Objective: Through resting state functional magnetic resonance imaging (rs-fMRI) we evaluate the spontaneous brain activity changes of maintenance hemodialysis (MHD) patients with restless legs syndrome (RSL) and analyzed the imaging features and related mechanisms of RLS in patients with MHD.
Method: We select 27 MHD patients with RLS and 27 patients without RSL matched by age, gender, cognitive function. Both groups underwent neuropsychological tests and MRI scans. MRI data analysis was performed to obtain and compare the amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo) values, which were mALFF, mfALFF, and mReHo. Clinical data were collected and compared. Differentiated indicators and RLS scores conduct Pearson correlation analysis.
Result: Compared with the MHD-nRLS group, the MHD-RLS group showed significantly lower mALFF values in the left precentral, right precentral gyrus, and right postcentral gyrus, lower mfALFF values in the left precentral gyrus, right precentral gyrus, left calcarine fissure, left lingual gyrus, left postcentral gyrus, and right postcentral gyrus, and lower mReHo values in the left precentral gyrus, right precentral gyrus, left calcarine fissure, left lingual gyrus, left postcentral gyrus, and right postcentral gyrus, and right postcentral gyrus (P < 0.05). The MHD-RLS group exhibited lower hemoglobin levels (P = 0.001), higher total iron-binding capacity levels (P = 0.011), and higher folic acid levels (P = 0.022). The above indicators were correlated with RLS scores using Pearson correlation analysis, and it was found that the mfALFF value of the right precentral gyrus and the right postcentral gyrus, and the mReHo values of the right precentral gyrus and right postcentral gyrus were negatively correlated with the RLS score (r = -0.567, P = 0.002;r = -0.705, P < 0.001;r = -0.414, P = 0.032; r = -0.410, P = 0.034), and the hemoglobin concentration was negatively correlated with the RLS scores (r = -0.394, P = 0.042).
Conclusion: Patients with MHD-RLS exhibit abnormal spontaneous brain activity in the right precentral gyrus and right postcentral gyrus within the sensorimotor network, along with lower hemoglobin levels, which may be associated with the pathogenesis and severity of MHD-RLS.
Introduction: Alzheimer's disease (AD) is a prevalent neurodegenerative disorder in the elderly, causing cognitive impairment. Its pathogenesis is characterized by amyloid beta deposition, neurofibrillary tangles, and neuroinflammation. Recent research has identified the link between gut dysbiosis, an imbalance of intestinal microorganisms, to this pathogenesis via the gut-brain axis. This study aims to review the probiotics' therapeutic effect, targeting the gut-brain axis, for AD treatment in animals.
Methods: The method utilized in this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Three reviewers searched articles through PubMed, Scopus, and Embase using advanced search strategy. Articles published between 2010 and 2023 that met the criteria were included.
Results: Of 2,273 articles, 21 animal studies measuring the effects of probiotics genera Lactobacillus and/or Bifidobacterium on AD via at least one of these four outcomes: AD pathology, cognitive function, neuroinflammation, and gut microbiota composition. The results demonstrated that probiotics could repair gut dysbiosis by decreasing pro-inflammatory bacteria and increasing anti-inflammatory bacteria. Repaired dysbiosis was found to be associated with less neuroinflammation as significant reductions in neuroinflammatory markers related to the pathogenesis of AD such as TNF-α (SMD = -2.08, P = 0.005), IL-6 (SMD = -2.98, P < 0.0005), and IL-1β (SMD = -2.49, P = 0.003) were observed. Reduced amyloid beta deposition (SMD = -1.17, P = 0.009) was reported, but reduction in tau hyperphosphorylation was found to be insignificant. For cognitive function, positive results were demonstrated for all three aspects of cognitive function including long-term memory (SMD = 2.55, P < 0.00001), short-term memory (SMD = 1.32, P = 0.003), and spatial recognition (SMD = -1.13, P < 0.00001).
Conclusions: Particular formulas of probiotics showed potential effectiveness in AD therapies with demonstrated association with the gut-brain axis. Future studies are required to investigate strain-specific results and optimal dosages and regimens.
Background: Neuronal hyperexcitability has been proposed to play a key role in Alzheimer's disease (AD). Understanding the relation between this enhanced excitability and AD pathology could provide a window for therapeutic interventions. However epileptiform activity is often subclinical, hidden on scalp EEG and very challenging to assess with current diagnostic modalities.
