Revista de neurologia最新文献

Introduction: The XVII edition of the post-European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting was held on 4-5 October 2024 in Madrid. This event was attended by Spanish neurologists specialized in multiple sclerosis (MS), who presented a summary of the most relevant advances discussed at the ECTRIMS congress, held days before in Copenhagen.

Aim: To present new developments in neurodegeneration and progression, the prodromal phase and diagnosis, the clinical use of biomarkers and neuroimaging, as well as the current role of patient-reported outcomes and digital monitoring. Highlights on the risk of infections and comorbidities in MS are also summarized. Content and Conclusions: In active MS lesions, there is no correlation between the myeloid cell phenotype and remyelination, while memory astrocytes, regulated by the CLEC16A gene, are present in chronic active lesions. Gray matter atrophy is associated with disability and progression independent of relapses, whereas cervical spinal cord atrophy predicts the prognosis of progressive forms and may lead to earlier diagnosis. Healthcare resource utilization increases in the years preceding the first demyelinating event, and although prodromal symptoms are highly variable, they are useful in identifying risk factors for the disease. The new McDonald criteria will facilitate the diagnosis of MS in patients with a radiologically isolated syndrome. Glial fibrillary acidic protein complements neurofilaments, and both biomarkers could soon be standardized for use in clinical practice; paramagnetic rim lesions and slowly expanding lesions are promising imaging markers. In another area, patient-reported health outcomes are valuable, although they are subject to selection bias and the need to define boundaries for their use. Finally, the risk of infections increases before diagnosis and may worsen with certain treatments. Comorbidities in MS should be managed as an integral part of disease management.

Introduction: The XVII edition of the post-European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting was held on 4-5 October 2024 in Madrid. This event was attended by Spanish neurologists specialized in multiple sclerosis (MS), who presented a summary of the most relevant advances discussed at the ECTRIMS congress, held days before in Copenhagen.

Aim: To summarize the main new findings in clinical research on MS. Content and Conclusions: The immunological changes throughout life and in response to MS treatments were analyzed. The impact of aging was also discussed, along with new developments related to symptomatic treatments, physical exercise, fatigue, and sleep disorders. Emphasis was placed on addressing ongoing challenges in measuring therapeutic failure and managing treatments for secondary progressive MS. Additionally, data from registries and real-world studies were presented, including new analyses on cladribine, highlighting the need to collect safety information. Regarding immune reconstitution therapies, mechanisms of action and the immune system's reconstitution process after treatment were explored. Finally, regarding therapeutic innovations, the first results from chimeric antigen receptor (CAR)-T cell therapy studies in MS were reported, representing a promising advancement in disease management.

Background: Persistent intracranial hypertension (ICH) is a difficulty that must frequently be faced in the neuro- intensive care unit (ICU). The management of ICH is quite varied, and the choice of measures is determined by the experience of attending doctors. We aimed to evaluate the efficacy of different intervention measures in treating non-traumatic persistent ICH.

Methods: A total of 119 non-traumatic intracranial hypertension cases treated in the neuro-ICU of the PLA General Hospital between 2010 and 2023 were retrospectively reviewed. Patients were divided into five groups according to the methods for controlling intracranial pressure (ICP). Based on the records of ICP, biochemical indicators, general status, and prognosis of patients in each group, the differences between groups and the differences within groups before and after intervention were compared. Repeated measures data of multiple groups were analyzed using generalized estimating equation (GEE) methods.

Results: External ventricular drain (EVD), lumbar drainage (LD) and Ommaya reservoir (OR) had advantages in reducing ICP compared with the drug therapy alone (DT) group. Among them, the Ommaya reservoir exhibited optimal efficacy. Intervention with repeated lumbar puncture (LP) and the Ommaya reservoir effectively improved the general state of patients, evidenced by decreased mRS scores. The median creatinine value in the OR group decreased significantly at three months, suggesting that this method can moderate the renal burden. The OR group had the lowest probability of electrolyte imbalances and renal function damage, while the LD and EVD groups had a higher probability of pulmonary infection.

Conclusions: The Ommaya reservoir is an effective and safe means of controlling ICP and thus has great potential in treating non-traumatic persistent ICH.

Purpose: Surgical revascularization is the preferred treatment for most patients with Moyamoya disease (MMD). Nevertheless, a considerable number of eligible patients choose non-surgical management. This study aimed to identify factors influencing treatment decisions, with particular emphasis on asymptomatic MMD patients.

Materials and methods: We conducted a retrospective analysis of MMD patients without surgical contraindications treated at our center between 2010 and 2022. Baseline characteristics were compared using Wilcoxon rank-sum and chi-squared tests. Multivariable logistic regression was used to identify factors associated with treatment selection.

Results: Among the 147 included patients, 62.6% underwent surgical treatment. Younger age (OR = 0.88, 95% CI: 0.88-0.94, p < 0.001), married status (OR = 653.3, 95% CI: 41.61-10,264.22, p < 0.001), and absence of hyperlipidemia (OR = 0.16, 95% CI: 0.03-0.85, p < 0.05) were significantly associated with choosing surgery. Asymptomatic patients underwent surgery at a higher rate than symptomatic patients (67.9% vs. 59.6%). Younger age was a significant predictor of surgical preference in both symptomatic and asymptomatic subgroups.

Conclusion: Younger age is strongly associated with the choice of surgical treatment in MMD, including in asymptomatic cases.

