Pub Date : 2024-04-01DOI: 10.1136/bmjno-2024-000706
Chin-Hen Chang, Timithy Mark McClellan, Kevin David Lopez, Thomas Wasser, Somkiat Hemtasilpa
Introduction Nerve conduction study (NCS) and electromyography (EMG) are electrodiagnostic studies that are highly tolerated by patients despite their nature of causing pain and discomfort. However, few studies have focused on the true tolerability of these procedures in patients. This study aimed to determine the true tolerance rate of NCS and EMG in patient populations and the factors that might be associated with them. Methods Participants scheduled for electrodiagnostic studies were prospectively recruited between March 2023 and September 2023. After completion of the study, the physicians completed a questionnaire on each patient’s tolerance of the studies. Results Of the 103 patients enrolled in the study, 98 were able to tolerate both tests, and 5 patients were intolerant to 1 or both tests. The overall tolerance rate of NCS and EMG was 95.1% (0.951, 95% CI 0.897 to 0.981). Age, sex, ethnicity, the type of NCS performed and the type of EMG performed were not associated with NCS or EMG intolerance. Conclusion Most patients tolerated the NCS and EMG; however, a small percentage of patients were intolerant. Clinicians should recognise the intolerance of certain patients when introducing and performing electrodiagnostic tests. Data are available upon reasonable request.
{"title":"Tolerability of electrodiagnostic studies in patients: a prospective study","authors":"Chin-Hen Chang, Timithy Mark McClellan, Kevin David Lopez, Thomas Wasser, Somkiat Hemtasilpa","doi":"10.1136/bmjno-2024-000706","DOIUrl":"https://doi.org/10.1136/bmjno-2024-000706","url":null,"abstract":"Introduction Nerve conduction study (NCS) and electromyography (EMG) are electrodiagnostic studies that are highly tolerated by patients despite their nature of causing pain and discomfort. However, few studies have focused on the true tolerability of these procedures in patients. This study aimed to determine the true tolerance rate of NCS and EMG in patient populations and the factors that might be associated with them. Methods Participants scheduled for electrodiagnostic studies were prospectively recruited between March 2023 and September 2023. After completion of the study, the physicians completed a questionnaire on each patient’s tolerance of the studies. Results Of the 103 patients enrolled in the study, 98 were able to tolerate both tests, and 5 patients were intolerant to 1 or both tests. The overall tolerance rate of NCS and EMG was 95.1% (0.951, 95% CI 0.897 to 0.981). Age, sex, ethnicity, the type of NCS performed and the type of EMG performed were not associated with NCS or EMG intolerance. Conclusion Most patients tolerated the NCS and EMG; however, a small percentage of patients were intolerant. Clinicians should recognise the intolerance of certain patients when introducing and performing electrodiagnostic tests. Data are available upon reasonable request.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"85 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140831293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjno-2024-000667
Louise Rath, Wei Zhen Yeh, Angie Roldan, Robb Wesselingh, Michael Zhong, Tracie Tan, Nabil Seery, Francesca Bridge, YiChao Foong, Olga Skibina, Cassie Nesbitt, Helmut Butzkueven, Mastura Monif, Anneke van der Walt
Background In Australia, tixagevimab/cilgavimab 150 mg/150 mg was a government-funded pre-exposure prophylaxis for COVID-19 people with multiple sclerosis (pwMS) and other neuroimmunological conditions (pwNIc) treated with anti-CD20 antibodies or sphingosine-1-phosphate receptor modulators were eligible. Objective To analyse the roll-out, uptake and real-world efficacy of tixagevimab/cilgavimab in the prevention and severity of COVID-19. To assess compliance with uptake depending on the location of delivery. Methods We undertook a single-centre study. 440 pwMS and pwNIc were eligible. Logistic regression was used to assess predictors of COVID-19 during follow-up and to assess predictors of uptake among those who consented. Results Of the eligible pwMS and pwNIc in our service, 52.7% (233/440) requested a consultation and were included in this study. Consultation resulted in 71.7% of people (167/233) receiving the treatment. Of these, 94.0% (157/167) had received three or more COVID-19 vaccines. Among those who received a single dose of tixagevimab/cilgavimab, 19.16% (32/167) tested positive for COVID-19 during the observational window. The majority of these were on ocrelizumab (68.8% (22/32)). None of those with COVID-19 required hospitalisation or supplemental oxygen. There was no difference in odds of COVID-19 during the observation period between those who received and did not receive tixagevimab/cilgavimab (adjusted OR, aOR 2.16 (95% CI 0.82 to 6.85), p=0.43). Uptake of tixagevimab/cilgavimab was highest when offered at the hospital infusion centre (aOR 3.09 (95% CI 1.08 to 9.94) relative to referral to the local pharmacy, p=0.04). Conclusion Tixagevimab/cilgavimab administration did not protect against subsequent COVID-19 in our cohort. Compliance with uptake was influenced by administration location. Data are available on reasonable request.
