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Early and active treatment with fingolimod for pediatric onset multiple sclerosis: the experience of an Italian pediatric center over the past 3 years.
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-02 DOI: 10.1007/s10072-025-08139-1
Carlotta Canavese, Marta Borgogno, Gloria Gallo, Martina Rosa-Brusin, Alessia Teneggi, Aba Tocchet, Daniele Marcotulli, Giovanni Morana

Aim: Describing the experience with early and high efficacy disease modifying treatment with fingolimod of a single Pediatric Multiple Sclerosis Center.

Method: We analyzed all pediatric multiple sclerosis (POMS) patients treated with fingolimod between May 2021 and April 2024. The study assessed the efficacy of fingolimod treatment defined as the absence of clinical relapses, disability progression, and new/enlarging or enhancing lesions on MRI. Cognitive profile has also been assessed at symptoms' onset and after one year of treatment.

Results: We included 6 patients (50% males) with average age at symptoms onset of 12.4 years and of 12.7 years at the diagnosis. Treatment with fingolimod was started on average 2.0 months (SD 1.7) after the diagnosis. The average treatment duration was 22.9 (SD 8.2) months and the average follow-up length 26.1 months (SD 8.9). None of the patients had clinical relapses during fingolimod treatment. Two patients showed new asymptomatic neuroradiological lesions after 18 months of treatment. All patients had normal cognitive profiles at first evaluation; four of them were tested after one year of treatment showing stable data.

Interpretation: Fingolimod offers better compliance and significantly improves patients' quality of life compared to injection therapies especially in pediatric population, reducing injection associated anxiety and risk of discontinuation. It appears to be safe and well tolerated and may be used as first line treatment in the highly active and aggressive disease course of pediatric onset multiple sclerosis.

{"title":"Early and active treatment with fingolimod for pediatric onset multiple sclerosis: the experience of an Italian pediatric center over the past 3 years.","authors":"Carlotta Canavese, Marta Borgogno, Gloria Gallo, Martina Rosa-Brusin, Alessia Teneggi, Aba Tocchet, Daniele Marcotulli, Giovanni Morana","doi":"10.1007/s10072-025-08139-1","DOIUrl":"https://doi.org/10.1007/s10072-025-08139-1","url":null,"abstract":"<p><strong>Aim: </strong>Describing the experience with early and high efficacy disease modifying treatment with fingolimod of a single Pediatric Multiple Sclerosis Center.</p><p><strong>Method: </strong>We analyzed all pediatric multiple sclerosis (POMS) patients treated with fingolimod between May 2021 and April 2024. The study assessed the efficacy of fingolimod treatment defined as the absence of clinical relapses, disability progression, and new/enlarging or enhancing lesions on MRI. Cognitive profile has also been assessed at symptoms' onset and after one year of treatment.</p><p><strong>Results: </strong>We included 6 patients (50% males) with average age at symptoms onset of 12.4 years and of 12.7 years at the diagnosis. Treatment with fingolimod was started on average 2.0 months (SD 1.7) after the diagnosis. The average treatment duration was 22.9 (SD 8.2) months and the average follow-up length 26.1 months (SD 8.9). None of the patients had clinical relapses during fingolimod treatment. Two patients showed new asymptomatic neuroradiological lesions after 18 months of treatment. All patients had normal cognitive profiles at first evaluation; four of them were tested after one year of treatment showing stable data.</p><p><strong>Interpretation: </strong>Fingolimod offers better compliance and significantly improves patients' quality of life compared to injection therapies especially in pediatric population, reducing injection associated anxiety and risk of discontinuation. It appears to be safe and well tolerated and may be used as first line treatment in the highly active and aggressive disease course of pediatric onset multiple sclerosis.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Scoliosis in spinal muscular atrophy in the era of disease-modifying therapy: a scoping review.
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-02 DOI: 10.1007/s10072-025-08155-1
Martina Gnazzo, Giulia Pisanò, Benedetta Piccolo, Emanuela Claudia Turco, Susanna Esposito, Maria Carmela Pera

Spinal muscular atrophy (SMA) frequently causes scoliosis (up to 90% of cases), due to weakened axial muscles impacting motor and respiratory function. While new SMA treatments improve motor function, their effect on scoliosis progression is unclear. This scoping review (2016-October 2024) analyzed literature from Pubmed, MEDLINE, EMBASE, and Scopus, focusing on studies of SMA, scoliosis, and treatment approaches. The aim of this work was to describe the clinical features and the possible therapeutic approaches of scoliosis in the "new population" of pharmacologically treated SMA patients. We included all types of SMA as well as all the approved disease modifying therapies (DMTs). The review found significant variability in scoliosis presentation and surgical intervention among different types of treated SMA patients. Early pharmacological treatment may slow scoliosis progression, particularly in Type II SMA. Interestingly, Type I SMA patients, who typically don't develop scoliosis due to severe hypotonia, showed an increased scoliosis onset. Larger studies are needed to fully evaluate the impact of different treatments on scoliosis progression in SMA, especially in Type I SMA patients, to establish updated standards of care.

