Frontiers in Neurology最新文献

Background: Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) might be useful for predicting and functional outcome in ischemic stroke patients after endovascular thrombectomy (EVT), but its clinical benefit remains controversial. Thus, this study aimed to evaluate the association of FVH on prognosis in ischemic stroke patients who received EVT.

Methods: PubMed, Embase, Cochrane Library, Web of Science, and Wanfang databases were searched for potentially eligible studies published up to March 2024. Pooled standard mean difference (SMD), risk ratios (RR) with 95% confidence intervals (CI) were employed to assess the association of FVH on prognosis in ischemic stroke patients who received EVT. All statistical analyses were conducted using STATA 12.0 software.

Results: A total of 10 studies were included in our study. The results indicated that higher FVH score were associated with better prognosis (SMD: 0.80, 95% CI 0.63-0.97). Moreover, the presence of FVH was significant associated with better functional outcome in ischemic stroke patients who received EVT (RR: 0.68, 95% CI, 0.58-0.79).

Conclusion: The current meta-analysis suggests that FVH is related the prognosis of ischemic stroke patients after EVT.

Introduction: After severe ischemic stroke (IS), circulating levels of symmetric dimethylarginine (SDMA) increase. We investigated the early dynamics of SDMA in stroke to potentially aid with prehospital identification of severe IS from hemorrhagic stroke (HS).

Methods: We performed targeted mass spectrometry (MS) measurements of SDMA in two sequential acute plasma samples (early and secondary) of 50 IS patients with LVO and 49 HS patients. Secondary samples of 227 IS and 84 HS patients with moderate to severe symptoms (NIHSS ≥ 7) subsequently underwent ELISA validation.

Results: The median (IQR) last-known-well (LKW) to sampling times were 43 min (35-67) for early samples in the MS analysis, and 83 min (65-113) for secondary samples in MS and ELISA analyses. No inter-group differences existed in early samples, but IS patients had significantly higher mean (IQR) SDMA levels in secondary samples in both analyses: 5.8 (5.3-6.9) vs. 5.1 (4.2-5.8) A.U. for HS, p < 0.001, with MS; and 0.82 (0.72-1.01) vs. 0.71 (0.58-0.85) nmol/mL for HS, p < 0.001, with ELISA. For IS patients, higher SDMA levels were associated with cardioembolic stroke: 0.84 (0.73-1.09) vs. 0.79 (0.71-0.91) nmol/mL for other etiologies, p = 0.042, and poor outcome: modified Rankin Scale (mRS) 4-6; 0.90 (0.73-1.06) vs. 0.80 (0.72-0.97) nmol/mL for mRS 0-3 (p = 0.045).

Conclusion: In a large clinical cohort of stroke patients with moderate to severe symptoms, our data suggest that SDMA can assist in differentiation of IS and HS patients already 1 h and a half after symptom onset. SDMA may prove to have future value in a diagnostic stroke biomarker panel.

Introduction: Posttraumatic stress disorder (PTSD) is a mental health disorder caused by experiencing or witnessing traumatic events. Recent studies show that patients with PTSD have an increased risk of developing dementia, including Alzheimer's disease (AD), but there is currently no way to predict which patients will go on to develop AD. The objective of this study was to identify structural and functional neural changes in patients with PTSD that may contribute to the future development of AD.

Methods: Neuroimaging (pseudo-continuous arterial spin labeling [pCASL] and structural magnetic resonance imaging [MRI]) and behavioral data for the current study (n = 67) were taken from our non-randomized open label clinical trial (ClinicalTrials.gov Identifier: NCT03229915) for treatment-seeking individuals with PTSD (n = 40) and age-matched healthy controls (HC; n = 27). Only the baseline measures were utilized for this study. Mean cerebral blood flow (CBF) and gray matter (GM) volume were compared between groups. Additionally, we utilized two previously established machine learning-based algorithms, one representing AD-like brain activity (Machine learning-based AD Designation [MAD]) and the other focused on AD-like brain structural changes (AD-like Brain Structure [ABS]). MAD scores were calculated from pCASL data and ABS scores were calculated from structural T₁-MRI images. Correlations between neuroimaging data (regional CBF, GM volume, MAD scores, ABS scores) and PTSD symptom severity scores measured by the clinician-administered PTSD scale for DSM-5 (CAPS-5) were assessed.

