BMC Neurology最新文献

Objective: Walking balance is essential for daily life, especially for people recovering from a stroke. The Functional Gait Assessment (FGA) is a tool commonly used to assess walking stability and predict the risk of falls. However, its reliability and validity in community-dwelling stroke survivors were not well-studied. This study is to investigate the psychometric properties of FGA in people with stroke.

Methods: Sixty-three people with stroke and thirty healthy older adults were recruited to this cross-sectional study. FGA, Fugl-Meyer Assessment Lower Extremity (FMA-LE), Ankle Muscle Strength Test, Montreal Cognitive Assessment (MoCA), Limit of Stability (LOS), Berg Balance Scale (BBS), Foot and Ankle Ability Measure (FAAM), Oxford Participation and Activities Questionnaire (Ox-PAQ), The 12-items Short Form Health Survey (SF-12) were assessed in a randomized order on day 1 and day 2. Healthy subjects only participated in the FGA assessment on day 1.

Results: The FGA score demonstrated excellent inter-rater reliability (ICC = 0.94) and good test-retest reliability (ICC = 0.85) in people with stroke. The SEM and MDC of the FGA score were 1.81 and 5.02, respectively. Significant correlations were found between FGA and FMA-LE, ankle strength, BBS, LOS, and FAAM (p < 0.05). The Bland-Altman plots indicated a mean difference of 0.71 with 95% limit of agreement (95%LOA) ranging from - 3.60 to 5.03 for the inter-rater measurements. An optimal cut-off point of ≥ 20 was identified, with lower scores indicating greater gait and balance impairment, effectively differentiating people with stroke from healthy adults.

Conclusion: FGA is a sensitive, reliable, and efficient tool for assessing gait and balance in people with stroke.

Background: Glial fibrillary acidic protein astrocytopathy (GFAP-A) is a rare central nervous system (CNS) autoimmune disorder with highly heterogeneous presentations. This study aims to describe the clinical and diagnostic features in a Chinese case series.

Methods: Six patients at a single tertiary center with positive GFAP antibody were included, the patients' data were retrospectively analyzed.

Results: The cohort included 3 males and 3 females, with a median age of 56 years (range 30-75). Prominent urinary dysfunction was observed in four patients (66.7%). Brain or spinal cord MRI abnormalities were present in only 50% (3/6) of patients. All patients exhibited CSF-specific oligoclonal bands and elevated indices of intrathecal IgG synthesis. A notable finding was the delayed detection of CSF GFAP antibody in five patients (83.3%), who tested negative at disease onset but turned positive upon follow-up testing weeks to months later.

Conclusion: This case series underscores the high frequency of autonomic urinary dysfunction and the potential for delayed antibody detection in Chinese GFAP-A patients. These findings suggest that clinical suspicion should remain high even with initial negative antibody testing, warranting repeat CSF analysis in suspected cases to avoid diagnostic delay.

Purpose: Chronic pain is a common consequence of stroke, often impairing survivors' quality of life. By targeting cranial nerves and brainstem regions involved in pain modulation, cranial nerve non-invasive neuromodulation (CN-NINM) offers a promising approach to pain relief. The aims of this study were to investigate the feasibility of using CN-NINM in people with chronic stroke and in healthy individuals, and to test the immediate effect of this modality on experimental pain.

Participants and methods: Thirteen adults with chronic stroke and 13 age-matched healthy adults were recruited for a single 20-min CN-NINM session, using a portable electrical tongue stimulator. The intensity of the stimulus was set by each participant at a comfortable sensation level. Feasibility was assessed in terms of recruitment, adherence, and adverse events. The effect of CN-NINM on pain was evaluated by a heat-induced thermal pain paradigm applied to the participant's forearm for 2 min before and after the CN-NINM application. Pre- and post-CN-NINM pain intensity was recorded continuously during the nociceptive stimulation using a 0-100 computerized visual analogue scale. Descriptive and non-parametric statistics were used to describe feasibility data and explore CN-NINM effects.

Results: Feasibility was supported by a recruitment rate of 1.4 person/month for stroke and 2.2 person/month for healthy participants, with 100% of adherence in both groups. No CN-NINM-related adverse effects were reported. On average, CN-NINM had no clear immediate effect on pain in both stroke and healthy participants, with no difference observed between the two groups.

Conclusion: The present study offers evidence concerning the feasibility of using CN-NINM for relieving pain in stroke and healthy individuals. Although this new approach appears to be safe and acceptable for both populations, its effect on experimental pain remains questionable and unconvincing. Further studies are needed to ascertain if clinical pain can be positively impacted by CN-NINM.

