Pub Date : 2025-11-21DOI: 10.1016/j.neurop.2025.100215
H. Guardiola , G. Arbona , Y. Jurgens , A. Morales Triado , S. Presas-Rodriguez , L. Álvarez Torres , O. Antolin Caminal , A. Teniente-Serra , C. Ramo-Tello , E. Montané , N. Depreux
Introduction
The anti-CD20 monoclonal antibodies, rituximab (RTX) and ocrelizumab (OCRE), are used routinely for the treatment of neuroimmunological diseases. However, infusion-related reactions (IRRs) are common, and their underlying mechanisms are not well defined.
Objectives
Our aim was to determine the incidence of IRRs during OCRE and RTX treatment for neuroimmunological diseases and to identify predisposing factors.
Methods
We conducted a retrospective observational study including patients who received at least one dose of OCRE or RTX between October 2018 and March 2022. Demographic data, comorbidities, immunological variables, and information about treatments and IRRs were collected. Statistical analysis was performed to assess IRR incidence, differences between groups, and predictors of IRR.
Results
Of 48 patients receiving 239 infusions, 17.6% presented IRRs. The incidence of IRRs was 40% among all patients: 41% in the OCRE group and 38% in the RTX group. Most IRRs were mild (90%). We found statistically significant differences in infusion time between both groups, with longer times associated with higher IRR incidence. Interestingly, a higher percentage of B lymphocytes prior to infusion was associated with increased risk of IRRs.
Conclusion
IRRs are common with both treatments, especially in the early stages. The percentage of B lymphocytes before infusion and longer infusion times are associated with a higher risk of developing IRRs. These findings may help to mitigate IRRs during treatment.
{"title":"Comparative study of infusion-related reactions to anti-CD20 drugs in neuroimmunological diseases of the central nervous system: a retrospective analysis of ocrelizumab and rituximab treatments","authors":"H. Guardiola , G. Arbona , Y. Jurgens , A. Morales Triado , S. Presas-Rodriguez , L. Álvarez Torres , O. Antolin Caminal , A. Teniente-Serra , C. Ramo-Tello , E. Montané , N. Depreux","doi":"10.1016/j.neurop.2025.100215","DOIUrl":"10.1016/j.neurop.2025.100215","url":null,"abstract":"<div><h3>Introduction</h3><div>The anti-CD20 monoclonal antibodies, rituximab (RTX) and ocrelizumab (OCRE), are used routinely for the treatment of neuroimmunological diseases. However, infusion-related reactions (IRRs) are common, and their underlying mechanisms are not well defined.</div></div><div><h3>Objectives</h3><div>Our aim was to determine the incidence of IRRs during OCRE and RTX treatment for neuroimmunological diseases and to identify predisposing factors.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study including patients who received at least one dose of OCRE or RTX between October 2018 and March 2022. Demographic data, comorbidities, immunological variables, and information about treatments and IRRs were collected. Statistical analysis was performed to assess IRR incidence, differences between groups, and predictors of IRR.</div></div><div><h3>Results</h3><div>Of 48 patients receiving 239 infusions, 17.6% presented IRRs. The incidence of IRRs was 40% among all patients: 41% in the OCRE group and 38% in the RTX group. Most IRRs were mild (90%). We found statistically significant differences in infusion time between both groups, with longer times associated with higher IRR incidence. Interestingly, a higher percentage of B lymphocytes prior to infusion was associated with increased risk of IRRs.</div></div><div><h3>Conclusion</h3><div>IRRs are common with both treatments, especially in the early stages. The percentage of B lymphocytes before infusion and longer infusion times are associated with a higher risk of developing IRRs. These findings may help to mitigate IRRs during treatment.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"6 1","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-15DOI: 10.1016/j.neurop.2025.100211
S. Lopes MD , M. Ribeiro MD , I. Mesquita MD , I. Carrilho MD , C. Garrido MD , M. Santos MD , S. Figueiroa MD , J. Martins MD , J. Cardoso MD , T. Temudo PhD
Background
Neurodegeneration with brain iron accumulation (NBIA) comprises a group of rare and heterogeneous genetic disorders, in which early diagnosis can be challenging.