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引用次数: 0
Mobility scale for acute stroke patients (MSAS): construct validity and reliability of the Italian scale. 急性脑卒中患者活动能力量表(MSAS):意大利量表的结构效度和信度。
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-12 DOI: 10.1007/s10072-024-07890-1
Serena Di Tondo, Mariele Colucci, Laura Abbruzzese, Giovanni Galeoto, Marco Tofani, Pierluigi Zoccolotti, Mauro Mancuso

Background: The Mobility Scale for Acute Stroke Patients (MSAS) was developed to discriminate between the lower levels of mobility in acute stroke patients in the first two weeks post-onset.

Objective: The present study aims to develop and validate an Italian version of the MSAS.

Methods: The English version of the MSAS was translated into Italian according to international guidelines. We recruited 58 patients admitted to a rehabilitation facility within 14 days of the stroke onset and administered the MSAS to test the internal consistency, concurrent validity, reliability, and responsiveness of the scale.

Results: As for internal consistency, Cronbach's alpha showed values equal to 0.96, and the alpha deleted analysis indicated that all the items have reason to exist. Concurrent validity showed statistically significant data for all sub-scales. The Italian version of the MSAS showed significant and high inter-rater reliabilities (all ICCs ≥ 0.75). The MSAS also showed excellent test-retest reliabilities (all ICCs ≥ 0.90). The reactivity of the scale, evaluated through the Student's t-test for paired samples on a sub-sample of 32 patients, showed statistically significant improvements over time for all items and the total scale.

Conclusions: The results show that the scale is stable and reliable both in the evaluation after 24 h and between different operators. High internal consistency and a strong concurrent validity were found. The scale also proved able to detect the improvement obtained by patients following the rehabilitation treatments.

背景:急性脑卒中患者活动能力量表(MSAS)的开发是为了区分急性脑卒中患者在发病后的头两周内活动能力水平较低。目的:本研究的目的是开发和验证一个意大利语版本的MSAS。方法:按照国际标准将MSAS的英文版本翻译成意大利语。我们招募了58例中风发作后14天内入住康复机构的患者,并进行了MSAS测试,以测试量表的内部一致性、并发效度、信度和反应性。结果:内部一致性方面,Cronbach’s alpha值为0.96,alpha删除分析表明所有条目都有存在的理由。所有子量表的并发效度数据均有统计学意义。意大利版的MSAS表现出显著和高的评分间信度(所有ICCs≥0.75)。MSAS也表现出优异的重测信度(所有ICCs≥0.90)。量表的反应性,通过对32名患者的子样本进行配对样本的学生t检验来评估,随着时间的推移,所有项目和总量表的统计显著改善。结论:该量表在24 h后的评价和不同操作人员之间的评价均稳定可靠。具有较高的内部一致性和较强的并发效度。该量表也被证明能够检测患者在康复治疗后获得的改善。
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引用次数: 0
Global, regional and national temporal trends in Parkinson's disease incidence, disability-adjusted life year rates in middle-aged and older adults: a cross-national inequality analysis and Bayesian age-period-cohort analysis based on the global burden of disease 2021. 帕金森病发病率、中老年人残疾调整寿命年率的全球、地区和国家时间趋势:基于 2021 年全球疾病负担的跨国不平等分析和贝叶斯年龄段队列分析。
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-14 DOI: 10.1007/s10072-024-07941-7
Jian Zhang, Yue Fan, Hao Liang, Yong Zhang

Background: Parkinson's disease (PD) ranks as the second most prevalent neurodegenerative disorder; however, its epidemiological characteristics among middle-aged and older adults at global, regional, and national levels remain inadequately documented.

