Neurologia i neurochirurgia polska最新文献

Aim of the study: This study aimed to evaluate the utility of speech acoustic analysis as a tool for diagnosing dysphagia in Parkinson's disease.

Clinical rationale for the study: Swallowing impairment is a common and potentially life-threatening symptom of Parkinson's disease (PD). Fiberoptic endoscopic examination of swallowing (FEES), considered the gold standard for dysphagia diagnosis, is often inaccessible in everyday clinical practice. Many studies highlight the link between speech and swallowing impairment in PD patients. Evaluating possible correlations between speech acoustic parameters and the presence or severity of dysphagia in PD could potentially indicate speech acoustic parameters for use in a non-invasive screening tool for swallowing impairment in PD patients.

Material and methods: This study included 40 patients with a clinical diagnosis of PD aged from 36 to 82 years. The disease duration varied from 1 to 25 years. All study participants were treated with oral medications, allowing them to achieve and maintain the best possible performance status. All study participants underwent a subjective and objective neurological examination, speech acoustic analysis, which was performed based on a standardized speech recording, and FEES, according to a specific study protocol. The obtained results were analyzed statistically.

Results: The presence of oropharyngeal dysphagia was confirmed among 92.5% of the analyzed patients. The FEES findings described in this study are consistent with the specific pattern of swallowing impairment characteristic of PD. The obtained results indicate the existence of multiple statistically significant correlations between the FEES findings and speech acoustic analysis parameters. The most important speech acoustic parameters in terms of swallowing impairment evaluation include the phonation time, efficiency coefficient, average efficiency, energy modulation depth, standard deviation of the length of the interval between segments, standard deviation of the length of the intervals between segments in the speech disfluency test, unharmonic-to-harmonic ratio (U2H), Yanagihara coefficient (YG), 1/Q, residual-to-harmonic ratio (R2H), and amplitude irregularity (APQ).

Conclusions: Speech acoustic analysis could be useful in everyday clinical practice for performing non-invasive dysphagia screening tests in PD patients, especially when an endoscopic examination is unavailable. Results obtained in the study require further validation in larger cohorts. However, if confirmed, this tool could be used to identify patients who potentially require an invasive examination of swallowing for individualized dysphagia management.

Introduction: The relationship between Parkinson's Disease (PD) and type 2 diabetes mellitus (T2DM) is attracting increasing research interest. Epidemiological data shows a remarkable association between these two age-related diseases. Evidence is emerging to suggest a common pathological pathway linking PD and T2DM, involving factors such as altered insulin signalling, insulin resistance, oxidative stress, mitochondrial dysfunction, neuroinflammation, and misfolded protein accumulation. The precise mechanisms underlying this interplay, however, remain less clear, and are likely to be bidirectional. The aim of this review was to examine the epidemiological association between PD and T2DM, summarise potential common mechanisms, and evaluate the role of antidiabetic medications in the treatment and prevention of PD progression.

Clinical implications: A deeper understanding of the shared pathophysiological pathways between PD and T2DM may pave the way for novel therapeutic approaches for patients with both diseases. Research into antidiabetic drugs, particularly GLP-1 receptor agonists, shows promise in potentially modifying the progression of PD.

Future directions: Investigation of the common pathophysiological mechanisms of PD and T2DM may lead to new treatment strategies for both diseases. Ongoing studies of the efficacy and safety of antidiabetic drugs in PD, particularly in larger populations, are essential to validate their long-term benefits and therapeutic potential.

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: The objective of this study was to identify cerebral regions specifically involved in speech comprehension for each sequentially acquired language (L1, L2, L3, L4) in multilingual individuals, and to explore the relationship between the sequence of language acquisition and its cortical representation.

Clinical rationale for study: Multilingualism is increasingly prevalent worldwide. However, the cortical representation of sequentially acquired languages remains inadequately explored. Currently, there are no established guidelines for the perioperative neurosurgical management of multilingual patients, presumably due to a lack of research on this topic.

Material and methods: Participants with a high communicative proficiency in at least three sequentially acquired foreign languages, learned after the age of three, were recruited. A passive listening paradigm was applied for this study. Brain anatomy was visualized using T1-weighted MRI, while functional brain activity (BOLD signal) was measured using echo-planar imaging. Cortical activity elicited by foreign languages (L2, L3, L4) was compared with native language (L1) and an 'unknown' (LN). Data processing and statistical analysis were conducted using SPM12 software.

Results: Twenty multilingual participants were included. A gradual decrease in left-hemisphere dominance was observed from L1 through L4. Compared to L1, L2 demonstrated increased cortical activation in the right middle temporal gyrus and left middle occipital gyrus, whereas L3 showed higher activation in the left fusiform gyrus. No areas of greater activation were identified for L4 compared to L1. Conversely, L1 showed numerous regions of heightened activation relative to subsequently acquired languages. When compared to LN, both L2 and L3 exhibited increased activity in the right insula. Additionally, L3 and L4 displayed elevated activity in the right hippocampus compared to LN.

Conclusions and clinical implications: Our study found distinct cortical localizations for sequentially acquired languages. We recommend routine perioperative cortical mapping for languages L2 and L3, in addition to L1. Mapping for L4 should be considered on a case-by-case basis. Further research into cortical areas involved in multilingual speech production is warranted.

