Neurological research and practice最新文献

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Trends and cost structure of drug-based secondary prevention of ischemic strokes. 基于药物的缺血性脑卒中二级预防的趋势和成本结构。
Neurological research and practice Pub Date : 2025-01-02 DOI: 10.1186/s42466-024-00356-x
Konstantin Kohlhase, Ferdinand O Bohmann, Christian Grefkes, Adam Strzelczyk, Laurent M Willems
{"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}
引用次数: 0
Psychological interventions for improvement of symptoms of post-stroke depression - study protocol of the depression-intervention study for optimization of reconvalesence after stroke (DISCOVER). 改善脑卒中后抑郁症状的心理干预——优化脑卒中后康复的抑郁干预研究方案(DISCOVER)
Neurological research and practice Pub Date : 2024-12-11 DOI: 10.1186/s42466-024-00347-y
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
{"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}
引用次数: 0
Virtual reality-guided therapy on a stroke unit: a feasibility study. 虚拟现实引导治疗中风单位:可行性研究。
Neurological research and practice Pub Date : 2024-12-02 DOI: 10.1186/s42466-024-00357-w
Jordi Kühne Escolà, Rumeysa Demirdas, Martin Schulze, Woon Hyung Chae, Lennart Steffen Milles, Doreen Pommeranz, Marvin Darkwah Oppong, Christoph Kleinschnitz, Martin Köhrmann, Benedikt Frank
{"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}
引用次数: 0
Ischemia/reperfusion injury in acute human and experimental stroke: focus on thrombo-inflammatory mechanisms and treatments. 急性人类中风和实验性中风的缺血再灌注损伤:关注血栓-炎症机制和治疗方法。
Neurological research and practice Pub Date : 2024-11-25 DOI: 10.1186/s42466-024-00355-y
Guido Stoll, Bernhard Nieswandt, Michael K Schuhmann
{"title":"Ischemia/reperfusion injury in acute human and experimental stroke: focus on thrombo-inflammatory mechanisms and treatments.","authors":"Guido Stoll, Bernhard Nieswandt, Michael K Schuhmann","doi":"10.1186/s42466-024-00355-y","DOIUrl":"10.1186/s42466-024-00355-y","url":null,"abstract":"<p><strong>Background: </strong>Despite high recanalization rates of > 90% after endovascular thrombectomy (EVT) clinical outcome in around 50% of treated acute ischemic stroke (AIS) patients is still poor. Novel treatments augmenting the beneficial effects of recanalization are eagerly awaited, but this requires mechanistic insights to explain and overcome futile recanalization.</p><p><strong>Main body: </strong>At least two mechanisms contribute to futile recanalization after cerebral large vessel occlusions (LVO): (i) the no reflow phenomenon as evidenced by randomly distributed areas without return of blood flow despite reperfusion of large cerebral arteries, and (ii) ischemia/reperfusion (I/R) injury, the paradoxically harmful aspect of blood flow return in transiently ischemic organs. There is accumulating evidence from experimental stroke models that platelets and leukocytes interact and partly obstruct the microvasculature under LVO, and that platelet-driven inflammation (designated thrombo-inflammation) extends into the reperfusion phase and causes I/R injury. Blocking of platelet glycoprotein receptors (GP) Ib and GPVI ameliorated inflammation and I/R injury providing novel therapeutic options. Recently, MRI studies confirmed a significant, up to 40% infarct expansion after recanalization in AIS thereby proofing the existance of I/R injury in the human brain. Moreover, analysis of minute samples of ischemic arterial blood aspirated directly from the pial cerebral collateral circulation under LVO during the routine EVT procedure confirmed platelet activation and platelet-driven leukocyte accumulation in AIS and, thus, the principal transferability of pathophysiological stroke mechanisms from rodents to man. Two recently published clinical phase 1b/2a trials targeted (thrombo-) inflammation in AIS: The ACTIMIS trial targeting platelet GPVI by glenzocimab provided encouraging safety signals in AIS similar to the ApTOLL trial targeting toll-like receptor 4, a central receptor guiding stroke-induced innate immunity. However, both studies were not powered to show clinical efficacy.