Cases
Retrospective review of clinical, neurophysiological, radiological, and molecular data from 18 pediatric NBIA patients (2004–2024): PLAN (n = 9), PKAN (n = 6), BPAN (n = 3). Median age at symptom onset was 12 months and at diagnosis 5 years, with no significant intergroup differences. Initial symptoms included developmental delay and regression. Key findings: cognitive impairment (100%), dystonia (83%), spasticity (72%). Epilepsy was more frequent in BPAN (100%) than PLAN (44%) or PKAN (16%). MRI findings, including the “eye of the tiger” sign and cerebellar atrophy, aided subtype differentiation. Four PKAN patients underwent DBS-GPi with transient benefit. Mortality was high (61% before 19 years), mainly due to respiratory complications.
Conclusions
This is the largest pediatric NBIA series in Portugal, aiming to improve characterization and differentiation of this disorder group.
{"title":"Neurodegeneration with brain iron accumulation: two decades of pediatric cases in a Portuguese Center","authors":"S. Lopes MD , M. Ribeiro MD , I. Mesquita MD , I. Carrilho MD , C. Garrido MD , M. Santos MD , S. Figueiroa MD , J. Martins MD , J. Cardoso MD , T. Temudo PhD","doi":"10.1016/j.neurop.2025.100211","DOIUrl":"10.1016/j.neurop.2025.100211","url":null,"abstract":"<div><h3>Background</h3><div>Neurodegeneration with brain iron accumulation (NBIA) comprises a group of rare and heterogeneous genetic disorders, in which early diagnosis can be challenging.</div></div><div><h3>Cases</h3><div>Retrospective review of clinical, neurophysiological, radiological, and molecular data from 18 pediatric NBIA patients (2004–2024): PLAN (n<!--> <!-->=<!--> <!-->9), PKAN (n<!--> <!-->=<!--> <!-->6), BPAN (n<!--> <!-->=<!--> <!-->3). Median age at symptom onset was 12<!--> <!-->months and at diagnosis 5<!--> <!-->years, with no significant intergroup differences. Initial symptoms included developmental delay and regression. Key findings: cognitive impairment (100%), dystonia (83%), spasticity (72%). Epilepsy was more frequent in BPAN (100%) than PLAN (44%) or PKAN (16%). MRI findings, including the “eye of the tiger” sign and cerebellar atrophy, aided subtype differentiation. Four PKAN patients underwent DBS-GPi with transient benefit. Mortality was high (61% before 19<!--> <!-->years), mainly due to respiratory complications.</div></div><div><h3>Conclusions</h3><div>This is the largest pediatric NBIA series in Portugal, aiming to improve characterization and differentiation of this disorder group.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"6 1","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1016/j.neurop.2025.100212
L. Monge-Galindo , J.J. Ortega-Albás , I.L. Gallán-Farina , P. Ortega-Gabás , L. Menéndez-Rúa , R. Armas-Zurita , S. Li-Chen , F. Hallal-Peche
Introduction
Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and abnormal rapid eye movement manifestations, such as cataplexy, sleep paralysis, and hypnagogic hallucinations. Symptoms usually begin in childhood or adolescence, and diagnosis is often delayed. Treatment typically involves wake-promoting agents, antidepressants, and more recently, histamine H3 receptor antagonists like pitolisant. Given its complexity, real-world evidence on treatment strategies is needed.
