Pub Date : 2026-02-05DOI: 10.1016/j.jocn.2026.111870
Yan He, Chengling Xia, Xiaolei Zhao, Ling Xiao, Qinglian Luo
Introduction: This study explores the prevalence of anxiety and depression at various time points during the rehabilitation of intracerebral hemorrhage (ICH) patients, ascertains their sleep quality, and analyzes influencing factors regarding psychological conditions, family and society.
Methods: Multiple questionnaires were employed to assess the disease and psychological status of ICH patients at different time points following onset. Assessments were conducted upon hospital admission, as well as at 1, 3, 6, and 12 months (s) after onset. Simultaneously, data regarding the rehabilitation support provided by caregivers or family members were collected. The prevalence and correlation of psychological disorders in patients during rehabilitation were analyzed. A comprehensive discussion was made on the factors influencing psychological disorders in ICH patients. Our study accounted for patient-specific, family, and psychological factors at different time points.
Results: 524 ICH patients were ultimately enrolled in this study. Results showed that the prevalence of moderate-to-severe anxiety and depression gradually declined over one year post-discharge, while the sleep quality fluctuated, peaking at 1 and 6 months. Multivariate analysis identified several risk factors, encompassing male gender, low muscle strength, lack of exercise, unemployment (OR < 1), hypertension, lower family income (OR > 1), prolonged daily caregiving hours (OR > 1), caregivers' limited disease knowledge, and low caregiver enthusiasm (OR < 1). Psychological scores exhibited intercorrelations. For instance, anxiety and depression were strongly correlated at 1 month post-discharge (r = 0.730). Admission SSS (Somatic Symptom Scale) scores significantly predicted anxiety, while depression was linked to PSQI (Pittsburgh Sleep Quality Index), SSS, and Barthel Index scores. The sleep quality was influenced by HAMD (Hamilton Depression Scale) and Barthel scores. These findings highlighted that psychological issues in ICH patients, though prevalent, declined over time, affected by patient characteristics (physical function, socioeconomic status), caregiver dynamics, and multidimensional psychological interactions.
Conclusion: Following the onset of ICH, patients commonly exhibit varying degrees of anxiety, depression, and sleep quality. The prevalence of these conditions declines progressively throughout the rehabilitation period. Psychological and sleep-related outcomes are influenced by a combination of individual characteristics, familial circumstances, and multiple psychosocial factors, underscoring the need for comprehensive nursing care and multidimensional support.
{"title":"Investigation of psychological and sleep states in patients with Intracerebral hemorrhage and analysis of influencing Factors: A Single-Center Case-Control study.","authors":"Yan He, Chengling Xia, Xiaolei Zhao, Ling Xiao, Qinglian Luo","doi":"10.1016/j.jocn.2026.111870","DOIUrl":"https://doi.org/10.1016/j.jocn.2026.111870","url":null,"abstract":"<p><strong>Introduction: </strong>This study explores the prevalence of anxiety and depression at various time points during the rehabilitation of intracerebral hemorrhage (ICH) patients, ascertains their sleep quality, and analyzes influencing factors regarding psychological conditions, family and society.</p><p><strong>Methods: </strong>Multiple questionnaires were employed to assess the disease and psychological status of ICH patients at different time points following onset. Assessments were conducted upon hospital admission, as well as at 1, 3, 6, and 12 months (s) after onset. Simultaneously, data regarding the rehabilitation support provided by caregivers or family members were collected. The prevalence and correlation of psychological disorders in patients during rehabilitation were analyzed. A comprehensive discussion was made on the factors influencing psychological disorders in ICH patients. Our study accounted for patient-specific, family, and psychological factors at different time points.</p><p><strong>Results: </strong>524 ICH patients were ultimately enrolled in this study. Results showed that the prevalence of moderate-to-severe anxiety and depression gradually declined over one year post-discharge, while the sleep quality fluctuated, peaking at 1 and 6 months. Multivariate analysis identified several risk factors, encompassing male gender, low muscle strength, lack of exercise, unemployment (OR < 1), hypertension, lower family income (OR > 1), prolonged daily caregiving hours (OR > 1), caregivers' limited disease knowledge, and low caregiver enthusiasm (OR < 1). Psychological scores exhibited intercorrelations. For instance, anxiety and depression were strongly correlated at 1 month post-discharge (r = 0.730). Admission SSS (Somatic Symptom Scale) scores significantly predicted anxiety, while depression was linked to PSQI (Pittsburgh Sleep Quality Index), SSS, and Barthel Index scores. The sleep quality was influenced by HAMD (Hamilton Depression Scale) and Barthel scores. These findings highlighted that psychological issues in ICH patients, though prevalent, declined over time, affected by patient characteristics (physical function, socioeconomic status), caregiver dynamics, and multidimensional psychological interactions.</p><p><strong>Conclusion: </strong>Following the onset of ICH, patients commonly exhibit varying degrees of anxiety, depression, and sleep quality. The prevalence of these conditions declines progressively throughout the rehabilitation period. Psychological and sleep-related outcomes are influenced by a combination of individual characteristics, familial circumstances, and multiple psychosocial factors, underscoring the need for comprehensive nursing care and multidimensional support.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"111870"},"PeriodicalIF":1.8,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1016/j.jocn.2026.111900
Minjun Park, Nathan D. McLaughlin, Mayur S. Patel, Jorge F. Urquiaga, Mauricio J. Avila
While physical therapy is a well-established preoperative intervention to manage pain and improve function for patients undergoing spinal surgery, its postoperative utility, particularly following fusion procedures, remains less well defined. We aim to systematically review the current literature on the efficacy of physical therapy following spine surgery. A systematic review in accordance with PRISMA guidelines was performed with a comprehensive search in PubMed, EBSCO, and CINAHL database. The database was searched up to March 2025 with the following MESH terms using AND or OR boolean operators: (“Spine/surgery” “Spinal Fusion” “Laminectomy” “Discectomy”), (“Physical Therapy Modalities” “Exercise Therapy” “Rehabilitation”), and (“Treatment Outcome” “Outcome Assessment (Health Care)” “Recovery of Function”). Thirty-one studies involving 4,335 patients were included: 22 RCTs, 8 retrospective analyses and 1 prospective cohort. Studies focused on lumbar surgeries (n = 25) and cervical surgeries (n = 6). In lumbar fusion studies (n = 7), 43% (3/7) demonstrated significant pain improvement and 17% (1/6) showed reduced disability with postoperative rehabilitation. Among non-instrumented lumbar procedures (n = 18), 63% (10/16) of studies found greater pain relief and 59% (10/17) observed reduced disability with physical therapy. Cervical studies revealed pain benefits in 40% (2/5) of trials and disability improvement in 33% (1/3) associated with postoperative physical therapy. Evidence supporting postoperative physical therapy following lumbar fusion is mixed with respect to pain, disability, and functional outcomes. In contrast, non-instrumented lumbar procedures show more consistent benefit, particularly in pain outcomes. Additional high-quality randomized controlled trials are warranted to better define the role of rehabilitation in post-operative spinal surgery care.
