Neurological research and practice最新文献

Background: Neurovascular networks (NVNs) in Germany are supra-regional care structures for patients with neurovascular diseases. Each NVN consists of a tertiary care center serving as the coordinating center-in some cases, two or three coordinating centers-and at least three partner hospitals. Since 2018, 19 neurovascular networks (NVNs) have been audited and certified. NVNs play a crucial role in stroke care in Germany, as first described and quantified in 2020.

Methods: The present article provides an update on interdisciplinary NVNs in Germany and outlines recent developments in neurovascular patient care. Audit reports from 19 NVNs, certified between 2021 and 2024, were analyzed, and compared to previously reported data from 2017 to 2019. Additionally, structural and quality-related parameters for coordinating centers and partner hospitals were compared.

Results: The number of NVNs increased from 15 to 19, with approximately 120,000 from an estimated 262,000 neurovascular patients in Germany now treated annually in certified NVN hospitals. In particular, annual thrombectomy rates at coordinating centers have increased over-proportionally (> 4400, as compared to previously < 2500), and surgical treatments for intracerebral hemorrhages have also increased. Process times-door-to-needle and door-to-groin times-remained stable or exhibited slight increases. Substantial variability was observed among NVN partner hospitals regarding procedural volumes.

Conclusions: The treatment of patients with neurovascular diseases in Germany has expanded considerably within certified NVN hospitals in recent years. The NVNs ensure comprehensive, high-quality stroke care nationwide.

White matter hyperintensities of presumed vascular origin (WMH) are associated with various clinical sequelae. In stroke patients, the total WMH burden is linked to recurrent cerebrovascular events and worse clinical outcomes. As WMH also affect the integrity of large-scale structural brain networks, we hypothesize that the extent of WMH-related network damage carries relevant information to explain outcome variability in addition to global WMH volume. Clinical and structural brain imaging data of 33 severely affected acute stroke patients were analyzed from two independent cohorts. Imaging data were acquired within the first two weeks after stroke. WMH-related localized and global network damage was derived. WMH network effects were differentially assessed for total, periventricular (pWMH), and deep WMH (dWMH). Using ordinal logistic regression analyses, network damage was associated with functional outcome at follow-up after three to six months. WMH were linked to a significant disconnection of multiple cortical and subcortical brain regions. Global and localized pWMH-related network damage affecting distinct brain regions of both hemispheres were independently associated with a worse outcome after adjustment for baseline symptom burden, age, brain infarct volume, and total WMH volume. Total and dWMH-related network disturbances did not show similar associations. This study indicates that pWMH-related network damage affecting specific brain regions is linked to functional outcome in acute stroke patients. It underscores the potential significance of pre-existing WMH-related network damage as a crucial factor in comprehending outcome variability after severe stroke.

Introduction: The median time to diagnosis of amyotrophic lateral sclerosis (ALS) is approximately 12 months after the onset of first symptoms. This diagnostic delay is primarily due to the nonspecific nature of early symptoms and the clinical challenges in differentiating ALS from its mimics. Therefore, the discovery of reliable biomarkers for the early and accurate diagnosis of ALS represents a critical medical need.

Methods: A total of 330 participants will be recruited across six international study sites. The cohort will include (1) pre-symptomatic gene mutation carriers, (2) symptomatic individuals up to 12 months after symptom onset with either ALS, ALS mimics, or a pure motor syndrome with yet unclear assignment, and (3) healthy controls. Participants will engage in a one-year longitudinal study, consisting of an initial evaluation at baseline visit and a follow-up visit 12 months later. Assessments will include an environmental and medical history questionnaire, neurological examinations, olfactory testing, cognitive/behavioral evaluations, and the collection of biological samples (serum, plasma, urine, tear fluid, and cerebrospinal fluid). Proteomic, metabolomic, and lipidomic analyses will be performed using mass spectrometry and targeted immunoassays, with all samples processed under standardized protocols. The resulting multimodal dataset will be systematically integrated in an effort to uncover a presymptomatic and early ALS signature. Perspective The premodiALS study aim to identify a clinico-molecular signature characteristic of presymptomatic and early ALS. These findings may have relevance to early diagnosis and future clinical practice for ALS disease.

