Neurological Sciences最新文献

Background: Stroke leads to reduced mobility and functional capacity, also negatively affects respiratory functions and muscle strength.

Aim: To examine the effects of adding upper extremity robotic rehabilitation to conventional treatment on respiratory parameters, functional capacity, mobility, and dyspnea.

Method: Thirty-four stroke patients aged 18-65/years were randomized into Conventional Rehabilitation (CR) or Upper Extremity Robotic Rehabilitation (RR) groups. Both groups received conventional treatment for 5 days/week, for 6 weeks. Additionally, the RR group participated in upper extremity robotic rehabilitation (ExoRehab X, Houston Bionics) twice/week. Respiratory muscle strength (Maximum Inspiratory Pressure-MIP and Maximum Expiratory Pressure-MEP) and respiratory functions (forced expiratory flow first second (FEV1)), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow-25-75% (FEF 25-75%) were assessed. Functional capacity was evaluated with 6-minute walk test (6-MWT), mobility was assessed with Timed Up and Go (TUG) test, and dyspnea was measured using Dyspnea-12 test.

Results: Both groups showed improvements in MIP, MEP, 6MWT and TUG scores. Additionally, significant increases were observed in PEF in the CR group and in FVC, FEV1, %FEF 25-75, and reduced dyspnea in the RR group (all p < 0.05). The groups were similar in terms of mean changes, except for FVC (p = 0.004) and FEV1 (p = 0.002), which were significantly higher in RR group.

Conclusion: Combining upper extremity robotic rehabilitation with conventional rehabilitation in stroke patients led to similar improvements in respiratory muscle strength, functional capacity, and mobility while also improving some respiratory parameters and reducing the perception of dyspnea.

Trial registration number: NCT05550311.

Background: The RAB32 Ser71Arg variant has been identified as a novel risk locus for Parkinson's disease (PD) in North American, European and North African populations. However, its pathogenicity in Asian populations remains unclear.

Method: To investigate this, we screened for the RAB32 c.213C > G (Ser71Arg) variant using Sanger sequencing in 1,099 PD patients and 1,549 controls. And we search for the RAB32 Ser71Arg variant in public databases to identified its mutant frequency.

Results: Our results show that no individuals carrying the RAB32 Ser71Arg variant were identified in our cohort. Additionally, this variant rarely appears in Asian population databases.

Conclusion: Our findings suggest that the RAB32 Ser71Arg variant is unlikely to be a risk locus for PD in Chinese patients, which is potentially attributed to racial or ethnic differences.

Aim: This study investigates the potential of 3-Hz orthostatic tremor (OT) as a diagnostic red-flag sign for differentiating multiple system atrophy (MSA) from Parkinson's disease (PD).

Patients and methods: A total of 615 PD patients and 234 MSA patients (120 MSA-P and 114 MSA-C) participated. OT at ~ 3 Hz and other frequencies was identified through rhythmic postural sway on the stabilogram map and confirmed by fast Fourier transform (FFT) analysis. Extensive assessment of OT occurrence, preferential stance conditions, sway direction, frequency spectrum, and intensity was performed and compared between the two diseases.

Results: Significant differences in OT features were observed. In PD, 104 patients (16.9%) exhibited tremors, mainly on a firm platform (79.8%), and preferentially in the medial-lateral direction (59.6%). About 40% of PD-related OT showed double peaks in the FFT map, with a frequency spectrum from 3.3 to 12.4 Hz. MSA tremors were observed in 133 patients (56.8%, including 46 MSA-P and 87 MSA-C patients), occurring after proprioceptive sensory input deprivation (94.7%). OT in MSA occurred exclusively in the anterior-posterior direction (100%), with no sub- or ultra-harmonics in the FFT map. Binominal logistic regression analyses demonstrated that frequency and stance conditions independently contributed to differentiating PD- and MSA-related OT. The 3-Hz tremor exhibited a sensitivity of 0.568, perfect specificity (1), an approximate negative predictive value of 0.8592, and a positive predictive value of 1 for MSA identification.

Conclusions: This study establishes the 3-Hz orthostatic tremor as a promising red flag sign for MSA identification.

