Acta Neurologica Scandinavica[JOURNAL]
Sun
200 papers
Ethical issues in stroke thrombolysis revisited.
Appelros P, Svensson E, Heidenreich K … +1 more , Svantesson M
Acta Neurol Scand · 2021 Dec · PMID 34725820 · Publisher ↗
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Repeated infusion of autologous adipose tissue-derived stem cells for Parkinson's disease.
Shigematsu K, Komori N, Tahara K … +1 more , Yamagishi H
Acta Neurol Scand · 2022 Jan · PMID 34716582 · Publisher ↗
BACKGROUND: Mesenchymal stem cells are expected to have a therapeutic effect on progressive neurodegenerative diseases for which there is currently no fundamental treatment. AIMS OF THE STUDY: The aim is to confirm that...
BACKGROUND: Mesenchymal stem cells are expected to have a therapeutic effect on progressive neurodegenerative diseases for which there is currently no fundamental treatment. AIMS OF THE STUDY: The aim is to confirm that repeated infusion of autologous adipose tissue-derived stem cells (ADSCs) can be safely administered to patients with Parkinson's disease, and to investigate the effects of this as a pilot study. METHODS: Three patients with Parkinson's disease received five or six repeated infusions of ADSCs at intervals of approximately one month. Observations were based on medical examinations by a neurologist and interviews with the patient and caregivers. The severity of Parkinson's disease was assessed using the Hoehn & Yahr staging scale and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS: No adverse events were observed during the observation period from the start of treatment to six months after the end of the last dose. MDS-UPDRS improved in all three patients. CONCLUSIONS: Repeated administration of Autologous ADSCs for Parkinson's disease was safe and feasible. The results of this pilot study provide insight into the value of further research.
Third Ventricle Volume Predicts Functional Outcome in Chronic Subdural Hematoma.
Martinez-Perez R, Kortz MW, Ung TH … +3 more , Rayo N, Lagares A, Cepeda S
Acta Neurol Scand · 2022 Feb · PMID 34716574 · Publisher ↗
OBJECTIVES: There is a lack of evidence demonstrating the utility of computed tomography (CT) to predict chronic subdural hematoma (CSDH) clinical outcomes. We aim to analyze the role of tomographic volumetric analysis i...
OBJECTIVES: There is a lack of evidence demonstrating the utility of computed tomography (CT) to predict chronic subdural hematoma (CSDH) clinical outcomes. We aim to analyze the role of tomographic volumetric analysis in patients with CSDH. METHODS: We performed a retrospective study of patients undergoing burr-hole craniostomy (BHC) for CSDH over five years at a tertiary care center. Degree of midline shift, radiographic density, subdural hematoma volume, acute blood volume, and third ventricle (3VV) and fourth ventricle (4VV) volume were estimated using semiautomatic segmentation of preoperative CT. Postoperative functional outcome was measured by two endpoints: National Institute of Health Stroke Scale (NIHSS) at discharge and short-term modified Rankin Scale (mRS) at 6-week follow-up. Univariate and multivariate analyses were performed using nonparametric tests. Discriminative capacity and optimal thresholds of independent variables were calculated by means of receiving-operative curves (ROC). RESULTS: A total of 79 patients were included for analysis with a median age of 78.5 years. Greater preoperative 3VV independently correlated with poor discharge NIHSS (p = .01) and short-term mRS (p = .03). A cutoff value of 0.545 mL demonstrated the highest sensitivity (77.1%) and specificity (88.8%) with an odds ratio for an mRS functional dependence of 9.29 (p = .001). CONCLUSIONS: Greater preoperative tomographic 3VV independently prognosticates poor discharge NIHSS and 6-week mRS. A threshold 3VV of 0.545 mL can be used to identify patients at higher risk of being dependent at first protocolized follow-up.
Caffeinated drinks, fruit juices, and epilepsy: A systematic review.
Asadi-Pooya AA, Zeraatpisheh Z, Rostaminejad M … +1 more , Damabi NM
Acta Neurol Scand · 2022 Feb · PMID 34694642 · Publisher ↗
The aim of this systematic review was to provide the required information regarding different aspects of the relationship between epilepsy/antiseizure medications and non-alcoholic drinks. The recommendations of the Pref...
