Pub Date : 2025-07-01Epub Date: 2025-08-04DOI: 10.1016/j.nrleng.2025.06.011
I. Otero-Luis , A. Saz-Lara , I. Cavero-Redondo , C. Pascual-Morena , I. Martínez-García , S. Nuñez de Arenas-Arroyo
Objective
To analyze the effectiveness of intrathecal baclofen in the treatment of spasticity of different aetiologies in the upper limbs, lower limbs, and both children and adults.
Design
Meta-analysis.
Subjects/Patients
People with spasticity of different aetiologies in treatment with intrathecal baclofen.
Methods
A systematic search was performed in the PubMed, Scopus, Cochrane Library, and Web of Science databases with the earliest data available up to November 1, 2022. Random-effects models were used to calculate pooled mean difference estimates and their respective 95% CIs to assess the effectiveness of intrathecal baclofen treatment on spasticity of different aetiologies using the modified Ashworth scale. All statistical analyses were performed with STATA 15 software.
Results
Finally, 11 studies were included in the meta-analysis. The effect of baclofen treatment administered by an intrathecal pump on spasticity measured by the modified Ashworth scale led to a significant decrease in spasticity in both adults (MD: −1.54; 95% CI: −1.80, −1.27) and children (MD: −0.70; 95% CI: −0.91, −0.49), with greater effectiveness for lower limb spasticity (MD: −1.45; 95% CI: −1.93, −0.97). The results should be interpreted with caution since there is heterogeneity due to differences between populations (age or types of diseases).
Conclusion
These findings are important for clinical practice, as they demonstrate the efficacy of intrathecal baclofen in treatment of spasticity, thus improving patient quality of life, being more effective at a younger age and longer duration of treatment, always taking into account statistical limitations.
{"title":"Effectiveness of the intrathecal baclofen pump in the treatment of spasticity of different aetiologies: A systematic review and meta-analysis","authors":"I. Otero-Luis , A. Saz-Lara , I. Cavero-Redondo , C. Pascual-Morena , I. Martínez-García , S. Nuñez de Arenas-Arroyo","doi":"10.1016/j.nrleng.2025.06.011","DOIUrl":"10.1016/j.nrleng.2025.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the effectiveness of intrathecal baclofen in the treatment of spasticity of different aetiologies in the upper limbs, lower limbs, and both children and adults.</div></div><div><h3>Design</h3><div>Meta-analysis.</div></div><div><h3>Subjects/Patients</h3><div>People with spasticity of different aetiologies in treatment with intrathecal baclofen.</div></div><div><h3>Methods</h3><div>A systematic search was performed in the PubMed, Scopus, Cochrane Library, and Web of Science databases with the earliest data available up to November 1, 2022. Random-effects models were used to calculate pooled mean difference estimates and their respective 95% CIs to assess the effectiveness of intrathecal baclofen treatment on spasticity of different aetiologies using the modified Ashworth scale. All statistical analyses were performed with STATA 15 software.</div></div><div><h3>Results</h3><div>Finally, 11 studies were included in the meta-analysis. The effect of baclofen treatment administered by an intrathecal pump on spasticity measured by the modified Ashworth scale led to a significant decrease in spasticity in both adults (MD: −1.54; 95% CI: −1.80, −1.27) and children (MD: −0.70; 95% CI: −0.91, −0.49), with greater effectiveness for lower limb spasticity (MD: −1.45; 95% CI: −1.93, −0.97). The results should be interpreted with caution since there is heterogeneity due to differences between populations (age or types of diseases).</div></div><div><h3>Conclusion</h3><div>These findings are important for clinical practice, as they demonstrate the efficacy of intrathecal baclofen in treatment of spasticity, thus improving patient quality of life, being more effective at a younger age and longer duration of treatment, always taking into account statistical limitations.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 577-585"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-06-21DOI: 10.1016/j.nrleng.2025.06.001
R.C. Braña Miranda , N.E. Quintanal Cordero , N. Pavón Fuentes , I. Pedroso Ibáñez , R. Macías González , J. Teijeiro Amador , A. Abreu Duque , R. Garbey Fernández
Introduction
Functional Neurosurgery constitutes a therapeutic alternative for patients with Parkinson's Disease (PD). It is known that both bilateral subthalamotomy and bilateral pallidotomy cause neurological complications, so in ablative techniques a bilateral approach to the GPi is not recommended in PD and caution is suggested with the indication of bilateral subthalamotomy. Our group has refined the surgical technique for the ablation of the subthalamic nucleus seeking to reduce the appearance of dyskinesias induced by surgery and obtain a better therapeutic effect, so the approach to the NST in a second surgical procedure in the opposite hemisphere to the one performed previously pallidotomy, would avoid the complications derived from bilateral pallidotomy and can be a safe alternative for patients even when they present symptoms of dyskinesias. We set out to evaluate the effect and safety of the combination of GPi and NST lesion in opposite cerebral hemispheres in PD patients.
