Acta Neurologica Scandinavica最新文献

The novel coronavirus disease 2019 (COVID-19) causes severe respiratory illness and is involved in ischemic stroke. Aimed to investigate the inflammatory markers and possible prognosis of COVID-19-related ischemic stroke in a special outbreak period after lifting of COVID-19 control measures in China, we conducted a multicenter retrospective analysis in southern China at three centers in Shenzhen. We included patients diagnosed with acute ischemic stroke or transient ischemic attack after infection with COVID-19 as the COVID-19-related ischemic stroke group and those only diagnosed with acute ischemic stroke or transient ischemic attack as the control group. In this study, the proportion of female patients, admission heart rate, and comorbid coronary heart disease and the proportion of cryptogenic stroke were higher, while the history of prior stroke was lower in the COVID-19-related ischemic stroke group. The COVID-19-related ischemic stroke group also exhibited elevated levels of monocytes, fibrinogen, alanine aminotransferase, direct bilirubin, monocyte-to-lymphocyte ratio (MLR), and fibrinogen-to-albumin ratio (FAR) but decreased levels of lymphocytes, albumin, and high-density lipoprotein. However, there were no statistically significant differences in the modified Rankin scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and mortality rate between the two groups at discharge. Our study is the first to show the alteration in inflammatory markers but no difference in discharge prognosis between the non-COVID-19 and the COVID-19-related ischemic stroke patients, during China’s COVID-19 relaxation period.

Epilepsy is a common chronic neurologic disorder, with about 30%-40% of patients suffering from recurrent seizures despite receiving enough antiseizure medication. Growing evidence of extensive structural and functional research has revealed that epilepsy is a network disorder, and the network investigation is crucial in the presurgical evaluation. This narrative review is aimed at providing an overview of the conceptual development of epileptic surgery, the epileptic network formation, and the network-oriented strategy in clinical practice. We searched the PubMed database before October 2022 with no language or regional restrictions for studies of network exploration in epilepsy patients. The study eligibility criteria were original connectivity or network research studies using neuroimaging or neurophysiological approaches, focusing on seizure localization, neuropsychological evaluation, neuromodulation, or surgical prognosis. The initial search revealed 2046 studies. The selection process presented 746 papers that meet the inclusion criteria. The results indicated that epilepsy was characterized by the alternation of brain networks, which account for the clinical, electrographic, and neurocognitive phenomena related to human seizures and changes across different disease stages. Hubs have garnered significant attention due to their extensive connections, which make them prone to facilitating the spread of seizures to various brain regions. Unlike the seizure onset zone, the removal of the majority of these ictogenic nodes demonstrated a significant correlation with positive outcomes. Therefore, performing a network analysis during the epilepsy presurgical evaluation seems essential and will influence surgical decisions. It is hoped that studying the network of epilepsy will enhance our ability to determine the most appropriate surgical strategy for patients with epilepsy, thus contributing to success in terms of effective seizure control with maximal sparing or even improvement of brain functioning.

Introduction. Our previous research showed that the gamma knife surgery (GKS) is a highly effective treatment for intracanalicular vestibular schwannomas (IVS). In the current study, we aimed to evaluate long-term quality of life (QoL) as a follow-up to the assessment of baseline clinical and demographic parameters in the original study. Moreover, QoL outcomes were compared with norms for the general population and for patients who underwent different ear, nose, and throat (ENT) procedures. Materials and Methods. The follow-up study included 92 patients (59 women and 33 men; mean age, 61.71 ± 12.55 years; range: 32-85 years) with unilateral IVS who underwent GKS. Patients completed the Assessment of Quality of Life, Penn Acoustic Neuroma Quality-of-Life, Glasgow Benefit Inventory, and WHO-5 Well-being Index questionnaires as well as a demographic survey. Neurosurgical parameters were assessed using the Koos and House-Brackmann scales and the results of audiological examinations. Results and Conclusions. QoL scores were within or above the norm in 38% of patients. There were significant differences in terms of comorbidities and emotional well-being between patients with QoL scores within or above the norm and patients with QoL scores below the norm. Comorbidities were more common in patients with QoL scores below the norm, and they influenced reported QoL (p = 0.009). Patients with QoL scores within or above the norm reported better emotional well-being than those with QoL scores below the norm. Long-term QoL outcomes were satisfactory, consistent with the results of the original study. Although GKS is a complex procedure, patients reported higher QoL than those using hearing aids and the same QoL as those after ENT surgery or reassurance. However, they reported a slightly lower QoL than patients taking ENT medications. GKS appears to be a promising treatment option for patients with IVS.

