Pub Date : 2026-01-22DOI: 10.1016/j.jocn.2026.111872
Sıddıka Sena İnan , Kübra Mehel Metin , Arzu Muz , İsmail Eren Durmuş , Suna Akın Takmaz , Levent Ertuğrul İnan
Background
Numerous studies have evaluated greater occipital nerve (GON) blockade for migraine prophylaxis using various techniques and anesthetic agents, yet a standardized protocol remains lacking. Although both lidocaine and bupivacaine are effective compared with placebo, no direct comparison exists. This study aimed to compare the efficacy of lidocaine and bupivacaine in GON blockade for chronic migraine.
Materials and methods
Data from 79 chronic migraine patients who underwent ultrasound-guided GON blockade at the University of Health Sciences Ankara Training and Research Hospital were retrospectively analyzed. Patients received either 1.5 mL of 2% lidocaine + 1 mL saline or 1.5 mL of 0.5% bupivacaine + 1 mL saline. Multivariate path analysis was used to evaluate the factors affecting pain reduction and to adjust for baseline differences. Blocks were administered weekly during the first month and monthly for two subsequent months on the side corresponding to pain. The number of headache days, attack duration, and Visual Analog Scale (VAS) scores were recorded before and after each session.
Results
Both groups showed significant reductions in headache days, attack duration, and VAS scores after treatment. Baseline values were similar except for disease duration, which was significantly longer in the bupivacaine group (p = 0.028). At the first month, the bupivacaine group reported significantly more headache days than the lidocaine group (P = 0.046), but no further intergroup differences were found. Although the lidocaine group showed lower pain scores in the first month in univariate analysis, multivariate path analysis revealed that the treatment group (Lidocaine vs. Bupivacaine) did not have a statistically significant effect on the change in VAS scores (p > 0.05). The baseline VAS score was the only significant predictor of pain reduction (β = -0.70, p < 0.001).
Conclusion
Lidocaine and bupivacaine were both effective for migraine prophylaxis via GON blockade. While lidocaine appeared to provide faster relief initially, regression analysis suggests that baseline pain severity, rather than the choice of agent or disease duration, is the primary determinant of treatment response.
背景：许多研究已经评估了使用各种技术和麻醉剂阻断大枕神经（GON）预防偏头痛的效果，但仍然缺乏标准化的方案。虽然利多卡因和布比卡因与安慰剂相比都有效，但没有直接的比较。本研究旨在比较利多卡因和布比卡因对慢性偏头痛的谷氨酰胺阻断的疗效。材料和方法回顾性分析安卡拉健康科学大学培训和研究医院超声引导下的79例慢性偏头痛患者的数据。患者接受1.5 mL 2%利多卡因+ 1ml生理盐水或1.5 mL 0.5%布比卡因+ 1ml生理盐水。多变量路径分析用于评估影响疼痛减轻的因素，并调整基线差异。第一个月每周给药，随后两个月每月给药。记录每次治疗前后头痛天数、发作持续时间和视觉模拟评分（VAS）。结果两组患者治疗后头痛天数、发作持续时间和VAS评分均显著减少。基线值相似，但布比卡因组的病程明显更长（p = 0.028）。在第一个月，布比卡因组报告的头痛天数明显多于利多卡因组（P = 0.046），但组间无进一步差异。虽然单因素分析中，利多卡因组第一个月疼痛评分较低，但多因素通径分析显示，治疗组（利多卡因vs布比卡因）对VAS评分变化无统计学意义（p > 0.05）。基线VAS评分是疼痛减轻的唯一显著预测因子（β = -0.70, p < 0.001）。结论利多卡因和布比卡因均可通过神经素阻断预防偏头痛。虽然利多卡因最初似乎提供更快的缓解，但回归分析表明，基线疼痛严重程度，而不是药物选择或疾病持续时间，是治疗反应的主要决定因素。
{"title":"Comparison of the efficacy of lidocaine and bupivacaine in GON blockade for prophylaxis of chronic migraine","authors":"Sıddıka Sena İnan , Kübra Mehel Metin , Arzu Muz , İsmail Eren Durmuş , Suna Akın Takmaz , Levent Ertuğrul İnan","doi":"10.1016/j.jocn.2026.111872","DOIUrl":"10.1016/j.jocn.2026.111872","url":null,"abstract":"<div><h3>Background</h3><div>Numerous studies have evaluated greater occipital nerve (GON) blockade for migraine prophylaxis using various techniques and anesthetic agents, yet a standardized protocol remains lacking. Although both lidocaine and bupivacaine are effective compared with placebo, no direct comparison exists. This study aimed to compare the efficacy of lidocaine and bupivacaine in GON blockade for chronic migraine.</div></div><div><h3>Materials and methods</h3><div>Data from 79 chronic migraine patients who underwent ultrasound-guided GON blockade at the University of Health Sciences Ankara Training and Research Hospital were retrospectively analyzed. Patients received either 1.5 mL of 2% lidocaine + 1 mL saline or 1.5 mL of 0.5% bupivacaine + 1 mL saline. Multivariate path analysis was used to evaluate the factors affecting pain reduction and to adjust for baseline differences<strong>.</strong> Blocks were administered weekly during the first month and monthly for two subsequent months on the side corresponding to pain. The number of headache days, attack duration, and Visual Analog Scale (VAS) scores were recorded before and after each session.</div></div><div><h3>Results</h3><div>Both groups showed significant reductions in headache days, attack duration, and VAS scores after treatment. Baseline values were similar except for disease duration, which was significantly longer in the bupivacaine group (p = 0.028). At the first month, the bupivacaine group reported significantly more headache days than the lidocaine group (P = 0.046), but no further intergroup differences were found. Although the lidocaine group showed lower pain scores in the first month in univariate analysis, multivariate path analysis revealed that the treatment group (Lidocaine vs. Bupivacaine) did not have a statistically significant effect on the change in VAS scores (p > 0.05). The baseline VAS score was the only significant predictor of pain reduction (β = -0.70, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Lidocaine and bupivacaine were both effective for migraine prophylaxis via GON blockade. While lidocaine appeared to provide faster relief initially, regression analysis suggests that baseline pain severity, rather than the choice of agent or disease duration, is the primary determinant of treatment response.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111872"},"PeriodicalIF":1.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146006772","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 : 2026-01-22DOI: 10.1016/j.jocn.2026.111873
Yue Han , Zhe Bian , Haochen Gu , Dunzhu Guo , Rui Li , Liping Liu , Dali Wang , Yanbo Peng
Background
The cumulative defined daily dose (cDDD) enables quantification of statin exposure, balancing therapeutic intensity and patient adherence. However, the relationship between statin cDDD and recurrence risk in ischemic stroke (IS) patients remains unclear.
