European Journal of Neurology最新文献

{"title":"Dorsolateral pontine lesions produce distinct ocular motor abnormalities with anatomical correlations","authors":"Hyun Sung Kim,&nbsp;Jae-Hwan Choi,&nbsp;Eun Hye Oh,&nbsp;Seo Young Choi,&nbsp;Kwang-Dong Choi","doi":"10.1111/ene.70010","DOIUrl":"https://doi.org/10.1111/ene.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>The dorsolateral portion of the caudal pons contains the vestibular nucleus (VN) and inferior cerebellar peduncle (ICP) that play important roles in conveying and processing vestibular and ocular motor signals. This study aimed to characterize ocular motor abnormalities along with their anatomical correlations in dorsolateral pons (DLP) lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed clinical features, and results of neuro-otological evaluations and neuroimaging of 18 patients with unilateral DLP lesions (17 with DLP infarction and 1 with cavernous malformation) from among 506 patients with pontine infarction in a stroke registry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most of the patients (<i>n</i> = 16) presented with isolated acute vestibular syndrome (AVS). The involved structures within the DLP were the ICP in four patients and the VN in the remaining 14. The unilateral ICP lesions were associated with consistent abnormalities in vestibular and ocular motor tests, including ipsilesional nystagmus without gaze-evoked nystagmus (GEN), and normal head impulse tests (HITs) and caloric response. In contrast, lesions of the VN were associated with a broader range of eye-movement abnormalities, including ipsi- or contralesional nystagmus with GEN, positive HITs, normal or abnormal caloric responses, and fixation nystagmus. Initial diffusion-weighted magnetic resonance imaging (within 48 h) was falsely negative in 41% (<i>n</i> = 7) of the DLP infarction cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates that unilateral DLP lesions frequently present with isolated AVS and diverse ocular motor abnormalities. These characteristics may be due to the complex involvement of afferent or efferent fibers to and from the VN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact heat evoked potentials reveal distinct patterns of spinal cord impairment in degenerative cervical myelopathy beyond MRI lesions","authors":"Paulina Simonne Scheuren,&nbsp;Markus Hupp,&nbsp;Nikolai Pfender,&nbsp;Maryam Seif,&nbsp;Carl Moritz Zipser,&nbsp;Florian Wanivenhaus,&nbsp;José Miguel Spirig,&nbsp;Michael Betz,&nbsp;Patrick Freund,&nbsp;Martin Schubert,&nbsp;Mazda Farshad,&nbsp;Armin Curt,&nbsp;Michèle Hubli,&nbsp;Jan Rosner","doi":"10.1111/ene.70001","DOIUrl":"https://doi.org/10.1111/ene.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Magnetic resonance imaging may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. We aimed to assess the value of contact heat evoked potentials (CHEPs) in addition to MRI and hypothesized that abnormal CHEPs may be evident in DCM independent of MR-lesions and are related to dynamic mechanical cord stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals with DCM underwent neurologic examination including segmental sensory (pinprick, light touch) and motor testing. The presence or absence of hyperintense signal on T2-weighted MRI (T2-positive/negative) was assessed. Phase-contrast MRI was used to assess spinal cord motion as an indicator of dynamic mechanical stress. Dermatomal somatosensory evoked potentials and CHEPs were recorded after stimulation of dermatomes C6, C8, and T4 (CHEPs only) to assess spinal cord integrity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 138 individuals included in this study (age 56 ± 13 years), 35% (<i>N</i> = 48) presented with T2-positive and 65% (<i>N</i> = 90) presented with T2-negative DCM. Abnormal CHEPs were present in T2-positive DCM (C6:41%; C8:32%; T4:24%) and T2-negative DCM (C6:35%; C8:54%; T4:26%). Multisegmental CHEP abnormalities at C6 and C8 were related to increased spinal cord motion (<i>p</i> = 0.030; ϵ² = 0.072), and reduced upper extremity pinprick (<i>p</i> = 0.046; ϵ² = 0.063) and motor scores (<i>p</i> = 0.005; ϵ² = 0.108).