Objectives and patients
This study describes three clinical cases of narcolepsy treated with pitolisant and followed longitudinally, focusing on clinical response, dose adjustments and functional outcomes. Case one involves an eight-year-old girl with excessive daytime sleepiness, later developing cataplexy. Pitolisant was titrated to 18 mg/day. In case two, a six-year-old boy presented with severe hypersomnia, cataplexy, hallucinations, and Tanner stage II pubertal development. Pitolisant started at 4.5 mg/day, increased to 9 and then to 13.5 mg/day. Case three concerns a 49-year-old man whose childhood-onset symptoms evolved into hypersomnolence, snoring, and non-restorative sleep. Pitolisant was started at 9 mg/day, increased to 36 mg/day, and then reduced to 18 mg/day.
Results
At five months, case one reported near-normal functioning. In case two, daytime sleepiness resolved, school attendance resumed, weight stabilized, and pubertal progression halted. In case three, Epworth Sleepiness Scale scores dropped, and the patient remained stable.
Conclusions
These cases illustrate diagnostic complexity and the need for personalized treatment. Pitolisant proved effective in improving excessive sleepiness, cataplexy, and functioning. The findings underscore the importance of early diagnosis, tailored pharmacotherapy, and real-world clinical data to refine management, especially in complex cases.
{"title":"Diagnostic and therapeutic challenges in narcolepsy: From childhood to complex comorbidity through 3 clinical cases","authors":"L. Monge-Galindo , J.J. Ortega-Albás , I.L. Gallán-Farina , P. Ortega-Gabás , L. Menéndez-Rúa , R. Armas-Zurita , S. Li-Chen , F. Hallal-Peche","doi":"10.1016/j.neurop.2025.100212","DOIUrl":"10.1016/j.neurop.2025.100212","url":null,"abstract":"<div><h3>Introduction</h3><div>Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and abnormal rapid eye movement manifestations, such as cataplexy, sleep paralysis, and hypnagogic hallucinations. Symptoms usually begin in childhood or adolescence, and diagnosis is often delayed. Treatment typically involves wake-promoting agents, antidepressants, and more recently, histamine H3 receptor antagonists like pitolisant. Given its complexity, real-world evidence on treatment strategies is needed.</div></div><div><h3>Objectives and patients</h3><div>This study describes three clinical cases of narcolepsy treated with pitolisant and followed longitudinally, focusing on clinical response, dose adjustments and functional outcomes. Case one involves an eight-year-old girl with excessive daytime sleepiness, later developing cataplexy. Pitolisant was titrated to 18 mg/day. In case two, a six-year-old boy presented with severe hypersomnia, cataplexy, hallucinations, and Tanner stage II pubertal development. Pitolisant started at 4.5 mg/day, increased to 9 and then to 13.5 mg/day. Case three concerns a 49-year-old man whose childhood-onset symptoms evolved into hypersomnolence, snoring, and non-restorative sleep. Pitolisant was started at 9 mg/day, increased to 36 mg/day, and then reduced to 18 mg/day.</div></div><div><h3>Results</h3><div>At five months, case one reported near-normal functioning. In case two, daytime sleepiness resolved, school attendance resumed, weight stabilized, and pubertal progression halted. In case three, Epworth Sleepiness Scale scores dropped, and the patient remained stable.</div></div><div><h3>Conclusions</h3><div>These cases illustrate diagnostic complexity and the need for personalized treatment. Pitolisant proved effective in improving excessive sleepiness, cataplexy, and functioning. The findings underscore the importance of early diagnosis, tailored pharmacotherapy, and real-world clinical data to refine management, especially in complex cases.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"6 1","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-13DOI: 10.1016/j.neurop.2025.100210
L. Folleco-Insuasty , I. Lacouture-Silgado , S. Martinez-Corredor , J. Bello-Romero , I. Baracaldo-Santamaría , J. Coral-Casas , O. Zorro-Guio
Introduction
Aneurysmal subarachnoid hemorrhage (aSAH) is a neurological emergency with high morbidity and mortality. Its timely management is crucial to improve the prognosis. This review analyzes diagnostic and therapeutic advances, with emphasis on the comparison between endovascular and surgical approaches, highlighting their impact on the clinical evolution of patients.
