Acta Neurologica Scandinavica最新文献

{"title":"Correction to “Hidden in Plain Sight: Non-Convulsive Status Epilepticus—Recognition and Management”","authors":"","doi":"10.1155/ane/9798608","DOIUrl":"https://doi.org/10.1155/ane/9798608","url":null,"abstract":"<p>M.O. Kinney, J.J. Craig, P.W. Kaplan, “Hidden in Plain Sight: Non-Convulsive Status Epilepticus—Recognition and Management,” <i>Acta Neurologica Scandinavica</i> 136 (2017): 280–292. https://doi.org/10.1111/ane.12732</p><p>In the article, there are errors in Table 6. Specifically, the values for Propofol and Midazolam in the ‘Death during infusion’ and ‘Withdrawal Seizures’ rows were inadvertently switched. The correct Table 6 is shown below:</p><p>We apologize for this error.</p>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/9798608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of Genetic Variants in Antioxidant Enzymes (SOD2 rs4880, CAT rs1001179) and Their Association With Clinical Phenotypes of Multiple Sclerosis: A Case–Control Study","authors":"Vasileios Siokas,&nbsp;Athanasios E. P. Raptis,&nbsp;Lamprini Karagiorgou,&nbsp;Martha-Spyridoula Katsarou,&nbsp;Ioannis Liampas,&nbsp;Chrysa Marogianni,&nbsp;Annia Tsolakou,&nbsp;Aristidis Tsatsakis,&nbsp;Nikolaos Drakoulis,&nbsp;Efthimios Dardiotis,&nbsp;Maria Papasavva","doi":"10.1155/ane/3853574","DOIUrl":"https://doi.org/10.1155/ane/3853574","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Multiple sclerosis (MS) is a chronic, autoimmune disease of the central nervous system with both environmental and genetic inputs. Oxidative stress (OS) seems to be implicated in MS pathophysiology via various mechanisms, including promotion of inflammation, demyelination, and neurodegeneration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of the current study was to investigate the potential association of two common genetic variants in antioxidant enzymes, namely <i>SOD2</i> rs4880 and <i>CAT</i> rs1001179, with MS susceptibility and distinct MS clinical features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A case–control study was conducted, including 200 clinically diagnosed patients with MS and 265 healthy controls, with no neurological background, from Greece. DNA was extracted and genotyping of the two variants, <i>SOD2</i> rs4880 and <i>CAT</i> rs1001179, was performed using the Competitive Allele-Specific PCR (KASP) assay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No statistically significant differences were found in genotype or allele frequency distributions between patients with MS and controls for these two investigated variants. However, in subgroup analyses that followed, potential associations were observed between <i>SOD2</i> rs4880 and <i>CAT</i> rs1001179 and specific clinical features in the MS cohort, including motor and sensory symptoms and the existence of spinal cord lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While no association was found between the studied variants and MS susceptibility in general, the findings suggest a possible involvement of <i>SOD2</i> rs4880 and <i>CAT</i> rs1001179 variants in shaping MS clinical variability. Further larger scale studies in independent populations are needed in order to understand the exact role of antioxidant enzyme variability in MS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/3853574","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Cerebral Hemodynamics and Efficacy of Revascularization Procedures in Ischemic Stroke","authors":"S. Salvemini,&nbsp;G. De Vanna,&nbsp;R. Gigli,&nbsp;G. Polonara,&nbsp;P. Rosettani,&nbsp;G. Viticchi,&nbsp;M. Bartolini,&nbsp;M. Silvestrini","doi":"10.1155/ane/2382834","DOIUrl":"https://doi.org/10.1155/ane/2382834","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We evaluated the possibility of identifying predictors of efficacy of revascularization treatments in patients with acute ischemic stroke (AIS) through mean flow velocity (MFV) changes in middle cerebral arteries (MCAs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Color-coded transcranial Doppler ultrasound (TCCD) was used to assess vessel status and cerebral hemodynamics of 40 consecutive AIS patients (19 females [47.5%], median age 72 years) with distal occlusion of the internal carotid artery (ICA) or MCA immediately after reperfusion treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Proximal occlusion was observed in 80% of cases. Seventy-five percent of cases had successful recanalization, defined as Grade 2b or 3 score at the modified thrombolysis in cerebral infarction (mTICI), while partial recanalization (Grade 2a mTICI) was achieved in 17.5%. Ipsilateral MFV in the mTICI 2b-3 subgroup was 86.1 ± 14.2 and 64.2 ± 6.2 cm/s in the contralateral side (<i>p</i> &lt; 0.05, <i>t</i>-test for independent samples). In patients with other mTICI values, there was no statistically significant difference in MFV values between the sides. The MFV ratio (MFV of occluded side/contralateral MFV) was significantly associated with NIHSS improvement after 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusions</h3>\u0000 \u0000 <p>Higher MFV values in the vessel undergoing mechanical thrombectomy compared with the contralateral side are associated with successful revascularization. The increase in MFV was statistically significant in cases involving the distal ICA and proximal segment of the MCA (M1) and nonsignificant in cases involving the distal segment of the vessel (M2). Performing a TCCD examination in stroke patients can be a valuable bedside approach to evaluate the effectiveness of treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/2382834","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Dependence of Cerebrospinal Fluid Pressure Metrics During Queckenstedt’s Test","authors":"Najmeh Kheram,&nbsp;Andrea Boraschi,&nbsp;Maria Rasenack,&nbsp;Nikolai Pfender,&nbsp;Andreas Spiegelberg,&nbsp;Martin Schubert,&nbsp;Vartan Kurtcuoglu,&nbsp;Armin Curt,&nbsp;Carl Moritz Zipser","doi":"10.1155/ane/2761843","DOIUrl":"https://doi.org/10.1155/ane/2761843","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Quantification of craniospinal compliance is a known practice in neurological diagnostics. It is regularly done through external volume application during infusion testing and takes 30–60 min. We previously described a reliable method to obtain cerebrospinal fluid pressure (CSFP) pulsatility curve using a 10-s auto-infusion test, also known as Queckenstedt’s test (QT). Metrics such as relative pulse pressure coefficient (RPPC-Q) and pressure at infinite compliance (P₀-Q) obtained by QT may contain information on cerebrospinal compliance. As compliance changes with age, it would be of value to quantify potential age-dependent changes in these QT-derived metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Lumbar puncture was performed in lateral recumbent position in 14 adults &lt; 50 years (38.7 ± 7.8 years, 7F) with no suspicion of spinal canal stenosis. Results were compared to 14 older patients (59.7 ± 9.3 years, 6F) (NCT02170155). CSFP was recorded during resting state and QT, and was repeated during head reclination. RPPC-Q and P₀-Q were computed from repeated QTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between the two groups, there was no difference in mean CSFP (<i>p</i> = 0.65), cardiac-driven CSFP peak-to-valley amplitude (CSFPp) (<i>p</i> = 0.75), or in mean CSFP rise during QT (△CSFP) (<i>p</i> = 0.10). However, CSFPp at peak QT was lower in the young cohort (3.1 {1.7} mmHg vs. 3.7 {1.7}, <i>p</i> = 0.002), as were median RPPC-Q (0.09 {0.09} vs. 0.18 {0.06}, <i>p</i> = 0.009), and P₀-Q (3.1 {5.4} vs. 7.1 {3.5}, <i>p</i> = 0.004). Regression analysis showed a positive correlation between age and both RPPC-Q (0.003, <i>p</i> = 0.02) and P₀-Q (0.2, <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The differences in RPPC-Q and P₀-Q between the two age groups suggest that information on craniospinal compliance can be derived from this simple bedside test. A study comparing these QT-derived metrics to their corresponding metrics obtained by infusion testing is warranted.</p>\u0000 \u0000 <p><b>Trial Registration:</b> ClinicalTrials.gov Registry NCT02170155</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/2761843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Density Lipoprotein Cholesterol Links Peripheral Lipid Metabolism to Brain Structure and Cognition","authors":"Jiatong Li,&nbsp;Tianshu Guan,&nbsp;Dongqing Zhu,&nbsp;Wenbo Yang,&nbsp;Liu Yang,&nbsp;Weikang Gong,&nbsp;Xiaoni Liu,&nbsp;Jia You,&nbsp;Jianfeng Feng,&nbsp;Xiangjun Chen","doi":"10.1155/ane/8831825","DOIUrl":"https://doi.org/10.1155/ane/8831825","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to assess dementia risk and cognitive function in relation to serum lipid levels and to elucidate the potential neurobiological mechanisms underlying these associations, which may be mediated by alterations in brain structures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study utilized UK Biobank data, incorporating dementia diagnoses, biochemistry tests, and brain structural imaging. The associations between baseline serum lipid levels and dementia diagnosis during follow-up were analyzed using generalized additive models with shrinkage smoothers. The associations between serum lipid levels and brain structure measures were also explored. Structural equation modeling was employed to elucidate the potential links between serum