Method
A retrospective study was carried out that included all patients operated on at the CIREN in a period of 22 years, who underwent a pallidotomy contralateral to the most affected hemibody; followed by a subthalamotomy of the opposite hemisphere in a second surgical procedure. The effect on the neurological condition was evaluated using section III of the MDS-UPDRS scale. Safety was evaluated according to the adverse effects scale and the Clavien and Dindo scale.
Results
Both surgical interventions had a positive impact on the patients' pharmacological treatment, significantly reducing the doses of L-dopa. A significant improvement was observed in the motor condition of the patients in relation to dyskinesias, as well as rigidity, bradykinesia and tremor.
Conclusions
The pallidotomy/subthalamotomy combination showed to be an effective alternative for the treatment of complicated PD, capable of allowing better motor control and a reduction in the dose of L-Dopa with a low rate of complications; it also allows to avoid complications derived from bilateral pallidotomy and subthalamotomy, proving to be a safe alternative for patients even when they present symptoms of dyskinesias.
{"title":"Effect of the combination pallidotomy-subthalamotomy performed in opposite cerebral hemispheres for the treatment of motor signs in Parkinson's disease","authors":"R.C. Braña Miranda , N.E. Quintanal Cordero , N. Pavón Fuentes , I. Pedroso Ibáñez , R. Macías González , J. Teijeiro Amador , A. Abreu Duque , R. Garbey Fernández","doi":"10.1016/j.nrleng.2025.06.001","DOIUrl":"10.1016/j.nrleng.2025.06.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Functional Neurosurgery constitutes a therapeutic alternative for patients with Parkinson's Disease (PD). It is known that both bilateral subthalamotomy and bilateral pallidotomy cause neurological complications, so in ablative techniques a bilateral approach to the GPi is not recommended in PD and caution is suggested with the indication of bilateral subthalamotomy. Our group has refined the surgical technique for the ablation of the subthalamic nucleus seeking to reduce the appearance of dyskinesias induced by surgery and obtain a better therapeutic effect, so the approach to the NST in a second surgical procedure in the opposite hemisphere to the one performed previously pallidotomy, would avoid the complications derived from bilateral pallidotomy and can be a safe alternative for patients even when they present symptoms of dyskinesias. We set out to evaluate the effect and safety of the combination of GPi and NST lesion in opposite cerebral hemispheres in PD patients.</div></div><div><h3>Method</h3><div>A retrospective study was carried out that included all patients operated on at the CIREN in a period of 22 years, who underwent a pallidotomy contralateral to the most affected hemibody; followed by a subthalamotomy of the opposite hemisphere in a second surgical procedure. The effect on the neurological condition was evaluated using section III of the MDS-UPDRS scale. Safety was evaluated according to the adverse effects scale and the Clavien and Dindo scale.</div></div><div><h3>Results</h3><div>Both surgical interventions had a positive impact on the patients' pharmacological treatment, significantly reducing the doses of L-dopa. A significant improvement was observed in the motor condition of the patients in relation to dyskinesias, as well as rigidity, bradykinesia and tremor.</div></div><div><h3>Conclusions</h3><div>The pallidotomy/subthalamotomy combination showed to be an effective alternative for the treatment of complicated PD, capable of allowing better motor control and a reduction in the dose of L-Dopa with a low rate of complications; it also allows to avoid complications derived from bilateral pallidotomy and subthalamotomy, proving to be a safe alternative for patients even when they present symptoms of dyskinesias.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 518-532"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-06-21DOI: 10.1016/j.nrleng.2025.06.003
J. Rodríguez-Pardo , J. Carneado-Ruiz , M. Martínez-Martínez , J.M. Moltó-Jordá , P. Irimia , J. Serena-Leal , Ó. Ayo-Martín , P. Martínez-Sánchez , J. Pagola , J. Fernández-Domínguez , on behalf of the Spanish Society of Neurosonology (SONES)
Introduction
Neurosonology is the field of study of the ultrasound techniques applied to neurological diseases. The Spanish Society of Neurosonology (SONES) was funded in 1997 to promote training and education in these techniques, especially focused on the study of cerebrovascular diseases. After 25 years, the increased use of other advanced neurovascular imaging techniques and the emergence of novel applications of ultrasound in other fields of neurology, have modified the classic role of neurosonology. From the SONES we aimed to evaluate the current status of neurosonology in Spain.
Methods
Cross-sectional survey of neurologists and neurology residents working in Spain regarding training, education, and local daily practice, including a strengths, weaknesses, opportunities and threats (SWOT) analysis.
Results
One-hundred seventy-eight neurologists and thirty-four neurology residents participated in the survey. A wide experience in vascular neurosonology (90% of respondents’ Neurology departments) and limited experience in brain parenchyma sonography (34%), cardiac echoscopy (25%), ultrasound-guided techniques (24%), and nerve ultrasound (14%) was reported. Fifty-three percent of the participants reported to have a full-time neurosonology lab in their department and only 14% reported to have neurologists dedicated exclusively to neurosonology. Most participants (54%) reported to lack continuous learning opportunities, and 97% to need training in one or more neurosonology techniques. Main SWOT were respectively requiring expertise, shortage of time, versatility and comprehensive management of the neurological patient.