The aim of this systematic review was to provide the required information regarding different aspects of the relationship between epilepsy/antiseizure medications and non-alcoholic drinks. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. MEDLINE and Scopus from the inception until 7 August 2021 were systematically searched. These key words were used: "epilepsy" OR "seizure" OR "antiepileptic" OR "antiseizure" OR "anticonvulsant" AND "coffee" OR "tea" OR "soda" OR "juice" OR "drink" OR "cola" OR "diet" (35 key word combinations). The primary search yielded 21 458 publications (PubMed, n = 4778; Scopus, n = 16 680). Only 50 studies met all the inclusion criteria and were included in the current systematic review. In total, 17 articles investigated various non-alcoholic drinks in human studies, 11 studies were case reports/series, and 22 articles were animal/in vitro studies. None of the studies provided a class 1 of evidence. There is limited evidence suggesting that certain drinks (eg, caffeinated energy drinks) might trigger seizures. Patients with epilepsy should avoid excessive consumption of certain fruit juices (eg, grapefruit, lime, pomegranate, kinnow, and star fruit) and caffeinated drinks. However, daily coffee and tea intake can be part of a healthy balanced diet, and their consumption does not need to be stopped in patients with epilepsy. Coffee/tea consumption is not harmful if consumed at levels of 200 mg (caffeine) in one sitting (about 2½ cups of coffee) or 400 mg daily (about five cups of coffee).
Myelin-associated oligodendrocyte basic protein rs616147 polymorphism as a risk factor for Parkinson's disease.
Siokas V, Aloizou AM, Liampas I … +7 more , Bakirtzis C, Tsouris Z, Sgantzos M, Liakos P, Bogdanos DP, Hadjigeorgiou GM, Dardiotis E
Acta Neurol Scand · 2022 Feb · PMID 34694630 · Publisher ↗
BACKGROUND: The rs616147 polymorphism of the myelin-associated oligodendrocyte basic protein (MOBP) gene locus has been associated with amyotrophic lateral sclerosis (ALS). ALS and Parkinson's disease (PD) are two common...
BACKGROUND: The rs616147 polymorphism of the myelin-associated oligodendrocyte basic protein (MOBP) gene locus has been associated with amyotrophic lateral sclerosis (ALS). ALS and Parkinson's disease (PD) are two common neurodegenerative disorders that share features regarding their etiology, pathophysiology, and genetic backgrounds. While the MOBP rs616147 polymorphism has been associated with ALS, little is known about its role in PD. OBJECTIVE: To assess the role of MOBP rs616147 on PD risk. METHODS: This case-control comparison study consists of 358 PD-affected cases and 358 controls from the Neurology Clinic of the University Hospital of Larissa, University of Thessaly, Faculty of Medicine, in Greece. The diagnosis of PD was made by a specialist neurologist according to the UK Parkinson's Disease Society Brain Bank's clinical criteria. All the participants were genotyped for the MOBP rs616147. Furthermore, in order to validate our results, we genotyped 327 patients with Alzheimer's disease (AD) for MOBP rs616147 and compared them with the control group. RESULTS: According to the univariate analysis, there was a significant association between rs616147 and PD in the dominant (OR [95% C.I.] = 0.70 [0.52-0.94], p = .018), the overdominant (OR [95% C.I.] = 0.68 [0.50-0.92], p = .011), and in the codominant (G/A VS G/G; OR [95% C.I.] = 0.66 [0.48-0.91], p = .035) modes of inheritance. In contrast, there was no association between the MOBP rs616147 polymorphism and AD. CONCLUSIONS: We provide preliminary results associating MOBP rs616147 genetic variant with PD.
Interictal brain activity changes in temporal lobe epilepsy: A quantitative electroencephalogram analysis.
Fonseca E, Quintana M, Seijo-Raposo I … +5 more , Ortiz de Zárate Z, Abraira L, Santamarina E, Álvarez-Sabin J, Toledo M
Acta Neurol Scand · 2022 Feb · PMID 34687043 · Publisher ↗
OBJECTIVES: To evaluate the usefulness of quantitative electroencephalography (qEEG) in the analysis of baseline activity in patients with temporal lobe epilepsy (TLE) and identify measures potentially associated with di...
