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Serum Glial Fibrillary Acidic Protein and Neurofilament Light Chain Levels Reflect Different Mechanisms of Disease Progression under B-Cell Depleting Treatment in Multiple Sclerosis. 血清胶质纤维酸性蛋白和神经丝蛋白轻链水平反映多发性硬化症患者在B细胞耗竭治疗下疾病进展的不同机制
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-16 DOI: 10.1002/ana.27096
Pascal Benkert, Aleksandra Maleska Maceski, Sabine Schaedelin, Johanna Oechtering, Amar Zadic, Juan Francisco Vilchez Gomez, Lester Melie-Garcia, Alessandro Cagol, Riccardo Galbusera, Suvitha Subramaniam, Johannes Lorscheider, Edoardo Galli, Jannis Mueller, Bettina Fischer-Barnicol, Lutz Achtnichts, Oliver Findling, Patrice H Lalive, Claire Bridel, Marjolaine Uginet, Stefanie Müller, Caroline Pot, Amandine Mathias, Renaud Du Pasquier, Anke Salmen, Robert Hoepner, Andrew Chan, Giulio Disanto, Chiara Zecca, Marcus D'Souza, Lars G Hemkens, Özgür Yaldizli, Tobias Derfuss, Patrick Roth, Claudio Gobbi, David Brassat, Björn Tackenberg, Rosetta Pedotti, Catarina Raposo, Jorge Oksenberg, Heinz Wiendl, Klaus Berger, Marco Hermesdorf, Fredrik Piehl, David Conen, Andreas Buser, Ludwig Kappos, Michael Khalil, Cristina Granziera, Ahmed Abdelhak, David Leppert, Eline A J Willemse, Jens Kuhle

Objective: To investigate the longitudinal dynamics of serum glial fibrillary acidic protein (sGFAP) and serum neurofilament light chain (sNfL) levels in people with multiple sclerosis (pwMS) under B-cell depleting therapy (BCDT) and their capacity to prognosticate future progression independent of relapse activity (PIRA) events.

Methods: A total of 362 pwMS (1,480 samples) starting BCDT in the Swiss Multiple Sclerosis (MS) Cohort were included. sGFAP levels in 2,861 control persons (4,943 samples) provided normative data to calculate adjusted Z scores.

Results: Elevated sGFAP levels (Z score >1) at 1 year were associated with a higher hazard for PIRA (hazard ratio [HR]: 1.80 [95% CI: 1.17-2.78]; p = 0.0079) than elevated sNfL levels (HR, 1.45 [0.95-2.24], p = 0.0886) in a combined model. Independent of PIRA events, sGFAP levels longitudinally increased by 0.49 Z score units per 10 years follow-up (estimate, 0.49 [0.29, 0.69], p < 0.0001). In patients experiencing PIRA, sGFAP Z scores were 0.52 Z score units higher versus stable patients (0.52 [0.22, 0.83], p = 0.0009). Different sNfL Z score trajectories were found in pwMS with versus without PIRA (interaction p = 0.0028), with an average decrease of 0.92 Z score units per 10 years observed without PIRA (-0.92 [-1.23, -0.60], p < 0.0001), whereas levels in patients with PIRA remained high.

Interpretation: Elevated sGFAP and lack of drop in sNfL after BCDT start are associated with increased risk of future PIRA. These findings provide a rationale for combined monitoring of sNfL and sGFAP in pwMS starting BCDT to predict the risk of PIRA, and to use sGFAP as an outcome in clinical trials aiming to impact on MS progressive disease biology. ANN NEUROL 2024.

