Abstract:Sudden unexpected death in epilepsy(SUDEP)refers to the sudden,unexpected,and witnessed or unwitnessed death of a patient with epilepsy,with or without evidence of a seizure,excluding status epilepticus,non-traumatic and non-drowning causes,and where autopsy reveals no structural or toxicological cause of death.Identifying high-risk populations and implementing appropriate interventions are crucial for SUDEP prevention.However,there is currently no consensus on how to select suitable recipients,content,responsible parties,and methods for disclosure.The Comorbidity Committee of China Association Against Epilepsy(CAAE)formed a working group to develop this consensus,employing the Delphi method to finalize 7 recommendations.The consensus addresses the recipients,content,responsible parties,and methods of SUDEP disclosure,with a focus on determining appropriate disclosure targets to avoid excessive anxiety caused by over-disclosure.

Abstract:Background The cerebrospinal fluid/serum albumin ratio(QAlb)serves as a critical indicator for assessing blood-brain barrier(BBB)permeability.This study aimed to assess BBB permeability in children with drug-resistant epilepsy(DRE)by calculating QAlb and to investigate its correlation with clinical characteristics,as well as its potential as a biological marker.Methods A total of 35 children diagnosed with DRE(epilepsy group)and 37 children with primary headache(control group)were admitted to The First Affiliated Hospital of Zhengzhou University between June 2018 and June 2023.QAlb values were derived from laboratory test results.Spearman rank correlation analysis was employed to explore the relationship between QAlb and variables such as disease duration,seizure type,seizure frequency,status epilepticus,and the number of antiepileptic seizure medicine(ASM).Results Compared with control group,the QAlb values were elevated[3.29(2.39,4.54)×103 vs.2.15(1.42,2.59)×103;Z=4.616,P=0.000],and the incidence of BBB dysfunction was higher[28.57%(10/35)vs.2.70%(1/37);χ2=9.299,P=0.002]in epilepsy group.Spearman rank correlation analysis indicated a positive correlation between QAlb and both seizure frequency(rs=0.587,P=0.000)and the number of ASM(rs=0.367,P=0.030)in children with DRE.Conclusions Some children with DRE exhibit BBB dysfunction.QAlb is positively correlated with seizure frequency and the number of ASM,suggesting its potential as a biological marker for identifying BBB dysfunction.

Abstract:Objective To explore predictive efficiency of amplitude integrated electroencephalography(aEEG)combined with heart rate variability(HRV)parameters in early prognosis of acute ischemic stroke patients after mechanical thrombectomy.Methods A total of 137 patients with acute ischemic stroke undergoing mechanical thrombectomy in He'nan Provincial People's Hospital were enrolled as the research objects between April 2021 and August 2024.According to 90 d prognosis by modified Rankin Scale(mRS),they were divided into good prognosis group(mRS score≤2,n=77)and poor prognosis group(mRS score>2,n=60).The clinical data(sociodemographic data,laboratory examination data at admission)were collected,preoperative aEEG data were collected to obtain aEEG score.After admission dynamic ECG examination was performed to obtain HRV parameters[standard deviation of normal R-R intervals(SDNN),standard deviation of normal R-R intervals index(SDNN index),root mean square successive difference of normal R-R intervals(RMSSD),and percentage of normal-to-normal intervals differing by more than 50 ms(pNN50)].The influencing factors of early prognosis in acute ischemic stroke patients after mechanical thrombectomy were screened by univariate and multivariate Logistic regression analyses,and predictive efficiency of aEEG score and HRV parameters of early prognosis in acute ischemic stroke patients after mechanical thrombectomy was evaluated by area under the curve(AUC)of receiver operating characteristic(ROC)curve.Results Multivariate Logistic regression analysis showed that higher National Institutes of Health Stroke Scale(NIHSS)score(OR=1.779,95%CI:1.038-3.050;P=0.037),higher neutrophil-to-lymphocyte ratio(OR=1.718,95%CI:1.016-2.905;P=0.044),and higher aEEG score(OR=1.933,95%CI:1.071-3.487;P=0.029)were risk factors for early poor prognosis in acute ischemic stroke patients after mechanial thrombectomy,while higher SDNN(OR=0.908,95%CI:0.864-0.953;P=0.000)and higher pNN50(OR=0.930,95%CI:0.866-0.998;P=0.043)were protective factors for good prognosis.The AUC values of aEEG score,SDNN,SDNN index,RMSSD and pNN50 for predicting early poor prognosis were 0.673,0.685,0.685,0.734 and 0.774,respectively.AUC of combined detection was 0.882,greater than those of single index(Z=4.742,P=0.000;Z=4.346,P=0.000;Z=4.360,P=0.000;Z=3.726,P=0.000;Z=2.776,P=0.006).Conclusions aEEG score combined with HRV parameters have high predictive efficiency for early prognosis in acute ischemic stroke patients after mechanical thrombectomy,which can assist clinical determination.