Methods
This article is a narrative review. An exhaustive literature search on aneurysmal subarachnoid hemorrhage was made in scientific databases: PUBMED, EMBASE, LILACS and TripDatabase, and articles referring to the diagnosis and treatment of this pathology.
Results
To get to know the updates and scientific advances in the early diagnosis and timely treatment of aSAH, whether endovascular or microsurgical, should be the goal of the treating group of patients who suffer from it. The continuous evolution in medical and interventional therapeutic measures, aimed at their initial management and their complications, corresponds to the need to seek alternatives to improve vital and functional outcomes for patients. New interventions could be implemented as treatment standards in the coming years, for example, the use of lumbar drainage systems of cerebrospinal fluid or new therapies for the prevention and management of late cerebral ischemia.
Conclusions
The management of this pathology is a therapeutic challenge and requires a multidisciplinary approach. Recent therapeutic advances have expanded the available options, improving the prognosis and functionality of patients.
{"title":"Update on diagnosis and treatment of aneurysmal subarachnoid hemorrhage: A literature review","authors":"L. Folleco-Insuasty , I. Lacouture-Silgado , S. Martinez-Corredor , J. Bello-Romero , I. Baracaldo-Santamaría , J. Coral-Casas , O. Zorro-Guio","doi":"10.1016/j.neurop.2025.100210","DOIUrl":"10.1016/j.neurop.2025.100210","url":null,"abstract":"<div><h3>Introduction</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) is a neurological emergency with high morbidity and mortality. Its timely management is crucial to improve the prognosis. This review analyzes diagnostic and therapeutic advances, with emphasis on the comparison between endovascular and surgical approaches, highlighting their impact on the clinical evolution of patients.</div></div><div><h3>Methods</h3><div>This article is a narrative review. An exhaustive literature search on aneurysmal subarachnoid hemorrhage was made in scientific databases: PUBMED, EMBASE, LILACS and TripDatabase, and articles referring to the diagnosis and treatment of this pathology.</div></div><div><h3>Results</h3><div>To get to know the updates and scientific advances in the early diagnosis and timely treatment of aSAH, whether endovascular or microsurgical, should be the goal of the treating group of patients who suffer from it. The continuous evolution in medical and interventional therapeutic measures, aimed at their initial management and their complications, corresponds to the need to seek alternatives to improve vital and functional outcomes for patients. New interventions could be implemented as treatment standards in the coming years, for example, the use of lumbar drainage systems of cerebrospinal fluid or new therapies for the prevention and management of late cerebral ischemia.</div></div><div><h3>Conclusions</h3><div>The management of this pathology is a therapeutic challenge and requires a multidisciplinary approach. Recent therapeutic advances have expanded the available options, improving the prognosis and functionality of patients.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"6 1","pages":"Article 100210"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deep brain stimulation (DBS) is a neurosurgical technique that modulates neural circuits through electrical impulses. Initially developed for motor disorders such as Parkinson's disease, its use has expanded to neuropsychiatric conditions, including treatment-resistant schizophrenia, obsessive-compulsive disorder (OCD), and chronic anorexia nervosa, with promising results. However, challenges remain regarding treatment personalization, identification of anatomical targets, and understanding its mechanisms of action.
Objective
To assess the effectiveness, safety, and technical factors associated with DBS in neuropsychiatric disorders through a systematic review of the available scientific literature.
Methods
A systematic review was conducted following PRISMA guidelines. Controlled clinical trials, observational studies, and case series with ≥ 10 participants were included, covering neuropsychiatric conditions such as OCD, treatment-resistant schizophrenia, and chronic anorexia nervosa. The primary outcomes were changes in clinical scales (e.g., PANSS, Y-BOCS) and adverse events, analyzed using critical appraisal tools such as RoB2 and the Newcastle-Ottawa scale.
