Neurologia i neurochirurgia polska最新文献

Aim of study: To perform a linguistic translation using validated methodology of the Parkinson's Disease Non-motor Questionnaire (NMSQuest) in a Polish Parkinson's Disease (PD) population, and apply the Polish NMSQuest to a real-life PD population.

Clinical rationale for study: Non-motor symptoms are one of the key drivers of quality of life in PD patients and occur from the prodromal stage to the end palliative stage. Clinical recognition is crucial to manage these symptoms, and the PD NMSQuest is a globally used patient-completed validated PD-specific tool which helps to flag 30 common NMS in the clinic.

Material and methods: Cognitive pretesting and linguistic translation were performed in 35 consecutive Polish PD patients using the translational programme recommended by the Movement Disorders Society. The validated and translated Polish version was then used in 70 consecutive PD patients (including the 35 original patients who performed the pretest) from outpatient clinics (43 males and 27 females). The mean age of the patients was 67.45 years (range 40-81) with a mean duration of PD of 12.32 years (range 2-24) and a median Hoehn and Yahr (HY) score of 3.

Results: 70 patients (mean age 67.45; mean duration of PD 12.32 years range 2-24; median HY score 3) provided 100% endorsement of the usefulness and need for using Polish NMSQuest using a cognitive pretest questionnaire. A subsequent study of the utility of the Polish NMSQuest showed it to be reliable across a large range of PD patients from 40-81 years and HY stages 1-4, with a mean declared NMS per patient of 6 across all stages of PD.

Conclusions and clinical implications: The Polish version of the NMSQuest is reliable, valid and endorsed by Polish PD patients. Subsequent clinical use shows this to be a useful self- declaration flagging tool for NMS which needs to be captured in clinical visits so that clinical care includes management of NMS in PD.

Epilepsy remains a significant global health challenge, with a substantial portion of patients experiencing inadequate seizure control despite existing therapeutic options. This review aimed at exploring recent advances in critical areas that, in the authors' opinion, hold promise for improving epilepsy treatment outcomes. Our paper briefly discusses issues related to gene therapy, including recently initiated clinical trials using this technique. Additionally, we explore the utility of machine learning techniques in diagnostics and predicting responses to antiseizure treatment. Next, we present novel drug delivery routes, such as intranasal and transdermal systems, which provide alternative methods to enhance drug efficacy and minimise side effects. Finally, we briefly characterise new antiseizure medication (ASMs) introduced within the European Union in the last five years, as well as ASMs currently in phase III clinical trials. In summary, this review highlights the potential impact of innovative treatments and technologies on epilepsy management.

Aim of study: Idiopathic intracranial hypertension (IIH) is a neurological condition characterised by increased intracranial pressure without a known cause, usually seen in young obese women. Optic nerve ultrasound elastography is a new imaging technique that evaluates the elastic properties of the optic nerve. In this method, deformations caused by mechanical forces applied on the optic nerve are measured using ultrasound waves and the elastic properties of the optic nerve are analysed. This study aimed to evaluate optic nerve (ON) and retrobulbar adipose tissue (RAT) elasticity, optic nerve sheath diameter (ONSD), and optic disc height (ODH) in patients with IIH.

Clinical rationale for study: Demonstration of structural changes in the optic nerve in IIH patients.

Material and methods: In this prospective study, bilateral ON and optic disc measurements were performed in 30 consecutive patients with IIH and 30 age- and sex-matched healthy volunteers. ONSD, ODH, and SWE (shear wave elastography) of the ON, and SWE of the RAT, were measured.

Results: Of 30 patients with IIH, 26 were female and four were male. The mean age of the patients diagnosed with IIH was 37.9 ± 9.9 years and the mean age of the control group was 38.9 ± 10.5 years (p = 0.594). Similarly, no significant difference was found between the two groups in terms of body mass index (BMI): the mean BMI of the patients was 30.8 ± 5.51 and the mean BMI of the control group was 29.6 ± 4.7 (p = 0.214). In the patients, mean ONSD (4.8 ± 1.4 mm), ODH (1.04 ± 1.06 mm), ON SWE [14.7 (4.57-100.7) kPa], and RAT SWE [4.05 (1.6-11. 3) kPa] significantly differed from those in the control group: ONSD (3.1 ± 0.4 mm), ODH (0.4 ± 0.09 mm), ON SWE [10.3 (4.8-42.9) kPa], and RAT SWE [3.58 (1.5-16.7) kPA] (p = 0.001, p = 0.001, p = 0.01, p = 0.033, respectively). The cut-off values for ONSD, ODH, ON SWE and RAT SWE to discriminate IIH patients from controls were 3.5 mm, 0.5 mm and 11.37 kPa and 3.63 kPA, respectively, areas under the curve (AUC) were 0.888, 0.892, 0.67 and 0.613, respectively, and accuracy values were 80%, 81%, 61% and 60%, respectively.

Conclusions: ON SWE, RAT SWE, ONSD and ODH measurements may be helpful in the diagnosis of IIH in addition to current imaging methods.

Clinical implications: We observed structural changes in the optic nerve and surrounding fatty tissue in IIH, and these factors should be taken into account in future diagnosis and treatment.

Introduction: This study aimed to identify predictive factors for long-term incomplete nidus obliteration following stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs).

Material and methods: A systematic search across the PubMed, Web of Science, and Scopus databases identified observational studies reporting such factors. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The study protocol was registered through PROSPERO. Each eligible study's quality was assessed using the modified Newcastle-Ottawa Scale. Odds ratios (ORs) were calculated for dichotomous parameters.

