Neurologia medico-chirurgica最新文献

{"title":"Development of Machine-learning Model to Predict Anticoagulant Use and Type in Geriatric Traumatic Brain Injury Using Coagulation Parameters.","authors":"Gaku Fujiwara, Yohei Okada, Eiichi Suehiro, Hiroshi Yatsushige, Shin Hirota, Shu Hasegawa, Hiroshi Karibe, Akihiro Miyata, Kenya Kawakita, Kohei Haji, Hideo Aihara, Shoji Yokobori, Motoki Inaji, Takeshi Maeda, Takahiro Onuki, Kotaro Oshio, Nobukazu Komoribayashi, Michiyasu Suzuki, Naoto Shiomi","doi":"10.2176/jns-nmc.2024-0066","DOIUrl":"10.2176/jns-nmc.2024-0066","url":null,"abstract":"<p><p>This study aimed to investigate the patterns of anticoagulation therapy and coagulation parameters and to develop a prediction model to predict the type of anticoagulation therapy in geriatric patients with traumatic brain injury. A retrospective analysis was performed using the nationwide neurotrauma database of Japan. Elderly patients (≥65 years) with traumatic brain injury. Patients were divided into 3 groups based on their daily anticoagulant medication (none, direct oral anticoagulant [DOAC], and vitamin K antagonist [VKA]), and coagulation parameters were compared in each group. We then developed a machine-learning model to predict the anticoagulant using coagulation parameters and visualized the pattern using a heat map. A total of 495 patients were enrolled and divided into 3 groups: none (n = 439), DOACs (n = 37), and VKA (n = 19). Comparing none to DOAC and DOAC to VKA for prothrombin time-international normalized ratio (PT-INR), the mean difference and 95% confidence intervals (CIs) were 0.38 (95% CI: 0.59-0.17) and 1.56 (95% CI: 1.21-1.90), and for activated partial thromboplastin time (APTT), the mean difference between none to DOAC and DOAC to VKA was 3.46 (95% CI: 0.98-5.94) and 95% CI was 7.39 (95% CI: 3.29-11.48). A prediction model for the type of anticoagulant used by PT-INR and APTT was developed using machine-learning methods, and a heat map visually revealed their relationship with acceptable predictive ability. This study revealed the characteristic patterns of coagulation parameters in anticoagulants and a pilot model to predict anticoagulant use.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"61-70"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Early-onset Efficacy of Anti-calcitonin Gene-related Peptide Monoclonal Antibodies for Patients with Migraine in Real-world Clinical Practice: Study Protocol for an Exploratory Clinical Trial.","authors":"Takafumi Tanei, Satoshi Maesawa, Yusuke Nishimura, Tomotaka Ishizaki, Yoshitaka Nagashima, Miki Hashida, Shun Yamamoto, Masahiko Ando, Yachiyo Kuwatsuka, Atsushi Hashizume, Toshihiko Wakabayashi, Ryuta Saito","doi":"10.2176/jns-nmc.2024-0201","DOIUrl":"10.2176/jns-nmc.2024-0201","url":null,"abstract":"<p><p>Three anti-calcitonin gene-related peptide monoclonal antibodies (CGRP-mAbs) are available in Japan: galcanezumab, fremanezumab, and erenumab. Early-onset efficacy has been demonstrated for each CGRP-mAb in comparison with placebo, but differences among the drugs are unclear. Only galcanezumab requires 2 doses at the initial injection. This study is a multicenter, open-label, randomized, two-group comparison trial, consisting of the random selection of a CGRP-mAb and 6 consecutive injections, and then discontinuation of the CGRP-mAb after 6 injections. The primary outcome is a comparison of early-onset efficacy between galcanezumab and both fremanezumab and erenumab after the initial injection. The secondary outcomes are comparisons between galcanezumab and both fremanezumab and erenumab, and between fremanezumab and erenumab as follows: weekly number of headache days, migraine days, and acute medication use are compared to baseline during one month after initial injection; time of subjectively perceiving onset of effect after initial injection; monthly changes in headache status from baseline to after third (3rd) injections; effective rates after initial and 3rd injections; improvement rates of depression scores between baseline and after 3rd injections; changes in number of absenteeism and presenteeism days in each month from baseline to after 3rd injections; proportion of ineffective cases after 3rd injections; recurrence rates and time to recurrence after CGRP-mAb discontinuation; effective rates of CGRP-mAb re-injections; detection of clinical factors associated with effectiveness after the initial and 3rd injections. The aim of this study is to investigate differences in early-onset efficacy among the CGRP-mAbs, and when and to what extent headache symptoms recur after discontinuation.