2017年 · 第50卷第09期

Parkinson's disease (Parkinson's disease) is a common neurodegenerative disease. The prevalence rate of people over 65 years old in China is 1.7%^[1], similar to developed countries such as Europe and the United States. With the increase of age, the prevalence of Parkinson's disease increases accordingly. It is estimated that the population of Parkinson's disease in China will reach 4.94×10 in 2030⁶People, about half of the global sick population^[2]。 Levodopa replacement therapy has long been recognized as an effective clinical treatment for Parkinson's disease throughout the treatment of the disease. However, no current treatment can prevent the progression of the disease. The emergence of motor complications marks the arrival of the middle and late stages of the course of Parkinson's disease, a fact that all Parkinson's patients and clinicians cannot avoid. The clinical symptoms in the middle and late stages of Parkinson's disease are complex and diverse, not limited to motor complications, but also include non-motor complications^[3,4]Both seriously weaken the treatment effect in the early stage of the disease, increase the disability of the disease, and affect the quality of life of patients^[5,6,7]。 The complexity of the related pathological mechanisms and clinical symptoms and the impact on the quality of life make the intermediate and late clinical intervention the focus and difficulty of the whole course of Parkinson's disease treatment. However, there are still many problems and confusions in the current clinical practice, including how to correctly identify different subtypes of motor complications, neglect of non-motor complications, and the advantages and disadvantages of levodopa replacement therapy in the intervention of motor complications. Therefore, it is particularly important to think about the research and clinical application of the pathogenesis of motor complications in Parkinson's disease and their prevention and treatment strategies.

Parkinson's disease (Parkinson's disease) is a common neurodegenerative disease in middle-aged and elderly people, and its main manifestations are four classical main signs (bradykinesia, quiescent tremor, myotonia and postural balance disorder). With the deepening of clinical research on Parkinson's disease, people gradually realize that Parkinson's disease not only manifests as motor symptoms, but also many non-motor symptoms, such as cognitive impairment, psychiatric symptoms, sleep disorders, etc. cognitive impairment is one of the most common non-motor symptoms of Parkinson's disease, including Parkinson's disease mild cognitive impairment (PD-MCI) and Parkinson's disease dementia (PDD). It is an important reason that affects the quality of life of patients, accelerates the progression of disease and increases the family and socio-economic burden. However, clinicians do not pay enough attention to the cognitive impairment of Parkinson's disease and lack awareness of early recognition, resulting in treatment delays, which will also affect the overall treatment effect of Parkinson's disease and lead to further decline in the quality of life of patients. Early detection and identification of cognitive impairment in Parkinson's disease can help patients receive more rigorous and targeted follow-up and treatment, thereby improving patients' quality of life and reducing family and social burden. Therefore, early detection, recognition and timely treatment of cognitive impairment in Parkinson's disease is very necessary.

Streptococcus suis infection is a zoonotic acute infectious disease, which is a rare disease. After human infection with this bacteria, it can be manifested as meningitis, sepsis, septic shock, endocarditis and pneumonia. Clinically, it is sometimes missed when the early manifestation is atypical. We report a patient with Streptococcus suis infection who was first diagnosed with suspected viral meningitis, relieved after treatment, and secondary to septic shock after cold in our hospital as follows, so as to remind everyone to strengthen their understanding of Streptococcus suis infection and achieve early diagnosis and treatment.

paraneoplastic neurological syndrome (PNS) is a neurological complication caused by tumors through remote effects. There is neither local tumor cell metastasis, compression and infiltration, nor other causes such as metabolic, infection or treatment-related damage. Since 1980s, a number of tumor neuronal antibodies (onconeural antibodies), represented by Hu antibodies, have been discovered, which suggests that the immune response secondary to tumor-neuron cross antigen is the cause of a considerable part of PNS^[1]。 Although early detection of tumors has an important impact on both PNS treatment and prognosis, there are many clinical cases where biopsy (biopsy) pathology cannot be obtained due to various reasons, resulting in diagnosis delay. At the same time, in recent years, new PNS-related antibodies have emerged in an endless stream, which has revealed more and more potential neuroimmunological mechanisms of PNS^[2]。 We report a patient with chronic proximal muscle weakness, tendon reflex reduction and autonomic nerve symptoms as the main manifestations. Electrophysiological examination showed involvement of sensory nerve, single motor nerve, presynaptic membrane, nerve root and autonomic nerve. Its serum PNS antibody screening clearly identified Y chromosome sex determining region associated high mobility group box protein 1 (sex-determining region of Y chromosome-related high mobility group box 1, SOX1) Positive antibody, combined with systemic PET-CT abnormalities and elevated serum neuron specific enolase (NSE), it is considered that small cell lung cancer (SCLC) is highly likely, and the patient will eventually die in a short time through follow-up. It is hoped that the practical application of SOX1 antibody in this example can provide reference for the diagnosis of SCLC-related PNS.

