首页 > 最新文献

Revue neurologique最新文献

英文 中文
Neurofilament-light: Impact of chronic stress on brain. 神经丝光:慢性压力对大脑的影响。
IF 3 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-10 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,A-V Desruelle,N Vallée,M Ogier","doi":"10.1016/j.neurol.2024.08.001","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.08.001","url":null,"abstract":"","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-10","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
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 : 2024-09-02 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。
{"title":"Impulse control disorder: Review on clinical, pharmacologic, and genetic risk factors.","authors":"V Leclercq, J-C Corvol","doi":"10.1016/j.neurol.2024.07.001","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.07.001","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126573","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
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 : 2024-08-29 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>1sec 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。
{"title":"The role of SEEG in the presurgical decision-making process in MRI-normal mesial temporal lobe epilepsy.","authors":"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","doi":"10.1016/j.neurol.2024.06.006","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.06.006","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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>1sec 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111509","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
Influence of continuous subcutaneous apomorphine infusion on cognition and behavior in Parkinson's disease: A systematic review. 持续皮下注射阿朴吗啡对帕金森病患者认知和行为的影响:系统综述。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-08-06 DOI: 10.1016/j.neurol.2024.06.008
J-F Houvenaghel, M Meyer, E Schmitt, A Arifi, E Benchetrit, A Bichon, C Cau, L Lavigne, E Le Mercier, V Czernecki, K Dujardin

Introduction: The efficacy of continuous subcutaneous apomorphine infusion (CSAI) for motor complications of Parkinson's disease (PD) is established. However, its effect on cognition and behavior remains controversial. The main objective of this systematic review was to describe the existing literature on the effects of CSAI on cognition and behavior and to determine the quality for each study.

Methods: PubMed/Medline, Embase, APA PsycInfo®, and Cochrane Library databases were searched, following PRISMA recommendations. Only longitudinal studies evaluating the effect of CSAI on cognition (global cognition, executive functions, visuospatial abilities, language, memory, attention, social cognition) and/or behavior (depression, anxiety, apathy, psychotic symptoms, impulse control disorders, neuropsychiatric fluctuations) in PD were included. The quality of the included studies was also assessed with a questionnaire.

Results: Twenty-three longitudinal studies evaluated the effect of CSAI on cognition and/or behavior. Overall, results were suggestive of positive effects, notably on executive functions and emotion recognition. However, there were some reports of cognitive slowing and long-term global cognitive deterioration. At the behavioral level, no study showed significant adverse effect of CSAI. Occasionally, a slight improvement of depression, anxiety, apathy, and neuropsychiatric fluctuations was reported. Nevertheless, only four studies met good quality criteria and controlled study regarding cognition were lacking.

Conclusion: The results suggest that CSAI has no obvious negative effects on cognition and behavior in PD. This treatment even shows promise in reducing certain symptoms such as neuropsychiatric fluctuations. However, due to methodological limitations in many studies, no robust conclusions can be drawn. Further multicenter controlled trials are needed to confirm these results.

