Most of the medical colleges and universities in China follow the traditional three-stage teaching mode centering on subjects, and a number of colleges and universities have implemented the teaching mode of organ-system-based curriculum (OSBC). With the OSBC course for the nervous system in our university as an example, this article analyzes the advantages and challenges of OSBC course of the nervous system in the context of integrative medicine.
Neurology

Migraine is the most common disabling primary headache with a significant socioeconomic burden. At present, some emerging drugs for migraine preventive treatment are under investigation internationally, which significantly promote the progress of migraine treatment. However, only few of this trial for migraine treatment are explored in China. In order to promote and standardize controlled clinical trials of migraine preventive therapy in China, and to provide methodological guidance for the design, implementation and evaluation of clinical trials, the Headache Collaborators of Chinese Society of Neurology formulated this consensus.
Humans ; Adult ; Consensus ; Migraine Disorders/therapy* ; Headache ; China ; Neurology

Objective: To retrospectively investigate the clinical data, radiological characteristics, treatment, and outcome of patients with parenchymal neuro-Behcet's disease (P-NBD) with particular emphasis on dizziness. Methods: This was a cross-sectional study of clinical data from 25 patients with a confirmed diagnosis of P-NBD who were admitted to the Department of Neurology of the First Medical Center of Chinese People's Liberation Army General Hospital between 2010 and 2022. The median age of the population was 37 years (range: 17-85 years). Clinical data were retrospectively analyzed, including gender, age of onset, disease duration, clinical manifestations, serum immune indicators, cerebrospinal fluid (CSF) routine biochemical and cytokine levels, cranial and spinal magnetic resonance imaging (MRI) findings, treatment, and outcome. Results: The majority of patients were male (16 cases; 64.0%), the mean age of onset was (28±14) (range: 4-58 years), and the disease course was acute or subacute. Fever was the most common clinical presentation, and the complaint of dizziness was not uncommon (8/25 patients). Analysis of serum immune indices, including complement (C3 and C4), erythrocyte sedimentation rate, interleukin-1 (IL-1), IL-6, IL-8 and tumor necrotic factor-alpha were abnormal in 80.0% of patients (20/25). Most of the 16/25 patients who underwent lumbar puncture tests had normal intracranial pressure and increased CSF white cell count and protein [median values were 44 (15-380) ×10⁶/L and 0.73 (0.49-2.81) g/L, respectively]. Of the five patients who underwent CSF cytokine tests, four patients had abnormal results; of these, an elevated level of IL-6 was most common, followed by IL-1 and IL-8. The most common site of involvement in cranial MRI was the brainstem and basal ganglia (60.0% respectively), followed by white matter (48.0%) and the cortex (44.0%). Nine cases (36.0%) showed lesions with enhancement and six cases (24.0%) showed mass-like lesions. Three patients (12.0%) patients had lesions in the spinal cord, most frequently in the thoracic cord. All patients received immunological intervention therapy; during follow up, the majority had a favorable outcome. Conclusions: P-NBD is an autoimmune disease with multiple system involvement and diverse clinical manifestations. The symptom of dizziness is not uncommon and can be easily ignored. Early treatment with immunotherapy is important and can improve the outcome of these patients.
Humans ; Male ; Female ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Behcet Syndrome/diagnosis* ; Interleukin-6 ; Retrospective Studies ; Cross-Sectional Studies ; Interleukin-8 ; Magnetic Resonance Imaging ; Neurology

Introduction. The COVID-19 pandemic presented an extraordinary challenge to the operations of private hospitals involved in neurological residency training. Numerous adaptations were made to restructure the hospital, including the special units and diagnostic centers. Teaching and training activities were swiftly transitioned to online platforms and research activities were streamlined. Manpower allocation into teams with active duties followed by mandatory quarantine periods became the norm.

Objective. To evaluate the effect of the COVID-19 pandemic on the neurology training program by comparing two periods: pre-pandemic and pandemic periods.

Methods. We reviewed the changes implemented by the hospital in response to the pandemic. We also looked into our residency training program pre-pandemic and the subsequent changes instituted to adapt to the pandemic.

Results. Due to the community quarantine imposed by the government, there was a drastic drop by as much as 70.5% in the out-patient census, 38.4% in the in-patient census, and 46.9% in neurodiagnostic (electroencephalography and electrodiagnostic medicine). The residents were reorganized into three teams of 4 residents, further divided into COVID and non-COVID rotations for 5 days straight duty. Consultants were also stratified into high-risk (on-call for emergency referrals in a work-from-home scheme) and non-high-risk (COVID patient rounds). Teleconsultation was likewise utilized. Academic activities were shifted to blended online learning.