{"title":"The effect of physical therapy in spine surgery: a systematic review","authors":"Minjun Park, Nathan D. McLaughlin, Mayur S. Patel, Jorge F. Urquiaga, Mauricio J. Avila","doi":"10.1016/j.jocn.2026.111900","DOIUrl":"10.1016/j.jocn.2026.111900","url":null,"abstract":"<div><div>While physical therapy is a well-established preoperative intervention to manage pain and improve function for patients undergoing spinal surgery, its postoperative utility, particularly following fusion procedures, remains less well defined. We aim to systematically review the current literature on the efficacy of physical therapy following spine surgery. A systematic review in accordance with PRISMA guidelines was performed with a comprehensive search in PubMed, EBSCO, and CINAHL database. The database was searched up to March 2025 with the following MESH terms using AND or OR boolean operators: (“Spine/surgery” “Spinal Fusion” “Laminectomy” “Discectomy”), (“Physical Therapy Modalities” “Exercise Therapy” “Rehabilitation”), and (“Treatment Outcome” “Outcome Assessment (Health Care)” “Recovery of Function”). Thirty-one studies involving 4,335 patients were included: 22 RCTs, 8 retrospective analyses and 1 prospective cohort. Studies focused on lumbar surgeries (n = 25) and cervical surgeries (n = 6). In lumbar fusion studies (n = 7), 43% (3/7) demonstrated significant pain improvement and 17% (1/6) showed reduced disability with postoperative rehabilitation. Among non-instrumented lumbar procedures (n = 18), 63% (10/16) of studies found greater pain relief and 59% (10/17) observed reduced disability with physical therapy. Cervical studies revealed pain benefits in 40% (2/5) of trials and disability improvement in 33% (1/3) associated with postoperative physical therapy. Evidence supporting postoperative physical therapy following lumbar fusion is mixed with respect to pain, disability, and functional outcomes. In contrast, non-instrumented lumbar procedures show more consistent benefit, particularly in pain outcomes. Additional high-quality randomized controlled trials are warranted to better define the role of rehabilitation in post-operative spinal surgery care.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"147 ","pages":"Article 111900"},"PeriodicalIF":1.8,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.jocn.2026.111882
Gao Yu , Ge Manyue , Jiang Yi , Pang Miao , Zhang Bin , Zhang Xiaoxi , Zhang Yongwei , Dai Zhao , Yang Pengfei , Liu Jianmin
Introduction
Recent advancements in endovascular thrombectomy (EVT) devices and pivotal trial evidence have revolutionised acute ischemic stroke management. However, translational gaps persist between guideline recommendations and real-world practice, particularly regarding operator experience-dependent technical preferences in resource allocation.
Methods
A national survey with 53 questions was designed to extract information regarding strategy decisions and clinical scenarios, including technical variations of thrombectomy and thrombolysis, blood pressure preference. The survey link was sent individually via email with a website link.
Results
1,289 responses from 883 hospitals were obtained and were included in the final analysis. Junior physicians exhibited reluctance to deviate from thrombolysis-centric paradigms, while senior physicians preferred thrombectomy. Conversely, junior physicians were more likely to use Balloon-guide catheters (BGC), thrombolysis after thrombectomy, local anesthesia, and radial access.
Conclusion
This nationwide study highlights significant heterogeneity in acute ischemic stroke management among Chinese physicians, driven by experience-based differences. Findings underscore the need for stratified training, standardized protocols, and collaborative platforms to harmonize practice and accelerate evidence translation.
{"title":"Experience-driven differences in acute ischemic stroke management: A nationwide study","authors":"Gao Yu , Ge Manyue , Jiang Yi , Pang Miao , Zhang Bin , Zhang Xiaoxi , Zhang Yongwei , Dai Zhao , Yang Pengfei , Liu Jianmin","doi":"10.1016/j.jocn.2026.111882","DOIUrl":"10.1016/j.jocn.2026.111882","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent advancements in endovascular thrombectomy (EVT) devices and pivotal trial evidence have revolutionised acute ischemic stroke management. However, translational gaps persist between guideline recommendations and real-world practice, particularly regarding operator experience-dependent technical preferences in resource allocation.</div></div><div><h3>Methods</h3><div>A national survey with 53 questions was designed to extract information regarding strategy decisions and clinical scenarios, including technical variations of thrombectomy and thrombolysis, blood pressure preference. The survey link was sent individually via email with a website link.</div></div><div><h3>Results</h3><div>1,289 responses from 883 hospitals were obtained and were included in the final analysis. Junior physicians exhibited reluctance to deviate from thrombolysis-centric paradigms, while senior physicians preferred thrombectomy. Conversely, junior physicians were more likely to use Balloon-guide catheters (BGC), thrombolysis after thrombectomy, local anesthesia, and radial access.</div></div><div><h3>Conclusion</h3><div>This nationwide study highlights significant heterogeneity in acute ischemic stroke management among Chinese physicians, driven by experience-based differences. Findings underscore the need for stratified training, standardized protocols, and collaborative platforms to harmonize practice and accelerate evidence translation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111882"},"PeriodicalIF":1.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.jocn.2026.111855
Jason Silvestre, Robert J. Ferdon, Robert A. Ravinsky, Charles A. Reitman
Background
The primary objectives of this study were to determine disparities in the supply, demand, and adequacy of the United States (US) neurologist workforce utilizing projections from the Health Resources and Services Administration (HRSA).