Results: Decreased CBF was observed in two brain regions (left caudate/striatum and left inferior parietal lobule/middle temporal lobe) in the PTSD group, compared to the HC group. Decreased GM volume was also observed in the PTSD group in the right temporal lobe (parahippocampal gyrus, middle temporal lobe), compared to the HC group. GM volume within the right temporal lobe cluster negatively correlated with CAPS-5 scores and MAD scores in the PTSD group.

Conclusion: Results suggest that patients with PTSD with reduced GM volume in the right temporal regions (parahippocampal gyrus) experienced greater symptom severity and showed more AD-like brain activity. These results show potential for early identification of those who may be at an increased risk for future development of dementia.

Introduction: Patients with myasthenia gravis (MG) display strong treatment heterogeneity. Recent studies have indicated that low-dose steroids or immunosuppressants are effective. However, factors affecting the add-on of non-corticosteroid immunosuppressants to corticosteroids remain unknown.

Method: Consecutive patients with MG were retrospectively reviewed from May 15, 2015, to December 29, 2020. We included one group of patients with steroid treatment alone and another group who transitioned to non-steroid immunosuppressant therapy. Clinical features of the included patients were analyzed. Univariate and multivariate Cox regression models were used to identify potential influential factors.

Results: A total of 107 patients with MG were analyzed, including 66 receiving corticosteroid treatment alone and 41 who subsequently also received non-corticosteroid immunosuppressant therapy. Eight potential factors were primarily selected in univariate analysis (Ps < 0.1). Achieving minimal symptom expression (MSE) within 6 months (HR: 4.424, 95%CI: 2.102-11.865), body mass index (BMI) (HR: 0.385, 95% CI: 0.186-0.797), quantitative MG (QMG) bulbar muscle score (HR: 1.553, 95% CI: 1.140-2.118), disease duration (HR: 0.987, 95% CI: 0.977-0.997) and relapse (HR: 2.638, 95% CI: 1.031-6.750) were finally identified as potential influencing factors.

Discussion: We found multifactorial clinical factors were highly associated with the add-on of non-steroid immunosuppressants after steroid treatment in patients with MG. Achieving MSE within 6 months, BMI, QMG bulbar muscle score at baseline before steroid treatment, disease duration, and disease relapse may represent crucial influencing factors, which should be considered to improve the long-term prognosis for patients with MG in future studies and practice.

Introduction: Intravenous immunoglobulin (IVIG) is the only approved treatment for multifocal motor neuropathy (MMN), a rare, chronic, immune-mediated demyelinating neuropathy. There is a significant gap in understanding of the role of serum immunoglobulin G (IgG) levels in the efficacy of IVIG in affected patients. We aimed to characterize the interplay between dose and exposure of IVIG and the effects of patient factors on individual variabilities.

Methods: Serum IgG trough concentration data from a phase 3, randomized, double-blind, placebo-controlled, crossover trial of IVIG 10% in 44 patients with MMN (NCT00666263) were analyzed using fit-for-purpose population PK modeling. Patient factors were tested as covariates, and IgG PK profiles following various dosing regimens were simulated.

Results: Serum IgG levels, with significant inter-patient variability, correlated with dose and treatment interruptions at the individual patient level. Simulated data for various dosing regimens (0.4-2 g/kg once every 1-4 weeks [Q1-4W]) revealed that more frequent dosing provided more stable IgG levels than less frequent dosing, and dose splitting over multiple days had no significant effects on PK.

Discussion: In patients with MMN, stable dosing and consistent serum IgG levels are crucial to avoid negative responses owing to treatment interruptions. Dosing intervals more frequent than Q4W may alleviate periodic symptom deterioration. Dose splitting potentially offers flexibility for patients requiring large volumes of IVIG without negatively affecting serum IgG PK, while maintaining treatment efficacy. Variability in serum IgG levels between patients suggests that individualizing IVIG treatment regimens and target IgG levels may play a key role in managing MMN.

