Neurologia i neurochirurgia polska最新文献

{"title":"Prolonged low-dose intravenous thrombolysis in early recurrent stroke.","authors":"David Černík, Jiri Neumann, Jan Macko, Simona Vondrackova, Marta Vachova, Jan Bilik, Veronika Sredlova, Pavol Viglas, David Cihlar","doi":"10.5603/pjnns.111187","DOIUrl":"https://doi.org/10.5603/pjnns.111187","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of acute ischemic stroke follows well-established guidelines and standards of care. However, the optimal management of ultra-early stroke recurrence remains unclear. We present outcomes of prolonged low-dose intravenous thrombolysis used as rescue therapy in this setting.</p><p><strong>Material and methods: </strong>This multicenter retrospective study included consecutive patients who received prolonged low-dose intravenous thrombolysis (20 mg of alteplase administered continuously over 10 hours) for early recurrent ischemic stroke. Clinical status was assessed using the National Institutes of Health Stroke Scale (NIHSS) at the time of recurrence and the day after rescue therapy. Functional outcome was evaluated using the modified Rankin Scale (mRS) at 90 days. Safety was assessed based on the occurrence of complications, intracerebral hemorrhage (ICH), and symptomatic intracerebral hemorrhage (sICH), defined according to the SITS-MOST criteria.</p><p><strong>Results: </strong>A total of 65 patients were enrolled across four centers (52.3% male; mean age 70.9 ± 12.2 years). The median NIHSS score was 4 after the initial stroke, increased to 10 at the time of recurrence, and improved to 6 following rescue therapy. Neurological improvement was observed in 70.8% of patients. A favorable functional outcome (90-day mRS ≤ 2) was achieved in 61.5% of patients. The 90-day mortality rate was 12.3%. Intracerebral hemorrhage occurred in 9.2% of patients, and no cases of symptomatic intracerebral hemorrhage were observed.</p><p><strong>Conclusions: </strong>Rescue therapy with prolonged low-dose intravenous thrombolysis appears to be an effective and safe alternative to therapeutic nihilism in patients with ultra-early recurrent ischemic stroke. Confirmation of these findings in a randomized controlled trial would be highly valuable.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112705","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":"Familial occurrence of multiple sclerosis - current state of knowledge.","authors":"Katarzyna Kubicka-Bączyk, Joanna Bączyk, Monika Adamczyk-Sowa","doi":"10.5603/pjnns.112253","DOIUrl":"https://doi.org/10.5603/pjnns.112253","url":null,"abstract":"<p><p>Multiple sclerosis (MS) is an immune-mediated, inflammatory, and neurodegenerative disease of the central nervous system with a complex, multifactorial etiology. Familial aggregation, along with a higher concordance rate in monozygotic than dizygotic twins, supports a significant, albeit non-Mendelian, genetic contribution to MS susceptibility. The strongest genetic association involves the human leukocyte antigen (HLA) region, particularly HLA-DRB1*15:01, while genome-wide association studies have identified over 200 additional susceptibility signals, most of which implicate immune regulation and, increasingly, microglial biology. These genetic effects are not sufficient to cause disease. Environmental and lifestyle factors, including Epstein-Barr virus infection, vitamin D deficiency, limited exposure to ultraviolet B radiation, cigarette smoking, and adolescent obesity, act as complementary risk modifiers. Biological factors related to sex, gut microbiota, epigenetic regulation, and gene-environment interactions further refine individual susceptibility. Familial MS should therefore be viewed as an enriched model of polygenic susceptibility interacting with shared environmental factors, rather than as a distinct entity linked to a single gene. Increasing evidence suggests that pathological processes associated with MS may begin many years before the first clinical symptoms. Projects such as the Genes and Environment in Multiple Sclerosis (GEMS) project and the development of integrated genetic and environmental risk scores may enable risk stratification among first-degree relatives and other high-risk groups. This review summarizes the current evidence on the familial occurrence of MS, highlights the interplay of inherited and acquired risk factors, and discusses implications for early detection and future primary prevention strategies.