Results: Two high-quality prospective cohort and three high-quality retrospective cohort studies were included, covering patients with complete (n = 638) and incomplete (n = 297) nidus obliteration. The mean age of the patients was 25.54 ± 12.81 years and the mean follow-up time was 95.98 ± 27.64 months. Predictors for incomplete obliteration of nidus included: AVM classified as Spetzler-Martin (SM) grade ≥ IV (odds ratio (OR) 10.57, 95% confidence interval (CI) 2.00-55.96, p = 0.006), the presence of multiple (> 1) feeding arteries (OR 6.47, 95% CI 2.20-19.10, p = 0.0007), nidus volume > 10 mL (OR 5.08, 95% CI 1.68-15.33, p = 0.004), and the occurrence of intranidal aneurysm (OR 3.33, 95% CI 1.10-10.08, p = 0.03). No statistically significant difference in proportions of patients with incomplete nidus obliteration was found between paediatric (≤ 18 years) and adult (> 18) patient cohorts (p = 0.95).

Conclusions: The following factors were found to be predictive for long-term incomplete nidus obliteration post-SRS for brain AVMs: SM grade equal to or higher than IV; the presence of multiple feeding arteries; AVM nidus volume exceeding 10 mL; and the occurrence of intranidal aneurysm. These findings will be beneficial in refining patient selection for radiosurgical treatment.

Introduction: Parkinson's Disease (PD) is a highly heterogeneous entity in terms of clinical manifestations, progression, and treatment response. This variability has given rise to the hypothesis that different clinical subtypes of the disease exist.

State of the art: To date, several clinical subtypes have been described, mostly based on different clinical features, and sometimes with the support of biomarkers, either fluid, neuroimaging, or neurophysiological. The most homogeneous subtypes detected are a 'benign subtype', characterised by younger age at onset, mild non-motor symptoms, and a slower rate of disease progression, and a 'malignant subtype', which features an older age at onset, a higher burden of non-motor symptoms, and faster disease progression.

Clinical implications: Despite extensive research, none of the subtypes identified so far seem to be biologically supported, so clinical subtyping does not elucidate PD aetiology and does not allow for the prediction of prognosis or treatment response. This study was aimed to review the literature on this topic and to examine the studies on PD subtyping. We also reviewed the proposed biomarkers for a biological classification of PD, and outlined the role of genetics and pathology within this context.

Future directions: In light of the recent proposal of a biological classification of PD, which might overcome the limits of the clinical diagnosis, PD subtyping should hopefully shepherd researchers towards a biological approach, also aided by recent advances in the field of biomarkers.

Aim of study: We aimed to assess the impact of acute kidney injury (AKI) during hospitalisation on short- and long-term outcomes of mechanical thrombectomy (MT) in patients with acute ischaemic stroke (AIS).

Clinical rationale for study: AKI is a common complication in AIS patients treated with MT. Some studies examining its impact on prognosis have shown an association of AKI with worse MT outcomes, but observations exceeding three months are lacking.

Material and methods: To this observational cohort study, we included all AIS patients treated with MT in the University Hospital in Krakow from 2019 to 2021. AKI during hospitalisation was diagnosed based on serum creatinine concentration levels according to the KDIGO (Kidney Disease Improving Global Outcomes) guidelines. We compared patients with and without AKI in terms of mortality and functional outcome (assessed with modified Rankin scale, mRS) at discharge, and at 90 and at 365 days from stroke onset. Good functional outcome was defined as mRS 0-2. We identified factors associated with mortality and a good functional outcome using univariate logistic regression analysis, with statistically significant variables subsequently included into multivariate analyses.

Results: Among 593 MT-treated AIS patients, AKI was found in 12.6%. Patients with AKI had significantly higher mortality and worse functional outcome at discharge, and at 90, and at 365 days from stroke onset. AKI was an independent factor associated with mortality and worse functional outcome at discharge, and at 90, and at 365 days from stroke onset. AKI remained independently associated with a lower chance of a good functional outcome in a 365-day follow-up when the analysis was limited to patients who survived until discharge (OR = 0.244, 95% CI: 0.095-0.624, p = 0.003).

Conclusions and clinical implications: AKI during hospitalisation is an independent risk factor of short- and long-term mortality and poor functional outcome in patients with AIS undergoing MT. There is a need to create a protocol to monitor kidney function and ensure prompt AKI treatment in MT-treated AIS patients.

The effect of botulinum toxin A (BoNTA) on non-motor symptoms (NMS) in patients with cervical dystonia remains an area of significant clinical interest, given the profound impact of these symptoms on patients' quality of life. While the therapeutic efficacy of BoNTA in alleviating motor symptoms of cervical dystonia is well established, its impact on NMS such as depression, anxiety disorder, and sleep disturbance requires further investigation. This systematic review synthesizes the latest evidence on the effects of BoNTA on these selected non-motor symptoms. A comprehensive search of the PubMed, Web of Science, and Scopus databases identified 266 articles, of which eight studies met our strict inclusion criteria. Pre- and post-intervention changes in depression, anxiety, and sleep disturbance were assessed in a total of 280 adult patients with cervical dystonia treated with BoNTA. The results indicate that BoNTA has a positive effect on depressive symptoms, with most studies showing a statistically significant improvement after treatment. Similarly, studies are reporting significant reductions in anxiety scores following BoNTA treatment. However, the effects of this treatment method on sleep disturbances were less conclusive, with none of the reviewed studies showing significant improvements in sleep quality or daytime sleepiness. The results highlight the potential of BoNTA to positively influence non-motor symptoms, particularly depression and anxiety, in patients with cervical dystonia, although its effects on sleep remain unclear. These findings underscore the need for further research to fully understand the mechanisms underlying the non-motor effects of BoNTA and to develop comprehensive treatment strategies.