Neurologia i neurochirurgia polska最新文献

Introduction: Immunosenescence is a natural process of immune system aging, which leads to significant changes in the functioning of both innate and adaptive immunity. Alterations in T and B lymphocytes can significantly impact the progression of neurological diseases including multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS).

State of the art: Immunosenescence affects T and B cell subsets, reducing their proliferative capacity and altering cytokine profiles. In MS, these changes promote disease progression and diminish responses to immunomodulatory therapies. In AD and PD, dysfunctional T and B cells contribute to sustained neuroinflammation, exacerbating neurodegeneration. ALS is similarly associated with altered adaptive immunity.

Clinical implications: Recognizing how immunosenescent T and B cells contribute to disease in older adults is crucial for refining treatment strategies. These age-related immune changes may explain varied responses to therapies and highlight the need for novel approaches targeting the aged immune system in neurodegenerative diseases.

Future directions: Future research should focus on identifying the mechanisms by which immunosenescent lymphocytes modulate neuroinflammation and neurodegeneration in aging populations. Novel biomarkers and immunomodulatory therapies tailored to older adults could significantly improve outcomes in patients with neurological diseases.

Rationale for the study: Burnout syndrome is a prolonged response to chronic work-related stress, characterized by exhaustion accompanied by mental and physical discomfort, a sense of reduced effectiveness and motivation, dysfunctional attitudes and behaviors at work. Neurologists are recognized as a high-risk group, but no large-scale study has previously examined burnout in this professional group in Poland.

Aim of the study: This study aimed to determine the prevalence of burnout among Polish neurologists and to identify individual and organizational predictors, as well as perceived work-related barriers to effective practice.

Material and methods: A cross-sectional online survey [Computer-Assisted Web Interview (CAWI)] was conducted among members of the Polish Neurological Society (n = 342). Burnout was assessed using the Oldenburg Burnout Inventory (OLBI), alongside validated measures of depressive symptoms, insomnia, loneliness, occupational hardiness, occupational self-efficacy, and psychosocial work conditions. Multiple linear regression analyses were performed to identify predictors of the dimensions of burnout: exhaustion and disengagement.

Results: A high prevalence of burnout was found: 87.0% of respondents met the criteria for exhaustion and 77.5% for disengagement. Being of a younger age was a predictive factor for exhaustion, while living in a larger city slightly reduced disengagement. Severity of depression and work pace were significant predictors of higher levels of both burnout dimensions. More severe exhaustion was additionally associated with higher emotional and quantitative job demands, insomnia, and - unexpectedly - greater peer support. Protective factors included workplace commitment, occupational self-efficacy, professional development opportunities, and occupational hardiness. The most frequently cited barriers in the workplace were administrative overload (85.4%), high work pace (64.0%), and staff shortages (56.7%).

Conclusions: Burnout is highly prevalent among Polish neurologists, driven by both individual vulnerabilities (belonging to a younger age group, depression, insomnia) and organizational stressors (workload, administrative burden). Strengthening professional resources such as self-efficacy and hardiness, enhancing career development opportunities, and reducing bureaucratic workload are essential strategies. Targeted interventions are needed, particularly for early-career neurologists, in order to maintain well-being and ensure sustainable neurological care.

Aim of the study: To assess the agreement between continuous invasive (IBP) and intermittent non-invasive blood pressure (NIBP) monitoring during endovascular treatment (EVT) of acute ischemic stroke (AIS) under general anesthesia, and to evaluate the frequency of clinically relevant discrepancies between both methods and the potential impact of IBP use on treatment initiation times.

Clinical rationale for the study: Intraprocedural hypotension during mechanical thrombectomy (MT) is associated with worse outcomes in AIS patients. While continuous IBP monitoring is frequently used during procedures with high-risk of hypotension, it is not universally adopted in stroke EVT. Accurate, real-time hemodynamic monitoring may be essential to guide timely therapeutic interventions and optimize outcomes.

