Neurological research and practice最新文献

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.

Background: Comorbid autoimmune disorders, including rheumatoid arthritis (RA), are common in people with multiple sclerosis (MS). Both conditions share pathogenic similarities, enabling potential overlap in treatments. While numerous disease-modifying therapies (DMT) are approved for MS and new options are under clinical trial, their effectiveness in RA varies.

Main body: A PubMed literature review was conducted to evaluate the effects of approved and currently investigated MS-DMT on MS and RA and vice versa. Certain MS-DMT showed beneficial effects for RA, such as teriflunomide, anti-CD20 therapies, and cladribine, while others demonstrated no significant impact (type-I interferons, Bruton´s tyrosine kinase (BTK) inhibitors) or lacked trials (sphingosine-1-phosphate receptor modulators, glatiramer acetate). In contrast, BTK inhibitors were shown to be effective for inactive secondary progressive forms of MS, whereas secukinumab showed limited effects in relapsing MS. Concerning DMT for RA in MS, no significant benefit was observed for abatacept, and there are no trials for Janus kinase inhibitors, or interleukin-(IL)-6 receptor inhibitors (tocilizumab, sarilumab). Adverse events, including RA exacerbation, were reported for some MS-DMT like dimethyl fumarate, alemtuzumab, and natalizumab. Tumor necrosis factor alpha (TNFα) inhibitors increased disease activity in MS patients.

Conclusion: Among approved DMT for MS and RA, teriflunomide and anti-CD20 therapies are the most suitable options for moderately or highly active MS with comorbid RA. Cladribine may also be considered, while TNFα inhibitors are contraindicated.

Background: Although brain atrophy is a prevalent finding in Wilson disease (WD), its role as a contributing factor to clinical symptoms, especially cognitive decline, remains unclear. The objective of this study was to investigate different neuroimaging biomarkers related to grey matter atrophy and their relationship with neurological and cognitive impairment in WD.

Methods: In this study, 30 WD patients and 30 age- and sex-matched healthy controls were enrolled prospectively and underwent structural magnetic resonance imaging (MRI). Regional atrophy was evaluated using established linear radiological measurements and the automated workflow volumetric estimation of gross atrophy and brain age longitudinally (veganbagel) for age- and sex-specific estimations of regional brain volume changes. Brain Age Gap Estimate (BrainAGE), defined as the discrepancy between machine learning predicted brain age from structural MRI and chronological age, was assessed using an established model. Atrophy markers and clinical scores were compared between 19 WD patients with a neurological phenotype (neuro-WD), 11 WD patients with a hepatic phenotype (hep-WD), and a healthy control group using Welch's ANOVA or Kruskal-Wallis test. Correlations between atrophy markers and neurological and neuropsychological scores were investigated using Spearman's correlation coefficients.

Results: Patients with neuro-WD demonstrated increased third ventricle width and bicaudate index, along with significant striatal-thalamic atrophy patterns that correlated with global cognitive function, mental processing speed, and verbal memory. Median BrainAGE was significantly higher in patients with neuro-WD (8.97 years, interquartile range [IQR] = 5.62-15.73) compared to those with hep-WD (4.72 years, IQR = 0.00-5.48) and healthy controls (0.46 years, IQR = - 4.11-4.24). Striatal-thalamic atrophy and BrainAGE were significantly correlated with neurological symptom severity.

Conclusions: Our findings indicate advanced predicted brain age and substantial striatal-thalamic atrophy patterns in patients with neuro-WD, which serve as promising neuroimaging biomarkers for neurological and cognitive functions in treated, chronic WD.

Background: Acute stroke care has evolved markedly in recent decades, yet long-term trends across stroke subtypes remain understudied. This study analyzed national trends in inpatient stroke care for ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in Germany from 2000 to 2021.

Methods: We conducted a retrospective analysis of nationwide hospital administrative data, assessing annual case counts, age-standardized rates, mean length of stay, and annual inpatient case days (AICD). Stroke unit (SU) treatments were analyzed from 2005 onward. Joinpoint regression identified changes in trends over time.

Results: IS case rates, length of stay, and AICD declined significantly until 2005/2006, after which they stabilized at remarkably high levels. Paralleled by a rapid expansion of SU care, in-hospital mortality from IS decreased significantly. Coding of unspecified stroke (I64) declined steeply, suggesting shifts in diagnostic precision. In contrast, ICH and SAH showed falling case rates but increasing lengths of stay, particularly among deceased patients. SU treatments rose continuously from 2005 to 2021, with age-standardized rates increasing by 7.1% annually.

Conclusions: Over two decades, total inpatient burden from stroke has declined, primarily due to reductions in IS admissions and mortality. However, longer hospital stays in SAH and ICH and an overall rising SU care indicate shifting but consistently high resource requirements. Thus, continued efforts in optimizing healthcare infrastructure seem reasonable and should consider a subtype-specific resource allocation in acute stroke care.