Sensory Disturbances Research Articles

Cerebral Revascularization: Boom or Doom for Neurosurgeons

Cerebral revascularization which was once commonly used technique became outdated and emerged in a new avatar. Fisher was the first person who promoted that most strokes were not due to vasospasm but due to CA disease. Improvement of various microsurgical methods and techniques are resulting in excellent outcomes. With the advent of modern techniques, cerebral revascularization has taken a back seat. However many diseases like moyamoya disease, complex intracranial aneurysms and skull based tumours, traditional cerebral revascularization methods play a very important role. Although an important method to treat strokes but is also associated with dreaded complication of intracranial haemorrhage. Cerebral collateral circulation channels are restored by cerebral revascularization. Although very commonly used treatment but underwent various modifications, implementations, expanding the horizons of diseases involved. All these innovations in the use of endovascular technique resulted in the decline of cerebral revascularization surgeries. New endovascular surgical approaches lead to shorter recovery times and the patients whose conditions are not indicated for the traditional cerebrovascular approaches can also be managed. One of the major and important drawback of Cerebral Revascularization is the intraoperative thrombosis which can result in severe motor and sensory disturbances. This article aims to weigh the pros and cons of cerebral revascularization.

Mechanisms of complex regional pain syndrome.

Complex Regional Pain Syndrome (CRPS) is a chronic pain disorder characterized by a diverse array of symptoms, including pain that is disproportionate to the initial triggering event, accompanied by autonomic, sensory, motor, and sudomotor disturbances. The primary pathology of both types of CRPS (Type I, also known as reflex sympathetic dystrophy, RSD; Type II, also known as causalgia) is featured by allodynia, edema, changes in skin color and temperature, and dystrophy, predominantly affecting extremities. Recent studies started to unravel the complex pathogenic mechanisms of CRPS, particularly from an autoimmune and neuroimmune interaction perspective. CRPS is now recognized as a systemic disease that stems from a complex interplay of inflammatory, immunologic, neurogenic, genetic, and psychologic factors. The relative contributions of these factors may vary among patients and even within a single patient over time. Key mechanisms underlying clinical manifestations include peripheral and central sensitization, sympathetic dysregulation, and alterations in somatosensory processing. Enhanced understanding of the mechanisms of CRPS is crucial for the development of effective therapeutic interventions. While our mechanistic understanding of CRPS remains incomplete, this article updates recent research advancements and sheds light on the etiology, pathogenesis, and molecular underpinnings of CRPS.

The use of acupuncture in the treatment of lumbar intervertebral disc herniation (сlinical case)

Abstract. The effectiveness of acupuncture in the treatment of discogenic compression radiculopathy has been proven in many scientific works. Acupuncture has a positive effect not only on the course of radiculopathy, but also on the size of the hernias and protrusions of the intervertebral discs themselves. Purpose. To study the effectiveness of acupuncture in the treatment of intervertebral disc herniation in the lumbar region. Material and methods. Before and after treatment (after 3 and 6 months), the patient was assessed: neurological status, results of an electrokymographic study of peripheral nerves of the lower extremities, MRI of the spine. Acupuncture was carried out at acupuncture points of the meridian of the stomach, bladder, gallbladder, colon, for a course of 40 procedures. Results. A 40‑year-old patient suffered from prolonged pain for 8 months. Conservative treatment with drug therapy and physical therapy did not provide satisfactory improvement in symptoms. On MRI of the PC department, the IVD herniation at the L4 — L5 level was 12 mm. When using acupuncture, the pain syndrome decreased clearly after the first sessions. Sensory disturbances and motor deficits gradually regressed. After 40 sessions over 3 months, electromyographic indicators of the affected right peroneal nerve improved. An unexpected result was a reduction in the size of the IVD hernia by 50 % to 6 mm.

Musculoskeletal mimics of lumbosacral radiculopathy.

Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non-radiating pain, tenderness, and give-way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high-yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.

