Journal of Central Nervous System Disease最新文献

{"title":"Dysregulation of tetrahydrobiopterin metabolism in myalgic encephalomyelitis/chronic fatigue syndrome by pentose phosphate pathway.","authors":"Sarojini Bulbule, Carl Gunnar Gottschalk, Molly E Drosen, Daniel Peterson, Leggy A Arnold, Avik Roy","doi":"10.1177/11795735241271675","DOIUrl":"10.1177/11795735241271675","url":null,"abstract":"<p><strong>Background: </strong>Tetrahydrobiopterin (BH4) and its oxidized derivative dihydrobiopterin (BH2) were found to be strongly elevated in ME/CFS patients with orthostatic intolerance (ME + OI).</p><p><strong>Objective: </strong>However, the molecular mechanism of biopterin biogenesis is poorly understood in ME + OI subjects. Here, we report that the activation of the non-oxidative pentose phosphate pathway (PPP) plays a critical role in the biogenesis of biopterins (BH4 and BH2) in ME + OI subjects.</p><p><strong>Research design and results: </strong>Microarray-based gene screening followed by real-time PCR-based validation, ELISA assay, and finally enzyme kinetic studies of glucose-6-phosphate dehydrogenase (G6PDH), transaldolase (TALDO1), and transketolase (TK) enzymes revealed that the augmentation of anaerobic PPP is critical in the regulations of biopterins. To further investigate, we devised a novel cell culture strategy to induce non-oxidative PPP by treating human microglial cells with ribose-5-phosphate (R5P) under a hypoxic condition of 85%N₂/10%CO₂/5%O₂ followed by the analysis of biopterin metabolism via ELISA, immunoblot, and dual immunocytochemical analyses. Moreover, the siRNA knocking down of the <i>taldo1</i> gene strongly inhibited the bioavailability of phosphoribosyl pyrophosphate (PRPP), reduced the expressions of purine biosynthetic enzymes, attenuated GTP cyclohydrolase 1 (GTPCH1), and suppressed subsequent production of BH4 and its metabolic conversion to BH2 in R5P-treated and hypoxia-induced C20 human microglia cells. These results confirmed that the activation of non-oxidative PPP is indeed required for the upregulation of both BH4 and BH2 via the purine biosynthetic pathway. To test the functional role of ME + OI plasma-derived biopterins, exogenously added plasma samples of ME + OI plasma with high BH4 upregulated inducible nitric oxide synthase (iNOS) and nitric oxide (NO) in human microglial cells indicating that the non-oxidative PPP-induced-biopterins could stimulate inflammatory response in ME + OI patients.</p><p><strong>Conclusion: </strong>Taken together, our current research highlights that the induction of non-oxidative PPP regulates the biogenesis of biopterins contributing to ME/CFS pathogenesis.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11331476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroencephalography as a tool for assessing delirium in hospitalized patients: A single-center tertiary hospital experience.","authors":"Nur Shairah Mohamad Faizal, Juen Kiem Tan, Michelle Maryanne Tan, Ching Soong Khoo, Siti Zaleha Sahibulddin, Nursyazwana Zolkafli, Rozita Hod, Hui Jan Tan","doi":"10.1177/11795735241274203","DOIUrl":"10.1177/11795735241274203","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a prevalent yet underdiagnosed disorder characterized by acute cognitive impairment. Various screening tools are available, including the Confusion Assessment Method (CAM) and 4 A's test (4AT). However, the results of these assessments may vary among raters. Therefore, we investigated the objective use of electroencephalography (EEG) in delirium and its clinical associations and predictive value.</p><p><strong>Method: </strong>This cross-sectional observational study was conducted at Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan, Malaysia, from April 2021 to April 2023. This study included patients aged ≥18 years with a preliminary diagnosis of delirium. Demographic and clinical data were collected along with EEG recordings evaluated by certified neurologists to classify abnormalities and compare the associated factors between patients with delirium with or without EEG abnormalities.