Objective
The aim of this study was to investigate the impact of statin cDDD on recurrence risk in IS patients.
Methods
This prospective cohort study enrolled 728 patients with acute ischemic stroke (AIS). After 1 year of follow-up, participants were stratified into four groups (Q1-Q4) according to the quartiles of statin cDDD, and Kaplan-Meier curves were used to estimate the risk of stroke recurrence. The association between cDDD and recurrence risk was examined using restricted cubic spline (RCS) and Cox proportional hazards models, with sensitivity analyses employed to assess population heterogeneity and confirm the robustness of the findings.
Results
Kaplan-Meier survival analysis revealed statistically significant differences in recurrence rates across quartiles (P < 0.001). RCS analysis confirmed a nonlinear negative correlation between cDDD and recurrence risk (P for nonlinearity < 0.001). Multivariate Cox regression demonstrated that the recurrence risk in Q4 was 87.7% lower than in Q1. Sensitivity analysis further confirmed that the association between cDDD and IS recurrence risk was independent of antihypertensive or antidiabetic medication use.
Conclusions
Statin cDDD shows a significant nonlinear inverse correlation with stroke recurrence, and exhibits a dose-dependent threshold effect.
{"title":"Association between the cumulative defined daily dose of statins and ischemic stroke recurrence: a cohort study","authors":"Yue Han , Zhe Bian , Haochen Gu , Dunzhu Guo , Rui Li , Liping Liu , Dali Wang , Yanbo Peng","doi":"10.1016/j.jocn.2026.111873","DOIUrl":"10.1016/j.jocn.2026.111873","url":null,"abstract":"<div><h3>Background</h3><div>The cumulative defined daily dose (cDDD) enables quantification of statin exposure, balancing therapeutic intensity and patient adherence. However, the relationship between statin cDDD and recurrence risk in ischemic stroke (IS) patients remains unclear.</div></div><div><h3>Objective</h3><div>The aim of this study was to investigate the impact of statin cDDD on recurrence risk in IS patients.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled 728 patients with acute ischemic stroke (AIS). After 1 year of follow-up, participants were stratified into four groups (Q1-Q4) according to the quartiles of statin cDDD, and Kaplan-Meier curves were used to estimate the risk of stroke recurrence. The association between cDDD and recurrence risk was examined using restricted cubic spline (RCS) and Cox proportional hazards models, with sensitivity analyses employed to assess population heterogeneity and confirm the robustness of the findings.</div></div><div><h3>Results</h3><div>Kaplan-Meier survival analysis revealed statistically significant differences in recurrence rates across quartiles (<em>P</em> < 0.001). RCS analysis confirmed a nonlinear negative correlation between cDDD and recurrence risk (<em>P</em> for nonlinearity < 0.001). Multivariate Cox regression demonstrated that the recurrence risk in Q4 was 87.7% lower than in Q1. Sensitivity analysis further confirmed that the association between cDDD and IS recurrence risk was independent of antihypertensive or antidiabetic medication use.</div></div><div><h3>Conclusions</h3><div>Statin cDDD shows a significant nonlinear inverse correlation with stroke recurrence, and exhibits a dose-dependent threshold effect.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"146 ","pages":"Article 111873"},"PeriodicalIF":1.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037282","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 : 2026-01-17DOI: 10.1016/j.jocn.2026.111863
Nan Xue , Wan Zhang , Xinyan Guo , Tianyu Ma , Mengwen Lu , Xinyi Ye , Min Jiang , Li Sun , Mingjin Yang , Xiaoyu Huang , Yong Zhang , Zhouao Zhang , Yanbo Wang , Ying Sheng
Background
Sleep disorder is increasingly recognized in myasthenia gravis (MG). However, its specific link to bulbar muscle weakness and short-term outcomes is not well established. This study aimed to investigate the prevalence of subjective sleep disorder (based on Pittsburgh Sleep Quality Index [PSQI] score) in a cohort of acetylcholine receptor (AChR) antibody-positive MG patients, and to explore its associations with bulbar muscle weakness, disease severity, and its value for the short-term outcome of MG.
Methods
We conducted a prospective cohort study of 163 AChR-MG patients. Subjective sleep quality was assessed using the PSQI score. Disease severity was evaluated with MG Specific Activities of Daily Living (MG-ADL) score, the Quantitative MG (QMG) score, and Myasthenia Gravis Foundation of America (MGFA) classification. Univariate and multivariable logistic regression were used to identify independent risk factors and establish prediction model for outcome. The predictive values were evaluated by receiver operating characteristic (ROC) curves. Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed.
