Clinical Neurology and Neurosurgery最新文献_第4页

Preexisting opioid daily MME and use duration within a national cohort of lumbar spine surgery patients on quality outcomes 在一项国家腰椎手术患者队列中，先前存在的阿片类药物每日MME和使用时间对质量结果的影响。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108732

Joseph Tingen , Helen Karimi , Emma Hartman , Hiba Hamid , Kayla Etienne , Jainith Patel , Alice Tang , Ron I. Riesenburger , James Kryzanski

Objective

Pain management surrounding lumbar spine surgery is a complex topic. Though some authors suggest that preoperative opioid use is a negative prognostic factor, its association with patient-reported outcomes and satisfaction after surgery remains controversial. We aimed to uncover the effect of preoperative opioid use on long-term outcomes using a national sample.

Methods

Using deidentified data from the lumbar spine surgery Quality Outcomes Database, we compared functional outcomes and satisfaction in 34,934 patients based on presence of preoperative opioid use. Outcomes included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and satisfaction indices. Regression subanalysis illustrated the effect of preoperative opioid duration and daily MME.

Results

44.1 % used opioids preoperatively. A greater percentage of patients using opioids underwent surgery with instrumentation (p < .005). They exhibited clinically comparable improvement in VAS, ODI, and satisfaction at 3- (p = .069, p < .005, p < .005, respectively) and 12-months (p < .05). Return to work was lower at 3- (74.32 % vs. 80.82 %, p < .005) and 12-months (48.99 % vs. 62.95 %, p < .005). They maintained low postoperative use although greater than opioid naïve patients at 3- (3.1 % vs. 1.2 %, p < .005) and 12-months (3.6 % vs. 0.8 %, p < .005). Preoperative daily MME had no significant effect on outcomes, although increasing duration negatively impacted VAS and ODI scores.

Conclusions

Preoperative opioid use by itself should not be used in surgical decision making but rather an individual risk assessment according to chronicity of opioid burden. Longer duration of use appears to impair postoperative improvement but not satisfaction with little influence by daily MME; however, larger, granular analyses remain necessary.

目的：腰椎手术的疼痛管理是一个复杂的话题。尽管一些学者认为术前使用阿片类药物是一个不利的预后因素，但其与患者报告的结果和术后满意度之间的关系仍存在争议。我们的目的是利用全国样本揭示术前使用阿片类药物对长期预后的影响：我们使用腰椎手术质量结果数据库中的去身份数据，根据术前是否使用阿片类药物对 34934 名患者的功能结果和满意度进行了比较。结果包括视觉模拟量表（VAS）、Oswestry 残疾指数（ODI）和满意度指数。回归子分析表明了术前阿片类药物持续时间和每日 MME 的影响：44.1%的患者在术前使用过阿片类药物。结果：44.1%的患者术前使用过阿片类药物，使用阿片类药物的患者中接受器械手术的比例更高（P术前使用阿片类药物本身不应作为手术决策依据，而应根据阿片类药物的长期使用情况进行个体风险评估。使用阿片类药物时间较长似乎会影响术后病情的改善，但并不会影响满意度，而每日 MME 的影响则很小；不过，仍有必要进行更大规模、更细致的分析。

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引用次数: 0

Characteristics and therapeutic profile of the patients with upper cervical spinal cord ependymoma from the medulla oblongata to C4: A cohort of 108 cases

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108758

Haiyue Lin , Xing-Yu Chen , Shixin Gu , Xiaodong Liu , Wentao Gu , Xiaoming Che , Jianlan Zhao , Rong Xie

Background

Upper cervical spinal ependymomas (uCSE) is routinely identified as intramedullary ependymomas located from the oblongata medulla to C4 level. Our study aimed to report the outcomes and treatment profiles of uCSE from our cohort of uCSE patients.

Methods

This retrospective observational study included 108 patients with upper cervical spinal ependymomas (uCSE) who underwent surgery at Huashan Hospital from 2008 to 2022. Demographic and clinical data were collected to identify risk factors may associated with post-operative spinal cord function, quality of life and respiratory function.

