European Neurology最新文献

Introduction: Cerebral small vessel disease (CSVD) is a major cause of primary lobar intracerebral hemorrhage (ICH) due to cerebral amyloid angiopathy (CAA) or hypertensive arteriopathy (HA). Sex differences in CSVD imaging markers and prevalence of CAA vs HA in lobar ICH remain unexplored.

Methods: We performed a retrospective analysis of patients with primary lobar ICH who underwent MRI during hospitalization. We collected demographic, clinical, and outcome data. We reviewed MRIs for CSVD markers and calculated composite CSVD burden score (cCSVDbs). We assigned possible/probable CAA using Boston criteria 2.0. We grouped patients based on their sex and examined associations between sex and CSVD markers, cCSVDbs, or CAA. Kaplan Meier survival analysis was used to determine ICH-onset age among patients with first-ever symptomatic lobar ICH.

Results: 214 patients were included (102 (47.66%) women). Men were more likely to be current alcohol abusers (25.69%vs9.09%, p=0.002), current smokers (24.30%vs12.12%, p=0.024), and have coronary artery disease (26.79%vs15.69%, p=0.048), and hyperglycemia on admission (142.79±59.59vs126.58±37.29, p=0.019). Women were older (74.91±11.69vs69.28±14.53 years, p=0.002), and more likely to have possible/probable CAA in univariate (97.06%vs88.39%; OR 4.33, 95%CI 1.19-15.67; p=0.025) but not multivariate analysis. We found no significant differences in MRI markers of CSVD, cCSVDbs, or CAA. Among patients who presented with their first-ever primary symptomatic lobar ICH (n=187), men were younger than women (73vs77 years, p=0.001).

Conclusions: In our cohort of patients with primary lobar ICH, we found no significant difference in clinical and imaging characteristics between sexes. However, men were more likely to have a younger lobar ICH-onset age compared to women.

Introduction: Epilepsy is a prevalent neurological disorder globally, with about 30% of patients developing resistance despite optimal antiseizure drug therapies. Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique and offers a potential therapeutic alternative for drug-resistant focal epilepsy, aiming to reduce seizure frequency and improve patient quality of life.

Methods: Following PRISMA guidelines, a search was performed on MEDLINE, Web of Science, and Cochrane Library from inception to June 2024. Included articles were randomized controlled trials reporting seizure frequency, IEDs, and adverse events in patients with focal epilepsy treated with tDCS. Quality assessment was conducted using RoB2, and data were analyzed using a random-effects model.

Results: Nine studies involving 253 patients met the inclusion criteria. tDCS significantly reduced seizure frequency at 1- and 2-month follow-up compared to placebo, with a mean difference (MD) of -2.62, 95% CI (-5.20, -0.04), p = 0.05 at 1 month and MD of -2.80, 95% CI (-5.08, -0.53), p = 0.02 at 2 months. No significant changes in IEDs were observed. Adverse events were generally mild and consisted of itching, skin rash, and headache being the most common.

Conclusion: tDCS reduces seizure frequency in patients with drug-resistant focal epilepsy and is associated with minimal adverse effects. However, there was no significant impact on IEDs, and the studies included exhibited considerable heterogeneity. More standardized research is required to validate these findings and optimize treatment protocols.

Introduction: Current guidelines recommend transthoracic echocardiography (TTE) for routine screening of cardiac emboli; however, the visualization of the left atrial appendage (LAA) where the thrombi are commonly found is poor. Transesophageal echocardiography (TEE) would provide better detectability of LAA thrombus, but it is a time-consuming and semi-invasive method. Extending non-gated carotid computed tomography angiography (CTA) examination to the LAA could reliably detect thrombi and could also aid treatment and secondary prevention of stroke.

Methods: We extended the CTA scan range of acute stroke patients 4 cm below the carina to include the left atrium and appendage. During the review, we evaluated LAA thrombi based on contrast relations. We then used gradient boosting to identify the most important predictors of LAA thrombi from a variety of different clinical parameters.

Results: We examined 240 acute stroke patients' extended CTA scans. We detected LAA thrombi in eleven cases (4.58%), eight of them had atrial fibrillation. 23.75% of all patients (57 cases) had recently discovered or previously known atrial fibrillation. Windsack morphology was the most commonly associated morphology with filling defects on CTA. According to the gradient-boosting analysis, LAA morphology showed the most predictive value for thrombi.

Conclusion: Our extended CTA scans reliably detected LAA thrombi even in cases where TTE did not and showed that 2 patients' LAA thrombus would have been untreated based on electrocardiogram monitoring and TTE. We also showed that the benefits of CTA outweigh the disadvantages arising from the slight amount of excess radiation.

Introduction: Endovascular thrombectomy (EVT) is the standard of care for patients with large-vessel occlusion acute ischemic stroke (AIS). There may be differing recanalization effectiveness based on patients' sex, and understanding such variations can improve patient outcomes by adjusting for differences. We aimed to assess the sex differences in outcome after EVT for patients with AIS.

