Neurological research and practice最新文献

{"title":"The impact of white matter lesions on seizure recurrence after first epileptic seizures in the elderly: a prospective study.","authors":"Jenny Weil, Louise Linka, Mariana Gurschi, Seyyid Abdulkerim Kidik, Alena Fuchs, Rebecca Schoenfeldt, Felix Zahnert, Leona Möller, Katja Menzler, André Kemmling, Susanne Knake, Lena Habermehl","doi":"10.1186/s42466-025-00391-2","DOIUrl":"10.1186/s42466-025-00391-2","url":null,"abstract":"<p><strong>Background: </strong>Despite considerable previous research, to what degree white matter lesions (WML) may be epileptogenic remains unclear. Therefore, the decision of initiating treatment with antiseizure medication (ASM) can be challenging in patients with only WML on neuroimaging. In this prospective study we assessed whether the prevalence, localization or severity of WML impact the risk of seizure recurrence in patients aged 60 years or older after first-time seizures.</p><p><strong>Methods: </strong>Data was analyzed from 168 patients, aged ≥ 60 years-old who had experienced a previous unprovoked seizure and had either a potentially epileptogenic lesion or WML on neuroimaging. The frequency of seizure recurrence was documented after 6, 12, and 24 months. Pearson´s chi-square test of independence (categorical variables) and the independent Student´s t-test (continuous variables) were used to analyze intergroup differences. Binary logistic regressions were calculated to examine the influence of WML locations as a predictor of seizure recurrence. Kaplan-Meier survival analyses and log-rank statistics were performed to determine the cumulative recurrence rates between the groups.</p><p><strong>Results: </strong>Fifteen patients had only potentially epileptogenic lesions on neuroimaging (EPI) and 93 showed WML only (OWML). Sixty patients showed both of them on neuroimaging (EWML). Frontal and parieto-occipital were the predominant WML locations. Neither severity nor location of WML had a significant impact on recurrence rates. The two-year cumulative probability of becoming seizure-free was significantly lower in the EPI group compared to the EWML (χ² [1] = 4.425, p = 0.035) and the OWML group (χ² [1] = 13.094, p < 0.001). A significant association between interictal epileptiform discharges in EEG and seizure recurrence was found in OWML patients (p = 0.004).</p><p><strong>Conclusion: </strong>We could not find any association between prevalence, severity or location of WML and seizure recurrence after first seizures in the elderly. Therefore, treatment with ASM should be started with caution in those patients. Our results show a trend of WML not having epileptogenic potential, but further studies are needed to get better evidence.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Protocol Registration and Results, NCT06836687, AZ 199/17, release: 03/19/2024 retrospectively registered. https://register.</p><p><strong>Clinicaltrials: </strong>gov/prs/beta/studies/S000EBC700000025/recordSummary.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113100","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":"Long-term outcomes of community-based intensive care treatment following neurological early rehabilitation- results of a multicentric German study.","authors":"Bernadette Einhäupl, Danae Götze, Stephanie Reichl, Lina Willacker, Romy Pletz, Thomas Kohlmann, Esther Henning, Lena Schmeyers, Andreas Straube, Rebekka Süss, Steffen Fleßa, Simone Schmidt, Jens D Rollnik, Friedemann Müller, Aukje Bartsch-de Jong, Svenja Blömeke, Jennifer Hartl, Nuria Vallejo, Daniel Liedert, Thomas Olander, Volker Ziegler, Renate Weinhardt, Felix Schlachetzki, Tatjana Groß, Susanne Hirmer, Lea Dillbaner, Lisa Kleinlein, Thomas Platz, Andreas Bender","doi":"10.1186/s42466-025-00384-1","DOIUrl":"10.1186/s42466-025-00384-1","url":null,"abstract":"<p><strong>Background: </strong>Weaning from mechanical ventilation (MV) and tracheal cannula (TC) during neurological early rehabilitation (NER) is mostly successful. However, some patients leave NER with TC/MV, requiring home-based specialized intensive care nursing (HSICN). Data on medical and demographic characteristics and long-term outcomes of these patients are limited.</p><p><strong>Methods: </strong>A multicentric retrospective observational study across five German NER hospitals collected data from neurological patients with TC/MV at discharge. The study aimed to assess patients' health status at NER discharge, and to identify predictors of post-discharge survival. Survival rates were analyzed using Kaplan-Meier estimates; further predictors of survival post-discharge were analyzed using Cox regression.