</p><p><strong>Conclusions: </strong>The fact that the significance of I/R injury in AIS has recently been formally established and given the decisive role of platelet-leukocytes interactions herein, new avenues for adjunct stroke treatments emerge. Adjusted study designs to increase the probability of success are of outmost importance and we look forward from what can be learned from the so far unpublished, presumbably negative ACTISAFE and MOST trials.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712359","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}
引用次数: 0
Letter to the editor in response to Professor Josef Finsterer. 致编辑的信,回应约瑟夫-芬斯特尔教授。
Neurological research and practice Pub Date : 2024-11-18 DOI: 10.1186/s42466-024-00337-0
Sreelakshmi V, Amrita Pattanaik, Srilatha Marate, Reeta S Mani, Aparna R Pai, Chiranjay Mukhopadhyay
{"title":"Letter to the editor in response to Professor Josef Finsterer.","authors":"Sreelakshmi V, Amrita Pattanaik, Srilatha Marate, Reeta S Mani, Aparna R Pai, Chiranjay Mukhopadhyay","doi":"10.1186/s42466-024-00337-0","DOIUrl":"10.1186/s42466-024-00337-0","url":null,"abstract":"","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649816","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}
引用次数: 0
MS brain health quality standards: a survey on the reality in clinical practice in Germany. 多发性硬化症脑健康质量标准:德国临床实践现状调查。
Neurological research and practice Pub Date : 2024-11-18 DOI: 10.1186/s42466-024-00333-4
Isabel Voigt, Katja Akgün, Hernan Inojosa, Judith Haas, Herbert Temmes, Sven G Meuth, Gavin Giovannoni, Tjalf Ziemssen
{"title":"MS brain health quality standards: a survey on the reality in clinical practice in Germany.","authors":"Isabel Voigt, Katja Akgün, Hernan Inojosa, Judith Haas, Herbert Temmes, Sven G Meuth, Gavin Giovannoni, Tjalf Ziemssen","doi":"10.1186/s42466-024-00333-4","DOIUrl":"10.1186/s42466-024-00333-4","url":null,"abstract":"<p><strong>Background: </strong>The quality of treatment is especially critical in the context of complex and chronic diseases such as multiple sclerosis (MS). The Brain Health Initiative, an independent international consortium of neurologists, reached a consensus on time-based quality standards prioritizing brain health-focused care for people with MS.</p><p><strong>Objectives: </strong>To gain deeper insights into the transferability of these quality standards to a specific area, we conducted a survey among MS experts across various MS centers in Germany.</p><p><strong>Methods: </strong>Participants were asked about time frames considered high standards and those currently being implemented in daily routine based on their experience.</p><p><strong>Results: </strong>The results reveal a large gap between ideal conceptions and their adaptation in the real world, mostly due to a lack of resources.</p><p><strong>Conclusions: </strong>Nevertheless, these guidelines and recommendations can be aspired to as ideals. Consensual and inclusive clinical pathways complemented by measurable quality indicators are needed to improve care and approach these ideals. Neither exists in the current management of MS.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649818","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}
引用次数: 0
Chikungunya-related Guillain-Barre syndrome is most commonly demyelinating and affects multiple cranial nerves. 与基孔肯雅病毒相关的格林-巴利综合征最常见的症状是脱髓鞘,会影响多个颅神经。
Neurological research and practice Pub Date : 2024-11-18 DOI: 10.1186/s42466-024-00336-1
Josef Finsterer
{"title":"Chikungunya-related Guillain-Barre syndrome is most commonly demyelinating and affects multiple cranial nerves.","authors":"Josef Finsterer","doi":"10.1186/s42466-024-00336-1","DOIUrl":"10.1186/s42466-024-00336-1","url":null,"abstract":"","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"56"},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649836","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}
