Transmission Dynamics and Optimal Control Strategies of a Hand-Foot-Mouth Disease Model with Treatment and Vaccination Interventions

In this article, the transmission dynamics of a Hand-Foot-Mouth disease model with treatment and vaccination interventions are studied. We calculated the basic reproduction number and proved the global stability of disease-free equilibrium when R0 R0 > 1. Meanwhile, we obtained the optimal control strategies minimizing the cost of intervention and minimizing the infected person. We also give some numerical simulations to verify our theoretical results.

Correlation of serum NSE and S100β levels with inflammatory response and immune response in children with hand-foot-mouth disease complicated by encephalitis

Objective:To study the correlation of serum NSE and S100β levels with inflammatory response and immune response in children with hand-foot-mouth disease (HFMD) complicated by encephalitis.Methods:Children who were diagnosed with hand-foot-mouth disease in Yulin Third Hospital between May 2015 and February 2017 were selected, children who were combined with central nervous system were selected as severe group, and children who were not combined with central nervous system were selected as mild group;children who received physical examination during the same period were selected as the control group. Serum was collected to determine the contents of NSE, S100β and inflammatory response mediators, and peripheral blood was collected to determine the contents of T cell subsets and NK cells.Results: Serum NSE and S100β levels of severe group and mild group were significantly higher than those of control group, and serum NSE and S100β levels of severe group were significantly higher than those of mild group;serum TNF-α, IL-6, IL-10, IL-17 and PCT levels as well as peripheral blood HLA-DR+CD4+, HLA-DR+CD8+, CD38+CD4+ and CD38+CD8+ levels of severe group and mild group were significantly higher than those of control group while peripheral blood CD3+T cell, CD4+T cell, CD8+T cell and NK cell levels were significantly lower than those of control group;serum TNF-α, IL-6, IL-10, IL-17 and PCT levels as well as peripheral blood HLA-DR+CD4+, HLA-DR+CD8+, CD38+CD4+ and CD38+CD8+ levels of severe group were significantly higher than those of mild group and positively correlated with NSE and S100β levels while peripheral blood CD3+T cell, CD4+T cell, CD8+T cell and NK cell levels were significantly lower than those of mild group and negatively correlated with NSE and S100β levels.Conclusion: The increase of serum NSE and S100β levels in children with HFMD complicated by encephalitis is closely related to inflammatory response activation and immune response disorder.

Anti-IgLON5 disease: a novel topic beyond neuroimmunology

Anti-IgLON5 disease is a recently defined autoimmune disorder of the nervous system associated with autoantibodies against IgLON5. Given its broad clinical spectrum and extremely complex pathogenesis, as well as difficulties in its early diagnosis and treatment, anti-IgLON5 disease has become the subject of considerable research attention in the field of neuroimmunology. Anti-IgLON5 disease has characteristics of both autoimmunity and neurodegeneration due to the unique activity of the antiIgLON5 antibody. Neuropathologic examination revealed the presence of a tauopathy preferentially affecting the hypothalamus and brainstem tegmentum, potentially broadening our understanding of tauopathies. In contrast to that seen with other autoimmune encephalitis-related antibodies, basic studies have demonstrated that IgLON5 antibody-induced neuronal damage and degeneration are irreversible, indicative of a potential link between autoimmunity and neurodegeneration in antiIgLON5 disease. Herein, we comprehensively review and discuss basic and clinical studies relating to anti-IgLON5 disease to better understand this complicated disorder.

Clinical and neuroimaging features of enterovirus71 related acute flaccid paralysis in patients with hand-foot-mouth disease