目的研究接受 B 细胞耗竭疗法(BCDT)的多发性硬化症患者(pwMS)血清胶质纤维酸性蛋白(sGFAP)和血清神经丝轻链(sNfL)水平的纵向动态变化,以及它们独立于复发活动(PIRA)事件预示未来进展的能力:方法:纳入瑞士多发性硬化(MS)队列中开始接受BCDT治疗的362名pwMS(1,480个样本)。2,861名对照者(4,943个样本)的sGFAP水平为计算调整后Z评分提供了标准数据:在综合模型中,1 年后 sGFAP 水平升高(Z 评分 >1)与 PIRA 的相关性(危险比 [HR]:1.80 [95% CI:1.17-2.78];p = 0.0079)高于 sNfL 水平升高(HR:1.45 [0.95-2.24];p = 0.0886)。与 PIRA 事件无关,sGFAP 水平每随访 10 年纵向增加 0.49 个 Z 评分单位(估计值,0.49 [0.29,0.69],p 解释:BCDT 开始后,sGFAP 升高和 sNfL 未下降与未来 PIRA 风险增加有关。这些发现为在开始使用 BCDT 的患者中联合监测 sNfL 和 sGFAP 以预测 PIRA 风险提供了依据,也为在旨在影响 MS 进展性疾病生物学的临床试验中使用 sGFAP 作为结果提供了依据。ann neurol 2024。
{"title":"Serum Glial Fibrillary Acidic Protein and Neurofilament Light Chain Levels Reflect Different Mechanisms of Disease Progression under B-Cell Depleting Treatment in Multiple Sclerosis.","authors":"Pascal Benkert, Aleksandra Maleska Maceski, Sabine Schaedelin, Johanna Oechtering, Amar Zadic, Juan Francisco Vilchez Gomez, Lester Melie-Garcia, Alessandro Cagol, Riccardo Galbusera, Suvitha Subramaniam, Johannes Lorscheider, Edoardo Galli, Jannis Mueller, Bettina Fischer-Barnicol, Lutz Achtnichts, Oliver Findling, Patrice H Lalive, Claire Bridel, Marjolaine Uginet, Stefanie Müller, Caroline Pot, Amandine Mathias, Renaud Du Pasquier, Anke Salmen, Robert Hoepner, Andrew Chan, Giulio Disanto, Chiara Zecca, Marcus D'Souza, Lars G Hemkens, Özgür Yaldizli, Tobias Derfuss, Patrick Roth, Claudio Gobbi, David Brassat, Björn Tackenberg, Rosetta Pedotti, Catarina Raposo, Jorge Oksenberg, Heinz Wiendl, Klaus Berger, Marco Hermesdorf, Fredrik Piehl, David Conen, Andreas Buser, Ludwig Kappos, Michael Khalil, Cristina Granziera, Ahmed Abdelhak, David Leppert, Eline A J Willemse, Jens Kuhle","doi":"10.1002/ana.27096","DOIUrl":"https://doi.org/10.1002/ana.27096","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the longitudinal dynamics of serum glial fibrillary acidic protein (sGFAP) and serum neurofilament light chain (sNfL) levels in people with multiple sclerosis (pwMS) under B-cell depleting therapy (BCDT) and their capacity to prognosticate future progression independent of relapse activity (PIRA) events.</p><p><strong>Methods: </strong>A total of 362 pwMS (1,480 samples) starting BCDT in the Swiss Multiple Sclerosis (MS) Cohort were included. sGFAP levels in 2,861 control persons (4,943 samples) provided normative data to calculate adjusted Z scores.</p><p><strong>Results: </strong>Elevated sGFAP levels (Z score >1) at 1 year were associated with a higher hazard for PIRA (hazard ratio [HR]: 1.80 [95% CI: 1.17-2.78]; p = 0.0079) than elevated sNfL levels (HR, 1.45 [0.95-2.24], p = 0.0886) in a combined model. Independent of PIRA events, sGFAP levels longitudinally increased by 0.49 Z score units per 10 years follow-up (estimate, 0.49 [0.29, 0.69], p < 0.0001). In patients experiencing PIRA, sGFAP Z scores were 0.52 Z score units higher versus stable patients (0.52 [0.22, 0.83], p = 0.0009). Different sNfL Z score trajectories were found in pwMS with versus without PIRA (interaction p = 0.0028), with an average decrease of 0.92 Z score units per 10 years observed without PIRA (-0.92 [-1.23, -0.60], p < 0.0001), whereas levels in patients with PIRA remained high.</p><p><strong>Interpretation: </strong>Elevated sGFAP and lack of drop in sNfL after BCDT start are associated with increased risk of future PIRA. These findings provide a rationale for combined monitoring of sNfL and sGFAP in pwMS starting BCDT to predict the risk of PIRA, and to use sGFAP as an outcome in clinical trials aiming to impact on MS progressive disease biology. ANN NEUROL 2024.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142453966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
The Relationship between Framingham Stroke Risk Profile on Incident Dementia and Alzheimer's Disease: A 40-Year Follow-Up Study Highlighting Female Vulnerability. 弗雷明汉卒中风险档案与痴呆症和阿尔茨海默病发病之间的关系:突显女性脆弱性的 40 年随访研究。
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-15 DOI: 10.1002/ana.27108
Jing Yuan, Qiushan Tao, Ting Fang Alvin Ang, Chunyu Liu, Sherral Devine, Sanford H Auerbach, Jesse Mez, Lindsay A Farrer, Wei Qiao Qiu, Rhoda Au

