Therapeutic Advances in Neurological Disorders最新文献

{"title":"Thrombectomy for patients with a large infarct core: a study-level meta-analysis with trial sequential analysis.","authors":"Hong-Jie Jhou, Li-Yu Yang, Po-Huang Chen, Cho-Hao Lee","doi":"10.1177/17562864241285552","DOIUrl":"10.1177/17562864241285552","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness and safety of endovascular treatment compared with medical management alone regarding outcomes for patients with a large infarct core remain uncertain.</p><p><strong>Objectives: </strong>To juxtapose the clinical outcomes of thrombectomy versus the best medical care in patients with a large infarct core.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources and methods: </strong>We conducted searches in PubMed, Cochrane, and Embase for articles published up until November 8, 2023. Randomized trials were selected for inclusion if they encompassed patients with large vessel occlusion and sizable strokes receiving thrombectomy. The primary outcome was functional outcomes at 3 months after pooling data using random-effects modeling. Safety outcomes included mortality at 3 months, symptomatic intracranial hemorrhage (SICH), and decompressive craniectomy. We performed a trial sequential analysis to balance type I and II errors.</p><p><strong>Results: </strong>From 904 citations, we identified six randomized trials, involving a cohort of 1897 patients with a large ischemic region. Of these, 953 individuals underwent endovascular thrombectomy. At 3 months, thrombectomy was significantly correlated with better neurological prognosis, as evidenced by the increased odds of good functional outcomes (odds ratio (OR), 2.90; 95% confidence interval (CI), 2.08-4.05) and favorable functional outcomes (OR, 2.40; 95% CI, 1.86-3.09). Mortality rates did not demonstrably diminish as a consequence of the endovascular management (OR, 0.78; 95% CI, 0.58-1.06). However, the incidence of SICH was greater in the thrombectomy group compared to those with only medical treatment (5.5% vs 3.2%; OR, 1.77; 95% CI, 1.11-2.83). The application of trial sequential analysis yielded definitive evidence regarding favorable function outcomes and a shift in the distribution of modified Rankin scale scores at 3 months; however, others remained inconclusive.</p><p><strong>Conclusion: </strong>The results from most of the included trials display consistency. Meta-analysis of these six randomized trials offers high-quality evidence that thrombectomy significantly mitigates disability in patients with a large infarction, while also increasing the risk of SICH.</p><p><strong>Trial registration: </strong>PROSPERO, CRD42023480359.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241285552"},"PeriodicalIF":4.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393574","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":"Clinical and ethical challenges in decision-making for patients with disorders of consciousness and locked-in syndrome from Chinese neurologists' perspectives.","authors":"Meiqi Li, Yifan Yan, Katja Kuehlmeyer, Wangshan Huang, Steven Laureys, Haibo Di","doi":"10.1177/17562864241283328","DOIUrl":"10.1177/17562864241283328","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and locked-in syndrome (LIS) have been the subject of intense debate.</p><p><strong>Objective: </strong>We aim to investigate the application of diagnostic knowledge, opinions about the administration of LST, and ethical challenges related to DoC and LIS.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Methods: </strong>A survey was conducted among Chinese neurologists. Questionnaires included three vignettes (unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS), and LIS). They were randomly distributed among neurologists from August 2018 to December 2019.</p><p><strong>Results: </strong>A sample of 360 questionnaires was included (response rate: 78%). Overall, 63% of the participants chose the correct diagnostic category. The neurologists who received the MCS case chose the category more accurately than the neurologists with the UWS (<i>p</i> < 0.001) and LIS case (<i>p</i> = 0.002). Most neurologists preferred never to limit LST for their patients (47%, 63%, and 67% in UWS, MCS, and LIS groups, <i>p</i> = 0.052). A large group of neurologists believed UWS patients could feel pain (73%), with no difference from MCS and LIS patients (<i>p</i> > 0.05). Deciding for patients in the absence of surrogates was rated extremely challenging.