Case presentation: A woman in her sixties presented with acute confusion. Despite a normal scalp electroencephalogram (EEG), magnetic resonance imaging (MRI) showed cytotoxic edema of the right mesial temporal lobe and hippocampal hypermetabolism was present on ([18F]-fluoro-2-deoxyglucose positron emission tomography (PET). Bilateral foramen ovale (FO) electrodes were placed to directly record mesial temporal activity and revealed continuous mesial temporal epileptic activity, while scalp EEG remained normal. After recovery, a new diagnosis of AD was established on cerebrospinal fluid. The lateralization of the epileptiform activity was congruent with the predominant side of tau pathology in the mesial temporal cortex on 18F-MK6240 PET. On follow-up MRI, two and five months later, the right hippocampus became atrophic.
Conclusion: This case highlights the significant role of neuronal hyperexcitability in early AD pathogenesis and how shared mechanisms between AD and epilepsy can complicate clinical management.
Background: Infection is a common complication in the acute phase after stroke; a systematic review in 2011 reported a post-stroke infection prevalence of 30%. Despite the plethora of primary data on post-stroke infections in recent times, a systematic review that synthesizes the data to provide comprehensive information to guide preventive, control, and management efforts is yet to be undertaken. This systematic review, therefore, aimed at bridging this gap by describing the epidemiology of post-stroke infections including the global prevalence and the associated mortality rates.
Methodology: A comprehensive search was conducted in PubMed, SCOPUS, and Web of Science resulting in 2210 studies, of which 73 studies covering 32,109,574 stoke patients were included in the systematic review. Prevalence data on defined post-stroke infections were extracted for analysis in RStudio version 4.3.3.
Results: The pooled prevalence of post-stroke infections and mortality rates were 9.14% and 15.91% respectively. The prevalence of post-stroke infections was highest for pneumonia (12.4%), followed by urinary tract infection (8.31%). Geographically, the prevalence of post-stroke infections for the various continents were Europe (10.41%), Africa (10.22%), South America (8.83%), North America (8.15%), Asia (8.09%), and Australia (7.88%). Common etiological agents of post-stroke infections included multidrug-resistant organisms particularly, Carbapenem-resistant Klebsiella pneumoniae (15.4-31.8%), Methicillin-resistant Staphylococcus aureus (9.8-15.4%), and Carbapenem-resistant Acinetobacter baumannii (38.5%).
Conclusion: This systematic review indicates about a 3-fold decline in the global prevalence of post-stroke infections in the last decade. Pneumonia is the most common post-stroke infection. Europe and Africa have the highest prevalence of post-stroke infections.
Background: The Headache Disability Questionnaire (HDQ) evaluates pain intensity, daily activities, work/school disruptions, and the impact on recreational activities. It was aimed to translate the HDQ into Turkish and evaluate its reliability and validity.
Methods: This study included 130 participants, consisting of 105 females and 25 males. The original HDQ was translated into Turkish language using Beaton guidelines. Reliability was assessed using internal consistency and Intraclass Correlation Coefficient. Exploratory (EFA) and Confirmatory Factor Analysis (CFA) were conducted to evaluate the structural validity. For convergent validity, the Turkish version of the HDQ, along with the Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment Scale (MIDAS), was administered to individuals with headaches. The HDQ was retested one week later to assess its reliability.
Results: The Turkish version of the HDQ demonstrated good reliability, with ICC and Cronbach's α values of 0.842 and 0.914, respectively. Standard error measurement (SEM) and Minimal Detectable Change (MDC) values were 5.89 and 16.33 units. Bland-Altman plots confirmed a high level of agreement between initial and retest scores EFA revealed a two-factor structure, clustering items into Factor 1 (items 1, 2, 5, 7, and 9) and Factor 2 (items 3, 4, 6, and 8), which was subsequently confirmed by CFA. Convergent validity was confirmed through good correlations with HIT-6, and MIDAS. No ceiling or floor effects were observed.
Conclusions: The study demonstrates that the Turkish version of the HDQ is a valid and reliable instrument for evaluating the effect of headaches on daily living, exhibiting strong internal consistency and test-retest reliability, making it suitable for both clinical practice and research purposes.
Trial registration: Trial registration date is January 30, 2021 (NCT04736654).
Clinical trials registration number: NCT04736654.
Objective: Anti-IgLON5 disease is a rare autoimmune mediated disease. It is mainly featured by sleep-related disturbance, parkinsonism, chorea and limb ataxia. Previous studies had clarified its clinical manifestations and predisposing genes. However, as far as we know, anti-IgLON5 disease combined with paraneoplastic cerebellar degeneration (PCD) with the detection of anti-Sulfatide IgG antibody, masquerading as meningoencephalitis had not been reported before.
