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.