BMJ Neurology Open最新文献

{"title":"CSF oligoclonal bands in neurological diseases besides CNS inflammatory demyelinating disorders.","authors":"Jingru Ren, Jianchun Wang, Ran Liu, Jing Guo, Yan Yao, Hongjun Hao, Feng Gao","doi":"10.1136/bmjno-2024-000912","DOIUrl":"10.1136/bmjno-2024-000912","url":null,"abstract":"<p><strong>Objective: </strong>To understand the distribution characteristics and clinical significance of cerebrospinal fluid (CSF) oligoclonal bands (OCBs) in different nervous system diseases besides typical central nervous system (CNS) inflammatory demyelinating disorders.</p><p><strong>Material: </strong>A total of 2259 patients who underwent CSF examination for OCBs at Peking University First Hospital from January 2011 to December 2023 were tested. A cohort of 257 patients presenting with various types of OCBs but without CNS inflammatory demyelinating diseases was included in the analysis. Relevant medical history was collected from all patients.</p><p><strong>Results: </strong>OCBs were most common in patients with autoimmune encephalitis. OCB types II and III were most common in patients with autoimmune encephalitis and CNS infection, whereas OCB types IV and V were present in immune-mediated neuropathy mostly. The distribution of OCBs also varied among different disease subtypes. Other CSF characteristics varied between diseases with different OCBs.</p><p><strong>Conclusions: </strong>In addition to CNS inflammatory demyelinating diseases, OCBs also appear in other neurological diseases including cerebral angiopathy and neurodegenerative conditions, informing the potential immune background. Further research is still needed to determine the significance of OCBs in these diseases.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000912"},"PeriodicalIF":2.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creutzfeldt-Jakob disease mimicking limbic encephalitis as a cause of rapid neurological deterioration.","authors":"Vinod Rajasingam, Donald P Peter Craig, Yun Hwang, Laveniya Satgunaseelan, Michael Buckland, Rodrigo Tomazini Martins","doi":"10.1136/bmjno-2024-000891","DOIUrl":"10.1136/bmjno-2024-000891","url":null,"abstract":"<p><strong>Background: </strong>A broad range of inflammatory and neurodegenerative conditions manifest with progressive cognitive and behavioural changes. A diagnostic challenge is the differentiation of limbic encephalitis (LE) from Creutzfeldt-Jakob disease (CJD). LE and CJD are distinct neurological conditions with distinct variations in their clinical course, with overlapping clinical presentations. LE can be subdivided into autoimmune paraneoplastic and non-paraneoplastic subtypes, under the umbrella of autoimmune LE. CJD is the most prevalent form of human prion disease and the subtype sporadic CJD (sCJD) the most common.</p><p><strong>Case presentation: </strong>This case study presents a 68-year-old man with a 6-week history of progressive cognitive decline and behavioural changes, ultimately leading to a dire clinical state. The initial symptoms included confusion, intermittent headaches and episodes of aggression towards his wife, preceded by 2 weeks of visual hallucinations. On examination, the patient displayed an ataxic gait, with signs of cerebellar dysfunction. The clinical course evolved, marked by myoclonic jerks, culminating in a decline in both his Glasgow Coma Scale (GCS) score and overall clinical status.</p><p><strong>Conclusion: </strong>The patient's rapidly deteriorating condition over 6 weeks was thought to be too rapid for sCJD, and the patient was treated initially as an LS. However, post-mortem biopsy findings confirmed CJD. Asymmetric periodic discharges on EEG, asymmetric neuroimaging changes and the manifestation of psychiatric symptoms should not preclude the diagnosis of sCJD. This case highlights the importance of recognising the potential rapid deterioration of sCJD, which would alert clinicians to earlier diagnosis and management.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000891"},"PeriodicalIF":2.