Abstract:Objective To summarize the visuo-oculomotor dysfunction in Parkinson's disease(PD)patients with dizziness,and to analyze the risk factors for dizziness.Methods A total of 80 patients with PD visiting Peking University First Hospital between January 2019 and October 2022 were enrolled and divided into dizziness group(n=35)and non-dizziness group(n=45)based on the presence or absence of dizziness complaints within one month prior to enrollment.Subjective dizziness severity was assessed using the Visual Analog Scales(VAS)and the Dizziness Handicap Inventory(DHI)for patients with dizziness.All patients underwent video-nystagmography(VNG)examinations,including without-fixation test,fixation test,reflexive saccade test,memory-guided saccade test,smooth pursuit test and optokinetic test,to obtain visuo-oculomotor function related parameters.Univariate and multivariate linear regression analyses were used to analyze influencing factors for DHI score.Univariate and multivariate Logistic regression analyses were used to screen influencing factors for dizziness in PD patients.Subgroups analysis of clinical characteristics and visuo-oculomotor function related parameters was performed based on the presence or absence of neurogenic orthostatic hypotension(nOH)in dizziness group.Results Multivariate linear regression analysis showed that the presence of nOH(standardized partial regression coefficient=0.385,P=0.031)and the average saccade latency(standardized partial regression coefficient=0.400,P=0.028)had positive influences on the DHI score.The presence of nOH(OR=4.701,95%CI:1.398-15.806;P=0.012)and a prolonged average saccade latency(OR=1.013,95%CI:1.002-1.025;P=0.022)were risk factors for dizziness in PD patients.Patients in the dizziness group were further divided into 2 subgroups based on the presence of nOH:subgroup without nOH(n=20)and subgroup with nOH(n=15).Compared to the subgroup without nOH,the subgroup with nOH had a higher proportion of obstructive sleep apnea-hypopnea syndrome(OSAHS,Fisher's exact probability:P=0.032),and shorter average saccade latencies at 10°(t=2.147,P=0.039)and 25°(t=2.698,P=0.011)targets.Conclusions The complication of nOH and prolonged average saccade latency are risk factors for dizziness in PD patients and increase the severity of dizziness.PD patients with dizziness are prone to manifest sleep disorders such as rapid eye movement sleep behavior disorder(RBD)and OSAHS.

Abstract:In 2024,the field of epilepsy has achieved a number of far-reaching advancements in basic and clinical research.These advancements cover aspects including the discovery of new targets for epilepsy surgery,the analysis of molecular pathological mechanisms,precise pharmacological research at the ion channel level,clinical progress in cell therapy and gene therapy,the development of new drugs,the application of wearable digital health technology,integrated psychological intervention for childhood epilepsy,and seizure prediction.Summarizing these research advancements is conducive to a more comprehensive understanding of the complexity of epilepsy,providing targets for further basic research and guiding clinical diagnosis and treatment.

