Neurological research and practice最新文献

Post-COVID can be associated with neurological symptoms such as neuropathy or fatigue. Histological analysis of affected nerves is rarely described and post mortem study of the brain and peripheral nerves are carried out only in few cases.In the case report, we describe the clinical and neuropathological findings of a 75-year-old female patient who presented with a motor and sensory axonal neuropathy after a SARS-CoV-2 infection seven weeks before and suddenly died. Laboratory testing of serum and CSF revealed no signs of systemic vasculitis or infectious diseases. A post mortem investigation was performed. Samples from the brain including the cranial nerves, peripheral nerves and skeletal muscles from different regions were analysed.The brain revealed lymphocytic cells predominantly in the basal ganglia and brain stem with involvement of the cranial nerves. Interestingly, a CNS involvement was not observed during lifetime. The sensory and motor peripheral nerves revealed a severe axonal neuritis. Skeletal muscle showed a neurogenic atrophy.This case report highlights that a post-infectious autoimmune disorder with CNS and PNS involvement should be considered in patients with post-COVID. The diagnosis of an ongoing inflammation may influence the treatment options.

Background: Numerous uncontrolled observational studies suggest that early spinal decompression and stabilization within 24 h of spinal cord injury (SCI) improve neurological recovery, forming the basis for recently published best practice guidelines. In this study, we aim to investigate current surgical practices in trauma centers across Germany, Austria, and Switzerland and to elucidate trauma- and patient-related factors influencing the timing of spine surgery.

Methods: We identified patients aged 16 years or older with traumatic SCI and permanent neurological deficits from the TraumaRegister DGU^® of the German Trauma Society (2008-2022). Trauma severity was assessed using the Abbreviated Injury Scale. Patients were categorized based on the timing of spine surgery (early surgery: day of admission; late surgery: subsequent days) and functional impairment (moderate vs. severe, based on the Glasgow Outcome Scale). Multivariate regression analyses were conducted to correlate patient and trauma-related factors with these endpoints.

Results: A total of 9938 patients with SCI at cervical, thoracic, and lumbar levels were identified. Among the 5025 patients who underwent spine surgery, 69% were operated on the day of admission, while 31% received surgery on subsequent days. Elderly patients (≥ 60 years) had a higher likelihood of delayed surgery (odds ratio [OR] 0.68-0.76). Trauma-related factors, including high cervical SCI, significant injuries beyond the spine, traumatic brain injury, and signs of hemorrhage, were strongly associated with late surgery (OR 0.38-0.83; p < 0.05). Conversely, patients with complete SCI or SCI at the thoracic or lumbar levels were more likely to undergo early surgery (OR 1.45-1.8; p < 0.001). Severe functional impairment was associated with advanced age (≥ 70 years), complete SCI, high cervical SCI, concomitant traumatic brain, signs of hemorrhage and comorbidities (OR 1.27-4.59; p < 0.01), whereas SCI at thoracic (OR 0.8) and lumbar (OR 0.4) levels correlated with moderate functional impairment (p < 0.01).

Conclusion: The majority of SCI patients in trauma centers across Germany, Austria, and Switzerland undergo early spinal surgery, reflecting adherence to best practice recommendations. Timing of surgery is significantly influenced by patient age and trauma complexity. Delays are more common in elderly patients and those with high cervical injuries or associated trauma, underscoring the need for individualized surgical decision-making. Given the strong correlation between injury severity, surgical timing, and functional impairment, future guidelines should refine criteria for early intervention to further optimize neurological recovery.

Background: Glioma-associated epilepsy (GAE) is a frequent and clinically significant complication in neuro-oncological practice. Its prevalence varies across glioma subtypes and is influenced by tumor biology, cortical involvement, tumor size, extent of resection, and disease progression. Despite its substantial impact on quality of life and clinical outcomes, GAE remains underrepresented in neurological and neuro-oncological guidelines. Moreover, novel findings in molecular subtyping and their relevance to tumor biology and GAE pathogenesis are not yet adequately reflected in clinical frameworks. Here, we aim to provide a comprehensive synthesis of epidemiology, pathophysiology, and management strategies for GAE based on the recent advances in glioma biology, cancer neuroscience, and epileptology.

