A Prediction Rule for the Dystonic Spread of Blepharospasm: A 4-Year Prospective Cohort Study

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2024-07-10 DOI:10.1002/ana.27025

Ziwen Xing MM, Yue Hu MM, Fei Teng PhD, Yunping Song PhD, Zhuang Wu MD, Ronghua Hong MD, Zhuoyu Zhang PhD, Hongkai Gu MM, Kangwen Peng MM, Yijing He PhD, Yuhui Chen BM, Lizhen Pan MD, Lingjing Jin PhD

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引用次数: 0

Abstract

Objective

Blepharospasm (BSP), focal dystonia with the highest risk of spread, lacks clear understanding of early spreading risk factors and objective prognostic indicators. We aimed to identify these risk factors through clinical and electrophysiological assessments, and to establish a predictive model for dystonic spread in BSP.

Methods

We prospectively followed BSP patients for 4 years, collecting data on dystonic spread, and conducting electrophysiological evaluations. The blink reflex, masseter inhibitory reflex, and trigeminal somatosensory evoked potential were assessed. Univariable and multivariable Cox proportional hazard regression models were used to assess clinical characteristics associated with BSP dystonic spread. A predictive model was constructed using a nomogram, and performance of the model was evaluated using the area under the receiver operating characteristic curve.

Results

A total of 136 enrolled participants (mean age 56.34 years) completed a 4-year follow-up. Among them, 62 patients (45.6%) showed spread to other body regions. Multivariable Cox regression analysis showed that a high Hamilton Anxiety Scale score (hazard ratio 1.19, 95% confidence interval 1.13–1.25, p < 0.001), prolonged trigeminal somatosensory evoked potential mandibular branch P1-N2 peak interval (hazard ratio 1.11, 95% confidence interval 1.02–1.21, p = 0.017), and elevated trigeminal somatosensory evoked potential mandibular branch P1-N2 peak amplitude (hazard ratio 1.26, 95% confidence interval 1.12–1.41, p < 0.001) were independent risk factors for BSP dystonic spread within 4 years. Combining these factors, the predictive models demonstrated excellent discriminative ability, with the receiver operating characteristic curve score being 0.797, 0.790, 0.847, and 0.820 at 1, 2, 3 and 4 years after enrollment, respectively.

Interpretation

We established a predictive model with significant value for anticipating dystonic spread in BSP, offering crucial evidence. These findings contribute essential insights into the early clinical identification of the development and evolution of BSP diseases. ANN NEUROL 2024;96:747–757

查看原文本刊更多论文

眼睑痉挛肌张力扩散的预测规则：一项为期 4 年的前瞻性队列研究

目的：眼睑痉挛（BSP）是具有最高扩散风险的局灶性肌张力障碍，但对其早期扩散的风险因素和客观预后指标缺乏清晰的认识。我们旨在通过临床和电生理学评估确定这些风险因素，并建立 BSP 肌张力障碍扩散的预测模型：我们对 BSP 患者进行了为期 4 年的前瞻性随访，收集了肌张力扩散的数据，并进行了电生理评估。对眨眼反射、颌下抑制反射和三叉神经躯体感觉诱发电位进行了评估。采用单变量和多变量 Cox 比例危险回归模型评估与 BSP 肌张力障碍扩散相关的临床特征。使用提名图构建了一个预测模型，并使用接收器操作特征曲线下面积评估了该模型的性能：共有 136 名参与者（平均年龄 56.34 岁）完成了为期 4 年的随访。其中，62名患者（45.6%）的癌细胞扩散至身体其他部位。多变量考克斯回归分析显示，汉密尔顿焦虑量表评分高（危险比为 1.19，95% 置信区间为 1.13-1.25，p 解释：我们建立了一个预测模型，该模型具有重要的预测意义：我们建立了一个预测模型，该模型对预测 BSP 的肌张力障碍扩散具有重要价值，提供了关键证据。这些发现为早期临床识别 BSP 疾病的发展和演变提供了重要的见解。ann neurol 2024.

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.

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