Methods: This study assessed temporal trends in PD among middle-aged and older adults by extracting incidence rates, disability-adjusted life year (DALY) rates, and corresponding age-specific rates (ASRs) from the Global Burden of Disease (GBD) database spanning 1990 to 2021. Estimated annual percentage change (EAPC) was employed to analyze trends over the past 30 years. The slope index of inequality (SII) and concentration index (CI) were utilized to evaluate disparities in the burden of PD across various countries. Additionally, Bayesian age-period-cohort (BAPC) modeling was applied to project DALY figures for the next 15 years.

Results: In 2021, the global incidence and DALY rates for middle-aged and older adults with PD stood at 79.68 and 477.50 cases per 100,000 population, respectively. Both incidence and DALY rates have exhibited an upward trajectory over the past 32 years, with EAPCs of 1.2 (95% UI: 1.1-1.3) and 0.6 (95% UI: 0.5-0.7), respectively. Among the five sociodemographic index (SDI) regions, the high-middle SDI region reported the highest incidence and DALY rates for PD in 2021, at 93.93 and 512.29 cases per 100,000 population, respectively. A positive correlation was observed between the SDI and age-specific incidence rate (ASIR) as well as age-specific DALY rate (ASDR). Disparities in the burden of PD among middle-aged and older adults, associated with SDI, are on the rise and are primarily concentrated in high SDI countries. It is projected that the global incidence and DALY rates for middle-aged and older adults with PD will experience significant increases over the next 15 years.

Conclusions: The global burden of PD among middle-aged and older adults has markedly escalated over the past 32 years, particularly in high-middle SDI regions. These findings underscore the necessity for the development of effective interventions and public health policies, contributing to the attainment of the sustainable development goals established by the World Health Organization (WHO).

背景:帕金森病(PD)是第二大流行的神经退行性疾病;然而,在全球、区域和国家层面,其在中老年人群中的流行病学特征仍未得到充分记录。方法:本研究通过从全球疾病负担(GBD)数据库中提取1990年至2021年的发病率、残疾调整生命年(DALY)率和相应的年龄特异性发病率(ASRs),评估中老年PD的时间趋势。估计年百分比变化(EAPC)用于分析过去30年的趋势。利用不平等斜率指数(SII)和浓度指数(CI)来评估各国PD负担的差异。此外,贝叶斯年龄-时期-队列(BAPC)模型应用于预测未来15年的DALY数据。结果:2021年,全球中老年PD发病率和DALY分别为79.68例/ 10万人和477.50例/ 10万人。在过去的32年中,发病率和DALY率均呈上升趋势,EAPCs分别为1.2 (95% UI: 1.1-1.3)和0.6 (95% UI: 0.5-0.7)。在5个社会人口指数(SDI)区域中,高、中SDI区域报告的PD发病率和DALY率在2021年最高,分别为每10万人93.93例和512.29例。SDI与年龄特异性发病率(ASIR)和年龄特异性DALY率(ASDR)呈正相关。与SDI相关的中老年人PD负担的差异正在上升,并且主要集中在SDI高的国家。据预测,在未来15年,全球中老年PD的发病率和DALY率将显著增加。结论:在过去的32年里,全球中老年人PD负担显著增加,特别是在SDI中高水平地区。这些调查结果强调,必须制定有效的干预措施和公共卫生政策,以促进实现世界卫生组织(卫生组织)制定的可持续发展目标。
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引用次数: 0
Plasmatic variability of direct oral anticoagulants in people with atrial fibrillation and previous gastric surgery: a pilot case series. 心房颤动和既往胃部手术患者体内直接口服抗凝剂的血浆变异性:试验性病例系列。
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-16 DOI: 10.1007/s10072-024-07937-3
Michele Romoli, Maria Vitiello, Enrico Maria Lotti, Giuseppe D'Antuono, Arianna Berardo, Claudia Faini, Valentina Tudisco, Vincenzo Mastrangelo, Marco Longoni

Background: Data on cardioembolic prevention with direct oral anticoagulants (DOAC) in atrial fibrillation (AF) patients with previous gastric surgery are lacking. We report inter- and intra-individual differences in DOAC concentration in people with gastric surgery, to identify potential treatment options.

Methods: Patients with previous gastric surgery receiving DOAC for AF as stroke secondary prevention, and undergoing peak-trough DOAC plasmatic testing were selected from the regional EDDIE-AF registry. DOAC levels were tested at least 75-102 h after DOAC initiation with Siemens Innovance® assays.

