Clinical Neurology and Neurosurgery最新文献

{"title":"Bridging the gap: A scoping review of endovascular and microsurgical approaches to anterior ethmoidal dural arteriovenous fistulas.","authors":"Samantha Schimmel, Emma Dunn, Emma Sargent, Daryl T Goldman, Elliot Pressman, Waldo Guerrero, Maxim Mokin, Siviero Agazzi, Kunal Vakharia","doi":"10.1016/j.clineuro.2025.108734","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108734","url":null,"abstract":"<p><strong>Introduction: </strong>Dural arteriovenous fistulas (dAVF) are abnormal anastomoses between meningeal arteries and dural venous sinuses. Typically, dAVF treatment involves an endovascular or microsurgical approach. Anterior ethmoidal artery (AEA) dAVFs pose unique challenges due to their anatomy and location. We performed a scoping review to characterize pre and postoperative characteristics of AEA dAVFs and elucidate their optimal management.</p><p><strong>Methods: </strong>The authors conducted a comprehensive literature search on PubMed and Embase using Arskey & O'Malley's scoping review framework. The search strategy included \"anterior,\" \"ethmoidal,\" and \"fistula\" and excluded review articles and studies with unrelated pathology. Data collected included patient demographics, presentation, angiographic features, treatment modalities, and clinical and radiological outcomes.</p><p><strong>Results: </strong>One-hundred and two articles describing 273 patients with an average age of 58.79 years were included. Two-hundred and sixty patients had surgery; 127 (49 %) had endovascular embolization and 133 (51 %) had open surgery. Surgical approach was significantly associated with complete dAVF obliteration (p = 0.003, X²=8.73, N = 206); patients treated endovascularly were less likely to have complete dAVF obliteration (85.9 % for endovascular versus 97.2 % for microsurgery). Additionally, patients with preoperative dAVF rupture had significantly greater rates of postoperative hemorrhage (p = 0.003, X²=11.86, N = 184).</p><p><strong>Discussion: </strong>Surgical techniques and endovascular embolization are commonly used when treating dAVF, and our results highlight that open surgery appears to be superior to endovascular embolization when considering complete AEA dAVF obliteration. Despite advancements in treatment modalities, complications such as stroke, hemorrhage, and recurrence persist, emphasizing the importance of continued research and refinement of therapeutic strategies.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108734"},"PeriodicalIF":1.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transorbital laser surgery for epilepsy: Anatomic-radiological feasibility of transorbital magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) for amygdalohippocampectomy in refractory epilepsy.","authors":"Doriam Perera Valdiva, Pedro Roldán, Roberto Manfrellotti, Dario Gagliano, Alejandra Mosteiro, Santiago Candela Canto, Abel Ferrés, Lorena Gómez, Jordi Rumià, Alberto Prats-Galino, Beatriz Villa, Alberto Di Somma, Joaquim Enseñat","doi":"10.1016/j.clineuro.2025.108718","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108718","url":null,"abstract":"<p><strong>Objective: </strong>to study the anatomical feasibility of laser fiber insertion for interstitial thermal therapy via transorbital approach to the temporo-mesial structures (amygdala-hippocampus-parahippocampus complex).</p><p><strong>Methods: </strong>Anatomical dissections were performed bilaterally on two human cadaveric heads via a transorbital approach, in which screws and laser fibers were used for magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) assisted by neuronavigation. In addition, eight transorbital trajectories were simulated using the transorbital entry points obtained from a cadaveric radiological study of four patients previously operated on for mesial temporal lobe epilepsy.</p><p><strong>Results: </strong>Successful placement of all four laser fibers was achieved in the anatomical specimens according to the predetermined plan, with an average vector error of 1.3 ± 0.2 mm, ensuring complete coverage of the amygdala-hippocampus-parahippocampus complex. Furthermore, simulations of patient trajectories confirmed safe vascular pathways. An optimal transorbital entry point was identified in the inferolateral quadrant of the orbit, specifically on the lateral wall above the greater wing of the sphenoid. However, the small size of the laser fiber-anchoring screw currently limits its clinical application. This technique may serve as a potential alternative to occipital access in laser surgery for epilepsy, in very specific situations.</p><p><strong>Conclusions: </strong>The placement of a transorbital laser fiber for MRIgLITT targeting the temporomesial structures in epilepsy is anatomically feasible; however, the small size of the anchoring screw presently precludes its clinical use.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108718"},"PeriodicalIF":1.