Ideggyogyaszati Szemle-Clinical Neuroscience最新文献

Background and purpose:

Gliomas are the most common primary malignant central nervous system tumors in adults, exhibiting a poor prognosis. Indoleamine 2, 3-dioxygenase-1 (IDO-1) has important functions in cancer immunotherapy due to its role in escaping cancer cells from the immune system. In this study we purposed to evaluate the correlation between IDO-1 expression and clinicopathological parameters in gliomas, and whether IDO-1 can be a prognostic marker.

Methods:

n=75 patients in total, n=25 patients with low grade glial tumors (LGG, grade 1-2), n=25 patients with high grade glial tumors (HGG, grade 3-4), and n=25 persons with normal brain tissue as control group were included in this study. IDO-1 expression was categorized by using immunohistochemical staining in biopsy specimens as high (H) and low (L) groups among the patients with gliomas. We used a 95% percent confidence interval and p <0.05 to analyze the association between the degree of IDO-1 expression, clinicopathological characteristics, and survival rates in glioma patients. 

Results:

In HGG, IDO-1 levels were higher than in control brain tissue and LGG (p< 0.001). The mean overall survival (OS) was longer in the L-IDO-1 group (64.53 ± 3.34) in months (95% CI: 57.969-71.098) compared to the H-IDO-1 group (43.74 ± 4.36) in months, (95% CI: 35.218-52.330) (p< 0.05).

Conclusion:

IDO-1 expression is an in­de­pendent prognostic biomarker to predict 
OS and progression in HGG. IDO-1 can be evaluated as an alternative instrument for precision medicine in the treatment of gliomas.

Background and purpose:

We retro­spec­tively studied the development of neuro­trauma case numbers during the COVID-19 pandemic in the largest trauma center in Hun­gary and compared them to the data of the previous year. We hypothesized that the decrease in the number of neurotrauma cases during the restrictions would sub­sequently lead to a significant increase in a so-called rebound phenomenon. Our goal was to better understand the effect of the pandemic and the restrictive measures on neurotrauma admissions to help better pre­pare for a new pandemic or for other mobility restrictions. 

Methods:

We compiled daily case numbers from January 1, 2019, to April 30, 2021, which included the treatment of 861 patients with spinal trauma and 1244 patients with head injuries from 2019 to 2020, and 871 and 1255 patients with spinal trauma and head injuries, respectively, from March 2020 to April 30, 2021. The parameters studied were patients’ age, admission date and time from injury to admission. We also conducted a minimum 3-month follow-up study with pa­tients admitted during the pandemic to determine the changes in the hazard ratio of mortality. 

Results:

We found that in each wave of the pandemic, during the restrictive measures, neurotrauma case numbers decreased. After the first restrictions, we observed a clinically relevant rebound effect among spinal trauma patients. The main findings of the follow-up were that the hazard ratio of mortality for COVID-19 infected patients was 2.5 (p < 0.001), compared with the mortality hazard ratio of COVID-19-negative patients.

Conclusion:

Restrictions during the pandemic significantly reduced population mobility helping slow down the spread of the virus and give time to healthcare systems to better prepare. At the same time, it also reduced the number of new neurotrauma cases. In case of spinal trauma patients, a rebound effect was observed after the restrictions, which may be due to increased mobility, activity and travel. The restrictive measures reduced trauma cases effectively, while not increased the time from injury to admission. 

Background and purpose:

Neuro­fibromatosis type 1 (NF1) is a rare, auto­somal dominant multisystemic disease. The NF1 gene is localized on chromosome 17q11.2. Patients with NF1 have different clinical presentations and comorbidities. The aim of the present study is to determine the novel mutations and neurological comorbidities of NF1.

Methods:

Patients who were diagnosed with NF1 by clinical criteria of the National Institutes of Health were included in the study. After a detailed examination, the NF1 gene was analysed with the help of next generation sequencing technology from pe­ripheral blood samples via MiSeq (Illu­mina, USA). Bioinformatic analyzes were per­for­med to evaluate the clinical sig­ni­fi­cance of the detected variants via the in­ternational databanks in accordance with the ACMG (American College of Medical Ge­netics) guide­line. In addition, cerebral-spinal MRI, cerebral angiography, and ENMG exa­mi­na­tions were performed if deemed necessary.

Results:

Twenty patients (12 female, 8 male) were included in the study. The mean age was 25.8±10 (10-56) years. Previously defined 13 different pathogenic mutations according to the ACMG criteria were identified in 18 patients. Also, two novel mutations were detected in 2 cases. Moreover, neurological comorbidities (moyamoya disease, multiple sclerosis, Charcot Marie Tooth Type 1A) were found in 3 patients with NF1.

Conclusion:

In the present study two novel mutations and three different neurological comorbidities were identified in NF1.