Conclusion
Vascular neurosonology is widely instituted in Spain, but the implementation of full-time neurosonology labs and training in non-vascular neurosonology techniques is yet scarce.
{"title":"Status of neurosonology in Spain. A study from the Spanish Society of Neurosonology (SONES)","authors":"J. Rodríguez-Pardo , J. Carneado-Ruiz , M. Martínez-Martínez , J.M. Moltó-Jordá , P. Irimia , J. Serena-Leal , Ó. Ayo-Martín , P. Martínez-Sánchez , J. Pagola , J. Fernández-Domínguez , on behalf of the Spanish Society of Neurosonology (SONES)","doi":"10.1016/j.nrleng.2025.06.003","DOIUrl":"10.1016/j.nrleng.2025.06.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Neurosonology is the field of study of the ultrasound techniques applied to neurological diseases. The Spanish Society of Neurosonology (SONES) was funded in 1997 to promote training and education in these techniques, especially focused on the study of cerebrovascular diseases. After 25 years, the increased use of other advanced neurovascular imaging techniques and the emergence of novel applications of ultrasound in other fields of neurology, have modified the classic role of neurosonology. From the SONES we aimed to evaluate the current status of neurosonology in Spain.</div></div><div><h3>Methods</h3><div>Cross-sectional survey of neurologists and neurology residents working in Spain regarding training, education, and local daily practice, including a strengths, weaknesses, opportunities and threats (SWOT) analysis.</div></div><div><h3>Results</h3><div>One-hundred seventy-eight neurologists and thirty-four neurology residents participated in the survey. A wide experience in vascular neurosonology (90% of respondents’ Neurology departments) and limited experience in brain parenchyma sonography (34%), cardiac echoscopy (25%), ultrasound-guided techniques (24%), and nerve ultrasound (14%) was reported. Fifty-three percent of the participants reported to have a full-time neurosonology lab in their department and only 14% reported to have neurologists dedicated exclusively to neurosonology. Most participants (54%) reported to lack continuous learning opportunities, and 97% to need training in one or more neurosonology techniques. Main SWOT were respectively requiring expertise, shortage of time, versatility and comprehensive management of the neurological patient.</div></div><div><h3>Conclusion</h3><div>Vascular neurosonology is widely instituted in Spain, but the implementation of full-time neurosonology labs and training in non-vascular neurosonology techniques is yet scarce.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 548-557"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-08-04DOI: 10.1016/j.nrleng.2025.06.012
A. Bartos , S. Diondet
Background and purpose
We report the development and validation of a unique, easily administered, but cognitively demanding 3-min test that does not require aids and can detect mild cognitive deficits (MCD).
Methods
The innovative Amnesia Light and Brief Assessment (ALBA) consists of 4 tasks: encoding the 6-word sentence “Indian summer brings first morning frost,” sequential demonstration of 6 gestures and their immediate recall, and final recall of the original sentence. The memory ALBA score is the sum of all correctly recalled sentence words and gestures. The ALBA was performed in 590 persons older than 50 years, including 60 individuals who completed a neuropsychological battery, equally divided into patients with MCD (Montreal Cognitive Assessment [MoCA] score of 21 ± 3 points) and matched cognitively normal (CN) individuals (MoCA of 27 ± 2).
Results
Compared to CN individuals, the patients with MCD recalled fewer correct sentence words (median, 5 vs 2) and gestures (4 vs 3), and had lower memory ALBA scores (10 vs 6) (all comparisons, P < .00001). The cut-off point for the memory ALBA score was ≤8, with 90% sensitivity, 77% specificity, and an AUC of 0.90. Memory ALBA score correlated significantly with all neuropsychological tests except the Digit Span forward. The ALBA was minimally associated with education and age in the normative sample.
Conclusions
The novel and efficient ALBA test was confirmed to have high discriminant and convergent validity, even in patients with mild cognitive deficits. The ALBA is an ultra-brief and universal cognitive test suitable for assessing cognitive impairment, dementia, and other conditions. It can easily be adapted to other cultures and administered under various conditions and settings in clinical practice and research.