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preexisting opioid daily MME and use duration within a national cohort of lumbar spine surgery patients on quality outcomes.","authors":"Joseph Tingen, Helen Karimi, Emma Hartman, Hiba Hamid, Kayla Etienne, Jainith Patel, Alice Tang, Ron I Riesenburger, James Kryzanski","doi":"10.1016/j.clineuro.2025.108732","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108732","url":null,"abstract":"<p><strong>Objective: </strong>Pain management surrounding lumbar spine surgery is a complex topic. Though some authors suggest that preoperative opioid use is a negative prognostic factor, its association with patient-reported outcomes and satisfaction after surgery remains controversial. We aimed to uncover the effect of preoperative opioid use on long-term outcomes using a national sample.</p><p><strong>Methods: </strong>Using deidentified data from the lumbar spine surgery Quality Outcomes Database, we compared functional outcomes and satisfaction in 34,934 patients based on presence of preoperative opioid use. Outcomes included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and satisfaction indices. Regression subanalysis illustrated the effect of preoperative opioid duration and daily MME.</p><p><strong>Results: </strong>44.1 % used opioids preoperatively. A greater percentage of patients using opioids underwent surgery with instrumentation (p < .005). They exhibited clinically comparable improvement in VAS, ODI, and satisfaction at 3- (p = .069, p < .005, p < .005, respectively) and 12-months (p < .05). Return to work was lower at 3- (74.32 % vs. 80.82 %, p < .005) and 12-months (48.99 % vs. 62.95 %, p < .005). They maintained low postoperative use although greater than opioid naïve patients at 3- (3.1 % vs. 1.2 %, p < .005) and 12-months (3.6 % vs. 0.8 %, p < .005). Preoperative daily MME had no significant effect on outcomes, although increasing duration negatively impacted VAS and ODI scores.</p><p><strong>Conclusions: </strong>Preoperative opioid use by itself should not be used in surgical decision making but rather an individual risk assessment according to chronicity of opioid burden. Longer duration of use appears to impair postoperative improvement but not satisfaction with little influence by daily MME; however, larger, granular analyses remain necessary.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108732"},"PeriodicalIF":1.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The PANDA score: External validation and modification of a simple upfront prediction tool for poor outcomes despite successful stroke thrombectomy.","authors":"Sonesh D Amin, Huanwen Chen, Scott E Rewinkel, David A Lockwood, Daniel Kim, Ryan A Priest, Gary M Nesbit, Jesse J Liu, Masahiro Horikawa, Wayne M Clark, Rachel K Laursen, Gaurav Jindal, Seemant Chaturvedi, Marco Colasurdo","doi":"10.1016/j.clineuro.2025.108722","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108722","url":null,"abstract":"<p><strong>Background: </strong>While endovascular thrombectomy (EVT) has become standard of care for patients' acute ischemic stroke (AIS) due to large vessel occlusion (LVO), many patients still suffer profound neurological disability, also termed futile recanalization (FR). The BAND score, which incorporates baseline disability, age, stroke severity, and treatment time window, is derived as a simple tool for upfront prediction of FR prior to EVT. This study aims to externally validate the BAND score and to incorporate upfront imaging biomarkers into the prediction tool.</p><p><strong>Methods: </strong>Consecutive stroke thrombectomy patients with anterior circulation LVO who achieved successful recanalization (mTICI 2b or greater) were retrospectively identified at a single institution from 2019 to 2023. Clinical information, procedural details, and 90-day outcomes were recorded. The performance of the BAND score in predicting FR (90-day modified Rankin scale [mRS] >3) and loss of complete independence (LCID, 90-day mRS>2) was assessed. Then, Alberta stroke programme early CT score (ASPECTS) was added to create the PANDA score (pre-stroke disability, age, NIH stroke scale, delay from last known normal, and ASPECTS). The performance of PANDA to predict FR was assessed and compared with the original BAND score and also the widely validated THRIVE score.</p><p><strong>Results: </strong>296 patients were included; 36.5 % experienced FR. BAND had areas under the receiver-operating curve (AUCs) of 0.72 and 0.74 for predicting FR and LCID, respectively (both p < 0.001). The new PANDA score had AUCs of 0.76 and 0.78 for predicting FR and LCID, respectively (both p < 0.001), and it outperformed both BAND and THRIVE (all p < 0.05). Of the 30 patients (11.2 %) with high PANDA scores (≥7), 24 patients (80.0 %) suffered FR and 26 (86.7 %) suffered LCID.</p><p><strong>Conclusion: </strong>This external validation study confirmed the adequate performance of BAND in predicting FR. The improved PANDA score performed better than the original BAND score and the widely validated THRIVE score.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108722"},"PeriodicalIF":1.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To identify long-term antiretroviral therapy as the cause of secondary mitochondrial disease, comprehensive investigations are required.","authors":"Josef Finsterer","doi":"10.1016/j.clineuro.2025.108720","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108720","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":" ","pages":"108720"},"PeriodicalIF":1.