BMC Neurology最新文献

Background: Symptom burden in primary brain tumor patients varies, emphasizing the need for comprehensive understanding to improve patient care. This study aims to identify distinct symptom clusters among brain tumor patients in Shanghai, China, using Latent Profile Analysis (LPA) to guide personalized diagnosis, treatment, and supportive care.

Methods: A longitudinal study was conducted among 161 patients with primary brain tumors in Shanghai. Participants completed the MD Anderson Symptom Inventory Brain Tumor Module (MDASI-BT) at three intervals: the day of admission (T1), three days after surgery (T2), and two weeks after surgery (T3). Latent Profile Analysis (LPA) was used to identify subgroups with unique symptom patterns.

Results: Six distinct subgroups were identified (entropy = 0.964), ranging from low-burden to persistently severe patterns. Subgroup membership was partially associated with age, tumor grade, and diagnosis. These subgroups were: transient postoperative burden group, stable symptom with cognitive emergence group, distress-predominant, low burden group, elderly-high grade, persistently severe group, nausea-dominant recovery group, and distress-plus-nausea, younger urban group.

Conclusion: Our findings reveal substantial heterogeneity in perioperative symptom experiences among brain tumor patients. Identifying subgroups with high and persistent symptom burden may help clinicians target interventions such as enhanced education, proactive monitoring, rehabilitation, psychological support, and antiemetic management. This subgroup-based approach may improve quality of life, reduce morbidity, and guide precision supportive care in neuro-oncology.

Objective: This study aimed to describe the changes in the etiology of adult epilepsy in different age groups over the past 25 years, with consideration of different time periods.

Methods: A retrospective study was conducted using the clinical data of patients with adult-onset epilepsy at The First Medical Center of Chinese PLA General Hospital between February 1999 and March 2024.

Results: The study included 5,712 patients from 25 provinces and 4 municipalities in China. The study found that the prevalence of unknown etiology has decreased overall, particularly after 2015, and that the proportion of epilepsy cases caused by metabolic etiologies has declined since 2016. However, since 2021, there has been an increase in immune-related epilepsy. The proportion of patients with structural epilepsy ranged from 29.7% to 90% across all age groups. Among epilepsy patients aged ≥ 51 years, structural epilepsy was predominant, accounting for the majority of cases. In particular, the proportion of epilepsy attributable to cerebrovascular disease increased with age at onset. With regard to gender, structural epilepsy was more common in males than in females.

Conclusions: This study highlights observed trends and changes in clinical diagnosis in epilepsy etiologies, revealing an obvious decrease in unknown etiology. The recent rise in immune-related epilepsy underscores the need for increased clinical vigilance. The observed gender and age disparities in structural epilepsy, particularly cerebrovascular-related cases in elderly males, provide critical insights for targeted preventive and therapeutic strategies.

Background: Age is defined as the patient's chronological age (in years) at hospital admission. The association between age and angiographic vasospasm remains controversial. This study aimed to explore the association between age and angiographic vasospasm in mechanically ventilated patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: A secondary analysis was performed based on a retrospective study conducted from 2010 to 2015 in the intensive care unit (ICU) of a French university hospital. Factors associated with angiographic vasospasm were identified using univariate and multivariate logistic regression analyses. The non-linear relationship between age and angiographic vasospasm was assessed using restricted cubic spline regression, and the threshold effect was evaluated using a two-piecewise linear regression model.

Results: The study included 231 mechanically ventilated patients with aSAH. Their median age was 56 years (range, 19-84 years). Patients were divided into two groups based on the median age of 56 years: younger (< 56 years) and older (≥ 56 years). The rate of angiographic vasospasm was 34.63% (N = 80). After adjusting for potential confounders, patients in the older group were less likely to develop angiographic vasospasm [odds ratio (OR), 0.40; 95% confidence interval (CI), 0.19-0.85; p = 0.017] compared with those in the younger group. After adjusting for confounders, when age was ≤ 53 years, the risk of angiographic vasospasm increased by 13% for each year increase in age (OR, 1.13; 95% CI, 1.05-1.22; p = 0.002). For age > 53 years, the risk of angiographic vasospasm decreased by 17% for each year increase in age (OR, 0.83; 95% CI, 0.77-0.89; p < 0.001).

Conclusion: Age was non-linearly associated with the risk of angiographic vasospasm in mechanically ventilated patients with aSAH.

