Frontiers in Neurology最新文献

Background: Epilepsy is commonly categorized based on etiology, treatment, and prognosis. Misclassification can occur due to the presence of interictal secondary bilateral synchronization (SBS) discharges seen on an electroencephalogram (EEG), misleading the classification process.

Objective: To examine the prevalence of interictal SBS discharges in patients with focal epilepsy and to identify predictors of these discharges.

Design: Retrospective analysis of patients who underwent long-term video EEG monitoring (LTVEM) from August 2001 to May 2014.

Methods: We included patients with focal epilepsy. The patients were divided into two groups based on whether or not they had SBS discharges.

Results: We found 1,017 patients who underwent LTVEM. Of the 221 patients included in the final analysis, 36 (16%) exhibited SBS discharges. Patients in the SBS group were younger and had an earlier onset age of epilepsy. They also had higher rates of unclear seizure onset zone and focal to bilateral tonic-clonic seizures. In the binary logistic regression analysis, young onset age of epilepsy was the only significant factor.

Conclusion: The prevalence of SBS discharges in focal epilepsy is relatively high (16%), emphasizing the importance of cautious interpretation of interictal EEG in epilepsy classification. Young age of disease onset is associated with higher rates of SBS.

Objective: This study aimed to explore autoantibody clusters and their correlations with clinical features in 644 myasthenia gravis (MG) patients.

Methods: Medical records of 664 MG patients were reviewed. Five autoantibodies (AChR, MuSK, titin, RyR, and LRP4) were selected for cluster analysis. The various clinical manifestations were compared between clusters. Separate association analyses between individual autoantibodies and clinical manifestations as well as among different MGFA subtypes were also performed without prior clustering.

Results: Two separate autoantibody clusters were identified, with significantly different clinical manifestations. Cluster 1 (485 patients) was characterized by higher proportions of RyR-, titin-, and AChR-, while cluster 2 (179 patients) had higher proportions of RyR+, titin+, and AChR+. Cluster 2 patients were older and had elevated QMG scores and odds of complications, particularly hypertension, diabetes, cardiovascular and cerebrovascular diseases, and eye conditions. Individual antibody analysis revealed that male cases were more likely to be AChR+ and titin+, and older age was associated with AChR+, RyR+, and titin+. Among MGFA subtypes, significant differences were detected in AChR, MuSK, titin, complications, thymoma, and hypertension. As MG severity increased from types I to V, AChR+, RyR+, and titin+ proportions peaked at stage IIa. MuSK+ patients were relatively rare and mostly present in the subtype b group. Type b patients had higher MuSK+ prevalence and increased cardiovascular and cerebrovascular disease incidence rates than type a cases.

Conclusion: Overall, cluster 2 features were less favorable to patients. This study provides valuable insights into the clinical and autoantibody profiles of Chinese MG patients.

Mechanical thrombectomy (MT) is a highly effective treatment for ischemic stroke associated with large vessel occlusion. Given its complexity, this procedure is widely used throughout the world in hospitals with different levels of experience. Therefore, practical quality assurance is advised to ensure a high standard of care across the board. In this perspective article, we propose the implementation of measuring serum S100B after MT as a surrogate outcome parameter for the extent of tissue damage as an additional quality indicator for internal and external benchmarking in endovascular therapy. We focus on the analysis of patients, in whom there is a discrepancy between the expected (e.g., based on favorable preconditions) and the actual biomarker outcome. We aim to illustrate the advantages and drawbacks of measuring S100B after MT, reliably depicting the procedure's quality and its use for comparison and identification of "outlier" patients in MT patient cohorts for further process and single-case analysis.

Background: Advances in neuroimaging have significantly enhanced our understanding of brain function, providing critical insights into the diagnosis and management of disorders of consciousness (DoC). Functional near-infrared spectroscopy (fNIRS), with its real-time, portable, and noninvasive imaging capabilities, has emerged as a promising tool for evaluating functional brain activity and nonrecovery potential in DoC patients. This review explores the current applications of fNIRS in DoC research, identifies its limitations, and proposes future directions to optimize its clinical utility.

