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Impulse control disorder: Review on clinical, pharmacologic, and genetic risk factors 冲动控制障碍:回顾临床、药物和遗传风险因素。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.07.001
V. Leclercq , J.-C. Corvol

Introduction

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms, among which impulse control disorders behaviors (ICD) emerge as significant non-motor manifestations. ICD in PD patients, including pathological gambling, hypersexuality, compulsive buying, among others, lead to considerable impairment and reduced quality of life. This review aims to explore the multifaceted risk factors associated with ICD in PD patients, including clinical, pharmacological, and genetic aspects, to enhance early identification, prevention, and management strategies.

Methods

A comprehensive review of literature was conducted to identify studies investigating risk factors for ICD in PD. Data from clinical, pharmacological, and genetic studies were analyzed to elucidate the complex interplay of factors contributing to ICD development.

Results

Clinical risk factors such as young age, male gender, and specific personality traits were consistently associated with a higher incidence of ICD. Environmental factors such as cultural nuances and geographic location influence ICD prevalence. Disease characteristics include early PD onset, longer disease duration, motor fluctuations, anxiety, depression, sleep disorders, and apathy. Pharmaceutical risk factors involve dopaminergic drugs, with dopamine agonists showing a dose-dependent association with ICD. Genetic risk factors highlight the involvement of dopaminergic and serotoninergic systems, with various neurotransmitter pathways implicated.

Conclusions

ICDs are common and severe in PD. Understanding the multifaceted risk factors for ICD in PD is crucial for identifying patients at high risk to develop these adverse effects and developing targeted interventions to prevent their occurrence. Given their frequency and potential consequences for the patient and their family, the current strategy is to systematically screen for ICDs throughout patient follow-up, particularly when prescribing dopamine agonists.
简介帕金森病(PD)是一种神经退行性疾病,以运动和非运动症状为特征,其中冲动控制障碍行为(ICD)是重要的非运动表现。帕金森病患者的冲动控制障碍行为(ICD)包括病态赌博、性欲亢进、强迫性购买等,会导致严重的身体损害和生活质量下降。本综述旨在探讨与帕金森病患者ICD相关的多方面风险因素,包括临床、药理学和遗传学方面,以加强早期识别、预防和管理策略:方法:我们对文献进行了全面回顾,以确定调查帕金森病 ICD 危险因素的研究。对临床、药理学和遗传学研究的数据进行了分析,以阐明导致 ICD 发生的各种因素之间复杂的相互作用:结果:年轻、男性和特定人格特征等临床风险因素始终与较高的 ICD 发生率相关。文化差异和地理位置等环境因素影响着 ICD 的发病率。疾病特征包括帕金森病发病早、病程长、运动波动、焦虑、抑郁、睡眠障碍和冷漠。药物风险因素涉及多巴胺能药物,多巴胺激动剂与 ICD 呈剂量依赖关系。遗传风险因素强调了多巴胺能系统和血清素能系统的参与,并与各种神经递质通路有关:结论:ICD在帕金森病中是一种常见且严重的疾病。了解帕金森病 ICD 的多方面风险因素对于识别高危患者和制定有针对性的干预措施以防止其发生至关重要。考虑到 ICD 的发生频率以及对患者及其家庭的潜在影响,目前的策略是在患者随访过程中系统筛查 ICD,尤其是在处方多巴胺受体激动剂时。
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引用次数: 0
Synapse and primary cilia dysfunctions in Autism Spectrum Disorders. Avenues to normalize these functions 自闭症谱系障碍中的突触和初级纤毛功能障碍。使这些功能正常化的途径。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.06.002
J.-J. Hauw , C. Hausser-Hauw , C. Barthélémy

Aim

An update on the plasticity of the brain networks involved in autism (autism spectrum disorders [ASD]), and the increasing role of their synapses and primary non-motile cilia.

Methods

Data from PubMed and Google on this subject, published until February 2024, were analyzed.

Results

Structural and functional brain characteristics and genetic particularities involving synapses and cilia that modify neuronal circuits are observed in ASD, such as reduced pruning of dendrites, minicolumnar pathology, or persistence of connections usually doomed to disappear. Proteins involved in synapse functions (such as neuroligins and neurexins), in the postsynaptic architectural scaffolding (such as Shank proteins) or in cilia functions (such as IFT-independent kinesins) are often abnormal. There is an increase in glutaminergic transmission and a decrease in GABA inhibition. ASD may occur in genetic ciliopathies. The means of modulating these specificities, when deemed useful, are described.

