Journal of Clinical Neuroscience最新文献

{"title":"White matter correlates of gait and balance dysfunction in essential tremor patients.","authors":"Swati Parida, Anand Kumar, Ashish Verma, Adith Krishna K, Varun Kumar Singh, Abhishek Pathak, Rameshwar Nath Chaurasia, Vijaya Nath Mishra, Deepika Joshi","doi":"10.1016/j.jocn.2024.110920","DOIUrl":"https://doi.org/10.1016/j.jocn.2024.110920","url":null,"abstract":"<p><strong>Background: </strong>Essential tremor (ET) is a syndrome characterized by both motor (tremor, gait, and balance dysfunction) and non-motor features like cognitive deficits, depression, sleep, mood, and anxiety disorders. The present study was conducted to characterize the clinical dysfunction and brain localization of gait and balance disturbances in ET patients.</p><p><strong>Methods: </strong>174 ET patients and 150 matched healthy controls were evaluated. ET was diagnosed using the Consensus Statement on the Classification of Tremors, from the Task Force on Tremors of the Movement Disorder Society criteria. Participants were assessed by using a structured neuropsychological battery and validated gait scores. Diffusion tensor imaging (DTI) data comprising mean diffusivity, radial diffusivity, axial diffusivity, and fractional anisotropy were analyzed for all subjects.</p><p><strong>Results: </strong>The mean age of essential tremor cases was 45.1 ± 14.08 years. Male: female ratio in ET cases was 2.5:1. Cognitive impairment was observed in a quarter of ET patients. A significant difference was observed in Berg balance scale scores, tandem gait missteps, and tandem stance time between ET cases and controls (p-value < 0.0001). ET patients with higher tremor scores and head tremors were more aged and had poor gait and cognitive scores (p < 0.0001). In our study, we observed poor gait scores significantly correlated with an increase in mean, radial, and axial diffusivities as well as a decrease in fractional anisotropy over various white matter clusters in the brain. No such correlation was observed among the controls.</p><p><strong>Conclusion: </strong>The present study demonstrates a correlation between gait scores and DTI metrics suggesting a neuroanatomic basis for gait impairment in ET patients.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"110920"},"PeriodicalIF":1.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681961","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":"Hemorrhagic transformation after thrombolytic therapy for acute ischemic stroke: Accuracy and improvement of existing predictive models in a rural population of the Midwest","authors":"Andrea Loggini ,&nbsp;Jessie Henson ,&nbsp;Julie Wesler ,&nbsp;Jonatan Hornik ,&nbsp;Karam Dallow ,&nbsp;Amber Schwertman ,&nbsp;Alejandro Hornik","doi":"10.1016/j.jocn.2024.110924","DOIUrl":"10.1016/j.jocn.2024.110924","url":null,"abstract":"<div><h3>Background</h3><div>Hemorrhagic transformation (HT) after rtPA in acute ischemic stroke is a known complication of thrombolytic therapy. Several grading scales have been introduced in clinical practice, aiming to quantify the risk of HT before rtPA is administered. The goals of this study are to evaluate the performance of existing grading scales in a rural population of the Midwest and improve the existing models.</div></div><div><h3>Methods</h3><div>This is a retrospective study of stroke patients treated with thrombolytics at Southern Illinois Healthcare from July 2017 to August 2024. Demographics, clinical presentations, laboratory values, neuroimaging, and stroke metrics were collected. HT found on neuroimaging within 24 h after rtPA was reviewed. mRS at 30 days was noted. The cohort was divided in two groups: HT and no-HT. The two groups were compared by univariate analyses. SEDAN, HAT, MSS, and THRIVE scores were calculated, and multivariable logistic regression analysis was run for each model. Area under the receiver operating characteristic curve (AUC) with its 95 % confidence interval was calculated for each grading scale. P value was set at 0.05.