Aim: This review examines the clinical application of fNIRS in monitoring DoC. Specifically, it investigates the potential value of combining fNIRS with brain-computer interfaces (BCIs) and closed-loop neuromodulation systems for patients with DoC, aiming to elucidate mechanisms that promote neurological recovery.

Methods: A systematic analysis was conducted on 155 studies published between January 1993 and October 2024, retrieved from the Web of Science Core Collection database.

Results: Analysis of 21 eligible studies on neurological diseases involving 262 DoC patients revealed significant findings. The prefrontal cortex was the most frequently targeted brain region. fNIRS has proven crucial in assessing brain functional connectivity and activation, facilitating the diagnosis of DoC. Furthermore, fNIRS plays a pivotal role in diagnosis and treatment through its application in neuromodulation techniques such as deep brain stimulation (DBS) and spinal cord stimulation (SCS).

Conclusion: As a noninvasive, portable, and real-time neuroimaging tool, fNIRS holds significant promise for advancing the assessment and treatment of DoC. Despite limitations such as low spatial resolution and the need for standardized protocols, fNIRS has demonstrated its utility in evaluating residual brain activity, detecting covert consciousness, and monitoring therapeutic interventions. In addition to assessing consciousness levels, fNIRS offers unique advantages in tracking hemodynamic changes associated with neuroregulatory treatments, including DBS and SCS. By providing real-time feedback on cortical activation, fNIRS facilitates optimizing therapeutic strategies and supports individualized treatment planning. Continued research addressing its technical and methodological challenges will further establish fNIRS as an indispensable tool in the diagnosis, prognosis, and treatment monitoring of DoC patients.

Background and purpose: The incidence of autonomic dysfunction is frequently underestimated and often overlooked in patients with autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A). This study comprehensively analyzes the clinical manifestations, laboratory and imaging findings, and treatment modalities for patients demonstrating GFAP-A involvement in the autonomic nervous system. The present article primarily elucidates the prevalence and prognosis of diverse autonomic system symptoms while examining the associated laboratory and imaging indicators. These findings aim to establish a foundation for personalized diagnosis and treatment strategies in such patients.

Method: We performed a retrospective data analysis from three cases of GFAP-A involvement in autonomic nerves from the Ninth People's Hospital of Suzhou and the Second Affiliated Hospital of Soochow University from 2020 to 2023. After an extensive literature review, we identified 39 cases involving GFAP-A and autonomic nervous system dysfunction. We also comprehensively analyzed the patient's clinical manifestations, laboratory biomarkers, and imaging findings.

Result: The study included a total of 42 patients, consisting of 15 females and 27 males. The primary manifestations of autonomic dysfunction included bladder dysfunction (41/42 cases), gastrointestinal dysfunction (18 /42 cases), heart rate variability (4/42 cases), unusual sweating (2/42 cases), and blood pressure fluctuations (1/42 cases). Other neurological symptoms comprised headache (12 /42 cases), limb weakness presentation (30/42 cases). Blood pressure variability is related to cerebrospinal fluid pressure and convulsive seizures. Heart rate variability is related to disorders of consciousness. unusual sweating was associated to age, gender, cerebrospinal fluid protein content and convulsive seizures. Gastrointestinal disorders have associations with gender, sleep disturbances, protein content in the cerebrospinal fluid, and brain MRI lesions. The prognosis of autonomic nerve dysfunction is associated to sleep disorder and cerebrospinal fluid protein content. The higher the cerebrospinal fluid protein level, the worse the prognosis of autonomic nervous system.

Conclusion: Bladder dysfunction and gastrointestinal dysfunction are the primary manifestations of autonomic dysfunction in GFAP-A patients, with a subset also experiencing abnormalities in heart rate, blood pressure, and sweating. These additional symptoms have implications for prognosis, necessitating heightened attention from clinicians toward GFAP-A patients.

Background: Despite existing treatments of generalized myasthenia gravis (gMG), there remains a need for more effective therapies with fewer side effects. Telitacicept, targeting B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL), emerges as a potential novel therapy for gMG.