</p><p><strong>Results: </strong>Among 312 patients, the one-year survival rate was 61.9%, decreasing to 38.1% after approximately 4 years. Older age, higher overall morbidity and discharge with MV were associated with an increased likelihood of death, while a longer stay in NER correlated with survival.</p><p><strong>Conclusions: </strong>Patients requiring HSICN after discharge from NER have a high mortality rate. Identifying survival predictors may help to identify patients at risk, and thus could be integrated into the decision-making process for NER discharge. The high mortality post-discharge warrants an evaluation of the current post-hospital care model. Optimizing therapeutic care in the HSICN setting may have the potential to reduce mortality and neuro-disability, and enhance the quality of life in these neurologically severely affected patients.</p><p><strong>Trial registration: </strong>The trial OptiNIV - Retrospective study of post-hospital intensive care in neurological patients has been retrospectively registered in the German Clinical Trials Register (DRKS) since 28.10.2022 with the ID DRKS00030580.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113097","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":"From routine to selective: how updated MRI guidelines reshape gadolinium use in Germany.","authors":"Marc Pawlitzki, Alexander Stahmann, Niklas Frahm, Mathia Kirstein, Melanie Peters, Peter Flachenecker, Tim Friede, Kerstin Hellwig, Dagmar Krefting, Michaela Mai, Clemens Warnke, Uwe K Zettl, David Ellenberger","doi":"10.1186/s42466-025-00387-y","DOIUrl":"10.1186/s42466-025-00387-y","url":null,"abstract":"<p><p>Magnetic resonance imaging (MRI) is a critical diagnostic tool and monitoring modality for multiple sclerosis (MS), frequently employing gadolinium-based contrast agents (Gd). However, concerns regarding the accumulation of Gd have prompted international guidelines (MAGNIMS-CMSC-NAIMS, 2021) to advocate for the limitation of Gd utilization. Consequently, we assessed of the impact of the 2021 guidelines on the use of Gd in MRI in MS patients in Germany by conducting a retrospective analysis of MRI data from 12,833 MS patients in the German MS Register (2019-2024). Generalized additive models were employed to analyze Gd use trends over time by MRI type (cranial, spinal, combined). From 2020 to 2024, a significant decline in Gd use was observed, with percentages dropping from 74.2 to 41.2% in cranial MRI, from 78.2 to 39.2% in spinal MRI and from 81.8 to 59.0% in combined MRI (p < 0.001). The most substantial decline occurred within the initial five years of MS. Gd use in MS MRI scans has significantly decreased in line with the updated guidelines. Nevertheless, its persistent utilization in over one-third of cases necessitates further examination.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096543","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":"Endovascular treatment in ischemic stroke with active cancer: retrospective analysis of university stroke center data.","authors":"Athina-Maria Aloizou, David-Dimitrios Chlorogiannis, Daniel Richter, Theodoros Mavridis, Dimitra Aloizou, Carsten Lukas, Ralf Gold, Christos Krogias","doi":"10.1186/s42466-025-00392-1","DOIUrl":"10.1186/s42466-025-00392-1","url":null,"abstract":"<p><strong>Introduction: </strong>Active cancer (AC) associates strongly with ischemic stroke (IS). Intravenous thrombolysis (IVT) is often contraindicated in AC, and endovascular treatment (EVT) is considered the gold treatment standard, although data on its safety and efficacy is scarce.</p><p><strong>Methods: </strong>Digital records of patients receiving EVT in a tertiary university hospital with comprehensive stroke center from 2016 to 2022 were assessed. Demographic, clinical, and laboratory parameters were extracted and compared between patients with and without AC. In-hospital mortality was set as the primary outcome.</p><p><strong>Results: </strong>39 AC and 297 non-AC patients were included. No significant differences were reported in demographic and baseline stroke parameters (NIHSS, mRS, stroke etiology). In-hospital mortality did not differ between groups (11/39 vs. 57/297, p > 0.99). Successful recanalization, change in mRS and NIHSS from admission to discharge, periinterventional complications, and stroke-related mortality were also comparable. Significantly fewer AC patients received IVT. In the binary logistic regression analysis (adjusting for confounder variables), older age, large artery atherosclerosis, unsuccessful recanalization, and higher admission NIHSS were independent predictors of all-cause in-hospital mortality (aOR): 1.04, 95% confidence interval (CI): 1.01-1.08; OR: 3.21, 95% CI: 1.03-9.92, OR: 7.28, 95% CI: 3.61-15.1, OR: 1.07, 95% CI: 1.01-1.14, p-value < 0.05, respectively).