Background and purpose:

The aim of the current observational study was to examine the level of adherence of Hungarian patients suffering from depression, using iFightDep­ression (iFD) guided online self-help tool with and without an extra weekly phone call support as well as identifying the predictors of adherence. Our hypotheses were: the additional weekly phone-calls would increase the adherence with the online self-help tool; furthermore, symptoms of depression will significantly decrease in the weekly phone support group.

Methods:

During the 6 weeks of iFD® intervention, patients were divided into two groups: the first, alongside of the treatment as usual (TAU) and iFD®, received a 20-minu­tes weekly phone call support while the other group partook in only the TAU+iFD® intervention. Measures: number of completed modules and Patient Health Questionnaire-9. The study included 102 participants with diagnosis of depression (70% female, mean age: 36.9 [SD = 11.40] ys). 

Results:

Participants completed on average 4.8 (SD = 1.73) out of 6 modules. The intervention group with additional phone support completed more modules than the group of no additional phone calls (Z = –5.416, p < 0.001, rank Cohen’s d = –1.267). Participants with higher level of education completed more modules than those with lower level of education (Z = –2.198, p = 0.028, rank Cohen’s d = –0.444). Baseline depressive symptoms correlated negatively with the number of completed modules (rS = –0.22, p = 0.028). Depressive symptoms were significantly reduced between the two measurement points (main effect of time: (F(1) = 179.173, p < 0.001, partial η2 = 0.642), the improvement was significantly larger in the iFD® + phone support group (time × group interaction: F(1) = 6.492, p = 0.012, partial η2 = 0.061).

Conclusion:

Weekly phone support increased treatment adherence. Negative correlation of symptom severity with adherence suggests that iFD can be effective in mild or moderate forms of depression. With regards to sociodemographic variables, only the level of education showed significant correlation with adherence. Our results support applicability of the iFD intervention in various kinds of sociodemographic groups.

Background and purpose:

Poststroke aphasia severity is related to several demographic, lesion-specific, and clinical factors. However, results about the importance of these factors are controversial. The aim of the current study was to investigate the effects of demographic and clinical factors on aphasia severity as well as on expressive and receptive language skills in a sample of Hungarian-speaking people with aphasia. 

Methods:

Ninety-four people with aphasia with mainly unilateral left-hemisphere stroke (87.88%) participated. We used multiple stepwise linear regression to investigate the relationships between potential predictors – i.e., sex, education, time postonset, etiology, lesion localisation, pathological changes in the brain caused by small vessel disease, and other neurogenic communication disorders/swallowing disorders – and language outcome. As outcome variables, we used the total score, the receptive score, and the expressive score of the Hungarian Aphasia Screening Test.

Results:

Less years of education, pathological changes in the brain (white matter hypodensities/hyperintensities and subcortical lacunar lesions) and apraxia of speech were associated with more severe aphasia. Pathological changes and apraxia of speech were also associated with lower expressive language skills in aphasia. Finally, education, pathological changes, and sex predicted receptive language skills in poststroke aphasia (p < 0.05 in all three models).  

Conclusion:

Pathological changes, apraxia of speech, education, and sex may affect language outcome in poststroke aphasia. We discuss our findings in light of the results of previous studies. 

Professor László Molnár was born in 1923. He completed his university studies in Szeged and continued his clinical work in Pécs. He qualified as a neurologist, psychiatrist and neurosurgeon. He first studied the regulation of cerebral blood circulation in animal experiments in Germany, and then worked in Paris as a fellow with Professor Seylaz. He obtained his doctorate at the Sorbonne. He obtained his Candidate’s thesis in 1966 and his Doctorate in 1977. Between 1969 and 1992 he was Head of the Neurological Clinic of the University of Debrecen, where he studied the consequences of focal ischemia in animal experiments. In Debrecen he founded the Cerebrovascular Department, the second in Europe to specialize in the care of stroke patients. Eleven of his staff became senior physicians, four became university professors, and six received PhDs and three MTA doctorates. He died in 1999.

Background and purpose:

Post-acute sequelae of COVID-19 (PASC) describes the occurrence of persistent symptoms following COVID-19 infection. Neurological and psychiatric symptoms may include fatigue, post-exertional malaise, cognitive complaints, sensorimotor symptoms, headache, insomnia, depression, and post-traumatic stress disorder. The aim of this study was to evaluate the long-term effects of COVID-19 infection on mental fatigue and cognitive flexibility in young adults.

Methods:

Simple random sampling method was used to enroll university students into the study between December 25 and 31, 2022. The time since active infection, central neurological findings (such as headache, dizziness, and loss of smell or taste), and the presence of lung involvement were recorded. The Mental Fatigue Scale (MFS) and the Cognitive Flexibility Inventory (CFI) were administered to all participants.