{"title":"Real-world efficacy, roll-out and uptake of intramuscular tixagevimab/cilgavimab as COVID-19 pre-exposure prophylaxis in people with multiple sclerosis and neuroimmunological conditions during the COVID-19 pandemic","authors":"Louise Rath, Wei Zhen Yeh, Angie Roldan, Robb Wesselingh, Michael Zhong, Tracie Tan, Nabil Seery, Francesca Bridge, YiChao Foong, Olga Skibina, Cassie Nesbitt, Helmut Butzkueven, Mastura Monif, Anneke van der Walt","doi":"10.1136/bmjno-2024-000667","DOIUrl":"https://doi.org/10.1136/bmjno-2024-000667","url":null,"abstract":"Background In Australia, tixagevimab/cilgavimab 150 mg/150 mg was a government-funded pre-exposure prophylaxis for COVID-19 people with multiple sclerosis (pwMS) and other neuroimmunological conditions (pwNIc) treated with anti-CD20 antibodies or sphingosine-1-phosphate receptor modulators were eligible. Objective To analyse the roll-out, uptake and real-world efficacy of tixagevimab/cilgavimab in the prevention and severity of COVID-19. To assess compliance with uptake depending on the location of delivery. Methods We undertook a single-centre study. 440 pwMS and pwNIc were eligible. Logistic regression was used to assess predictors of COVID-19 during follow-up and to assess predictors of uptake among those who consented. Results Of the eligible pwMS and pwNIc in our service, 52.7% (233/440) requested a consultation and were included in this study. Consultation resulted in 71.7% of people (167/233) receiving the treatment. Of these, 94.0% (157/167) had received three or more COVID-19 vaccines. Among those who received a single dose of tixagevimab/cilgavimab, 19.16% (32/167) tested positive for COVID-19 during the observational window. The majority of these were on ocrelizumab (68.8% (22/32)). None of those with COVID-19 required hospitalisation or supplemental oxygen. There was no difference in odds of COVID-19 during the observation period between those who received and did not receive tixagevimab/cilgavimab (adjusted OR, aOR 2.16 (95% CI 0.82 to 6.85), p=0.43). Uptake of tixagevimab/cilgavimab was highest when offered at the hospital infusion centre (aOR 3.09 (95% CI 1.08 to 9.94) relative to referral to the local pharmacy, p=0.04). Conclusion Tixagevimab/cilgavimab administration did not protect against subsequent COVID-19 in our cohort. Compliance with uptake was influenced by administration location. Data are available on reasonable request.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"2017 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140831314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjno-2023-000558
Alishba Kamran, Neha Saleem Paryani, Noor Fatima Suri, Javeria Khan, Fahad Amir, Marium Mehmood, Sehan Siraj Lashkerwala, Javeria Hayat, Shayan Marsia
Background and purpose We conducted a systematic review and meta-analysis to assess the incidence of acute kidney injury (AKI) in patients undergoing CT angiography (CTA) and CT perfusion (CTP) for acute ischaemic stroke (AIS). Concerns over contrast-induced nephropathy (CIN) often lead medical centres to mandate pre-imaging serum creatinine level assessments, causing unnecessary delays. We aim to confirm further the practice of conducting CTA/CTP without first testing creatinine. Methods We searched PubMed, Cochrane Central and Scopus from inception until March 2023 for studies reporting on AKI in patients with AIS receiving CTA/CTP. Outcomes of interest were (1) the odds of AKI in patients receiving CTA/CTP versus non-contrast CT and (2) the overall incidence of AKI and haemodialysis in patients with AIS undergoing CTA/CTP. Results Results were pooled using a random effects model. 13 studies were included (5 cohort and 8 single-arm studies) with 5104 patients in total, out of which 4347 patients received CTA/CTP and 757 patients received no contrast. In case–control studies, 4.8% (OR=0.66, 95% CI 0.35 to 1.22, Z=1.32, p=0.19) of patients who received CTA/CTP developed AKI, compared with 7.7% of patients in the control group. Temporary haemodialysis was required for two patients in the analysed studies. Conclusions Non-randomised evidence suggests that CTA/CTP is not associated with a statistically significant increase in the risk of AKI in patients with stroke. Further well-designed prospective studies are required to explore potential risk factors of CIN in specific patient populations such as diabetes mellitus and chronic kidney disease. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Incidence of acute kidney injury in patients with acute ischaemic stroke undergoing CT angiography (CTA) and CT perfusion (CTP): a systematic review and meta-analysis","authors":"Alishba Kamran, Neha Saleem Paryani, Noor Fatima Suri, Javeria Khan, Fahad Amir, Marium Mehmood, Sehan Siraj Lashkerwala, Javeria Hayat, Shayan Marsia","doi":"10.1136/bmjno-2023-000558","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000558","url":null,"abstract":"Background and purpose We conducted a systematic review and meta-analysis to assess the incidence of acute kidney injury (AKI) in patients undergoing CT angiography (CTA) and CT perfusion (CTP) for acute ischaemic stroke (AIS). Concerns over contrast-induced nephropathy (CIN) often lead medical centres to mandate pre-imaging serum creatinine level assessments, causing unnecessary delays. We aim to confirm further the practice of conducting CTA/CTP without first testing creatinine. Methods We searched PubMed, Cochrane Central and Scopus from inception until March 2023 for studies reporting on AKI in patients with AIS receiving CTA/CTP. Outcomes of interest were (1) the odds of AKI in patients receiving CTA/CTP versus non-contrast CT and (2) the overall incidence of AKI and haemodialysis in patients with AIS undergoing CTA/CTP. Results Results were pooled using a random effects model. 13 studies were included (5 cohort and 8 single-arm studies) with 5104 patients in total, out of which 4347 patients received CTA/CTP and 757 patients received no contrast. In case–control studies, 4.8% (OR=0.66, 95% CI 0.35 to 1.22, Z=1.32, p=0.19) of patients who received CTA/CTP developed AKI, compared with 7.7% of patients in the control group. Temporary haemodialysis was required for two patients in the analysed studies. Conclusions Non-randomised evidence suggests that CTA/CTP is not associated with a statistically significant increase in the risk of AKI in patients with stroke. Further well-designed prospective studies are required to explore potential risk factors of CIN in specific patient populations such as diabetes mellitus and chronic kidney disease. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"1 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140800531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjno-2023-000570
Xueli Zhang, Zhuoting Zhu, Yu Huang, Xianwen Shang, Terence J O'Brien, Patrick Kwan, Jason Ha, Wei Wang, Shunming Liu, Xiayin Zhang, Katerina Kiburg, Yining Bao, Jing Wang, Honghua Yu, Mingguang He, Lei Zhang
Background Alzheimer’s disease (AD) and age-related macular degeneration (AMD) share similar pathological features, suggesting common genetic aetiologies between the two. Investigating gene associations between AD and AMD may provide useful insights into the underlying pathogenesis and inform integrated prevention and treatment for both diseases. Methods A stratified quantile–quantile (QQ) plot was constructed to detect the pleiotropy among AD and AMD based on genome-wide association studies data from 17 008 patients with AD and 30 178 patients with AMD. A Bayesian conditional false discovery rate-based (cFDR) method was used to identify pleiotropic genes. UK Biobank was used to verify the pleiotropy analysis. Biological network and enrichment analysis were conducted to explain the biological reason for pleiotropy phenomena. A diagnostic test based on gene expression data was used to predict biomarkers for AD and AMD based on pleiotropic genes and their regulators. Results Significant pleiotropy was found between AD and AMD (significant leftward shift on QQ plots). APOC1 and APOE were identified as pleiotropic genes for AD–AMD (cFDR <0.01). Network analysis revealed that APOC1 and APOE occupied borderline positions on the gene co-expression networks. Both APOC1 and APOE genes were enriched on the herpes simplex virus 1 infection pathway. Further, machine learning-based diagnostic tests identified that APOC1, APOE (areas under the curve (AUCs) >0.65) and their upstream regulators, especially ZNF131, ADNP2 and HINFP, could be potential biomarkers for both AD and AMD (AUCs >0.8). Conclusion In this study, we confirmed the genetic pleiotropy between AD and AMD and identified APOC1 and APOE as pleiotropic genes. Further, the integration of multiomics data identified ZNF131, ADNP2 and HINFP as novel diagnostic biomarkers for AD and AMD. Data are available in a public, open access repository. GRASP database for GWAS data (); GTEx database for gene expression data (); GEO database for gene expression data (); and UK Biobank for GWAS data ().
背景阿尔茨海默病（AD）和老年性黄斑变性（AMD）具有相似的病理特征，表明两者之间存在共同的遗传病因。研究阿尔茨海默病和老年性黄斑变性之间的基因关联可能有助于深入了解其潜在的发病机制，并为这两种疾病的综合预防和治疗提供依据。方法 基于17 008例AD患者和30 178例AMD患者的全基因组关联研究数据，构建了分层量纲-量纲（QQ）图，以检测AD和AMD之间的多重性。使用基于贝叶斯条件假发现率（cFDR）的方法来识别多向性基因。英国生物库用于验证多效性分析。进行了生物网络和富集分析，以解释多效性现象的生物学原因。使用基于基因表达数据的诊断测试，根据多效基因及其调控因子预测AD和AMD的生物标志物。结果 发现 AD 和 AMD 之间存在显著的多效性（QQ 图上显著左移）。APOC1和APOE被确定为AD-AMD的多效基因（cFDR 0.65），其上游调控因子，尤其是ZNF131、ADNP2和HINFP，可成为AD和AMD的潜在生物标志物（AUC>0.8）。结论 在这项研究中，我们证实了AD和AMD之间的遗传多效性，并确定了APOC1和APOE为多效基因。此外，通过整合多组学数据，我们发现 ZNF131、ADNP2 和 HINFP 是新型的 AD 和 AMD 诊断生物标记物。数据可在公开、开放的资源库中获取。GWAS数据的GRASP数据库（）；基因表达数据的GTEx数据库（）；基因表达数据的GEO数据库（）；GWAS数据的英国生物库（）。