Objective:To investigate clinical and neuroimaging features of enterovirus71(EV71) related acute flaccid paralysis in patients with hand-fool-mouth disease.Methods:Nine patients with acute flaccid paralysis met the criterion of EV71 induced hand-foot-mouth disease underwent spinal and brain MR imaging from May 2008 to Sep 2012.Results:One extremity flaccid was found in four cases(3 with lower limb,1 with upper limb),two limbs flaccid in three cases(2 with lower limbs,1 with upper limbs),and four limbs flaccid in two cases.Spinal MRI studies showed lesion with high signal in T2-weighted images(T2WI) and low signal T1-weighted images(T1WI) in the spinal cord of all nine cases,and the lesions were mainly in bilateral and unilateral anterior hom of cervical spinal cord and spinal cord below thoracic 9(T9) level.In addition,the midbrain,pons, and medulla,which were involved in 3 cases with brainstem encephalitis,demonstrated abnormal signal.Moreover,spinal cord contrast MRI studies showed mild enhancement in corresponding anterior hom of the involved side,and strong enhancement in its ventral root.Conclusions: EV71 related acute flaccid paralysis in patients with hand-foot-mouth disease mainly affected the anterior hom regions and ventral root of cervical spinal cord and spinal cord below T9 level. MR imaging could efficiendy show the characteristic pattern and extent of the lesions which correlated well with the clinical features.

Application of Seasonal Auto-regressive Integrated Moving Average Model in Forecasting the Incidence of Hand-foot-mouth Disease in Wuhan,China

Outbreaks of hand-foot-mouth disease（HFMD） have occurred many times and caused serious health burden in China since 2008. Application of modern information technology to prediction and early response can be helpful for efficient HFMD prevention and control. A seasonal auto-regressive integrated moving average（ARIMA） model for time series analysis was designed in this study. Eighty-four-month（from January 2009 to December 2015） retrospective data obtained from the Chinese Information System for Disease Prevention and Control were subjected to ARIMA modeling. The coefficient of determination（R^2）, normalized Bayesian Information Criterion（BIC） and Q-test P value were used to evaluate the goodness-of-fit of constructed models. Subsequently, the best-fitted ARIMA model was applied to predict the expected incidence of HFMD from January 2016 to December 2016. The best-fitted seasonal ARIMA model was identified as（1,0,1）（0,1,1）12, with the largest coefficient of determination（R^2=0.743） and lowest normalized BIC（BIC=3.645） value. The residuals of the model also showed non-significant autocorrelations（P_（Box-Ljung（Q））=0.299）. The predictions by the optimum ARIMA model adequately captured the pattern in the data and exhibited two peaks of activity over the forecast interval, including a major peak during April to June, and again a light peak for September to November. The ARIMA model proposed in this study can forecast HFMD incidence trend effectively, which could provide useful support for future HFMD prevention and control in the study area. Besides, further observations should be added continually into the modeling data set, and parameters of the models should be adjusted accordingly.

Clinical observation on the treatment of severe hand-foot-mouth disease with antelope horn powder combined with auricular point application

Objective:To explore the Clinical observation on the treatment of severe hand-foot-mouth disease with antelope horn powder combined with auricular point application.Methods:From July 2016 to June 2018,90 children were randomly divided into control group(n=30),treatment group(n=30)and control group(n=30).The control group was treated with routine western medicine,the treatment group 1 was treated with oral antelope horn powder on the basis of control group,the second group was treated with auricular point application on the basis of treatment group 1,and the time of symptom relief and clinical cure were observed in each group.Related immune function and related inflammatory factors,serum neuron-specific enolase(NSE),safety index.Results:In treatment group 1,the time of herpes regression,antipyretic,antispasmodic time and clinical cure time were shorter than those of control group,and the time of treatment 2 group was shorter than that of group 1(P<0.05).The levels of CD3,CD4 and CD8 were increased after treatment in the three groups,especially in the treatment group(P<0.05),and the levels of TNF-毩αand IL-2,IL-6,IL-10 were decreased after treatment in the three groups,especially in the treatment group(P<0.05).NSE decreased after treatment in three groups,especially in treatment group 2(P<0.05).Conclusion:The application of antelope horn powder combined with auricular point application can obviously improve the severe hand,foot and mouth disease,and the clinical curative effect is definite.It is worth popularizing and applying in clinical practice.