Case presentation: In our study, four patients with gMG to standard treatments underwent an 8-week course of telitacicept monotherapy. Post-treatment, all patients exhibited satisfactory improvements. The Myasthenia Gravis Foundation of America Quantitative Myasthenia Gravis (MGFA-QMG) scores, 15-item Myasthenia Gravis Quality of Life (MGQOL-15) scores, and MG-associated Activities of Daily Living (MG-ADL) scores showed a marked reduction, indicating decreased disease severity and enhanced quality of life. Additionally, immunological assessments revealed a decrease in CD19⁺B lymphocyte counts and acetylcholine receptor (AChR) antibodies. Only one patient reported a mild, transient injection reaction.

Conclusion: Favorable clinical improvement and mild adverse events for gMG in treated with telitacicept were observed. However, larger-scale and longer-term studies are necessary to confirm these results and fully establish the role of telitacicept in the treatment of gMG.

Background: Migraine is a primary headache disorder that affects more than 1 billion individuals globally and imposes a significant disability burden on society. Although migraine patients commonly experience poor sleep quality, the relationship between migraine and sleep is not yet fully understood. This study therefore aimed to determine the association between sleep quality and migraine severity.

Methods: A comparative cross-sectional study was conducted with 1,399 participants across all regions of Saudi Arabia from August to October 2023 using standardized questionnaires. Participants were categorized into patients with migraine and non-migraine patients, according to the International Headache Society (IHS) criteria. This study utilized The Migraine Disability Assessment Scale (MIDAS) and Pittsburgh Sleep Quality Index (PSQI) to evaluate migraine severity and sleep quality, respectively.

Results: The prevalence of migraine was 25%, while poor sleep quality was evident in 42.4% of the patients. No significant difference in PSQI scores was observed between patients with migraine and non-migraine patients (p = 0.821). Migraine patients with poor sleep quality showed significantly higher MIDAS scores than those with good sleep quality (10.37 vs. 6.58; p = 0.002), while patients with migraine with higher levels of disability had higher PSQI scores than those with lower levels of disability, although the difference was not statistically significance (7.61 vs. 6.81, p = 0.053). A significant positive correlation was found between the PSQI and MIDAS scores (r = 0.179, p < 0.001). MIDAS was also significantly positively correlated with the following PSQI components: subjective sleep quality (p = 0.047), sleep latency (p < 0.001), sleep disturbance (p < 0.001), and daytime dysfunction (p < 0.001).

Conclusion: These findings suggest a notable correlation between poor sleep quality and increased migraine severity, emphasizing the importance of addressing sleep disturbance as a potential strategy to mitigate migraine severity and improve patient outcomes.

Background: Many inflammatory markers like systemic immune-inflammatory index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) are associated with stroke. However, studies on the relationship between stroke and systemic inflammatory response index (SIRI) are scarce. This study was aimed at evaluating the potential association of SIRI with stroke.

Methods: Our cross-sectional study included adults with sufficient SIRI and stroke data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). We used multivariable logistic regression, interaction tests, smoothed curve fitting, and subgroup analysis for assessing the independent relationship between SIRI and stroke.

Results: Of 36,176 participants in this study, 1,414 (3.9%) had experienced a stroke. In a fully adjusted model, the systemic inflammatory response index displayed a significant and positive correlation with stroke (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.04-1.15, p = 0.0006). Meanwhile, the odds of stroke increased by 39% in the 4th quartile, relative to the 1st quartile (OR = 1.39, 95% CI = 1.17-1.65, p = 0.0002). Additional interaction tests and subgroup analysis revealed that age, sex, race, education, marriage, BMI (body mass index), smoking, diabetes mellitus, hypertension, and coronary heart disease (CHD) were not positively correlated (p interaction >0.05). Moreover, we also found a nonlinear correlation between SIRI and stroke, with an inflection point of 2.17.

Conclusion: Our results indicate that SIRI is significantly and positively related to stroke; however, its role in stroke needs to be further confirmed by large-scale prospective studies.