</div></div><div><h3>Results</h3><div>Out of 279 patients included in this study, HT occurred in 8.6 % of patients (n = 24), whereas 91.4 % (n = 255) had no-HT. The two groups were similar in baseline characteristics and stroke severity. HT group had significantly worse mRS 0–2 at 30 days (42 % vs. 69 %, p &lt; 0.05). SEDAN score demonstrated the highest accuracy in predicting HT after rtPA (AUC = 0.65, 95 % CI:0.56–0.75). Adding 1 point for smoking to the score, SEDAN-S, improved the accuracy of the model (AUC = 0.67, 95 % CI:0.57–0.77).</div></div><div><h3>Conclusions</h3><div>Existing predictive scales of HT after rtPA underperform in our rural population. Among those, SEDAN score is the most accurate predictor. Adding smoking status to the score improves its accuracy. Further larger studies in similar rural populations should be performed to confirm our results.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110924"},"PeriodicalIF":1.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643973","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":"Epidemiological and clinical characteristics of primary spinal cord glioblastomas: A systematic review and meta-analysis","authors":"Pedro Lucas Negromonte Guerra ,&nbsp;Inaê Carolline Silveira da Silva ,&nbsp;Deoclides Lima Bezerra Júnior ,&nbsp;Anderson Albert Primo Lopes ,&nbsp;Geraldo de Sá Carneiro Filho ,&nbsp;Eduardo Vieira de Carvalho Júnior","doi":"10.1016/j.jocn.2024.110862","DOIUrl":"10.1016/j.jocn.2024.110862","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary spinal cord glioblastomas (GBMs) are rare neoplasms with distinct clinical and epidemiological characteristics compared to other spinal cord tumors and cranial GBMs. Despite their rarity, their aggressive nature and challenging prognosis make them clinically significant. This study aims to elucidate the clinical and epidemiological characteristics of primary spinal cord GBMs and compare them with cranial GBMs and other spinal cord tumors.</div></div><div><h3>Methodology</h3><div>The inclusion criteria included case reports or series of primary spinal cord GBMs, while excluding inconclusive histopathological cases and articles not in English or Portuguese. A systematic review and <em>meta</em>-analysis were conducted using PubMed and Mendeley search engines.</div></div><div><h3>Results</h3><div>The data from 237 patients (mean age: 28.6 years; male-to-female ratio 1.35:1) were analyzed. On radiological imaging, GBMs exhibited patterns similar to those of cranial GBMs. Most tumors were located in the cervical and thoracic regions, with motor deficits as the primary presenting symptom. Almost all patients underwent surgical treatment (88,6%), often followed by adjuvant therapy with chemotherapy (56.5 %) and radiotherapy (68 %). The median progression-free survival (PFS) was 11.5 months, while overall survival (OS) was 15.3 months, with no significant sex or age differences observed.</div></div><div><h3>Conclusion</h3><div>Primary spinal cord GBMs are rare but aggressive tumors, predominantly affecting young males. Despite similarities with cranial GBMs, differences in incidence, age distribution and aggressiveness exist.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110862"},"PeriodicalIF":1.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621291","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":"Customized GPT model largely increases surgery decision accuracy for pharmaco-resistant epilepsy","authors":"Kuo-Liang Chiang ,&nbsp;Yu-Cheng Chou ,&nbsp;Hsin Tung ,&nbsp;Chin-Yin Huang ,&nbsp;Liang-Po Hsieh ,&nbsp;Kai-Ping Chang ,&nbsp;Shang-Yeong Kwan ,&nbsp;Wan-Yu Huang","doi":"10.1016/j.jocn.2024.110918","DOIUrl":"10.1016/j.jocn.2024.110918","url":null,"abstract":"<div><h3>Background</h3><div>To develop an enhanced epilepsy diagnosis system by integrating an expert-informed ontology with a custom generative pre-trained transformer (GPT), validated by inferring possible seizure lateralization and localization using retrospective textual data from the pre-surgical assessments of patients with pharmaco-resistant epilepsy (PRE).