Results

The mean age of included patients was 44.30 ± 12.71 years old. The most common uCSE was ependymoma (103 of 108, 95.37 %), followed by subependymoma (3 of 108, 2.78 %) and anaplastic Ependymoma (2 of 108, 1.85 %). Age (P = 0.003), sex (P = 0.004), duration of symptoms (P = 0.010), pre-operative bladder functions (P = 0.012), post-operative pneumonia (P = 0.013) and Carbon Dioxide Retention (CDR) (P = 0.004) could independently correlate with Iiving quality of uCSE patients. Post-operative spinal cord function was associated with pneumonia immediately after operation (P = 0.017). In addition, post-operative pneumonia correlated with tumor location (P = 0.048), pre-operative McCormick scores (P = 0.008)/ motor functions (P = 0.022)/ NRS scores (P = 0.020), and tracheotomy immediately after operation (P < 0.001). Tracheotomy immediately after operation was associated with tumor location (P = 0.023), unsteady walking (P = 0.033), pre-operative NRS scores (P = 0.029), post-operative pneumonia (P < 0.001) and CDR (P < 0.001).

Conclusion

Within uCSE patients, post-operative quality of life is associated with pre-operative spinal cord function and symptom duration, which emphasizing the importance of early intervention. Their post-operative respiratory dysfunctions also correlated with post-operative spinal cord function and quality of life.

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引用次数: 0

Clinical and safety outcomes of decompressive surgery for patients with degenerative lumbar spine disease in the Gaza Strip: a prosective study

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108774

Belal Alhabil , Amira Al-Azar , Shahd Alroobi , Haneen Awadallah , Motaz Hammad , Suheir Shaat , Mohammed Elmadhoun , Mohammed Alnajjar , Belal Aldabbour

Objectives

A significant number of patients with degenerative lumbar spine disease (DSD) require decompressive surgery. Disparities in surgical care exist between different countries and regions. This study reports on the clinical and safety outcomes of lumbar decompressive surgery performed in the Gaza Strip, a poor and underserved area with a fragile healthcare system.

Methods

Patients with DSD were prospectively followed up after undergoing lumbar decompressive surgery at two major governmental hospitals in the Gaza Strip between October 2019 and March 2020. Outcomes were assessed using the Core Outcome Measure Index (COMI-back) and the Oswestry Disability Index (ODI), measured both before and three months after surgery. Surgical complication rates were also evaluated. A paired t-test was performed to explore the significance of differences in the mean pre- and postoperative scores for each COMI variable and the ODI item.

Results

Sixty-six patients were included, consisting of 41 (62.1 %) males and 25 (37.9 %) females, with a mean age of 61.02 ± 11.4 years. The total COMI-back score decreased from 27.3 ± 6 to 10.3 ± 10 postoperatively (p < 0.0001). A decrease of 15.15 points was also noted between the mean ODI scores before and after surgery (p < 0.0001). Similar significant decreases were observed across all COMI-back and ODI items. The three-month global outcome indicated that the operation benefited 47 patients (71.2 %). Likewise, 39 (59 %) and 19 (28.7 %) reported being “highly satisfied” or “satisfied” with the overall state of their back/leg symptoms, respectively. Eight (12.1 %) patients experienced a postoperative complication: six (9.5 %) had wound infections, one (1.5 %) sustained a dural tear, one (1.5 %) experienced a CSF leak, and one (1.5 %) needed reoperation. The mean hospital stay was 2 days ± 1.3 days.

Conclusion

The study shows a significant improvement across all outcome parameters from baseline to the three-month postoperative follow-up, with rates of surgical complications and hospital stays comparable to global averages.

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引用次数: 0

Clinical, etiological, and therapeutic profile of early-onset absence seizures: A case series analysis 早发性失神性癫痫的临床、病因学和治疗概况：一个病例系列分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2024.108673

Patrizia Bergonzini , Elisa Caramaschi , Alessandra Spallino , Giovanni Battista Dell'Isola , Elisabetta Spezia , Alberto Verrotti , Lorenzo Iughetti

