Journal of Clinical Neurology最新文献

Background and purpose: Rapid eye movement (REM) sleep without atonia makes it difficult to detect REM sleep stages using electromyography in patients with REM sleep behavior disorder (RBD). The objectives of this study were to propose an automated REM sleep detector that requires only electroencephalography (EEG) and electrooculography (EOG) data, and to evaluate its performance using real-world polysomnography (PSG) data in RBD patients.

Methods: This multicenter study used 310 PSG datasets obtained from 5 tertiary hospitals. The data were divided into RBD (n=200) and non-RBD (n=110), as well as, into Parkinson's disease (PD) with RBD (n=76), PD without RBD (n=46), idiopathic RBD (iRBD) (n=124), and healthy controls (n=64). An automated computerized REM detection algorithm was implemented using U-Sleep's publicly available pretrained network.

Results: The U-Sleep-based REM sleep-detection algorithm correctly identified REM sleep with an area under the receiver operating characteristic curve (AUC) of 0.90±0.14. The classification performance of the REM sleep detector differed significantly between RBD and non-RBD patients (AUC=0.88±0.13 vs. 0.93±0.14, p=0.007). The REM sleep detector accurately classified REM sleep in the order of healthy controls, PD without RBD, iRBD, and PD with RBD, with AUC values of 0.94±0.02, 0.92±0.03, 0.90±0.02, and 0.86±0.02, respectively.

Conclusions: Our U-Sleep-based REM sleep detector based on only EEG and EOG data showed good performance in detecting REM sleep. However, it performed considerably worse in RBD, especially in PD with RBD. Using transfer learning with fine-tuning by expert review, a high-performance REM sleep-detecting system will be realized.

Background and purpose: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are inflammatory demyelinating conditions of the central nervous system that have distinct pathological mechanisms. There is a paucity of studies comparing the accumulation of subclinical lesions between MS and NMOSD, especially during the clinical remission period. Recent advances in neuroimaging techniques, those particularly involving the use of machine learning (ML) methods for lesion segmentation, have provided new opportunities to quantitatively assess the volumes of brain lesions and how they change over time. In this study, we aimed to use ML-based lesion segmentation methods to measure differences in lesion volumes and their changes during the remission period between patients with MS and NMOSD.

Methods: This study included a retrospective cohort of 31 patients with MS and patients with 30 aquaporin-4-positive (AQP4⁺) NMOSD from the National Cancer Center registry. Serial 3D brain magnetic resonance imaging (MRI) scans obtained during the interattack period were analyzed using ML-based segmentation. MRI data preprocessing included alignment, distortion correction, and normalization, with lesion mapping and statistical analyses determining changes in lesion volumes.

Results: The MS patients exhibited significant increases in the median lesion volume (from 3,493 mm³ to 4,430 mm³, p<0.001), indicating ongoing subclinical activity without clinical relapses. In contrast, the NMOSD patients showed no significant change in the median lesion volume (from 640 mm³ to 930 mm³, p=0.129), supporting an attack-dependent disease course. The lesion volume increased by 193 mm³/year in the MS group, compared with only 25 mm³/year in the NMOSD group (p=0.017).

Conclusions: These findings highlight the distinct pathogenic processes of the two conditions and hence the need for specialized therapeutic and monitoring strategies for patients with MS and AQP4⁺ NMOSD.

Background and purpose: Existing rehabilitation programs for neurological critical patients are based on early mobilization or exercise. However, whether there is an optimal rehabilitation program in terms of its rehabilitation efficacy needs further exploration.

Methods: An optimal rehabilitation program for neurological critical patients was developed in July 2020 and evaluated in December 2020. Retrospective data on the duration of the rehabilitation intervention, mortality rate, treatment adverse events (AE), and functional status were collected in the hospital electronic database from January to June 2020. The Manchester Mobility Score (MMS), UK Medical Research Council (MRC) muscle strength score, and Barthel Index for the ability to perform the activities of daily living were used to evaluate body function.

Results: The incidence of nonfatal serious AEs was significantly lower in patients treated with the optimized rehabilitation program (1.71% vs. 3.41%), while the rehabilitation time was significantly shorter (23.17±6.99 days vs. 26.34±6.25 days, mean±standard deviation) and there were significant improvements in activity ability (MMS: 10.88±3.31 vs. 7.89±3.31), muscle strength (MRC muscle strength score: 9.56±3.84 vs. 7.84±3.36), and activities of daily living (Barthel Index: 27.36±9.34 vs. 19.47±6.25). Importantly, the nutritional status of the patients was also significantly improved by the optimal program.