Main body: This review highlights recent insights into the epidemiology, clinical impact, pathophysiology, and therapeutic strategies for GAE. We focus on both lower-grade gliomas, in which GAE is most prevalent over lifetime-particularly in tumors harboring isocitrate dehydrogenase (IDH) mutations-as well as high-grade gliomas where GAE remains a clinically relevant and complex issue. In addition to diffuse glioma subtypes, this review also addresses low-grade epilepsy-associated tumors (LEAT), a distinct and heterogeneous group with an inherently high risk of seizures. The pathomechanisms of GAE are reviewed with regard to glioma subtype-specific alterations of the tumor metabolism, neuroinflammation, increased glutamatergic activity, as well as the interaction between tumor cells and non-neoplastic cells. Key pathways implicated in both GAE and tumor biology include the IDH and mTOR signaling and a range of tumor related somatic mutations. With regard to the prognostic and therapeutic significance of GAE, we highlight the essential importance of accurate molecular tumor classification. In addition to reviewing common and tumor-specific side effects of anti-seizure medication (ASM), the emerging role of therapeutic approaches targeting both tumor growth and epileptogenesis is discussed.

Conclusion: Glioma (subtype) specific mechanisms of epileptogenesis and selection of ASM is an emerging topic with future potential to improve the therapy of GAE and tumor growth alike.

Epilepsy affects over 50 million individuals worldwide, a significant proportion of whom are women with epilepsy (WWE) of childbearing age. This population faces unique challenges related to hormonal fluctuations, e.g., during life stages such as breastfeeding or menopause. Antiseizure medications (ASMs) further complicate reproductive health by influencing menstrual function, contraception, pregnancy outcomes, bone health, and menopausal transition due to their teratogenic potential and hormonal interactive effects. Consequently, treatment strategies for WWE must consider these interactions and the risks associated with ASMs during pregnancy. This review aims to consolidate current data and guidelines for managing WWE throughout their reproductive years. These findings emphasize the importance of preconception counseling to optimize ASM regimens, ensuring both maternal well-being and fetal safety. Key recommendations from major international pregnancy registries are summarized to guide clinicians in selecting ASMs that minimize the risk of congenital malformations while maintaining effective seizure control. Additionally, this review explores the role of folic acid supplementation in preventing neural tube defects and outlines contraceptive options tailored for WWE. In conclusion, comprehensive education on the implications of epilepsy for reproductive health is crucial for WWE. By fostering informed decision-making through personalized counseling and careful medication management before, during, and after pregnancy, healthcare providers can significantly improve outcomes for both mothers and their children.

Background: Mechanical thrombectomy (MT) is a highly effective treatment for large vessel occlusion (LVO) ischemic stroke. However, a substantial share of patients have lethal outcome within 3 months. Individualization of outcome prognostication is needed to support clinical decision-making throughout the care pathway after MT. We investigate predictors of lethal outcome in patients with nonfatal LVO, defined by discharge alive from primary treating hospital, in a large prospective registry study of MT under routine care conditions.

Methods: 6,518 patients with nonfatal LVO treated by MT enrolled in the German Stroke Registry-Endovascular Treatment from May 2015-December 2021 were analysed with regard to lethal outcome by 3 month follow-up. Univariate group comparisons and multiple logistic regression analysis were performed to identify patients with high odds for survival or lethal outcome.

Results: We report 11.6% (757/6,518) 3 month mortality following hospital discharge after LVO treated by MT. Besides better functional outcome at discharge (modified Rankin scale < 4, odds ratio, OR [95% confidence interval, CI]: 2.38 [1.71-3.32], p < 0.001; National Institute of Health Stroke scale < 8, OR [95%CI]: 3.45 [2.55-4.66], p < 0.001), intravenous thrombolysis (OR [95%CI]: 1.48 [1.17-1.88], p = 0.001), successful recanalization (OR [95%CI]: 1.43 [1.08-1.90], p = 0.014) and discharge to a neurorehabilitative facility (versus nursing home: OR [95%CI]: 0.39 [0.26-0.58], p < 0.001; versus home: OR [95%CI]: 0.69 [0.49-0.97], p = 0.032) were independent predictors of survival. Predictors of lethal outcome were older age (OR [95%CI]: 1.09 [1.07-1.10], p < 0.001), male sex (OR [95%CI]: 1.24 [1.00-1.55], p = 0.049), premorbid disability (OR [95%CI]: 1.47 [1.08-2.02], p = 0.016), active smoking (OR [95%CI]: 1.51 [1.06-2.14], p = 0.023), anticoagulation therapy prior to LVO (OR [95%CI]: 1.45 [1.09-1.92], p = 0.010), stroke etiology, general anaesthesia during MT (OR [95%CI]: 1.31 [1.02-1.69], p = 0.035) and intracerebral haemorrhage (OR [95%CI]: 1.50 [1.13-1.99], p = 0.005).

