Neurologia最新文献_第6页

Síndrome de dolor regional complejo y fibromatosis palmar secundarios a tratamiento con primidona 用普萘醌治疗的复杂区域疼痛综合征和继发性棕榈纤维瘤病

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-07-01 DOI: 10.1016/j.nrl.2023.10.001

C. Utrilla-Pérez, M.C. Mateos-de Pablo, C. Guijarro-Castro

引用次数: 0

Acute inflammatory demyelinating polyneuropathy shortly after administration of intravitreal ranibizumab: A clinical and electrophysiological annotation 急性炎症脱髓鞘多神经病变后不久给予玻璃体内雷尼珠单抗：临床和电生理注释

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-07-01 DOI: 10.1016/j.nrl.2023.06.008

J. Berciano , A. García

引用次数: 0

Tendencias de la mortalidad por esclerosis múltiple en España de 1981 a 2020 1981年至2020年西班牙多发性硬化症死亡率趋势

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-07-01 DOI: 10.1016/j.nrl.2023.06.014

L. Cayuela , A. de Albóniga-Chindurza , S. Gómez Enjuto , J. Lapeña-Motilva , S. Sainz de la Maza , A. González García , A. Cayuela

Objective

Assess time trends in mortality from multiple sclerosis (MS) in the Spanish population (1981-2020), considering the influence of independent effects of gender, age, period, and birth cohort.

Methods

MS deaths and populations needed for calculations were obtained from the National Institute of Statistics. Age-standardised mortality rates (ASMR) and trend analysis were performed using joinpoint regression software. Age-period-cohort (APC) analysis was performed using the web-based statistical tool of the US National Cancer Institute to explore the underlying reason for the MS mortality.

Results

ASMR increased significantly in both women and men (1.7% and 1.2% respectively). The joinpoint analysis detected no trend change for women, but for men it detects a first period where rates remain stable (1981-2000; annual percentage change: −0.7%, not significant) followed by a period of significant increase (2000-2020; 2.6%, P < .05). For period effects, a steady increase was observed among women since the early 1990s and among men since the late 1990s. A birth cohort-related increase in mortality was detected: women born from 1916 onwards see their risk of MS mortality increase until it peaks in 1956, after which it decreases. A similar pattern is observed in men, albeit with a decade delay (from 1926 to 1966).

Conclusion

ASMR shows a steady increase in both sexes over the last decades, although it has been more intense in men. The decreasing birth cohort pattern for MS mortality in men born since the mid-1960s and women born since the mid-1950s is similar to APC analyses in other countries.

目的评估西班牙人群（1981-2020）多发性硬化症（MS）死亡率的时间趋势，考虑性别、年龄、时期和出生队列的独立影响。方法计算所需的死亡人数和人口数由国家统计局提供。采用结合点回归软件进行年龄标准化死亡率（ASMR）和趋势分析。使用美国国家癌症研究所基于网络的统计工具进行年龄-时期-队列（APC）分析，以探讨多发性硬化症死亡率的潜在原因。结果男性和女性的asmr均显著增高（分别为1.7%和1.2%）。结合点分析没有发现女性的趋势变化，但对于男性，它发现了第一个时期，发病率保持稳定(1981-2000；年百分比变化：- 0.7%，不显著)，然后是一段显著增长时期(2000-2020；2.6%, P <；. 05)。对于经期效应，自20世纪90年代初以来，在女性中观察到稳步增长，而在20世纪90年代末以来，在男性中观察到稳步增长。与出生队列相关的死亡率增加被发现：1916年以后出生的女性患多发性硬化症的死亡率增加，直到1956年达到顶峰，之后下降。在男性中也观察到类似的模式，尽管晚了十年（从1926年到1966年）。结论：在过去的几十年里，asmr在两性中都有稳定的增长，尽管在男性中更为强烈。60年代中期以后出生的男性和50年代中期以后出生的女性的MS死亡率下降的出生队列模式与其他国家的APC分析相似。

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引用次数: 0

Effectiveness of the intrathecal baclofen pump in the treatment of spasticity of different aetiologies: A systematic review and meta-analysis 鞘内巴氯芬泵治疗不同病因痉挛的有效性：系统回顾和荟萃分析

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-07-01 DOI: 10.1016/j.nrl.2023.06.007

I. Otero-Luis , A. Saz-Lara , I. Cavero-Redondo , C. Pascual-Morena , I. Martínez-García , S. Nuñez de Arenas-Arroyo

Objective

To analyze the effectiveness of intrathecal baclofen in the treatment of spasticity of different aetiologies in the upper limbs, lower limbs, and both children and adults.