Results:

The study included 102 cases and 111 controls. The case group had a significantly higher total MFS score (12.95; 9.69 respectively) (p<0.001) and significantly lower total CFI score (100.01; 109.84 respectively) (p<0.001) than the control group. The case group experienced more frequent mental fatigue than the control group (p<0.001). Among all participants, a history of COVID-19 infection was identified as a risk factor for developing mental fatigue (odds ratio/OR: 2.74). In the case group, female sex (OR: 0.38) and lung involvement (OR: 10.74) were risk factors for developing mental fatigue.

Conclusion:

This study demonstrates that COVID-19 infection might have long-term negative effects on cognitive health, likely due to a combination of organic and psychogenic mechanisms. 

Background and purpose:

In our collaborative project, called MRI First!, every patient arriving with neurological symptoms of acute stroke and without contraindications was examined by MRI. Our aim was to detect the symptomatic lesions, to obtain appropriate information about the brain parenchyma and to analyse parenchymal perfusion and brain vasculature.

Methods:

The examinations were conduc­ted on a Philips Ingenia 1.5 Tesla scanner with the following protocol: DWI-ADC, FLAIR, T2 FFE/SWI, PWI, and contrast-enhanced MRA. 415 patients were examined between January 2020 and May 2021. 179 patients arrived within-, and 136 patients after 4.5 hours symptoms onset time, while 100 patients had “wake-up” stroke.

Results:

Within the 4.5 hours group, 81 cases had acute ischemic lesion, 48 of them received reperfusion therapy. Acute ische­mic lesion was found in 64 patients in the wake-up stroke group and in 64 in the 4.5-24 hours group. In these groups 10 and 12 patients obtained reperfusion therapy, respectively. Further 117 cases were considered as stroke mimics, in which cases unnecessary intravenous thrombolysis was avoidable.

Conclusion:

MRI is accepted as a sensitive diagnostic modality providing detailed information regarding the brain parenchyma, its perfusion and vasculature. Nonetheless, its worldwide utilization in acute stroke is low and further information should be collected on which patient groups would gain the most benefit from acute MR imaging. Our continuous work is aimed at that goal.

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome or idiopathic brachial plexopathy, is a multifocal inflammatory neuropathy that usually affects the upper limbs. The classic picture is a patient with acute onset of asymmetric upper extremity symptoms, excruciating pain, rapid onset of multifocal paresis often involving winged scapula, and a monophasic course of the disease. 
We present an unusual case of recurrent NA characterized first by right brachial plexitis and then isolated left posterior interosseous nerve palsy. 

Background and purpose:

There is a significant correlation between the upper and lower cervical alignments associated with a compensatory mechanism to maintain horizontal gaze. Evaluating this correlation before cervical fusion operations is essential, particularly in the upper cervical region, to prevent the occurrence of postoperative malalignment. This study was designed to investigate whether evaluating the interdependency between the upper and lower cervical alignments on neutral supine magnetic resonance imaging (MRI) or supine MRI with neck extension is possible. 

Methods:

This study included 36 male and 30 female volunteers without symptoms aged between 16 and 60 years. Cervical radiographic images and supine cervical spinal MRI scans were obtained twice on the neutral supine position and on the supine position with pillows placed at 5 cm high under the shoulder. Cervical lordosis (CL) (C2–7 Cobb angle), C0–2 Cobb angle, C2–7 sagittal vertical axis (C2–7SVA), T1 slope (T1S), and T1 slope minus CL (T1S-CL (C2S)) were measured from the imaging sets from each patient, including X-ray images and two MRI scans, and the main values were obtained. The mean values of the measurements from the radiographic images were compared with those obtained from MRI scans using Student’s t-test. The agreement between the parameters (C0–2 Cobb angle, CL Cobb angle, and T1S-CL) obtained from the radiographic images and MRI scans was evaluated using Pearson correlation analysis.

Results:

Pearson correlation analysis revealed significant correlations between the C0–2 and C2–7 Cobb angles in standing X-ray and neutral MRI values (r = −0.425 and -0.397, respectively). In plain radiography and MR studies, the T1 slope was correlated with the C2–7 angle (r = 0.4824, 0.734, and 0.702, respectively). The C2 slope values were also significantly correlated with the C0–2 Cobb angle in standing X-ray and neutral MRI images (r = 0.5595 and 0.5719, respectively). There were significant correlations between the C2 slope and C2–7 Cobb angles in all modalities (r = −0.5645, −0.7917, and −0.8526).

Conclusion:

Negative correlations between the upper and lower cervical alignments are also present in supine MRI studies, consequently in the supine position, with statistical significance. The C2 slope is an important cervical spine parameter that is significantly correlated with both the C0–2 and CL Cobb angles. The C2 slope can be used to evaluate the interdependency of the upper and lower cervical alignments.