BMC Neurology最新文献

Background: Post-stroke spasticity affects a significant proportion of stroke survivors and impairs quality of life. Repeated intramuscular injections of OnabotulinumtoxinA are widely used for spasticity management; however, long-term real-world outcomes remain underreported. This study aimed to evaluate the long-term safety and treatment continuation patterns, and to identify predictors of treatment discontinuation associated with repeated onabotulinumtoxinA treatment.

Methods: This retrospective, single-center study included 224 post-stroke patients treated with OnabotulinumtoxinA between 2012 and 2023. Inclusion criteria were a diagnosis of post-stroke spasticity, initiation of treatment before 2021, and at least three years of follow-up. Outcomes assessed included treatment continuation rates, reasons for discontinuation, dose trends, and predictors of treatment discontinuation. Logistic regression and repeated measures ANOVA were used for statistical analyses.

Results: Of the 224 patients, 94 (42%) continued treatment as of December 2023. Reasons for discontinuation included improvement and completion (n = 59, 45.4%), unknown reason (n = 39, 30.0%), Change of doctor or relocation (n = 13, 10.0%), insufficient efficacy (n = 13, 10.0%), switch to other treatment (n = 4, 3.1%), and adverse events (n = 2, 1.5%). Long-term treatment was associated with progressive dose escalation (p < 0.05).Logistic regression analysis showed that cerebral infarction was significantly associated with treatment completion due to improvement(p = 0.004), while a lower initial dose demonstrated a non-significant trend toward treatment completion (p = 0.051).

Conclusions: Repeated onabotulinumtoxinA injections were not associated with unexpected safety concerns over long-term follow-up. Approximately 25% of patients discontinued treatment during the observation period, including cases documented as treatment completion due to clinical improvement. Stroke type was associated with treatment discontinuation patterns, supporting the importance of individualized long-term treatment planning.

Background: Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), affects 14 million people in the US. Neurologic manifestations of PASC (Neuro-PASC) are particularly debilitating. However, the evolution of these symptoms and factors associated with recovery are poorly understood. This study aimed to characterize Neuro-PASC symptom evolution using a mobile phone application and assess user experience.

Methods: The Neuro-COVID Recovery Care Companion (NCRCC) mobile application consists of questionnaires integrated within Northwestern Medicine's online MyChart platform which interfaces with the electronic medical record. Neuro-PASC patients completed daily surveys of twelve Neuro-PASC symptoms and their perceived percent recovery compared to their pre-COVID baseline. Patients also completed Patient-Reported Outcomes Measurement Information System (PROMIS) quality-of-life (QoL) surveys and NIH toolbox cognitive assessments at baseline and at 3-month follow up. Participants were retrospectively classified as "Improvers" or "Non-Improvers" based on the slope and range of their percent subjective recovery.

Results: Data from 63 participants presenting an average of 12.7 months after symptom onset were analyzed, including 27 (42.9%) Improvers and 36 (57.1%) Non-Improvers. Fewer women were Improvers (50% vs 75.7%; p = 0.04). Multiple correspondence analysis showed that patients presenting with a constellation of anosmia, dysgeusia, and a lack of insomnia (p = 0.023) were less likely Improvers. Improvers had more fluctuations in their subjective recovery than Non-Improvers with greater mean variance (7.01 vs 3.79; p = 0.0004) and positive recovery slope (5.84 vs 0; p < 0.0001). There were no differences in QoL and cognition at initial assessment, but Improvers showed a trend toward increased processing speed and decreased sleep disturbance after 3 months. Both groups found the NCRCC application easy-to-use, useful, and satisfactory.

Conclusions: Our findings reveal previously unrecognized fluctuations in subjective recovery of Neuro-PASC, and that women and patients presenting with anosmia and dysgeusia are less likely to improve one year from COVID-19 onset. We found broad alterations in QoL in both groups suggesting that strategies to reduce sleep disturbance and improve cognition may contribute to subjective improvement. Our results suggest similar mobile applications may benefit patients with other ill-defined chronic diseases, by equipping and empowering them on their often windy road to recovery.

Background: Long-term changes in healthy behavior are more likely when small improvements are made in daily health habits. Health applications can serve as cost-effective tools to help people adopt healthier lifestyles. In response to this need, we developed the MAPS app - an easy-to-use and innovative mobile health app for the primary prevention of stroke.