Conclusion. There was a need to reorganize resident staffing brought about by the hospital changes as well, to ensure safety during the pandemic. The pandemic has forced us to shift to alternative methods of teaching and examination, such as teleneurology. Regular assessments and adjustments to the training program will need to be done to adapt to an evolving situation.

This is a case of a 7-year-old Filipino female who presented with undulating movements of the abdomen that occur only while awake, following the initiation of treatment for clinically diagnosed pulmonary tuberculosis. Systemic physical examination was normal. The neurological examination was also unremarkable. The 2-hr video EEG showed no electroencephalographic changes or ictal pattern correlating with the abdominal dyskinesia, highly suggesting a movement disorder. Craniospinal Magnetic Resonance Imaging (MRI) with Gadolinium showed typical results. The patient responded to the trial of carbamazepine after three weeks of treatment with complete resolution of abdominal dyskinesia.
Neurology ; Movement Disorders

Background and objective : Neurodevelopmental disabilities in adolescents have signifi cant effects on medical and social function. One of these challenges is their transition into adult care. Parental involvement is critical because these young adults may have more diffi culties in making informed decisions independently. Thus, the transition process involves not only the direct health care needs of the young adult, but the needs and concerns of the parents or carers who are instrumental in guiding that process. This study aims to explore the expectations and experiences of family carers of youths with chronic neurodevelopmental disorders who have undergone or are about to undergo transition into adult healthcare in a Filipino-based health care system. Methods: A descriptive phenomenology was used to gain an in-depth understanding of parents’ perceptions and experiences of their youths’ transition process from a pediatric to an adult health care setting. The results were analyzed manually using Colaizzi’s method, which involves integrating both the destructured and restructured analysis principles of phenomenology. Purposive sampling was used to interview 13 family carers of 13 youths with various neurodevelopmental disorders using a semi-structured interview questionnaire. Results : Despite the lack of information on the transition process, our study found that carers did not have a strong inclination to resist the transition event. Most of the carers treat the health care provider as a major decision maker in determining the timing and manner of transition, adopting a “doctor knows best” attitude. Several other hindrances and facilitators to successful transition were also identifi ed and are similar to the current literature. Conclusion This study provides a greater understanding of carers’ perceptions and experiences of transition care for youths with neurodevelopmental disorders in the local setting. They exhibited trust and confi dence in the medical profession as a whole, and had a “doctor knows best” attitude that may enable successful transitioning.
Transitional Care ; Neurology ; Neurodevelopmental Disorders ; Caregivers

PURPOSE: We report two cases of uveo-meningeal syndrome involving the retina, uvea, and optic disc in both eyes after viral meningitis. CASE SUMMARY: A 16-year-old female was referred to our department with blurred vision in both eyes. She was hospitalized in the pediatric ward with viral meningitis. She showed a norma best-corrected visual acuity (BCVA) and normal intraocular pressure in both eyes, but had severe inflammation in the anterior chamber on slit lamp examination, and optic disc edema and multiple whitish lesions on fundus examination. She was treated with intravenous antibiotic injections and steroid eye drops. After close observation, inflammation in the anterior chamber, optic disc edema, and the multiple whitish lesions in the retina were improved. A 27-year-old male who was treated for viral meningitis at the neurology department was referred to us with blurred vision in both eyes. His BCVAs were 0.7 (right eye) and 0.6 (left eye). The intraocular pressure was normal in both eyes. Slit lamp examination revealed inflammation in the anterior chamber and optic disc edema, and a fundus examination revealed multiple infiltrations. He received treatment for presumed herpes virus infection. After close observation, inflammation in the anterior chamber, optic disc edema, and multiple infiltrations with hemorrhage in the retina were improved. CONCLUSIONS: Clinicians should consider the possibility of uveo-meningeal syndrome, which can cause inflammation in the uvea,retina, and optic disc simultaneous with viral meningitis accompanying blurred vision.
Adolescent ; Adult ; Anterior Chamber ; Edema ; Female ; Hemorrhage ; Humans ; Inflammation ; Intraocular Pressure ; Male ; Meningitis ; Meningitis, Viral ; Neurology ; Ophthalmic Solutions ; Retina ; Slit Lamp ; Uvea ; Vision Disorders ; Visual Acuity