Interpretation

The wide range of clinical manifestations of ASD is strongly associated with abnormalities in the morphology, functions, and plasticity of brain networks, involving their synapses and non-motile cilia. Their modulation offers important research perspectives on treatments when needed, especially since brain plasticity persists much later than previously thought. Improved early detection of ASD and additional studies on synapses and primary cilia are needed.
目的:更新自闭症(自闭症谱系障碍 [ASD])相关大脑网络的可塑性,以及其突触和初级非运动性纤毛所起的日益重要的作用:方法:分析了PubMed和Google上截至2024年2月发表的有关这一主题的数据:结果:在ASD患者中观察到了涉及突触和纤毛的大脑结构和功能特征以及改变神经元回路的遗传特异性,如树突修剪减少、小柱病理或通常注定消失的连接持续存在。参与突触功能的蛋白质(如神经ligins 和 neurexins)、参与突触后结构支架的蛋白质(如 Shank 蛋白)或参与纤毛功能的蛋白质(如不依赖于 IFT 的驱动蛋白)常常出现异常。谷氨酸传递增加,GABA 抑制减少。遗传性纤毛疾病也可能导致 ASD。在认为有用时,还介绍了调节这些特异性的方法:ASD的临床表现多种多样,与大脑网络的形态、功能和可塑性异常密切相关,涉及其突触和非运动性纤毛。对它们的调节为必要时的治疗提供了重要的研究视角,特别是因为大脑可塑性的持续时间比以前认为的要晚得多。我们需要加强对自闭症的早期检测,并对突触和初级纤毛进行更多的研究。
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引用次数: 0
The role of SEEG in the presurgical decision-making process in MRI-normal mesial temporal lobe epilepsy SEEG 在核磁共振成像正常的颞叶中段癫痫患者手术前决策过程中的作用。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.06.006
H. Catenoix , K. Decaestecker , M. Hermier , M. Chochoi , V. Guinet , A. Montavont , J. Isnard , S. Boulogne , W. Szurhaj , C. Haegelen , N. Reyns , M. Guenot , P. Derambure , J. Jung , S. Rheims

Objectives

In patients with mesial temporal lobe epilepsy (mTLE) and normal MRI, anterior temporal lobectomy sparing the hippocampus might be considered because of the risk of post-operative memory deficit. However, it is unclear whether some patients with normal MRI and non-invasive EEG and semiological pattern highly suggestive of mesial temporal seizures demonstrate a seizure onset network sparing the hippocampus, potentially warranting surgery.

Methods

A retrospective study of 17 patients with mTLE epilepsy and normal MRI who underwent SEEG. Only patients whose non-invasive presurgical data suggested an unilateral mesial temporal epileptogenic zone (EZ), as defined by combination of ictal semiology and ictal EEG during scalp video-EEG, were included. SEEG data were analyzed using both visual and quantitative approaches. Two EZ organization were defined: (i) EZ involved the hippocampus at the onset of the ictal discharge (HIP group): (ii) patients in whom a delay > 1 sec was observed between the seizure onset and the involvement of the hippocampus (nHIP group). Non-invasive clinical and functional imaging data, as well as post-operative outcomes, were compared across groups.

Results

Eleven patients were included in HIP group and 6 in the nHIP group. In the nHIP group, the maximal epileptogenicity was in the amygdala in five patients and in the entorhinal cortex in one. The hippocampus normalized interictal spiking activity was not different between groups. None of the patients characteristics collected during the non-invasive presurgical workup was associated with the SEEG-based organization of the EZ. Twelve patients underwent a surgical resection, including temporal cortectomy sparing hippocampus in six. Seizure and neuropsychological post-operative outcomes were similar.

