Journal of Clinical Neuroscience最新文献

{"title":"Atlantoaxial instability in Chiari formation- an analysis based on static and dynamic head imaging in 35 patients","authors":"Atul Goel ,&nbsp;Mohamed Saad Abdel Aziz ,&nbsp;Abhidha Shah ,&nbsp;Apurva Prasad ,&nbsp;Ravikiran Vutha ,&nbsp;Mohamed Abdulbasit Almzeogi","doi":"10.1016/j.jocn.2025.111310","DOIUrl":"10.1016/j.jocn.2025.111310","url":null,"abstract":"<div><h3>Background</h3><div>The study evaluates dynamic imaging in cases with Chiari formation to identify and qualify the nature of atlantoaxial instability.</div></div><div><h3>Materials and Methods</h3><div>During the period June 2023 to February 2024, 35 consecutive and selected cases of Chiari formation surgically treated by atlantoaxial fixation and subjected to preoperative static and dynamic head imaging were analyzed. There were 19 males and 16 females and their ages ranged from 23 to 62 years (average 41 years). Apart from conventional imaging with plain radiographs, magnetic resonance imaging (MRI) and computerized tomography (CT), all patients underwent dynamic head flexion–extension, head right-left rotation and lateral right-left head tilt CT imaging. They also underwent an open mouth motion X-ray of the craniovertebral junction. As per the defined parameter, facetal mal-alignment of more than 5 mm on any dynamic imaging was considered to indicate atlantoaxial instability. On rotatory and lateral head tilt imaging, atlantoaxial instability was subdivided according to its presence on one or both sides. Depending on the degree of facetal mal-alignment, atlantoaxial instability was classified in 3 grades. Vertical atlantoaxial instability was assessed on dynamic head flexion–extension imaging.</div></div><div><h3>Results</h3><div>On static imaging, all patients were identified to have central or axial atlantoaxial dislocation (CAAD) as per previously described parameters. Dynamic head rotation imaging confirmed atlantoaxial instability on one side in 6 patients and on both sides in 29 patients. Lateral head tilt confirmed atlantoaxial instability on one side in 9 cases and on both sides in 26 cases. Dynamic head flexion–extension imaging identified vertical atlantoaxial instability in 3 cases.</div></div><div><h3>Conclusions</h3><div>Dynamic imaging helps in identifying atlantoaxial instability in cases with Chiari formation even when the other validated parameters are within the range of ‘normal’. Such investigation can influence the surgical management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111310"},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928979","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":"Pediatric traumatic brain injury: precision risk assessment models and an online calculator for enhanced patient care","authors":"Foad Kazemi ,&nbsp;Elena Ghotbi ,&nbsp;Julian L. Gendreau ,&nbsp;Alan R. Cohen","doi":"10.1016/j.jocn.2025.111308","DOIUrl":"10.1016/j.jocn.2025.111308","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury (TBI) is a significant public health challenge demanding extensive medical resources. Accurate, individualized risk assessments for extended length of stay (LOS), non-routine discharge, ICU/OR transfers, and direct ED discharges are crucial for optimizing patient care, prompting the authors to develop a reliable risk stratification tool to support clinicians and multidisciplinary care teams.</div></div><div><h3>Methods</h3><div>A retrospective review of electronic health records was conducted to identify pediatric TBI cases (age ≤18) using ICD-10 codes based on the modified CDC framework. Data on demographics, neighborhood socioeconomic disadvantage (assessed using the Social Deprivation Index [SDI]), and injury severity (assessed using Injury Severity Scores [ISS]) were collected. The backward elimination method was employed in the multivariate regression analysis to achieve the most parsimonious model. Model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and Spiegelhalter’s z-test, respectively.