OBJECTIVES: To evaluate the usefulness of quantitative electroencephalography (qEEG) in the analysis of baseline activity in patients with temporal lobe epilepsy (TLE) and identify measures potentially associated with disease duration and drug resistance. MATERIALS AND METHODS: Cross-sectional study of adult patients with TLE and controls who underwent video-EEG monitoring. Representative artifact-free resting wakefulness baseline EEG segments were selected for quantitative analysis. The fast Fourier transform (FFT) approach was used for the power spectral analysis, with computation of FFT power ratios and alpha-delta and alpha-theta ratios for both hemispheres. The resulting measures were compared between TLE patients and controls and their values as predictors of epilepsy duration and drug resistance analyzed. RESULTS: Thirty-nine TLE patients and 23 controls were included. The TLE patients had a lower alpha-delta ratio in the posterior quadrant ipsilateral to the epileptic focus and a lower alpha-theta ratio in the ipsilateral anterior/posterior quadrants and temporal region. A younger age at onset and longer epilepsy duration correlated with a higher theta power ratio in the contralateral anterior and posterior quadrants and temporal region. No qEEG measures predicted drug resistance. CONCLUSIONS: Quantitative electroencephalography background activity may contribute to the diagnosis of TLE and provide useful information on disease duration. A lower alpha-delta and alpha-theta ratio may be reliable baseline qEEG measures for identifying patients with TLE. A higher contralateral theta power ratio may be indicative of longer epilepsy duration.
Efficacy of high-intensity aerobic exercise on common multiple sclerosis symptoms.
Langeskov-Christensen M, Hvid LG, Jensen HB … +4 more , Nielsen HH, Petersen T, Stenager E, Dalgas U
Acta Neurol Scand · 2022 Feb · PMID 34687036 · Publisher ↗
OBJECTIVES: Fatigue and walking impairment are disabling symptoms of multiple sclerosis (MS). We investigated the effects of progressive aerobic exercise (PAE) on fatigue, walking, cardiorespiratory fitness (VO max), and...
OBJECTIVES: Fatigue and walking impairment are disabling symptoms of multiple sclerosis (MS). We investigated the effects of progressive aerobic exercise (PAE) on fatigue, walking, cardiorespiratory fitness (VO max), and quality of life in people with MS (pwMS). MATERIALS & METHODS: Randomized controlled trial (1:1 ratio, stratified by sex) with a 24-week crossover follow-up and intention-to-treat analysis. Allocation to an exercise (24 weeks of PAE followed by self-guided physical activity) and a waitlist (24 weeks of habitual lifestyle followed by PAE) group. PAE comprised two supervised sessions per week; 30-60 min, 65-95% of maximum heart rate. Fatigue impact (Modified Fatigue Impact Scale; MFIS) and severity (Fatigue Severity Scale; FSS), walking ability (12-item MS Walking Scale; MSWS-12) and capacity (Six-Minute Walk Test; 6MWT, Six Spot Step Test; SSST), quality of life (Short Form 36 health survey; SF-36), and VO max were measured at baseline, 24 weeks, and 48 weeks. RESULTS: Eighty-six pwMS were enrolled. Following PAE between-group differences showed reductions in MFIS (-5.3 [95% CI: -10.9;0.4], point estimate >clinical relevance), MFIS subscore (-2.8 [-5.6;-0.1]), and MFIS subscore (-0.9 [-1.6;-0.2]), and an increase in VO max (+3.5 ml O /min/kg [2.0;5.1]). MSWS-12 (-5.9 [-11.9; 0.2]) and 6MWT (+14 m [-5;33]) differences suggested potential small walking improvements. No changes observed in FSS, SSST, or SF-36. CONCLUSIONS: In a representative sample of pwMS, PAE induced a clinically relevant reduction in fatigue impact, whereas small and no effects were seen for walking and quality of life, respectively. The results need confirmation in a future trial due to the study limitations.
Machine learning analysis of heart rate variability to detect delayed cerebral ischemia in subarachnoid hemorrhage.
Odenstedt Hergès H, Vithal R, El-Merhi A … +3 more , Naredi S, Staron M, Block L
Acta Neurol Scand · 2022 Feb · PMID 34677832 · Publisher ↗
OBJECTIVES: Approximately 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) develop delayed cerebral ischemia (DCI). DCI is associated with increased mortality and persistent neurological deficits. This stud...
