Acta Neurologica Scandinavica最新文献

{"title":"Sensory Issues and Fatigue Are Key Factors Contributing to Sexual Dysfunction in Women With Multiple Sclerosis","authors":"K. Novotna,&nbsp;L. Friedova,&nbsp;J. Motyl,&nbsp;M. Vaneckova,&nbsp;D. Horakova,&nbsp;M. Andelova","doi":"10.1155/ane/9946835","DOIUrl":"https://doi.org/10.1155/ane/9946835","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aim</h3>\u0000 \u0000 <p>Sexual dysfunction (SD) is a prevalent yet underrecognized concern among women with multiple sclerosis (MS), substantially affecting quality of life. This study was aimed at investigating the magnetic resonance imaging (MRI) correlates of SD, with a particular focus on the spinal cord (SC), and to explore associations between SD and other disability metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>SD was assessed using the Female Sexual Function Index (FSFI) questionnaire, administered to 251 female patients with multiple sclerosis (PwMSs). All PwMSs underwent brain and cervical SC MRI at 3T, alongside EDSS, assessment of depression, fatigue, cognition, manual dexterity, and gait. Quantitative brain and SC MRI measures were obtained, including global and regional brain volumes, SC volume, and lesion counts in the brain and SC. Associations between quantitative MRI metrics, disability, and SD were analyzed using partial correlation, controlling for age and disease duration. Subsequently, the predictive value of MRI and clinical variables for SD severity was evaluated using linear regression models adjusted for age and disease duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rate was 58.5%, with 32.7% PwMS meeting the criteria for SD. PwMS with SD exhibited significantly reduced right and left cingulate (<i>p</i> = 0.03 and 0.04) volumes. However, no significant correlations were observed between SD severity and quantitative MRI measures when controlling for age and disease duration. Fatigue and depression demonstrated moderate correlations with overall SD severity (rho = −0.491/−455, <i>p</i> &lt; 0.001). Shorter 2-min walking test distance was associated with a higher risk of SD (<i>p</i> = 0.029). Sensory dysfunction (<i>p</i> = 0.025) and depression (<i>p</i> &lt; 0.030) were the only independent predictors of SD severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among MRI predictors of SD, we identified only a reduction of cingulate volume in PwMS with SD. Walking performance, depression, and sensory dysfunction were key predictors for SD presence and severity, highlighting the need for targeted screening for SD in PwMS with these risk factors. Exploring the role of contributing factors (use of antidepressants and medication for neuropathic pain) and interventions, that is, physical exercise, is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/9946835","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002248","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":"Identifying Red Flags in Myasthenia Gravis Diagnosis, Reassessment, and Myasthenic Crisis: An Italian Delphi-Based Position Paper","authors":"Francesco Habetswallner,&nbsp;Luca Bello,&nbsp;Fiammetta Biasini,&nbsp;Bernardo Maria De Martino,&nbsp;Fiammetta Vanoli,&nbsp;Paolo E. Alboini,&nbsp;Giovanni Antonini,&nbsp;Carlo Antozzi,&nbsp;Valentina Damato,&nbsp;Vincenzo Di Stefano,&nbsp;Amelia Evoli,&nbsp;Matteo Gastaldi,&nbsp;Raffaele Iorio,&nbsp;Michelangelo Maestri,&nbsp;Renato Mantegazza,&nbsp;Roberto Massa,&nbsp;Rita Rinaldi,&nbsp;Francesco Saccà,&nbsp;Carmelo Rodolico","doi":"10.1155/ane/9927870","DOIUrl":"https://doi.org/10.1155/ane/9927870","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Myasthenia gravis (MG) is a complex autoimmune disorder affecting neuromuscular transmission, often leading to diagnostic and therapeutic challenges. Timely identification of “red flags” in diagnosis, therapeutic reassessment, and myasthenic crisis is crucial to optimizing patient outcomes. This Delphi-based consensus is aimed at synthesizing expert recommendations for improving clinical practice in Italy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scientific board of 19 MG specialists and an extended panel of 47 neuromuscular experts participated in a structured Delphi methodology. Over an 11-month period, consensus was developed across four areas: diagnostic red flags, confirmatory instrumental examinations, therapeutic reassessment, and the continuum from exacerbation to impending myasthenic crisis or to crisis. The threshold for achieving consensus was set at ≥ 75% agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Globally, 68 statements reached consensus. Key findings include the identification of “red flags” for suspecting MG, with fluctuating and fatigable muscle weakness serving as primary diagnostic indicators, often involving ocular, bulbar, and respiratory muscles. Instrumental tests, such as repetitive nerve stimulation and antibody assays, were deemed essential for diagnostic confirmation. Therapeutic reassessment in MG is warranted for unsatisfactory symptom control, clinically significant adverse events, new or worsening comorbidities, planning pregnancy, or neoplastic disease. Persistent fluctuations, exacerbations, or triggers like infections should prompt adjustments, aiming to optimize treatment while minimizing risks. High-risk factors and triggers for myasthenic crises, including thymoma and infections, were identified, with arterial blood gas analysis highlighted as critical for crisis management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This consensus provides actionable recommendations to enhance the identification and management of MG, addressing diagnostic delays, therapy optimization, and crisis prevention. These findings aim to guide clinical practice and foster a systematic approach to managing this heterogeneous disorder.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/9927870","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983964","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":"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}