Results
The median PSQI score was 7.0 (5.0, 9.0) and the prevalence of sleep disorder (PSQI > 5) was 73.6 %. Patients with bulbar weakness had significantly higher PSQI scores than those without (P < 0.001). PSQI score showed significant positive correlations with MG-ADL (r = 0.319, P < 0.001),QMG (r = 0.356, P < 0.001) in MG patients. A higher baseline PSQI score was identified as an independent risk factor for poor outcome at 6 months (odds ratio: 1.642 [95 % CI: 1.340–2.014], P < 0.001), with a area under curve (AUC) of 0.797. A predictive model combining PSQI score, bulbar weakness, and female gender demonstrated good discrimination, with a AUC of 0.840, a sensitivity of 0.688, and a specificity of 0.870.
Conclusion
Poor sleep quality is highly prevalent in AChR-MG and was more serious in patients with bulbar weakness. PSQI score was an independent risk factor for poor short-term outcome. Routine assessment of sleep may aid in risk stratification and personalized management.
背景：睡眠障碍在重症肌无力（MG）中得到越来越多的认识。然而，其与球肌无力和短期预后的具体联系尚不明确。本研究旨在调查主观睡眠障碍（基于匹兹堡睡眠质量指数[PSQI]评分）在乙酰胆碱受体（AChR）抗体阳性MG患者队列中的患病率，并探讨其与球肌无力、疾病严重程度的关系，及其对MG短期预后的价值。方法对163例AChR-MG患者进行前瞻性队列研究。主观睡眠质量采用PSQI评分进行评估。采用MG特定日常生活活动（MG- adl）评分、定量MG （QMG）评分和美国重症肌无力基金会（MGFA）分级评估疾病严重程度。采用单因素和多因素logistic回归识别独立危险因素，建立预后预测模型。采用受试者工作特征（ROC）曲线评价预测价值。对模型进行了标定分析和决策曲线分析（DCA）。结果PSQI评分中位数为7.0(5.0,9.0)，睡眠障碍患病率（PSQI > 5）为73.6%。有球无力的患者PSQI评分明显高于无球无力的患者（P < 0.001）。MG患者PSQI评分与MG- adl （r = 0.319, P < 0.001）、QMG （r = 0.356, P < 0.001）呈显著正相关。较高的基线PSQI评分被确定为6个月预后不良的独立危险因素（优势比：1.642 [95% CI: 1.340-2.014], P < 0.001），曲线下面积（AUC）为0.797。结合PSQI评分、球无力和女性性别的预测模型具有良好的鉴别能力，AUC为0.840，敏感性为0.688，特异性为0.870。结论睡眠质量差在AChR-MG患者中普遍存在，且在球无力患者中更为严重。PSQI评分是短期预后不良的独立危险因素。常规睡眠评估有助于风险分层和个性化管理。
{"title":"Association of sleep disorder with bulbar weakness and short-term outcomes in myasthenia gravis","authors":"Nan Xue , Wan Zhang , Xinyan Guo , Tianyu Ma , Mengwen Lu , Xinyi Ye , Min Jiang , Li Sun , Mingjin Yang , Xiaoyu Huang , Yong Zhang , Zhouao Zhang , Yanbo Wang , Ying Sheng","doi":"10.1016/j.jocn.2026.111863","DOIUrl":"10.1016/j.jocn.2026.111863","url":null,"abstract":"<div><h3>Background</h3><div>Sleep disorder is increasingly recognized in myasthenia gravis (MG). However, its specific link to bulbar muscle weakness and short-term outcomes is not well established. This study aimed to investigate the prevalence of subjective sleep disorder (based on Pittsburgh Sleep Quality Index [PSQI] score) in a cohort of acetylcholine receptor (AChR) antibody-positive MG patients, and to explore its associations with bulbar muscle weakness, disease severity, and its value for the short-term outcome of MG.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study of 163 AChR-MG patients. Subjective sleep quality was assessed using the PSQI score. Disease severity was evaluated with MG Specific Activities of Daily Living (MG-ADL) score, the Quantitative MG (QMG) score, and Myasthenia Gravis Foundation of America (MGFA) classification. Univariate and multivariable logistic regression were used to identify independent risk factors and establish prediction model for outcome. The predictive values were evaluated by receiver operating characteristic (ROC) curves. Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed.</div></div><div><h3>Results</h3><div>The median PSQI score was 7.0 (5.0, 9.0) and the prevalence of sleep disorder (PSQI > 5) was 73.6 %. Patients with bulbar weakness had significantly higher PSQI scores than those without (P < 0.001). PSQI score showed significant positive correlations with MG-ADL (r = 0.319, P < 0.001),QMG (r = 0.356, P < 0.001) in MG patients. A higher baseline PSQI score was identified as an independent risk factor for poor outcome at 6 months (odds ratio: 1.642 [95 % CI: 1.340–2.014], P < 0.001), with a area under curve (AUC) of 0.797. A predictive model combining PSQI score, bulbar weakness, and female gender demonstrated good discrimination, with a AUC of 0.840, a sensitivity of 0.688, and a specificity of 0.870.</div></div><div><h3>Conclusion</h3><div>Poor sleep quality is highly prevalent in AChR-MG and was more serious in patients with bulbar weakness. PSQI score was an independent risk factor for poor short-term outcome. Routine assessment of sleep may aid in risk stratification and personalized management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111863"},"PeriodicalIF":1.8,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979137","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 : 2026-01-16DOI: 10.1016/j.jocn.2026.111862
Kyle Bennett , Yi Chen Zhao , James King
{"title":"Meningitis secondary to clival communication with the sphenoid sinus","authors":"Kyle Bennett , Yi Chen Zhao , James King","doi":"10.1016/j.jocn.2026.111862","DOIUrl":"10.1016/j.jocn.2026.111862","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111862"},"PeriodicalIF":1.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979139","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 : 2026-01-16DOI: 10.1016/j.jocn.2026.111867
Joshua Estin , Alejandro Lopez , Steven Vanni , Sara Jarret , Karthik Madhavan
Cervical kyphosis in the presence of multilevel disc degeneration poses a significant challenge to surgical correction. Anterior cervical discectomy and fusion (ACDF) is a well-established approach to decompress the neural elements and relieve pain but may not specifically correct kyphosis. We describe an anterior only ACDF approach utilizing a novel lagging technique (Vanni technique) to correct cervical kyphosis. The objective is to reestablish lordosis without adding the morbidity of corpectomies or posterior osteotomies. The ACDF procedure with the lagging technique is summarized in the following steps: (1) multilevel discectomy, (2) lordotic interbody cage placement at each level, (3) lordotic plate positioning secured by a temporary pin, (4) bicortical screw placement bilaterally at each level using a screw exchange lagging technique, allowing the vertebral bodies to be sequentially translated toward the plate using progressively shorter bicortical screws until flush, and (5) final screw tightening and locking to the plate. In two illustrative cases, patients underwent anterior cervical discectomies and fusions from C3 to C7 using the Vanni lagging technique to correct deformity. Postoperative follow up showed improvement in Sagittal Vertical Axis (SVA) and lordosis with solid fusion. The current technique report provides a detailed description of a multilevel ACDF procedure with a novel lagging technique to effectively correct cervical deformity. It obviates the need for more extensive and morbid corpectomies and osteotomies in selected patients with reducible deformities.