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring the neurological complications of chimeric antigen receptor (CAR) T-cell therapy in patients with sensory and physical impairments and non-native-speaking backgrounds using modified immune effector cell-associated encephalopathy (ICE) scores: a case series.","authors":"Christina Kazzi, Ty Simpson, Cassandra Abbott, Miriam Wronski, Nabil Seery, Tracie Huey-Lin Tan, Robb Wesselingh, Katherine Ko, Shu Min Wong, Shafqat Inam, Constantine Tam, Shaun Fleming, Terence J O'Brien, Rubina Alpitsis, Andrew Spencer, Charles Malpas, Mastura Monif","doi":"10.1136/bmjno-2024-000927","DOIUrl":"10.1136/bmjno-2024-000927","url":null,"abstract":"<p><strong>Background: </strong>Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common complication of chimeric antigen receptor (CAR) T-cell therapy. Current practice guidelines recommend the immune effector cell-associated encephalopathy (ICE) score for the assessment and monitoring of ICANS.</p><p><strong>Objective: </strong>To demonstrate modifications to ICE score to patients with vision and hearing impairments or who are who are from non-native-speaking backgrounds.</p><p><strong>Methods: </strong>We discuss five cases and the modifications made to adapt the ICE score to meet patients' needs.</p><p><strong>Results: </strong>Modifications to ICE score was feasible and it assisted with CAR T cell therapy outcome monitoring.</p><p><strong>Discussion: </strong>These cases highlight the need for flexible and patient-tailored strategies and the importance of collaboration between multidisciplinary teams and patients' families/caregivers when monitoring patients for ICANS after CAR T-cell therapy.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000927"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunoglobulin unresponsive Guillain-Barré syndrome: rinse or repeat? A systematic review.","authors":"Thomas Roe, Alex Gordon, Nicholas Gourd, Charlotte Thomas, James Ward, Chinar Osman, Ahilanandan Dushianthan","doi":"10.1136/bmjno-2024-000907","DOIUrl":"10.1136/bmjno-2024-000907","url":null,"abstract":"<p><strong>Introduction: </strong>Severe Guillain-Barré syndrome (GBS) patients may not show improvement after a single course of intravenous immunoglobulin (IVIg) therapy. Current treatment options include either a second course of IVIg or therapeutic plasma exchange (TPE). This systematic review aims to evaluate the current literature on the use of a second course of IVIg or TPE in patients who fail to show clinical improvement after the first IVIg course.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Medline databases up until 26 October 2023. Studies that evaluated adult patients with confirmed GBS who have failed one full course of IVIg and subsequently received either repeat IVIg or TPE were included. Risk of bias was performed using study-specific checklists. A narrative synthesis of results is presented.</p><p><strong>Results: </strong>A total of 37 articles were identified (1 randomised controlled trial (RCT), 3 observational and 33 case reports/series), consisting of 422 patients in total. 12 studies evaluated repeat IVIg and 24 studies evaluated TPE after IVIg. There was no superiority of a repeat course of IVIg or TPE in all clinical outcome measures.</p><p><strong>Conclusions: </strong>The evidence suggests with a low degree of certainty that there is no beneficial effect of further IVIg in unresponsive GBS. The quality of evidence regarding TPE after IVIg is insufficient to suggest any efficacy due to a lack of RCTs. We recommend standardised case reporting with consideration for a multinational case registry and RCTs to determine the efficacy of TPE after initial IVIg unresponsiveness.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000907"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume contracted state, mortality and functional outcomes in patients with acute ischaemic stroke due to large vessel occlusion.","authors":"Vivek Yedavalli, Hamza Adel Salim, Dhairya A Lakhani, Janet Mei, Licia P Luna, Yasmin Aziz, Vaibhav Vagal, Adam A Dmytriw, Adrien Guenego, Victor Urrutia, Elisabeth B Marsh, Aakanksha Sriwastwa, Raf Llinas, Hanzhang Lu, Risheng Xu, Dylan Wolman, Benjamin Pulli, Argye Hillis, Gregory W Albers, Max Wintermark, Kambiz Nael, Jeremy J Heit, Tobias D Faizy, Mona N Bahouth","doi":"10.1136/bmjno-2024-000974","DOIUrl":"10.1136/bmjno-2024-000974","url":null,"abstract":"<p><strong>Background: </strong>Acute ischaemic stroke (AIS) is a leading cause of mortality and disability globally, with volume contracted state (VCS), as indicated by an elevated blood urea nitrogen to creatinine (BUN/Cr) ratio, potentially influencing outcomes. This study investigates the association between VCS and clinical outcomes in patients with AIS due to large vessel occlusion (LVO).