Background: Corticomuscular coupling (CMC) reflects the neural communication between the central and peripheral nervous systems, particularly during motor control. However, the corticomuscular coupling characteristics during upper limb motor tasks in stroke patients remain unclear. This study aims to explore the differences in corticomuscular coupling characteristics between stroke patients and healthy subjects.

Methods: A total of 25 stroke patients in the subacute phase with dominant hemisphere and 20 age-matched healthy controls were enrolled in the study. Participants performed an isometric wrist extension task at 50% of their maximum voluntary contraction (MVC) for 15 s, during which surface electromyography (sEMG) signals measured from the flexor carpi radialis and extensor carpi ulnaris, as well as functional near-infrared spectroscopy (fNIRS) data from the prefrontal cortex, supplementary motor area, and primary motor cortex, were simultaneously recorded. Corticomuscular coupling metrics (phase synchronization index (PSI), coherence), fNIRS measures (cortical activation, functional connectivity), and sEMG parameters (root mean square (RMS), median frequency (MF), and fuzzy approximate entropy (fApEn)) were analyzed.

Results: Stroke patients demonstrated significantly reduced PSI and coherence values in specific corticomuscular couplings compared to age-matched healthy controls. Moreover, enhanced cortical activation, stronger functional connectivity, and diminished muscle activation (with lower sEMG complexity) were observed in specific cortical regions and assessed muscles.

Conclusion: This study reveals differences in the mapping relationship between cortical activation and sEMG signals across time-domain and frequency-domain indices in stroke patients compared to healthy subjects, providing new theoretical insights into the interaction between brain activity and motor execution. These results underscore the disrupted corticomuscular coupling in stroke patients and suggest its value in characterizing the central-peripheral interaction during motor execution, which may inform future rehabilitation assessment strategies.

Objective: Status epilepticus (SE) is a common neurological emergency associated with significant morbidity and mortality, with approximately one-third of patients demonstrating resistance to first-line treatment. Electroencephalography (EEG) plays a critical role not only in the diagnosis of SE but also in its monitoring and prognostication. This study aims to evaluate the performance of SE-specific severity scoring systems-Status Epilepticus Severity Score (STESS) and Epidemiology-Based Mortality Score in Status Epilepticus (EMSE)-in predicting mortality, in comparison with four widely used systemic severity scores: Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and the Inflammation, Nutrition, Consciousness, Neurologic function, and Systemic condition (INCNS) score. Furthermore, the effects on mortality of the Glasgow Coma Scale (GCS) for assessing level of consciousness, the age-adjusted Charlson Comorbidity Index (ACCI) for evaluating comorbidities, and the pre-SE Modified Rankin Scale (mRS) for measuring pre-existing morbidity will also be investigated.

Methods: A total of 200 status epilepticus (SE) episodes in 188 patients with available EEG data, followed over a four-year period, were included in the study. The sensitivity, specificity, accuracy, and area under the curve (AUC) of each scoring system were calculated and compared.

Results: The SOFA score demonstrated the highest performance in predicting mortality (AUC = 0.81). Systemic severity scores such as SAPS II, SOFA, APACHE II, and INCNS were found to be more effective in predicting mortality than the SE-specific scores STESS and EMSE.

Conclusion: The evaluated scoring systems accounted for approximately 48% of mortality among adult SE patients; however, none were sufficient to predict mortality either alone or in combination. Therefore, there is a need for more specific prognostic scoring systems.

Background: Approximately 900,000 MRI brain scans are performed annually in the United Kingdom alone, with incidental findings frequently encountered. One of the most prevalent findings is white matter hyperintensities (WMHs). WMHs often indicate cerebral small vessel disease (cSVD) but can also be associated with migraine and demyelination. Prospective population studies have already confirmed a high prevalence of WMHs in elderly patients. In younger patients, or when the radiological burden is low, WMHs are commonly considered non-specific. Routinely collected data represents a valuable resource to facilitate further study. We aimed to describe the prevalence of WMHs in a direct to scan referral population and to understand associations with age, demographics, performance status and referral criteria.

Methods: We performed a service evaluation of our local two-week wait suspected central nervous system cancer pathway to understand the association between age, demographics, performance status, referral criteria, imaging outcomes and both the prevalence and radiological characteristics of WMHs. Analysis was performed using R version 4.1.3.

