Canadian Journal of Neurological Sciences最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.