</p><p><strong>Conclusion: </strong>A large proportion of Chinese neurologists in our study didn't apply the accurate diagnostic categories to the description of DoC and LIS patients. This calls for more education and training. Most Chinese neurologists were reluctant to limit LST for patients. This may indicate that there may be a need to emphasize the allocation of more resources toward long-term care in China.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241283328"},"PeriodicalIF":4.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393558","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":"Cerebral air embolism following a hemodialysis session successfully treated with hyperbaric oxygen: a case report.","authors":"Amine Bousbaa, Marianne Renou, Coralie Poulain, Pierre Laurent, Najeh El Esper, Gabriel Choukroun, Pauline Caillard","doi":"10.1177/17562864241287457","DOIUrl":"https://doi.org/10.1177/17562864241287457","url":null,"abstract":"<p><p>We describe here the first case of cerebral air embolism (CAE) due to a dysfunctional long-term central venous catheter for hemodialysis in a 39-year-old woman with a history of lung transplantation. Air emboli are rare but potentially fatal complications of hemodialysis, in particular, when they involve the brain. Early management with hyperbaric oxygen therapy (HBOT) is critical to prevent deterioration of the patient's condition. In this case, our patient presented her first symptoms, likely a seizure due to multiple cerebral air emboli, during her hemodialysis session. She was then monitored in the Nephrology Intensive Care Unit in accordance to the medical reference center (with HBOT). Twelve hours later, she experienced secondary deterioration, presenting with acute aphasia, left hemineglect syndrome, and hemiplegia. She was rapidly transferred to the medical reference center for HBOT. The patient fully recovered after receiving three sessions of HBOT. She also presented a seizure during each HBOT session, attributed to hyperoxia. She never experienced another seizure after the episode of CAE. This case highlights the importance of considering patients who have a lung transplant to be at increased risk for air emboli during hemodialysis and the need to rapidly recognize symptoms and start treatment, including HBOT, to optimize recovery.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241287457"},"PeriodicalIF":4.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475375","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":"Long-term analysis of infections and associated risk factors in patients with multiple sclerosis treated with ocrelizumab: pooled analysis of 13 interventional clinical trials.","authors":"Tobias Derfuss, Robert Bermel, Chien-Ju Lin, Stephen L Hauser, Ludwig Kappos, Timothy Vollmer, Giancarlo Comi, Gavin Giovannoni, Hans-Peter Hartung, Martin S Weber, Jianmei Wang, Nikki Jessop, Cathy Chognot, Licinio Craveiro, Amit Bar-Or","doi":"10.1177/17562864241277736","DOIUrl":"https://doi.org/10.1177/17562864241277736","url":null,"abstract":"<p><strong>Background: </strong>Patients with multiple sclerosis (PwMS) have an increased risk of infections.</p><p><strong>Objectives: </strong>To characterize incidence, clinical characteristics, outcomes and risk factors of infections, and serious infections (SIs) in ocrelizumab (OCR)-treated PwMS.</p><p><strong>Design: </strong><i>Post-hoc</i> analysis of pooled data from 6155 patients in 13 clinical trials.</p><p><strong>Methods: </strong>Descriptive analyses of clinical characteristics and outcomes were reported over ⩽14 years. A Poisson Generalized Estimating Equation model was constructed to examine risk factors in a subgroup of patients with longer exposure to OCR (<i>n</i> = 2092).