Acta Neurologica Scandinavica最新文献_第2页

Cerebrospinal Fluid Metabolites Mediate the Impact of Gut Microbiota on Amyotrophic Lateral Sclerosis: Novel Insights From Mendelian Randomization 脑脊液代谢物介导肠道微生物群对肌萎缩性侧索硬化的影响：孟德尔随机化的新见解

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-11-10 DOI: 10.1155/ane/5582939

Yuxin Fu, Tengfei Su, Jie Cao, Yue Lang, Xiang Yin, Jie Shao, Li Cui

Background

Previous studies have noted changes in the gut microbiota of amyotrophic lateral sclerosis patients, with some assessing its impact through metabolites or inflammatory factors. However, most of these are observational, and peripheral systems may not accurately reflect central nervous system pathology. This study uniquely explores the influence of gut microbiota on amyotrophic lateral sclerosis by metabolites in cerebrospinal fluid, which is directly connected to the central nervous system.

Methods

Data on gut microbiota, cerebrospinal fluid metabolites, and amyotrophic lateral sclerosis were derived from large-scale genome-wide association studies. We employed two-sample and mediation Mendelian randomization to examine the causal effects of gut microbiota and cerebrospinal fluid metabolites on amyotrophic lateral sclerosis, as well as the mediating role of cerebrospinal fluid metabolites between gut microbiota and disease progression. Furthermore, the results were validated through various sensitivity analyses.

Results

Two-sample Mendelian randomization analysis revealed significant associations between three gut microbiota and four cerebrospinal fluid metabolites and amyotrophic lateral sclerosis. Notably, mediation Mendelian randomization analysis indicated that cyanobacteria may promote the onset of amyotrophic lateral sclerosis by increasing the levels of 3-methoxytyramine sulfate in cerebrospinal fluid. Additionally, the sensitivity analysis confirmed the robustness of the Mendelian randomization results.

Conclusions

This study addresses the gap in causal inference within the research on the relationship between gut microbiota, cerebrospinal fluid metabolomics, and amyotrophic lateral sclerosis, thereby advancing our understanding of the molecular mechanisms underlying the disease. The findings will provide a scientific basis for early intervention and precision treatment of the disease.

先前的研究已经注意到肌萎缩侧索硬化症患者肠道微生物群的变化，一些研究通过代谢物或炎症因子评估其影响。然而，这些大多是观察性的，外周系统可能不能准确反映中枢神经系统病理。本研究独特地探讨了肠道微生物群通过脑脊液代谢物对肌萎缩性侧索硬化症的影响，脑脊液与中枢神经系统直接相关。方法肠道菌群、脑脊液代谢物和肌萎缩性侧索硬化症的数据来源于大规模全基因组关联研究。我们采用双样本和中介孟德尔随机化来研究肠道微生物群和脑脊液代谢物对肌萎缩性侧索硬化症的因果影响，以及脑脊液代谢物在肠道微生物群和疾病进展之间的中介作用。此外，通过各种敏感性分析验证了结果。结果双样本孟德尔随机化分析显示，3种肠道菌群和4种脑脊液代谢物与肌萎缩性侧索硬化症有显著相关性。值得注意的是，孟德尔随机分析表明，蓝藻可能通过增加脑脊液中硫酸3-甲氧基酪胺的水平来促进肌萎缩性侧索硬化症的发生。此外，敏感性分析证实了孟德尔随机化结果的稳健性。本研究解决了肠道微生物群、脑脊液代谢组学与肌萎缩性侧索硬化症之间关系研究中因果推断的空白，从而促进了我们对该疾病的分子机制的理解。研究结果将为该病的早期干预和精准治疗提供科学依据。

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引用次数: 0

Independent Predictors for Operative Treatment of Chronic Subdural Hematoma 慢性硬膜下血肿手术治疗的独立预测因素

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-11-06 DOI: 10.1155/ane/2759676

J. M. B. Reimer, R. M. Brohet, B. Jacobs, J. Blaauw, R. M. Arntz, K. H. Kho, R. J. M. Groen, M. Foumani, J. van der Naalt, M. H. den Hertog

Objectives

Treatment of chronic subdural hematoma (CSDH) can be conservative or operative. Since clinical guidelines are lacking, a large variation in daily management of CSDH exists. We aimed to quantify the number of CSDH patients that are treated operatively and conservatively and to develop a prediction model that provides insight into the arguments behind the choice for operative treatment.

Methods

All consecutive CSDH patients ≥ 18 years that were treated in three neurosurgical centers in the Netherlands between 2003 and 2019 were retrospectively included. Our outcome measure was the decision for operative treatment after initial diagnosis. Combining conventional multivariable logistic regression analysis and machine learning, four prediction models were developed and compared. The prediction model with the best performance was used for further analyses.

