Yong-Hong Liu

Identification of microRNA-205 as a potential prognostic indicator for human glioma

Altered microRNA-205 (miR-205) expression has been found in glioma tissue samples and cell lines; however, the clinical significance of this is unclear. The aim of this study was to confirm the miR-205 expression pattern in human glioma and to investigate its clinical relevance. Quantitative reverse-transcription polymerase chain reaction assays showed that miR-205 expression was significantly lower in glioma tissues than in non-neoplastic brain tissues (P<0.001). Statistical analysis revealed a significant correlation between low miR-205 expression and both high grade glioma (World Health Organization [WHO] criteria, P=0.008) and a low Karnofsky performance status score (P=0.02). Survival analysis demonstrated that the cumulative 5-year overall survival rate of patients with glioma in the high miR-205 expression group was significantly higher than that in the low miR-205 expression group (P<0.001). Multivariate Cox regression analysis further indicated that miR-205 expression (P=0.01) and WHO grade (P=0.01) were independent prognostic indicators of the overall survival of patients with glioma. Moreover, subgroup analyses revealed that the cumulative 5-year overall survival rate of patients with high grade (III-IV) glioma was significantly worse for the low miR-205 expression group than for the high miR-205 expression group (P<0.001), but no significant difference was found for patients with low grade (I-II) glioma (P=0.09). In conclusion, down-regulation of miR-205 was associated with glioma progression. Our data are the first to suggest that miR-205 holds potential as a prognostic factor for glioma, especially for patients with advanced disease.

Expression and prognostic value of NDRG2 in human astrocytomas

OBJECTIVE The pathological grading system of human astrocytoma is usually used to evaluate the outcomes of brain glioma patients. However, it is true that some astrocytoma patients with similar grades underwent obvious discrepancy in survival. Increasing evidence shows that certain tumor biomarkers are more suitable for prognosis assessment of tumors than the grading system. NDRG2, a member of the N-myc downstream-regulated gene family, plays an important role in cell proliferation and differentiation, but whether it can be used as a biomarker for prognosis assessment of astrocytomas remains unknown. METHODS Immunohistochemistry and semi-quantitative RT-PCR were performed to examine the expression profile of NDRG2 in human astrocytoma specimens. Spearman correlation coefficient was used to describe the association between NDRG2 expression and the clinical parameters of astrocytoma patients. RESULTS Our results showed that both protein and mRNA expression levels of NDRG2 were significantly downregulated in astrocytomas. In the analysis of the relationship of NDRG2 expression with pathological grades of astrocytoma and with patient survival rate, we found that NDRG2 expression was negatively correlated with pathological grading but positively with the life span of astrocytoma patients. CONCLUSION NDRG2 can serve as a potential prognostic biomarker for human astrocytoma.

Bilateral medial medullary infarction presenting as Guillain–Barré-like syndrome

Bilateral medial medullary infarction (MMI) is a very rare occurence characterized by acute-onset or progressive quadriplegia, ingual paresis and impaired deep sensation [1]. The disease is requently misdiagnosed at acute stage since the presenting sympoms are similar with other neurological diseases. We describe wo cases having weakness in the limbs with involvement of bular nerve-innervated muscles and respiratory muscles. They were nitially diagnosed as having Guillain–Barre syndrome (GBS). Subequent clinical and imaging features supported the diagnosis of ilateral MMI. The clinical features and differential diagnosis of ilateral MMI will be discussed in this report.

Levetiracetam-associated aggravation of myoclonic seizure in children

Some antiepileptic drugs (AEDs) have been reported to aggravate generalized seizures. We have seen three children whose myoclonic seizures increased on starting treatment with Levetiracetam. In all seizures aggravation was temporally associated to the introduction of the drug. All became seizure-free on withdrawal of levetiracetam with a switch to an alternative antiepileptic drug and this persisted for at least 6 months. This suggests that some children with myoclonic seizures may have an aggravation on starting treatment with levetiracetam but this requires further studies.

The characteristics and related influencing factors of ambulatory EEGs in patients seizure-free for 3—5 years

OBJECTIVE Epileptic patients have a higher relapse risk when EEGs before the initiation of anti-epileptic drug (AED) withdrawal show epileptiform activity. The purpose of this study is to assess the characteristics of ambulatory EEGs before the decision to withdraw AEDs and to clarify potential influencing factors for abnormal EEGs. METHODS 214 epileptic patients were included in the study. These patients were seizure-free for 3-5 years on AED medication. Ambulatory 24-h EEGs were performed before the decision to withdraw AEDs. The demographical data and clinical information of the patients were used for the analysis of influencing factors for EEG findings. RESULTS Ambulatory EEGs showed abnormalities in 41.1% of the patients (88/214). Of 88 patients with abnormal EEGs, 43 had unequivocal epileptic discharges; and 45 only had nonspecific EEG abnormalities. In our analysis, the potential factors for abnormal EEGs included female, delayed therapy, longer duration of intractability/treatment response time and medications failed. CONCLUSIONS In many patients ambulatory EEGs remain abnormal even after seizure-free for 3-5 years; and many factors influenced the characteristics of the EEGs. The findings can assist in establishment of therapeutic principles.