Introduction: The vestibular implant is a neuroprosthesis which offers a potential treatment approach for patients suffering from vestibulopathy. Investigating the influence of electrical stimulation parameters is essential to improve the vestibular implant response. Optimization of the response focuses on the electrically evoked vestibulo-ocular reflex. It aims to facilitate high peak eye velocities and adequate alignment of the eye movement responses. In this study, the basic stimulation parameters of the vestibular implant were tested for their effect on the electrically evoked vestibulo-ocular reflex.

Methods: Four stimulation parameters, including the stimulation amplitude, phase duration, stimulus rate and speed of change of stimulation, were systematically tested in a cohort of nine subjects with a vestibulo-cochlear implant. These parameters were tested to evaluate their effect on fitting settings (i.e., threshold of activation, upper comfortable limit and dynamic range) as well as on the electrically evoked vestibulo-ocular reflex (peak eye velocity and alignment).

Results: It was confirmed that, in addition to current amplitude, the peak eye velocity of the response can be increased by increasing the phase duration and pulse rate. Both parameters have little effect on the alignment of the eye response. However, a longer phase duration decreased the range between the threshold of activation and the upper comfortable limit of the electrical stimulation (i.e., dynamic range). Furthermore, these results show that next to the amplitude of the stimulation, the speed of change in stimulation has a determinative positive effect on the peak eye velocity.

Conclusion: The observations in this study imply that the vestibular implant response, in terms of peak eye velocity, can be optimized with a higher pulse rate and longer phase duration. However, this comes at a trade-off between the dynamic range and power consumption. This study provides essential insights for fitting strategies in future vestibular implant care.

Resting-state functional MRI (fMRI) has revealed functional changes at the cortical level in degenerative cervical myelopathy (DCM) patients. The aim of this study was to systematically integrate static and dynamic functional connectivity (FC) to unveil abnormalities of functional networks of DCM patients and to analyze the prognostic value of these abnormalities for patients using resting-state fMRI. In this study, we collected clinical data and fMRI data from 44 DCM patients and 39 healthy controls (HC). Independent component analysis (ICA) was performed to investigate the group differences of intra-network FC. Subsequently, both static and dynamic FC were calculated to investigate the inter-network FC alterations in DCM patients. k-means clustering was conducted to assess temporal properties for comparison between groups. Finally, the support vector machine (SVM) approach was performed to predict the prognosis of DCM patients based on static FC, dynamic FC, and fusion of these two metrics. Relative to HC, DCM patients exhibited lower intra-network FC and higher inter-network FC. DCM patients spent more time than HC in the state in which both patients and HC were characterized by strong inter-network FC. Both static and dynamic FC could successfully classify DCM patients with different surgical outcomes. The classification accuracy further improved after fusing the dynamic and static FC for model training. In conclusion, our findings provide valuable insights into the brain mechanisms underlying DCM neuropathology on the network level.

Background: Pediatric-onset multiple sclerosis (POMS) patients often exhibit a wide range of cognitive deficits. Therefore, therapeutic approaches should aim not only to prevent cognitive decline but also to promote cognitive improvement.

Objective: This study aimed to explore the effects of natalizumab (NTZ) on cognitive function, as measured by the Symbol Digit Modalities Test (SDMT), in both POMS and adult-onset multiple sclerosis (AOMS) patients.

Method: A total of 63 patients (34 AOMS and 29 POMS) were enrolled in this retrospective, single-center study. Patients were clinically and radiologically assessed every 6 months, and they completed the SDMT at baseline and after at least 24 months of follow-up. SDMT values were reported as corrected values (cSDMT) and z-scores (zSDMT). Annualized cSDMT and zSDMT scores were calculated by dividing the change in scores by the length of the follow-up period (expressed in years).