Abstract:Sepsis-associated encephalopathy(SAE)is a serious complication of sepsis leading to neurological dysfunction.The pathogenesis of sepsis-associated encephalopathy is complex,and studies have proved that it is closely related to neuroinflammation,oxidative stress,pyroptosis,blood-brain barrier disruption,etc..Nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome,a multiprotein complex mediating inflammatory response and participating in innate immunity,is involved in occurence and developing of sepsis-associated encephalopathy.The activation of NLRP3 inflammasome is associated with apoptosis,pyroptosis,ferroptosi and autophagy.Traditional Chinese medicine plays a role in preventing and treating sepsis-associated encephalopathy,and studies have found that traditional Chinese medicine intervention significantly inhibits the activation of NLRP3 inflammasome.This article discusses the relationship between NLRP3 inflammasome and sepsis-associated encephalopathy.It reviews the potential and promise of traditional Chinese medicine targeting NLRP3 inflammasome as a treatment for the corresponding conditions,to provide valuable references and assistance for future sepsis-associated encephalopathy treatment strategies.

Abstract:Objective To investigate the expression of quinolinic acid phosphoribosyltransferase(QPRT)in glioma patients and its associations with clinicopathological features and prognosis.Methods Public databases including The Cancer Genome Atlas(TCGA),TARGET,GTEx,GEPIA2 and UALCAN were used to analyze QPRT expression in glioma and its relationships with disease-specific survival(DSS),overall survival(OS)and progression free survival(PFS).Additionally,219 pathologically confirmed glioma cases treated at The First Affiliated Hospital of Xinjiang Medical University from July 2010 to December 2018 were enrolled.Immunohistochemical staining was performed to determine QPRT positivity in lower-grade glioma(LGG)and glioblastoma(GBM).Factors affecting survival were identified using Log-rank test and multivariable Cox proportional hazards regression.Univariable and multivariable Logistic regression analyses were conducted to screen risk factors for OS and PFS in glioma patients.Results Bioinformatic analyses showed that QPRT was highly expressed in the combined GBM and LGG(GBMLGG)cohort,LGG and GBM(P=0.000,0.000,0.000).QPRT expression was significantly correlated with immune cell infiltration scores in both LGG and GBM.It was positively associated with age in the GBMLGG cohort,LGG and GBM(P=0.000,0.000,0.000).It was negatively associated with tumor mutational burden(TMB)in the GBMLGG cohort,LGG and GBM(P=0.000,0.000,0.000),and positively associated with microsatellite instability(MSI;P=0.001,0.019,0.032).Immunohistochemical staining based on clinical samples showed a QPRT positivity rate was 59.82%(131/219).Compared with the QPRT-negative group,the QPRT-positive group had higher proportions of age>50 years(P=0.027),receipt of adjuvant chemoradiotherapy(P=0.021),GBM diagnosis(P=0.000),death(P=0.000),disease progression(P=0.000)and tumor recurrence(P=0.000),and had shorter OS(P=0.000)and PFS(P=0.000).Logistic regression showed age>50 years(OR=2.149,95%CI:1.037-4.453;P=0.040),GBM(OR=10.269,95%CI:3.635-29.013;P=0.000),and QPRT positivity(OR=5.444,95%CI:2.675-11.080;P=0.000)were risk factors for death;GBM(OR=28.821,95%CI:3.409-243.648;P=0.002),tumor recurrence(OR=23.538,95%CI:2.836-195.336;P=0.003)and QPRT positivity(OR=6.323,95%CI:2.850-14.025;P=0.000)were risk factors for progression.Cox proportional hazards regression analysis showed that GBM(RR=8.330,95%CI:4.727-14.681;P=0.000)and QPRT positivity(RR=1.692,95%CI:1.066-2.685;P=0.026)were risk factors for worse OS,while absence of recurrence was protective(RR=0.507,95%CI:0.314-0.819;P=0.006).For PFS,GBM(RR=5.825,95%CI:3.436-9.876;P=0.000)and QPRT positivity(RR=1.548,95%CI:1.017-2.356;P=0.041)were risk factors.Conclusions QPRT is highly expressed in glioma and serves as an independent risk factor for poorer OS and PFS,suggesting that QPRT may be a potential molecular biomarker for prognostication in glioma.