Introduction: Bowel and bladder symptoms are frequent in people with Multiple Sclerosis (PwMS) and early diagnosis and treatment become crucial to improve their quality of life (QoL). The study aims to design a multidisciplinary questionnaire for screening bladder and bowel symptoms in PwMS.

Materials and methods: The Bowel and Bladder Symptoms Screening in Multiple Sclerosis (BBSS-MS) questionnaire for screening bowel and bladder symptoms was designed in Italian following a three-steps process. In the first step, a dedicated board of experts identified a pool of items, which will be analysed for content, clarity, and consistency during the second step. During the third step, the relevance of each item was evaluated through a two-round process following the Delphi method. For each round of the Delphi method, medians, the 25th and 75th percentiles, and the IQR of the score for each statement were calculated. Stata 16.1 software was used to conduct all analyses.

Results: The Board identified 22 items to include in the BBSS-MS, based on existing questionnaire and clinical expertise. After discussing about the comprehensibility and clarity of items, the first version of the BBSS-MS composed of 22 items was proposed. Following, a Panel of 44 experts scored the relevance of each question and all the questions reached the score to be included in the questionnaire. The final 21-item version of the BBSS-MS was proposed.

Discussion and conclusion: To our knowledge, the BBSS-MS represents the first self-reported hybrid questionnaire for screening bladder and bowel symptoms in an Italian MS population.

Objective: This study aimed to evaluate the effectiveness of robot-assisted gait training (RAGT) and explore the optimal exercise prescription using a network meta-analysis approach.

Data sources: A comprehensive search was conducted on randomized controlled trials comparing robotic and conventional rehabilitation published up to January 2024 in PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang, and SinoMed databases.

Review methods: The evaluation parameters included Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), and 6-Minute Walk Test (6MWT). Two investigators independently performed study screening, data extraction, and bias evaluation. Data were merged, analyzed, and plotted using Review Manager 5.4.1 and Stata 18.0 software.

Results: A total of 21 articles involving 822 subjects were included in the analysis. RAGT positively influenced FMA-LE score (MD = 3.74, 95%CI 3.02-4.46, P < 0.05), FAC score (MD = 0.31, 95%CI 0.1-0.53, P < 0.05), BBS score (MD = 3.63, 95%CI 2.46-4.80, P < 0.05), and 6MWT score (MD = 23.73, 95%CI 15.31-32.14, P < 0.05). Surface under the cumulative ranking curve (SUCRA) values indicated that an exercise time of 40-60 min/training (97.4%), exercise frequency of 2-5 times/week (87.6%), and exercise duration of 8-12 weeks (78.1%) were most effective in improving the FMA-LE score.

Conclusions: RAGT can effectively improve lower limb motor function, walking function, balance function, and walking endurance in stroke patients. For optimal improvement in FMA-LE score, an exercise time of 40-60 min/training, exercise frequency of 2-5 times/week, and exercise duration of 8-12 weeks are recommended.

Background: Human herpesvirus (HHV)-6 encephalitis secondary to chimeric antigen receptor (CAR)-T cell therapyis relatively rare in clinical practice and needs to be differentiated from immune effector cell-associatedneurotoxicity syndrome (ICANS).

Methods: We retrospectively reported a case of HHV-6 encephalitis secondary to CAR-T cell therapy.

Results: A male patient from China with diffuse large B-cell lymphoma underwent chimeric CAR-T cell therapy anddeveloped a generalized rash on the 8^th day, followed by cognitive changes, memory loss, and disorientation onthe 14^th day after CAR-T cell therapy. Initially, ICANS was suspected. A lumbar puncture was performed on the 18^th day. The cerebrospinal fluid (CSF) analysis revealed slightly elevated protein levels and a high presence of HHV-6B sequences by mNGS. Brain MRI showed bilateral hippocampal abnormalities. The patient was ultimatelydiagnosed with HHV-6 encephalitis and treated with ganciclovir and dexamethasone. After one week of treatment,follow-up CSF analysis showed a reduction in HHV-6B sequences. The patient was discharged with improvedmemory and orientation.

Conclusion: HHV-6 encephalitis secondary to CAR-T cell therapy may be easily confused with ICANS. Timely andaggressive diagnostic procedures, such as mNGS of CSF and cranial imaging, along with prompt antiviral therapy,are crucial for improving patient outcomes.