Acta Neurologica Scandinavica最新文献

Background: Resuming active participation in valued areas of life is critical for stroke survivors; however, little is known about the possible components restricting life participation in young survivors. Here, we identified independent determinants of such long-term restrictions among potential stroke-related complications and explored the interplay between these potential explanatory variables.

Methods: Seven years after the index stroke, a consecutive cohort of young (18–54 years at onset) ischemic stroke survivors (n = 222) reported their self-rated participation according to the Stroke Impact Scale (SIS). Using linear regression and partial correlations, the independent association with the SIS participation score was analyzed for the following potential correlates: depressive symptoms, anxiety, cognition, mobility, activities of daily living, fatigue, neurological deficits, demographics, and vascular risk factors.

Results: Fifty-seven percent reported restrictions sometimes or more often for at least one of the seven SIS participation items, with the largest proportions reported for “controlling life” (40%), “work” (37%), and “active recreation” (37%). Communication (partial r = 0.39, p < 0.001), depressive symptoms (partial r = −0.30, p < 0.001), mobility (partial r = 0.20, p = 0.029), and social situation (living alone; partial r = −0.19, p = 0.02) were independently associated with participation. The structure of the interplay between the explanatory variables was further analyzed using a network model.

Conclusion: Participation restrictions among young ischemic stroke survivors in the long term are common and have been previously reported. Limitations in communication and depressive symptoms were important determinants of restricted participation as well as limited mobility and living alone, emphasizing the need for sustained interventions and support from a broad perspective for young stroke survivors.

Guillain–Barré syndrome (GBS) is an autoimmune peripheral nerve disorder characterized by progressive muscle weakness. Transforming growth factor-beta 1 (TGF-β1) is a major immune-regulating cytokine; therefore, serum concentration of TGF-β1 and its genotypes may contribute to developing GBS. This study is aimed at evaluating the changes in TGF-β1 serum level in GBS and investigating the association of TGF-β1 gene +869C/T and −509C/T) single-nucleotide polymorphisms (SNPs) with GBS susceptibility and TGF-β1 cytokine level. A case–control study was conducted with 200 GBS patients and 200 age-, sex-, and ethnicity-matched healthy controls (HCs). Serum levels of TGF-β1 and anti-GM1 autoantibodies were assessed using enzyme-linked immunosorbent assays. The tetra-primer amplification refractory mutation system-PCR was used to detect the targeted TGF-β1 gene SNPs. In this study, 79% of patients were reported with antecedent events, primarily diarrhea (44%). Overall, 89% of patients were affected with severe GBS; among them, 17% required mechanical ventilation and 21% remained functionally disabled after 6 months. TGF-β1 serum levels were significantly higher in GBS patients compared to HCs (p < 0.0001), demonstrating a cut-off of > 414.02 ng/mL for GBS. In addition, serum levels were correlated to higher GBS-disability scores (r_s = 0.338, p < 0.0001) and were associated with severe GBS (p = 0.04). Elevated TGF-β1 concentration was associated with poor clinical outcomes in patients at 6 months of disease onset (p = 0.006). The TGF-β1-509 T/T genotype was more frequent in Campylobacter jejuni-seropositive patients compared to seronegative patients (OR = 2.87, p_c = 0.04), especially in those with the axonal GBS variant (OR = 3.8, p_c = 0.07). However, no significant associations were found between TGF-β1 SNPs and overall the disease susceptibility or serum TGF-β1 concentration. The study concluded that elevated serum TGF-β1 concentration is associated with both GBS susceptibility and clinical severity and is linked to worse functional outcomes. While the –509 T/T genotype may be linked to C. jejuni–driven axonal GBS, there was no overall polymorphism association with GBS risk or cytokine levels. These findings might be crucial in understanding and predicting disease susceptibility and severity of GBS.

Introduction: The sacroiliac joint (SIJ), despite limited mobility, plays a crucial role in load transfer and pelvic stability. As a true diarthrodial joint, it accounts for 15%–38% of low back pain cases. This study evaluated the clinical outcomes of radiofrequency ablation (RFA) for SIJ syndrome and examined predictors of treatment response.

Methods: We retrospectively analyzed 101 patients treated with intra-articular RFA between 2017 and 2020. Pain and function were assessed using the Visual Analog Scale (VAS), Oswestry disability index (ODI), and McNab criteria.

