Neurological research and practice最新文献

{"title":"Severe subacute combined degeneration of the spinal cord resulting from nitrous oxide (N2O) abuse: a case series.","authors":"Lucas C Adam, Anuschka Grobelny, Katrin Hahn, Heinrich J Audebert, Patricia Krause, Christiana Franke, Klemens Ruprecht","doi":"10.1186/s42466-024-00364-x","DOIUrl":"https://doi.org/10.1186/s42466-024-00364-x","url":null,"abstract":"<p><strong>Objective: </strong>To describe the demographic, clinical, laboratory, and radiological findings, and the clinical course of seven patients with severe N2O-induced subacute combined degeneration of the spinal cord (SACD).</p><p><strong>Methods: </strong>Retrospective study with prospective follow-up of patients with SACD associated with N2O abuse presenting at a single center between 2014 and 2024.</p><p><strong>Results: </strong>The median age (range) of the seven patients (one woman, six men) was 24 (18-33) years. Prior to disease onset, patients had consumed N2O daily over a median (range) of 12 (3-20) weeks, with a mean (SD; range) inhalation dosage of 2376.7 (2872.7; 160-9000) g of N2O per day. Clinical presentations included paresthesia and paresis in the legs and gait disturbances. All patients exhibited characteristic signal alterations in the posterior columns spanning from C1 to T10 on T2-weighted spinal MRIs. Electrophysiology demonstrated polyneuropathies in all but one patient. Vitamin B12 levels were decreased in four, but normal in three patients. Methylmalonic acid levels were elevated in all patients. Although the median (interquartile range [IQR]) modified Rankin Scale score improved from 3.0 (3.0-4.0) at baseline to 1.0 (1.0-2.0; p < 0.05, Wilcoxon matched-pairs signed-rank test) at follow-up after the start of vitamin B12 supplementation, all five patients who could be examined on follow-up exhibited persistent deficits on the last follow-up assessment at a median (range) of 5 (3-116) months after disease onset.</p><p><strong>Conclusions: </strong>N2O abuse over a few weeks can lead to severe SACD. The diagnosis is supported by characteristic findings on spinal MRI and elevated methylmalonic acid levels, while normal vitamin B12 levels do not rule out N2O-induced SACD. Although there was some clinical improvement upon cessation of N2O abuse and vitamin B12 supplementation, residual deficits persisted.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of oral anticoagulants with risk of brain haemorrhage expansion compared to no-anticoagulation.","authors":"Roland Veltkamp, Kirsten Haas, Viktoria Rücker, Uwe Malzahn, Adrian Heeger, David Kinzler, Patrick Müller, Pascal Rappard, Timolaos Rizos, Johannes Schiefer, Christian Opherk, Waltraud Pfeilschifter, Katharina Althaus, Peter Schellinger, Bernadette Gaida, Maria Magdalena Gabriel, Georg Royl, Darius G Nabavi, Karl Georg Haeusler, Christian H Nolte, Marc E Wolf, Sven Poli, Marilen Sieber, Pascal Mosimann, Peter U Heuschmann, Jan C Purrucker","doi":"10.1186/s42466-024-00358-9","DOIUrl":"https://doi.org/10.1186/s42466-024-00358-9","url":null,"abstract":"<p><strong>Background: </strong>The impact of direct oral anticoagulants (DOAC) on haematoma size after intracerebral haemorrhage (ICH) compared to no-anticoagulation is controversial and prospective data are lacking.</p><p><strong>Methods: </strong>The investigator-initiated, multicentre, prospective RASUNOA-prime study enrolled patients with non-traumatic ICH and atrial fibrillation while on a DOAC, vitamin K antagonist (VKA) or no anticoagulation (non-OAC). Neuroimaging was reviewed centrally blinded to group allocation. Primary endpoint was haematoma expansion (≥ 6.5 ml or ≥ 33%, any new intraventricular blood or an increase in modified Graeb score by ≥ 2 points) between baseline and follow-up scan within 72 h after symptom onset.</p><p><strong>Results: </strong>Of 1,440 patients screened, 951 patients with ICH symptom onset less than 24 h before admission were enrolled. Baseline scans were performed at a median of 2 h (IQR 1-6) after symptom onset. Neurological deficit and median baseline haematoma volumes (11 ml; IQR 4-39) did not differ among 577 DOAC, 251 VKA and 123 non-OAC patients. Haematoma expansion was observed in DOAC patients in 142/356 (39.9, 95%-CI 34.8-45.0%), VKA in 47/155 (30.3, 95-CI 23.1%-37.6%), versus non-OAC in 22/74 (29.7, 19.3-40.1%). Unspecific reversal agents in DOAC-ICH (212/356, 59.6%) did not affect the haematoma expansion rate compared to no-antagonization.