Review of Vishwachi (Cervical Radiculopathy) and its Management by Sahachara Taila Matra Basti

Cervical radiculopathy, a prevalent condition in today's world, arises from degenerative changes in the cervical spine. It commonly emerges during the fourth and fifth decades of life. Lifestyle factors, such as prolonged screen use, sedentary habits, and occupational strain, significantly contribute to its widespread occurrence. This ailment disrupts daily life, causing neck pain, radiating discomfort, and sensory disturbances. The contemporary surge in cervical radiculopathy highlights the impact of evolving lifestyles on musculoskeletal health, underscoring the need for proactive preventive measures. The Sushruta Samhita Nidana Sthana classifies Vishwachi under Vata Vikara, affecting the neck and upper extremities with symptoms akin to cervical radiculopathy. Both conditions share manifestations of Ruka, Stambha, Toda, Karmakshaya, and Chestapaharan of Bahu with Vata being the predominant Dosha responsible for Shoola. This article explores the impact of Matra Basti in managing Vishwachi, recognizing Basti as the premier therapeutic approach for Vata Vikara. There are many Siddha Taila used for Matra Basti in Vishwachi. Sahachara Taila (Cha.Chi.28/145) is one of them. The focus is on assessing the efficacy of Sahachara Taila Matra Basti in addressing the manifestations of Vishwachi, aligning with the acknowledged effectiveness of Basti in treating disorders associated with the Vata Dosha.

ĐÁNH GIÁ CÁC YẾU TỐ LIÊN QUAN ĐẾN BIẾN CHỨNG SAU PHẪU THUẬT NỘI SOI ĐẶT TẤM LƯỚI TRƯỚC PHÚC MẠC ĐƯỜNG VÀO Ổ BỤNG ĐIỀU TRỊ THOÁT VỊ BẸN

Laparoscopic surgery with transabdominal preperitoneal mesh placement (TAPP) has been the primary choice for inguinal hernia treatment. This method has been approved to be safe with a low complication rate. This study was conducted to evaluate preoperative risk factors that may contribute to an escalation in immediate and distant complications in patients undergoing TAPP surgery. For patients undergoing TAPP surgery, the incidence of intraoperative complications was 3.8%, and the failure rate was 1.9%. Postoperative complications occurred in 10.5% of patients. Complications within the first month predominantly included fluid accumulation (15.4%), while pain and sensory disturbance in the abdominal region were observed in 26.9% during the follow-up of distant complications. Multivariate logistic regression analysis revealed that overweight patients (BMI > 24.9 kg/m2) were more likely to experience postoperative complications at one month (OR=3.2; p=0.03) and distant complications (OR=2.4; p=0.02) compared to the normal-weight group (BMI<24.9 kg/m2). Postoperative complications are generally mild and can often be managed conservatively, primarily involving pain and sensory disturbances in the abdominal region. The current study also highlights that overweight and obesity are risk factors contributing to an increased incidence of postoperative complications, emphasizing the need for thorough counseling regarding these risks for patients

Cortical dysmorphology and reduced cortico-collicular projections in an animal model of autism spectrum disorder.

Autism spectrum disorder is a neurodevelopmental disability that includes sensory disturbances. Hearing is frequently affected and ranges from deafness to hypersensitivity. In utero exposure to the antiepileptic valproic acid is associated with increased risk of autism spectrum disorder in humans and timed valproic acid exposure is a biologically relevant and validated animal model of autism spectrum disorder. Valproic acid-exposed rats have fewer neurons in their auditory brainstem and thalamus, fewer calbindin-positive neurons, reduced ascending projections to the midbrain and thalamus, elevated thresholds, and delayed auditory brainstem responses. Additionally, in the auditory cortex, valproic acid exposure results in abnormal responses, decreased phase-locking, elevated thresholds, and abnormal tonotopic maps. We therefore hypothesized that in utero, valproic acid exposure would result in fewer neurons in auditory cortex, neuronal dysmorphology, fewer calbindin-positive neurons, and reduced connectivity. We approached this hypothesis using morphometric analyses, immunohistochemistry, and retrograde tract tracing. We found thinner cortical layers but no changes in the density of neurons, smaller pyramidal and non-pyramidal neurons in several regions, fewer neurons immunoreactive for calbindin-positive, and fewer cortical neurons projecting to the inferior colliculus. These results support the widespread impact of the auditory system in autism spectrum disorder and valproic acid-exposed animals and emphasize the utility of simple, noninvasive auditory screening for autism spectrum disorder.