OBJECTIVES: Approximately 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) develop delayed cerebral ischemia (DCI). DCI is associated with increased mortality and persistent neurological deficits. This study aimed to analyze heart rate variability (HRV) data from patients with aSAH using machine learning to evaluate whether specific patterns could be found in patients developing DCI. MATERIAL & METHODS: This is an extended, in-depth analysis of all HRV data from a previous study wherein HRV data were collected prospectively from a cohort of 64 patients with aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, from 2015 to 2016. The method used for analyzing HRV is based on several data processing steps combined with the random forest supervised machine learning algorithm. RESULTS: HRV data were available in 55 patients, but since data quality was significantly low in 19 patients, these were excluded. Twelve patients developed DCI. The machine learning process identified 71% of all DCI cases. However, the results also demonstrated a tendency to identify DCI in non-DCI patients, resulting in a specificity of 57%. CONCLUSIONS: These data suggest that machine learning applied to HRV data might help identify patients with DCI in the future; however, whereas the sensitivity in the present study was acceptable, the specificity was low. Possible confounders such as severity of illness and therapy may have affected the result. Future studies should focus on developing a robust method for detecting DCI using real-time HRV data and explore the limits of this technology in terms of its reliability and accuracy.
Carotid intima-media thickness and risk of mild cognitive impairment: A systematic review and meta-analysis.
Nath M, Misra S, Nair P … +1 more , Kumar P
Acta Neurol Scand · 2022 Feb · PMID 34672362 · Publisher ↗
Mild cognitive impairment (MCI) is an early phase of cognitive decline signalling the beginning of severe neurological diseases. Carotid intima-media thickness (cIMT) has shown some correlation with MCI development. This...
Mild cognitive impairment (MCI) is an early phase of cognitive decline signalling the beginning of severe neurological diseases. Carotid intima-media thickness (cIMT) has shown some correlation with MCI development. This study was conducted to investigate the impact of elevated cIMT on the risk of MCI in adults. A literature search was conducted in PubMed, EMBASE, Cochrane Library, Scopus, Google Scholar and CINAHL databases till 30 July 2021, with keywords: ('Carotid Intima-Media Thickness' OR 'cIMT' OR 'IMT' AND 'Cognitive Impairment' OR 'Cognition' OR 'Cognitive Decline' AND 'Mild Cognitive Impairment' OR 'MCI'). Pooled standardized mean difference (SMD)/odds ratio (OR) and 95% confidence interval (CI) were determined for factor-disease association using either fixed (when I <50%) or random effect (when I >50%) models. Eight studies involving 1,585 MCI cases and 6,700 normal subjects were included in our meta-analysis which showed no significant association of increased cIMT with the risk of MCI [SMD 1.17, 95% CI -0.09 to 2.42]. However, sensitivity analysis revealed an outlier study significantly affecting the effect size. On omitting the outlier study, the re-evaluated meta-analysis revealed a significant association of cIMT with the risk of MCI [SMD 0.52, 95% CI 0.26 to 0.78]. This significant association was also observed during subgroup analysis in Caucasian population [SMD 0.65, 95% CI 0.13 to 1.18] but not in Asian population [SMD 0.39, 95% CI -0.01 to 0.79]. Elevated cIMT poses a potential risk for MCI. However, more population-based studies are required to corroborate these findings.
Cognitive change after DBS in refractory epilepsy: A randomized-controlled trial.
Heminghyt E, Herrman H, Skogan AH … +5 more , Konglund A, Egge A, Lossius M, Dietrichs E, Taubøll E
Acta Neurol Scand · 2022 Jan · PMID 34658033 · Publisher ↗
OBJECTIVES: Deep brain stimulation of the anterior thalamic nucleus (ANT-DBS) reduces seizure frequency in patients with refractory epilepsy. There are, however, few studies on treatment-related changes in cognitive func...
OBJECTIVES: Deep brain stimulation of the anterior thalamic nucleus (ANT-DBS) reduces seizure frequency in patients with refractory epilepsy. There are, however, few studies on treatment-related changes in cognitive functions. The main objective of this study was to investigate cognitive changes in patients receiving ANT-DBS. We also explored whether possible effects were related to stimulation duration and whether change in seizure frequency was associated with cognitive changes. MATERIALS AND METHODS: Bilateral ANT electrodes were implanted in 18 patients with refractory epilepsy, aged 18-52 years. Immediately after implantation, patients were randomized to stimulation ON (n = 8) or OFF (n = 10) for the first 6 months (blinded phase). During the following 6-month open phase, both groups received stimulation. Neuropsychological assessments were conducted before implantation (T1), at the end of the blinded period (T2), and 1 year after implantation (T3). RESULTS: Groupwise comparisons across the three time points revealed changes in performance in two of 22 cognitive test scores: motor speed and sustained attention. We found no significant group differences in cognitive change from T1 to T2. Patients reported fewer symptoms of executive dysfunction after 12 months of stimulation. Patients showing significant improvement in seizure frequency had better performance in a measure of verbal learning. CONCLUSION: Our results indicate that ANT-DBS has very limited effects on cognitive functioning, as measured by formal tests after 6- or 12-month stimulation. ANT-DBS may have a positive influence on executive function. Our findings provide limited support for an association between change in seizure frequency and cognitive functioning.
