European Neurology最新文献

{"title":"Factors Associated with Time to Change of Resuscitation Code (Do-Not-Resuscitate) and Time to Death after a Stroke: Palliative Aspects from a Tertiary Center.","authors":"Melissa Correia, Léon von Fournier, Markus Schettle, Giovanna Brandi, David Blum, Susanne Wegener, Caroline Hertler","doi":"10.1159/000547188","DOIUrl":"10.1159/000547188","url":null,"abstract":"<p><strong>Introduction: </strong>Strokes rank among the most common acute conditions in neurology, leading to substantial increases in morbidity and mortality rates. It is essential to preserve patients' autonomy in decision-making regarding resuscitation measures to prevent unnecessary interventions and safeguard their right to self-determination. This study aimed to identify the factors associated with an active decision against post-stroke patient resuscitation.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 139 patients from 2014 to 2021 at the University Hospital Zurich, Switzerland. All patients died within 3 months after stroke, with a documented active decision against resuscitation within this timespan. We examined sociodemographic and clinical factors, including outcome scores associated with the decision to change of code status.</p><p><strong>Results: </strong>Our cohort had a median age of 76.8 years, with 58% men. The median duration from stroke until do-not-resuscitate (DNR) decision was 4 days (range = 0-69), and 3 days (range = 0-59) from DNR decision until death. In total, 5 (range = 0-23) documented discussions were held with each patient's family during the disease trajectory. Existing pre-stroke illnesses did not significantly influence these decisions. A total of 22.3% (n = 31) of patients received a consultation from palliative care specialists and/or palliative treatment, and 9.4% (n = 13) were referred to the PC ward.</p><p><strong>Conclusions: </strong>Our findings suggest that decisions against resuscitation primarily result from collaboration between healthcare professionals and families, respecting patients' wishes, and were neither associated with comorbidities nor the severity of stroke. Every fifth patient was seen by a palliative care specialist, supporting the complex decision-making in this non-cancer population.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-9"},"PeriodicalIF":2.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fourteen Biomarkers and Subsequent Disability in Patients with Stroke Recurrence: Results from the SPARCL Trial.","authors":"Elena Meseguer, Peter Ganz, Weihang Bao, Larry B Goldstein, Gregory M Preston, Henrik Sillesen, K Michael A Welch, Pierre Amarenco","doi":"10.1159/000545149","DOIUrl":"10.1159/000545149","url":null,"abstract":"<p><strong>Introduction: </strong>In patients enrolled in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial levels of osteopontin, neopterin, N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase, monocyte chemoattractant protein-1 (MCP-1), resistin, matrix metalloproteinase-9 (MMP-9), adiponectin, high-sensitive C-reactive protein (hsCRP), lipoprotein-associated phospholipase-A2 (Lp-PLA2), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble CD40-ligand (sCD40L), and HDL cholesterol (HDL-c) were measured 1-6 months after the qualifying stroke or TIA. We determined whether any of these biomarkers were associated with disability in case of recurrence.</p><p><strong>Methods: </strong>Among 463 recurrent strokes, the associations of these biomarkers with the National Institutes of Health-Stroke Scale (NIHSS), Barthel Index, and modified Rankin Score (mRS) measured after 90 days were assessed. Using adjusted logistic regression analysis, biomarker levels were compared between unfavorable versus favorable outcome (NIHSS ≥2 versus 0-1; Barthel Index <95 versus 95-100; and mRS 2-6 versus 0-1).</p><p><strong>Results: </strong>Higher baseline levels of osteopontin (OR: 1.166; 95% CI: 1.01-1.347, p = 0.0367) and neopterin (OR: 1.531; 95% CI: 1.07-2.188, p = 0.0195) predicted poorer outcomes after recurrent stroke. For participants with ischemic stroke, higher levels of neopterin (OR: 1.488; 95% CI: 1.022-2.167, p = 0.0384) and NT-proBNP, (OR: 1.399; 95% CI: 1.035-1.891, p = 0.0289) were predictor of unfavorable mRS. Analyses including stroke and TIA showed that lower HDL-c levels were associated with an unfavorable mRS (OR: 0.564; 95% CI: 0.328-0.971, p = 0.0387).