Typical absence seizures represent a distinctive form of epileptic activity typically observed in pediatric populations, predominantly manifesting between the ages of 4 and 10, constituting Childhood Absence Epilepsy (CAE). However, a subset of patients presents with Early-onset Absence Epilepsy (EOAE), characterized by seizure onset before the fourth year of life, often displaying favorable outcomes with antiseizure medication. Conversely, atypical absence seizures exhibit prolonged duration and frequently entail tonic, atonic, or myoclonic motor elements, suggesting a more severe clinical course, commonly associated with epileptic encephalopathies of childhood onset. Recent genetic investigations have highlighted the involvement of specific genes, notably the SLC1A2 mutation, identified in 10 % of EOAE cases, underlying the GLUT1 deficiency syndrome. Timely recognition of such genetic anomalies facilitates tailored interventions, including ketogenic dietary regimes, shown to ameliorate epileptic symptomatology and neurocognitive sequelae. This retrospective study aimed to delineate the distinct features of EOAE and early-onset atypical absence seizures, facilitating prompt diagnosis, particularly emphasizing genetic aberrations, and initiating precision therapeutic approaches to optimize patient outcomes. Evaluation of 23 patients with absence epilepsy onset within the first four years of life, conducted at the Neuropediatrics Outpatient Clinic of the Policlinico of Modena, revealed that children with atypical absences often exhibit a complex clinical and electroencephalographic phenotype, frequently associated with genetic abnormalities. Notably, neurocognitive prognosis appears less favorable in this subgroup, with half of the patients displaying pharmacoresistance. In contrast, all EOAE cases demonstrated seizure freedom, corroborating previous literature suggesting a relatively benign clinical course in these individuals.

典型失神发作是一种特殊形式的癫痫活动，通常在儿科人群中观察到，主要表现在4至10岁之间，构成儿童期失神癫痫（CAE）。然而，有一小部分患者表现为早发性失智性癫痫（EOAE），其特征是在4岁之前癫痫发作，抗癫痫药物治疗通常显示出良好的结果。相反，非典型失神发作持续时间较长，常伴有强直性、无张力性或肌阵挛性运动因素，表明其临床病程更为严重，通常与儿童期癫痫性脑病有关。最近的遗传学研究强调了特定基因的参与，特别是SLC1A2突变，在10. %的EOAE病例中发现，是GLUT1缺乏症的基础。及时识别这种遗传异常有助于量身定制的干预措施，包括生酮饮食方案，可改善癫痫症状和神经认知后遗症。本回顾性研究旨在描述EOAE和早发非典型失神发作的独特特征，促进及时诊断，特别强调遗传畸变，并启动精确的治疗方法以优化患者的预后。Modena Policlinico神经儿科门诊对23例4岁以内癫痫缺失患者进行了评估，发现非典型癫痫缺失的儿童通常表现出复杂的临床和脑电图表型，通常与遗传异常有关。值得注意的是，在这个亚组中，神经认知预后似乎不太好，有一半的患者表现出耐药性。相比之下，所有EOAE病例均表现出癫痫发作自由，证实了先前文献表明这些个体的临床病程相对良性。

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引用次数: 0

A prospective design is required to calculate the epidemiological parameters of patients with SARS-CoV-2-vaccination associated GBS

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108756

Josef Finsterer

引用次数: 0

Revealing the diagnostic value of cerebrospinal fluid presepsin (sCD14) as a new biomarker for postneurosurgical and nosocomial central nervous system infections: A systematic review and meta-analysis of diagnostic test accuracy studies

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108767

Hazem E. Mohammed , Mohamed Nasser , Moaz Elsayed Abouelmagd , Mohamed E. Haseeb , Mohamed Khalafalla Darwish , Mohamed Salem Abdelqader , Ahmed Tawfik , Rania Elsayed Mahmoud Abdel-Mawla , Mahmoud Diaa Hindawi

Background

Central nervous system (CNS) infections represent life-threatening conditions. Emerging evidence suggests cerebrospinal fluid (CSF) presepsin (sCD14) as a promising biomarker for these infections. However, its diagnostic accuracy remains controversial. This study aimed to systematically evaluate the reliability of CSF presepsin in diagnosing CNS infections through a comprehensive meta-analysis.

Methods

A systematic search of PubMed, Scopus, and Web of Science databases was conducted up to November 2024. Five prospective studies involving 384 participants were included. CSF presepsin levels were compared between infected and non-infected patients. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive predictive value (PPV), and negative predictive value (NPV) were calculated using a random-effects model. Publication bias and clinical utility were assessed through Deek’s funnel plot and Fagan’s nomogram, respectively.