Impact of target depth on safety and efficacy outcomes in MR-guided focused ultrasound thalamotomy for tremor patients

OBJECTIVE Target depth, defined by the z-coordinate in the dorsoventral axis relative to the anterior commissure–posterior commissure axial plane of the MR-guided focused ultrasound (MRgFUS) lesion, is considered to be critical for tremor improvement and the occurrence of side effects such as gait impairment. However, although different z-coordinates are used in the literature, there are no comparative studies available with information on optimal lesion placement. This study aimed to compare two different MRgFUS lesion targets (z = +2 mm vs z = 0 mm) regarding efficacy and safety outcomes. METHODS The authors conducted a retrospective analysis of 52 patients with pharmacoresistant tremor disorders who received unilateral MRgFUS thalamotomy in the ventral intermediate nucleus for the first time between 2017 and 2022 by one neurosurgeon, with two different z-coordinates, either z = +2 mm (+2-mm group; n = 17) or z = 0 mm (0-mm group; n = 35), but otherwise identical parameters. Standardized video-recorded assessments of efficacy (including the Washington Heights-Inwood Genetic Study of Essential Tremor scale) and safety (using a standardized grading system) outcomes at baseline and at 6 months posttreatment were reviewed and compared. Moreover, overall patient satisfaction was extracted as documented by the examiner at 6 months. RESULTS Based on a multiple logistic regression analysis, the authors found that a more dorsal target with a z-coordinate of +2 mm as compared with 0 mm was associated with a higher incidence of any persistent side effect at 6 months (p = 0.02). Most consistently, sensory disturbances, although mild and nondisturbing in most cases, occurred more frequently in the +2-mm group (35% vs 11%, p = 0.007), while no significant differences were found for gait impairment (29% vs 35%) and arm ataxia (24% vs 11%). On the other hand, average tremor suppression was similar (63.6% vs 60.2%) between the groups. Here, higher efficacy was associated with a higher side effect burden in the 0-mm group but not in the +2-mm group. Despite the occurrence of side effects, general patient satisfaction was high (87% would undergo MRgFUS again) as most patients valued tremor suppression more. CONCLUSIONS A more ventral MRgFUS target of z = 0 mm seems to be associated with a more favorable safety and a comparable efficacy profile as compared with a more dorsal target of z = +2 mm, but prospective studies are warranted.

Assessment of postoperative pain, dysesthesia, and weather sensitivity after pterional and temporal neurosurgical approaches.

Many neurosurgical approaches require incision of the temporal muscle (TM). Consequently, patients often report reduced opening of the mouth, facial asymmetry, numbness, and pain after lateral craniotomies. A systematic assessment of these postoperative subjective complaints is lacking in the literature. Therefore, in this study, the authors evaluate subjective complaints after pterional, frontolateral-extended pterional, or temporal craniotomy using a 6-item questionnaire. They examine the association of these subjective complaints with the extent of the mobilization of the TM. The questionnaire assessed complaints about limited opening of the mouth, pain in the mastication muscles, facial asymmetry, sensory deficits in the temporal region, weather sensitivity, and headache. Eligible patients with benign intracranial processes operated on using lateral cranial approaches between 2016 and 2019 were included. The questionnaire was answered before surgery (baseline) and 3 and 15 months after surgery. Surgeons documented the extent of TM incision. Among the 55 patients in this study, all complaints apart from headache showed an increase at a statistically significant rate at 3 months postoperatively, that is, limited mouth opening (p < 0.0001), pain in the mastication muscles (p < 0.0001), an impression of asymmetry in the mastication muscles (p = 0.0002), sensory disturbances in the temporal region (p < 0.0001), and weather sensitivity (p < 0.001). Only pain in the mastication muscles showed a relevant decrease at 15 months postsurgery (p = 0.058). The extent of the mobilized TM was associated with pain in the mastication muscles at 3 months (p = 0.0193). Subjective complaints in patients following lateral craniotomy can be detected. As the extent of the mobilized TM relevantly influenced pain in the mastication muscles, the authors conclude that one should sparsely mobilize the TM. Furthermore, a neurosurgeon should be aware and warn the patient of subjective postoperative complaints and inform the patient about their natural course.