简介:持续皮下注射阿朴吗啡(CSAI)对帕金森病(PD)运动并发症的疗效已得到证实。然而,其对认知和行为的影响仍存在争议。本系统性综述的主要目的是描述CSAI对认知和行为影响的现有文献,并确定每项研究的质量:方法:按照 PRISMA 建议检索了 PubMedline/Medline、Embase、APA PsycInfo® 和 Cochrane 图书馆数据库。只纳入了评估 CSAI 对认知(整体认知、执行功能、视觉空间能力、语言、记忆、注意力、社会认知)和/或行为(抑郁、焦虑、冷漠、精神病性症状、冲动控制障碍、神经精神波动)的影响的纵向研究。此外,还通过问卷对纳入研究的质量进行了评估:23项纵向研究评估了CSAI对认知和/或行为的影响。总体而言,研究结果表明CSAI对认知和/或行为有积极影响,尤其是在执行功能和情绪识别方面。不过,也有一些关于认知能力减退和长期整体认知能力退化的报告。在行为方面,没有研究显示 CSAI 有明显的不良影响。偶尔有报告称,抑郁、焦虑、冷漠和神经精神波动略有改善。然而,只有四项研究达到了良好质量标准,并且缺乏有关认知能力的对照研究:结果表明,CSAI 对帕金森病患者的认知和行为没有明显的负面影响。结论:研究结果表明,CSAI 对帕金森病患者的认知和行为没有明显的负面影响,甚至有望减轻某些症状,如神经精神波动。然而,由于许多研究在方法上存在局限性,因此无法得出可靠的结论。还需要进一步的多中心对照试验来证实这些结果。
{"title":"Influence of continuous subcutaneous apomorphine infusion on cognition and behavior in Parkinson's disease: A systematic review.","authors":"J-F Houvenaghel, M Meyer, E Schmitt, A Arifi, E Benchetrit, A Bichon, C Cau, L Lavigne, E Le Mercier, V Czernecki, K Dujardin","doi":"10.1016/j.neurol.2024.06.008","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.06.008","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy of continuous subcutaneous apomorphine infusion (CSAI) for motor complications of Parkinson's disease (PD) is established. However, its effect on cognition and behavior remains controversial. The main objective of this systematic review was to describe the existing literature on the effects of CSAI on cognition and behavior and to determine the quality for each study.</p><p><strong>Methods: </strong>PubMed/Medline, Embase, APA PsycInfo®, and Cochrane Library databases were searched, following PRISMA recommendations. Only longitudinal studies evaluating the effect of CSAI on cognition (global cognition, executive functions, visuospatial abilities, language, memory, attention, social cognition) and/or behavior (depression, anxiety, apathy, psychotic symptoms, impulse control disorders, neuropsychiatric fluctuations) in PD were included. The quality of the included studies was also assessed with a questionnaire.</p><p><strong>Results: </strong>Twenty-three longitudinal studies evaluated the effect of CSAI on cognition and/or behavior. Overall, results were suggestive of positive effects, notably on executive functions and emotion recognition. However, there were some reports of cognitive slowing and long-term global cognitive deterioration. At the behavioral level, no study showed significant adverse effect of CSAI. Occasionally, a slight improvement of depression, anxiety, apathy, and neuropsychiatric fluctuations was reported. Nevertheless, only four studies met good quality criteria and controlled study regarding cognition were lacking.</p><p><strong>Conclusion: </strong>The results suggest that CSAI has no obvious negative effects on cognition and behavior in PD. This treatment even shows promise in reducing certain symptoms such as neuropsychiatric fluctuations. However, due to methodological limitations in many studies, no robust conclusions can be drawn. Further multicenter controlled trials are needed to confirm these results.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902786","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
Mothership versus Drip-and-Ship for stroke in a rural area: A French prospective observational study. 在农村地区治疗中风的母婴护理与滴注护理:一项法国前瞻性观察研究。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-29 DOI: 10.1016/j.neurol.2024.06.007
M Raquin, C Lambert, P Paris, N Bourgois, P Clavelou, X Moisset, A Ferrier

Background: The availability of mechanical thrombectomy (MT) is limited. Thus, there are two paradigms for patients living closer to a primary stroke center (PSC) than a comprehensive stroke center (CSC) capable of MT: "Mothership" (direct referral to a CSC) and "Drip-and-Ship" (referral to a PSC for imaging and thrombolysis and transfer to a CSC for thrombectomy or monitoring). We aimed to compare the prognosis of patients at three months between the two paradigms in a rural area.

Materials: From September 2019 to March 2021, we prospectively included patients living closer to a PSC than the one CSC, regardless of the type of stroke or reperfusion treatment. The proportion of patients with a good functional outcome (Rankin≤2) at three months was compared between the two initial orientations for all patients and for subgroups: patients with ischemic stroke and patients treated by MT.

Results: Among the 206 patients included, 103 were admitted directly to the CSC (82.5% had an ischemic stroke and 24.3% a MT) and 103 initially admitted to a PSC and then transferred to the CSC (100% had an ischemic stroke and 52.4% a MT). The proportion of patients with a good outcome was comparable between the two groups (54.5% vs. 43.7%, P=0.22). Among the 79 patients who underwent MT, the prognosis at three months was better in the Mothership group (49.3% vs. 15.3%, P=0.01).

Conclusion: The functional prognosis is comparable between Mothership and Drip-and-Ship paradigms in our setting, despite a trend towards a better prognosis for the Mothership. As has been shown in urban settings, the mothership paradigm also leads to a better prognosis for patients treated with MT in a rural setting.