Results: Both POMS and AOMS groups showed improvement in annualized cSDMT and zSDMT scores, but the improvement was significantly greater in the POMS group compared to the AOMS group (+3.85 ± 4.32 vs. +1.76 ± 2.80, p = 0.010 for cSDMT; 0.41 ± 0.40 vs. 0.25 ± 0.34, p = 0.026 for zSDMT). After re-baselining at 6 months, 93% of POMS patients (27 patients) and 85.3% of AOMS patients (29 patients, p = 0.84) achieved NEDA-3 (no evidence of disease activity). The NEDA-3 status, along with clinical and demographic parameters at baseline, did not account for the observed SDMT improvement.

Conclusion: The favorable clinical, radiological, and neuropsychological outcomes observed in this study support the use of natalizumab as a viable treatment option in POMS.

Introduction: A bibliometric analysis is used to assess the impact of research in a particular field. However, a specialized bibliometric analysis focused on hypothermic brain protection has not yet been conducted. This study aimed to identify the 100 most-cited articles published in the field of hypothermic brain protection and analyze their bibliometric characteristics.

Methods: After screening articles from the Web of Science citation database, complete bibliographic records were imported into Python for data extraction. The following parameters were analyzed: title, author's name and affiliation, country, publication year, publication date, first author, corresponding author, study design, language, number of citations, journal impact factors, keywords, Keywords Plus^®, and research topic.

Results: The 100 articles were published between 1990 and 2016. The citation frequency for each publication ranged from 86 to 470. Among the 100 articles, 73 were original articles, 18 were review articles, 8 were clinical articles, and 1 was editorial material. These papers were published in 37 journals, with the Journal of Cerebral Blood Flow and Metabolism being the most prolific with 15 papers. Eighteen countries contributed to the 100 publications, 51 of which were from United States institutions. In addition, the keywords in the Sankey plot indicated that research in the field of hypothermic brain protection is growing deeper and overlapping with other disciplines.

Discussion: The results provide an overview of research on hypothermic brain protection, which may help researchers better understand classical research, historical developments, and new discoveries, as well as providing ideas for future research.

Many patients with COVID-19 experience increased arterial stiffness and abnormal cerebral hemodynamics. Although previous studies have explored the effects of cold environments on cardiovascular health and cerebral hemodynamics, there is still no research on the changes in cardiovascular and cerebral hemodynamics in sedentary female students recovering from COVID-19 while performing high-intensity interval training (HIIT) in cold environments. This study investigates the effects of 1 week of HIIT in a cold environment on cerebral hemodynamics and arterial stiffness (AS) in sedentary female college students, providing new insights into the pathophysiological mechanisms in this specific context. Thirty-six participants were randomly divided into a control group (n = 12), a room temperature (RE) group (n = 12), and a cold environment (CE) group (n = 12). HIIT was performed for four 4-min running training sessions, with a 4-min interval between each training session, The training duration was 1 week, with a frequency of 2 sessions per day, while the control group did not undergo any training. After training, the AS in the CE group significantly decreased (p < 0.05), with an average reduction of 11% in brachial-ankle pulse wave velocity, showing a significantly greater improvement compared to the RE group and the control group (p < 0.05), while no significant changes were observed in the RE group (p > 0.05). In the Y-Balance Tests (YBTs), the concentrations of cerebral oxygenated hemoglobin and total hemoglobin significantly increased (p < 0.05) during unilateral leg support tests in both the CE and RE groups, and the increase of CE group is greater than that of RE group. In contrast, in the control group, the concentrations of cerebral oxygenated hemoglobin and total hemoglobin significantly decreased during left leg support (p < 0.05). Our study found that performing HIIT in a cold environment not only effectively reduces AS in sedentary female college students after COVID-19, improves cardiovascular function, but also significantly enhances cerebral hemodynamics, helping them alleviate the negative impacts of post-COVID-19 sequelae and sedentary behavior on health. Future research should further explore the mechanisms by which sedentary behavior, post-COVID-19 recovery status, and adaptation to cold environments collectively influence cardiovascular function and cerebral hemodynamics, providing a more comprehensive understanding of these factors.