Anti-Myelin-associated Glycoprotein Neuropathy

Anti-myelin-associated glycoprotein (MAG) neuropathy, which occurs secondary to immunoglobulin (Ig)M paraproteinemia such as monoclonal gammopathy of undetermined significance, is characterized by slow progression, sensory or sensorimotor disturbances, and ataxia. The estimated prevalence of this neuropathy in Japan is 0.28 per 100,000 population with male preponderance. This neuropathy is diagnosed based on the detection of M protein and anti-MAG antibodies in patients' serum. Nerve conduction studies show prolonged distal latency, and histopathological evaluation of sural nerve biopsies shows widely spaced myelin on electron microscopy. Usually, immunotherapy, including administration of intravenous Ig and corticosteroids, is ineffective, and rituximab is beneficial in approximately 50% of patients. Novel therapies, such as administration of Bruton's tyrosine kinase inhibitors are expected to benefit patients with the MYD88L265P mutation.

Hypo-connectivity of the primary somatosensory cortex in Parkinson's disease: a resting-state functional MRI study.

Parkinson's disease (PD) is characterized by a range of motor symptoms as well as documented sensory dysfunction. This sensory dysfunction can present itself either as a "pure" sensory disturbance or as a consequence of sensory-motor integration within the central nervous system. This study aims to investigate changes in the functional connectivity of the primary somatosensory cortex (S1) and its clinical significance in Parkinson's disease (PD), an area that has received limited attention in previous neuroimaging studies. This study included thirty-three patients with PD and thirty-four healthy controls (HCs). Clinical evaluations were conducted to assess the clinical manifestations, severity, and functional capacity of all the patients. Resting-state functional MRI (fMRI) was employed to evaluate the functional connectivity of six paired S1 subregions in the participants. Seed-based correlation (SBC) analysis was utilized to construct the correlation matrix among the subregions and to generate connectivity maps between the subregions and the remaining brain voxels. Finally, the study employed partial least-squares (PLS) correlation analysis to investigate the association between modified functional connectivity and clinical characteristics in PD patients. In the correlation matrix, patients with PD demonstrated a notable decrease in functional connectivity across various S1 subregions in comparison to HCs (p < 0.001, corrected using network-based methods). In connectivity maps, hypo-connectivity was primarily observed in the sensorimotor network as common patterns (p < 0.001, corrected for false discovery rate) and in the default mode network (DMN) as distinct patterns. Moreover, this study identified a negative association between the correlation matrix within S1 subregions and the scores for axial symptoms and postural instability/gait difficulty (PIGD) in PD patients. Nevertheless, a direct relationship between the connectivity maps of S1 subregions and clinical assessment scales was not established. This study offers novel insights into the neurobiological mechanisms that contribute to S1 dysfunction in PD, highlighting the significant involvement of S1 hypo-connectivity in the motor disturbances observed in PD patients.

Feasibility of 2-Point Fixation by Absorbable Plates Using the Transoral Approach in Management of the Zygomatic Complex Fractures.

The purpose of this study was to retrospectively evaluate the feasibility of 2-point fixation using absorbable plates by the transoral approach in the management of the zygomatic complex (ZMC) fractures. Twenty-five patients (15 male and 10 female, age range 16y to 55y) with Knight and North Group Ⅲ zygomatic fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using absorbable plates placed at the zygomaticomaxillary buttress and infraorbital rim. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mouth opening, facial asymmetry, diplopia, and paresthesia. Postoperatively, all patients achieved uneventful healing; facial symmetry and wound healing were achieved, along with sensory recovery involving the infraorbital nerve. Complications such as sensory disturbances, infection, diplopia, malunion, and nonunion were not encountered in these patients. Two-point fixation using absorbable plates by transoral approach can provide sufficient stabilization for Knight and North Group III zygomatic fractures.