{"title":"The sensitive Amnesia Light and Brief Assessment (ALBA) is a valid 3-min test of 4 tasks indicative of mild cognitive deficits","authors":"A. Bartos , S. Diondet","doi":"10.1016/j.nrleng.2025.06.012","DOIUrl":"10.1016/j.nrleng.2025.06.012","url":null,"abstract":"<div><h3>Background and purpose</h3><div>We report the development and validation of a unique, easily administered, but cognitively demanding 3-min test that does not require aids and can detect mild cognitive deficits (MCD).</div></div><div><h3>Methods</h3><div>The innovative Amnesia Light and Brief Assessment (ALBA) consists of 4 tasks: encoding the 6-word sentence “Indian summer brings first morning frost,” sequential demonstration of 6 gestures and their immediate recall, and final recall of the original sentence. The memory ALBA score is the sum of all correctly recalled sentence words and gestures. The ALBA was performed in 590 persons older than 50 years, including 60 individuals who completed a neuropsychological battery, equally divided into patients with MCD (Montreal Cognitive Assessment [MoCA] score of 21<!--> <!-->±<!--> <!-->3 points) and matched cognitively normal (CN) individuals (MoCA of 27<!--> <!-->±<!--> <!-->2).</div></div><div><h3>Results</h3><div>Compared to CN individuals, the patients with MCD recalled fewer correct sentence words (median, 5 vs 2) and gestures (4 vs 3), and had lower memory ALBA scores (10 vs 6) (all comparisons, <em>P</em> <!--><<!--> <!-->.00001). The cut-off point for the memory ALBA score was ≤8, with 90% sensitivity, 77% specificity, and an AUC of 0.90. Memory ALBA score correlated significantly with all neuropsychological tests except the Digit Span forward. The ALBA was minimally associated with education and age in the normative sample.</div></div><div><h3>Conclusions</h3><div>The novel and efficient ALBA test was confirmed to have high discriminant and convergent validity, even in patients with mild cognitive deficits. The ALBA is an ultra-brief and universal cognitive test suitable for assessing cognitive impairment, dementia, and other conditions. It can easily be adapted to other cultures and administered under various conditions and settings in clinical practice and research.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 586-598"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2024-08-08DOI: 10.1016/j.nrleng.2024.08.001
M.J. Abenza Abildúa , T. Olmedo Menchen , A. Pérez Villena , S. Ruhland Paulete , F.J. Navacerrada Barrero , J. de Ojeda Ruíz de Luna , C. Algarra Lucas , G. Cordero Martín , S. Martínez Ubierna , C. Jimeno Montero , I.J. Navarro López , E. Suárez Gisbert , Á. Gómez de la Riva , C. Pérez López , M.L. Herreros Fernández
Introduction
We analyze the diagnostic utility of urgent EEG (electroencephalogram) performed in children under 16 years of age in our center.
Material and methods
Descriptive, retrospective, observational study of consecutive patients from 0 to 16 years of age, who underwent an urgent EEG for any reason, from January to December 2022.
Results
Of the 388 patients, 70 were children: 37 (52.85%) women, and 33 (47.14%) men. Average age: 6.27 ± 4.809. Of the 70 patients, 6 (8.57%) had previous epilepsy. Reasons for consultation: 17 febrile seizures, 10 first focal seizures, 10 first TCG seizures, 6 paroxysmal episodes, 6 absences, 3 myoclonus of extremities, 3 syncope, 2 SE, 2 visual alterations, 2 low level of consciousness, 2 cyanosis, 2 suspected meningitis or encephalitis, 1 choking, 1 atypical headache, 1 chorea, 1 presyncope, 1 language delay. Of the 70 patients, 47 had a normal EEG (67.14%). Of the 47 patients with a normal EEG, 10 were diagnosed with epilepsy, and 3 of them began receiving antiepileptic treatment upon discharge. None of the patients with suspected syncope or paroxysmal disorder (17 patients, 24.28%) had EEG abnormalities. Of the 17 patients with atypical febrile seizures, 3 had EEG abnormalities.
Conclusions
A third of the EEG records performed in the Emergency Department showed alterations, probably due to the time taken. Almost half of the patients with suspected epilepsy or EE showed EEG abnormalities, which confirmed the diagnosis in these cases and encouraged the clinician to start drug treatment. No case with a high suspicion of epilepsy was dismissed due to the normality of the EEG recording in our series. No patient diagnosed with syncope or paroxysmal disorder had EEG abnormalities. Nearly a quarter of patients with atypical febrile seizures showed EEG abnormalities. We barely register cases of status epilepticus, probably due to the degree of complexity of our center.