Materials and methods: In this prospective observational study, 30 AIS patients undergoing MT under general anesthesia were included. Simultaneous IBP and NIBP measurements were recorded throughout the procedure. Non-invasive blood pressure was measured every 5 minutes on one arm, while IBP was continuously recorded from a radial arterial catheter in the contralateral upper extremity. Paired readings were analyzed using Bland-Altman plots. The proportion of time with clinically relevant discrepancies between measurements was calculated. Additionally, door-to-groin (DTG) times were compared between patients with and without intended IBP monitoring.

Results: A total of 481 paired IBP and NIBP readings were analyzed. While mean differences for systolic blood pressure (SBP) and mean arterial pressure (MAP) were small (-0.64 mm Hg and -0.99 mm Hg, respectively), limits of agreement were wide (SBP: -40.6 to 39.4 mm Hg; MAP: -28.5 to 26.5 mm Hg). Diastolic blood pressure (DBP) showed poor agreement with a mean bias of -7.64 mm Hg. Discrepancies of ≥ 20 mm Hg for SBP occurred in 41.0% (IQR = 28.0-59.4%) of the procedure time, and discrepancies > 15 mm Hg for MAP in 29.6% (IQR = 22.8-58.5%). DTG times did not differ significantly between the IBP and NIBP groups (median: 41 vs. 38 minutes, p = 0.217).

Conclusions and clinical implications: Non-invasive blood pressure may show limited agreement with IBP and miss clinically relevant hemodynamic changes due to its intermittent nature and overestimation of blood pressure during hypotensive episodes. Invasive monitoring does not appear to delay treatment initiation and may improve blood pressure control in AIS patients undergoing EVT under general anesthesia. These findings, from a pilot study, should be interpreted with caution but provide a basis for larger prospective investigations.

Aim of the study: Absence epilepsy, though primarily affecting children, can also emerge during adolescence or adulthood, showing a wide spectrum of clinical presentations and treatment responses. The aim of this study is to evaluate the clinical and electroencephalographic (EEG) characteristics of absence epilepsy and identify factors that influence treatment outcomes and long-term prognosis.

Clinical rationale for the study: While childhood absence epilepsy (CAE) is often associated with favorable prognosis, a subset of patients experiences drug resistance and persistent seizures. Understanding the clinical and EEG predictors of treatment success or failure can support more effective, individualized therapeutic strategies and improve long-term management.

Material and methods: This prospective study included 57 pediatric patients diagnosed with absence epilepsy. Clinical data and EEG findings were analyzed focusing on age of onset, seizure frequency, EEG patterns, family history, and treatment response. Patients were followed over a 12-month period to assess seizure outcomes and treatment efficacy.

Results: Childhood absence epilepsy was the most common subtype, identified in 73.7 % of cases. A total of 85% of patients achieved seizure remission within six months of initiating treatment. A favorable prognosis was significantly associated with early age of onset, presence of typical 3-4 Hz spike-and-wave discharges on EEG, and rapid response to first-line anti-epileptic drugs (AEDs). In contrast, patients diagnosed with juvenile absence epilepsy (JAE), myoclonic absence seizures, or absence seizures with eyelid myoclonia often required more complex treatment regimens and demonstrated a higher risk of persistent seizures.

Conclusions and clinical implications: Absence epilepsy encompasses a range of clinical syndromes, and outcomes are influenced by seizure type, age at onset, EEG characteristics, and initial treatment response. Early diagnosis and prompt initiation of appropriate therapy are critical for achieving seizure control. However, some patients, particularly those with atypical absence syndromes, may continue to experience therapeutic challenges, highlighting the need for tailored treatment approaches and long-term follow-up.

Introduction: To evaluate the long-term follow-up in patients with multiple sclerosis (MS) with positive John Cunningham virus (JCV) index treated with natalizumab.

Clinical rationale for the study: The prognosis in MS patients with positive JCV index in short-term follow-up is frequently analyzed; however, it is still not clear what the long-term outcomes in these patients are.