</p><p><strong>Conclusion: </strong>Baseline haematoma volume and risk of haematoma expansion did not differ statistically significantly in patients with and without DOAC.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared prognostic information in amyotrophic lateral sclerosis - systematic assessment of the patients' perception of neurofilament light chain and the ALS functional rating scale.","authors":"Lukas Maximilian Möhwald, André Maier, Torsten Grehl, Ute Weyen, Patrick Weydt, René Günther, Paul Lingor, Bettina Göricke, Susanne Petri, Julian Grosskreutz, Matthias Boentert, Isabell Cordts, Jochen H Weishaupt, Johannes Dorst, Christoph Münch, Thomas Meyer, Petra Baum","doi":"10.1186/s42466-024-00363-y","DOIUrl":"10.1186/s42466-024-00363-y","url":null,"abstract":"<p><strong>Background: </strong>In amyotrophic lateral sclerosis (ALS), neurofilament light chain (NfL) was introduced as a prognostic biomarker. More recently, NfL values can be shared on the patient's ALS app. Also, the ALS functional rating scale (ALSFRS-R) is an established patient-reported assessment of disease progression. The scale can be obtained during clinic visits or remotely. However, few systematic data are available on the patients' perception of prognostic information about NfL and ALSFRS-R and the remote sharing of these data.</p><p><strong>Methods: </strong>In a multicenter study, 149 ALS patients were assessed for their perception of shared information about NfL and ALSFRS-R using an investigator-designed survey and established questionnaires. The recommendation of NfL and ALSFRS-R to fellow patients was assessed using the Net Promoter Score (NPS). Burden by shared information was investigated in two distinct settings: (1) clinic information when receiving results on NfL and/or ALSFRS-R during clinic visits and (2) remote information about NfL values and self-rating of the ALSFRS-R via the ALS app. General anxiety was measured by the Fear of Progression Questionnaire - Short Form (FoP-Q-SF).</p><p><strong>Results: </strong>Information about NfL and ALSFRS-R, respectively (n = 149), were regarded as relevant for patients themselves (75.2% and 77.2%) and for research (98% and 96%). The NPS showed a high recommendation rate for NfL (+ 21) and ALSFRS-R (+ 26). Only a minority of patients perceived shared information about NfL as burdensome, with a lower burden in the clinic setting (n = 1, 4.2%) than in the remote setting (n = 8, 12%; p = 0.015). Remote digital assessment of the ALSFRS-R was well received, with a reported burden in 9.8% (n = 9) of the participants. The FoP-Q-SF revealed fear of progression in 40% of the respondents (n = 60).</p><p><strong>Conclusions: </strong>This study underscored the relevance of information about NfL and ALSFRS-R from the patient's perspective. Furthermore, patients proved to appreciate the relevance of this data for ALS research. Sharing information about NfL or ALSFRS-R was rarely perceived as burdensome even in a remote setting using the ALS app. These findings pave the way for further development of the patient-centered approach to sharing prognostic information in ALS.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257578","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":"Development and application of a clinical core data set for deep brain stimulation in Parkinson's disease, dystonia or tremor: from data collection to data exchange and data sharing.","authors":"Anna-Lena Hofmann, Jonas Widmann, Lilly Brandstetter, Udo Selig, Fabian Haug, Julian Haug, Rüdiger Pryss, Jasper Mecklenburg, Andrea Kreichgauer, Philipp Capetian, Christian J Hartmann, Christian Niklas, Petra Ritter, Patricia Krause, Alfons Schnitzler, Jens Volkmann, Andrea A Kühn, Peter Heuschmann, Kirsten Haas","doi":"10.1186/s42466-024-00362-z","DOIUrl":"10.1186/s42466-024-00362-z","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive clinical data regarding factors influencing the individual disease course of patients with movement disorders treated with deep brain stimulation might help to better understand disease progression and to develop individualized treatment approaches.