Conclusion

In patients with MRI-normal mTLE, SEEG should be included in the surgical decision-making process because seizure organization cannot be predicted from non-invasive investigations. When hippocampus is not included in the EZ, temporal resection sparing the hippocampus can be considered.
目的:对于磁共振成像(MRI)正常的颞叶间叶癫痫(mTLE)患者,由于术后记忆缺失的风险,可能会考虑行颞叶前部切除术,但要保留海马。然而,目前尚不清楚的是,一些核磁共振成像正常、无创脑电图和符号学模式高度提示颞叶中叶癫痫发作的患者是否表现出癫痫发作网络,从而可能需要进行手术:对17名磁共振成像正常、接受SEEG检查的mTLE癫痫患者进行回顾性研究。只有非侵入性手术前数据显示单侧颞中叶致痫区(EZ)的患者才被纳入研究,该致痫区是由发作期半身像和发作期头皮视频脑电图共同定义的。采用视觉和定量方法对 SEEG 数据进行分析。定义了两种 EZ 组织:(i) EZ 在发作放电开始时涉及海马(HIP 组):(ii) 在发作开始和涉及海马之间观察到延迟>1 秒的患者(nHIP 组)。对各组的非侵入性临床和功能成像数据以及术后结果进行比较:结果:11 名患者被纳入 HIP 组,6 名被纳入 nHIP 组。在 nHIP 组中,5 名患者的最大致痫区在杏仁核,1 名患者的最大致痫区在内侧皮层。海马正常化发作间期尖峰活动在各组之间没有差异。在非侵入性手术前检查中收集的患者特征均与基于 SEEG 的 EZ 组织无关。12 名患者接受了手术切除,其中 6 人接受了颞叶皮质切除术,保留了海马。癫痫发作和神经心理学术后结果相似:结论:对于磁共振成像正常的mTLE患者,手术决策过程中应包括SEEG,因为非侵入性检查无法预测发作组织。结论:对于磁共振成像正常的 mTLE 患者,手术决策过程中应包括 SEEG,因为非侵入性检查无法预测发作组织。如果 EZ 中不包括海马,则可考虑颞叶切除,但要保留海马。
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引用次数: 0
Inflammatory sensory neuronopathies 炎症性感觉神经元病。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2023.12.012
J.-C. Antoine
Inflammatory sensory neuronopathies are rare disorders mediated by dysimmune mechanisms targeting sensory neurons in the dorsal root ganglia. They constitute a heterogeneous group of disorders with acute, subacute, or chronic courses, and occur with cancer, systemic autoimmune diseases, notably Sjögren syndrome, and viral infections but a noticeable proportion of them remains isolated. Identifying inflammatory sensory neuronopathies is crucial because they have the potential to be stabilized or even to improve with immunomodulatory or immunosuppressant treatments provided that the treatment is applied at an early stage of the disease, before a definitive degeneration of neurons. Biomarkers, and notably antibodies, are crucial for this early identification, which is the first step to develop therapeutic trials.
炎症性感觉神经元病是由针对背根神经节感觉神经元的免疫异常机制介导的罕见疾病。它们是一组具有急性、亚急性或慢性病程的异质性疾病,与癌症、系统性自身免疫性疾病(尤其是斯约格伦综合征)和病毒感染同时发生,但其中仍有相当一部分是孤立存在的。鉴别炎症性感觉神经元病至关重要,因为只要在疾病的早期阶段,即在神经元发生明确的变性之前采用免疫调节或免疫抑制剂治疗,炎症性感觉神经元病就有可能得到稳定甚至改善。生物标志物,尤其是抗体,对于这种早期识别至关重要,而这正是开展治疗试验的第一步。
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引用次数: 0
The pattern of cortical thickness associated with executive dysfunction in MCI and SCC: The MEMENTO cohort 与 MCI 和 SCC 执行功能障碍相关的皮层厚度模式:MEMENTO 队列。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.02.394
D. Andriuta , M. Roussel , G. Chene , C. Fischer , J.-F. Mangin , B. Dubois , B. Vellas , F. Pasquier , F. Tison , F. Blanc , O. Hanon , C. Paquet , A. Gabelle , M. Ceccaldi , C. Annweiler , P. Krolak-Salmon , R. David , I. Rouch-Leroyer , A. Benetos , O. Moreaud , O. Godefroy

Background

The association between the pattern of cortical thickness (CT) and executive dysfunction (ED) in mild cognitive impairment (MCI) and subjective cognitive complaints (SCC) is still poorly understood. We aimed to investigate the association between CT and ED in a large French cohort (MEMENTO) of 2323 participants with MCI or SCC.

Methods

All participants with available CT and executive function data (verbal fluency and Trail Making Test [TMT]) were selected (n = 1924). Linear regressions were performed to determine relationships between executive performance and the brain parenchymal fraction (BPF) and CT using FreeSurfer.

Results

The global executive function score was related to the BPF (sß: 0.091, P < 0.001) and CT in the right supramarginal (sß: 0.060, P = 0.041) and right isthmus cingulate (sß: 0.062, P = 0.011) regions. Literal verbal fluency was related to the BPF (sß: 0.125, P < 0.001) and CT in the left parsorbitalis region (sß: 0.045, P = 0.045). Semantic verbal fluency was related to the BPF (sß: 0.101, P < 0.001) and CT in the right supramarginal region (sß: 0.061, P = 0.042). The time difference between the TMT parts B and A was related to the BPF (sß: 0.048, P = 0.045) and CT in the right precuneus (sß: 0.073, P = 0.019) and right isthmus cingulate region (sß: 0.054, P = 0.032).

