Acta neurologica Belgica最新文献

Introduction: Neuroblastoma (NB) is the most common extracranial solid tumour in children, with low 5-year survival rates in high-risk cases. Identifying new tumour biomarkers is essential for risk stratification. This study investigated the potential of LC3B as a prognostic biomarker for high-risk NB.

Methods: Peripheral blood, tissue samples, and clinical data were collected from 53 children with NB. The expression rates of 16 biomarker antibodies in peripheral blood mononuclear cells were analysed using flow cytometry. NB mRNA expression profiles and clinical data from 282 tissue samples were obtained from the Gene Expression Omnibus database (GSE49710). Multivariate logistic regression assessed factors influencing high-risk NB, and a receiver operating characteristic curve (ROC) was plotted.

Results: Flow cytometry revealed that LC3B expression in peripheral blood mononuclear cells was significantly lower in the high-risk group compared to the low-intermediate-risk groups (P < 0.05). Analysis of the Gene Expression Omnibus database indicated that LC3B mRNA was highly expressed in low- to intermediate-risk patients but weakly in high-risk patients (P < 0.01). ROC analysis showed that LC3B expression has prognostic value for high-risk NB [AUC = 0.684, 95% CI: (0.541, 0.827)], which improves when combined with neuron-specific enolase (NSE) [AUC = 0.789, 95% CI: (0.667, 0.911)]. The expression level of LC3B mRNA in tumour tissues provided the best prognostic model for high-risk NB [AUC = 0.855, 95% CI: (0.808, 0.903)].

Conclusion: LC3B may be a novel prognostic biomarker for screening high-risk patients with NB, and combined detection with NSE could enhance prognostic accuracy.

Introduction and objectives: Multiple sclerosis (MS) is a chronic neurologic disease that primarily affects adults of working age. Symptoms related to the disease can lead to unemployment and challenges in the workplace. This study aims to review the challenges related to work life in actively working adult patients with MS, and investigate the relationship of these challenges with disease-related factors such as cognitive, emotional, and physical disability, as well as the coping strategies employed.

Methods: One hundred fifty patients with a definitive diagnosis of relapsing-remitting multiple sclerosis (RRMS) were included in the study. We evaluated fatigue, cognition, mood, extremity functions, disability, and coping strategies for difficulties at work.

Results: In our study, as patients' cognitive levels decreased, their scores on psychological/cognitive barriers, physical barriers, and total barriers increased. We found a negative correlation between work-related difficulties and patients' cognitive levels. As patients' scores on depression, fatigue, and hopelessness tests increased, their scores across all work-related barriers also increased.

Conclusion: This study highlights the importance of evaluating the clinical symptoms, work-related challenges, and coping strategies in the follow-up of working patients with MS. Therefore, we suggest prioritizing adaptive coping and vocational rehabilitation to mitigate work-related difficulties.

Background: Although fatigue is one of the most prevalent symptoms in patients with multiple sclerosis (MS), its underlying mechanisms remain insufficiently understood. Emerging evidence suggests that interoceptive sensibility and maladaptive metacognitive beliefs may play a central role in the development and maintenance of fatigue. The present study examined the interplay between interoceptive sensibility, maladaptive metacognitive beliefs, affective symptoms, and fatigue in individuals with MS.

Methods: In this cross-sectional study, 240 patients with relapsing-remitting MS completed validated self-report measures of interoceptive sensibility, metacognitive beliefs, fatigue, and affective symptoms. Symptom networks were estimated using EBICglasso regularization. Expected influence and bridge expected influence indices were calculated to identify central and bridging nodes, with network stability tested via non-parametric bootstrapping. Based on network results, serial mediation analyses were conducted to examine pathways linking interoceptive sensibility, metacognition, anxiety, and fatigue.

Results: In the network analysis, anxiety and general fatigue emerged as primary bridging symptoms, while the Multidimensional Assessment of Interoceptive Awareness subscale "Not Worrying" showed negative bridge values, suggesting potential protective effects. Cognitive confidence also displayed significant bridge connections with fatigue and affective symptoms. Mediation analyses demonstrated that the protective effect of Not Worrying on general fatigue was indirectly effected by reduced anxiety and increased cognitive confidence (total indirect effect: b = - 0.92, 95% CI [-1.24, - 0.61]).

Conclusion: Fatigue is a complex structure intertwined with interoceptive sensibility, metacognitive beliefs, and psychological symptoms. Approaches such as metacognitive therapy and mindfulness-based interventions may therefore be particularly effective in alleviating MS fatigue.

Background: Patients with ischaemic stroke are increasingly encountered in neurological practice. Current guidelines recommend hospital admission for monitoring and coordination of appropriate aftercare, regardless of stroke severity. However, the clinical necessity of admitting all such patients remains uncertain. Some neurologists argue that selected low-risk patients can be discharged directly from the emergency department (ED). Given the ongoing debate and lack of high-quality evidence, we aimed to explore current practices and attitudes toward the management of patients with ischaemic stroke with minor neurological deficits in the Netherlands.

Methods: A national online survey was conducted to explore current variations in clinical practice regarding admission strategies for patients with ischaemic stroke. The survey included five clinical cases and was distributed to neurologists and neurology trainees. We assessed which patient and stroke characteristics influenced the decision to admit a patient.