Objectives: Strokes are often accompanied by physical and cognitive impairments affecting driving safety. After the recommended period of abstinence from driving, the patient must decide whether his or her driving safety is still impaired, which requires a valid self-assessment of the own driving skills. At present, it is uncertain whether stroke survivors are able to provide a valid self-assessment.

Methods: 12 stroke patients and 17 healthy controls participated in this prospective longitudinal on-road study. All participants underwent repeated neuropsychological and standardized on-road assessment at 4-month intervals (2 and 6 months after the stroke in the patient group). Statistical analyses included repeated measures ANOVA, group comparisons and correlation analyses.

Results: Our results revealed that in stroke survivors compared to healthy drivers, the validity of self-assessment (VSA) of the own on-road driving performance is impaired in the direction of overestimation (at both time points). In addition, the VSA of stroke survivors at second time point correlated with driving-relevant cognitive and non-cognitive measures.

Discussion: Our results suggest that the VSA of the own driving competence is impaired after stroke. Other than expected, the differences between stroke survivors and healthy drivers did not disappear within the 4-months-interval. Consequently, an impaired VSA in stroke survivors must be considered before deciding to let them drive again.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a critical condition requiring multidisciplinary management, particularly in the intensive care setting. Despite existing guidelines, gaps in evidence and variability in practice remain, necessitating practical, consensus-driven recommendations for acute care and management.

Objective: To develop comprehensive, practical consensus statement for the acute management of aSAH, addressing high- and low-evidence areas, through a modified Delphi consensus approach among German-speaking neurointensivists and neuroradiologists.

Methods: Senior experts from neurology, neurosurgery, neurocritical care, and interventional neuroradiology were selected for their academic and clinical expertise. The consensus process included iterative rounds of Delphi surveys, a face-to-face meeting, and online discussions. Consensus statements were formulated based on literature review, expert input, and iterative validation, with a consensus threshold of ≥ 70% agreement.

Results: The group reached consensus on key aspects of aSAH management, including diagnostic protocols, invasive monitoring, blood pressure and temperature control, prophylactic and therapeutic measures for vasospasm and delayed cerebral ischemia, nutrition, and mobilization. Specific guidance was provided for early surgical/endovascular intervention, invasive hemodynamic monitoring, enteral nutrition initiation, and fever prevention. The consensus emphasized evidence-informed strategies where available and expert-derived recommendations in areas lacking robust data, such as therapeutic hypothermia and multimodal monitoring.

Conclusion: This practical consensus statement provides a standardized approach to aSAH management, balancing guideline-based evidence with expert consensus to address clinical uncertainties. Due to the used methods and composition of the group, the results should be considered as a multi-institutional protocol of an experienced neurointensivist group, but certainly not as evidence based-guidelines. Adoption of this consensus may improve outcomes and harmonize care in the intensive management of aSAH.

Background: Burnout is an increasing challenge and highly prevalent among healthcare professionals. Time-critical emergencies, high workload, the second-victim phenomenon, and moral distress have been identified as key risk factors of burnout. However, measures to mitigate the impact of stressful events have not yet been fully utilized and data in Germany is still limited.

Methods: To address this gap, the Young Neurology section of the German Neurological Society conducted a nationwide survey between October 7 and November 18, 2024, assessing 318 Neurology residents and 175 Neurology specialists. The study examined the frequency of stressful events, risk factors, coping mechanisms, and burnout severity.

Results: Stressful events occurred monthly and most often in emergency rooms, intensive care units, and general wards. Most residents were at risk of burnout and often lacked direct supervision during critical incidents. Common training-independent causes were high patient numbers, the second-victim phenomenon, and poor communication. Knowledge and skill related causes were specific to residents. Burnout was independently correlated to the frequency of stressful events, job satisfaction, institutional factors, age, number of children, and debriefing offer. While job satisfaction was generally good, 30% of participants thought about changing the employer and 10% about leaving Neurology. Dysfunctional coping strategies including the use of alcohol and medication were common and significantly correlated with increased burnout risk. The most relevant mitigation strategies were structured onboarding, debriefing, and improvement of processes.

Conclusion: Our findings confirm high burnout rates, particularly during residency, and highlight the urgent need for targeted intervention.