Conclusions: The optimized rehabilitation program was superior to the nonoptimized program in decreasing AEs and improving the activity ability, muscle strength, and ability to perform the activities of daily living.

Background and purpose: Polypharmacy is common in Parkinson's disease (PD). This includes appropriate medications for PD-related symptoms and comorbid conditions, but also potentially inappropriate medications (PIMs). We aimed to determine the prescribing trends of PIMs based on the 2019 Beers Criteria in Korean patients with PD.

Methods: This retrospective observational study analyzed PD patients aged 40 years or older whose PIM prescribing patterns from 2014 to 2019 were included in the HIRA (Korean Health Insurance Review and Assessment Service) nationwide claims database in South Korea. The prevalence and usage were analyzed for both overall PIMs and PIMs that can exacerbate PD symptoms (PIM^PDs). Additionally, the most frequently prescribed PIMs and PIM^PDs were investigated.

Results: PIMs were used at least once in 38.3% of 257,142 patients with PD. The mean number of PIM items used per patient was 2.61. The PIM usage ratio, corresponding to the proportion of the total amount of PIMs to all medications per patient, was 19.7%. The proportion of patients taking PIMs among all PD patients decreased significantly up to 2018 but then increased in 2019, while the PIM usage ratio increased steadily up to 2018 and then decreased in 2019. Excluding the representative PD medications, the most frequently prescribed PIM was amitriptyline. PIM^PDs were also commonly used, including levosulpiride and haloperidol.

Conclusions: The prevalence and usage of PIMs were high in Korean PD patients during 2014-2019, and the utilization of PIM^PDs persisted throughout this period. These findings can be used to develop evidence-based guidelines for robust polypharmacy management strategies to ensure the safety of medications used by PD patients.

Background and purpose: Tenecteplase (TNK) is a promising alternative thrombolytic agent for the treatment of acute ischemic stroke (AIS). However, its potential use is being impeded by the lack of regulatory approval and reimbursement policies for TNK in AIS in many countries, including South Korea. To address this therapeutic gap, the Korean Stroke Society developed scientific statement intended to inform policy changes and support the introduction of TNK in regions where it is not yet accessible, with the aim of enabling AIS patients to benefit from this advancement in thrombolytic therapy.

Methods: We reviewed randomized controlled trials (RCTs), meta-analyses, and systematic reviews published between January 2010 and November 2024 involving AIS patients treated with intravenous TNK. Meta-analyses were included if they exclusively evaluated RCTs and provided clinical evidence on the efficacy and safety of TNK. The statements were thoroughly reviewed and finalized by international expert panels after iterative revisions.

Results: The statements suggest that TNK at 0.25 mg/kg can be considered as an alternative to alteplase for intravenous thrombolysis within 4.5 hours of the onset of AIS. The clinical outcomes in patients with large-vessel occlusion who are candidates for endovascular thrombectomy are better for TNK at 0.25 mg/kg than for alteplase.

Conclusions: These statements are intended to support the adoption of TNK in countries where it is not yet available, including South Korea, by providing up-to-date clinical evidence. Their implementation may broaden the therapeutic options for AIS patients and help align acute stroke care practices with international standards.

Background and purpose: Compare clinical and lab characteristics of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis cases with and without brain atrophy.

Methods: Assess cerebral atrophy using median temporal lobe atrophy (MTA) and global cortical atrophy (GCA) scores in 82 anti-NMDAR encephalitis cases.

Results: GCA (+) cases had higher proportions of status epilepticus (p<0.001), memory problems (p=0.031), sepsis (p<0.001), and mechanical ventilation need (p=0.001) than GCA (-) cases. MTA (+) cases had higher memory problems (p<0.001) and sepsis (p=0.002) than MTA (-) cases. GCA (+) and MTA (+) groups had higher max modified Rankin Scale (mRS) (p<0.001, p=0.002) and 1-year mRS (p<0.001, p=0.004) scores than GCA (-) and MTA (-) groups. GCA (+) group had a longer hospital stay and a larger proportion of cases with limited treatment response (both p<0.001) than the GCA (-) group. GCA (p=0.005) was found to be a significant predictive factor for the mRS score 1 year after onset in multiple linear regression analysis.

Conclusions: MTA and GCA may be associated with severity and prognosis in anti-NMDAR encephalitis.