{"title":"Shared genetic aetiology of Alzheimer’s disease and age-related macular degeneration by APOC1 and APOE genes","authors":"Xueli Zhang, Zhuoting Zhu, Yu Huang, Xianwen Shang, Terence J O'Brien, Patrick Kwan, Jason Ha, Wei Wang, Shunming Liu, Xiayin Zhang, Katerina Kiburg, Yining Bao, Jing Wang, Honghua Yu, Mingguang He, Lei Zhang","doi":"10.1136/bmjno-2023-000570","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000570","url":null,"abstract":"Background Alzheimer’s disease (AD) and age-related macular degeneration (AMD) share similar pathological features, suggesting common genetic aetiologies between the two. Investigating gene associations between AD and AMD may provide useful insights into the underlying pathogenesis and inform integrated prevention and treatment for both diseases. Methods A stratified quantile–quantile (QQ) plot was constructed to detect the pleiotropy among AD and AMD based on genome-wide association studies data from 17 008 patients with AD and 30 178 patients with AMD. A Bayesian conditional false discovery rate-based (cFDR) method was used to identify pleiotropic genes. UK Biobank was used to verify the pleiotropy analysis. Biological network and enrichment analysis were conducted to explain the biological reason for pleiotropy phenomena. A diagnostic test based on gene expression data was used to predict biomarkers for AD and AMD based on pleiotropic genes and their regulators. Results Significant pleiotropy was found between AD and AMD (significant leftward shift on QQ plots). APOC1 and APOE were identified as pleiotropic genes for AD–AMD (cFDR <0.01). Network analysis revealed that APOC1 and APOE occupied borderline positions on the gene co-expression networks. Both APOC1 and APOE genes were enriched on the herpes simplex virus 1 infection pathway. Further, machine learning-based diagnostic tests identified that APOC1, APOE (areas under the curve (AUCs) >0.65) and their upstream regulators, especially ZNF131, ADNP2 and HINFP, could be potential biomarkers for both AD and AMD (AUCs >0.8). Conclusion In this study, we confirmed the genetic pleiotropy between AD and AMD and identified APOC1 and APOE as pleiotropic genes. Further, the integration of multiomics data identified ZNF131, ADNP2 and HINFP as novel diagnostic biomarkers for AD and AMD. Data are available in a public, open access repository. GRASP database for GWAS data (<https://grasp.nhlbi.nih.gov/FullResults.aspx>); GTEx database for gene expression data (<https://www.gtexportal.org/>); GEO database for gene expression data (<https://www.ncbi.nlm.nih.gov/geo/>); and UK Biobank for GWAS data (<https://www.ukbiobank.ac.uk/>).","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"48 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Essential tremor (ET) is a movement disorder that affects 4%–5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral MR-guided focused ultrasound thalamotomy (MRgFUS) are available. In this retrospective cohort study, we examined the demographics of patients with ET who have received MRgFUS and evaluated trends in DBS usage in the USA after the introduction of MRgFUS in 2016. Methods We used multiple databases to examine the demographics of patients who received DBS and MRgFUS, and trends in DBS. To assess the demographics, we queried the TriNetX database from 2003 to 2022 to identify patients diagnosed with ET and stratify them by DBS or MRgFUS treatment by using Current Procedural Terminology codes. Patient demographics were reported as frequencies and percentages. To examine the trends in DBS for ET, the yearly frequency of DBS procedures done for ET between 2012 and 2019 was extracted from the National Inpatient Sample (NIS) database, and breakpoint analysis was performed. Additionally, the yearly frequency of MRgFUS procedures for ET was obtained from Insightec Exlabate. Results Most of the patients (88.69%) in the cohort extracted from TriNetX database self-identified as white, followed by black or African American (2.40%) and Asian (0.52%). A higher percentage of black patients received MRgFUS treatment than DBS (4.10% vs 1.88%). According to the NIS database, from 2012 to 2020, 13 525 patients received DBS for ET. Conclusion This study provides an overview of the characteristics of patients who undergo DBS or MRgFUS. We found notable differences in sex and race among patients who underwent each treatment type. Additionally, until at least the beginning of 2020, the number of DBS procedures for ET was not negatively affected after the introduction of MRgFUS. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from TriNETx Healthcare Network, National Inpatient Sample and Insightec Exablate. Restrictions apply to the availability of these data, which were used under license for this study.