Design

Meta-analysis.

Subjects/Patients

People with spasticity of different aetiologies in treatment with intrathecal baclofen.

Methods

A systematic search was performed in the PubMed, Scopus, Cochrane Library, and Web of Science databases with the earliest data available up to November 1, 2022. Random-effects models were used to calculate pooled mean difference estimates and their respective 95% CIs to assess the effectiveness of intrathecal baclofen treatment on spasticity of different aetiologies using the modified Ashworth scale. All statistical analyses were performed with STATA 15 software.

Results

Finally, 11 studies were included in the meta-analysis. The effect of baclofen treatment administered by an intrathecal pump on spasticity measured by the modified Ashworth scale led to a significant decrease in spasticity in both adults (MD: −1.54; 95% CI: −1.80, −1.27) and children (MD: −0.70; 95% CI: −0.91, −0.49), with greater effectiveness for lower limb spasticity (MD: −1.45; 95% CI: −1.93, −0.97). The results should be interpreted with caution since there is heterogeneity due to differences between populations (age or types of diseases).

Conclusion

These findings are important for clinical practice, as they demonstrate the efficacy of intrathecal baclofen in treatment of spasticity, thus improving patient quality of life, being more effective at a younger age and longer duration of treatment, always taking into account statistical limitations.

目的分析鞘内注射巴氯芬治疗上肢、下肢及儿童和成人不同病因痉挛的疗效。不同病因的痉挛患者使用鞘内巴氯芬治疗。方法系统检索PubMed、Scopus、Cochrane Library和Web of Science数据库，检索到2022年11月1日的最早数据。采用随机效应模型计算汇总均差估计值及其各自的95% ci，采用改良Ashworth量表评估鞘内巴氯芬治疗不同病因痉挛的有效性。所有统计分析均采用STATA 15软件进行。结果最终有11项研究被纳入meta分析。经鞘内泵给予巴氯芬治疗对经改良Ashworth量表测量的痉挛的影响导致两名成人的痉挛显著降低(MD: - 1.54；95% CI: - 1.80, - 1.27)和儿童(MD: - 0.70；95% CI: - 0.91, - 0.49)，对下肢痉挛更有效(MD: - 1.45；95% ci:−1.93,−0.97)。由于人群之间的差异（年龄或疾病类型），结果存在异质性，因此应谨慎解释。结论这些发现对临床实践具有重要意义，因为它们证明了鞘内巴氯芬治疗痉挛的有效性，从而改善了患者的生活质量，在考虑到统计局限性的情况下，更年轻、更长的治疗时间更有效。

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引用次数: 0

The sensitive Amnesia Light and Brief Assessment (ALBA) is a valid 3-min test of 4 tasks indicative of mild cognitive deficits 灵敏遗忘轻与短暂评估（ALBA）是一种有效的3分钟4个任务的测试，表明轻度认知缺陷

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-07-01 DOI: 10.1016/j.nrl.2023.02.007

A. Bartos , S. Diondet

Background and purpose

We report the development and validation of a unique, easily administered, but cognitively demanding 3-min test that does not require aids and can detect mild cognitive deficits (MCD).

Methods

The innovative Amnesia Light and Brief Assessment (ALBA) consists of 4 tasks: encoding the 6-word sentence “Indian summer brings first morning frost,” sequential demonstration of 6 gestures and their immediate recall, and final recall of the original sentence. The memory ALBA score is the sum of all correctly recalled sentence words and gestures. The ALBA was performed in 590 persons older than 50 years, including 60 individuals who completed a neuropsychological battery, equally divided into patients with MCD (Montreal Cognitive Assessment [MoCA] score of 21 ± 3 points) and matched cognitively normal (CN) individuals (MoCA of 27 ± 2).

Results

Compared to CN individuals, the patients with MCD recalled fewer correct sentence words (median, 5 vs 2) and gestures (4 vs 3), and had lower memory ALBA scores (10 vs 6) (all comparisons, P < .00001). The cut-off point for the memory ALBA score was ≤8, with 90% sensitivity, 77% specificity, and an AUC of 0.90. Memory ALBA score correlated significantly with all neuropsychological tests except the Digit Span forward. The ALBA was minimally associated with education and age in the normative sample.

