Loss of signals from substantia nigra (SN) and locus coeruleus (LC) on neuromelanin (NM)-sensitive sequences of MRI is reported as a potential biomarker in patients with Parkinson's disease (PD) and related diseases. This scoping review aims to consolidate current knowledge on MRI techniques to visualize and quantify these signals and their clinical applications in PD. Publicly available databases were searched for original studies using MRI to quantify NM in PD and other related disorders. Different studies were compared based on MRI sequence, quantification techniques and correlations with clinical scores. Furthermore, studies on genetic forms of PD and prodromal PD were also evaluated and compared. The most common MRI sequences used were T1-weighted sequences and gradient echo sequences. Different studies used different quantitative measures such as signal-to-noise ratio, contrast-to-noise ratio and contrast ratio. Morphometric evaluations such as volume and area of the SN and LC signals were also used. Most studies showed evidence of significant difference in the signals in different stages of PD compared to controls both at the SN and LC. There were significant correlations between the SN and LC signals and clinical scores. Hence, quantification of these signals may be reliable in diagnosis and disease monitoring in PD. The relative ease of signal quantification and widespread availability of MRI may make it a quantitative surrogate biomarker.
{"title":"Quantification of Neuromelanin as a Neuroimaging Biomarker for Parkinson's Disease.","authors":"Leroy D'Souza, Samanth Mallikarjun, Albert Stezin","doi":"10.1017/cjn.2025.10490","DOIUrl":"10.1017/cjn.2025.10490","url":null,"abstract":"<p><p>Loss of signals from substantia nigra (SN) and locus coeruleus (LC) on neuromelanin (NM)-sensitive sequences of MRI is reported as a potential biomarker in patients with Parkinson's disease (PD) and related diseases. This scoping review aims to consolidate current knowledge on MRI techniques to visualize and quantify these signals and their clinical applications in PD. Publicly available databases were searched for original studies using MRI to quantify NM in PD and other related disorders. Different studies were compared based on MRI sequence, quantification techniques and correlations with clinical scores. Furthermore, studies on genetic forms of PD and prodromal PD were also evaluated and compared. The most common MRI sequences used were T1-weighted sequences and gradient echo sequences. Different studies used different quantitative measures such as signal-to-noise ratio, contrast-to-noise ratio and contrast ratio. Morphometric evaluations such as volume and area of the SN and LC signals were also used. Most studies showed evidence of significant difference in the signals in different stages of PD compared to controls both at the SN and LC. There were significant correlations between the SN and LC signals and clinical scores. Hence, quantification of these signals may be reliable in diagnosis and disease monitoring in PD. The relative ease of signal quantification and widespread availability of MRI may make it a quantitative surrogate biomarker.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716880","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}
MRI-guided focused ultrasound (MRgFUS) thalamotomy has expanded the surgical treatment envelope for patients with essential tremor who fail on first-line pharmacological therapies. Understanding differences in access to MRgFUS thalamotomy, a procedure publicly funded in Ontario, is a first step to ensuring equitable opportunity for treatment across the province. In this brief communication, we explore the frequency of referrals directed to our tremor program between 2018 and 2023. We highlight differences in referral rates by jurisdiction and medical specialty, and explore associations with socio-economic factors. Our findings inform public policy and identify geographical areas for targeted outreach to enhance equitable access.
