Acta Neurologica Scandinavica最新文献

Introduction: Stroke is a condition demanding prompt treatment. Differentiating stroke cases from mimics poses a challenge in the prehospital setting. An optimal prehospital scale to identify stroke is still not available. The aims of the study were to (i) explore whether dysphagia, visual impairment, skin sensory loss, or combinations of these symptoms could improve diagnostic stroke accuracy beyond FAST (face, arm, speech, and time) scale and (ii) identify sex differences in stroke diagnostic models.

Materials and Methods: We included 319 patients with stroke or transient ischemic attack (TIA) and 119 stroke mimics in a 1-year period in 2013–2014 and 258 stroke/TIA cases and 90 mimics in a validation cohort in 2023, admitted to the Stroke Unit at the University Hospital of North Norway. Retrospective data on clinical presentations were collected from patient records.

Results: Stroke cases were older than mimics and a larger proportion were men. Age explained 7.5% of the variance in odds ratio (OR) for stroke in women and 1.7% in men, while hypertension or coronary heart disease explained 10.2% in women and 3.7% in men. Adding dysphagia to FAST increased OR for stroke from 3.95 (95% confidence interval (CI) 2.00–7.81) to 4.30 (95% CI 2.14–8.64) and explained variance in OR for stroke by 0.5% in women. Adding visual impairment to FAST increased OR from 5.72 (95% CI 2.74–12.0) to 7.69 (95% CI 3.50–16.9) and explained variance in OR for stroke by 1.9% in men. In the validation cohort, the explained variance in OR for stroke did not increase by adding any more clinical presentations to FAST. Stroke mimics accounted for 27.2% and 25.9% in the two cohorts.

Conclusions: By adding clinical presentations to FAST, no meaningful change in diagnostic performance was gained. An optimal scale for prehospital stroke identification is still needed.

Background: Focal hand dystonia (FHD) has a significant impact on the hand motor function, especially for writers and musicians. Recently, many neurosurgeons have used thalamotomy to treat refractory FHD; this systematic review is aimed at assessing the efficacy and safety of thalamotomy for FHD.

Methods: PubMed, Medline, and Embase were searched to select relevant studies concerning thalamotomy for FHD. Demographic characteristics, surgical parameters, efficacy, and safety were extracted.

Results:A systematic review was performed including 254 patients among 15 studies. The writer’s cramp rating scale (WCRS), writing movement scores (WMS), and symptom severity scores (SSS) were assessed for hand dystonia disability. Besides, Tubiana musician’s dystonia scale (TMDS) and task-specific focal hand dystonia’s scale (TSFD) were assessed for hand motor performance. Transient complications were reported in 48 patients (18.9%) with permanent complications occurring in nine cases (3.5%).

Conclusion: Thalamotomy is an alternative option for FHD. Thalamotomy can alleviate hand dystonia disability and improve hand motor function. Although thalamotomy has certain complications, the incidence of permanent complications is relatively low. Thalamotomy needs to be fully evaluated before surgery to ensure safety.

Sleep disorders are common in patients with epilepsy, affecting their quality of life. In this study, we aimed to explore the sleep structure of adult patients with epilepsy and determine its correlation with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS). We also examined the impact of intermittent hypoxemia on nocturnal sleep structure, respiratory-related events, and excessive daytime sleepiness (EDS). This case–control polysomnography study included 81 patients with epilepsy and 86 healthy controls. Polysomnography combined with video electroencephalography was used to assess sleep structure, respiratory-related events, and factors related to EDS. Patients with epilepsy had a higher prevalence of sleep disorders, hypoxemia, and EDS than controls. Comorbid moderate-to-severe OSAHS was associated with increased risk of severe hypoxemia and awakening. Intermittent and mean hypoxemia worsened with increasing apnea-hypopnea index. The incidence of EDS increased drastically in patients with comorbid moderate-to-severe OSAHS. The total sleep period time was a significant independent predictor of the occurrence of EDS in patients with comorbid moderate-to-severe OSAHS. The study findings indicate that patients with epilepsy experience changes in sleep structure, and the coexistence of OSAHS increases the risk of hypoxemia and EDS. These findings are useful in clinical prognostication of patients with epilepsy comorbid with OSAHS.