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CHEPs revealed distinct patterns of spinal cord impairment independent of structural T2-positive lesions, which were associated with measures of cord motion. CHEPs thus provide valuable complementary diagnostic insights into spinal cord integrity beyond MRI. This is especially important in incipient myelopathy to inform early diagnosis and timely interventions before the development of definite cord lesions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brief international cognitive assessment for MS (BICAMS) and NEDA maintenance in MS patients: A 2-year follow-up longitudinal study","authors":"E. Leveraro,&nbsp;M. Cellerino,&nbsp;C. Lapucci,&nbsp;M. Dighero,&nbsp;L. Nasone,&nbsp;T. Sirito,&nbsp;D. Boccia,&nbsp;N. Cavalli,&nbsp;G. Bavestrello,&nbsp;A. Uccelli,&nbsp;G. Boffa,&nbsp;M. Inglese","doi":"10.1111/ene.70007","DOIUrl":"https://doi.org/10.1111/ene.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been validated in many cross-sectional studies. However, longitudinal data on BICAMS subset trajectories and their correlation with disease activity during follow-up are scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to (i) assess BICAMS changes in MS patients initiating high-efficacy disease-modifying-treatments (DMTs), (ii) compare these changes based on maintenance of “no-evidence-of-disease-activity” (NEDA-3) status over 24 months, and (iii) determine baseline clinical parameters predictive of cognitive changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 101 MS patients (mean age:40,45 ± 11; Relapsing–Remitting-MS:81%) initiating highly-effective-DMTs. Patients underwent Expanded Disability Status Scale (EDSS), BICAMS, and Hospital Anxiety and Depression Scale (HADS), at baseline and after 24 months. Regression-based change index (RB-CI) had been used for cognitive change evaluation over follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During follow-up, 78 (77.3%) patients maintained NEDA-3 status. Considering a 90% of confidence levels for RB-CI, 12 (11.9%) improved at SDMT, 13 (12.9%) at CVLT-II and 13 (12.9%) at BVMT-R; while 7 (6.9%) were classified as worsened at SDMT, 11 (10.9%) at CVLT-II and 8 (7.9%) at BVMT-R. SDMT scores significantly improved at follow-up for the entire group (<i>p</i> = 0.003) and in patients maintaining NEDA-3 (<i>p</i> &lt; 0.001). The multivariable regression model assessing the SDMT improvement (<i>n</i> = 12; <i>z</i> = 1.65), was significant and explained 21% of the variance (<i>p</i> = 0.038; Nagelkerke <i>R</i>² = 0.212). Lower EDSS proved to be an independent predictor of SDMT reliable improvement (<i>p</i> = 0.027) in our sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings showed that early disease activity control—especially in patients with low baseline disability—may yield significant benefits even in terms of cognitive performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hereditary spastic paraplegias: When to expect bladder dysfunction a genetic and urodynamic study","authors":"Pauline Lallemant-Dudek,&nbsp;Marine Guillaud-Bataille,&nbsp;Claire Hentzen,&nbsp;Charles Joussain,&nbsp;Bertrand Pichon,&nbsp;Gilberte Robain,&nbsp;Rebecca Haddad,&nbsp;Giulia Coarelli,&nbsp;Anna Heinzmann,&nbsp;Pierre Denys,&nbsp;Gérard Amarenco,&nbsp;Alexandra Durr","doi":"10.1111/ene.70003","DOIUrl":"10.1111/ene.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The aim of this study was to characterize hereditary spastic paraplegias (HSP) patients' urodynamic profiles and development of bladder symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a multicentric retrospective study which included patients presenting with bladder disorders. We reviewed medical and urodynamic records in individuals with HSP and recorded age at onset of gait and bladder disorders, disability stage at the time of urodynamic assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 122 participants. They were mostly men (<i>n</i> = 74) with a median age at interview of 54.6 ± 13.0 [25–76] years. The underlying genetic cause was identified in 70% of participants, with 54 heterozygous mutations in <i>SPAST,</i> followed by 7 <i>SPG11</i> and 6 <i>SPG7</i>. The age at onset of motor disorder was significantly younger than for the beginning of bladder dysfunction (49.3 vs. 29.7 years-old, <i>p</i> &lt; 0.001). Detrusor overactivity was present in most participants (72.1%), followed by detrusor-sphincter-dyssynergia (65.3%). Similar proportions were present in the <i>SPAST</i> group as well as the non-<i>SPAST</i> group. The <i>SPAST</i> group developed urinary symptoms later than the non-SPAST group as compared to the age at onset of spasticity (53.8 ± 11.3 and 44.1 ± 13.2 for the <i>SPAST</i> group vs. 44.1 ± 13.2 and 25.5 ± 17.3 for the non-SPAST group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We