</p><p><strong>Conclusions: </strong>EVT was shown as safe and effective in AC patients as in non-AC patients. Long-term functional outcomes are often poorer in AC, due to the cancer itself, but given how oncological treatment depends on functional status, AC patients should be considered for EVT.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096541","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":"Real-world disease burden and planned treatment optimization after MANAGE-PD implementation in Germany: a cross-sectional study.","authors":"Martin Südmeyer, David J Pedrosa, Frank Siebecker, Carolin Arlt, Jaakko Kopra, Wolfgang H Jost","doi":"10.1186/s42466-025-00383-2","DOIUrl":"https://doi.org/10.1186/s42466-025-00383-2","url":null,"abstract":"<p><strong>Background: </strong>In Germany, the approach to treatment optimization for patients with advanced Parkinson's disease (PD) is considered somewhat conservative. The MANAGE-PD tool ( www.managepd.eu ) was developed to help identify patients with advanced PD and to facilitate treatment decision making and appropriate allocation of patients to device-aided therapies (DAT). This prospective, non-interventional study aimed to investigate the real-world disease burden of PD and treatment optimization after MANAGE-PD implementation.</p><p><strong>Methods: </strong>Adult PD patients (N = 278) visited specialist clinics and neurologist's practices in Germany in 2022. Disease burden was assessed using the Unified PD rating scale (UPDRS parts II-IV), the non-motor symptoms scale (NMSS) and the 8-item Parkinson's disease Questionnaire (PDQ-8). Data on planned treatment changes were collected. Data were analyzed by disease control categories according to the MANAGE-PD tool.</p><p><strong>Results: </strong>Mean scores for motor and non-motor symptoms, quality of life, and comorbidity burden were worse in patients with lower disease control measured by MANAGE-PD. For 52.8% of patients in Category 2 (inadequately controlled-might benefit from oral optimization), no change in oral treatment was planned. No change in oral treatment and no DAT initiation was planned for 37.9% and 65.0% of patients in Category 3 (inadequately controlled-might benefit from DAT). Patient refusal and needing more time to decide were the most common reasons for not making treatment changes.</p><p><strong>Conclusions: </strong>This study supports the validity of MANAGE-PD by showing its high association with disease burden and emphasizes the importance of timely provision of necessary information to enable informed decisions about treatment optimization.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064597","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":"Neuropsychiatric changes following striatal stroke- results from the observational PostPsyDis study.","authors":"Anna Kufner, Ana Sofía Ríos, Benjamin Winter, Uchralt Temuulen, Ahmed Khalil, Ulrike Grittner, Johanna Schöner, Asli Akdeniz, Ulrike Lachmann, Golo Kronenberg, Arno Villringer, Karen Gertz, Matthias Endres","doi":"10.1186/s42466-025-00390-3","DOIUrl":"https://doi.org/10.1186/s42466-025-00390-3","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke can lead to neuropsychiatric sequelae such as depression and post-traumatic stress disorder (PTSD), resulting in poorer functional outcomes. The POST-stroke PSYchological DIStress PostPsyDis; NCT01187342) study aimed to investigate whether ischemic lesions in the striatum increase the risk of depression and PTSD after stroke.</p><p><strong>Methods: </strong>This monocenter, observational, case-control study included 84 ischemic stroke patients with striatal (n = 54) and non-striatal ischemic brain lesions (n = 30). Primary study endpoints included symptoms of depression (assessed via the Geriatric Depression Scale; GDS-30) and PTSD (assessed via the Posttraumatic Symptom Scale; PTSS-10) 90 days post-stroke. A normative functional connectome was used to obtain a measure of striatal connectivity to the rest of the brain (\"striatal network\"). Network damage scores were used to estimate damage of each lesion to the striatal network.