Background. Pain is common in Parkinson’s disease (PD) and impairs quality of life. The King’s PD pain questionnaire (KPPQ) is a standardized, reliable, and valid self-administered questionnaire for screening of pain in PD. We developed a linguistically validated German version of the KPPQ and applied it to a cohort with fluctuating PD. Methods. The interculturally adapted German translation was performed according to internationally accepted procedures in coordination with the authors of the original publication but without further psychometric validation. After final approval by all translators and original authors, the German version was then tested for feasibility and comprehension in 30 PD patients. After final adaption, the German KPPQ together with the German quantitative KPPS were applied to an independent cohort of fluctuating PD patients within the VALIDATE-PD study. Results. The use of the German version of the KPPQ in clinical practice or in the VALIDATE-PD study revealed no significant problems of understanding. Sufficient datasets were available from 47 patients with motor fluctuations (24 (51%) males, 23 (49%) females; median (interquartile range (IQR)) age: 65 (58-73) years; median (IQR) Hoehn and Yahr stage: 2.5 [2-3]). Total pain was reported by 43 (92%) of participants with a median number of 4 (IQR: 2-5) pain subtypes. We did not observe any associations of total pain frequency, neither with gender nor with other demographic or clinical parameters. Conclusions. The German version of the KPPQ is recommended as a questionnaire for assessing the frequency of pain and its subtypes in PD in clinical studies and/or routine care.

Objectives. There are few contemporary, prospective studies reporting on the long-term risk of stroke and other cardiovascular (CV) events after transient ischemic attack (TIA). The primary aim was to examine the risk of new CV events within 5 years after TIA. The secondary aim was to identify baseline predictors of long-term CV events, including inflammatory biomarkers in a subgroup analysis. Materials and Methods. In a prospective, multicenter study, we enrolled 577 TIA patients between 2012 and 2014. The primary outcome was a composite of stroke, acute coronary syndrome, and CV death. We used data from the Norwegian Cardiovascular Disease Registry. In a subgroup of 112 patients, blood samples were analyzed for inflammatory biomarkers. Results. The primary outcome occurred in 108 patients (18.7%), of which 69 patients (12.0%) had a stroke. Sixty-one (56.5%) of the events occurred during year two through five. Increasing age (HR 1.05; 95% CI, 1.03-1.08), male sex (HR 1.82; 95% CI, 1.16-2.85), hypertension (HR 1.67; 95% CI, 1.04-2.67), and acute infarction on brain imaging (HR 1.84; 95% CI, 1.17-2.91) were significant predictors for the primary outcome. In the subgroup analysis, none of the blood inflammatory biomarkers were associated with CV events. Conclusions. The risk of CV events was highest during the first year after TIA, with a lower but sustained risk throughout the follow-up. This emphasizes the importance of both early initiation of and long-term continuation of secondary preventive treatment after TIA. Inflammatory biomarkers are probably not important as prognostic markers of cardiovascular disease in TIA patients.

Objective. To explore whether the new-onset refractory status epilepticus caused by autoimmune encephalitis has a better prognosis. Methods. This retrospective observational study enrolled patients with NORSE who were admitted from January 2015 to February 2024. The clinical data and clinical outcomes of the patients were collected and analyzed, and the primary outcome was seizures still at follow-up. Statistical analyses were performed using SPSS software V.22.0. Results. Among the 42 patients with NORSE, 15 (35.7%) had autoimmune encephalitis (AE), 3 (7.1%) patients had central nervous system infections, 24 (57.1%) patients had an unknown etiology, and 4 (9.5%) patients died in the hospital. Modified Rankin scale (MRS) scores at discharge of NORSE patients in the autoimmune encephalitis group and non-AE group were compared (P = 0.339). After 4 years of follow-up, analysis of patients who still had seizures showed that the only risk factor was etiology and that patients with nonautoimmune encephalitis etiology were more prone to later epilepsy (P = 0.030 (OR = 16.767, 95% CI: 1.454-213.395)). The MRS scores of the AE group and non-AE group were compared (P ≤ 0.001), with the autoimmune group having a better functional outcome. Significance. The overall prognosis of patients with autoimmune encephalitis may be better than that of patients with other etiologies, and later epilepsy is more likely in patients with nonautoimmune encephalitis. However, this result requires further validation in larger studies with more data.