背景:机械取栓术(MT)的可用性有限。因此,对于居住地距离初级卒中中心(PSC)比综合卒中中心(CSC)更近且有能力进行机械取栓术的患者,有两种治疗模式:"母船"(直接转诊至综合卒中中心)和 "滴灌-转运"(转诊至初级卒中中心进行影像学检查和溶栓,然后转运至综合卒中中心进行血栓切除术或监测)。我们的目的是在农村地区比较两种模式下患者三个月后的预后:从 2019 年 9 月到 2021 年 3 月,我们前瞻性地纳入了居住在离 PSC 比 CSC 更近的患者,无论中风或再灌注治疗的类型如何。结果:在纳入的206名患者中,有103人的功能预后良好(Rankin≤2):在纳入的 206 例患者中,103 例直接入住 CSC(82.5% 为缺血性卒中,24.3% 为 MT),103 例最初入住 PSC 后转入 CSC(100% 为缺血性卒中,52.4% 为 MT)。两组患者预后良好的比例相当(54.5% 对 43.7%,P=0.22)。在接受MT的79名患者中,母船组患者三个月后的预后更好(49.3%对15.3%,P=0.01):结论:在我们的环境中,母船式和点滴加船式的功能性预后相当,尽管母船式的预后有更好的趋势。正如在城市环境中所显示的那样,在农村环境中,母船模式也能为接受 MT 治疗的患者带来更好的预后。
{"title":"Mothership versus Drip-and-Ship for stroke in a rural area: A French prospective observational study.","authors":"M Raquin, C Lambert, P Paris, N Bourgois, P Clavelou, X Moisset, A Ferrier","doi":"10.1016/j.neurol.2024.06.007","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.06.007","url":null,"abstract":"<p><strong>Background: </strong>The availability of mechanical thrombectomy (MT) is limited. Thus, there are two paradigms for patients living closer to a primary stroke center (PSC) than a comprehensive stroke center (CSC) capable of MT: \"Mothership\" (direct referral to a CSC) and \"Drip-and-Ship\" (referral to a PSC for imaging and thrombolysis and transfer to a CSC for thrombectomy or monitoring). We aimed to compare the prognosis of patients at three months between the two paradigms in a rural area.</p><p><strong>Materials: </strong>From September 2019 to March 2021, we prospectively included patients living closer to a PSC than the one CSC, regardless of the type of stroke or reperfusion treatment. The proportion of patients with a good functional outcome (Rankin≤2) at three months was compared between the two initial orientations for all patients and for subgroups: patients with ischemic stroke and patients treated by MT.</p><p><strong>Results: </strong>Among the 206 patients included, 103 were admitted directly to the CSC (82.5% had an ischemic stroke and 24.3% a MT) and 103 initially admitted to a PSC and then transferred to the CSC (100% had an ischemic stroke and 52.4% a MT). The proportion of patients with a good outcome was comparable between the two groups (54.5% vs. 43.7%, P=0.22). Among the 79 patients who underwent MT, the prognosis at three months was better in the Mothership group (49.3% vs. 15.3%, P=0.01).</p><p><strong>Conclusion: </strong>The functional prognosis is comparable between Mothership and Drip-and-Ship paradigms in our setting, despite a trend towards a better prognosis for the Mothership. As has been shown in urban settings, the mothership paradigm also leads to a better prognosis for patients treated with MT in a rural setting.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856398","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
Poststroke cognitive outcome is better accounted for by white matter abnormalities automated segmentation than visual analysis. 与视觉分析相比,白质异常自动分割能更好地解释中风后的认知结果。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-13 DOI: 10.1016/j.neurol.2024.06.004
B Lawson, J Martin, A Aarabi, E Ouin, S Tasseel-Ponche, M Barbay, D Andriuta, M Roussel, O Godefroy

Background and aims: The association between white matter abnormalities (WMA) and cognitive decline previously reported in poststroke patients has been mainly documented using visual scales. However, automated segmentation of WMA provides a precise determination of the volume of WMA. Nonetheless, it is rarely used in the stroke population and its potential advantage over visual scales is still unsettled. The objective of this study was to examine whether automated segmentation of WMA provides a better account than the visual Fazekas and Wahlund scales of the decline in executive functions and processing speed in stroke patients.

