Acta neurologica Belgica最新文献

Purpose

The present study evaluates the impact of virtual reality (VR) technology on balance function in patients with different neurological disorders, and explores the effects of diverse VR parameters on treatment efficacy.

Methods

A comprehensive search of PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases was conducted up to December 15, 2024. Data from 44 studies Involving 2,019 patients were independently screened and extracted by two researchers. Risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias Tool, and meta-analysis was performed using RevMan 5.4.1 software. The quality of evidence was evaluated using GRADE.

Results

VR significantly improved balance ability in patients with different neurological disorders (SMD = 0.75; 95% CI: 0.62–0.87; Z = 11.96; p < 0.001), with the most pronounced effect in Parkinson’s disease (SMD = 0.95; 95% CI: 0.67–1.22; Z = 6.75; p < 0.001). Significant improvements were also noted in static balance (SMD = 0.73; 95% CI: 0.42–1.04; Z = 4.59; p < 0.001), Berg Balance Scale (SMD = 0.76; 95% CI: 0.61–0.90; Z = 10.25; p < 0.001), Timed Up and Go (SMD = − 0.30; 95% CI: − 0.50 to − 0.09; Z = 2.87; p = 0.004), and Tinetti Scale (SMD = 0.53; 95% CI: 0.18–0.88; Z = 2.94; p = 0.003). However, improvements in the Activities-specific Balance Confidence scale (SMD = 0.29; 95% CI: − 0.04–0.61; Z = 1.72; p = 0.09) and Functional Reach Test scores (SMD = 0.17; 95% CI: − 0.30–0.63; Z = 0.70; p = 0.49) were not significant. Combining VR with other therapies yielded better results (SMD = 0.78; 95% CI: 0.63–0.93; Z = 10.29; p < 0.001). Treatments lasting no more than 30 min (SMD = 0.78; 95% CI: 0.63–0.94; Z = 9.73; p < 0.001) and Intervention periods not exceeding 6 weeks (SMD = 0.78; 95% CI: 0.61–0.95; Z = 9.02; p < 0.001) were more effective.

Conclusion

VR technology effectively improves balance In patients with neurological disorders. Optimal results are achieved with sessions under 30 min and intervention periods less than six weeks.

The prevalence of epilepsy is high in people with intellectual disability (ID) and increases with growing severity of the ID. People with epilepsy and ID are not only at risk of different types of seizure-related complications (such as injuries and sudden unexpected death) but also of different types of physical impairments and of psychiatric, cognitive and behavioral comorbidities. ID is also associated with drug-resistant epilepsy (OR 3.38). Polytherapy is frequent in this population and leads to (among others) psycho-behavioral and bone health adverse events. All these factors together complicate the care for these persons and cause a great deal of social dependency. They function at a lower level than the severity of the ID alone would predict. Due to the common intractability of the epilepsy, alternative treatments are needed such as ketogenic diet and in specific cases neurosurgery and neuromodulation. The behavioral disorder is mostly multifactorial and the treatment may be complex. The family burden and stress should be taken into account, as well as the transition from child to adult neurologist and the possibility of admission to institutes.

Objective

This study aimed to retrospectively evaluate the prevalence of COVID-19 infection among patients with Parkinson’s disease (PD), along with the clinical course and factors associated with mortality.

Methods

A total of 1,786 patients diagnosed with Parkinson’s disease and registered at our hospital were screened. Among these, 222 had undergone PCR testing for COVID-19, of whom 76 tested negative and 152 tested positive, indicating a COVID-19 prevalence of 8.51% in the PD population. Due to insufficient data, 63 of the COVID-19 positive patients were excluded. The final study cohort included 177 patients: 89 patients with PD (50.3%) and 88 age- and sex-matched controls (49.7%). Clinical, laboratory, and prognostic parameters were compared between groups.

Results

The prevalence of dementia was significantly higher in the PD group. Mortality at both 28 and 90 days was also significantly increased among patients with PD. Notably, those receiving combined therapy with dopamine agonists and levodopa had lower mortality rates at both time points. In patients who died within 28 or 90 days, levels of age, neutrophil count, lymphocyte count, D-dimer, ferritin, C-reactive protein (CRP), and troponin differed significantly compared to survivors.

