Annals of Indian Academy of Neurology最新文献

Background and objectives: The quality of life may be negatively impacted by postoperative cognitive dysfunction (POCD) following off-pump coronary artery bypass grafting (OPCAB). It is still unclear how useful the jugular venous lactate and oxygen parameters are in predicting POCD following OPCAB.

Methods: This prospective observational study was conducted over a period of 15 months and included 54 individuals. It sought to determine the sensitivity and specificity of jugular venous lactate and oxygen parameters for early POCD prediction in patients undergoing OPCAB. Neuropsychological tests were conducted to assess baseline cognitive function. Under ultrasound guidance, the jugular bulb was cannulated. The jugular venous lactate and oxygen parameters were measured at the time of surgery, following each graft, and 6 and 24 h later. Confusion assessment method-intensive care unit score was assessed on the third postoperative day for postoperative delirium (POD). POCD was defined as a composite Z score ≥1.96 or two Z scores in individual tests at 1 week. The jugular venous lactate and oxygen parameters of the Decline (D) group were compared to those of the Normal (N) group. Receiver operating characteristic curves were used to assess the diagnostic efficacy of derived variables.

Results: The incidence of POD and POCD was 18.5% and 11.1%, respectively. At T3, all derived variables showed a significant increase, although the arterio-jugular venous lactate difference (AJDL) and modified lactate oxygen index (mLOI) were substantially greater at T3 in group D compared to group N. When predicting POCD, mLOI demonstrated the highest sensitivity at 72.22%, while AJDL showed the highest specificity at 90.7%.

Conclusions: For prediction of early POCD in patients undergoing elective OPCAB, mLOI had highest sensitivity, while AJDL had high specificity.

Background and objectives: Neurologic deterioration frequently occurs during the acute phase of isolated pontine infarction (IPI). However, the factors that predict early neurologic deterioration (END) are not well understood. The purpose of this study is to identify and analyze the predictors of END in individuals with IPI.

Methods: One hundred and fifty-three patients diagnosed with acute IPI were included in this retrospective study, including 41 individuals in the END group and 112 in the non-END group. Demographic characteristics, clinical data, and imaging features were collected and compared. Logistic regression analysis was used to identify independent predictors of END in patients with IPI, and a receiver operating characteristic (ROC) curve was constructed to assess model performance.

Results: Univariate analysis demonstrated significant differences between the two groups regarding diabetes mellitus, National Institute of Health Stroke Scale (NIHSS) score at admission, etiological classification, and infarct area, with P values less than 0.05. Multivariate binary logistic regression analysis revealed that the NIHSS score at admission and the infarct size were independent predictors of END. The combined ROC analysis of the NIHSS score at admission and the infarct area for predicting END showed a sensitivity of 85.4%, specificity of 83.0%, and an area under the curve of 0.887.

Conclusions: Basilar artery branch disease is the primary cause of END observed in IPI. Both the NIHSS score at admission and the size of the infarct serve as significant predictors for END in IPI, and the combination of two factors provides value in predicting END and outcomes of IPI patients. Early prediction of END also can guide treatment strategies, aimed at improving patient prognosis.

Background and objectives: The adenosine pathway in drug-resistant epilepsy (DRE) due to hippocampal sclerosis (HS) is largely unexplored. The present study aims to provide new insights into the role of adenosine pathway in patients with DRE associated with HS (DRE-HS).

Methods: Quantitative polymerase chain reaction and immunohistochemistry were used to analyze 10 genes involved in adenosine pathway ( ADARB1 , ADK , NT5E , ADORA1 , C-FOS, C-MYC, CREB1, C-JUN, NF-kB1, and MAPK ) in surgically resected sclerosed hippocampi (n = 37) and compare their expressions with control hippocampi (n = 38) obtained from the autopsy. Expression analyses were also carried out in peripheral blood of 20 matched patients and 30 healthy controls.