Results: The cohort (53.5% female, mean age 69.0 ± 14.2 years, BMI 28.18 ± 4.87) showed significant improvements in pain (VAS: 7.68 ± 1.4 to 2.6 ± 1.54 at 24 h, p < 0.001) and function (ODI: 57.5 ± 17.5 to 37.9 ± 16.97 at 12 months, p < 0.001). McNab scores improved from 2.36 ± 1.03 at 6 weeks to 3.32 ± 0.88 at 12 months (p < 0.001). Higher BMI was strongly associated with poorer outcomes (VAS r = 0.433–0.719, ODI r = 0.990, McNab r = –0.960 to –0.914; all p < 0.001). Prior spinal surgery affected short-term recovery but not long-term results.

Conclusion: Intra-articular RFA is an effective treatment for SIJ syndrome, offering sustained pain relief and functional improvement up to 12 months. High BMI negatively impacts outcomes, highlighting the value of adjunctive strategies like weight management and rehabilitation to enhance long-term success.

Near-occlusion (NO) with and without full collapse seems to cause low blood flow in symptomatic carotid stenosis. If the stroke mechanism is hypoperfusion in NO, the stump pressure should be low. The aim was to compare and describe stump pressure and blood flow in conventional ≥ 50% stenosis, NO without full collapse, and NO with full collapse. In this prospective single-center study, consecutive patients with symptomatic ≥ 50% carotid stenosis (NASCET grading), undergoing carotid endarterectomy (CEA) were recruited. NO was diagnosed by three blinded observers who reviewed computed tomography angiographies (CTA). Intraoperative measurements of ICA flow before and after CEA and stump pressure were recorded. One hundred and eighty-one patients were included; 116 (64%) had conventional ≥ 50% stenosis, and 66 (36%) had NO. Before CEA, the median ICA flow was significantly lower in NO (90 ml/min) compared to conventional ≥ 50% stenosis (170 mL/min, p < 0.001). In contrast, no difference was observed after CEA (NO 170 mL/min, conventional ≥ 50% stenosis 180 mL/min, p = 0.48). The ICA flow change was significantly higher in NO compared to conventional stenosis (p < 0.001). There was a significant correlation between the distal ICA diameter on CTA and the ICA flow before CEA (r = 0.579, p < 0.001). There were no differences in stump pressure between NO and conventional ≥ 50% stenoses (median 53 (range 41–66) mmHg and median 54 (range 40–67) mmHg, respectively, p = 0.93), nor any correlation between the stump pressure and the distal ICA diameter (r = 0.063, p = 0.41). NO causes low ICA flow, and to our knowledge, this is the first time this causal link between ICA flow and NO is clearly established. Since patients with NO did not have low stump pressure, the mechanism of stroke in NO does not seem to be hypoperfusion.

Objective: This study was aimed at evaluating the efficacy of the “zipper method,” a novel treatment strategy combining alternating plasma exchange (PLEX) and intravenous immunoglobulin (IVIG) pulse therapy, in adult patients with severe Guillain–Barré syndrome (GBS) requiring mechanical ventilation.

Methods: A retrospective analysis was conducted on seven adult patients diagnosed with severe GBS and treated with mechanical ventilation from June 2022 to August 2023. Three received the “zipper method” (alternating PLEX and IVIG pulse therapy), and the other four were treated with the classic method (PLEX followed by IVIG pulse therapy). Clinical outcomes, including duration of continuous mechanical ventilation (CMV), length of stay (LOS) in the ICU, total hospital stay, muscle strength recovery as measured by the Muscle Research Council (MRC) score, and Guillain–Barré Syndrome Disability Scale (GBS-DS) and days to unaided walking, were compared between the two groups.

Results: The “zipper method” group exhibited significant improvements in clinical outcomes compared to the classic method group. Specifically, the duration of CMV was reduced to 17.67 days, the LOS in the ICU was 22.33 days, the mean days to hospital discharge were 40.67 days, and the MRC score at 1 month was 43.67 and at 2 months was 56.67. Furthermore, the GBS-DS score at 2 months posttreatment was 1.00 and the mean days to unaided walking were 80.6 days, indicating a marked reduction in disability.

Conclusion: The “zipper method” offers a promising new approach for the treatment of severe GBS in adults, leading to faster recovery of muscle strength and shorter ICU stays and length of hospital stay. This treatment strategy has the potential to improve patient outcomes and reduce the burden of severe GBS on healthcare systems. Further research, including prospective studies and randomized controlled trials, is warranted to validate these findings and explore the broader applicability of the “zipper method” in adult GBS treatment.