Dynamic stability during gait in idiopathic normal pressure hydrocephalus and Parkinson's disease.
Nikaido Y, Okada Y, Urakami H … +6 more , Ishida N, Akisue T, Kawami Y, Kuroda K, Kajimoto Y, Saura R
Acta Neurol Scand · 2022 Feb · PMID 34633069 · Publisher ↗
OBJECTIVES: To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disea...
OBJECTIVES: To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disease severity in each disease. MATERIALS AND METHODS: The 5-m gait of 36 iNPH (precerebrospinal fluid drainage), 20 PD (medicated state), and 25 healthy controls (HC) were evaluated using three-dimensional motion analysis. Ambulatory dynamic stability was defined as the ability to maintain the extrapolated center of mass within the base of support at heel contact, with the distance between the two referred to as the margin of stability (MOS). RESULTS: Anteroposterior direction (AP) MOS was significantly larger in the iNPH and PD groups than in the HC group; no significant difference was found between the iNPH and PD groups. Mediolateral direction (ML) MOS was significantly larger in the iNPH and PD groups than in the HC group and significantly larger in the iNPH group than in the PD group. In the iNPH group, the disease severity was positively correlated with only ML MOS. In the PD group, the disease severity was positively correlated with the AP MOS and ML MOS. CONCLUSIONS: Dynamic stability in iNPH increases in AP and ML, and it may be associated with not only iNPH-associated gait disturbance but also with a voluntarily cautious gait strategy. Dynamic stability in PD only increased in AP, and this may be associated with PD symptoms. These findings will help physicians understand the difference in pathological gait including dynamic stability between patients with iNPH and PD.
Brain networks in migraine with and without aura: An exploratory arterial spin labeling MRI study.
Park S, Lee DA, Lee HJ … +2 more , Shin KJ, Park KM
Acta Neurol Scand · 2022 Feb · PMID 34633068 · Publisher ↗
OBJECTIVES: The aim of this exploratory study was to investigate the underlying pathomechanisms of migraine with aura (MA) and migraine without aura (MO) in the interictal phase using a connectivity analysis. METHODS: We...
OBJECTIVES: The aim of this exploratory study was to investigate the underlying pathomechanisms of migraine with aura (MA) and migraine without aura (MO) in the interictal phase using a connectivity analysis. METHODS: We prospectively enrolled patients who were newly diagnosed with migraine. All patients underwent brain MRI, including diffusion tensor imaging and arterial spin labeling perfusion MRI. We analyzed the differences between patients with MA and those with MO in structural connectivity based on diffusion tensor imaging and functional connectivity based on arterial spin labeling perfusion MRI using a graph theoretical analysis. RESULTS: We enrolled 58 patients with migraine (11 patients with MA and 47 patients with MO). There were no differences between patients with MA and those with MO in the network measures of global structural connectivity. However, differences in global functional connectivity were found between the two groups. The assortative coefficient was lower in patients with MA than in those with MO (-0.050 vs. -0.012, p = .017). There were no differences in local structural and functional connectivity between patients with MA and those with MO. CONCLUSION: We found differences in global functional connectivity between patients with MO and those with MA. The study of MA and MO using a connectivity analysis may shed light on migraine pathophysiology. We suggest it is worthwhile to investigate if changes in functional connectivity may serve as novel biomarkers in MA. In this regard, ASL MRI appears to be valuable in the context of network analysis, but further studies are needed to confirm our findings.
Narcolepsy treatment in Sweden: An observational study.
Gauffin H, Fast T, Komkova A … +3 more , Berntsson S, Boström I, Landtblom AM
Acta Neurol Scand · 2022 Feb · PMID 34611886 · Publisher ↗
OBJECTIVES: To describe the pharmacological treatments (2005-2017) and the healthcare utilization (1997-2016) for patients with narcolepsy in Sweden in order to create a framework for future organizational and economic a...