Results: We identified 1033 patients, referred over a 30-month period. Mean patient age was 51.3±18.3 years with 65% females. As expected, WMHs were present on 89.7% of scans in patients aged over 80, with 98.1% of these consistent with cSVD upon review by an experienced neuroradiologist. We show an important association between WMHs deemed representative of cSVD and both performance status and levels of deprivation. However, WMHs were also present in approximately 1 in 5 patients under 50 years old and were typically deemed non-specific. Our analysis showed prevalence of WMH, its radiological burden and likelihood of WMHs being attributed to cSVD all increased with age. It is therefore feasible to consider that these changes may represent early cSVD.

Conclusions: We demonstrate a prevalence of radiological cSVD comparable to the wider literature in elderly patients whilst highlighting the potential underestimation of cSVD in the younger population, in whom further study of WMHs is required. There is potential for routinely collected data to define the prevalence and characteristics of radiological cSVD more accurately whilst facilitating further research.

Background: This study employed neurite orientation dispersion and density imaging (NODDI) to investigate gray matter microstructural changes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with cognitive impairment, assessing early diagnostic potential.

Methods: The study comprised 23 OSAHS patients (OSA-NCI group), 43 OSAHS patients with experiencing cognitive impairment (OSA-CI group), and 15 healthy controls (HC group). Fractional anisotropy (FA), neurite density index (NDI), orientation dispersion index (ODI), and volume fraction of isotropic water molecules (Viso) in regions of interest (ROIs) were calculated. Correlations between these parameters and Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores were examined. Diagnostic effect was evaluated using receiver operating characteristic (ROC) curve analysis, and area under the curve (AUC) was calculated.

Results: Significant variations were observed in the NDI, ODI, Viso, and FA. Compared to HCs, the NDI and ODI in the OSA-NCI group decreased, while the Viso value increased. NDI and ODI showed slight increases in the OSA-CI group but remained below HC levels; Viso significantly increased. However, FA did not significantly differ. NDI, ODI, and Viso strongly correlated with MoCA scores in specific gray matter regions; FA showed weak correlations (r < 0.5). ROC analysis confirmed the effectiveness of the NODDI parameters, with average AUC values of 0.689 for the Viso value, 0.676 for the ODI, and 0.635 for the NDI; however, FA showed limited diagnostic utility (AUC 0.452).

Conclusion: This study suggests the potential diagnostic utility of NODDI in detecting gray matter pathology in OSAHS patients with cognitive impairment, though further validation in larger, independent cohorts is needed.

Background: Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system through persistent inflammation and demyelination. Cladribine, an immunosuppressive agent, has emerged as a promising high-efficacy disease-modifying therapy. However, concerns remain regarding its long-term safety, particularly the risks of lymphopenia, infections, and malignancy. This study aimed to evaluate the efficacy and safety of oral cladribine, including a control group defined by placebo, fingolimod, and natalizumab, by analyzing the impact of cladribine on the annualized relapse rate, relapse-free rate, expanded disability status, and adverse outcomes, such as malignancy, infections, and persistent lymphopenia.

Methods: This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The databases PubMed, Web of Science, and Google Scholar were comprehensively searched to identify randomized controlled trials and observational studies comparing oral cladribine with other MS treatments or placebo.

Results: This study included 24,976 patients with MS. Cladribine significantly reduced annualized relapse rates (mean difference [MD] = - 0.09; P = 0.0004), especially versus placebo (MD = - 0.15; P = 0.0002). No overall difference in Expanded Disability Status Scale was identified, although fingolimod showed better post-treatment outcomes (MD = 0.40; P < 0.00001). Relapse-free rates were similar, except in the placebo subgroup favoring cladribine (MD = 2.46; P < 0.00001). Cladribine was associated with an increased risk of persistent lymphopenia (odds ratio [OR] = 20.20; P < 0.00001), whereas infection (OR = 1.18; P = 0.78) and malignancy rates (OR = 1.87; P = 0.63) were comparable to those of the controls. The interpretation was limited by study heterogeneity and the absence of a pooled analysis of several secondary outcomes.

Conclusion: Cladribine may be a valuable therapeutic option for relapsing-remitting MS with a strong efficacy profile. The lymphopenia incidence highlights the need for regular hematological monitoring to ensure the safety of cladribine.