{"title":"Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA","authors":"Diwas Gautam, Vishal Venkatraman, Joshua Horns, Lexie Zidanyue Yang, Hui-Jie Lee, Panagiotis Kassavetis, Jumana Alshaikh, Paolo Moretti, Ben Shofty, Shervin Rahimpour","doi":"10.1136/bmjno-2023-000582","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000582","url":null,"abstract":"Background Essential tremor (ET) is a movement disorder that affects 4%–5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral MR-guided focused ultrasound thalamotomy (MRgFUS) are available. In this retrospective cohort study, we examined the demographics of patients with ET who have received MRgFUS and evaluated trends in DBS usage in the USA after the introduction of MRgFUS in 2016. Methods We used multiple databases to examine the demographics of patients who received DBS and MRgFUS, and trends in DBS. To assess the demographics, we queried the TriNetX database from 2003 to 2022 to identify patients diagnosed with ET and stratify them by DBS or MRgFUS treatment by using Current Procedural Terminology codes. Patient demographics were reported as frequencies and percentages. To examine the trends in DBS for ET, the yearly frequency of DBS procedures done for ET between 2012 and 2019 was extracted from the National Inpatient Sample (NIS) database, and breakpoint analysis was performed. Additionally, the yearly frequency of MRgFUS procedures for ET was obtained from Insightec Exlabate. Results Most of the patients (88.69%) in the cohort extracted from TriNetX database self-identified as white, followed by black or African American (2.40%) and Asian (0.52%). A higher percentage of black patients received MRgFUS treatment than DBS (4.10% vs 1.88%). According to the NIS database, from 2012 to 2020, 13 525 patients received DBS for ET. Conclusion This study provides an overview of the characteristics of patients who undergo DBS or MRgFUS. We found notable differences in sex and race among patients who underwent each treatment type. Additionally, until at least the beginning of 2020, the number of DBS procedures for ET was not negatively affected after the introduction of MRgFUS. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from TriNETx Healthcare Network, National Inpatient Sample and Insightec Exablate. Restrictions apply to the availability of these data, which were used under license for this study.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"10 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1136/bmjno-2023-000578
Jihoon Kang, Hyunjoo Song, Seong Eun Kim, Jun Yup Kim, Hong-Kyun Park, Yong-Jin Cho, Kyung Bok Lee, Juneyoung Lee, Ji Sung Lee, Ah Rum Choi, Mi Yeon Kang, Philip B Gorelick, Hee-Joon Bae
Background The landscape of stroke care has shifted from stand-alone hospitals to cooperative networks among hospitals. Despite the importance of these networks, limited information exists on their characteristics and functional attributes. Methods We extracted patient-level data on acute stroke care and hospital connectivity by integrating national stroke audit data with reimbursement claims data. We then used this information to transform interhospital transfers into a network framework, where hospitals were designated as nodes and transfers as edges. Using the Louvain algorithm, we grouped densely connected hospitals into distinct stroke care communities. The quality and characteristics in given stroke communities were analysed, and their distinct types were derived using network parameters. The clinical implications of this network model were also explored. Results Over 6 months, 19 113 patients with acute ischaemic stroke initially presented to 1009 hospitals, with 3114 (16.3%) transferred to 246 stroke care hospitals. These connected hospitals formed 93 communities, with a median of 9 hospitals treating a median of 201 patients. Derived communities demonstrated a modularity of 0.904, indicating a strong community structure, highly centralised around one or two hubs. Three distinct types of structures were identified: single-hub (n=60), double-hub (n=22) and hubless systems (n=11). The endovascular treatment rate was highest in double-hub systems, followed by single-hub systems, and was almost zero in hubless systems. The hubless communities were characterised by lower patient volumes, fewer hospitals, no hub hospital and no stroke unit. Conclusions This network analysis could quantify the national stroke care system and point out areas where the organisation and functionality of acute stroke care could be improved. Data is available with permission from the Korean Health Insurance Review and Assessment Service (HIRA). As this study used a government-owned database, it requires special permission to use it.
{"title":"Network analysis of stroke systems of care in Korea","authors":"Jihoon Kang, Hyunjoo Song, Seong Eun Kim, Jun Yup Kim, Hong-Kyun Park, Yong-Jin Cho, Kyung Bok Lee, Juneyoung Lee, Ji Sung Lee, Ah Rum Choi, Mi Yeon Kang, Philip B Gorelick, Hee-Joon Bae","doi":"10.1136/bmjno-2023-000578","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000578","url":null,"abstract":"Background The landscape of stroke care has shifted from stand-alone hospitals to cooperative networks among hospitals. Despite the importance of these networks, limited information exists on their characteristics and functional attributes. Methods We extracted patient-level data on acute stroke care and hospital connectivity by integrating national stroke audit data with reimbursement claims data. We then used this information to transform interhospital transfers into a network framework, where hospitals were designated as nodes and transfers as edges. Using the Louvain algorithm, we grouped densely connected hospitals into distinct stroke care communities. The quality and characteristics in given stroke communities were analysed, and their distinct types were derived using network parameters. The clinical implications of this network model were also explored. Results Over 6 months, 19 113 patients with acute ischaemic stroke initially presented to 1009 hospitals, with 3114 (16.3%) transferred to 246 stroke care hospitals. These connected hospitals formed 93 communities, with a median of 9 hospitals treating a median of 201 patients. Derived communities demonstrated a modularity of 0.904, indicating a strong community structure, highly centralised around one or two hubs. Three distinct types of structures were identified: single-hub (n=60), double-hub (n=22) and hubless systems (n=11). The endovascular treatment rate was highest in double-hub systems, followed by single-hub systems, and was almost zero in hubless systems. The hubless communities were characterised by lower patient volumes, fewer hospitals, no hub hospital and no stroke unit. Conclusions This network analysis could quantify the national stroke care system and point out areas where the organisation and functionality of acute stroke care could be improved. Data is available with permission from the Korean Health Insurance Review and Assessment Service (HIRA). As this study used a government-owned database, it requires special permission to use it.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"48 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The shift towards milder strokes and studies suggesting that stroke symptoms vary by age and sex may challenge the Face-Arm-Speech Time (FAST) coverage. We aimed to study the proportion of stroke cases admitted with FAST symptoms, sex and age differences in FAST presentation and explore any additional advantage of including new item(s) from the National Institute of Health Stroke Scale (NIHSS) to the FAST algorithm. Methods This registry-based study included patients admitted with acute stroke to Sahlgrenska University Hospital (November 2014 to June 2019) with NIHSS items at admission. FAST symptoms were extracted from the NIHSS at admission, and sex and age differences were explored using descriptive statistics. Results Of 5022 patients, 46% were women. Median NIHSS at admission for women was (2 (8–0) and for men 2 (7–0)). In total, 2972 (59%) had at least one FAST symptom, with no sex difference (p=0.22). No sex or age differences were found in FAST coverage when stratifying for stroke severity. 52% suffered mild strokes, whereas 30% had FAST symptoms. The most frequent focal NIHSS items not included in FAST were sensory (29%) and visual field (25%) and adding these or both in modified FAST algorithms led to a slight increase in strokes captured by the algorithms (59%–67%), without providing enhanced prognostic information. Conclusions 60% had at least one FAST symptom at admission, only 30% in mild strokes, with no sex or age difference. Adding new items from the NIHSS to the FAST algorithm led only to a slight increase in strokes captured. Data are available upon reasonable request. Data from registries are subject to the Personal Data Act (Swedish law No SFS 1998:204). Data may be available to researchers upon request, after review of secrecy (contact the author ks.sunnerhagen@neuro.gu.se). According to the Swedish regulation (epn.se/en/start/regulations/), the permission to use data can only be according to application and approval from the ethical board.