Background: Vertigo is a highly prevalent symptom with wide-ranging causes and adverse consequences. While common risk factors for vertigo have been identified, their causal relationship with vertigo remains not fully known. Thus, identifying the modifiable factors causally related to vertigo is crucial for preventing vertigo.

Methods: A comprehensive Mendelian randomization study was employed to investigate the causal effects of vertigo among more than 40 genetically predicted modifiable risk factors, categorized into lifestyle traits, blood parameters, and metabolic comorbidities. This study used two different vertigo summary statistics from the deCODE and FinnGen consortia. Estimates were calculated using the inverse-variance weighted method and validated through alternative approaches.

Results: The results indicated that genetically predicted higher educational level was significantly associated with a decreased risk of vertigo (deCODE: odds ratio (OR) = 0.757, 95% CI = 0.697–0.822, p_{FDR[false discover rate]} < 0.001; FinnGen: OR = 0.796, 95%CI = 0.703–0.901, p_FDR = 0.007), while genetically predicted longer television watching was significantly associated with an increased risk of vertigo (deCODE: OR = 1.193, 95%CI = 1.076–1.323, p_FDR = 0.011; FinnGen: OR = 1.269, 95%CI = 1.085–1.483, p_FDR = 0.030). Additionally, genetically predicted elevated levels of alanine transaminase (ALT) were positively associated with the risk of vertigo. Genetically predicted increased physical activity was suggestively related to a reduced risk of vertigo, while higher triglyceride, body mass index (BMI), and diastolic blood pressure (DBP) were suggestively associated with an increased risk of vertigo (p_raw < 0.05).

Conclusions: Our findings indicate that genetically predicted increased educational levels and physical activity were associated with a decreased risk of vertigo, while higher levels of ALT and triglycerides, television watching time, BMI, and DBP were positively associated with the risk of vertigo. Thus, modifying these factors would decrease the risk of vertigo.

Background: Dysregulation of microRNA expression emerges as a crucial factor in the pathogenesis of autoimmune diseases, and their importance in modulating immune responses and disease progression is evident.

Methods: This study investigated the expression patterns of miRNAs in the brain tissues of C57BL/6J mice using the experimental autoimmune encephalomyelitis (EAE) model, which mimics multiple sclerosis (MS). The model was treated with Oenothera biennis oil, a potential therapeutic agent.

Results: Our research has revealed a novel and significant likelihood of association between miR-182-5p, miR-200c-3p, miR-206-3p, miR-429-3p, miR-1298-5p, and diseases resembling the EAE model, such as MS. This groundbreaking discovery could have profound implications in diagnosing and treating autoimmune diseases that mimic the EAE animal model.

Conclusions: These miRNAs, identified in our study, might serve as potential therapeutic targets in MS, potentially leading to more effective treatments and improved patient outcomes.

Objective: This study is aimed at elucidating the prognostic utility of somatosensory evoked potentials (SEPs) N20 in the recovery of upper limb functionality among stroke patients with varying cerebral lesions.

Methods: A cohort of 60 stroke patients enrolled in this study and stratified into two groups: 30 patients with strokes affecting the basal ganglia and 30 with thalamic involvement. Each patient underwent an SEP test after admission and participated in rehabilitation training for 3 months. Assessments were carried out using the Fugl–Meyer Assessment for Upper Extremity (FMA-UE), the Modified Ashworth Scale (MAS), and the Modified Barthel Index (MBI) at admission and 3 months after treatment to analyze the correlation between SEP-N20 indices and the function assessment scales in the two groups.

Results: (1) SEP in stroke patients revealed notable abnormalities, in which a more pronounced reduction of the amplitude ratio of the N20 (SEPAR-N20) wave between the affected and unaffected sides was observed in the thalamus group (p < 0.05). (2) After 3 months, a significant positive correlation was established between the improvement rate of FMA-UE scores and SEPAR-N20 in the basal ganglia group (r = 0.696, p < 0.0001). Conversely, this correlation was not evident within the thalamus group (r = −0.157, p > 0.05). (3) There was no significant correlation between MAS or MBI scores and SEPAR-N20 in either group (p > 0.05).