Background and purpose: Using post-treatment methods to predict functional outcomes of acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) is crucial in stroke medicine. The National Institute of Health Stroke Scale (NIHSS) score at 24 h has been widely used; however, there is a paucity of data on using earlier NIHSS scores and their association with outcome. In this study, we aimed to investigate the usage of NIHSS at 1-h time window -ultra-early neurological improvement (UENI)- as a surrogate marker associated with the functional outcomes of AIS patients treated with EVT.

Methods: We included 485 adults (≥18 years old) who underwent emergency EVT at four academic comprehensive stroke centers between 2020 and 2021. Patients with pre-EVT Alberta Stroke Program Early CT Score (ASPECTS) < 6, missing follow-up data, and missing data of the first hour NIHSS were excluded (n = 20). UENI was defined as post-EVT NIHSS reduction of 4 points or more or NIHSS as 0-1 within 1-h post-EVT. An mRS score of 0-2 after three months was defined as favorable outcome, and independent walking independence was defined as mRS of 3.

Results: A total of 465 patients were included in our final analysis. We identified 122 (26.2%) patients with UENI. While 82.79% of the patients with UENI achieved favorable functional outcomes at 3-months, only 32.36% of patients without UENI had favorable functional outcome (p < 0.0001). In addition, lower hospitalization costs were associated with patients who had UENI, compared to No-UENI (p = 0.003). A multivariate logistic regression analysis revealed that younger age (p < 0.0001), shorter last know normal to puncture time (LKNPT) (p = 0.013), higher pre-treatment ASPECTS (p = 0.039), final modified thrombolysis in cerebral infarction (mTICI) ≥2b (p = 0.002), and fewer number of EVT attempts (p = 0.002) were variables independently associated with UENI. The presence of UENI was independently associated with a better outcome OR: 7.999 (95% C.I. 4.415-14.495).

Conclusion: UENI was observed in about a quarter of patients with AIS undergoing EVT. Younger age, shorter LKNPT, higher pre-treatment ASPECTS, final mTICI≥2b, and fewer number of EVT attempts, were independently associated with UENI. The presence of UENI was independently associated with better functional outcome at 3 months.

Objective: To investigate the association between high-sensitivity C-reactive protein (Hs-CRP) levels and the risk of postoperative delirium (POD) following general anesthesia.

Methods: This retrospective cross-sectional study included 644 patients who underwent general anesthesia. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between Hs-CRP and POD, with subgroup analyses used to assess stratified associations. Receiver operator characteristic (ROC) curve analysis was employed to assess the predictive efficacy of Hs-CRP for POD. Restricted cubic spline (RCS) analysis was conducted to explore the linear relationship between the log-transformed Hs-CRP (Log₁₀Hs-CRP) and POD risk.

Results: The total population consisted of 644 individuals with a mean age of 64.02 ± 13.20 years, 506 (78.60%) of whom were male, and 114 patients (17.7%) had POD. Compared to the lower Hs-CRP group, patients in the higher Hs-CRP group exhibited higher age, heart rate, white blood cell count, blood urea nitrogen, creatinine, uric acid, fasting glucose, hemoglobin A1c, fibrinogen, D-dimer, and a higher prevalence of CKD, but lower hemoglobin, high-density lipoprotein cholesterol, albumin and estimated glomerular filtration rate. Additionally, the prevalence of POD was higher in the higher Hs-CRP group (24.7% vs. 9.5%, p < 0.001). Multivariate logistic regression confirmed that elevated Hs-CRP and its forms (Log₁₀Hs-CRP, standardized Hs-CRP, and higher Hs-CRP group) consistently increased the risk of POD across all adjusted models (p < 0.05). Stratified analyses further highlighted significant associations between Hs-CRP and POD in specific subgroups, notably in patients aged ≥65 years, female patients, and those with or without hypertension, diabetes, or stroke history, and without chronic kidney disease (p < 0.05). ROC curve analysis demonstrated that Hs-CRP had a significant predictive ability for POD in the overall population (AUC = 0.646), as well as in male (AUC = 0.644) and female patients (AUC = 0.654). Additionally, RCS analysis indicated a linear positive association between Log₁₀Hs-CRP and POD risk (p = 0.003, nonlinear p = 0.896).

Conclusion: Elevated Hs-CRP levels are significantly associated with an increased risk of POD following general anesthesia.