Objective: Existing research on the link between Life's Essential 8 (LE8) and the risk of Parkinson's disease (PD) remains limited. This study aimed to elucidate how LE8 relates to PD risk among USA adults aged 40 and above.

Methods: Data were derived from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Propensity score matching (PSM) was employed to control for selection bias. Multivariable logistic regression was applied to assess the association between LE8 and PD prevalence, while restricted cubic spline (RCS) modeling was adopted to explore potential relationships. Additionally, subgroup analyses were conducted to further examine the connection between LE8 and PD.

Results: A total of 18,270 participants were included, among whom 259 reported having PD. An inverse association was observed between LE8 and PD. Prior to matching, the odds ratio (OR) for per 1 point increase in LE8 was 0.98, and 0.97 after matching. Compared with individuals with low LE8 scores (<50), those with moderate scores (50-79) had a PD OR of 0.62 before matching and 0.52 after matching. Participants with high LE8 scores (≥80) observed a PD OR of 0.43 prior to matching and 0.32 post-matching. RCS curves suggested a non-linear inverse trend. Subgroup analyses revealed a consistent inverse association between LE8 scores and PD risk across the majority of strata.

Conclusion: Among adults aged 40 and older, LE8 was inversely correlated with PD prevalence. Given the cross-sectional design, causal relationships cannot be inferred; however, the findings suggest that lifestyle modifications may aid in PD prevention and warrant further investigation in prospective studies.

Objective: To evaluate the feasibility of plaque-based radiomics extracted from high-resolution magnetic resonance imaging (HR-MRI) data for assessing the short-term outcomes of endovascular treatment in patients with symptomatic intracranial artery stenosis.

Methods: HR-MRI was performed on patients with symptomatic intracranial artery stenosis. Plaque-based radiomics describing the morphological features and pixel value of the image were extracted from the HR-MRI data. Demographic features were also collected. The short-term favorable outcome was defined by a postoperative residual stenosis rate <35% with the absence of perioperative complications. Univariate analysis was conducted to identify features associated with favorable outcomes. Based on the results of this analysis, a prediction model was developed using logistic regression. The performance of both clinical and radiomic models was evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC).

Results: From January 2022 to December 2023, 42 consecutive patients with symptomatic intracranial artery stenosis were enrolled. Digital subtraction angiography (DSA) revealed a more than 70% stenosis rate in these patients. The stents were implemented in all 42 patients; 21 (50%) of these were male, and the mean age of all patients was 52.74 ± 13.02 years. Thirty-five patients (83.33%) had impaired sensory or motor function of the limbs. In the univariate analysis, 11 morphologic or first-order radiomics features and five clinical features were initially identified as potentially associated with short-term favorable outcomes. Logistic multivariate analysis further indicated that shape-flatness (p = 0.04, Odd ratio (OR) = 169.02, 95% CI: 1.30-22,026.5) and first-order-minimum (p = 0.02, OR = 94.63, 95% CI: 1.93-4592.5) might be independently related to post-stenting outcomes. A prediction model constructed based on the above morphologic and first-order features showed an AUC of 0.82 in this small cohort.

Conclusion: Plaque-based radiomic features, which describe the shape and voxel characteristics extracted from HR-MRI data, are associated with the short-term outcomes of patients treated with stent implementation.

Introduction: Migraine diagnosis relies on clinical criteria that encompass various pain features and associated symptoms, which can vary widely across patients. The aim of this study was to analyze the potential association between sociodemographic factors and the characteristics of migraine attacks.

Methods: We conducted an observational longitudinal study with prospective and real-time data collection using a custom-designed smartphone application. Clinical features and accompanying symptoms of each attack were recorded.

Results: A total of 377 migraine attacks from 51 patients were analyzed. Headache intensity was higher in women (p = 0.038), in those with lower cognitive reserve (p = 0.049), and in patients with higher Headache Impact Test-6 (HIT-6) scores (p = 0.020). Hemicranial pain was more common in patients with a longer disease duration (p = 0.028) and female sex was associated with a higher frequency of nausea (p = 0.034).

Conclusions: Prospective and real-time recording of migraine attacks provides added value by more accurately capturing their clinical variability. Our findings suggest that sociodemographic variables influence attack characteristics, supporting the need for more personalized therapeutic approaches.

Intracerebral hemorrhage (ICH) is a devastating stroke subtype with high morbidity and mortality. Beyond primary injury from blood extravasation, secondary injury driven by erythrocyte lysis and its toxic degradation products exacerbates inflammation, oxidative stress, and neuronal damage. Accelerating endogenous hematoma resolution, including the removal of erythrocytes and their byproducts, represents a promising therapeutic strategy. This review systematically delineates three key mechanisms of hematoma resolution post-ICH: (1) erythrophagocytosis by microglia/macrophages through Tyro3, Axl, and Mertk (TAM) receptors, the cluster of differentiation (CD) 36 receptor, the triggering receptor expressed on myeloid cells 2, and the signal regulatory protein α receptor; (2) clearance of hemolytic products through the hemoglobin-haptoglobin-CD163 and hemin-hemopexin-CD91 axes; and (3) glymphatic and meningeal lymphatic drainage. Pharmacological, genetic, and physical interventions targeting these pathways have demonstrated potential to enhance phagocytosis, promote glymphatic and meningeal lymphatic function, accelerate hematoma resolution, and improve neurological outcomes in ICH models. By leveraging the intrinsic clearance mechanisms of the intracerebral hematoma, this review highlights promising therapeutic targets and strategies to overcome current clinical limitations and demonstrates significant translational potential.