Conclusions

In a large clinically based cohort of participants presenting with either MCI or SCC (a potential early stage of Alzheimer's disease [AD]), ED was related to the BPF and CT in the left pars orbitalis, right precuneus, right supramarginal, and right isthmus cingulate regions. This pattern of lesions adds knowledge to the conventional anatomy of ED and could contribute to the early diagnosis of AD.
背景:人们对轻度认知障碍(MCI)和主观认知抱怨(SCC)患者皮层厚度(CT)模式与执行功能障碍(ED)之间的关系仍然知之甚少。我们的目的是在一个由 2323 名 MCI 或 SCC 患者组成的大型法国队列(MEMENTO)中调查 CT 与 ED 之间的关系:我们选取了所有具有 CT 和执行功能数据(言语流畅性和寻迹测试 [TMT])的参与者(n=1924)。使用FreeSurfer进行线性回归,以确定执行力表现与脑实质分数(BPF)和CT之间的关系:结果:总体执行功能得分与 BPF 相关(sß:0.091,PC结论:在一个以临床为基础的大型参与者队列中,在出现 MCI 或 SCC(阿尔茨海默病 [AD] 的潜在早期阶段)时,ED 与左侧眶旁区、右侧楔前区、右侧边际上区和右侧扣带回峡区的 BPF 和 CT 有关。这种病变模式增加了对 ED 传统解剖学的了解,有助于早期诊断 AD。
{"title":"The pattern of cortical thickness associated with executive dysfunction in MCI and SCC: The MEMENTO cohort","authors":"D. Andriuta ,&nbsp;M. Roussel ,&nbsp;G. Chene ,&nbsp;C. Fischer ,&nbsp;J.-F. Mangin ,&nbsp;B. Dubois ,&nbsp;B. Vellas ,&nbsp;F. Pasquier ,&nbsp;F. Tison ,&nbsp;F. Blanc ,&nbsp;O. Hanon ,&nbsp;C. Paquet ,&nbsp;A. Gabelle ,&nbsp;M. Ceccaldi ,&nbsp;C. Annweiler ,&nbsp;P. Krolak-Salmon ,&nbsp;R. David ,&nbsp;I. Rouch-Leroyer ,&nbsp;A. Benetos ,&nbsp;O. Moreaud ,&nbsp;O. Godefroy","doi":"10.1016/j.neurol.2024.02.394","DOIUrl":"10.1016/j.neurol.2024.02.394","url":null,"abstract":"<div><h3>Background</h3><div><span>The association between the pattern of cortical thickness (CT) and executive dysfunction (ED) in </span>mild cognitive impairment (MCI) and subjective cognitive complaints (SCC) is still poorly understood. We aimed to investigate the association between CT and ED in a large French cohort (MEMENTO) of 2323 participants with MCI or SCC.</div></div><div><h3>Methods</h3><div><span>All participants with available CT and executive function data (verbal fluency and Trail Making Test [TMT]) were selected (</span><em>n</em> <!-->=<!--> <span>1924). Linear regressions<span> were performed to determine relationships between executive performance and the brain parenchymal fraction (BPF) and CT using FreeSurfer.</span></span></div></div><div><h3>Results</h3><div>The global executive function score was related to the BPF (sß: 0.091, <em>P</em> <!-->&lt;<!--> <!-->0.001) and CT in the right supramarginal (sß: 0.060, <em>P</em> <!-->=<!--> <!-->0.041) and right isthmus cingulate (sß: 0.062, <em>P</em> <!-->=<!--> <!-->0.011) regions. Literal verbal fluency was related to the BPF (sß: 0.125, <em>P</em> <!-->&lt;<!--> <!-->0.001) and CT in the left parsorbitalis region (sß: 0.045, <em>P</em> <!-->=<!--> <!-->0.045). Semantic verbal fluency was related to the BPF (sß: 0.101, <em>P</em> <!-->&lt;<!--> <!-->0.001) and CT in the right supramarginal region (sß: 0.061, <em>P</em> <!-->=<!--> <!-->0.042). The time difference between the TMT parts B and A was related to the BPF (sß: 0.048, <em>P</em> <!-->=<!--> <span>0.045) and CT in the right precuneus (sß: 0.073, </span><em>P</em> <!-->=<!--> <!-->0.019) and right isthmus cingulate region (sß: 0.054, <em>P</em> <!-->=<!--> <!-->0.032).</div></div><div><h3>Conclusions</h3><div><span><span>In a large clinically based cohort of participants presenting with either MCI or SCC (a potential early stage of Alzheimer's disease [AD]), ED was related to the BPF and CT in the left </span>pars orbitalis, right </span>precuneus<span><span>, right supramarginal, and right isthmus cingulate regions. This pattern of lesions adds knowledge to the conventional anatomy of ED and could contribute to the early </span>diagnosis of AD.</span></div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"180 10","pages":"Pages 1100-1107"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurofilament-light: Impact of chronic stress on brain 神经丝光:慢性压力对大脑的影响。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.08.001
C. Ramdani , A.-V. Desruelle , N. Vallée , M. Ogier
{"title":"Neurofilament-light: Impact of chronic stress on brain","authors":"C. Ramdani ,&nbsp;A.-V. Desruelle ,&nbsp;N. Vallée ,&nbsp;M. Ogier","doi":"10.1016/j.neurol.2024.08.001","DOIUrl":"10.1016/j.neurol.2024.08.001","url":null,"abstract":"","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"180 10","pages":"Pages 1139-1141"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reprint of: Scientific statement from the French neurovascular and cardiac societies for improved detection of atrial fibrillation after ischaemic stroke and transient ischaemic attack 重印本:法国神经血管和心脏学会关于改进缺血性中风和短暂性缺血发作后心房颤动检测的科学声明。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.10.001
Nicolas Gaillard , Jean-Claude Deharo , Laurent Suissa , Pascal Defaye , Igor Sibon , Christophe Leclercq , Sonia Alamowitch , Céline Guidoux , Ariel Cohen , French Neurovascular Society, French Society of Cardiology