Methods
This was an analysis of US-based neurologists leveraging data from the HRSA. Supply and demand were defined as the number of full-time equivalent (FTE) neurologists working and needed, respectively. Adequacy was defined as the ratio of supply over demand. Linear regression was used to analyze neurologist workforce trends from 2024 to 2037.
Results
From 2024 to 2037, the national supply of neurologists was projected to increase from 21,010 to 23,310 FTEs (10.9 % increase, P < 0.001). Over the study period, the demand for neurologists was also projected to increase from 23,720 to 25,560 FTEs (7.8 % increase, P < 0.001). Neurologist workforce adequacy was projected to increase from 2024 to 2037 (88.6 % to 91.2 %, P < 0.001). By 2037, neurologist adequacy was projected to be lowest in the South (77.5 %) and highest in the Northeast (129 %) (P < 0.001). Non-metropolitan areas were projected to have lower neurologist adequacy than metropolitan areas (21.4 % vs 102 %, P < 0.001). In 2037, the states with the lowest projected neurologist workforce adequacy were Idaho (23.5 %), Wyoming (25.0 %), and Alaska (33.3 %). In 2024, neurology ranked 29th out of 35 specialties for physician adequacy.
Conclusions
As a specialty, neurology has among the least adequate physician workforces with deficiencies concentrated in non-metropolitan areas and certain identified states. While some future projected improvements were observed, additional strategies may be needed to enhance neurologist workforce adequacy in areas with identified deficiencies.
{"title":"Geographic disparities in the supply, demand, and adequacy of the United States neurologist workforce","authors":"Jason Silvestre, Robert J. Ferdon, Robert A. Ravinsky, Charles A. Reitman","doi":"10.1016/j.jocn.2026.111855","DOIUrl":"10.1016/j.jocn.2026.111855","url":null,"abstract":"<div><h3>Background</h3><div>The primary objectives of this study were to determine disparities in the supply, demand, and adequacy of the United States (US) neurologist workforce utilizing projections from the Health Resources and Services Administration (HRSA).</div></div><div><h3>Methods</h3><div>This was an analysis of US-based neurologists leveraging data from the HRSA. Supply and demand were defined as the number of full-time equivalent (FTE) neurologists working and needed, respectively. Adequacy was defined as the ratio of supply over demand. Linear regression was used to analyze neurologist workforce trends from 2024 to 2037.</div></div><div><h3>Results</h3><div>From 2024 to 2037, the national supply of neurologists was projected to increase from 21,010 to 23,310 FTEs (10.9 % increase, P < 0.001). Over the study period, the demand for neurologists was also projected to increase from 23,720 to 25,560 FTEs (7.8 % increase, P < 0.001). Neurologist workforce adequacy was projected to increase from 2024 to 2037 (88.6 % to 91.2 %, P < 0.001). By 2037, neurologist adequacy was projected to be lowest in the South (77.5 %) and highest in the Northeast (129 %) (P < 0.001). Non-metropolitan areas were projected to have lower neurologist adequacy than metropolitan areas (21.4 % vs 102 %, P < 0.001). In 2037, the states with the lowest projected neurologist workforce adequacy were Idaho (23.5 %), Wyoming (25.0 %), and Alaska (33.3 %). In 2024, neurology ranked 29th out of 35 specialties for physician adequacy.</div></div><div><h3>Conclusions</h3><div>As a specialty, neurology has among the least adequate physician workforces with deficiencies concentrated in non-metropolitan areas and certain identified states. While some future projected improvements were observed, additional strategies may be needed to enhance neurologist workforce adequacy in areas with identified deficiencies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111855"},"PeriodicalIF":1.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.jocn.2026.111874
Tiantian Zou , Mengyi Xu , Ying Liu
Background
Severe traumatic brain injury (sTBI) leads to substantial neurological dysfunction and diminished quality of life. However, prospective evidence regarding the long-term effects of early rehabilitation nursing on neurological recovery in sTBI patients remains scarce.
Methods
This prospective cohort study enrolled 73 sTBI patients (Glasgow Coma Scale ≤ 8) between January and December 2022. Patients were allocated to receive routine nursing (control group, n = 35) or early rehabilitation nursing (research group, n = 38), which comprised psychological support, cognitive intervention, and motor rehabilitation initiated within 48 h of stabilization. Outcomes including consciousness (GCS), motor function (Fugl-Meyer Assessment), functional independence (Functional Independence Measure), neurological deficit (NIHSS), quality of life (QOL-100), and global outcome (Glasgow Outcome Scale-Extended) were assessed at baseline, 6, 12, and 18 months.
Results
Repeated-measures analysis revealed significant Time × Group interactions across all outcomes (p < 0.001), indicating divergent recovery trajectories. At 18 months, the research group demonstrated superior GCS (14.82 ± 0.89 vs. 13.45 ± 1.12, p < 0.001), FMA (87.24 ± 5.67 vs. 79.86 ± 6.34, p < 0.001), FIM (95.42 ± 4.85 vs. 85.71 ± 5.92, p < 0.001), and GOSE scores (7.21 ± 0.74 vs. 6.43 ± 0.95, p < 0.001), alongside lower NIHSS scores (7.18 ± 2.45 vs. 13.57 ± 3.21, p < 0.001). Quality of life improved significantly across all domains in the research group. Effect sizes were uniformly large (Cohen’s d: 0.92–2.24).
Conclusions
Early rehabilitation nursing was associated with sustained improvements in neurological function, functional independence, and quality of life over 18 months. These findings warrant confirmation through multicenter randomized controlled trials.