{"title":"A novel bicortical alternating screw exchange lagging technique for reduction of cervical spinal deformity","authors":"Joshua Estin , Alejandro Lopez , Steven Vanni , Sara Jarret , Karthik Madhavan","doi":"10.1016/j.jocn.2026.111867","DOIUrl":"10.1016/j.jocn.2026.111867","url":null,"abstract":"<div><div>Cervical kyphosis in the presence of multilevel disc degeneration poses a significant challenge to surgical correction. Anterior cervical discectomy and fusion (ACDF) is a well-established approach to decompress the neural elements and relieve pain but may not specifically correct kyphosis. We describe an anterior only ACDF approach utilizing a novel lagging technique (Vanni technique) to correct cervical kyphosis. The objective is to reestablish lordosis without adding the morbidity of corpectomies or posterior osteotomies. The ACDF procedure with the lagging technique is summarized in the following steps: (1) multilevel discectomy, (2) lordotic interbody cage placement at each level, (3) lordotic plate positioning secured by a temporary pin, (4) bicortical screw placement bilaterally at each level using a screw exchange lagging technique, allowing the vertebral bodies to be sequentially translated toward the plate using progressively shorter bicortical screws until flush, and (5) final screw tightening and locking to the plate. In two illustrative cases, patients underwent anterior cervical discectomies and fusions from C3 to C7 using the Vanni lagging technique to correct deformity. Postoperative follow up showed improvement in Sagittal Vertical Axis (SVA) and lordosis with solid fusion. The current technique report provides a detailed description of a multilevel ACDF procedure with a novel lagging technique to effectively correct cervical deformity. It obviates the need for more extensive and morbid corpectomies and osteotomies in selected patients with reducible deformities.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111867"},"PeriodicalIF":1.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979167","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 : 2026-01-15DOI: 10.1016/j.jocn.2026.111865
Tiago Pedro , Carolina Silva , Pedro Simão , Osvaldo Sousa , Vasco Carvalho , Patrícia Polónia , António Vilarinho , Pedro Alberto Silva , Maria Luís Silva , Luís Albuquerque
Introduction
Management of unruptured intracranial aneurysms (UIAs) is challenging when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving patients in a therapeutic “gray zone”. This study compared one-year outcomes between conservative and interventional management in patients with UIAs and inconclusive UIATS scores.
Methods
We retrospectively reviewed 149 adults with angiographically confirmed saccular UIAs and inconclusive UIATS scores treated at a tertiary center (2018–2024). Patients were stratified by management strategy: conservative (68 patients) or interventional (81 patients, endovascular or surgical). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. One-year outcomes included aneurysm rupture, procedural complications, ischemic and hemorrhagic events, retreatment, and functional status (mRS).
Results
After IPTW, the weighted pseudo-population comprised 125 patients managed conservatively and 143 treated. Intervention was associated with better functional outcomes (aOR 2.526, 95 % CI 1.075–5.935, p = 0.033) versus conservative management. Among patients managed conservatively, the aneurysm rupture rate was 4.0 %.
Conclusions
Active treatment in patients with unruptured intracranial aneurysms and inconclusive UIATS guidance yielded better functional results at one year, highlighting the need to improve current decision strategies through broader future research.
Key messages
What is already known on this topic: Management of unruptured intracranial aneurysms is uncertain when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving clinicians without clear guidance. Evidence directly comparing conservative and interventional strategies in this subgroup is limited.
What this study adds: In patients with inconclusive UIATS recommendations, interventional management was associated with better one-year functional outcomes compared with conservative care.
How this study might affect research, practice or policy: These findings support consideration of active treatment even when UIATS is indeterminate, emphasizing individualized, multidisciplinary decision-making.
