BACKGROUND: After local injection of Botulinum toxin type-A (BoTX-A), not only the function of the neuromuscular conjunction was affected, but also the changes occurred remote from the injected site. F-waves result from the back fire of the motoneuron activation, which may indirectly reflect the functional state of the motoneurons.OBJECTIVE: To evaluate the remote effect of local BoTX-A injection by F-wave test.DESIGN: Self-control study based on patients with movement disorders.SETTING: Neruologic clinic in a university hospital.PARTICIPANTS: Twenty-six patients with movement disorders not received previous local BoTX-A were selected from Neurological Clinic in Renmin Hospital of Wuhan University between September 2002 and July 2003, including 19 cases with hemificiospasm, 5 Meige syndrome and 2 torticollis spasmodicus.INTERVENTIONS: F- and M-waves of ulnar and tibial nerves were recorded before 1, 12 - 24 weeks after local injection of BoTX-A in 26 patients.MAIN OUTCOME MEASURES: The following parameters were analyzed:latency(ML) and amplitude (Mamp) of M-wave, minimal (Fmin) and average latency (Fave), amplitude of negative peak(Famp), duration (Fdur), persistence (Fpcr) and chronodispersion (Fchr) of F-wave.RESULTS: No definite F-response of ulnar nerve stimulation was obtained 1 week after injection in 3 HFS patients (5 nerves) . Fave prolonged significantly on ulnar and tibal nerve and Fdur increased significantly on ulnar nerve 1 week after injection, but there was no significant difference 12 - 24 weeks later, compared with before injection. No significant correlation of the altered F-wave parameters was found with the dosage of BoTX-A.CONCLUSION: Fdur and Fave could sensitively assess the remote effect,which correlates with distance away from the injected muscle, rather than the dosage of BoTX-A.

Objective To evaluate the remote effect of local injection of botulinum toxin by use of the F-wave measures. Methods The F-wave responses as well as M-waves were recorded before injection, and at 1 week,12 to 24 weeks after local injection of botulinum toxin type-A (BTX-A) in 26 patients, including 19 with hemi-facial spasm (HFS),5 Meige syndrome and 2 torticollis spasmodicus (TS).The following parameters were analyzed: M-wave latency (ML) and amplitude (Mamp), F-wave minimal latency(Fmin) and average latency(Fave),amplitude (Famp), duration (Fdur), persistence (Fper) and chronodispersion (Fchr). The above parameters were obtained through the electric stimulation of ulnar and tibial nerves, and recorded from the abductor digiti minimi and extensor digitorum brevis, respectively. Results No definite F-wave was obtained by electric stimulation of ulnar nerve at 1 week after injection in 3 HFS patients (5 nerves). The Fave recorded from electric stimulation of ulnar and tibial nerves prolonged significantlyand Fdur from ulnar nerve increased significantly at 1 week after injection, but were not significantly different from those of pre-injection when recorded at 12 to 24 weeks after injection. No significant correlation of the altered F-wave parameters was found with the dosage of BTX-A. Conclusion Fdur and Fave could sensitively assess the remote effect of the local injection of BTX-A, the remote effect might be correlated with the distance between injected muscle and tested muscle, rather than the dosage of BTX-A.

Randomized placebo-controlled trials are the primary means of evaluating the effectiveness of treatments. Patients experience symptom relief or adverse effects after taking placebo, which is called placebo effects or nocebo effects. The placebo and nocebo effects are particularly common in headache and have an important impact on the results of clinical trials, so it is important to understand its mechanism and influencing factors. This review describes the mechanism, clinical manifestations and risk factors of placebo and nocebo effects in headache treatment, and discusses how to avoid the placebo and nocebo effects on clinical treatment.