Atrial fibrillation (AF) is the primary cause of ischaemic stroke and transient ischaemic attack (TIA). AF is associated with a high risk of recurrence, which can be reduced using optimal prevention strategies, mainly anticoagulant therapy. The availability of effective prophylaxis justifies the need for a significant, coordinated and thorough transdisciplinary effort to screen for AF associated with stroke. A recent French national survey, initiated and supported by the Société française neurovasculaire (SFNV) and the Société française de cardiologie (SFC), revealed many shortcomings, such as the absence or inadequacy of telemetry equipment in more than half of stroke units, insufficient and highly variable access to monitoring tools, delays in performing screening tests, heterogeneous access to advanced or connected ambulatory monitoring techniques, and a lack of dedicated human resources. The present scientific document has been prepared on the initiative of the SFNV and the SFC with the aim of helping to address the current shortcomings and gaps, to promote efficient and cost-effective AF detection, and to improve and, where possible, homogenize the quality of practice in AF screening among stroke units and outpatient post-stroke care networks. The working group, composed of cardiologists and vascular neurologists who are experts in the field and are nominated by their peers, reviewed the literature to propose statements, which were discussed in successive cycles, and maintained, either by consensus or by vote, as appropriate. The text was then submitted to the SFNV and SFC board members for review. This scientific statement document argues for the widespread development of patient pathways to enable the most efficient AF screening after stroke. This assessment should be carried out by a multidisciplinary team, including expert cardiologists and vascular neurologists.
心房颤动(房颤)是缺血性中风和短暂性脑缺血发作(TIA)的主要原因。心房颤动具有很高的复发风险,而采用最佳预防策略(主要是抗凝疗法)可以降低复发风险。有效的预防措施的可用性证明,有必要开展一项重要、协调和彻底的跨学科工作,筛查与中风相关的房颤。最近,由法国神经血管协会(SFNV)和法国心脏病协会(SFC)发起并支持的一项法国全国性调查显示了许多不足之处,如超过半数的中风科室没有遥测设备或遥测设备不足、监测工具不足且使用情况参差不齐、筛查测试延迟、先进或联网的非卧床监测技术使用情况参差不齐,以及缺乏专门的人力资源。本科学文件由国家卒中筛查中心(SFNV)和国家急性心肌梗死筛查中心(SFC)共同编写,旨在帮助解决目前存在的不足和差距,促进高效、经济的心房颤动检测,提高并尽可能统一卒中单元和卒中后门诊护理网络的心房颤动筛查实践质量。工作组由该领域的心脏病专家和血管神经科专家组成,他们由同行提名,通过查阅文献提出声明,并在连续的周期内对声明进行讨论,根据情况以协商一致或投票的方式维持声明。声明文本随后提交给 SFNV 和 SFC 董事会成员审阅。本科学声明文件主张广泛制定患者路径,以便在卒中后进行最有效的房颤筛查。该评估应由包括心脏病专家和血管神经学家在内的多学科团队进行。
{"title":"Reprint of: Scientific statement from the French neurovascular and cardiac societies for improved detection of atrial fibrillation after ischaemic stroke and transient ischaemic attack","authors":"Nicolas Gaillard ,&nbsp;Jean-Claude Deharo ,&nbsp;Laurent Suissa ,&nbsp;Pascal Defaye ,&nbsp;Igor Sibon ,&nbsp;Christophe Leclercq ,&nbsp;Sonia Alamowitch ,&nbsp;Céline Guidoux ,&nbsp;Ariel Cohen ,&nbsp;French Neurovascular Society,&nbsp;French Society of Cardiology","doi":"10.1016/j.neurol.2024.10.001","DOIUrl":"10.1016/j.neurol.2024.10.001","url":null,"abstract":"<div><div>Atrial fibrillation (AF) is the primary cause of ischaemic stroke and transient ischaemic attack (TIA). AF is associated with a high risk of recurrence, which can be reduced using optimal prevention strategies, mainly anticoagulant therapy. The availability of effective prophylaxis justifies the need for a significant, coordinated and thorough transdisciplinary effort to screen for AF associated with stroke. A recent French national survey, initiated and supported by the Société française neurovasculaire (SFNV) and the Société française de cardiologie (SFC), revealed many shortcomings, such as the absence or inadequacy of telemetry equipment in more than half of stroke units, insufficient and highly variable access to monitoring tools, delays in performing screening tests, heterogeneous access to advanced or connected ambulatory monitoring techniques, and a lack of dedicated human resources. The present scientific document has been prepared on the initiative of the SFNV and the SFC with the aim of helping to address the current shortcomings and gaps, to promote efficient and cost-effective AF detection, and to improve and, where possible, homogenize the quality of practice in AF screening among stroke units and outpatient post-stroke care networks. The working group, composed of cardiologists and vascular neurologists who are experts in the field and are nominated by their peers, reviewed the literature to propose statements, which were discussed in successive cycles, and maintained, either by consensus or by vote, as appropriate. The text was then submitted to the SFNV and SFC board members for review. This scientific statement document argues for the widespread development of patient pathways to enable the most efficient AF screening after stroke. This assessment should be carried out by a multidisciplinary team, including expert cardiologists and vascular neurologists.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"180 10","pages":"Pages 1000-1020"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Remote neurological evaluation reliably identifies patients eligible to endovascular therapy while non-eligible to intravenous thrombolysis 远程神经评估能可靠地识别出符合血管内治疗条件但不符合静脉溶栓条件的患者。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.05.006
L. Lucas , A. Georget , L. Rouxel , P. Briau , M. Couture , J.-S. Liegey , S. Debruxelles , M. Poli , S. Sagnier , P. Renou , S. Olindo , F. Rouanet , X. Maurin , A. Benard , I. Sibon

