Neurologia i neurochirurgia polska最新文献

Introduction: Dopamine agonist withdrawal syndrome (DAWS) comprises a wide range of neuropsychiatric and autonomic symptoms that occur in temporal relation with the reduction or withdrawal of dopamine agonists (DAs) in a dose-dependent manner. This syndrome was described as an important complication in Parkinson's disease (PD) and restless legs syndrome (RLS) treatment.

State of the art: Dopamine agonist withdrawal syndrome affects even up to 24% of PD patients treated with DAs in whom the medication was tapered. Predominant symptoms include the following: anxiety, depression, irritability, panic attacks, sleep disorders, and suicidal thoughts along with autonomic problems such as fatigue, orthostatic hypotension, nausea, and vomiting. Dopamine agonist withdrawal syndrome remains a therapeutic challenge as it is refractory to levodopa (LD), other PD therapies, anti-depressants, and anti-psychotics. The therapy-resistant syndrome may be a pitfall for patients trapped between intolerable side effects of DAs (impulse control disorder [ICD]) and withdrawal symptoms.

Clinical implications: Recognition of DAWS as a threatening condition is important for choosing the best treatment option for the patient. Due to the increasingly widespread use and efficacy of advanced therapies such as deep brain stimulation, enteral and subcutaneous LD, as well as apomorphine infusions, the risk of DAWS development should be considered. Dose reduction or discontinuation of DAs should be carefully planned and managed individually (personalized, based on main symptoms).

Future directions: Further research should focus on the natural evolution, risk factors, and duration of DAWS. Development of new generation DAs, such as tavapadon, which may reduce the side effects of dopaminergic therapy, may set new standards for treatment. Guidelines on the taper velocity of DAs, risk factors, and management therapies are to be established to improve detection and treatment of DAWS.

Cerebral small vessel disease (SVD) is commonly observed on neuroimaging among elderly individuals and is recognized as a risk factor for stroke, cognitive decline, gait impairment, and mood disturbance. Clinical features often vary in severity and presentation even among patients with similar SVD findings on brain imaging. The Standards for Reporting Vascular Changes on Neuroimaging (STRIVE) initiative (STRIVE 1 and 2) established standardized terminology for the radiological features of SVD and clarified their interrelationships. This article presents current knowledge about the effects of SVD on structural and functional brain connectivity, as well as the radiological and clinical implications of SVD, with particular attention to cognitive and behavioral disturbances.

Not available.

Introduction: Deep brain stimulation (DBS) is an established treatment for advanced Parkinson's disease (PD), but outcomes in genotype-defined PD remain debated. GBA1 variants are associated with faster cognitive decline, while their impact on DBS motor benefit is less clear.

State of the art: To assess whether DBS motor response differs by genotype in PD by pooling change in Unified Parkinson's Disease Rating Scale III (UPDRS III) (medication-OFF) from baseline to the first postoperative follow-up (T1, ~12 months). Secondary objectives were to summarise cognitive and quality-of-life outcomes after DBS across genotypes using structured narrative synthesis and to determine whether any clinical evidence links epigenetic biomarkers to DBS outcomes.

Material and methods: PubMed and Embase were searched (1 January 2000 to 3 November 2025). Eligible studies reported pos toperative outcomes stratified by GBA1, LRRK2 or PRKN carrier status in DBS-treated PD (any target). The primary endpoint was change in UPDRS III in the medication-OFF state from baseline to T1. A random-effects meta-analysis pooled genotype- -defined comparisons of variant carriers vs. non-carriers; because evidence was dominated by GBA1 cohorts, LRRK2/PRKN findings were summarised descriptively. A scoping search was performed for clinical epigenetic biomarker studies in DBS-treated PD.

Results: Eleven studies were included. Quantitative synthesis of five datasets (UPDRS III medication-OFF) showed no significant difference in motor improvement between variant carriers and non-carriers [standardised mean difference (SMD) = -0.124, 95% confidence interval (CI): -0.331 to 0.083; I2 = 22.3%). Similar non-significant results were observed for the medication-ON state. Cognitive and quality-of-life outcomes could not be pooled due to heterogeneous reporting; narrative synthesis suggested earlier cognitive decline in GBA1 carriers vs. non-carriers despite comparable short-term motor benefit. No clinical studies linking epigenetic biomarkers to DBS outcomes were identified.

Conclusions: At approximately 12 months, motor improvement after DBS appears broadly comparable between genotype- -defined variant carriers and non-carriers, with the most consistent evidence available for GBA1. Inference - particularly for cognition and quality of life - is constrained by gene/variant heterogeneity, observational study design, and the predominance of subthalamic nucleus-DBS (STN-DBS) cohorts. Clinical epigenetic predictors of DBS response remain unstudied, supporting the need for hypothesis-driven, genotype-stratified biomarker cohorts.

Not available.

Introduction: Multiple sclerosis (MS) itself and disease modifying treatment (DMT) used in MS are risk factors of adverse herpes zoster (HZ) infection development. During HZ infection complications might develop, e.g. postherpetic neuralgia or optic neuritis, decreasing patients' quality of life. Data concerning HZ development in MS patients is limited. The authors aimed to assess the number of reports on adverse HZ development in MS patients treated with different DMTs.