</p><p><strong>Results: </strong>Over a median (max) treatment period of 3.7 (13.9) years, 420/6155 patients (6.8%) experienced 583 SIs, excluding coronavirus disease 2019. Incidence rates in relapsing multiple sclerosis (RMS; 1.50 per 100 patient years [95% confidence interval (CI): 1.34-1.68]) and progressive multiple sclerosis (PMS; 3.70 [95% CI: 3.27-4.17]) remained stable over this period. Lower respiratory tract, urinary tract, abdominal and gastrointestinal, and skin infections were the most commonly reported SIs. Most SIs (~90%) resolved, and treatment with OCR was continued in >80% of cases. The presence of 1 or ⩾2 comorbidities (rate ratio = 1.66, 2.73, respectively), recent relapse activity (2.06), and Expanded Disability Status Scale (EDSS) score ⩾6.0 (2.02) were significant risk factors for SIs in patients with RMS treated over a median (max) period of 8.3 (11.2) years. In patients with primary PMS treated over a median (max) period of 7.1 (11.8) years, an EDSS score ⩾6.0 was associated with the greatest risk of SIs, a 4-fold increase (rate ratio, 4.31), followed by abnormal immunoglobulin (Ig)M levels (1.89), the presence of ⩾2 comorbidities (1.80), and having overweight/obesity (1.46). Time on OCR and abnormal IgG levels were not significantly associated with an increased SI risk.</p><p><strong>Conclusion: </strong>Continuous long-term treatment with OCR is associated with a manageable infection risk profile. Optimal disease control and addressing modifiable risk factors may reduce the risk of infections.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241277736"},"PeriodicalIF":4.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475384","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":"Patient-reported treatment satisfaction in essential tremor: levels of satisfaction and predictors of satisfaction.","authors":"Anjali Varghese, Diane S Berry, Ali Ghanem, Nora C Hernandez, Elan D Louis","doi":"10.1177/17562864241271994","DOIUrl":"https://doi.org/10.1177/17562864241271994","url":null,"abstract":"<p><strong>Background: </strong>Although managing symptoms is paramount for both essential tremor (ET) patients and their healthcare providers, studies of treatment satisfaction are surprisingly lacking.</p><p><strong>Objectives: </strong>We evaluated the satisfaction of patients who used a range of treatments and assessed the relation of a wide array of factors to satisfaction.</p><p><strong>Methods: </strong>One hundred four ET participants (age = 74.5 ± 10.2 years) completed a battery of self-report items. These included demographic information, measures of tremor and clinical history, psychological state, current ET treatment, and a series of questions about satisfaction with treatment.</p><p><strong>Results: </strong>Analyses of responses to the four current treatment satisfaction questions revealed that the proportion of participants who were satisfied ranged from 35.0% to 57.3% (i.e., approximately 1/3 to 1/2); conversely, the proportion who were dissatisfied ranged from 9.2% to 37.0%. The remainder were neutral. Higher satisfaction levels were observed in participants who were included in treatment selection and who had undergone deep brain stimulation surgery, <i>p</i>'s < 0.05. Lower levels of satisfaction were found in participants with a negative psychological state, higher self-rated tremor severity, head/voice/jaw tremors, and more severe physical side effects; and who used botulinum toxin therapy, <i>p</i>'s < 0.05.</p><p><strong>Conclusion: </strong>Between 1/3 and 1/2 of patients were satisfied with their treatment, whereas up to 1/3 were dissatisfied. In this initial exploration of correlates of treatment satisfaction in ET patients, we identified a number of associations between satisfaction and clinical, psychological and treatment variables. Additional research is warranted to further explore the nature of these relations over time.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241271994"},"PeriodicalIF":4.7,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393573","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":"Effects of visual feedback balance system combined with weight loss training system on balance and walking ability in the early rehabilitation stage of stroke: a randomized controlled exploratory study.","authors":"Wei Lu, Mingming Wen, Yinxia Li, Feng Liu, Yongping Li, Hengchun Zhang, Min Zhang","doi":"10.1177/17562864241266512","DOIUrl":"https://doi.org/10.1177/17562864241266512","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have suggested that the Pro-Kin visual feedback balance system can promote the recovery of balance function in stroke patients.</p><p><strong>Objectives: </strong>However, this system has not been used effectively in the early stages of stroke rehabilitation. This study aimed to investigate the effect of Pro-Kin system combined with weight loss system for the early recovery of balance and walking ability following a stroke.