{"title":"Access to MRI-Guided Focused Ultrasound Thalamotomy for Essential Tremor in Ontario: Geographic and Socioeconomic Referral Patterns.","authors":"Inthuja Suthananthan, Nadia Scantlebury, Audrey Boudah, Camryn Rohringer, Michael Schwartz, Nir Lipsman, Agessandro Abrahao","doi":"10.1017/cjn.2025.10494","DOIUrl":"10.1017/cjn.2025.10494","url":null,"abstract":"<p><p>MRI-guided focused ultrasound (MRgFUS) thalamotomy has expanded the surgical treatment envelope for patients with essential tremor who fail on first-line pharmacological therapies. Understanding differences in access to MRgFUS thalamotomy, a procedure publicly funded in Ontario, is a first step to ensuring equitable opportunity for treatment across the province. In this brief communication, we explore the frequency of referrals directed to our tremor program between 2018 and 2023. We highlight differences in referral rates by jurisdiction and medical specialty, and explore associations with socio-economic factors. Our findings inform public policy and identify geographical areas for targeted outreach to enhance equitable access.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716930","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}
Manraj Ks Heran, David Volders, M Patrice Lindsay, Michael D Hill, Dylan Blacquiere, Gord Gubitz, Norine Foley, Rebecca Lund, Anita Mountain, Michel Shamy
{"title":"Canadian Stroke Best Practice Recommendations: Endovascular Thrombectomy for Acute Ischemic Stroke, Interim Update 2025.","authors":"Manraj Ks Heran, David Volders, M Patrice Lindsay, Michael D Hill, Dylan Blacquiere, Gord Gubitz, Norine Foley, Rebecca Lund, Anita Mountain, Michel Shamy","doi":"10.1017/cjn.2025.10444","DOIUrl":"https://doi.org/10.1017/cjn.2025.10444","url":null,"abstract":"","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-17"},"PeriodicalIF":2.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145671026","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}
Background: Levodopa-induced dyskinesia (LID) is a disabling symptom of Parkinson's disease (PD). There have been prior attempts to find risk factors contributing to this symptom, but risk factors for the severity of LID have not been comprehensively studied. We aimed to evaluate factors that correlate with LID severity in patients with PD based on the Unified Dyskinesia Rating Scale (UDysRS).
Methods: A cross-sectional study was designed on 52 idiopathic PD patients who were referred for LID between 2023 and 2024. Their demographic and clinical records were studied. Furthermore, cognitive decline (MoCA), PD severity (Hoehn and Yahr) and the severity of dyskinesia (UDysRS) were examined. The association between factors and LID severity was evaluated by carrying out univariate regression and multivariate regression backward elimination analysis.
Results: The mean age of patients with LID was 59.9 ± 11.4 years. Results of univariate regression analysis indicated that male sex (β = -0.24, P = 0.04), BMI (β = -0.3, P = 0.005), H&Y (β = 0.4, P = 0.002), diabetes mellitus (β = 0.3, P = 0.018) and levodopa dosage per kilogram (β = 0.37, P = 0.01) were significant factors involved in the severity of dyskinesia. The univariate regression model results showed that lack of constipation (P = 0.04), hyperlipidemia (P = 0.04) and total daily levodopa dosage per kilogram (P = 0.01) were associated with the severity of end-dose dystonia.
Conclusion: This study revealed that female sex, more advanced PD, diabetes mellitus, daily levodopa dosage per kilogram body weight and BMI are associated with the severity of LID. Also, it suggests that hyperlipidemia and lack of constipation are associated with the severity of end-dose dystonia.