Abstract:Resting-state electroencephalography(rsEEG)has emerged as a crucial tool in epilepsy research due to its advantages of high temporal resolution and non-invasiveness.Graph theory-based functional connectivity(FC)analysis has revealed common"locally enhanced,globally impaired"characteristics in epilepsy patients,including reduced global efficiency,deviation from small-world properties,and abnormal centrality of key nodes.These topological changes not only facilitate the understanding of the pathological mechanisms of epileptic networks but also assist in seizure detection,epileptogenic focus localization,and treatment outcome prediction.In recent years,studies combining machine learning(ML)and graph neural network(GNN)have further improved the accuracy of rsEEG in seizure prediction and treatment efficacy assessment.However,there are still shortcomings in segmentation strategies,threshold selection,and standardization of analysis procedures.This review summarizes research progress and clinical application prospects based on graph theory,emphasizes its potential value in precise diagnosis and treatment of epilepsy,and proposes that future verification and standardization in large-sample and multi-center studies are necessary.

Abstract:Objective To report a case of subcortical band heterotopia(SBH)caused by CEP85L gene variation,summarize its clinical characteristics,and conduct a literature review to delineate the pathogenesis,clinical and imaging features,treatment,and prognosis of lissencephaly(LIS)spectrum disorders associated with pathogenic variation in CEP85L gene.Methods and Results A 40-year-old female diagnosed as SBH due to a variation of CEP85L gene presented with drug-resistant epilepsy(DRE),and brain MRI showed posterior predominant SBH.The patient underwent 18F-FDG PET scan,showing hypometabolism in the posterior regions.Genetic test revealed that the patient had c.174T>A(p.Ser58Arg)heterozygous mutation in the second exon of CEP85L gene,and the genotype of her parents showed wild type.The patient was diagnosed as posterior predominant SBH caused by the CEP85L gene variation.After the adjustment of antiepileptic seizure medicine(ASM)and performing transcutaneous auricular vagus nerve stimulation(taVNS),the frequency of seizures decreased,but remained relatively frequent.Conclusions The CEP85L gene variation is a rare cause of posterior predominant LIS spectrum disorders.Seizures are the most common clinical manifestation,and most patients present with DRE.The majority of patients are not suitable for surgical treatment.The case reported here expands the genetic lineage and clinical phenotypic spectrum of LIS spectrum disorders.

Abstract:Objective To report clinical characteristics of Lennox-Gastaut syndrome(LGS)caused by CHD2 gene de novo variation.Methods and Results Three children with LGS admitted to Peking University People's Hospital from June 2023 to May 2024 were enrolled.Their onset ages were 3 months,3 years and 4 months,and 3 years and 5 months,respectively.All 3 cases were transformed from infantile spasms(IS),presenting with spasm epileptic seizures,tonic seizures and global developmental delay.EEG initially showed hypsarrhythmia,which later progressed to generalized and multifocal discharges during disease progression.Whole exome sequencing(WES)revealed a missense variant c.2740C>T(p.Arg914Cys)in Case 1,a nonsense variant c.806C>G(p.Ser269*)in Case 2,and a missense variant c.2492A>C(p.His831Pro)in Case 3;neither parent carried the same type of variation,all variants were de novo.Three patients received antiepileptic seizure medicine(ASM),and at the last follow-up,seizures remained uncontrolled in all patients.Conclusions LGS caused by CHD2 gene variation typically present in childhood,often with delayed motor and language development.Most patients have uncontrollable seizures that are often resistant to medication.