Results
Out of 3351 initial records, 11 studies with 235 participants were included. Significant improvements were observed in specific symptoms: a 40% reduction in motor tics (p < 0.001) in Tourette syndrome, and a 10% increase in body mass index (p = 0.02) in anorexia nervosa. However, the effects on Alzheimer's disease were heterogeneous, showing cognitive decline in patients < 65 years (p = 0.006). Adverse events included mild neuropsychological impairment and severe perioperative complications in isolated cases.
Discussion
DBS proves effective in refractory neuropsychiatric disorders, modulating specific symptoms and improving quality of life. Methodological limitations persist in the literature, such as small sample sizes and heterogeneity in stimulation parameters. The need for multicenter studies and biomarkers to predict therapeutic responses is emphasized.
{"title":"Deep brain stimulation in neuropsychiatric disorders: A systematic review","authors":"J.T. Soto Joven , C.C. Bermudez Riveros , J.P. Alzate Granados","doi":"10.1016/j.neurop.2025.100209","DOIUrl":"10.1016/j.neurop.2025.100209","url":null,"abstract":"<div><h3>Introduction</h3><div>Deep brain stimulation (DBS) is a neurosurgical technique that modulates neural circuits through electrical impulses. Initially developed for motor disorders such as Parkinson's disease, its use has expanded to neuropsychiatric conditions, including treatment-resistant schizophrenia, obsessive-compulsive disorder (OCD), and chronic anorexia nervosa, with promising results. However, challenges remain regarding treatment personalization, identification of anatomical targets, and understanding its mechanisms of action.</div></div><div><h3>Objective</h3><div>To assess the effectiveness, safety, and technical factors associated with DBS in neuropsychiatric disorders through a systematic review of the available scientific literature.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PRISMA guidelines. Controlled clinical trials, observational studies, and case series with ≥<!--> <!-->10 participants were included, covering neuropsychiatric conditions such as OCD, treatment-resistant schizophrenia, and chronic anorexia nervosa. The primary outcomes were changes in clinical scales (e.g., PANSS, Y-BOCS) and adverse events, analyzed using critical appraisal tools such as RoB2 and the Newcastle-Ottawa scale.</div></div><div><h3>Results</h3><div>Out of 3351 initial records, 11 studies with 235 participants were included. Significant improvements were observed in specific symptoms: a 40% reduction in motor tics (<em>p</em> < 0.001) in Tourette syndrome, and a 10% increase in body mass index (<em>p</em> = 0.02) in anorexia nervosa. However, the effects on Alzheimer's disease were heterogeneous, showing cognitive decline in patients <<!--> <!-->65 years (<em>p</em> = 0.006). Adverse events included mild neuropsychological impairment and severe perioperative complications in isolated cases.</div></div><div><h3>Discussion</h3><div>DBS proves effective in refractory neuropsychiatric disorders, modulating specific symptoms and improving quality of life. Methodological limitations persist in the literature, such as small sample sizes and heterogeneity in stimulation parameters. The need for multicenter studies and biomarkers to predict therapeutic responses is emphasized.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"6 1","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.neurop.2025.100208
O.A. Mahmood, M.G. Aliraqi
Introduction
Hematological parameters are considered to be implicated in the pathogenesis of acute ischemic stroke. Otherwise, to our knowledge, it is still not known whether there are any differences between small and large vessel strokes, in terms of these parameters.
Methods
Prospectively included in the study, a hundred small-vessel stroke (n = 50) and large-vessel stroke patients (n = 50) were managed in Ibn-sena teaching hospital, Mosul between Oct. 2023 and Aug. 2024. Complete history, neurological examination was done at admission, and blood samples for CBC were collected within the first 48 h of admission. White blood cells (WBCs), neutrophils, lymphocytes, neutrophil/lymphocyte ratio (N/L ratio), monocytes, eosinophils, basophil, hemoglobin (HB), RBC count, packed cell volume (PCV), red cell distribution width (RDW), red cell distribution width index (RDWI), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet count, platelet distribution width (PDW) and mean platelet volume (MPV) were obtained, and comparison between the two groups in terms of these parameters was done and with 50 control patients.