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"71-80"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Seizure Outcome Using Combinations of Four Noninvasive Presurgical Modalities in Magnetic Resonance Imaging-negative Focal Intractable Epilepsy.","authors":"Rofat Askoro, Kota Kagawa, Go Seyama, Akitake Okamura, Akira Hashizume, Tae Onari, Yutaka Hirokawa, Koji Iida, Nobutaka Horie","doi":"10.2176/jns-nmc.2024-0194","DOIUrl":"10.2176/jns-nmc.2024-0194","url":null,"abstract":"<p><p>In focal epilepsy cases, precise identification and resection of the epileptogenic zone increase the likelihood of achieving a seizure-free outcome. Nevertheless, localizing the source of epilepsy in magnetic resonance imaging-negative epilepsy cases presents significant challenges for clinicians. In this study, we evaluated the diagnostic efficacy and impact on the seizure outcome by using 4 noninvasive modalities, including scalp video electroencephalography, magnetoencephalography, fluorodeoxyglucose-positron emission tomography, and iomazenil single-photon emission computed tomography, in a cohort of patients with magnetic resonance imaging-negative focal epilepsy who underwent resective surgery. The concordance status of each modality was assessed relative to the lobar resection area, and surgical outcome was assessed by Engel Classification at least 1 year after surgery. Comparison and diagnostic analyses were calculated for each individual and all possible combinations of scalp video electroencephalography, magnetoencephalography, fluorodeoxyglucose-positron emission tomography, and single-photon emission computed tomography with respect to Engel class I outcome. Eighteen patients (66.6%, 18/27) had Engel class I outcomes. Patients with at least 2 concordant modalities were associated with Engel class I outcome (p = 0.0262). For individual modality, fluorodeoxyglucose-positron emission tomography achieved the highest yield of sensitivity (72.2%) compared to scalp video electroencephalography, magnetoencephalography, and single-photon emission computed tomography (50.0%, 61.1%, and 61.6%, respectively). Scalp video electroencephalography, magnetoencephalography, and single-photon emission computed tomography showed similar specificities of 77.7%, while fluorodeoxyglucose-positron emission tomography showed a specificity of 55.5%. Combined modalities were able to achieve the highest sensitivity of 83.3% when there were at least 2 concordant modalities and a specificity of 100% with various multiple combinations. Our study showed that lobar concordance from multiple modalities increases the sensitivity and specificity for a seizure-free outcome in magnetic resonance imaging-negative focal epilepsy patients who underwent resective surgery.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"81-91"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Temporal versus Mandibular Branch Stimulation.","authors":"Yuki Amano, Bunsho Asayama, Shusaku Noro, Takenori Abe, Masahiro Okuma, Kaori Honjo, Yoshinobu Seo, Hirohiko Nakamura","doi":"10.2176/jns-nmc.2024-0062","DOIUrl":"10.2176/jns-nmc.2024-0062","url":null,"abstract":"<p><p>Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), delayed postoperative relief is one of its main issues. We previously evaluated the morphology of the lateral spread response (LSR) and reported the correlation between delayed relief after MVD and polyphasic morphology of the LSR. The purpose of this study was to investigate the correlation between the morphology of the LSR with stimulation of the temporal and mandibular branches of the facial nerve and delayed relief of persistent HFS after MVD. We retrospectively analysed and compared data from 49 of 205 consecutive patients who underwent MVD for HFS at our hospital between January 2015 and March 2022. Based on the pattern of the initial LSR morphology, patients were divided into 4 groups (LSR with temporal branch stimulation/LSR with mandibular branch stimulation; polyphasic/polyphasic group, polyphasic/monophasic