Results

Of 684 included patients (29% female, median age 75 years), 428 (63%) were treated operatively. The multivariable logistic regression model performed best with an area under the curve of 0.90, a sensitivity of 0.87, and a specificity of 0.78. Independent predictors for operative treatment were treating facility, younger age, premorbid mRS ≤ 1, focal neurological deficit, cognitive impairment, and MGS score on admission, larger hematoma volume, and ≥ 10 mm midline shift on baseline CT. The highest predictive value for operative treatment was found for treating facility, hematoma volume, and ≥ 10 mm midline shift.

Conclusion

While most CSDH patients are treated operatively, over a third are treated conservatively. Decisions for operative treatment are influenced by premorbid level of functioning, symptoms on admission, CT parameters, and, notably, interhospital variation, highlighting the need for standardized treatment guidelines.

目的慢性硬膜下血肿（CSDH）的治疗可采用保守治疗或手术治疗。由于缺乏临床指南，CSDH的日常管理存在很大差异。我们的目的是量化接受手术和保守治疗的CSDH患者的数量，并建立一个预测模型，为选择手术治疗背后的争论提供见解。方法回顾性分析2003年至2019年在荷兰三家神经外科中心连续治疗的≥18岁的CSDH患者。我们的结局指标是初步诊断后手术治疗的决定。结合传统的多变量逻辑回归分析和机器学习，建立了四种预测模型并进行了比较。采用性能最佳的预测模型进行进一步分析。结果684例患者（女性29%，中位年龄75岁）中，428例（63%）行手术治疗。多变量logistic回归模型的曲线下面积为0.90，灵敏度为0.87，特异度为0.78。手术治疗的独立预测因素为治疗设施、年龄较小、发病前mRS≤1、局灶性神经功能缺损、认知功能障碍、入院时MGS评分、血肿体积较大、基线CT中线移位≥10 mm。手术治疗的最高预测价值是治疗设施、血肿量和≥10 mm中线移位。结论虽然大多数CSDH患者采用手术治疗，但超过三分之一的患者采用保守治疗。手术治疗的决定受发病前功能水平、入院时症状、CT参数，尤其是医院间差异的影响，这突出了标准化治疗指南的必要性。

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引用次数: 0

Urinary and Bowel Symptoms in Idiopathic Normal Pressure Hydrocephalus 特发性常压脑积水的泌尿和肠道症状

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-31 DOI: 10.1155/ane/9580070

Andreas Eleftheriou, Johanna Rydja, Susanna Walter, Rafael Holmgren, Fredrik Lundin

<div> <section> <h3> Background</h3> <p>Idiopathic normal pressure hydrocephalus (iNPH) patients have gait and balance disturbance, cognitive impairment and urinary urgency/incontinence. Gait and balance symptoms have been examined carefully. There is presently a lack of evidence-based criteria to make recommendations regarding the characteristics and evaluation of urinary incontinence. Additionally, patients with urinary incontinence may also have faecal incontinence. The aims of this prospective single-centre study with a pre–post design and a control group were to characterise the urinary symptoms, to investigate possible bowel symptoms and to evaluate possible reversibility after shunt surgery.</p> </section> <section> <h3> Patients and Methods</h3> <p>Fifty-seven iNPH patients (27 females, median age 77 years) answered the questionnaires preoperatively, and 42 patients postoperatively. Meanwhile, 42 healthy individuals (HIs) (25 females, median age 71 years) were included. Before and 3 months after the shunt surgery, patients and HIs were asked to answer three questionnaires: the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI), Wexner’s Faecal Incontinence Score in the Swedish language (Wexner’s FI) and a bowel function questionnaire. The HIs followed the study protocol only once.</p> </section> <section> <h3> Results</h3> <p>The mean duration of iNPH-related symptoms was 24 months (range 6–120). Urinary incontinence appeared in 84.6% of the patients. Urinary leakage was always present in 13.5% vs. none of the HIs, with an improvement in some patients after the shunt operation. Bowel disturbances (more frequent bowel movements, a longer defecation time, incomplete evacuation feeling, abdominal pain and bloating, involuntary gas leakage and soiling) were reported by 67.5% of patients. The patients’ bowel function influenced their daily life as compared to the HIs. Postoperatively, bowel symptoms were improved with fewer bowel function-dependent limitations in social life. The total ICIQ-UI score was significantly different between the patients and HIs (<i>p</i> < 0.001) and improved significantly postoperatively (<i>p</i> < 0.001).</p> </section> <section> <h3> Conclusion</h3> <p>Urinary and bowel incontinence symptoms were notable features in this cohort of iNPH patients, causing limitations in their social life. Postoperatively, both symptoms improved to some extent.</p> </section> <section> <h3> Trial Registration</h3>