Results
Neutrophil to lymphocyte ratio was highest in large vessel disease group and lowest in control group (small versus large, small versus control, large versus control, P = 0.003, < 0.001, < 0.001 respectively), and the opposite was the case with lymphocyte count (small versus large, small versus control, large versus control P = 0.003, < 0.001, < 0.001, respectively). We have found expressively higher total white blood cell (P = 0.004, < 0.001), and lower monocyte count (P = 0.001, < 0.001) in patients with small and large vessel diseases respectively compared to controls. Platelet count and mean platelet volume were significantly higher in small vessel disease compared to controls (P = 0.04, 0.02, respectively). Neutrophil count and RDW were inferentially higher in the large vessel group compared to controls (P = 0.005, 0.03, respectively), and no other significant differences were found among groups.
Conclusions
Hematological parameters are invaluable tools to confirm the diagnosis of ischemic stroke and to predict stroke subtypes with modest sensitivity.
{"title":"Hematolgical parameters: Are they predictors of ischemic stroke subtypes?","authors":"O.A. Mahmood, M.G. Aliraqi","doi":"10.1016/j.neurop.2025.100208","DOIUrl":"10.1016/j.neurop.2025.100208","url":null,"abstract":"<div><h3>Introduction</h3><div>Hematological parameters are considered to be implicated in the pathogenesis of acute ischemic stroke. Otherwise, to our knowledge, it is still not known whether there are any differences between small and large vessel strokes, in terms of these parameters.</div></div><div><h3>Methods</h3><div>Prospectively included in the study, a hundred small-vessel stroke (<em>n</em> = 50) and large-vessel stroke patients (<em>n</em> = 50) were managed in Ibn-sena teaching hospital, Mosul between Oct. 2023 and Aug. 2024. Complete history, neurological examination was done at admission, and blood samples for CBC were collected within the first 48 h of admission. White blood cells (WBCs), neutrophils, lymphocytes, neutrophil/lymphocyte ratio (N/L ratio), monocytes, eosinophils, basophil, hemoglobin (HB), RBC count, packed cell volume (PCV), red cell distribution width (RDW), red cell distribution width index (RDWI), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet count, platelet distribution width (PDW) and mean platelet volume (MPV) were obtained, and comparison between the two groups in terms of these parameters was done and with 50 control patients.</div></div><div><h3>Results</h3><div>Neutrophil to lymphocyte ratio was highest in large vessel disease group and lowest in control group (small versus large, small versus control, large versus control, <em>P =</em> 0.003, <<!--> <!-->0.001, <<!--> <!-->0.001 respectively), and the opposite was the case with lymphocyte count (small versus large, small versus control, large versus control <em>P =</em> 0.003, <<!--> <!-->0.001, <<!--> <!-->0.001, respectively). We have found expressively higher total white blood cell (<em>P =</em> 0.004, <<!--> <!-->0.001), and lower monocyte count (<em>P =</em> 0.001, <<!--> <!-->0.001) in patients with small and large vessel diseases respectively compared to controls. Platelet count and mean platelet volume were significantly higher in small vessel disease compared to controls (<em>P =</em> 0.04, 0.02, respectively). Neutrophil count and RDW were inferentially higher in the large vessel group compared to controls (<em>P =</em> 0.005, 0.03, respectively), and no other significant differences were found among groups.</div></div><div><h3>Conclusions</h3><div>Hematological parameters are invaluable tools to confirm the diagnosis of ischemic stroke and to predict stroke subtypes with modest sensitivity.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"5 4","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-18DOI: 10.1016/j.neurop.2025.100207
P. Gruezo-Realpe , D.J. Japón-Cueva , C.R. Alarcón , A. Noritz-Mero , R. Cedeño-Morejon , A. Chango-Pinargote , L. Viñan-Paucar , N. Aguirre-Verduga , D.M. Andrade , G.S. Suárez , M.L. Iturralde , J. García-Córdova , M. Quintero-Jácome , L. Villacis-Palma , E. Velásquez-Barreiro , R. Pilco-Rojas , A. Suárez-Calderón , M. Pérez-Román , S. Borja-Landires , D. Cabezas-Euvin , V. Campozano
Background/objective
Traumatic brain injury (TBI) is a major cause of morbidity and mortality, with symptoms ranging from seizures to speech disorders. TBI often requires stabilization, neuroimaging, and correction of metabolic imbalances like dysnatremia, which can worsen outcomes. This study evaluates the relationship between dysnatremia, clinical parameters, and neuroimaging findings in acute TBI patients.