背景:左旋多巴诱导的运动障碍(LID)是帕金森病(PD)的致残症状。以前曾有尝试寻找导致这种症状的危险因素,但对LID严重程度的危险因素尚未进行全面研究。我们的目的是基于统一运动障碍评定量表(UDysRS)评估PD患者中与LID严重程度相关的因素。方法:对2023年至2024年间转诊的52例特发性PD患者进行横断面研究。研究了他们的人口统计学和临床记录。此外,还检查了认知能力下降(MoCA)、PD严重程度(Hoehn和Yahr)和运动障碍严重程度(UDysRS)。通过单因素回归和多因素回归反向消除分析,评价各因素与LID严重程度的相关性。结果:LID患者平均年龄59.9±11.4岁。单因素回归分析结果显示,男性(β = -0.24, P = 0.04)、BMI (β = -0.3, P = 0.005)、H&Y (β = 0.4, P = 0.002)、糖尿病(β = 0.3, P = 0.018)和左旋多巴剂量(β = 0.37, P = 0.01)是影响运动障碍严重程度的重要因素。单因素回归模型结果显示,有无便秘(P = 0.04)、高血脂(P = 0.04)和每千克左旋多巴日总剂量(P = 0.01)与终剂量肌张力障碍的严重程度相关。结论:女性性别、PD晚期、糖尿病、kg体重每日左旋多巴剂量、BMI与LID严重程度相关。此外,它还提示高脂血症和缺乏便秘与终剂量肌张力障碍的严重程度有关。
{"title":"Assessment of Clinical and Demographic Factors Influencing the Severity of Levodopa-Induced Dyskinesia.","authors":"Shamim Kazemi, Narges Yazdi, Seyedamirhassan Habibi, Elahe Amini, Farhad Salari, Mohammad Rohani","doi":"10.1017/cjn.2025.10440","DOIUrl":"https://doi.org/10.1017/cjn.2025.10440","url":null,"abstract":"<p><strong>Background: </strong>Levodopa-induced dyskinesia (LID) is a disabling symptom of Parkinson's disease (PD). There have been prior attempts to find risk factors contributing to this symptom, but risk factors for the severity of LID have not been comprehensively studied. We aimed to evaluate factors that correlate with LID severity in patients with PD based on the Unified Dyskinesia Rating Scale (UDysRS).</p><p><strong>Methods: </strong>A cross-sectional study was designed on 52 idiopathic PD patients who were referred for LID between 2023 and 2024. Their demographic and clinical records were studied. Furthermore, cognitive decline (MoCA), PD severity (Hoehn and Yahr) and the severity of dyskinesia (UDysRS) were examined. The association between factors and LID severity was evaluated by carrying out univariate regression and multivariate regression backward elimination analysis.</p><p><strong>Results: </strong>The mean age of patients with LID was 59.9 ± 11.4 years. Results of univariate regression analysis indicated that male sex (<i>β</i> = -0.24, <i>P</i> = 0.04), BMI (<i>β</i> = -0.3, P = 0.005), H&Y (<i>β</i> = 0.4, <i>P</i> = 0.002), diabetes mellitus (<i>β</i> = 0.3, <i>P</i> = 0.018) and levodopa dosage per kilogram (<i>β</i> = 0.37, <i>P</i> = 0.01) were significant factors involved in the severity of dyskinesia. The univariate regression model results showed that lack of constipation (<i>P</i> = 0.04), hyperlipidemia (<i>P</i> = 0.04) and total daily levodopa dosage per kilogram (<i>P</i> = 0.01) were associated with the severity of end-dose dystonia.</p><p><strong>Conclusion: </strong>This study revealed that female sex, more advanced PD, diabetes mellitus, daily levodopa dosage per kilogram body weight and BMI are associated with the severity of LID. Also, it suggests that hyperlipidemia and lack of constipation are associated with the severity of end-dose dystonia.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-6"},"PeriodicalIF":2.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145671017","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}
Tawfik Elsherbini, Vanessa Léger, Arline-Aude Bérubé, Samuel Lapalme-Remis, Mark Keezer, Dang Khoa Nguyen
Cenobamate (CNB) has shown efficacy in reducing seizures in drug-resistant epilepsy (DRE) in clinical trials. We conducted a retrospective study at the Centre hospitalier de l'Université de Montréal epilepsy clinic to assess CNB's real-world efficacy and safety. Among 109 patients, follow-up data were available for 68 at 3 months, 53 at 6 months and 54 at 12 months. Median seizure frequency reduction was 50.0%, 57.3% and 73.3%, respectively. Seizure freedom at 12 months was 25.9%. CNB was discontinued in 8.3% of individuals due to adverse events (non-serious) or treatment inefficacy. Our findings support CNB's effectiveness in a DRE population.