Spinal Dural Arteriovenous Fistulas: Surgical Outcome Analysis of Twenty Cases

Background: Spinal dural arteriovenous fistulas (SDAVFs) are rare complex spinal vascular shunts, which caninevitably lead to severe disability if remain untreated. Methods: Retrospective analysis of SDAVFs patientsina period of three years (2019 to 2021) who presented with progressive paraparesis, bladder symptoms and/or sensory disturbances. They were evaluated by MRI and localization of the fistula was done by spinal catheter angiogram. Spinal AV fistulas were simply classified as extradural and intradural.They all underwent microsurgical shunt interruption. Neurological function was evaluated by Aminoff-Logue Scale (ALS) consecutively at the day before surgery, 6 months and 1year after surgery. Results: A total of 20 patients (mean age 35 ± 10 years, 16 (80.0%) are male.The mean interval from onset to diagnosis was 6 ± 3 months. Among the anatomical location of fistulas, 1(05.0%) was in cervical, 16 (80.0%)were inthoracic, and 3 (15.0%) were in lumbar. Among the angiographic types of fistulas, 18(90.0%) were intradural and,2(10.0%) were extradural.Mean pre-treatment ALS was 5.3 and mean last examination ALS was 3.9. There was a significant improvement of the ALS between pretreatment and last examination ALS (P = 0.0009). Among 20 surgical procedures there were complications in three cases (15%): epidural hematoma in 1 case, cerebrospinal fluid leakage in 1 case and post-operative wound infection in 1 case Conclusions: In our study,microsurgical interruption of timely diagnosed SDAVF showed good and stable results over time. Bang. J Neurosurgery 2023; 12(2): 137-141

Clinical characteristics of patients with autoimmune nodopathy with anti-neurofascin155 antibodies.

According to the latest guidelines on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), patients with CIDP with anti-neurofascin 155 (NF155) antibodies are referred to as autoimmune nodopathy (AN), an autoimmune disorder distinct from CIDP. We aimed to compare the clinical data of patients with AN with anti-NF155 antibodies with those of anti-NF155 antibodies-negative patients with CIDP, and to summarize the clinical characteristics of patients with AN with anti-NF155 antibodies. Nine patients with AN with anti-NF155 antibodies and 28 serologically negative patients with CIDP were included in this study. Diagnosis was made according to the diagnostic criteria in the European Academy of Neurology (EAN)/Peripheral Nerve Society (PNS) guidelines on CIDP published in 2021. Demographics, clinical manifestations, electrophysiological examination, cerebrospinal fluid (CSF) tests, and response to treatment were retrospectively analyzed. Compared with serologically negative patients with CIDP, those patients with AN with anti-NF155 antibodies were younger (p=0.007), had a younger onset age (p=0.009), more frequent ataxia (p=0.019), higher CSF protein levels (p=0.001), and more frequent axon damage in electrophysiology (p=0.025). The main characteristics of patients with AN with anti-NF155 antibodies include younger age and onset age, limb weakness, sensory disturbance, ataxia, multiple motor-sensory peripheral neuropathies with demyelination and axonal damage on electrophysiological examination, markedly elevated CSF protein levels, and varying degrees of response to immunotherapy. Patients with AN with anti-NF155 antibodies differed from serologically negative patients with CIDP in terms of clinical characteristics. When AN is suspected, testing for antibodies associated with the nodes of Ranvier is essential for early diagnosis and to guide treatment.

Sensory Symptoms without Structural Pathology in Patients with Gluten Sensitivity.

The patients were selected from the gluten neurology clinic based at the Royal Hallamshire Hospital, Sheffield, UK, on the basis of sensory symptoms but normal neuroaxis imaging and peripheral nerve evaluation. A total of 30 patients were identified with a mean age at presentation of 47 years. The prevalence of enteropathy was 78%. The sensory disturbance was characterised by tingling at 50%, numbness at 27%, pain at 20%, burning at 13% and "buzzing" feeling at 7%. The distribution of the sensory symptoms included hands and feet in 27% of the patients, torso in 27%, legs only in 23%, face in 17% and arms only in 10%. For five patients, the sensory disturbance was migratory and affected different parts of the body at any given time. After the introduction of a gluten-free diet, 77% of patients noted significant improvement in their sensory symptoms. In one-third of the patients, there was a complete resolution of the sensory symptoms. Unexplained sensory symptoms can be seen in patients with gluten sensitivity and respond to strict adherence to a gluten-free diet.