Objective: Sex differences in the association between cardiovascular risk factors and the incident all-cause dementia and the subtype Alzheimer's disease (AD) risk are unclear.

Methods: Framingham Heart Study (FHS) participants (n = 4,171, 54% women, aged 55 to 69 years) were included at baseline and followed up to 40 years. The Framingham Stroke Risk Profile (FSRP) was dichotomized into 2 levels (cutoff: 75th percentile of the FSRP z-scores). Cause-specific hazard models, with death as a competing event, and restricted mean survival time (RMST) model were used to analyze the association between FSRP levels and incident all-cause dementia and AD. Interactions between FSRP and sex were estimated, followed by a sex-stratified analysis to examine the sex modification effect.

Results: High FSRP was significantly associated with all-cause dementia (hazard ratio [HR] = 1.25, robust 95% confidence interval [CI] = 1.21 to 1.29, p < 0.001) and AD (HR = 1.58, robust 95% CI = 1.57 to 1.59, p < 0.001) in cause-specific hazard models. High FSRP was significantly associated with incident dementia (HR = 2.81, robust 95% CI = 2.75 to 2.87, p < 0.001) and AD (HR = 2.96, robust 95% CI = 2.36 to 3.71, p < 0.001) in women, but not in men. Results were consistent in the RMST models. Current diabetes and high systolic blood pressure as FSRP components were significantly associated with dementia and AD in women but not in men.

Interpretation: High FSRP in mid- to early late life is a critical risk factor for all-cause dementia and AD, particularly in women. Sex-specific interventions and further research to elucidate underlying mechanisms are warranted. ANN NEUROL 2024.

研究目的心血管风险因素与全因痴呆和亚型阿尔茨海默病(AD)发病风险之间的性别差异尚不清楚:弗雷明汉心脏研究(FHS)的参与者(n = 4,171 人,54% 为女性,年龄在 55 岁至 69 岁之间)被纳入基线研究并随访 40 年。弗雷明汉卒中风险档案(FSRP)被分为两个等级(分界线:FSRP z分数的第75百分位数)。以死亡为竞争事件的特定病因危险模型和受限平均生存时间(RMST)模型用于分析FSRP水平与全因痴呆症和注意力缺失症之间的关系。对FSRP与性别之间的交互作用进行了估计,随后进行了性别分层分析,以检验性别修饰效应:结果:高FSRP与全因痴呆症有明显相关性(危险比[HR] = 1.25,稳健的95%置信区间[CI] = 1.21至1.29,P 解释:中年至晚年的高FSRP是全因痴呆症和注意力缺失症的关键风险因素,尤其是对女性而言。有必要采取针对不同性别的干预措施,并开展进一步研究以阐明其潜在机制。ann neurol 2024.
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引用次数: 0
Subarachnoid Hemorrhage Following Ischemia Due to Dolichoectatic Aneurysm. 多发性动脉瘤导致缺血后蛛网膜下腔出血。
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-15 DOI: 10.1002/ana.27111
Daisuke Tahara, Kohei Asano, Keizo Yasui, Yasushi Iwasaki
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引用次数: 0
Mechanical Thrombectomy for Pediatric Stroke: Focal Cerebral Arteriopathy Versus Cardioembolic Etiologies-Pooled Analysis of the Save ChildS and KidClot Cohort. 小儿脑卒中的机械取栓术:局灶性脑动脉病变与心肌栓塞病因--拯救儿童联盟和 KidClot 队列的汇总分析》。
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1002/ana.27088
Julien Boucherit, Marios Psychogios, Manoëlle Kossorotoff, Jens Fiehler, Basile Kerleroux, André Kemmling, Olivier Naggara, Sarah Lee, Thi Dan Linh Nguyen-Kim, François Eugene, Moritz Wildgruber, Gregoire Boulouis, Peter B Sporns

Background: The study aimed to compare outcomes of mechanical thrombectomy (MT) in pediatric patients with acute ischemic stroke (AIS) caused by focal cerebral arteriopathy (FCA) versus cardioembolism (CE).

