Neurological Sciences最新文献

Introduction: Parkinson's disease (PD) presents with a variety of non-motor symptoms such as sleep disorders, hyposmia, pain, cognitive dysfunction, neuropsychiatric and autonomic symptoms. One of the most neglected motor symptoms is the impairment of eye movements, which occurs in 75% of PD patients. The aim of our study was to investigate the relationship between the severity of non-motor symptoms and the impairment of different types of eye movements.

Methods: We conducted a cross-sectional study with idiopathic PD patients in which non-motor symptoms were assessed using standardised scales. The impairment of smooth pursuit, saccades, antisaccades and visually-guided saccades was evaluated with eye-tracker analysis, using battery of tests.

Results: The mean age of our subjects was 65.06 (± 9.135; 43-80) years with a median disease duration of 4 (2-7) years. The duration of PD correlated positively with visually-guided memory saccades. We found moderate positive correlations between scales for sleep quality, depression, anxiety, and nonmotor experiences of daily living (PDSS-2, RBDSQ, BAI, BDI-II, MDS-UPDRS I) with deviation of fast smooth pursuit movements and latency of saccades and antisaccades. Number of correct answers in different trials testing visually-guided memory saccades were most strongly negatively correlated with scales assessing depression, sleep quality and cognitive functions (MoCA).

Conclusion: Different types of eye movement parameters correlate with scales assessing non-motor symptoms, possibly caused by the same pathophysiological mechanism in PD. Further research that addresses these challenges and focuses on the relationship between eye movements and specific non-motor symptoms in PD could provide valuable insights into the comprehensive management of this complex disease.

Background and aim: Anti-myelin-associated glycoprotein (anti-MAG) neuropathy is typically a chronic, progressive, predominantly sensory distal and demyelinating neuropathy, with ataxia and postural tremor METHODS AND RESULTS: Herein we describe an atypical case of anti-MAG neuropathy, characterized by acute lower limb weakness and severe ataxia with difficulty in stance and walking, resembling a Guillain-Barrè Syndrome. The presence of disproportionate distal nerve conduction slowing, and an IgM k monoclonal component have arisen the suspect of anti-MAG neuropathy, confirmed by high titer anti-MAG antibody. Rituximab treatment was started, and patient experienced a dramatic clinical worsening which was rescued by Plasma Exchange.

Interpretation: We described an atypical case of anti-MAG neuropathy that was challenging in diagnosis and therapeutic management.

Background: New Onset Refractory Status Epilepticus (NORSE) is a neurological emergency with high mortality. Cryptogenic NORSE (cNORSE) is defined by a lack of an identifiable structural, toxic or metabolic etiology despite extensive workup. Survivors often develop significant long-term neurological sequelae and drug-resistant epilepsy. However, studies have shown that despite prolonged hospitalization, a significant proportion of cNORSE patients can achieve favourable functional outcomes.

Methods: A retrospective review of adult cNORSE patients between July 2019 and July 2023 in a tertiary hospital in Singapore was performed.

Results: Thirteen patients with cNORSE were identified. Median age at presentation was 32.2 [IQR: 23.9-44.1] years and 6 (46.2%) of the patients were male. Eight (61.5%) patients fulfilled criteria for Febrile Infection-Related Epilepsy Syndrome (FIRES). Eight (61.5%) patients had abnormal index brain MRIs. The median duration of ICU stay was 37.0 [22.8-41.5] days. The total number of anti-seizure medications (ASMs) and anesthetics used was 6 [5-7] and 3 [2-4] respectively. All patients received immunotherapy and the time to immunotherapy initiation from SE onset was 2 [1-3] days. 4 (30.8%) patients demised during inpatient stay. Of 9 surviving patients, the median MRS on discharge was 4 [3-5]. MRS at 3 month and 1 year follow ups was 2 [1-5] and 1.0 [0.8-5.0] respectively.

Conclusions: This retrospective study characterizes a cryptogenic NORSE cohort in a tertiary hospital in Singapore. Cryptogenic NORSE is associated with significant morbidity and mortality; however, long term outcomes may still be favourable in patients with initially severe illness and protracted ICU stay.

Background: We investigated the risk of ischemic stroke in ALS and analyzed the effect of ALS-related physical disability using the Korean National Health Insurance Service database.

Methods: A total of 2,251 ALS patients diagnosed between January 1, 2012, and December 31, 2015, and 1:10 age- and sex-matched control populations were included. Cases that participated in the national health check-up programs were selected. A Cox hazard regression model was used to examine the hazard ratios (HRs) for ischemic stroke in ALS after adjusting for potential confounders.

Results: A total of 681 ALS patients and 10,934 non-ALS participants were selected. ALS patients were slightly younger than the control group (60.3 ± 10.1 years vs. 61.0 ± 10.5 years, p = 0.105), and the proportion of male patients was similar between the two groups (61.6% vs. 60.9%, p = 0.722). ALS patients were more likely to have a lower body mass index (23.1 ± 2.92 vs. 24.0 ± 3.1, p < 0.001) and obstructive sleep apnea syndrome (0.59% vs. 0.06%, p < 0.001) than the controls. In ALS patients, the incidence rate of ischemic stroke was 6.32 per 1,000 person-years, and the adjusted HR of ischemic stroke was 2.58 (95% confidence interval 1.38 - 4.82) compared with the matched group. The risk of ischemic stroke did not differ by the presence of disability in ALS patients.