Methods
A multicenter retrospective cohort study was conducted in three hospitals in Guayaquil, Ecuador, including 200 ICU patients with acute TBI from 2018 to 2023. Data were collected from clinical histories, neuroimaging, and biochemical analyses, with serum sodium levels measured at admission, 24, and 48 h post-admission. Statistical analyses included Chi-square tests, Kruskal-Wallis tests, Pearson correlation, and logistic regression to assess associations.
Results
Of the 200 patients, 85.5% were male. Alcohol consumption was higher in patients with dysnatremia (p = 0.010). Glasgow Coma Scale (GCS) and FOUR Scale scores were lower in hypernatremic patients at both admission and 48 h (p < 0.001). Hypernatremia was linked to increased ventilatory support (94.5%) and higher mortality (41.8%) (p = 0.017). Neuroimaging showed associations between hypernatremia and subarachnoid hemorrhage, cerebral edema, and contusions (p < 0.05). Logistic regression revealed that higher GCS scores were linked to reduced mortality (OR = 0.717, p < 0.001).
Conclusions
Hypernatremia correlates with lower neurological scores, abnormal neuroimaging findings, increased ventilatory support, and higher mortality in patients with acute TBI. Serum sodium monitoring may aid early risk stratification and guide critical care interventions. Prospective studies are warranted to standardize protocols and optimize dysnatremia management in TBI.
{"title":"Association between radiological findings and clinical outcome in secondary dysnatremia to acute traumatic brain injury","authors":"P. Gruezo-Realpe , D.J. Japón-Cueva , C.R. Alarcón , A. Noritz-Mero , R. Cedeño-Morejon , A. Chango-Pinargote , L. Viñan-Paucar , N. Aguirre-Verduga , D.M. Andrade , G.S. Suárez , M.L. Iturralde , J. García-Córdova , M. Quintero-Jácome , L. Villacis-Palma , E. Velásquez-Barreiro , R. Pilco-Rojas , A. Suárez-Calderón , M. Pérez-Román , S. Borja-Landires , D. Cabezas-Euvin , V. Campozano","doi":"10.1016/j.neurop.2025.100207","DOIUrl":"10.1016/j.neurop.2025.100207","url":null,"abstract":"<div><h3>Background/objective</h3><div>Traumatic brain injury (TBI) is a major cause of morbidity and mortality, with symptoms ranging from seizures to speech disorders. TBI often requires stabilization, neuroimaging, and correction of metabolic imbalances like dysnatremia, which can worsen outcomes. This study evaluates the relationship between dysnatremia, clinical parameters, and neuroimaging findings in acute TBI patients.</div></div><div><h3>Methods</h3><div>A multicenter retrospective cohort study was conducted in three hospitals in Guayaquil, Ecuador, including 200 ICU patients with acute TBI from 2018 to 2023. Data were collected from clinical histories, neuroimaging, and biochemical analyses, with serum sodium levels measured at admission, 24, and 48 h post-admission. Statistical analyses included Chi-square tests, Kruskal-Wallis tests, Pearson correlation, and logistic regression to assess associations.</div></div><div><h3>Results</h3><div>Of the 200 patients, 85.5% were male. Alcohol consumption was higher in patients with dysnatremia (p = 0.010). Glasgow Coma Scale (GCS) and FOUR Scale scores were lower in hypernatremic patients at both admission and 48 h (p < 0.001). Hypernatremia was linked to increased ventilatory support (94.5%) and higher mortality (41.8%) (p = 0.017). Neuroimaging showed associations between hypernatremia and subarachnoid hemorrhage, cerebral edema, and contusions (p < 0.05). Logistic regression revealed that higher GCS scores were linked to reduced mortality (OR = 0.717, p < 0.001).</div></div><div><h3>Conclusions</h3><div>Hypernatremia correlates with lower neurological scores, abnormal neuroimaging findings, increased ventilatory support, and higher mortality in patients with acute TBI. Serum sodium monitoring may aid early risk stratification and guide critical care interventions. Prospective studies are warranted to standardize protocols and optimize dysnatremia management in TBI.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"5 4","pages":"Article 100207"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parkinson's disease (PD), a prevalent neurodegenerative disorder characterized by motor dysfunction, presents a significant therapeutic challenge due to the lack of disease-modifying treatments. Emerging evidence suggests a crucial role of the gut microbiota in PD pathogenesis, particularly through its influence on the gut-brain axis.