Mobile Stroke: An Experience of Intravenous Thrombolysis Guided by Teleconsultation Based on Google Glass.

Telestroke is a success story of the telemedicine service after the introduction of teleradiology [1]. Evidence suggests that telestroke may help to resolve the shortage of neurological expertise in underserved areas, shorten the time to treatment and improve the use of intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA), thus preventing permanent neurological impairment [2,3]. China is currently facing the problem of geographical disparity in the neurological expertise between urban and rural areas, and the rate of IV rt-PA treatment is extremely low [4]. Due to this situation, the Chinese government and agencies are making efforts to develop telemedicine. Here, we report the experience of IV thrombolysis guided by a teleconsultation system based on Google Glass for an acute ischemic stroke patient.

Cognitive function after fetal exposure to antiepileptic drugs.

To the Editor: Meador et al. (April 16 issue)1 suggest that children who had been exposed to valproate in utero had significantly lower IQ scores than those who had been exposed to other antiepileptic drugs. However, the results of their study should be interpreted with caution. Many factors have a role in the neuropsychological development of children, apart from fetal exposure to antiepileptic drugs. We are not given details of the quality of the home environment, which has been recognized as a key environmental influence on child development.2 The Home Screening Questionnaire (HSQ) is a widely used tool to assess the qualities of the home environment that may influence the development of children,3 such as emotional and verbal responses of the mother and avoidance of restriction and punishment. Although the study by Meador and colleagues included detailed monitoring of multiple potential confounding factors relating to child IQ, the HSQ may be helpful for obtaining more detailed and appropriate assessments of and conclusions about the children at the age of 6 years.

Postictal apnea as an important mechanism for SUDEP: A near-SUDEP with continuous EEG-ECG-EMG recording

Sudden unexpected death in epilepsy (SUDEP) is one of the most frequent causes of death among patients with epilepsy. Most SUDEP or near-SUDEP are unwitnessed and not observed or recorded during video-EEG recording in epilepsy monitoring units. This report describes a young woman with post ictal apnea and generalized EEG suppression (PGES) after a secondary generalized tonic-clonic seizure (sGTCS). This was accompanied by bradycardia and then ventricular tachycardia (VT). But at the end of VT, the patients breath recovered without any intervention, such as cardio-respiratory resuscitation. This case report with continuous EEG, EKG, EMG during near SUDEP may provide insights into the mechanism of action.

Seizure freedom in epilepsia partialis continua (EPC) through vagus nerve stimulation (VNS) therapy: A case report.

Vagus nerve stimulation (VNS) is generally considered as a palliative treatment for patients with drug-resistant partial-onset epilepsy. We report a case in which a patient with drug-resistant epilepsia partialis continua (EPC), became seizure-free for 15 months with VNS combined with antiepileptic medication regimens. To our knowledge, similar cases have not been reported previously.

S163. Evaluating consciousness and higher cortical cognitive function during elimination of visual fixation in IGE patients with fixation–off sensitivity

Introduction This paper set out to demonstrate the clinical features of IGE patients coexisting with FOS, meanwhile to evaluate the consciousness and higher cognitive functions during the long term generalized epileptic discharges elicited by elimination of central vision and fixation. Methods The database of EEG records was searched for FOS and IGE over 4 years from January 2014 to November 2017 at Xijing hospital, Xi’an, China. FOS was evaluated according to the technique proposed by Panayiotopoulos. Photic stimulation procedure was performed according the methodology of updated European algorithm for visual stimulation. In order to evaluate the degree of possible transient impaired consciousness and cognitive function caused by the epileptic discharges, neuropsychological evaluation was performed during video-EEG monitoring with eyes open and with eye closed according the procedure developed by the European taskforce. For comparison, performance during eye open period was set as the normal baseline. Results We identified five (four males and one female) young IGE patients with FOS (one GTCS-only; one JME, two EMA/JS, one IGPE photosensitivity epilepsy). Three of them had family history of epilepsy. All the patients presented with FOS, two of them manifest with FOS associated with seizures captured by video-EEG, four of them coexisted with photosensitivity (two confirmed, two probable). The GTCS was well managed on AED. Two patients complained the GTCS were only provoked by and emotional stress, one patient complained seizures were only triggered by television, the other two patients reported no precipitating factors. The EEG features of FOS presented as high amplitude generalized epileptic discharge predominantly over frontal and occipital regions. Consciousness (awareness and responsiveness) looked like well-preserved during longstanding generalized epileptic discharge induced by elimination of visual fixation, while mild transitory impairment of higher cognitive functions was observed when neuropsychological testing was performed. Conclusion (1) The fixation-off phenomenon as a reflex EEG phenomenon in IGE may either manifest with seizures or represent an EEG abnormality associated with higher cortical cognitive impairment. (2) Neuropsychological assessment can make a highly contribution to the understanding of the mechanisms of consciousness and higher cortical cognitive function in epilepsy. Both concomitant Video-EEG and high-precision neuropsychological testing are necessary to detect the subtle symptom. (3) FOS may be not self-limiting, could occur in several different idiopathic generalized epilepsy syndromes, and therefore, their occurrence alone is not sufficient to characterize a definite epilepsy syndrome.