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving 298 patients with LVO-AIS from two comprehensive stroke centres. Patients were divided into two groups based on BUN/Cr ratio: ≤20 (n=205) and >20 (n=93). Primary outcomes included 90-day mortality and unfavourable functional outcomes, defined as a modified Rankin Scale score of 3-6. Secondary outcomes included the successful reperfusion, haemorrhagic transformation and National Institutes of Health Stroke Scale score at discharge.</p><p><strong>Results: </strong>Patients with a BUN/Cr ratio >20 had significantly higher 90-day mortality (35% vs 13%, p<0.001) and this association remained significant after adjusting for confounding factors (OR 2.20; 95% CI 1.11 to 4.39; p=0.024). However, VCS was not significantly associated with unfavourable functional outcomes at 90 days (OR 1.28; 95% CI 0.67 to 2.51; p=0.46). Age and initial stroke severity were more strongly associated with long-term functional outcomes.</p><p><strong>Conclusions: </strong>VCS is associated with higher odds of 90-day mortality in patients with LVO-AIS but not with unfavourable functional outcomes. These findings suggest the need for further research into the role of hydration management in improving survival in patients with AIS, potentially informing future treatment protocols.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000974"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First validation of the novel Freiburg Neurointerventional Score purposely designed for use by emergency medical dispatchers for detecting anterior circulation large-vessel occlusion in patients with suspected stroke.","authors":"Matthias L Herrmann, Florian F Schuchardt, Clara Franck, Simone Meier, Max Henningsen, Friederike S Brohl, Christoph Sonntag, Nicole Wimmesberger, Wolf-Dirk Niesen, Hans-Jörg Busch, Christian A Taschner, Erik Farin-Glattacker, Jochen Brich","doi":"10.1136/bmjno-2024-000859","DOIUrl":"10.1136/bmjno-2024-000859","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Background: </strong>Detecting an anterior circulation large-vessel occlusion (aLVO) as a cause of stroke during emergency calls could optimise dispatch, particularly in rural areas. Numerous stroke severity scales assessing motor and cortical signs have been designed for direct patient contact; however, none have been purposely designed for emergency calls. This study aimed to prospectively validate the novel Freiburg Neurointerventional Score (FRENS) in patients presenting with a suspected acute stroke to detect aLVO.</p><p><strong>Methods: </strong>Patients aged ≥18 years with suspected acute stroke brought directly to our tertiary hospital by paramedics, between May 2021 and 2022, were included in this study. We used the FRENS and National Institutes of Health Stroke Scale (NIHSS) to analyse the FRENS convergent validity. We evaluated and compared the predictive ability and test characteristics of the FRENS and five established NIHSS-based stroke severity scales for the detection of an aLVO stroke. We analysed the number of steps required for the completion of the FRENS algorithm.</p><p><strong>Results: </strong>Among the 1042 analysed patients, the FRENS items showed high convergent validity with corresponding NIHSS items. A positive FRENS was statistically significantly correlated with an aLVO stroke. The FRENS had the highest sensitivity and negative predictive values for an aLVO stroke and the highest sensitivity value for M2 occlusions. The FRENS provided results after two and all four steps, in 71% and <3% of cases, respectively.</p><p><strong>Conclusions: </strong>The FRENS enabled the rapid, sensitive detection of an aLVO in patients with suspected acute stroke. Designed for use in emergency calls, the FRENS requires translation and validation in a prehospital setting.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000859"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord demyelination predicts neurological deterioration in patients with mild degenerative cervical myelopathy.","authors":"Abdul Al-Shawwa, Michael Craig, Kalum Ost, David Anderson, Steve Casha, W Bradley Jacobs, Nathan Evaniew, Saswati Tripathy, Jacques Bouchard, Peter Lewkonia, Fred Nicholls, Alex Soroceanu, Ganesh Swamy, Kenneth C Thomas, Stephan duPlessis, Michael Mh Yang, Julien Cohen-Adad, Nicholas Dea, Jefferson R Wilson, David W Cadotte","doi":"10.1136/bmjno-2024-000940","DOIUrl":"10.1136/bmjno-2024-000940","url":null,"abstract":"<p><strong>Background: </strong>Degenerative cervical myelopathy (DCM) is the most common form of atraumatic spinal cord injury globally. Clinical guidelines regarding surgery for patients with mild DCM and minimal symptoms remain uncertain. This study aims to identify imaging and clinical predictors of neurological deterioration in mild DCM and explore pathophysiological correlates to guide clinical decision-making.