European Neurology最新文献

Introduction: Narcolepsy is a rare sleep disorder with a complex clinical picture, which may affect the daily functioning of patients. Artificial intelligence (AI) has emerged as a promising tool in healthcare, potentially offering valuable support to patients. However, its accuracy in specific medical domains remains inadequately assessed. This study aimed to evaluate and compare the accuracy, completeness, and readability of responses from ChatGPT, Gemini, and Perplexity to queries about narcolepsy.

Methods: This study was a cross-sectional study. A set of 28 common patient questions was selected and entered into the three chatbots. Responses were independently reviewed by three sleep physicians. Accuracy and completeness were rated on predefined 5-point and 3-point scales, respectively. Readability was evaluated using six validated formulas.

Results: All chatbots showed median accuracy ranging from "more correct than incorrect" to "completely correct," with no significant performance differences. The topics with the lowest scores were "treatment and prognosis" for ChatGPT and Perplexity and "diagnosis" for Gemini. Gemini responses were significantly less complete compared to ChatGPT and Perplexity, with median completeness scores for ChatGPT and Perplexity ranging from "nearly complete" to "complete" and for Gemini ranging from "incomplete" to "nearly complete." All chatbots' responses required an advanced reading level, with Perplexity showing lower readability in five metrics.

Conclusion: Our findings highlight the potential of AI chatbots to deliver mostly accurate responses to narcolepsy-related queries. However, these tools have limitations, including text accessibility, as the readability of the responses did not align with the recommended standards for health information. Therefore, their use should be integrated with appropriate guidance from healthcare professionals to avoid potential misunderstandings.

Introduction: Given the increasing number of patients suffering from pain associated with dysautonomic symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we aimed to estimate the occurrence of small fiber neuropathy (SFN) in a cohort of long coronavirus disease 19 (COVID-19) patients reporting postinfectious neuropathic pain.

Methods: The study cohort included 18 patients suffering from neuropathic pain (neuropathic pain score DN4 ≥4) appearing after or during SARS-CoV-2 infection and lasting ≥90 days; presenting normal nerve conduction studies excluding large fiber damage. Patients underwent multimodal SFN evaluation by skin biopsy, quantitative sensory testing (QST), laser evoked potential (LEP) recording and electrochemical skin conductance (ESC; Sudoscan).

Results: Out of 18 patients, 17 were analyzed. Participants' ages averaged 44 ± 9 years, with 94% females. Fourteen (82%) had abnormal skin biopsy results. Notably, 12/17 (70%) patients presented with autonomic complaints, all of whom had abnormal skin biopsy results. At 6-month follow-up, 10/17 patients reported a subjective improvement in pain and/or dysautonomia with or without symptomatic pharmacological or non-pharmacological treatment. In our cohort, QST showed the highest sensibility (79%) and specificity (67%), followed by LEP (sensibility 71%, specificity 67%). ESC showed poor reliability in the screening of SFN with a sensibility of 7% and specificity of 50%.

Conclusion: The results of our study suggest that SFN may develop during or shortly after SARS-CoV-2 infection, provoking disabling sensory and dysautonomic symptoms that tend to persist for more than 6 months. Furthermore, our findings imply that noninvasive exams are a useful complement to biopsy in the diagnostic process of SFN.

This article examines a rare 1894 letter by American homeopath Stella Hunt (1860-1925), recounting her 1892 visit to Jean-Martin Charcot's clinics at the Salpêtrière Hospital in Paris. As one of the few female physicians of her time, Hunt offers a unique perspective on Charcot's teaching, the clinical environment, and the reception of women in French medical institutions. The article also provides biographical insights into Hunt's career and explores the intersections between homeopathy and neurology at the close of the 19th century.

Introduction: While small-scale studies have linked calcifications to functional impairment of the choroid plexus, their association with systemic inflammation remains uncertain. This study investigates the relationship between choroid plexus calcifications (CPCs) and the systemic immune-inflammation index (SII), a reliable biomarker of systemic inflammation, in middle-aged and older adults.

Methods: A cross-sectional, population study of 814 adults aged ≥40 years quantified CPC volumes using CT and automated segmentation. SII was calculated from blood cell counts. Nonparametric and linear regression models assessed the association between CPC and SII.

Results: Participants had a mean age of 54.5 ± 11.6 years (59% women), with mean CPC volume of 651.2 ± 373.3 µL, and mean SII of 446.8 ± 247.2 × 109 L. Nonparametric regression indicated a weak negative association between CPC volume and SII. All models showed nonsignificant negative coefficients, suggesting CPC may reflect a resolved inflammatory state rather than active dysfunction.

Conclusions: Study results challenge prior assumptions linking calcifications to choroid plexus dysfunction and systemic inflammation. Although CPC volume was not associated with SII, further research incorporating advanced imaging and broader biomarkers is needed to clarify the role of CPC in inflammatory processes.

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% vs. 9.09%, p = 0.002), current smokers (24.30% vs. 12.12%, p = 0.024) and have coronary artery disease (26.79% vs. 15.69%, p = 0.048), and hyperglycemia on admission (142.79 ± 59.59 vs. 126.58 ± 37.29, p = 0.019). Women were older (74.91 ± 11.69 vs. 69.28 ± 14.53 years, p = 0.002), and more likely to have possible/probable CAA in univariate (97.06% vs. 88.39%; 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 (73 vs 77 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: Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder characterized by involuntary movements, psychiatric symptoms and cognitive decline. Its prevalence is highest in individuals of European descent. However, a previous study in 2007 in Iceland showed an unusually low incidence and prevalence. The aim of this study was to investigate the incidence and prevalence of HD in Iceland between 2008 and 2022 as well as age, sex, symptoms, number of cytidine-adenosine-guanosine (CAG) repeats, treatment, and prognosis.