group, monophasic/polyphasic group, monophasic/monophasic group). The results of MVD surgery for HFS were evaluated 1 week, 1 month and 1 year postoperatively, by evaluating whether or not the symptoms of HFS persisted at the time of each follow-up. We found significant differences in residual postoperative HFS 1 week postoperatively among the 4 groups (p < 0.05), as assessed using m*n Yates chi-square test. There is a significant correlation between delayed relief after MVD and polyphasic morphology of the initial LSR in patients with HFS. The LSR with temporal rather than mandibular branch stimulation might be useful for predicting delayed relief following MVD in HFS patients.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"45-51"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Approach to Study Cranial Shape in Children with Normal and Sagittal Synostosis: An Application of Geometric Morphometrics.","authors":"Tadashi Miyagawa, Akira Yamaura","doi":"10.2176/jns-nmc.2024-0168","DOIUrl":"10.2176/jns-nmc.2024-0168","url":null,"abstract":"<p><p>To provide appropriate treatment, neurosurgeons and pediatricians must understand the chronological changes of the cranial morphology in normal children and the differences between normal and sagittal synostosis children. However, this issue has remained unresolved due to the traditional methods of analyzing cranial morphology. Therefore, we applied a new and precise method, geometric morphometrics, to understand cranial morphology in children with normal and sagittal synostosis. This study analyzed morphological differences in the cranium of 30 control children and 14 children with sagittal synostosis using geometric morphometrics and the landmark method on the lateral view of the three-dimensional computed tomography of the skull. The results showed that morphological changes in the cranium of normal children with age could be visualized (p < 0.01), with the parietooccipital and suboccipital areas being the main areas of change. Morphological analysis revealed different cranial morphologies among the control, scaphocephalic sagittal synostosis, and non-scaphocephalic sagittal synostosis groups (p < 0.01), as evidenced by a fan-like spread and reduced cranial height in the sagittal synostosis group compared to the control cranium. Visualization in wireframes could reveal morphological differences, even if small, with statistical differences. This study clarified 3 issues regarding the cranial morphology in normal and sagittal children. The study showed evident age-related differences and changes in the cranial morphology in normal children. Differences in cranial morphologies among the 3 groups were identified. Finally, the study demonstrates that geometric morphometrics is a precise and appropriate method for analyzing morphological differences and changes.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"92-101"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stepwise Improvement of Cerebral Hemodynamics in Staged Angioplasty for Carotid Artery Stenosis.","authors":"Fumiaki Oka, Takayuki Oku, Akiko Kawano, Koki Okazaki, Takuma Nishimoto, Mototsugu Shimokawa, Hideyuki Ishihara","doi":"10.2176/jns-nmc.2024-0142","DOIUrl":"10.2176/jns-nmc.2024-0142","url":null,"abstract":"<p><p>Staged angioplasty (SAP) is used as an alternative to preventing cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS), particularly among patients with compromised cerebral haemodynamics. Although SAP is presumed to prevent CHS by gradually restoring cerebral blood flow (CBF), few studies have examined haemodynamic changes, and none have evaluated CBF during the chronic phase of SAP. In the present study, in addition to the clinical outcome of SAP, we measured both resting CBF and cerebrovascular reactivity (CVR) throughout all stages of SAP, including the chronic phase, using quantitative N-isopropyl-p-[I-123] iodoamphetamine (¹²³I-IMP) single-photon emission computed tomography (SPECT) and evaluated the effects of SAP on cerebral haemodynamics. In total, 28 patients underwent SAP. Among them, 19 had a successful procedure. Nine received stenting at the first stage of the procedure because of inadequate dilatation. Patients who underwent SAP had a lower incidence of hyperperfusion than those who underwent stenting at the first stage (5.3% vs. 33.3%). Nevertheless, the results did not significantly differ (p = 0.08). In an analysis limited to the patients who underwent successful SAP, the resting CBF was unchanged except for immediately after the first stage, on the other hand, the CVR increased at each stage. After the first stage, 14 (74%) patients recovered from the steal phenomenon. After the second stage, the CVR normalised. SAP may help to improve cerebral haemodynamics gradually. Consequently, it has the potential to prevent CHS or hyperperfusion among patients with severely impaired CVR, which is a significant risk factor for CHS.