Revue neurologique最新文献

{"title":"An outpatient TIA clinic works! Insights from the creation and the first year of Bordeaux TIA clinic.","authors":"P Briau, C Morando, S Olindo, F Rouanet, I Sibon, P Renou","doi":"10.1016/j.neurol.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.neurol.2025.03.015","url":null,"abstract":"<p><strong>Background: </strong>While the benefits of urgent management of transient ischemic attacks (TIA) are now well established, there is still no consensus on the best care pathway for TIA, particularly regarding hospitalization in an intensive care stroke unit compared to outpatient management in a TIA clinic. The objective of this study was to report the different steps required for the development of a TIA clinic addressing both the healthcare needs as well as architectural and economic constraints of a hospital, then to describe the results of the first year of activity of our TIA clinic.</p><p><strong>Method: </strong>First, we described the various steps of the development of our TIA clinic and its operational modalities. Then we performed a cohort study of all patients with suspected TIA admitted in the outpatient clinic at Bordeaux University Hospital between November 7, 2022, until November 7, 2023. We analyzed data including characteristics of the population, diagnoses, treatments, hospitalization rate and length of stay. To assess the risk reduction of stroke occurrence three months after TIA, we compared the stroke rate predicted by the ABCD₂ score to the observed stroke rate of our population at three months.</p><p><strong>Rsults: </strong>A total of 507 patients were admitted to the TIA clinic during the first year with a median length of stay of 5hours. Compared to the period when TIA were hospitalized in our intensive care stroke unit, this represents a tenfold increase in the rate of TIA patients admitted in our stroke unit with a tenfold reduction in the length of hospital stay. Among patients, 13.4% had a minor stroke, 34.5% had a probable TIA, 25.4% had a possible TIA, 26.6% had a differential diagnosis and 11% were subsequently hospitalized in the intensive care stroke unit. Most patients were referred by general practitioners. Our TIA clinic demonstrated a 68% reduction in the risk of stroke after TIA with an observed stroke rate of 0.98% after 3 months compared to the 3.1% predicted by the ABCD2 score.</p><p><strong>Conclusion: </strong>The opening of a TIA clinic in Bordeaux metropole has significantly improved the management of TIA patients, which was previously inadequate in our territory. This study demonstrated that a hybrid model operating as an outpatient day hospital is effective as it successfully reduced the stroke rate after TIA, while increasing the capacity of TIAs admission to a stroke unit and shortening hospital stays.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010113","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":"Door-to-puncture time in ischemic stroke with large vessel occlusion in France: Patient and hospital factors.","authors":"F Gilbert, A Consoli, P Lavallee, J Caroff, M Mazighi, G Marnat, C Arquiza, J C Ferre, A Viguier, M Kyheng, D Weisenburger, B Lapergue","doi":"10.1016/j.neurol.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.neurol.2025.03.013","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy of endovascular therapy (EVT) in reducing disability is strongly time-dependent. Door to groin puncture (DTP) time has been reported to be a reliable parameter to assess the delay between admission and treatment initiation and can be shortened via faster, more optimized workflow. We aimed to assess the DTP time in France and have analyzed potentially associated factors at both patient and hospital levels.</p><p><strong>Methods: </strong>From January 2020 to December 2022, data were collected in the prospective, multi-centered, ongoing Endovascular Treatment in Ischemic Stroke (ETIS) registry. All patients directly admitted to comprehensive stroke centers with large vessel occlusion treated by EVT were included in the analysis and their DTP times were analyzed. We investigated hospital-related factors (prenotification, patient's hospital arrival location, type of imaging, number of available angiosuites, type of anesthesia) and patient-related factors, which could affect DTP time.</p><p><strong>Results: </strong>Among 3847 patients from 28 centers [mean age: 71.2; median NIHSS: 16 (10-20)], the median DTP time was 105minutes (IQR: 84 to 137). Pre-stroke mRS>1, admission during off-hours and admission to centers equipped with only one dedicated angiosuite were associated with a longer DTP time. Centers not equipped with an emergency department had a significantly shorter DTP time.</p><p><strong>Conclusion: </strong>The median DTP time in France is 105min. Further efforts, such as increasing the number of available angiosuites in CSCs, and implementing direct imaging paradigms should be applied to optimize workflows and to reduce DTP time, a major marker of the efficacy of comprehensive stroke centers.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046317","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":"Advances and research priorities in the respiratory management of ALS: Historical perspectives and new technologies.","authors":"J Kleinerova, E L Tan, S Delaney, M Smyth, P Bede","doi":"10.1016/j.neurol.