Therapeutic Advances in Neurological Disorders最新文献

{"title":"Short delay to initiate plasma exchange or immunoadsorption as synergistic therapies for patients in the acute phase of anti-NMDAR encephalitis.","authors":"Miao Su, Zichao Wu, Qiuyan Luo, Huiyu Feng, Hongyan Zhou","doi":"10.1177/17562864241276208","DOIUrl":"10.1177/17562864241276208","url":null,"abstract":"<p><strong>Background: </strong>Combined first-line therapies have been frequently adopted for patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Plasma exchange (PE) or immunoadsorption (IA) was used as an add-on option following initial immunotherapies, including high-dose steroids and intravenous immunoglobulin (IVIG). However, whether a shorter delay of PE or IA can improve the early recovery prognosis of patients with anti-NMDAR encephalitis remains largely unknown.</p><p><strong>Objective: </strong>To compare short-term clinical improvement between patients with early and late initiation of PE or IA in anti-NMDAR encephalitis.</p><p><strong>Design: </strong>A retrospective study was conducted for patients admitted with anti-NMDAR encephalitis between January 2015 and December 2023 (<i>n</i> = 29), including 21 patients who received PE or IA as synergistic therapies.</p><p><strong>Methods: </strong>The clinical prognosis was compared between the early PE/IA group and the late PE/IA group in the research. Primary outcome included changes in the Clinical Assessment Scale for Autoimmune Encephalitis (∆CASE) at 90 and 120 days after encephalitis onset. Secondary outcomes included changes in the modified Rankin scale (∆mRS) after 90 and 120 days from encephalitis onset, and the length of intensive care unit (ICU) stay for patients with severe anti-NMDAR encephalitis.</p><p><strong>Results: </strong>The ∆CASE scores after 90 and 120 days from encephalitis onset revealed a significant difference between patients with early and late initiation of PE or IA (<i>p</i> ⩽ 0.05). A significant difference in the ∆mRS was also found between patients with early and late initiation of PE or IA in severe encephalitis (<i>p</i> ⩽ 0.05). No significant difference was found in the length of ICU admission (<i>p</i> = 0.101).</p><p><strong>Conclusion: </strong>Our findings emphasize the importance of considering PE or IA as early as feasible for patients with anti-NMDAR encephalitis, even when steroids and IVIG are in use.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial signature in retrieved thrombi of patients with acute ischemic stroke-a systematic review.","authors":"Armin Zarrintan, Sherief Ghozy, Kasthuri Thirupathi, Kalah Walden, Waleed Brinjikji, David F Kallmes, Ramanathan Kadirvel","doi":"10.1177/17562864241296713","DOIUrl":"https://doi.org/10.1177/17562864241296713","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke (AIS) imposes a major healthcare burden. It is hypothesized that bacterial infection could influence atherosclerosis and thrombus formation, potentially contributing to AIS.</p><p><strong>Objectives: </strong>We aim to systematically review all studies that have investigated the presence of bacterial signatures within thrombi retrieved following mechanical thrombectomy (MT) procedures in patients with AIS.</p><p><strong>Design: </strong>This systematic review is designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist.</p><p><strong>Data sources and methods: </strong>A comprehensive search was conducted in the Web of Sciences, PubMed, Scopus, and Embase databases to identify relevant studies.</p><p><strong>Results: </strong>The literature search and screening included 11 studies involving 674 patients, with 414 (61.4%) being male and 260 (38.6%) females. Among all the patients, 393 (58.3%) were positive for bacterial presence in their retrieved thrombi. The most utilized technique for bacterial signature detection was bacterial DNA extraction followed by polymerase chain reaction amplification of the 16S rRNA gene sequence. <i>Staphylococcus aureus</i> was the most studied bacteria among the studies analyzed.