Conclusion: The extent of SEP abnormality poststroke is associated with the location of the lesion. Strokes involving the thalamus exhibited more pronounced changes in the N20 component. SEPAR-N20 might serve as a valuable predictor for the recovery of upper limb functionality, particularly in cases of basal ganglia strokes.

Trial Registration: Chinese Clinical Trial Registry: ChiCTR2300075570

Hemispherectomy is the most promising treatment for patients with severe hemispheric intractable epilepsy. Several techniques for this surgical intervention have been established, but the choice of technique is currently mostly dependent on the surgeon’s experience with a specific approach. We aim to demonstrate whether the choice of the surgical technique moderates surgical outcome in patients with severe hemispheric intractable epilepsy, as measured by seizure freedom and the incidence of death after surgery. We extracted 2382 articles from PubMed and Cochrane. Two independent experts selected 555 articles. We performed a meta-analysis for all studies and a pooled data analysis for studies where information on individual patients was available. None of the retrieved studies was randomized. Disconnective surgery yielded significantly higher rates of seizure freedom (0.83) than resective (0.70, p < 0.001) or combined surgery (0.64, p < 0.001) for patients with at least 1 year follow–up (N cases = 1165). For death (N cases = 1197), resective surgery had the highest rate of death within a year (0.07), significantly higher than disconnective surgery (0.012, p = 0.001) and combined surgical techniques (0.006, p < 0.001). The assessed techniques did not systematically differ in rate of acute complications, but in their type, for example, acute neurological complications were most common after disconnective surgery (p < 0.001), unspecific symptoms after resective surgery (p < 0.004). Chronic neurological complications were most common after resective surgery (p < 0.001). Seizure freedom is more likely following disconnective surgery as compared to resective or combined techniques. Disconnective and combined surgical techniques lead to fewer chronic complications and death than resective approaches.

Introduction: Early identification of stroke is important. The Face Arm Speech Test (FAST) and the modified National Institutes of Health Stroke Scale (mNIHSS) are two tools for stroke identification.

Aim: The aims of this study are to investigate (a) whether the use of the mNIHSS in an emergency medical service (EMS) setting improves stroke/transient ischaemic attack (TIA) identification compared with the FAST, (b) to what extent “code stroke” is activated, and (c) which neurologic deficits/symptoms affect stroke identification.

Methods: The method used is a retrospective pre–post-implementation study. EMS stroke identification was examined before and after the introduction of the mNIHSS, replacing the FAST, for EMS stroke screening. The FAST was replaced with the mNIHSS on 1 December 2022. Patients ≥ 18 years of age, diagnosed with stroke/TIA from 1 January 2021 to 31 May 2023 and under the care of the EMS, not more than 72 h before hospital care, were included. Data was manually extracted from EMS medical records regarding whether the FAST or mNIHSS was performed and if stroke/TIA was identified by the EMS personnel. The association between the applied stroke screening tool and EMS identification of stroke/TIA was then studied.

Results: A total of 1849 EMS missions with a hospital-confirmed diagnosis of stroke/TIA were included. The most common diagnosis was ischaemic stroke, 59.4%. Haemorrhagic stroke constituted 10.8%, and TIA 29.8%. Stroke/TIA was identified in 82.5% of cases. When the mNIHSS was used for stroke assessment, stroke/TIA was identified in 87.6% of cases. The corresponding figure for the FAST was 88.4%. For patients in whom neurological symptoms were unassessed, or a method for assessment other than the mNIHSS/FAST was applied, the identification rate for stroke/TIA was 41.6%. When a physician was consulted, “code stroke” was activated in 58.6% of all cases. The corresponding figure for the mNIHSS was 57.2% and for the FAST 59.9%.