OBJECTIVES: To describe the pharmacological treatments (2005-2017) and the healthcare utilization (1997-2016) for patients with narcolepsy in Sweden in order to create a framework for future organizational and economic analyses. MATERIAL & METHODS: Patients of all ages with a diagnosis of narcolepsy registered in the National Patient Registry in specialist care in Sweden were included and information on treatments for narcolepsy was retrieved from The Swedish Prescribed Drug Register. RESULTS: We collected 2508 patients with narcolepsy, 43,3% men and 56,7% women and 47,9% were prescribed modafenil, 33,8% metylphenidate and 26,2% amphetamine. In total, 3817 treatments were initiated. Patients treated with amphetamine had a higher mean age. More women than men used modafinil, methylphenidate, amphetamine and antidepressants. The narcolepsy population had more outpatient than inpatient healthcare. Patients treated with sodium oxybate had more outpatient visits than other narcolepsy patients, before and during treatment (p = .00). CONCLUSIONS: This study gives valuable information on pharmaceutical treatments and healthcare utilization for patients with narcolepsy and can be used to estimate the healthcare cost in the future. Patients with sodium oxybate treatment had more outpatient visits than other patients before and during treatment which may be due to the need to monitor potentially severe side-effects or may indicate that patients with sodium oxybate treatment have a severe disease. The number of included patients was less than expected; however, this may depend on patients escaping our collection of data, which does not contain information from primary care.
Stroke admissions and revascularization treatments in Denmark during COVID-19.
Drenck N, Grundtvig J, Christensen T … +5 more , Iversen HK, Kruuse C, Truelsen T, Wienecke T, Christensen H
Acta Neurol Scand · 2022 Feb · PMID 34605006 · Full text
OBJECTIVE: The aim of this study was to assess the number of stroke-related admissions and acute treatments during the first two waves of COVID-19 and lockdowns in the Capital Region of Denmark and the Region of Zealand....
OBJECTIVE: The aim of this study was to assess the number of stroke-related admissions and acute treatments during the first two waves of COVID-19 and lockdowns in the Capital Region of Denmark and the Region of Zealand. MATERIALS & METHODS: The weekly numbers of admitted patients with stroke were retrieved from electronic patient records from January 2019 to February 2021 and analysed to reveal potential fluctuations in patient volumes during the pandemic. RESULTS: A total of 23,688 patients were included, of whom 2049 patients were treated with tissue-type plasminogen activators (tPA) and 552 underwent endovascular thrombectomy (EVT). We found a transient decrease in the number of weekly admitted patients (pts/week) with all strokes (-9.8 pts/week, 95% CI: -19.4; -0.2, p = .046) and stroke mimics (-30.1 pts/week, 95% CI: -39.9; -20.3, p < .001) during the first lockdown compared to pre-COVID-19. The number of subarachnoid haemorrhage, intracerebral haemorrhage, and ischaemic stroke admissions showed insignificant declines. Analysing all COVID-19 periods collectively revealed increased volumes of ischaemic stroke (+6.2 pts/week, 95% CI: +1.6; +10.7, p = .009) compared to pre-COVID levels, while numbers of stroke mimics remained lower than pre-COVID. Weekly tPA and EVT treatments remained constant throughout the study period. CONCLUSIONS: Our results are comparable with other studies in finding reductions in stroke-related admissions early in the pandemic. This is the first study to report increased stroke volumes following the first wave of the pandemic. The mechanisms behind the observed drop and subsequent rise in strokes are unclear and warrant further investigation.
1H-MRS reveals metabolic alterations in generalized tonic-clonic seizures before and after treatment.
Wan X, Liu L, Wang W … +6 more , Tan Q, Su X, Zhang S, Yang X, Yue Q, Gong Q
Acta Neurol Scand · 2022 Feb · PMID 34595746 · Publisher ↗
AIMS: To explore the possible metabolic alterations of bilateral dorsolateral prefrontal cortices (DLPFC) of generalized tonic-clonic seizures (GTCS) patients before and after antiepileptic drugs treatment as compared wi...