{"title":"Assessment of the diagnostic utility of the electroencephalogram in pediatric emergencies","authors":"M.J. Abenza Abildúa , T. Olmedo Menchen , A. Pérez Villena , S. Ruhland Paulete , F.J. Navacerrada Barrero , J. de Ojeda Ruíz de Luna , C. Algarra Lucas , G. Cordero Martín , S. Martínez Ubierna , C. Jimeno Montero , I.J. Navarro López , E. Suárez Gisbert , Á. Gómez de la Riva , C. Pérez López , M.L. Herreros Fernández","doi":"10.1016/j.nrleng.2024.08.001","DOIUrl":"10.1016/j.nrleng.2024.08.001","url":null,"abstract":"<div><h3>Introduction</h3><div>We analyze the diagnostic utility of urgent EEG (electroencephalogram) performed in children under 16 years of age in our center.</div></div><div><h3>Material and methods</h3><div>Descriptive, retrospective, observational study of consecutive patients from 0 to 16 years of age, who underwent an urgent EEG for any reason, from January to December 2022.</div></div><div><h3>Results</h3><div>Of the 388 patients, 70 were children: 37 (52.85%) women, and 33 (47.14%) men. Average age: 6.27 ± 4.809. Of the 70 patients, 6 (8.57%) had previous epilepsy. Reasons for consultation: 17 febrile seizures, 10 first focal seizures, 10 first TCG seizures, 6 paroxysmal episodes, 6 absences, 3 myoclonus of extremities, 3 syncope, 2 SE, 2 visual alterations, 2 low level of consciousness, 2 cyanosis, 2 suspected meningitis or encephalitis, 1 choking, 1 atypical headache, 1 chorea, 1 presyncope, 1 language delay. Of the 70 patients, 47 had a normal EEG (67.14%). Of the 47 patients with a normal EEG, 10 were diagnosed with epilepsy, and 3 of them began receiving antiepileptic treatment upon discharge. None of the patients with suspected syncope or paroxysmal disorder (17 patients, 24.28%) had EEG abnormalities. Of the 17 patients with atypical febrile seizures, 3 had EEG abnormalities.</div></div><div><h3>Conclusions</h3><div>A third of the EEG records performed in the Emergency Department showed alterations, probably due to the time taken. Almost half of the patients with suspected epilepsy or EE showed EEG abnormalities, which confirmed the diagnosis in these cases and encouraged the clinician to start drug treatment. No case with a high suspicion of epilepsy was dismissed due to the normality of the EEG recording in our series. No patient diagnosed with syncope or paroxysmal disorder had EEG abnormalities. Nearly a quarter of patients with atypical febrile seizures showed EEG abnormalities. We barely register cases of status epilepticus, probably due to the degree of complexity of our center.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 499-506"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-08-04DOI: 10.1016/j.nrleng.2025.06.010
M.E. Ramos-Araque , M. Castellanos , L. Naya Rios , E. López-Cancio , J. Molina Gil , J. Marta-Moreno , H. Tejada-Meza , M. Temprano Fernández , C. Antón González , D. Vidal de Francisco , J. Tejada-García , J.L. Maciñeiras Montero , P. Vicente Alba , J.M. García-Sánchez , B. Aguilera Irazabal , M. Martínez-Zabaleta , I.N. Diez , A. Pinedo Brochado , I. Azkune Calle , M.M. Freijo , J.F. Arenillas
Background
Our primary aim was to investigate the incidence of non-cardioembolic minor acute ischemic stroke (AIS) and high-risk transient ischemic attack (TIA) and to identify predictors of stroke recurrence/death and severe bleeding. We also evaluated the rates of TIA, major vascular events, therapeutic management and predictors of poor functional outcome at 3 months in these patients.
Methods
We retrospectively reviewed data from all stroke patients evaluated at the emergency department of 19 hospitals belonging to the NORDICTUS stroke network between July and December 2019. Consecutive patients with non-cardioembolic minor AIS (NIHSS ≤5) and high-risk TIA (ABCD2 ≥6 or ipsilateral stenosis ≥50%) were included. We recorded clinical, neuroimaging and therapeutic variables. Follow-up was performed at 30 and 90 days. Functional prognosis was assessed with the modified Rankin scale score (mRS).
Results
Of 8275 patients, 1679 (20%) fulfilled IMMINENT criteria (1524 AIS/155 TIA), resulting in a global incidence of 48/100,000 inhabitants per-year. Recurrent stroke/death occurred in 73 (4.3%) patients. Extracranial ipsilateral stenosis (>50%): HR 1.999 (95% CI: 1.115–3.585, p = 0.020) and lack of hyperacute cerebral arterial assessment: HR 1.631 (95% CI: 1.009–2.636, p = 0.046) were associated with recurrent stroke/death at 90 days. Intracranial stenosis was associated with poor prognosis (p = 0.044). Reperfusion therapy was given to 147 (9%) and urgent double antiplatelet therapy (DAPT) to 320 (21%) patients.
Conclusion
Twenty percent of our stroke patients presented as non-cardioembolic high-risk TIA or minor AIS. Extracranial ipsilateral stenosis and lack of hyperacute cerebral arterial assessment were predictors of stroke recurrence/death; intracranial stenosis was associated with poor outcome. Despite current recommendations there was a low penetrance of DAPT.