Effect of interferon + Potassium Sodium Dehydroandrograpolide Succinate therapy on inflammatory response and immune response in children with hand-foot-mouth disease

Objective: To investigate the effect of interferon + Potassium Sodium Dehydroandrograpolide Succinate therapy on inflammatory response and immune response in children with hand-foot-mouth disease. Methods: A total of 116 children with hand-foot-mouth disease who were treated in this hospital between September 2016 and February 2018 were selected as the study subjects and divided into the control group (n=58) and the Potassium Sodium Dehydroandrograpolide Succinate group (n=58) by random number table method. Control group received symptomatic + interferon therapy, and Potassium Sodium Dehydroandrograpolide Succinate group received symptomatic + interferon + Potassium Sodium Dehydroandrograpolide Succinate therapy, and they were treated for 1 week. The differences in the serum contents of inflammatory factors, adhesion molecules and humoral immunity indexes were compared between the two groups before and after treatment. Results:Before treatment, serum levels of inflammatory factors, adhesion molecules and humoral immunity indexes were not significantly different between the two groups. After 1 week of treatment, serum inflammatory factors IL-1β, IL-10, PCT and hs-CRP levels of Potassium Sodium Dehydroandrograpolide Succinate group were lower than those of control group;serum adhesion molecules CD44, ICAM-1 and VCAM-1 levels were lower than those of control group;serum humoral immunity indexes IgA, IgG, C3 and C4 levels were lower than those of control group. Conclusion: Interferon + Potassium Sodium Dehydroandrograpolide Succinate therapy can effectively reduce the systemic inflammatory response and improve the humoral immune function in children with hand-foot-mouth disease.

Clinical characteristics and treatment of severe encephalitis associated with neurogenic pulmonary edema caused by enterovirus 71 in China

BACKGROUND： Hand-foot-mouth disease has become a major public health issue in children in China. In the present prospective study we investigated the clinical characteristics and emergency management of children with severe encephalitis associated with NPE caused by enterovirus 71.METHODS： The study was conducted in 2 pediatric intensive care units （PICUs） over a 2-month period. Clinical records were reviewed of critically ill children with severe encephalitis associated with NPE caused by EV71 who were admitted to PICUs during the period of May to June 2008 in Fuyang.RESULTS： We reviewed the complete records of 36 children, of whom 23 （63.9%） were male and 13 （36.1%） female. Their age ranged from 4 to 48 months, with an average of 15.8 months. All children except one were under 3 years of age. The overall mortality in these children was 19.4%. The average duration of critical life threatening signs and symptoms was 2.1 days （12 hours-5 days）. Nervous system diseases included brainstem encephalitis in 27 children （75%）, brainstem encephalitis associated with myelitis in 6 children （16.7%）, and general encephalitis in 3 chidren （8.3%）, respectively. In 12 patients of NPE （33.3%） pink or bloody bubble sputum and asymmetric pulmonary edema or hemorrhage was the primary manifestation but no typical exanthema was observed. Five children died of acute onset of NPE and / or pulmonary hemorrhage with rapid progression of cardiopulmonary failure within hours after admission. Therapeutic management consisted of mechanical ventilation and administration of mannitol, methylprednisolone, intravenous immunoglobulin （IVIG） and vasoactive drugs, associated with the need of fluid volume resuscitation in 9 （25%） of the 36 children.CONCLUSION： In children less than 3 years of age found to be affected by severe EV71 encephalitis associated with NPE, one fifth may die. The major organ systems infected by severe EV71 include the central nervous system, the respiratory system, and the cardiovascular system. Early diagnosis and evaluation, respiratory support, treatment of intracranial hypertension, and mainttenance of function of the cardiovascular system are the most important therapeutic measures.

Serial Brain Positron Emission Tomography Fused to Magnetic Resonance Imaging in Post-Infectious and Autoantibody-Associated Autoimmune Encephalitis

Serial positron emission tomography fused to magnetic resonance imaging showed progression of GAD65 autoimmune encephalitis.

Encephalitis with convulsive status in an immunocompetent pediatric patient caused by Bartonella henselae

Cat scratch's disease caused by Bartonella henselae, is known to be a self-limited benign process in immunocompetent children. The association with neurologic manifestations is very uncommon especially in patient with no immunologic defects and in cases without specific treatment. A 7 years old male patient, without any immunocromised defect, presented an atypic presentation of the cat scratch disease. The patient came to the hospital in two opportunities in a status epilepticus, in both cases the diagnosis was encephalitis by Bartonella henselae and the evolution with treatment was monitored with PCR(polymerase chain reaction) in cerebrospinal fluid and blood, as well as IFI(IgM, IgG) serology(indirect immunofluorescence). The patient had a favorable clinical and laboratory evolution for 6 months showing no recurrence of the disease.

