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Subclinical imaging activity in multiple sclerosis patients during war-related psychological stress. 多发性硬化症患者在战争相关心理压力下的亚临床影像活动。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-06 DOI: 10.1002/acn3.52241
Omri Zveik, Tal Friedman-Korn, Ariel Rechtman, Tal Ganz, Garrick Hoichman, Lyne Shweiki, Dana Ekstein, Adi Vaknin-Dembinsky

Objectives: Psychological stress has been suggested as a contributory factor in the onset and progression of multiple sclerosis (MS). The 7 October 2023 terrorist attacks in Israel caused significant psychological stress, providing a unique context to study its impact on MS activity. This study aims to assess the impact of war-related psychological stress on MS activity using magnetic resonance imaging (MRI) scans and clinical follow-up.

Methods: This observational retrospective case-control study includes 93 patients with MS (pwMS) who had routine annual MRI scans from three periods (7 October 2021 to 7 January 2022; 7 October 2022 to 7 January 2023; and 7 October 2023 to 7 January 2024). Data were collected from medical records and MRI scans at Hadassah Medical Center. MRI scans were classified as active if new or enlarging T2 lesions and/or enhancing T1 lesions were present.

Results: MRI activity significantly increased among pwMS during the first 3 months of the war compared to the corresponding period in the preceding year (11/93 vs. 23/93, P = 0.0139), with an OR of 4.0 (95% confidence interval: 1.29-16.442). pwMS with an EDSS score ≥4 showed a significant increase in MRI activity (P = 0.045), whereas no significant increase was observed in patients with an EDSS score ≤3.5 (P = 0.23). Additionally, MRI activity increased later during the war compared to the previous year (P < 0.0001).

Interpretation: This study provides evidence of increased MRI-detected disease activity in pwMS during periods of war-related psychological stress. Our findings highlight the importance of considering psychological stress in MS management. Healthcare providers should be aware of the potential for increased disease activity in pwMS during extreme stress and may consider more frequent monitoring, including MRI scans, or treatment adjustments during such periods.

目的:心理压力被认为是多发性硬化症(MS)发病和进展的一个促成因素。2023 年 10 月 7 日在以色列发生的恐怖袭击造成了巨大的心理压力,为研究其对多发性硬化症活动的影响提供了独特的背景。本研究旨在利用磁共振成像(MRI)扫描和临床随访评估与战争有关的心理压力对多发性硬化症活动的影响:这项观察性回顾性病例对照研究包括 93 名多发性硬化症患者(pwMS),他们在三个时期(2021 年 10 月 7 日至 2022 年 1 月 7 日;2022 年 10 月 7 日至 2023 年 1 月 7 日;2023 年 10 月 7 日至 2024 年 1 月 7 日)每年进行常规磁共振成像扫描。数据来自哈大沙医疗中心的医疗记录和核磁共振扫描。如果出现新的或增大的 T2 病变和/或增强的 T1 病变,则 MRI 扫描被归类为活动:EDSS评分≥4分的pwMS患者的MRI活动明显增加(P = 0.045),而EDSS评分≤3.5分的患者的MRI活动没有明显增加(P = 0.23)。此外,与前一年相比,核磁共振成像活动在战争后期有所增加(P 解释:本研究提供的证据表明,在与战争有关的心理压力期间,pwMS 的 MRI 检测到的疾病活动增加。我们的研究结果强调了在多发性硬化症管理中考虑心理压力的重要性。医疗服务提供者应意识到,在极端应激期间,pwMS 的疾病活动可能会增加,因此可考虑在此期间进行更频繁的监测(包括 MRI 扫描)或调整治疗方法。
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引用次数: 0
Infantile Krabbe disease (0-12 months), progression, and recommended endpoints for clinical trials. 婴幼儿克拉伯病(0-12 个月)、病情发展和临床试验的推荐终点。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-05 DOI: 10.1002/acn3.52114
Melissa R Greco, Mabel A Lopez, Maria L Beltran-Quintero, Ecenur Tuc Bengur, Michele D Poe, Maria L Escolar

Objective: Krabbe disease is due to deficiency of galactocerebrosidase, resulting in progressive neurodegeneration due to demyelination. The purpose of this study is to document disease progression in the newly classified infantile-onset (0-12 months). We evaluated the outcomes of hematopoietic stem cell transplantation (HSCT) and described meaningful clinical endpoints.

Methods: Patients with infantile Krabbe disease were prospectively evaluated between 2000 and 2022. All patients underwent comprehensive and standardized protocols. Descriptive statistics and Kaplan-Meier survival curves were used for analysis.

