Journal of Clinical Neuroscience最新文献

英文中文

Surgical management of pontine brainstem cavernous malformations: A systematic review Emphasizing safe entry zones and clinical outcomes

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-05 DOI: 10.1016/j.jocn.2025.111106

Brandon Edelbach , Ahmad K. AlMekkawi , Dylan Glaser , Vani B. Patel , Amulya Manchikanti , Rohit Rajput , Carlos A. Bagley , Tarek Y. El Ahmadieh , Jonathan D. Breshears , Yifei Duan

Objective

Safe entry zones (SEZs) have emerged as important corridors for accessing brainstem cavernous malformations (BSCM) while minimizing morbidity. This systematic review and meta-analysis aims to provide a comprehensive analysis of the surgical management of pontine BSCM via SEZs.

Methods

A systematic literature search was performed in PubMed for articles reporting on the surgical management of pontine BSCM via SEZ. Data were extracted on patient demographics, clinical presentation, BSCM characteristics, surgical approach, use of SEZs, and clinical outcomes.

Results

Fifteen studies with a total of 78 patients were included. The cohort was 62.8 % female with an average age of 37.62 ± 14.7 years. The most common presenting symptoms varied based on BSCM location within the pons. The two most common BSCM locations were peritrigeminal (24.4 %) and middle peduncle (10.3 %). The most frequently used surgical approach was the retrosigmoid approach (41.0 %), and the most commonly utilized SEZ was the lateral pontine zone (52.2 %). Gross total resection was achieved in 69.2 % of cases. Good clinical outcome (follow-up mRS < 2) was observed in 64.1 % of patients, with clinical deterioration observed in 7.7 %.

Conclusion

Surgical resection of pontine BSCM can be performed with acceptable morbidity and mortality rates when utilizing SEZs and careful preoperative planning. The lateral pontine, supratrigeminal, and peritrigeminal SEZs are associated with high rates of complete resection and improved neurological outcomes. Future studies with standardized reporting and longer follow-ups are needed to further refine surgical techniques and patient selection.

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引用次数: 0

Knowledge and diagnostic confidence of general practitioners in managing idiopathic intracranial hypertension: A nationwide survey from the Northern regions of Oman

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-05 DOI: 10.1016/j.jocn.2025.111080

Asma AlHosni , Younis Al-Mufargi , Manar AL’ Abdulsalam , Al-Zahraa Al-Arafati , Abdullah Al Sawafi , Talal Alkhawaldi , Tariq Al-Saadi

Background

Idiopathic intracranial hypertension (IIH) is a rare but potentially vision-threatening condition, often underrecognized in primary care settings. Timely diagnosis and effective management are critical to prevent complications, yet knowledge gaps among general practitioners (GPs) may hinder optimal care. This study assessed the knowledge and diagnostic confidence of GPs in Oman regarding IIH.

Methods

A cross-sectional survey was conducted among 150 GPs in the Al Batinah region and Muscat. The survey evaluated familiarity with IIH, recognition of clinical symptoms, diagnostic practices, and confidence in managing the condition. Descriptive statistics, chi-square tests, and ordinal regression analyses were used to assess associations between knowledge levels, professional background, and confidence in IIH management.

Results

While 95.3 % of respondents accurately defined IIH, only 20.7 % could identify its symptoms, and 11.3 % were aware of appropriate treatment options. Significant associations were found between higher knowledge scores and international medical training (p = 0.001), as well as internship location (p = 0.001). Confidence in diagnosing IIH was strongly associated with clinical exposure to IIH patients (p < 0.001).

Conclusions

The study highlights critical knowledge gaps and low diagnostic confidence among GPs in Oman regarding IIH, particularly in recognizing symptoms and management strategies. Findings suggest that international training and clinical exposure enhance IIH knowledge and confidence, underscoring the need for targeted educational interventions to improve diagnosis and patient outcomes

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引用次数: 0

Preventing postoperative delirium: Advancements in cognitive protection strategies

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-04 DOI: 10.1016/j.jocn.2025.111102

Ali Fakhrudin , Aziziyah Munawaroh , Donal , Ramtia Darma Putri , Rizky Andana Pohan , Erfan Ramadhani , Safta Hastini

引用次数: 0

Clinical trials targeting tau should be halted

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-04 DOI: 10.1016/j.jocn.2025.111101

Andi Olluri

Experimental drugs lowering brain tau are heralded as improvements in the treatment of Alzheimer’s disease. However, the outcomes in clinical trials testing these agents have consistently failed to improve patient outcomes, i.e. slow down disease or improving cognition. Furthermore, the scientific rationale behind such drugs is rather poor in the first place and has been questioned. Therefore, I argue that trials of anti-tau drugs should be halted.