</div></div><div><h3>Methods</h3><div>We developed an AI system for epilepsy diagnosis using Protégé with OWL/SWRL, integrating a knowledge base with seizure semiology, seizure types EEG descriptors, expert insights, and literature to pinpoint seizure locations. A customized GPT model was then tailored for specific diagnostic needs. Validated through 16 surgical cases, the system’s accuracy in seizure localization and the JSON (JavaScript Object Notation) Epilepsy Matcher’s term matching capabilities were confirmed against a Protégé-based knowledge base.</div></div><div><h3>Results</h3><div>A total of 117 patients with PRE underwent video-EEG monitoring at a single institution. However, only 16 of these patients received epilepsy surgery. The Protégé system achieved 75 % accuracy in diagnosing epilepsy from 16 cases using semiology, which increased to 87.5 % with EEG data. The Json Epilepsy Matcher further improved accuracy to 87.5 % with symptoms alone and 93.8 % when including EEG data, highlighting the benefits of applying GPT techniques.</div></div><div><h3>Conclusions</h3><div>This study highlights the efficacy of the JSON Epilepsy Matcher in improving seizure diagnosis accuracy. When combined with EEG data, it achieves a 93.8 % accuracy rate, suggesting a potential improvement in the practicality and generalizability of the original ontology expert system, boosting physicians’ confidence in confirming surgery and potentially sparing many children from prolonged suffering. This innovative approach not only improves diagnostic accuracy but also sets a precedent for future applications of AI in neurology.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110918"},"PeriodicalIF":1.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621282","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":"Telehealth interventions for stroke management and rehabilitation in low- and middle-income countries: A scoping review","authors":"Jeya Anandakumar ,&nbsp;Htun Ja Mai ,&nbsp;Natalie BV Riblet ,&nbsp;Hena Waseem","doi":"10.1016/j.jocn.2024.110906","DOIUrl":"10.1016/j.jocn.2024.110906","url":null,"abstract":"<div><h3>Introduction</h3><div>The burden of stroke is higher in low- and middle-income countries (LMICs) than in high-income countries due to the lack of stroke care centers, stroke specialist, and rehabilitation access. One way to increase access to stroke care in LMICs is through the use of telehealth.</div></div><div><h3>Material &amp; method</h3><div>We performed a scoping review to summarize the evidence on telehealth in LMICs. We searched Medline, SCOPUS, and Web of Science through February 18th, 2022. Reviewers screened for studies reporting on health outcomes following telehealth interventions (imaging, thrombolysis, and rehabilitation) in LMICs. We included all study designs.</div></div><div><h3>Results</h3><div>Out of 259 studies, 10 studies met the eligibility criteria. Nine reported on functional or disability measures, 6 reported on cerebral infarction or intracerebral hemorrhage, 5 reported on door-to-needle time to thrombolysis, and 6 reported on mortality rate. Out of 9 studies, 8 reported that the use of telehealth for stroke management and rehabilitation in LMICs has led to a decrease in the degree of post-stroke disability. However, the comparison group may have received no rehabilitation treatment at all in LMICs. All 5 studies that measured administration of thrombolytic therapy in respective telehealth interventions were within the recommended 3-hour time window. Studies with a comparison arm found that there was no significant difference in mortality and cerebral infarction/intracerebral hemorrhage rates between telehealth and control.</div></div><div><h3>Conclusion</h3><div>Evidence from this review suggests that telehealth may improve post-stroke disability and facilitate the timely administration of thrombolytics therapy within the 3-hour window by allowing remote access to distant tertiary stroke care center in situations where it would otherwise be delayed in LMICs due to logistical barriers such as an extended travel time. Further research using randomized and quasi-experimental studies are needed in LMICs to determine the overall effectiveness of telehealth intervention for stroke management and rehabilitation.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110906"},"PeriodicalIF":1.