of the method lies in the wide and safe range of its capabilities used in various fields of medicine, including the rehabilitation of neurological diseases. It is indicated that SWT works by emitting acoustic waves (shock waves) that carry energy and can propagate through tissues, focus on a given area of the body, exerting a precisely directed therapeutic effect, without damaging other tissues of the body. It has been noted that shock waves can generate interstitial and extracellular responses, causing many beneficial effects such as pain relief, vascularization, protein biosynthesis, cell proliferation, neuro- and chondroprotection, and destruction of calcium deposits in musculoskeletal structures. The combination of these effects can lead to tissue regeneration and significant pain relief, improving functional outcomes in damaged structures. Given these facts, SWT demonstrates great potential as a useful method of regenerative medicine for the treatment of various pathologies. It is emphasized that the modern concept of tissue regeneration is closely related to neoangiogenesis. This is a new interpretation of the therapeutic effect and opens new horizons for the use of SWT, in addition to traditional orthopedic applications. In recent years, SWT has been shown to be a safe and effective method of reducing muscle spasticity. Possible mechanisms include nitric oxide formation, decreased excitability of motor neurons, induction of neuromuscular dysfunction, and direct effects on rheological properties. It has also been investigated that SWT can affect neuromuscular junctions, causing degeneration and a decrease in acetylcholine receptors, which in turn causes a significant reduction in maximal muscle action potential. A large number of clinical studies evaluating the effect of SWT on muscle spasticity in patients after stroke have shown that the use of SWT helps reduce pain, improve muscle strength, stimulate revascularization and neurogenesis. Also, the use of SWT improves motor function, reduces pain and restores functional independence in patients with post-stroke spasticity. Decreased muscle tone was also observed in children with cerebral palsy. Radial SWT reduces pain and muscle tone in patients with multiple sclerosis without side effects. SWT has been used also to treat carpal tunnel syndrome as a new and non-invasive method. It is noted that during the experimental study it was found that under the influence of SWT is the regeneration of neurons by accelerating the elimination of the damaged axon, increasing the proliferation of Schwann cells and increasing the regeneration of axons. It is emphasized that the mechanism of SWT in pinching neuropathy has not been fully studied, but two main effects, such as anti-inflammatory and neuronal regeneration effect, are potential recovery mechanisms in this pathology. SWT can be successfully used in neurological diseases to relieve pain, spastic and tunnel syndromes, inflammatory processes and to improve overall functional status. Potential new uses for SWT include spasticity, neuropathic changes, and other neurological disorders. Due to its non-invasive approach, lack of major side effects, recurrence, good tolerability and compliance with patients, SWT offers new rehabilitation perspectives in neurology.

Neurological Deficits of Coronavirus Disease-19: A Systematic Literature Review

Aim: To review neurological aspects of patients infected with COVID-19 including neurological dysfunctions and possible pathophysiology. Methods: A systematic review of articlesfrom PubMed, Ovid MEDLIN, DOAJ databases and grey literature included the WHO-COVID-19 database, and medRxiv.Articles published from January 2020 until June 2020 were included in the review. Out of the226 titles and abstracts, 213 were identified after the removing duplicates. With a screening of 119 studies carried by all authors, 83 full-text articles were assessed based on inclusion criteria of the neurological perspectives with COVID-19. Subsequently, 45 texts were removed. A total of 38 studies were included in the last scrutiny.Specifically, case reports, cohort studies, and case series were included Results: Reviewed evidence was presented in textual and tabulated format, which includes methodology, characteristics of included studies and summary of findings. Correlational evidence of COVID-19 disease and neurological dysfunctions with possible pathophysiology isreviewed. Conclusion:The findings provide evidence for physicians and neurologists working with COVID-19 patients about the possible probable complications and clinical presentations due to the SARS-CoV-2 infection. Keywords: COVID-19; SARS-CoV-2; Coronavirus Disease; Respiratory illness; Neurology; Nervous system; Critical Illness;

Neurological effects of COVID-19 in infants and children.

Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in children are becoming increasingly apparent as the coronavirus disease (COVID‐19) pandemic continues. While children manifest relatively milder features of the disease, accumulating evidence warrants concern that COVID‐19 exacts both acute‐ and long‐term effects on the developing central and peripheral nervous systems. This review focuses on the relatively underinvestigated topic of the effects of SARS‐CoV‐2 on the brain in infancy and childhood, concluding that clinicians should be attentive to both the acute effects and long‐term consequences of COVID‐19 from a neurological perspective.