Methods: The analyses were conducted on the 358 patients of the GRECogVASC cohort with an MRI performed at six months poststroke in the Amiens center. WMA were visually analyzed using the Fazekas (subcortical abnormalities) and Wahlund scales. Segmentation was performed using LST (3.0.3). Following preliminary studies to determine the optimal segmentation threshold, we examined the relationship between cognitive status and WMA volume computed at each threshold using receiver operating characteristic (ROC) curves. Finally, we assessed the ability of both Fazekas and Wahlund visual scores and WMA volume to account for cognitive scores by using a bivariate Pearson correlation analysis, comparing correlation coefficients with the Fisher transformation and repeating correlation analysis after adjustment for the lesion volume.

Results: Increasing the threshold led to an underestimation of WMA (P=0.0001) (significant for a threshold ≥0.2) and an improvement in correct rejection of signal changes in the stroke cavity (P=0.02) (significant for a threshold ≤0.5), susceptibility artifacts (P=0.002) (significant for a threshold ≤0.6), and corticospinal degeneration (P=0.03) (significant for a threshold ≤0.5). WMA volume decreased with increasing threshold (P=0.0001). Areas under the curve (AUC) did not differ according to the threshold (processing speed: P=0.85, executive cognitive functions: P=0.7). Correlation coefficients between cognitive scores and WMA were higher for WMA volume than the Fazekas (processing speed: Z=-3.442, P=0.001; executive functions: Z=-2.751, P=0.006) and Wahlund scores (processing speed: Z=-3.615, P=0.0001; executive functions: Z=-2.769, P=0.006). Adjustment for lesion volume did not alter the correlations with WMA volume (processing speed: r=-0.327 [95%CI: -0.416; -0.223], P=0.0001; executive functions: r=-0.262 [95%CI: -0.363; -0.150], P=0.0001).

Conclusion: This study shows that WMA volume assessed by automated segmentation provides a better account of cognitive disorders than visual analysis. This should favor its wider use to refine imaging determinants of poststroke cognitive disorders.