{"title":"The long-term influence of early rehabilitation nursing on neurological improvement and life quality in patients with severe traumatic brain injury: A prospective cohort study","authors":"Tiantian Zou , Mengyi Xu , Ying Liu","doi":"10.1016/j.jocn.2026.111874","DOIUrl":"10.1016/j.jocn.2026.111874","url":null,"abstract":"<div><h3>Background</h3><div>Severe traumatic brain injury (sTBI) leads to substantial neurological dysfunction and diminished quality of life. However, prospective evidence regarding the long-term effects of early rehabilitation nursing on neurological recovery in sTBI patients remains scarce.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled 73 sTBI patients (Glasgow Coma Scale ≤ 8) between January and December 2022. Patients were allocated to receive routine nursing (control group, n = 35) or early rehabilitation nursing (research group, n = 38), which comprised psychological support, cognitive intervention, and motor rehabilitation initiated within 48 h of stabilization. Outcomes including consciousness (GCS), motor function (Fugl-Meyer Assessment), functional independence (Functional Independence Measure), neurological deficit (NIHSS), quality of life (QOL-100), and global outcome (Glasgow Outcome Scale-Extended) were assessed at baseline, 6, 12, and 18 months.</div></div><div><h3>Results</h3><div>Repeated-measures analysis revealed significant Time × Group interactions across all outcomes (p < 0.001), indicating divergent recovery trajectories. At 18 months, the research group demonstrated superior GCS (14.82 ± 0.89 vs. 13.45 ± 1.12, p < 0.001), FMA (87.24 ± 5.67 vs. 79.86 ± 6.34, p < 0.001), FIM (95.42 ± 4.85 vs. 85.71 ± 5.92, p < 0.001), and GOSE scores (7.21 ± 0.74 vs. 6.43 ± 0.95, p < 0.001), alongside lower NIHSS scores (7.18 ± 2.45 vs. 13.57 ± 3.21, p < 0.001). Quality of life improved significantly across all domains in the research group. Effect sizes were uniformly large (Cohen’s d: 0.92–2.24).</div></div><div><h3>Conclusions</h3><div>Early rehabilitation nursing was associated with sustained improvements in neurological function, functional independence, and quality of life over 18 months. These findings warrant confirmation through multicenter randomized controlled trials.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111874"},"PeriodicalIF":1.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.jocn.2026.111886
Peng Lu , Rundong Chen , Meihua Huyan , Weilong Hua , Yilei Zhang , Hongjian Zhang , Zifu Li , Yongwei Zhang , Jianmin Liu , Pengfei Yang , Lei Zhang
Background
Hyperglycemia on admission is associated with heightened hemorrhagic risk in acute ischemic stroke (AIS), but whether this risk association differs between bridging therapy (intravenous alteplase followed by endovascular thrombectomy [EVT]) and direct EVT remains unclear.
Methods
This post hoc analysis of the DIRECT-MT trial (2016–2019) included 627 patients with anterior circulation large-vessel occlusion AIS eligible for alteplase from multiple centers. Baseline glucose levels were assessed, and hemorrhagic outcomes followed the Heidelberg scheme: hemorrhagic transformation (HT; radiologic umbrella that includes hemorrhagic infarction [HI] and parenchymatous hematoma [PH]) and symptomatic intracranial hemorrhage (sICH). Logistic regression and restricted cubic spline models evaluated glucose-hemorrhage associations and the treatment-by-glucose interactions.
Results
Median age was 69 years (43 % female), with median baseline glucose of 7.8 mmol/L. Elevated glucose was associated with greater odds of hemorrhagic transformation (HT) (adjusted OR 1.168 per 1 mmol/L; 95 % CI, 1.100–1.243). A significant interaction indicated higher hemorrhagic risk with bridging therapy versus direct EVT at glucose levels > 11.1 mmol/L. In the > 11.1 mmol/L subgroup (n = 71), bridging therapy was associated with increased PH risk (OR 4.84; 95 % CI 1.34–21.95, p = 0.024), whereas no excess risk was seen at ≤ 11.1 mmol/L. No significant differences were observed for HI or sICH.
Conclusion
Admission hyperglycemia was associated with higher odds of hemorrhagic complications in AIS patients undergoing EVT. In patients with marked admission hyperglycemia (>11.1 mmol/L), bridging therapy was associated with higher odds of parenchymal hematoma than direct EVT, whereas no excess risk was observed at lower glucose levels. These exploratory findings apply only to EVT-eligible patients and primarily inform the choice between bridging therapy and direct EVT, suggesting that, when blood glucose is markedly elevated, a direct EVT strategy may warrant consideration alongside early glucose assessment and careful glycemic management.
入院时高血糖与急性缺血性卒中（AIS）出血风险增高相关，但这种风险关联在桥接治疗（静脉注射阿替普酶后血管内取栓）和直接取栓之间是否存在差异尚不清楚。方法：对DIRECT-MT试验（2016-2019）的事后分析，包括来自多个中心的627例符合阿替普酶治疗条件的前循环大血管闭塞AIS患者。基线血糖水平评估，出血结局遵循海德堡方案：出血性转化（HT）；放射学包括出血性梗死（HI）和实质血肿（PH）)和症状性颅内出血（sICH）。Logistic回归和限制三次样条模型评估了葡萄糖与出血的关系和葡萄糖治疗的相互作用。结果中位年龄为69岁（43%为女性），中位基线血糖为7.8 mmol/L。血糖升高与出血性转化（HT）的几率增加相关（调整后的OR为1.168 / 1mmol /L； 95% CI为1.100-1.243）。显著的相互作用表明，在血糖水平为11.1 mmol/L时，桥接治疗比直接EVT有更高的出血风险。在11.1 mmol/L亚组（n = 71）中，桥接治疗与PH风险增加相关（OR 4.84; 95% CI 1.34-21.95, p = 0.024），而≤11.1 mmol/L时未见额外风险。HI和sICH没有显著性差异。结论接受EVT的AIS患者入院时高血糖与出血并发症发生率增高有关。在入院时有明显高血糖（11.1 mmol/L）的患者中，桥接治疗比直接EVT发生实质血肿的几率更高，而在血糖水平较低的患者中没有观察到额外的风险。这些探索性发现仅适用于EVT符合条件的患者，并主要告知桥接治疗和直接EVT之间的选择，这表明，当血糖明显升高时，直接EVT策略可能需要考虑早期血糖评估和仔细的血糖管理。