Results: One hundred and thirty-seven children with infantile Krabbe disease were included (68 males and 69 females). Of the 137, 96 were not treated and 41 underwent hematopoietic stem cell transplantation. Twenty-three were asymptomatic and 18 symptomatic. Initial symptoms included irritability, developmental delay or loss of milestones, feeding difficulties, spasticity, and reflux with an average survival of 2.2. Abnormalities in nerve conduction studies, auditory brainstem responses, and brain MRIs were evident in both groups of patients. Age at transplantation and signs and symptoms determined functional outcomes. Symptomatic and asymptomatic transplanted patients showed an increase in galactocerebrosidase and a decrease in psychosine, but did not reach the normal range. The median survival for transplanted symptomatic patients was 5 years while asymptomatic was extended to 15.5 years.

Interpretation: Infantile Krabbe disease with onset before 12 months is rapidly progressive. Irreversible brain damage occurs unless timely HSCT is performed. HSCT does not prevent the progression of peripheral nerve disease. This study can be used to monitor patients and evaluate the effects of future therapies.

目的:克拉伯病是由于缺乏半乳糖脑苷脂酶,导致脱髓鞘引起的进行性神经变性。本研究的目的是记录新分类的婴儿型发病者(0-12 个月)的疾病进展情况。我们评估了造血干细胞移植(HSCT)的结果,并描述了有意义的临床终点:2000年至2022年期间,我们对婴幼儿克拉伯病患者进行了前瞻性评估。所有患者都接受了全面的标准化方案治疗。分析采用了描述性统计和卡普兰-梅耶生存曲线:结果:共纳入137名患有婴儿克拉伯病的儿童(68名男性和69名女性)。在137名患儿中,96名未接受治疗,41名接受了造血干细胞移植。23名无症状,18名有症状。最初的症状包括易怒、发育迟缓或丧失里程碑、喂养困难、痉挛和反流,平均存活时间为2.2天。两组患者的神经传导研究、听觉脑干反应和脑部核磁共振成像均明显异常。移植时的年龄以及体征和症状决定了功能性结果。有症状和无症状的移植患者半乳糖脑苷脂酶升高,精神氨酸降低,但未达到正常范围。无症状移植患者的中位生存期为5年,而无症状患者的中位生存期延长至15.5年:解读:12 个月前发病的婴儿克拉伯病进展迅速。除非及时进行造血干细胞移植,否则会造成不可逆的脑损伤。造血干细胞移植并不能阻止周围神经疾病的进展。这项研究可用于监测患者病情和评估未来疗法的效果。
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引用次数: 0
Medial intracranial carotid artery calcifications and hematoma expansion in deep intracerebral hemorrhage. 颅内颈内动脉钙化和深部脑出血血肿扩大。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-04 DOI: 10.1002/acn3.52240
Federico Mazzacane, Stefan Moraru, Beatrice Del Bello, Federica Ferrari, Erica Ferro, Alessandra Persico, Jawed Nawabi, Alessandro Padovani, Anna Cavallini, Andrea Morotti

Background: Medial intracranial carotid artery calcifications (ICAC) are associated with impaired vascular physiology, increased arterial stiffness and pulse pressure. Their presence might therefore be associated with increased risk of intracerebral hemorrhage (ICH) expansion, according to the avalanche model. We explored the association between ICAC presence and pattern and hematoma expansion (HE).

Methods: Retrospective analysis of a monocentric, prospectively collected cohort of ICH patients admitted between June 2017 and October 2023. ICAC pattern was determined by Kockelkoren's rating scale on admission CT; medial ICAC were defined with a >6 points cutoff. A follow-up CT scan was performed within 72 h. HE was analyzed as a dichotomous (≥6 mL and/or ≥33%) and as a categorical (none/mild/moderate/severe) variable, and its predictors were explored with logistic and ordinal regression respectively, accounting for baseline volume, onset-to-CT time, and anticoagulation. All the analyses were stratified by ICH location (supratentorial deep vs lobar ICH).

Results: A total of 201 patients were included (median age 78, 42% females, 59% deep ICH). Medial ICAC were significantly more common in deep ICH with HE compared with non-expanders (72% vs 49%, p = 0.03), whereas there was no association between ICAC and HE in lobar ICH (53% vs 52%, p = 0.85). This association between medial ICAC and HE in deep ICH remained significant in logistic (aOR 3.11, 95% CI [1.19-9.06], p = 0.03) and ordinal regression (acOR 2.42, 95% CI [1.19-4.99], p = 0.01).

Interpretation: Ipsilateral medial ICAC are associated with higher odds of HE in deep ICH. Our findings are best interpreted as hypothesis generating, requiring prospective validation and further research to characterize the underlying biological mechanisms.