Results

Infected patients exhibited significantly higher CSF presepsin levels (mean difference: 760.16 pg/mL; 95 % confidence interval (CI): 426.26–1094.05, p < 0.01). Pooled sensitivity and specificity were 87 % (95 % CI: 82–91 %) and 67 % (95 % CI: 60–74 %), respectively, with a DOR of 13.04 (95 % CI: 7.51–22.64). The pooled PPV and NPV were 79 % (95 % CI: 73–84 %) and 79 % (95 % CI: 71–85 %), respectively. The area under the curve of the summary receiver operating characteristic curve was 86 %, emphasizing high diagnostic accuracy. No statistically significant publication bias was detected (P = 0.12).

Conclusion

CSF presepsin demonstrated potential as a diagnostic biomarker for CNS infections, demonstrating high sensitivity and moderate specificity. Further large-scale studies are needed to refine its clinical applicability and establish standardized thresholds.

{"title":"Revealing the diagnostic value of cerebrospinal fluid presepsin (sCD14) as a new biomarker for postneurosurgical and nosocomial central nervous system infections: A systematic review and meta-analysis of diagnostic test accuracy studies","authors":"Hazem E. Mohammed , Mohamed Nasser , Moaz Elsayed Abouelmagd , Mohamed E. Haseeb , Mohamed Khalafalla Darwish , Mohamed Salem Abdelqader , Ahmed Tawfik , Rania Elsayed Mahmoud Abdel-Mawla , Mahmoud Diaa Hindawi","doi":"10.1016/j.clineuro.2025.108767","DOIUrl":"10.1016/j.clineuro.2025.108767","url":null,"abstract":"<div><h3>Background</h3><div>Central nervous system (CNS) infections represent life-threatening conditions. Emerging evidence suggests cerebrospinal fluid (CSF) presepsin (sCD14) as a promising biomarker for these infections. However, its diagnostic accuracy remains controversial. This study aimed to systematically evaluate the reliability of CSF presepsin in diagnosing CNS infections through a comprehensive meta-analysis.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Scopus, and Web of Science databases was conducted up to November 2024. Five prospective studies involving 384 participants were included. CSF presepsin levels were compared between infected and non-infected patients. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive predictive value (PPV), and negative predictive value (NPV) were calculated using a random-effects model. Publication bias and clinical utility were assessed through Deek’s funnel plot and Fagan’s nomogram, respectively.</div></div><div><h3>Results</h3><div>Infected patients exhibited significantly higher CSF presepsin levels (mean difference: 760.16 pg/mL; 95 % confidence interval (CI): 426.26–1094.05, p < 0.01). Pooled sensitivity and specificity were 87 % (95 % CI: 82–91 %) and 67 % (95 % CI: 60–74 %), respectively, with a DOR of 13.04 (95 % CI: 7.51–22.64). The pooled PPV and NPV were 79 % (95 % CI: 73–84 %) and 79 % (95 % CI: 71–85 %), respectively. The area under the curve of the summary receiver operating characteristic curve was 86 %, emphasizing high diagnostic accuracy. No statistically significant publication bias was detected (P = 0.12).</div></div><div><h3>Conclusion</h3><div>CSF presepsin demonstrated potential as a diagnostic biomarker for CNS infections, demonstrating high sensitivity and moderate specificity. Further large-scale studies are needed to refine its clinical applicability and establish standardized thresholds.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108767"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to editor "Intraoperative indocyanine green (ICG) videoangiography in spinal hemangioblastoma surgery - helpful tool or unnecessary?" by Jan-Helge Klinger et al. [1] 致编辑的信“术中吲吲吲胺绿（ICG）视频血管造影在脊髓血管母细胞瘤手术中的应用——有用的工具还是不必要的？”作者：Jan-Helge Klinger等。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2024.108717

Savera Ejaz Ahmed , Javeria Imran , Marhama Alamgeer

引用次数: 0

Evaluation of resilience in pediatric well-controlled epilepsy patients

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2025.108779

Mutluay Arslan , Ayşe Nur Coşkun , Canan Üstün , Özgen Hür , Bülent Ünay

Objective

The main objective of this study was to assess the resilience scores of children with well-controlled epilepsy and their healthy counterparts using the Connor-Davidson Resilience Scale (CD-RISC). The secondary objective was to investigate the potential association between the age at onset, seizure type, and anti-seizure medication, and resilience in pediatric patients with well-controlled epilepsy.