背景：特发性常压脑积水（iNPH）患者有步态和平衡障碍、认知障碍和尿急/尿失禁。已仔细检查步态和平衡症状。目前缺乏基于证据的标准来推荐尿失禁的特征和评估。此外，尿失禁的患者也可能有大便失禁。本前瞻性单中心研究采用前后设计和对照组，目的是描述泌尿系统症状，调查可能的肠道症状，并评估分流手术后可能的可逆性。患者与方法57例iNPH患者术前接受问卷调查，其中女性27例，中位年龄77岁，术后42例。同时纳入健康个体42例（女性25例，中位年龄71岁）。在分流术前和术后3个月，要求患者和HIs填写3份问卷：国际尿失禁咨询问卷-尿失禁简表（ICIQ-UI）、瑞典语Wexner粪便失禁评分（Wexner 's FI）和肠功能问卷。他只遵循了一次研究方案。结果inph相关症状的平均持续时间为24个月（范围6 ~ 120个月）。84.6%的患者出现尿失禁。13.5%的患者一直存在尿漏，而所有患者均无尿漏，分流手术后一些患者有所改善。67.5%的患者报告了肠道紊乱（排便更频繁，排便时间更长，排便不完全感，腹痛和腹胀，不自主气体泄漏和污染）。与HIs相比，患者的肠道功能影响了他们的日常生活。术后，肠道症状得到改善，社交生活中依赖肠道功能的限制减少。患者与HIs的ICIQ-UI总分差异有统计学意义（p < 0.001），术后ICIQ-UI总分显著改善（p < 0.001）。结论尿失禁和肠失禁是这组iNPH患者的显著特征，限制了他们的社交生活。术后两种症状均有一定改善。试验注册编号NCT04808076。

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引用次数: 0

Poor Academic Performance in University Students With Primary Headache Disorders: A Systematic Review 原发性头痛疾病的大学生学习成绩差：一项系统综述

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-28 DOI: 10.1155/ane/9503632

Valeria Velasquez-Sanchez, Gabriela Vilchez-Aranibar, Victor Velásquez-Rimachi

Introduction

Primary headache disorders, including migraines, tension-type headaches, and cluster headaches, significantly impact university students′ academic performance through absenteeism, lack of concentration, reduced productivity, and poor grades. This systematic review aims to determine the proportion of university students with impaired academic performance due to primary headache disorders.

Methods

The review protocol is registered in PROSPERO (CRD42023414524). We conducted a systematic review following the PRISMA guidelines. Cross-sectional observational studies assessing academic performance in university students with primary headache disorders were included. We excluded studies on secondary headaches, studies involving mixed populations (i.e., those combining university students with schoolchildren or postgraduate students without separate data), and intervention designs. We searched in multiple databases including MEDLINE, EMBASE, SCOPUS, PsycInfo, and Web of Science, up to January 3, 2023. Search strategies were developed incorporating keywords related to “headache disorders,” “cephalalgia,” and “academic performance.” Two independent reviewers conducted study selection and data extraction, with disagreements resolved by a third reviewer. We used the Joanna Briggs Institute (JBI) tool for prevalence studies to assess the risk of bias. Due to study heterogeneity, meta-analyses were not feasible, and a narrative synthesis was performed.

Results

Twelve cross-sectional observational studies with 8685 participants (predominantly female, 74%) were included. Migraine was the most reported headache type (83%). According to the JBI tool, only one study had a low risk of bias, while most showed moderate to high bias levels. Among students with primary headache disorders, 53% exhibited poor academic performance, 18% reported low productivity, 14% low concentration, 11% absenteeism, and 4% below-average grades.

Conclusion

A substantial proportion of university students with primary headache disorders show impaired academic performance, with poor performance being the most frequent outcome. This review highlights the need for further research with standardized assessment tools to better quantify and address the academic impact of primary headache disorders.