</p><p><strong>Conclusions: </strong>Higher levels of osteopontin, neopterin and NT-ProBNP and lower levels of HDL-c after stroke were independently associated with greater disability in case of recurrent stroke.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-10"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483736","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 History of the Evans Index.","authors":"Kimberley J R Fleuren, Peter J Koehler, Erik I Hoff","doi":"10.1159/000545917","DOIUrl":"10.1159/000545917","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"92-96"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973828","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":"Clinical and Brain MRI Characteristics of Patients with Anti-N-Methyl-<sc>d</sc>-Aspartate Receptor Encephalitis: A 10-Year Retrospective Study.","authors":"Yuliang Wang, Qin Zhou, Zhaojun Dai, Yingwei Qiu, Hongyan Zhou, Li Feng, Jing Zhao","doi":"10.1159/000546521","DOIUrl":"10.1159/000546521","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to investigate the diagnostic utility of brain Magnetic resonance imaging (MRI) in anti-N-methyl-<sc>d</sc>-aspartate receptor encephalitis (anti-NMDAR encephalitis) and analyze the relationship between clinical and brain MRI characteristics and disease prognosis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on forty-six (59% female, median age: 24.5 years) clinically identified anti-NMDAR encephalitis patients from December 2012 to April 2022. All the patients underwent multiparametric MRI, with thirteen returning for follow-up. All the relevant clinical information was collected. The initial and follow-up brain MRI was sequentially analyzed for signal abnormalities, involvement of anatomy and structure, and brain/structure atrophy by two experienced neuroradiologists. Additionally, the relationship between clinical and brain MRI features and prognosis was examined.</p><p><strong>Results: </strong>The most common symptom (33/46, 72%) in anti-NMDAR encephalitis was aberrant psychiatric behavior. Five (10%) cases combined with other positive antibodies. Although 91% of patients with mRS >2 before treatment, a statistically significant decrease mRS were observed after treatment (mRS: 3.50 ± 0.94 vs. mRS: 1.91 ± 1.53, p < 0.001). More than half of the patients had abnormal MRI findings. T2-weighted fluid-attenuated inversion recovery (FLAIR) hyperintense lesions that involve the frontal lobe and the limbic system are the characteristic imaging predilection of anti-NMDAR encephalitis. On follow-up MRI, we noticed 5 patients with significant hippocampal atrophy. Further analysis showed that the hippocampal involvement was a significant factor in predicting worse mRS scores both before and after treatment (p < 0.05).</p><p><strong>Conclusion: </strong>T2-FLAIR hyperintense lesions in the frontal lobe and the limbic system are indicative of anti-NMDAR encephalitis. The involvement of the hippocampus is a risk factor for a poor prognosis.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"71-81"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625665","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":"Clinical Manifestations of Tuberous Sclerosis: A Retrospective Analysis of 20 Cases.","authors":"Xu Zhang, Cong Xie, Zhihua Si, Ju Liu, Aihua Wang, Meng Kong, Jinzhi Liu, Zhangyong Xia","doi":"10.1159/000546608","DOIUrl":"10.1159/000546608","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberous sclerosis (TSC) is an autosomal dominant genetic disorder with a wide range of clinical manifestations. This study aimed to retrospectively analyze the clinical records of TSC patients, focusing on the first onset times and age ranges for various symptoms.</p><p><strong>Methods: </strong>The clinical data of TSC patients were analyzed retrospectively, including general information, clinical manifestations, and treatment plans, with particular attention to the first onset times and age ranges for different symptoms.</p><p><strong>Results: </strong>The study found that 15 patients presented with different types of skin lesions, 13 patients, including 6 with intellectual disabilities, experienced epileptic seizures. Additionally, 14 patients had kidney damage, 6 showed varying degrees of cardiac involvement, and 8 exhibited lung lesions.