Shuanghuanglian injection downregulates nuclear factor-kappa B expression in mice with viral encephalitis

A mouse model of viral encephalitis was induced by intracranial injection of a Coxsackie virus B3 suspension. Quantitative real-time reverse transcription-PCR and western blot assay were applied to detect mRNA and protein expression of intelectin-2 and nuclear factor-kappa B in the viral encephalitis and control groups. Nuclear factor-kappa B and intelectin-2 mRNA and protein expression were significantly increased in mice with viral encephalitis. After intraperitoneal injection of Shuanghuanglian at a dose of 1.5 mg/kg for 5 successive days, intelectin-2 and nuclear factor-kappa B protein and mRNA expression were significantly decreased. To elucidate the relationship between intelectin-2 and nuclear factor-kappa B, mice with viral encephalitis were administered an intracerebral injection of 107 pfu recombinant lentivirus expressing intelectin shRNA. Both protein and mRNA levels of intelectin and nuclear factor-kappa B in brain tissue of mice were significantly decreased. Experimental findings suggest that Shuanghuanglian injection may downregulate nuclear factor-kappa B production via suppression of intelectin production, thus inhibiting inflammation associated with viral encephalitis.

Chinese herbal medicine for hand-foot-and-mouth disease in children: An overview of systematic reviews

Objective:To summarize the use of Chinese herbal medicines (CHM) for the treatment of hand-foot-and-mouth disease (HFMD) in children and to provide high-level evidence for clinical decision-making.Methods:We conducted an overview of systematic reviews (SRs).Two English-language and four Chinese-language electronic databases were searched from inception to March 31,2018.Published SRs and meta-analyses evaluating CHM use in children with HFMD and reporting clinically-relevant outcomes such as time to fever resolution were eligible for inclusion in this overview.Reviews were accepted if the intervention featured CHM with or without other treatment.Two authors evaluated the methodological quality of the included SRs by using ASMTAR and ROBIS.Results:Thirty SRs comprising 90 244 children with HFMD were included in this overview of SRs.All SRs were published in Chinese between 2011 and 2017.All intervention arms received CHM with or without conventional treatment and were compared against control arms receiving no treatment,conventional treatment alone,or placebo.All 30 reviews reported the time to fever resolution and results demonstrated that CHM had a greater benefit in reducing fever compared with controls.Twenty-three reviews reported the time to rash resolution which presented similar results.Fourteen SRs reported the time to oral ulcer healing and CHM demonstrated a significantly reduced time to resolution compared to controls.The quality of the included SRs was low to moderate as assessed by the AMSTAR tool.Conclusion:Published reviews demonstrated potential benefits of CHM in children with HFMD.Overall,the methodological quality of reviews included in this overview of SRs was low and our findings should be interpreted with caution.We would strongly recommend that future SRs be designed and reported rigorously following PRISMA in order to provide more robust evidence on which to base clinical guidance.

Paroxysmal speech disorder as the initial symptom in a young adult with anti-N-methyl-D-aspartate receptor encephalitis: A case report

BACKGROUND Anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis is a treatable but frequently misdiagnosed autoimmune disease.Speech dysfunction,as one of the common manifestations of anti-NMDAR encephalitis,is usually reported as a symptom secondary to psychiatric symptoms or seizures rather than the initial symptom in a paroxysmal form.We report a case of anti-NMDAR encephalitis with paroxysmal speech disorder as a rare initial manifestation,and hope that it will contribute to the literature.CASE SUMMARY A 39-year-old man with anti-NMDAR encephalitis initially presented with paroxysmal nonfluent aphasia and was misdiagnosed with a transient ischemic attack and cerebral infarction successively.The patient subsequently presented with seizures,but no abnormalities were found on brain magnetic resonance imaging or electroencephalogram.Cerebrospinal fluid(CSF)analysis revealed mild pleocytosis and increased protein levels.Anti-NMDAR antibodies in serum and CSF were detected for a conclusive diagnosis.After immunotherapy,the patient made a full recovery.CONCLUSION This case suggests that paroxysmal speech disorder may be the presenting symptom of anti-NMDAR encephalitis in a young patient.

