Revista de neurologia最新文献

Background: Virtual reality (VR) generates a virtual environment with which one can interact as if it were real. In Stroke, which represents one of the highest causes of cognitive impairment in Europe, the use of VR in cognitive rehabilitation has been studied through the performance of different types of tasks, which could have different impacts. For this reason, the objective of this study was to review the use of VR tasks based exclusively on daily activities for the cognitive rehabilitation of people with stroke over 18 years of age.

Methods: A search was carried out of the databases PubMed, Web of Science, and Scopus, obtaining 531 articles that, after applying inclusion/exclusion criteria, were reduced to eight (six randomized clinical trials and two quasi-experimental studies).

Results: The number of positive results was higher than the number of negative results only in global cognitive function. In specific cognitive functions the number of positive results was lower than the negatives.

Conclusions: These results highlight the need to carry out more studies with larger samples to obtain robust results and conclusions. Furthermore, this study highlights the value of research in this topic due to the interesting lines of future research.

Introduction: The management of minor ischemic stroke presents significant challenges due to variability in the application of neuroimaging protocols and endovascular treatment (EVT). The lack of consensus on the need for computed tomography angiography (CTA) in these cases highlights the importance of investigating the prevalence and clinical implications of large vessel occlusion (LVO) in this population.

Methodology: Analysis of the multicenter CODICT registry in patients with minor ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) score ≤5) treated at tertiary stroke alert (SA) centers in the Valencian Community between July 1, 2020 and November 30, 2023. The frequency of LVO, defined as occlusions in the internal carotid artery, vertebral artery, basilar artery, and critical segments of the middle (M1, M2), anterior (A1, A2), and posterior (P1, P2) cerebral arteries, was evaluated using CTA.

Results: A total of 5473 SA activations were identified during the study period. A total of 833 patients suffered a minor ischemic stroke. LVO was observed in 17.5% (n = 146) of minor strokes on CTA. EVT was performed in 48.6% (n = 71) of patients with minor stroke and LVO. The most frequently occluded vessels were the middle cerebral artery (MCA) in its M1 and M2 segments, both in 35.6% (n = 52) of cases. However, the vessels most frequently treated with EVT were in the M1, in 29.5% (n = 43) of cases, followed by the M2, in 10.9% (n = 16) of cases.

Conclusions: This study highlights the importance of performing CTA in all patients who meet SA activation criteria, regardless of clinical severity. The presence of LVO changed the clinical management in almost half of the patients with minor stroke and LVO.

Introduction: Stroke has an enormous impact on society, both socially and economically. It is the most common cause of admission and prolonged stay in the Neurology ward.

Methods: We performed a cost-effectiveness analysis of stroke treatment in the Complejo Hospitalario de Santiago de Compostela, where patients are treated in a stroke unit. Firstly, an analysis of the costs of treatment in the stroke unit was carried out, which had not been done before. The costs were compared with those that would be incurred if the disease was treated without the stroke unit, verifying that the existence of such a unit implies an increase in treatment costs. Next, various parameters reflecting the efficacy of the treatment were analyzed to finally perform a cost-effectiveness analysis in order to determine whether the increase in costs is justified by an improvement in outcomes.

Results: Stroke treatment in the centralized stroke unit would be cost-effective if we use mortality during hospitalization or 3 months after discharge, the mRS parameter at discharge or 3 months after discharge, and severe disability at discharge as measures of effectiveness.

Conclusion: The increased costs of a stroke unit are justified by the improved health of the patients.

Background: Spinal muscular atrophy (SMA) is a neurodegenerative disease in which there has been an increase in survival over the past decade due to proactive, multidisciplinary management and the emergence of disease-modifying therapies. Despite this, there are still several critical challenges that significantly impact the quality of life of individuals with SMA individuals. Given the need to better understand the reality of this disease, Fundación de Atrofia Muscular Espinal (FundAME) created a patient registry (RegistrAME).

Methods: RegistrAME is a longitudinal prospective study that collects clinical data and patient-reported outcomes.

Results: The registry included 336 individuals, 51.8% of whom were over 16 years old. Most adult subpopulations were classed as type 2 (49.4%) or type 3 (44.8%). Regarding functional status, 19% walked (39.4% used wheelchairs), 46.6% sat without support (84% needed help to sit), and 34.5% were non-sitters. Furthermore, 24.7% reported having no useful function in their hands or not being able to reach their mouths with their hands. Our study indicates that the adult SMA population is progressively accessing disease-modifier treatments. However, 21.8% of the population is still untreated.