Case presentation: A 57-year-old Chinese female presented with walking unsteadily for 12 days and logagnosia for 2 days and was admitted to our hospital. She had a past history of breast cancer. Magnetic resonance imaging (MRI) revealed leptomeningeal enhancement (prominent in cerebellar hemisphere). Arterial spin labeling (ASL) perfusion showed hyperperfusion in the cerebellar hemisphere and interhemispheric fissure cistern. MRI and ASL indicated the diagnosis was meningoencephalitis. However, IgG anti-IgLON5 antibody was positive in both serum and cerebrospinal fluid. Therefore, the diagnosis was anti-IgLON5 disease. In addition, the patient combined with PCD due to positive anti-Yo-antibody in serum fluid .
Conclusions: Whereas sleep disturbance is the most common feature in patients with anti-IgLON5 disease, our case presented with walking unsteadily and logagnosia. Anti-IgLON5 disease combined with PCD with the detection of anti-Sulfatide IgG antibody, masquerading as meningoencephalitis is very rare. Therefore, if meningoencephalitis did not recover with conventional treatment, anti-IgLON5 disease and PCD should be considered as the differential diagnosis.
Introduction: Whether double filtration plasmapheresis (DFPP) is effective in the patients who do not response to the initial immunotherapy is uncertain. This retrospective study aimed to evaluate the efficacy and safety of DFPP in the treatment of patients who had no improvement after initial immunotherapy (steroids and/or immunoglobulin (IVIG)), and moreover, to investigate the factors associated with the efficacy of DFPP.
Methods: From January 1st, 2014, to December 30th,2018, a total of 26 patients who were diagnosed autoimmune encephalitis (AE) and were received the treatment of DFPP after unsuccessful or incomplete recovery from their early immune therapy (including intravenous high-dose cortisone, IVIG and or immunosuppressant) for at least 21 days were investigated. Their plasmapheresis volume, the course of disease, treatment sessions, and complications were recorded. The efficacy of DFPP within a week were assessed by modified Rankin scale (mRS). These patients were followed until six months after the last session of DFPP treatment.
Results: The duration between the onset of symptoms and DFPP administration was 54.5 days (range 21-243 days). The median DFPP sessions for each patient were three (range 2-6 sessions), and the mean volume of plasma exchange was 50.5 ± 11.1 ml/kg/session. Total clinically relevant improvement was observed in 57.7% of the patients. The median mRS was decreased from 5 to 4 within one week after DFPP treatment (P < 0.001). Only one patient relapsed in the following six months after DFPP. The effectiveness of DFPP has no relationship with age, gender, the type of antibody, with or without neoplasm, clinical course and the volume of plasma exchange. Most patients tolerated well, except 2 cases. One encountered mild allergic reaction and the other had a transient hypotension during DFPP treatment, but both were corrected rapidly.
Conclusion: DFPP is an effective and safe treatment option for patients who have poor responsiveness to early immunotherapy).
Background: A sustainable pandemic preparedness strategy is essential to ensure equitable access to healthcare for individuals with neurodegenerative diseases. Moreover, it is vital to provide clinicians and researchers in the neurodegenerative disease fields with resources and infrastructure to ensure continuity of their work during a (health) crisis.
Methods: We established an international collaboration between researchers, clinicians, and patient representatives from the Netherlands, Poland, and the United Kingdom. We co-created a pandemic preparedness plan primarily informed by examples from those affected by or working in the field of Parkinson's disease, with potential application to other neurodegenerative diseases or the general population. This plan builds upon insights and experiences from four population-based studies during the COVID-19 pandemic. Between March and November 2023, we organised two hybrid meetings in Bristol (United Kingdom) and Rotterdam (the Netherlands), and two online meetings.
Results: Research recommendations included three core factors in questionnaire design during health crises: 1) using existing, validated questions, 2) questionnaire adaptability and flexibility, and 3) testing within and outside the research group. Additionally, we addressed burden of participation, and we advocated for robust data sharing practices, underlining the importance of regulatory measures extending beyond the COVID-19 pandemic. We also shared clinical perspectives, including strategies to mitigate social isolation; challenges in virtual versus in-person consultations; and systemic changes to recognise and prevent moral injury in healthcare professionals.
Conclusion: In this pandemic preparedness plan, we provide research and clinical recommendations tailored to the field of Parkinson's disease, with broader relevance to other neurodegenerative diseases and the general population. This establishes an essential framework for setting up new studies and safeguarding research and clinical practices when a new pandemic or other (health) crisis emerges.
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