背景:颅内颈动脉内侧钙化(ICAC)与血管生理功能受损、动脉僵化和脉压升高有关。因此,根据雪崩模型,钙化的存在可能与脑内出血(ICH)扩大的风险增加有关。我们探讨了 ICAC 的存在和模式与血肿扩大(HE)之间的关联:对 2017 年 6 月至 2023 年 10 月间收治的 ICH 患者进行单中心前瞻性队列回顾性分析。ICAC模式由入院CT上的Kockelkoren评分表确定;内侧ICAC的定义以大于6分为分界线。HE 作为二分变量(≥6 mL 和/或≥33%)和分类变量(无/轻度/中度/重度)进行分析,其预测因素分别采用逻辑回归和序数回归进行探讨,并考虑基线体积、发病至 CT 时间和抗凝情况。所有分析均按 ICH 位置(幕上深部 ICH 与脑叶 ICH)进行分层:共纳入 201 名患者(中位年龄 78 岁,42% 为女性,59% 为深部 ICH)。在伴有 HE 的深部 ICH 中,内侧 ICAC 明显多于非扩张者(72% vs 49%,p = 0.03),而在大叶 ICH 中,ICAC 与 HE 之间没有关联(53% vs 52%,p = 0.85)。在逻辑回归(aOR 3.11,95% CI [1.19-9.06],p = 0.03)和序数回归(acOR 2.42,95% CI [1.19-4.99],p = 0.01)中,深部 ICH 中内侧 ICAC 与 HE 之间的关系仍然显著:同侧内侧 ICAC 与深部 ICH 发生 HE 的较高几率相关。我们的发现最好被解释为假设的产生,需要前瞻性验证和进一步研究以确定其潜在的生物学机制。
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引用次数: 0
Distinct neuroinflammatory patterns between cerebral microbleeds and microinfarcts in cerebral amyloid angiopathy. 脑淀粉样变性血管病中脑微出血和微梗塞之间不同的神经炎症模式
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-04 DOI: 10.1002/acn3.52226
Laurent Puy, Romain Barus, Marco Pasi, Maud Pétrault, Vincent Deramecourt, Charlotte Cordonnier, Vincent Bérézowski

In this neuropathological study, we investigated neuroinflammation surrounding recent and old cerebral microbleeds (CMBs) and cerebral microinfarcts (CMIs) in 18 cases of cerebral amyloid angiopathy (CAA). We used several serial stainings and immunolabellings to identify microvascular lesions, define their recent or old stage, and characterize neuroinflammatory response (scavenging activity and astrogliosis). We found that both CMBs and CMIs induce a neuroinflammatory response, which was more pronounced in old lesion than recent. Astrogliosis and scavenging activity were differentially prominent according to the ischemic/hemorrhagic nature of the lesion. Our findings provide insights into the pathophysiology of microvascular injuries in CAA.

在这项神经病理学研究中,我们调查了18例脑淀粉样血管病(CAA)患者的近期和陈旧性脑微小出血(CMBs)和脑微梗塞(CMIs)周围的神经炎症。我们使用了多种序列染色和免疫标记来识别微血管病变,确定其近期或远期阶段,并描述神经炎症反应(清除活性和星形胶质细胞增生)的特征。我们发现,CMBs 和 CMIs 都会诱发神经炎症反应,而且老病变比新病变更明显。星形胶质细胞增多和清除活性因病变的缺血/出血性质而异。我们的研究结果为了解 CAA 中微血管损伤的病理生理学提供了见解。
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引用次数: 0
Motor phenotypes associated with genetic neurodevelopmental disorders. 与遗传性神经发育障碍有关的运动表型。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-02 DOI: 10.1002/acn3.52231
Alexandra Santana Almansa, LeeAnne Green Snyder, Wendy K Chung, Jennifer M Bain, Siddharth Srivastava

Objective: There is a growing number of monogenic disorders implicated in neurodevelopmental disorders (NDDs), including autism spectrum disorder and intellectual disability. Motor impairment is frequently seen in these disorders, although not clearly defined. We aimed to characterize the motor phenotype of genetic NDDs.

Methods: We analyzed data from Simons Searchlight, collecting information on patients with genetic NDDs. Data analyzed included Vineland Adaptive Behavior Scales Second Edition (Vineland-II) motor standard scores, motor milestones and tone abnormalities.

Results: In total, 959 patients with 57 genetic disorders were included. Disorders associated with Vineland-II motor standard score <56 included GRIN2B-related disorder (mean standard score = 53.5), HNRNPH2-related disorder (mean standard score = 55.8) and SCN2A-related disorder (mean standard score = 49.9). The only genetic condition with a mean age of sitting unsupported ≥18 months was GRIN1-related disorder (mean age = 26.3 months). Genetic conditions with a mean age of walking independently ≥36 months included CTNNB1-related disorder (mean age = 37.4 months) and HNRNPH2-related disorder (mean age = 41.9 months). Tone abnormalities included hypotonia in 83% (577/696), hypertonia in 16% (112/696), a diagnosis of cerebral palsy (CP) in 10% (73/696) and a diagnosis specifically of spastic CP in 3% (23/696).

Interpretation: Patients with genetic NDDs have a spectrum of motor impairment, which warrant further characterization.

