查看更多>>摘要：Objectives High on‐treatment platelet reactivity (HTPR) determined by platelet function assays is present in certain patients with ischemic stroke or transient ischemic attack (TIA)。 However， it is unclear whether HTPR is associated with poor clinical outcomes。 Our study aimed to investigate the relationship of HTPR with recurrent vascular events in ischemic stroke or TIA。 Methods Pubmed (MEDLINE)， EMBASE， and Cochrane Library were searched for eligible studies from inception to January 1， 2022。 Stata 17。0 software was used to calculate the risk ratio (RR)。 Subgroup and sensitivity analyses were conducted to assess the source of heterogeneity。 A random‐effects model was used when heterogeneity was present。 Primary endpoint of the meta‐analysis was the risk ratio of recurrent vascular events in HTPR Patients。 While stroke and TIA， all‐cause death， early neurological deterioration， early new ischemic lesions， and stroke severity measured by National Institute of Health Stroke Scale (NIHSS) scores at admission were also pooled。 Results Thirty articles (7995 patients) were eligible including 28 cohort studies and 2 prospective case–control studies。 The prevalence of HTPR varied from 5。9% to 60%。 HTPR was associated with an increased risk of recurrent vascular events (RR?=?2。94， 95% CI 2。04–4。23)， stroke recurrence (RR?=?2。05; 95% CI 1。43–2。95)， and all‐cause mortality (RR?=?2。43; 95% CI 1。83–3。22)。 Subgroup analysis showed that HTPR determined by optical aggregometry， Verify‐Now system and 11dh TXB2 is related to a higher risk of recurrent vascular events (RR?=?3。53， 95% CI 1。51–9。40; RR?=?2。16， 95% CI 1。02–4。56; RR?=?3。76， 95% CI 1。51–9。40， respectively)。 Moreover， patients with HTPR had an increased incidence of early neurological deterioration (RR?=?2。75; 95% CI 1。76–4。30) and higher NIHSS scores at admission (Mean difference 0。19， 95% CI 0。01–0。36)。 Conclusions This meta‐analysis demonstrates HTPR is associated with higher risk of recurrent vascular events， early neurological deterioration and increased severity in patients with ischemic stroke and TIA。 HTPR measured by platelet function assays may guide the use of antiplatelet agents in ischemic stroke and TIA。
查看更多>>摘要：Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is more than merely a respiratory disease， as it also presents with various neurological symptoms。 SARS‐CoV‐2 may infect the central nervous system (CNS) and thus is neurotropic。 However， the pathophysiological mechanism of coronavirus disease 2019 (COVID‐19)‐associated neuropathy remains unclear。 Many studies have reported that SARS‐CoV‐2 enters the CNS through the hematogenous and neuronal routes， as well as through the main host neurological immune responses and cells involved in these responses。 The neurological immune responses to COVID‐19 and potential mechanisms of the extensive neuroinflammation induced by SARS‐CoV‐2 have been investigated。 Although CNS infection with SARS‐CoV‐2 was shown to lead to neuronal impairment， certain aspects of this mechanism remain controversial and require further analysis。 In this review， we discussed the pathway and mechanisms of SARS‐CoV‐2 invasion in the CNS， and associated clinical manifestations， such as anosmia， headache， and hyposmia。 Moreover， the mechanism of neurological damage caused by SARS‐CoV‐2 may provide potential treatment methods for patients presenting with SARS‐CoV‐2‐associated neuropathy。
查看更多>>摘要：Background Previous studies with a limited sample size suggested more severe dopaminergic transporter (DAT) lesions in the striatum of progressive supranuclear palsy (PSP) than those in Parkinson's disease (PD) and multiple system atrophy–parkinsonism (MSA‐P)。 However， few studies had taken various subtypes of PSP into consideration， making the reanalysis of DAT imaging in larger PSP cohort with various subtypes in need。 Objectives To compare the dopaminergic lesion patterns of PSP with MSA‐P and PD， and to explore the specific striatal subregional patterns of different PSP subtypes。 Methods 11C‐CFT positron emission tomography (PET) imaging was conducted in 83 PSP patients consisting of different subtypes， 61 patients with PD， 41 patients with MSA‐P， and 43 healthy volunteers。 Demographic and clinical data were compared by the chi‐squared test or one‐way analysis of variance。 A generalized linear model was used to examine intergroup differences in tracer uptake values after adjusting for age， disease duration， and disease severity。 Areas under the receiver operating characteristic curve were calculated to assess the diagnostic accuracy of subregional DAT binding patterns。 Results The patients with PSP presented more severe DAT loss in the striatum than in PD and MSA‐P， especially in caudate。 In PSP， the subregional lesion was still more severe in putamen than in caudate， similar to that in PD and MSA‐P。 Among detailed subtypes， no significant difference was detected。 Conclusion The dopaminergic lesions were more severe in PSP， and no difference was detected among subtypes。
Stefan KrebsMarek SykoraMario KrammelMichael Girsa...