{"title":"To treat or not to treat? An inverse probability weighting analysis of intracranial aneurysms with inconclusive UIATS scores","authors":"Tiago Pedro , Carolina Silva , Pedro Simão , Osvaldo Sousa , Vasco Carvalho , Patrícia Polónia , António Vilarinho , Pedro Alberto Silva , Maria Luís Silva , Luís Albuquerque","doi":"10.1016/j.jocn.2026.111865","DOIUrl":"10.1016/j.jocn.2026.111865","url":null,"abstract":"<div><h3>Introduction</h3><div>Management of unruptured intracranial aneurysms (UIAs) is challenging when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving patients in a therapeutic “gray zone”. This study compared one-year outcomes between conservative and interventional management in patients with UIAs and inconclusive UIATS scores.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 149 adults with angiographically confirmed saccular UIAs and inconclusive UIATS scores treated at a tertiary center (2018–2024). Patients were stratified by management strategy: conservative (68 patients) or interventional (81 patients, endovascular or surgical). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. One-year outcomes included aneurysm rupture, procedural complications, ischemic and hemorrhagic events, retreatment, and functional status (mRS).</div></div><div><h3>Results</h3><div>After IPTW, the weighted pseudo-population comprised 125 patients managed conservatively and 143 treated. Intervention was associated with better functional outcomes (aOR 2.526, 95 % CI 1.075–5.935, p = 0.033) versus conservative management. Among patients managed conservatively, the aneurysm rupture rate was 4.0 %.</div></div><div><h3>Conclusions</h3><div>Active treatment in patients with unruptured intracranial aneurysms and inconclusive UIATS guidance yielded better functional results at one year, highlighting the need to improve current decision strategies through broader future research.</div></div><div><h3>Key messages</h3><div><strong>What is already known on this topic:</strong> Management of unruptured intracranial aneurysms is uncertain when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving clinicians without clear guidance. Evidence directly comparing conservative and interventional strategies in this subgroup is limited.</div><div><strong>What this study adds:</strong> In patients with inconclusive UIATS recommendations, interventional management was associated with better one-year functional outcomes compared with conservative care.</div><div><strong>How this study might affect research, practice or policy:</strong> These findings support consideration of active treatment even when UIATS is indeterminate, emphasizing individualized, multidisciplinary decision-making.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111865"},"PeriodicalIF":1.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979136","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 : 2026-01-14DOI: 10.1016/j.jocn.2026.111864
Abhijith V. Matur , Sanjit Shah , Zachary J. Plummer , Juan C. Mejia-Munne , Yash Patil , Michael K. Coffin , Owoicho Adogwa , Rani Nasser , Joseph S. Cheng , Justin N. Virojanapa
Background
Esophageal perforation is a known but rare complication of anterior cervical discectomy and fusion (ACDF). Due to its rarity, factors associated with esophageal perforation have not been conclusively identified.
Methods
A retrospective study of patients who underwent ACDF at a tertiary care center between September 2016 and September 2021. Patients were identified using CPT codes 22551, 22552, 22554, and 22558. All subaxial cervical interbody fusions utilizing an anterior approach, including both discectomies and corpectomies, were included. Odontoid screws, cervical arthroplasty, and posterior-only fusions were excluded. Patients who were determined to have esophageal perforation were identified based on head and neck surgeon involvement in their hospital admission and ICD-10 code K22.3.
Results
A total of 1454 patients met our inclusion criteria, among whom 13 patients were determined to have had a confirmed esophageal perforation (0.89%). There was a statistically significant association between multilevel ACDF and surgery for suspected esophageal perforation (p = 0.04655). There were no statistically significant associations between surgery for suspected esophageal perforation and age, female sex, active smoking status, diabetes, coronary artery disease, chronic obstructive pulmonary disease, or gastroesophageal reflux disease. Perforation occurred because of intraoperative injury in 4 patients and 3 patients underwent initial ACDF for an indication of trauma.
Conclusion
This study suggests that there may be an association between multilevel ACDF and esophageal perforation. Further larger studies will be needed to confirm this along with other risk factors for esophageal perforation.
{"title":"Esophageal Injury Following Anterior Cervical Discectomy and Fusion: A Single-institution Retrospective Study","authors":"Abhijith V. Matur , Sanjit Shah , Zachary J. Plummer , Juan C. Mejia-Munne , Yash Patil , Michael K. Coffin , Owoicho Adogwa , Rani Nasser , Joseph S. Cheng , Justin N. Virojanapa","doi":"10.1016/j.jocn.2026.111864","DOIUrl":"10.1016/j.jocn.2026.111864","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal perforation is a known but rare complication of anterior cervical discectomy and fusion (ACDF). Due to its rarity, factors associated with esophageal perforation have not been conclusively identified.</div></div><div><h3>Methods</h3><div>A retrospective study of patients who underwent ACDF at a tertiary care center between September 2016 and September 2021. Patients were identified using CPT codes 22551, 22552, 22554, and 22558. All subaxial cervical interbody fusions utilizing an anterior approach, including both discectomies and corpectomies, were included. Odontoid screws, cervical arthroplasty, and posterior-only fusions were excluded. Patients who were determined to have esophageal perforation were identified based on head and neck surgeon involvement in their hospital admission and ICD-10 code K22.3.</div></div><div><h3>Results</h3><div>A total of 1454 patients met our inclusion criteria, among whom 13 patients were determined to have had a confirmed esophageal perforation (0.89%). There was a statistically significant association between multilevel ACDF and surgery for suspected esophageal perforation (p = 0.04655). There were no statistically significant associations between surgery for suspected esophageal perforation and age, female sex, active smoking status, diabetes, coronary artery disease, chronic obstructive pulmonary disease, or gastroesophageal reflux disease. Perforation occurred because of intraoperative injury in 4 patients and 3 patients underwent initial ACDF for an indication of trauma.</div></div><div><h3>Conclusion</h3><div>This study suggests that there may be an association between multilevel ACDF and esophageal perforation. Further larger studies will be needed to confirm this along with other risk factors for esophageal perforation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111864"},"PeriodicalIF":1.8,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979138","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 : 2026-01-13DOI: 10.1016/j.jocn.2026.111860