Trial registration: This clinical trial was registered on ClinicalTrials.gov (NCT05370274) on April 27, 2022.

Background: This study utilized the MIMIC-IV 3.0 database to investigate the correlation between the endothelial activation and stress index (EASIX) and the short-term (30-day) and long-term (1-year) death rates of patients with ischemic stroke (IS), thus providing insights into optimizing the risk stratification and management in clinical practice.

Methods: Data from the MIMIC-IV 3.0 database were used. IS patients were identified by ICD codes. log2-EASIX scores were calculated based on admission platelet count, creatinine, and lactate dehydrogenase levels and patients were grouped into quartiles. The primary outcome was 30-day all - cause death rate, and the secondary was 1-year death rate. Multivariate Cox models, LASSO regression, Kaplan - Meier curves, restricted cubic splines, subgroup and interaction analyses were performed. R software was used for data cleaning and statistical analysis.

Results: This study enrolled 3,625 acute IS patients, stratified into four groups by log₂-EASIX quartiles (Q1: -3.24 to -0.55; Q2: -0.55, 0.17]; Q3: 0.17, 1.06]; Q4: 1.06 to 7.15). Q4 had markedly higher 30-day (32.0%) and 1-year (50.7%) mortality than Q1 (15.0%, 29.3%). Fully adjusted Cox models showed Q4 vs. Q1 had elevated 30-day (HR = 1.291, 95%CI:1.035-1.610, P = 0.024) and 1-year (HR = 1.246, 95%CI:1.059-1.467, P = 0.008) mortality risks, with a significant 1-year mortality trend (P = 0.004). RCS analysis revealed nonlinear associations between EASIX and both mortalities (all P < 0.05). Bonferroni-corrected subgroup analyses found only GCS had a modifying effect (P < 0.004). ROC analysis showed EASIX had moderate predictive value (30-day AUC = 0.7545; 1-year AUC = 0.7277).

Conclusions: EASIX is independently linked to short- and medium-term ACM in ICU-admitted IS patients; higher EASIX correlates with increased mortality, serving as a useful risk stratification and prognosis tool. Limited to moderate-severe ICU IS cases, prospective studies are required to verify its causal mechanisms.

Background: Vestibular migraine causes recurrent vertigo attacks that significantly impact quality of life. While various preventive medications are used, their comparative effectiveness was unknown. Previous systematic reviews have been limited by pairwise comparisons only or exclusion of newer treatments. The lack of head-to-head trials comparing all available treatments further complicates evidence-based decision-making. This evidence gap has real-world consequences, has also substantial economic burden of Vestibular migraine. There is a need for direct comparison studies between the most promising treatments to provide clearer guidance for clinical practice.

Objective: To determine the comparative effectiveness and safety of preventive treatments for vestibular migraine through systematic review and network meta-analysis. Given the lack of head-to-head randomized trials, a network meta-analysis (NMA) provides the most appropriate method to compare available treatments by combining both direct and indirect evidence.

Methods: We searched Embase, Scopus, PubMed, and Cochrane Library from inception to January 15, 2025. We included randomized controlled trials (RCTs) and prospective observational studies (n ≥ 30 for CGRP antagonists) comparing preventive treatments for vestibular migraine diagnosed according to either Bárány Society/International Headache Society criteria (post-2012) or Neuhauser criteria (pre-2012). Primary outcomes were monthly vertigo frequency and quality of life (DHI scores). We conducted frequentist network meta-analysis and assessed certainty using GRADE.

Results: From 340 identified records, nine studies met inclusion criteria. Five RCTs (419 patients) comparing seven treatments were included in the network meta-analysis. All treatments significantly reduced monthly vertigo attacks versus control. Propranolol ranked highest (P-score: 0.794; -7.04 attacks/month, 95% CI -12.77 to -1.31), followed by valproic acid (-5.95, 95% CI -9.01 to -2.89) and venlafaxine (-5.94, 95% CI -8.98 to -2.90). Galcanezumab showed moderate efficacy (-5.80, 95% CI -10.61 to -0.99) with zero discontinuations. Network heterogeneity was negligible (τ²<0.001). Evidence certainty was moderate for galcanezumab and low to very low for other treatments.

Conclusions: All evaluated treatments effectively reduce vertigo frequency in vestibular migraine. While propranolol showed the largest effect, this relied on indirect evidence. Galcanezumab offers the best balance of efficacy, tolerability, and evidence quality. Head-to-head trials are urgently needed.

Prospero registration: CRD420251089507.