Conclusion

Patients with Parkinson’s disease represent a vulnerable population at increased risk for adverse outcomes from COVID-19. Close clinical monitoring, continuous dopaminergic treatment, and a personalized approach are essential for optimizing management during COVID-19 infection.

Objectives

Patients diagnosed with amyotrophic lateral sclerosis (ALS) typically describe symptoms of fatigue. Despite this frequency, the underlying mechanisms of fatigue are poorly understood, and are likely multifactorial. To help clarify mechanisms, the present systematic review was undertaken to determine the risk factors related to fatigue in ALS.

Methods

A systematic review was conducted using PubMed and Google Scholar databases using key words. From a total of 40,014 articles, 18 articles were included in the final review, following PRISMA guidelines. Meta-regression and subgroup analyses were conducted to study the relationship between fatigue in ALS and different covariates.

Results

Eighteen studies were included in the analysis. A number of factors were investigated, including age, sex, disease severity and duration, site of disease onset, neurophysiological parameters, and respiratory symptoms, depression and anxiety, sleep disorders, and pain. Combined analyses established that participants with ALS who reported fatigue had more severe disease, as confirmed by lower functional rating scores, than those who did not report fatigue. The remaining factors including depression, anxiety and pain, were not found to be related to the onset of fatigue in ALS. Overall, fatigue worsened quality of life in patients diagnosed with ALS.

Discussion

Fatigue in ALS appears to be particularly associated with progressive neurological deficit and disability, linked to both central and peripheral neuromuscular mechanisms.

Aims

This study aimed to evaluate the responsiveness of the Six-Spot Step Test (SSST) in people with multiple sclerosis to assess its capability as a measure for detecting changes in gait and balance capacity following a 10-week training intervention.

Methods

The SSST, Timed 25-Foot Walk, and mini-BESTest were administered to 71 individuals with MS, ranging from mild to severe disability, before and after a 10-week program of progressive resistance and balance training. However, 16 patients were lost to follow-up. This study adhered to the COSMIN framework for reporting and evaluating the psychometric properties of health-related outcome measures.

Results

Spearman's analyses revealed a moderate negative correlation between changes in the SSST and the mini-BESTest (r_s = -0.33, p = 0.02) and changes in the SSST and the Timed 25-Foot Walk (r_s = -0.37, p = 0.01). Significant median (min;max) changes and corresponding effect sizes (ES) were observed in the SSST (-1.4 (-11.4;4.7), p < 0.001, ES = -0.84), the Mini-BESTest (3 (-3;13), p < 0.001, ES = 0.89), and the Timed 25-Foot Walk (0.09 (-0.21;0.54), p < 0.001, ES = 0.71).

Conclusion

The SSST serves as a sensitive measure for changes in gait and balance capacity. Furthermore, the consistently large effect sizes observed across all three gait and balance assessments following the exercise intervention suggest that these measures reflect a shared underlying construct—functional mobility—which is essential for independent community living.

Background

Overactive bladder (OAB) symptoms significantly affect the independence and quality of life in patient with multiple sclerosis (PwMS) by limiting daily activities. This study aimed to explore differences in fear of falling (FoF), gait, dual-task performance, and self-perceived impact of disease among PwMS with and without OAB.

Method

Participants were divided into two groups based on their Overactive Bladder Questionnaire (OAB-V8) scores: OAB (score ≥ 8) and non-OAB (score < 8). Assessments included the Falls Efficacy Scale-International (FES-I) for FoF, the 2-Minute Walk Test (2MWT) for gait capacity, the Dual-Task Questionnaire (DTQ) for dual-task performance, and the Multiple Sclerosis Impact Scale-29 (MSIS-29) for self-perceived impact of disease.

Results

The study included 78 PwMS. Significant differences were found between groups in fall history, number of falls, and all outcome measures (OAB-V8, FES-I, DTQ, 2MWT, MSIS-29; p < 0.001). OAB-V8 scores positively correlated with FES-I, DTQ, and MSIS-29 (r = 0.71–0.78, p < 0.001) and negatively with 2MWT (r = −0.38, p < 0.001). Similar patterns were observed between FES-I, DTQ, and MSIS-29, which showed strong positive correlations, while both negatively correlated with 2MWT.

Conclusion

PwMS with OAB exhibit higher FoF, poorer gait, and impaired dual-task performance compared to those without OAB. These findings highlight the significant impact of OAB on functional and disease-related outcomes.