原发性头痛疾病，包括偏头痛、紧张性头痛和丛集性头痛，通过缺勤、注意力不集中、生产力下降和成绩差，显著影响大学生的学习成绩。本系统综述旨在确定因原发性头痛疾病而导致学习成绩受损的大学生比例。方法本综述方案在PROSPERO注册（CRD42023414524）。我们按照PRISMA指南进行了系统审查。横断面观察性研究评估了患有原发性头痛疾病的大学生的学习成绩。我们排除了继发性头痛的研究、涉及混合人群的研究（即将大学生与小学生或研究生结合起来，没有单独的数据）和干预设计。我们检索了多个数据库，包括MEDLINE， EMBASE， SCOPUS， PsycInfo和Web of Science，截止到2023年1月3日。研究人员制定了搜索策略，将与“头痛疾病”、“头痛”和“学习成绩”相关的关键词纳入其中。两名独立审稿人进行研究选择和数据提取，分歧由第三名审稿人解决。我们使用乔安娜布里格斯研究所（JBI）的流行病学研究工具来评估偏倚风险。由于研究的异质性，meta分析是不可行的，并进行了叙述综合。结果纳入12项横断面观察性研究，共8685名受试者（主要为女性，74%）。偏头痛是报告最多的头痛类型（83%）。根据JBI工具，只有一项研究具有低偏倚风险，而大多数研究显示中等至高偏倚水平。在患有原发性头痛疾病的学生中，53%表现为学习成绩差，18%报告生产力低，14%报告注意力不集中，11%旷课，4%低于平均成绩。结论相当比例的大学生原发性头痛疾病表现为学习成绩下降，学习成绩差是最常见的结果。本综述强调需要进一步研究标准化评估工具，以更好地量化和解决原发性头痛疾病的学术影响。

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引用次数: 0

Translation and Validation of the Quality of Life in Essential Tremor Rating Scale 特发性震颤分级量表生活质量的翻译与验证

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-28 DOI: 10.1155/ane/1373319

Victor S. Hvingelby, Lisa Østergaard Bak, Martin Andreasen, Rikke Nan Valdemarsen, Mette Møller, Andreas Nørgaard Glud

Background

Essential tremor is a common movement disorder, characterized by kinetic tremor, most commonly of the upper extremities. The Quality of Life in Essential Tremor (QUEST) scale is an oft-used subjective rating scale of tremor severity and quality of life (QoL) in these patients, including for monitoring subjective improvement after advanced treatment. It contains subdomains concerned with overall and health-related QoL, a self-assessment of tremor severity and of the functional impact of tremor on activities of daily living. The questionnaire has not been validated in Danish. This study was aimed at translating and validating the QUEST and piloting it among Danish ET patients.

Methods

The translation and cultural adaptation of the QUEST was carried out per the guidelines of the World Health Organization (WHO) and the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) task force for translation and cultural adaptation. It was subsequently disseminated among a cohort of ET patients.

Results

The QUEST was successfully translated and piloted among 112 ET patients. Respondents found the QUEST to be understandable (75/77; 97.4%). For categorical items, there was a high degree of agreement in responses at retest (60.0%–94.0%). According to Cohen′s kappa, agreement was mostly strong. Continuous outcomes were more variable, particularly the subdomains of the functional self-assessment. The mean score for each subdomain ranged from 19.46 (SD 21.87) for work and finance, 24.13 (SD 25.31) for communication, 32.49 (SD 23.21) for psychosocial, 40.21 (SD 34.11) for hobby and leisure, and 42.77 (SD 27.08) for physical. In general, subdomains were weakly to moderately correlated with overall health and QoL.

Conclusion

We have successfully translated and validated the QUEST questionnaire for use among Danish ET patients. The questionnaire is now available for Danish clinicians and researchers treating ET patients. The results indicate some unmet needs in the Danish cohort of tremor patients.

原发性震颤是一种常见的运动障碍，以动态性震颤为特征，最常见于上肢。特发性震颤患者生活质量（QUEST）量表是特发性震颤患者常用的震颤严重程度和生活质量（QoL）主观评定量表，包括监测晚期治疗后的主观改善情况。它包含与总体和健康相关的生活质量有关的子域，震颤严重程度的自我评估以及震颤对日常生活活动的功能影响。该问卷尚未在丹麦进行验证。本研究旨在翻译和验证QUEST，并在丹麦ET患者中进行试点。方法按照世界卫生组织（WHO）和国际药物经济学与成果研究学会（ISPOR）翻译与文化适应工作组的指导方针，对QUEST进行翻译与文化适应。随后在一组ET患者中传播。结果QUEST在112例ET患者中成功翻译和试点。受访者认为QUEST是可以理解的（75/77;97.4%）。对于分类题，重测时的回答有很高的一致性（60.0% ~ 94.0%）。根据科恩的kappa，大多数人的意见都很一致。连续结果变化更大，尤其是功能自我评估的子领域。每个子领域的平均得分为工作和金融19.46 (SD 21.87)，沟通24.13 (SD 25.31)，心理社会32.49 (SD 23.21)，爱好和休闲40.21 (SD 34.11)，身体42.77 （SD 27.08）。总体而言，子域与整体健康和生活质量呈弱至中度相关。结论：我们已经成功翻译并验证了QUEST问卷在丹麦ET患者中的应用。丹麦临床医生和研究人员现在可以使用该问卷来治疗ET患者。结果表明在丹麦的震颤患者队列中存在一些未满足的需求。

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引用次数: 0

Nonmotor Symptoms Reduce Quality of Life in Parkinson′s Disease Depending on Disease Stage and Age at Onset 非运动症状降低帕金森病患者的生活质量取决于疾病分期和发病年龄