{"title":"Elevated baseline glucose and hemorrhagic complications in bridging vs direct EVT","authors":"Peng Lu , Rundong Chen , Meihua Huyan , Weilong Hua , Yilei Zhang , Hongjian Zhang , Zifu Li , Yongwei Zhang , Jianmin Liu , Pengfei Yang , Lei Zhang","doi":"10.1016/j.jocn.2026.111886","DOIUrl":"10.1016/j.jocn.2026.111886","url":null,"abstract":"<div><h3>Background</h3><div>Hyperglycemia on admission is associated with heightened hemorrhagic risk in acute ischemic stroke (AIS), but whether this risk association differs between bridging therapy (intravenous alteplase followed by endovascular thrombectomy [EVT]) and direct EVT remains unclear.</div></div><div><h3>Methods</h3><div>This post hoc analysis of the DIRECT-MT trial (2016–2019) included 627 patients with anterior circulation large-vessel occlusion AIS eligible for alteplase from multiple centers. Baseline glucose levels were assessed, and hemorrhagic outcomes followed the Heidelberg scheme: hemorrhagic transformation (HT; radiologic umbrella that includes hemorrhagic infarction [HI] and parenchymatous hematoma [PH]) and symptomatic intracranial hemorrhage (sICH). Logistic regression and restricted cubic spline models evaluated glucose-hemorrhage associations and the treatment-by-glucose interactions.</div></div><div><h3>Results</h3><div>Median age was 69 years (43 % female), with median baseline glucose of 7.8 mmol/L. Elevated glucose was associated with greater odds of<!--> <!-->hemorrhagic transformation (HT)<!--> <!-->(adjusted OR<!--> <!-->1.168<!--> <!-->per 1 mmol/L; 95 % CI,<!--> <!-->1.100–1.243). A significant interaction indicated higher hemorrhagic risk with bridging therapy versus direct EVT at glucose levels > 11.1 mmol/L. In the > 11.1 mmol/L subgroup (n = 71), bridging therapy was associated with increased PH risk (OR 4.84; 95 % CI 1.34–21.95, p = 0.024), whereas no excess risk was seen at ≤ 11.1 mmol/L. No significant differences were observed for HI or sICH.</div></div><div><h3>Conclusion</h3><div>Admission hyperglycemia was associated with higher odds of hemorrhagic complications in AIS patients undergoing EVT. In patients with marked admission hyperglycemia (>11.1 mmol/L), bridging therapy was associated with higher odds of parenchymal hematoma than direct EVT, whereas no excess risk was observed at lower glucose levels. These exploratory findings apply only to EVT-eligible patients and primarily inform the choice between bridging therapy and direct EVT, suggesting that, when blood glucose is markedly elevated, a direct EVT strategy may warrant consideration alongside early glucose assessment and careful glycemic management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111886"},"PeriodicalIF":1.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.jocn.2026.111869
Hua Yang , Hao Wen , Jiadan Ye , Li Yang , Zhigang Zhao
Background:
Despite the ongoing controversy around the prophylactic use of antiseizure medications (ASMs) in seizure-naïve patients undergoing brain tumor surgery, this practice has persisted for years. This study aims to develop and validate a machine-learning framework for stratifying postoperative seizure risk.
Methods:
Demographic, tumor topographic, surgery-related details, and biomarkers were collected from a retrospective study involving patients undergoing glioma resection. The dataset was split in a stratified manner into an 80/20 ratio for training and testing purposes. Machine learning (ML) models, including random forest (RF), XGBoost, gradient boosting decision tree (GBDT), multi-layer perceptron (MLP), bootstrap-aggregation ensemble classifier with decision tree classifier (Bagging), and logistic regression (LR), were developed and evaluated. The SHAP method was applied to interpret the attribution values of the top features.
Results:
Among the 786 eligible patients, with a median age of 42.0 years (interquartile range [IQR] = 25.3-54.0), 154 (19.6%) experienced postoperative seizures. The multi-layer perceptron model demonstrated the best predictive performance, incorporating demographic, topographic, surgery-related, and biomarker variables (Test: AUC: 0.74, Accuracy: 0.70, Sensitivity: 0.56, Specificity: 0.73). Notably, a simpler model relying solely on demographic and topographic features also yielded comparable performance.
Conclusions:
This study underscores the effectiveness of the multi-layer perceptron model, which integrates demographic, topographic, surgery-related, and biomarker variables. This integration successfully developed a personalized prediction model for postoperative seizure risk. Such a model holds the potential to aid physicians in optimizing postoperative management, particularly in guiding decisions regarding the duration and discontinuation of prophylactic antiseizure medications.
