Acta neurologica Belgica最新文献

英文中文

Headache symptoms in children and adolescents with ADHD: evaluating family history and the role of methylphenidate treatment 儿童和青少年多动症患者的头痛症状：评估家族史和哌甲酯治疗的作用

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

Acta neurologica Belgica

Pub Date : 2025-10-18 DOI: 10.1007/s13760-025-02912-x

Valentina Nicolardi, Giuseppe Accogli, Luigi Macchitella, Sara Scoditti, Isabella Fanizza, Anna Maria Spalluto, Antonio Trabacca

Background

Clinical and epidemiological studies have reported a comorbidity between Attention Deficit Hyperactivity Disorder (ADHD) and migraine. Pharmacological treatments such as methylphenidate have also been hypothesized to contribute to the onset of headaches. This study aimed to investigate the percentage of headaches in a pediatric ADHD population, comparing children treated with methylphenidate to those not receiving pharmacological therapy, while also considering the potential influence of family history, sex, and age.

Methods

A retrospective cross-sectional analysis was conducted on 118 children and adolescents diagnosed with ADHD (68 treated with methylphenidate, 50 untreated). Headache presence and features were assessed using a structured questionnaire based on international diagnostic criteria. Binomial and multinomial logistic regressions were used to evaluate the effects of methylphenidate use and family history on headache presence and type, controlling for age and sex.

Results

Headache symptoms were significantly more frequent in participants with a family history of headache, regardless of medication status. No main effect of methylphenidate on overall headache percentage was observed. However, the combination of methylphenidate treatment and positive family history was significantly associated with migraine-compatible headache presentations. Cephalalgy was not significantly linked to any of the variables. The absence of family history was strongly associated with the absence of headache symptoms.

Conclusions

Family history appears to be a key factor in headache percentage among children with ADHD. While methylphenidate alone does not increase headache risk, its interaction with familial predisposition may contribute to migraine-like symptoms. Family history should be carefully considered during clinical assessment.

背景：临床和流行病学研究已经报道了注意缺陷多动障碍（ADHD）和偏头痛的合并症。药物治疗如哌醋甲酯也被认为是导致头痛发作的原因。本研究旨在调查小儿多动症人群中头痛的百分比，比较使用哌甲酯治疗的儿童和未接受药物治疗的儿童，同时考虑家族史、性别和年龄的潜在影响。方法：对118例诊断为ADHD的儿童和青少年进行回顾性横断面分析（68例使用哌甲酯治疗，50例未使用）。使用基于国际诊断标准的结构化问卷评估头痛的存在和特征。采用二项和多项logistic回归评估哌醋甲酯使用和家族史对头痛存在和类型的影响，控制年龄和性别。结果：头痛症状在有头痛家族史的参与者中明显更频繁，无论药物状况如何。没有观察到哌醋甲酯对整体头痛百分比的主要影响。然而，哌甲酯治疗和阳性家族史的结合与偏头痛相容性头痛的表现显著相关。头痛症与任何变量均无显著关联。家族史的缺失与头痛症状的消失密切相关。结论：家族史似乎是ADHD儿童头痛发生率的关键因素。虽然哌醋甲酯单独不会增加头痛的风险，但它与家族易感性的相互作用可能会导致偏头痛样症状。在临床评估时应仔细考虑家族史。

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引用次数: 0

Clinical implications of the recalibrated CHA₂DS₂-VA score for women after ischemic stroke: a prospective cohort study 重新校准的CHA₂DS₂-VA评分对女性缺血性卒中后的临床意义：一项前瞻性队列研究

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

Acta neurologica Belgica

Pub Date : 2025-10-13 DOI: 10.1007/s13760-025-02916-7

Priyanka Boettger, Jamschid Sedighi, Kerstin Piayda, Martin Juenemann, Omar Alhaj Omar, Bernhard Unsoeld, Samuel Sossalla, Michael Buerke

Introduction

The 2024 ESC atrial fibrillation guidelines introduced the CHA₂DS₂-VA score by removing female sex as an independent risk criterion. Although intended to simplify risk stratification and avoid sex-based overtreatment, the real-world implications for women who present with AF-related ischemic stroke/TIA remain unclear. In this prospective observational study, we examined the clinical implications of CHA₂DS₂-VA recalibration in a post-stroke setting, focusing on sex-specific differences in stroke severity and early functional outcome, and on the proportion of women who newly fall below the anticoagulation threshold (score ≤ 1).