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621299","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":"CT perfusion derived relative cerebral blood volume < 42 % is negatively associated with poor functional outcomes at discharge in anterior circulation large vessel occlusion stroke","authors":"Dhairya A. Lakhani ,&nbsp;Aneri B. Balar ,&nbsp;Vaibhav Vagal ,&nbsp;Hamza Salim ,&nbsp;Janet Mei ,&nbsp;Manisha Koneru ,&nbsp;Sijin Wen ,&nbsp;Burak Berksu Ozkara ,&nbsp;Hanzhang Lu ,&nbsp;Richard Wang ,&nbsp;Risheng Xu ,&nbsp;Mehreen Nabi ,&nbsp;Ishan Mazumdar ,&nbsp;Andrew Cho ,&nbsp;Kevin Chen ,&nbsp;Sadra Sepehri ,&nbsp;Francis Deng ,&nbsp;Nathan Hyson ,&nbsp;Victor Urrutia ,&nbsp;Licia P. Luna ,&nbsp;Vivek S. Yedavalli","doi":"10.1016/j.jocn.2024.110907","DOIUrl":"10.1016/j.jocn.2024.110907","url":null,"abstract":"<div><h3>Background and aim</h3><div>Recent studies have shown that the CT Perfusion (CTP) parameter of rCBV &lt; 42 % lesion volume can predict 90-day functional outcomes in stroke patients. However, its correlation with discharge outcomes, including functional dependence, has not been investigated. Our study aims to evaluate the relationship between rCBV &lt; 42 % and poor functional outcomes at discharge, defined as a modified Rankin score (mRS) of 3 or higher.</div></div><div><h3>Materials and methods</h3><div>This retrospective study analyzed patients with confirmed occlusion on CT angiography, who also received CT perfusion between 9/1/2017 and 10/01/2023. Statistical tests (Student’s T, Mann-Whitney U, and Chi-Square) were used to assess differences. Univariable and multivariable logistic regression analyses were performed to evaluate the associations of rCBV &lt; 42 % with discharge mRS. A p-value ≤ 0.05 was considered significant.</div></div><div><h3>Results</h3><div>A total of 268 patients [median age: 68 years (IQR: 59–77), 56.3 % female] met the inclusion criteria. Among them, 85 patients (31.7 %) received intravenous thrombolysis (IVT), and 221 patients (82.5 %) underwent mechanical thrombectomy (MT). After adjusting for various variables, logistic regression analysis indicated that rCBV &lt; 42 % lesion volume was associated with poor functional outcomes at discharge (aOR = 0.97, p &lt; 0.05). T.</div></div><div><h3>Conclusion</h3><div>The rCBV &lt; 42 % could be a valuable tool in prognosticating AIS-LVO patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110907"},"PeriodicalIF":1.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621280","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":"Surgical management of symptomatic recurrent Rathke’s cleft cysts: A systematic review and individual-participant data meta-analysis","authors":"Yilong Zheng ,&nbsp;Joel Qi Xuan Foo ,&nbsp;Xinni Xu ,&nbsp;Vincent Diong Weng Nga","doi":"10.1016/j.jocn.2024.110917","DOIUrl":"10.1016/j.jocn.2024.110917","url":null,"abstract":"<div><div>The optimal management of symptomatic recurrent Rathke’s cleft cysts (RCCs) is unclear. Here, we compared the outcomes of various surgical approaches for symptomatic recurrent RCCs. PubMed and Embase were systematically reviewed for studies that reported individual-participant data on outcomes after surgical treatment for symptomatic recurrent RCCs presenting with headache and/or visual field defect. The primary outcome was symptomatic recurrence, and the secondary outcome was postoperative complications. Subgroup analyses were performed based on the number of recurrences, duration since initial surgery, previous treatment, and symptoms of recurrence. Of the 713 studies screened, 14 studies (30 recurrences in 24 patients) were included in the <em>meta</em>-analysis. Cyst wall resection was the most common treatment (n = 17, 56.7 %), followed by drainage with intrasellar stent insertion (n = 7, 23.3 %) and resection with intracystic bleomycin (n = 6, 20.0 %). Most of the cases were first recurrences (56.7 %, n = 17). The mean (SD) duration between the initial treatment and onset of symptomatic recurrence was 3.0 (3.6) years. Over a median [IQR] follow-up period of 1.2 [0.4, 2.5] years, patients who underwent cyst wall resection had a significantly higher incidence of symptomatic recurrence at 58.8 %, compared to a 0 % symptomatic recurrence rate in patients treated with