{"title":"Cenobamate for Drug-Resistant Epilepsy: Initial Experience from a Single Tertiary Center.","authors":"Tawfik Elsherbini, Vanessa Léger, Arline-Aude Bérubé, Samuel Lapalme-Remis, Mark Keezer, Dang Khoa Nguyen","doi":"10.1017/cjn.2025.10487","DOIUrl":"10.1017/cjn.2025.10487","url":null,"abstract":"<p><p>Cenobamate (CNB) has shown efficacy in reducing seizures in drug-resistant epilepsy (DRE) in clinical trials. We conducted a retrospective study at the Centre hospitalier de l'Université de Montréal epilepsy clinic to assess CNB's real-world efficacy and safety. Among 109 patients, follow-up data were available for 68 at 3 months, 53 at 6 months and 54 at 12 months. Median seizure frequency reduction was 50.0%, 57.3% and 73.3%, respectively. Seizure freedom at 12 months was 25.9%. CNB was discontinued in 8.3% of individuals due to adverse events (non-serious) or treatment inefficacy. Our findings support CNB's effectiveness in a DRE population.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145671039","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}
Matti Douglas Allen, Danielle Carter, Jodi Warman-Chardon, Jocelyn Zwicker, Ari Breiner
In this retrospective case series, we present two patients with primary lateral sclerosis (PLS) and spasticity-related gait impairment. Both patients were assessed with 6-min walk tests (6MWT) and timed up and go (TUG) at baseline and after 4 weeks of oral levetiracetam. Following levetiracetam therapy, Patient 1 improved 27.3% (148.5 to 189 m) on 6MWT and 26.1% (23-17 s) on TUG. Patient 2 improved 18% (90 m in 4:29 min to 112 m in 6 min) on 6MWT and 10% (46-41 s) on TUG. Larger prospective trials of levetiracetam for spasticity and gait may be considered in PLS.
在这个回顾性病例系列中,我们提出了两例原发性侧索硬化症(PLS)和痉挛相关的步态障碍患者。在基线和口服左乙拉西坦4周后,对两名患者进行6分钟步行试验(6MWT)和up and go (TUG)计时。左乙拉西坦治疗后,患者1在6MWT上改善27.3% (148.5 ~ 189 m), TUG上改善26.1% (23 ~ 17 s)。患者2在6MWT上改善了18%(4:29分钟90米至6分钟112米),在TUG上改善了10%(46-41秒)。左乙拉西坦对PLS痉挛和步态的更大的前瞻性试验可能会被考虑。
{"title":"Case Series Assessing the Use of Levetiracetam for Gait Improvement in Primary Lateral Sclerosis.","authors":"Matti Douglas Allen, Danielle Carter, Jodi Warman-Chardon, Jocelyn Zwicker, Ari Breiner","doi":"10.1017/cjn.2025.10465","DOIUrl":"https://doi.org/10.1017/cjn.2025.10465","url":null,"abstract":"<p><p>In this retrospective case series, we present two patients with primary lateral sclerosis (PLS) and spasticity-related gait impairment. Both patients were assessed with 6-min walk tests (6MWT) and timed up and go (TUG) at baseline and after 4 weeks of oral levetiracetam. Following levetiracetam therapy, Patient 1 improved 27.3% (148.5 to 189 m) on 6MWT and 26.1% (23-17 s) on TUG. Patient 2 improved 18% (90 m in 4:29 min to 112 m in 6 min) on 6MWT and 10% (46-41 s) on TUG. Larger prospective trials of levetiracetam for spasticity and gait may be considered in PLS.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-3"},"PeriodicalIF":2.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662639","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}
Ronda Lun, Cody Doolan, Katrina Hannah Dizon Ignacio, Mohammed A Almekhlafi, Brian H Buck, Luciana Catanese, Aleksander Tkach, Tolulope Sajobi, Richard H Swartz, Bijoy K Menon, Nishita Singh
Background: There is an increasing number of patients with cancer and acute ischemic stroke (AIS). We aim to compare outcomes in patients treated with thrombolysis for AIS with a history of cancer to those without.
Methods: This is a post hoc analysis of the Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT) trial, evaluating tenecteplase versus alteplase in patients with AIS within 4.5 h of onset. ICD-10 codes via administrative data linkage were used to identify a history of cancer. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Other outcomes included mRS 0-1 at 90 days, return to pre-stroke function, mortality and bleeding. Analysis was done using logistic regression for binary outcomes adjusted for age, stroke severity, presence of cancer history and time from onset to needle. A generalized linear regression model was used for numeric outcomes, with effect measures reported as adjusted risk ratios (aRR).