引用次数: 0

Response to Letter to The Editor: Hyponatremia is associated with cognitive decline in hospitalized patients after stroke

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-03 DOI: 10.1016/j.jocn.2025.111103

Yoshihiro Yoshimura

引用次数: 0

A new paradigm for neurodegenerative diseases classification: A clinical perspective

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-03 DOI: 10.1016/j.jocn.2025.111099

Alexandros Giannakis, Spiridon Konitsiotis

A vast progress has been made in the understanding of neurodegenerative diseases during the past few years. However, clinical diagnostic accuracy continues to be very low, despite the introduction of various diagnostic tools and repeated revisions of diagnostic criteria. For instance, patients with Alzheimer’s disease (AD) may present with symptoms that overlap with other neurodegenerative conditions like dementia with Lewy bodies (DLB), making accurate diagnosis challenging. This diagnostic uncertainty can lead to delayed or incorrect treatment, significantly impacting patients’ quality of life and prognosis. Thus, the definite diagnosis still relies on post-mortem pathological findings, placing a significant burden on both clinicians and researchers. As a growing body of evidence indicates, co-pathology seems to be the rule among neurodegenerative diseases. Additionally, a single pathological diagnosis, such as AD, can manifest in various clinical presentations, ranging from predominantly cognitive impairment to significant motor symptoms. Each of these presentations currently requires its own set of complicated diagnostic criteria. Perhaps, the time has come for a much-needed radical revision of existing clinical diagnostic criteria. Inclusion of patients do not neatly fit into existing diagnostic categories for neurodegenerative diseases, in future large-scale, longitudinal studies and/or clinical trials, and systematic assessment of their clinical features and disease progression using machine learning could generate valuable data on patients with mixed pathologies and improve our understanding of how to effectively treat these complex cases.

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引用次数: 0

Addressing cognitive impairment in hypertensive patients: Risk factors and clinical implications

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-03 DOI: 10.1016/j.jocn.2025.111105

Yetty Morelent , Santi Tri Meilina , Hidayati Azkiya , Elvima Nofrianni , Sumianto , Willa Putri , Dhini Mufti , Aldora Pratama , Ramtia Darma Putri , Erfan Ramadhani

Cognitive impairment is a major public health challenge, particularly among aging populations with hypertension. The study by Zuo and Yang provides valuable insights into the predictive risk factors for cognitive decline in hypertensive patients, utilizing a model with strong discriminative ability (AUC ROC: 0.802 in training set, 0.756 in test set). This letter highlights seven key risk factors identified in the study: gender, age, education level, poverty income ratio (PIR), depression, vigorous physical activity, and creatinine levels. Men exhibited a higher risk of cognitive impairment than women, likely due to estrogen’s neuroprotective effects. Advancing age and lower education levels were also strong predictors of cognitive decline. Additionally, socioeconomic disparities and depression significantly influenced cognitive health, underscoring the need for integrated mental health and policy interventions. Protective factors, such as vigorous physical activity and lower creatinine levels, emphasize the importance of lifestyle-based strategies. Implementing this predictive model in routine clinical assessments can aid in early detection and personalized intervention. Future research should refine these findings, incorporating genetic predisposition and dietary influences to enhance cognitive health management in hypertensive patients.

认知障碍是一项重大的公共卫生挑战，尤其是在患有高血压的老龄人口中。左和杨的研究利用一个具有很强判别能力的模型（AUC ROC：训练集为 0.802，测试集为 0.756），对高血压患者认知功能下降的预测风险因素提供了有价值的见解。这封信强调了研究中发现的七个关键风险因素：性别、年龄、教育水平、贫困收入比（PIR）、抑郁、剧烈运动和肌酐水平。男性患认知障碍的风险高于女性，这可能是由于雌激素具有神经保护作用。年龄的增长和教育水平的降低也是认知能力下降的重要预测因素。此外，社会经济差异和抑郁症也对认知健康产生了重大影响，这突出表明有必要采取综合的心理健康和政策干预措施。保护性因素，如剧烈的体育锻炼和较低的肌酐水平，强调了基于生活方式的策略的重要性。在常规临床评估中采用这一预测模型有助于早期检测和个性化干预。未来的研究应完善这些发现，将遗传易感性和饮食影响因素纳入其中，以加强高血压患者的认知健康管理。

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引用次数: 0

Association of serum levels of inflammation and oxidative stress markers with cognitive outcomes in multiple sclerosis; a systematic review 多发性硬化症患者血清炎症和氧化应激标志物水平与认知预后的关系系统回顾。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110990

Sara Daneshvar , Farinush Moradi , Mehrab Rahmani , Pouya Golshaniniya , Negin Frounchi , Sina Seifimansour , Mahnaz Talebi , Sarvin Sanaie , Amirreza Naseri

Background

Multiple sclerosis (MS) is an immune-mediated disease with cognitive impairment being a crucial manifestation. Oxidative stress and inflammation play significant roles in the disease’s pathogenesis. This systematic review explores the association between inflammation and oxidative stress markers, with cognitive outcomes in MS patients.