</p><p><strong>Methods: </strong>Patients with mild DCM underwent advanced MRI scans that included T2-weighted, diffusion tensor imaging and magnetisation transfer (MT) sequences, along with clinical outcome measures at baseline and 6-month intervals after enrolment. Quantitative MRI (qMRI) metrics were derived above and below maximally compressed cervical levels (MCCLs). Various machine learning (ML) models were trained to predict 6 month neurological deterioration, followed by global and local model interpretation to assess feature importance.</p><p><strong>Results: </strong>A total of 49 patients were followed for a maximum of 2 years, contributing 110 6-month data entries. Neurological deterioration occurred in 38% of cases. The best-performing ML model, combining clinical and qMRI metrics, achieved a balanced accuracy of 83%, and an area under curve-receiver operating characteristic of 0.87. Key predictors included MT ratio (demyelination) above the MCCL in the dorsal and ventral funiculi and moderate tingling in the arm, shoulder or hand. qMRI metrics significantly improved predictive performance compared to models using only clinical (bal. acc=68.1%) or imaging data (bal. acc=57.4%).</p><p><strong>Conclusions: </strong>Reduced myelin content in the dorsal and ventral funiculi above the site of compression, combined with sensory deficits in the hands and gait/balance disturbances, predicts 6-month neurological deterioration in mild DCM and may warrant early surgical intervention.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000940"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute therapeutic effects and pathophysiology of eosinophilic granulomatosis with polyangiitis neuropathy.","authors":"Nanami Yamanaka, Yukio Takeshita, Ryota Sato, Takashi Nawata, Tatsuya Okafuji, Susumu Fujikawa, Miwako Fujisawa, Kinya Matsuo, Joe Nemoto, Yuki Mizumoto, Hideaki Nishihara, Masaya Honda, Mariko Oishi, Toshihiko Maeda, Fumitaka Shimizu, Michiaki Koga, Takashi Kanda, Masayuki Nakamori","doi":"10.1136/bmjno-2024-000938","DOIUrl":"10.1136/bmjno-2024-000938","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the effects of early treatment and pathophysiology on eosinophilic granulomatosis with polyangiitis neuropathy (EGPA-N).</p><p><strong>Methods: </strong>Twenty-six consecutive patients with EGPA-N were diagnosed and treated within a day of admission and underwent clinical analysis. Peripheral nerve recovery rates were evaluated after early treatment by identifying the damaged peripheral nerve through detailed neurological findings.</p><p><strong>Results: </strong>The eosinophil count at onset was significantly correlated with the total number of damaged nerves. There was a strong correlation between the timing of treatment and the recovery rate in patients who started treatment within 50 days, as the recovery rate did not increase after 50 days of treatment. Antineutrophil cytoplasmic antibodies (ANCA)-negative cases showed significantly higher recovery rates than ANCA-positive cases. Vasculitis was detected in 67% of ANCA-positive and 29% of ANCA-negative patients in the sural nerve and skin biopsy specimen. In addition, infiltration of eosinophils into peripheral nerve tissues was observed in 40% of ANCA-negative patients, whereas it was absent in ANCA-positive patients. Intrafascicular oedema was found in 95% of all patients.</p><p><strong>Discussion: </strong>Our results suggest three pathological pathways: (1) ischaemic peripheral nerve due to vasculitis mainly in ANCA-positive cases, (2) direct infiltration and degranulation of eosinophils in ANCA-negative cases and (3) progression of axonal ischaemia due to intrafascicular oedema in both cases. The study also found that ANCA-negative cases exhibited better responsiveness to acute-phase treatment than ANCA-positive cases. It is essential to treat patients with EGPA-N as early as possible because the patients could recover time-dependently within 50 days of the onset.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000938"},"PeriodicalIF":2.