Methods

In a prospective cohort of 714 consecutive stroke patients, 161 (22.5%) had documented AF. Risk stratification was performed using both CHA₂DS₂-VASc and the revised CHA₂DS₂-VA score. Stroke severity (NIHSS) and functional outcome (mRS) were analyzed by sex. Propensity score matching and multivariable logistic regression were used to examine the independent association between sex and stroke severity.

Results

Female patients with AF were older and had a higher vascular risk burden than men. They presented with significantly more severe strokes (median NIHSS 12 vs. 8; P < 0.01) and tended toward worse outcomes. After score recalibration, 11 of 81 women (13.6%) had a CHA₂DS₂-VA score ≤ 1, falling below the ESC anticoagulation threshold—despite having experienced an ischemic stroke. Most of these patients had cardioembolic strokes and moderate-to-severe neurological deficits. In matched analyses, female sex remained independently associated with severe stroke (aOR 1.54, 95% CI 1.03–2.29).

Conclusion

In this prospective cohort of AF-related ischemic stroke, women had greater comorbidity burden and higher stroke severity than men. A subgroup with CHA₂DS₂-VA ≤ 1 nonetheless sustained ischemic stroke, and exploratory 5-year follow-up suggested excess recurrence without anticoagulation. These findings require validation in larger cohorts.

2024年ESC房颤指南引入了CHA₂DS₂-VA评分，取消了女性作为独立风险标准。尽管旨在简化风险分层并避免基于性别的过度治疗，但对af相关缺血性卒中/TIA女性的现实意义仍不清楚。在这项前瞻性观察性研究中，我们研究了CHA₂DS₂-VA重新校准在卒中后的临床意义，重点关注卒中严重程度和早期功能结局的性别差异，以及新降至抗凝阈值以下的女性比例（评分≤1）。方法：在一项包括714例连续卒中患者的前瞻性队列研究中，161例（22.5%）有房颤记录。使用CHA₂DS₂-VASc和修订后的CHA₂DS₂-VA评分进行风险分层。按性别分析脑卒中严重程度（NIHSS）和功能结局（mRS）。使用倾向评分匹配和多变量逻辑回归来检验性别与脑卒中严重程度之间的独立关联。结果：女性房颤患者年龄较大，血管风险负担高于男性。结论：在心房纤颤相关缺血性卒中的前瞻性队列中，女性比男性有更大的共病负担和更高的卒中严重程度。CHA₂DS₂-VA≤1的亚组仍存在缺血性卒中，探索性5年随访提示无抗凝治疗的过度复发。这些发现需要在更大的队列中进行验证。

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引用次数: 0

Efficacy and safety of microvascular decompression in trigeminal neuralgia secondary to multiple sclerosis: a systematic review and meta-analysis. 微血管减压治疗多发性硬化继发三叉神经痛的疗效和安全性：一项系统综述和荟萃分析。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

Acta neurologica Belgica

Pub Date : 2025-10-13 DOI: 10.1007/s13760-025-02909-6

Bardia Hajikarimloo, Salem M Tos, Ibrahim Mohammadzadeh, Ali Mortezaei, Arman Hasanzade, Dorsa Najari, Azin Ebrahimi, Mohammad Amin Habibi

Background: The role of microvascular decompression (MVD) in patients with multiple sclerosis-related trigeminal neuralgia (MS-TN) remains unclear. Central demyelination is the primary underlying cause of MS-TN, and the absence of vascular compression raises questions about the role of MVD in MS-TN patients. We aimed to evaluate the efficacy and safety of MVD in MS-TN patients.

Methods: On April 9, 2025, a thorough search was performed, including studies that reported outcomes of MVD in MS-TN patients.