Methods

This study adhered to the Joanna Briggs Institute (JBI) and PRISMA 2020 methods. Eligibility criteria included studies with MS patients, evaluating serum inflammation and/or oxidative stress markers, assessing cognitive function, and examining the relationship between these factors. PubMed, Scopus, Embase, and Web of Science, were searched and the risk of bias was assessed using the JBI checklists.

Results

Out of 1609 identified records, 10 studies were included in this systematic review. The studies were published between 2006 and 2023 and involved 629 MS patients. Current evidence suggests a negative correlation between TNF-α, and cognitive outcomes in MS (reported in three out of five studies). Associations between the decreased native and total thiol levels, as well as interleukin (IL)-17A with cognitive impairment, and the correlation between IL-6 and C-reactive protein (CRP) with cognitive scores in MS are also reported (one study for each). IL-10 (four studies), glutathione peroxidase (GPX), reduced glutathione (GSH), catalase activity (CAT), ischemia-modified albumin (IMA), IL-8, IL-18, and IL-2 (one study for each) did not found to be associated with cognition in MS and evidence regarding the possible role of interferon-gamma (IFN-γ), total antioxidant capacity (TAC), and malondialdehyde (MDA) is not definitive.

Discussion

The review findings suggest a complex association between oxidative stress and inflammation with cognitive outcomes in MS. Diversity in study designs, participant characteristics, and assessment methods makes the findings of this study inconclusive and highlights the need for future research.

背景：多发性硬化症（MS）是一种以认知障碍为重要表现的免疫介导性疾病。氧化应激和炎症在该病的发病机制中起重要作用。本系统综述探讨了炎症和氧化应激标志物与多发性硬化症患者认知结果之间的关系。方法：本研究遵循Joanna Briggs Institute （JBI）和PRISMA 2020方法。入选标准包括对MS患者的研究，评估血清炎症和/或氧化应激标志物，评估认知功能，并检查这些因素之间的关系。检索PubMed、Scopus、Embase和Web of Science，并使用JBI核对表评估偏倚风险。结果：在1609份确定的记录中，本系统综述纳入了10项研究。这些研究发表于2006年至2023年间，涉及629名多发性硬化症患者。目前的证据表明，TNF-α与MS患者的认知结果呈负相关（5项研究中有3项报道）。还报道了MS患者天然硫醇和总硫醇水平以及白细胞介素(IL)-17A与认知功能障碍之间的关系，以及IL-6和c反应蛋白（CRP）与认知评分之间的关系（各一项研究）。IL-10（四项研究）、谷胱甘肽过氧化物酶（GPX）、还原性谷胱甘肽（GSH）、过氧化氢酶活性（CAT）、缺血修饰白蛋白（IMA）、IL-8、IL-18和IL-2（各一项研究）未被发现与多发性硬化症的认知相关，有关干扰素γ (IFN-γ)、总抗氧化能力（TAC）和丙二醛（MDA）可能作用的证据也不确定。讨论：回顾研究结果表明氧化应激和炎症与ms认知结果之间存在复杂的关联，研究设计、参与者特征和评估方法的多样性使得本研究的结果不具有结论性，并强调了未来研究的必要性。

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引用次数: 0

Endoscopic paramaxillary ligation of the internal maxillary artery 上颌内动脉的内窥镜下结扎术。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110969

Alejandro Vargas-Moreno, Maria Luna De La Ossa, Roger Velazco Hernandez

Endoscopic skull base surgery is increasingly utilized for managing skull base tumors. Complex techniques for resecting multicompartmental lesions can lead to higher intraoperative bleeding rates. While embolization can reduce blood flow, it may not always be feasible and can introduce additional risks. Endoscopic techniques allow for direct visualization and coagulation of parent arteries. This study discusses a subperiosteal transoral medial dissection technique, endoscopic paramaxillary corridor, to enable early vascular control prior to resection.