Mini-Review on SARS-CoV-2 Infection and Neurological Manifestations: A Perspective

The coronavirus, also known as SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus-19), with its rapid rate of transmission, has progressed with a great impact on respiratory function and mortality worldwide. The nasal cavity is the promising gateway of SARS-CoV-2 to reach the brain via systemic circulatory distribution. Recent reports have revealed that the loss of involuntary process of breathing control into the brainstem that results in death is a signal of neurological involvement. Early neurological symptoms, like loss of smell, convulsions, and ataxia, are the clues of the involvement of the central nervous system that makes the entry of SARS-CoV-2 further fatal and life-threatening, requiring artificial respiration and emergency admission in hospitals. Studies performed on patients infected with SARS-CoV-2 has revealed three-stage involvement of the Central Nervous System (CNS) in the progression of SARS-CoV-2 infection: Direct involvement of CNS with headache, ataxia, dizziness, altered or impaired consciousness, acute stroke or seizures as major symptoms, peripheral involvement with impaired taste, smell, vision, and altered nociception, and skeletal muscle impairment that includes skeletal muscle disorders leading to acute paralysis in a particular area of the body. In the previous era, most studied and researched viruses were beta coronavirus and mouse hepatitis virus, which were studied for acute and chronic encephalitis and Multiple Sclerosis (MS). Although the early symptoms of SARS-CoV are respiratory pathogenesis, the differential diagnosis should always be considered for neurological perspective to stop the mortalities.

Stigmatization of attention deficit hyperactivity disorder (ADHD) in adults

A neurological-behavioral developmental condition called ADHD first manifests in childhood. characterized by signs including trouble focusing, hyperactivity, and poorly restrained impulsivity. From a neurological perspective, ADHD is viewed as a persistent, chronic syndrome for which there is no known treatment. It is said that children “grow” out of this affliction or come to terms with it as adults. On the other hand, it develops for certain people. However, when this syndrome is severe, it becomes a concern. Let's take an esoteric approach to understanding this illness. Any illness, especially one that affects one's capacity for self-control, is always the outcome of a transgression of some moral standards. In the case of ADHD, the main mental principles and abilities in which there is a disorder and, accordingly, punishment. This article provides feedback and feedback on stigmatization of Attention Deficit Hyperactivity Disorder (ADHD) in adults.

A Cardiac Surgical Perspective on Hypothermia for Protection of Neural Tissues

Background: In clinical and basic science medicine, we often isolate ourselves in silos, unaware of developments in other related disciplines. Our team has had substantial experience, both in the operating room and in the laboratory, with protecting the brain and the spinal cord via hypothermia. Herein, we briefly share this experience with our colleagues in Neurology, eager for comments and advice from the neurologic perspective. Methods: 1) Clinical brain protection via deep hypothermic circulatory arrest (DHCA) for surgery of the aortic arch. For aortic arch replacement (performed for aortic arch aneurysm or aortic dissection), the aortic arch must be opened and native perfusion stopped. We have decades of experience in many hundreds of patients with this technique. This experience is reviewed. 2) Experimental protection of the spinal cord via cooling. We review our laboratory experience with a novel, recirculating cooling catheter for the vulnerable spinal cord. 3) Experimental protection of the brain via an intraventricular cooling catheter. We review our laboratory experience cooling the brain with a balloon-tipped catheter residing the lateral ventricles. Results: 1) Deep hypothermic circulatory arrest for aortic arch surgery provides superb brain protection for periods up to 45 minutes or longer. Clinical neurologic function, and quantitative neurologic tests, show excellent brain preservation. 2) The novel spinal cooling catheter provides excellent cooling of the spinal cord in a large animal model, without apparent injury of any type. 3) The intraventricular brain cooling catheter provides excellent cooling of the brain, documented by both direct temperature probe and high-tech brain imaging. Conclusions: We wish herein (in this article) to share this experience across our disciplines (Cardiac Surgery and Neurology). We welcome advice from the Neurology community on these surgically-directed methods for cooling and protection of neurological tissue in both the brain and the spinal cord.