Results: A total of 107 respondents completed the survey, comprising 72 neurologists (67%) and 36 neurology trainees (33%). Admission rates for ischaemic stroke with minor neurological deficits varied considerably across the five clinical vignettes, ranging from 21% to 89%. Willingness to randomise patients into a trial evaluating admission versus ED discharge was high, with rates between 77% and 94% across cases. The majority of respondents (89%) considered a risk threshold of up to 5% for secondary deterioration acceptable to justify direct discharge from the ED. Of these, 44% would accept a risk of 1-2%, while 45% would accept a risk of 3-5%. Only 10% indicated that all ischaemic stroke patients should be admitted regardless of risk.

Conclusion: Current guideline-driven practice in the Netherlands leads to hospital admission for nearly all patients with ischaemic stroke. However, our survey reveals substantial heterogeneity among neurologists and trainees regarding the willingness to consider direct ED discharge under specific conditions. If certain criteria are met, a majority would opt for ED discharge, with 89% accepting a risk of up to 5% for early neurological deterioration. These findings underscore the need for evidence-based admission strategies, potentially enabling safe ED discharge for selected patients and more efficient use of hospital resources.

Background: It is well known that scientific literature has a significant gender gap, as gender differences were not considered until very recently. Women were often excluded from studies, and even when included, the results are rarely analyzed separately by gender. This study aims to investigate gender-specific differences in patients with Myasthenia Gravis (MG) by segregating data from our cohort of patients in Antwerp (Belgium).

Methods: We analyzed the data of our previously published cohort of 163 patients with MG visited in the Antwerp University Hospital between 2019 and 2021, segregating the information by gender to observe any significant differences.

Results: The analysis revealed several notable gender-specific differences. Women experienced a delay in diagnosis of over one year more frequently than men. They also had dysarthria as presenting symptom more often than men. The MGFA scores at maximum severity were higher in women, who also reported more limitations due to the disease and required more treatments to control it. While some differences could be attributed to the younger onset of the disease in women, certain differences were independently influenced by gender.

Conclusions: Women experience more limitations due to MG than men and may face a more severe disease course. These differences should be taken into account when determining follow-up and treatment strategies. Additionally, these findings highlight the importance of segregating data by gender in scientific studies to better understand gender-specific differences in disease presentation and management.

Background: Idiopathic intracranial hypertension (IIH) is associated with well-known classical neuroimaging hallmarks, but not all patients exhibit these typical findings. We aimed to investigate novel imaging features that could aid in diagnosing IIH and to assess the relationships between these features and cerebrospinal fluid (CSF) opening pressures.

Methods: A total of 57 IIH patients (50 females, mean age 37 years) and 57 age- and sex-matched controls (mean age 34 years) were retrospectively evaluated. CSF opening pressures, brain MRI and MR venography findings were reviewed for typical IIH imaging features and novel basal cistern measurements, including Meckel cave dimensions, prepontine AP diameter, cerebellopontine cistern volume, mamillopontine distance, and pontomesencephalic/interpeduncular angles. Associations between imaging parameters and CSF opening pressure were analyzed.

Results: Empty sella was the most frequent typical imaging finding, present in nearly all patients with IIH. Compared to controls, IIH patients showed increased prepontine AP diameter and larger Meckel cave measurements, while mamillopontine distance was reduced. Higher CSF opening pressure was associated with optic nerve sheath enlargement and/or bilateral transverse sinus stenosis. Mamillopontine distance demonstrated the best diagnostic performance (AUC: 0.710), with 66.7% sensitivity and 70.2% specificity at a 6.35 mm cut-off.

Conclusions: In addition to classical imaging findings, Meckel cave, prepontine AP diameter, and mamillopontine distance measurements differ significantly in patients with IIH from controls. High CSF opening pressure is associated with optic nerve sheath enlargement and bilateral transverse sinus stenosis.

Introduction & objective: The Mini-Addenbrooke's Cognitive Examination (M-ACE) is an easy-to-administer and quick screening test that assesses four basic cognitive areas, namely orientation, verbal fluency, memory, and visuospatial abilities, out of 30 points. The objective of this study is to introduce M-ACE to the Turkish cognitive science literature and evaluate its applicability in Turkish society in comparison with the Mini-Mental State Examination (MMSE).

Materials & methods: A total of 90 native Turkish speakers aged 60 and over with at least 12 years of formal education, including 30 patients with mild cognitive impairment (MCI group), 30 patients with Alzheimer's disease (AD group), and 30 healty control subjects (control group), who applied to the neurology outpatient clinic between November 2020 and November 2021, were included in this prospective study. All participants were underwent MMSE and the Turkish version of M-ACE by experienced neurologists.

Results: The optimal M-ACE cut-off values were 24.5 for differentiating MCI from controls (90% sensitivity, 73% specificity), 23.5 for distinguishing AD from controls (97% sensitivity, 90% specificity), and 19.5 for differentiating MCI from AD (70% sensitivity, 80% specificity).

Conclusion: Turkish version of the M-ACE is a valid tool for assessing cognitive impairments in the elderly population.