Frontiers in Neurology最新文献

Objectives: This study aimed to develop and validate a robust predictive model for accurately identifying migraine without aura (MWoA) individuals from migraine patients.

Methods: We recruited 637 migraine patients, randomizing them into training and validation cohorts. Participant's medical data were collected such as demographic data (age, gender, self-reported headache characteristics) and clinical details including symptoms, triggers, and comorbidities. The model stability, which was developed using multivariable logistic regression, was tested by the internal validation cohort. Model efficacy was evaluated using the area under the receiver operating characteristic curve (AUC), alongside with nomogram, calibration curve, and decision curve analysis (DCA).

Results: The study included 477 females (average age 46.62 ± 15.64) and 160 males (average age 39.78 ± 19.53). A total of 397 individuals met the criteria for MWoA. Key predictors in the regression model included patent foramen ovale (PFO) (OR = 2.30, p = 0.01), blurred vision (OR = 0.40, p = 0.001), dizziness (OR = 0.16, p < 0.01), and anxiety/depression (OR = 0.41, p = 0.02). Common symptoms like nausea (OR = 0.79, p = 0.43) and vomiting (OR = 0.64, p = 0.17) were not statistically significant predictors for MWoA. The AUC values were 79.1% and 82.8% in the training and validation cohorts, respectively, with good calibration in both.

Conclusion: The predictive model developed and validated in this study demonstrates significant efficacy in identifying MWoA. Our findings highlight PFO as a potential key risk factor, underscoring its importance for early prevention, screening, and diagnosis of MWoA.

Introduction: Amantadine has been shown to accelerate cognitive and functional brain recovery after cerebrovascular accidents. However, the efficacy of this drug in TBI patients remains poorly defined.

Methods: We performed a systematic review and meta-analysis of randomized trials (RCTs) evaluating the effects of amantadine in TBI patients. The Cochrane, Embase, and PubMed databases were systematically searched for trials published up to March 24, 2024. Data from previous RCTs were extracted and quality assessed according to Cochrane recommendations. Means and standard deviations with 95% confidence intervals were aggregated across studies. The primary outcomes assessed were Glasgow Coma Scale (GCS), Mini Mental State Examination (MMSE) and the Disability Rating Scale (DRS).

Results: From 1,292 database results, 6 studies with 426 patients were included, of which 205 received amantadine (48.12%). The Glasgow Coma Scale score on day 7 (MD 1.50; 95% CI 0.08-2.92; p = 0.038; I ² = 68%) was significantly higher in patients treated with amantadine than those treated with placebo. The Mini Mental State Examination (MD 3.23; 95% CI 0.53-5.94; p = 0.019; I ² = 0%) was also better in patients treated with amantadine. No significant differences in Disability Rating Scale, day 3 GCS, Glasgow Outcome Scale (GOS), length of hospital stay, or duration of mechanical ventilation were observed between amantadine and placebo groups.

Conclusion: In our analysis, TBI patients benefit from the use of amantadine in the day 7 GCS score and show better results in the MMSE test, but placebo patients benefit from not using amantadine in the DRS between weeks 3 and 4. No other statistically significant results were found related to the use of this medication.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_ record.php?ID=CRD42024538110, CRD42024538110.

Introduction: Assistive technologies (ATs) offer significant potential to improve the quality of life for individuals with Amyotrophic Lateral Sclerosis (ALS). This study explores the concept of integrated user value (IUV), focusing on five key aspects: quality, user experience, cost-effectiveness, safety, and accessibility. Understanding IUV is crucial for enhancing the development and deployment of ATs in ALS disease management.

Methods: A systematic search approach was utilized to collect data from Facebook ALS support groups, comprising posts from individuals with ALS and their caregivers. Using a predefined set of keywords, 416 posts were analyzed. The posts were categorized based on the five aspects of IUV, and an in-depth content analysis was conducted to explore patterns, challenges, and experiences associated with AT usage.

Results: The analysis revealed significant challenges across all aspects of IUV. Quality and user experience were interlinked, with users frequently citing inadequate designs and unmet customization needs. Cost-effectiveness was a key concern, with high costs and limited insurance coverage contributing to financial strain. Accessibility issues, including delays in acquiring devices and insufficient public facilities, further highlighted systemic challenges. Safety concerns emphasized the need for personalized and intuitive AT designs.

Discussion: The findings underscore the importance of a holistic approach to AT development, integrating all five aspects of IUV. Recommendations include enhancing product quality, ensuring affordability, prioritizing user-centered design, and addressing accessibility gaps. Collaboration between AT designers, healthcare providers, and policymakers is essential to optimize AT value and improve the quality of life for individuals with ALS and their caregivers.

Introduction: The National Institutes of Health (NIH) Toolbox Near Visual Acuity Test is a novel digitized measure designed to provide an assessment of near vision in a time-and cost-effective manner. This study is the first to report the psychometric properties of the NIH Toolbox Near Visual Acuity Test in a sample of community-dwelling middle-aged and older adults.

Methods: Ninety-eight adults (ages 40-81) completed the tablet-based near vision test and the gold standard chart-based near vision test. Performance on the tablet-and chart-based near vision tests was expressed in logarithmic units. Chart-and tablet-based administration order was counterbalanced. To assess test-retest reliability, the NIH Toolbox Near Visual Acuity Test was administered twice within the same day. Additionally, two equivalent versions of the chart-based test were randomly assigned to participants.

Results: Analyses revealed that test-retest reliability of the NIH Toolbox Near Visual Acuity Test was good (intraclass correlation = 0.87, p < 0.001). Concurrence between the NIH Toolbox Near Visual Acuity Test and gold standard chart-based test was also good (r = 0.79, p < 0.001).