Results: Of the 1577 patients enrolled, 37 (2.35%) had a prior diagnosis of cancer. At 90 days, cancer patients were less likely to achieve 90-day mRS 0-2 (aOR of 0.33 [95% CI 0.15-0.75]) and had higher mortality (aOR 3.75 [95% CI 1.76-7.75]) as compared to those without cancer. Length of stay was longer in patients with cancer than those without cancer (median 11.5 days [IQR 7-24.5] vs 5 days [IQR 3-11], respectively, aRR 2.76 [95% CI 2.58-2.94]).
Conclusion: Patients with AIS and a history of cancer had worse functional outcomes, prolonged length of stay and higher rates of mortality as compared to those with no diagnosis of cancer.
背景:癌症合并急性缺血性脑卒中(AIS)的患者越来越多。我们的目的是比较有癌症病史和没有癌症病史的AIS患者接受溶栓治疗的结果。方法:这是加拿大(AcT)试验中静脉注射替奈普酶与阿替普酶治疗急性缺血性卒中的事后分析,在发病后4.5小时内评估替奈普酶与阿替普酶对AIS患者的疗效。通过管理数据链接使用ICD-10代码来确定癌症病史。主要观察指标为90天的改良Rankin量表(mRS) 0-2。其他结果包括90天mRS 0-1、恢复中风前功能、死亡率和出血。采用logistic回归对年龄、中风严重程度、癌症病史和从发病到打针时间等因素进行校正后的二元结果进行分析。数值结果采用广义线性回归模型,效果测量报告为调整风险比(aRR)。结果:入组的1577例患者中,37例(2.35%)既往诊断为癌症。在第90天,与没有癌症的患者相比,癌症患者达到90天mRS 0-2的可能性更小(aOR为0.33 [95% CI 0.15-0.75]),死亡率更高(aOR为3.75 [95% CI 1.76-7.75])。癌症患者的住院时间长于无癌症患者(中位数分别为11.5天[IQR 7-24.5]和5天[IQR 3-11], aRR为2.76 [95% CI 2.58-2.94])。结论:与没有癌症诊断的患者相比,患有AIS并有癌症病史的患者功能预后更差,住院时间更长,死亡率更高。
{"title":"Response to Thrombolysis in Patients with a Diagnosis of Cancer: A Post Hoc Analysis of the AcT Trial.","authors":"Ronda Lun, Cody Doolan, Katrina Hannah Dizon Ignacio, Mohammed A Almekhlafi, Brian H Buck, Luciana Catanese, Aleksander Tkach, Tolulope Sajobi, Richard H Swartz, Bijoy K Menon, Nishita Singh","doi":"10.1017/cjn.2025.10481","DOIUrl":"10.1017/cjn.2025.10481","url":null,"abstract":"<p><strong>Background: </strong>There is an increasing number of patients with cancer and acute ischemic stroke (AIS). We aim to compare outcomes in patients treated with thrombolysis for AIS with a history of cancer to those without.</p><p><strong>Methods: </strong>This is a post hoc analysis of the Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT) trial, evaluating tenecteplase versus alteplase in patients with AIS within 4.5 h of onset. ICD-10 codes via administrative data linkage were used to identify a history of cancer. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Other outcomes included mRS 0-1 at 90 days, return to pre-stroke function, mortality and bleeding. Analysis was done using logistic regression for binary outcomes adjusted for age, stroke severity, presence of cancer history and time from onset to needle. A generalized linear regression model was used for numeric outcomes, with effect measures reported as adjusted risk ratios (aRR).</p><p><strong>Results: </strong>Of the 1577 patients enrolled, 37 (2.35%) had a prior diagnosis of cancer. At 90 days, cancer patients were less likely to achieve 90-day mRS 0-2 (aOR of 0.33 [95% CI 0.15-0.75]) and had higher mortality (aOR 3.75 [95% CI 1.76-7.75]) as compared to those without cancer. Length of stay was longer in patients with cancer than those without cancer (median 11.5 days [IQR 7-24.5] vs 5 days [IQR 3-11], respectively, aRR 2.76 [95% CI 2.58-2.94]).</p><p><strong>Conclusion: </strong>Patients with AIS and a history of cancer had worse functional outcomes, prolonged length of stay and higher rates of mortality as compared to those with no diagnosis of cancer.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662685","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}
Background: Social deprivation is associated with worse functional recovery and social participation after stroke. Home-based, individualized rehabilitation provided by Community Stroke Rehabilitation Teams (CSRTs) improves these outcomes. This study aimed to show that CSRTs offered an effective specific rehabilitation for socially deprived patients.