引用次数: 0
Prevalence of comorbid autoimmune diseases and antibodies in newly diagnosed multiple sclerosis patients. 新诊断的多发性硬化症患者合并自身免疫性疾病和抗体的患病率。
Neurological research and practice Pub Date : 2024-11-12 DOI: 10.1186/s42466-024-00351-2
Konstantin Fritz Jendretzky, Lisa-Marie Lezius, Thea Thiele, Franz Felix Konen, André Huss, Lena Heitmann, Yunus Emre Güzeloglu, Philipp Schwenkenbecher, Kurt-Wolfram Sühs, Jelena Skuljec, Mike Peter Wattjes, Torsten Witte, Christoph Kleinschnitz, Refik Pul, Hayrettin Tumani, Stefan Gingele, Thomas Skripuletz
{"title":"Prevalence of comorbid autoimmune diseases and antibodies in newly diagnosed multiple sclerosis patients.","authors":"Konstantin Fritz Jendretzky, Lisa-Marie Lezius, Thea Thiele, Franz Felix Konen, André Huss, Lena Heitmann, Yunus Emre Güzeloglu, Philipp Schwenkenbecher, Kurt-Wolfram Sühs, Jelena Skuljec, Mike Peter Wattjes, Torsten Witte, Christoph Kleinschnitz, Refik Pul, Hayrettin Tumani, Stefan Gingele, Thomas Skripuletz","doi":"10.1186/s42466-024-00351-2","DOIUrl":"10.1186/s42466-024-00351-2","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing multiple sclerosis (MS) is challenging due to diverse symptoms and the absence of specific biomarkers. Concurrent autoimmune diseases (AID) or non-specific antibodies further complicate diagnosis, progression monitoring, and management. Data on AID prevalence in MS patients are sparse. This study aims to identify concurrent AIDs alongside MS.</p><p><strong>Methods: </strong>In this retrospective single-center study, we analyzed patient records at our university hospital from 2010 to 2017, focusing on cases suspected of inflammatory demyelinating disease. The 2017 McDonald criteria were applied. Additionally, we measured neurofilament light (NfL) levels from available CSF samples in our biobank.</p><p><strong>Results: </strong>We identified a total of 315 patients, of whom 66% were women. In total, 13.7% of all patients had concurrent AID, while 20.3% had isolated antibody findings without AID. The most common AID was autoimmune thyroiditis (8.9%), followed by chronic inflammatory skin diseases (1.6%), arthritis (1%), type 1 diabetes (1%), Sjögren's syndrome (0.6%), and inflammatory bowel diseases (0.6%). Cardiolipin antibodies were the most frequent isolated antibody finding (8.6%). Our data showed that, from the perspective of the initial demyelinating event, neither comorbid AID nor isolated antibodies significantly influenced relapses or MS progression over a median follow-up of 9 months. Standard CSF parameters and NfL levels were similar between the groups at the time of MS diagnosis.</p><p><strong>Conclusion: </strong>Our study shows that AIDs, particularly autoimmune thyroiditis, frequently occur at the onset of MS. The proportion of AIDs commonly treated with immunomodulatory therapy in our cohort was similar to that observed in the general population. Comorbid AID did not affect NfL levels, indicating similar disease activity. Future research should explore new AID emergence during the course of MS, especially considering the increased incidence of rheumatic diseases later in life.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"55"},"PeriodicalIF":0.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635172","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}
引用次数: 0
Prevalence, diagnosis and management of intracranial atherosclerosis in White populations: a narrative review. 白种人颅内动脉粥样硬化的患病率、诊断和管理:叙述性综述。
Neurological research and practice Pub Date : 2024-11-11 DOI: 10.1186/s42466-024-00341-4
Evangelos Panagiotopoulos, Maria-Ioanna Stefanou, George Magoufis, Apostolos Safouris, Odysseas Kargiotis, Klearchos Psychogios, Sofia Vassilopoulou, Aikaterini Theodorou, Maria Chondrogianni, Eleni Bakola, Frantzeska Frantzeskaki, Tatiana Sidiropoulou, Stavros Spiliopoulos, Georgios Tsivgoulis
