Neurologia i neurochirurgia polska最新文献

Clinical rationale for study: Oxidative stress (OS) is believed to play a crucial role in the development of neuronal injury associated with ischaemic stroke (IS). The evaluation of redox homeostasis in patients with acute ischaemic stroke (AIS) and its relation to stroke subtypes and short-term outcomes has scarcely been studied, and the findings are unclear.

Aim of study: This study evaluates OS and antioxidant status in patients with AIS in the Podlaskie Voivodeship in Poland within 2-5 days of stroke onset, compared to healthy controls.

Material and methods: The study involved 187 patients with AIS, with 85 receiving intravenous thrombolysis and/or mechanical thrombectomy, and included 94 healthy controls as a comparison group. The research measured serum total oxidant status (TOS) and total antioxidant status (TAS) using Erel's method-based kits, and calculated the oxidative stress index (OSI).

Results: Significant differences were found in TOS levels between patients with AIS and healthy controls (p = 0.049). Serum TAS concentrations were significantly higher in patients with AIS due to large artery atherosclerosis (LAA) than in those with cardioembolism (CE) or small vessel occlusion (SVO) aetiology, as classified by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria (p = 0.043). Receiver Operating Characteristic (ROC) curve analysis established cut-off values as potential indicators of OS in patients with AIS: TAS < 1.34 mmol/L, TOS > 5.6 μmol H2O2 equiv./L, and OSI > 3.96.

Conclusions and clinical implications: Our findings demonstrate that an imbalance of oxidant and antioxidant status might play a role in the pathogenesis of IS. Patients in the initial phase of IS showed increased TOS, but no change in TAS, compared to healthy controls. This suggests effective initial antioxidant defence. TOS levels exhibited potential utility as clinical diagnostic biomarkers in patients with AIS. Although an imbalance towards oxidants may play a role in the pathogenesis of IS, these markers alone do not adequately predict stroke severity. Therefore, an analysis of the oxidant and antioxidant balance could play a crucial role in clarifying the pathogenic pathways of IS, presenting valuable diagnostic and prognostic tools, and identifying novel targets for antioxidant-focused therapies with neuroprotective agents.

Introduction: Multiple sclerosis (MS) is a progressive disease that, if untreated, leads to significant disability. In recent years, several effective disease-modifying therapies (DMTs) have been approved in the European Union and are now available in Poland. This study aimed to evaluate the selected epidemiological and clinical aspects of Polish individuals with MS and to compare the findings with data collected 15 years ago.

Material and methods: Sociodemographic and clinical data were collected from patients with MS between February and April 2024 using a standardized questionnaire across 19 treatment centers in Poland.

Results: The study included 3,165 MS patients (mean age, 42.03 years; female-to-male ratio, 2.2:1). The mean disease duration was 10.6 ± 7.85 years, with symptom onset at 30.66 ± 9.84 years and diagnosis at 32.74 ± 10.22 years. The mean Expanded Disability Status Scale (EDSS) score was 2.58 ± 1.6, with mild disability (EDSS 0-3.5) in 78.35% of patients and moderate-to-severe disability (EDSS ≥ 4.0) in 21.65%. Multiple sclerosis subtypes included relapsing-remitting (RRMS) (86.87%), secondary progressive (SPMS) (7.04%), and primary progressive (PRMS) (6.03%). Relapses occurred in 20.43% of patients within the last year, with an overall annual relapse rate of 1.2 in this group. Monofocal onset of the disease was observed in 87.05% of patients, and multifocal onset in 12.95%. Comorbidities were present in 59.73% of patients. Diagnostic tests included magnetic resonance imaging (MRI) (99.84% of patients), cerebrospinal fluid (CSF) analysis (90.91% of patients), visual evoked potentials (VEP) (32.41% of patients), and optical coherence tomography (OCT) (16.11% of patients). At the time of data collection, 97.09% of patients were receiving DMTs, with the following distribution: dimethyl fumarate (25.91%), ofatumumab (16.44%), ocrelizumab (8.62%), teriflunomide (7.44%), natalizumab (5.80%), interferon beta-1a (5.58%), interferon beta-1b (4.97%), ozanimod (4.69%), siponimod (4.15%), glatiramer acetate (4.05%), fingolimod (3.29%), cladribine (3.20%), ponesimod (1.96%), and other therapies (0.88%).

