Journal of Clinical Neurology最新文献

Background and purpose: Migraine is a common neurological disorder associated with structural and functional brain changes, while small vessel disease (SVD) is the leading cause of white matter damage in older adults. Diffusion tensor imaging (DTI) is effective for assessing white matter, and the peak width of skeletonized mean diffusivity (PSMD) is a novel marker for such damage. No study has used PSMD to assess SVD in migraine patients. This study aimed to investigate the relationship between migraine and SVD using PSMD.

Methods: Seventy-three migraine patients and 73 healthy controls underwent brain DTI to calculate PSMD. Clinical data on migraine characteristics were collected. We compared PSMD values between groups and analyzed correlations with clinical factors in patients with migraine.

Results: Patients with migraine had a significantly higher PSMD than healthy controls (2.08×10⁻⁴ mm²/s vs. 2.04×10⁻⁴ mm²/s, p=0.027), indicating increased white matter damage due to SVD. However, there was no difference in the PSMD between men and women with migraine. No significant differences in the PSMD were found between patients with migraine with and without aura (2.14×10⁻⁴ mm²/s vs. 2.07×10⁻⁴ mm²/s, p=0.074). A positive correlation existed between the PSMD and disease duration in men with migraine (r=0.601, p=0.006). Sex differences were evident, with men having a higher prevalence of aura and with women having a greater headache intensity (47.3% vs. 12.9%, p=0.002; 6.0 vs. 8.0, p=0.025).

Conclusions: Our findings indicate a potential association between migraine and SVD, with PSMD serving as a useful MRI marker for assessing white matter damage in headache disorders.

Background and purpose: Cerebral small vessel disease (cSVD) is associated with the vascular geometry of the intracranial arteries. This study aimed to determine the associations of the burden of pre-existing cSVD with the geometry and hemodynamic parameters of the middle cerebral artery (MCA) in patients with acute ischemic stroke.

Methods: This study enrolled consecutive patients with acute ischemic stroke in the MCA territory who underwent high-resolution vessel wall magnetic resonance imaging and four-dimensional flow magnetic resonance imaging in accordance with the protocol of Kyung Hee University Hospital. Patients were categorized into two groups based on the burden of pre-existing cSVD in the hemisphere contralateral to the stroke lesion: those with a modified burden score of 0-4 (low cSVD burden) and those with a modified burden score of 5-7 (high cSVD burden). The vascular geometry (straight, U-shaped, or inverted-U- and S-shaped) and wall shear stress (WSS) measured at five different points in the contralesional MCA were compared between the two burden groups.

Results: This study included 145 patients with cSVD: 109 with a low burden and 36 with a high burden. A low cSVD burden was correlated with a U- or inverted-U-shaped MCA (p< 0.001). A high cSVD burden was associated with an S-shaped MCA (reference U- or inverted U-shaped MCA: odds ratio [OR]=8.653, 95% confidence interval [CI]=2.789-26.843, p<0.001), and with an increased maximum WSS at the second quintile point (OR=1.109, 95% CI=1.005-1.225, p=0.040) and elevated variability (standard deviation: OR=1.759, 95% CI=1.277-2.423, p=0.001).

Conclusions: A tortuous MCA along with an increased WSS magnitude and variability were independently associated with a high cSVD burden.

Amyloid positron-emission tomography (PET) is the optimal method for detecting amyloid plaque deposition in patients experiencing cognitive decline, which is essential for diagnosing Alzheimer's disease. However, its clinical application globally has been restricted by the high cost, short radiotracer half-life, and significant accessibility challenges. In particular, the lack of treatment options following diagnosis has been considered the largest obstacle to using amyloid PET as a diagnostic tool. Consequently, the current appropriate-use recommendations for amyloid PET tend to support restricting its use. However, the relatively low cost and superior accessibility of amyloid PET in South Korea have resulted in it being used much more frequently in clinical settings than in other countries. The recent introduction of disease-modifying drugs has increased the importance and frequency of amyloid PET usage. Considering these circumstances, this article presents expert opinions on the appropriate use of amyloid PET in South Korea based on existing recommendations and survey results from dementia experts in South Korea.

Background and purpose: To evaluate the clinical efficacy and safety of pregabalin in Korean adults with restless legs syndrome (RLS).

Methods: In this randomized, multicenter, double-blind, placebo-controlled trial, 78 patients with RLS with an International Restless Legs Scale (IRLS) score ≥15 were randomized 1:1 to receive either pregabalin (n=39) or placebo (n=39) for 12 weeks. The primary efficacy outcome was the change in the IRLS score, and the secondary outcomes included the Clinical Global Impression-Improvement scale and changes in scores on other RLS symptom questionnaires. Safety was assessed by monitoring treatment-emergent adverse events (TEAE). This study was registered at ClinicalTrials.gov (NCT04161027).

Results: At baseline, the mean IRLS scores were 23.2±5.8 in the pregabalin and 24.5±5.2 in the placebo group (p=0.297). After 12 weeks, the baseline-adjusted change in the IRLS score was -6.8 (95% confidence interval [CI] -9.3 to -4.3) in the pregabalin group and -5.4 (95% CI -7.9 to -2.8) in the placebo group, with no significant difference between the groups (p=0.420). The secondary efficacy outcomes did not differ between the two groups. The incidence of TEAE was similar between the two groups (48.7% vs. 51.3%, p=0.821), with dizziness being the most common TEAE.

Conclusions: This study failed to demonstrate the therapeutic effect of pregabalin compared with placebo for RLS in Korean adults. Possible reasons for the negative results include low dose, insufficient sample size, and substantial placebo response. Further investigations are warranted to optimize pregabalin therapy in Korean adults with RLS.

Structural magnetic resonance imaging (sMRI) plays a pivotal role in the evaluation of neurological disorders by providing high-resolution anatomical information. Recent advances in quantitative postprocessing techniques have expanded the utility of sMRI beyond visual assessments by enabling the detection of subtle morphological changes associated with various neurological and psychiatric conditions. This review summarizes current clinical applications of sMRI-based analysis, including brain volumetry, shape analysis, voxel-based morphometry (VBM), surface-based morphometry, source-based morphometry, and voxel-based lesion-symptom mapping (VLSM). Volumetric and shape-based analyses allow for assessments of region-specific atrophy and subregional morphological alterations, while VBM and surface-based morphometry provide complementary insights into tissue volumes and the architecture of the cortical surface. Source-based morphometry reveals network-level patterns of structural covariance, and VLSM directly correlates lesion locations with functional outcomes, particularly in stroke. It has been demonstrated that these methodologies are clinically relevant in conditions such as Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, and major depressive disorder. By quantifying structural brain alterations that are not readily detectable using conventional imaging methods, these tools improve diagnostic accuracy, support prognostication, and facilitate monitoring of treatment effects. This review highlights the growing integration of sMRI postprocessing techniques into clinical neurology.