Ideggyogyaszati Szemle-Clinical Neuroscience最新文献

Background and purpose: Neurosurgical approaches in Sylvian arachnoid cysts include microsurgery, endoscopy, and shunting. Yet, their relative safety and efficacy is still under debate. This retrospective study evaluated 36 pediatric patients with Sylvian arachnoid cysts and treated with different surgical types to contribute to global data.

Methods: The study included 24, 8, and 4 patients receiving endoscopic, microsurgical, and shunt surgeries, respectively. Preoperative and postoperative assessments included the patients' demographics and symptoms, cyst size and type, psychomotor status, length of hospital stay, and complications with a mean follow-up of 37.3 months.

Results: All types of surgeries alleviated headaches and seizures in most of the patients. Shunt operations led to the highest reduction in cyst size in the early postoperative period and relieved cranial palsy in all patients. Microsurgery achieved greater healing regarding hemiparesis and seizures, and reduced cyst size more effectively in the early postoperative period than endoscopy. Complication rates were similar between the endoscopy and microsurgery groups.

Conclusion: Arachnoid cyst surgery is efficient and relatively safe. The higher efficacy of microsurgery may be associated with the lesser chronic presence of cysts in this group rather than its technical superiority. Endoscopic surgery is challenging, yet it may be advocated to avoid craniotomy and shunt complications. Surgical-type decisions for arachnoid cysts should be patient-tailored based on careful preoperative clinical and radiological examinations.

Background and purpose: Computerised interactive devices provide various treatment options for post-stroke rehabilitation, and may be applicable to treat neuropsychological deficits. This study aimed to identify a single rehabilitation task capable of improving both motor and cognitive functions in stroke patients.

Methods: This prospective randomised controlled trial involved post-stroke patients with hemispatial neglect who were divided into four groups. All groups received conventional treatment. Besides this, the control group made sorter exercises, while the three experimental groups engaged in the following additional activities: exercises with a gravity-supporting exoskeleton; exercises with an upper limb device with sensors on the patient; exercises with an upper limb device with sensors on a touchscreen. All groups used the unaffected side, except the exoskeleton group. Following measures were assessed pre- and post-test: upper limb subsection of the Fugl-Meyer scale (FM-UL), functional independence measure (FIM), line bisection test (LBT), Bells test.

Results: The programme (four weeks, 15 sessions) was completed by 59 post-stroke patients (less than 6 months after stroke). Significant associations were observed between time since stroke onset and improvements in FM-UL (p = .039), and motor (p = .021) and total FIM (p = .034). The motion abilities of the affected upper limb improved regardless of the treated side (p FM-UL = 0.45; p FIM = 0.416; p motor FIM = 0.395; p Bells test = 0.347; p LBT = 0.887). Bells test and LBT showed a strong correlation (-0.593). The effectiveness of the computerised interactive rehabilitation exercises in treating hemispatial neglect was comparable to conventional exercises, improving motor abilities of patients, as well as reducing hemispatial neglect in post-stroke patients.

Conclusion: This form of therapy is effective for both motor and certain cognitive deficits.

Background and purpose: The early and accurate diagnosis of depression is essential for the timely initiation of appropriate treatment. However, the use of traditional diagnostic methods is often subjective, labour-intensive, and time-consuming. Automated voice analysis offers promising solution to overcome these challenges by enabling the objective measurement of voice-based biometric features. The aim of this study is to review the research practice and findings of voice analysis methods supported by machine learning, to uncover inconsistencies, and to formulate constructive suggestions for future research.

Methods: This paper presents the results of a so-called umbrella review, which integrates the findings of already published systematic literature reviews and meta-analyses. For the identification of publications, we used the PubMed, Scopus, and ProQuest databases, following the PRISMA guidelines. The search interval covered the last 5 years. The search was conducted using predefined search terms and selection criteria, with the involvement of independent reviewers. Prior to detailed analysis, the methodological quality of the publications was assessed using the AMSTAR2 evaluation system.

Results: Through the systematic literature search, we identified a total of 162 unique records. Based on the inclusion and exclusion criteria, 6 publications were selected for detailed analysis. The results highlight the background factors limiting the applicability of the developed models and also emphasize the importance of acoustic characteristics that can be identified as biomarkers of depression despite methodological inconsistencies. This review supports the importance of machine learning and voice analysis in advancing the diagnostics of depression. However, to translate research outcomes into practice, beyond the application of standardized methods, validation across diverse test groups is necessary, among other things.