Herpes zoster is an acute infectious disease of the skin and mucosa caused by the reactivation of varicella-zoster virus latent in the dorsal root ganglia. It can involve the first branch of the trigeminal nerve and form ocular herpes zoster. Its ocular complications are common, but orbital apex syndrome is very rare. We now report a case of orbital apex syndrome secondary to ocular herpes zoster diagnosed and treated as follows.

Behcet's disease, also known as Behcet's disease, is a chronic systemic vascular inflammatory disease, which is highly prevalent in East Asia, the Middle East and the Mediterranean region. Its prevalent age is 16~40 years old, mainly manifested as recurrent oral ulcer, genital ulcer, ophthalmia and skin damage, and can also involve the digestive system, nervous system, joints, lungs, kidneys, epididymis and other organs. The prognosis of most patients is good, but the prognosis of patients involving the eye, nervous system and large blood vessels is poor. Neurological Behcet's disease (NBD) accounts for 5% ~49% of Behcet's disease in large sample studies abroad^[1,2]Can be manifested as headache, cognitive and behavioral disorders, hemiplegia, ophthalmoplegia, visual field loss, intracranial aneurysm, etc. Only 14% of spinal cord involvement^[3]。 At present, there are few reports on Behcet's disease myelitis at home and abroad. We reported and analyzed the clinical data of one patient, hoping to increase the understanding of this disease.

POEMS syndrome can involve multiple systems, mainly manifested as multiple peripheral neuropathy, organ enlargement, endocrine diseases, skin changes, positive serum M-protein band, and other rare manifestations include pestle, edema, cachexia, fever, telangiectasia, papilledema, high intracranial pressure, etc. The syndrome with intracranial arterial thrombosis is often reported, while intracranial venous sinus thrombosis is rarely reported. The diagnosis and treatment of a patient with POEMS syndrome complicated with intracranial venous sinus thrombosis admitted to us are reported below.

Parkinson's disease is a common neurodegenerative disease in middle-aged and elderly people. Besides typical motor symptoms, it is accompanied by many non-motor symptoms, including cognitive decline, autonomic symptoms, sensory impairment, visual hallucinations, etc. Eye and visual dysfunction are also widespread in patients with Parkinson's disease, but they are neglected because most of the manifestations are hidden and mixed with aging, senile eye diseases and drug factors. Early and timely identification is not only helpful for the diagnosis and differentiation of Parkinson's disease, but also can better judge the progression and prognosis of the disease.

Parkinson's disease is a neurodegenerative disease involving multiple organs and systems. The clinical manifestations are classical motor symptoms and increasingly recognized non-motor symptoms^[1]。 Motor and non-motor symptom interactions influence clinical and life events in patients with Parkinson's disease. Gastrointestinal involvement, as one of the non-motor symptoms of Parkinson's disease, has attracted much attention because of its early onset and high incidence. In addition to gastrointestinal autonomic nerve involvement^[2]The infection of intestinal microorganisms and the pathogenesis of Parkinson's disease, the fluctuation of clinical symptoms, and the impact on the pharmacokinetics of Parkinson's disease therapeutic drugs have also received widespread attention. Helicobacter pylori (Hp) is a bacterium in the gastrointestinal tract, which is closely related to the occurrence of intestinal diseases such as gastroduodenal ulcer, gastritis and gastric cancer. In addition, the relationship between Hp infection and extraintestinal diseases has become a hot research topic in recent years^[3,4]。 Because of its treatability, especially the relationship with the pathogenesis, clinical manifestation and therapeutic effect of Parkinson's disease, this field has attracted people's attention. Current related studies have found that Hp infection may be correlated with the etiology, clinical manifestations and therapeutic effect of Parkinson's disease, but the conclusions are inconsistent. Therefore, we summarized the relevant literature at home and abroad to review the prevalence of Hp infection in patients with Parkinson's disease, the role of Hp infection in the pathogenesis of Parkinson's disease, and the influence of Hp infection and radical cure on the symptoms and treatment of patients with Parkinson's disease.