Conclusions: Lethal outcome after hospital discharge within 3 months after MT is frequent, accounting for more than one quarter of overall 3-month mortality after MT of LVO. Predictors of survival enable individual outcome prognostication, which assists clinical decision-making with regard to surveillance concerning complications, rehabilitative resource allocation and counselling about goals of care.

Trial registration: ClinicalTrials.gov (Identifier: NCT03356392, Date of registration: 2017/11/22).

This letter to the editor aims to comment on the article « User expectations and experiences of an assistive robotic arm in amyotrophic lateral sclerosis: a multicenter observational study » recently published by Spittel et al. (Neurol Res Pract, 6(1), 42).

This correspondence responds to Schoene et al.'s study on the impact of the COVID-19 pandemic on brain death (BD) detection in German hospitals. While their data-driven approach provides valuable insights, this response emphasizes the need to contextualize BD determination within the lived clinical and ethical realities of the pandemic. It argues that the reduction in BD assessments cannot solely be attributed to organizational lapses but must also account for ethical dilemmas, safety concerns, and triage pressures faced by healthcare providers. The author highlights the limitations of rigid BD protocols during public health emergencies and advocates for flexible, ethically guided practices. Drawing on international experience, including temporary adaptations in Cuba's BD policies, the letter underscores the importance of physician support, context-sensitive decision-making, and humanistic engagement with families. Ultimately, it calls for a reexamination of how BD determinations are understood and implemented under crisis conditions, urging reforms that integrate medical standards with compassionate care and ethical reflection.

Background: Digital mobility outcomes (DMOs) have emerged as novel biomarkers offering objective, quantitative, and examiner-independent outcome measures for clinical studies. Unfortunately, research efforts on DMOs have not yet investigated the domain of clinical utility in Parkinson's disease, i.e. providing evidence of improvements in health outcomes, diagnosis, decision-making, or prevention when compared to e.g. standard-of-care procedures. This manuscript, via a consensus building approach, aims to create a structured conceptual framework to map the knowledge generated by DMOs with clinical domains that could benefit from it.

Methods: We conducted a three-round consensus-building study with 12 experts recruited from the Mobilise-D consortium's Parkinson's Disease Working Group. The experts designed and ranked different aspects of the conceptual framework via a 5-level Likert scale for level of agreement. Consensus for the different points evaluated was based on a double threshold: the simultaneous presence of a high level of agreement had to be accompanied by a low level of disagreement. As secondary objectives, the experts were asked to rate the practical application of DMOs by evaluating the timeline to applicability, the foreseen challenges for their implementation in clinical settings, and their main role in the decision-making process.

Results: A full consensus on the clinical utility framework was achieved after three rounds. The final framework consisted of three main categories (Disease Diagnosis, Patient Evaluation, and Treatment Evaluation) and six underlying domains (Enhancing Diagnostic Procedure, Predicting Risk, Timely Detecting Deterioration, Enhancing Clinical Judgment, Selecting Treatment, and Monitoring Treatment Response). The experts believed in the next 1-5 years DMOs will play a relevant role in clinical decision making, complementing care knowledge with useful digital biomarkers information. However, the main challenge to address is the definition of clear reference value for DMOs interpretability.

Conclusions: This framework provides a structure for subsequent studies to build into by diversifying expert cohorts and expand our findings beyond PD. Additionally, our results support researchers planning future clinical trials where DMOs can play a valuable role for clinical decision support. Ultimately, this is the first step toward developing guidelines to assess DMOs' clinical utility and support their integration into Real World clinical practice.