Abstract:Objective To explore the risk factors for cluster seizures in children with epilepsy and to construct a risk prediction Nomogram model based on these factors.Methods Total 200 children with epilepsy who were treated at The Affiliated Hospital of Xuzhou Medical University between March 2022 and September 2023 were enrolled.Based on the presence or absence of cluster seizures,the pediatric patients were divided into cluster seizures group(n=98)and no cluster seizures group(n=102).Univariate and multivariate stepwise Logistic regression analyses were employed to identify risk factors for cluster seizures.A Nomogram model was then constructed based on these factors.The model's performance was evaluated using receiver operating characteristic(ROC)curve analysis,calibration curves,and the Hosmer-Lemeshow goodness-of-fit test to validate its discriminative capacity,calibration accuracy and stability.Results Logistic regression analysis identified the following independent risk factors for cluster seizures:structural etiology(OR=3.403,95%CI:1.442-8.027;P=0.005),infantile-onset seizures(OR=4.720,95%CI:2.150-10.365;P=0.000),multiple seizure types(OR=6.446,95%CI:2.085-19.933;P=0.001),and generalized-multifocal discharges(OR=13.257,95%CI:4.669-37.641;P=0.000).The Nomogram model incorporating these risk factors demonstrated excellent predictive performance,with an area under the curve(AUC)of 0.768(95%CI:0.703-0.834,P=0.000).The optimal cutoff value for predicting cluster seizures was 0.513.Calibration curves showed good agreement between predicted and observed probabilities,and the Hosmer-Lemeshow goodness-of-fit test indicated that the model had good stability(P=0.988).Conclusions Epileptic children exhibiting structural etiology,infantile-onset seizures,multiple seizure types,and generalized-multifocal discharges are more susceptible to cluster seizures.The developed Nomogram model based on these factors provides a valuable clinical tool for predicting the risk of cluster seizures in children with epilepsy.

Abstract:Objective To investigate the risk factors for epilepsy recurrence in anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis patients with epileptic seizure.Methods A total of 78 anti-NMDAR encephalitis patients with epileptic seizure admitted to Beijing Tiantan Hospital,Capital Medical University from August 2013 to September 2022 were included.Clinical data of the patients were analyzed,and epilepsy recurrence was observed during follow-up period.According to whether epilepsy recurrence occurred during the follow-up period,the patients were divided into epilepsy recurrence group(n=18)and epilepsy non-recurrence group(n=60).Univariate and multivariate Logistic regression analyses were used to screen risk factors for epilepsy recurrence in anti-NMDAR encephalitis patients with epileptic seizure.Results During(2.21±0.45)years'follow-up,18 cases(23.08%)experienced epilepsy recurrence.Multivariate Logistic regression analysis showed that combined tumors(OR=24.154,95%CI:2.597-224.640;P=0.005),cognitive impairment(OR=7.809,95%CI:1.338-45.557;P=0.022),and cortical lesions on MRI(OR=9.868,95%CI:1.223-79.620;P=0.032)were risk factors for epilepsy recurrence in anti-NMDAR encephalitis patients with epileptic seizure.Conclusions Combined tumors,cognitive impairment,and cortical lesions on MRI are risk factors for epilepsy recurrence in anti-NMDAR encephalitis patients with epileptic seizure.For patients with these factors,longer duration of antiepileptic seizure medicine(ASM)should be used to avoid epilepsy recurrence.

Abstract:Objective To investigate the clinical correlation between hyperhomocysteinemia caused by MTHFR gene mutation and developmental epileptic encephalopathy(DEE),as well as the corresponding intervention strategies.Methods and Results A female child,aged 2 years and 5 months,presented with infantile spasm(IS)as the initial symptom.Video electroencephalography(VEEG)showed highly irregular,which progressively evolved into generalized multifocal discharges consistent with Lennox-Gastaut syndrome(LGS),accompanied by tonic clonic seizure.MRI showed delayed myelination and leukomalacia.Genetic testing showed the compound heterozygous mutations in the MTHFR gene:c.154C>T(p.Arg52X)and c.889T>C(p.Tyr297His).These were inherited from her mother[c.154C>T(p.Arg52X)]and father[c.889T>C(p.Tyr297His)].This genetic testing resulted in severely elevated serum homocysteine level of 161 μmol/L.Following treatment with a combination of antiepileptic seizure medication(ASM),betaine and B vitamins,the homocysteine level decreased to 70 μmol/L and seizure frequency was reduced.However,significant neurodevelopmental delay persisted.Conclusions The novel compound heterozygous mutations of MTHFR gene[c.154C>T(p.Arg52X)and c.889T>C(p.Tyr297His)]expand the spectrum of known MTHFR gene mutation.These mutations disrupt folate metabolism,leading to severe hyperhomocysteinemia and DEE.This case underscores the critical importance of early metabolic intervention for improving clinical outcomes.