内窥镜颅底手术越来越多地被用于治疗颅底肿瘤。切除多室病变的复杂技术会导致术中出血率升高。虽然栓塞可以减少血流，但并不总是可行，而且会带来额外的风险。内窥镜技术可以直接观察和凝固母动脉。本研究讨论了一种骨膜下经口内侧剥离技术--内窥镜腋下走廊，该技术可在切除前尽早控制血管。

引用次数: 0

Evaluating the safety and efficacy of proton radiotherapy for intracranial pediatric ependymomas: A single-arm meta-analysis 评价质子放疗治疗颅内儿科室管膜瘤的安全性和有效性：单臂荟萃分析。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience

Pub Date : 2025-02-01 DOI: 10.1016/j.jocn.2024.110977

Lucca B. Palavani , Gabriel Semione , Gustavo de Oliveira Almeida , Henrique L. Lepine , Pedro Borges , Bernardo Vieira Nogueira , Gisele Lúcia , Márcio Yuri Ferreira , Anna Pereira , David Abraham Batista da Hora , Matheus de Jesus Leone Pereira , Fabio Torregrossa , Fernando De Nigris Vasconcellos , Raphael Bertani , Raphael Bastianon , Carolina Benjamin , Cleiton Formentin

Background

Ependymomas account for 6% to 10% of childhood central nervous system tumors. This study aimed to evaluate the safety and efficacy of proton radiotherapy in intracranial ependymoma patients.

Methods

We performed a systematic review and single-arm meta-analysis. We searched Medline, Embase, Cochrane, and Web of Science for eligible trials. Random-effects model was used to calculate the risk ratios (RRs), with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3.

Results

Ten cohorts comprising 908 patients with ependymoma were included. The patient population had an average age of 3.5 years, and 53.4 % were male. In terms of proportion, nine outcomes were analyzed: 3-year Progression-Free Survival (PFS; Proportion = 0.63; 95 % CI [0.40–0.87]; I2 = 95 %), 5-year Local Control (LC; Proportion = 0.79; 95 % CI [0.69–0.90]; I2 = 85 %), 5-year Event-Free Survival (EFS; Proportion = 0.65; 95 % CI [0.52–0.78]; I2 = 95 %), 5-year Overall Survival (OS; Proportion = 0.83; 95 % CI [0.77–0.90]; I2 = 82 %), 2-year OS (Proportion = 0.91; 95 % CI [0.88–0.94]; I2 = 0 %), 3-year OS (Proportion = 0.92; 95 % CI [0.89;0.95]; I2 = 43 %). Additionally, neurological (Proportion = 0.17; 95 % CI [0.07–0.27]; I2 = 97 %), dermatological (Proportion = 0.20; 95 % CI [0.00–0.44]; I2 = 82 %), and brainstem complications (Proportion = 0.03; 95 % CI [0.01–0.04]; I2 = 31 %) were investigated.

Conclusion

While proton radiotherapy appears safe and effective based on current data, these results should be approached cautiously, as broad confidence intervals in some adverse event rates suggest variability in outcomes.

背景：室管膜瘤占儿童中枢神经系统肿瘤的6% ~ 10%。本研究旨在评价质子放疗治疗颅内室管膜瘤的安全性和有效性。方法：我们进行了系统回顾和单臂荟萃分析。我们检索了Medline、Embase、Cochrane和Web of Science来寻找符合条件的试验。采用随机效应模型计算风险比（rr），置信区间为95%。使用RStudio 4.2.3版本进行统计分析。结果：纳入10个队列，共908例室管膜瘤患者。患者平均年龄为3.5岁，男性占53.4%。就比例而言，分析了9个结果：3年无进展生存期（PFS）；比例= 0.63；95% ci [0.40-0.87]；I2 = 95%)， 5年局部控制(LC；比例= 0.79；95% ci [0.69-0.90]；I2 = 85%)， 5年无事件生存率(EFS；比例= 0.65；95% ci [0.52-0.78]；I2 = 95%)， 5年总生存率(OS；比例= 0.83；95% ci [0.77-0.90]；I2 = 82%)， 2年OS(比例= 0.91；95% ci [0.88-0.94]；I2 = 0%)， 3年OS(比例= 0.92；95% ci [0.89;0.95]；i2 = 43%)。此外，神经系统(比例= 0.17；95% ci [0.07-0.27]；I2 = 97%)，皮肤病学(比例= 0.20；95% ci [0.00-0.44]；I2 = 82%)，脑干并发症(比例= 0.03；95% ci [0.01-0.04]；I2 = 31%)。结论：虽然根据目前的数据，质子放疗似乎是安全有效的，但这些结果应该谨慎对待，因为一些不良事件发生率的广泛置信区间表明结果存在差异。

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