本研究的主要目的是调查非心源性轻微急性缺血性卒中（AIS）和高风险短暂性脑缺血发作（TIA）的发生率，并确定卒中复发/死亡和严重出血的预测因素。我们还评估了这些患者在3个月时TIA的发生率、主要血管事件、治疗管理和功能不良预后的预测因素。方法回顾性分析2019年7月至12月NORDICTUS卒中网络所属19家医院急诊科评估的所有卒中患者的数据。纳入连续的非心源性轻微AIS （NIHSS≤5）和高危TIA （ABCD2≥6或同侧狭窄≥50%）患者。我们记录了临床、神经影像学和治疗变量。随访时间分别为30天和90天。采用改良Rankin评分（mRS）评价功能预后。结果在8275例患者中，1679例（20%）达到了迫在眉睫的标准（1524例AIS/155例TIA），导致每年全球发病率为48/100,000居民。73例（4.3%）患者发生卒中复发/死亡。颅外同侧狭窄（>50%）： HR 1.999 （95% CI: 1.115-3.585, p = 0.020）和缺乏超急性脑动脉评估：HR 1.631 （95% CI: 1.009-2.636, p = 0.046）与90天卒中复发/死亡相关。颅内狭窄与预后不良相关（p = 0.044）。147例（9%）患者接受再灌注治疗，320例（21%）患者接受紧急双重抗血小板治疗。结论20%的脑卒中患者表现为非心源性高危TIA或轻微AIS。颅内外同侧狭窄和缺乏超急性脑动脉评估是卒中复发/死亡的预测因素；颅内狭窄与预后不良相关。尽管目前的建议，但DAPT的外显率很低。
{"title":"Incidence and outcoMes of MInor stroke and high-risk traNsient ischEmic attack in NordicTus. IMMINENT study","authors":"M.E. Ramos-Araque , M. Castellanos , L. Naya Rios , E. López-Cancio , J. Molina Gil , J. Marta-Moreno , H. Tejada-Meza , M. Temprano Fernández , C. Antón González , D. Vidal de Francisco , J. Tejada-García , J.L. Maciñeiras Montero , P. Vicente Alba , J.M. García-Sánchez , B. Aguilera Irazabal , M. Martínez-Zabaleta , I.N. Diez , A. Pinedo Brochado , I. Azkune Calle , M.M. Freijo , J.F. Arenillas","doi":"10.1016/j.nrleng.2025.06.010","DOIUrl":"10.1016/j.nrleng.2025.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Our primary aim was to investigate the incidence of non-cardioembolic minor acute ischemic stroke (AIS) and high-risk transient ischemic attack (TIA) and to identify predictors of stroke recurrence/death and severe bleeding. We also evaluated the rates of TIA, major vascular events, therapeutic management and predictors of poor functional outcome at 3 months in these patients.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed data from all stroke patients evaluated at the emergency department of 19 hospitals belonging to the NORDICTUS stroke network between July and December 2019. Consecutive patients with non-cardioembolic minor AIS (NIHSS ≤5) and high-risk TIA (ABCD2 ≥6 or ipsilateral stenosis ≥50%) were included. We recorded clinical, neuroimaging and therapeutic variables. Follow-up was performed at 30 and 90 days. Functional prognosis was assessed with the modified Rankin scale score (mRS).</div></div><div><h3>Results</h3><div>Of 8275 patients, 1679 (20%) fulfilled IMMINENT criteria (1524 AIS/155 TIA), resulting in a global incidence of 48/100,000 inhabitants per-year. Recurrent stroke/death occurred in 73 (4.3%) patients. Extracranial ipsilateral stenosis (>50%): HR 1.999 (95% CI: 1.115–3.585, <em>p</em> <!-->=<!--> <!-->0.020) and lack of hyperacute cerebral arterial assessment: HR 1.631 (95% CI: 1.009–2.636, <em>p</em> <!-->=<!--> <!-->0.046) were associated with recurrent stroke/death at 90 days. Intracranial stenosis was associated with poor prognosis (<em>p</em> <!-->=<!--> <!-->0.044). Reperfusion therapy was given to 147 (9%) and urgent double antiplatelet therapy (DAPT) to 320 (21%) patients.</div></div><div><h3>Conclusion</h3><div>Twenty percent of our stroke patients presented as non-cardioembolic high-risk TIA or minor AIS. Extracranial ipsilateral stenosis and lack of hyperacute cerebral arterial assessment were predictors of stroke recurrence/death; intracranial stenosis was associated with poor outcome. Despite current recommendations there was a low penetrance of DAPT.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 489-498"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-06-23DOI: 10.1016/j.nrleng.2025.06.006
L. Cayuela , A. de Albóniga-Chindurza , S. Gómez Enjuto , J. Lapeña-Motilva , S. Sainz de la Maza , A. González García , A. Cayuela
Objective
Assess time trends in mortality from multiple sclerosis (MS) in the Spanish population (1981–2020), considering the influence of independent effects of gender, age, period, and birth cohort.
Methods
MS deaths and populations needed for calculations were obtained from the National Institute of Statistics. Age-standardised mortality rates (ASMR) and trend analysis were performed using joinpoint regression software. Age-period-cohort (APC) analysis was performed using the web-based statistical tool of the US National Cancer Institute to explore the underlying reason for the MS mortality.
Results
ASMR increased significantly in both women and men (1.7% and 1.2% respectively). The joinpoint analysis detected no trend change for women, but for men it detects a first period where rates remain stable (1981–2000; annual percentage change: −0.7%, not significant) followed by a period of significant increase (2000–2020; 2.6%, P < 0.05). For period effects, a steady increase was observed among women since the early 1990s and among men since the late 1990s. A birth cohort-related increase in mortality was detected: women born from 1916 onwards see their risk of MS mortality increase until it peaks in 1956, after which it decreases. A similar pattern is observed in men, albeit with a decade delay (from 1926 to 1966).