Objective To investigate prospectively the diagnostic significance of ulnar/median nerve amplitude ratio in motor neuron disorders.Methods Patients referral to our department between May 2009 and February 2012,due to muscle weakness,inflexible,cramps and atrophy,were consecutively enrolled.Conventional nerve conduction studies of 4 extremities (using surface electrodes) and needle electromyography were performed in all patients with fixed examiner.The compound muscle action potentials (CMAP) were recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) with stimulation of ulnar and median nerve at wrist,respectively.Moreover,the ratio of CMAP amplitude between ADM and APB (ADM/APB) was calculated in the patients who met the diagnostic criteria for definite amyotrophic lateral sclerosis (ALS) and Hirayama disease (HD).The patients with Guillain-Barré syndrome (GBS) and other popyneuropathies (PN) were served as case-controls,and 34 healthy volunteers (aged (45.7 ± 16.3) years) as normal-controls.Results (1) There were 78 cases with ALS,25 HD,51 GBS and 140 other PN,with the mean age(years) of 54.7 ± 11.6,17.6 ± 2.2,41.3 ± 18.4 and 57.1 ± 14.3,respectively.(2) ADM/APB in the ALS subgroup was 2.28 ±2.87 (0.12-22.38),HD0.66±0.36 (0.05-1.34),GBS 1.42 ± 1.33 (0.25-9.85),other PN 1.36 ± 1.48 (0.08-14.44) and normal-controls 1.07 ± 0.28 (0.61-1.64,F =6.872,P =0.000),respectively.(3) The areas under receiver operator characteristic curve in patients with ALS was 0.830 (s-x =0.039) and HD 0.691 (sx =0.039,P =0.000) ; the diagnostic sensitivity and specificity for ALS patients were 36.7％ and 93.3％,respectively,with cutoff value of ADM/APB =2; and the diagnostic sensitivity and specificity for HD patients were 53.6％ and 89.0％,respectively,with cutoff value of ADM/APB =0.7.Conclusions The ulnar/median CMAP amplitude ratio increases in ALS,but decreases in HD,which may be served as a relatively specific electrophysiological index.ADM/APB amplitude ratio ＞ 2.0 is suggested to be a diagnostic parameter for ALS and ＜ 0.7 for HD.

Migraine and cardiovascular disease （CVD） impose huge economic burdens on societies.Currently，research reports on the association of migraine with CVD are lacking.Recent studies have indicated that the incidence of CVD is significantly higher in patients with migraine compared with the general population.Therefore，this paper provides a concise review of the existing evidence linking migraine to CVD and the potential underlying mechanisms.

Acid sensing ion channels (ASICs) are voltage-independent,proton-gated,cation-selective channels composed of 6 different subunits which are encoded by 4 genes.These channels are sensitive to extracellular protons and open when the pH value decreases.Recently,accumulating evidences have suggested that activation of ASICs is involved in many physiological and pathological conditions associated with tissue acidification,including synaptic transmission,inflammation,ischemia,pain and epileptic seizures.Therefore,targeting these channels emerges as a potential promising therapeutic strategy to combat these diseases.This review will focus on the structure and distribution of ASICs,with special emphasis on their changes in the process of epilepsy,the influence they exert on seizure severity,as well as the possible mechanisms by which they modulate this disease.

Homeostatic synaptic plasticity is an important negative feedback regulation mechanism that maintains the functional stability of the nervous system, acting by regulating the release of presynaptic neurotransmitters or interfering with the synthesis of postsynaptic receptors. A series of studies have demonstrated strong links between homeostatic synaptic plasticity and a variety of seemingly disparate neurological and psychiatric disorders, including autism spectrum disorder, intellectual disability, schizophrenia, fragile X syndrome, etc. In-depth understanding of homeostatic synaptic plasticity at cellular and molecular levels may help finding new targets and therapies for treatment of these related diseases. In this review, we explore the possible mechanisms of synaptic homeostasis regulatory system in neurological diseases as follows.

Background: and Purpose We aimed to determine the clinical features of Miller Fisher syndrome (MFS) in southern China and compare them with those presenting in other countries. Methods: We collected the medical records of patients diagnosed with MFS during 2013–2016.We analyzed the age, sex, onset season, precursor events, clinical symptoms and signs, findings of nerve conduction studies (NCS), cerebrospinal fluid (CSF), therapeutic remedies, nadir time, and length of hospital stay of patients with MFS in southern China. We concurrently compared the differences between urban and rural areas and between patients with incomplete ophthalmoplegia (IO) and complete ophthalmoplegia (CO). Results: The study enrolled 72 patients: 36 from rural areas and 36 from urban areas, and 50 males and 22 females. The mean age at onset was 47.72 years, and 30 (41.7%) and 21 (29.2%) patients developed MFS in spring and winter, respectively. The typical triad of ophthalmoplegia, ataxia, and areflexia was observed in 50 (69.4%) patients. A history of upper respiratory tract infection 1 week before onset was found in 52.8% of the patients, while 5.6% experienced gastrointestinal infections and 48 (73.8%) exhibited albuminocytological dissociation in the CSF study. Only 26 (36.1%) patients presented abnormalities in NCS. Moreover, restricted outward eyeball movement presented in 83.5% of the patients with classic MFS and acute ophthalmoplegia, and bilateral symmetrical ophthalmoplegia presented in 64.2%. With the exception of the higher proportion of NCS abnormalities in urban areas (47.2% vs. 25.0%), urban and rural differences were insignificant regarding sex ratio, age at onset, high-incidence season, precursor events, disease characteristics, and albuminocytological dissociation in the CSF. Furthermore, patients with CO were older than those with IO (64.53±7.69 vs. 43.19±14.40 years [mean±standard deviation], p<0.001). Conclusions The patients with MFS were mostly male and middle-aged, and most presented in winter and (especially) spring. More than half of the patients had clear precursor events, most of which were classic MFS with the typical triad. More than 70% of the patients presented albuminocytological dissociation in the CSF. NCS abnormalities were uncommon in MFS. The age at onset was lower in patients with IO than in patients with CO; bilateral symmetrical extraocular muscle paralysis was the most common symptom, and the external rectus was the most frequently involved muscle.