Background and Aims: Carpal tunnel syndrome (CTS) is the most prevalent peripheral mononeuropathy affecting the median nerve. It can be managed with physiotherapy, localised steroid injections, or surgery. Our study compared outcomes of two surgical techniques, that is, partial flexor retinaculum release (FRR) and conventional complete FRR in moderate to severe CTS.

Methods: It was a single-blinded cohort study conducted at Mayo Hospital, Lahore, Pakistan, over a 12-month period in 2022. Sampling was stratified random with a total sample size of 66. Inclusion criteria were patients between 18 and 70 years of age, having Grade 3 to 6 CTS (Bland electrophysiological classification), having undergone at least one localised steroid injection on the symptomatic side, with no other spinal cord deformities. The rest were excluded. Interventions studied were complete FRR and partial FRR, sparing transverse carpal ligament and antebrachial fascia. Data was analysed using the statistical package for social sciences (SPSS) Version 26. Analytic tests used were chi-square test, linear-to-linear test, independent sample t-test and Mann–Whitney U test with a p value of <0.05.

Results: Partial FRR was done in 34 patients (51.51%) and complete FRR in 32 patients (48.48%). There was no significant difference in postoperative outcomes when compared independently. Linear regression analysis showed a significant role of partial FRR in predicting postoperative Boston questionnaire for symptom severity scale (BQSSS) scores (p = 0.021) and Boston questionnaire for functional severity scale (BQFSS) scores (p = 0.045) when other independent variables are accounted. No such relationship was demonstrated with postoperative visual analogue scale (VAS) scores (p = 0.531).

Interpretation: Partial FRR is a novel technique for the management of CTS, resistant to local steroid administration. This technique showed no significant difference in postoperative outcomes from its traditional counterpart, with a possibility of improved postoperative structural and functional recovery that needs further evaluation.

Objective: Delayed emergency responses in patients with large vessel occlusion stroke (LVOS) are associated with reduced access to timely reperfusion therapy and worse clinical outcomes. The present study was aimed at identifying modifiable factors contributing to delays before hospital arrival in LVOS patients undergoing endovascular treatment (EVT).

Methods: In this retrospective analysis of prospectively collected data, consecutive acute LVOS patients undergoing EVT at two comprehensive stroke centers between December 2020 and December 2021 were enrolled. Neurologists administered a standardized questionnaire to patients or their caregivers within 24 h after the procedure. Emergency response delay was defined as onset to groin (OTG) time, measured from symptom onset or last known normal to groin puncture, exceeding 6 h. Baseline characteristics, process times, and clinical data were collected for all enrolled patients, and factors influencing the emergency process and outcomes were analyzed.

Results: Of the 366 patients initially considered, 14 with in-hospital stroke were excluded, leaving 352 patients for analysis. The median age was 70 years (63, 76), and 135 patients (38.4%) experienced treatment delays. The median National Institutes of Health Stroke Scale (NIHSS) score was 14 (11, 18), and the median Alberta Stroke Program Early CT Score (ASPECTS) was 9 (7.85, 10). Multivariate analysis identified the main modifiable factors associated with reduced emergency response delay as early calling of emergency services (odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.22–0.76), initial consultation with a neurologist (OR = 0.35, 95% CI: 0.20–0.62), and stroke awareness (OR = 0.51, 95% CI: 0.29–0.89). Among elderly patients and those whose stroke onset occurred during sleep, early contact with emergency services (120) significantly reduced prehospital delays (OR = 0.48, 95% CI: 0.21–0.94 and OR = 0.30, 95% CI: 0.10–0.86).

Conclusion: Emergency physician involvement, stroke awareness, and early calling of emergency services (120) are modifiable factors that can reduce delays in the emergency response process. For patients eligible for EVT, minimizing prehospital delays may require prioritizing both community education on stroke recognition and system-level improvements to ensure rapid emergency activation and timely neurological assessment.

Introduction: This study is aimed at investigating brain injury biomarkers neurofilament light (NfL), tau, neuron-specific enolase (NSE), calcium-binding protein S100B (S100B) and glial fibrillary acidic protein (GFAP) in blood during general anaesthesia and abdominal surgery in patients without cerebral injury, to evaluate the effect of general anaesthesia and surgery per se on the release of these biomarkers.