Methods

This cross-sectional case-control study was performed on children aged 10–18 in a Training and Research Hospital Pediatric Neurology and Pediatric Outpatient Clinic. The study encompassed a total of 103 participants, comprising 57 children diagnosed with epilepsy and 46 healthy counterparts. Resilience and its individual components, namely hardiness, flexibility, coping, purpose, optimism, regulation of emotion and cognition, and self-efficacy, were assessed utilizing the Connor-Davidson Resilience Scale (CD-RISC).

Results

There was no statistically significant difference observed in the total CD-RISC scores between children with epilepsy (61.0 ± 17.7) and the healthy cohort (60.8 ± 14.4) (p: 0.97). Furthermore, a comprehensive analysis revealed no significant correlations between the CD-RISC total score and its individual component scores, taking into consideration various factors such as age, gender, age at onset, last seizure date, seizure type, EEG findings, and brain MRI findings.

Conclusion

Regardless of age, gender, age at onset, seizure type and anti-seizure medication, in well-controlled epilepsy, resilience is similar to that of healthy children. New studies are needed to evaluate resilience in children with epilepsy who have uncontrolled seizures and receive polytherapy.

{"title":"Evaluation of resilience in pediatric well-controlled epilepsy patients","authors":"Mutluay Arslan , Ayşe Nur Coşkun , Canan Üstün , Özgen Hür , Bülent Ünay","doi":"10.1016/j.clineuro.2025.108779","DOIUrl":"10.1016/j.clineuro.2025.108779","url":null,"abstract":"<div><h3>Objective</h3><div>The main objective of this study was to assess the resilience scores of children with well-controlled epilepsy and their healthy counterparts using the Connor-Davidson Resilience Scale (CD-RISC). The secondary objective was to investigate the potential association between the age at onset, seizure type, and anti-seizure medication, and resilience in pediatric patients with well-controlled epilepsy.</div></div><div><h3>Methods</h3><div>This cross-sectional case-control study was performed on children aged 10–18 in a Training and Research Hospital Pediatric Neurology and Pediatric Outpatient Clinic. The study encompassed a total of 103 participants, comprising 57 children diagnosed with epilepsy and 46 healthy counterparts. Resilience and its individual components, namely hardiness, flexibility, coping, purpose, optimism, regulation of emotion and cognition, and self-efficacy, were assessed utilizing the Connor-Davidson Resilience Scale (CD-RISC).</div></div><div><h3>Results</h3><div>There was no statistically significant difference observed in the total CD-RISC scores between children with epilepsy (61.0 ± 17.7) and the healthy cohort (60.8 ± 14.4) (p: 0.97). Furthermore, a comprehensive analysis revealed no significant correlations between the CD-RISC total score and its individual component scores, taking into consideration various factors such as age, gender, age at onset, last seizure date, seizure type, EEG findings, and brain MRI findings.</div></div><div><h3>Conclusion</h3><div>Regardless of age, gender, age at onset, seizure type and anti-seizure medication, in well-controlled epilepsy, resilience is similar to that of healthy children. New studies are needed to evaluate resilience in children with epilepsy who have uncontrolled seizures and receive polytherapy.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108779"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to Editor: Socioeconomic influences on stroke outcomes: A comprehensive zip code-based hospital analysis.

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 Epub Date: 2025-02-12 DOI: 10.1016/j.clineuro.2025.108784

Alireza Karandish, Muhammed Amir Essibayi, Deepak Khatri, Neil Haranhalli, David J Altschul

引用次数: 0

Correlation of the clinical rating scale for tremor with a global assessment 震颤临床评定量表与整体评估的相关性。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2025-02-01 DOI: 10.1016/j.clineuro.2024.108710

Susanna D. Howard , Shikha Singh , Dominick Macaluso , Jesse Y. Hsu , Iahn Cajigas , Liming Qiu , Casey H. Halpern , Whitley W. Aamodt , John T. Farrar

Objective

The Fahn-Tolosa-Marín Clinical Rating Scale for Tremor (CRST) includes three parts (tremor severity, motor task performance, functional disability) and a separate global assessment of impairment completed by both the patient and examiner. Although the CRST is used to determine tremor severity and the efficacy of treatments for tremor, the instrument may not sufficiently capture the patient’s perspective. The objective of this study was to determine the association of the CRST subpart and total scores with the global assessment.