Results: Fifteen studies involving 230 patients were included. The meta-analysis revealed a pooled pain-free rate of 61% (95% CI: 10%-100%) and an adequate pain relief rate of 99% (95% CI: 93%-100%) at the initial follow-up. Our findings suggested that at the last follow-up, MVD resulted in a pooled pain-free rate of 29% (95% CI: 19%-41%) and an adequate pain relief rate of 76% (95% CI: 61%-89%), with a pooled complication rate of 16% (95% CI: 6%-29%).

Conclusion: MVD is associated with favorable initial pain-free and adequate pain-relief outcomes, acceptable long-term pain-related outcomes, and a relatively low complication rate. In MS-TN individuals with apparent NVC and no sign of brainstem lesions in the MRI studies, MVD can be associated with more favorable outcomes.

背景：微血管减压（MVD）在多发性硬化症相关三叉神经痛（MS-TN）患者中的作用尚不清楚。中枢性脱髓鞘是MS-TN的主要潜在原因，血管压迫的缺失引发了MVD在MS-TN患者中的作用的问题。我们的目的是评估MVD在MS-TN患者中的疗效和安全性。方法：在2025年4月9日，进行了全面的检索，包括报道MS-TN患者MVD结局的研究。结果：纳入15项研究，涉及230例患者。荟萃分析显示，在最初的随访中，总无痛率为61% (95% CI: 10%-100%)，疼痛缓解率为99% （95% CI: 93%-100%）。我们的研究结果表明，在最后一次随访中，MVD导致29%的总无痛率（95% CI: 19%-41%）和76%的充分疼痛缓解率（95% CI: 61%-89%），合并并发症发生率为16% （95% CI: 6%-29%）。结论：MVD与良好的初始无痛和充分的疼痛缓解结果，可接受的长期疼痛相关结果以及相对较低的并发症发生率相关。在MRI检查中有明显NVC且没有脑干病变迹象的MS-TN患者中，MVD可能与更有利的结果相关。

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引用次数: 0

The therapeutic efficacy of nanoparticles in the treatment of alzheimer's disease. 纳米颗粒治疗阿尔茨海默病的疗效。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

Acta neurologica Belgica

Pub Date : 2025-10-13 DOI: 10.1007/s13760-025-02905-w

Thabisa L Ntondini, Tobeka Naki, Sibusiso Alven

The build-up of beta-amyloid plaques in the brain leads to Alzheimer's disease (AD), a neurodegenerative condition. AD affects more than 30 million individuals globally every year. No cure for AD has been discovered yet. The available therapeutic options are administered to slow down the progress of the disease. The currently available treatment plans are used to relieve symptoms and improve cognitive abilities, thus slowing progression. Nanotechnology is highly effective and has demonstrated significant benefits across various medical applications. Nanoparticles have been explored as promising drug delivery systems for the targeted delivery of anti-AD therapeutics and for the precise diagnosis of the condition. Nanoparticles, such as dendrimers, lipid-based nanoparticles, polymer-based nanoparticles, and metal-based nanoparticles, have been designed and reported to inhibit Aβ aggregation, fibril formation, and disaggregating mature fibrils, prevent neuroinflammation and Aβ1-42-induced cell damage, treat oxidative stress and lower hallmark of Aβ, and display excellent capability to bypass blood-brain barrier (BBB). This review is focused on the preclinical therapeutic outcomes of nanoparticles and the challenges encountered in the treatment of AD. This review highlights the significant advancements of nanoparticles that are currently undergoing clinical trials for management of AD.

大脑中β -淀粉样蛋白斑块的积累会导致阿尔茨海默病（AD），这是一种神经退行性疾病。阿尔茨海默病每年影响全球3000多万人。目前还没有发现治疗阿尔茨海默病的方法。现有的治疗方案都是为了减缓疾病的进展。目前可用的治疗方案用于缓解症状和改善认知能力，从而减缓病情发展。纳米技术是非常有效的，并已在各种医疗应用中显示出显著的好处。纳米颗粒作为抗阿尔茨海默病治疗药物的靶向递送和精确诊断的有前途的药物递送系统已被探索。纳米颗粒，如树状大分子、脂质纳米颗粒、聚合物纳米颗粒和金属纳米颗粒，已经被设计并报道可以抑制Aβ聚集、原纤维形成和成熟原纤维的分解，预防神经炎症和Aβ1-42诱导的细胞损伤，治疗氧化应激和降低Aβ的标志，并显示出绕过血脑屏障（BBB）的优异能力。这篇综述的重点是纳米颗粒的临床前治疗结果和在治疗阿尔茨海默病中遇到的挑战。这篇综述强调了目前正在进行治疗阿尔茨海默病临床试验的纳米颗粒的重大进展。