Risk-benefit analysis of COVID-19 vaccines - a neurological perspective.

Rare neurological complications can occur after COVID-19 vaccination, but recent studies show that such complications are much more common after SARS-CoV-2 infection. Novel approaches to risk–benefit analysis such as Bayesian network models can integrate the latest global evidence with local factors to inform decision-making and support the global vaccination effort.

Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center

Abstract Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.

Psychosis.

Psychosis can manifest in primary psychotic disorders, neurologic diseases, and medical conditions. This article reviews the definition of psychotic symptoms and the evaluation and management of psychosis in primary psychiatric and neurologic disorders frequently seen in neurologic practice. Emerging evidence supports significant connections between psychosis and structural and functional brain changes in both primary psychotic and neurologic disorders. In addition to antidopaminergic activity, the mechanism of new-generation antipsychotics shifts to act on serotonin receptors, which potentially contributes to their benefits in the treatment of negative symptoms of psychosis and a lesser frequency of extrapyramidal side effects compared with typical antipsychotics. This is also helpful in the treatment of psychosis in patients who have neurodegenerative diseases and are vulnerable to developing extrapyramidal side effects from typical antipsychotics. Even with significant overlap, management of psychosis in primary psychotic disorders differs from the approach of psychosis in neurologic diseases. This article helps clinicians learn how to practically evaluate psychosis from both psychiatric and neurologic perspectives.

A Perspective from the Field: How Can We Empower the Next Generation of Physician to Heal the Opioid Epidemic?

ABSTRACT Despite the continued emphasis on prescription opioids in the media and rise in substance use seen during the COVID-19 pandemic, medical school graduates today are unprepared to turn the tide on the opioid epidemic. In this paper, we review the current state of these topics in undergraduate medical education and explore what an educationally driven, forward-thinking approach to “healing” problematic substance use in our society might entail. These initiatives are discussed with the ultimate purpose of detailing how the education of future clinicians is necessary to improve our outcomes with the epidemic. We offer four educational initiatives relating to (1) comprehensive pain management, (2) developing a natural history of SUD by uniting psychiatric and neurological perspectives (3) providing patient exposure and training opportunities (4) enhancing and standardizing care through evidence-based medicine. This perspective is contextualized with a brief discussion of the national climate and societal factors that act inseparably on the present crisis. In focusing our efforts on the next generation of physicians, we hope to reform and improve the practices of future providers and begin to elicit meaningful change.

Acute porphyrias - A neurological perspective.

Acute hepatic porphyrias (AHP) can cause severe neurological symptoms involving the central, autonomic, and peripheral nervous system. Due to their relative rarity and their chameleon‐like presentation, delayed diagnosis and misdiagnosis are common. AHPs are genetically inherited disorders that result from heme biosynthesis enzyme deficiencies and comprise four forms: acute intermittent porphyria (AIP), variegate porphyria (VP), hereditary coproporphyria (HCP), and ALA‐dehydratase porphyria (ALADP). Depending on the clinical presentation, the main differential diagnoses are Guillain‐Barré syndrome and autoimmune encephalitis. Red flags that could raise the suspicion of acute porphyria are neurological symptoms starting after severe (abdominal) pain, in association with reddish urine, hyponatremia or photodermatitis, and the presence of encephalopathy and/or axonal neuropathy. We highlight the diagnostic difficulties by presenting three cases from our neurological intensive care unit and give a comprehensive overview about the diagnostic findings in imaging, electrophysiology, and neuropathology.