目的:越来越多的单基因疾病与神经发育障碍(NDD)有关,包括自闭症谱系障碍和智力障碍。这些疾病中经常出现运动障碍,但并没有明确的定义。我们旨在描述遗传性 NDDs 的运动表型特征:我们分析了西蒙斯探照灯的数据,收集了遗传性 NDDs 患者的信息。分析的数据包括维尼兰适应行为量表第二版(Vineland-II)运动标准分、运动里程碑和音调异常:结果:共纳入了 959 名患有 57 种遗传疾病的患者。与维尼兰-II 运动标准分数相关的疾病 解释:遗传性 NDD 患者的运动障碍范围广泛,需要进一步鉴定。
{"title":"Motor phenotypes associated with genetic neurodevelopmental disorders.","authors":"Alexandra Santana Almansa, LeeAnne Green Snyder, Wendy K Chung, Jennifer M Bain, Siddharth Srivastava","doi":"10.1002/acn3.52231","DOIUrl":"https://doi.org/10.1002/acn3.52231","url":null,"abstract":"<p><strong>Objective: </strong>There is a growing number of monogenic disorders implicated in neurodevelopmental disorders (NDDs), including autism spectrum disorder and intellectual disability. Motor impairment is frequently seen in these disorders, although not clearly defined. We aimed to characterize the motor phenotype of genetic NDDs.</p><p><strong>Methods: </strong>We analyzed data from Simons Searchlight, collecting information on patients with genetic NDDs. Data analyzed included Vineland Adaptive Behavior Scales Second Edition (Vineland-II) motor standard scores, motor milestones and tone abnormalities.</p><p><strong>Results: </strong>In total, 959 patients with 57 genetic disorders were included. Disorders associated with Vineland-II motor standard score <56 included GRIN2B-related disorder (mean standard score = 53.5), HNRNPH2-related disorder (mean standard score = 55.8) and SCN2A-related disorder (mean standard score = 49.9). The only genetic condition with a mean age of sitting unsupported ≥18 months was GRIN1-related disorder (mean age = 26.3 months). Genetic conditions with a mean age of walking independently ≥36 months included CTNNB1-related disorder (mean age = 37.4 months) and HNRNPH2-related disorder (mean age = 41.9 months). Tone abnormalities included hypotonia in 83% (577/696), hypertonia in 16% (112/696), a diagnosis of cerebral palsy (CP) in 10% (73/696) and a diagnosis specifically of spastic CP in 3% (23/696).</p><p><strong>Interpretation: </strong>Patients with genetic NDDs have a spectrum of motor impairment, which warrant further characterization.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Onasemnogene-abeparvovec administration to premature infants with spinal muscular atrophy. 给患有脊髓性肌萎缩症的早产儿服用奥那西莫金-阿贝帕沃韦克(Onasemnogene-abeparvovec)。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-28 DOI: 10.1002/acn3.52213
Stephen M Brown, Aparna S Ajjarapu, Divya Ramachandra, Laura Blasco-Pérez, Mar Costa-Roger, Eduardo F Tizzano, Charlotte J Sumner, Katherine D Mathews

Twin girls born at 30 weeks' gestation with spinal muscular atrophy (SMA) received onsasemnogene-abeparvovec (OA) at 3.5 weeks of life. They had no treatment-related adverse events, normal acquisition of motor milestones, and normal neurological examination at 19 months. Genotyping revealed 0 copies of SMN1 and a single, hybrid SMN2 gene containing the positive genetic modifier c.835-44A>G. This was associated with full-length SMN2 blood mRNA expression levels similar to a 2 copy SMA infant. The observed favorable outcomes are likely due to the genetic modifier combined with early drug administration enabled by prematurity.

妊娠30周时出生的患有脊髓性肌萎缩症(SMA)的双胞胎女孩在出生3.5周时接受了onsasemnogene-abeparvovec(OA)治疗。她们没有出现与治疗相关的不良反应,运动发育里程碑正常,19 个月时神经系统检查正常。基因分型结果显示,SMN1基因为0个拷贝,SMN2基因为单个杂合基因,含有阳性遗传修饰符c.835-44A>G。观察到的良好结果很可能是由于基因修饰因子与早产儿早期用药相结合的结果。
{"title":"Onasemnogene-abeparvovec administration to premature infants with spinal muscular atrophy.","authors":"Stephen M Brown, Aparna S Ajjarapu, Divya Ramachandra, Laura Blasco-Pérez, Mar Costa-Roger, Eduardo F Tizzano, Charlotte J Sumner, Katherine D Mathews","doi":"10.1002/acn3.52213","DOIUrl":"10.1002/acn3.52213","url":null,"abstract":"<p><p>Twin girls born at 30 weeks' gestation with spinal muscular atrophy (SMA) received onsasemnogene-abeparvovec (OA) at 3.5 weeks of life. They had no treatment-related adverse events, normal acquisition of motor milestones, and normal neurological examination at 19 months. Genotyping revealed 0 copies of SMN1 and a single, hybrid SMN2 gene containing the positive genetic modifier c.835-44A>G. This was associated with full-length SMN2 blood mRNA expression levels similar to a 2 copy SMA infant. The observed favorable outcomes are likely due to the genetic modifier combined with early drug administration enabled by prematurity.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":"3042-3046"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical trials for Lennox-Gastaut syndrome: Challenges and priorities. 伦诺克斯-加斯豪特综合征的临床试验:挑战与优先事项。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-23 DOI: 10.1002/acn3.52211
Juliet K Knowles, Aaron E L Warren, Ismail S Mohamed, Carl E Stafstrom, Hyun Yong Koh, Debopam Samanta, Renée A Shellhaas, Gita Gupta, Tracy Dixon-Salazar, Linh Tran, Sonal Bhatia, Jane M McCabe, Anup D Patel, Zachary M Grinspan