Results: Eight patients with previous gastric surgery were included (mean age 75 years, 50% women). Overall, only 20/36 tests were within range (55.5%; apixaban 75.0%; dabigatran 0%; edoxaban 64.3%; rivaroxaban 33.3%). Rivaroxaban and dabigatran failed to reach therapeutic peak-trough concentrations. Apixaban and edoxaban reached therapeutic levels in 4/6 and 3/7 cases respectively, with marginal out-of-target concentrations in all remaining cases.

Conclusions: Our data support a consistent variability in DOAC absorption after gastric surgery, suggesting that implementation of DOAC plasmatic testing may help in ensuring therapeutic levels are met whenever DOACs are preferred over warfarin.

背景:目前还缺乏关于曾接受过胃部手术的房颤(AF)患者使用直接口服抗凝剂(DOAC)预防心肌栓塞的数据。我们报告了胃部手术患者 DOAC 浓度在个体间和个体内的差异,以确定潜在的治疗方案:方法:从地区性 EDDIE-AF 登记处选取既往接受过胃部手术的患者,接受 DOAC 治疗房颤作为中风二级预防,并接受峰透 DOAC 血浆检测。使用西门子Innovance®检测仪在开始使用DOAC后至少75-102小时检测DOAC水平:结果:共纳入了 8 名曾接受过胃部手术的患者(平均年龄 75 岁,50% 为女性)。总体而言,只有 20/36 次检测结果在范围之内(55.5%;阿哌沙班 75.0%;达比加群 0%;依度沙班 64.3%;利伐沙班 33.3%)。利伐沙班和达比加群未达到治疗峰-槽浓度。阿哌沙班和埃多沙班分别在4/6和3/7的病例中达到治疗水平,其余所有病例中均有轻微的目标外浓度:我们的数据支持胃手术后 DOAC 吸收的一致性变异,这表明只要 DOAC 优于华法林,实施 DOAC 血浆检测可能有助于确保达到治疗水平。
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引用次数: 0
Exercise therapy can effectively improve trunk performance and sitting balance in spinal cord injury: a systematic review and meta-analysis. 运动疗法可有效改善脊髓损伤患者的躯干功能和坐位平衡:一项系统综述和荟萃分析。
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-30 DOI: 10.1007/s10072-024-07960-4
Hiroki Okawara, Tomonori Sawada, Saki Onuki, Keiko Sugai, Toshiki Okubo, Masahiro Ozaki, Osahiko Tsuji, Narihito Nagoshi, Yasunori Sato, Masaya Nakamura

Objective: To determine the effects of exercise on trunk performance and balance in patients with spinal cord injury (SCI).

Methods: We searched the databases MEDLINE, Cochrane Library, EMBASE, Physiotherapy Evidence Database, Web of Science, PsycINFO, and CINAHL from inception to June 2020. Our search targeted studies such as randomized or non-randomized controlled trials and randomized crossover trials that evaluated the effects of exercise on trunk performance and balance in patients with SCI.

Results: Seventeen eligible studies with 432 patients with SCI were included in the meta-analysis. The exercise significantly improved several measures: Berg Balance Scale (mean differences [MD] = 4.58; 95% confidence intervals [CI], 0.35, 8.8; p = 0.03), Modified Functional Reach Test (MD = 5.29; 95% CI, 4.16, 6.42; p < 0.01), T-shirt test (MD = 5.62; 95% CI, - 3.82, - 7.42; p < 0.01), Timed Up and Go (MD = - 1.70; 95% CI, - 0.23, - 3.16; p = 0.02). Improvements were also noted in total static sitting balance (standardized mean differences [SMD] = 1.21; 95% CI, 0.79, 1.63; p < 0.01), and total dynamic sitting balance (SMD = 1.01; 95% CI, 0.30, 1.73; p < 0.01). In the subgroup analysis, exercise with sensory input enhancement significantly improved total static (SMD = 1.37; 95% CI, 0.64, 2.11; p < 0.01) and total dynamic sitting balance (SMD = 1.78; 95% CI, 0.28, 3.29; p = 0.02).

Conclusions: Exercise may improve sitting balance in patients with SCI. Moreover, enhancement of sensory input had an add-on effect in improving sitting balance.

Registration: PROSPERO (CRD42020185904).