</p><p><strong>Results: </strong>One hundred and twenty patients were recruited, with 80.0% displaying EEG abnormalities, mostly generalized slowing (moderate to severe) and primarily generalized slowing (mild to severe), and were characterized by theta activity. Age was significantly associated with EEG abnormalities, with patients aged 75 and older demonstrating the highest incidence (88.2%). The CAM scores were strongly correlated with EEG abnormalities (r = 0.639, <i>P</i> < 0.001) and was a predictor of EEG abnormalities (<i>P</i> < 0.012), indicating that EEG can complement clinical assessments for delirium. The Richmond Agitation and Sedation Scale (RASS) scores (r = -0.452, <i>P</i> < 0.001) and Barthel index (BI) (r = -0.582, <i>P</i> < 0.001) were negatively correlated with EEG abnormalities. Additionally, a longer hospitalization duration was associated with EEG abnormalities (r = 0.250, <i>P</i> = 0.006) and emerged as a predictor of such changes (<i>P</i> = 0.030).</p><p><strong>Conclusion: </strong>EEG abnormalities are prevalent in patients with delirium, particularly in elderly patients. CAM scores and the duration of hospitalization are valuable predictors of EEG abnormalities. EEG can be an objective tool for enhancing delirium diagnosis and prognosis, thereby facilitating timely interventions.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep cervical lymph nodes in Parkinson's disease and atypical Parkinson's disease: A potential ultrasound biomarker for differential diagnosis.","authors":"Zhaoying Dong, Xinyi Du, Ling Wang, Xiaoya Zou, Hongzhou Zuo, Yong Yan, Guojun Chen, Oumei Cheng, Yong Zhang","doi":"10.1177/11795735241259429","DOIUrl":"10.1177/11795735241259429","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) is a common degenerative disease caused by abnormal accumulation of α-synuclein. The glymphatic pathway is essential for removing macromolecular proteins including α-synuclein from the brain, which flows into deep cervical lymph nodes (DCLNs) through meningeal lymphatics. As a terminal station for the cerebral lymphatic system drainage, DCLNs can be easily assessed clinically.</p><p><strong>Objectives: </strong>Although the drainage function of the cerebral lymphatic system is impaired in PD, the correlation between DCLNs and PD remains unknown.</p><p><strong>Design: </strong>Single-center retrospective cross-sectional study.</p><p><strong>Methods: </strong>The size of the DCLNs were measured using ultrasound. The Movement Disorder Society Sponsored Revision Unified Parkinson's Disease Rating Scale and other scales were used to assess PD motor and non-motor symptoms.</p><p><strong>Results: </strong>Compared with the healthy control (HC) and the atypical Parkinson's disease (AP) groups, the size of the second and third DCLNs in the Parkinson's disease (PD) group was significantly smaller (<i>P</i> < .05). The width diameter of the third DCLN (DCLN3(y)) was significantly smaller in the PD group than in the AP group (<i>P</i> = .014). DCLN3(y) combined with a variety of clinical features improved the sensitivity of AP identification (sensitivity = .813).</p><p><strong>Conclusion: </strong>DCLNs were able to distinguish HC, PD and AP and were mainly located in Robbins ΙΙA level. PD and AP were associated with different factors that influenced the size of the DCLNs. DCLN3(y) plays an important role in differentiating PD from AP, which, combined with other clinical features, has the ability to distinguish PD from AP; in particular, the sensitivity of AP diagnosis was improved.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased flow in ischemic stroke with coexisting intracranial artery stenosis and white matter hyperintensities.","authors":"Xiaowei Song, Wenwen Chen, Xihai Zhao, Zhuozhao Zheng, Zhenhua Sang, Rui Li, Jian Wu","doi":"10.1177/11795735241266572","DOIUrl":"10.1177/11795735241266572","url":null,"abstract":"<p><strong>Background: </strong>Stroke patients with coexisting intracranial artery stenosis (ICAS) and white matter lesions (WML) usually have a poor outcome. However, how WML affects stroke prognosis has not been determined.</p><p><strong>Objective: </strong>To investigate the quantitative forward flow at the middle cerebral artery in ICAS patients with different degrees of WML using 4D flow.</p><p><strong>Design: </strong>Single-center cross-sectional cohort study.