Objective: Lennox-Gastaut syndrome (LGS) is a severe, childhood-onset epilepsy that is typically refractory to treatment. We surveyed the current landscape of LGS treatment, aiming to identify challenges to the development of efficacious therapies, and to articulate corresponding priorities toward clinical trials that improve outcomes.

Methods: The LGS Special Interest Group of the Pediatric Epilepsy Research Consortium integrated evidence from the literature and expert opinion, into a narrative review.

Results: We provide an overview of approved and emerging medical, dietary, surgical and neuromodulation approaches for LGS. We note that quality of care could be improved by standardizing LGS treatment based on expert consensus and empirical data. Whereas LGS natural history is incompletely understood, prospective studies and use of large retrospective datasets to understand LGS across the lifespan would enable clinical trials that address these dynamics. Recent discoveries related to LGS pathophysiology should enable development of disease-modifying therapies, which are currently lacking. Finally, clinical trials have focused chiefly on seizures involving "drops," but should incorporate additional patient-centered outcomes, using emerging measures adapted to people with LGS.

Interpretation: Clinicians and researchers should enact these priorities, with the goal of patient-centered clinical trials that are tailored to LGS pathophysiology and natural history.

目的:伦诺克斯-加斯托特综合征(Lennox-Gastaut syndrome,LGS)是一种严重的儿童癫痫,通常难治。我们调查了 LGS 目前的治疗情况,旨在确定开发有效疗法所面临的挑战,并阐明改善疗效的临床试验的相应优先事项:方法:儿科癫痫研究联盟 LGS 特别兴趣小组将文献和专家意见中的证据整合成一篇叙述性综述:我们概述了已获批准和新出现的治疗 LGS 的药物、饮食、手术和神经调控方法。我们注意到,根据专家共识和经验数据对 LGS 治疗进行标准化可以提高护理质量。虽然人们对 LGS 自然史的了解尚不全面,但通过前瞻性研究和使用大型回顾性数据集来了解 LGS 的整个生命周期,将有助于针对这些动态变化开展临床试验。有关 LGS 病理生理学的最新发现将有助于开发目前尚缺乏的疾病改变疗法。最后,临床试验主要关注涉及 "滴 "的癫痫发作,但应采用适合 LGS 患者的新措施,纳入更多以患者为中心的结果:临床医生和研究人员应制定这些优先事项,目标是根据 LGS 的病理生理学和自然史开展以患者为中心的临床试验。
{"title":"Clinical trials for Lennox-Gastaut syndrome: Challenges and priorities.","authors":"Juliet K Knowles, Aaron E L Warren, Ismail S Mohamed, Carl E Stafstrom, Hyun Yong Koh, Debopam Samanta, Renée A Shellhaas, Gita Gupta, Tracy Dixon-Salazar, Linh Tran, Sonal Bhatia, Jane M McCabe, Anup D Patel, Zachary M Grinspan","doi":"10.1002/acn3.52211","DOIUrl":"10.1002/acn3.52211","url":null,"abstract":"<p><strong>Objective: </strong>Lennox-Gastaut syndrome (LGS) is a severe, childhood-onset epilepsy that is typically refractory to treatment. We surveyed the current landscape of LGS treatment, aiming to identify challenges to the development of efficacious therapies, and to articulate corresponding priorities toward clinical trials that improve outcomes.</p><p><strong>Methods: </strong>The LGS Special Interest Group of the Pediatric Epilepsy Research Consortium integrated evidence from the literature and expert opinion, into a narrative review.</p><p><strong>Results: </strong>We provide an overview of approved and emerging medical, dietary, surgical and neuromodulation approaches for LGS. We note that quality of care could be improved by standardizing LGS treatment based on expert consensus and empirical data. Whereas LGS natural history is incompletely understood, prospective studies and use of large retrospective datasets to understand LGS across the lifespan would enable clinical trials that address these dynamics. Recent discoveries related to LGS pathophysiology should enable development of disease-modifying therapies, which are currently lacking. Finally, clinical trials have focused chiefly on seizures involving \"drops,\" but should incorporate additional patient-centered outcomes, using emerging measures adapted to people with LGS.</p><p><strong>Interpretation: </strong>Clinicians and researchers should enact these priorities, with the goal of patient-centered clinical trials that are tailored to LGS pathophysiology and natural history.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":"2818-2835"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The prevalence of neuropsychiatric symptoms and correlation with MRI findings in CADASIL patients. CADASIL患者神经精神症状的发生率及其与磁共振成像结果的相关性。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI: 10.1002/acn3.52214
Li Bai, HaoTian Yan, Yu Guo, Yong Shan, Qing Peng, Haiqiang Jin, Yunchuang Sun, Fan Li, Wei Sun, Wei Zhang, Zihao Zhang, Zhaoxia Wang, Yun Yuan, Chen Ling