背景 脑卒中向轻度脑卒中的转变以及有关脑卒中症状因年龄和性别而异的研究可能会对 "面-臂-言语时间"（FAST）的覆盖范围提出挑战。我们的目的是研究具有 FAST 症状的入院脑卒中病例比例、FAST 表现的性别和年龄差异，并探讨将美国国立卫生研究院脑卒中量表 (NIHSS) 的新项目纳入 FAST 算法是否会带来额外优势。方法 这项以登记为基础的研究纳入了 Sahlgrenska 大学医院收治的急性卒中患者（2014 年 11 月至 2019 年 6 月），患者入院时具有 NIHSS 项目。从入院时的 NIHSS 中提取 FAST 症状，并使用描述性统计学方法探讨性别和年龄差异。结果 5022 名患者中，46% 为女性。入院时女性 NIHSS 中位数为 2（8-0），男性为 2（7-0）。共有 2972 名患者（59%）至少有一种 FAST 症状，无性别差异（P=0.22）。根据中风严重程度进行分层后，FAST 的覆盖率没有发现性别或年龄差异。52% 的患者为轻度脑卒中，而 30% 的患者有 FAST 症状。未纳入 FAST 的最常见病灶 NIHSS 项目是感觉（29%）和视野（25%），在改进的 FAST 算法中增加这两项或两项会使算法捕获的脑卒中略有增加（59%-67%），但不会提供更好的预后信息。结论 60% 的患者在入院时至少有一种 FAST 症状，只有 30% 的患者为轻度脑卒中，且无性别或年龄差异。在 FAST 算法中增加 NIHSS 的新项目只会使捕捉到的脑卒中略有增加。数据可在合理要求下提供。登记处的数据受《个人数据法》（瑞典法律编号 SFS 1998:204）管辖。经保密审查后，研究人员可索取数据（请联系作者 ks.sunnerhagen@neuro.gu.se）。根据瑞典法规 (epn.se/en/start/regulations/)，只有在提出申请并获得伦理委员会批准后才能使用数据。
{"title":"The precision by the Face Arm Speech Time (FAST) algorithm in stroke capture, sex and age differences: a stroke registry study","authors":"Guri Hagberg, Haakon Ihle-Hansen, Tamar Abzhandadze, Malin Reinholdsson, Adam Viktorisson, Hege Ihle-Hansen, Katharina Stibrant Sunnerhagen","doi":"10.1136/bmjno-2023-000574","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000574","url":null,"abstract":"Background The shift towards milder strokes and studies suggesting that stroke symptoms vary by age and sex may challenge the Face-Arm-Speech Time (FAST) coverage. We aimed to study the proportion of stroke cases admitted with FAST symptoms, sex and age differences in FAST presentation and explore any additional advantage of including new item(s) from the National Institute of Health Stroke Scale (NIHSS) to the FAST algorithm. Methods This registry-based study included patients admitted with acute stroke to Sahlgrenska University Hospital (November 2014 to June 2019) with NIHSS items at admission. FAST symptoms were extracted from the NIHSS at admission, and sex and age differences were explored using descriptive statistics. Results Of 5022 patients, 46% were women. Median NIHSS at admission for women was (2 (8–0) and for men 2 (7–0)). In total, 2972 (59%) had at least one FAST symptom, with no sex difference (p=0.22). No sex or age differences were found in FAST coverage when stratifying for stroke severity. 52% suffered mild strokes, whereas 30% had FAST symptoms. The most frequent focal NIHSS items not included in FAST were sensory (29%) and visual field (25%) and adding these or both in modified FAST algorithms led to a slight increase in strokes captured by the algorithms (59%–67%), without providing enhanced prognostic information. Conclusions 60% had at least one FAST symptom at admission, only 30% in mild strokes, with no sex or age difference. Adding new items from the NIHSS to the FAST algorithm led only to a slight increase in strokes captured. Data are available upon reasonable request. Data from registries are subject to the Personal Data Act (Swedish law No SFS 1998:204). Data may be available to researchers upon request, after review of secrecy (contact the author ks.sunnerhagen@neuro.gu.se). According to the Swedish regulation (epn.se/en/start/regulations/), the permission to use data can only be according to application and approval from the ethical board.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"41 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rationale Intracranial atherosclerotic disease (ICAD) is a pathological process that causes progressive stenosis and cerebral hypoperfusion, leading to stroke occurrence and recurrence around the world. The exact duration of dual antiplatelet therapy (DAPT) for ICAD is unclear in view of long-term risk of bleeding complications. Aim The current study aims to study the efficacy and safety of long-term DAPT (up to 12 months) in patients with ICAD. Sample size Using 80% power and an alpha error of 5 %, presuming a 10%–15% drop-out rate, a total of 2200 patients will be recruited for the study. Methodology This is a prospective, randomised, double-blind, placebo controlled trial. Study outcomes The primary outcomes include recurrent ischaemic stroke (IS) or transient ischaemic attack and any intracranial haemorrhage (ICH), major or minor systemic bleeding at the end of 12 months. Secondary outcomes include composite of any stroke, myocardial infarction or death at the end of 12 months. The safety outcomes include any ICH, major or minor bleeding as defined using GUSTO (Global Use of Streptokinase and tPA for occluded Coronary Arteries) classification at the end of 12 months and 1 month after completion of the drug treatment phase. Discussion The study will provide level I evidence on the duration of DAPT among patients with IS due to ICAD of more than or equal to 50%.