have shown that the most common urodynamic pattern in HSP is detrusor overactivity associated with detrusor-sphincter dyssynergia, as would be expected for upper motor neuron lesions. We assessed the temporal window of onset, showing that urinary disorders are secondary to spastic gait in HSP and particularly frequent when walking capability deteriorates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microembolic signal detection in acute ischemic stroke: Clinical relevance and impact on treatment individualization—A narrative review","authors":"Eleni Bakola,&nbsp;Lina Palaiodimou,&nbsp;Odysseas Kargiotis,&nbsp;Apostolos Safouris,&nbsp;Klearchos Psychogios,&nbsp;Theodoros Karapanayiotides,&nbsp;Christos Moschovos,&nbsp;Vijay K. Sharma,&nbsp;Mark N. Rubin,&nbsp;João Sargento Freitas,&nbsp;Claudio Baracchini,&nbsp;Christos Krogias,&nbsp;Andrei V. Alexandrov,&nbsp;Tsivgoulis Georgios","doi":"10.1111/ene.16584","DOIUrl":"https://doi.org/10.1111/ene.16584","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Microembolic signals (MES) can be detected using transcranial Doppler (TCD) ultrasound in several clinical scenarios, including acute ischemic stroke (AIS). This narrative review aims to provide insights into their role in AIS patient management and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present narrative review consolidates current observational and randomized evidence on the prevalence and clinical relevance of MES in different AIS subtypes and settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MES prevalence is higher in AIS patients with large artery atherosclerosis, indicating unstable or vulnerable plaques, and lower in those with small vessel disease. Detecting MES can significantly aid in managing AIS patients, particularly when the cause is unclear, as MES detected in different cerebral arteries can indicate conditions like covert cardioembolism, aortic arch atherosclerosis, or coagulation disorders, including cancer-related stroke. MES are associated with higher risk of stroke recurrence, independently of the underlying stroke mechanism. The detection of MES during and after acute systemic or endovascular reperfusion procedures in large-vessel occlusion patients appears to be predictive of adverse clinical outcomes and recurrent stroke. Finally, a reduction in MES detection may serve as surrogate marker and intermediate endpoint evaluating secondary stroke prevention treatments in the settings of randomized-controlled clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MES detection on TCD in AIS remains a useful diagnostic tool as it helps the clinicians to approach the stroke underlying mechanism by detecting and quantifying ongoing cerebral embolization and localizing an embolic source in real time. In addition, it allows monitoring and treatment individualization in stroke patients, while further determining recurrent stroke risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.16584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual antiplatelet therapy after minor strokes or high-risk TIA: Evidence from the Austrian stroke registry","authors":"Stefan Krebs,&nbsp;Dominika Miksova,&nbsp;Michael Knoflach,&nbsp;Thomas Gattringer,&nbsp;Simon Fandler-Höfler,&nbsp;Fahrner Marlen,&nbsp;Martha Marko,&nbsp;Stefan Greisenegger,&nbsp;Wilfried Lang,&nbsp;Julia Ferrari,&nbsp;Marek Sykora,&nbsp;the Austrian Stroke Unit Registry Collaborators","doi":"10.1111/ene.70012","DOIUrl":"10.1111/ene.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Three large, randomized trials demonstrated the benefit of short-term dual antiplatelet therapy (DAPT) versus monotherapy after non-cardioembolic minor stroke or high-risk transient ischemic attack (TIA). The aim of this study was to evaluate effects of DAPT versus monotherapy on functional outcomes and safety in a real-life setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with minor stroke (NIHSS &lt;4) or high-risk TIA (ABCD2 score ≥4) of non-cardioembolic origin without major vessel occlusion or revascularization therapy (thrombolysis or thrombectomy) treated between 2018 and 2023 were analyzed based on a prospective nationwide stroke unit registry. Data on risk factors, stroke etiology, admission stroke severity (NIHSS), functional status at 3 months (mRS), and mortality were extracted. Excellent functional outcome (mRS 0–1) at 3 months, early neurological deterioration (END), symptomatic intracranial hemorrhage (SICH) and major extracranial