Introduction: Pituitary metastases (PMs) are rare malignancy manifestations, generally deemed to have an extremely poor prognosis. Differential diagnosis from primary pituitary lesions is often difficult, as their features can mimic those of pituitary neuroendocrine tumours (PitNETs). This study aimed to report a single surgeon's experience in managing PMs and to gather the existing evidence on their clinical and neuroradiological presentation to build a model of 'red flags' that help raise the suspicion of PMs in the context of sellar lesions.

Material and methods: We retrieved an original 10-year surgical series of patients undergoing endoscopic transsphenoidal (TNS) surgery for suspected PitNETs, and we additionally conducted a systematic review of case reports or series of patients with PMs.

Results: The local series consisted of n = 6 PMs. The literature review yielded n = 149 works reporting n = 340 PMs. Overall, the clinical presentation and neuroradiological features of n = 346 PMs were analysed and compared to data retrieved from n = 361 PitNETs from our original cohort. Primary features associated with PMs were: the presence of headaches (OR 1.24, p = 0.001), visual field deficits (OR 1.19, p = 0.02), extraocular nerve palsies (OR 1.23, p = 0.001), diabetes insipidus (OR 2.13, p < 0.001), MRI features of pituitary stalk/infundibular involvement (OR 1.98, p = 0.001), cavernous sinus invasion (OR 1.57, p = 0.004), and T2w flow voids (OR 1.13, p = 0.001). An incidental diagnosis (OR 0.49, p < 0.001) and cystic changes (OR 0.77, p = 0.02) were less common among PMs. Secondary features involved an acute onset of symptoms (OR 1.25, p = 0.001), the presence of oncological history (OR 1.89, p = 0.001), sellar walls erosion (OR 1.55, p = 0.002), and gross appearance of a firm (OR 2.01, p < 0.001) and easily bleeding lesion (OR 1.99, p < 0.001). Sellar enlargement predicted a lower risk of PMs (OR 0.54, p = 0.001).

Conclusion: We have compiled a list of primary and secondary red flags, including clinical and neuroradiological features, to serve as a guiding tool for clinicians to raise suspicion of PMs and aid in the differential diagnosis of various lesions centered in the sella.

Introduction: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy.

Clinical rationale for the study: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies.

Material and methods: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05.

Results: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant.

Conclusions and clinical implications: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.

Introduction: Individuals with spinal cord injury (SCI) frequently experience sleep disorders, including sleep-disordered breathing (SDB), sleep-related movement disorders (SMDs), circadian rhythm sleep disorders (CRSDs), and insomnia.

Material and methods: A literature search was conducted using PubMed, Web of Science, and Scopus to identify systematic reviews, meta-analyses, clinical guidelines, and relevant studies on sleep disorders in individuals with SCI. A systematic review proved impossible; instead, studies were selected based on their relevance. The main findings were synthesized into a narrative overview.

State of the art: Sleep disorders exacerbate SCI-related complications. However, despite their high prevalence, many patients remain undiagnosed and untreated. Therefore, the goal of research in this field is to: (i) develop home-based diagnostic methods for people who are unable or unwilling to attend an overnight sleep study, (ii) identify the reasons for missed diagnoses, side effects, and factors related to ineffectual treatment adherence, and (iii) develop safe treatment options.

Clinical implications: SDB is highly prevalent, confined primarily to high-level injuries, and presents difficult diagnostic problems because of its distinct clinical patterns. Home-based diagnostics and noninvasive treatment methods show promise, but adherence to these methods and their applicability in terms of SCI patients remain challenging. SMDs, such as periodic leg movement syndrome and restless legs syndrome, often accompany other SCI symptoms and require careful differential diagnosis. Pharmacological treatment provides partial relief, but safer, long-term alternatives are needed. Both CRSDs and insomnia tend to be aggravated by pain and psychological factors. New strategies such as melatonin and behavioral interventions offer brighter future for patients.

Future directions: Additional research is needed to develop strategies to prevent and treat exacerbations and establish personalized diagnostic/treatment approaches, including home monitoring.

Aim of the study: Recent evidence suggests that Parkinson's disease (PD) and glucose metabolism disorders may share some common dysregulation pathways. This study sought to determine the incidence of hypoglycemic episodes in PD patients and identify associated risk factors for these events.

Clinical rationale for the study: Hypoglycemia in PD, especially at night, is not well understood. This study quantified hypoglycemia in PD patients and identified autonomic dysfunction as a key risk factor, providing new insights for research into metabolic aspects of PD.

Material and methods: Thirty-five patients diagnosed with PD and 20 control subjects underwent a study consisting of a clinical and biometric assessment and two weeks of continuous glucose monitoring using the Freestyle Libre system to detect episodic hypoglycemia.

Results: Among PD patients, 18 (51.4%) had episodes of hypoglycemia, and 67.8% of the events occurred between 0:00 and 6:00 a.m. Compared to the control group, there were significantly more hypoglycemic episodes registered in PD patients (3.6/pt vs. 1.4/pt; p = 0.0006). Predictors of the occurrence of hypoglycemic episodes in the PD group were lower two-week average glycemic levels (OR: 0.85, p = 0.016), glycemic variability index (OR: 1.46, p = 0.02), and SCOPA-AUT scale score (OR: 1.23, p = 0.04).

Conclusions and clinical implications: Patients with PD are at higher risk of hypoglycemic episodes, especially at night and in the morning. Patients with autonomic dysfunction are at risk for hypoglycemic episodes. Recognizing hypoglycemic episodes can enhance the management of PD by enabling targeted interventions aimed at reducing glycemic variability.