Prevalence analysis of hand,foot and mouth disease in China,2008-2018

Objective:To analyze the prevalence of hand,foot and mouth disease(HFMD)in China during 2008-2018 and to provide reference for the prevention and control of HFMD.Methods:Literature eligible for selection was retrieved from the China's national knowledge infrastructure project(CNKI),and data from 2008-2018 Chinese HFMD reports were systematically analyzed.Excel and SPSS 20.00 were used for statistical analysis,and GraphPad Prism 6 was used for mapping.Results:The analysis showed that the average incidence rate of HFMD in China from 2008 to 2018 was 123.37±93.14 cases per 100,000 people,with a male-to-female ratio of(1.50±0.15):1,and the vast majority of cases were concentrated in the under-5 age group,mainly in scattered children.The time of onset of HFMD showed obvious seasonal characteristics,in which single-peak provinces were higher than double-peak provinces,with double-peak trends in April-July and October-November,respectively,and single-peak trends mainly in May-July.Based on the spatial distribution study,the incidence pattern showed obvious regional differences(P<0.05),with high incidence concentrated in the southeastern part of the country,and a gradual increase in incidence from west to east and north to south of China.EV71,CA16 and other enteric viruses were the main pathogens of HFMD,with EV71 accounting for 53.5%,CA16 is accounting for 14.3%and other enteric viruses accounting for 32.2%of the pathogens.Conclusions:The incidence of HFMD in China is high,with obvious geographical,seasonal,gender and age distribution characteristics.According to the pattern of HFMD incidence in the region,early prevention and control of key areas and groups is an effective way to cut off the spread of the disease.

Persistent delayed auditory memory and executive function deficits 5 years after West Nile Virus Encephalitis: A neuropsychological and neuroimaging single case study

There are presently no in-depth published neuropsychological studies of West Nile Virus (WNV) encephalitis patients that have been well-correlated with high resolution structural MRI. In this study a middleaged male who developed West Nile Virus encephalitis five years previously was examined three times over a two year period. We examined him with the Wechsler Adult Intelligence Scales—Fourth Edition and the Wechsler Memory Scale—Fourth Edition (WAIS-IV/WMS-IV) and Advanced Clinical Solutions battery supplemented by tests of attention, executive, motor and sensory functions. Neuroradiological imaging revealed hypodensities within the left hippocampus in the axial and coronal planes with T2-FLAIR MRI. The man was previously high functioning and although he had prior history of well-controlled epilepsy it seems unlikely that the epilepsy could fully account for the neuropathological changes. The patient had previously completed a demanding six year double science degree program before he became ill with WNV and he had been a successful manager and director of a research company. Delayed auditory memory scores were at least two standard deviation units below age expected levels and semantic fluency and Booklet Category Tests of executive function were also in the impaired range. Moreover the illness onset profile of muscle weakness, extreme fatigue, memory complaints as well as inability to carry out research projects involving planning on the job were highly consistent with WNV encephalitis. If the memory and executive function deficits had been premorbid manifestations of epilepsy it is unlikely he would have attained the levels he did educationally and occupationally. This left hippocampal lesion is characteristic of other encephalitic viral infections such as herpes simplex virus. To our knowledge this is the first lateralized WNV encephalitis medial temporal lobe patient in the published literature.

Anti-N-methyl-D-aspartate Receptor Encephalitis Associated with Peripheral Nerve Injury:A Case Report

A patient with Anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis presented with quadriplegia and multiple peripheral neuropathy with axonal lesion,confirmed by electrophysiological examination.The muscle strength in the limbs of the patient gradually recovered almost completely,accompanied by the reversal of neuroelectrophysiological symptoms,and the improvement of clinical manifestations,including consciousness,respiration and cognitive function.It was revealed that the neuropathy in NMDAR encephalitis involved motor or sensorimotor nerves more than pure sensory nerves.No autoantibodies were detectable,in contrast to other anti-NMDAR overlapping syndromes.Although the underlying mechanism remains unclear,it may be associated with autoimmune generalization.In conclusion,when patients with NMDAR encephalitis present with severe limb paralysis,the possibility of peripheral nerve damage should be considered.