Results: C-JUN , NT5E , C-FOS , ADARB1 , and ADORA1 were significantly upregulated in the hippocampus, whereas in blood, C-JUN , NT5E , C-FOS , and ADORA1 were significantly downregulated. ADARB1 , NF-kB1 , MAPK1, C-FOS, and CREB1 showed the reverse direction of expressions in post-surgery blood samples. On clinico-genetic analysis, MAPK1 and ADARB1 correlated with neuronal dispersion in the dentate gyrus ( P = 0.02 and 0.03, respectively) and C-JUN correlated with neuronal loss in CA1 ( P = 0.01) and CA4 ( P = 0.04) areas. In blood, MAPK1 , NF-kB1 , and C-FOS expressions correlated negatively with the age of onset of seizures ( P = 0.02, 0.03, and 0.03, respectively). In addition, ADARB1 expression correlated with neuronal loss in CA3 and CA4 areas ( P ≤ 0.001 and 0.04, respectively).

Conclusion: Genes with similar expression patterns in the brain and peripheral blood are potential biomarkers in DRE-HS. Significant clinico-genetic correlations warrant further studies for developing novel therapeutic interventions.

Myelin oligodendrocyte glycoprotein antibody-associated disease has been recently identified to be a distinct autoimmune central nervous system disorder. There is significant clinical and radiological overlap with multiple sclerosis and aquaporin-4-IgG-associated neuromyelitis optica spectrum disorders. Clinical course is variable in that patients may have a monophasic or relapsing course, disease severity is unpredictable, and unlike other idiopathic autoimmune inflammatory disorders, there is no gender predilection and it is more likely to affect pediatric population. There are no clear-cut treatment guidelines. Duration and dose of oral steroids after the first attack, role of immunosuppressants in relapsing disease, and duration of therapy for the latter are not certain. Currently, there are no disease-specific therapies available, though some novel therapies are under trial. Some of these challenges will be addressed in this paper.

Background and objectives: Although widely described in Parkinson's disease (PD), peripheral neuropathy (PNP) is scarcely reported in progressive supranuclear palsy (PSP). We aimed to compare the frequency, clinical and electrophysiologic characteristics of PNP in PSP and PD patients.

Methods: This cross-sectional study included 23 PSP and 93 PD patients. Demographic data, Movement Disorders Society-Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III), Hoehn-Yahr staging, Toronto Clinical Neuropathy Score, nerve conduction study (NCS), and sympathetic skin response (SSR) were recorded. Diagnosing isolated large fiber neuropathy required abnormal NCS. Isolated small fiber neuropathy required clinical findings of pinprick and thermal sensory loss and/or allodynia and/or hyperalgesia with/without impaired SSR, along with normal NCS.

Results: PNP was commoner in PSP than PD (65.2% vs. 50.5%, P = 0.21). While a comparable proportion in both groups had clinical neuropathy, NCS abnormalities predominated in PSP (65.2% vs. 39.8%, P = 0.03). All patients had distal symmetrical axonal polyneuropathy. A significantly higher proportion of PSP patients had large fiber involvement (65.21% vs. 39.78%, χ 2 = 4.82; P = 0.03) and mixed fiber PNP (60.9% vs. 33.3%, P = 0.01). PSP patients with neuropathy had a significantly shorter disease duration [median (interquartile range {IQR} = 2 (2-3) years vs. 6 (3-9) years, P < 0.001], higher MDS-UPDRS-III score [median (IQR) = 47 (36-54) vs. 34 (28-49), P = 0.049], higher Hoehn-Yahr stage [median (IQR) = 4 (2-5) vs. 3 (1-5), P < 0.001], and shorter duration of levodopa use [median (IQR) = 2 (1-2) years vs. 3.5 (2-5) years, P = 0.006]. NCS parameters were comparable between PSP and PD patients with neuropathy. While PNP in PSP was not associated with any of the clinical variables, a longer disease duration was independently associated with PNP in PD.

Conclusions: PNP affected two-thirds of PSP patients and was more prevalent than PD. Both groups had distal symmetrical axonal polyneuropathy, with mixed fiber PNP predominating in PSP. A longer disease duration in PD was associated with PNP.