{"title":"STENOSIS: Long-term single versus dual antiplatelet therapy in patients with ischaemic stroke due to intracranial atherosclerotic disease – a randomised trial","authors":"Rohit Bhatia, MV Padma Srivastava, Risha Sarkar, Saman Fatima, Imnameren Longkumer, Ajay Garg, Pooja Gupta, Jeyaraj Durai Pandian, Dheeraj Khurana, PN Sylaja, Shweta Jain, Deepti Arora, Aneesh Dhasan, Meenakshi Sharma","doi":"10.1136/bmjno-2023-000532","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000532","url":null,"abstract":"Rationale Intracranial atherosclerotic disease (ICAD) is a pathological process that causes progressive stenosis and cerebral hypoperfusion, leading to stroke occurrence and recurrence around the world. The exact duration of dual antiplatelet therapy (DAPT) for ICAD is unclear in view of long-term risk of bleeding complications. Aim The current study aims to study the efficacy and safety of long-term DAPT (up to 12 months) in patients with ICAD. Sample size Using 80% power and an alpha error of 5 %, presuming a 10%–15% drop-out rate, a total of 2200 patients will be recruited for the study. Methodology This is a prospective, randomised, double-blind, placebo controlled trial. Study outcomes The primary outcomes include recurrent ischaemic stroke (IS) or transient ischaemic attack and any intracranial haemorrhage (ICH), major or minor systemic bleeding at the end of 12 months. Secondary outcomes include composite of any stroke, myocardial infarction or death at the end of 12 months. The safety outcomes include any ICH, major or minor bleeding as defined using GUSTO (Global Use of Streptokinase and tPA for occluded Coronary Arteries) classification at the end of 12 months and 1 month after completion of the drug treatment phase. Discussion The study will provide level I evidence on the duration of DAPT among patients with IS due to ICAD of more than or equal to 50%.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"33 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140156272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/bmjno-2023-000608
Sean YW Tan, Nushan Gunawardana, Rhys C Roberts
Background The COVID-19 pandemic prompted rapid changes in outpatient neurology services and there remain unanswered questions regarding its long-term impact. First, what are the lasting changes of the pandemic on demographics and outcomes of new referrals and patients reviewed at outpatient neurology clinics? Safety concerns about virtual consultations during the initial stages of the pandemic were also raised. Has the continual adoption of virtual consultations led to negative outcomes for patients? Methods New referrals and first clinic appointments in 2019 (prepandemic baseline) and 2022 (postpandemic) in a tertiary referral centre were compared retrospectively. 7294 referrals (4946 clinic appointments) in 2019 and 6989 referrals (3976 clinic appointments) in 2022 were assessed. Outcomes investigated were rates of referrals accepted, time to clinic consultation, number of outpatient investigations per appointment, rates of discharge and the risk of reassessment. Results There was a change in triaging practice postpandemic, with more patients being offered virtual assessments. Virtual appointments were offered to a specific suitable cohort of patients. This resulted in a faster time to consultation, fewer investigations, higher rates of discharge, with a reduced risk of reassessment compared with prepandemic patients, and patients postpandemic who were seen face to face. Conclusion Outpatient neurology services have adapted postpandemic by effectively triaging referrals and allocating new patients appropriately to face-to-face or virtual clinics, improving patient outcomes and safety. Data are available upon reasonable request.