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintenance of intraoperative correction with multi-rod constructs in adult long construct spine fusion surgery.","authors":"Anthony L Mikula, Zach Pennington, Abdelrahman M Hamouda, Ahmad Nassr, Brett Freedman, Arjun S Sebastian, Benjamin D Elder, Jeremy L Fogelson","doi":"10.1016/j.clineuro.2025.108729","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108729","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to evaluate the risk factors for loss of intraoperative correction, as measured by lumbar lordosis (LL), with an emphasis on rod characteristics.</p><p><strong>Methods: </strong>A retrospective study identified patients at least 50 years of age who underwent instrumented fusion with an upper instrumented vertebrae (UIV) in the upper thoracic spine (T1-T6) or thoracolumbar junction (T10-L2) to the pelvis. Inclusion criteria included intraoperative x-rays that allowed for LL measurement, postop standing x-rays, and a minimum follow up of 24 months with the original rods still in place.</p><p><strong>Results: </strong>One hundred and twelve patients (69 % women) were included with an average (SD) follow up of 58 months (29). Twenty-two patients (20 %) had a 10° change in LL from intraoperative to postoperative, and risk factors included a two-rod compared to multi rod (>2) construct (23 % vs 0 %, p = 0.04), male sex (34 % vs 13 %, p = 0.02), UIV near the thoracolumbar junction (28 % vs 8 %, p = 0.02), and higher L4-S1 intraoperative lordosis (41° vs 36°, p = 0.024). Forty-one patients (37 %) had a 10° change in LL at two years, and risk factors included male sex (60 % vs 26 %, p < 0.001) and a UIV near the thoracolumbar junction (48 % vs 21 %, p = 0.003).</p><p><strong>Conclusions: </strong>Risk factors for loss of LL between intraoperative and postoperative alignment include two-rod constructs, male sex, lower UIV, and greater intraoperative LL. Multi-rod (3 +) constructs may be a modifiable surgical technique that better maintains the spinal alignment that was achieved in the operating room.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108729"},"PeriodicalIF":1.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The overlap of diabetic and inflammatory neuropathies: Epidemiology, possible mechanisms, and treatment implications.","authors":"Yusuf A Rajabally, Young Gi Min","doi":"10.1016/j.clineuro.2025.108719","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108719","url":null,"abstract":"<p><p>Diabetic polyneuropathy is the common neuropathy of diabetes. However, several inflammatory neuropathies may occur during diabetes. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents the most treatable example. There has been uncertainty about a higher risk of CIDP in subjects with diabetes. Contradicting earlier reports, subsequent epidemiological studies failed to confirm an association. However, more recent studies from different populations have shown a two-fold relative risk of concurrent diabetes with CIDP. Recognition of CIDP is important in diabetes as treatment response rates have been reported as comparable with or without diabetes. However, with diabetes, the clinical presentation of CIDP and the resulting disability may be more severe due to additional axonal loss from pre-existing diabetic polyneuropathy and delayed diagnosis. An association of nodo-paranodopathy has similarly been described with a three-fold relative risk of concurrent diabetes in seropositive subjects, particularly those harbouring anti-contactin 1 antibodies. Although rare, recognition of nodo-paranodopathy, with characteristic clinical features, in the context of diabetes is likewise important in view of treatment implications. Other inflammatory neuropathies in diabetes are the painful or painless, cervical, or lumbar, radiculoplexus neuropathies. These need distinguishing from variant, multifocal forms of CIDP, as are not treatable, although remit spontaneously over months or years. There are reports of possible association of Guillain-Barré syndrome (GBS), and particularly of greater GBS severity, with diabetes. Finally, vasculitic neuropathy may also occur in diabetes and requires early suspicion, urgent investigations and immunosuppressant treatment. As the worldwide prevalence of diabetes rises, prompt recognition of its concurrent inflammatory neuropathies, is essential.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108719"},"PeriodicalIF":1.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D printed titanium banana interbody cages versus titanium-coated PEEK bullet cages for TLIF.","authors":"Connor C Jacob, Ryan Eaton, Jacob Ward, Katelyn Sette, Seth Wilson, Matthieu D Weber, Olivia Duru, Alexander Keister, Markus E Harrigan, Andrew J Grossbach, Stephanus Viljoen","doi":"10.1016/j.clineuro.2025.108731","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108731","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar degenerative spinal disease is a common, major cause of pain and disability. Titanium and polyetheretherketone (PEEK) are popular materials for interbody implants although evidence is mixed on which material is superior in terms of fusion and subsidence. The purpose of this study was to evaluate the clinical outcome of 3D printed titanium (3DPT) cages in patients undergoing TLIFs, as well as complication profiles based on widely used outcome metrics and reoperation events.