Methods: Data from the Save ChildS and KidClot cohorts were merged. Children with AIS because of FCA or CE that underwent MT were included. The study used the Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation (CASCADE) for stroke cause assessment. Descriptive statistics and multivariable regression models were used to analyze final modified thrombolysis in cerebral infarction (mTICI) scores, periprocedural complications, and functional outcomes assessed by the modified Rankin scale (mRS) at 6 to 12 months.

Results: The analysis included 60 children with 14 FCA and 46 CE cases. CE etiology was associated with better revascularization (good to excellent thrombolysis in cerebral infarction scores) and shift toward better outcomes (common adjusted odds ratio of mRs for CE vs FCA: 0.27, 95% CI: [0.06-0.97], p = 0.039), with no difference in favorable outcome rates. FCA was associated with significantly lower rates of excellent revascularization (21% vs 65%, p < 0.001). No difference in complications' rates was observed between the groups (7.2% in FCA vs 5.5%, p = 0.69).

Interpretation: We found that pediatric AIS because of CE etiology has more favorable procedural outcomes compared to FCA following MT. This translated to mixed functional outcomes that may be more favorable in the CE group. These findings highlight the need for further research to refine treatment protocols for pediatric stroke, particularly in understanding and managing FCA in children. ANN NEUROL 2024.

背景:该研究旨在比较由局灶性脑动脉病变(FCA)和心肌栓塞(CE)引起的急性缺血性卒中(AIS)儿科患者的机械取栓术(MT)疗效:方法:合并拯救儿童联盟(Save ChildS)和KidClot队列的数据。纳入了因 FCA 或 CE 而接受 MT 的 AIS 患儿。研究采用儿童动脉缺血性卒中标准化分类和诊断评估(CASCADE)进行卒中原因评估。研究采用描述性统计和多变量回归模型分析了脑梗死改良溶栓治疗(mTICI)的最终评分、围手术期并发症以及6至12个月时改良Rankin量表(mRS)评估的功能预后:分析包括60名患儿,其中14例FCA,46例CE。CE病因与较好的血管再通效果(脑梗塞溶栓评分从良好到优秀)和较好的预后有关(CE vs FCA的mRs调整后常见几率比:0.27,95% CI:[0.06-0.97],p = 0.039),但良好预后率没有差异。FCA 的优良血管再通率明显较低(21% vs 65%,P 解释:我们发现,由于 CE 病因导致的小儿 AIS 与 MT 后的 FCA 相比,具有更有利的手术结果。这转化为混合功能结果,CE 组可能更有利。这些发现强调了进一步研究完善小儿卒中治疗方案的必要性,尤其是在理解和管理儿童 FCA 方面。ann neurol 2024。
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引用次数: 0
Priorities and Recommendations to Make ALS a Livable Disease Emanating from the 2024 National Academies of Sciences, Engineering, and Medicine Report Living with ALS. 美国国家科学、工程和医学研究院 2024 年报告《与 ALS 共存》中提出的使 ALS 成为一种可治愈疾病的优先事项和建议。
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1002/ana.27097
Ileana M Howard, Suma Babu, Chelsey Carter, Stacey A Sakowski, Jerome E Kurent, Merit E Cudkowicz, Eva L Feldman

Amyotrophic lateral sclerosis (ALS) is a relentless, fatal neurodegenerative disease. The progressive loss of voluntary muscle function, diagnostic delays, lack of effective treatments, and challenges accessing multidisciplinary care and resources have tremendous impact on quality of life. The congressionally directed ALS committee of the National Academies of Science, Engineering, and Medicine, in their 2024 report "Living with ALS," recommends critical actions for specific United States stakeholders to make ALS a livable disease over the next decade. This review summarizes the context and recommendations of the report. Advocacy efforts are critical to make these recommendations a reality for the ALS community. ANN NEUROL 2024.