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.neurol.2025.04.008","url":null,"abstract":"<p><p>Respiratory involvement has been identified as a cardinal feature of amyotrophic lateral sclerosis (ALS) since its earliest descriptions in the 19th century. Since these initial reports, considerable research has been undertaken to clarify the pathophysiology and progression rates associated with respiratory compromise and effective management strategies have been developed. Clinical trials routinely incorporate respiratory measures as study end points, non-invasive ventilation is now widely used in the home setting, cough-assist techniques are commonly used, advanced neurophysiology techniques and wearable technologies have been integrated into respiratory monitoring protocols, and palliative guidelines have been developed to effectively manage respiratory distress. Despite the widespread implementation of these interventions, epidemiology studies are inconsistent and some studies suggest that survival in ALS has not improved significantly with the introduction of these measures. The outcomes of diaphragmatic pacing trials have been disappointing, advanced neurophysiology techniques are not routinely utilised, spinal and brainstem imaging are not commonly undertaken and significant geographical differences exist in proceeding to tracheostomy. The worldwide COVID pandemic has given impetus for remote monitoring, connected devices, video-consultations, and timely vaccinations in ALS; lessons that are invaluable long after the pandemic. Respiratory monitoring and management in ALS is a swiftly evolving facet of ALS care with considerable quality of life benefits.</p>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051295","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":"Artificial intelligence applied to electroencephalography in epilepsy","authors":"C. Alvarado-Rojas ,&nbsp;G. Huberfeld","doi":"10.1016/j.neurol.2025.02.007","DOIUrl":"10.1016/j.neurol.2025.02.007","url":null,"abstract":"<div><div>Artificial intelligence (AI) is progressively transforming all fields of medicine, promising substantial changes in clinical practice. In the context of epilepsy, electroencephalography (EEG), a technique used for over a century, has historically been resistant to automated analysis due to the complexity of the signals and the challenges posed by artifact management. While the human eye excels at recognizing patterns, algorithms have demonstrated superior capabilities in detecting and characterizing specific features, such as long-term dynamics and synchrony. Furthermore, the advent of wearable EEG devices has led to an exponential increase in data volume, surpassing the limits of visual interpretation. AI algorithms are now being developed to address these limitations, offering enhanced efficiency in both identifying subtle signal features and managing massive datasets. This review explores the fundamental principles of AI and its transformative potential in the field of EEG. It discusses the implications and the current limitations, including improvements limited to aggregation of already known knowledge, for epilepsy diagnosis, medical and surgical treatment, and innovative approaches to patient monitoring, including seizure forecasting, highlighting how AI is poised to redefine the management of epilepsy.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 403-410"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754015","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":"Epilepsy and Alzheimer disease: New insights and perspectives","authors":"Sophie Dupont","doi":"10.1016/j.neurol.2025.03.005","DOIUrl":"10.1016/j.neurol.2025.03.005","url":null,"abstract":"<div><div>Numerous epidemiological and pathophysiological arguments suggest a bidirectional link between late-onset epilepsy and Alzheimer's disease. However, the temporal and causal relationship between the pathophysiological processes underlying these two conditions remains unclear. It is likely that these connections are complex, requiring consideration of various scenarios of causality and reciprocity. In the absence of targeted therapies that effectively address the progression of both diseases, specific measures can be taken to improve patient care. These include screening for cognitive disorders in patients with late-onset epilepsy, detecting subclinical EEG activity in patients with Alzheimer's disease, and identifying and managing cardiovascular risk factors in both populations. Looking ahead, it is evident that global population aging and the potential demographic surge in these two patient groups will necessitate greater efforts to raise awareness and enhance the training of physicians and healthcare professionals in the emerging field of “epileptogeriatrics”.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 382-390"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764918","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":"Recent progress and challenges in gene therapy for pharmacoresistant focal epilepsy","authors":"D.M. Kullmann","doi":"10.1016/j.neurol.2025.02.008","DOIUrl":"10.1016/j.neurol.2025.02.008","url":null,"abstract":"<div><div>Pharmacoresistant focal epilepsy represents a major unmet need. Recent years have seen several gene therapy strategies validated mainly in rodent models of temporal lobe epilepsy, and some of these have been de-risked for clinical trials. This review considers some of the challenges in progressing from experimental models to the clinic. Among these are identifying promising promoter-transgene combinations, establishing safe and efficacious doses, achieving optimal delivery, and extrapolating across different aetiologies.