</p><p><strong>Results: </strong>Patients with striatal lesions had higher GDS-30 scores at 90 days post-stroke (median 5.6 vs. 3.0; Cohen's d = 0.39; p = 0.057), indicating a small to moderate effect. However, no meaningful group differences were observed in the incidence of depression or PTSD. In multivariable regression analyses, striatal infarction had an adjusted beta coefficient (β) of 1.9 (95%CI 0.19-3.7; p = 0.076) for GDS-10 and 1.8 (95%CI -1.9-5.5; p = 0.25) for PTSS-10 scores after 90 days. Only female sex was independently associated with PTSD severity (adjusted β = 5.1, 95% CI 1.3-8.8; p = 0.008). Analyzing lesion connectivity to the striatal network did not change these findings.</p><p><strong>Conclusions: </strong>Taken together, the PostPsyDis study suggests a high rate of psychiatric morbidity in stroke patients. Moreover, the study suggests increased neuropsychiatric symptoms in patients with striatal lesions. There is a clear need for larger studies to investigate the role of the striatum in post-stroke neuropsychiatric disorders.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT01187342) Registered 23 August 2009, https://clinicaltrials.gov/study/NCT01187342 .</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059644","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":"Exploring the relationship of clinical walking tests with 8-months inertial measurement unit (IMU)-based real world mobility tracking in stroke and spinal cord injury survivors.","authors":"Andreas Hug, Tamara Spingler, Viola Pleines, Laura Heutehaus, Mircea Ariel Schoenfeld, Björn Hauptmann, Jürgen Moosburger, Roland Thietje, Oliver Pade, Wolfgang Rössy, Klaus Stecker, Jochen Klucken, Tiziana Daniel, Michel Wensing, Cornelia Hensel, Rüdiger Rupp, Norbert Weidner","doi":"10.1186/s42466-025-00386-z","DOIUrl":"https://doi.org/10.1186/s42466-025-00386-z","url":null,"abstract":"<p><strong>Background: </strong>Mobility is crucial for participation and quality of life in individuals with sensorimotor impairments, yet scientific evidence on its course in real-world settings is limited. So-called wearables for measuring physical activity might help to overcome this knowledge gap allowing daily measurements of mobility. The aim of the present study is to examine the relationship between clinical walking tests and inertial measurement unit-based mobility tracking in the community setting of stroke and spinal cord injury (SCI) survivors.</p><p><strong>Methods: </strong>At a single observational time point, the precision of the activity tracker was evaluated in a standardized parcours in healthy subjects and stroke or SCI survivors (n=57). This was followed by a multicenter observational cohort study (n=116 participants), in which the mobility of stroke and SCI survivors was assessed over 8 months immediately after discharge from acute inpatient rehabilitation. Daily distances covered in the community setting were recorded using the activity tracker. Established walking tests-including the 10-meter walk test (10MWT) and the timed up and go test (TUG)-were conducted at baseline, as well as at 4- and 8-month follow up visits. The relationship between daily distances in the ambulatory setting and 10MWT or TUG performance at discrete study visits (baseline, 4 months (midterm), and 8 months (final) after hospital discharge) was analyzed using regression models.</p><p><strong>Results: </strong>The precision of the activity tracker in measuring covered distance in a standardized parcours varied by mobility type. The highest precision was achieved in manual wheelchair users (deviation from zero: -1.5±1.03% (p=0.15) while the least favorable precision was observed in participants with SCI and significant walking impairment (-14.6±2% (p<0.001). The widely used 10MWT speed showed a relationship with the ambulatory daily distance. The regression coefficients [m/(1m/s)] were: 874 (95% CI: 578-1171) at baseline (p<0.001), 895 (95% CI: 614-1176) at midterm (p<0.001), and 824 (95% CI: 537-1112) at the final visit (p<0.001). Interestingly, in the category of good walkers with the most favorable walking speeds the daily covered distance unmasked distinct subgroups with shorter and longer daily distances.</p><p><strong>Conclusions: </strong>For SCI and stroke survivors, especially medium to fast walkers, activity tracking in real-world settings adds valuable insight beyond clinical walking tests. Clinical studies on rehabilitative interventions for mobility improvement should consider real-life daily distance as a key endpoint.