</div></div><div><h3>Results</h3><div>A total of 2954 TBI cases were identified with an average age of 7.05 years. Of these, 28.4 % had extended LOS, 8.3 % had a non-routine discharge, 23.4 % required ICU/OR transfer, and 52.3 % were discharged directly from the ED; respective predictive models achieved AUCs of 0.89, 0.87, 0.89, and 0.88, demonstrating good discrimination. All the referenced models had a Spiegelhalter z-test p-value greater than 0.05, indicating an adequate fit. All models were used to develop an open-access online calculator available at: <span><span>https://jhpedsnsgy.shinyapps.io/JHPedsNSGY/</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusions</h3><div>By integrating readily accessible data in the ED, these predictive models and the online calculator empower clinicians to deliver precise, individualized risk assessments, enhance neurosurgical decision-making, and improve high-value care for pediatric TBI patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111308"},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923672","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":"PERSIMS: Comparing doctors and patients PERSpectives on quality of life In Multiple Sclerosis","authors":"Inês Margarido ,&nbsp;Inês V. Carvalho ,&nbsp;Cátia Oliveira ,&nbsp;Danna Krupka ,&nbsp;Miguel Duarte ,&nbsp;Nathalia Barros ,&nbsp;Luís Ruano ,&nbsp;Manuel Salavisa ,&nbsp;Sónia Batista ,&nbsp;Joana Guimarães ,&nbsp;Maria José Sá ,&nbsp;José Vale ,&nbsp;Luís Isidoro","doi":"10.1016/j.jocn.2025.111313","DOIUrl":"10.1016/j.jocn.2025.111313","url":null,"abstract":"<div><h3>Background</h3><div>Advances in Multiple Sclerosis (MS) therapy have improved prognosis, but significant disability can still occur. Understanding the perspectives of doctors and patients on how MS and its treatment impact quality of life (QoL) is crucial. We aimed to explore the perceptions of MS patients and neurologists on MS symptoms, treatment, and their impact on QoL.</div></div><div><h3>Methods</h3><div>A cross-sectional online survey was conducted, targeting adult patients with MS and physicians experienced in MS care. Patients’ quality of life (QoL) was assessed using the MS Quality of Life (MSQOL-54) scale.</div></div><div><h3>Results</h3><div>252 patients and 53 doctors completed the survey. Relapses in the previous year were associated with lower physical (p = 0.026) and mental (p = 0.022) health scores. Being satisfied with disease-modifying treatment (DMT) and being involved in its choice were also associated with higher physical (both p &lt; 0.001) and mental (p = 0.024 and p = 0.002, respectively) health scores; these scores were not different in patients under moderate versus high-efficacy DMTs (physical p = 0.582 and mental p = 0.180). Patients’ and doctors’ perspectives differ in what they value for QoL. Patients prioritized mental health (p = 0.024), while doctors focused on the impact of physical aspects on QoL (p = 0.030 and p = 0.004). Patients valued information about social support (p &lt; 0.001) more than doctors and considered fatigue more challenging to discuss (p = 0.039), whereas doctors highlighted sexual dysfunction as difficult to address (p &lt; 0.001). Doctors prioritized workplace adaptations (p = 0.041), while patients preferred faster access to healthcare to improve QoL (p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Incorporating patient-reported outcomes in MS care is essential to align treatment plans with patients’ priorities and improve their QoL.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111313"},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928977","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":"Making the diagnosis of degenerative cervical myelopathy in clinical practice: essential evidence-based examination tools for healthcare practitioners","authors":"Suhani Sharma ,&nbsp;Alisha Sial ,&nbsp;Stone Sima ,&nbsp;Anju Aggarwal ,&nbsp;Derek Yull ,&nbsp;Ashish Diwan","doi":"10.1016/j.jocn.2025.111297","DOIUrl":"10.1016/j.jocn.2025.111297","url":null,"abstract":"<div><div>Degenerative cervical myelopathy (DCM) is a progressive neurological disorder characterized by cervical spinal cord compression, leading to significant disability worldwide. The variability in clinical presentations and the subtle onset of symptoms make early diagnosis challenging, often resulting in delayed intervention. The objective of this study is to provide an evidence-based approach for the clinical examination and diagnosis of DCM, aimed at enhancing the role of general practitioners and allied health providers in early detection. Early identification and appropriate intervention in DCM are critical to mitigating irreversible neurological deficits and improving long-term patient outcomes. General practitioners play a key role in the initial recognition of DCM signs and symptoms, which is crucial for timely referral to specialist care and diagnostic imaging, such as MRI. Enhanced awareness and understanding among primary care providers can significantly reduce diagnostic delays and improve management strategies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111297"},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923429","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":"Modified microcatheter first-pass effect: Enhancing diagnostic accuracy and treatment strategies for ICAS in acute ischemic stroke","authors":"Rundong Chen ,&nbsp;Weilong Hua ,&nbsp;Yilei Zhang ,&nbsp;Zifu Li ,&nbsp;Hongjian Zhang ,&nbsp;Yongwei Zhang ,&nbsp;Pengfei Yang ,&nbsp;Lei Zhang ,&nbsp;Jianmin Liu","doi":"10.1016/j.jocn.2025.111309","DOIUrl":"10.1016/j.jocn.2025.111309","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the effectiveness of the modified microcatheter first-pass effect in guiding treatment decisions for ICAS-related occlusions during endovascular therapy (EVT) for AIS.