</p><p><strong>Methods: </strong>A total of 62 patients who underwent radiological diagnosis of stroke were randomly divided into two groups: a control group (<i>n</i> = 31) and a treatment group (<i>n</i> = 31). Both groups received conventional balance training. The treatment group also received training on the Pro-Kin system in conjunction with a weight loss system. Balance was measured using the Berg Balance Scale (BBS), Timed 'Up & Go' (TUG) test and Pro-Kin system. Walking ability was assessed using the Functional Ambulation Classification (FAC). The tests were performed before the start of treatment and on the 4th week following the training. There was no statistically significant difference between the groups before training.</p><p><strong>Results: </strong>After 4 weeks of training in both groups, there were significant improvements in balance and walking ability. BBS values and FAC were significantly higher (<i>p</i> < 0.01), TUG times, ellipse area and motion trajectory length were significantly reduced (<i>p</i> < 0.01, <i>p</i> < 0.05) after training. The treatment group outperformed the control group (<i>p</i> < 0.05). In addition, there was a positive correlation between balance function and walking ability (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>The Pro-Kin system combined with weight loss system is a viable method that promotes early reconstruction of balance and walking ability following a stroke.</p><p><strong>Trial registration: </strong>Clinical trial number ChiCTR1900026370. https://www.chictr.org.cn/showprojEN.html?proj=43736.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241266512"},"PeriodicalIF":4.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393572","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":"Efficacy and safety of patent foramen ovale closure for mitigating migraine: a systematic review and meta-analysis of randomized trials and observational studies.","authors":"Todung Donald Aposan Silalahi, Timotius Ivan Hariyanto","doi":"10.1177/17562864241271033","DOIUrl":"10.1177/17562864241271033","url":null,"abstract":"<p><strong>Background: </strong>Although often asymptomatic, patent foramen ovale (PFO) may cause disabling migraine symptoms. Evidence regarding PFO closure for prevention of migraine is still ambiguous and conflicting.</p><p><strong>Objectives: </strong>This study aims to analyze the efficacy and safety of PFO closure for mitigating migraine symptoms.</p><p><strong>Design: </strong>This is a systematic review and meta-analysis of randomized clinical trials (RCTs) and observational studies.</p><p><strong>Data sources and methods: </strong>A comprehensive search was conducted on the Scopus, Medline, ClinicalTrials.gov, and Cochrane Library databases up until March 12, 2024. This review incorporates literature that examines the comparison between PFO closure and control with outcome data related to migraine. We employed random-effect models to analyze the standardized mean difference (SMD) and odds ratio (OR) for presentation of the outcomes.</p><p><strong>Results: </strong>A total of five RCTs and six observational studies were incorporated. The results of our meta-analysis showed higher reduction of monthly migraine attacks from baseline (SMD -0.34; 95% CI: -0.51, -0.18, <i>p</i> < 0.0001, <i>I</i> ² = 19%) and monthly migraine days from baseline (SMD -0.30; 95% CI: -0.53, -0.08, <i>p</i> = 0.009, <i>I</i> ² = 0%) among PFO closure than control. However, the complete resolution of migraine (especially based on the evidence from RCTs; <i>p</i> = 0.24), HIT-6 score (<i>p</i> = 0.08), and MIDAS score (<i>p</i> = 0.15) did not differ significantly between two groups of intervention. The majority of adverse events reported were atrial fibrillation and access site infection/bleeding that only occurred in small proportions of patients (⩽5%).</p><p><strong>Conclusion: </strong>This study suggests better efficacy of PFO closure in reducing monthly migraine attacks and days with similar safety profile when compared to control.</p><p><strong>Registration: </strong>PROSPERO (CRD42023453635).</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241271033"},"PeriodicalIF":4.