Shaan Patel , Shiva A. Nischal , Ayush Sinha , Kush M. Kale , Pious D. Patel , Jack Jallo , Srinivas K. Prasad
<div><h3>Background</h3><div>External ventricular drains (EVDs) are fundamental to neurocritical care, yet substantial procedural heterogeneity persists, particularly regarding bolt-mounted versus tunnelled catheter fixation. The relative safety and effectiveness of these approaches remain unclear, with conflicting data from observational studies and a lack of trial-level evidence.</div></div><div><h3>Objective</h3><div>To compare bolt-mounted and tunnelled EVDs across accuracy, reoperation, and key safety outcomes using systematic review, meta-analysis, and trial-sequential analysis.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, PubMed, Embase, and CENTRAL databases were searched (November 2025) for randomised or observational studies comparing bolt-mounted with tunnelled EVDs in adults. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Primary outcomes were optimal catheter placement (Kakarla Grade I) and reoperation for EVD-related complications. Secondary outcomes included iatrogenic intracranial haemorrhage (ICH), cerebrospinal fluid (CSF) infection, CSF leak, catheter obstruction or malfunction, accidental discontinuation, and drainage duration. Random-effects meta-analyses were conducted using restricted maximum likelihood estimation. Heterogeneity was quantified, and certainty of evidence was assessed using GRADE. Trial-sequential analysis was performed for reoperation to determine whether available data met required information size thresholds.</div></div><div><h3>Results</h3><div>Ten studies encompassing 2008 patients (800 bolt-mounted, 1208 tunnelled) were included. Bolt-mounted EVDs demonstrated significantly higher optimal catheter accuracy (RR 1.27; 95% CI: 1.06–1.51; <em>P <</em> 0.01; I<sup>2</sup> = 29.6 %). Reoperation was numerically lower with bolt-mounted systems (RR 0.51; 95% CI: 0.22–1.36; <em>P =</em> 0.19; I<sup>2</sup> = 85 %), although trial-sequential analysis showed the cumulative Z-curve crossed the monitoring boundary without reaching the required information size, indicating insufficient evidence for definitive inference. Bolt-mounted EVDs were associated with lower CSF leak risk (RR 0.13; 95% CI: 0.04–0.47; <em>P <</em> 0.01) and reduced catheter obstruction (RR 0.46; 95% CI: 0.25–0.83; <em>P</em> < 0.05). No significant differences were observed in iatrogenic ICH (RR 1.23; 95% CI: 0.54–2.81; <em>P =</em> 0.62), CSF infection (RR 0.88; 95% CI: 0.71–1.09; <em>P =</em> 0.23), accidental discontinuation (RR 0.41; 95% CI: 0.11–1.59; <em>P =</em> 0.20), or drainage duration (MD 0.56 days; 95% CI = -1.02–2.13; <em>P</em> = 0.49).</div></div><div><h3>Conclusions</h3><div>Bolt-mounted EVDs were associated with higher catheter accuracy, reduced CSF leak, and improved mechanical reliability without increased infection or haemorrhage. Although reoperation may be lower with bolt-mounted systems, current evidence remains underpowered for firm conclusions. Thes
外脑室引流（evd）是神经危重症治疗的基础，但在操作上的异质性仍然存在，特别是在螺栓固定与隧道导管固定方面。这些方法的相对安全性和有效性尚不清楚，观察性研究的数据相互矛盾，缺乏试验水平的证据。目的通过系统评价、荟萃分析和试验序列分析，比较螺栓式和隧道式evd在准确性、再手术和关键安全性方面的差异。方法遵循PRISMA指南，检索PubMed、Embase和CENTRAL数据库（2025年11月），比较成人螺栓安装与隧道式evd的随机或观察性研究。两位审稿人独立筛选研究、提取数据并评估偏倚风险。主要结果为最佳导管放置（Kakarla分级I级）和evd相关并发症的再手术。次要结局包括医源性颅内出血（ICH）、脑脊液（CSF）感染、CSF泄漏、导管阻塞或故障、意外停药和引流时间。随机效应荟萃分析采用限制性最大似然估计进行。对异质性进行量化，并使用GRADE评估证据的确定性。对再操作进行试验-序列分析，以确定可用数据是否满足所需的信息大小阈值。结果纳入了10项研究，包括2008例患者（800例螺栓安装，1208例隧道）。螺栓式evd显示出更高的最佳导管准确性（RR 1.27; 95% CI: 1.06-1.51; P < 0.01; I2 = 29.6%）。螺栓安装系统的再手术数值较低（RR 0.51; 95% CI: 0.22-1.36; P = 0.19; I2 = 85%），尽管试验-序列分析显示累积z曲线越过监测边界，但未达到所需的信息大小，表明明确推断的证据不足。栓装evd与较低的脑脊液泄漏风险（RR 0.13; 95% CI: 0.04-0.47; P < 0.01）和减少导管阻塞（RR 0.46; 95% CI: 0.25-0.83; P < 0.05）相关。在医源性脑出血（RR 1.23, 95% CI: 0.54-2.81, P = 0.62）、脑脊液感染（RR 0.88, 95% CI: 0.71-1.09, P = 0.23）、意外停药（RR 0.41, 95% CI: 0.11-1.59, P = 0.20）或引流时间（MD 0.56天，95% CI = -1.02-2.13, P = 0.49）方面，两组间无显著差异。结论螺栓安装evd具有更高的导管准确性，减少CSF泄漏，提高机械可靠性，而不会增加感染或出血。尽管螺栓安装系统的再手术率可能较低，但目前的证据仍不足以得出确切的结论。这些发现挑战了关于隧道导管的历史假设，并可能为当代神经危重症护理中特定环境的设备选择提供信息。
{"title":"Safety and effectiveness of bolt-mounted versus tunnelled external ventricular drains: A systematic review, meta-analysis and trial-sequential analysis","authors":"Shaan Patel , Shiva A. Nischal , Ayush Sinha , Kush M. Kale , Pious D. Patel , Jack Jallo , Srinivas K. Prasad","doi":"10.1016/j.jocn.2026.111860","DOIUrl":"10.1016/j.jocn.2026.111860","url":null,"abstract":"<div><h3>Background</h3><div>External ventricular drains (EVDs) are fundamental to neurocritical care, yet substantial procedural heterogeneity persists, particularly regarding bolt-mounted versus tunnelled catheter fixation. The relative safety and effectiveness of these approaches remain unclear, with conflicting data from observational studies and a lack of trial-level evidence.</div></div><div><h3>Objective</h3><div>To compare bolt-mounted and tunnelled EVDs across accuracy, reoperation, and key safety outcomes using systematic review, meta-analysis, and trial-sequential analysis.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, PubMed, Embase, and CENTRAL databases were searched (November 2025) for randomised or observational studies comparing bolt-mounted with tunnelled EVDs in adults. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Primary outcomes were optimal catheter placement (Kakarla Grade I) and reoperation for EVD-related complications. Secondary outcomes included iatrogenic intracranial haemorrhage (ICH), cerebrospinal fluid (CSF) infection, CSF leak, catheter obstruction or malfunction, accidental discontinuation, and drainage duration. Random-effects meta-analyses were conducted using restricted maximum likelihood estimation. Heterogeneity was quantified, and certainty of evidence was assessed using GRADE. Trial-sequential analysis was performed for reoperation to determine whether available data met required information size thresholds.