Introduction/background

Early identification of suspected stroke patients who might be eligible for a reperfusion strategy is a daily challenge in the management of patient referrals. The aim of this study was to evaluate the performance of a remote medical assessment in identifying patients eligible for endovascular therapy (EVT) while not eligible for intravenous thrombolysis (IVT), compared with a decision based on bedside clinico-radiological data.

Methods

Patients admitted to the emergency department for acute neurological symptoms lasting for less than 24 h were prospectively included. Assessment of the clinical severity and medical history was performed simultaneously by two vascular neurologists (VNs), one remotely using a mobile telemedicine solution (NOMADEEC), the other at the bedside. RACE score was calculated from the NIHSS score. At the end of the evaluation, both VNs quoted their treatment convictions (IVT/EVT). Final therapeutic decision following brain and vascular imaging was recorded and compared to remote and bedside predictions. The performances of three different conditions were evaluated: complete medical evaluation (NIHSS + medical history), NIHSS score alone, and RACE score alone. Remote and bedside performances were also compared. Diagnostic accuracy parameters (sensitivity, specificity, positive and negative predictive values) of each condition were estimated, along with their two-sided 95% binomial confidence intervals.

Results

Out of 215 enrolled patients, 186 had a complete evaluation, 91 (54.3%) were diagnosed with an ischemic stroke or transient ischemic attack and 46 (24.7%) had an intracranial occlusion. Considering the three conditions evaluated remotely, RACE score-based decision provided the best sensitivity 54.6% [95% CI 23.4; 83.2]/specificity 80.6% [73.9; 86.2] combination. However, the complete medical evaluation had the best specificity (88.6% [82.9; 92.9] compared to RACE scores alone (P = 0.038). Remote and bedside performances did not differ (κ = 0.68 [0.59; 0.77]).