Methods: We conducted a prospective, pre-post, single-arm, multicomponent interventional pilot study over 6 months to evaluate the ability of the MAPS app to enhance healthy habits and reduce stroke risk factors among a healthy adult population recruited from an urban employer in Germany. Daily health habits were assessed using questionnaires at the beginning of the study, at 3 months, and at 6 months. We also measured estimated stroke risk over 5 and 10 years, as well as systolic blood pressure, Body Mass Index (BMI), abdominal circumference, LDL cholesterol, and HbA1c levels at the beginning and after 6 months.

Results: A total of 35 participants were recruited. One participant was lost to follow-up. Our analysis showed significant improvements in the daily health habits questionnaire after 6 months (mean change of 5.6 points; 95% confidence interval (CI) 3.20 to 7.95). We observed significant reductions in the estimated 5-year stroke risk (mean change - 0.3%; 95% CI -0.52 to -0.04), BMI (mean change - 0.6 kg/m²; 95% CI -1.17 to -0.02), and abdominal circumference (mean change - 2.8 cm; 95% CI -5.28 to -0.25). Changes in LDL cholesterol and HbA1c levels were not significant. Male participants tended to have lower initial scores on daily habit questionnaires, particularly in dietary health choices, and benefited more from participation in the study.

Conclusions: Our results suggest that the MAPS app may help promote healthier daily habits and reduce stroke risk. While promising, these preliminary findings require further validation through larger randomized controlled trials. Additionally, they indicate potential gender-specific responses that need more investigation.

Trial registration: The study was registered retrospectively in the German Clinical Trials Register on 25th November 2024. (DRKSID DRKS00034491). Trial registration was submitted before enrollment started, but it was finalized after recruitment began due to technical issues.

Background: The rare genetic disease Duchenne muscular dystrophy (DMD) mostly affects males, impacting mobility and pulmonary/cardiac function from childhood. This study explored non-professional caregiving in DMD, comparing burden across regions and by care recipients' ambulatory status.

Methods: Data were from the Adelphi Real World Disease Specific Programme™, a cross-sectional survey in Europe (France, Germany, Spain), the United States of America (USA), and Japan from October 2022-November 2023. Caregivers reported health status (their own and that of dependents with DMD) via the EQ-5D-5L, and their own productivity via the Work Productivity and Impairment Index (WPAI).

Results: Of 216 individuals with DMD, 45.8%, 41.7% and 12.5% were from Europe, USA and Japan, respectively; 54.4% were ambulatory, 68.4%, 52.2% and 11.1% in Europe, USA and Japan, respectively. Individuals with DMDs' mean (standard deviation; SD) EQ-5D-5L index value was 0.19 (0.27), with no significant difference across regions, but was higher in ambulatory than non-ambulatory individuals (p < 0.0001). Individuals with DMDs' mean (SD) EQ-VAS score was 24.3 (27.9), differed across regions (p < 0.0001), but did not differ by ambulatory status. In the USA, Europe and Japan, 38.9%, 23.5% and 7.4% of caregivers, respectively, worked full-time (p = 0.0020). Caregiver employment did not differ significantly between ambulatory/non-ambulatory dependents. Mean caregiver absenteeism, presenteeism and overall work impairment were 9.7%, 37.8% and 42.4%, respectively, with no significant differences between regions or ambulatory/non-ambulatory dependents. Mean activity impairment was 49.0%, (Japan: 67.6%, Europe: 49.4%, USA: 43.4%; p = 0.0002), and higher in caregivers of non-ambulatory than ambulatory dependents (p < 0.0001). Most caregivers reported no problems with their own mobility, self-care, usual activities, or pain/discomfort. The severity of anxiety/depression varied across regions (p < 0.0001), with no significant difference by dependents' ambulatory status. Mean (SD) caregivers' EQ-VAS score and index value were 26.9% (30.3%) and 0.83 (0.23), respectively. EQ-VAS score differed significantly across regions (USA: 52.1% [33.3%], Europe: 8.9% [1.7%], Japan: 8.9% [1.7%]; p < 0.0001), but not by dependents' ambulatory status. EQ-5D-5L index value did not differ significantly across regions or with dependents' ambulatory status.

Conclusions: Non-professional caregiving in DMD presented a substantial burden, varying across regions, and greater for those caring for non-ambulatory than ambulatory dependents.

Background: Futile recanalisation (FR) defined as functional dependence despite successful reperfusion, is common after endovascular therapy for acute stroke. We aimed to evaluate whether the Vessel Distance Index (VDI), a novel imaging parameter, has the potential to predict the risk of FR.