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060677","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":"Switch to tenecteplase for intravenous thrombolysis in stroke patients: experience from a German high-volume stroke center.","authors":"Alexander Sekita, Gabriela Siedler, Jochen A Sembill, Manuel Schmidt, Ludwig Singer, Bernd Kallmuenzer, Lena Mers, Anna Bogdanova, Stefan Schwab, Stefan T Gerner","doi":"10.1186/s42466-025-00388-x","DOIUrl":"https://doi.org/10.1186/s42466-025-00388-x","url":null,"abstract":"<p><strong>Background: </strong>Tenecteplase (TNK) offers promising efficacy and safety data for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) and pharmacological advantages over alteplase (rt-PA), justifying its gradual adoption as primary thrombolytic agent. At our tertiary care center, we transitioned from rt-PA to TNK, providing valuable real-world insights into this process, including its use beyond the 4.5-hour time window.</p><p><strong>Methods: </strong>We retrospectively analyzed our stroke registry to compare clinical and procedural data from AIS patients treated with rt-PA (up to 6 months before transition) and those treated with TNK (up to 6 months after transition, starting June 2024). Primary endpoints included treatment metrics, such as door-to-needle (DTN), door-to-imaging (DTI), imaging-to-needle (ITN), door-to-groin and door-to-recanalization times. Safety outcomes comprised rate of any intracranial hemorrhage (ICH), symptomatic ICH (sICH), parenchymatous hematoma type 2 (PH 2) and post-thrombolysis angioedema. A semiquantitative questionnaire evaluated satisfaction with TNK and changes in lysis behavior among nurses and physicians 3 months post-implementation.</p><p><strong>Results: </strong>During the twelve-month period (December 1, 2023 - November 30, 2024), 276 patients underwent IVT. Median DTN times were significantly shorter with TNK (n = 138) compared to rt-PA (n = 138) (TNK 27 min [IQR 19-39] vs. rt-PA 34 min [IQR 25-62]; p = 0.011). No significant differences were observed in safety outcomes, including any ICH (TNK 9% vs. rt-PA 6%; p = 0.30), sICH (2% vs. 1%; p = 0.31), PH 2 rates (1% in both groups), or angioedema (3% vs. 1%; p = 0.18). Staff satisfaction with TNK was high, citing advantages in preparation, administration, and time efficiency. Importantly, no changes in lysis behavior were reported following the transition.</p><p><strong>Conclusions: </strong>Transitioning to TNK in routine practice at a tertiary care center seems feasible with reduced ITN and consequently DTN times. Functional outcomes at discharge were comparable without significant difference in the rate of (s)ICH. Overall, the transition to TNK was well-received by medical staff, highlighting TNK's practical advantages in acute stroke care.</p><p><strong>Trial registration: </strong>N.A.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12051303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045525","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":"Neurological disorders caused by recreational use of nitrous oxide-a retrospective study from a German metropolitan area and review of the literature.","authors":"Asya Tshagharyan, Se-Jong You, Christian Grefkes, Elke Hattingen, Joachim P Steinbach, Pia S Zeiner, Marcel Hildner, Iris Divé","doi":"10.1186/s42466-025-00385-0","DOIUrl":"https://doi.org/10.1186/s42466-025-00385-0","url":null,"abstract":"<p><strong>Background: </strong>The recreational use of nitrous oxide (N₂O) has seen a worldwide rise in the recent years, resulting in an increased incidence of neurological complications due to N₂O-induced functional vitamin B₁₂ deficiency. Here, we report on a cohort of patients admitted to a tertiary care center with neurological symptoms in the context of recreational N₂O use between 2020 and 2024.</p><p><strong>Methods: </strong>We screened the database of the University Hospital Frankfurt for patients ≥ 18 years of age who presented with neurological deficits and a history of N₂O consumption between January 2020 and December 2024. We analyzed the spectrum of neurological deficits as well as radiological and laboratory findings.