Neurologia i neurochirurgia polska最新文献

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.

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.

Introduction: Functional movement disorders (FMD) are defined by diverse phenotypes of altered movements that lack corresponding pathology in an anatomical region, and are typically characterized by inconsistent findings on neurological examination.

State of the art: While there are several suggestive clinical features indicating FMD, objective biomarkers are still lacking. We conducted a systematic review of the literature with an emphasis on literature published after February 2019 aiming to summarise current knowledge on biomarkers of FMD. We divided our findings into four main categories: genetic, biofluid, neuroimaging, and electrophysiological biomarkers. For the differential diagnosis of functional tremor, functional tic-like behaviours (FTLB), and functional myoclonus, previous studies support the use of electrophysiological biomarkers. Evidence from neuroimaging research supports the multi-network model of FMD as a condition affecting the attentional, sensorimotor, self-agency/multimodal integration, and limbic/salience circuits. Biomarkers such as neurofilament light chain, inflammatory, and autoimmune factors should still be considered experimental, since results are based on small sample sizes. There is preliminary evidence from a genetic study that in FMD there is a complex interaction between individual predisposing risk genes involved in the serotonergic pathway.

Clinical implications: Although the diagnosis of FMD remains challenging, and depends mainly on clinical judgement, research is underway to identify potential biomarkers to improve diagnostic confidence. Previous studies indicate that, in addition to psychological symptoms, biological changes can be detected in patients with FMD. This is evidenced by different patterns of neurotransmission related to stress responses and emotional regulation.

Future directions: We believe it is vital to conduct larger trials in diverse populations from different regions of the world in order to find more reliable biomarkers of FMD.

Introduction: Multiple sclerosis (MS) is a progressive disease leading to disability, that mostly affects young and middle-aged adults. This study was aimed at evaluating the impact of sociodemographic and clinical factors, including changes in access to disease-modifying therapies (DMTs), on the quality of life (QoL) of Polish individuals with MS and to compare the findings to earlier national studies.

Material and methods: Data was collected from patients with MS across 19 MS treatment centres in Poland between February and April 2024. QoL was assessed using the EuroQol five-dimension, five-level (EQ-5D-5L) index and the EQ Visual Analogue Scale (EQ-VAS). Sociodemographic and clinical data was obtained via a standardised questionnaire.

Results: The study included 3,165 patients with MS (mean age: 42.03 years; disease duration: 10.6 ± 7.85 years; female-to-male ratio 2.2:1). The mean EQ-5D-5L index score was 0.89 (± 0.15), and the mean EQ-VAS score was 71.58 (± 18.67), indicating an overall moderate-to-good QoL in the studied cohort. Pain/discomfort (80.7%) and anxiety/depression (79.6%) were the most frequently reported problems. Higher QoL scores were associated with younger age, relapsing-remitting MS, lower disability (EDSS ≤ 3.5), shorter disease duration, lack of comorbidities, employment, urban residence, childlessness, DMT usage, and infrequent DMTs switches (p < 0.001). When compared to earlier Polish studies, these results suggest a meaningful improvement in QoL over the past decade.

Conclusions: The QoL of Polish patients with MS remains diminished compared to that of the general population. However, there has been a notable improvement compared to previous national data. This trend probably reflects advances in MS care, including wider access to novel DMTs and optimised treatment strategies.