</div></div><div><h3>Results</h3><div>Ten studies encompassing 2008 patients (800 bolt-mounted, 1208 tunnelled) were included. Bolt-mounted EVDs demonstrated significantly higher optimal catheter accuracy (RR 1.27; 95% CI: 1.06–1.51; <em>P <</em> 0.01; I<sup>2</sup> = 29.6 %). Reoperation was numerically lower with bolt-mounted systems (RR 0.51; 95% CI: 0.22–1.36; <em>P =</em> 0.19; I<sup>2</sup> = 85 %), although trial-sequential analysis showed the cumulative Z-curve crossed the monitoring boundary without reaching the required information size, indicating insufficient evidence for definitive inference. Bolt-mounted EVDs were associated with lower CSF leak risk (RR 0.13; 95% CI: 0.04–0.47; <em>P <</em> 0.01) and reduced catheter obstruction (RR 0.46; 95% CI: 0.25–0.83; <em>P</em> < 0.05). No significant differences were observed in iatrogenic ICH (RR 1.23; 95% CI: 0.54–2.81; <em>P =</em> 0.62), CSF infection (RR 0.88; 95% CI: 0.71–1.09; <em>P =</em> 0.23), accidental discontinuation (RR 0.41; 95% CI: 0.11–1.59; <em>P =</em> 0.20), or drainage duration (MD 0.56 days; 95% CI = -1.02–2.13; <em>P</em> = 0.49).</div></div><div><h3>Conclusions</h3><div>Bolt-mounted EVDs were associated with higher catheter accuracy, reduced CSF leak, and improved mechanical reliability without increased infection or haemorrhage. Although reoperation may be lower with bolt-mounted systems, current evidence remains underpowered for firm conclusions. Thes","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111860"},"PeriodicalIF":1.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979080","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}
Traumatic Brain Injury (TBI) poses a significant public health challenge in India, with nearly 2 million cases annually and limited CT availability causing delays in diagnosis. This study evaluated CEREBO®, a machine learning-enhanced near-infrared spectroscopy (mNIRS) device, as a rapid, non-invasive triage tool for TBI.
Methodology
A prospective quasi-experimental study was conducted at AIIMS, New Delhi, enrolling 202 suspected TBI patients. Participants were divided into control (standard care) and experimental (standard care + CEREBO®) groups. CEREBO® findings were compared with CT as the gold standard. Diagnostic performance (sensitivity, specificity, accuracy), time to preliminary diagnosis, and potential of impact on triage decisions were assessed.
Results
CEREBO® demonstrated high diagnostic performance with 98% sensitivity, 90% specificity, and 93.9% accuracy for detecting intracranial pathology. In a post-hoc exploratory simulation, using CEREBO®’s negative result as a hypothetical criterion for deferring CT suggested that CT imaging could have been potentially avoided in 82.1% of red (critical condition) cases and 80.6% of yellow (stable but urgent) cases. These simulations also indicated that CEREBO® may help identify patients whose urgency of care could be underestimated by initial triage classification.
Conclusion
The NIRS device demonstrated rapid, non-invasive assessment capability across a broad patient population, supporting its potential utility as an adjunct screening tool in resource-limited trauma settings. These findings suggest that the device may help streamline triage, optimize CT utilization, and improve workflow efficiency in high-volume emergency environments.
{"title":"Clinical assessment of a Near-Infrared spectroscopy device for rapid triage in traumatic brain injury","authors":"Vedang Bhushan Mahajan , Vivek Tandon , Sri Surya Krishna Gour , Amol Raheja , Aarosh Dhamija , Vinamrita Patni , Deepak Gupta , Deepak Agrawal , Atin Kumar , P Sarat Chandra","doi":"10.1016/j.jocn.2026.111850","DOIUrl":"10.1016/j.jocn.2026.111850","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic Brain Injury (TBI) poses a significant public health challenge in India, with nearly 2 million cases annually and limited CT availability causing delays in diagnosis. This study evaluated CEREBO®, a machine learning-enhanced near-infrared spectroscopy (mNIRS) device, as a rapid, non-invasive triage tool for TBI.</div></div><div><h3>Methodology</h3><div>A prospective quasi-experimental study was conducted at AIIMS, New Delhi, enrolling 202 suspected TBI patients. Participants were divided into control (standard care) and experimental (standard care + CEREBO®) groups. CEREBO® findings were compared with CT as the gold standard. Diagnostic performance (sensitivity, specificity, accuracy), time to preliminary diagnosis, and potential of impact on triage decisions were assessed.</div></div><div><h3>Results</h3><div>CEREBO® demonstrated high diagnostic performance with 98% sensitivity, 90% specificity, and 93.9% accuracy for detecting intracranial pathology. In a post-hoc exploratory simulation, using CEREBO®’s negative result as a hypothetical criterion for deferring CT suggested that CT imaging could have been potentially avoided in 82.1% of red (critical condition) cases and 80.6% of yellow (stable but urgent) cases. These simulations also indicated that CEREBO® may help identify patients whose urgency of care could be underestimated by initial triage classification.</div></div><div><h3>Conclusion</h3><div>The NIRS device demonstrated rapid, non-invasive assessment capability across a broad patient population, supporting its potential utility as an adjunct screening tool in resource-limited trauma settings. These findings suggest that the device may help streamline triage, optimize CT utilization, and improve workflow efficiency in high-volume emergency environments.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111850"},"PeriodicalIF":1.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959594","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 : 2026-01-10DOI: 10.1016/j.jocn.2026.111857
Romil Kukadiya , Arth Shah , Soaham Desai
Background
Subacute Encephalopathy with Seizures in Alcoholics (SESA) syndrome is an underrecognized neurological complication among chronic alcohol users, characterized by subacute encephalopathy, seizures, focal neurological deficits, and distinctive EEG and neuroimaging findings. Despite advancements, gaps remain in standardized diagnosis, therapeutic management, and long-term outcomes.