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-27 DOI: 10.1155/ane/2145092

Roberta Bovenzi, Matteo Conti, Valerio Chiurchiù, Valentino De Franco, Alessandra Di Pucchio, Mariangela Pierantozzi, Tommaso Schirinzi, Rocco Cerroni, Alessandro Stefani, Nicola Biagio Mercuri, Claudio Liguori

In this observational study, which presents a secondary analysis related to a previously published work from our group, we aimed to examine the impact of nonmotor symptom (NMS) burden on HR-QoL in 154 outpatients with Parkinson′s disease (PD), ranging from mild to moderate-advanced disease stages, with a specific focus on motor disease progression and age at onset (AAO). To this purpose, NMS burden was measured using the NMS scale (NMSS), overall HR-QoL using the Parkinson′s Disease Questionnaire-39 (PDQ-39), and sleep disturbances using the Parkinson′s Disease Sleep Scale-2nd version (PDSS-2). The scores of the three scales were correlated with motor impairment and the amount of dopaminergic therapy. Furthermore, NMSS, PDQ-39, and PDSS-2 scores were compared between early onset PD (EOPD, AAO ≤ 50) and late-onset PD (LOPD, AAO > 50), as well as between “poor sleepers” and “good sleepers” based on the validated PDSS-2 cutoff of 18/60. We found that total NMSS, PDSS-2, and PDQ-39 scores significantly increased with advancing disease stage. EOPD patients had lower NMSS and PDSS-2 global scores compared to LOPD patients, despite the latter having longer disease duration and similar PDQ-39 scores. The NMSS global score correlated with each single domain of the PDQ-39, with the strongest associations observed in the “mobility,” “activity of daily living,” and “cognition” domains. Over one-third of patients were classified as “poor sleepers” (PDSS-2 ≥ 18) and exhibited higher NMSS and PDQ-39 total scores compared to “good sleepers.” In conclusion, this study enlightens the increasing impact of NMS and sleep disturbances on patients′ HR-QoL with disease progression and across different AAO, underscoring the need to address such modifiable factors to alleviate the burden of the disease.

在这项观察性研究中，对我们小组先前发表的一项工作进行了二次分析，我们旨在研究154名帕金森病（PD）门诊患者的非运动症状（NMS）负担对HR-QoL的影响，范围从轻度到中晚期疾病阶段，特别关注运动疾病进展和发病年龄（AAO）。为此，使用NMS量表（NMSS）测量NMS负担，使用帕金森病问卷-39 （PDQ-39）测量总体HR-QoL，使用帕金森病睡眠量表-2版（PDSS-2）测量睡眠障碍。三个量表的得分与运动障碍和多巴胺能治疗的量相关。此外，比较早发性PD （EOPD, AAO≤50）和晚发性PD （LOPD, AAO > 50）之间的NMSS、PDQ-39和PDSS-2评分，以及基于验证的PDSS-2临界值18/60的“睡眠不良者”和“睡眠良好者”之间的评分。我们发现NMSS、PDSS-2和PDQ-39总评分随着疾病分期的进展而显著增加。与LOPD患者相比，EOPD患者的NMSS和PDSS-2总体评分较低，尽管LOPD患者的病程更长，PDQ-39评分相似。NMSS总体得分与PDQ-39的每个单一领域相关，在“流动性”、“日常生活活动”和“认知”领域观察到最强的关联。超过三分之一的患者被归类为“睡眠不良者”（PDSS-2≥18），与“睡眠良好者”相比，他们表现出更高的NMSS和PDQ-39总分。总之，本研究揭示了随着疾病进展和不同AAO， NMS和睡眠障碍对患者HR-QoL的影响越来越大，强调了解决这些可改变因素以减轻疾病负担的必要性。

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引用次数: 0

N-Methyl-D-Aspartate Receptor (NMDAR) Antibodies Induce Diverse Calcium Activity Patterns on Cultured Astrocytes and Astrocyte–Neuron Cocultures n -甲基- d -天冬氨酸受体（NMDAR）抗体诱导星形胶质细胞和星形胶质细胞-神经元共培养不同的钙活性模式

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-23 DOI: 10.1155/ane/2861013

Neşe Ayşit, Sevginur Bostan, Canan Aysel Ulusoy, Erdem Tüzün, Fazlı Kemal Bayat

Background

Preliminary evidence suggests that astrocytes might contribute to the disease mechanisms of N-methyl-D-aspartate receptor (NMDAR) encephalitis. However, the precise role of astrocytes in the pathogenesis of encephalitis is poorly understood.