Conclusion: The application of machine learning in depression detection promises numerous advantages, such as objective diagnosis or early detection. This technology could offer cost-effective solution in the long run while providing greater access to mental health services. Nevertheless, the field is still evolving, and further research is needed to enhance the reliability of these methods.

Background and purpose - Carotid revascularization through carotid endarterectomy (CEA) and carotid artery stenting (CAS) are well established secondary preventive measures after ischemic stroke in unilateral carotid artery stenosis, but in the presence of contralateral carotid occlusion (CCO) the evidence regarding the optimal management of the stenotic carotid is not as clear even though the risk of ischemic stroke is high. The purpose of our review is to summarize recent findings and suggest its future implications. Methods - We conducted a systematic literature review using PubMed and ScienceDirect databases supplemented with studies found from Google Scholar. Results - Recent guidelines recommend CAS over CEA in patients with CCO, but in contrast some studies favor CEA over CAS after analysis of the complications and clinical outcome. Discussion - The decision between CEA and CAS depends upon a variety of factors such as neurological status, surgical risk factors, medical comorbidities, age, and imaging findings (presence of silent infarcts, plaque characteristics and the state of collateral circulation). Due to the contradictory observations the authors suggest further multicenter studies to establish the optimal management of patients with carotid stenosis and CCO and also summarize their personal opinion.

Disability progression can occur in all phenotypes of multiple sclerosis (MS) from the early stages of the disease, which may be due to incomplete recovery from clinical relapses and/or more insidious deterioration of neurological functions independent of relapses. Progression independent of relapse is more common in patients with progressive MS than in patients with relapsing-remitting MS. Its main background may be the activation of innate immune cells and the development of chronic active lesions, referred to as smoldering disease. Their identification may help in the early recognition of aggressive forms. Finding effective therapies targeting progressive mechanisms is a major need. A better understanding of the mechanisms underlying the progression of MS, the identification and validation of biomarkers and new therapeutic targets could lead to further success of therapies. In this communication, we summarize the theoretical background of smoldering disease and potential imaging modalities for its detection.

Chorea-acanthocytosis (VPS13A disease) is a rare multisystem neurodegenerative disorder with a broad phenotypic spectrum. It is characterized by neuropsychiatric symptoms and the presence of acanthocytes. However, the relationship between acanthocytes and disease severity remains unclear. Diagnosis is established through genetic testing. We present two sisters with VPS13A disease, each exhibiting distinct clinical presentations. The younger presents with severe symptoms including drug-resistant epilepsy, neuropsychiatric issues, chorea, and self-mutilation, along with the presence of acanthocytes in her blood smear (10%). Genetic testing identified a homozygous synonymous mutation in the VPS13A gene (Chromosome 9: 79971783 G>C, exon 55, c.7806G>C, Pro2602=). Conversely, the older sister experiences only well controlled epileptic seizures and elevated creatine kinase levels, with no acanthocytes in peripheral blood smears, which have been performed three times. She also harbors the same homozygous synonymous mutation in the VPS13A gene. Our report highlights siblings with identical mutations but differing clinical presentations, emphasizing the variability in VPS13A disease manifestations. The younger sister has acanthocytosis and chorea, whereas the older did not demonstrate those features. The term "VPS13A disease" is proposed to encompass this group of diseases, acknowledging that acanthocytes or chorea may not always be present. Our findings support this terminological shift. Additionally, we first mentioned this synonymous mutation (NM_033305.3: c.7806G>C exon 55, p. Pro2602=) in the VPS13A gene, contributing to the understanding of this condition.

The increasing morbidity and mortality of dementia places a significant burden on society in economic, social and health terms. In addition to the therapy of partially detectable etiologies, diet can also play a major role in reducing the risk of dementia. The most commonly studied dietary patterns in relation to cognitive decline are the Mediterranean diet, the DASH (Dietary Approaches to Stop Hypertension) diet for the prevention of hypertension, and the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which has emerged as a new approach in the last decade, combining elements of the Mediterranean and DASH diets, but there is also considerable research on the ketogenic diet and intermittent fasting. This study aims to summarise all dietary factors that may play a role in the prevention and development of cognitive decline.

Background and purpose: There are some new results that the angiotensin receptor blockers (ARB) therapy may associate with a lower risk of epilepsy. However, its pathomechanism and the patient characteristics are lacking. We asses, whether ARB therapy is associates with lower incidence of acute symptomatic seizures, compared with no ARB therapy in patients with acute stroke.