Conclusions: Our findings suggest that ALS patients have an increased risk of ischemic stroke compared with controls, but the risk did not differ by the presence of disability in ALS.

Introduction: Among non-pharmacological approach for chronic migraine (CM), Short-Term Psychodynamic Psychotherapy (STPP) is suggested in CM and, particularly, in interrupting medication overuse (MO). In this study, we aim at identifying clinical predictive factors to identify CM patients who could more likely respond to STPP.

Methods: We designed a prospective real-world observational study on CM patients undergoing STPP. We collected clinical data related to migraine burden (baseline headache days, number of acute medications used, MIDAS, HIT-6), as well as psychiatric comorbidities (though MINI) and mentalization level obtained by the STPP first interview phase (called BPI) to use them as predictive factors by univariate and discriminant function analysis at 3 (early) and 6 months (only sustained response).

Results: We recruited 119 patients (mean age 39.90 ± 14.4, F = 102); 113(94%) completed the STPP treatment. All patients presented a low-to-intermediate mentalization level. After stand-alone STPP, we observed a reduction in monthly headache days and MO at 3 months. Mentalization level didn't affect the STPP outcome (p = 0.40). Early response was directly related to a higher baseline headache days number, the previous used of alternative therapies, and higher Hamilton Depression scale scores. Sustained response was predicted by current use of preventive therapy, pain intensity, HIT-6 score, hypomania, and dysthymia.

Conclusion: This real-world study showed that STPP could represent a valid therapeutic option in complex CM patients with a high number of headache days and comorbid depression.

Introduction: Capgras syndrome (CS) is a delusional misidentification phenomenon increasingly reported in patients with Parkinson's disease (PD) and Lewy Body Dementia (LBD). Aim of the present scoping review was to provide an overview on current evidence on the pharmacological treatment of CS in PD and LBD, identifying knowledge gaps in the literature.

Methods: The following databases were consulted: PubMed, Google Scholar, the Cochrane Database and Web of Science.

Results: The search query covered a time period from 1976 until 2022. Fourteen studies on PD (11 single case reports, 3 case series) and five on LBD (all single case reports) met the inclusion criteria. Most PD patients with CS had cognitive decline and visual hallucinations, and were managed by reducing dopaminergic therapy and prescribing neuroleptics (quetiapine, clozapine or pimavanserin), which often resulted in improvement. Neuroleptics have also been used in LBD, but with variable efficacy.

Conclusion: Although neuroleptics and dopaminergic dose adjustments appear to be beneficial for CS in PD and LBD, robust evidence is lacking. Future prospective studies are essential to establish evidence-based guidelines for this challenging syndrome.

Objective: This study aimed to determine the repeatable effect of acupotomy on specific acupoints of paralyzed limbs in stroke patients with hemiplegia, using musculoskeletal ultrasound combined with acupuncture.

Methods: 102 patients with limb motor dysfunction post-cerebral stroke were randomly divided into two groups: the treatment group (T group) received ultrasound-guided acupotomy plus a basic treatment regimen (51 patients) and the control (C) group underwent the basic treatment regimen (51 patients) over 4 weeks, with a 6-month follow-up period. The T group was treated with ultrasound-guided acupotomy on the first day. Both groups received the same basic treatment. The primary outcome, the improvement in limb function, was evaluated using the Shangtianmin Hemiplegia Function Rating Scale score from baseline to 6 months. The secondary outcome measures included the neurological deficit scale, activities of daily living scale, modified Ashworth scale, and safety evaluation.

Results: The mean total Shangtianmin Hemiplegia Function rating scale score improved (p < 0.001) after the first ultrasound-guided acupotomy treatment compared with baseline. After 6 months, the mean score of the upper limb in the T group was 8.86 ± 2.86, and in the C group, it was 6.08 ± 3.99 (difference, 2.78; 95% confidence interval, 1.42-4.15, p < 0.001). The mean score of the lower limb was 10.35 ± 1.80 in the T group and 6.86 ± 3.04 in the C group (difference, 3.49; 95% confidence interval, 2.51-4.47, p < 0.001).

Conclusions: The function of the hemiplegic limb is significantly improved under ultrasound-guided acupotomy treatment combined with acupuncture.

Trial registration: Chinese Clinical Trials Register, ChiCTR1900028395, Registered 20 December 2019. https://www.chictr.org.cn/showproj.aspx?proj=47018 . Approved no. of the ethics committee: 2019NL-169-02.

Bilateral identical duplications of the middle cerebral artery are extremely rare. We report this anatomical variation in a 56-year-old woman. The anatomical variation was identified using magnetic resonance angiography, which was performed to evaluate cerebrovascular disease. Bilaterally, one middle cerebral artery originated from the internal carotid artery bifurcation and the other originated from the internal carotid artery terminal segment. The anatomical variations were incidental findings, and the patient was asymptomatic.