Material and methods: The EudraVigilance database was analyzed to identify HZ reports among all adverse event reports related to MS disease-modifying therapies from 2003 to 2024. Reporting odds ratios (RORs) for the drugs were calculated, and Fisher's exact test was used. When p < 0.05, results were concluded statistically significant.

Results: The authors identified 2,017 reports of HZ associated with MS DMTs. The highest ROR values were noted for fingolimod (4.09), cladribine (3.33), and alemtuzumab (2.27). The lowest ROR values were noted for glatiramer acetate (0.17), interferons (≈ 0.21) and teriflunomide (0.35).

Conclusions: The study shows that some DMTs used in MS might significantly increase the risk of HZ development.

Clinical implications: While treating MS patient with DMTs the risk of adverse HZ should be evaluated. Vaccination against HZ should be recommended for patients to benefit the most from the available treatment.

Introduction: Existing evidence suggests that a high glucose-to-potassium ratio (GPR) is associated with poor outcomes in various conditions: acute, critical, and urgent. This study investigated the association of the GPR with 3-month functional outcomes in Caucasian patients with acute ischemic stroke (AIS), who underwent mechanical thrombectomy (MT), as well as its potential as a biomarker.

Material and methods: In a prospective study, 20 commonly available parameters in 464 patients with AIS were analyzed. Of these patients, 309 achieved a good outcome, defined as a modified Rankin Scale (mRS) score of 0-2, while 155 experienced an unfavorable outcome (mRS 3-6) at day 90.

Results: Both, univariate model and multivariate logistic regression model adjusted for age and sex, indicated that GPR was associated with an unfavorable outcome [odds ratio (OR) = 1.78; 95% confidence intervals (CI): 1.34-2.40, p < 0.001, OR = 1.68, 95% CI: 1.26-2.26, p < 0.001; respectively]. A further multivariate logistic regression model, adjusted for parameters with a significance threshold of 0.05 in univariate analysis, showed that an increased GPR (OR = 2.38, 95% CI: 1.48-3.90, p < 0.001) was linked to an unfavorable outcome. Additionally, factors such as older age (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001), longer intervention duration (OR = 1.46, 95% CI: 0.99-2.13, p = 0.037), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.15, 95% CI: 1.09-1.23, p < 0.001), hemorrhagic transformation (HT) on computed tomography 24 h post-stroke onset (OR = 2.04, 95% CI: 1.08-3.86; p = 0.029), larger initial ischemic core volume on perfusion computed tomography (CT) (OR = 1.01, 95% CI: 1.00-1.02, p = 0.05), successful reperfusion (OR = 0.20, 95% CI: 0.08-0.49, p < 0.001), and higher C-reactive protein (CRP) levels (OR = 1.01, 95% CI: 1.00-1.03, p = 0.029) were also associated with an unfavorable outcome. Similar results were obtained when GPR was analyzed as a categorical variable. The relationship between GPR and the 90-day outcome was demonstrated to be linear. Receiver operating characteristics (ROC) analysis indicated an area under the curve (AUC) of 0.634 (95% CI: 0.580-0.688, p < 0.001) with sensitivity and specificity being 52.3% and 70.6%, respectively for GPR in predicting an unfavorable outcome at day 90.

Conclusions: It was confirmed that GPR was associated with unfavorable outcome at day 90 in AIS patients who received MT.

Clinical implications: Further studies on the significance of predictive value of GPR are required across various clinical scenarios, including different populations and outcome measures. Additionally, enhancing the predictive power of GPR by incorporating definitive disease biomarkers should be considered.

Introduction: Glioblastoma is the most prevalent and aggressive primary tumor of the nervous system. The condition manifests with a high rate of recurrence, predominantly in a localized pattern. The impact of distant recurrence on survival and the associated factors are a controversial subject. This study aims to determine whether the pattern of distant recurrence exerts any influence on progression-free survival, survival after first progression, and overall survival in patients with de novo glioblastoma and low residual tumor volume (RTV) < 5 cc. It also aims to identify which factors predict distant recurrence.

Material and methods: A retrospective single-center cohort study included patients aged 18 years or over with de novo glioblastoma and RTV < 5 cc after histological diagnosis, who were treated between 2017 and 2023 in our center. Kaplan-Meier curves were utilized for time-to-event analyses. Risk factors were assessed by univariable analysis and logistic regression.

Results: The analysis encompassed 102 patients with a median survival period of 12.9 months. Distant recurrence was associated with a more extended progression-free survival (11.9 months; p = 0.003) and overall survival (21.5 months; p = 0.021) compared with the remaining patterns (6.1 and 12.7 months, respectively), with no significant impact on survival after the first progression. Epidermal growth factor receptor (EGFR) amplification (odds ratio [OR] = 3.42, 95% confidence interval [CI]: 1.14-10.60; p = 0.029) and Ki-67 < 30% (OR = 6.15, 95% CI: 1.12-33.67; p = 0.036) were identified as independent risk factors for distant recurrence.

Conclusions: Distant recurrence in glioblastomas with low tumor burden after diagnosis is associated with superior progression-free survival and overall survival compared with other recurrence patterns. The EGFR amplification and Ki-67 < 30% were identified as independent risk factors for distant progression.

Clinical implications: The study underscores the significance of incorporating molecular profiling into decision-making processes for patients with glioblastoma. Furthermore, stratification by recurrence patterns has the potential to enhance the efficacy of future clinical trials.