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"22-28"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embosphere Size Selection and Dilution Rate in Preoperative Tumor Embolization of the External Carotid Artery System Using a Small-diameter Catheter.","authors":"Takao Hashimoto, Yusuke Arai, Hirofumi Okada, Muneaki Kikuno, Hiroki Sakamoto, Kyosuke Matsunaga, Michihiro Kohno","doi":"10.2176/jns-nmc.2024-0059","DOIUrl":"10.2176/jns-nmc.2024-0059","url":null,"abstract":"<p><p>The widespread adoption of preoperative embolization in highly vascularized brain tumors often involves the frequent use of Embosphere (Merit Medical Systems, South Jordan, Utah, USA). Nevertheless, inconsistency in size selection and dilution rates across different institutions requires comprehensive examination. This study explored the appropriate size and dilution rate of Embosphere microspheres. To assess catheter occlusion and Embosphere breakage, various dilutions (4-, 10-, 20-, 30-, and 60-fold) of Embosphere 300-500 and 500-700 μm were injected into the catheter in vitro. Results indicated that 20-fold or higher dilutions of Embosphere 300-500 μm and 30-fold or higher dilutions of Embosphere 500-700 μm showed no occlusion of the Excelsior SL-10 microcatheter (Stryker, Fremont, CA, USA) or Embosphere breakage. For embolization, to reduce the risk of Excelsior SL-10 occlusion further, a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm were employed. For 195 blood vessels in 107 patients (84 with meningioma and 23 with schwannoma), embolization was carried out using a 30-fold dilution of Embosphere 300-500 μm when the provocative test was negative and a 60-fold dilution of Embosphere 500-700 μm when the test was positive or when there was a risk of migration into neurotrophic vessels. Contrast-enhanced magnetic resonance imaging after embolization revealed a reduced enhancement effect in 69.1% of cases. Embolization using a 30-fold dilution of Embosphere 300-500 μm and a 60-fold dilution of Embosphere 500-700 μm with an Excelsior SL-10 catheter is safe and satisfactory, which minimizes microcatheter occlusion.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"1-8"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Carotid Artery Stenting for Carotid Artery Stenosis in Maintenance Hemodialysis Patients.","authors":"Shuki Okuhara, Tomoaki Murakami, Shingo Toyota, Kosei Okochi, Koichi Nakashima, Kazuhiro Tohara, Shuhei Yamada, Takamune Achiha, Maki Kobayashi, Haruhiko Kishima","doi":"10.2176/jns-nmc.2024-0193","DOIUrl":"10.2176/jns-nmc.2024-0193","url":null,"abstract":"<p><p>Most previous large studies of carotid artery stenting (CAS) in maintenance hemodialysis patients are old-era, do not describe the types of stents and method of protection, and their effectiveness is unknown. CAS has progressed remarkably, and tailor-made CAS is now possible in hemodialysis patients according to the lesion. We aimed to analyze the outcomes of CAS in maintenance hemodialysis patients treated in our institution.We retrospectively investigated the data of patients who underwent elective CAS in our institution between January 2012 and April 2023. Firstly, we verified the outcomes of CAS in maintenance hemodialysis patients. Secondly, the outcomes of CAS in maintenance hemodialysis patients were compared with CAS in nondialysis patients during the same period.During the study period, 212 patients with carotid stenosis underwent CAS. Among these, 18 patients undergoing maintenance hemodialysis were identified for analysis. All 18 patients underwent lesion-specific tailor-made CAS. All 18 patients were technically successfully stented with good vasodilation and improvement in stenosis. No symptomatic cerebral infarction occurred within 30 days after CAS. There was no difference between dialysis and nondialysis patients in the risk of symptomatic complications and death occurring within 30 days after surgery. There was a higher risk of hemorrhagic complications not associated with prognosis in the dialysis group (23.1% vs 1.0%, P = 0.0047). No in-stent restenosis (>50% stenosis) and ipsilateral cerebral infarction at 1 year occurred during follow-up.CAS in hemodialysis patients may be safe and effective.