Acta neurologica Belgica最新文献

Introduction: Migraine is a chronic neurovascular disease classified into two main subtypes: migraine with and without aura. Aura occurs in approximately 30 percent of migraine patients. Few studies have reported a higher frequency of aura among healthcare workers. This study aimed to investigate the frequency of aura in migraineurs among healthcare and non-healthcare workers and compare their aura characteristics.

Methods: A total of 482 migraine patients, 117 healthcare workers, and 371 non-healthcare workers were included. Demographic data, migraine, and aura characteristics were recorded during a face-to-face survey.

Results: The number of male participants was significantly higher in the healthcare worker group (p:0.013). In this group, the migraine diagnosis age was younger (p:0.001) and the migraine duration was longer (p:0.031). The presence of aura was significantly more frequent in the healthcare worker group (46.2%) (p:0.001). In the healthcare worker group, the presence of aura in all attacks was more frequent (p:0.012). The duration of aura was similar in both groups (p:0.518). The frequency of aura was higher in doctors (47.7%) than in nurses (41.9%), but the difference was not significant (p:0.583). Neurologists (50%) and non-neurologists (46.4%) had similar aura frequencies (p:0.752).

Conclusions: We found aura frequency higher in healthcare workers with migraine than in the general population. Our findings may indicate that the aura prevalence is underestimated in the general population with migraine. Identifying migraine with aura, given its association with serious disorders, may enable a more thorough evaluation of the affected individuals and potentially improve patient outcomes.

Background: Mental chronometry tests, including upper and lower extremity functions, evaluate the temporal congruence component of motor imagery. This study aimed to compare the utilization of upper and lower extremity functions in mental chronometry tests.

Methods: This study included 70 individuals with multiple sclerosis and was designed based on an a priori power analysis. Mental chronometry tests, including the Box and Block Test (BBT) and the Timed Up and Go Test (TUG), were administered, and execution times, motor imagery times, and mental chronometry ratios were compared between the most and least affected extremities.

Results: A significant difference was observed in execution times between the most and least affected extremities in BBT (p = 0.001). Similarly, motor imagery times in BBT were significantly different between most and least affected extremities (p = 0.009). However, no significant difference was found in mental chronometry ratio between the most and least affected extremities (p = 0.179). Comparisons between upper and lower extremity tests revealed that the mental chronometry ratio was significantly higher for BBT than for TUG test in both the most affected and least affected extremities (p = 0.001).

Conclusion: Individuals with MS showed differences in imagery-execution congruence between upper- and lower-extremity mental chronometry tasks, with higher congruence observed in the upper-extremity task. These findings support a task-specific interpretation of motor imagery performance rather than a generalized advantage of upper-extremity motor imagery.

Trial registration: Not applicable. This study was observational and did not involve a clinical trial registration.

Background: Relapsing-remitting multiple sclerosis (RRMS) often necessitates treatment changes due to safety concerns, inadequate efficacy, or patient-specific factors. While second-line therapies (e.g., natalizumab, ocrelizumab) are effective, real-world evidence on outcomes after switching or discontinuing these therapies are limited, particularly in diverse healthcare settings.

Objective: This study aimed to evaluate treatment transition patterns, reasons for discontinuation, and six-month clinical/MRI outcomes in patients with RRMS switching between second-line therapies or discontinuing treatment.

Methods: A retrospective cohort study was conducted at Sina Hospital, Tehran, Iran, including 338 RRMS patients who switched or discontinued second-line therapies including fingolimod, natalizumab, ocrelizumab and rituximab. Clinical and MRI data were collected at baseline (therapy change/discontinuation) and six-month follow-up. Outcomes included relapse frequency, disability progression (Expanded Disability Status Scale [EDSS]), and MRI lesion activity. Statistical analysis was done using paired t-tests and descriptive statistics.

Results: Among 338 patients (83.1% female, mean age 33.9 years), treatment transitions occurred most frequently to ocrelizumab (42.3%) or rituximab (33.4%). Safety concerns (32.0%), inadequate efficacy (29.9%), tolerability issues (13.6%), and pregnancy planning (8.9%) were primary reasons for therapy changes. Overall paired analyses of EDSS scores showed a strong correlation between pre- and post-switch measurements (r = 0.944, p < 0.001), although the average change for the entire cohort was minimal and not statistically significant. Notably, the subgroup of patients who switched from fingolimod to ocrelizumab demonstrated a statistically significant reduction in EDSS scores, with a mean difference of 0.19 (p = 0.019). Furthermore, among 110 patients whose treatment change was driven solely by inadequate efficacy (e.g., ongoing relapses or poor symptom control), the mean EDSS improved significantly from 2.41 (± 1.74) at baseline to 2.16 (± 1.80) at six months, with a mean difference of 0.25 (p < 0.001) and a strong correlation between baseline and follow-up scores (r = 0.92, p < 0.001).

Conclusion: B-cell-depleting therapies, particularly ocrelizumab, may help lower disability in active RRMS, but longer follow-up is needed to confirm sustained benefits. Personalized strategies that balance efficacy, safety, and patient-specific factors (e.g., PML risk, pregnancy) are essential. Although most patients had low baseline disability, which may limit generalizability, these findings still offer real-world insight into treatment transitions. Longer prospective studies are needed to confirm long-term outcomes.

Rasmussen encephalitis (RE) is a rare, immune-mediated disorder characterized by drug-resistant focal epilepsy, progressive unilateral hemispheric dysfunction, and cognitive and motor decline, with epilepsia partialis continua (EPC) as a particularly disabling feature. Hemispheric disconnection can control seizures in up to 80% of cases but carries high risk of severe deficits, particularly in dominant-hemisphere involvement. Responsive neurostimulation (RNS) is FDA-approved for medically intractable focal epilepsy, but experience in RE-related EPC remains limited. We describe a 13-year-old right-handed male with dominant-hemisphere RE and refractory EPC. He failed 10 antiseizure medications, steroids, IVIG, and rituximab. MRI revealed left basal ganglia, mesial temporal, insular, and frontal hyperintensities; fMRI confirmed left hemispheric language dominance. Intracranial EEG localized seizure onset to the left perisylvian region. Hemispheric disconnection was declined due to functional risk, and off-label RNS therapy was pursued. Three cortical strip electrodes were implanted over the left posterior frontal convexity, with two connected to the device. Initial RNS recordings demonstrated near-continuous epileptiform discharges. Lead-to-lead stimulation reduced EPC propagation to the right shoulder and neck by > 50% over 30 months, though facial EPC persisted. Long episode burden decreased from 4000-6000/day to ~ 600/day. Cognitive, speech, and motor function remained stable. No device- or stimulation-related adverse effects occurred despite ongoing rituximab-induced immunosuppression. Initiation of cenobamate correlated with further reduction in long episodes. This case demonstrates that RNS can provide meaningful seizure reduction and functional stabilization in RE patients who are not candidates for hemispheric disconnection, while preserving cognition and language. RNS also allows longitudinal monitoring of epileptiform activity, offering an objective biomarker to guide therapy. Literature reports similarly show 50-75% seizure reduction with RNS, status epilepticus control, and stabilization of cognitive function, while other neuromodulation approaches-including chronic cortical stimulation, thalamic DBS, GPi and zona incerta stimulation, rTMS, tDCS, and VNS-also show promise. Overall, neuromodulation represents a feasible and evolving strategy for managing RE-related EPC, especially in dominant-hemisphere cases where conventional surgery carries high risk.