Objective To systematically evaluate the efficacy and safety of decompressive craniectomy and conservative treatment within 48 h of onset in malignant middle cerebral artery infarction.Methods Cochrane Library,Pubmed,Embase,CNKI,Chinese Biomedical Database,VIP information database,Wanfang database were searched,and the retrieval time was from the library being built to April 31,2015.Review Mannager 5.2 statistical analysis software was used to evaluate the treatment efficacy of decompressive craniectomy and conservative therapy,amd modified Rankin scale (mRS) scores were considered as the efficacy evaluation criteria.Results A total of six randomized controlled trial studies and two prospective studies were selected,including 201 patients from the decompressive craniectomy group and 197 patients from the conservative treatment group.The mortality of the two groups atter 12 months of treatment was significantly different (mRS scores=6,P=-0.000,OR=0.18,95％ CI:0.12-0.29).Moderate or severe disability rate after 6 months of treatment was significantly different (mRS scores=4-5,P=0.000,OR=3.36,95％CI:1.95-5.78),and that after 12 months of treatment was also significantly different (P=0.000,OR=4.62,95％CI:2.64-8.07).The number of patients enjoyed good life quality (mRS scores ≤ 3) 6 and 12 months after treatment between the two groups was statistically significant (P=0.010,OR=2.69,95％CI:1.21-5.96;P=0.020,OR=2.07,95％CI:1.11-3.87);mortality rate (mRS scores=6) and disability rate (mRS scores=3-5) of patients aged more than 60 years between the two groups were significantly different (P=0.000,OR=0.20,95％CI:0.10-0.42;P=0.000,OR=4.94,95％CI:2.35-10.35).Conclusion Regardless of age greater or less than 60 years old,decompressive craniectomy can significantly reduce the mortality of patients with malignant middle cerebral artery infarction within 48 hours as compared with conservative treatment,but surgery may increase moderate to severe disability.

Objective To investigate the mechanism of acid sensing ion channel (ASIC) 1a in the development of Purkinje cells in the cerebellum.Methods Newborn C57BL/6 mice were chosen and Purkinje cells were obtained from these mice by in vitro culture.Purkinje cells were divided into experimental group and control group,and shRNA-ASIC1a or shRNA-control sequence was used to construct recombinant plasmid lentivirus infections at the early and late stages of cell developments.The morphological structures of Purkinje cells were detected by immunofluorescent staining and the dendritic branches were counted at the early and late stages of cell developments.Western blotting was employed to detect the calcium binding protein D-28K,glial fibrillary acidic protein,Zic,parvalbumin and N-methyl-D-aspartate receptor (NMDAR) expressions.Real time (RT)-PCR was used to detect the expressions of endoplasmic reticulum stress related factor CCAAT/enhancer binding protein homologous protein CHOP and protein kinase R-like ER kinase (PERK).Results Immunofluorescence indicated that Purkinje cells showed obvious morphological differences between the experimental group and control group;the dendrite growth and development in the control group were significantly better than those in the experimental group (P＜0.05);the number of 2nd and 3nd stage dendritic branches of Purkinje cells in the control group was significantly larger than that in the experimental group (P＜0.05).Western blotting showed that D-28K expression in the Purkinje cells of experimental group was significantly decreased as compared with that in the control group at the early stage (P＜0.05);NMDAR expression in the Purkinje cells of experimental group was significantly increased as compared with that in the control group at the early and late stages (P＜0.05).RT-PCR results showed that CHOP and PERK expressions in the Purkinje cells of experimental group were significantly higher than those in the control group (P＜0.05).Conclusion ASIC1a has an important role in the development of cerebella Purkinje cells.