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.

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.

In clinical trials and animal models, indolent substances have been observed to induce pain relief (placebo analgesia) or increased pain (nocebo hyperalgesia). In recent years, advances in neurobiology field are not only about simple superposition of psychological mechanisms, but also about complex changes in neural networks. This article summarizes the neurophysiological changes and activated characteristics of brain regions in placebo analgesia and nocebo hyperalgesia, and expounds the underlying mechanisms involved in placebo analgesia and nocebo hyperalgesia in these brain regions, and how different brain regions interact with each other.

Abstract: Objective To explore the pain threshold, current perception threshold and pain tolerance threshold of migraine patients in the interpartial period of headache, so as to clarify their sensory sensitivity. Methods From September 2019 to June 2021 ,27 migraine patients and healthy subjects with matched age, gender and education level were collected in Department of Neurology, People’s Hospital of Wuhan University. During the interpartial period of migraine, the pain perception threshold (PPT) of the bilateral first trigeminal nerve and median nerve was measured by the Von Frey fiber, and the current perception thresholds (CPT) of the bilateral first trigeminal nerve and median nerve and the pain tolerance threshold(PTT) of the bilateral median nerve were recorded by sensory nerve quantitative detector. Results In our study, no significant statistical differences were found between PPT and CPT and healthy controls, but PTT values were significantly decreased compared with the control group. Conclusion The reduced threshold of pain tolerance during interpartial period may be related to central sensitization, which may be caused by abnormal sensory inputs of Aδ and C fibers.

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.

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 analyze the clinical features and validation of Brighton criteria in Guillain-Barré syndrome (GBS) patients from southern China.Methods The clinical data of hospitalized GBS patients from 69 hospitals of 14 provinces/cities in southern China,the area south of the Huaihe River,between 1 January 2013 and 30 September 2016,were collected and analyzed retrospectively,and patients were classified according to the Brighton criteria of case definition,ranging from a highest (defined as level one) to a lowest (level four) level of diagnostic certainty.Results A total of 1 358 GBS patients were collected,including 51 cases with cranial nerve variants,157 with Miler-Fisher syndrome and 1 150 with classic GBS characterized by flaccid weakness of limbs.Among 1 150 cases of classic GBS,49.57％ (570/1 150) patients had antecedent events,with respiratory infection predominated (71.23％,406/570);83.74％ (963/1 150) presented limb weakness at onset,99.21％ (1 124/1 133) reached the peak within four weeks,with a score of 3.15 ± 1.16 for Hughes Disability Scale;99.56％ (1 128/1 133)developed bilateral weakness and 95.39％ (1 097/1 150) manifested flexia or hyporeflexia;the cerebrospinal fluid showed albuminocytologic dissociation in 80.58％ (772/958) patients whose lumbar puncture was performed;demyelinating GBS accounted for 48.14％ (401/833) and axonal subtype 18.01％ (150/833) respectively in patients with findings of nerve conduction studies available.According to Brighton criteria,the patients were stratified as level one in 44.09％ (507/1 150),level two in 45.74％ (526/1 150),level three in 7.57％ (87/1 150) and level four in 2.61％ (30/1 150) of all the patients,and 69.55％ (507/729),28.67％ (209/729),0％ (0/729) and 1.78％ (13/729),respectively in the patients with complete data (n =729).Conclusions In southern China,demyelinating subtype of GBS is predominant,whereas the proportion of axonal subtype is remarkably lower than that in northern China.The Brighton criteria have a high sensitivity for the diagnosis of GBS in southern China,and examination of cerebrospinal fluid and electrodiagnostic studies are necessary for stratified diagnosis.

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.

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.

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.