bleeds were defined as study endpoints and adjusted for covariates using inverse probability of treatment weighted regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two Thousand Two Hundred Fifty-four of 8546 patients with non-cardioembolic minor stroke or high-risk TIA received DAPT. Patients treated with DAPT had significantly more risk factors and comorbidities compared to those treated with monotherapy. After robust statistical adjustment, DAPT was significantly associated with lower occurrence of END (OR 0.50 95% CI 0.35–0.72), increased odds of excellent outcome at 3 months (aOR 1.59; 95% CI 1.20–2.09) and equivalent frequencies of SICH (aOR 1.19, 95% CI 0.30–4.73) or major extracranial bleeding (aOR 0.84; 95% CI 0.16–4.56).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DAPT in non-cardioembolic minor stroke or high-risk TIA in a real-life setting appears to be safe and associated with improved functional outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating gait and postural responses to subthalamic stimulation and levodopa: A prospective study using wearable technology","authors":"Ilaria Cani,&nbsp;Ilaria D'Ascanio,&nbsp;Luca Baldelli,&nbsp;Giovanna Lopane,&nbsp;Saverio Ranciati,&nbsp;Paolo Mantovani,&nbsp;Alfredo Conti,&nbsp;Pietro Cortelli,&nbsp;Giovanna Calandra-Buonaura,&nbsp;Lorenzo Chiari,&nbsp;Luca Palmerini,&nbsp;Giulia Giannini","doi":"10.1111/ene.16580","DOIUrl":"10.1111/ene.16580","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> \u0000 <span>Background</span>\u0000 </h3>\u0000 \u0000 <p>\u0000 <span>The efficacy of subthalamic stimulation on axial signs of Parkinson's disease (PD) is debated in the literature. This study delves into the dynamic interplay of gait and posture, specifically probing their nuanced response to subthalamic stimulation and levodopa.</span>\u0000 </p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> \u0000 <span>Methods</span>\u0000 </h3>\u0000 \u0000 <p>\u0000 <span>We used wearable sensor technology to examine alterations in the spatiotemporal parameters of gait and posture in individuals with PD before and 6 months after subthalamic deep brain stimulation (STN-DBS) surgery. Thirty-three subjects with PD were evaluated in two pre-operative and four post-operative conditions comprising OFF/ON medication and stimulation states. Standardized response mean (SRM) values were calculated to assess treatment responsiveness.</span>\u0000 </p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> \u0000 <span>Results</span>\u0000 </h3>\u0000 \u0000 <p>\u0000 <span>Significant improvements in spatiotemporal gait parameters, including speed, stride length, cadence, and turning, were observed following STN-DBS surgery. Quantitatively, stimulation outperformed levodopa in enhancing gait speed, stride length, and turning, as indicated by SRM. Levodopa moderately improved stride time variability and asymmetry, while stimulation alone demonstrated limited efficacy. Postural parameters exhibited minimal change following STN-DBS, although stimulation showed a slight benefit in certain postural aspects.</span>\u0000 </p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> \u0000 <span>Conclusion</span>\u0000 </h3>\u0000 \u0000 <p>\u0000 <span>Our findings suggest positive effects of stimulation and levodopa on gait and postural parameters, with STN-DBS demonstrating superior efficacy in enhancing gait speed, stride length, and turning. However, gait variability remains unaddressed by current therapies, highlighting the need for novel treatments targeting regions beyond the basal ganglia.</span>\u0000 </p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.16580","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of exploring neuropsychiatric and cognitive symptoms after spontaneous intracerebral hemorrhage","authors":"Giuseppe Scopelliti,&nbsp;Charlotte Cordonnier,&nbsp;Leonardo Pantoni","doi":"10.1111/ene.16585","DOIUrl":"10.1111/ene.16585","url":null,"abstract":"&lt;p&gt;Spontaneous intracerebral hemorrhage (ICH) is an extremely dangerous condition, with overall greater social-economic burden than ischemic stroke despite lower incidence. Approximately half of patients with acute ICH do not survive beyond the first year, and those who do often face significant, lasting disability [&lt;span&gt;1&lt;/span&gt;]. Qiuyi Jiang et al. investigated one of the more subtle long-term effects of ICH, the affective and cognitive symptoms that have been often overlooked by stroke neurologists, but are an especially pressing burden for patients and their caregivers [&lt;span&gt;2, 3&lt;/span&gt;]. This study, conducted in China, included nearly 1600 patients, marking the largest cohort on this topic to date. However, the majority of participants had deep ICH (85%) and were relatively young (median age 57 years), limiting the generalizability of the findings to older populations with lobar ICH.