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 438-444"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754029","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":"Pathophysiology of SUDEP: How far are we from understanding?","authors":"E. Boglietti ,&nbsp;D. Haddad ,&nbsp;L. Bezin ,&nbsp;S. Rheims","doi":"10.1016/j.neurol.2025.03.010","DOIUrl":"10.1016/j.neurol.2025.03.010","url":null,"abstract":"<div><div>Sudden and unexpected death in epilepsy patients (SUDEP) is the leading cause of death in patients suffering from drug-resistant epilepsy. A significant number of studies have been conducted in both patients and animal models to examine the initial cascade of events that directly cause death as well as the factors that contribute to the long-term risk of SUDEP. This review aims to discuss the main pathophysiological hypotheses that are currently considered in both clinical and pre-clinical models of SUDEP. Studies have highlighted that SUDEP is typically triggered by a seizure, with central fatal apnea as the primary cause of death. Findings also suggest that chronic impairments in respiratory regulation may contribute to SUDEP risk, with serotonin dysfunction playing a key role in the associated respiratory abnormalities. These insights on SUDEP pathophysiology contribute to better risk assessment, though gaps remain in understanding the precise mechanisms linking SUDEP and transient peri-ictal respiratory dysfunction.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 432-437"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923771","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":"Multiple sclerosis and epilepsy","authors":"H. Catenoix ,&nbsp;W. Grabon ,&nbsp;S. Rheims ,&nbsp;S. Vukusic ,&nbsp;R. Marignier","doi":"10.1016/j.neurol.2025.03.008","DOIUrl":"10.1016/j.neurol.2025.03.008","url":null,"abstract":"<div><div>Epilepsy is a notable comorbidity in multiple sclerosis (MS), with a prevalence significantly higher than in the general population. This co-occurrence suggests shared pathophysiological mechanisms, including cortical demyelination, chronic inflammation and neurodegeneration, which predispose MS patients to seizures. Advanced imaging studies highlight the role of cortical lesions and atrophy in epileptogenesis, while inflammatory processes further lower the seizure threshold. Additionally, MS-associated network dysfunction disrupts normal neural activity, contributing to seizure susceptibility. This review synthesizes epidemiological, neuroimaging, and clinical evidence to elucidate the complex relationship between epilepsy and MS. It emphasizes the importance of personalized care and the need for further research to refine treatment protocols, improve outcomes, and enhance the quality of life for this unique patient population.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 391-396"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780974","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":"Detection of brain somatic mutations from stereo-EEG electrodes in focal epilepsy: Current advances and future perspectives","authors":"R. Checri ,&nbsp;S. Baldassari ,&nbsp;S. Baulac","doi":"10.1016/j.neurol.2025.03.003","DOIUrl":"10.1016/j.neurol.2025.03.003","url":null,"abstract":"<div><div>Brain somatic mutations are increasingly recognized as major drivers of focal epilepsy particularly in malformations of cortical development. While traditionally relying on surgically resected tissue for genetic analysis, recent advances in molecular techniques now enable the recovery and analysis of DNA from stereo-electroencephalography (SEEG) electrodes. This minimally invasive approach provides unprecedented opportunities to identify somatic mutations in patients who may not undergo resective surgery. Here, we review the current state of molecular analyses from SEEG electrodes, including recent developments in DNA sequencing, transcriptomics, and epigenetic profiling. We discuss how genetic testing may be integrated into presurgical evaluations, providing new opportunities for comprehensive molecular phenotyping of focal epilepsies. These innovations hold promises in enhancing surgical outcome prediction and guiding toward targeted therapies.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 425-431"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788886","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":"Targeted therapies in epilepsies","authors":"S. Auvin","doi":"10.1016/j.neurol.2025.04.003","DOIUrl":"10.1016/j.neurol.2025.04.003","url":null,"abstract":"<div><div>In recent years, the increasing availability of antiseizure medications has not reduced the incidence of drug-resistant epilepsy. Precision medicine offers the potential for mechanism-driven treatments for rare pediatric epilepsies. The concept of precision medicine is not new in the field of epilepsy, as demonstrated by the use of pyridoxine for antiquitin deficiency (pyridoxine-dependent epilepsy) and the ketogenic diet for GLUT1 deficiency syndrome. More recently, preclinical evidence has led to phase 3 clinical trials, such as the use of everolimus to inhibit the mTOR pathway in tuberous sclerosis complex. However, preclinical findings do not always translate into effective treatments, as illustrated by the heterogeneous effects of quinidine in KCNT1-related epilepsy. Currently, an exponential increase in compounds identified at the preclinical level will require clinical trial validation. However, it remains uncertain whether these developments will lead to improved efficacy in drug-resistant epilepsy or have any disease-modifying effects. This article does not explicitly address antisense oligonucleotides or gene therapy.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 450-455"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923773","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}