Epilepsy is a clinical syndrome of hypersynchronous abnormal discharge of brain neurons caused by many reasons. The clinical manifestations are characterized by seizure, transience, repetition and stereotype. antiepileptic drugs can alleviate many forms of seizures, and about 2/3 of epilepsy patients will be controlled^[1,2]However, at present, 1/3 of patients cannot be effectively controlled and become refractory epilepsy^[3]。 Epilepsy has a significant impact on the quality of life of patients, and also affects the social and mental health of patients^[4,5]。 Therefore, there is still a long way to go to find more effective and better acceptable treatments for epilepsy.

Epilepsy can cause serious effects on the patient's body and mind, and even lead to death. It has become a serious burden for residents in various countries all over the world. However, the specific cause of death caused by epilepsy is still not fundamentally clear. Therefore, we analyze and summarize the epidemiology, high-risk factors and prevention and treatment strategies of epilepsy-related death, hoping to provide better clinical guidance, so as to minimize the risk of epilepsy-related death.

nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of prescription or over-the-counter drugs that are widely used worldwide because of their good anti-inflammatory, antipyretic and analgesic effects. At present, the drug is widely used in the treatment of rheumatic diseases, rheumatoid arthritis, various acute and chronic pain, postoperative analgesia, acute and chronic fever. In recent years, researchers have found that it also plays a certain role in chemoprevention of tumors. Long-term and extensive use of NSAIDs can cause adverse reactions such as gastrointestinal reactions, liver and kidney function impairment, hematological abnormalities, and skin abnormalities, which are also closely related to the central nervous system. We briefly reviewed the role of NSAIDs in the prevention and treatment of central nervous system diseases and the adverse reactions of central nervous system.

As an important clinical tool in the field of cerebrovascular diseases, the National Institutes of Health Stroke Scale (NIHSS) has been recognized by medical practitioners at home and abroad. Since the development of NIHSS, this set of scales has been widely used in clinical practice and clinical research of cerebrovascular diseases. In recent years, with the continuous breakthrough of treatment methods in the acute phase of ischemic cerebrovascular disease, NIHSS has been listed as an important scale tool by current clinical guidelines.

Promulgation of Expert Consensus on Posterior Circulation Ischemia in China (hereinafter referred to as the Consensus) in 2006^[1], promoted people's understanding of posterior circulation ischemic disease and its related problems, but was also questioned by clinical neurologists^[2,3]。 This paper begins with questioning, and then expounds from four aspects: doubt, existence, suggestion and exploration.

suspected non-Alzheimer pathophysiology (SNAP) is a biomarker-based concept proposed by Professor Jack of Mayo Clinic in the United States in 2012, that is, there is evidence of nerve damage [including abnormal tau protein aggregation or brain atrophy or metabolic abnormalities in tau-negative areas susceptible to Alzheimer's disease (AD)] but lack of amyloid deposition^[1,2]。 Clinically, most of these people show normal cognitive function or mild cognitive impairment.

Parkinson's disease is a chronic progressive neurological disease with main clinical manifestations of motor symptoms and non-motor symptoms, which bring adverse effects on the quality of life of patients and their caregivers, families and society. Dopamine receptor agonist monotherapy, a cornerstone of symptomatic treatment in early Parkinson's disease, can delay levodopa-related motor complications while managing symptoms. Rotigoltin transdermal patch is a non-ergot dopamine receptor agonist that can provide stable plasma drug concentrations for up to 24 hours. As the only transdermal patch in clinic, one patch a day is used to improve Parkinson's disease symptoms. Although several international studies have confirmed the efficacy and tolerability of rotigotine transdermal patch in patients with early Parkinson's disease, there are no data to evaluate the efficacy and safety of patients with early Parkinson's disease in China. Therefore, we conducted a pivotal study of rotigoltin transdermal patch in the treatment of early-stage Parkinson's disease patients in China. The full paper was published in April 2016 inParkinsonism&Related DisordersMagazine^[1]。