</p><p><strong>Methods: </strong>Ischemic stroke patients with symptomatic middle cerebral artery (MCA) atherosclerosis were included, and they were divided into 2 groups based on Fazekas scale on Flair image (mild group = Fazekas 0-2, and severe group = Fazekas >2), TOF-MRA and 4D flow were performed to quantify the stenosis degree and forward flow at the proximal of stenosis. The flow parameters were compared between different white matter hyperintensity (WMH) groups, as well as in different MCA stenosis groups, logistic regression was used to validate the association between forward flow and WMH.</p><p><strong>Results: </strong>A total of 66 patients were included in this study (mean age 56 years old, 68.2% male). 77.3% of them presented with WMH (Fazekas 1-5). Comparison of flow index between mild and severe WMH groups found a significantly lower forward flow (2.34 ± 1.09 vs 3.04 ± 1.35), higher PI (0.75 ± 0.43 vs 0.66 ± 0.32), and RI (0.49 ± 0.19 vs 0.46 ± 0.15) at ipsilateral infarction MCA in the severe WMH group, all <i>P</i>-values <0.05. After adjusting for other covariates, forward mean flow at ipsilateral infarction MCA is still associated with severe WMH independently, OR = 0.537, 95% CI (0.294, 0.981), <i>P</i> = 0.043.</p><p><strong>Conclusion: </strong>Intracranial artery stenosis patients with coexisting severe WMH suffer from significantly decreased flow, which could explain the poor clinical outcome in this population, and also provide some insight into recanalization therapy in the future.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world effectiveness of cladribine as an escalation strategy for MS: Insights from the Czech nationwide ReMuS registry.","authors":"Pavel Potuznik, Jiri Drahota, Dana Horakova, Marek Peterka, Aneta Mazouchova, David Matyas, Zbysek Pavelek, Marta Vachova, Eva Recmanova, Ivana Stetkarova, Jana Libertinova, Jan Mares, Pavel Stourac, Marketa Grunermelova, Alena Martinkova, Jana Adamkova, Pavel Hradilek, Radek Ampapa, Michal Dufek, Eva Kubala Havrdova, Dominika Stastna","doi":"10.1177/11795735241262743","DOIUrl":"10.1177/11795735241262743","url":null,"abstract":"<p><strong>Background: </strong>Cladribine, a selective immune reconstitution therapy, is approved for the treatment of adult patients with highly active multiple sclerosis (MS).</p><p><strong>Objectives: </strong>Provide experience with cladribine therapy in a real-world setting.</p><p><strong>Methods: </strong>This is a registry-based retrospective observational cohort study. First, using data from the Czech nationwide registry ReMuS, we analysed patients who initiated cladribine from September 1, 2018 to December 31, 2021. Second, we analysed a subgroup of patients who initiated cladribine between September 1, 2018 to June 30, 2020, thus possessing a follow-up period of at least 2 years. We evaluated demographic and MS characteristics including disease-modifying therapies (DMTs) before and after cladribine administration, relapses, Expanded Disability Status Scale (EDSS), and adherence.</p><p><strong>Results: </strong>In total, 617 patients (335 with follow-up of at least 2 years) started cladribine therapy in the study period (mean age 37.0, mean disease duration 8.4 years, 74.1% females). In most cases, cladribine was administered as a second-line drug, a total of 80.7% had been escalated from a platform DMT. During 2 years before cladribine initiation, the average annualised relapse rate (ARR) was .67. Following cladribine initiation, the ARR decreased to .28 in the first year and .22 in the second year. Overall, across the entire two-year treatment period, 69.0% of patients were relapse-free and the average ARR was .25. As for EDSS development, the median baseline EDSS was 2.5 and remained stable even after 24 months. The adherence to treatment ranged of around 90%.</p><p><strong>Conclusion: </strong>This nationwide study confirms the efficacy of cladribine in real-world settings, especially in patients who are not treatment-naïve. In addition, the study shows an exceptionally high adherence rate, a finding that underscores the invaluable role of cladribine, but also the value of registry-based studies in capturing real-world clinical practice.