背景和目的:之前报道的脑卒中后患者白质异常(WMA)与认知能力下降之间的关系主要是通过视觉量表来记录的。然而,WMA 的自动分割可精确测定 WMA 的体积。然而,这种方法很少用于脑卒中人群,而且其与视觉量表相比的潜在优势仍未确定。本研究的目的是探讨自动分割 WMA 是否比视觉法泽卡斯量表和瓦伦德量表更能说明中风患者执行功能和处理速度的下降情况:分析对象是亚眠中心脑卒中后六个月进行磁共振成像的 358 名 GRECogVASC 队列患者。使用 Fazekas(皮层下异常)和 Wahlund 量表对 WMA 进行视觉分析。使用 LST(3.0.3)进行分割。在初步研究确定最佳分割阈值后,我们使用接收器操作特征曲线(ROC)检查了认知状态与每个阈值下计算的 WMA 体积之间的关系。最后,我们使用双变量皮尔逊相关分析评估了 Fazekas 和 Wahlund 视觉评分和 WMA 体积对认知评分的解释能力,比较了 Fisher 转换后的相关系数,并在调整病变体积后重复了相关分析:提高阈值会导致 WMA 被低估(P=0.0001)(阈值≥0.2 时显著),并改善对卒中腔信号变化(P=0.02)(阈值≤0.5 时显著)、易感伪影(P=0.002)(阈值≤0.6 时显著)和皮质脊髓变性(P=0.03)(阈值≤0.5 时显著)的正确剔除。随着阈值的升高,WMA 体积减小(P=0.0001)。曲线下面积(AUC)并不因阈值而异(处理速度:P=0.85;执行认知功能:P=0.7)。认知评分与 WMA 之间的相关系数在 WMA 容量方面高于 Fazekas(处理速度:Z=-3.442,P=0.001;执行功能:Z=-2.751,P=0.006)和 Wahlund 评分(处理速度:Z=-3.615,P=0.0001;执行功能:Z=-2.769,P=0.0001):Z=-2.769,P=0.006)。对病变体积的调整并没有改变与 WMA 体积的相关性(处理速度:r=-0.327 [95%CI:-0.416;-0.223],P=0.0001;执行功能:r=-0.262 [95%CI:-0.363;-0.150],P=0.0001):本研究表明,与视觉分析相比,通过自动分割评估的 WMA 体积能更好地说明认知障碍。结论:本研究表明,与视觉分析相比,通过自动分割评估的 WMA 容量能更好地说明认知障碍,这将有利于其更广泛地用于完善卒中后认知障碍的影像学决定因素。
{"title":"Poststroke cognitive outcome is better accounted for by white matter abnormalities automated segmentation than visual analysis.","authors":"B Lawson, J Martin, A Aarabi, E Ouin, S Tasseel-Ponche, M Barbay, D Andriuta, M Roussel, O Godefroy","doi":"10.1016/j.neurol.2024.06.004","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.06.004","url":null,"abstract":"<p><strong>Background and aims: </strong>The association between white matter abnormalities (WMA) and cognitive decline previously reported in poststroke patients has been mainly documented using visual scales. However, automated segmentation of WMA provides a precise determination of the volume of WMA. Nonetheless, it is rarely used in the stroke population and its potential advantage over visual scales is still unsettled. The objective of this study was to examine whether automated segmentation of WMA provides a better account than the visual Fazekas and Wahlund scales of the decline in executive functions and processing speed in stroke patients.</p><p><strong>Methods: </strong>The analyses were conducted on the 358 patients of the GRECogVASC cohort with an MRI performed at six months poststroke in the Amiens center. WMA were visually analyzed using the Fazekas (subcortical abnormalities) and Wahlund scales. Segmentation was performed using LST (3.0.3). Following preliminary studies to determine the optimal segmentation threshold, we examined the relationship between cognitive status and WMA volume computed at each threshold using receiver operating characteristic (ROC) curves. Finally, we assessed the ability of both Fazekas and Wahlund visual scores and WMA volume to account for cognitive scores by using a bivariate Pearson correlation analysis, comparing correlation coefficients with the Fisher transformation and repeating correlation analysis after adjustment for the lesion volume.</p><p><strong>Results: </strong>Increasing the threshold led to an underestimation of WMA (P=0.0001) (significant for a threshold ≥0.2) and an improvement in correct rejection of signal changes in the stroke cavity (P=0.02) (significant for a threshold ≤0.5), susceptibility artifacts (P=0.002) (significant for a threshold ≤0.6), and corticospinal degeneration (P=0.03) (significant for a threshold ≤0.5). WMA volume decreased with increasing threshold (P=0.0001). Areas under the curve (AUC) did not differ according to the threshold (processing speed: P=0.85, executive cognitive functions: P=0.7). Correlation coefficients between cognitive scores and WMA were higher for WMA volume than the Fazekas (processing speed: Z=-3.442, P=0.001; executive functions: Z=-2.751, P=0.006) and Wahlund scores (processing speed: Z=-3.615, P=0.0001; executive functions: Z=-2.769, P=0.006). Adjustment for lesion volume did not alter the correlations with WMA volume (processing speed: r=-0.327 [95%CI: -0.416; -0.223], P=0.0001; executive functions: r=-0.262 [95%CI: -0.363; -0.150], P=0.0001).</p><p><strong>Conclusion: </strong>This study shows that WMA volume assessed by automated segmentation provides a better account of cognitive disorders than visual analysis. This should favor its wider use to refine imaging determinants of poststroke cognitive disorders.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617059","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
French consensus procedure for neuropsychological assessment in multiple sclerosis. 法国多发性硬化症神经心理学评估共识程序。
IF 2.8 4区 医学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-07-12 DOI: 10.1016/j.neurol.2024.06.005
C Jougleux, H Joly, H Brissard, B Lenne, S François, F Hamelin, N Derache, J Morin, F Reuter, R Colamarino, A Ruet

Cognitive impairment is one of the invisible symptoms of Multiple sclerosis (MS), which could be associated with depression, unemployment, reduced social interaction, inability to drive, and compromised quality of life. Moreover, the presence of cognitive impairment can be considered as a long-term prognostic factor and in the follow-up of disability. So, cognitive assessment is a crucial element in clinical follow-up of patients with MS (pwMS). International recommendations mention the use of the Brief International Cognitive Assessment in MS (BICAMS). The BICAMS, that has been recently validated in French is a brief non-exhaustive assessment, developed as a short screening battery, hence needing other supplemented tests. The present paper aims to propose a consensus, approved by expert French consensus from the Cognition group of the SF-SEP (http://sfsep.org [Société Francophone de la Sclérose en Plaques]), for cognitive assessment of pwMS suggesting the tools that should be used in order to apprehend the other cognitive impairments that could appear in MS.