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"37-44"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Selection Criteria of Single-joint Hybrid Assistive Limb for Upper Limb Paralysis After Stroke: A Phase I Trial.","authors":"Hiroshi Ohmae, Taku Matsuda, Maki Fujimoto, Yuka Nakanowatari, Megumi Yamada, Nori Sato, Kimiko Umemura, Ryoma Morigaki, Tetsuya Matsuura, Yasushi Takagi","doi":"10.2176/jns-nmc.2024-0137","DOIUrl":"10.2176/jns-nmc.2024-0137","url":null,"abstract":"<p><p>Robotic rehabilitation is a high-intensity intervention for upper limb paralysis after a stroke. This study explored the safety and feasibility of using a single-joint hybrid assistive limb (HAL-SJ) exoskeletal device for upper limb paralysis in patients with acute stroke. In total, 11 patients with stroke (6 with moderate paralysis and 5 with severe paralysis) were enrolled between October 2021 and October 2023 in a stroke care unit. The patients underwent HAL training 3 times a week for 6 sessions. No serious adverse events related to HAL-SJ occurred, and participants demonstrated significant improvements in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) (pre- vs. post-intervention; p < 0.05). The minimal clinically important difference (MCID) for FMA-UE was surpassed in 5 patients (83.3%) with moderate paralysis and 2 (40.0%) with severe paralysis. Regarding ARAT, 4 patients (66.7%) with moderate paralysis exceeded the MCID, whereas none (0.0%) with severe paralysis did. These findings suggest that HAL-SJ is both safe and feasible, particularly for individuals with moderate paralysis.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"15-21"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Clazosentan on Vasospasm Reduction and Functional Recovery after Aneurysmal Subarachnoid Hemorrhage.","authors":"Sosho Kajiwara, Takayuki Kawano, Yu Hasegawa, Yukihiko Nakamura, Kiyohiko Sakata, Jin Kikuchi, Masaru Hirohata, Motohiro Morioka","doi":"10.2176/jns-nmc.2024-0204","DOIUrl":"10.2176/jns-nmc.2024-0204","url":null,"abstract":"<p><p>In every hospital in Japan, until 2022, the primary treatment for preventing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) involved a combination of ozagrel sodium (Oz), fasudil hydrochloride (Fs), cilostazol, and statins. However, with the approval of clazosentan in January 2022, it has been used as a first-choice drug more frequently. Despite this shift, limited evidence exists regarding the use of clazosentan as the first choice for DCI prevention. In this study, we analyzed the efficacy and outcomes of these two treatments in aSAH patients. Patients treated with Oz+Fs were enrolled between January 2014 and March 2022. In April 2022, clazosentan was prescribed to prevent DCI. Clinical data were collected, and propensity-score matching was conducted based on the clazosentan group. The primary endpoint was the functional outcome at discharge and 6-12 months after admission; the secondary endpoints were the incidence of cerebral vasospasm (CV) and DCI. In this study, 221 patients were included, and 27 were selected from both groups after matching. The incidence of CV was significantly lower in the clazosentan group (11.1% vs. 55.6%, p<0.01), and the incidence of DCI tended to be lower in the clazosentan group (3.7% vs. 25.9%, p=0.05). No significant difference was observed in the primary endpoint of functional outcome at discharge; however, a significant improvement in functional outcome was observed in the clazosentan group at 6 months (96.3% vs. 70.4%, p<0.05). Clazosentan significantly reduced the incidence of CV and improved functional outcomes in patients with aSAH compared to Oz+Fs.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"29-36"},"PeriodicalIF":2.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}