</div></div><div><h3>Methods</h3><div>This study analyzed data from 31 AIS patients with a positive modified microcatheter first-pass effect from the OCEAN-AIS-EVT REGISTRY collected between July 2023 and January 2024. We evaluated diagnostic accuracy, procedural efficiency, recanalization rates, and safety.</div></div><div><h3>Results</h3><div>ICAS was confirmed in all cases. The median age was 69 years, with 61.29 % males. The median NIHSS score was 9, and ASPECTS was 9. Stenosis primarily occurred in the M1 segment of the middle cerebral artery (74.19 %). The median puncture-to-recanalization time was 18.92 min. Successful recanalization (eTICI grade 3) was achieved in 87.10 % of cases. Post-procedural hemorrhage occurred in 12.90 % of patients, with symptomatic hemorrhage in 3.23 %. At 90-day follow-up, 80.64 % had an mRS score of 0–2.</div></div><div><h3>Conclusion</h3><div>The modified microcatheter first-pass effect may serve as a promising preliminary tool for guiding EVT strategy in ICAS-related AIS. By confirming distal vessel patency, it enables direct angioplasty without prior thrombectomy, simplifying the procedure and reducing mechanical manipulation. While this exploratory approach has shown potential to enhance treatment efficiency and improve clinical outcomes, larger-scale prospective studies are needed to further validate these preliminary findings.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111309"},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917337","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":"Massive pneumocephalus as a risk factor for recurrence after chronic subdural hematoma surgery: A systematic review and meta-analysis","authors":"Xiaolin Du ,&nbsp;Kun Zhou ,&nbsp;Cheng Wang ,&nbsp;Junquan Chen ,&nbsp;Hua Yang","doi":"10.1016/j.jocn.2025.111275","DOIUrl":"10.1016/j.jocn.2025.111275","url":null,"abstract":"<div><h3>Background</h3><div>Symptomatic chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition predominantly managed through burr hole drainage. Postoperatively, pneumocephalus frequently manifests in CSDH cases, and in some instances, tension pneumocephalus may evolve into a life-threatening complication. Despite several studies examining the association between pneumocephalus and recurrence, the outcomes have remained inconclusive.</div></div><div><h3>Methods</h3><div>An extensive literature review was carried out utilizing PubMed, EmBase, Web of Science (including Medline), and the Cochrane Library for literature available until September 2024. Studies concerning the association between pneumocephalus and recurrence were identified. Utilizing the PRISMA guidelines, titles, abstracts, and full texts of the selected studies were examined, with articles gradually excluded based on predefined criteria. Data extracted from these studies were processed through RevMan 5.4 software. The primary outcome assessed was hematoma recurrence, while secondary outcomes involved prognosis and mortality rate.</div></div><div><h3>Results</h3><div>The analysis incorporated nineteen investigations, involving an aggregate of 3,202 individuals with confirmed CSDH diagnoses. The findings indicated that the recurrence rate (RR) in the pneumocephalus group was markedly higher in comparison to the control group (OR, 3.22; 95 % CI, 2.47–4.20, <em>P</em> &lt; 0.00001). The subgroup with extensive pneumocephalus presented a notably higher RR compared to the no/minimal pneumocephalus subgroup (<em>P</em> &lt; 0.00001). Furthermore, the massive pneumocephalus subgroup exhibited a higher RR when contrasted with the no/minimal/moderate pneumocephalus group (<em>P</em> &lt; 0.00001). In addition, the massive pneumocephalus subgroup demonstrated a higher RR compared to the moderate pneumocephalus subgroup (<em>P</em> = 0.003). Nevertheless, no statistically significant variation in RR was identified between the moderate pneumocephalus and no/minimal pneumocephalus groups (<em>P</em> = 0.34). The analysis also demonstrated that outcomes in the pneumocephalus group were poorer when compared with the control group (OR, 0.18; 95 % CI, 0.09–0.35, <em>P</em> &lt; 0.00001). Conversely, no statistically significant difference in mortality rates between the pneumocephalus and control groups (<em>P</em> = 0.67).