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081639","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":"De novo progressive multifocal leukoencephalopathy during ocrelizumab treatment in a patient with primary progressive multiple sclerosis.","authors":"Simona Halúsková, Miroslav Mareš, Linda Bláhová, Věra Křivková, Alena Martinková, Edvard Ehler, Leoš Ungermann, Martin Vališ, Štěpán Frydrych","doi":"10.5603/pjnns.113747","DOIUrl":"https://doi.org/10.5603/pjnns.113747","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081683","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":"Snoring prevalence in hospitalized ischemic stroke patients under adaptive versus standard ward lighting: a sequential two-cohort observational study.","authors":"Szymon J Jurga, Maksymilian A Brzezicki, Jacek Bojarski, Robert Smoleński, Izabela Wojtasz, Filip Czop, Gabriel Słonina, Ewa S Stryjewska, Przemysław T Zakowicz, Iwona Towpik, Radosław Kaźmierski","doi":"10.5603/pjnns.113469","DOIUrl":"https://doi.org/10.5603/pjnns.113469","url":null,"abstract":"<p><strong>Aim of the study: </strong>To examine whether snoring, an objective marker of upper-airway instability, differs between acute ischemic stroke patients hospitalized under standard fluorescent ward lighting and those hospitalized after installation of an adaptive, time-of-day-varying LED system.</p><p><strong>Clinical rationale for the study: </strong>Sleep-disordered breathing affects most patients in the acute stroke period and is independently associated with worse neurological outcomes, recurrence, and mortality. Ward lighting is a modifiable environmental factor, but its relationship to objectively recorded snoring, an acoustic marker of upper-airway instability, has not previously been examined in stroke.</p><p><strong>Material and methods: </strong>In this single-center, sequential two-cohort observational study, two non-overlapping groups of acute ischemic stroke patients were compared: one admitted under standard lighting (n = 47) and one admitted after installation of adaptive lighting (n = 46). No patient was studied under both conditions. Snoring was recorded with the WatchPAT 300 (ZOLL Itamar Medical, Caesarea, Israel), and the analysis was performed at the patient level. The primary comparison was the prevalence of snoring above 45 dB (Fisher's exact test); secondary comparisons were the proportion of sleep time and the duration spent snoring above threshold (Mann-Whitney U test). Respiratory indices and sleep architecture were compared to assess group balance.</p><p><strong>Results: </strong>Snoring above threshold was observed in 47 of 47 patients (100%) in the standard-lighting group and 37 of 46 patients (80%) in the adaptive-lighting group (p = 1.1 × 10-3). Both the proportion of sleep time spent snoring (p = 7.8 × 10-4) and the duration of snoring (p = 1.1 × 10-3) were lower in the adaptive-lighting group. Among patients who snored, mean snoring intensity did not differ between groups (p = 0.09). The two groups were comparable on all measured respiratory indices and on sleep architecture (all p > 0.05).</p><p><strong>Conclusions and clinical implications: </strong>Snoring prevalence and burden were lower in the cohort hospitalized under adaptive ward lighting, in the context of two groups well matched on respiratory severity and sleep architecture. The non-randomized design precludes causal inference, but the association supports adaptive lighting as a low-risk, non-pharmacological candidate intervention worth testing in a randomized trial with polysomnographic endpoints.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075285","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":"CD8+ T cells in synucleinopathies: differential immune mechanisms in Parkinson's disease and multiple system atrophy.","authors":"Marta Żółtowska, Aleksandra Wesołowska, Paulina Jasak, Natalia Madetko-Alster, Piotr Alster","doi":"10.5603/pjnns.112255","DOIUrl":"https://doi.org/10.5603/pjnns.112255","url":null,"abstract":"<p><strong>Introduction: </strong>Synucleinopathies, including Parkinson's disease (PD) and multiple system atrophy (MSA), are characterized by α-synuclein aggregation and progressive neurodegeneration. Increasing evidence implicates adaptive immune mechanisms, particularly CD8+ T cells, in their pathogenesis.</p><p><strong>Aim of the study: </strong>To summarize and compare the role of CD8+ T lymphocytes in PD and MSA, with an emphasis on disease-specific immune mechanisms.</p><p><strong>Material and methods: </strong>A structured narrative review of PubMed, Embase, and Scopus databases was performed, and 15 relevant studies were included.