Pathological changes in heroin-induced spongiform leukoencephalopathy and therapeutic effect of comprehensive rehabilitation:a follow-up study
Abstract：BACKGROUND:Documentation of heroin-induced spongiform leukoencephalopathy(HSLE) in heroin addicts is scarce in both Mainland China and abroad.Chinese researchers have attempted to define the diagnosis and characteristic changes in magnetic resonance imaging(MRI) of this disease,with ongoing studies of the features in the pathological changes,but the implementation of rehabilitation treatment for HSLE patients has not been addressed. OBJECTIVE:To explore the pathological mechanism and effective comprehensive rehabilitation protocol of HSLE. DESIGN:Diagnosis-based retrospective analysis. SETTING and PARTICIPANTS:Between January 2001 and June 2003,4 heroin addicts were identified to have toxic encephalopathy in the Department of Neurology,the People's Hospital of Shenzhen. INTERVENTIONS:The 4 patients with HSLE received comprehensive rehabilitation treatment including medication with dexametasone,encephalon polytide,cytidine diphosphate choline,and Vitamin B,intravascular irradiation with low-energy laser,hyperbaric treatment,balance training, acupuncture,and psychological consultation,etc.and the therapeutic effects were observed to formulate the optimal comprehensive rehabilitation treatment protocol. MAIN OUTCOME MEASURES:Recoveries in cognition,psychology and linguistic ability were observed,with the blood supply and functional recovery assessed by single-photon emission computed tomography(SPECT). RESULTS:Clinical assessment was performed 10 weeks after treatment,which yielded significant improvement in cognition,psychology,linguistic ability,balance,as well as walking and ability to perform daily activities.Changguchun scale for intelligence assessment was adopted to evaluate the patients' cognition.The scores were 9,8,28 and 26 respectively before treatment for the 4 cases,while 35,32,35 and 35 respectively after treatment.In term of psychological improvement,the symptoms of drug abstinence,addiction and desire disappeared in case 1 and 2.Linguistic abilities were improved in 3 patients,of whom patient 1 was capable of speaking clearly and fluently after treatment,with patients 2 and 3 found to have significantly alleviated cerebellar language involvement.In balance response examination,patient 1 scored 18 after treatment vs 3 before treatment,and the other 3 patients scored 20 vs 7,16 vs 10, and 17 vs 11 respectively. The MBI scores for activity of daily life were 95 after treatment vs 35 before treatment in case 1, 100 vs 40 in case 2, 90 vs 30 in case 3,and 95 vs 40 in case 4.SPECT examination showed insufficient blood supply in the bilateral cerebellum and basal ganglia with severe functional impairment of the brain cells in all 4 cases,which were obviously improved after treatment. CONCLUSION:Comprehensive rehabilitation benefits the recovery of patients with HSLE.The pathological mechanism of HSLE involves not only the central nervous demyelination and immune response,but also cerebral ischemia and hypoxia.
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Publication Date：2004-01-01
Pages：3( 1339-1341 )