Methods: We retrospectively analyzed 250 consecutive AIS patients who underwent EVT from July 2019 to February 2022 across two large comprehensive tertiary care stroke centers in China. Outcomes of male patients were compared to females, where poor outcome was defined as a modified Rankin score (mRS) of 3-6 at 90 days.

Results: Male patients had higher rates of symptomatic intracranial hemorrhage (sICH) (12.50% vs. 4.05%, p = 0.042) and higher hospitalization costs (114,541.08 vs. 105,790.27 RMB, p = 0.024). Male patients also had a longer median onset-to-needle time (ONT) (146.00 [104.00, 202.00] versus 120.00 [99.25, 144.75], p = 0.026). However, there were no differences in hospitalization length (p = 0.251), 90-day favorable outcome (p = 0.952), and 90-day mortality (p = 0.931) between the sexes.

Conclusion: Female patients had lower hospitalization costs and sICH rates than males after EVT for AIS. Identifying such differences and implementing measures, including adaptations to workflow optimization, would help to reduce the ONT and last known normal-to-puncture time seen in males to improve patient outcomes. Despite such variations, favorable outcomes and mortality are similar in female and male AIS patients.

Introduction: The objective of this study was to evaluate the effects and safety of monoamine oxidase-B inhibitors (MAO-B inhibitors) for early Parkinson's disease (PD).

Methods: All studies that assessed the efficacy of MAO-B inhibitors in patients with early PD were searched. Publications were screened, and data were extracted according to predefined criteria. Rev Man 5.4 and Stata 14.0 software were used for statistical analysis. Outcomes assessed included change of Unified Parkinson's Disease Rating Scale (UPDRS) total score, UPDRS part II score, UPDRS part III score, and the incidence of adverse events.

Results: Thirty trials were identified and included in this meta-analysis. Compared with placebo, rasagiline, selegiline, safinamide, and zonisamide were significantly more effective, with a standardized mean difference (SMD) of -0.41 (95% confidence interval (CI) = -0.64 to -0.18), SMD = -0.38 (95% CI = -0.51 to -0.24), SMD = -0.37 (95% CI = -0.54 to -0.21), and SMD = -0.31 (95% CI = -0.57 to -0.05) on the UPDRS III score change, respectively. The surface under the cumulative ranking results showed that rasagiline ranked first in improving UPDRS II and UPDRS III, respectively. For safety outcomes, safinamide combination with dopaminergic treatment had lower risk of incurring any adverse events (risk ratio = 0.1, 95% CI = 0.01-0.2), and no statistical difference in incidence of adverse events was observed among other MAO-B inhibitor regimes and placebo.

Conclusion: Rasagiline, selegiline, safinamide, and zonisamide were effective compared to placebo in the treatment of early PD, but rasagiline was the most effective drug. As for safety, safinamide combination with dopaminergic treatment had lower risk of incurring any adverse events.

Background: Mechanical thrombectomy represents a mainstay of management for acute ischemic stroke in the setting of large vessel occlusion. However, there are no clinical practice guidelines defining the role of thrombectomy at the extremes of age. In this scoping review, we aimed to summarize the existing medical and neurosurgical literature pertaining to mechanical thrombectomy in nonagenarians. The PubMed database was queried using the following terms and relevant citations assessed: "thrombectomy nonagenarian," "thrombectomy age 90," "stroke nonagenarian," and "ischemic stroke thrombectomy." Common measurable outcomes, including mortality, modified Rankin scale (mRS) score, and thrombolysis in cerebral infarction (TICI) scale score, were utilized to compare results.

Summary: Thrombectomy was shown to improve functional outcomes in all eight of the studies included in the analysis. Mortality was assessed in only two reported studies, and thrombectomy was shown to provide a mortality benefit in 1 study among patients for whom first-pass reperfusion was achieved. Other outcomes of reported interest included greater early neurologic recovery at discharge and improved functional outcomes at 90 days among nonagenarians who underwent thrombectomy as compared to those who received thrombolytic therapy alone. Nonagenarians with good functional status at baseline were the most likely to have favorable outcomes.

Key messages: Mechanical thrombectomy improves outcomes among nonagenarians presenting with acute ischemic stroke due to large vessel occlusion. Further large-scale prospective studies are warranted to optimize patient selection and develop clinical practice guidelines specific to this important patient demographic.

Introduction: Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS.

Methods: We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0-1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex.

Results: In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain "emotion," "strength," and "participation." Patients with NIHSS ≥1 had lower scores in all SIS domains except "emotions" and "mobility." Patients ≥50 years had lower score in "mobility" (p = 0.004) and females in domain of "social participation" (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL.

Discussion/conclusions: Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected "mobility" and females "social participation."