肌萎缩侧索硬化症(ALS)是一种无情的、致命的神经退行性疾病。肌肉自主功能的逐渐丧失、诊断延误、缺乏有效的治疗方法,以及在获得多学科护理和资源方面的挑战,都对患者的生活质量产生了巨大影响。由国会指导的美国国家科学院、工程院和医学院 ALS 委员会在其 2024 年报告《与 ALS 共存》中,建议美国特定利益相关方在未来十年采取关键行动,使 ALS 成为一种宜居疾病。本综述总结了报告的背景和建议。要使这些建议成为 ALS 社区的现实,宣传工作至关重要。ann neurol 2024.
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引用次数: 0
Advanced MRI Measures of Myelin and Axon Volume Identify Repair in Multiple Sclerosis. 髓鞘和轴突体积的高级 MRI 测量可识别多发性硬化症的修复。
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1002/ana.27102
Gretel Sanabria-Diaz, Alessandro Cagol, Po-Jui Lu, Muhamed Barakovic, Mario Ocampo-Pineda, Xinjie Chen, Matthias Weigel, Esther Ruberte, Nina de Oliveira S Siebenborn, Riccardo Galbusera, Sabine Schädelin, Pascal Benkert, Jens Kuhle, Ludwig Kappos, Lester Melie-Garcia, Cristina Granziera

Objective: Pathological studies suggest that multiple sclerosis (MS) lesions endure multiple waves of damage and repair; however, the dynamics and characteristics of these processes are poorly understood in patients living with MS.

Methods: We studied 128 MS patients (75 relapsing-remitting, 53 progressive) and 72 healthy controls who underwent advanced magnetic resonance imaging and clinical examination at baseline and 2 years later. Magnetization transfer saturation and multi-shell diffusion imaging were used to quantify longitudinal changes in myelin and axon volumes within MS lesions. Lesions were grouped into 4 classes (repair, damage, mixed repair damage, and stable). The frequency of each class was correlated to clinical measures, demographic characteristics, and levels of serum neurofilament light chain (sNfL).

Results: Stable lesions were the most frequent (n = 2,276; 44%), followed by lesions with patterns of "repair" (n = 1,352; 26.2%) and damage (n = 1,214; 23.5%). The frequency of "repair" lesion was negatively associated with disability (β = -0.04; p < 0.001) and sNfL (β = -0.16; p < 0.001) at follow-up. The frequency of the "damage" class was higher in progressive than relapsing-remitting patients (p < 0.05) and was related to disability (baseline: β = -0.078; follow-up: β = -0.076; p < 0.001) and age (baseline: β = -0.078; p < 0.001). Stable lesions were more frequent in relapsing-remitting than in progressive patients (p < 0.05), and in younger patients versus older (β = -0.07; p < 0.001) at baseline. Further, "mixed" lesions were most frequent in older patients (β = 0.004; p < 0.001) at baseline.

Interpretation: These findings show that repair and damage processes within MS lesions occur across the entire disease spectrum and that their frequency correlates with patients disability, age, disease duration, and extent of neuroaxonal damage. ANN NEUROL 2024.