Trial registration: The study was registered in the German Clinical Trial Register (DRKS-ID DRKS00035214) on 7 October 2024.

Background: In Germany, multidisciplinary care for people with Parkinson's disease (PwP, PD) is mainly provided in the inpatient setting. Differences in user groups between established and effective interventions like PD Multimodal Complex Therapy (PD-MCT) and Geriatric Complex Therapy (GCT) have not been investigated.

Methods: This real-world bicenter prospective observational study involved PwP undergoing 14-day inpatient multidisciplinary therapies at two German university hospitals providing either PD-MCT or GCT. Demographic and clinical variables were recorded before and device-based gait variables before and after therapy. Non-parametric and parametric tests including ANCOVA with age as covariate were conducted to compare groups at baseline, and an exploratory binomial logistic regression (LR) to identify predictors of 'therapy response' concerning gait speed.

Results: Between 09/2017 and 09/2022, 100 (41% female) and 102 (34.3% female) PwP received GCT or PD-MCT, with significant (p < 0.003) mean or median differences (GCT vs. PD-MCT) in age (74.7 vs. 65.6 years), disease duration (9.9 vs. 7.4 years), and HY stage (3 vs. 2.5). The GCT group showed significantly reduced lower extremity (SPPB), global cognitive (MoCA) and executive function (TMT), lower quality of life, and higher fear of falling (FES-I). There were significant (p < 0.004) between-group differences in gait parameters at both normal and fast pace, e.g., reduced gait speed and step length among GCT users. After age-adjustment, differences in gait speed, fast-pace step length, lower extremity and executive function, fear of falling and quality of life persisted. The exploratory LR model was statistically significant (p < 0.05, R² = 0.312) and revealed lower fear of falling and gait speed as predictors of 'therapy response', independent of therapy type, age, sex, disease duration or stage.

Conclusion: GCT users show higher age and severity, particularly concerning mobility impairments independent of age. It is unclear if, on a national level, actual PD-MCT/GCT user groups align with intended target groups. Health insurance data analyses could help refine clinical recommendations and public health policies for more targeted multidisciplinary PD care.

Trial registration: Park Move Study: DRKS, DRKS00020948. Registered 30 March 2020-retrospectively registered, https://drks.de/search/de/trial/DRKS00020948/details.

Introduction: Olfactory impairment is common in glioblastoma and has been associated with unfavorable overall survival. However, prior studies were limited by imbalances in key prognostic factors and the absence of longitudinal olfactory assessments to evaluate treatment-related neurotoxicity. The aim of the study is to determine whether olfactory function serves as an independent prognostic marker for survival, neurocognitive outcomes, and quality of life in glioblastoma.

Methods: Prospective, multicenter cohort study enrolling 64 glioblastoma patients and 64 matched healthy controls. Patients are stratified by extent of resection, O6-Methylguanine-DNA Methyltransferase promoter methylation, radiographic involvement of olfactory regions, baseline olfactory status, age, and Karnofsky performance status. Olfactory function is assessed serially using Sniffin' Sticks (identification and threshold tests) from diagnosis through treatment. Coronal T2- and T1-weighted MRI scans are reviewed independently by two blinded neuroradiologists to detect olfactory region involvement. Neurocognitive testing, psychosocial screening, and quality of life assessments are conducted at defined intervals. Next-generation sequencing from tumor tissue is employed to explore molecular underpinnings of hyposmia. Blood samples are collected in every study visit for potential parallel translational studies.

Perspective: This is the first longitudinal study evaluating olfactory function as a prognostic biomarker in glioblastoma. Findings may inform risk stratification, guide neuroprotective strategies, and improve survivorship care.

Trial registration: ClinicalTrials.gov, NCT06954636, date of registration 04-16-2025 (retrospectively registered); https://clinicaltrials.gov/study/NCT06954636?cond=glioblastoma&intr=olfactory&rank=1 .

Background: In randomized controlled trials, add-on cannabidiol (CBD) has been shown to reduce seizure frequency in patients with Lennox-Gastaut syndrome, Dravet syndrome and Tuberous sclerosis complex. Real-world studies provide insights into the drug's profile in other off-label indications. This study evaluated factors predicting efficacy, retention, and tolerability of add-on CBD used for off-label treatment in clinical practice for patients with refractory focal-onset, genetic generalised, and other unclassified epilepsies.