&lt;/p&gt;&lt;p&gt;Although the study explicitly focused on “small” ICHs (median volume of 10 mL), it should be noted that the majority of previous studies on long-term cognitive and neuropsychiatric outcomes of ICH have also predominantly included patients with smaller hematoma volumes [&lt;span&gt;4, 5&lt;/span&gt;]. This is mainly because larger hemorrhages are associated with poor short-term survival, or patients are less likely to be able to attend outpatient clinic for long term follow-up. Similar considerations can be made regarding studies on the long-term cognitive consequences of ischemic stroke, in which patients with more severe events and language impairment are often excluded, resulting in an unavoidable bias in evaluating long-term trajectories [&lt;span&gt;6&lt;/span&gt;]. Nevertheless, we might hypothesize that those patients suffering from lower levels of disability after the index event are probably the ones who are going to benefit the most from a long-term stroke neuropsychiatric and cognitive follow-up.&lt;/p&gt;&lt;p&gt;Given that most studies have predominantly focused on small ICHs, our understanding of the cognitive and neuropsychiatric consequences of ICH survivors so far may reflect more the influence of the underlying cerebral small vessel disease (e.g., arteriolosclerosis and cerebral amyloid angiopathy) rather than the direct impact of the initial ICH event. Although this study did not assess MRI features of cerebral small vessel disease, the authors found that potentially modifiable factors related to ICH at baseline (e.g., blood pressure levels, length of hospitalization, and anteroposterior diameter of the index ICH) could influence long-term cognitive and affective outcomes. This finding underscores the importance of consistently including cognitive and affective measures as outcome variables in clinical trials of acute phase interventions.&lt;/p&gt;&lt;p&gt;Another important catch on the current topic is the complex presentation of affective symptoms following an ICH, and, more broadly, in patients with cerebrovascular diseases. Qiuyi Jiang and colleagues adopted a pragmatic approach,","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.16585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular risk factors are associated with grey matter atrophy in secondary progressive multiple sclerosis","authors":"Nevin A. John,&nbsp;Yingtong Li,&nbsp;Floriana De Angelis,&nbsp;Jonathan Stutters,&nbsp;Ferran Prados,&nbsp;Anisha Doshi,&nbsp;Alberto Calvi,&nbsp;Thomas Williams,&nbsp;Domenico Plantone,&nbsp;Thanh Phan,&nbsp;Claudia A. M. Gandini Wheeler-Kingshott,&nbsp;Frederik Barkhof,&nbsp;Jeremy Chataway,&nbsp;MS-SMART Investigators","doi":"10.1111/ene.16586","DOIUrl":"10.1111/ene.16586","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Comorbidities including vascular risk factors can be associated with whole and regional brain atrophy in multiple sclerosis (MS). This has been examined in mixed MS cohorts in prospective or observational studies; however, the association between vascular comorbidities (VCM) in secondary progressive MS (SPMS) and brain atrophy has been less well studied. The aim was to investigate the cross-sectional and longitudinal association between VCM, comorbidity burden and brain atrophy in SPMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Post hoc analysis of 445 participants from the MS–Secondary Progressive multi-arm trial (MS-SMART)−a multi-arm multicentre phase-2b randomised placebo-controlled trial of three agents in SPMS (NCT01910259). VCM (hypertension, hyperlipidaemia) but also asthma, hypothyroidism and osteoporosis were recorded. Regional and whole brain volume (WBV), and percentage brain volume change were calculated using SIENAX and SIENA, respectively. Multiple linear regression was used to investigate the cross-sectional and longitudinal relationships between VCM, overall comorbidity count and whole brain, grey matter (GM) and white matter (WM) atrophy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort was predominantly female (67%), mean age 55 with median