Conclusions

The novel and efficient ALBA test was confirmed to have high discriminant and convergent validity, even in patients with mild cognitive deficits. The ALBA is an ultra-brief and universal cognitive test suitable for assessing cognitive impairment, dementia, and other conditions. It can easily be adapted to other cultures and administered under various conditions and settings in clinical practice and research.

背景和目的我们报告了一种独特的，易于管理的，但对认知要求高的3分钟测试的开发和验证，该测试不需要辅助，可以检测轻度认知缺陷（MCD）。方法创新的遗忘轻简评估（ALBA）由4个任务组成：对6个单词的句子“印度的夏天带来了第一个早晨的霜冻”进行编码，顺序演示6个手势及其即时记忆，最后回忆原句子。记忆ALBA分数是所有正确回忆的句子、单词和手势的总和。在590名50岁以上的老年人中进行了ALBA，其中60人完成了神经心理学测试，平均分为MCD患者（蒙特利尔认知评估[MoCA]评分21±3分）和匹配的认知正常（CN）患者（MoCA评分27±2分）。结果与CN个体相比，MCD患者回忆起的正确句子单词（中位数，5比2）和手势（中位数，4比3）较少，记忆ALBA评分（10比6）较低(所有比较，P <；.00001)。记忆ALBA评分的截止点≤8，灵敏度90%，特异性77%，AUC为0.90。记忆ALBA得分与除数字跨距外的所有神经心理测试均显著相关。在规范样本中，ALBA与教育程度和年龄的关系最小。结论ALBA测试具有较高的判别效度和收敛效度，适用于轻度认知障碍患者。ALBA是一种超简短和通用的认知测试，适用于评估认知障碍、痴呆和其他疾病。它可以很容易地适应其他培养，并在临床实践和研究中的各种条件和设置下进行管理。

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引用次数: 0

Angiopatía mineralizante: una causa de ictus arterial isquémico en la infancia temprana tras traumatismo craneoencefálico leve 矿化血管病：轻度脑外伤后儿童早期缺血性动脉中风的病因

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-06-01 DOI: 10.1016/j.nrl.2024.05.001

G. Prieto-Berchez , M.T. González-Campillo , J. Vicente-Rueda , E. López-Laso

Introduction

Mineralizing angiopathy of lenticulostriate arteries has been reported as etiology of acute arterial ischemic stroke of basal ganglia after minor head trauma, mostly in infants. Patients present with focal neurological deficit, commonly hemiparesis, minutes to hours after head trauma. Diagnostic clue is the finding of ischemic stroke of basal ganglia after minor head trauma together with basal ganglia calcifications.

Results

We present a 21-month-old infant with an acute right hemiparesis preceded by mild head trauma 8 hours before. Neuroimaging studies showed an ischemic stroke of left basal ganglia together with bilateral basal ganglia calcifications. Other ancillary studies were normal. The patient received treatment with acetylsalicylic acid for antiplatelet therapy. Prognosis was excellent, he recovered the focal neurological deficit, and no recurrences nor neurological sequelae were found after a 6 year follow-up.

Conclusions

A high index of suspicion is necessary to identify mineralizing angiopathy of lenticulostriate arteries as etiology of an acute arterial ischemic stroke of basal ganglia after minor head trauma in early infancy. Stroke recurrence is possible.

有报道称，小头部外伤后基底节区急性动脉缺血性脑卒中主要发生在婴儿身上。患者表现为局灶性神经功能缺损，通常为偏瘫，头部外伤后数分钟至数小时。诊断线索为轻微颅脑外伤后基底神经节缺血性脑卒中合并基底神经节钙化。结果我们报告了一个21个月大的婴儿，在8小时前出现急性右半瘫，并伴有轻度头部创伤。神经影像学研究显示左基底节区缺血性中风伴双侧基底节区钙化。其他辅助研究正常。患者给予乙酰水杨酸抗血小板治疗。患者预后良好，局灶性神经功能缺损恢复，随访6年无复发及神经系统后遗症。结论早期颅脑外伤后基底节区急性动脉缺血性脑卒中的病因应高度怀疑。中风有可能复发。

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引用次数: 0

Point-of-care ultrasound for transient ischemic attack assessment in transient ischemic attack clinics: Consensus document of the Spanish Society of Neurosonology 在短暂性脑缺血发作诊所，即时超声评估短暂性脑缺血发作：西班牙神经声学学会共识文件

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-06-01 DOI: 10.1016/j.nrl.2023.04.004