Methods: This prospective observational study was conducted at Sahlgrenska University Hospital, Gothenburg, Sweden, between September and November 2021. Patients scheduled for mixed abdominal surgery under general anaesthesia were included. Vital parameters and near-infrared spectroscopy (NIRS) for cerebral perfusion were continuously monitored. Blood pressure was kept close to each patients’ preanaesthetic mean arterial pressure. Vasopressors and fluids were administered at the discretion of the attending physician, not influenced by the study.

Results: There were 23 patients (11 females [48%] and 12 males [52%]) included in the study. NfL, tau, NSE and S100B increased significantly when 2- and 24-h concentrations were compared with preoperative values, whilst GFAP did not. The continuous mean arterial blood pressure was 83.5 mmHg, with a 62.2–90.4 mmHg range. The mean NIRS was 77.5% (range 62.2–90.4). No patient had a drop in NIRS of 12% or more. Postoperative symptoms of confusion or neurological deficits were not observed in any patient within 48 h from the start of anaesthesia.

Conclusion: General anaesthesia and abdominal surgery in patients with well-maintained cerebral perfusion and no clinical signs of postoperative cerebral injury caused an increase in levels of brain injury biomarkers NfL, tau, NSE and S100B in blood. Interestingly, there was no increase in levels of GFAP in the blood. These data suggest that GFAP is the only biomarker, amongst the investigated biomarkers, which is not released into the bloodstream during general anaesthesia and surgery in patients with no suspected brain injury. More extensive studies on this subject are warranted.

Trial Registration: ClinicalTrials.gov identifier: NCT03919370.

Background: Tuberous sclerosis complex (TSC) is a genetic disorder commonly associated with drug-resistant epilepsy. Although epileptogenic tubers (ETs) can be localized in 60% of TSC patients, approximately 40% remain undetectable despite comprehensive multimodal evaluations. The functional network mechanisms underlying seizure generation and propagation in patients with TSC are poorly understood.

Methods: Resting-state fMRI (rs-fMRI) data from 10 surgically treated patients with TSC (postoperative seizure freedom for ≥ 3 years) and 10 age-matched healthy controls were analyzed. Functional connectivity (FC) between four thalamic subregions—mediodorsal thalamus (MDT), anterior thalamic nucleus (ANT), centromedian thalamus (CMT), and pulvinar—and ETs, non-ETs, or normal cortices was assessed. Secondary projection analysis mapped corticothalamic networks associated with ETs.

Results: MDT-ET connectivity was significantly reduced compared with MDT-non-ETs (p = 0.01) and MDT-normal cortices in controls (p = 0.03). Secondary analysis identified hyperconnectivity between ET-associated thalamic clusters and the left middle frontal gyrus (p_GFR < 0.001). No significant differences were observed in other thalamic subregions.

Conclusions: The selective reduction in MDT-ET connectivity highlights disrupted thalamocortical synchronization as a key network mechanism in TSC-related epilepsy. Enhanced left middle frontal gyrus–thalamic connectivity suggests compensatory cortical engagement within epileptogenic networks. These findings position rs-fMRI as a critical tool for delineating network-based biomarkers, advancing precision therapeutic strategies in TSC.

Background: While clinical trials have shown no differences between monthly and quarterly regimens of fremanezumab, limited real-life data exist for comparison. This study is aimed at comparing treatment regimens in real life.

Methods: This observational, multicentre study conducted a retrospective analysis of patients initiating monthly or quarterly fremanezumab. Primary endpoints were the comparison of monthly migraine days’ reduction, adverse effects, and treatment discontinuation rates at 3 and 6 months. Secondary endpoints included changes in headache and medication intake frequencies, response rates, and patient-reported outcomes.

Results: One hundred and eleven patients were included, with a median age of 48.5 years, 91% women, and 54.1% with chronic migraine. Sixty-four patients received a monthly regimen and 47 a quarterly. Baseline characteristics were similar. Reductions in monthly migraine days did not differ between treatment regimens (−5 [IQR −9, −1] for monthly versus −6 [IQR −8, −3] for quarterly at 3 months, p = 0.867, and −5 [IQR −10, −2] versus −5.5 [IQR −8.5, −3] at 6 months, p = 0.666, respectively). Adverse effects and discontinuation rates were similar between groups. Secondary endpoints were comparable, except for a higher PGIC scale for the quarterly group at 6 months (6 [IQR 4–6] versus 4 [IQR 2–6], p = 0.007). No differences were observed in the subgroup analysis of episodic or chronic migraine.

Conclusions: Monthly and quarterly fremanezumab demonstrated comparable effectiveness, tolerability, and adherence in real life. Quarterly regimen may result in a more favorable global impression of change.