Material and methods: We performed retrospective chart review in MS patients with positive JCV index treated with natalizumab in the Department of Neurology, Medical University of Warsaw. According to the progressive multifocal leukoencephalopathy (PML) risk stratification algorithm established for MS patients treated with natalizumab, we have divided the patients included in our study into the following subgroups according to the JCV index results: JCV Index < 0.9, 0.9-1.5, > 1.5.

Results: We have included 42 patients in our study, 28 females (67%), aged 42.9 ± 9.6 years, with mean disease duration of 13 ±7.07 years and median time of natalizumab therapy of 35 months. The most frequent indication for natalizumab use was lack of efficacy of disease-modifying drug (DMD) previously used (n = 29, 69%). The median extended disability status scale (EDSS) at the moment of last evaluation was 3.0 (range 0.0-8.5). In 14 patients (33.3%), the extended-interval dosing (EID) algorithm was implemented, while frequent brain magnetic resonance imaging (MRI) was done in 15 cases (36%). In one case, natalizumab-related serious adverse event (SAE) occurred, which was PML, but the patient survived and improved with time. When it comes to the number of patients belonging to each of the JCV subgroups, 18 (43%) were in the group with JCV index of < 0.9, 8 had intermediate JCV index (19%) and 16 (38%) had the JCV index > 1.5. There were no statistically significant differences concerning demographic data between the group with the lowest and moderate JCV index, only patients with the highest JCV index (> 1.5), were characterized by the highest disease duration (p = 0.0072). The EID algorithm was used in these cases significantly more frequently (p = 0.0023) than in the group with the lowest JCV index. Also, frequent MRI was performed significantly more often in this group (p = 0.0085). In the first group (JCV < 0.9), average variation of JCV index was between 0.17 and 0.34, in the second group (JCV 0.9-1.5) - between 1.03 to 1.54, and in the third group - between 2.6-2.8.

Conclusions: Based on our data, it can be concluded that long-term therapy with natalizumab seems to be safe, even in patients with positive JCV index.

Clinical implications: Natalizumab can be used for long-term treatment of patients with MS even with positive JCV index if recommended precautions such as EID and frequent brain MRIs are followed.

Introduction: Malignancies may coexist in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), possibly indicating shared immune mechanisms or risk factors. This study aimed to assess the frequency of cancer in patients with CIDP and the clinical characteristics of CIDP subgroups with and without cancer.

Material and methods: The study included 61 patients with CIDP (mean age 61.6 ± 11.8 years). Cancer was diagnosed after CIDP in 14 cases (23%). Diagnostic parameters: clinical, biochemical and electrophysiological, and their correlations were analyzed in patients with and without cancer.

Results: At chronic inflammatory demyelinating polyradiculoneuropathy diagnosis, the mean inflammatory neuropathy cause and treatment (INCAT) score was 2.29 ± 1.68 in the cancer group and 2.21 ± 1.81 in the non-cancer group (p = 0.891). At cancer diagnosis, the scores were 2.79 ± 1.81 vs. 2.40 ± 1.73, respectively (p = 0.489). Immunoglobulin levels were more variable in cancer patients, especially immunoglobulin M (IgM), although the differences were not significant. Cerebrospinal fluid (CSF) protein levels averaged 102.04 mg/dL in cancer patients and 92.67 mg/dL in those without cancer. In CIDP patients with cancer, a strong negative correlation was found between peroneal nerve motor latency and the INCAT score (r = -0.58). In those without cancer, CSF protein levels positively correlated with compound muscle action potentials (CMAP) latency and negatively with conduction velocity in both the ulnar and peroneal nerves.

Conclusions: While not statistically significant, trends indicate that malignancy in CIDP may be linked to a more aggressive disease course, distinct immune profiles, and alternative pathogenic mechanisms, warranting further investigation into targeted therapies.

No abstract is required in Letter to the Editors.