</p><p><strong>Conclusion: </strong>By integrating the clinical features and imaging characteristics of TSC, multiple manifestations of the disease were identified, providing further clinical evidence for its recognition. This is beneficial for early monitoring and effective disease prevention and improvement.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"82-91"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265769","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 Origins of Neuromuscular Electrodiagnosis, 1800-1950: A Crucial Period.","authors":"Laurent Tatu, Yann Péréon","doi":"10.1159/000544957","DOIUrl":"10.1159/000544957","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"32-39"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656598","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":"Farewell Editorial.","authors":"Julien Bogousslavsky","doi":"10.1159/000546545","DOIUrl":"10.1159/000546545","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"42-43"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539701","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":"Effectiveness of Transcranial Direct Current Stimulation in Treating Drug-Resistant Focal Epilepsy: A Systematic Review and Meta-Analysis.","authors":"Luis A Marin-Castañeda, Jimena Gonzalez-Salido, Iris E Martínez-Juárez, Nadia Palomera-Garfias, Brandon Flores, Daniela Muñoz-Guerrero, Gerson Ángel Alavez, Geronimo Pacheco Aispuro","doi":"10.1159/000543106","DOIUrl":"10.1159/000543106","url":null,"abstract":"<p><strong>Introduction: </strong>Epilepsy is a prevalent neurological disorder globally, with about 30% of patients developing resistance despite optimal antiseizure drug therapies. Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique and offers a potential therapeutic alternative for drug-resistant focal epilepsy, aiming to reduce seizure frequency and improve patient quality of life.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a search was performed on MEDLINE, Web of Science, and Cochrane Library from inception to June 2024. Included articles were randomized controlled trials reporting seizure frequency, IEDs, and adverse events in patients with focal epilepsy treated with tDCS. Quality assessment was conducted using RoB2, and data were analyzed using a random-effects model.</p><p><strong>Results: </strong>Nine studies involving 253 patients met the inclusion criteria. tDCS significantly reduced seizure frequency at 1- and 2-month follow-up compared to placebo, with a mean difference (MD) of -2.62, 95% CI (-5.20, -0.04), p = 0.05 at 1 month and MD of -2.80, 95% CI (-5.08, -0.53), p = 0.02 at 2 months. No significant changes in IEDs were observed. Adverse events were generally mild and consisted of itching, skin rash, and headache being the most common.</p><p><strong>Conclusion: </strong>tDCS reduces seizure frequency in patients with drug-resistant focal epilepsy and is associated with minimal adverse effects. However, there was no significant impact on IEDs, and the studies included exhibited considerable heterogeneity. More standardized research is required to validate these findings and optimize treatment protocols.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"18-27"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122511","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":"Predicting Postoperative Delirium Using Intraoperative Neuromonitoring in Patients Undergoing Craniotomy for Aneurysm Clipping Surgery.","authors":"Abdullah M Al-Qudah, Leen Alkalbani, Pooja S Tallapaneni, Diti Vinuthna Vinuthna, Varshapriya Suresh, Katherine M Anetakis, Donald Crammond, Jeffrey Balzer, Varun Shandal, Shyam Visweswaran, Kathirvel Subramaniam, Senthilkumar Sadhasivam, Parthasarathy Thirumala","doi":"10.1159/000541593","DOIUrl":"10.1159/000541593","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative delirium (POD) that is associated with intracranial surgeries can have several adverse outcomes, including a high rate of morbidity and mortality. The use of intraoperative neurophysiological monitoring (IONM) via somatosensory evoked potentials (SSEP) and electroencephalography (EEG) provides continuous information regarding cerebral blood flow (CBF) during aneurysm clipping. In this study, we hypothesize that CBF changes during aneurysm clipping increase the risk of POD. We aimed to demonstrate that significant changes in IONM data during surgery increase the risk of POD after adjusting for clinical and intraoperative factors.