Methods: Patients who underwent mechanical thrombectomy for acute anterior circulation large vessel occlusion between March 2022 and January 2025 were retrospectively reviewed. FR was defined as a modified Rankin Scale (mRS) score ≥ 3 at 90 days post-procedure. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of FR. The discriminatory ability of significant variables was evaluated using receiver operating characteristic (ROC) curve analysis. The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used to compare FR risk models constructed from significant variables. Youden's index was used to determine the optimal cut-off threshold of VDI. Additionally, the Jonckheere-Terpstra trend test was used to evaluate whether VDI levels showed a monotonic trend across cohorts stratified by occlusion site and infarct progression rate (IPR) associated with FR risk.

Results: A total of 26 patients, accounting for 41.3% of the cohort (n = 63), were identified with FR. Advanced age, higher NIHSS score, lower ASPECTS score, and higher VDI value were independently associated with FR (p < 0.05). The ROC curve demonstrated that the combined model achieved the best predictive performance (AUC = 0.93, p < 0.001), outperforming any single variable. VDI showed a significant upward trend with FR risk in high IPR, and MCA groups (p < 0.05).

Conclusion: These findings suggest that VDI and traditional indicators can accurately predict long-term clinical outcomes before surgery and provide guidance for clinical practice.

Background: Diphenhydramine (DPH) is a common over-the-counter medication. DPH overdoses occur across all age groups, and abuse among adolescents has been increasing in recent years. We report two adolescent cases in which a false-positive tricyclic antidepressant (TCA) reaction on a urinary drug screening kit (UDS) led to the diagnosis of DPH poisoning, with a discussion of the mechanism of false positives based on an experiment using UDS and a literature review of the false positive cases by DPH.

Case reports: Case 1: A 13-year-old female patient was admitted for confusion and seizures. A UDS, SIGNIFY^™ ER (Abbott Diagnostics Medical, USA) (SIG), showed a positive reaction to TCA. However, empty bottles of DPH-containing drugs, not TCA, were found at her home. She improved with supportive care alone and was discharged without sequelae. Case 2: A 13-year-old female patient presented with a generalized tonic-clonic seizure and impaired consciousness. On arrival, SIG showed a positive reaction to TCA. After admission, she confessed to having taken an overdose of multiple drugs, including DPH. In both cases, the blood DPH concentrations were in the toxic range, and urine DPH concentrations were below 100 micrograms per milliliter (µg/mL).

Experiment: DPH standard samples were added to urine from a healthy adult to create urine samples with multiple concentrations of DPH, which were subsequently used in SIG. Although the result was TCA-negative at 100 µg/mL, it turned out to be false positive at 500 µg/mL, suggesting that the kit-specific threshold concentration for TCA false positivity exists between 100 and 500 µg/mL.

Discussion and conclusions: Our cases and literature review indicate that SIG is prone to yield false positive TCA results in DPH overdose. Considering the increasing incidence of over-the-counter medication overdoses among adolescents in Japan, it is anticipated that there will be more pediatric cases of DPH poisoning in emergency departments. When a TCA-positive result is obtained on SIG, clinicians should consider not only TCA intoxication but also the possibility of DPH overdose. The mechanism of false positives cannot be explained by DPH alone, and the involvement of metabolites is suggested.

Background: Lecanemab has been approved for the treatment of mild cognitive impairment due to Alzheimer's disease (AD) and mild AD dementia based on the efficacy in slowing cognitive decline and preliminary safety data from the phase Ⅲ Clarity AD trial. However, this trial excluded patients with high risk of cerebral hemorrhage, such as individuals with intracranial aneurysms or > 4 microhemorrhages.

Case presentation: A 70-year-old male with mild AD, intracranial aneurysm, microhemorrhages, and APOE ε3/ε4 genotype received lecanemab after multidisciplinary evaluation and informed consent. Over six months of intensive monitoring, cognitive function stabilized with no deterioration, daily activities were preserved, microhemorrhages remained stable (with one new small lesion noted at 3 months), and no aneurysm rupture or severe adverse events (including amyloid-related imaging abnormalities) occurred.

Conclusions: This case suggests that, despite hemorrhage risks, lecanemab may have a manageable risk-benefit profile in selected real-world AD patients under intensive monitoring and multidisciplinary care, with its application beyond clinical trial criteria requiring more nuanced and individualized consideration.