摘要病理学研究表明,多发性硬化症(MS)病变经历了多次损伤和修复过程;然而,人们对多发性硬化症患者体内这些过程的动态和特征却知之甚少:我们对 128 名多发性硬化症患者(75 名复发缓解型,53 名进行性)和 72 名健康对照者进行了研究,他们在基线和两年后接受了先进的磁共振成像和临床检查。磁化传递饱和度和多壳扩散成像用于量化多发性硬化症病变内髓鞘和轴突体积的纵向变化。病变被分为 4 类(修复、损伤、混合修复损伤和稳定)。每类病变的频率与临床测量、人口统计学特征和血清神经丝轻链(sNfL)水平相关:结果:稳定型病变最常见(n = 2 276;44%),其次是 "修复 "型病变(n = 1 352;26.2%)和损伤型病变(n = 1 214;23.5%)。修复 "病变的频率与残疾率呈负相关(β = -0.04;p 解释:这些研究结果表明,多发性硬化症病变内的修复和损伤过程发生在整个疾病谱中,其频率与患者的残疾程度、年龄、病程和神经轴损伤程度相关。ann neurol 2024.
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引用次数: 0
Bilaterally Symmetrical Globus Pallidus Infarction. 双侧对称性苍白球梗塞
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1002/ana.27090
Lizhang Chen, Jing Yang, Jinmei Li, Li He
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引用次数: 0
Reply to “Letter on Multiple Acyl-Coenzyme A Dehydrogenase Deficiency Is Associated with Sertraline Use” 回复 "关于多种酰基辅酶 A 脱氢酶缺乏症与使用舍曲林有关的信函"。
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1002/ana.27106
Sofie Sunebo MD, Hanna Appelqvist PhD, Bo Häggqvist PhD, Olof Danielsson MD, PhD
{"title":"Reply to “Letter on Multiple Acyl-Coenzyme A Dehydrogenase Deficiency Is Associated with Sertraline Use”","authors":"Sofie Sunebo MD,&nbsp;Hanna Appelqvist PhD,&nbsp;Bo Häggqvist PhD,&nbsp;Olof Danielsson MD, PhD","doi":"10.1002/ana.27106","DOIUrl":"10.1002/ana.27106","url":null,"abstract":"","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142453970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Multiple Aneurysms and Cerebral Infarction in a Patient with Sneddon Syndrome. 一名斯内登综合征患者的多发性动脉瘤和脑梗塞。
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1002/ana.27110
Xintong Song, Xingquan Zhao, Qian Zhang, Yi Ju
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引用次数: 0
Heightened Reticulospinal Excitability after Severe Corticospinal Damage in Chronic Stroke. 慢性中风皮层脊髓严重受损后网状脊髓兴奋性增强
IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-10 DOI: 10.1002/ana.27103
Ronan A Mooney, Manuel A Anaya, Joan M Stilling, Pablo A Celnik

Objective: After severe corticospinal tract damage poststroke in humans, some recovery of strength and movement proximally is evident. It is possible that alternate motor pathways, such as the reticulospinal tract, may be upregulated to compensate for the loss of corticospinal tract input. We investigated the extent of reticulospinal tract excitability modulation and its inter-dependence on the severity of corticospinal tract damage after stroke in humans.

Methods: We used a novel startle conditioned transcranial magnetic stimulation paradigm to elicit ipsilateral motor evoked potentials, an index of reticulospinal tract excitability, in 22 chronic stroke participants with mild to severe corticospinal tract damage and 14 neurotypical age-matched controls.

Results: We found that ipsilateral motor evoked potential presence was higher in the paretic arm of people with severe corticospinal tract damage compared to their non-paretic arm, people with mild corticospinal tract damage, and age-matched controls. Interestingly, ipsilateral motor evoked potential presence was correlated with motor impairment across the entire stroke cohort, whereby individuals with worse impairment exhibited more frequent ipsilateral motor evoked potentials (ie, higher reticulospinal tract excitability).

Interpretation: Following severe corticospinal tract damage, upregulated reticulospinal tract activity may compensate for a loss of corticospinal tract input, providing some proximal recovery of isolated and within-synergy movements, but deficits in performing out of synergy movements and finger fractionation remain. Interventions aimed at modulating the reticulospinal tract could be beneficial or detrimental to ameliorating motor impairment depending on the degree of reliance on this pathway for residual motor output. ANN NEUROL 2024.

目的:人类中风后皮质脊髓束严重受损,近端力量和运动明显有所恢复。网状脊髓束等替代运动通路有可能被上调,以补偿皮质脊髓束输入的损失。我们研究了网状脊髓束兴奋性调节的程度及其与人类中风后皮质脊髓束损伤严重程度的相互关系:方法:我们使用一种新颖的惊吓条件性经颅磁刺激范式来诱发同侧运动诱发电位,这是网状脊髓束兴奋性的一个指标:我们发现,与非瘫痪臂、皮质脊髓束轻度受损者和年龄匹配的对照组相比,皮质脊髓束重度受损者的瘫痪臂同侧运动诱发电位更高。有趣的是,同侧运动诱发电位的出现与整个中风队列中的运动损伤相关,损伤较重的患者同侧运动诱发电位出现的频率更高(即网状脊髓束兴奋性更高):解释:皮质脊髓束严重受损后,网状脊髓束活性上调可弥补皮质脊髓束输入的损失,使孤立运动和协同内运动得到一定程度的近端恢复,但协同外运动和手指分节运动的障碍仍然存在。根据残余运动输出对网状脊髓束的依赖程度,旨在调节网状脊髓束的干预措施可能对改善运动障碍有益,也可能有害。ann neurol 2024.
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引用次数: 0
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Annals of Neurology
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