{"title":"Seizure risk prediction using machine learning following glioma resection surgery in seizure-naïve patients","authors":"Hua Yang , Hao Wen , Jiadan Ye , Li Yang , Zhigang Zhao","doi":"10.1016/j.jocn.2026.111869","DOIUrl":"10.1016/j.jocn.2026.111869","url":null,"abstract":"<div><h3>Background:</h3><div>Despite the ongoing controversy around the prophylactic use of antiseizure medications (ASMs) in seizure-naïve patients undergoing brain tumor surgery, this practice has persisted for years. This study aims to develop and validate a machine-learning framework for stratifying postoperative seizure risk.</div></div><div><h3>Methods:</h3><div>Demographic, tumor topographic, surgery-related details, and biomarkers were collected from a retrospective study involving patients undergoing glioma resection. The dataset was split in a stratified manner into an 80/20 ratio for training and testing purposes. Machine learning (ML) models, including random forest (RF), XGBoost, gradient boosting decision tree (GBDT), multi-layer perceptron (MLP), bootstrap-aggregation ensemble classifier with decision tree classifier (Bagging), and logistic regression (LR), were developed and evaluated. The SHAP method was applied to interpret the attribution values of the top features.</div></div><div><h3>Results:</h3><div>Among the 786 eligible patients, with a median age of 42.0 years (interquartile range [IQR] = 25.3-54.0), 154 (19.6%) experienced postoperative seizures. The multi-layer perceptron model demonstrated the best predictive performance, incorporating demographic, topographic, surgery-related, and biomarker variables (Test: AUC: 0.74, Accuracy: 0.70, Sensitivity: 0.56, Specificity: 0.73). Notably, a simpler model relying solely on demographic and topographic features also yielded comparable performance.</div></div><div><h3>Conclusions:</h3><div>This study underscores the effectiveness of the multi-layer perceptron model, which integrates demographic, topographic, surgery-related, and biomarker variables. This integration successfully developed a personalized prediction model for postoperative seizure risk. Such a model holds the potential to aid physicians in optimizing postoperative management, particularly in guiding decisions regarding the duration and discontinuation of prophylactic antiseizure medications.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111869"},"PeriodicalIF":1.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.jocn.2026.111877
Roya Abolfazli , Mohammad Ali Sahraian , Vahid Shaygannejad , Fereshteh Ashtari , Sareh Shahmohammadi , Maryam Poursadeghfard , Seyed Mohammad Baghbanian , Nastaran Majdinasab , Mohammad Ali Nahayati , Samaneh Hosseini , Javad Yousefi Azarfam , Samira Navardi , Hamid Reza Torabi , Hormoz Ayromlou , Morteza Saeidi , Mahnaz Talebi , Alireza Nikseresht , Zahra Niknam , Amirreza Azimi , Behnaz Sedighi , Sara Samadzadeh
<div><h3>Background</h3><div>Oral therapies for relapsing–remitting multiple sclerosis (RRMS) may enhance treatment satisfaction and quality of life. Patient-reported outcome measures (PROMs) provide structured insight into treatment effectiveness and disease impact beyond clinician-reported scales.</div></div><div><h3>Objective</h3><div>To assess treatment satisfaction and other PROMs in RRMS patients initiating dimethyl fumarate (DMF), either treatment-naïve or switching from injectable therapies.</div></div><div><h3>Methods</h3><div>PROFIT was a 12-month, multicenter, phase 4, open-label, single-arm observational study conducted in Iran. Patients received DMF with a slow-dose titration regimen to mitigate gastrointestinal adverse effects. The primary endpoint was the change in treatment satisfaction, assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM-14), from baseline to month 12 among previously treated patients. Key secondary endpoints included changes in additional PROMs, including health-related quality of life (HRQoL), depressive symptoms, sleep quality, and work productivity. Patient-reported outcomes were assessed using the EuroQol-5D-3L (EQ-5D-3L), Beck Depression Inventory–Fast Screen (BDI-7), Pittsburgh Sleep Quality Index (PSQI), and Work Productivity and Activity Impairment–Multiple Sclerosis (WPAI-MS) at baseline, 6 months, and 12 months. Adverse events were monitored monthly, with safety evaluated as a secondary outcome.</div></div><div><h3>Results</h3><div>Of 645 patients (72.3 % female; mean age 34.0 years), 473 (73.3 %) completed the 12-month follow-up, while 172 (26.7 %) discontinued treatment. The primary endpoint, change in treatment satisfaction (TSQM-14) among previously treated patients, showed significant improvement across all domains: effectiveness (+13.01), side effects (+7.76), convenience (+35.21), and global satisfaction (+15.75) (all p < 0.001). Secondary endpoints also demonstrated favorable changes, including EQ-5D-3L utility (+0.07), EQ-5D Visual Analogue Scale (VAS) (+3.86), PSQI (–1.62), WPAI absenteeism (–7.55 %), and BDI-7 (–0.11) (all p < 0.001). Treatment discontinuations (26.7 %) were primarily due to gastrointestinal adverse events (n = 45, 26.0 %), followed by physician decision (n = 34, 20.0 %), disease progression (n = 26, 15.0 %), patient preference (n = 19, 11.0 %), pregnancy (n = 14, 8.0 %), elevated liver enzymes (n = 13, 7.0 %), and other causes (n = 21, 12.0 %). Adverse events declined over time, confirming a favorable and manageable safety profile.</div></div><div><h3>Conclusion</h3><div>DMF was associated with improvements in treatment satisfaction, quality of life, sleep quality, work productivity, and depressive symptoms in both treatment-naïve and previously treated RRMS patients, with high adherence and manageable side effects. These findings provide real-world evidence from an Iranian RRMS cohort, supporting DMF as a well-tolerated, patient-centered option
{"title":"Longitudinal effects of dimethyl fumarate on patient-reported outcome measures in multiple sclerosis: treatment satisfaction, quality of life, depressive symptoms, sleep, and work productivity","authors":"Roya Abolfazli , Mohammad Ali Sahraian , Vahid Shaygannejad , Fereshteh Ashtari , Sareh Shahmohammadi , Maryam Poursadeghfard , Seyed Mohammad Baghbanian , Nastaran Majdinasab , Mohammad Ali Nahayati , Samaneh Hosseini , Javad Yousefi Azarfam , Samira Navardi , Hamid Reza Torabi , Hormoz Ayromlou , Morteza Saeidi , Mahnaz Talebi , Alireza Nikseresht , Zahra Niknam , Amirreza Azimi , Behnaz Sedighi , Sara Samadzadeh","doi":"10.1016/j.jocn.2026.111877","DOIUrl":"10.1016/j.jocn.2026.111877","url":null,"abstract":"<div><h3>Background</h3><div>Oral therapies for relapsing–remitting multiple sclerosis (RRMS) may enhance treatment satisfaction and quality of life. Patient-reported outcome measures (PROMs) provide structured insight into treatment effectiveness and disease impact beyond clinician-reported scales.</div></div><div><h3>Objective</h3><div>To assess treatment satisfaction and other PROMs in RRMS patients initiating dimethyl fumarate (DMF), either treatment-naïve or switching from injectable therapies.</div></div><div><h3>Methods</h3><div>PROFIT was a 12-month, multicenter, phase 4, open-label, single-arm observational study conducted in Iran. Patients received DMF with a slow-dose titration regimen to mitigate gastrointestinal adverse effects. The primary endpoint was the change in treatment satisfaction, assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM-14), from baseline to month 12 among previously treated patients. Key secondary endpoints included changes in additional PROMs, including health-related quality of life (HRQoL), depressive symptoms, sleep quality, and work productivity. Patient-reported outcomes were assessed using the EuroQol-5D-3L (EQ-5D-3L), Beck Depression Inventory–Fast Screen (BDI-7), Pittsburgh Sleep Quality Index (PSQI), and Work Productivity and Activity Impairment–Multiple Sclerosis (WPAI-MS) at baseline, 6 months, and 12 months. Adverse events were monitored monthly, with safety evaluated as a secondary outcome.