Autonomic Dysfunction Contributes to Impairment of Cerebral Autoregulation in Patients with Epilepsy

Patients with epilepsy frequently experience autonomic dysfunction and impaired cerebral autoregulation. The present study investigates autonomic function and cerebral autoregulation in patients with epilepsy to determine whether these factors contribute to impaired autoregulation. A total of 81 patients with epilepsy and 45 healthy controls were evaluated, assessing their sudomotor, cardiovagal, and adrenergic functions using a battery of autonomic nervous system (ANS) function tests, including the deep breathing, Valsalva maneuver, head-up tilting, and Q-sweat tests. Cerebral autoregulation was measured by transcranial Doppler examination during the breath-holding test, the Valsalva maneuver, and the head-up tilting test. Autonomic functions were impaired during the interictal period in patients with epilepsy compared to healthy controls. The three indices of cerebral autoregulation—the breath-holding index (BHI), an autoregulation index calculated in phase II of the Valsalva maneuver (ASI), and cerebrovascular resistance measured in the second minute during the head-up tilting test (CVR2-min)—all decreased in patients with epilepsy. ANS dysfunction correlated significantly with impairment of cerebral autoregulation (measured by BHI, ASI, and CVR2-min), suggesting that the increased autonomic dysfunction in patients with epilepsy may augment the dysregulation of cerebral blood flow. Long-term epilepsy, a high frequency of seizures, and refractory epilepsy, particularly temporal lobe epilepsy, may contribute to advanced autonomic dysfunction and impaired cerebral autoregulation. These results have implications for therapeutic interventions that aim to correct central autonomic dysfunction and impairment of cerebral autoregulation, particularly in patients at high risk for sudden, unexplained death in epilepsy.

Clopidogrel can be an effective complementary prophylactic for drug-refractory migraine with patent foramen ovale

The present study aims to determine the potential prophylactic effect of clopidogrel for migraine with patent foramen ovale (PFO) in patients who are poor responders to two or more common preventive medications. Migraineurs underwent contrast-enhanced transcranial doppler examination to confirm the presence of PFO and determine the right-to-left shunt degree. Clopidogrel 75 mg/day was added to the existing prophylactic regimen for 3 months and 6 months. The presence of PFO was found in 56.8% (151/266) of all patients with migraine and 70.2% (59/84) of migraine with aura (MHA), and among MHA a large shunt was observed in 36 patients. Twenty-six patients with drug-refractory migraine took clopidogrel 75 mg/day for 3 months. Compared with those at baseline, headache frequencies and attack durations were significantly lower (6.17±3.93/month (M) vs 3.28±2.67/M, p=0.003; 13.62±13.98/hour (H) vs 7.36±7.33/H, p=0.0049, respectively); visual analog scale scores and migraine disability assessment scores were also obviously decreased (6.32±1.97 vs 4.71±1.20, p<0.001; 22.14±7.13 vs 16.00±5.92, p=0.001, respectively). These improvements were maintained for 6 months in 12 patients. We concluded that PFO was closely correlated with migraine, especially in MHA. Clopidogrel could act as an effective complementary prophylactic for migraine with PFO in patients with poor response to routine prophylactics.

Kongcun Town Asymptomatic Intracranial Artery Stenosis study in Shandong, China: cohort profile

PurposeThe population-based Kongcun Town Asymptomatic Intracranial Artery Stenosis (KT-aICAS) study aims to investigate the prevalence of aICAS and major cardiovascular risk factors (CRFs) or biomarkers related to the development and prognosis of aICAS.ParticipantsThe KT-aICAS study included 2311 rural residents who were aged ≥40 years and living in Kongcun Town, Shandong Province, China. Baseline examination was conducted from October 2017 to October 2018, during which information on demographics, socioeconomics, personal and family medical history, and lifestyle factors was collected through face-to-face interviews, physical examination and blood tests. aICAS was initially screened using transcranial Doppler examination and then diagnosed using magnetic resonance angiography. Atherosclerosis in carotid arteries was diagnosed via carotid ultrasonography. High-resolution MRI was further used to evaluate the vessel wall of aICAS. Neuropsychological assessments were performed in the participants diagnosed with aICAS and the age-matched and sex-matched controls.Findings to dateOf the 2311 participants, 2027 (87.7%) completed the diagnostic procedure and aICAS was detected in 154 persons, resulting in an overall prevalence of 7.6%. The prevalence of aICAS increased with advancing age from 5.1% in participants aged 40–49 years to 12.7% in those aged ≥70 years (p<0.001). aICAS was detected in 305 intracranial arteries, including 221 (72.5%) in the anterior circulation and 84 (27.5%) in the posterior circulation (p<0.001). In addition, major CRFs were highly prevalent among middle-aged and elderly rural dwellers who were free of clinical stroke.Future plansFollow-up examinations will be performed every 3 years following the baseline examination. This study will increase our knowledge about the natural history of aICAS and facilitate studies of aICAS-associated disorders among rural-dwelling Chinese adults, such as ischaemic stroke and vascular cognitive impairment.Trial registration numberChiCTR1800017197.

Evaluation of Early Acute Cerebral Infarction with Transcranial Doppler

Objective: For patients with early acute cerebral infarction (ACI), transcranial Doppler ultrasound was used in the clinical examination, and its application effect was observed and analyzed. Methods: This study was carried out between October 2018 and October 2019. 50 patients with ACI included as the research object was evaluated by transcranial Doppler and CT examination, and the application of the two examination methods was compared. Results: The results of transcranial Doppler examination showed that the abnormal rate of blood flow velocity and the ratio of both sides (VACA) in patients with early ACI was higher than that of CT examination. Conclusion: With the impact on the location and area of vascular occlusion in patients, VACA can effectively reflect the status and effectiveness of the collateral circulation function of the patient’s pia vessels during cerebral infarction.