L. Amaya-Pascasio , J. Rodríguez-Pardo de Donlebún , A. Arjona-Padillo , J. Fernández-Domínguez , M. Martínez-Martínez , R. Muñoz-Arrondo , J.M. García-Sánchez , J. Pagola Pérez de la Blanca , J. Carneado-Ruiz , P. Martínez-Sánchez

In recent years, there has been increasing recognition of the benefits offered by rapid-access transient ischemic attack (TIA) clinics for the early assessment of patients with suspected TIA. These clinics, designed to deliver specialized diagnoses and treatments, play an important role in mitigating the risk of stroke recurrence. Most of these clinics benefit from using ultrasound diagnostic imaging conducted by qualified neurologists, which guides the treatment and management of TIA patients. This consensus document, developed by a working group from the Spanish Society of Neurosonology, introduces a novel concept for point-of-care ultrasound (POCUS), specifically focusing on optimizing the diagnostic process for TIA patients in the outpatient setting. The aim is to encourage experienced neurovascular clinicians to adopt a standardized, disease-oriented POCUS that can identify ultrasonographic findings related to the underlying cause of the TIA. Additionally, the document seeks to centralize the recommended diagnostic evaluations for TIA patients. By doing so, the goal is to optimize the diagnostic workup and subsequent treatment performed by the neurologist, fostering a more cohesive and effective approach to managing TIA cases.

近年来，人们越来越认识到快速访问短暂性脑缺血发作（TIA）诊所对疑似TIA患者的早期评估所提供的好处。这些诊所旨在提供专门的诊断和治疗，在降低中风复发风险方面发挥着重要作用。大多数这些诊所受益于由合格的神经科医生进行的超声诊断成像，这指导了TIA患者的治疗和管理。这份共识文件是由西班牙神经声学学会的一个工作组开发的，介绍了一种新的护理点超声（POCUS）概念，特别侧重于优化门诊TIA患者的诊断过程。目的是鼓励有经验的神经血管临床医生采用标准化的、以疾病为导向的POCUS，以识别与TIA潜在原因相关的超声检查结果。此外，该文件试图集中推荐TIA患者的诊断评估。通过这样做，目标是优化神经科医生的诊断检查和后续治疗，培养一种更有凝聚力和有效的方法来管理TIA病例。

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引用次数: 0

Prevalence of multiple sclerosis in Spain. Estimates from the Primary Care Clinical Database (BDCAP) 西班牙多发性硬化症患病率。来自初级保健临床数据库（BDCAP）的估计

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-06-01 DOI: 10.1016/j.nrl.2023.06.006

L. Cayuela , C. García-Muñoz , S. Sainz de la Maza , A. Cayuela

Introduction

The global prevalence of multiple sclerosis (MS) has increased in recent decades. However, there is a need for updated prevalence data for Spain.

Objective

To analyze the prevalence of MS in Spain using data from the Primary Care Clinical Database (BDCAP, for its Spanish initials) and to compare the prevalence results in different autonomous communities (AC) according to sex in 2021.

Methods

This cross-sectional study extracted data from the BDCAP on patients with MS according to sex, age, and place of residence in 2021. Crude prevalence rates were calculated, using the population assigned for each year of the study as the denominator. The geographic pattern of MS prevalence was analyzed using the following risk estimators: standardized prevalence ratio, smoothed relative risk (RR), and posterior probability of RR >1.

Results

We estimated 61 753 cases of MS, with a crude estimated prevalence rate of 132.0 cases per 100 000 person-years and a female/male ratio of 2.0. The age-standardized prevalence rate was 123.5 cases per 100 000 person-years. Age-specific prevalence rates were lower in men than in women. All indicators showed a north-south gradient. Seven ACs for women and 5 ACs for men showed a significant excess risk (primarily in the north of Spain), whereas 8 ACs for both women and men presented lower risk (mainly in the south).

Conclusions

Our results provide the most recent prevalence data for MS and the geographic patterns at the ACs level in Spain, revealing a north-south gradient. Our results pave the way for future strategies to manage the impact of MS in Spain and to understand causal hypotheses.