EDSS 6.0. In total, 13% and 9% had hypertension and hyperlipidaemia, respectively. In cross-sectional regression models, VCM was associated with decreased cortical GM volume [(hypertension <i>β</i> = −0.30, 95%CI −0.54 to −0.06, <i>p</i> = 0.01) (hyperlipidaemia <i>β</i> = −0.37, 95%CI −0.64 to −0.09, <i>p</i> = 0.008)]; but not WBV. Having ≥2 comorbidities was also associated with decreased cortical GM volume (<i>β</i> = −0.36, 95%CI −0.61 to −0.10, <i>p</i> = 0.007). No relationship was observed between VCM/comorbidity count and whole brain or GM atrophy rate over 96 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>People with SPMS with VCM or increased overall comorbidity burden showed reduced whole brain and especially cortical grey matter volumes, but no significant impact on subsequent 2-year atrophy rate was detected.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.16586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hematopoietic stem cell transplantation for multiple sclerosis: no inflammation, no response","authors":"Richard K. Burt,&nbsp;Tobias Alexander,&nbsp;the EBMT Autoimmune Diseases Working Party (ADWP)","doi":"10.1111/ene.16565","DOIUrl":"10.1111/ene.16565","url":null,"abstract":"&lt;p&gt;In this edition of the &lt;i&gt;European Journal of Neurology&lt;/i&gt;, Braun et al. report results from a systematic literature review of publications reporting on autologous hematopoietic stem cell transplantation (HSCT) for multiple sclerosis (MS) undergoing progressive neurological decline in baseline without clinical relapses or decline between clinical relapses. They compared 665 patients with progressive multiple sclerosis (PMS) of which 74 were primary progressive MS (PPMS) defined as PMS from diagnosis and 591 with secondary progressive MS (SPMS) defined as PMS after an initial relapsing–remitting course. As controls they used 647 patients with RRMS defined as a relapsing–remitting course with stable neurological disability between relapses [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;There are 16 disease modifying therapies (DMTs) approved by the Food and Drug Administration for RRMS. The effectiveness of DMTs for PMS is questionable or at best less clear. Multiple studies have demonstrated superiority of HSCT for RRMS including a large meta-analysis of 4831 patients [&lt;span&gt;2&lt;/span&gt;] and a phase III randomized trial [&lt;span&gt;3&lt;/span&gt;]. Because an effective therapy is needed for PMS, Braun et al. summarized the published outcome of HSCT for PMS. They found highly variable results in PMS patients in terms of achieving progression-free survival and no evidence of disease activity (NEDA-3), suggesting that HSCT does not halt progression in this patient cohort but may provide clinical benefit in selected patients.&lt;/p&gt;&lt;p&gt;RRMS is a dynamic and repetitive immune mediated breakdown in the blood–brain barrier, extravasation of immune cells, and macrophage stripping of myelin followed healing of the blood–brain barrier, remyelination and repair [&lt;span&gt;4&lt;/span&gt;]. Neuronal damage starts during RRMS and becomes the predominate pathophysiology during SPMS [&lt;span&gt;5&lt;/span&gt;]. PPMS is predominately neuronal degenerative from onset [&lt;span&gt;6&lt;/span&gt;]. For this reason, immune based therapies including all DMTs and autologous HSCT are most effective in RRMS but of limited value for PMS (PPMS or SPMS) [&lt;span&gt;6&lt;/span&gt;]. During the transition from predominately inflammatory RRMS into late SPMS, patients transition through a stage of SPMS with residual smoldering inflammation [&lt;span&gt;7&lt;/span&gt;]. It is during this stage that immune based therapies such as HSCT are still of benefit, albeit to a lesser amount. On this background, recent guidelines and recommendations from the European Group for Blood and Marrow Transplantation (EBMT) Autoimmune Diseases Working Party (ADWP) and the Joint Accreditation Committee of EBMT and the International Society for Cellular Therapy (ISCT) (JACIE) suggest HSCT as standard indication in patients with active relapsing–remitting MS failing DMTs, and a clinical option in patients with progressive MS with active inflammatory component, but generally not in patients with progressive MS without active inflammatory component [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Identifying subsets of","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.16565","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}