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI-informed machine learning-driven brain age models for classifying mild cognitive impairment converters.","authors":"Hanna Lu, Jing Li","doi":"10.1177/11795735241266556","DOIUrl":"https://doi.org/10.1177/11795735241266556","url":null,"abstract":"<p><strong>Background: </strong>Brain age model, including estimated brain age and brain-predicted age difference (brain-PAD), has shown great potentials for serving as imaging markers for monitoring normal ageing, as well as for identifying the individuals in the pre-diagnostic phase of neurodegenerative diseases.</p><p><strong>Purpose: </strong>This study aimed to investigate the brain age models in normal ageing and mild cognitive impairments (MCI) converters and their values in classifying MCI conversion.</p><p><strong>Methods: </strong>Pre-trained brain age model was constructed using the structural magnetic resonance imaging (MRI) data from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) project (N = 609). The tested brain age model was built using the baseline, 1-year and 3-year follow-up MRI data from normal ageing (NA) adults (n = 32) and MCI converters (n = 22) drew from the Open Access Series of Imaging Studies (OASIS-2). The quantitative measures of morphometry included total intracranial volume (TIV), gray matter volume (GMV) and cortical thickness. Brain age models were calculated based on the individual's morphometric features using the support vector machine (SVM) algorithm.</p><p><strong>Results: </strong>With comparable chronological age, MCI converters showed significant increased TIV-based (Baseline: <i>P</i> = 0.021; 1-year follow-up: <i>P</i> = 0.037; 3-year follow-up: <i>P</i> = 0.001) and left GMV-based brain age than NA adults at all time points. Higher brain-PAD scores were associated with worse global cognition. Acceptable classification performance of TIV-based (AUC = 0.698) and left GMV-based brain age (AUC = 0.703) was found, which could differentiate the MCI converters from NA adults at the baseline.</p><p><strong>Conclusions: </strong>This is the first demonstration that MRI-informed brain age models exhibit feature-specific patterns. The greater GMV-based brain age observed in MCI converters may provide new evidence for identifying the individuals at the early stage of neurodegeneration. Our findings added value to existing quantitative imaging markers and might help to improve disease monitoring and accelerate personalized treatments in clinical practice.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic polymorphisms and post-stroke upper limb motor improvement - A systematic review and meta-analysis.","authors":"Sandeep K Subramanian, Riley T Morgan, Carl Rasmusson, Kayla M Shepherd, Carol L Li","doi":"10.1177/11795735241266601","DOIUrl":"https://doi.org/10.1177/11795735241266601","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke upper limb (UL) motor improvement is associated with adaptive neuroplasticity and motor learning. Both intervention-related (including provision of intensive, variable, and task-specific practice) and individual-specific factors (including the presence of genetic polymorphisms) influence improvement. In individuals with stroke, most commonly, polymorphisms are found in Brain Derived Neurotrophic Factor (BDNF), Apolipoprotein (APOE) and Catechol-O-Methyltransferase (COMT). These involve a replacement of cystine by arginine (APOEε4) or valines by 1 or 2 methionines (BDNF:val⁶⁶met, met⁶⁶met; COMT:val¹⁵⁸met; met¹⁵⁸met). However, the implications of these polymorphisms on post-stroke UL motor improvement specifically have not yet been elucidated.</p><p><strong>Objective: </strong>Examine the influence of genetic polymorphism on post-stroke UL motor improvement.</p><p><strong>Design: </strong>Systematic Review and Meta-Analysis.</p><p><strong>Methods: </strong>We conducted a systematic search of the literature published in English language. The modified Downs and Black checklist helped assess study quality. We compared change in UL motor impairment and activity scores between individuals with and without the polymorphisms. Meta-analyses helped assess change in motor impairment (Fugl Meyer Assessment) scores based upon a minimum of 2 studies/time point. Effect sizes (ES) were quantified based upon the Rehabilitation Treatment Specification System as follows: small (0.08-0.18), medium (0.19 -0.40) and large (≥0.41).