</p><p><strong>Methods: </strong>A retrospective review was conducted for patients receiving 1- or 2-level TLIF at an academic medical center between January 2018 and May 2022. Patients were divided into two cohorts according to the material of interbody cage(s), either 3DPT banana or titanium-coated PEEK bullet. Radiographs, patient-reported outcome measures (PROMs), and complications were analyzed and compared. All included patients had radiographic and clinical follow-up of at least one year.</p><p><strong>Results: </strong>200 patients with 277 interbody cage-implanted levels were included. Patients received either 3DPT (n = 140) or PEEK (n = 60) interbody cages with 202 and 75 instrumented vertebral levels per cohort, respectively. At one year, the 3DPT cohort demonstrated a higher fusion rate of 93.3 % compared to the PEEK cohort's fusion rate of 73.2 % (p < 0.0001). Subsidence rates were 6.0 % and 25.0 % for the 3DPT and PEEK groups, respectively (p < 0.0001).</p><p><strong>Conclusion: </strong>While 3DPT and PEEK interbody cages demonstrated few adverse events at short- and long-term follow-up, 3DPT exhibited a higher rate of fusion and lower rate of subsidence at one year.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108731"},"PeriodicalIF":1.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic facet overgrowth causing radiculopathy - A rare spinal manifestation of Proteus syndrome.","authors":"Anish Kosanum, Colllin Labak, Eric Herring, Manish K Kasliwal","doi":"10.1016/j.clineuro.2025.108730","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.108730","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108730"},"PeriodicalIF":1.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term effect of non-invasive brain stimulation on hemispatial neglect, functional outcomes, and mortality after stroke: ELETRON trial extend.","authors":"Luana Aparecida Miranda, Fernanda Cristina Winckler, Taís Regina da Silva, Hélio Rubens de Carvalho Nunes, Gabriel Pinheiro Modolo, Natalia Cristina Ferreira, Diandra B Favoretto, Luan Aguiar, Silméia Garcia Zanati Bazan, Taiza G S Edwards, Octávio Pontes-Neto, Gustavo José Luvizutto, Rodrigo Bazan","doi":"10.1016/j.clineuro.2024.108705","DOIUrl":"https://doi.org/10.1016/j.clineuro.2024.108705","url":null,"abstract":"<p><strong>Introduction: </strong>Our primary clinical trial indicated that anodal stimulation of the right posterior parietal region associated with specific and perceptual task training was superior to placebo in reducing stroke-induced hemispatial neglect (HN) immediately after the treatment protocol. However, our primary study did not investigate whether this benefit was maintained in the long term after stroke. Therefore, this study aimed to evaluate the long-term effects of the protocol applied in the ELETRON trial on outcomes associated with HN, functionality, and mortality.</p><p><strong>Methods: </strong>This was a pilot, multicenter, prospective, randomized, double-blind trial in patients with HN after stroke who underwent either active tDCS (anodal tDCS or C-tDCS) or sham tDCS in addition to specific and perceptual task training. The outcomes were evaluated on the last day of the session and after 1 year of stimulation (follow-up). Daily evolution rates were calculated as the difference between the values observed between the moments divided by the follow-up time for each individual. The primary outcome was the rate of HN evolution according to the BIT-C scale. The secondary outcome was CBS evolution rate. The exploratory outcomes were the evolution rate of functional disability and autonomy assessed by FIM and BI, quality of life assessed by EQ 5D, stroke severity using the NIHSS, and functional dependence assessed by mRS. Death was examined separately. A linear regression model with a time-adjusted identity link function was used to explain the evolution rates of each outcome of A-tDCS and C-tDCS as a function of sham tDCS. Survival models were adjusted to compare mortality groups.</p><p><strong>Results: </strong>The evolution rate of BIT-C was not different between A-tDCS (B = 3.18; CI: -4.84-11.19; p = 0.438) and C-tDCS (B = -0.95; CI: -8.97-7.07; p = 0.816) with sham. The secondary and exploratory outcomes showed the same pattern. In addition, there were no statistically significant differences in mortality over time between A-tDCS and S-tDCS (B = 0.322; 95 % CI 0.284-6.707; p = 0.689) and between C-tDCS and S-tDCS (B = -0.798; 95 % CI 0.063-3.195; p = 0.425).</p><p><strong>Conclusion: </strong>The benefits of A-tDCS and C-tDCS were maintained for all long-term post-stroke outcomes.</p><p><strong>Trial registration: </strong>RBR-78jvzx - Brazilian Registry of Clinical Trials (Rebec), registered on March 13, 2016.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"108705"},"PeriodicalIF":1.8,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}