Discussion: Findings provide support for the reliability and validity of the NIH Toolbox Near Visual Acuity Test as a near vision assessment for middle-aged to older adult populations. With further research, the integration of this test within the widely used NIH Toolbox may provide a more efficient means to understanding how near visual acuity influences neurocognitive test performance and brain function in middle-aged to older adult populations.

Mutations in ASH1L have been associated with a range of phenotypes, including intellectual disability (ID), autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), seizures, as well as differences in skeletal, muscular, and sleep functions. In this study, we describe a patient diagnosed with mild ID, and whole-exome sequencing (WES) of the family identified a novel heterozygous nonsense variant, NM_018489.2: c.2479A > T (p.Lys827*), located in exon 3 of ASH1L, which was predicted to be pathogenic. The nonsense variant in the mild ID patient may disrupt ASH1L function by destabilizing its spatial conformation, leading to decreased activity of the catalytic H3K36 methylation, thereby affecting neurological function. A review of reported ASH1L nonsense mutations to explore genotype-phenotype correlations suggested that these variants typically result in a loss of function. Our findings contribute to understanding the neurodevelopmental pathogenesis of mild ID in patients with the ASH1L nonsense variant mutation.

Background: Recent scientific interest has focused on exploring the potential relationships between fatigue, respiratory function and balance in multiple sclerosis (MS) subjects. While some studies suggest that fatigue may impact respiratory function and postural stability, the exact nature of these associations remains under investigation. Ultrasound imaging is increasingly being used to examine the structural and functional characteristics of core muscles, aiming to better understand how these variables might be interconnected. Understanding these associations is crucial for developing targeted interventions to enhance overall physical performance in this population. This study examines the relationship between fatigue, respiratory function, balance, and ultrasound variables of abdominal musculature in MS.

Methods: A cross-sectional study was conducted involving 27 subjects diagnosed with MS, comprising 17 females and 10 males. Study variables were: fatigue (Modified Fatigue Impact Scale-MFIS); respiratory function (Forced Vital Capacity-FVC and Forced Expiratory Volume in the first second-FEV1); balance (Berg Balance Scale-BBS and Trunk Impairment Scale Dynamic-TIS DYN); and ultrasound measurements of abdominal and diaphragmatic musculature. Correlations were analyzed using Spearman's correlation, with a statistical significance level of p < 0.05.

Results: Significant correlations were found between respiratory function and balance scores. FVC showed a moderate correlation with BBS (r = 0.443), while FEV1 had a high correlation with BBS (r = 0.500) and a moderate correlation with TIS DYN (r = 0.427). MFIS showed a moderate negative correlation with BBS (r = -0.402). The strength and function of the central abdominal musculature, particularly the internal oblique, were crucial for trunk stability and postural control.

Conclusion: These findings highlight the interplay between respiratory function, balance, fatigue, and abdominal muscle morphology in MS, emphasizing the potential benefits of interventions targeting respiratory function to improve balance and reduce fatigue, ultimately enhancing quality of life in this population.

Background: The optimal timing of cranioplasty (CP) after decompressive craniectomy (DC) is inconclusive. This article aims to investigate the effect of different timing of CP on the neurologic prognosis of patients, and to explore the feasibility and safety of ultra-early CP (within 3 weeks) following DC.

Methods: The duration time of surgery, intraoperative bleeding volume, surgery-related complications, and activities of daily living (ADL) scores were retrospectively analyzed in 23 patients underwent ultra-early CP performed within 3 weeks, and compared with 136 patients with non-ultra-early CP performed within the same time period.

Results: The mean duration time of surgery in the ultra-early group was significantly shorter than that in the non-ultra-early group. ADL scores were significantly lower in the ultra-early group than in the non-ultra-early group both before and 1 month after CP, but there was no statistically significant difference in ADL scores between the two groups at long-term follow-up. The overall incidence of surgery-related complications was 17.39% (4/23) in the ultra-early group and 14.71% (20/136) in the non-ultra-early group, and there was no statistically significant difference in the comparison between the two groups (p = 0.739).

Conclusion: Both ultra-early and non-ultra-early CP can significantly improve the neurological prognosis of patients. Ultra-early CP can significantly shorten the length of surgery and does not increase the incidence of surgery-related complications, which has a certain degree of safety and feasibility, and can be popularized under the premise of strict screening of indications, but further research is still needed.

Background: Headaches are common complaints in the emergency department (ED) and have raised concern about acute medication overuse. Chinese medicine is a major complementary and alternative medicine in China and effective for headaches. This study aims to summarize characteristics of headache patients at EDs and the utilization of Chinese medicine for headache managements in EDs.

Methods: The study conducted a retrospective analysis based on existing electronic medical records at EDs from four branches of Guangdong Provincial Hospital of Chinese Medicine. Only complete medical records with a first diagnosis of headache within the specified timeframe were included. Data was extracted, screened and standardized using a structured approach. Descriptive analyses and Apriori algorithm-based association rules were employed for the study.

Results: A total of 3,355 medical records were analyzed, with over 86% of headaches classified as non-urgent. Approximately 97% of the patients received a general diagnosis of headaches without further classification. Hypertension was the most prevalent concomitant diagnosis, affecting 27.42% of the patients. Western medicine was prescribed to 66% of the patients for headaches and co-existing conditions, while each type of acute medication was prescribed to fewer than 10% of the patients. Conversely, over one-third of the patients utilized headache-specific patented Chinese herbal medicine products. Additionally, oral and topical Chinese herbal medicine treatments were also administered for headaches in the emergency departments.

Conclusion: The majority of headaches consulting in the EDs were non-urgent and treated with various forms of Chinese medicine, alone or in conjunction of western medicine. Chinese herbal medicine may be promoted as alternatives to Western acute medications for treating benign headaches.