Laminar patterns of projections from vM1 to vS1. The projection pattern from vM1 to vS1 is not uniform but varies between layers in vS1 9,21. To validate the layer dependency of the projection pattern from the vM1 infarction area, we injected an anterograde tracer, Biotinylated dextran amine (BDA), into vM1 (Fig. 1A) and identified vM1 axonal innervations in vS1. The signal intensity (green line in Fig. 1B) of the anterogradely labelled axons from vM1 was calculated. For this calculation, the signal of the soma, which is the result of a small amount of retrograde labelling by BDA 22 , was excluded. At the population level, the signal intensity was relatively stronger in L1 and L5b, but weaker in L4 compared to the mean intensity of all layers (N = 3) (Figs. 1C and S1). As summarised in Fig. 1D, vM1 axons projected densely to L1 and L5b.
Antiseizure drug (ASD)-induced skin rash remains the main side effect of seizure management in patients with glioma. New generations of ASDs, such as levetiracetam (LEV) and lacosamide (LCM) are associated with less frequent skin rashes than conventional ASDs. However, there are few reports regarding the incidence of skin rashes by LEV and LCM in patients with glioma. Therefore, the aim of this study was to investigate the incidence and risk factors of LEV- and LCM-associated skin rashes in patients with glioma. We compared the incidence of ASD-associated skin rash between 353 patients with glioma and 125 patients with meningioma, who received LEV or LCM and underwent surgery between 2017 and 2019 at our institution. Furthermore, to evaluate the association between potential risk factors and ASD-associated skin rashes, univariate and multivariate analyses were performed. The incidence of ASD-associated skin rash in patients with glioma was higher (11%) than in those with meningiomas (1.6%). The multivariate regression analysis showed that adjuvant treatment with radiotherapy (p = 0.023) and a history of drug allergy (p = 0.023) were significant risk factors for ASD-associated skin rash. The rate of ASD-related skin rashes in patients with glioma was also higher than the previously reported rates of 1-3% in patients with epilepsy. Our results indicate that adjuvant treatment with radiotherapy and a history of drug allergy correlated with a high incidence of ASD-related skin rashes in patients with patients who receive LEV and LCM. Patients with these two factors should be carefully checked for skin rashes.
OBJECTIVE Patients sometimes experience transient neurological events (TNEs) during the early postoperative period after revascularization surgery for childhood moyamoya disease. The clinical background and pathophysiology of TNEs remain unclear. This study aimed to evaluate the incidence rate of TNEs and discuss the factors associated with pediatric moyamoya disease. METHODS The authors retrospectively reviewed 110 cerebral hemispheres of 61 pediatric patients younger than 15 years who were treated from 2011 to 2020. All children underwent either simple double-direct or combined revascularization surgery. Of these 61 patients, 52 underwent bilateral surgery and 9 underwent unilateral surgery. The authors calculated the incidence of TNEs in accordance with a previously reported TNE definition. Cerebral blood flow (CBF) was evaluated in all eligible cases with xenon CT immediately after revascularization surgery. RESULTS The incidence rate of TNEs in patients with childhood moyamoya disease was 26.4%. TNEs occurred after an average (range) of 6.26 (2–12) days postoperatively without triggers, and all identified TNEs spontaneously resolved within 2 weeks. The most common symptoms were dysarthria, facial palsy, and numbness around the mouth, followed by sensory disturbance of the upper extremities. The presence of focal hyperperfusion on xenon CT performed immediately after revascularization surgery was strongly correlated with the incidence of TNEs (p = 0.0001). Focal hyperperfusion was observed in 43 of 110 operative sides (39.1%). Notably, only 25.6% of patients with focal hyperperfusion showed numerical global hyperperfusion. In addition, a decrease in CBF compared with the thalamic region in the contralateral side was observed in TNE-affected cases (p = 0.0443). CONCLUSIONS TNEs occurred more frequently in childhood moyamoya disease patients than expected. The clinical background, including symptoms, timing, and duration, was almost identical to TNEs in adults. Focal hyperperfusion, rather than numerical global hyperperfusion, was strongly correlated with the incidence of TNEs. Furthermore, the authors advocate the notion that a clinical course where symptoms occur without triggers may be a unique characteristic of TNEs, especially in childhood moyamoya disease.
Stroke (Ischemic Stroke) 14 15 Number of words in the main text (not including Abstract, Methods, References and figure legends) : 16 word count,1988 words 17Abstract (max, 200 words) 1 2 Primary motor cortex (M1) infarction occasionally causes sensory impairment. Because sensory 3 signal plays an important role in motor control, sensory impairment compromises recovery and 4 rehabilitation from motor disability. Despite the importance of sensory-motor integration for 5 rehabilitation after M1 infarction, the neural mechanism of the sensory impairment is poorly 6 understood. We show that the sensory processing in the primary somatosensory cortex (S1) was 7 impaired in the acute phase of M1 infarction and recovered in a layer-specific manner in the subacute 8 phase. This layer dependent recovery process and the anatomical connection pattern from M1 to S1 9 suggested the functional connectivity from M1 to S1 plays a key role in the impairment of sensory 10 processing in S1. The simulation study demonstrated that the loss of inhibition from M1 to S1 in the 11 acute phase of M1 infarction could cause the sensory processing impairment in S1, and the 12 complementation of inhibition could recover the temporal coding. Taken together, we revealed how 13 focal stroke of M1 alters cortical network activity of sensory processing, in which inhibitory input 14 from M1 to S1 may be involved. 15 16 17
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