抗接触蛋白相关蛋白-2抗体相关脑炎临床特征分析

目的 总结抗接触蛋白相关蛋白-2(CASPR2)抗体相关脑炎的临床特征。方法与结果收集2017年8月至2022年8月中山大学附属第三医院诊断与治疗的13例抗CASPR2抗体相关脑炎患者。首发表现:9例表现为边缘系统症状,2例表现为周围神经症状(均为肢体疼痛),1例为小脑性共济失调,1例肢体乏力。抗CASPR2抗体检测:13例患者均进行血清抗CASPR2抗体检测,均呈阳性;10例患者接受脑脊液抗CASPR2抗体检测,5例呈阳性;有3例患者合并其他自身抗体阳性。头部MRI检查:13例患者中2例表现为单侧或双侧颞叶内侧T2-FLAIR成像高信号;2例存在脑微出血灶。治疗:2例仅单纯采用激素治疗,4例仅静脉注射免疫球蛋白,5例则先后接受激素+静脉注射免疫球蛋白治疗,1例仅接受利妥昔单抗治疗,1例先后接受静脉注射免疫球蛋白+激素+蛋白A免疫吸附+利妥昔单抗。随访:进行1~5年的随访,2例失访;1例患者自行停药后复发,经治疗后改良Rankin量表(mRS)评分为零;余10例患者中1例症状未见改善,1例部分症状存在不能正常生活,6例正常生活,2例死亡。结论 抗CASPR2抗体相关脑炎临床特征复杂,血清抗体检测对于明确诊断至关重要。

感染相关性自身免疫性脑炎临床特征分析

目的总结新疆地区不同抗体类型感染相关性自身免疫性脑炎的临床特征,并探讨相关实验室指标的诊断价值。方法共纳入2018年1月至2023年10月新疆维吾尔自治区人民医院诊断与治疗的47例感染相关性自身免疫性脑炎患者,包括抗富亮氨酸胶质瘤失活蛋白1(LGI1)抗体相关脑炎18例(38.30%)、抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎16例(34.04%)、抗髓鞘少突胶质细胞糖蛋白(MOG)抗体相关脑炎8例(17.02%)、抗γ-氨基丁酸B型受体(GABABR)脑炎5例(10.64%),采集社会人口学资料、临床表现、实验室及其他辅助检查结果,绘制受试者工作特征(ROC)曲线以评价相关实验室指标对不同抗体类型感染相关性自身免疫性脑炎的诊断价值。结果抗LGI1抗体相关脑炎、抗NMDAR脑炎、抗MOG抗体相关脑炎、抗GABABR脑炎患者发病年龄(χ^(2)=9.500,P=0.023),肌无力(χ^(2)=9.967,P=0.019)、视力下降(χ^(2)=9.967,P=0.019)和癫痫发作(χ^(2)=8.046,P=0.045),脑脊液白细胞计数(χ^(2)=15.237,P=0.002)和氯化物(F=4.156,P=0.011)差异具有统计学意义,其中,抗LGI1抗体相关脑炎患者发病年龄晚于抗NMDAR脑炎(Z=-2.384,P=0.017)和抗MOG抗体相关脑炎(Z=-2.420,P=0.016)患者,抗NMDAR脑炎患者脑脊液白细胞计数高于抗LGI1抗体相关脑炎(Z=-3.307,P=0.001)和抗MOG抗体相关脑炎(Z=-2.835,P=0.005)患者,抗NMDAR脑炎(t=3.159,P=0.007)和抗GABABR脑炎(t=-4.592,P=0.007)患者脑脊液氯化物高于抗LGI1抗体相关脑炎患者。ROC曲线显示,发病年龄诊断抗LGI1抗体相关脑炎的曲线下面积为0.722(95%CI:0.569~0.875,P=0.012),灵敏度为0.556、特异度为0.821,截断值为54.50岁。脑脊液白细胞计数诊断抗LGI1抗体相关脑炎的曲线下面积为0.706(95%CI:0.558~0.855,P=0.019),灵敏度为0.889、特异度为0.571,截断值为4.50×10^(6)/L;诊断抗NMDAR脑炎的曲线下面积为0.790(95%CI:0.643~0.937,P=0.002),灵敏度为0.600、特异度为0.967,截断值为13.50×10^(6)/L。脑脊液氯化物诊断抗LGI1抗体相关脑炎的曲线下面积为0.748(95%CI:0.598~0.898,P=0.005),灵敏度为0.722、特异度为0.714,截断值为122.70 mmol/L。结论新疆地区不同抗体类型感染相关性自身免疫性脑炎具有特定的临床特征,发病年龄、脑脊液白细胞计数和氯化物对抗LGI1抗体相关脑炎具有良好的诊断价值,脑脊液白细胞计数对抗NMDAR脑炎具有良好的诊断价值。