Methods

To characterize the impact of NMDAR antibodies on the activity of astrocytes, we isolated and purified serum IgG from three patients with NMDAR encephalitis and three healthy controls. Primary cultured mouse astrocytes and neuron–astrocyte cocultures were incubated with 5 μg patient or control IgG for 12 and 24 h. Cell viability and astrocyte activity were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and calcium (Ca²⁺) imaging studies (using a vector expressing a genetically encoded indicator under the GFAP promoter), respectively. Supernatant levels of TNF-α, a mediator of astrocyte–neuron interactions, were measured by ELISA.

Results

Purified serum IgG from N-methyl-D-aspartate receptor-antibody positive patients (NMDAR-Ab+ IgG) and healthy controls did not alter the viability of isolated astrocytes and cocultures. NMDAR-Ab+ IgG suppressed the duration and amplitude of Ca²⁺ activity of isolated astrocytes at 12 and/or 24 h, whereas all parameters of Ca²⁺ activity were enhanced by NMDAR-Ab+ IgG in astrocyte–neuron cocultures at 12 h. TNF-α levels were increased in supernatants of NMDAR-Ab+ IgG–administered astrocyte–neuron cocultures but not isolated astrocytes.

Discussion

This study provides the first preliminary evidence on the impact of patient-derived NMDAR-Ab+ IgG on astrocytic activity. Our results imply that the interaction of NMDAR-Abs with neurons and astrocytes creates a positive feedback loop reinforcing the activation of astrocytes. TNF-α might be one of the perpetrators of this loop.

初步证据表明星形胶质细胞可能参与n -甲基- d -天冬氨酸受体（NMDAR）脑炎的发病机制。然而，星形胶质细胞在脑炎发病机制中的确切作用尚不清楚。方法从3例NMDAR脑炎患者和3例健康对照者中分离纯化血清IgG，观察NMDAR抗体对星形胶质细胞活性的影响。将原代培养的小鼠星形胶质细胞和神经元-星形胶质细胞共培养物与5 μg患者或对照IgG孵育12和24 h。细胞活力和星形胶质细胞活性分别通过3-（4,5-二甲基噻唑-2-基）-2,5-二苯基溴化四唑（MTT）和钙（Ca2+）成像研究（使用在GFAP启动子下表达遗传编码指示剂的载体）进行评估。采用ELISA法检测星形胶质细胞-神经元相互作用的介质TNF-α的上清水平。结果n -甲基- d -天冬氨酸受体抗体阳性患者（NMDAR-Ab+ IgG）和健康对照纯化血清IgG未改变离体星形胶质细胞和共培养细胞的活力。NMDAR-Ab+ IgG在12和/或24 h时抑制离体星形胶质细胞Ca2+活性的持续时间和幅度，而NMDAR-Ab+ IgG在12 h时增强星形胶质细胞-神经元共培养中Ca2+活性的所有参数。NMDAR-Ab+ igg给药的星形胶质细胞-神经元共培养上清中TNF-α水平升高，但离体星形胶质细胞未升高。本研究首次提供了患者源性NMDAR-Ab+ IgG对星形细胞活性影响的初步证据。我们的研究结果表明，NMDAR-Abs与神经元和星形胶质细胞的相互作用产生了一个正反馈循环，加强了星形胶质细胞的激活。TNF-α可能是这种循环的肇事者之一。

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引用次数: 0

Peroneal Electrical Transcutaneous Neuromodulation (Peroneal eTNM) in the Treatment of Essential Tremor 经皮腓电神经调节（Peroneal eTNM）治疗原发性震颤

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-21 DOI: 10.1155/ane/5231029

Petra Bártová, Eva Augste, Filip Strouhal, Jan Krhut, Martin Slovák, Lukáš Peter, Martin Schmidt, David Školoudík

Objectives

Given the limitations of the currently available treatment options for essential tremor (ET), the development of a safe and effective method to manage ET is warranted. The aim of this study is to investigate the safety and feasibility of peroneal electrical transcutaneous neuromodulation (peroneal eTNM) in patients with ET.

Methods

Patients enrolled in the study were treated with peroneal eTNM daily for 30 min over 6 weeks, followed by a 6-week follow-up period without stimulation. Peroneal eTNM was administered alongside their chronic medication.

Results

A total of 12 patients (eight men, mean age 60.2 ± 17.7 years, mean disease duration 9.2 ± 7.8 years) were enrolled. All patients were able to use the stimulation at home without assistance. During the study, only two transient treatment-related adverse events were reported. Seven patients (58.3%) reported subjective improvement using the Patient Global Impression of Improvement questionnaire at the end of treatment (EoT), and five patients (41.7%) reported improvement at the end of study (EoS). We observed a significant reduction in the total Essential Tremor Rating Assessment Scale (TETRAS) score, with median (IQR) values decreasing from 38.3 (30.5–49.0) at baseline to 36.5 (20.8–41.5) at EoT and 34.5 (13.0–36.8) at EoS. Similarly, tremor severity, as measured visually and with an accelerometer, showed significant improvement. However, no significant changes were observed in tools assessing quality of life and general disability.