</p><p><strong>Results: </strong>In PD, CD8+ T cells infiltrate the substantia nigra at early disease stages, often preceding overt neurodegeneration and α-synuclein deposition, and exhibit a cytotoxic phenotype characterized by granzyme and interferon-γ expression, with potential direct interactions with MHC class I-expressing neurons. Peripheral findings further support a CD8-dominant immune response with expansion of cytotoxic subsets. In contrast, MSA is associated with a relatively CD4-dominant immune profile, with increased CD4/CD8 ratios and a broader inflammatory environment, in which CD8+ T cells appear to play a more modulatory role. Across synucleinopathies, CD8+ T cells demonstrate regional CNS infiltration, phenotypic heterogeneity, and association with microglial activation.</p><p><strong>Conclusions: </strong>CD8+ T cells represent a heterogeneous and context-dependent component of adaptive immunity in synucleinopathies, with a predominantly cytotoxic and potentially pathogenic role in PD and a more modulatory function in MSA. These disease-specific d ifferences pr ovide in sight in to un derlying ne uroimmune me chanisms an d su pport th e po tential of CD8+ T-cell-related pathways as biomarkers and targets for tailored immunomodulatory strategies.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012342","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":"Spinal cord stimulation in the treatment of chronic pain: from evidence to clinical practice - part 2.","authors":"Tomasz Mandat, Katarzyna Kotfis, Paweł Sokal, Dariusz Kosson, Ewelina Kamińska, Piotr Przygodzki, Jan Cybulski, Izabela Łach, Michał Jakubczyk, Maciej Niewada, Jarosław Sławek","doi":"10.5603/pjnns.111712","DOIUrl":"https://doi.org/10.5603/pjnns.111712","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord stimulation (SCS) is a treatment option for patients with chronic pain who have not responded adequately to conventional therapies. Despite the use of this technique in clinical practice in Poland, specialists do not have guidelines specifying the place of SCS in the therapeutic algorithm.</p><p><strong>Aim of the study: </strong>The primary objective is to propose a therapeutic pathway for patients with chronic pain, specifically incorporating SCS. The scope of the paper includes an eligibility assessment algorithm for SCS, procedural details, and post-implantation management. Furthermore, the assessment includes a cost-utility analysis and the estimated number of implantations for the 2025-2026 period.</p><p><strong>Material and methods: </strong>The position statement reflects input from experts in neurosurgery, anesthesiology, and neurology, and is supplemented by a discussion of European guidelines on the use of SCS in patients with chronic pain.</p><p><strong>Discussion: </strong>Spinal cord stimulator implantation is indicated when conventional treatments provided by a specialized pain clinic prove insufficient. The procedure requires a multidisciplinary team decision based on the patient's clinical history and may be preceded by a trial phase to assess efficacy. Post-implantation care involves monitoring, parameter adjustment, and continued management at a specialized pain clinic. In the population analyzed, SCS implantation was shown to be cost-effective. The number of SCS implantations is estimated at 458 and 524 in 2025 and 2026, respectively.</p><p><strong>Conclusions: </strong>This paper may serve as a starting point for further administrative work, including clarification of the scope and conditions for the provision of healthcare services.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912958","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":"Montreal Cognitive Assessment performance in older adults with post-stroke delirium: global and subscale analysis.","authors":"Elżbieta Klimiec-Moskal, Piotr Koceniak, Agnieszka Słowik, Tomasz Dziedzic","doi":"10.5603/pjnns.112862","DOIUrl":"https://doi.org/10.5603/pjnns.112862","url":null,"abstract":"<p><strong>Aim of the study: </strong>We investigated whether global cognitive performance and scores on individual MoCA subscales differ between patients with and without post-stroke delirium.</p><p><strong>Clinical rationale for the study: </strong>Although delirium and cognitive decline are interrelated, associations between post-stroke delirium and specific cognitive deficits remain unclear.</p><p><strong>Material and methods: </strong>We analyzed data from the Prospective Observational Polish Study on post-stroke delirium (PROPOLIS) and selected patients without prior cognitive decline who underwent the Montreal Cognitive Assessment (MoCA) on days 1 and 8 after ischemic stroke. We included patients with delirium on day 1 who were delirium-free by day 8 and patients without delirium matched for age, stroke severity, lesion hemisphere, and pre-stroke cognitive performance. We used MoCA-Blind for the primary analysis because some patients were unable to perform visual MoCA items.