Objective: To assess the prevalence, timing, and functional impact of neuropsychiatric symptoms in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to assess whether these neuropsychiatric symptoms are associated with magnetic resonance imaging (MRI) features of the patients.

Methods: Our study included a total of 78 patients with CADASIL. To assess neuropsychiatric symptoms, we evaluated the caregivers using the Neuropsychiatric Inventory (NPI). Patients were considered to have an irritability, depression, apathy, aggression, or anxiety disorder if they scored ≥1 in the NPI. Subsequently, we conducted a more detailed assessment of irritability, depression, apathy, aggression, and anxiety. Multivariate logistic regression was employed to analyze the relationships between neuropsychiatric symptoms and clinical/MRI features in the patients.

Results: Overall, 57.69% of patients with CADASIL experienced neuropsychiatric symptoms. Among these symptoms, irritability was the most prevalent (52.56%), followed by depression (19.23%), apathy (17.95%), aggression (7.69%), and anxiety (6.41%). The mean age of onset for irritability was the youngest, followed by anxiety, apathy, aggression, and depression. Among patients with both stroke/TIA and neuropsychiatric symptoms, 31.03% reported experiencing neuropsychiatric symptoms prior to stroke/TIA. Furthermore, both irritability and apathy had a negative impact on the patients' daily functioning. Additionally, there was a correlation between the presence of neuropsychiatric symptoms and the patients' MRI lesion burden.

Interpretation: Our study has discovered that neuropsychiatric symptoms are highly prevalent in patients with CADASIL and may occur before cerebrovascular events, suggesting that neuropsychiatric symptoms of CADASIL deserve more attention and earlier exploration.

目的评估大脑常染色体显性动脉病伴皮层下梗死和白质脑病(CADASIL)患者神经精神症状的发生率、发生时间和对功能的影响,并评估这些神经精神症状是否与患者的磁共振成像(MRI)特征相关:我们的研究共纳入 78 名 CADASIL 患者。为了评估神经精神症状,我们使用神经精神量表(NPI)对护理人员进行了评估。如果患者在 NPI 中得分≥1,则被认为患有易怒、抑郁、冷漠、攻击性或焦虑症。随后,我们对易怒、抑郁、冷漠、攻击性和焦虑进行了更详细的评估。我们采用多变量逻辑回归分析了患者的神经精神症状与临床/MRI特征之间的关系:总体而言,57.69%的CADASIL患者有神经精神症状。在这些症状中,最常见的是烦躁(52.56%),其次是抑郁(19.23%)、冷漠(17.95%)、攻击性(7.69%)和焦虑(6.41%)。易激惹的平均发病年龄最小,其次是焦虑、冷漠、攻击性和抑郁。在既有中风/TIA 又有神经精神症状的患者中,31.03% 的患者报告在中风/TIA 之前出现过神经精神症状。此外,易怒和冷漠对患者的日常功能有负面影响。此外,神经精神症状的存在与患者的磁共振成像病灶负荷之间存在相关性:我们的研究发现,神经精神症状在CADASIL患者中非常普遍,而且可能在脑血管事件之前就已出现,这表明CADASIL的神经精神症状值得更多关注和更早探讨。
{"title":"The prevalence of neuropsychiatric symptoms and correlation with MRI findings in CADASIL patients.","authors":"Li Bai, HaoTian Yan, Yu Guo, Yong Shan, Qing Peng, Haiqiang Jin, Yunchuang Sun, Fan Li, Wei Sun, Wei Zhang, Zihao Zhang, Zhaoxia Wang, Yun Yuan, Chen Ling","doi":"10.1002/acn3.52214","DOIUrl":"10.1002/acn3.52214","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence, timing, and functional impact of neuropsychiatric symptoms in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to assess whether these neuropsychiatric symptoms are associated with magnetic resonance imaging (MRI) features of the patients.</p><p><strong>Methods: </strong>Our study included a total of 78 patients with CADASIL. To assess neuropsychiatric symptoms, we evaluated the caregivers using the Neuropsychiatric Inventory (NPI). Patients were considered to have an irritability, depression, apathy, aggression, or anxiety disorder if they scored ≥1 in the NPI. Subsequently, we conducted a more detailed assessment of irritability, depression, apathy, aggression, and anxiety. Multivariate logistic regression was employed to analyze the relationships between neuropsychiatric symptoms and clinical/MRI features in the patients.</p><p><strong>Results: </strong>Overall, 57.69% of patients with CADASIL experienced neuropsychiatric symptoms. Among these symptoms, irritability was the most prevalent (52.56%), followed by depression (19.23%), apathy (17.95%), aggression (7.69%), and anxiety (6.41%). The mean age of onset for irritability was the youngest, followed by anxiety, apathy, aggression, and depression. Among patients with both stroke/TIA and neuropsychiatric symptoms, 31.03% reported experiencing neuropsychiatric symptoms prior to stroke/TIA. Furthermore, both irritability and apathy had a negative impact on the patients' daily functioning. Additionally, there was a correlation between the presence of neuropsychiatric symptoms and the patients' MRI lesion burden.</p><p><strong>Interpretation: </strong>Our study has discovered that neuropsychiatric symptoms are highly prevalent in patients with CADASIL and may occur before cerebrovascular events, suggesting that neuropsychiatric symptoms of CADASIL deserve more attention and earlier exploration.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":"3010-3018"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52214","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Matched oligoclonal bands: Diagnostic utility and clinical characteristics. 匹配的寡克隆带:诊断效用和临床特征。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-22 DOI: 10.1002/acn3.52162
Yoji Hoshina, Justin R Abbatemarco, Stefanie J Rodenbeck, Jason T Poon, Suzanne C Liu, M Mateo Paz Soldan, John E Greenlee, John W Rose, Lisa K Peterson, Lisa Johnson, Alen Delic, Tammy L Smith, Stacey L Clardy