lipids, brain structures, and cognitive impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 283,234 participants, combining dementia diagnoses with blood biochemistry data, HDL-C levels showed a nearly significant negative linear correlation with dementia diagnosis (edf ≈ 1, <i>p</i> = 0.057) after appropriate adjustments. HDL-C also exhibited linear associations with several brain structure indicators, including the volume of the right accumbens area and the central corpus callosum, the area of the superior parietal region, and the mean cortical thickness of the right lateral occipital, right superior frontal, and left transverse temporal regions. Structural equation modeling in 19,707 participants revealed that HDL-C was a significant negative predictor of cognitive impairment, with this association potentially mediated by the positive effect of HDL-C on brain volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings suggest a potential protective role of HDL-C against dementia and highlight dietary interventions as a feasible and accessible strategy for dementia prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/8831825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Short-Term Efgartigimod Benefits Myasthenia Gravis Patients Undergoing Thymectomy","authors":"Xiao-He Zhang,&nbsp;Hao Zhang,&nbsp;Jia-Duo Li,&nbsp;Zu-Lin Pan,&nbsp;Yong-Bing Liu,&nbsp;Ying-Ping Xue,&nbsp;Xu-Guang Zheng,&nbsp;Xiao-Jing Zhang,&nbsp;Guo-Yan Qi","doi":"10.1155/ane/8889388","DOIUrl":"https://doi.org/10.1155/ane/8889388","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Thymectomy is an effective way to alleviate muscle weakness for myasthenia gravis (MG) patients with and without thymoma. However, thymectomy may exacerbate MG. Efgartigimod as a neonatal Fc receptor (FcRn) blocker has been found to be effective in generalized MG, and this study aims to explore whether application of efgartigimod before surgery can also benefit MG patients who undergo thymectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively included 140 patients from Shijiazhuang People’s Hospital in this study. Using propensity score matching (PSM) with a 1:3 nearest-neighbor ratio, 44 patients were selected: 11 were allocated to the efgartigimod group and 33 to the non-efgartigimod group. Clinical features, quantitative antibody test results, MGFA class at different periods, thymic pathology, operation information, and muscle functional change as evaluated by both MG ADL and QMG scores were collected. Patients were divided into two groups: the efgartigimod group and the nonefgartigimod group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Patients who received efgartigimod therapy prior to their operations had a greater decline in MG ADL score (adjusted <i>β</i> coefficient = 5.27 [1.32,9.21], adjusted <i>p</i> = 0.012). After PSM, patients in the efgartigimod group showed lower surgery decision-to-finished-surgery times (<i>p</i> &lt; 0.001), postoperative therapy time in the ICU (<i>p</i> = 0.007), better MGFA class after surgery (<i>p</i> = 0.001), more functional improvement in QMG scores (<i>p</i> &lt; 0.001), and larger declines in antibody titer (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For MG patients awaiting thymectomy, short-term efgartigimod serves as an effective bridging therapy. It optimizes patients’ preoperative conditions, potentially shortens the waiting time for surgery as well as postoperative ICU stay and presents a viable alternative to conventional preoperative optimization strategies such as high-dose prednisolone, plasma exchange, and intravenous immunoglobulin.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/8889388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison and Validation of Diagnostic Criteria of Malignant Middle Cerebral Artery Infarction","authors":"Meng Liu,&nbsp;Yanan Wang,&nbsp;Xing Hua,&nbsp;Linrui Huang,&nbsp;Ming Liu,&nbsp;Simiao Wu","doi":"10.1155/ane/9938771","DOIUrl":"https://doi.org/10.1155/ane/9938771","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Malignant middle cerebral artery infarction (mMCAi) is a critical condition. Decompressive hemicraniectomy (DHC) improves survival after mMCAi, but its surgical indications vary across studies. We aimed to compare and validate diagnostic criteria of mMCAi.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, we recruited patients with acute ischemic stroke in the MCA territory. Based on eight diagnostic criteria of mMCAi reported in randomized trials of DHC, we examined their agreement in diagnosing mMCAi by these criteria and explored their prognostic value on 3-month death. In patients meeting any of these criteria, we investigated the association of DHC with functional outcomes (assessed by modified Rankin scale, mRS). We proposed an operational definition of mMCAi.