Methods: A retrospective epidemiological study was conducted with clinical information obtained from medical records of individuals diagnosed with HD 2008-2022. Information was also obtained from the Department of Genetics at University Hospital of Iceland and neurologists managing HD patients.

Results: Among the 22 diagnosed individuals (11 men) identified, the point prevalence on December 31, 2022, was 4.38 per 100,000 inhabitants, with an average annual incidence rate of 0.314 per 100,000 person-years. The average age at symptom onset was 46.3 years. A total of 21 out of 22 individuals had confirmed HD through genetic testing, with an average CAG repeat length of 42.3 (range 40-45). Five individuals died during the study period, with the most common cause of death being aspiration pneumonia. The average age at death was 70.4 years.

Conclusion: The prevalence and incidence of HD in Iceland have increased compared to the 2007 study but remain lower than in other European populations. Results showed a lower number of CAG repeats in the Icelandic HD population, potentially explaining the higher age at symptom onset and death compared to global averages.

Introduction: Levodopa-entacapone-carbidopa intestinal gel (LECIG) is a recently introduced device-aided treatment option for advanced Parkinson's disease. Data on long-term outcomes remain limited, with only two published studies to date. This study aimed to report long-term outcomes of LECIG treatment, focusing on safety, adverse events, and treatment adherence.

Methods: In this retrospective longitudinal observational single-center study, the medical records of 27 consecutive patients treated with LECIG at Helsinki University Hospital between 2020 and 2024 were analyzed. Adverse events, treatment discontinuations, and medication changes were assessed during the first 2 years of treatment. Clinically significant weight loss was defined as weight loss of >5% over 12 months. Fisher's exact test was used to assess the association between living situation and treatment discontinuation.

Results: In total, 10 patients (37%) discontinued the treatment, with 6 (60%) within the first year. Living alone was significantly associated with discontinuation (p = 0.033) compared to living with a spouse or in an institution. Three patients died during follow-up from causes unrelated to LECIG treatment. Adverse events were frequent, including inner tube complications requiring 41 inner tube replacements. Clinically significant weight loss was observed in 29% of patients.

Conclusions: In long-term treatment, adverse events with LECIG appear similar to those observed with levodopa-carbidopa intestinal gel (LCIG). However, weight loss and the discontinuation rate appear higher with LECIG. Yet, no direct comparison to LCIG was made in this study. Similar to LCIG, the discontinuation rate is particularly high among patients living alone.

Introduction: Pain, particularly cramping, in people living with amyotrophic lateral sclerosis (ALS) is often underrecognized and under-treated. Despite affecting over 70% of people living with ALS (plwALS), cramping pain remains inadequately managed due to its complex nature and the difficulties plwALS face in communicating their symptoms as the disease progresses. This systematic review explores both pharmacological and non-pharmacological treatments for cramping pain in ALS, aiming to assess and compare their efficacy.

Methods: The systematic review was conducted following PRISMA guidelines, and the protocol was registered with PROSPERO (ID CRD42024521649). A comprehensive search was performed across MEDLINE, Embase, Scopus, and Cochrane databases from inception until February 1, 2024, using specific search terms related to ALS and cramping.

Results: The search resulted in the identification of 368 studies. After duplicates were removed, abstracts screened, and full texts reviewed, nine studies were included. Pharmacological interventions such as mexiletine demonstrated significant reductions in cramp frequency and intensity in several trials, with varying doses showing distinct levels of effectiveness. Other medications like dronabinol and levetiracetam were also tested but showed limited efficacy in reducing cramp severity. Among non-pharmacological options, supervised exercise programs, particularly those incorporating stretching and functional mobility, were effective in reducing cramping pain intensity, while unsupervised home exercise programs did not show significant improvements.

Conclusion: The review demonstrates the scarcity of high-quality research on cramping pain management in ALS. Mexiletine emerged as the most promising pharmacological intervention, providing notable relief, while supervised exercise therapy demonstrated beneficial effects.

Introduction: This systematic review and meta-analysis was conducted to investigate the association between alcohol use pattern and ischemic stroke risk.

Methods: We searched PubMed, Scopus, Web of Sciences, Embase, and CENTRAL till the 1st of June, 2024. Studies were included if they were articles that assessed the impact of alcohol drinking pattern on the risk of ischemic stroke. The random-effect model was utilized to combine the results. Data analysis was performed using Meta XL, version 5.3.

Results: The total number of included participants was 21,293,471 from 125 studies. The model that investigated the association between light alcohol use and ischemic stroke risk showed no association (relative risk [RR] = 0.97, 95% confidence interval [CI]: 0.89-1.05). Moderate alcohol use was associated with significant decrease in ischemic stroke risk (RR = 0.87; 95% CI: 0.83-0.92), while heavy alcohol use was associated with significant increase in ischemic stroke risk (RR = 1.31; 95% CI: 1.19-1.44). Subgroup analysis among males showed results similar to the primary analysis while among females, and only moderate alcohol drinking was significantly associated with ischemic stroke (RR = 0.50; 95% CI: 0.33-0.75). Moderate and heavy wine use was associated with significant reduction in ischemic stroke risk (RR = 0.61; 95% CI: 0.45-0.84; RR = 0.77; 95% CI: 0.63-0.93).

Conclusions: Our analysis provided a strong and robust evidence that there was a significant association between moderate and heavy alcohol use with ischemic stroke risk. However, this association varied by several variables including type of alcohol with the effect being more protective among people who use wine.