</p><p><strong>Results: </strong>We retrieved 10 (4 good and 6 fair quality) studies. Compared to those with BDNF val⁶⁶met and met⁶⁶met polymorphism, meta-analyses revealed lower motor impairment (large ES) in those without the polymorphism at intervention completion (0.5, 95% CI: 0.11-0.88) and at retention (0.58, 95% CI:0.06-1.11). The presence of CoMT val¹⁵⁸met or met¹⁵⁸met polymorphism had similar results, with lower impairment (large ES ≥1.5) and higher activity scores (large ES ranging from 0.5-0.76) in those without the polymorphism. Presence of APOEε4 form did not influence UL motor improvement.</p><p><strong>Conclusion: </strong>Polymorphisms with the presence of 1 or 2 met alleles in BDNF and COMT negatively influence UL motor improvement.</p><p><strong>Registration: </strong>https://osf.io/wk9cf/.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases.","authors":"Mehran Rashidi, Saba Naghavi, Neda Ramezani, Fereshteh Ashtari, Vahid Shaygannejad, Sayed Mohsen Hosseini, Iman Adibi","doi":"10.1177/11795735241262738","DOIUrl":"10.1177/11795735241262738","url":null,"abstract":"<p><strong>Background: </strong>Appropriate treatment reduces the severity and duration of relapses in demyelinating diseases of Central Nervous System (CNS). If high-dose corticosteroids treatment fails, therapeutic plasma exchange (TPE) is considered as a rescue treatment.</p><p><strong>Objectives: </strong>This study aimed to investigate early clinical response and complications of TPE and prognostic factors in CNS demyelinating relapses.</p><p><strong>Design: </strong>This prospective observational study was designed in a tertiary center during one year.</p><p><strong>Methods: </strong>All adult patients diagnosed corticosteroid-resistant Multiple Sclerosis (MS), NeuroMyelitis Optica Spectrum Disorder (NMOSD), idiotypic Transverse Myelitis or Clinical Isolated Syndrome relapses, were eligible. Clinical response is defined based on Expanded Disability Status Scale (EDSS) at discharge. Clinical and laboratory complications recorded.</p><p><strong>Results: </strong>Seventy-two patients were analyzed which 58.3% patients were female. MS was diagnosed for 61.1% of cases. Thirty-five patients (48.6%) responded and the mean differences of EDSS significantly decreased 0.60 score (CI95%:0.44-.77). Electrolyte imbalances and thrombocytopenia occurred in 80.6% and 55.6% of cases respectively and 40.3% of patients had systemic reactions. However, 26.4% patients experienced moderate to severe complications. In patients with moderate to severe disability, responders were younger (MD: 8.42 years, CI95%: 1.67-15.17) and had lower EDSS score at admission (median:6, IQR: 5.5-6 against 7.5 IQR: 6.5-8). The risk of failure was higher in active progressive MS patients compared with RRMS patients (OR: 6.06, CI 95%:1.37-26.76). Patients with thrombocytopenia were hospitalized more than others (MD: 1.5 days, CI 95%: 0-3). Females were more prone to hypokalemia and systemic reactions (OR: 3.11, CI 95%:1.17-8.24 and OR: 6.67, CI 95%:2.14-20.81 respectively).</p><p><strong>Conclusion: </strong>The most common indication of TPE was corticosteroid-resistant severe MS relapses. About half of the patients presented an early clinical response. Lower disability, younger age and RRMS diagnosis are prognostic factors of better response. One out of four patients experienced moderate to severe complications, mainly electrolyte imbalances and systemic reactions. Appropriate interventions against these complications should be considered during TPE, especially in females.