Canadian Journal of Neurological Sciences最新文献

Background: Diagnosing clinically uncertain parkinsonian syndromes (CUPS) is challenging. Dopamine transporter (DaT) SPECT imaging (DaTscan) aids in differentiation, but its real-world impact on management in Canada, where it is not publicly funded, is unclear. The objective was to determine the impact of DaTscan results on clinical management for patients with CUPS in a Canadian tertiary care movement disorder service.

Methods: We conducted a retrospective chart review of 42 patients with CUPS referred for a DaTscan from a tertiary clinic in London, Ontario. DaTscan result was categorized as "Abnormal" (positive scan) or "Normal" (negative scan). The primary outcome was a change in management (Present/Absent). The association was assessed using Fisher's Exact test.

Results: Forty-two patients were included (median age 63 years; 50% female). Twenty-seven scans (64%) were abnormal, and 15 (36%) were normal. Overall, clinical management was changed in 13 patients (31%; 95% CI: 18% to 47%). A change in management was significantly more likely after a normal scan (60%, 9/15 patients) compared to an abnormal scan (15%, 4/27 patients) (p = 0.009). Changes after a normal scan primarily involved discontinuing dopaminergic therapy (7/9, 78%).

Conclusions: In this specialized clinic, DaTscan results informed management in 31% of CUPS patients. A normal scan provides the objective evidence needed to withdraw unnecessary dopaminergic medications confidently.

Background: The aim of this study was to investigate the effects of central vestibular dysfunction on physical functionality and cognitive function in individuals with multiple sclerosis (MS).

Methods: Fifty-two fully ambulatory individuals with MS (Expanded Disability Status Scale [EDSS] ≤ 4) were included and divided into two groups: those with central vestibular involvement (Group 1; n = 25) and those without (Group 2; n = 27). Central vestibular involvement was assessed using videonystagmography. Physical and cognitive functions were evaluated in all participants using the Glittre Activities of Daily Living (ADL) test, Godin Leisure-Time Exercise Questionnaire (GLTEQ), and the physical dimension of the MSQoL-54 for physical functionality, and the BICAMS, Trail Making Test (TMT), Word List Generation test and the cognitive dimension of the MSQoL-54 for cognitive function.

Results: According to the physical functionality assessment results, the time required to complete the Glittre ADL test was longer in group 1 than in group 2 (p = 0.01). The score for the physical dimension of the MSQoL-54 was lower in group 1 (p = 0.045). In the BICAMS Symbol Digit Modalities Test, Group 1 scored lower than Group 2 (p = 0.013). A significant difference between the groups was also observed in the time taken to complete the TMT (p = 0.017). Additionally, Group 1 exhibited lower scores on the cognitive dimension of the MSQoL-54 (p = 0.012).

Conclusion: Physical functionality and specific cognitive domains differed between MS participants with and without central vestibular involvement. It should be considered that vestibular dysfunction may adversely impact cognitive and physical functionality, even in low-moderate disability level.

Background: A better understanding of calcitonin gene-related peptide (CGRP) inhibitor use is in migraine treatment needed.

Methods: A retrospective, observational, population-based cohort study was conducted using administrative data. Adults (≥18 years) who received ≥1 prophylactic CGRP inhibitor in Canada (six provinces) between 2018 (first approved) and 2023 were identified. CGRP inhibitor use was described; migraine-related acute medication and healthcare use were compared pre-post CGRP inhibitor initiation (independent and paired t-tests).

Results: 12,851 adults were identified. CGRP inhibitor use increased from 11.8 (incident/prevalent) to 22.4 (incident) and 57.3 (prevalent) per 100,000 adults. Erenumab use decreased over time, as use of newer agents increased. During the 1-year period after CGRP inhibitor initiation, 57.4% had concomitant use with a different prophylactic migraine medication class (onabotulinumtoxinA injection: 23.2%; oral non-CGRP inhibitor: 34.2%), and 30.4% stopped use (21.3% switched to a different prophylactic migraine medication class; 9.1% discontinued all prophylactic migraine medication). During the 1-year period after CGRP inhibitor initiation (versus before), days of supply for migraine-related acute medication was lower (mean [standard deviation]: 129 [191] versus 145 [197] days; mean difference [95% confidence interval]: -16: [-22, -11] days), as were the number of healthcare visits (7.36 [8.70] versus 9.18 [10.10]; -1.82 [-2.06, -1.58]).