目的:探讨运动对脊髓损伤(SCI)患者躯干功能和平衡的影响。方法:检索MEDLINE、Cochrane Library、EMBASE、Physiotherapy Evidence Database、Web of Science、PsycINFO、CINAHL等数据库,检索时间自成立至2020年6月。我们的搜索目标是研究,如随机或非随机对照试验和随机交叉试验,以评估运动对脊髓损伤患者躯干性能和平衡的影响。结果:17项符合条件的研究纳入了432例SCI患者。运动显著改善了多项指标:Berg平衡量表(mean difference [MD] = 4.58;95%置信区间[CI], 0.35, 8.8;p = 0.03),修正功能到达测试(MD = 5.29;95% ci, 4.16, 6.42;结论:运动可以改善脊髓损伤患者的坐姿平衡。此外,感官输入的增强对改善坐姿平衡有附加效应。注册:PROSPERO (CRD42020185904)。
{"title":"Exercise therapy can effectively improve trunk performance and sitting balance in spinal cord injury: a systematic review and meta-analysis.","authors":"Hiroki Okawara, Tomonori Sawada, Saki Onuki, Keiko Sugai, Toshiki Okubo, Masahiro Ozaki, Osahiko Tsuji, Narihito Nagoshi, Yasunori Sato, Masaya Nakamura","doi":"10.1007/s10072-024-07960-4","DOIUrl":"10.1007/s10072-024-07960-4","url":null,"abstract":"<p><strong>Objective: </strong>To determine the effects of exercise on trunk performance and balance in patients with spinal cord injury (SCI).</p><p><strong>Methods: </strong>We searched the databases MEDLINE, Cochrane Library, EMBASE, Physiotherapy Evidence Database, Web of Science, PsycINFO, and CINAHL from inception to June 2020. Our search targeted studies such as randomized or non-randomized controlled trials and randomized crossover trials that evaluated the effects of exercise on trunk performance and balance in patients with SCI.</p><p><strong>Results: </strong>Seventeen eligible studies with 432 patients with SCI were included in the meta-analysis. The exercise significantly improved several measures: Berg Balance Scale (mean differences [MD] = 4.58; 95% confidence intervals [CI], 0.35, 8.8; p = 0.03), Modified Functional Reach Test (MD = 5.29; 95% CI, 4.16, 6.42; p < 0.01), T-shirt test (MD = 5.62; 95% CI, - 3.82, - 7.42; p < 0.01), Timed Up and Go (MD = - 1.70; 95% CI, - 0.23, - 3.16; p = 0.02). Improvements were also noted in total static sitting balance (standardized mean differences [SMD] = 1.21; 95% CI, 0.79, 1.63; p < 0.01), and total dynamic sitting balance (SMD = 1.01; 95% CI, 0.30, 1.73; p < 0.01). In the subgroup analysis, exercise with sensory input enhancement significantly improved total static (SMD = 1.37; 95% CI, 0.64, 2.11; p < 0.01) and total dynamic sitting balance (SMD = 1.78; 95% CI, 0.28, 3.29; p = 0.02).</p><p><strong>Conclusions: </strong>Exercise may improve sitting balance in patients with SCI. Moreover, enhancement of sensory input had an add-on effect in improving sitting balance.</p><p><strong>Registration: </strong>PROSPERO (CRD42020185904).</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":" ","pages":"1581-1597"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A rare family of SMA combined with type B Kufs disease. 一个罕见的 SMA 合并 B 型 Kufs 病家族。
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-18 DOI: 10.1007/s10072-024-07949-z
Feifei Tian, Jing Li, Ziyang Wu, Xin Li, Liangtao Zhao, Zhipeng Yan, Wei Yuan, Haiping Wei, Kai Li, Guode Wu
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引用次数: 0
FLAMES and holocord involvement in a child with myelin oligodendrocyte glycoprotein antibody associated disease. 儿童髓鞘少突胶质细胞糖蛋白抗体相关疾病的火焰和全息影像累及
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-23 DOI: 10.1007/s10072-024-07955-1
Ramandeep Singh, Archit Goel, Arvinder Wander
{"title":"FLAMES and holocord involvement in a child with myelin oligodendrocyte glycoprotein antibody associated disease.","authors":"Ramandeep Singh, Archit Goel, Arvinder Wander","doi":"10.1007/s10072-024-07955-1","DOIUrl":"10.1007/s10072-024-07955-1","url":null,"abstract":"","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":" ","pages":"1951-1953"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bilateral striatal necrosis in a case with ADAR1-related Aicardi Goutières Syndrome. adar1相关Aicardi gouti<e:1>综合征双侧纹状体坏死1例。
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-02 DOI: 10.1007/s10072-024-07977-9
Miraç Yıldırım, Fatma Pınar Tabanlı, Ömer Bektaş, Serap Teber
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引用次数: 0
Intermittent theta burst stimulation vs. high-frequency repetitive transcranial magnetic stimulation for post-stroke dysfunction: a Bayesian model-based network meta-analysis of RCTs. 间歇性θ波爆发刺激与高频重复经颅磁刺激治疗脑卒中后功能障碍:基于贝叶斯模型的随机对照试验网络荟萃分析
IF 2.7 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-21 DOI: 10.1007/s10072-024-07918-6
Yanbing Huang, Caihui Li, Rongda Cai, Tianlai Lin, Weiwen Chen