近几十年来，多发性硬化症（MS）的全球患病率有所上升。然而，需要更新西班牙的流行率数据。目的利用西班牙初级保健临床数据库（Primary Care Clinical Database， BDCAP）的数据分析西班牙MS的患病率，并比较2021年不同性别自治区（AC） MS的患病率结果。方法：本横断面研究根据性别、年龄和居住地提取2021年MS患者BDCAP数据。计算粗患病率，使用分配给研究的每一年的人口作为分母。使用以下风险估计值分析MS患病率的地理分布：标准化患病率、平滑相对风险（RR）和RR >；1的后验概率。结果我们估计了61 753例MS，粗略估计患病率为每10万人年132.0例，男女比为2.0。年龄标准化患病率为每10万人年123.5例。男性按年龄划分的患病率低于女性。所有指标都显示出南北梯度。女性有7例ACs，男性有5例ACs，显示出明显的过度风险（主要在西班牙北部），而女性和男性都有8例ACs，风险较低（主要在南部）。结论sour结果提供了西班牙ACs水平MS的最新患病率数据和地理分布，呈现南北梯度。我们的结果为未来管理西班牙MS影响的策略和理解因果假设铺平了道路。

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引用次数: 0

Validation of the American-Spanish Oxford Cognitive Screen (OCS-Sp): Normative data and psychometric properties in acute stroke patients 美国-西班牙牛津认知筛查（OCS-Sp）的验证：急性中风患者的标准数据和心理测量特性

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-06-01 DOI: 10.1016/j.nrl.2023.04.005

T. Julio-Ramos , C. Foncea-Gonzalez , C. Farias-Ulloa , S. Inostroza-Rojas , J. Conejeros-Pavez , D. Gutierrez-Vasquez , B. Soler-Leon , J. Saez-Martinez , P. Solinas-Ivys , N. Demeyere , S. Martinez-Ferreiro , C. Mendez-Orellana

Introduction

Cognitive impairment is a typical sequel and a solid long-term disability predictor that can be screened at early stages post-stroke. However, most routinely used cognitive screening tools were designed to detect dementia, which differs significantly from post-stroke cognitive impairment, including focal cognitive deficits. The Oxford Cognitive Screen (OCS), a cognitive bedside screening tool specifically designed for acute stroke, provides a good alternative for clinical practice.

Aim

This study aims at validating an American-Spanish version of the OCS (OCS-Sp) in healthy participants and acute stroke patients.

Methods

The original version of the OCS was linguistically and culturally adapted into American Spanish. A total of 152 volunteers were recruited, 87 healthy controls and 65 acute stroke patients. Normative data analysis for determining cut-off scores and psychometric validation and reliability analyses in the stroke cohort were completed.

Results

Following a linear regression model demonstrating age, gender, and particularly years of education affecting the performance of the OCS-Sp, the cut-off scores obtained for all subtests were adjusted by these demographic variables. Logistic regression classification analyses revealed that all subtests could discriminate between patients and healthy volunteers. No differences in performance between versions A and B of the test (p > 0.05) were found. The test–retest reliability results in patients showed high agreement between the scores obtained at both time points.

Conclusions

The OCS-Sp obtained similar psychometric scores to the original English version, demonstrating its validity and reliability as an instrument to assess cognitive impairments in American Spanish-speaking acute stroke patients.

认知障碍是脑卒中后典型的后遗症，也是一个可靠的长期残疾预测指标，可以在早期阶段进行筛查。然而，大多数常规使用的认知筛查工具被设计用于检测痴呆症，这与中风后的认知障碍（包括局灶性认知缺陷）有很大不同。牛津认知筛查（OCS）是一种专门为急性脑卒中设计的认知床边筛查工具，为临床实践提供了一个很好的选择。目的本研究旨在验证美国-西班牙版本的OCS （OCS- sp）在健康参与者和急性脑卒中患者中的应用。方法从语言和文化上对原始版本的美国西班牙语进行了改编。总共招募了152名志愿者，87名健康对照者和65名急性中风患者。完成了确定临界值的规范数据分析以及卒中队列的心理测量验证和信度分析。结果采用线性回归模型显示年龄、性别，特别是受教育年限对OCS-Sp成绩的影响，所有子测试的截止分数均通过这些人口统计学变量进行调整。逻辑回归分类分析显示，所有亚测试都可以区分患者和健康志愿者。测试的版本A和版本B之间的性能没有差异(p >；0.05)。患者的重测信度结果显示两个时间点的得分高度一致。结论OCS-Sp量表获得的心理测量分数与英文原版相似，证明了OCS-Sp量表作为评估美国西语急性脑卒中患者认知功能障碍的效度和可靠性。

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引用次数: 0

Dystonic head tremor and neurocysticercosis 张力性头震颤和神经囊虫病

IF 2.9 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia

Pub Date : 2025-06-01 DOI: 10.1016/j.nrl.2023.06.009

A. Kleebayoon , V. Wiwanitkit

引用次数: 0