{"title":"The Lasting impact of the COVID-19 pandemic on outpatient neurology consultations","authors":"Sean YW Tan, Nushan Gunawardana, Rhys C Roberts","doi":"10.1136/bmjno-2023-000608","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000608","url":null,"abstract":"Background The COVID-19 pandemic prompted rapid changes in outpatient neurology services and there remain unanswered questions regarding its long-term impact. First, what are the lasting changes of the pandemic on demographics and outcomes of new referrals and patients reviewed at outpatient neurology clinics? Safety concerns about virtual consultations during the initial stages of the pandemic were also raised. Has the continual adoption of virtual consultations led to negative outcomes for patients? Methods New referrals and first clinic appointments in 2019 (prepandemic baseline) and 2022 (postpandemic) in a tertiary referral centre were compared retrospectively. 7294 referrals (4946 clinic appointments) in 2019 and 6989 referrals (3976 clinic appointments) in 2022 were assessed. Outcomes investigated were rates of referrals accepted, time to clinic consultation, number of outpatient investigations per appointment, rates of discharge and the risk of reassessment. Results There was a change in triaging practice postpandemic, with more patients being offered virtual assessments. Virtual appointments were offered to a specific suitable cohort of patients. This resulted in a faster time to consultation, fewer investigations, higher rates of discharge, with a reduced risk of reassessment compared with prepandemic patients, and patients postpandemic who were seen face to face. Conclusion Outpatient neurology services have adapted postpandemic by effectively triaging referrals and allocating new patients appropriately to face-to-face or virtual clinics, improving patient outcomes and safety. Data are available upon reasonable request.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"85 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140128753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1136/bmjno-2023-000531
Rohit Bhatia, MV Padma Srivastava, Saman Fatima, Risha Sarkar, Imnameren Longkumer, Shailesh Gaikwad, Leve S Joseph Devaranjan, Ajay Garg, Jeyaraj Durai Pandian, Dheeraj Khurana, PN Sylaja, Shweta Jain, Deepti Arora, Aneesh Dhasan, Sanjith Aaron, Angel T Miraclin, Pamidimukkala Vijaya, Srijithesh P Rajendran, Jayanta Roy, Biman Kanti Ray, Vivek Nambiar, Paul J Alapatt, Meenakshi Sharma
Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thrombolytic agent is better than another during bridging therapy. Aim The current study aims to understand if one thrombolytic agent is superior to the other during bridging therapy in the treatment of AIS and LVO. Sample size estimates Using 80% power and an alpha error of 5 %, presuming a 10% drop out rate, a total of 372 patients will be recruited for the study. Methods and design This study is a prospective, randomised, multicentre, open-label trial with blinded outcome analysis design. Study outcomes The primary outcomes include proportion of patients who will be independent at 3 months (modified Rankin score (mRS) ≤2 as good outcome) and proportion of patients who achieve recanalisation modified thrombolysis in cerebral infarction grade 2b/3 at first angiography run at the end of EVT. Secondary outcomes include proportion of patients with early neurological improvement, rate of symptomatic intracerebral haemorrhage (ICH), rate of any ICH, rate of any systemic major or minor bleeding and duration of hospital stay. Safety outcomes include any intracranial bleeding or symptomatic ICH. Discussion This trial is envisioned to confirm the theoretical advantages and increase the strength and quality of evidence for use of tenecteplase (TNK) in practice. Also, it will help to generate data on the efficacy and safety of biosimilar TNK. Trial registration number CTRI/2022/01/039473.
{"title":"RE-OPEN: Randomised trial of biosimilar TNK versus TPA during endovascular therapy for acute ischaemic stroke due to large vessel occlusions","authors":"Rohit Bhatia, MV Padma Srivastava, Saman Fatima, Risha Sarkar, Imnameren Longkumer, Shailesh Gaikwad, Leve S Joseph Devaranjan, Ajay Garg, Jeyaraj Durai Pandian, Dheeraj Khurana, PN Sylaja, Shweta Jain, Deepti Arora, Aneesh Dhasan, Sanjith Aaron, Angel T Miraclin, Pamidimukkala Vijaya, Srijithesh P Rajendran, Jayanta Roy, Biman Kanti Ray, Vivek Nambiar, Paul J Alapatt, Meenakshi Sharma","doi":"10.1136/bmjno-2023-000531","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000531","url":null,"abstract":"Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thrombolytic agent is better than another during bridging therapy. Aim The current study aims to understand if one thrombolytic agent is superior to the other during bridging therapy in the treatment of AIS and LVO. Sample size estimates Using 80% power and an alpha error of 5 %, presuming a 10% drop out rate, a total of 372 patients will be recruited for the study. Methods and design This study is a prospective, randomised, multicentre, open-label trial with blinded outcome analysis design. Study outcomes The primary outcomes include proportion of patients who will be independent at 3 months (modified Rankin score (mRS) ≤2 as good outcome) and proportion of patients who achieve recanalisation modified thrombolysis in cerebral infarction grade 2b/3 at first angiography run at the end of EVT. Secondary outcomes include proportion of patients with early neurological improvement, rate of symptomatic intracerebral haemorrhage (ICH), rate of any ICH, rate of any systemic major or minor bleeding and duration of hospital stay. Safety outcomes include any intracranial bleeding or symptomatic ICH. Discussion This trial is envisioned to confirm the theoretical advantages and increase the strength and quality of evidence for use of tenecteplase (TNK) in practice. Also, it will help to generate data on the efficacy and safety of biosimilar TNK. Trial registration number CTRI/2022/01/039473.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"10 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140156242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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