The aim of this study was to compare and quantify the spatiotemporal and gait parameters obtained by foot pressure analysis during the gait in a group of Parkinson's disease (PD) patients compared with other Parkinsonism diseases, especially multiple system atrophy (MSA). Thirty-seven out of ninety-three patients who visited the center of neurology or rehabilitation with features of Parkinsonism were recruited. Spatiotemporal gait parameters were collected using gait analysis system. The results did not differ in terms of the stride length, step width, double stance phase, stride time, cadence, velocity, gait line and single support line differences, anterior-posterior position of center of pressure, and maximal gait line velocity; the lateral symmetry showed a significant difference between the PD and the MSA groups (p < 0.05). The study evaluated the differences in terms of spatiotemporal parameters between the PD and MSA along with other Parkinsonism diseases; it showed that the PD patients had a gait tendency to deviate laterally compared to the MSA patients. The result suggests conducting the gait foot pressure analysis might help distinguish PD from other Parkinsonism diseases in early stage, aiding the early decision for the treatment plans.
Foot ; Gait ; Humans ; Multiple System Atrophy ; Neurology ; Parkinson Disease ; Parkinsonian Disorders ; Rehabilitation

INTRODUCTION: The objective of this focus group discussion was to explore the experiences and perceptions
of former medical students with the undergraduate neurology curriculum.

METHODS: Perceptual patterns were derived from transcriptions of the discussion of the participants in a
focus group discussion involving faculty, residents and postgraduate interns. Data were analyzed using
latent content analysis and constant comparison techniques.

RESULTS: Shared experiences in clinical clerkship were mostly negative. The difficult initial patient encounters
were suggested to be minimized through hierarchal modeling, modification of the subject contents and
early clinical exposures. An environment created to be conducive to learning and neuroscience subjects
suited for the primary physician will equip the medical graduates better. The perceived pressures forced
the participants to find ways to cope. Neuroanatomy helped much in the clinics. The group suggested
more clinical correlates and the use of drawings to aid the graduates attain the competency in neurology
for a primary physician.

CONCLUSION: The participants' experiences were largely negative and were brought about by a varied form
of pressures. Contributing factors were identified and suggestions to improve learning and retention
were given.

The nineteenth century neuroscience studied the instinct of animal to understand the human mind. In particular, it has been found that the inheritance of unconscious behavior like instinct is mediated through ganglion chains, such as the spinal cord or sympathetic nervous system, which control unconscious reflexes. At the same time, the theory of Inheritance of Acquired Characteristics (hereafter ‘IAC’) widely known as Lamarck's evolutionary theory provided the theoretical frame on the origin of instinct and the heredity of action that the parental generation's habits were converted into the nature of the offspring generation. Contrary to conventional knowledge, this theory was not originally invented by Lamarck, and Darwin also did not discard this theory even after discovering the theory of natural selection in 1838 and maintained it throughout his intellectual life. Above all, in the field of epigenetics, the theory of ‘IAC’ has gained attention as a reliable scientific theory today. Darwin discovered crucial errors in the late 1830s that the Lamarck version's theory of ‘IAC’ did not adequately account for the principle of the inheritance of unconscious behavior like instinct. Lamarck's theory regarded habits as conscious and willful acts and saw that those habits are transmitted through the brain to control conscious actions. Lamarck's theory could not account for the complex and elaborate instincts of invertebrate animals, such as brainless ants. Contrary to Lamarck's view, Darwin established the new theory of ‘IAC’ that could be combined with contemporary neurological theory, which explains the heredity of unconscious behavior. Based on the knowledge of neurology, Darwin was able to translate the ‘principle of habit’ into a neurological term called ‘principle of reflex’. This article focuses on how Darwin join the theory of ‘IAC’ with nineteenth century neuroscience and how the neurological knowledge from the nineteenth century contributed to Darwin's overcoming of Lamarck's ‘IAC’. The significance of this study is to elucidate Darwin's notion of ‘IAC’ theory rather than natural selection theory as a principle of heredity of behavior. The theory of ‘IAC’ was able to account for the rapid variation of instincts in a relatively short period of time, unlike natural selection, which operates slowly in geological time spans of tens of millions of years. The nineteenth century neurological theory also provided neurological principles for ‘plasticity of instinct,’ empirically supporting the fact that all nervous systems responsible for reflexes respond sensitively to very fine stimuli. However, researchers of neo-Darwinian tendencies, such as Richard Dawkins and evolutionary psychologists advocating the ‘selfish gene’ hypothesis, which today claim to be Darwin's descendants, are characterized by human nature embedded in biological information, such as the brain and genes, so that it cannot change at all. This study aims to contribute to reconstructing the evolutionary discourse by illuminating Darwin's insights into the “plasticity of nature” that instincts can change relatively easily even at the level of invertebrates such as earthworms.
Animals ; Ants ; Brain ; Epigenomics ; Ganglion Cysts ; Heredity ; Human Characteristics ; Humans ; Instinct ; Invertebrates ; Nervous System ; Neurology ; Neurosciences ; Oligochaeta ; Parents ; Psychology ; Reflex ; Selection, Genetic ; Spinal Cord ; Sympathetic Nervous System ; Transcutaneous Electric Nerve Stimulation ; Wills