</p><p><strong>Methods: </strong>The clinical core data set was developed by a multidisciplinary working group within the German transregional collaborative research network ReTune. The development followed standardized methodology comprising review of available evidence, a consensus process and performance of the first phase of the study. To ensure high data quality, measures for standardized training, monitoring as well as plausibility and data quality tests were implemented.</p><p><strong>Results: </strong>The clinical core data set comprises information about medical history, clinical symptoms, information about deep brain stimulation surgery, complications and outcome for the main neurological movement disorders Parkinson's disease, tremor, and dystonia. Its applicability as well as data exchange and quality control was tested within the first phase of the study in 51 patients from Würzburg.</p><p><strong>Conclusions: </strong>Within the ReTune project, a standardised clinical core data set for Parkinson's disease, dystonia and tremor was developed. The collection as well as concepts for the implementation of monitoring and data exchange were elaborated and successfully tested. Trial registration number ClinicalTrials.gov (DRKS-ID: DRKS00031878).</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070473","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":"Process evaluation of a cross-sectoral, coordinated follow-up care of stroke patients: a qualitative study.","authors":"Theresa Schrage, Claudia Glissmann, Götz Thomalla, David Leander Rimmele, Holger Schmidt, Michael Rosenkranz, Stefan Boskamp, Martin Härter, Levente Kriston","doi":"10.1186/s42466-024-00360-1","DOIUrl":"10.1186/s42466-024-00360-1","url":null,"abstract":"<p><strong>Background: </strong>Implementation of interventions to improve follow-up stroke care is complex due to the involvement of various stakeholders and challenges of health care coordination. The aim of this study was to evaluate the process of implementing a cross-sectoral, coordinated follow-up care for stroke patients (the StroCare intervention).</p><p><strong>Methods: </strong>As part of a multicenter interventional trial, this qualitative study was performed in a pre-post design with semi-structured interviews conducted with patients and health care employees. The multicomponent intervention was implemented in eight participating acute care and rehabilitation clinics. The interviews were analyzed using qualitative content analysis. Contents were coded using eight a priori defined categories (acceptability, adoption, appropriateness, feasibility, fidelity, sustainability, patient-centeredness, satisfaction with treatment, and pandemic-related effects) with the possibility of inductively developed categories.</p><p><strong>Results: </strong>Interviews with 21 patients and 34 interviews with 23 employees were conducted. In addition to the deductive categories, three inductive categories (psychosocial implications, interconnectedness, and potential for improvement) emerged. Acceptability, adoption, and appropriateness were assessed positively before the intervention. However, poor feasibility had a negative impact on adoption and appropriateness. In contrast, outcomes related to patient care (patient-centeredness and psychosocial implications) were independent from this effect.</p><p><strong>Conclusions: </strong>Similar to other implementation studies of stroke care interventions, implementation of eHealth Services in the StroCare project met barriers in usability and adaptability of new software. However, high adoption and appropriateness in regard to patient-centeredness, psychosocial implications, and an overall benefit for the patients supported continuation of the remaining intervention components. Trial registration The trial is registered at ClinicalTrials.gov (NCT04159324), registration date 12/11/19.