drainage and intrasellar stent insertion or resection with intracystic bleomycin (p = 0.014). Patients who underwent cyst wall resection also had the highest risk of symptomatic recurrence on subgroup analysis, though this was statistically significant only among patients who underwent cyst wall resection as their preceding treatment (p = 0.021). There were no significant differences in postoperative complication rates between the treatment arms. In conclusion, for patients with symptomatic recurrent RCCs presenting with headache and/or visual field defects, drainage with intrasellar stent insertion and intracystic bleomycin may be superior to cyst wall resection alone. This approach may reduce the risk of another symptomatic recurrence within one year.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110917"},"PeriodicalIF":1.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621296","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":"Use of tools for assessing the methodological quality of primary research in leading neurosurgical journals: A review of reviews","authors":"Alexander J. Savage ,&nbsp;Christopher G. Shafik ,&nbsp;Simon A. Savage ,&nbsp;Jackson D. Catalano ,&nbsp;Jin W. Tee ,&nbsp;Hamed Akhlaghi ,&nbsp;Rana S. Dhillon ,&nbsp;Tom J. O’Donohoe","doi":"10.1016/j.jocn.2024.110916","DOIUrl":"10.1016/j.jocn.2024.110916","url":null,"abstract":"<div><div>Systematic reviews (SRs) and <em>meta</em>-analyses (MAs) require a comprehensive and reproducible strategy to assess the methodological quality of the included studies. This research-on-research study evaluated the methods used to assess research quality by SRs and MAs published in leading neurosurgical journals, and identified factors associated with the publication of a comprehensive and reproducible assessment. We systematically surveyed SRs published in the 10 leading neurosurgical journals between 01/11/2019 and 31/12/2021. PubMed was used to search the MEDLINE database, which was supplemented by individual journal searches. Included SRs were assessed using a standardised data extraction tool. Descriptive statistics were utilised to identify factors associated with methodological and reporting quality of the tool-based quality assessment. A total of 564 SRs were included in the analysis. 326 (57.80%) included MAs, 165 (29.26%) included at least one Randomized Controlled Trial (RCT) and 29 (5.14%) included only RCTs. Scales were the most commonly used tool for methodological quality assessment (32.45%), followed by domain-based tools (24.82%) and checklists (9.93%). The number of included studies was inversely associated with multiple methodological quality assessment metrics. A positive association was observed between the number of included patients and multiple methodological quality assessment metrics. We established that the methodological and reporting quality of tool-based quality assessment requires improvement. This issue is particularly pertinent for SRs limited to non-randomised studies, which account for the vast majority of neurosurgical SRs. We recommend the use of domain-based tools for methodological quality assessment as these provide a more nuanced assessment of methodological quality.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110916"},"PeriodicalIF":1.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621301","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":"Association between gait profile and spinal alignment in patients with adolescent idiopathic scoliosis","authors":"Il-Soo Eun ,&nbsp;Yoon Jae Cho ,&nbsp;Tae Sik Goh ,&nbsp;Jae Yoon Jeong ,&nbsp;Jung Sub Lee","doi":"10.1016/j.jocn.2024.110915","DOIUrl":"10.1016/j.jocn.2024.110915","url":null,"abstract":"<div><div>This study aimed to investigate the association between gait profile and spinal alignment in adolescent idiopathic scoliosis (AIS). The study group consisted of 80 AIS and 80 healthy controls. All participants underwent radiographic imaging and measured gait analysis. The gait profile included gait speed, step length, stance phase, cadence, single leg support, double legs support, gait asymmetry (GA), and phase coordination index (PCI). The spinal alignment parameters included pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), and coronal balance (CB). The mean age of the AIS group was 15.1 years, while the control group was 14.6 years. Significant differences were observed between the AIS patients and controls in gait speed, step length, stance phase, cadence, single leg support, double legs support, GA, PT, TK, SVA, and CB. However, no significant differences were found in PCI, SS, PI, and LL (<em>p</em> &gt; 0.05). Additionally, correlation analysis revealed a close relationship between gait profile and spinal alignment parameters. Step length was significantly related to PT, SS, and LL, while GA was correlated with TK in AIS patients. Multiple regression analysis for predictors of step length found that PT and SS accurately predicted step length. First, the AIS group showed significant differences in gait kinematics and spinal alignment compared to the control group. Second, statistically significant correlations were found between gait profile and spinal alignment parameters. Specifically, PT and SS accurately predicted step length, and TK was correlated with GA in AIS patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110915"},"PeriodicalIF":1.9,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621278","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":"Evaluating the efficacy and safety of flow diverter in pediatric cerebral aneurysm treatment: A systematic review and meta-analysis","authors":"Marcelo Porto Sousa ,&nbsp;Filipe Virgilio Ribeiro ,&nbsp;Sávio Batista ,&nbsp;Marcelo Antonio Pinheiro Braga ,&nbsp;Jairo Porfírio de Oliveira Júnior ,&nbsp;Pedro Cotta Abrahão Reis ,&nbsp;Christian Ken Fukunaga ,&nbsp;Gabriel Verly ,&nbsp;Hugo Nunes Pustilnik ,&nbsp;Chiara Donnangelo Pimentel ,&nbsp;Felippe Figueiredo Torres Ribeiro ,&nbsp;Herika Negri Brito ,&nbsp;Raphael Bertani","doi":"10.1016/j.jocn.2024.110909","DOIUrl":"10.1016/j.jocn.2024.110909","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial aneurysms are uncommon in pediatric patients, accounting for less than 5% of all intracranial aneurysms. Despite their rarity, they present notable challenges because of their non-saccular morphology. Given the rising utilization of flow-diverter (FD) devices such as the Pipeline Embolization Device (PED), there’s a significant need for a systematic review and <em>meta</em>-analysis to evaluate their applicability for pediatric populations and assess their safety and efficacy.</div></div><div><h3>Methods</h3><div>Medline, Embase, and Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95 % confidence intervals under a random-effects model, I² to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥3 patients and focused on outcomes such as immediate and final occlusion, good clinical outcomes, complications, and mortality.</div></div><div><h3>Results</h3><div>The analysis comprised seven studies involving 80 patients with a total of 91 aneurysms. Immediate occlusion was observed in 49 out of 62 cases with a rate of 90 % (95 % CI: 74 % to 100 %). Final occlusion was achieved 71 out of 87 aneurysms a rate of 88 % (95 % CI: 78 % to 98 %). Notably, good clinical outcomes were reported for 59 out of 67 patients, representing a rate of 92 % (95 % CI: 83 % to 100 %). Complications occurred in 5 out of 73 patients, with an incidence rate of 3 % (95 % CI: 0 % to 11 %). The total mortality analysis revealed that 5 out of 72 patients died, resulting in a rate of 6 % (95 % CI: 0 % to 12 %). However, when examining mortality related to the FD, no patients died, resulting in a mortality rate of 0 % (95 % CI: 0 % to 3 %).</div></div><div><h3>Conclusion</h3><div>Our systematic review and <em>meta</em>-analysis reveal promising outcomes for FD treatment in pediatric intracranial aneurysms. We observed high occlusion rates and favorable clinical results, suggesting that the technique is safe and effective in the short term. However, further studies are necessary to validate and expand upon these findings.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"130 ","pages":"Article 110909"},"PeriodicalIF":1.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621293","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}