Objective: To describe patient clinical characteristics associated with matched oligoclonal bands (OCB).

Methods: A retrospective review at the University of Utah examined patients with matched OCB from 2015 to 2020. Clinical data, diagnosis, and outcomes were collected. Patients were classified with either multiple sclerosis (MS), other inflammatory neurologic disorder (other-IND), or noninflammatory neurologic disorder (NIND).

Results: Of 539 identified patients, 436 (53.4% female) were matched-only, while 103 (43.7% female) were matched + unique. Patients with matched-only bands were older (57.4 ± 16 vs. 52 ± 14.2, p < 0.001) and more likely to have a history of autoimmune disease (40.1% vs. 28.2%, p = 0.024) and/or cancer (28.7% vs. 16.5%, p = 0.012). Patients with matched + unique bands were more likely to have CSF pleocytosis (52.4% vs. 25.9%, p < 0.001), high IgG index (52.2% vs. 7.6%, p < 0.001), and an abnormal MRI (86.9% vs. 63.1%, p < 0.001). More than two-thirds of matched-only patients had NIND, while 33% and 41.7% of matched + unique patients had MS and other-IND, respectively. Patients exhibiting matched-only bands and a high IgG index demonstrated a significantly higher incidence of other-IND compared to those with matched-only bands and a normal IgG index (55.6% vs. 30.4%, p = 0.013). While Kaplan-Meier survival curves demonstrated higher mortality in the matched-only cohort compared to the matched + unique cohort (p = 0.02), multivariable Cox regression analysis showed this difference was not statistically significant when adjusting for various factors. A history of cancer was the significant predictor of increased mortality risk (Hazard ratio = 3.147, 95% CI [2.196, 4.51]).

Interpretation: Patients with matched only versus matched + unique OCB have distinct clinical profiles.

