Acta neurologica Belgica最新文献

Ischemic stroke, accounting for approximately 80% of all stroke cases, remains a leading cause of death and disability worldwide. Effective management of ischemic stroke is heavily influenced by its etiology, which can range from large-artery atherosclerosis and cardiac embolism to cerebral small-vessel occlusions and cryptogenic strokes. Cardioembolic stroke, which makes up about 30% of ischemic strokes, often leads to more severe symptoms and worse outcomes, necessitating anticoagulation therapy for prevention. Cryptogenic strokes, comprising over 25% of ischemic strokes, pose significant challenges for treatment and prevention due to their elusive nature. Thorough investigation of cardioembolic sources during the acute phase of stroke is crucial. While transthoracic and transesophageal echocardiography are traditional methods for detecting intracardiac thrombi and patent foramen ovale (PFO), cardiac CT has emerged as a non-invasive, efficient alternative. Cardiac CT can effectively visualize intracardiac thrombi, PFO, valvular abnormalities, tumors, and complex aortic plaques. This review discusses the potential applications of cardiac CT in ischemic stroke, emphasizing its role in identifying stroke etiology, predicting stroke risk, and assessing patient prognosis. The integration of advanced imaging technologies and artificial intelligence further enhances its diagnostic accuracy and clinical utility, promising to improve outcomes and reduce the healthcare burden associated with ischemic stroke.

Objectives: The purpose of this meta-analysis was to conduct a comparative study by systematically examining and analyzing trials that studied the impacts of levodopa and bromocriptine, either separately or together, in treating Parkinson's disease (PD).

Methods: An extensive literature search was conducted across PubMed (Medline), Scopus, and Web of Science databases, using targeted keywords for studies published up to October 2024. The methodological quality of included RCTs was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool, and bias evaluation was performed using RevMan (version 5). Statistical analyses were conducted in STATA version 17, applying random-effects models. The overall quality of evidence was evaluated using the GRADE approach.

Results: The thorough evaluation identified 12 randomized controlled trials with a total of 4,060 participants, 1,956 in the intervention group and 2,104 in the comparison group, all diagnosed with PD. A combined effect size of 0.18 (SMD: 0.18; 95% CI: -0.03, 0.39) was found through quantitative analysis of motor scales for the Unified Parkinson's Disease Rating Scale (UPDRS). An effect size of 0.50 (OR: 0.50; 95% CI: 0.31, 0.80) was determined for dyskinesia. Dystonia occurrences showed a significant effect size of 0.44 (OR: 0.44; 95% CI: 0.24, 0.81; I2: 87.28%; P value: 0.0001). Hallucination and dizziness occurrences showed effect sizes of 0.91 (OR: 0.91; 95% CI: 0.36, 2.30) and 1.36 (OR: 1.36; 95% CI: 0.91, 2.04) overall, respectively. Quality assessment revealed high-certainty evidence for dyskinesia and dystonia reduction with bromocriptine, while other outcomes showed low to very low certainty. Meta-regression analyses showed no significant correlation between population characteristics and outcomes.

Conclusion: This thorough meta-analysis offers an understanding of how bromocriptine compares in effectiveness to levodopa and other treatments for managing PD.

Aims: This study aims to evaluate the reliability and validity of the Community Balance and Mobility Scale (CB&M) in people with multiple sclerosis (PwMS).

Methods: A total of 65 PwMS (Expanded Disability Status Scale (EDSS) ≤ 5.5) were included in the study. Test-retest, internal consistency (item-total score correlation, Cronbach's alpha coefficient) intra-rater, and inter-rater reliability were investigated for the reliability of the CB&M. For intra-rater and inter-rater reliability, CB&M measurements of 34 PwMS were videotaped. The validity of the CB&M was assessed through criterion (predictive and concurrent validity) and construct validity. Construct validity was evaluated using hypothesis testing which included examining correlations with EDSS, Timed Up and Go Test (TUG), and Dynamic Gait Index (DGI).

Results: Test-retest reliability demonstrated a good to excellent correlation (ICC = 0.995, p < 0.001). Cronbach's alpha was 0.971 (p < 0.001). Intra-rater (ICC = 0.993, p < 0.001) and inter-rater reliability (ICC = 0.986, p < 0.001) of the CB&M were also good to excellent. Cohen's kappa range values ​​of the scale vary between 0.958 - 0.665, and the percentage agreement varies between 97% and 75%. For the convergent validity of CB&M, strong correlations were observed with EDSS (r=-0.831, p < 0.001), TUG (r=-0.854, p < 0.001), and DGI (r = 0.865, p < 0.001). Additionally, the CB&M demonstrated an excellent correlation with the BBS (r = 0.907, p < 0.001). The scale exhibited no floor-ceiling effect.

Conclusion: CB&M is a reliable and valid tool for assessing balance and mobility in PwMS and offers significant advantages for evaluating balance in PwMS, as it provides comprehensive information about the balance and mobility requirements essential for community living.