Methods: A retrospective cohort study recruiting all patients who had started CBD between 2019 and 2023 for off-label treatment at six German epilepsy centres. Data on baseline and follow-up were obtained from patients' medical records.

Results: A total of 108 patients (mean age 27.3; median 36; range 1.4-68 years, 56 male) were treated with CBD. At three months, 42 (38.9% considering all 108 patients that started CBD) reported at least a 50% reduction in seizures, including 28 patients (25.9%) with a 50-74% reduction, and 14 (13%) with a reduction of 75-99%. Among those 48 patients experiencing tonic-clonic seizures (TCS), at least 50% response was reported by 45.8%, and eight (16.7%) patients were free of TCS. Sex, age, epilepsy syndrome, concomitant clobazam (CLB) use, and the number of concomitant or previous ASMs were not predictive of response. Mean seizure days per month significantly decreased from a mean of 16.8 (median: 13.5) to 14.5 (median 10, p = 0.002). The probability of patients remaining on CBD treatment was 85.2% (n = 92/108, 16 discontinuations) at three months, 73.5% at six months and 61.1% at twelve months; retention was better in children or adolescents compared to adults (log-rank p = 0.014). Using the CGI-C for overall impression, 69 (63.0%) patients were rated as very much, much, or minimally improved; for behaviour, 60 (55.6%) reported within this range of improvement. TEAEs were reported in 41 (38%) patients. The most frequent were diarrhoea (n = 15), sedation (n = 13), and nausea and vomiting (n = 7).

Conclusions: Our results suggest CBD to be an effective ASM, with 50% responder rates similar to those observed in regulatory trials for other ASMs licensed in focal epilepsies. Its off-label use in refractory focal-onset, genetic generalised, and other unclassified epilepsies seems to be safe and well-tolerated.

Background: Ischemic stroke (IS) and retinal ischemia (IR) share similar vascular risk factors, but differ in their risk for subsequent or recurrent stroke and therapeutic options. This study characterizes the cardiovascular risk profiles and magnitude of atherosclerosis of the carotid artery of patients with central retinal artery occlusion (CRAO) in relation to the presence of the retrobulbar "spot sign" on orbital color-coded sonography (OCCS).

Methods: We performed a retrospective analysis on the detailed cardiovascular risk factors and neuroimaging data in patients with IR presenting between 2009 and 2023. Based on OCCS findings, CRAO were further divided into hyperechoic ("spot sign positive", ssCRAO) or hypoechoic CRAO (heCRAO). Statistical analyses were performed with Mann-Whitney-U and χ [2] testing. P-values were considered significant if < 0.05.

Results: Overall, 112 patients were identified (heCRAO: n = 32; ssCRAO: n = 80). ssCRAO patients were significantly older (median 74 years vs. 66.5 years, Mann-Whitney-U: p-value < 0.001). Overall, 15/103 (14.6%) patients had concurrent acute ischemic stroke- 9 in the ipsilateral internal carotid territory, 2 in other territories and 4 disseminated. Further significant differences were found regarding the echogenicity of atherosclerosis (AS) in the two subgroups with (mainly) echorich AS being more common in the ssCRAO group (p-value < 0.001, n = 108) and the distribution of high-grade vs. low-grade stenoses of the ipsi- and contralateral carotid artery (p-value < 0.05, n = 99). 20 out of 112 patients had atrial fibrillation (aFib) with 17 of these being on ongoing oral anticoagulation.

Conclusion: According to this study, atherosclerosis may be one of the most important risk factors for IR while a specific embolic source could not be demonstrated (i.e. acute plaque rupture). By contrast, current oral anticoagulation for aFib in CRAO patients was high, thus only an incidental finding and may be an incidental finding due to its prevalence in the elderly. Furthermore, we were able to distinguish two subgroups of IR that differ in risk factors and most likely also in etiology, therapy and prognosis. The study underlines the importance of OCCS to detect "spot signs" in IR with indications for both, acute thrombolysis and secondary prevention.