Methods: There was a single-center, retrospective, observational cross-sectional study, enrolled patients with acute stroke admitted to our hospital, from 1 January 2019 to 31 December 2021. The data source was our hospital medical database. We allocated the enrolled patients into two groups, by receiving or not ARB therapy and defined a 7 days exposure window after stroke onset whether acute seizures appear. The primary outcome was the incidence of acute seizures associated with ARB therapy compared with no ARB therapy. The comparison of these groups was performed with t-test for independent samples. Analysis of seizure predictors was tested in univariable and multivariable logistic regression models.

Results: The study included 1611 patients, mean [SD] age was 72.1 [±13.3] years; 801 (49.7%) were women, and 811 (50.3%) were men. The acute symptomatic seizures occurred in 4 of 235 patients (1.70%) in the ARB group and 78 of 1376 patients (5.67%) in the control group (P=0.014). In univariable analysis the variables significantly associated with acute symptomatic seizures: ARB the-rapy (odds ratio [OR], 0.29; 95% CI, 0.10-0.79; p=0.016), and with inverse association the hemorrhagic stroke (OR, 1.60; 95% CI, 1.50-4.52; p<0.001). In multivariable analy-sis, in addition to haemorrhage (OR, 2,46; 95% CI, 1,41-4,40; p<0.001) the ARB therapy remains significant (OR, 0.33; 95% CI, 0.12-0.91; p=0.032) as an independent predictor.

Conclusion: Due to our results the ARB therapy associates with a lower incidence of acute symptomatic seizures, which raise a question about its antiseizure property. Therefore, additional studies require to give more evidences about advantage of ARB therapy in these patients.

Dissection with subarachnoid hemorrhage is an unstable and dangerous condition because of the high rate of rerupture. The mortality of dissecting pseudoaneurysm is the worst among cerebral aneurysms. Dissecting pseudoaneurysms causing subarachnoid hemorrhage should be treated by endovascular intervention in the acute phase in most of the cases. Life-saving intervention must be performed urgently. Based on the treatment principle, interventions can be divided into two groups: deconstructive techniques involving the occlusion of the parent vessel and reconstructive techniques involving the preservation of the parent vessel. During reconstructive endovascular treatment, we currently use flow diverters, the disadvantage of which is that they require double platelet aggregation treatment, which complicates or prevents further open neurosurgical operations. A deconstructive technique is occlusion of the parent vessel proximal to the origin of the dissection. Good radiological and clinical results can be achieved using both techniques. In our case report, the unconscious state of a young boy was caused by massive ventricular hemorrhage and cerebral hematoma, the background of which was the rupture of an A2 dissection pseudoaneurysm. Parent vessel occlusion was performed urgently, while preserving the Heubner artery. With our treatment, a symptom-free recovery was achieved.

Background and purpose: Despite being recognised for a long time as a non-motor characteristic of Parkinson's disease (PD), pain is still a symptom that is underdiagnosed and undertreated. This study aimed to assess the relationship between PD patients' pain and sleep disturbances, depression, cognitive functions, fatigue and quality of life.

Methods: A total of 100 patients with primary PD were recruited for this study. Their demographic and clinical features, including age, gender distribution, educational level, smoking, lateralization and duration of PD, and comorbid diseases were recorded. The patients were divided into two groups: patients with and without pain. The scores on the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr Scale, Mini-Mental State Examination, Parkinson's Disease Questionnaire-39 (PDQ-39), Fatigue Severity Scale, Beck Depression and Anxiety Inventories, and Epworth Sleepiness Scale were compared between the two groups.

Results: Statistical analyses regarding questionnaires revealed higher scores in various domains for PD patients with pain, although significance was not found in all measures (p > 0.05). However, PDQ-39 test scores were significantly higher in PD patients with pain compared to those without pain (p = 0.036). Patients with pain presented significantly higher scores than those without pain for all domains of the UPDRS and Hoehn-Yahr Scale (p < 0.05). In order of frequency, musculoskeletal pain, radicular pain, parkinsonian pain, headache, neuropathic pain, and inflammatory pain were detected.

Conclusion: Our findings show that pain was prevalent in more than half of the participants, with musculoskeletal pain being the most common type. Additionally, experiencing multiple types of pain concurrently may highlight the complexity of pain presentation in this population, suggesting that pain in PD is frequent, complex, and related to impairment of quality of life of the patients.