Canadian Journal of Neurological Sciences最新文献

A perceived barrier to effective treatment of pediatric-onset multiple sclerosis (POMS) is access to disease-modifying therapies (DMTs). An online Canada-wide survey of POMS DMT prescribers was used to identify patterns in, and barriers to, DMT access. Nineteen prescribers provided responses. Overall, DMT access via private versus government drug plans was variable. First-generation (e.g., beta-interferon) DMTs were more accessible via government plans versus second-generation DMTs (e.g., ocrelizumab). Most DMTs were available through private insurance plans. B-cell depleting therapies were the most difficult to access. Variability in DMT access for POMS raises concerns about health equity and care optimization.

Introduction: Anterior skull base meningiomas account for 6% to 13% of all meningiomas. The extended endoscopic endonasal approach (EEA) to these meningiomas offers many advantages such as early devascularization, adequate tumor resection and preservation of neurovascular structures. This study aims to evaluate the clinical outcomes of patients undergoing EEA for anterior skull base meningiomas, including recurrence rate and prognostic factors.

Methods: This is a retrospective study conducted on adult patients who underwent EEA for anterior skull base meningiomas at The Ottawa Hospital Civic Campus between October 2014 and October 2023.

Results: Twenty-five patients underwent EEA for anterior skull base meningiomas. The mean preoperative tumor volume was significantly larger in the olfactory groove (OG) group (19.54 cm³) compared to the tuberculum sellae (TS) group (7.04 cm³). Mean surgical duration was 351 minutes, and mean blood loss was 472 ml. A nasoseptal flap was used in 92% of cases. CSF leaks occurred in four cases (16%) and were managed with lumbar drainage. Total or near-total resection was achieved in 87.5% of OG cases and 82.4% of TS cases. Subtotal resections were significantly associated with larger tumor volumes (p = 0.03). Most of our cohort's histopathological findings were World Health Organization grade I meningiomas (92%). Our mean follow-up was 5.56 years and tumor recurrence was seen in one patient.

Conclusion: Extended EEA for anterior skull base meningiomas is a safe and effective technique enabling total resection with a low recurrence rate. Optimal patient selection and multilayered reconstruction are critical to minimize complications.

Background: In Canada, the management of migraine is commonly carried out by primary care providers. Guidelines for the acute and preventative management of migraine in Canada are published by the Canadian Headache Society (CHS). There are currently limited data describing prescribing patterns among clinicians caring for patients with migraine in Canada.

Aims: Our aim for this exploratory study was to characterize the current pharmacological treatments prescribed for patients with migraine in Nova Scotia, Canada, seeking care through their primary care providers.

Methods: We conducted a retrospective cross-sectional analysis of deidentified electronic medical record (EMR) data collected from January 2019 to December 2023 from the Maritime Research Network for Family Practice (MaRNet-FP) to identify prescribing patterns for the acute and preventative management of migraine in Nova Scotia.

Results: In total, 3075 active patients who received a diagnosis of migraine were identified in the MaRNet-FP EMR database (6.53% of total patients). Migraine patients were predominantly female (81%) with an average age of 44 ± 16 years. Between 2019 and 2023, 50% of patients with a migraine diagnosis received a prescription for a medication that can be used for the acute management of migraine, most commonly, nonsteroidal anti-inflammatory drugs and triptans. Over the same period, 60.4% of patients were prescribed a medication that can be used for the prevention of migraine, the most common of which were anti-depressants and beta-blockers.

Conclusion: Our findings demonstrate alignment with CHS guidelines but highlight potential undertreatment of migraine.

Background/objective: The benefit of endovascular treatment (EVT) in acute ischemic strokes (AIS) due to medium vessel occlusion (MeVO) remains unclear, as recent randomized controlled trials (RCTs) have shown neutral results. This meta-analysis examines the pooled efficacy and safety of EVT in MeVO.

Methods: A systematic review and meta-analysis of two RCTs (DISTAL and ESCAPE-MeVO) involving 1073 participants was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcome was the risk ratios (RR) of excellent functional outcome, defined as modified Rankin score (mRS) 0-1 at 90 days. Secondary outcomes included mRS 0-2 and symptomatic intracranial hemorrhage (sICH).

Results: The RR implied no significant difference between the two treatment arms; for the primary efficacy outcome, RR (mRS 0-1) was 0.95 (95% CI: 0.81-1.10; I² = 0%), and for the secondary efficacy outcome, RR (mRS 0-2) was 0.98 (95% CI: 0.88-0.09; I² = 10%). The EVT + best medical treatment (BMT) arm demonstrated a higher risk of sICH (RR: 2.39, 95% CI: 1.26-4.53; I² = 0%) and serious adverse events (SAE) (RR: 1.32, 95% CI: 1.11-1.56; I² = 0%), while mortality at 90 days (RR: 1.29, 95% CI: 0.94-1.76; I² = 16%) showed no significant difference.

Conclusions: Our study showed that, in patients with AIS due to MeVO, EVT did not lead to better outcomes at 90 days when compared to BMT and was associated with a higher risk of sICH and SAEs compared to usual care, and this result was confirmed in a trial sequential analysis.

Prospero registration: The study protocol was registered with the International Prospective Register of Systematic Reviews under the registration identification number CRD420250653970.