</div></div><div><h3>Results</h3><div>Of 645 patients (72.3 % female; mean age 34.0 years), 473 (73.3 %) completed the 12-month follow-up, while 172 (26.7 %) discontinued treatment. The primary endpoint, change in treatment satisfaction (TSQM-14) among previously treated patients, showed significant improvement across all domains: effectiveness (+13.01), side effects (+7.76), convenience (+35.21), and global satisfaction (+15.75) (all p < 0.001). Secondary endpoints also demonstrated favorable changes, including EQ-5D-3L utility (+0.07), EQ-5D Visual Analogue Scale (VAS) (+3.86), PSQI (–1.62), WPAI absenteeism (–7.55 %), and BDI-7 (–0.11) (all p < 0.001). Treatment discontinuations (26.7 %) were primarily due to gastrointestinal adverse events (n = 45, 26.0 %), followed by physician decision (n = 34, 20.0 %), disease progression (n = 26, 15.0 %), patient preference (n = 19, 11.0 %), pregnancy (n = 14, 8.0 %), elevated liver enzymes (n = 13, 7.0 %), and other causes (n = 21, 12.0 %). Adverse events declined over time, confirming a favorable and manageable safety profile.</div></div><div><h3>Conclusion</h3><div>DMF was associated with improvements in treatment satisfaction, quality of life, sleep quality, work productivity, and depressive symptoms in both treatment-naïve and previously treated RRMS patients, with high adherence and manageable side effects. These findings provide real-world evidence from an Iranian RRMS cohort, supporting DMF as a well-tolerated, patient-centered option ","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111877"},"PeriodicalIF":1.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.jocn.2026.111896
Anthony N. Baumann , Robert J. Trager , Dalton McGlamery , Shahabeddin Yazdanpanah , Keegan T. Conry , Gordon Preston , Jacob C. Hoffmann
Background
Off-label use of gabapentin for neuropathic pain conditions such as cervical radiculopathy (CR) remains controversial due to limited evidence of benefit and safety concerns (e.g., opioid co-prescription, adverse drug events [ADEs], dizziness, and hospitalization risk), necessitating further research. This study explores safety risks and health service utilization in adults with newly diagnosed CR, comparing gabapentin to nonsteroidal anti-inflammatory drugs (NSAIDs) to inform clinical practice.
Methods
This retrospective propensity-matched cohort study using the TriNetX database included opioid-naïve adults (≥18 years) with newly-diagnosed CR without history of spinal surgery, spinal neoplasms, myelopathy, opioid-use disorder or cervical injection. Patients were divided into gabapentin or NSAID cohorts based on prescription at CR diagnosis, and matched for demographics, prescriptions, and comorbidities. Outcomes included incidence and risk ratios (RRs) of safety and health service utilization markers assessed through one year. Significance was evaluated at P < 0.0036 (Bonferroni-corrected).
Results
After matching, there were 23,379 patients (mean age: 53 years; 57% female) per cohort. About 14% of patients per cohort were co-prescribed opioids at CR diagnosis. Compared to the NSAID cohort, the gabapentin cohort had a statistically significant (P < 0.0036) increased risk of posterior cervical fusion (RR: 3.23), opioid-related disorder (RR: 2.87), cervical corticosteroid injection (RR: 2.52), opioid-related ADEs (RR: 2.32), anterior cervical discectomy and fusion (RR: 2.10), acute respiratory failure (RR: 1.80), cervical spine magnetic resonance imaging (RR: 1.43), inpatient visits (RR: 1.38), oral opioid prescription (RR: 1.34), and cervical spine radiographic imaging (RR: 1.21). Risk of dizziness, falls, somnolence, and emergency department visits was not significantly increased (P > 0.0036).
Conclusion
Gabapentin prescription for newly-diagnosed CR in adults was associated with increases in opioid prescription, adverse safety events, and health service utilization compared to NSAIDs, corroborating its lack of guideline recommendation for CR. No outcome favored gabapentin over NSAIDs. Gabapentin was occasionally co-prescribed with opioids at CR diagnosis, raising concerns.
{"title":"Comparative safety and health service utilization for gabapentin versus non-steroidal anti-inflammatory drugs for cervical radiculopathy: A retrospective cohort study of academic centers","authors":"Anthony N. Baumann , Robert J. Trager , Dalton McGlamery , Shahabeddin Yazdanpanah , Keegan T. Conry , Gordon Preston , Jacob C. Hoffmann","doi":"10.1016/j.jocn.2026.111896","DOIUrl":"10.1016/j.jocn.2026.111896","url":null,"abstract":"<div><h3>Background</h3><div>Off-label use of gabapentin for neuropathic pain conditions such as cervical radiculopathy (CR) remains controversial due to limited evidence of benefit and safety concerns (e.g., opioid co-prescription, adverse drug events [ADEs], dizziness, and hospitalization risk), necessitating further research. This study explores safety risks and health service utilization in adults with newly diagnosed CR, comparing gabapentin to nonsteroidal anti-inflammatory drugs (NSAIDs) to inform clinical practice.</div></div><div><h3>Methods</h3><div>This retrospective propensity-matched cohort study using the TriNetX database included opioid-naïve adults (≥18 years) with newly-diagnosed CR without history of spinal surgery, spinal neoplasms, myelopathy, opioid-use disorder or cervical injection. Patients were divided into gabapentin or NSAID cohorts based on prescription at CR diagnosis, and matched for demographics, prescriptions, and comorbidities. Outcomes included incidence and risk ratios (RRs) of safety and health service utilization markers assessed through one year. Significance was evaluated at P < 0.0036 (Bonferroni-corrected).</div></div><div><h3>Results</h3><div>After matching, there were 23,379 patients (mean age: 53 years; 57% female) per cohort. About 14% of patients per cohort were co-prescribed opioids at CR diagnosis. Compared to the NSAID cohort, the gabapentin cohort had a statistically significant (P < 0.0036) increased risk of posterior cervical fusion (RR: 3.23), opioid-related disorder (RR: 2.87), cervical corticosteroid injection (RR: 2.52), opioid-related ADEs (RR: 2.32), anterior cervical discectomy and fusion (RR: 2.10), acute respiratory failure (RR: 1.80), cervical spine magnetic resonance imaging (RR: 1.43), inpatient visits (RR: 1.38), oral opioid prescription (RR: 1.34), and cervical spine radiographic imaging (RR: 1.21). Risk of dizziness, falls, somnolence, and emergency department visits was not significantly increased (P > 0.0036).</div></div><div><h3>Conclusion</h3><div>Gabapentin prescription for newly-diagnosed CR in adults was associated with increases in opioid prescription, adverse safety events, and health service utilization compared to NSAIDs, corroborating its lack of guideline recommendation for CR. No outcome favored gabapentin over NSAIDs. Gabapentin was occasionally co-prescribed with opioids at CR diagnosis, raising concerns.</div><div><em>Level of Evidence:</em> Level IV.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111896"},"PeriodicalIF":1.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Idiopathic normal pressure hydrocephalus (iNPH) is a neurological syndrome resulting from increased cerebrospinal fluid volume without significant increase in intracranial pressure. The diagnosis is difficult and investigating other tools that can assist in this process is essential. Auditory Evoked Potentials (AEPs) can be used to assess the auditory pathway integrity and monitor cognitive auditory functions. The objective of this study was to investigate the applicability of the AEPs as a potential monitoring tool for detecting clinical improvements associated with cerebrospinal fluid removal by lumbar puncture and VPS placement in patients with iNPH.