AIMS: To explore the possible metabolic alterations of bilateral dorsolateral prefrontal cortices (DLPFC) of generalized tonic-clonic seizures (GTCS) patients before and after antiepileptic drugs treatment as compared with healthy controls (HCs) using proton magnetic resonance spectroscopy (1H-MRS). METHODS: We included 23 newly diagnosed and unmedicated GTCS patients and 23 sex- and age-matched HCs. Metabolites including N-acetyl aspartate (NAA), myo-inositol (Ins), choline (Cho), creatine (Cr), and glutamate + glutamine (Glu + Gln, Glx) concentrations were quantified by using LCModel software and then corrected for the partial volume effect of cerebrospinal fluid. RESULTS: The results demonstrated that metabolite concentrations were not equal between the left and the right DLPFC. Compared with HC, NAA of the left DLPFC and Cr of the right DLPFC were significantly lower in pre-treatment patients. Self-controlled study revealed that the patients' NAA of the left DLPFC increased while their Cr of the right DLPFC decreased after treatment. Correlation analysis showed a negative correlation between the duration of medication and the pre- and post-treatment difference of Cr. CONCLUSION: These findings may shed a light on the metabolic mechanism of GTCS and the neurobiochemical mechanisms of AEDs.
Treatment of occipital neuralgia using onabotulinum toxin A.
Marcolla IMG, Camargo CHF, Coutinho L … +4 more , Ferreira MG, Tiburtino Meira A, Piovesan EJ, Ghizoni Teive HA
Acta Neurol Scand · 2022 Feb · PMID 34542909 · Publisher ↗
OBJECTIVES: To determine the effectiveness of botulinum toxin in a sample of patients diagnosed with greater occipital nerve neuralgia. MATERIAL AND METHODS: Twenty-nine patients (28 females, 1 male) were treated for gre...
OBJECTIVES: To determine the effectiveness of botulinum toxin in a sample of patients diagnosed with greater occipital nerve neuralgia. MATERIAL AND METHODS: Twenty-nine patients (28 females, 1 male) were treated for greater occipital nerve neuralgia with onabotulinum toxin type A; the Visual Analog Pain Scale was used to determine pain severity at treatment and again 12 weeks after application. RESULTS: Average doses of onabotulinum toxin type A of 18.66±6.44 U per nerve and 35.96±12.89 U per patient were utilized. Average pain severity among the sample was 9.81±0.89 prior to botulinum toxin application and 3.68±2.31 points (p<0.0001) twelve weeks after application. Pain frequency decreased from 29.93±0.37 to 12.17±11.05 days with pain per month (p<0.0001). Six patients reported absence of pain after application (p=0.023). Dose did not correlate with the degree of clinical response observed, and no side effects were reported. CONCLUSION: Our findings suggest onabotulinum toxin type A is a safe and effective treatment alternative for patients suffering from refractory greater occipital nerve neuralgia.
Meta-analysis of association between migraine and risk of dementia.
Wang L, Wu JC, Wang FY … +2 more , Chen X, Wang Y
Acta Neurol Scand · 2022 Jan · PMID 34523724 · Publisher ↗
OBJECTIVES: The association between migraine and dementia has rarely been investigated, and available results are conflicting. Thus, the aim of this meta-analysis was to evaluate whether an association exists between mig...
OBJECTIVES: The association between migraine and dementia has rarely been investigated, and available results are conflicting. Thus, the aim of this meta-analysis was to evaluate whether an association exists between migraine and dementia. MATERIALS & METHODS: We searched for cohort studies from databases including PubMed, EBSCO, Web of Science, and EMBASE database from inception to April 1, 2021, using subject and free words. RevMan 5.1 software was used to calculate the risk ratio (RR) of dementia in patients with migraine. Subgroup and sensitivity analyses were conducted to assess the source of heterogeneity. A random-effects model was used when heterogeneity was present. The Funnel plot and Egger's test were used to evaluate publication bias. RESULTS: Five published cohort studies covering a total of 249,303 individuals were identified. Pooled analysis showed that migraine was associated with increased risk of all-cause dementia (RR: 1.34, 95% CI: 1.13-1.59) and Alzheimer's disease (AD) (RR: 2.49, 95% CI: 1.16-5.32). However, we did not found any association between migraine and risk of vascular dementia (VaD) (RR: 1.51, 95% CI: 0.77-2.96). CONCLUSIONS: Our results revealed that migraine was a potential risk indicator for AD and all-cause dementia.
The impact of a Danish stroke campaign: A cross-sectional study.