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381597","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":"A comprehensive prediction model of drug-refractory epilepsy based on combined clinical-EEG microstate features.","authors":"Jinying Zhang, Chaofeng Zhu, Juan Li, Luyan Wu, Yuying Zhang, Huapin Huang, Wanhui Lin","doi":"10.1177/17562864241276202","DOIUrl":"10.1177/17562864241276202","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is a chronic neurological disorder characterized by recurrent seizures that significantly impact patients' quality of life. Identifying predictors is crucial for early intervention.</p><p><strong>Objective: </strong>Electroencephalography (EEG) microstates effectively describe the resting state activity of the human brain using multichannel EEG. This study aims to develop a comprehensive prediction model that integrates clinical features with EEG microstates to predict drug-refractory epilepsy (DRE).</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Methods: </strong>This study encompassed 226 patients with epilepsy treated at the epilepsy center of a tertiary hospital between October 2020 and May 2023. Patients were categorized into DRE and non-DRE groups. All patients were randomly divided into training and testing sets. Lasso regression combined with Stepglm [both] algorithms was used to screen independent risk factors for DRE. These risk factors were used to construct models to predict the DRE. Three models were constructed: a clinical feature model, an EEG microstate model, and a comprehensive prediction model (combining clinical-EEG microstates). A series of evaluation methods was used to validate the accuracy and reliability of the prediction models. Finally, these models were visualized for display.</p><p><strong>Results: </strong>In the training and testing sets, the comprehensive prediction model achieved the highest area under the curve values, registering 0.99 and 0.969, respectively. It was significantly superior to other models in terms of the C-index, with scores of 0.990 and 0.969, respectively. Additionally, the model recorded the lowest Brier scores of 0.034 and 0.071, respectively, and the calibration curve demonstrated good consistency between the predicted probabilities and observed outcomes. Decision curve analysis revealed that the model provided significant clinical net benefit across the threshold range, underscoring its strong clinical applicability. We visualized the comprehensive prediction model by developing a nomogram and established a user-friendly website to enable easy application of this model (https://fydxh.shinyapps.io/CE_model_of_DRE/).</p><p><strong>Conclusion: </strong>A comprehensive prediction model for DRE was developed, showing excellent discrimination and calibration in both the training and testing sets. This model provided an intuitive approach for assessing the risk of developing DRE in patients with epilepsy.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241276202"},"PeriodicalIF":4.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381596","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":"Risk of major adverse cardiovascular events and all-cause mortality under treatment with GLP-1 RAs or the dual GIP/GLP-1 receptor agonist tirzepatide in overweight or obese adults without diabetes: a systematic review and meta-analysis.","authors":"Maria-Ioanna Stefanou, Lina Palaiodimou, Aikaterini Theodorou, Apostolos Safouris, Urs Fischer, Peter J Kelly, Jesse Dawson, Mira Katan, Aristeidis H Katsanos, Vaia Lambadiari, Sotirios Giannopoulos, Andrei V Alexandrov, Gerasimos Siasos, Georgios Tsivgoulis","doi":"10.1177/17562864241281903","DOIUrl":"https://doi.org/10.1177/17562864241281903","url":null,"abstract":"<p><strong>Background: </strong>Among the currently approved antiobesity medications, the glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) liraglutide and semaglutide, and the dual glucose-dependent-insulinotropic-polypeptide (GIP)/GLP-1 RA tirzepatide have been suggested to reduce cardiovascular-risk in overweight or obesity without diabetes.</p><p><strong>Objectives: </strong>The objective of this study was to evaluate the cardio- and neuroprotective potential of these novel agents in the nondiabetic overweight/obese adult population.</p><p><strong>Data sources and methods: </strong>A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate the risk of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality in overweight or obese adults without diabetes treated with GLP-1 or GIP/GLP-1 RAs (vs placebo). Secondary outcomes included the risk of myocardial infarction (MI) and stroke.