Conclusions: These results provide evidence of a progressive impairment and increased sensitivity to treatment discontinuations in the SMA adult population, along with delayed or reduced access to commercialised SMA drugs and clinical trials. A more rigorous evaluation of the disease's impact and treatment benefits in the adult SMA population is necessary.

Introduction Monoclonal antibodies against calcitonin gene-related peptide (CGRP) have revolutionized migraine treatment, though one-third of patients do not respond to these medications. One of the emergent reasons for this apparent lack of response could be a wearing-off effect, as the case of our patient illustrates. Clinical Case A woman aged 36 years with the diagnosis of migraine with aura since childhood, which transforms to chronic migraine and daily headache, with analgesic overuse for the past 5 years. She failed to respond to multiple oral preventatives, botulinum toxin, and two CGRP antibodies (erenumab and galcanezumab). After initiating quarterly eptinezumab, she noticed a relevant improvement in the number of headache days per month for the first 8 weeks but experienced a clear wearing-off effect during the third month of treatment, for two consecutive treatments. We altered administration to every 8 weeks, which better controlled her migraine frequency. Conclusions CGRP antibodies can show a wearing-off effect, which should be identified in order to plan individualized treatment and avoid an incorrect interpretation as therapeutic failure. Our case also shows that patients with chronic migraine refractory to two antibodies can respond to a third CGRP antibody, in this case, intravenous eptinezumab.

In epidemiology, the relative frequency of a disease is expressed as the proportion of individuals affected, typically expressed as a percentage, or per thousand individuals. Another important measure is the odds, which represents the ratio of affected individuals to unaffected individuals, calculated by dividing by the proportion of affected individuals by the proportion of unaffected individuals. To assess whether a specific factor increases or decreases the risk of disease, researchers compare the proportion of affected individuals in an exposed group (where the factor is present) with an unexposed group (where the factor is absent). This comparison can be quantified using three key measures: Risk Difference (RD): The absolute difference in disease risk between the exposed and unexposed groups. Relative Risk (RR): The ratio of disease risk in the exposed group to that in the unexposed group. Odds Ratio (OR): The ratio of the odds of disease in the exposed group to the odds in the unexposed group. While risk reflects the proportion of individuals affected within a population, odds represent the ratio of affected to unaffected individuals. The OR is particularly useful in case-control studies because it can approximate the RR when diseases are rare, providing valuable insights even when direct risk calculations are not feasible.

Abusive head trauma (AHT), commonly known as "shaken infant syndrome" is a severe form of child abuse characterized by the triad of acute encephalopathy, retinal hemorrhages, and cerebral hemorrhage, leading to high mortality and neurological complications. Many caregivers are unaware of the risks associated with shaking an infant, making prevention efforts essential. Our center observed an increase in AHT cases from late 2021 to early 2022, prompting the creation of a regional prevention campaign. This initiative introduced a scannable quick response (QR) code linking easily accessible educational materials on AHT prevention and parenting resources that promote safer caregiving practices.

Introduction: Autoimmune encephalitis (AE) represents a severe neuropsychiatric disorder that requires early diagnosis. This study describes the frequency, clinical characteristics, and paraclinical findings in patients with possible autoimmune encephalitis treated in a neurological emergency department, as well as factors associated with poor functional prognosis at discharge.

Material and methods: This was an observational ambispective cohort study including patients diagnosed with AE who were treated in a neurological emergency department in 2022. Demographic, clinical, and paraclinical characteristics were evaluated, along with functional outcomes using the modified Rankin scale (mRS); ≤2 points, was considered as good prognosis. In the statistical analysis we used the chi-squared test, Fisher's exact test, Student's T-test, and Mann-Whitney U test.

Results: Out of 9046 patients, 31 (0.3%) met the criteria for probable autoimmune encephalitis (PAE). The average age was 28.4 ± 12.1 years and 51.6% were female. Cognitive alterations (90.3%), psychosis (74.2%), abnormal movements (71%), catatonia (67.7%), seizures/status epilepticus (64.5%, 19.4%), and dysautonomia (58.1%) were observed; 58.1% had a good functional prognosis. Factors associated with poor prognosis included older age (24.8 ± 5.0 vs. 33.4 ± 16.8, p = 0.049), status epilepticus (0% vs. 46.2%, p = 0.002), and lower frequency of headache (61.1% vs. 15.4%, p = 0.025).

Conclusions: AE represents a rare diagnosis even in a neurological emergency center; older age, status epilepticus and absence of headache were associated with poor functional prognosis at discharge.