Bull Iversen A, Paaske Johnsen S, Christensen B … +2 more , Bondo Christensen M, Andersen G
Acta Neurol Scand · 2022 Jan · PMID 34523120 · Publisher ↗
OBJECTIVES: To investigate the impact of the Danish stroke campaign, 1 year after initiation. MATERIALS & METHODS: The campaign ran in various media during 2019-2020. We performed a two-centre, repeated cross-sectional s...
OBJECTIVES: To investigate the impact of the Danish stroke campaign, 1 year after initiation. MATERIALS & METHODS: The campaign ran in various media during 2019-2020. We performed a two-centre, repeated cross-sectional study in 2018 (before campaign) and again in 2020 based on data from structured interviews of patients and bystanders, medical records and the Danish Stroke Registry. Primary outcomes were patient delay and system delay. Patient delay is defined as the time from symptom onset until the first contact to a healthcare professional, whereas system delay is the time from this contact until arrival at the stroke centre. Secondary outcomes were primary emergency medical services (EMS) contact, arrival at a stroke centre within 3 h of symptom onset, initiation of reperfusion therapy and knowledge of ≥2 core symptoms of stroke. RESULTS: We included 852 patients with stroke or transient ischemic attack. Patient delay and system delay were a median of 166 min and 96 min before the campaign and were non-significantly reduced by 16 min (95% CI -128 to 97) and 7 min (95% CI -21 to 6) in the second period. We found no significant differences in the clinical outcomes. The knowledge of ≥2 core symptoms increased from 22% to 30% (OR 1.63; 95% CI 1.15 to 2.30) in patients and from 53% to 65% (OR 1.81; 95% CI 1.24 to 2.64) in bystanders. CONCLUSION: Patient delay, system delay and clinical outcomes remained relatively unchanged. However, the knowledge of core symptoms had improved 1 year after campaign initiation.
Initial cognitive impairment predicts shorter survival of patients with glioblastoma.
Bruhn H, Blystad I, Milos P … +5 more , Malmström A, Dahle C, Vrethem M, Henriksson R, Lind J
Acta Neurol Scand · 2022 Jan · PMID 34514585 · Publisher ↗
OBJECTIVES: Seizures as presenting symptom of glioblastoma (GBM) are known to predict prolonged survival, whereas the clinical impact of other initial symptoms is less known. Our main objective was to evaluate the influe...
OBJECTIVES: Seizures as presenting symptom of glioblastoma (GBM) are known to predict prolonged survival, whereas the clinical impact of other initial symptoms is less known. Our main objective was to evaluate the influence of different presenting symptoms on survival in a clinical setting. We also assessed lead times, tumour size and localization. METHODS: Medical records of 189 GBM patients were reviewed regarding the first medical appointment, presenting symptom/s, date of diagnostic radiology and survival. Tumour size, localization and treatment data were retrieved. Overall survival was calculated using Kaplan-Meier and Mann-Whitney U test. Cox regression was used for risk estimation. RESULTS: Cognitive impairment as the initial symptom was often misinterpreted in primary health care leading to a delayed diagnosis. Initial global symptoms (66% of all patients) were associated with reduced survival compared to no global symptoms (median 8.4 months vs. 12.6 months). Those with the most common cognitive dysfunctions: change of behaviour, memory impairment and/or disorientation had a reduced median survival to 6.4 months. In contrast, seizures (32%) were associated with longer survival (median 11.2 months vs. 8.3 months). Global symptoms were associated with larger tumours than seizures, but tumour size had no linear association with survival. The setting of the first medical appointment was evenly distributed between primary health care and emergency units. CONCLUSION: Patients with GBM presenting with cognitive symptoms are challenging to identify, have larger tumours and reduced survival. In contrast, epileptic seizures as the first symptom are associated with longer survival and smaller tumours.
Stroke Mimics on the Stroke Unit - Temporal trends 2008-2017 at a large Norwegian university hospital.
Barra M, Faiz KW, Dahl FA … +1 more , Naess H
Acta Neurol Scand · 2021 Dec · PMID 34498731 · Publisher ↗
OBJECTIVES: The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital...
OBJECTIVES: The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). MATERIALS & METHODS: All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospital between 2008-2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age- and sex-dependent SM incidence. RESULTS: SMs were on average younger thaan CVA patients (68.3 vs. 71.4 years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p < 0.001), but this trend appears flattening, represented by a significant quadratic time-term, odds ratio 1.009 (p < 0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. CONCLUSIONS: SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age- and sex-dependent incidence of SM has been increasing but appears to flatten out.
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