감각정보의 기억형성과정에 대한 교육신경학적 해석과 적용

교육활동은 학습자에게 의미있는 감각정보의 생성을 유도하며 시작된다. 이러한 감각정보가 학습자의 신경계에 어떠한 장기기억을 형성하게 되느냐에 따라서 교육활동의 성과 또한 천차만별로 다르게 나타날 수 있다. 이런 의미에서 감각정보의 기억형성과정은 학습자가 교육활동의 목표를 얼마나 달성했는지와 밀접한 연관성을 지니게 된다. 교육활동은 학습자의 신경계에 교육적으로 의미있는 변화를 일으키려는 의도적인 활동이라고 볼 수 있는 것이다. 그러므로 교육활동의 계획과 준비 및 진행과 검증 등에서 감각정보의 기억형성과정이 학습자의 몸속 신경계에서 어떻게 이루어지는지 중요하게 고려될 필요가 있다. 따라서 본 연구는 감각정보의 기억형성과정에 대한 신경과학적 이해를 바탕으로 교육신경학적 해석을 진행하고 적용의 예시를 제안하고자 하였다. 감각정보는 감각자극에 대한 개별 신경세포들의 흥분과 억제를 통해 우리 몸 신경계의 병렬적 처리와 위계적 처리 간 상호작용에 기반하는 통합적 양상을 거쳐 생성된다. 그리고 이렇게 생성된 감각정보의 기억형성과정은 신경세포들 간 시냅스 연결 강도가 강화 또는 약화되는 변화를 기반으로 신경세포군 및 뇌 영역들 간 상호작용의 양상이 통합되어 장기적으로 지속되는 변화를 거치게 되면서 이루어진다. 이러한 신경과학적 이해를 바탕으로 본 연구에서는 감각정보의 기억형성과정에 대한 유형을 서로 다른 신경회로의 활동에 기반하여 이루어지는 외현적 기억형성과정과 암묵적 기억형성과정 두 가지로 구분하고, 감각정보의 기억형성과정 원리를 효율적 선택을 위한 경쟁의 원리와 상호작용에 기반한 통합의 원리로 이해하여 교육신경학적 해석을 진행하였다. 그리고 교육신경학적 해석의 교육적 시사점과 적용의 예시를 제안하고 교육학 연구 지평의 확대를 위한 새로운 연구의 필요성을 제언하였다.

Introduction—Stories of the old world: The Narrative Policy Framework in the European context

Introduction—Stories of the old world: The Narrative Policy Framework in the European context

Time Perception is a Focal Symptom of Attention-Deficit/Hyperactivity Disorder in Adults.

Attention-Deficit/Hyperactivity Disorder (ADHD) is classically associated with symptoms that include inattentiveness, hyperactivity, and impulsivity together with a variety of other observable externalized symptoms. ADHD has also been associated with specific internalized cognitive symptoms, including restlessness and emotional impulsivity. This disorder has been recognized as a lifelong condition and can be recognized by a variety of unique cognitive phenomena. In addition to the frequently ignored affective symptoms exhibited by individuals diagnosed with ADHD, problems with time perception have been noted, although these are considered to be secondary issues. Temporal shifts in cognitive processing, however, may be at the very root of ADHD-related symptoms, given the importance of coordinated signal translation in the construction of behavior. In this review, we consider the evidence that suggests that differences in time perception are a central symptom in adults with ADHD. Some of these differences include the feeling of time moving faster, which causes difficulties in prospective time tasks and inaccuracies in time estimation tasks. We analyze the literature from both neurological and psychological perspectives and include an assessment of tools that can be administered via computer to measure time perception. We also suggest several computer-based methods that might be used to address problems with time perception in both children and adults. We strongly recommend the inclusion of ADHD symptoms associated with time perception in the next revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.

Neuronal synchronization in long-range time-varying networks.

We study synchronization in neuronal ensembles subject to long-range electrical gap junctions which are time-varying. As a representative example, we consider Hindmarsh-Rose neurons interacting based upon temporal long-range connections through electrical couplings. In particular, we adopt the connections associated with the direct 1-path network to form a small-world network and follow-up with the corresponding long-range network. Further, the underlying direct small-world network is allowed to temporally change; hence, all long-range connections are also temporal, which makes the model much more realistic from the neurological perspective. This time-varying long-range network is formed by rewiring each link of the underlying 1-path network stochastically with a characteristic rewiring probability pr, and accordingly all indirect k(>1)-path networks become temporal. The critical interaction strength to reach complete neuronal synchrony is much lower when we take up rapidly switching long-range interactions. We employ the master stability function formalism in order to characterize the local stability of the state of synchronization. The analytically derived stability condition for the complete synchrony state agrees well with the numerical results. Our work strengthens the understanding of time-varying long-range interactions in neuronal ensembles.

Values and functions of memory in elderly people

The issue of memory in the elderly is usually dealt with from a medical, neurological or neuropsychological perspective, or even from an educational or therapeutic one, depending on whether we want to prevent or treat age-related memory disorders. This is tantamount to forgetting that memory is the major function of the elderly in many societies, both past and present.