</p><p><strong>Results: </strong>Of the 162 eligible patients, 18 patients with delirium were matched to 46 patients without delirium. On day 1, patients with delirium had significantly lower total MoCA-Blind scores (median: 10.5 vs. 15, p < 0.001) and on the following MoCA subscales: attention, language, delayed recall, and orientation. On day 8, patients with delirium had lower scores of total MoCA- -Blind (median: 12 vs. 17, p < 0.001) and MoCA subscales: attention, language, abstraction, and orientation. Between days 1 and 8, both groups improved on MoCA-Blind, but patients with delirium showed greater improvement in attention (median change: 1 vs. 0, p = 0.044) and the orientation subscale (median change: 0.5 vs. 0, p = 0.011) than patients without delirium.</p><p><strong>Conclusions and clinical implications: </strong>Delirium following ischemic stroke is associated with worse global cognitive performance rather than deficits in specific MoCA subscales. Resolution of delirium is associated with improvements in attention and orientation, but not in other subscales.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840646","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":"Leukodystrophy associated with a mutation in the ERLIN2 gene.","authors":"Kamila Żur-Wyrozumska, Viktoriia Popadynets, Małgorzata Smyczyńska","doi":"10.5603/pjnns.113618","DOIUrl":"https://doi.org/10.5603/pjnns.113618","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148830750","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":"Recommendations of Multiple Sclerosis and Neuroimmunology Section of the Polish Neurological Society and the Polish Society of Gynecologists and Obstetricians for family planning and pregnancy management in women with multiple sclerosis: an update.","authors":"Alicja Kalinowska, Monika Adamczyk-Sowa, Halina Bartosik-Psujek, Waldemar Brola, Alina Kułakowska, Dagmara Mirowska-Guzel, Monika Nojszewska, Piotr Sieroszewski, Mariusz Stasiołek, Sławomir Wawrzyniak, Ewa Wender-Ożegowska","doi":"10.5603/pjnns.111529","DOIUrl":"https://doi.org/10.5603/pjnns.111529","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the Central Nervous System that most commonly affects females of reproductive age. Therefore, the issue of family planning is relevant in this population, especially in the context of starting and planning future disease modifying therapy (DMT), so that the risks to mother and child are minimized, while reproductive goals are met.</p><p><strong>State of the art: </strong>Over the recent years the number of pregnancies in MS women has been increasing, as opposed to the trend in the general population. This is a result of several advancements in MS treatment and the growing body of evidence regarding DMT safety in the context of pregnancy and breastfeeding. It is not justified to delay DMT or to discourage patients from pregnancy planning. Instead, a highly individualized approach is recommended. The gynecological and obstetric approach to prenatal care and delivery should not differ from that offered to a general female population. Exclusive breastfeeding and early treatment reinitiation should be encouraged, with beta-interferons, glatiramer acetate and anti-CD20 monoclonal antibodies allowed in lactating women. Most DMTs require effective contraception and a pre-specified wash-out period before conception. On the other hand, beta-interferons, glatiramer acetate and dimethyl fumarate could be used until conception or even throughout pregnancy, as in the case of beta-interferons and glatiramer acetate. In females with highly active disease natalizumab could be continued until 34 gestational weeks, preferably every 6-8 weeks.</p><p><strong>Clinical implications: </strong>Family planning for women with MS requires an informed multi-disciplinary counselling. Neurologists are typically not trained in contraceptive use and family planning, while gynecologists and obstetricians are not aware of the most recent advances in MS immunotherapy. The aim of this statement is to provide multidisciplinary guidance in pregnancy planning and MS management during pregnancy and post-partum.</p><p><strong>Future directions: </strong>Family planning counselling should become part of routine MS care. Multidisciplinary approach is needed and should be encouraged with providing guidelines and educational resources to both, healthcare professionals and patients.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796071","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":"Diagnostic pitfalls in autoimmune encephalitis.","authors":"Jakub Radziwon, Artur Bystrzyński, Marek Dąbrowski, Jarosław Sławek","doi":"10.5603/pjnns.113290","DOIUrl":"https://doi.org/10.5603/pjnns.113290","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796087","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}