</p><p><strong>Methods: </strong>470 patients undergoing craniotomy for aneurysm clipping surgery with IONM were retrospectively reviewed for the development of POD. Significant IONM changes were evaluated based on a visual review of EEG and SSEP data and documentation of significant changes during surgery. Data changes during IONM were classified as SSEP changes, EEG changes, or IONM changes (SSEP and/or EEG changes).</p><p><strong>Results: </strong>Of the 470 patients who underwent aneurysm clipping, 115 (24.5%) had POD and 35 (30.4%) had IONM changes. IONM and SSEP changes were significantly associated with POD (p < 0.001). After adjusting for confounding variables, IONM and SSEP changes were significantly associated with POD (adjusted odds ratio (aOR) 2.4 [CI: 1.40-4.17]; p = 0.002) and (aOR 2.49 [CI: 1.39-4.45]; p = 0.002), respectively. We also found that the odds of POD were higher in patients with ruptured aneurysms and in patients who developed focal neurological deficits postoperatively (aOR 2.76, 1.72-4.42; p < 0.001) and (aOR 2.11, 1.02-4.36, p = 0.04), respectively.</p><p><strong>Conclusion: </strong>Patients who develop POD after craniotomy for aneurysm clipping surgery are twice as likely to have experienced significant IONM or SSEP changes during the surgery. Patients with ruptured aneurysms and who develop postoperative focal neurological deficits are also more than twice as likely to develop POD. These findings provide a strong platform for future research in testing therapeutic interventions based on IONM changes, which aim to decrease the risk of POD after aneurysm clipping surgeries.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500010","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":"Small Fiber Neuropathy in Long COVID: A Cohort Study with Multimodal Assessment and Follow-Up.","authors":"Natalia Drobinska, Mayssam Nehme, Fréderic Assal, Emmanuel Laffitte, Idris Guessous, Agustina M Lascano","doi":"10.1159/000546015","DOIUrl":"10.1159/000546015","url":null,"abstract":"<p><strong>Introduction: </strong>Given the increasing number of patients suffering from pain associated with dysautonomic symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we aimed to estimate the occurrence of small fiber neuropathy (SFN) in a cohort of long coronavirus disease 19 (COVID-19) patients reporting postinfectious neuropathic pain.</p><p><strong>Methods: </strong>The study cohort included 18 patients suffering from neuropathic pain (neuropathic pain score DN4 ≥4) appearing after or during SARS-CoV-2 infection and lasting ≥90 days; presenting normal nerve conduction studies excluding large fiber damage. Patients underwent multimodal SFN evaluation by skin biopsy, quantitative sensory testing (QST), laser evoked potential (LEP) recording and electrochemical skin conductance (ESC; Sudoscan).</p><p><strong>Results: </strong>Out of 18 patients, 17 were analyzed. Participants' ages averaged 44 ± 9 years, with 94% females. Fourteen (82%) had abnormal skin biopsy results. Notably, 12/17 (70%) patients presented with autonomic complaints, all of whom had abnormal skin biopsy results. At 6-month follow-up, 10/17 patients reported a subjective improvement in pain and/or dysautonomia with or without symptomatic pharmacological or non-pharmacological treatment. In our cohort, QST showed the highest sensibility (79%) and specificity (67%), followed by LEP (sensibility 71%, specificity 67%). ESC showed poor reliability in the screening of SFN with a sensibility of 7% and specificity of 50%.</p><p><strong>Conclusion: </strong>The results of our study suggest that SFN may develop during or shortly after SARS-CoV-2 infection, provoking disabling sensory and dysautonomic symptoms that tend to persist for more than 6 months. Furthermore, our findings imply that noninvasive exams are a useful complement to biopsy in the diagnostic process of SFN.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"52-63"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215370","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}