Methods: This was a retrospective study conducted in real-care conditions. Social deprivation was assessed by the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé score. The outcome questionnaires included the Frenchay Activity Index (FAI) and the EuroQol-5Dimension. We compared these outcomes between deprived and non-deprived (ND) populations. Rehabilitation of the deprived population was assessed by comparing interventions across both groups.
Results: We included 198 deprived patients and 140 ND patients. Deprived patients were more often women (p = 0.027), more likely to live alone at home (p = 0.01), and were referred later to a CSRT, despite having greater activity limitations at baseline (p < 0.001). They also had a lower FAI at baseline (13.2 vs. 16.6; p = 0.007). Although their FAI improved over time (+2.4 ± 5.5; p < 0.001), the improvement was modest and insufficient to close the gap with the ND group (15.7 vs. 20.7; p < 0.001). Regarding program characteristics, the deprived population received input from a greater number of healthcare professionals (2.7 ± 1.2 vs 2.4 ± 1.3; p = 0.017) and more often from the intervention "Health professional relationship" (34.2% vs 15.6%; p = 0.005).
Conclusion: These findings highlight the intersectionality of stroke-related challenges and the critical need to design post-stroke rehabilitation strategies that are more equitable and responsive to gender and social determinants of health.
背景:社会剥夺与脑卒中后较差的功能恢复和社会参与有关。社区脑卒中康复小组(CSRTs)提供的以家庭为基础的个性化康复改善了这些结果。本研究旨在证明csrt为社会剥夺患者提供了有效的特异性康复。方法:这是一项在真实护理条件下进行的回顾性研究。社会剥夺情况是由圣和其他所有圣和其他所有圣和其他所有考试中心的评估来评估的。结果问卷包括法国活动指数(FAI)和euroqol -5维度。我们比较了贫困和非贫困(ND)人群的这些结果。通过比较两组的干预措施来评估贫困人口的康复情况。结果:纳入198例贫困患者和140例ND患者。被剥夺的患者更多是女性(p = 0.027),更有可能独自生活在家里(p = 0.01),尽管在基线时有更大的活动限制(p < 0.001),但后来被转到CSRT。他们在基线时的FAI也较低(13.2 vs. 16.6; p = 0.007)。虽然他们的FAI随着时间的推移而改善(+2.4±5.5;p < 0.001),但改善幅度不大,不足以缩小与ND组的差距(15.7比20.7;p < 0.001)。在项目特征方面,被剥夺人群从更多的卫生保健专业人员(2.7±1.2 vs 2.4±1.3;p = 0.017)和更多的干预“卫生专业人员关系”(34.2% vs 15.6%; p = 0.005)得到输入。结论:这些发现强调了卒中相关挑战的交叉性,以及设计卒中后康复策略的迫切需要,这些策略更加公平,并对性别和健康的社会决定因素做出反应。
{"title":"Community Stroke Rehabilitation Teams and Social Deprivation: Challenges and Perspectives.","authors":"Soléane Vielotte, Alix Poyet, Jean-Yves Salle, Stéphane Mandigout, Maxence Compagnat, Jean-Christophe Daviet","doi":"10.1017/cjn.2025.10482","DOIUrl":"10.1017/cjn.2025.10482","url":null,"abstract":"<p><strong>Background: </strong>Social deprivation is associated with worse functional recovery and social participation after stroke. Home-based, individualized rehabilitation provided by Community Stroke Rehabilitation Teams (CSRTs) improves these outcomes. This study aimed to show that CSRTs offered an effective specific rehabilitation for socially deprived patients.</p><p><strong>Methods: </strong>This was a retrospective study conducted in real-care conditions. Social deprivation was assessed by the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé score. The outcome questionnaires included the Frenchay Activity Index (FAI) and the EuroQol-5Dimension. We compared these outcomes between deprived and non-deprived (ND) populations. Rehabilitation of the deprived population was assessed by comparing interventions across both groups.</p><p><strong>Results: </strong>We included 198 deprived patients and 140 ND patients. Deprived patients were more often women (<i>p</i> = 0.027), more likely to live alone at home (<i>p</i> = 0.01), and were referred later to a CSRT, despite having greater activity limitations at baseline (<i>p</i> < 0.001). They also had a lower FAI at baseline (13.2 vs. 16.6; <i>p</i> = 0.007). Although their FAI improved over time (+2.4 ± 5.5; <i>p</i> < 0.001), the improvement was modest and insufficient to close the gap with the ND group (15.7 vs. 20.7; <i>p</i> < 0.001). Regarding program characteristics, the deprived population received input from a greater number of healthcare professionals (2.7 ± 1.2 vs 2.4 ± 1.3; <i>p</i> = 0.017) and more often from the intervention \"Health professional relationship\" (34.2% vs 15.6%; <i>p</i> = 0.005).</p><p><strong>Conclusion: </strong>These findings highlight the intersectionality of stroke-related challenges and the critical need to design post-stroke rehabilitation strategies that are more equitable and responsive to gender and social determinants of health.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649982","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}
Ananth P Abraham, Madeline W Elder, Isabella Watson, Annika Weir, Ash Singhal, Faizal Aminmohamed Haji, Mandeep S Tamber
