神経学的障害

Objectives: Implantation of a dorsal column stimulator (DCS) for axial spine and radicular pain is a commonly performed procedure. Despite the benefits of this device to reduce pain and improve quality of life, some patients elect to have the device explanted. The purpose of this study is to describe pre-operational factors among patients who elected to have their DCS explanted and how these factors are associated with reason for explantation.

Materials and methods: We conducted a retrospective descriptive study using the database of a private outpatient orthopedic clinic. We included all patients who had a DCS explanted between January 1, 2007 and June 19, 2014. Data was collected on patient demographics, past medical and back surgery history, as well as details of implantation, permanent device implantation, and subsequent explantation. Reasons for explantation were categorized as: inadequate pain control using three categories (with no device related pain/discomfort, with device related pain/discomfort, or inadequate pain control and patient wants MRI), or pain resolved.

Results: A consecutive sample of 100 subjects who underwent explantation of a DCS was identified for review. Of these 100 subjects, 14 were excluded. Based on our data, we hypothesize that sex (57% female, 43% male) degenerative disc disease (72%), previous back surgery (70%), BMI classified as overweight (subject average=28.3), history of tobacco usage (57%), and history of narcotic use (80%) may be potential risk factors for explantation.

Conclusion: With respect to clinical evaluation of patients as candidates for spinal cord stimulator implantation, we cannot recommend that any of the evaluated variables be considered a contraindication to proceeding with a trial procedure. Future studies are planned to compare these data to a control group of subjects to establish risk factors predisposing individuals to explantation of a DCS.

Neurofibromatosis type 2 (NF2), now called NF2-schwannomatosis is a debilitating genetic syndrome that can cause widespread physical impairment such as deafness, visual impairment, and limb weakness. The molecular and physical manifestations of NF2 have been well described, and several studies have demonstrated the negative impact of NF2 on Quality of Life (QOL). In contrast, few studies have addressed whether there are specific psychiatric associates of NF2-schwannomatosis. This current review summarises what is known about psychiatric features associated with NF2-schwannomatosis. For comparison, the prevalence of similar features in other genetically distinct neuro-cutaneous disorders is also briefly described. It is hoped that the information provided in this review will highlight potential areas for future research in NF2-schwannomatosis, with the subsequent aims of optimizing holistic service provision and enhancing the quality of life for patients with NF2-schwannomatosis.

Aim: To assess the prevalence of migraine in students at Dubai Medical College, UAE

Material and methods: A cross sectional questionnaire based study was undertaken for three months between December 2020 and February 2021, in Dubai Medical College for Girls, UAE.

Results: The students from the first to the final year of MBBS participated in the study. (n=147) 37% of the students from this sample size are giving a history of migraine. Family history of migraine is noted in 45% of students from this sub-group. The duration of migraine history is between 1-5 years in nearly 62% of them with duration of 1-5 hours and occurring at a frequency of one episode per week in the maximum number of students with a history of migraine. 58% of the students experienced an aura preceding the migraine attack, while 42% of the students had no preceding aura. Lack of sleep, examination and physical stress and psychological factors (anxiety, depression, anger) constituted the main triggering factors for the migraine attacks. Conversely, adequate sleep, rest, medication (analgesics) and coffee were the salient relieving factors. The students were suffering from mild to moderately severe migraine predominantly, while not many of them had severe migraine. Associated illness in the form of anxiety, allergic rhinitis and polycystic ovarian disease was noted in some of the students with migraine. Medical advice for the migraine was obtained by a very small number of the students.

Conclusion: Headache of migraine can have a detrimental effect on a student’s life both personally and professionally. Measures avoiding triggering factors, prophylactic drug treatment and launching of migraine awareness programs at high school levels would all be greatly beneficial in alleviating the student’s headache and halting its progress to a chronic illness; thereby influencing a student’s quality of life remarkably

Retinoic acid (RA) is the active form of vitamin A that functions as a ligand for nuclear RA receptors that directly bind genomic control regions to regulate gene expression. However, some studies have suggested that RA may have nongenomic effects outside of the nucleus, particularly with regard to synaptic plasticity. Recent results demonstrate that treatment with pharmacological levels of RA can alter synaptic plasticity which may be useful to treat neurological diseases. However, these results and those reported by others have not shown that endogenous RA is normally required for synaptic plasticity (or any other nongenomic effect) as there are no reports of genetic loss of function studies that remove endogenous RA in adult brain. The implication is that pharmacological levels of RA result in nongenomic effects, some of which may be helpful to treat certain diseases but in other cases this may cause unwanted side effects.

Objective: To investigate the changes of retinal thickness and P-ERG signals in adult patients with anisometropic and strabismic amblyopia.

Methods: Sixty patients with monocular adult amblyopia, including 30 Anisotropic Amblyopes (AA group) and 30 Strabismic Amblyopes (SA group), were enrolled in our study at the outpatient clinic of The Hefei First Peoples Hospital of Anhui medical University from June 2019 to November 2020. Retinal Nerve Fiber Layer (RNFL) thickness was measured within 3.4 mm diameter range surrounding the optic nerve, and Ganglion Cell Complex (GCC) layer thickness within 6 mm diameter range surrounding the fovea by an Optovue RTVue Optical Coherence Tomography (OCT) in both amblyopic and fellow eyes. The amplitude and latency of P50 and N95 in Pattern-Electroretinogram (P-ERG) were recorded by a Roland electrophysiology instrument under two stimulation conditions with different temporal and spatial frequencies that were designed to bias the parvocellular and magnocellular pathways respectively. Data between amblyopic and fellow eyes was statistically analyzed by paired t test. The correlation between axial length and parameters of OCT and P-ERG was examined by Pearson correlation test.

Results: Changes in RNFL thickness: In the AA group, RNFL thickness in temporal sector was significantly thinner (p=0.033), while that in the nasal, superior and inferior sectors increased (p0.05) was found between amblyopic eyes and fellow eyes. Changes in GCC thickness compared with fellow eyes, in the AA group, GCC layer thickness of amblyopic eyes was significantly increased (p=0.039), whereas in the SA group, we did not find a significant difference between amblyopic eyes and fellow eyes (p>0.05). P-ERG stimulated mode biased the parvocellular pathway when compared with fellow eyes (n=15), in the AA group, the amplitudes of P50 (p=0.004) and N95 (p=0.038) were significantly decreased in amblyopic eyes, but no significant latent time difference (p>0.05) was found. In the same stimulus pattern, no statistically significant difference (n=15, p>0.05) between amblyopic eyes and fellow eyes was found in the amplitude and latency of P50 and N95 in the SA group. P-ERG stimulated mode biased the magnocellular pathway the amplitude and latency of P50 and N95 showed no statistically significant difference (p>0.05) in either the AA group or the SA group. We found no significant correlation between axial length and OCT, P-ERG parameters (p>0.05) in either group.

Conclusion: Our results showed that the alterations in structure and function of retina that could be seen in adult anisometropic amblyopia were not found in adult strabismic amblyopia group. We thought the functional loss in anisometropic amblyopia was more bias to the parvocellular pathway. These findings indicated that the pathological mechanisms were different between anisometropic and strabismic amblyopia.