Understanding Functional Neurological Disorder: Recent Insights and Diagnostic Challenges.

Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric situations. Its treatment typically involves a multidisciplinary technique addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions. Recent advances in neuroimaging and a deeper exploration of its epidemiology, pathophysiology, and clinical presentation have shed new light on this disorder. This paper synthesizes the current knowledge on FND, focusing on its epidemiology and underlying mechanisms, neuroimaging insights, and the differentiation of FND from feigning or malingering. This review highlights the phenotypic heterogeneity of FND and the diagnostic challenges it presents. It also discusses the significant role of neuroimaging in unraveling the complex neural underpinnings of FND and its potential in predicting treatment response. This paper underscores the importance of a nuanced understanding of FND in informing clinical practice and guiding future research. With advancements in neuroimaging techniques and growing recognition of the disorder's multifaceted nature, the paper suggests a promising trajectory toward more effective, personalized treatment strategies and a better overall understanding of the disorder.

From single to combinatorial therapies in spinal cord injuries for structural and functional restoration.

Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychosocial implications for affected people, their families, and their communities; the financial costs can be challenging for their families and health institutions. Treatments aimed at restoring the spinal cord after spinal cord injury, which have been tested in animal models or clinical trials, generally seek to counteract one or more of the secondary mechanisms of injury to limit the extent of the initial damage. Most published works on structural/functional restoration in acute and chronic spinal cord injury stages use a single type of treatment: a drug or trophic factor, transplant of a cell type, and implantation of a biomaterial. Despite the significant benefits reported in animal models, when translating these successful therapeutic strategies to humans, the result in clinical trials has been considered of little relevance because the improvement, when present, is usually insufficient. Until now, most studies designed to promote neuroprotection or regeneration at different stages after spinal cord injury have used single treatments. Considering the occurrence of various secondary mechanisms of injury in the acute and sub-acute phases of spinal cord injury, it is reasonable to speculate that more than one therapeutic agent could be required to promote structural and functional restoration of the damaged spinal cord. Treatments that combine several therapeutic agents, targeting different mechanisms of injury, which, when used as a single therapy, have shown some benefits, allow us to assume that they will have synergistic beneficial effects. Thus, this narrative review article aims to summarize current trends in the use of strategies that combine therapeutic agents administered simultaneously or sequentially, seeking structural and functional restoration of the injured spinal cord.

Current understanding of the molecular mechanisms of chemotherapy-induced peripheral neuropathy.

Chemotherapy-induced peripheral neuropathy (CIPN) is the most common off-target adverse effects caused by various chemotherapeutic agents, such as cisplatin, oxaliplatin, paclitaxel, vincristine and bortezomib. CIPN is characterized by a substantial loss of primary afferent sensory axonal fibers leading to sensory disturbances in patients. An estimated of 19-85% of patients developed CIPN during the course of chemotherapy. The lack of preventive measures and limited treatment options often require a dose reduction or even early termination of life-saving chemotherapy, impacting treatment efficacy and patient survival. In this Review, we summarized the current understanding on the pathogenesis of CIPN. One prominent change induced by chemotherapeutic agents involves the disruption of neuronal cytoskeletal architecture and axonal transport dynamics largely influenced by the interference of microtubule stability in peripheral neurons. Due to an ineffective blood-nerve barrier in our peripheral nervous system, exposure to some chemotherapeutic agents causes mitochondrial swelling in peripheral nerves, which lead to the opening of mitochondrial permeability transition pore and cytochrome c release resulting in degeneration of primary afferent sensory fibers. The exacerbated nociceptive signaling and pain transmission in CIPN patients is often linked the increased neuronal excitability largely due to the elevated expression of various ion channels in the dorsal root ganglion neurons. Another important contributing factor of CIPN is the neuroinflammation caused by an increased infiltration of immune cells and production of inflammatory cytokines. In the central nervous system, chemotherapeutic agents also induce neuronal hyperexcitability in the spinal dorsal horn and anterior cingulate cortex leading to the development of central sensitization that causes CIPN. Emerging evidence suggests that the change in the composition and diversity of gut microbiota (dysbiosis) could have direct impact on the development and progression of CIPN. Collectively, all these aspects contribute to the pathogenesis of CIPN. Recent advances in RNA-sequencing offer solid platform for in silico drug screening which enable the identification of novel therapeutic agents or repurpose existing drugs to alleviate CIPN, holding immense promises for enhancing the quality of life for cancer patients who undergo chemotherapy and improve their overall treatment outcomes.

