Revue neurologique最新文献

Objective: To develop standardized benchmarks for evaluating endovascular treatment of ischemic stroke by analyzing treatment efficacy and safety. This allows the comparison of new techniques and devices with solid standards and quality control.

Materials and methods: We conducted a systematic review and meta-analysis of randomized controlled trials from the MEDLINE, OVID, and Cochrane databases from January 2015 (MRCLEAN trial published date) to June 2025, focusing on predefined clinical outcomes. After applying the inclusion and exclusion criteria, 35 studies were included from the initial search of 1949 (1.8%). The benchmarks selected were modified treatment for ischemic cerebral infarction (mTICI)≥2b, modified Rankin Scale (mRS)≤2, symptomatic hemorrhagic transformation rate, and death rate. According to concept of confidence of interval (CI) 95%, everything that falls outside the border is defined as statistically significant.

Results: The I² rages from 61.6% to 93.86%. The mTICI≥2b rate was 75.5% (95% CI: 75.7 to 81.5), the mRS≤2 was 43.5% (95% CI: 40.0 to 47.2), with a symptomatic hemorrhagic transformation rate of 5.4% (95% CI: 4.5 to 6.4), and a death rate of 18.4% (95% CI: 16.2 to 20.8) at three months. Subgroup analysis suggest trend in favour of higher mTICI≥2b rate intra-arterial thrombolysis+MT vs. MT. The mRS≤2 rate was lower in the large core trial and higher in the intra-arterial thrombolysis+MT.

Conclusion: The derived benchmarks served as reference standards for assessing new endovascular treatments and quality control. This methodology enhances the quality of evidence, aids in clinical decision-making, and fosters advancements in treatment technologies.

Background: Since 2005, the standard treatment for newly diagnosed glioblastoma involves radiotherapy combined with concomitant and adjuvant temozolomide (TMZ), as per the Stupp protocol. A known long-term complication of radiotherapy is Radiation-Induced Leukoencephalopathy (RIL), characterized by diffuse FLAIR-hyperintensities and cortico-subcortical brain atrophy, often leading to cognitive, balance and urinary impairments. While RIL has been typically described years after treatment in long survivors, there is little information regarding early-onset RIL (<6 months) and its potential risk factors.

Objective: This ancillary study aims to assess the incidence of early-onset RIL in glioblastoma patients treated within the ASTER phase III trial. Additionally, we explored potential risk factors, including genetic susceptibility, and evaluate whether Losartan, a PPARγ agonist, reduces early RIL incidence.

Methods: We conducted a retrospective analysis of data from the ASTER trial, a randomized, placebo-controlled phase III study evaluating the effects of Losartan on corticosteroid needs in glioblastoma patients receiving standard radiotherapy with concomitant TMZ. Patients were included if they had MRI scans available at baseline and six months post-treatment, with no evidence of tumor progression. Early-onset RIL was defined as an increase of at least two points on the simplified Scheltens rating scale, with associated cortical-subcortical atrophy. Genetic testing focused on the PPARγ germline SNP rs2120825. Statistical analyses included univariate comparisons of clinical and genetic variables.

Results: Among the 31 patients included, 29% (n=9) developed early-onset RIL. No significant associations were found between early RIL and known risk factors such as smoking (P=0.43), hypertension (P=0.12), age (P=0.067), or PPARγ TG polymorphism (P=0.68). Similarly, Losartan administration (100mg/day) showed no significant effect on prevention of early RIL (P=0.72). The limited power of the study may explain the lack of significant findings.

Conclusion: This study reports a high incidence (29%) of early-onset RIL in glioblastoma patients treated with the Stupp protocol, highlighting the question of individual sensitivity to this severe side effect. While previous research suggests a role for PPARγ in radiation-induced toxicity, this study was underpowered to confirm whether Losartan, as PPARγ agonist, could offer protection against early-onset RIL. The lack of significant results underscores the need for larger, prospective trials to further investigate these factors and develop targeted preventive strategies.

Background and objectives: The Montreal Cognitive Assessment has been recommended by the Movement Disorder Society (MDS) for screening cognitive disorders in Parkinson's disease (PD), although validations of language variants are required. This study aimed to determine the reliability and validity of the Vietnamese Montreal Cognitive Assessment (MoCA-V) in Vietnamese PD patients.

Methods: PD patients from a movement disorder clinic at a tertiary hospital in Vietnam were recruited. Participants underwent the MoCA-V and Mini-Mental State Examination (MMSE) assessments. Patients were classified into three cognitive groups: dementia, mild cognitive impairment (MCI), and normal cognition (NC), based on the MDS diagnostic criteria. The reliability of the MoCA-V was determined through internal consistency and test-retest reliability. Validity was assessed through concurrent validity, convergent validity, and criterion validity. Exploratory analysis of diagnostic accuracy was performed as a secondary objective.