目的:描述与匹配寡克隆带(OCB)相关的患者临床特征:描述与匹配的寡克隆带(OCB)相关的患者临床特征:犹他大学的一项回顾性研究对2015年至2020年的匹配OCB患者进行了检查。收集了临床数据、诊断和结果。患者被分为多发性硬化症(MS)、其他炎症性神经系统疾病(other-IND)或非炎症性神经系统疾病(NIND):在 539 名已确认的患者中,436 人(53.4% 为女性)为纯匹配患者,103 人(43.7% 为女性)为匹配 + 唯一患者。仅有匹配带的患者年龄较大(57.4 ± 16 vs. 52 ± 14.2,P 解释:仅有匹配带的患者与匹配 + 唯一带的患者相比,年龄更大:仅配型与配型+独特的 OCB 患者具有不同的临床特征。
{"title":"Matched oligoclonal bands: Diagnostic utility and clinical characteristics.","authors":"Yoji Hoshina, Justin R Abbatemarco, Stefanie J Rodenbeck, Jason T Poon, Suzanne C Liu, M Mateo Paz Soldan, John E Greenlee, John W Rose, Lisa K Peterson, Lisa Johnson, Alen Delic, Tammy L Smith, Stacey L Clardy","doi":"10.1002/acn3.52162","DOIUrl":"10.1002/acn3.52162","url":null,"abstract":"<p><strong>Objective: </strong>To describe patient clinical characteristics associated with matched oligoclonal bands (OCB).</p><p><strong>Methods: </strong>A retrospective review at the University of Utah examined patients with matched OCB from 2015 to 2020. Clinical data, diagnosis, and outcomes were collected. Patients were classified with either multiple sclerosis (MS), other inflammatory neurologic disorder (other-IND), or noninflammatory neurologic disorder (NIND).</p><p><strong>Results: </strong>Of 539 identified patients, 436 (53.4% female) were matched-only, while 103 (43.7% female) were matched + unique. Patients with matched-only bands were older (57.4 ± 16 vs. 52 ± 14.2, p < 0.001) and more likely to have a history of autoimmune disease (40.1% vs. 28.2%, p = 0.024) and/or cancer (28.7% vs. 16.5%, p = 0.012). Patients with matched + unique bands were more likely to have CSF pleocytosis (52.4% vs. 25.9%, p < 0.001), high IgG index (52.2% vs. 7.6%, p < 0.001), and an abnormal MRI (86.9% vs. 63.1%, p < 0.001). More than two-thirds of matched-only patients had NIND, while 33% and 41.7% of matched + unique patients had MS and other-IND, respectively. Patients exhibiting matched-only bands and a high IgG index demonstrated a significantly higher incidence of other-IND compared to those with matched-only bands and a normal IgG index (55.6% vs. 30.4%, p = 0.013). While Kaplan-Meier survival curves demonstrated higher mortality in the matched-only cohort compared to the matched + unique cohort (p = 0.02), multivariable Cox regression analysis showed this difference was not statistically significant when adjusting for various factors. A history of cancer was the significant predictor of increased mortality risk (Hazard ratio = 3.147, 95% CI [2.196, 4.51]).</p><p><strong>Interpretation: </strong>Patients with matched only versus matched + unique OCB have distinct clinical profiles.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":"2846-2854"},"PeriodicalIF":4.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142453940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cognitive status and demographics modify the association between subjective cognition and amyloid. 认知状况和人口统计学改变了主观认知与淀粉样蛋白之间的关联。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-10-23 DOI: 10.1002/acn3.52209
Corey J Bolton, Omair A Khan, Dandan Liu, Sydney Wilhoite, Logan Dumitrescu, Amalia Peterson, Kaj Blennow, Henrik Zetterberg, Timothy J Hohman, Angela L Jefferson, Katherine A Gifford

Objective: This study examined the effect of cognitive status, education, and sex on the association between subjective cognitive decline (SCD) and Alzheimer's disease (AD) biomarkers in non-demented older adults.

Methods: Vanderbilt Memory and Aging Project participants (n = 129), dementia or stroke free, completed fasting lumbar puncture, SCD assessment, and cognitive assessment. Cerebrospinal fluid (CSF) biomarkers for AD were analyzed. Linear regression models related SCD to CSF AD biomarkers and follow-up models assessed interactions of SCD × cognitive status, sex, reading level, and education on AD biomarkers.

Results: In main effect models, higher SCD was associated with more amyloidosis (p-values <0.004). SCD was not associated with tau, p-tau, or neurofilament light (NFL) levels (p-values >0.38). SCD score interacted with cognitive status (p < 0.02), sex (p = 0.03), and education (p-values <0.005) on amyloidosis. In stratified models, higher SCD was associated with more amyloid in cognitively unimpaired (p-values <0.003), men (p = 0.0003), and higher education. No SCD score × reading-level interaction was found (p-values >0.51) though SCD related to amyloid markers in the higher reading-level group (p-values <0.004).

Interpretation: Higher SCD was associated with greater cerebral amyloid accumulation, one of the earliest pathological AD changes. SCD appears most useful in detecting early AD-related brain changes prior to objective cognitive impairment, in men, and those with higher quantity and quality of education and highlight the importance of considering these factors.

研究目的本研究探讨了认知状况、教育程度和性别对非痴呆老年人主观认知能力下降(SCD)与阿尔茨海默病(AD)生物标志物之间关系的影响:范德比尔特记忆与衰老项目参与者(n = 129)无痴呆或中风,完成空腹腰椎穿刺、SCD 评估和认知评估。对AD的脑脊液(CSF)生物标志物进行了分析。线性回归模型将 SCD 与 CSF AD 生物标志物联系起来,后续模型评估了 SCD × 认知状况、性别、阅读水平和教育程度对 AD 生物标志物的交互作用:在主效应模型中,SCD越高,淀粉样变性越多(P值为0.38)。SCD得分与认知状况相互影响(p 0.51),但在阅读水平较高的组别中,SCD与淀粉样蛋白标记物有关(p值 解释:SCD较高与淀粉样蛋白增多有关:较高的 SCD 与较多的脑淀粉样蛋白积聚有关,而淀粉样蛋白积聚是 AD 最早的病理变化之一。在客观认知障碍出现之前,SCD似乎最有助于检测与早期AD相关的脑部变化,适用于男性、受教育数量和质量较高的人群,并强调了考虑这些因素的重要性。
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Annals of Clinical and Translational Neurology
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