Objective: This research aims to comprehensively assess the efficacy of intermittent theta-burst stimulation (iTBS) vs. high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in post-stroke dysfunction.

Materials and methods: Until January 2024, extensive electronic database searches were conducted (PubMed, Embase, Cochrane Library, Web of Science, etc.). Fugl-Meyer Assessment for Upper Extremities (FMA-UE) was used to assess upper limb (UL) dysfunction; post-stroke dysphagia (PSD) was identified by Standardized Swallowing Assessment (SSA), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), and Penetration/Aspiration Scale (PAS). Results were analyzed by network meta-analysis (NMA), and the mean difference (MD) and 95% confidence intervals (95% CI) were also reported. We conducted a descriptive analysis due to the inability to synthesize data on post-stroke cognitive impairment (PSCI).

Results: 19 studies were included for NMA analysis. For UL disorder, the efficacy of treatments was ranked as HF-rTMS [MD (95%CI):3.00 (1.69,4.31)], iTBS [MD (95%CI): 2.16 (0.84, 3.50)], and sham stimulation (reference). For PSD, the efficacy of treatment to reduce scores of FEDSS or SSA were iTBS [FEDSS, MD (95%CI): -0.80 (-1.13, -0.47); SSA, MD (95%CI): -3.37 (-4.36, -2.38)], HF-rTMS [FEDSS, MD (95%CI): -0.43 (-0.76, -0.10); SSA, MD (95%CI): -2.62 (-3.91, -1.35)], and sham stimulation(reference). Descriptive analysis of PSCI found that both iTBS and HF-rTMS were effective in improving PSCI.

Conclusions: HF-rTMS demonstrates superior efficacy in UL dysfunction, while iTBS is more effective in PSD. Clinicians should carefully evaluate the type and severity of post-stroke dysfunction in each patient to select the most appropriate treatment.

目的:本研究旨在综合评估间歇性脉冲刺激(iTBS)与高频重复经颅磁刺激(HF-rTMS)对脑卒中后功能障碍的疗效。材料和方法:直到2024年1月,进行了广泛的电子数据库检索(PubMed, Embase, Cochrane Library, Web of Science等)。Fugl-Meyer上肢功能评估(FMA-UE)用于评估上肢(UL)功能障碍;卒中后吞咽困难(PSD)通过标准化吞咽评估(SSA)、光纤内镜吞咽困难严重程度量表(FEDSS)和穿透/吸入量表(PAS)进行鉴定。结果采用网络荟萃分析(NMA)进行分析,并报告平均差值(MD)和95%置信区间(95% CI)。由于无法综合脑卒中后认知障碍(PSCI)的数据,我们进行了描述性分析。结果:纳入19项研究进行NMA分析。对于UL障碍,治疗效果排名为HF-rTMS [MD (95%CI):3.00 (1.69,4.31)], iTBS [MD (95%CI): 2.16(0.84, 3.50)]和假刺激(参考)。对于PSD,治疗对降低FEDSS或SSA评分的疗效为iTBS [FEDSS, MD (95%CI): -0.80 (-1.13, -0.47);马里兰州SSA (95% ci): -3.37 (-4.36, -2.38)], HF-rTMS(联邦政府,MD (95% ci): -0.43 (-0.76, -0.10);SSA, MD (95%CI): -2.62(-3.91, -1.35)]和假刺激(参考)。对PSCI的描述性分析发现,iTBS和HF-rTMS对改善PSCI均有效。结论:HF-rTMS对UL功能障碍的治疗效果较好,而iTBS对PSD的治疗效果更好。临床医生应仔细评估每位患者脑卒中后功能障碍的类型和严重程度,以选择最合适的治疗方法。
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引用次数: 0
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Neurological Sciences
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