Development
The gut-brain axis, a bidirectional communication network involving neural, hormonal, and immune pathways, appears to be significantly modulated by the gut microbiota. Dysbiosis, an imbalance in gut microbial composition, has been implicated in PD progression. Metabolites produced by gut bacteria, such as short-chain fatty acids, are key mediators of gut-brain signaling and may contribute to PD pathogenesis. Preclinical studies utilizing animal models of PD have demonstrated the neuroprotective potential of probiotics, live microorganisms that confer health benefits to the host. These studies report improvements in motor symptoms, reduced neuroinflammation, decreased oxidative stress, and restoration of gut and blood–brain barrier integrity following probiotic administration.
Conclusions
While the precise mechanisms underlying the beneficial effects of probiotics in PD require further investigation, these interventions hold promise for disease management. Further research is warranted to elucidate the therapeutic potential of probiotics in PD and to develop targeted interventions for modulating the gut microbiota to improve clinical outcomes.
{"title":"Bridging the gap: Unveiling the gut's influence on Parkinson's disease through probiotic interventions","authors":"A.Y. Nápoles-Medina , B.R. Aguilar-Uscanga , B.G. Nápoles-Medina , P.A. Brand-Rubalcava , A.R. Tejeda-Martínez , M.E. Flores-Soto","doi":"10.1016/j.neurop.2025.100206","DOIUrl":"10.1016/j.neurop.2025.100206","url":null,"abstract":"<div><h3>Introduction</h3><div>Parkinson's disease (PD), a prevalent neurodegenerative disorder characterized by motor dysfunction, presents a significant therapeutic challenge due to the lack of disease-modifying treatments. Emerging evidence suggests a crucial role of the gut microbiota in PD pathogenesis, particularly through its influence on the gut-brain axis.</div></div><div><h3>Development</h3><div>The gut-brain axis, a bidirectional communication network involving neural, hormonal, and immune pathways, appears to be significantly modulated by the gut microbiota. Dysbiosis, an imbalance in gut microbial composition, has been implicated in PD progression. Metabolites produced by gut bacteria, such as short-chain fatty acids, are key mediators of gut-brain signaling and may contribute to PD pathogenesis. Preclinical studies utilizing animal models of PD have demonstrated the neuroprotective potential of probiotics, live microorganisms that confer health benefits to the host. These studies report improvements in motor symptoms, reduced neuroinflammation, decreased oxidative stress, and restoration of gut and blood–brain barrier integrity following probiotic administration.</div></div><div><h3>Conclusions</h3><div>While the precise mechanisms underlying the beneficial effects of probiotics in PD require further investigation, these interventions hold promise for disease management. Further research is warranted to elucidate the therapeutic potential of probiotics in PD and to develop targeted interventions for modulating the gut microbiota to improve clinical outcomes.</div></div>","PeriodicalId":74283,"journal":{"name":"Neurology perspectives","volume":"5 4","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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