Objective: Early placement of a ventricular access device (VAD) in premature post-hemorrhagic ventricular dilatation based on ventricular size criteria, coupled with an aggressive tapping regimen to control ventricular size, may improve developmental outcomes. As this treatment paradigm represents a significant departure from traditional care, we present results of an institutional quality improvement protocol implementation study focusing on safety and resource use for those seeking to implement a similar care pathway.
Methods: Infants treated under the new ventricular size-driven protocol were retrospectively compared to a historical cohort managed according to clinical symptomatology. Process and compliance measures related to protocol implementation were tracked, as were complications and measures of resource use.
Results: Ventricular access device (VAD) placement occurred earlier and at a smaller ventricle size, but beyond the protocol-mandated timeframe. Although more resource-intensive than customary care, compliance with protocol-directed screening ultrasounds and VAD aspirations by trained clinicians was high. Intensive ultrasound surveillance altered the management of only one infant during their treatment course. An increased rate of complications related to earlier and more aggressive treatment in these fragile infants was not observed.
Conclusions: Protocol compliance was satisfactory and no safety issues were noted. Although VAD placement occurred sooner, a majority of infants received intervention outside of the mandated timeframe and at a ventricular size above the desired intervention threshold. Minimizing transfer delays from peripheral neonatal intensive care units and improving access to the operating room were identified as areas for improvement. It appears possible to decrease the frequency of ultrasound surveillance without compromising safety.
{"title":"Early Intervention Management Pathway for Intraventricular Hemorrhage of Prematurity: A Quality Improvement Analysis.","authors":"Ananth P Abraham, Madeline W Elder, Isabella Watson, Annika Weir, Ash Singhal, Faizal Aminmohamed Haji, Mandeep S Tamber","doi":"10.1017/cjn.2025.10470","DOIUrl":"https://doi.org/10.1017/cjn.2025.10470","url":null,"abstract":"<p><strong>Objective: </strong>Early placement of a ventricular access device (VAD) in premature post-hemorrhagic ventricular dilatation based on ventricular size criteria, coupled with an aggressive tapping regimen to control ventricular size, may improve developmental outcomes. As this treatment paradigm represents a significant departure from traditional care, we present results of an institutional quality improvement protocol implementation study focusing on safety and resource use for those seeking to implement a similar care pathway.</p><p><strong>Methods: </strong>Infants treated under the new ventricular size-driven protocol were retrospectively compared to a historical cohort managed according to clinical symptomatology. Process and compliance measures related to protocol implementation were tracked, as were complications and measures of resource use.</p><p><strong>Results: </strong>Ventricular access device (VAD) placement occurred earlier and at a smaller ventricle size, but beyond the protocol-mandated timeframe. Although more resource-intensive than customary care, compliance with protocol-directed screening ultrasounds and VAD aspirations by trained clinicians was high. Intensive ultrasound surveillance altered the management of only one infant during their treatment course. An increased rate of complications related to earlier and more aggressive treatment in these fragile infants was not observed.</p><p><strong>Conclusions: </strong>Protocol compliance was satisfactory and no safety issues were noted. Although VAD placement occurred sooner, a majority of infants received intervention outside of the mandated timeframe and at a ventricular size above the desired intervention threshold. Minimizing transfer delays from peripheral neonatal intensive care units and improving access to the operating room were identified as areas for improvement. It appears possible to decrease the frequency of ultrasound surveillance without compromising safety.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649995","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}
Solmaz Setayeshgar, Lily W Zhou, Mirna Hennawy, Gillian Frosst, Jennifer K Ferris, Alison de Wit, Kate Smolina
Background: Stroke remains a leading cause of death in British Columbia (BC), Canada. Understanding whether mortality declines are driven by prevention (reduced incidence) or improved survival (treatment) can inform public health and acute care planning.