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026065","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":"Increase of nitrous oxide-induced neurological disorders - a German multicenter experience.","authors":"Julius Nicolai Meißner, Janina Neuneier, Iason Bartzokis, Mathias Rehm, Ahmad Al-Hayali, Marcus Müller, Sebastian Paus, Volker Limmroth, Gereon R Fink, Gabor C Petzold, Louisa Nitsch","doi":"10.1186/s42466-024-00361-0","DOIUrl":"10.1186/s42466-024-00361-0","url":null,"abstract":"<p><strong>Background: </strong>Nitrous oxide (N₂O), commonly known as laughing gas, is widely recognized for its anesthetic and analgesic effects, and is frequently used in medical contexts. However, its misuse can lead to significant neurological complications, which are often under-recognized in clinical practice. Recent data on such cases in Germany are rare. We here report the spectrum of neurological complications associated with the recreational use of N₂O, as encountered in German neurology centers.</p><p><strong>Methods: </strong>We retrospectively analyzed of 23 cases presenting with neurological symptoms following N₂O abuse between July 2020 and August 2024 across five neurology departments in Germany. Data were collected on patient demographics, clinical manifestations, diagnostic findings, and treatment approaches.</p><p><strong>Results: </strong>Over the last four years the number of cases increased. Clinical presentations primarily included neuropathy, found in all patients, along with myelopathy. The most common symptoms were sensory loss, ataxia, and motor deficits.</p><p><strong>Conclusion: </strong>Our data suggest that N₂O abuse is on the rise in Germany. Further initiatives are warranted to raise awareness among users, healthcare and professionals.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019221","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":"The role of the left primary motor cortex in apraxia.","authors":"Ksenia Perlova, Claudia C Schmidt, Gereon R Fink, Peter H Weiss","doi":"10.1186/s42466-024-00359-8","DOIUrl":"10.1186/s42466-024-00359-8","url":null,"abstract":"<p><strong>Background: </strong>Apraxia is a motor-cognitive disorder that primary sensorimotor deficits cannot solely explain. Previous research in stroke patients has focused on damage to the fronto-parietal praxis networks in the left hemisphere (LH) as the cause of apraxic deficits. In contrast, the potential role of the (left) primary motor cortex (M1) has largely been neglected. However, recent brain stimulation and lesion-mapping studies suggest an involvement of left M1 in motor cognitive processes-over and above its role in motor execution. Therefore, this study explored whether the left M1 plays a specific role in apraxia.</p><p><strong>Methods: </strong>We identified 157 right-handed patients with first-ever unilateral LH stroke in the sub-acute phase (< 90 days post-stroke), for whom apraxia assessments performed with the ipsilesional left hand and lesion maps were available. Utilizing the maximum probability map of Brodmann area 4 (representing M1) provided by the JuBrain Anatomy Toolbox in SPM, patients were subdivided into two groups depending on whether their lesions involved (n = 40) or spared (n = 117) left M1. We applied a mixed model ANCOVA with repeated measures to compare apraxic deficits between the two patient groups, considering the factors \"body part\" and \"gesture meaning\". Furthermore, we explored potential differential effects of the anterior (4a) and posterior (4p) parts of Brodmann area 4 by correlation analyses.</p><p><strong>Results: </strong>Patients with and without M1 involvement did not differ in age and time post-stroke but in lesion size. When controlling for lesion size, the total apraxia scores did not differ significantly between groups. However, the mixed model ANCOVA showed that LH stroke patients with lesions involving left M1 performed differentially worse when imitating meaningless finger gestures. This effect was primarily driven by lesions affecting Brodmann area 4p.</p><p><strong>Conclusions: </strong>Even though many current definitions of apraxia disregard a relevant role of (left) M1, the observed differential effect of M1 lesions, specifically involving subarea 4p, on the imitation of meaningless finger gestures in the current sample of LH stroke patients suggests a specific role of left M1 in imitation when high amounts of (motor) attention and sensorimotor integration are required.