{"title":"Prevalence, diagnosis and management of intracranial atherosclerosis in White populations: a narrative review.","authors":"Evangelos Panagiotopoulos, Maria-Ioanna Stefanou, George Magoufis, Apostolos Safouris, Odysseas Kargiotis, Klearchos Psychogios, Sofia Vassilopoulou, Aikaterini Theodorou, Maria Chondrogianni, Eleni Bakola, Frantzeska Frantzeskaki, Tatiana Sidiropoulou, Stavros Spiliopoulos, Georgios Tsivgoulis","doi":"10.1186/s42466-024-00341-4","DOIUrl":"10.1186/s42466-024-00341-4","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic disease (ICAD) represents a leading cause of ischemic stroke worldwide, conferring increased risk of recurrent stroke and poor clinical outcomes among stroke survivors. Emerging evidence indicates a paradigm shift, pointing towards increasing detection rates of ICAD among White populations and an evolving epidemiological profile across racial and ethnic groups. The present review aims to provide a comprehensive overview of ICAD, focusing on its pathophysiology, diagnostic approach, and evolving epidemiological trends, including underlying mechanisms, advanced neuroimaging techniques for diagnostic evaluation, racial disparities in prevalence, and current and emerging management strategies.</p><p><strong>Main body: </strong>Atherosclerotic plaque accumulation and progressive arterial stenosis of major intracranial arteries comprise the pathophysiological hallmark of ICAD. In clinical practice, the diagnosis of intracranial artery stenosis (ICAS) or high-grade ICAS is reached when luminal narrowing exceeds 50% and 70%, respectively. Advanced neuroimaging, including high-resolution vessel wall MRI (HRVW-MRI), has recently enabled ICAD detection before luminal stenosis occurs. While earlier studies disclosed significant racial disparities in ICAS prevalence, with higher rates among Asians, Hispanics, and Blacks, recent evidence reveals rising detection rates of ICAD among White populations. Genetic, environmental and epigenetic factors have been suggested to confer an increased susceptibility of certain ethnicities and races to ICAD. Nevertheless, with improved accessibility to advanced neuroimaging, ICAD is increasingly recognized as an underlying stroke etiology among White patients presenting with acute ischemic stroke and stroke of undetermined etiology. While conventional management of ICAS entails risk factor modification, pharmacotherapy, and endovascular treatment in selected high-risk patients, substantial progress remains to be made in the management of ICAD at its early, pre-stenotic stages.</p><p><strong>Conclusion: </strong>ICAD remains a critical yet underappreciated risk factor for ischemic stroke across all populations, highlighting the need for increased awareness and improved diagnostic strategies. The emerging epidemiological profile of ICAD across racial groups necessitates a reassessment of risk factors, screening protocols and preventive strategies. Future research should focus on refining the diagnostic criteria and expanding the therapeutic options to cover the full spectrum of ICAD, with the aim of improving patient outcomes and reducing the global burden of intracranial atherosclerosis and stroke.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"6 1","pages":"54"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635177","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}
引用次数: 0
Restless legs syndrome: abbreviated guidelines by the German sleep society and the German neurological society. 不宁腿综合征:德国睡眠学会和德国神经学会的简略指南。
Neurological research and practice Pub Date : 2024-11-06 DOI: 10.1186/s42466-024-00353-0
Claudia Trenkwalder, Ambra Stefani, Cornelius G Bachmann, Christian Maihöfner, Johannes Mathis, Lucia Muntean, Julian Mollin, Joachim Paulus, Anna Heidbreder
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