</p><p><strong>Results: </strong>We identified a total of 20 patients, 16 males and 4 females, with a median age of 21 years. We found a steady increase in the number of cases, with no cases in 2020 and 2021 and a definite peak in 2024. The mean daily N₂O consumption was 2500 g. All patients reported sensory deficits; 85% had gait disturbances and 70% had motor deficits. Less frequent symptoms included pain, bladder or bowel dysfunction, fatigue and spasticity. The median score on the modified Rankin scale (mRS) was 2, with some patients being wheelchair-bound. The most frequently observed lesion pattern was combined myelo-polyneuropathy. T2-hyperintense myelon lesions were observed in 11 of 15 patients (73.3%). Surprisingly, laboratory work-up revealed normal vitamin B₁₂ levels in nearly all patients (95%), whereas homocysteine and methylmalonic acid levels were prominently elevated in all patients (100%). In addition, 13 patients (65%) presented with hematological abnormalities. All of the patients who presented for follow-up (20%) reported continued use of N₂O. There was no neurological improvement in any of these cases.</p><p><strong>Conclusions: </strong>Our study confirms that the increasing incidence of N₂O-induced neurotoxicity reported in other countries can also be observed in Germany. Therefore, it underlines the relevance of the current debate on health policies. In addition, our study highlights the pitfalls of vitamin B12 laboratory testing and emphasizes the need to address substance addiction in treatment.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047608","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":"Motor phenotypes of amyotrophic lateral sclerosis - a three-determinant anatomical classification based on the region of onset, propagation of motor symptoms, and the degree of upper and lower motor neuron dysfunction.","authors":"Thomas Meyer, Matthias Boentert, Julian Großkreutz, Patrick Weydt, Sarah Bernsen, Peter Reilich, Robert Steinbach, Annekathrin Rödiger, Joachim Wolf, Ute Weyen, Albert C Ludolph, Jochen Weishaupt, Susanne Petri, Paul Lingor, René Günther, Wolfgang Löscher, Markus Weber, Christoph Münch, André Maier, Torsten Grehl","doi":"10.1186/s42466-025-00389-w","DOIUrl":"https://doi.org/10.1186/s42466-025-00389-w","url":null,"abstract":"<p><strong>Background: </strong>In amyotrophic lateral sclerosis (ALS), heterogeneity of motor phenotypes is a fundamental hallmark of the disease. Distinct ALS phenotypes were associated with a different progression and survival. Despite its relevance for clinical practice and research, there is no broader consensus on the classification of ALS phenotypes.</p><p><strong>Methods: </strong>An expert consensus process for the classification of ALS motor phenotypes was performed from May 2023 to December 2024. A three-determinant anatomical classification was proposed which is based on the (1) region of onset (O), (2) the propagation of motor symptoms (P), and (3) the degree of upper (UMN) and/or lower motor neuron (LMN) dysfunction (M). Accordingly, this classification is referred to as the \"OPM classification\".</p><p><strong>Results: </strong>Onset phenotypes differentiate the site of first motor symptoms: O1) head onset; O2d) distal arm onset; O2p) proximal arm onset; O3r) trunk respiratory onset; O3a) trunk axial onset; O4d) distal leg onset; O4p) proximal leg onset. Propagation phenotypes differentiate the temporal propagation of motor symptoms from the site of onset to another, vertically distant body region: PE) earlier propagation (within 12 months of symptom onset); PL) later propagation (without propagation within 12 months of symptom onset), including the established phenotypes of \"progressive bulbar paralysis\" (O1, PL), \"flail-arm syndrome\" (O2p, PL), and \"flail-leg syndrome\" (O4d, PL); PN) propagation not yet classifiable as time since symptom onset is less than 12 months. Phenotypes of motor neuron dysfunction differentiate the degree of UMN and/or LMN dysfunction: M0) balanced UMN and LMN dysfunction; M1d) dominant UMN dysfunction; M1p) pure UMN dysfunction (\"primary lateral sclerosis\", PLS); M2d) dominant LMN dysfunction; M2p) pure LMN dysfunction (\"progressive muscle atrophy\", PMA); M3) dissociated motor neuron dysfunction with dominant LMN and UMN dysfunction of the arms and legs (\"brachial amyotrophic spastic paraparesis\"), respectively.</p><p><strong>Conclusion: </strong>This consensus process aimed to standardize the clinical description of ALS motor phenotypes in clinical practice and research - based on the onset region, propagation pattern, and motor neuron dysfunction. This \"OPM classification\" contributes to specifying the prognosis, to defining the inclusion or stratification criteria in clinical trials and to correlate phenotypes with the underlying disease mechanisms of ALS.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004184","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}