Conclusion
ASMR shows a steady increase in both sexes over the last decades, although it has been more intense in men. The decreasing birth cohort pattern for MS mortality in men born since the mid-1960s and women born since the mid-1950s is similar to APC analyses in other countries.
{"title":"Multiple sclerosis mortality trends in Spain from 1981 to 2020","authors":"L. Cayuela , A. de Albóniga-Chindurza , S. Gómez Enjuto , J. Lapeña-Motilva , S. Sainz de la Maza , A. González García , A. Cayuela","doi":"10.1016/j.nrleng.2025.06.006","DOIUrl":"10.1016/j.nrleng.2025.06.006","url":null,"abstract":"<div><h3>Objective</h3><div>Assess time trends in mortality from multiple sclerosis (MS) in the Spanish population (1981–2020), considering the influence of independent effects of gender, age, period, and birth cohort.</div></div><div><h3>Methods</h3><div>MS deaths and populations needed for calculations were obtained from the National Institute of Statistics. Age-standardised mortality rates (ASMR) and trend analysis were performed using joinpoint regression software. Age-period-cohort (APC) analysis was performed using the web-based statistical tool of the US National Cancer Institute to explore the underlying reason for the MS mortality.</div></div><div><h3>Results</h3><div>ASMR increased significantly in both women and men (1.7% and 1.2% respectively). The joinpoint analysis detected no trend change for women, but for men it detects a first period where rates remain stable (1981–2000; annual percentage change: −0.7%, not significant) followed by a period of significant increase (2000–2020; 2.6%, <em>P</em> <!--><<!--> <!-->0.05). For period effects, a steady increase was observed among women since the early 1990s and among men since the late 1990s. A birth cohort-related increase in mortality was detected: women born from 1916 onwards see their risk of MS mortality increase until it peaks in 1956, after which it decreases. A similar pattern is observed in men, albeit with a decade delay (from 1926 to 1966).</div></div><div><h3>Conclusion</h3><div>ASMR shows a steady increase in both sexes over the last decades, although it has been more intense in men. The decreasing birth cohort pattern for MS mortality in men born since the mid-1960s and women born since the mid-1950s is similar to APC analyses in other countries.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 558-566"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-08-04DOI: 10.1016/j.nrleng.2025.06.009
V.M.M. Anlacan , F.G.C. Gabriel , R.D.G. Jamora , E.Q. Villanueva III , M.C.C. Sy , M.H.L. Lee Yu , A.I. Espiritu
Introduction
This study aimed to determine whether encephalopathy is associated with such COVID-19 outcomes as disease severity, mortality, respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, and length of ICU and hospital stay.
Methods
We performed a subgroup analysis comparing outcomes in patients with and without encephalopathy, based on data from a nationwide retrospective cohort study among adult patients hospitalized with COVID-19 at 37 hospital sites in the Philippines. The patient outcomes included for analysis were disease severity, mortality, respiratory failure, ICU admission, duration of ventilator dependence, and length of ICU and hospital stay.
Results
Of a total of 10 881 COVID-19 admissions, 622 patients had encephalopathy. The adjusted hazard ratios (aHR) for mortality among mild and severe cases were 9.26 and 1.63 times greater (P < .001), respectively, in the encephalopathy group compared to the no-encephalopathy group. Encephalopathy was associated with increased risk of severe COVID-19 (adjusted odds ratio [aOR]: 7.95; P < .001), respiratory failure (aHR: 5.40; P < .001), longer hospital stays (aOR: 1.36; P < .001), and admission to the ICU (aOR: 4.26; P < .001). We found no sufficient evidence that encephalopathy was associated with length of ICU stay (aOR: 1.11; P = .522) or duration of ventilator dependence (aOR: 0.88; P = .428).
Conclusions
Encephalopathy was associated with COVID-19 severity, mortality, respiratory failure, ICU admission, and longer hospital stays.