抗LGI1抗体自身免疫性脑炎^(18)F-FDG PET/CT影像学特征

目的研究抗富亮氨酸胶质瘤失活1蛋白(leucine-rich glioma-inactivated 1,LGI1)抗体自身免疫性脑炎(autoimmune encephalitis,AE)患者头部^(18)F-脱氧葡萄糖(^(18)F-deoxyglucose,FDG)正电子发射计算机断层显像(positron emission tomography,PET)/电子计算机断层显像(computed tomography,CT)影像学特点,探讨PET/CT在抗LGI1-AE早期诊断中的应用价值。方法回顾性分析2014年10月至2020年11月在首都医科大学附属北京天坛医院神经内科诊断为LGI1-AE的43例患者[其中急性期24例(56%),慢性期19例(44%)]的资料,分析患者^(18)F-FDG PET/CT的影像及临床特征。结果^(18)F-FDG PET显像结果显示,40例(93%)LGI1-AE患者出现明显的代谢异常,而只有26例(60%)患者出现异常磁共振(magnetic resonance imaging,MRI)信号(P<0.05)。^(18)F-FDG PET代谢异常在治疗后是可逆的,大多数患者出院后^(18)F-FDG PET的代谢几乎均正常。LGI1-AE患者的高代谢区位于基底节区(basal ganglia,BG)和内侧颞叶(medial temporal lobe,MTL)。在33例(77%)患者中观察到BG区高代谢,72%的患者表现出MTL高代谢。共有22例患者(51%)表现出面臂肌张力障碍性癫痫发作(faciobrachial dystonic seizures,FBDS),其余患者表现出非FBDS症状(49%)。FBDS患者中有7例(7/21)检测到仅BG区高代谢,而非FBDS患者中只有2例患者(2/19)检测到BG区高代谢(33%vs 10%,P<0.05)。结论^(18)F-FDG PET/CT对抗LGI1-AE患者的早期诊断阳性率高。FBDS患者多表现为仅BG区高代谢,这表明BG区可能参与FBDS发作。

抗神经丝重链抗体相关脑炎一例并文献复习

目的 报告国内首例抗神经丝重链抗体相关脑炎病例,并复习相关文献,总结抗神经丝重链抗体相关脑炎的临床特征。方法与结果 1例63岁女性抗神经丝重链抗体相关脑炎患者临床表现为认知功能障碍、反复癫痫发作、失语;头部MRI显示双侧额顶叶多发异常信号,部分脑回略肿胀,幕上脑室系统扩张,脑萎缩以双侧颞叶、海马为甚;18F-DPA714 PET/MRI显示额颞顶枕叶多脑区局灶性摄取异常增高,提示神经炎症;脑电图呈频繁痫样放电;脑脊液白细胞计数和葡萄糖升高,血清和脑脊液自身免疫性脑炎相关抗体阴性,血清TBA法显示小脑神经丝样荧光包绕浦肯野细胞,进一步检测抗神经丝蛋白抗体,血清抗神经丝重链抗体强阳性(1∶1000)。临床诊断为抗神经丝重链抗体相关脑炎,予静脉注射免疫球蛋白和甲泼尼龙治疗,预后改善。结论 抗神经丝重链抗体相关脑炎临床罕见,临床表现多样,早期诊断与鉴别诊断困难,早期予以免疫治疗对预后至关重要。