认知障碍是多发性硬化症(MS)的隐形症状之一,可能与抑郁、失业、社交减少、无法驾驶和生活质量下降有关。此外,认知障碍的存在可被视为长期预后因素和残疾随访因素。因此,认知评估是对多发性硬化症患者(pwMS)进行临床随访的关键因素。国际建议提及使用多发性硬化症简明国际认知评估(BICAMS)。BICAMS 最近在法国得到了验证,它是一种简短而非详尽的评估方法,作为一种简短的筛查方法而开发,因此需要其他辅助测试。本文旨在提出一项共识,该共识得到了 SF-SEP (http://sfsep.org [Société Francophone de la Sclérose en Plaques])认知小组法国专家的认可,该共识建议使用哪些工具来对多发性硬化症患者可能出现的其他认知障碍进行认知评估。
{"title":"French consensus procedure for neuropsychological assessment in multiple sclerosis.","authors":"C Jougleux, H Joly, H Brissard, B Lenne, S François, F Hamelin, N Derache, J Morin, F Reuter, R Colamarino, A Ruet","doi":"10.1016/j.neurol.2024.06.005","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.06.005","url":null,"abstract":"<p><p>Cognitive impairment is one of the invisible symptoms of Multiple sclerosis (MS), which could be associated with depression, unemployment, reduced social interaction, inability to drive, and compromised quality of life. Moreover, the presence of cognitive impairment can be considered as a long-term prognostic factor and in the follow-up of disability. So, cognitive assessment is a crucial element in clinical follow-up of patients with MS (pwMS). International recommendations mention the use of the Brief International Cognitive Assessment in MS (BICAMS). The BICAMS, that has been recently validated in French is a brief non-exhaustive assessment, developed as a short screening battery, hence needing other supplemented tests. The present paper aims to propose a consensus, approved by expert French consensus from the Cognition group of the SF-SEP (http://sfsep.org [Société Francophone de la Sclérose en Plaques]), for cognitive assessment of pwMS suggesting the tools that should be used in order to apprehend the other cognitive impairments that could appear in MS.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604079","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
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 : 2024-06-25 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。
{"title":"Synapse and primary cilia dysfunctions in Autism Spectrum Disorders. Avenues to normalize these functions.","authors":"J-J Hauw, C Hausser-Hauw, C Barthélémy","doi":"10.1016/j.neurol.2024.06.002","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.06.002","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>Data from PubMed and Google on this subject, published until February 2024, were analyzed.</p><p><strong>Results: </strong>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.</p><p><strong>Interpretation: </strong>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.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141459017","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 Medicine Pub Date : 2024-06-24 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 24h 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, 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","doi":"10.1016/j.neurol.2024.05.006","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.05.006","url":null,"abstract":"<p><strong>Introduction/background: </strong>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.</p><p><strong>Methods: </strong>Patients admitted to the emergency department for acute neurological symptoms lasting for less than 24h 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.</p><p><strong>Results: </strong>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]).</p><p><strong>Discussion/conclusion: </strong>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.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-06-24","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
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 3 4区 医学 Q2 Medicine Pub Date : 2024-06-17 DOI: 10.1016/j.neurol.2024.06.001
T Nanda, S Nanda, A Manna, J Mukherjee, M Mandal, J Benito-León
{"title":"Limb-girdle muscle weakness and muscle hypertrophy: Do not dismiss spinal muscular atrophy.","authors":"T Nanda, S Nanda, A Manna, J Mukherjee, M Mandal, J Benito-León","doi":"10.1016/j.neurol.2024.06.001","DOIUrl":"https://doi.org/10.1016/j.neurol.2024.06.001","url":null,"abstract":"","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420680","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
期刊
Revue neurologique
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1