Methods: We conducted a population-based study of 123,075 stroke events from 2002 to 2022 among BC residents aged 35-110 years, using linked administrative datasets. We calculated age-standardized rates of stroke events, 30-day case fatality and mortality, stratifying the rates by sex, age, income and geography. Regression models estimated temporal changes and relative contributions of declining event rates and case fatality to mortality reductions.
Results: Age-standardized stroke event rates declined by 33% in females (208-140 per 100,000) and 25% in males (248-187) but increased among adults aged 35-54 (+14% females, +27% males). Females experienced a higher burden of stroke events as pre-admission deaths, particularly among 85+. Case fatality fell by 22% in females (40-31 per 100 events) and 15% in males (37-32), with the greatest improvements in younger adults. Mortality declined by 53% in females (72-34 per 100,000) and 43% in males (72-41) primarily driven by declines in case fatality. Disparities by sex, income and geography persisted.
Conclusion: Improved survival is the main driver of declining stroke mortality in BC, particularly in recent years. Socioeconomic, sex and age disparities persist, warranting focused strategies to address inequities and the rising stroke burden among younger populations.
{"title":"Trends and Drivers of Declining Stroke Mortality in British Columbia: A Population-Based Study (2002-2022).","authors":"Solmaz Setayeshgar, Lily W Zhou, Mirna Hennawy, Gillian Frosst, Jennifer K Ferris, Alison de Wit, Kate Smolina","doi":"10.1017/cjn.2025.10483","DOIUrl":"10.1017/cjn.2025.10483","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a leading cause of death in British Columbia (BC), Canada. Understanding whether mortality declines are driven by prevention (reduced incidence) or improved survival (treatment) can inform public health and acute care planning.</p><p><strong>Methods: </strong>We conducted a population-based study of 123,075 stroke events from 2002 to 2022 among BC residents aged 35-110 years, using linked administrative datasets. We calculated age-standardized rates of stroke events, 30-day case fatality and mortality, stratifying the rates by sex, age, income and geography. Regression models estimated temporal changes and relative contributions of declining event rates and case fatality to mortality reductions.</p><p><strong>Results: </strong>Age-standardized stroke event rates declined by 33% in females (208-140 per 100,000) and 25% in males (248-187) but increased among adults aged 35-54 (+14% females, +27% males). Females experienced a higher burden of stroke events as pre-admission deaths, particularly among 85+. Case fatality fell by 22% in females (40-31 per 100 events) and 15% in males (37-32), with the greatest improvements in younger adults. Mortality declined by 53% in females (72-34 per 100,000) and 43% in males (72-41) primarily driven by declines in case fatality. Disparities by sex, income and geography persisted.</p><p><strong>Conclusion: </strong>Improved survival is the main driver of declining stroke mortality in BC, particularly in recent years. Socioeconomic, sex and age disparities persist, warranting focused strategies to address inequities and the rising stroke burden among younger populations.</p>","PeriodicalId":56134,"journal":{"name":"Canadian Journal of Neurological Sciences","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642946","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}