</p><p><strong>Results: </strong>Sixteen RCTs (13 and 3 on GLP-1 RAs and tirzepatide, respectively) comprising 28,168 participants were included. GLP-1 or GIP/GLP-1 RAs reduced MACE (odds ratio (OR): 0.79; 95% confidence interval (CI): 0.71-0.89; <i>p</i> < 0.01; <i>I</i> ² = 0) and all-cause mortality (OR: 0.80; 95% CI: 0.70-0.92; <i>p</i> < 0.01; <i>I</i> ² = 0), while there was a trend toward lower cardiovascular-mortality (OR: 0.84; 95% CI: 0.71-1.01; <i>p</i> = 0.06; <i>I</i> ² = 0%) compared to placebo. Additionally, GLP-1 or GIP/GLP-1 RAs reduced the odds of MI (OR: 0.72; 95% CI: 0.61-0.86; <i>p</i> < 0.01; <i>I</i> ² = 0%) and nonfatal-MI (OR: 0.72; 95% CI: 0.61-0.85; <i>p</i> < 0.01; <i>I</i> ² = 0%); while no associations between antiobesity treatment and fatal-MI, stroke, nonfatal, or fatal stroke were uncovered.</p><p><strong>Conclusion: </strong>GLP-1 and GIP/GLP-1 RAs reduce cardiovascular-risk and all-cause mortality in overweight or obese adults without diabetes. Additionally, GLP-1 RAs and GIP/GLP-1 RAs attenuate the risk of MI. Since data on stroke are still limited, future RCTs are warranted to evaluate the neuroprotective potential of these novel antiobesity agents.</p><p><strong>Trial registration: </strong>PROSPERO CRD42024515966.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241281903"},"PeriodicalIF":4.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354292","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":"Long-term effects of vagus nerve stimulation on EEG aperiodic components in patients with drug-resistant epilepsy.","authors":"Yujiao Yang, Jing Wang, Xiongfei Wang, Chongyang Tang, Jiahui Deng, Zhaofen Yan, Qinqin Deng, Dong Chen, Jian Zhou, Yuguang Guan, Mengyang Wang, Tianfu Li, Guoming Luan","doi":"10.1177/17562864241279124","DOIUrl":"10.1177/17562864241279124","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant epilepsy (DRE) affects approximately one-third of epilepsy patients who do not achieve adequate seizure control with medication. Vagus nerve stimulation (VNS) is an adjunctive therapy for DRE, but its long-term effects on cortical excitability remain unclear.</p><p><strong>Objectives: </strong>This study aims to elucidate the long-term effects of VNS on electroencephalography (EEG) aperiodic components in patients with DRE. Our objective is to identify biomarkers that can serve as indicators of therapeutic efficacy and provide mechanistic insights into the underlying neural processes.</p><p><strong>Design: </strong>This longitudinal observational study focused on patients with DRE undergoing VNS therapy at Sanbo Brain Hospital. The reduction in seizure frequency rates was quantified over short-term (⩽1 year), medium-term (1-3 years), and long-term (⩾3 years) intervals to assess the therapeutic efficacy of VNS. Both the periodic and aperiodic components of EEG data were analyzed.</p><p><strong>Methods: </strong>Advanced signal processing techniques were utilized to parameterize the periodic and aperiodic components of EEG data, focusing particularly on \"offset\" and \"exponent.\" These measures were compared before and after VNS therapy. Correlation analyses were conducted to explore the relationship between these EEG parameters and clinical outcomes.</p><p><strong>Results: </strong>In all, 18 patients with DRE participated in this study. During the long-term follow-up period, the responder rate was 55.56%. Significant decreases were observed in aperiodic offset (<i>p</i> = 0.022) and exponent (<i>p</i> = 0.039) among responders. The impact of age on these results was not significant. Correlation analyses revealed a negative association between therapeutic efficacy and a decrease in offset (<i>R</i> = -0.546, <i>p</i> = 0.019) and exponent (<i>R</i> = -0.636, <i>p</i> = 0.019).</p><p><strong>Conclusion: </strong>EEG aperiodic parameters, including offset and exponent, have the potential to serve as promising biomarkers for evaluating the efficacy of VNS. An understanding of the regulatory influence of VNS on cortical excitability through these aperiodic parameters could provide a basis for the development of more effective stimulation parameters and therapeutic strategies.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"17 ","pages":"17562864241279124"},"PeriodicalIF":4.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381599","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}