Comparison of Clinical Features, Short-Term Outcome of Guillain-Barré Syndrome Between Adults and Children: A Retrospective Study in Vietnam

BackgroundDespite extensive research on Guillain-Barré syndrome (GBS) in adults and children, there is a lack of comparison regarding short-term outcomes in various age groups. Our study aims to elucidate the differences in clinical features and short-term outcomes in Vietnam. MethodsAfter retrospective data collection, we compared clinical features in patients with GBS aged ≤16 years at Children's Hospital 2 and aged >16 years at University Medical Center Ho Chi Minh City from 2017 to 2021. A positive short-term outcome was recorded if patients had a GBS Disability Score of 0 to 2 at hospital discharge. ResultsWe analyzed 109 adults (58.7% males; mean age 50.6 ± 17.7) and 111 children (58.6% males; mean age 7.2 ± 4.9). Comparable antecedent infection and immunization incidence in both groups were observed (35.8% vs 45.9%, P > 0.05). Pain and sensory disturbance were the most common onset symptom in adults (57.8%), whereas lower limb weakness predominated in children (61.3%). Ophthalmoplegia (18.3% vs 5.4%), pain, sensory disturbance (85.3% vs 67.6%), ataxia (33.0% vs 15.3%) were more prevalent in adults (P < 0.05). The axonal subtype was prominent in both adults (51.4%) and children (53.2%). Patients were classified into: classic GBS (49.5% and 68.5%), GBS variants (11.0% and 15.3%), classic Miller Fisher syndrome (MFS) (1.8% and 1.8%), MFS variants (2.8% and 0%), and GBS/MFS overlap (34.9% and 14.4%). Short-term outcomes did not significantly differ based on age. ConclusionsAge-related variations in clinical features were observed, but adults and children exhibited similar short-term functional outcomes.

Survey of the characteristics of numbness in ischemic stroke patients: a cross-sectional study in the early rehabilitation phase

Sensory disturbance is a common symptom of post-stroke. In traditional Chinese medicine (TCM), this symptom is classified as numbness (Ma Mu). While there have been many studies on the therapeutic effect of numbness in TCM, little research has been conducted on the characteristics of numbness. This study aimed to investigate the characteristics of numbness in patients with ischemic stroke in the early rehabilitation phase. This study consisted of two phases. Phase 1 investigated the characteristics of numbness based on medical literature; Phase 2 investigated the characteristics of numbness in patients with ischemic stroke in the early rehabilitation phase based on the cross-sectional study. Phase 1 identified 9 characteristics of numbness based on 11 medical /literature, including: S1 (feeling of heaviness in the affected area), S2 (feeling of tension in the affected area), S3 (sensation of crawling insects), S4 (numbness in a fixed position), S5 (increased numbness with movement), S6 (increased numbness when exposed to cold), S7 (increased numbness when exposed to moisture), S8 (decreased with warm compresses), S9 (decreased when pressed). Phase 2, a clinical survey of 67 patients, recorded 9 characteristics (S1 to S9). We found that there is a relationship between the degree of sensory disturbance according to Fugl-Meyer Assessment with S2 and S6, and obesity with S5. The study examined the characteristics of numbness in ischemic stroke patients in the early rehabilitation phase from the perspective of TCM. This study provided a basis for individualized diagnosis and treatment combining traditional and modern medicine.