Conclusions: The stroke identification rate does not appear to differ between the FAST and mNIHSS. The FAST and mNIHSS result in “code stroke” activation to an equal extent. Speech impairment and arm or leg paresis appear to improve EMS stroke identification. Conversely, impaired balance, convulsions, and vertigo/dizziness are associated with a lower identification rate. Both initial EMS suspicion of stroke and the subsequent application of a stroke scale appear to facilitate stroke identification.

Objectives: North Sea–Progressive Myoclonus Epilepsy (NS-PME) is a rare, childhood-onset disorder primarily characterized by movement disorders including progressive myoclonus and ataxia; subsequently accompanied by varying degrees of epilepsy. While motor symptoms are clearly defined, quality of life (QoL) has never been investigated in NS-PME. Additionally, nonmotor symptoms (NMS) including anxiety, depression, and cognitive problems are known to impact QoL and are increasingly being reported in other movement disorders. Hence, we examined the presence of anxiety and depression symptoms and the degree of QoL in NS-PME.

Materials and Methods: Data were collected from multiple cross-sectional, survey-based studies conducted between 2014 and 2020 at the University Medical Center Groningen (UMCG), the Netherlands. First, data on QoL, anxiety, and depression symptoms were collected from 11 persons with NS-PME. Second, to compare outcomes in NS-PME with controls (n = 21) and other hyperkinetic movement disorders (HMDs; n = 146), data from previously conducted studies in the UMCG were reused. The surveys used include the SF-36/RAND-36, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI).

Results: Symptoms of anxiety and depression were not present in the majority of persons with NS-PME. Compared to QoL scores of controls and other HMDs, persons with NS-PME scored significantly worse on physical functioning domains and, although nonsignificant, rendered the highest scores on emotional functioning domains.

Conclusion: Firstly, we did not find indications for significantly increased anxiety or depression symptoms in NS-PME. Secondly, our findings on QoL in NS-PME reveal the following: (1) a floor effect of the SF-36 questionnaire and (2) suggest a disability paradox in NS-PME, in which persons with NS-PME reported good emotional well-being, despite physical challenges. To explore the presence of a disability paradox further and generate more suitable QoL measures for movement disorders such as NS-PME, future studies should elaborate on personal perspectives, including the exploration of coping mechanisms.

Objectives: Mental fatigue is a common and debilitating symptom following an aneurysmal subarachnoid hemorrhage (aSAH). However, its long-term prevalence and consequences remain unclear. In this longitudinal pilot study, the Mental Fatigue Scale (MFS) was used to evaluate the prevalence, severity, and dynamics of mental fatigue for up to 5 years and to correlate patient demographics and early complications to the development of mental fatigue.

Method: Functional outcomes were scored using the Glasgow Outcome Scale-Extended (GOSE) during telephone interviews 1, 3, and 5 years after aSAH. The MFS questionnaires (maximum score 42, ≥ 10.5 points indicating mental fatigue) were subsequently sent by mail. Patient admission data and events during the acute phase were recorded.

Results: Of 64 included patients, 31 could be assessed at all time points. Mental fatigue (MFS score ≥ 10.5) was present in 58%, 48%, and 52% of the patients at 1, 3, and 5 years, respectively. A significant decrease in the total MFS score was observed between 1 and 5 years (p = 0.025). The proportion of patients experiencing severe mental fatigue halved from 1 to 3 years. The median (range) MFS scores were significantly higher for women (14.5, 0–29.5) than for men (3, 0–17.5) at 1 year (p = 0.043). Compared with patients experiencing loss of consciousness at ictus (LOCi), those without LOCi exhibited a progressive decline in the total MFS score (p = 0.003).

Conclusions: Although total MFS scores significantly improved, mental fatigue was a common and persistent symptom affecting half of the patients up to 5 years following aSAH. Mental fatigue was more prevalent in women than men; further, patients who experienced LOCi during the acute phase improved less over time. Our results highlight the importance of evaluating mental fatigue when assessing patient recovery and long-term outcomes.

Trial Registration: Clinical Trial NCT06239142