Discussion/conclusion

This real-life study performed in the setting of emergency demonstrates that remote medical evaluations including recording of extensive medical information and NIHSS examination to address patient's eligibility to revascularization treatment is swiftly feasible and is as effective as bedside prediction to EVT and/or IVT. Remote standardized medical evaluation might improve the decision of patients’ primary orientation and avoid overcrowding of comprehensive stroke centres.
导言/背景:早期识别可能符合再灌注策略的疑似卒中患者是患者转诊管理中的一项日常挑战。本研究旨在评估远程医疗评估在识别符合血管内治疗(EVT)条件但不符合静脉溶栓(IVT)条件的患者方面的性能,并与基于床旁临床放射学数据的决策进行比较:方法:前瞻性地纳入因急性神经症状持续时间少于 24 小时而入住急诊科的患者。临床严重程度和病史评估由两名血管神经学家(VN)同时进行,其中一名使用移动远程医疗解决方案(NOMADEEC)进行远程评估,另一名在床边进行评估。根据 NIHSS 评分计算 RACE 评分。在评估结束时,两位 VN 都会提出他们的治疗意见(IVT/EVT)。记录脑部和血管成像后的最终治疗决定,并与远程和床旁预测进行比较。评估了三种不同情况下的表现:完整的医学评估(NIHSS+病史)、单独的 NIHSS 评分和单独的 RACE 评分。同时还比较了远程和床旁预测的性能。对每种情况的诊断准确性参数(灵敏度、特异性、阳性预测值和阴性预测值)及其双侧 95% 二项式置信区间进行了估算:在 215 名登记患者中,186 人进行了完整的评估,91 人(54.3%)被诊断为缺血性中风或短暂性脑缺血发作,46 人(24.7%)患有颅内闭塞。考虑到远程评估的三种情况,基于 RACE 评分的决策提供了最佳的灵敏度 54.6% [95% CI 23.4; 83.2] / 特异性 80.6% [73.9; 86.2] 组合。然而,与单独的 RACE 评分相比,完整的医学评估具有最佳的特异性(88.6% [82.9; 92.9])(P=0.038)。远程和床边的表现没有差异(κ=0.68 [0.59; 0.77]):这项在急诊环境下进行的真实研究表明,远程医疗评估(包括记录大量医疗信息和 NIHSS 检查)可迅速确定患者接受血管再通治疗的资格,并且与床旁预测 EVT 和/或 IVT 一样有效。远程标准化医疗评估可改善患者的首要定位决策,避免综合卒中中心人满为患。
{"title":"Remote neurological evaluation reliably identifies patients eligible to endovascular therapy while non-eligible to intravenous thrombolysis","authors":"L. Lucas ,&nbsp;A. Georget ,&nbsp;L. Rouxel ,&nbsp;P. Briau ,&nbsp;M. Couture ,&nbsp;J.-S. Liegey ,&nbsp;S. Debruxelles ,&nbsp;M. Poli ,&nbsp;S. Sagnier ,&nbsp;P. Renou ,&nbsp;S. Olindo ,&nbsp;F. Rouanet ,&nbsp;X. Maurin ,&nbsp;A. Benard ,&nbsp;I. Sibon","doi":"10.1016/j.neurol.2024.05.006","DOIUrl":"10.1016/j.neurol.2024.05.006","url":null,"abstract":"<div><h3>Introduction/background</h3><div>Early identification of suspected stroke patients who might be eligible for a reperfusion strategy is a daily challenge in the management of patient referrals. The aim of this study was to evaluate the performance of a remote medical assessment in identifying patients eligible for endovascular therapy (EVT) while not eligible for intravenous thrombolysis (IVT), compared with a decision based on bedside clinico-radiological data.</div></div><div><h3>Methods</h3><div><span><span>Patients admitted to the emergency department for acute </span>neurological symptoms lasting for less than 24</span> <span>h were prospectively included. Assessment of the clinical severity and medical history<span><span><span> was performed simultaneously by two vascular neurologists (VNs), one remotely using a mobile telemedicine solution (NOMADEEC), the other at the bedside. </span>RACE score was calculated from the </span>NIHSS score. At the end of the evaluation, both VNs quoted their treatment convictions (IVT/EVT). Final therapeutic decision following brain and vascular imaging was recorded and compared to remote and bedside predictions. The performances of three different conditions were evaluated: complete medical evaluation (NIHSS</span></span> <!-->+<!--> <!-->medical history), NIHSS score alone, and RACE score alone. Remote and bedside performances were also compared. Diagnostic accuracy parameters (sensitivity, specificity, positive and negative predictive values) of each condition were estimated, along with their two-sided 95% binomial confidence intervals.</div></div><div><h3>Results</h3><div><span><span>Out of 215 enrolled patients, 186 had a complete evaluation, 91 (54.3%) were diagnosed with an ischemic stroke or </span>transient ischemic attack and 46 (24.7%) had an intracranial occlusion. Considering the three conditions evaluated remotely, RACE score-based decision provided the best sensitivity 54.6% [95% CI 23.4; 83.2]/specificity 80.6% [73.9; 86.2] combination. However, the complete medical evaluation had the best specificity (88.6% [82.9; 92.9] compared to RACE scores alone (</span><em>P</em> <!