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引用次数: 0

Autonomic dysfunction in patients with episodic cluster headache during remission period. 发作性丛集性头痛缓解期患者的自主神经功能障碍。

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

Acta neurologica Belgica

Pub Date : 2025-10-13 DOI: 10.1007/s13760-025-02915-8

Alba López-Bravo, Elena Bellosta Diago, Marisa de la Rica Escuín, Laura Díez Galán, Sonia Santos Lasaosa

Background: The hypothalamus is involved in cluster headache (CH) pathophysiology and is a hub for autonomic control. While cranial autonomic symptoms are prominent during attacks, other autonomic manifestations may be present in CH. This study aims to explore the autonomic nervous system (ANS) in patients with CH during remission period.

Methods: Cross-sectional study including 30 CH and 30 age- and sex-matched controls. We analysed time- and frequency-domain parameters of heart rate variability (HRV) and active orthostatic tests. To investigate the sympathetic nervous system, plasma norepinephrine (NE) levels were determined. All assessments were performed during remission period.

Results: All HRV parameters were lower in CH; the percentage of adjacent R-R intervals that differ by more than 50 milliseconds (pNN50) and standard deviation of normal-to-normal R-R intervals in 24 h (SDNN) were significantly lower in CH (pNN50, 31.0 [5.3-44.3] vs. 44.5 [25.8-58.5], p = 0.043; SDNN, 79.6 ± 42.6 vs. 99.6 ± 42.6, p = 0.004). All other time-domain parameters, including the root mean square of successive R-R differences (RMSSD) were lower in CH than in controls (RMSSD 59.5 ± 36.9 vs. 77.3 ± 39.4, p = 0.077). Compared to controls, mean HR was significantly higher in CH (64.2 [59.6-75.8] vs. 60.4 [57.3-62.7], p = 0.038). Supine and upright NE levels were significantly higher in CH, (supine 228.9 [161.6-324.1] vs. 209.9 [151.2-314.1], p = 0.015; standing 376.1 [264.6-527.8 vs. 327.4 [256.4-400.9], p = 0.019).

Conclusions: The present study indicates a significant decrease in HRV and an upward trend of plasmatic NE levels in CH during remission periods, suggesting an imbalance of the ANS in this state.

背景：下丘脑参与丛集性头痛（CH）的病理生理，是自主神经控制的中枢。虽然发作期间颅自主神经症状突出，但在CH中可能存在其他自主神经表现。本研究旨在探讨缓解期CH患者的自主神经系统（ANS）。方法：横断面研究，包括30名CH和30名年龄和性别匹配的对照组。我们分析了心率变异性（HRV）的时域和频域参数和主动直立试验。为了研究交感神经系统，测定血浆去甲肾上腺素（NE）水平。所有评估均在缓解期进行。结果：CH组HRV各项参数均较低；相邻R-R区间相差大于50毫秒的百分比（pNN50）和24 h正态R-R区间的标准差（SDNN）显著低于CH （pNN50, 31.0[5.3-44.3]比44.5 [25.8-58.5],p = 0.043； SDNN, 79.6±42.6比99.6±42.6,p = 0.004）。所有其他时域参数，包括连续R-R差的均方根（RMSSD）， CH组均低于对照组（RMSSD为59.5±36.9比77.3±39.4,p = 0.077）。与对照组相比，CH组的平均HR显著高于对照组（64.2 [59.6-75.8]vs. 60.4 [57.3-62.7], p = 0.038）。仰卧位和直立位的NE水平显著高于CH（仰卧位228.9[161.6-324.1]比209.9 [151.2-314.1],p = 0.015；站立位376.1[264.6-527.8]比327.4 [256.4-400.9],p = 0.019）。结论：本研究表明，在缓解期，心肌梗死患者HRV显著下降，血浆NE水平呈上升趋势，提示该状态下ANS失衡。

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