Methods

This cross-sectional study included patients with essential tremor who completed a CRST within a tertiary health system electronic health record from 2013 to 2023. The global assessment was rated on a 0–100 % (most severe impairment) scale.

Results

116 patients were included. The total CRST score was significantly associated with the examiner-reported global assessment (Spearman’s correlation coefficient (ρ) 0.63, 95 % confidence interval (CI) 0.51 – 0.73, p < 0.001) but not the patient-reported global assessments (ρ 0.15, 95 % CI −0.04 – 0.33, p = 0.13). There were no significant associations between Part A, B, or C sub-scores and the patient-reported global assessments.

Conclusion

CRST scores have a stronger association with the examiner-reported global assessment than the patient-reported global assessment. The impact of tremor may be determined by functional detriments not readily measured with the CRST. By using the global assessments as a standard for comparison, our findings call into question the relevance of the CRST total scores and sub-scores as an accurate patient-centered outcome metric.

目的：Fahn-Tolosa-Marín震颤临床评定量表（CRST）包括三个部分（震颤严重程度、运动任务表现、功能残疾）和由患者和检查者共同完成的单独的整体损伤评估。虽然CRST用于确定震颤的严重程度和治疗震颤的疗效，但该仪器可能不能充分地捕捉患者的视角。本研究的目的是确定CRST子部分和总分与整体评估的关系。方法：这项横断面研究纳入了2013年至2023年在三级卫生系统电子健康记录中完成CRST的特发性震颤患者。全球评估评分为0-100 %（最严重损害）。结果：纳入116例患者。总CRST评分与审查员报告的整体评估显著相关(Spearman相关系数（ρ） 0.63, 95 %置信区间（CI） 0.51 - 0.73， p 结论：CRST评分与审查员报告的整体评估的相关性强于患者报告的整体评估。震颤的影响可以通过CRST无法测量的功能损害来确定。通过使用全局评估作为比较标准，我们的研究结果对CRST总分和分值作为准确的以患者为中心的结果指标的相关性提出了质疑。

{"title":"Correlation of the clinical rating scale for tremor with a global assessment","authors":"Susanna D. Howard , Shikha Singh , Dominick Macaluso , Jesse Y. Hsu , Iahn Cajigas , Liming Qiu , Casey H. Halpern , Whitley W. Aamodt , John T. Farrar","doi":"10.1016/j.clineuro.2024.108710","DOIUrl":"10.1016/j.clineuro.2024.108710","url":null,"abstract":"<div><h3>Objective</h3><div>The Fahn-Tolosa-Marín Clinical Rating Scale for Tremor (CRST) includes three parts (tremor severity, motor task performance, functional disability) and a separate global assessment of impairment completed by both the patient and examiner. Although the CRST is used to determine tremor severity and the efficacy of treatments for tremor, the instrument may not sufficiently capture the patient’s perspective. The objective of this study was to determine the association of the CRST subpart and total scores with the global assessment.</div></div><div><h3>Methods</h3><div>This cross-sectional study included patients with essential tremor who completed a CRST within a tertiary health system electronic health record from 2013 to 2023. The global assessment was rated on a 0–100 % (most severe impairment) scale.</div></div><div><h3>Results</h3><div>116 patients were included. The total CRST score was significantly associated with the examiner-reported global assessment (Spearman’s correlation coefficient (ρ) 0.63, 95 % confidence interval (CI) 0.51 – 0.73, p < 0.001) but not the patient-reported global assessments (ρ 0.15, 95 % CI −0.04 – 0.33, p = 0.13). There were no significant associations between Part A, B, or C sub-scores and the patient-reported global assessments.</div></div><div><h3>Conclusion</h3><div>CRST scores have a stronger association with the examiner-reported global assessment than the patient-reported global assessment. The impact of tremor may be determined by functional detriments not readily measured with the CRST. By using the global assessments as a standard for comparison, our findings call into question the relevance of the CRST total scores and sub-scores as an accurate patient-centered outcome metric.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108710"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0