{"title":"Association between encephalopathy and clinical outcomes of COVID-19: Findings from the Philippine CORONA Study","authors":"V.M.M. Anlacan , F.G.C. Gabriel , R.D.G. Jamora , E.Q. Villanueva III , M.C.C. Sy , M.H.L. Lee Yu , A.I. Espiritu","doi":"10.1016/j.nrleng.2025.06.009","DOIUrl":"10.1016/j.nrleng.2025.06.009","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to determine whether encephalopathy is associated with such COVID-19 outcomes as disease severity, mortality, respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, and length of ICU and hospital stay.</div></div><div><h3>Methods</h3><div>We performed a subgroup analysis comparing outcomes in patients with and without encephalopathy, based on data from a nationwide retrospective cohort study among adult patients hospitalized with COVID-19 at 37 hospital sites in the Philippines. The patient outcomes included for analysis were disease severity, mortality, respiratory failure, ICU admission, duration of ventilator dependence, and length of ICU and hospital stay.</div></div><div><h3>Results</h3><div>Of a total of 10<!--> <!-->881 COVID-19 admissions, 622 patients had encephalopathy. The adjusted hazard ratios (aHR) for mortality among mild and severe cases were 9.26 and 1.63 times greater (<em>P</em> <!--><<!--> <!-->.001), respectively, in the encephalopathy group compared to the no-encephalopathy group. Encephalopathy was associated with increased risk of severe COVID-19 (adjusted odds ratio [aOR]: 7.95; <em>P</em> <!--><<!--> <!-->.001), respiratory failure (aHR: 5.40; <em>P</em> <!--><<!--> <!-->.001), longer hospital stays (aOR: 1.36; <em>P</em> <!--><<!--> <!-->.001), and admission to the ICU (aOR: 4.26; <em>P</em> <!--><<!--> <!-->.001). We found no sufficient evidence that encephalopathy was associated with length of ICU stay (aOR: 1.11; <em>P</em> <!-->=<!--> <!-->.522) or duration of ventilator dependence (aOR: 0.88; <em>P</em> <!-->=<!--> <!-->.428).</div></div><div><h3>Conclusions</h3><div>Encephalopathy was associated with COVID-19 severity, mortality, respiratory failure, ICU admission, and longer hospital stays.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 567-576"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-08-04DOI: 10.1016/j.nrleng.2025.06.008
Y. Zhang , Y. Lin , C.C.W. Zhong , F.F. Ho , I.X.Y. Wu , C. Mao , X. Yang , V.C.H. Chung
Background
Systematic reviews (SR) of high methodological quality can provide the best evidence for clinical practice. However, the methodological quality of SRs on Parkinson's disease treatments has not been evaluated comprehensively. The study aims to assess the methodological quality of a representative sample of SRs on Parkinson's disease treatments.
Methods
Four databases were searched to obtain potentially eligible SRs published between January 2016 and December 2021. A pre-designed questionnaire was used to extract the bibliographical characteristics of the included SRs. The AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews) tool was used to assess the methodological quality of SRs. Factors associated with methodological quality were assessed using multivariate regression analyses.
Results
A total of 119 eligible SRs were included and appraised. Only one SR (0.8%) was of high overall methodological quality. Four (3.4%) and 7 (5.9%) SRs were of moderate and low overall methodological quality, respectively. Among the appraised SRs, only 3 (2.5%) applied a comprehensive literature search strategy, 11 (9.2%) provided a list of excluded studies with justifications for exclusion, and 4 (3.4%) reported the sources of funding among the original studies included in the SR. Cochrane SRs and SRs published in journals with higher impact factors had relatively higher overall methodological quality.
Conclusions
This study demonstrated that SRs on Parkinson's disease treatments are of low methodological quality. To enhance the quality and hence the trustworthiness of SRs, the protocols of future reviews should be designed and registered a priori, and researchers should conduct a comprehensive literature search, provide a list of excluded studies with justifications for exclusion, and report sources of funding for the included original studies.
{"title":"Methodological quality of systematic reviews on treatments for Parkinson's disease: A cross-sectional study","authors":"Y. Zhang , Y. Lin , C.C.W. Zhong , F.F. Ho , I.X.Y. Wu , C. Mao , X. Yang , V.C.H. Chung","doi":"10.1016/j.nrleng.2025.06.008","DOIUrl":"10.1016/j.nrleng.2025.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Systematic reviews (SR) of high methodological quality can provide the best evidence for clinical practice. However, the methodological quality of SRs on Parkinson's disease treatments has not been evaluated comprehensively. The study aims to assess the methodological quality of a representative sample of SRs on Parkinson's disease treatments.</div></div><div><h3>Methods</h3><div>Four databases were searched to obtain potentially eligible SRs published between January 2016 and December 2021. A pre-designed questionnaire was used to extract the bibliographical characteristics of the included SRs. The AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews) tool was used to assess the methodological quality of SRs. Factors associated with methodological quality were assessed using multivariate regression analyses.</div></div><div><h3>Results</h3><div>A total of 119 eligible SRs were included and appraised. Only one SR (0.8%) was of high overall methodological quality. Four (3.4%) and 7 (5.9%) SRs were of moderate and low overall methodological quality, respectively. Among the appraised SRs, only 3 (2.5%) applied a comprehensive literature search strategy, 11 (9.2%) provided a list of excluded studies with justifications for exclusion, and 4 (3.4%) reported the sources of funding among the original studies included in the SR. Cochrane SRs and SRs published in journals with higher impact factors had relatively higher overall methodological quality.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that SRs on Parkinson's disease treatments are of low methodological quality. To enhance the quality and hence the trustworthiness of SRs, the protocols of future reviews should be designed and registered a priori, and researchers should conduct a comprehensive literature search, provide a list of excluded studies with justifications for exclusion, and report sources of funding for the included original studies.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 6","pages":"Pages 507-517"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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