Objectives
This scoping review aims to synthesize published evidence on the clinical presentation, EEG and neuroimaging findings, management strategies, and outcomes of SESA syndrome, while proposing refined diagnostic criteria and a severity grading scale.
Methods
Studies reporting adult patients with chronic alcohol abuse presenting with SESA syndrome, as defined by the co-occurrence of encephalopathy, seizures, and focal deficits with supporting EEG or neuroimaging findings, were included. All study designs were eligible; reviews, commentaries, and editorials without original data were excluded. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, relevant grey literature, and conference abstracts from January 1981 to April 2025. Reference lists of included articles were manually screened. Data were extracted independently into standardized forms for demographics, clinical features, diagnostics, management, and outcomes. Quality appraisal used the Joanna Briggs Institute checklist.
Results
Forty-five patient cases from 29 studies were included. SESA syndrome presents with a consistent triad, varied seizure types, hallmark EEG LPDs, and reversible MRI abnormalities. Proposed criteria and severity scale may facilitate early recognition and guide management.
Conclusions
SESA syndrome requires heightened awareness and multidisciplinary management. Future research should validate proposed diagnostic tools and elucidate pathophysiology and long-term outcomes.
背景：亚急性脑病伴酒精发作（SESA）综合征是慢性酒精使用者中未被充分认识的神经系统并发症，其特征为亚急性脑病、癫痫发作、局灶性神经功能缺损以及独特的脑电图和神经影像学表现。尽管取得了进步，但在标准化诊断、治疗管理和长期结果方面仍存在差距。目的：本综述旨在综合已发表的关于SESA综合征的临床表现、脑电图和神经影像学表现、治疗策略和结局的证据，同时提出完善的诊断标准和严重程度分级量表。方法纳入了报告以SESA综合征为表现的成年慢性酒精滥用患者的研究，SESA综合征的定义为脑病、癫痫发作和局灶性缺陷的共同出现，并伴有EEG或神经影像学的支持。所有的研究设计都是合格的；没有原始数据的评论、评论和社论被排除在外。系统检索1981年1月至2025年4月的PubMed/MEDLINE、Embase、Web of Science、相关灰色文献和会议摘要。人工筛选纳入文章的参考文献列表。数据被独立提取为人口统计学、临床特征、诊断、管理和结果的标准化形式。质量评估使用了乔安娜布里格斯研究所的检查表。结果纳入29项研究的45例患者。SESA综合征表现为一致的三联征、不同的发作类型、标志性的脑电图lpd和可逆性MRI异常。建议的标准和严重程度可以促进早期识别和指导管理。结论ssesa综合征需要提高认识和多学科管理。未来的研究应验证提出的诊断工具，阐明病理生理学和长期结果。
{"title":"SESA syndrome: synthesizing evidence and proposing diagnostic criteria and severity grading—a scoping review","authors":"Romil Kukadiya , Arth Shah , Soaham Desai","doi":"10.1016/j.jocn.2026.111857","DOIUrl":"10.1016/j.jocn.2026.111857","url":null,"abstract":"<div><h3>Background</h3><div>Subacute Encephalopathy with Seizures in Alcoholics (SESA) syndrome is an underrecognized neurological complication among chronic alcohol users, characterized by subacute encephalopathy, seizures, focal neurological deficits, and distinctive EEG and neuroimaging findings. Despite advancements, gaps remain in standardized diagnosis, therapeutic management, and long-term outcomes.</div></div><div><h3>Objectives</h3><div>This scoping review aims to synthesize published evidence on the clinical presentation, EEG and neuroimaging findings, management strategies, and outcomes of SESA syndrome, while proposing refined diagnostic criteria and a severity grading scale.</div></div><div><h3>Methods</h3><div>Studies reporting adult patients with chronic alcohol abuse presenting with SESA syndrome, as defined by the co-occurrence of encephalopathy, seizures, and focal deficits with supporting EEG or neuroimaging findings, were included. All study designs were eligible; reviews, commentaries, and editorials without original data were excluded. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, relevant grey literature, and conference abstracts from January 1981 to April 2025. Reference lists of included articles were manually screened. Data were extracted independently into standardized forms for demographics, clinical features, diagnostics, management, and outcomes. Quality appraisal used the Joanna Briggs Institute checklist.</div></div><div><h3>Results</h3><div>Forty-five patient cases from 29 studies were included. SESA syndrome presents with a consistent triad, varied seizure types, hallmark EEG LPDs, and reversible MRI abnormalities. Proposed criteria and severity scale may facilitate early recognition and guide management.</div></div><div><h3>Conclusions</h3><div>SESA syndrome requires heightened awareness and multidisciplinary management. Future research should validate proposed diagnostic tools and elucidate pathophysiology and long-term outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111857"},"PeriodicalIF":1.8,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922421","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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