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 1290 patients with MCA infarction (mean age 68.2 years, 58.2% men), with an incidence of mMCAi ranging from 4.4% to 20.9%. All criteria but HeADDFIRST reached substantial to almost perfect agreement with each other in diagnosing mMCAi (Cohen′s kappa ranging from 0.64 to 0.92). Three-month death rates of patients with mMCAi ranged from 42.3% to 73.2%, with hazard ratios of death ranging from 3.79 to 5.65. DHC improved the overall distribution of mRS scores and reduced the risk of death at 3 months in patients who met any criteria of DESTINY, HAMLET, DESTINY II, or HeADDFIRST. Patients who met either HAMLET or DESTINY II criteria had comparable incidence (around 12%, Cohen′s kappa 0.92) and 3-month case fatality (around 60%). Based on these two criteria, we proposed an operational definition for mMCAi, which identified 14.0% of patients with mMCAi who benefited from DHC on reducing 3-month death (OR 0.35, 95% CI 0.12–0.97) and improving mRS distribution (common OR 2.62, 95% CI 1.02–6.71).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with MCA infarction who met HAMLET or DESTINY II criteria had a relatively high incidence and case fatality, and both benefited from DHC.</p>\u0000 \u0000 <p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03222024</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/9938771","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal Fluid Metabolites Mediate the Impact of Gut Microbiota on Amyotrophic Lateral Sclerosis: Novel Insights From Mendelian Randomization","authors":"Yuxin Fu,&nbsp;Tengfei Su,&nbsp;Jie Cao,&nbsp;Yue Lang,&nbsp;Xiang Yin,&nbsp;Jie Shao,&nbsp;Li Cui","doi":"10.1155/ane/5582939","DOIUrl":"https://doi.org/10.1155/ane/5582939","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous studies have noted changes in the gut microbiota of amyotrophic lateral sclerosis patients, with some assessing its impact through metabolites or inflammatory factors. However, most of these are observational, and peripheral systems may not accurately reflect central nervous system pathology. This study uniquely explores the influence of gut microbiota on amyotrophic lateral sclerosis by metabolites in cerebrospinal fluid, which is directly connected to the central nervous system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on gut microbiota, cerebrospinal fluid metabolites, and amyotrophic lateral sclerosis were derived from large-scale genome-wide association studies. We employed two-sample and mediation Mendelian randomization to examine the causal effects of gut microbiota and cerebrospinal fluid metabolites on amyotrophic lateral sclerosis, as well as the mediating role of cerebrospinal fluid metabolites between gut microbiota and disease progression. Furthermore, the results were validated through various sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two-sample Mendelian randomization analysis revealed significant associations between three gut microbiota and four cerebrospinal fluid metabolites and amyotrophic lateral sclerosis. Notably, mediation Mendelian randomization analysis indicated that <i>cyanobacteria</i> may promote the onset of amyotrophic lateral sclerosis by increasing the levels of 3-methoxytyramine sulfate in cerebrospinal fluid. Additionally, the sensitivity analysis confirmed the robustness of the Mendelian randomization results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study addresses the gap in causal inference within the research on the relationship between gut microbiota, cerebrospinal fluid metabolomics, and amyotrophic lateral sclerosis, thereby advancing our understanding of the molecular mechanisms underlying the disease. The findings will provide a scientific basis for early intervention and precision treatment of the disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/5582939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent Predictors for Operative Treatment of Chronic Subdural Hematoma","authors":"J. M. B. Reimer,&nbsp;R. M. Brohet,&nbsp;B. Jacobs,&nbsp;J. Blaauw,&nbsp;R. M. Arntz,&nbsp;K. H. Kho,&nbsp;R. J. M. Groen,&nbsp;M. Foumani,&nbsp;J. van der Naalt,&nbsp;M. H. den Hertog","doi":"10.1155/ane/2759676","DOIUrl":"https://doi.org/10.1155/ane/2759676","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Treatment of chronic subdural hematoma (CSDH) can be conservative or operative. Since clinical guidelines are lacking, a large variation in daily management of CSDH exists. We aimed to quantify the number of CSDH patients that are treated operatively and conservatively and to develop a prediction model that provides insight into the