Conclusion: CGRP inhibitor use increased from 2018 to 2023. After CGRP inhibitor initiation, most patients had concomitant use with a different prophylactic migraine medication class, and some stopped use; migraine-related acute medication and healthcare use were lower (versus before). Findings provide a real-world description of the evolving landscape of CGRP inhibitor use in Canada.

Background: Stroke remains a major public health issue globally. Tele-rehabilitation, incorporating internet-based interventions and wearable devices, offers an accessible strategy for post-discharge rehabilitation. This study evaluates their effectiveness in stroke patients.

Methods: A total of 160 subacute stroke patients hospitalized between November 2022 and September 2023 were enrolled and randomly allocated to four groups at discharge (n = 40 per group): a control group receiving conventional rehabilitation, an internet-based tele-rehabilitation (ITR) group, a wearable-device-assisted (WDA) group and a combined intervention (IWT) group, which received both ITR and WDA training. The primary outcome was assessed by the Modified Barthel Index (MBI) at discharge, 4 weeks and 12 weeks post-discharge, with the 12-week score prespecified as the primary endpoint. Secondary outcomes included Berg Balance Scale (BBS), simplified Fugl-Meyer Assessment (sFMA), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Mini-Mental State Examination (MMSE) and Zarit Burden Interview (ZBI), all assessed at discharge, 4 weeks and 12 weeks post-discharge.

Results: At baseline, no significant differences were observed among groups (P > 0.05). Over 12 weeks, all intervention groups demonstrated significant improvements in MBI, BBS and sFMA compared to the control group (P < 0.05), with the IWT group achieving the greatest gains (P < 0.01). Anxiety, depression and caregiver burden significantly decreased across intervention groups, with the IWT group showing the most pronounced reductions (P < 0.01). Cognitive function also improved significantly, particularly in the IWT group (P < 0.01).

Conclusion: ITR and WDA training enhances functional and psychological recovery in stroke patients, highlighting its potential clinical significance in managing stroke recovery.

Background: Parkinson's disease (PD) is a neurodegenerative disorder whose diagnostic motor symptoms appear only after significant progression of neurodegeneration. Identification of preclinical markers is essential. Idiopathic rapid eye movement sleep behavior disorder (iRBD) has a high risk of conversion to PD. Olfactory impairment (hyposmia) is present in both PD and iRBD; hyposmia in iRBD may be an additional clue indicating the development of PD. The processes underlying hyposmia in iRBD are unknown. Using resting-state functional connectivity (rsFC), a "sensory olfactory subnetwork" (SOS) has been identified that is thought to represent the processing of basic sensory olfactory information. We investigated whether changes in the SOS are seen in both PD and iRBD and whether changes are associated with hyposmia in both conditions.

Methods: The University of Pennsylvania Smell Identification Test (UPSIT) and a seed-based approach to analyze SOS region rsFC in early PD, iRBD and healthy controls (HC) were employed. Our SOS regions included (right hemisphere) anterior piriform cortex, dorsal insula (INSd), ventral insula (INSv), posterior insula (INSp) and ventral posterior thalamus (THLvp).

Results: Compared to HC, idiopathic iRBD and PD participants performed significantly worse on UPSIT and exhibited lower FC between INSd and INSv and higher FC between INSd and THLvp and INSv and THLvp. UPSIT scores were negatively correlated with FC between INSv and THLvp and INSp and THLvp.

Conclusion: Idiopathic iRBD may be associated with similar functional and perceptual olfactory alterations and potential compensatory changes as early PD, which may show promise as additional preclinical biomarkers of PD.