</p><p><strong>Conclusion: </strong>Bacterial infections and the presence of bacteria within thrombi may significantly contribute to AIS by initiating or exacerbating atherosclerosis or thrombosis. Understanding the mechanisms by which bacteria affect vascular health is crucial for developing effective preventive and therapeutic strategies for stroke patients.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11550500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of COVID-19 infection on multiple sclerosis disease course across 12 countries: a propensity-score-matched cohort study.","authors":"David Levitz, Yi Chao Foong, Paul Sanfilippo, Tim Spelman, Louise Rath, Angie Roldan, Anoushka Lal, Mastura Monif, Vilija Jokubaitis, Serkan Ozakbas, Raed Alroughani, Cavit Boz, Murat Terzi, Tomas Kalincik, Yolanda Blanco, Matteo Foschi, Andrea Surcinelli, Katherine Buzzard, Olga Skibina, Guy Laureys, Liesbeth Van Hijfte, Cristina Ramo-Tello, Aysun Soysal, Jose Luis Sanchez-Menoyo, Mario Habek, Elisabetta Cartechini, Juan Ignacio Rojas, Rana Karabudak, Barbara Willekens, Talal Al-Harbi, Yara Fragoso, Tamara Castillo-Triviño, Danny Decoo, Maria Cecilia Aragon de Vecino, Eli Skromne, Carmen-Adella Sirbu, Chao Zhu, Daniel Merlo, Melissa Gresle, Helmut Butzkueven, Anneke Van Der Walt","doi":"10.1177/17562864241278496","DOIUrl":"https://doi.org/10.1177/17562864241278496","url":null,"abstract":"<p><strong>Background: </strong>The relationship between coronavirus disease 2019 (COVID-19) infection and multiple sclerosis (MS) relapse and disease progression remains unclear. Previous studies are limited by small sample sizes and most lack a propensity-matched control cohort.</p><p><strong>Objective: </strong>To evaluate the effect of COVID-19 infection on MS disease course with a large propensity-matched cohort.</p><p><strong>Design: </strong>This multi-centre cohort study analysed relapse and disability outcomes post-COVID-19 infection after balancing covariates using a propensity score matching method. The study period was from the 11th of September 2019 to the 16th of February 2023. The mean follow-up period was 1.7 years.</p><p><strong>Methods: </strong>Data were retrieved from the MSBase Registry. Propensity scores were obtained based on age, sex, disease duration, baseline Expanded Disability Status Scale (EDSS), MS course, relapses pre-baseline, disease-modifying therapy (DMT) class and country. Primary outcomes were time to first relapse, annualised relapse rate (ARR) and time to confirm EDSS progression. Secondary outcomes were time to EDSS of 3, 4 or 6. Sensitivity analyses with baseline DMT classes were performed.</p><p><strong>Results: </strong>The study included 2253 cases and 6441 controls. After matching, there were 2161 cases and an equal number of matched controls. Cases had a significantly higher ARR (ARR = 0.10 [95% CI 0.09-0.11]) compared to controls (ARR = 0.07 [95% CI 0.06-0.08]). Cases had a significantly greater hazard of time to first relapse compared to controls (hazard ratio (HR) = 1.54 [95% CI 1.29-1.84]). There was no association between COVID-19 infection and 24-week EDSS progression (HR = 1.18 [95% CI 0.92-1.52]), or time to EDSS of 3, 4 or 6. For patients on interferons and glatiramer acetate (BRACE), COVID-19 infection was associated with a greater hazard of time to first relapse (HR = 1.83 [95% CI 1.25-2.68]) and greater hazard of time to EDSS of 3 (HR = 2.04 [95% CI 1.06-3.90]) compared to patients on BRACE therapy without COVID-19 infection.</p><p><strong>Conclusion: </strong>COVID-19 infection was associated with a significantly increased MS relapse rate and a shorter time to first relapse. There was no effect on confirmed EDSS progression over the short term. These results support ongoing COVID-19 risk minimisation strategies to protect patients with MS.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}