Abstract:Objective To investigate the predictive value of mismatch negativity(MMN)combined with P300 for cognitive dysfunction at 6 months after traumatic brain injury(TBI)in adult patients.Methods A total of 75 adult TBI patients admitted to Xiangya Hospital,Central South University from January 2021 to January 2024 were enrolled.MMN and P300 were monitored within 7 d after TBI.Cognitive function was assessed at 6 months after TBI using the Telephone Interview for Cognitive Status(TICS),with a score of<27 indicating cognitive dysfunction.Univariate and multivariate Logistic regression analyses were used to identify influencing factors for cognitive dysfunction at 6 months after TBI.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was calculated to evaluate the predictive performance of the identified factors.Results Lower absolute value of Fz MMN amplitude(OR=0.426,95%CI:0.188-0.968;P=0.041)and Cz P300 amplitude(OR=0.399,95%CI:0.188-0.847;P=0.017)were identified as risk factors for cognitive dysfunction at 6 months after TBI.ROC curve showed that the AUC for the absolute value of Fz MMN amplitude was 0.713(95%CI:0.595-0.830,P=0.002),with an optimal cutoff value of 2.37 μV.The AUC for the absolute value of Cz P300 amplitude was 0.752(95%CI:0.641-0.863,P=0.000),with an optimal cutoff value of 3.28 μV.When these 2 indicators were combined for ROC curve,the combined indicator yielded an AUC of 0.781(95%CI:0.676-0.886,P=0.000).Delong test revealed no statistically significant differences in AUC between the combined indicator and the absolute value of Fz MMN amplitude(Z=1.574,P=0.115)or the absolute value of Cz P300 amplitude(Z=0.939,P=0.348),suggesting comparable predictive performance among the 3 indicators.Conclusions MMN combined with P300 may serve as a favorable indicator for predicting cognitive dysfunction at 6 months after TBI.

Abstract:Objective To explore and evaluate the application value of pressure reactivity index(PRx)based on invasive intracranial pressure(ICP)and mean flow index(Mx)based on transcranial Doppler ultrasonography(TCD)noninvasive monitoring in severe traumatic brain injury(sTBI).Methods The clinical data of 64 patients with sTBI treated in He'nan Provincial People's Hospital from January 2024 to February 2025 were included.According to the Glasgow Outcome Scale(GOS),the patients were divided into the good prognosis(GOS score 3-5)group(n=31)and the poor prognosis(GOS score 1-2)group(n=33).All patients received ICP monitoring immediately after surgery for 3-7 d.The ICP-related indicators including average ICP,cerebral perfusion pressure(CPP)and PRx were collected,and the ICP dose with a threshold of 20 mm Hg(DICP20)was obtained.All patients were monitored by TCD with an interval of≥3 d immediately after operation,and the specific value of Mx was obtained.Univariate and multivariate Logistic regression analyses were used to analyze of influencing factors for 6-month post-discharge prognostic outcomes in patients with sTBI.The receiver operating characteristic(ROC)curve was further drawn,and the area under the curve(AUC)was calculated to evaluate the ability of each parameter to predict poor prognosis.Pearson correlation analysis was used to further analyze the correlation between PRx and Mx.Results Logistic regression analysis showed that higher ICP(OR=2.439,95%CI:1.077-5.526;P=0.033),higher PRx(OR=14.932,95%CI:2.215-100.666;P=0.005)and higher Mx(OR=3.087,95%CI:1.145-8.324;P=0.026)were risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI.The AUC of ICP,PRx and Mx was 0.912(95%CI:0.814-0.968,P=0.033),0.958(95%CI:0.876-0.992,P=0.005)and 0.859(95%CI:0.749-0.933,P=0.026),and the prediction efficiency of the three was the same(Z=0.850,P=0.396;Z=1.128,P=0.259;Z=1.856,P=0.063).Pearson correlation analysis showed that the overall correlation between the mean values of all records of PRx and Mx was moderate(r=0.521,P=0.000).Conclusions ICP,PRx and Mx were the risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI.Mx can be used as a noninvasive way to evaluate the cerebral autoregulation(CA)function of patients with sTBI,and has a certain predictive ability for the prognosis.There was a moderate correlation between PRx and Mx,suggesting that they provide different information of CA function.

