Neurologia i neurochirurgia polska最新文献

Aim of the study: To assess safety and feasibility of intrathecal chemotherapy (IC) and disease monitoring via Ommaya reservoir (OR) in routine clinical practice in patients with leptomeningeal disease (LMD).

Clinical rationale of the study: Leptomeningeal disease carries poor prognosis with an average survival of 3-6 months after diagnosis. OR are an accessible alternative to serial lumbar punctures for delivery of IC and disease monitoring in these patients but are not widely used, partially due to safety concerns.

Material and methods: This single-center retrospective cohort study enrolled patients who received at least one administration of IC via OR for LMD between 2017 and 2022 at a tertiary academic center. Demographics, primary malignancy, treatment type, complications, adverse events and outcomes were recorded for each enrolled patient.

Results: We identified 22 patients (17 females, 5 males) with mean age 50.9 ± 14.8 years. The primary cancers were breast (12), leukemia (3), ovarian carcinoma (3), CNS lymphoma (1), urothelial carcinoma (1), spinal melanocytoma (1), and high-grade glioma (1). A total of 208 IC injections via OR were performed [median 9 OR injections per patient (interquartile range (IQR) 5-13)]. Five patients (23%) experienced mild adverse events of grade 2 or lower by Common Terminology Criteria for Adverse Events. The overall risk of adverse events from injections was 3.4% (7/208). Eight patients (36.3%) converted into negative CSF cytology and 18 patients (82%) had clinical and/or radiological progression of their LMD (median 2 months following first injection). Eleven patients (50%) died of their LMD during follow-up. Median OS and PFS from the first injection were 5.3 months [95% CI: 4.8-NE (not estimable)] and 4.3 months [95% CI: 1.8-16.0], respectively.

Conclusions and clinical implications: Our single-center cohort study suggests that the use of intrathecal chemotherapy via Ommaya reservoir in routine clinical practice is a safe and feasible option and should be considered for treatment and frequent disease monitoring in eligible patients with leptomeningeal disease. Neurologists, especially neuro-oncologists, can significantly contribute to the care of patients of leptomeningeal disease via administering intrathecal chemotherapy.

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: Prior research regarding multiple sclerosis (MS) has extensively examined the inflammatory processes, while the mechanisms of neurodegeneration, particularly cerebral atrophy, remain less understood. The purpose of this systematic review was to summarize the current knowledge about the degree and pattern of atrophy in various types of MS, and its relationship with the clinical progression of the disease and the impact of treatment on brain volume loss.

Material and methods: A systematic review was performed in accordance with the PRISMA guidelines. Relevant articles published between 1 January 2018 and 1 July 2024 available in the PubMed and Cochrane Library databases were obtained using a systematic search strategy. The following keywords were used to screen the publications: 'multiple sclerosis' and/or 'MS' and 'atrophy'. The eligibility criteria that identified and described outcomes were pre-established by the authors. Studies constituting clinical research protocols, theoretical inspections, articles describing other measurement methods or comparing measuring methods, conference abstracts and articles in a language other than English were excluded.

Results: Of the 1,911 records obtained from the systematic search based on keywords, 26 were included in the final review. Publications enabled the analysis of atrophy in patients compared to the healthy population, the evaluation of atrophy concerning different MS subtypes, its correlation with disability progression, the patterns of atrophy and the impact of disease-modifying therapies. Moreover, clinical trials involving atrophy measurements in MS patients were also collected.

Discussion: This systematic review confirmed the role of assessing volumetric changes in brain regions as a useful tool in the diagnosis of MS, assessment of its progression, and response to treatment. Given the relatively small number of new reports in the last six years, it also indicated the need for further research, especially using atrophy to assess the efficacy of therapy.

Introduction: Tandem lesions, where extracranial and intracranial vascular pathology coexists, have a poor prognosis and are a significant cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO); they present unique challenges in diagnosis and endovascular treatment.

Aim of the study: This retrospective study analyzed demographic parameters, risk factors, qualification procedures, fibrinolytic therapy, interventional management, complications, technical aspects, and clinical outcomes in tandem-occlusion anterior circulation stroke (TOS) patients treated at a Thrombectomy Capable Stroke Center (TCSC) in Wejherowo from 2020 to 2024. Acute stroke patients with TOS were compared to two groups: patients with isolated intracranial artery occlusion (iLVO) and patients with isolated extracranial internal carotid artery (iICA) lesion.

Material and methods: A total number of 193 patients who underwent endovascular therapy (EVT) were involved. The comparison between selected populations was performed to analyze frequency, risk factors, procedure complexity, complications, and clinical outcome.

Results: In the observed group the prevalence of tandem lesions was 17.1%, isolated extracranial internal carotid artery (ICA) occlusion was 11.4%, and isolated intracranial artery occlusion-71.5%. Tandem and ICA occlusion patients were younger (66.21 ± ± 9.8 vs. 70.34 ± 12.16; p < 0.01) and had a higher prevalence of smoking (45% vs. 26.1%; p < 0.05) compared to the intracranial LVO group. The latter had a higher rate of atrial fibrillation (21.2% vs. 60.9%; p < 0.001). Time intervals, including onset-to- -reperfusion (301.66 vs. 246.15 minutes; p < 0.01) and related to it: groin-to-first pass, groin-to-recanalization were significantly prolonged in the tandem group. Clinical outcomes, as measured by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), were worse in the tandem group compared to both the intracranial LVO (mRS 0-2: 24.2% vs. 44.9%; p < 0,01; NIHSS: 9.96 vs. 7.01; p < 0.01) and isolated extracranial ICA occlusion groups (mRS 0-2: 24.2% vs. 59.1%; p < 001; NIHSS: 9.96 vs. 4.53; p < 0.01). There were no significant differences in complication rates between the groups.

Conclusions and clinical implications: In the analyzed cohort of interventionally treated AIS patients, the presence of tandem lesions was correlated with poor clinical outcomes and associated with the presence of atherosclerosis risk factors. Endovascular procedures in these cases were more complex and involved extended time intervals. Conversely, patients with isolated intracranial lesions were generally older, with atrial fibrillation being the primary risk factor. In these patients, endovascular procedure times were shorter and resulted in more favorable clinical outcomes.