Conclusions: This study highlights substantial progress in the diagnostic and therapeutic management of MS in Poland over the past 15 years. The widespread implementation of MRI and CSF analysis, alongside significantly improved access to DMTs, has contributed to notably better clinical outcomes. These improvements are reflected in reduced relapse rates, slower disability progression, and a decreased prevalence of secondary progressive MS.

Introduction: Deep brain stimulation (DBS) is an effective therapy for patients with advanced Parkinson's Disease (PD). The significant improvement in motor symptoms is undeniable. However, adverse events from the procedure can also occur.

Clinical rationale for study: Several sources have confirmed metabolic changes after a DBS procedure. However, there is no summary of the current state of knowledge about the impact of DBS on metabolic parameters changes expressed in weight gain in PD individuals, something which could guide further research.

Material and methods: We conducted a systematic review following PRISMA recommendations on articles evaluating a gain of weight and/or body mass index (BMI) after subthalamic nucleus (STN) DBS, globus pallidus internus (GPi) DBS, and ventral intermediate nucleus of the thalamus (VIM) DBS in patients with PD. Four databases were searched by two independent authors according to the established criteria. The collected data involved body mass, BMI or changes in these parameters before DBS and after the procedure, mean age of patients, disease duration, gender, L-dopa equivalent daily dose, and the Unified Parkinson's Disease Rating Scale part III.

Results: Of 1,290 articles found, 30 were evaluated as eligible and were included in the analysis. The study sample size ranged from 10 to 124 patients (mean, 32.6 ± 23.5, N = 1,110). The mean age across studies was 59.8 ± 7.5 (range 51.8 - 66, N = 636) years with mean value of the last follow-up point 13.6 ± 8.9 (range 1-38) months. A meta-analysis was performed for STN-DBS only, due to limited data on GPi-DBS and VIM-DBS. The mean body weight was higher by 6.15 kg one year after STN-DBS procedure (p < 0.001, 95% CI: 4.49-7.81), which was associated with statistically non-significant heterogeneity. It showed an increase in BMI of 1.87 kg/m2 (p < 0.001, 95% CI: 1.11-2.64). In this comprehensive review, possible causes of this state are identified, as well as the DBS impact on glucose and lipid profile.

Conclusions: STN-DBS procedures contribute to significant weight gain in PD patients. A precise mechanism of this phenomenon has several possible explanations. Until this issue is fully clarified, we believe it is necessary to continuously monitor metabolic parameters and closely observe cardiometabolic risk in this group of patients.

Background: Hereditary spastic paraplegias (HSPs) are a group of genetically heterogeneous, progressive disorders with a broad spectrum of clinical presentation. Among autosomal dominant inherited forms of HSP, the most common are SPG4, SPG3 and SPG31.

Material and methods: Our aim was the clinical characterisation of a large group of patients with SPG4, SPG3 and SPG31. Neurological assessments as well as neuroimaging, electrophysiological, neuropsychological and ophthalmological examinations were performed to characterise in detail the clinical picture in HSP patients.

Results: In our study group of 179 individuals from 60 families, three forms of AD-HSP: SPG4, SPG3 and SPG31 were diagnosed in 125, 36 and 18 patients, respectively. 48 of the probands had a positive family history of autosomal dominant hereditary disorder, while the other 12 probands represented apparently isolated cases. The pure form of HSP (pHSP) was found in a large majority (138 symptomatic patients), whereas a distinctly complex phenotype (cHSP) was found only in 32 individuals. The number of patients with cHSP became greater after including the results of electroneurography.

Conclusions: The primarily pure form of HSP is present in patients with SPG4, SPG3 and SPG31. Nevertheless, the presence of additional symptoms provides evidence that in AD-HSP not only the cortico-spinal tract is involved. The most common additional symptom is polyneuropathy. We suggest that all patients with a genetic diagnosis of SPG4 and SPG3 should have electrophysiological testing performed, and then periodically repeated, for the purpose of controlling the involvement of peripheral nerves. We found a considerable variability, including in terms of age at onset and the progression rate of disability, mainly in SPG4.