Abstract:Intracranial pressure(ICP)monitoring serves as a critical component in the management of neurocritical care patients.Hydraulic-coupled intracranial pressure monitoring via external ventricular drainage(EVD-ICP)monitoring offers a clinically practical approach that enables both dynamic physiological assessment and therapeutic intervention,and has gained widespread adoption.However,the significant variability persists across healthcare institutions regarding the procedural standardization and the implementation of systematic management protocols.Building upon evidence-based medical principles and multidisciplinary expert consensus,this"Chinese expert consensus on the management of hydraulic-coupled intracranial pressure monitoring via external ventricular drainage"synthesizes key aspects of EVD-ICP monitoring,including clinical indications,procedural workflows,trouble shooting strategies,monitoring duration,complication prevention and management.The expert consensus aims to standard the technique and management of EVD-ICP monitoring,enhance diagnostic and therapeutic outcomes in the neurocritical care patients,and promote the standardized,precise and efficient application of this technology across clinical settings.

Abstract:The monitoring,evaluation and critical care management of neurological complications after endovascular treatment for acute ischemic stroke are essential components in optimizing patient outcomes and reducing both disability and mortality rates.Neurological complications,such as hemorrhagic transformation,vessel reocclusion,malignant brain edema and post-stroke epilepsy,which occur after endovascular treatment can significantly influence the overall effectiveness of the treatment.However,current critical care management of neurological complications are often hindered by inconsistencies in management standards and lack of standardized protocols.This expert consensus,grounded in evidence-based medicine and incorporating the clinical insights of professionals from multiple disciplines,provides a systematic approach to key areas including the identification of risk factors,appropriate monitoring and evaluation,and effective critical care management strategies for the most common postoperative neurological complications.Together,these elements form a comprehensive and standardized management framework.The primary goal of this consensus is to deliver scientifically sound and clinically applicable guidance for neurological complications management after endovascular treatment in patients with acute ischemic stroke.

Abstract:Objective To analyze the changes in biomarkers associated with sleep disorders in anti-leucine-rich glioma-inactivated 1(LGI1)antibody-associated encephalitis,and to preliminarily explore the mechanism of sleep disorders.Methods Fifty patients with anti-LGI1 antibody-associated encephalitis who admitted He'nan Provincial People's Hospital from April 2015 to September 2022 were selected.Serum and cerebrospinal fluid(CSF)samples were collected for biomarkers detection,and Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the presence of sleep disorders.Results The 50 patients were divided into the sleep disorders(>7)group(n=28)and the no sleep disorders(≤7)group(n=22)based on PSQI score.Compared with the no sleep disorders group,the sleep disorders group in serum and CSF showed higher levels of neurofilament light chain(NfL;t=6.690,P=0.000;t=2.356,P=0.023),glial fibrillary acidic protein(GFAP;t=3.713,P=0.000;t=2.768,P=0.008),ionized calcium-binding adapter molecule 1(Iba1;t=5.042,P=0.000;t=3.472,P=0.001),orexin A(t=3.250,P=0.002;t=5.376,P=0.000),cortisol(t=2.487,P=0.016;t=5.779,P=0.000),tumor necrosis factor-α(TNF-α;t=3.832,P=0.000;t=5.122,P=0.000)and chemokine(C-X-C motif)ligand 13(CXCL13;t=2.483,P=0.017;t=4.116,P=0.000),while only interleukin-1β(IL-1β)increased in CSF(t=2.526,P=0.015).Conclusions Sleep disorders associated with anti-LGI1 antibody-associated encephalitis is elevated in levels of neuroinjury markers,neuroendocrine markers and neuroimmune markers,suggesting that sleep disorders associated with anti-LGI1 antibody-associated encephalitis is not a single mechanism and may be related to the extensive involvement of the neuro-endocrine-immune network.