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative systematic review on the lived experience of functional neurological disorder.","authors":"Andrea Szasz, Anthony Korner, Loyola McLean","doi":"10.1136/bmjno-2024-000694","DOIUrl":"10.1136/bmjno-2024-000694","url":null,"abstract":"<p><strong>Objectives: </strong>Functional neurological disorder (FND) is a complex disorder, recently attracting much research into aetiology and treatment. However, there is limited research on the patient's lived experience. This paper addresses this gap to ask: 'What is the subjective life experience of adult patients living with FND?'</p><p><strong>Methods: </strong>From 1980 to 2020, Medline, PsycInfo, Scopus, Science Direct, PubMed, CINAHL and Embase were searched for English language qualitative adult research. The disciplines used general medicine, psychiatry, physiotherapy, nursing, neurology, psychosomatic medicine and occupational therapy. The qualitative literature search included book chapters, theses, fellowship reports and conference articles as well as peer-reviewed scientific journals.The Critical Appraisal Skills Programme tool was used to assess 33 papers, with eight papers included in the final synthesis. Nine additional papers, suggested during review, were evaluated but excluded from synthesis, though incorporated elsewhere in the paper. Two authors used an integrative immersion approach to identify the literature's main themes using line-by-line and top-down methods.</p><p><strong>Results: </strong>Eight main themes were identified: lost, body-mind dualism, preceding stressful events, relatedness, stigma, the battle or fight, the burden and losses of the illness and trust versus mistrust. From these emerged a central overarching theme of relationally regulated selves, which posits the essence of the lived experience of FND as responding to stressful experiences within a relational, regulatory context.</p><p><strong>Conclusions: </strong>The prevalent themes give valuable insight into the lived experience of FND and the impact of stressors, past and present, and the relational environment in the development of and recovery from the disorder. Further research is needed to support the formulation of the patient experience and cocreated recovery pathways.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000694"},"PeriodicalIF":2.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising early detection of degenerative cervical myelopathy: a systematic review of quantitative screening tools for primary care.","authors":"Sean Inzerillo, Pemla Jagtiani, Salazar Jones","doi":"10.1136/bmjno-2024-000913","DOIUrl":"10.1136/bmjno-2024-000913","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis of degenerative cervical myelopathy (DCM) is often challenging due to subtle, non-specific symptoms, limited disease awareness and a lack of definitive diagnostic criteria. As primary care physicians are typically the first to encounter patients with early DCM, equipping them with effective screening tools is crucial for reducing diagnostic delays and improving patient outcomes. This systematic review evaluates the efficacy of quantitative screening methods for DCM that can be implemented in primary care settings.</p><p><strong>Methods: </strong>A systematic search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted across PubMed, Embase and Cochrane Library up to July 2024 using keywords relevant to DCM screening. Studies were included if they evaluated the sensitivity and specificity of DCM screening tools applicable to primary care settings. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.</p><p><strong>Results: </strong>The search identified 14 studies evaluating 18 screening methods for DCM. Questionnaires consistently showed high diagnostic accuracy, with Youden indices exceeding 0.60, while only three out of nine conventional physical performance tests met the same threshold. Sensor-assisted tests, particularly those using advanced technology like finger-wearable gyro sensors, exhibited the highest diagnostic accuracy but present challenges related to accessibility and learning curves.</p><p><strong>Conclusion: </strong>This review highlights the potential of quantitative screening methods for early DCM detection in primary care. While questionnaires and conventional tests are effective and accessible, sensor-assisted tests offer greater accuracy but face implementation challenges. A tailored, multifaceted approach is crucial for improving outcomes. Future research should focus on validating these tools in diverse populations and standardising diagnostic criteria.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":"e000913"},"PeriodicalIF":2.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}