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11716253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960793","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":"Trends and cost structure of drug-based secondary prevention of ischemic strokes.","authors":"Konstantin Kohlhase, Ferdinand O Bohmann, Christian Grefkes, Adam Strzelczyk, Laurent M Willems","doi":"10.1186/s42466-024-00356-x","DOIUrl":"10.1186/s42466-024-00356-x","url":null,"abstract":"<p><strong>Background: </strong>Advances in secondary stroke prevention, including direct oral anticoagulants (DOACs), dual antiplatelet therapies (DAPT), and cardiovascular risk management, have changed costs over the past decade. This study aimed to evaluate annual treatment costs and trends in drug-based secondary prophylaxis after ischemic strokes.</p><p><strong>Methods: </strong>Annual treatment costs were evaluated using the net costs per defined daily dosage (DDD) of discharge medications for ischemic stroke patients treated in 2020 at the University Hospital Frankfurt, Germany. Evaluated drugs included acetylsalicylic acid, adenosine diphosphate inhibitors, DOACs, vitamin K antagonists, lipid-lowering drugs (LLD), antihypertensives (AHT), and oral antidiabetics (OD). Kruskal-Wallis test examined intergroup differences in substance groups and stroke etiologies. DDD development between 2004 and 2021 was further evaluated for significant trend changes using an interrupted time series analysis.</p><p><strong>Results: </strong>The study included 422 patients (70.5 ± 12.9 years, 43.1% female). Etiologies divided into large-artery atherosclerosis (29.9%), cardioembolic (25.6%), cryptogenic (26.8%), and small-vessel disease (17.8%). The total estimated annual drug expenditure was € 241,808; of which 51.6% was due to DOACs (median € 1157 [Q1-Q3:1157-1157], p < 0.006), 20.0% to AHTs (€127.8 [76.7-189.8]), 15.7% to ODs (€525.6 [76.7-641.5]), and 8.7% to LLDs (€43.8 [43.8-43.8]). Cardioembolic strokes had the highest annual costs per patient (€1328.6 [1169.0-1403.4]) with higher expenditure for DOACs (p < 0.001) and AHTs (p < 0.026). DAPT costs were highest for large-vessel strokes (p < 0.001) and accounted for 2.5% of total costs. There was a significant trend change in DDDs for clopidogrel in 2010 (p < 0.001), for prasugrel in 2017 (p < 0.001), for ASA in 2015 (p < 0.001) and for DOACs in 2012 (p = 0.017).</p><p><strong>Conclusions: </strong>DOACs for cardioembolic strokes were the primary cost driver in drug-based secondary stroke prevention, whereas permanent ASA and DAPT only accounted for a minor cost proportion. LLDs were associated with lower costs than AHTs and ODs. There were significant changes in DDDs for the respective substances, whereas the costs for DOACs as the most expensive pharmaceuticals remained widely stable across the last decade.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916778","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":"Psychological interventions for improvement of symptoms of post-stroke depression - study protocol of the depression-intervention study for optimization of reconvalesence after stroke (DISCOVER).","authors":"Lino Braadt, Simone Fischer, Markus Naumann, Philipp Zickler, Thomas Schneider-Axmann, Laura Mühlich, Katharina Körber, Alexander Lassner, Wolfgang Strube, Astrid Röh, Alkomiet Hasan, Michael Ertl","doi":"10.1186/s42466-024-00347-y","DOIUrl":"10.1186/s42466-024-00347-y","url":null,"abstract":"<p><strong>Introduction: </strong>Besides functional outcomes, mental health and health-related quality of life (HRQoL) are significant measures in chronic diseases, such as stroke. Post-stroke depression (PSD) is an important complication affecting up to one in three stroke survivors. So far, specific programs to screen, detect and treat these patients are lacking but might be a crucial component in stroke aftercare.