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11188695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term, home-based transcranial direct current stimulation coupled with computerized cognitive training in frontotemporal dementia: A case report.","authors":"Donna C Tippett, Kyriaki Neophytou, Yuan Tao, Jessica Gallegos, Christopher Morrow, Chiadi U Onyike, Kyrana Tsapkini","doi":"10.1177/11795735241258435","DOIUrl":"10.1177/11795735241258435","url":null,"abstract":"<p><p>We present the case of a 62-year-old woman with probable behavioral variant of frontotemporal dementia (bvFTD) with cognitive/language deficits who demonstrated improved performance on cognitive/language testing and in functional tasks following long-term, home-based transcranial direct current stimulation (tDCS) coupled with computerized cognitive training (CCT). The patient underwent home-based tDCS (anode on the left prefrontal cortex and cathode on the right homologue) for 46 sessions over 10 weeks along with CCT. On post-treatment testing, the patient improved by 3 points on the Mini-Mental State Exam (MMSE) (23 to 26). She also showed improvement on several cognitive/language tasks, such as immediate recall of single words and word pairs, total accurate words in sentence repetition, delayed recall, semantic processing, and sentence level comprehension. There was no decline in several other cognitive and language tasks. Family members reported subjective improvements in expressiveness, communication, and interaction with others as well as increased attention to grooming and style which contrasted with her pre-treatment condition. This report suggests that home-based tDCS combined with CCT for an extended period may slow decline, and improve cognitive/language performance and everyday function in FTD.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The assistive potential of functional electrical stimulation to support object manipulation in functional upper extremity movements after stroke: A randomized cross-over study.","authors":"Chiara Höhler, Joachim Hermsdörfer, Klaus Jahn, Carmen Krewer","doi":"10.1177/11795735241247812","DOIUrl":"10.1177/11795735241247812","url":null,"abstract":"<p><strong>Background: </strong>After standard care, 55%-75% of patients after stroke show a persistent paresis of the upper limb (UL). Assistive devices are developed to increase the patients' level of independence in daily life.</p><p><strong>Objectives: </strong>To investigate the potential of Functional Electrical Stimulation (FES) to assist object manipulation in activities of daily life.</p><p><strong>Design: </strong>Seventeen patients after stroke were tested and analyzed in a randomized cross-over design.</p><p><strong>Methods: </strong>Functional grasping was assessed by means of the Action Research Arm Test (ARAT) and the modified Box and Block Test (mBBT), in one session with and another without FES assistance. The order of sessions was randomized. Patients' motivation was assessed after each session. Task performance and motivation were compared between conditions using the Wilcoxon test and subgroup analyses were performed for impairment severity by distribution-based mixed-factor analyses.</p><p><strong>Results: </strong>When analyzing the total ARAT, FES did not effectively assist the overall performance (<i>P</i> = .142), but did assist the performance of objects of the Grasp category (<i>P</i> = .020). Impairment severity showed an interaction with the orthotic effect (<i>P</i> = .012), as severely impaired patients profited from FES assistance and mild-moderately impaired did not. When focusing on the more functional items of the ARAT (i.e., excluding scores from thumb-middle and thumb-ring finger combinations), there was a significant orthotic effect of FES on task performance (<i>P</i> = .023). Further, there was an orthotic effect for the number of transported blocks in the mBBT (<i>P</i> = .033), exclusively prominent in the group of severely impaired patients. Functional Electrical Stimulation did not increase the patients' motivation (<i>P</i> = .959), which was high after both conditions.</p><p><strong>Conclusion: </strong>Functional Electrical Stimulation has the potential to support object manipulation, but is dependent on impairment severity and object type. To observe a consistent orthotic effect, features of the stimulator should be further developed to generate appropriate grasps and forces across subjects and objects.</p><p><strong>Trial registration: </strong>The trial was registered with the German Clinical Trials Register (DRKS00025889).</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11075593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}