-->=<!--> <!-->0.038). Remote and bedside performances did not differ (κ<!--> <!-->=<!--> <!-->0.68 [0.59; 0.77]).</div></div><div><h3>Discussion/conclusion</h3><div>This real-life study performed in the setting of emergency demonstrates that remote medical evaluations including recording of extensive medical information and NIHSS examination to address patient's eligibility to revascularization treatment is swiftly feasible and is as effective as bedside prediction to EVT and/or IVT. Remote standardized medical evaluation might improve the decision of patients’ primary orientation and avoid overcrowding of comprehensive stroke centres.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"180 10","pages":"Pages 1108-1116"},"PeriodicalIF":2.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Migraine treatment: Position paper of the French Headache Society 偏头痛治疗:法国头痛协会立场文件。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.09.008
X. Moisset , G. Demarquay , S. de Gaalon , C. Roos , A. Donnet , P. Giraud , E. Guégan-Massardier , C. Lucas , J. Mawet , D. Valade , V. Corand , C. Gollion , N. Moreau , L. Grangeon , M. Lantéri-Minet , A. Ducros
The French migraine management recommendations were published in 2021. However, in the last three years, new data have come to light and new drugs have been approved (eptinezumab, rimegepant and atogepant) by the European Medicines Agency that require us to take a position on their use and to update certain elements of the recommendations. The first important message concerns the position of the French Headache Society on the use of preventive treatments (monoclonal antibodies and gepants) targeting the calcitonin gene-related peptide (CGRP) pathway. In terms of efficacy and safety, and as suggested by other national headache societies, these treatments can be offered as first-line treatment, although the scope defined by the French national health authority for possible reimbursement is limited to patients with severe migraine, at least eight headache days per month and for whom two previous preventive treatments have failed. Another important change concerns the position of topiramate as a preventive treatment for migraine in women of childbearing age. This treatment has been proposed as a first-line treatment for chronic migraine. However, recent pharmacovigilance data have highlighted a potential adverse effect on neurodevelopment in children exposed in utero. As a result, this treatment is formally contraindicated during pregnancy and must be used with extreme caution in women of childbearing age (effective contraception, no therapeutic alternative available and annual follow-up as with valproate). It can therefore no longer be offered as first-line treatment for women of childbearing age.
法国偏头痛管理建议于 2021 年发布。然而,在过去三年中,新的数据不断涌现,欧洲药品管理局也批准了新的药物(eptinezumab、rimgepant和atogepant),这就要求我们对这些药物的使用采取立场,并更新建议中的某些内容。第一个重要信息涉及法国头痛协会对使用针对降钙素基因相关肽(CGRP)通路的预防性治疗(单克隆抗体和gepants)的立场。就疗效和安全性而言,正如其他国家的头痛学会所建议的那样,这些疗法可作为一线治疗手段,但法国国家卫生当局规定的可报销范围仅限于严重偏头痛患者、每月头痛天数至少8天且之前两种预防性疗法均无效的患者。另一个重要变化涉及托吡酯作为育龄妇女偏头痛预防治疗药物的地位。该疗法已被建议作为慢性偏头痛的一线治疗方法。然而,最近的药物警戒数据显示,该药物可能会对子宫内接触该药物的儿童的神经发育产生不良影响。因此,该疗法被正式列为妊娠期禁忌症,育龄妇女在使用该疗法时必须格外谨慎(采取有效的避孕措施,没有其他治疗方法可供选择,并与丙戊酸钠一样每年进行随访)。因此,不能再将其作为育龄妇女的一线治疗药物。
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引用次数: 0
Limb-girdle muscle weakness and muscle hypertrophy: Do not dismiss spinal muscular atrophy 肢腰肌无力和肌肉肥大:不要忽视脊髓性肌萎缩症。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-12-01 DOI: 10.1016/j.neurol.2024.06.001
T. Nanda , S. Nanda , A. Manna , J. Mukherjee , M. Mandal , J. Benito-León
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引用次数: 0
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Revue neurologique
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