arguments behind the choice for operative treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All consecutive CSDH patients ≥ 18 years that were treated in three neurosurgical centers in the Netherlands between 2003 and 2019 were retrospectively included. Our outcome measure was the decision for operative treatment after initial diagnosis. Combining conventional multivariable logistic regression analysis and machine learning, four prediction models were developed and compared. The prediction model with the best performance was used for further analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 684 included patients (29% female, median age 75 years), 428 (63%) were treated operatively. The multivariable logistic regression model performed best with an area under the curve of 0.90, a sensitivity of 0.87, and a specificity of 0.78. Independent predictors for operative treatment were treating facility, younger age, premorbid mRS ≤ 1, focal neurological deficit, cognitive impairment, and MGS score on admission, larger hematoma volume, and ≥ 10 mm midline shift on baseline CT. The highest predictive value for operative treatment was found for treating facility, hematoma volume, and ≥ 10 mm midline shift.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While most CSDH patients are treated operatively, over a third are treated conservatively. Decisions for operative treatment are influenced by premorbid level of functioning, symptoms on admission, CT parameters, and, notably, interhospital variation, highlighting the need for standardized treatment guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/2759676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary and Bowel Symptoms in Idiopathic Normal Pressure Hydrocephalus","authors":"Andreas Eleftheriou,&nbsp;Johanna Rydja,&nbsp;Susanna Walter,&nbsp;Rafael Holmgren,&nbsp;Fredrik Lundin","doi":"10.1155/ane/9580070","DOIUrl":"https://doi.org/10.1155/ane/9580070","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Idiopathic normal pressure hydrocephalus (iNPH) patients have gait and balance disturbance, cognitive impairment and urinary urgency/incontinence. Gait and balance symptoms have been examined carefully. There is presently a lack of evidence-based criteria to make recommendations regarding the characteristics and evaluation of urinary incontinence. Additionally, patients with urinary incontinence may also have faecal incontinence. The aims of this prospective single-centre study with a pre–post design and a control group were to characterise the urinary symptoms, to investigate possible bowel symptoms and to evaluate possible reversibility after shunt surgery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patients and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Fifty-seven iNPH patients (27 females, median age 77 years) answered the questionnaires preoperatively, and 42 patients postoperatively. Meanwhile, 42 healthy individuals (HIs) (25 females, median age 71 years) were included. Before and 3 months after the shunt surgery, patients and HIs were asked to answer three questionnaires: the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI), Wexner’s Faecal Incontinence Score in the Swedish language (Wexner’s FI) and a bowel function questionnaire. The HIs followed the study protocol only once.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The mean duration of iNPH-related symptoms was 24 months (range 6–120). Urinary incontinence appeared in 84.6% of the patients. Urinary leakage was always present in 13.5% vs. none of the HIs, with an improvement in some patients after the shunt operation. Bowel disturbances (more frequent bowel movements, a longer defecation time, incomplete evacuation feeling, abdominal pain and bloating, involuntary gas leakage and soiling) were reported by 67.5% of patients. The patients’ bowel function influenced their daily life as compared to the HIs. Postoperatively, bowel symptoms were improved with fewer bowel function-dependent limitations in social life. The total ICIQ-UI score was significantly different between the patients and HIs (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and improved significantly postoperatively (&lt;i&gt;p&lt;/i&gt; &lt; 0.001).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Urinary and bowel incontinence symptoms were notable features in this cohort of iNPH patients, causing limitations in their social life. Postoperatively, both symptoms improved to some extent.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Trial Registration&lt;/h3&gt;\u0000 ","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2025 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/9580070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}