Results: Among 40 PD patients (dementia: 37.5%, MCI: 52.5%, NC: 10.0%), the MoCA-V demonstrated good internal consistency (Cronbach's alpha=0.83; 95% confidence interval [0.74-0.90]) and high test-retest reliability (total score's intraclass correlation coefficient=0.84 [0.69-0.92]; P<0.001). The total score showed strong correlations with the patient's cognitive status (Kendall's tau-b=0.63; P<0.001) and the MMSE total score (Spearman's rho=0.86; P<0.001), indicating high concurrent and convergent validity. The scale's criterion validity in discriminating cognitive impairment (including dementia and MCI) from NC and dementia from non-dementia was high (area under the curve [AUC]=0.98) and moderate (AUC=0.88), respectively. Notably, the MoCA-V demonstrated superior sensitivity compared to the MMSE in differentiating cognitive impairment from NC.

Conclusions: The MoCA-V is a reliable and valid instrument for cognitive assessment in Vietnamese PD patients across all PD stages, with superior sensitivity to the MMSE for detection of cognitive impairment.

Background: To analyze the clinical, radiological, therapeutic, and clinical outcomes of the leukodystrophy-like phenotype in neuropsychiatric systemic lupus erythematosus (NPSLE).

Methods: We conducted this systematic review following the Preferred Report Items for Systematic Review and Meta-analysis (PRISMA). We searched Pubmed, Embase, and Web of Science databases for articles published until May 31, 2025, using the terms "systemic lupus erythematosus" AND ("diffuse white matter lesions" OR "leukoencephalopathy" OR "leukodystrophies"). Additionally, we report five patients with leukodystrophy-like phenotype in early-onset NPSLE.

Results: Thirty-three cases were reviewed. The mean age was 36.9±14.9years, and 28 (84.8%) were female patients. A previous diagnosis of SLE was present in 66% of cases. The main neurological symptoms included headache (33.3%), seizures (15.1%), and consciousness disturbances (15.1%). Among the 17 patients with cerebrospinal fluid (CSF) abnormalities, elevated protein levels were observed in 11 (40.7%) cases, and pleocytosis in 6 (22.2%). MRI findings were reported in 31 patients, typically showing cerebral white matter lesions characterized by hyperintense areas with T2-weighted or fluid-attenuated inversion recovery (FLAIR) sequences. Most patients were treated with high-dose corticosteroid pulse therapy (22/32), while others received cyclophosphamide pulses (18/32), therapeutic plasma exchange (PLEX) (4/32), or rituximab (6/32). Overall, the therapeutic response was satisfactory, with clinical improvement in 23 out of 33 patients.

Conclusion: In light of the severe clinical presentation of the leukodystrophy-like phenotype in NPSLE, early diagnosis and aggressive treatment are crucial for successful outcomes, as suggested by our review, which reported clinical improvement in 70% of patients. Future prospective studies are needed to confirm these findings.

Background: Parkinson's disease (PD) patients often report seeing persons or animals rather than objects but this phenomenon remains poorly understood. Here, we use three experimental tasks to confirm such observation and to explore its cognitive mechanisms.

Method: Fourteen PD patients with visual hallucinations (PD-VH), 14 PD patients without visual hallucinations (PD-NVH) and 14 controls with similar cognitive performance were tested using ambiguous stimuli. Ambiguous stimuli were morphs in which visual features from faces and flowers were melted together (Experiments 1 and 2) and a black and white picture where a Dalmatian dog was hidden (Experiment 3). In Experiment 1, participants categorised ambiguous stimuli either as face or flower. In Experiment 2, they were shown an ambiguous stimulus, then a mask, and finally two ambiguous stimuli, one of which was identical to the first stimulus. In this discrimination task, participants chose which of the two last stimuli had been presented before. In Experiment 3, participants guessed the items hidden in the picture. We assessed group differences for categorisation with logistic modelling and computed sensitivity index and criterion psychophysical measures in Experiments 1 and 2. The ratio of living beings identified in the Dalmatian dog task was compared across groups.

Results: In the categorisation task, the PD-VH group tended to use a smaller proportion of visual features (point of subjective equality [PSE]=41.5%) to label a stimulus as Face compared to PD-NVH (51%) and controls (56.2%). In the discrimination task, criterion c was lower in the PD-VH group compared to controls (c: -0.16 vs. 0.27; P=0.005). In the Dalmatian dog task, the PD-VH group reported seeing livings beings more frequently than controls (P=0.040). A bias towards living beings was confirmed in the PD-VH group in the three tasks, and a bias toward non-living beings was measured in controls in the discrimination task.

Interpretation: Observing that controls exhibited bias toward non-living beings in the discrimination task, we suggest that impaired top-down control over perception processes explains the bias toward living beings in PD-VH visual misperceptions.