</p><p><strong>Methods: </strong>Between March 2024 and Febuary 2025 all consecutive adult patients with stroke, admitted to the University Hospital of Augsburg, are screened for signs of depression (PHQ-9 (Patient Health Questionnaire-9) score of ≥ 10). Eight weeks later, those patients with persisting signs of depression will be randomized to receive either a behavioural activation intervention or a mindfulness-based intervention via telephone. Depressive symptoms will be assessed at baseline (V1), after 84, 180 (V2-V3) and after 365 days (V4) using the PHQ-9 score. Secondary outcomes include the functional outcome, quality of life (EuroQol-5 Dimensions; EQ-5D), overall functioning, and incidence of major cardiovascular events including recurrent transient ischemic attack, stroke, and mortality.</p><p><strong>Perspective: </strong>Our aim is to provide proof-of-concept evidence for the efficacy of telepsychological need-adapted interventions for patients with post-stroke depression. Regular screening for PSD with implementation of a feasible treatment option could reduce the long-term prevalence of PSD and improve quality of life.</p><p><strong>Trial registration: </strong>This trial was registered at German Clinical Trials Register (DRKS) on 07.03.2024, ID: DRKS00033792. German Clinical Trials Register (drks.de).</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"61"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815394","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":"Virtual reality-guided therapy on a stroke unit: a feasibility study.","authors":"Jordi Kühne Escolà, Rumeysa Demirdas, Martin Schulze, Woon Hyung Chae, Lennart Steffen Milles, Doreen Pommeranz, Marvin Darkwah Oppong, Christoph Kleinschnitz, Martin Köhrmann, Benedikt Frank","doi":"10.1186/s42466-024-00357-w","DOIUrl":"https://doi.org/10.1186/s42466-024-00357-w","url":null,"abstract":"<p><strong>Background: </strong>VR (Virtual Reality) has emerged as a recent treatment approach in neurorehabilitation. The feasibility of VR-guided therapy in the acute phase after stroke has not been assessed.</p><p><strong>Methods: </strong>This was a cohort study of consecutive patients with suspected stroke who were admitted to the Essen University Hospital Stroke Unit between March 2022 and May 2022. All patients who had an indication for physical or occupational therapy due to upper extremity sensorimotor, cognitive or perceptual deficits were included and considered for VR-guided treatment. We excluded patients with predominant deficits in lower extremity function, since these could not be targeted with our VR system. A multidimensional approach was used to assess the feasibility of VR-guided therapy, which included characterization of eligible patients, resource utilization as well as treatment acceptance. For this purpose, we analyzed baseline and clinical characteristics, causes for withholding the treatment as well as qualitative and quantitative treatment metrics in patients who received VR-guided therapy.</p><p><strong>Results: </strong>Out of 326 patients admitted with suspected stroke, n = 172 were included in our final analysis. Of these, n = 37 (21.5%) received VR-guided therapy. The most common cause for withholding treatment were neuropsychological limitations (22.9%), followed by physical impairment, comorbidity and level of consciousness alterations (all 17.8%). Patients who received VR-guided therapy tended to have better functional status and less severe neurological deficits. VR-guided sessions had a median duration of 20 min (IQR 17-29) with additional 13 min (IQR 9-17) of preparation time. In the majority of patients who received VR-guided therapy, motivation was rated equal or higher as compared with conventional treatment (76%) and therapists considered VR-guided therapy well feasible (65%).</p><p><strong>Conclusions: </strong>Despite important treatment barriers, VR may provide additional opportunities to enhance functional recovery in the acute phase after stroke for selected patients. Our findings could aid in planning further randomized controlled trials which are required to refine approaches and assess the effectiveness of VR-guided therapy in the acute setting.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776134","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}