Conclusion

This pilot study demonstrates that peroneal eTNM is safe and feasible for patients with ET. Despite the limited sample size, ET patients treated with peroneal eTNM showed significant improvement in tremor severity as measured by both subjective and objective tools. Future studies with a larger sample size and sham-controlled design are needed to confirm these findings and further validate the potential of peroneal eTNM in the treatment of patients with ET.

Trial Registration

ClinicalTrials.gov identifier: NTC06036368

鉴于目前特发性震颤（ET）治疗方案的局限性，开发一种安全有效的治疗ET的方法是必要的。本研究的目的是探讨经皮腓电神经调节（peroneal eTNM）治疗ET患者的安全性和可行性。方法入组的患者在6周内每天接受30分钟的腓电eTNM治疗，然后进行6周的无刺激随访。腓骨eTNM与慢性药物同时使用。结果共纳入12例患者，其中男性8例，平均年龄60.2±17.7岁，平均病程9.2±7.8年。所有患者都能在家中无需辅助的情况下使用刺激。在研究期间，仅报告了两起与治疗相关的短暂不良事件。7名患者（58.3%）在治疗结束时使用患者总体改善印象问卷报告主观改善，5名患者（41.7%）在研究结束时报告改善（EoS）。我们观察到总特发性震颤等级评估量表（TETRAS）评分显著降低，中位数（IQR）值从基线时的38.3（30.5-49.0）降至EoT时的36.5（20.8-41.5）和EoS时的34.5（13.0-36.8）。同样，用视觉和加速度计测量的震颤严重程度也有显著改善。然而，在评估生活质量和一般残疾的工具中没有观察到明显的变化。结论本初步研究表明，腓骨eTNM治疗ET患者是安全可行的。尽管样本量有限，但经腓骨eTNM治疗的ET患者在主观和客观指标上均表现出震颤严重程度的显著改善。未来的研究需要更大的样本量和假对照设计来证实这些发现，并进一步验证腓侧eTNM治疗ET患者的潜力。试验注册临床试验

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引用次数: 0

The Relationship Between Alcohol Consumption and Persistent Posttraumatic Headache After Mild Traumatic Brain Injury: A Single-Center Study 饮酒与轻度外伤性脑损伤后持续性创伤后头痛的关系：一项单中心研究

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-10 DOI: 10.1155/ane/8359474

Yuanrun Zhu, Gengjing Chen, Jin Huang, Ping He, Zhifeng Wu, Chen Jiang

Traumatic brain injury (TBI) is a prevalent neurosurgical emergency that imposes a significant healthcare burden. Even mild TBI can lead to chronic headache. However, the relationship between posttraumatic headache and alcohol use remains unclear. This study is aimed at investigating the association between alcohol consumption and the development of persistent posttraumatic headache following mild TBI. Adult patients with mild TBI, treated between January 2023 and December 2023, were included. Follow-up interviews were conducted at least 6 months after hospital discharge. Logistic regression analysis was employed to adjust for baseline characteristics and other comorbidities. A total of 207 patients were analyzed, with an overall incidence of persistent posttraumatic headache of 36.2%. The regression analysis revealed an inverse relationship between alcohol consumption and persistent posttraumatic headache (OR: 0.355, 95% CI: 0.175, 0.717) after adjusting for confounding factors. This association remained unchanged after accounting for TBI- or headache-related alcohol avoidance (OR: 0.436, 95% CI: 0.212, 0.897). Female sex emerged as an independent risk factor for persistent posttraumatic headache (OR: 2.206, 95% CI: 1.107, 4.393). Other variables, including age, duration of hospital stay, in-hospital neurological symptoms, vomiting, sleep disorders, education level, and comorbidities, did not significantly affect the risk of persistent posttraumatic headache in the regression model. In conclusion, alcohol consumption is inversely associated with persistent posttraumatic headache in mild TBI patients. Although TBI- or headache-induced alcohol avoidance provides a plausible explanation for this inverse relationship, it may not fully account for the phenomenon. Female patients are at a higher risk of developing persistent posttraumatic headache after mild TBI. Further studies with low bias are needed to explore this relationship. Medical recommendations regarding alcohol consumption should be provided cautiously, considering the latest evidence, to inform patients with mild TBI about the potential risk of posttraumatic headache.