</div></div><div><h3>Conclusions</h3><div>The recurrence of CSDH is linked to the volume of postoperative pneumocephalus. While small or moderate volumes of pneumocephalus do not influence the RR of CSDH, extensive pneumocephalus is considered a marked risk factor for postoperative recurrence in individuals with CSDH. Although pneumocephalus does not appear to affect mortality rates, it has a notable impact on the prognosis of CSDH. These conclusions necessitate further confirmation through large-scale, meticulously designed prospective studies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111275"},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923745","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 features and surgical outcomes of primary intracranial synovial sarcomas","authors":"Pengcheng Zuo ,&nbsp;Bochao Zhang ,&nbsp;WanJing Zou ,&nbsp;Huan Li ,&nbsp;Yang Wang","doi":"10.1016/j.jocn.2025.111298","DOIUrl":"10.1016/j.jocn.2025.111298","url":null,"abstract":"<div><h3>Objective</h3><div>Primary intracranial synovial sarcomas (PISSs) are extremely rare, with only 30 reported cases in the literature. The aim of this study is to outline the clinical characteristics of PISSs, examine prognostic risk factors, and attempt to develop an optimal treatment strategy based on the available data.</div></div><div><h3>Methods</h3><div>We included a total of 33 PISS cases, comprising 3 patients from our institution and 30 patients documented in the literature. We collated clinical data from these cases and conducted an analysis of prognostic risk factors using Cox proportional hazards models and Kaplan-Meier methods.</div></div><div><h3>Results</h3><div>The cohort consisted of 21 males and 12 females, with an average age of 30.0 ± 18.5 years (ranging from 1 to 81 years). Among these cases, gross total resection (GTR) was performed in 21 (63.6 %) cases, non-GTR in 11 (33.3 %), and biopsy in 1 (3.0 %) case. Additionally, 25 patients (78.1 %) received RT (Radiotherapy), and 6 patients (18.8 %) underwent CT (Chemotherapy). Over a mean follow-up period of 11.5 ± 14.1 months (ranging from 2 to 84 months), tumor recurrence was observed in 27 patients (90 %), and 21 patients (70 %) died, with an average follow-up duration of 18.9 ± 21.6 months (ranging from 2 to 105 months). Multivariate Cox regression analysis revealed that non-GTR and no RT was independent adverse factors for both PFS (Progression-Free Survival) and OS (Overall Survival). Kaplan-Meier analysis revealed that non-GTR (p = 0.0001) and the absence of radiotherapy (p &lt; 0.0001) were predictive of shorter OS.</div></div><div><h3>Conclusion</h3><div>In our study, we observed that PISSs predominantly affect young males, and the prognosis of this disease is relatively poor. Our statistical analysis revealed that GTR and postoperative radiotherapy are beneficial for both PFS and OS. Therefore, we recommend GTR combined with postoperative radiotherapy as the standard treatment approach.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111298"},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911869","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":"Postoperative stereotactic radiosurgery for intracranial solitary fibrous tumors/hemangiopericytomas: A systematic review and meta-analysis","authors":"Bardia Hajikarimloo ,&nbsp;Salem M. Tos ,&nbsp;Ibrahim Mohammadzadeh ,&nbsp;Mohammad Amin Habibi","doi":"10.1016/j.jocn.2025.111302","DOIUrl":"10.1016/j.jocn.2025.111302","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) are infrequent neoplastic lesions characterized by hypercellularity and considerable vascularization. SFT/HPCs are associated with a considerably higher likelihood of recurrence and development of metastasis. Maximal safe resection with the goal of achieving gross total resection (GTR) is the gold-standard therapeutic option; however, it is challenging due to considerable vascularization and susceptibility to intraoperative hemorrhage concurrent with adjacency to the critical neurovascular structures. SRS has been demonstrated as an efficient adjuvant treatment option for intracranial SFT/HPCs. This <em>meta</em>-analysis evaluated the efficacy and safety of postoperative SRS in intracranial SFT/HPCs.