Methods
This longitudinal study, evaluated 17 individuals with iNPH, aged over 60 years who underwent the ventriculoperitoneal shunt, by Auditory Brainstem Response (ABR) and Cortical Auditory Evoked Potentials (CAEP) at three different times: before the lumbar puncture during the Tap test, two to four hours after the lumbar puncture, and after the ventriculoperitoneal shunt.
Results
A decrease in P3 latency was observed after lumbar puncture during Tap test. No statistically significant differences were observed between assessments for P1, N1 P2, N2 latencies or P1-N1, P2-N2 and N2-P3 amplitudes of the CAEP, as well as for the absolute and interpeaks latencies of the ABR.
Conclusions
After the removal of significant volumes of cerebrospinal fluid in patients with iNPH, lower P3 latency values were found, suggesting an increase in the speed of acoustic information processing, during the Tap test. This result brings an insight on the applicability of this procedure as an auxiliary method for monitoring clinical improvements associated with cerebrospinal fluid removal in iNPH.
背景：二didiopathic normal pressure cephalus （iNPH）是一种神经系统综合征，由脑脊液容量增加而颅内压力没有明显增加引起。诊断是困难的，研究其他工具可以帮助这一过程是必不可少的。听觉诱发电位（AEPs）可用于评估听觉通路完整性和监测认知听觉功能。本研究的目的是探讨AEPs作为一种潜在的监测工具的适用性，用于检测iNPH患者腰椎穿刺去除脑脊液和放置VPS相关的临床改善。方法本纵向研究对17例接受脑室-腹膜分流术的60岁以上iNPH患者在三个不同的时间（Tap试验中腰椎穿刺前、腰椎穿刺后2 - 4小时、脑室-腹膜分流术后）进行听觉脑干反应（ABR）和皮质听觉诱发电位（CAEP）评估。结果Tap试验腰椎穿刺后P3潜伏期明显降低。在CAEP的P1、N1、P2、N2潜伏期或P1-N1、P2-N2和N2- p3振幅评估以及ABR的绝对潜伏期和峰间潜伏期评估之间无统计学差异。结论iNPH患者在大量抽取脑脊液后，发现P3潜伏期值较低，提示Tap测试时声信息处理速度加快。这一结果对该程序作为监测与iNPH脑脊液去除相关的临床改善的辅助方法的适用性提出了见解。
{"title":"Neurophysiological insights into iNPH: ABR and CAEP responses to lumbar puncture and shunt surgery","authors":"Lucas Pinto Mielle , Nayara Pereira Santos , Liliane Aparecida Fagundes Silva , Sandro Luíz de Andrade Matas , Carla Gentile Matas","doi":"10.1016/j.jocn.2026.111884","DOIUrl":"10.1016/j.jocn.2026.111884","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic normal pressure hydrocephalus (iNPH) is a neurological syndrome resulting from increased cerebrospinal fluid volume without significant increase in intracranial pressure. The diagnosis is difficult and investigating other tools that can assist in this process is essential. Auditory Evoked Potentials (AEPs) can be used to assess the auditory pathway integrity and monitor cognitive auditory functions. The objective of this study was to investigate the applicability of the AEPs as a potential monitoring tool for detecting clinical improvements associated with cerebrospinal fluid removal by lumbar puncture and VPS placement in patients with iNPH.</div></div><div><h3>Methods</h3><div>This longitudinal study, evaluated 17 individuals with iNPH, aged over 60 years who underwent the ventriculoperitoneal shunt, by Auditory Brainstem Response (ABR) and Cortical Auditory Evoked Potentials (CAEP) at three different times: before the lumbar puncture during the Tap test, two to four hours after the lumbar puncture, and after the ventriculoperitoneal shunt.</div></div><div><h3>Results</h3><div>A decrease in P3 latency was observed after lumbar puncture during Tap test. No statistically significant differences were observed between assessments for P1, N1 P2, N2 latencies or P1-N1, P2-N2 and N2-P3 amplitudes of the CAEP, as well as for the absolute and interpeaks latencies of the ABR.</div></div><div><h3>Conclusions</h3><div>After the removal of significant volumes of cerebrospinal fluid in patients with iNPH, lower P3 latency values were found, suggesting an increase in the speed of acoustic information processing, during the Tap test. This result brings an insight on the applicability of this procedure as an auxiliary method for monitoring clinical improvements associated with cerebrospinal fluid removal in iNPH.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111884"},"PeriodicalIF":1.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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