创伤性脑损伤（TBI）是一种常见的神经外科急症，给医疗保健带来了沉重的负担。即使是轻微的创伤性脑损伤也会导致慢性头痛。然而，创伤后头痛与饮酒之间的关系尚不清楚。本研究旨在探讨轻度创伤性脑损伤后持续性创伤后头痛与饮酒之间的关系。纳入了2023年1月至2023年12月期间接受治疗的轻度TBI成年患者。随访访谈在出院后至少6个月进行。采用Logistic回归分析调整基线特征和其他合并症。共分析了207例患者，其中持续性创伤后头痛的总发生率为36.2%。在校正混杂因素后，回归分析显示饮酒与持续性创伤后头痛呈负相关（OR: 0.355, 95% CI: 0.175, 0.717）。在考虑脑外伤或头痛相关的酒精避免后，这种关联保持不变（or: 0.436, 95% CI: 0.212, 0.897）。女性是持续性创伤后头痛的独立危险因素（OR: 2.206, 95% CI: 1.107, 4.393）。其他变量，包括年龄、住院时间、住院神经系统症状、呕吐、睡眠障碍、教育水平和合并症，在回归模型中对持续创伤后头痛的风险没有显著影响。总之，酒精摄入与轻度创伤性脑损伤患者持续性创伤后头痛呈负相关。虽然创伤性脑损伤或头痛引起的酒精避免为这种反比关系提供了一个合理的解释，但它可能不能完全解释这一现象。女性患者在轻度创伤性脑损伤后出现持续性创伤后头痛的风险较高。需要进一步的低偏倚研究来探索这种关系。考虑到最新证据，应谨慎提供有关饮酒的医学建议，以告知轻度脑外伤患者创伤后头痛的潜在风险。

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引用次数: 0

Higher High-Density Lipoprotein Cholesterol Levels Are Associated With an Unfavorable Outcome After Thrombolysis for Stroke: The Lipid Paradox 较高的高密度脂蛋白胆固醇水平与卒中溶栓后的不利结果相关：脂质悖论

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Acta Neurologica Scandinavica

Pub Date : 2025-10-03 DOI: 10.1155/ane/1668467

Ming-Ya Luo, Fu-Liang Zhang, Shan Lv, Yu Song, Yao Yu, Zhen-Ni Guo, Yi Yang

Background

Effects of serum cholesterol levels on stroke outcomes remain controversial, especially in intravenous thrombolysis (IVT)–treated patients. This study explored the association between lipid levels and outcomes in patients with acute ischemic stroke (AIS) who received IVT with recombinant tissue plasminogen activator (rt-PA).

Methods

AIS patients who received rt-PA thrombolysis from April 2015 to December 2018 were retrospectively enrolled. Fasting lipid profiles, including total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (HDL-C), were collected. Stroke outcomes included hemorrhagic transformation, 3-month unfavorable outcome (modified Rankin scale > 2), and 3-month mortality.

Results

We enrolled 698 IVT-treated patients with AIS. Binary logistic regression analysis showed that a higher HDL-C level was independently associated with a higher risk of a 3-month unfavorable outcome (odds ratio 1.999, 95% confidence interval 1.204–3.320, p = 0.007). Patients were then divided into high and low HDL-C groups according to a cutoff HDL-C of 1.415 mmol/L. After propensity score matching to adjust for baseline factors, patients in the high HDL-C group were more likely to experience a 3-month unfavorable outcome than those in the low HDL-C group (p = 0.041).

Conclusions

A higher HDL-C level was independently associated with a 3-month unfavorable outcome in IVT-treated patients with AIS. The current study received approval from the Ethics Committee of the First Hospital of Jilin University (No. NCT05028868).

背景血清胆固醇水平对脑卒中预后的影响仍然存在争议，特别是在静脉溶栓治疗的患者中。本研究探讨了接受重组组织型纤溶酶原激活剂（rt-PA） IVT的急性缺血性卒中（AIS）患者的脂质水平与预后之间的关系。方法回顾性分析2015年4月至2018年12月接受rt-PA溶栓治疗的AIS患者。收集空腹脂质谱，包括总胆固醇、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇（HDL-C）。卒中结局包括出血性转化、3个月不良预后（修正Rankin量表）和3个月死亡率。结果纳入698例接受ivt治疗的AIS患者。二元logistic回归分析显示，较高的HDL-C水平与较高的3个月不良结局风险独立相关（优势比1.999,95%置信区间1.204 ~ 3.320,p = 0.007）。然后根据HDL-C的临界值1.415 mmol/L将患者分为高、低HDL-C组。在倾向评分匹配调整基线因素后，高HDL-C组患者比低HDL-C组患者更有可能经历3个月的不良结果（p = 0.041）。结论：在接受ivt治疗的AIS患者中，较高的HDL-C水平与3个月的不良预后独立相关。本研究已获得吉林大学第一医院伦理委员会批准（No. 5）；NCT05028868)。

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