</div></div><div><h3>Methods</h3><div>On February 5, 2025, a comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted. Studies that evaluated SRS in intracranial SFT/HPCs and reported local tumor control (LTC), overall survival (OS), and progression-free survival (PFS) were included. The analysis was conducted in the R program.</div></div><div><h3>Results</h3><div>Ten studies with 228 patients and 469 SFT/HPCs were included. The <em>meta</em>-analysis showed a pooled overall LTC rate of 68 % (95 %CI: 55 %–80 %), 1-year LTC rate of 94 % (95 %CI: 90 %–97 %), and 5-year LTC rate of 60 % (95 %CI: 42 %–76 %). The <em>meta</em>-analysis revealed a pooled overall OS rate of 59 % (95 %CI: 43 %–75 %), 5-year OS rate of 85 % (95 %CI: 67 %–97 %), and 10-year OS rate of 64 % (95 %CI: 25 %–95 %). In addition, The <em>meta</em>-analysis revealed a pooled ARE rate of 6 % (95 %CI: 3 %–9 %).</div></div><div><h3>Conclusion</h3><div>Postoperative SRS is an efficient and safe adjuvant therapeutic option for intracranial SFT/HPCs. SRS has comparative results to conventional RT with lower ARE. Further prospective multicenter studies with large sample sizes are required to validate our findings.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111302"},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917338","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":"Hirayama disease beyond the collar: imaging evidence of surgical stabilization","authors":"Kanwaljeet Garg ,&nbsp;Sandeep Mishra ,&nbsp;Deepti Vibha ,&nbsp;P.S. Chandra","doi":"10.1016/j.jocn.2025.111306","DOIUrl":"10.1016/j.jocn.2025.111306","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111306"},"PeriodicalIF":1.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911872","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":"Factors related to in-hospital mortality in patients with refractory Status Epilepticus","authors":"Miriam Paul-Arias ,&nbsp;Daniel Vázquez-Justes ,&nbsp;Javier Trujillano ,&nbsp;Alejandro Quílez","doi":"10.1016/j.jocn.2025.111301","DOIUrl":"10.1016/j.jocn.2025.111301","url":null,"abstract":"<div><h3>Background</h3><div>Status Epilepticus (SE) is a neurological emergency characterized by prolonged or recurrent seizures without recovery between episodes. SE is associated with high morbidity and mortality, especially when it becomes refractory.</div><div>SE is refractory (RSE) when it persists despite first-line and second-line antiseizure treatment. The factors related to mortality remain poorly understood.</div></div><div><h3>Objective</h3><div>Our objective was to analyze the factors related to in-hospital mortality in patients with RSE at our center.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with RSE who required hospitalization between 2019 and 2024. Patients with post-anoxic SE were excluded. Demographics, semiology, etiology and management data were obtained. We analyzed the relationship between different variables and in-hospital mortality. Variables related to mortality in the bivariate analysis were included in logistic regression analysis.</div></div><div><h3>Results</h3><div>Ninety-four patients with suspected RSE were hospitalized. Five were excluded due to post-anoxic SE and nine were not refractory SE. Finally, 80 patients were included.</div><div>The mean age was 60 (range 20–90). Forty-three (53.8%) were female. Thirty-two (40.0%) patients had previous diagnosis of epilepsy. Twenty-nine (36.3%) patients died during hospitalization.</div><div>In the bivariate analysis, factors related to mortality were older age, a history of cancer and chronic kidney disease, hemodynamic instability, renal failure, electrolyte disturbances, seizure recurrence, a history of previous epilepsy, acute symptomatic etiology and Status Epilepticus Severity Score (STESS) (all p &lt; 0.05).</div><div>In multivariate analysis, age [OR 7.763 (CI 1.11–54.40)], hemodynamic instability [OR 23.41 (3.91–140.20)] and seizure recurrence [OR 20.97 (2.25–195.68)] were associated with in-hospital mortality. A past history of epilepsy was inversely related to mortality [OR 0.014 CI 95 % (0.005–0.550)]. A simple scoring system incorporating these variables predicted mortality better than STESS.</div></div><div><h3>Conclusion</h3><div>Complications during hospitalization, such as hemodynamic instability and seizure recurrence, appear to be important variables related to in-hospital mortality in patients with RSE. A previous history of epilepsy appears to be inversely related to mortality.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"137 ","pages":"Article 111301"},"PeriodicalIF":1.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911870","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}