6页
查看更多>>摘要：Objectives The Austrian Prehospital Stroke Scale (APSS) score was developed to predict large vessel occlusion (LVO) and improve prehospital transportation triage。 Its accuracy has been previously analyzed retrospectively。 We now aimed to investigate the accuracy， as well as the impact of the implementation of a triage strategy using this score on treatment times and outcome in a prospective study。 Matherial & Methods Prospective diagnostic test accuracy and before‐after interventional study。 EMS prospectively evaluated APSS in patients suspected of stroke。 Accuracy was compared with other LVO scores。 Patients with APSS ≥4 points were brought directly to the comprehensive stroke center。 Treatment time frames， neurological， and radiological outcome before and after the APSS implementation were compared。 Results A total of 307 patients with suspected stroke were included from October 2018 to February 2020。 Treatable LVO was present in 79 (26%)。 Sensitivity of APSS to detect those was 90%， specificity 79%， positive predictive value 66%， negative predictive value 95%， and area under the curve 0。87 (95% CI 0。83–0。91)。 This was similar to in‐hospital NIHSS (AUC 0。89 95% CI 0。89–0。92， p?=?。06) and superior to CPSS (AUC 0。83 95% CI 0。78–0。87， p?=?。01)。 Implementation of APSS triage increased direct transportation rate for LVO patients (21% before vs。 52% after; p?<?。001) with a significant time benefit (alert to groin puncture time benefit: 51?min (95% CI 28–74; p?<?。001)。 Neurological and radiological outcome did not differ significantly。 Conclusions Austrian Prehospital Stroke Scale triage showed an accuracy comparable with in‐hospital NIHSS， and lead to a significant optimization of prehospital workflows in patients with potential LVO。
查看更多>>摘要：Objective Recent national guidelines recommend alteplase treatment for ischemic stroke within 4。5?h of symptom‐onset based on meta‐analyses of randomized controlled clinical trials (RCT)。 A detailed description of missing outcome data (MOD) due to participant loss to follow‐up has never been published。 The objective of this study was to perform a methodlogical survey on missing outcome data in an alteplase for ischemic stroke meta‐analysis。 Materials and Methods A methodological survey was performed on a chosen meta‐analysis of alteplase for ischemic stroke RCTs that most closely aligns with recent national guideline recommendations。 Data were collected to assess the number of participants lost to follow‐up; differential lost to follow‐up between allocation groups; baseline characteristics of those lost to follow‐up; and the imputation methods used by individual trials and the chosen meta‐analysis。 The number of participants lost to follow‐up was compared with the fragility index; and repeated for individually positive RCTs in the meta‐analysis。 Results The methodological survey revealed a substantial degree of missing information regarding MOD in the chosen meta‐analysis and in individual RCTs。 Single imputation was exclusively used in all RCTs and in the meta‐analysis。 The number of participants lost to follow‐up was greater than the fragility index in the chosen meta‐analysis and individually positive component RCTs suggesting that MOD may impact the direction of the reported effect or effect size。 Conclusion This methodological survey of an alteplase for ischemic stroke meta‐analysis revealed MOD may be an important source of unrecognized bias。 This survey highlights the need for sensitivity analyses using more robust methods of imputation。
查看更多>>摘要：Objectives Deep brain stimulation of the anterior thalamic nucleus (ANT‐DBS) is an established option in treatment‐resistant epilepsy and obtained FDA approval in 2018。 Increased psychiatric comorbidity is well known in epilepsy。 The main objective of this study was to investigate possible neuropsychiatric treatment‐related changes in patients receiving ANT‐DBS。 Materials and Methods Bilateral ANT electrodes were implanted in 18 adult patients with refractory epilepsy in a randomized， double‐blinded study。 Immediately after implantation， patients were randomized to stimulation ON (n?=?8) or OFF (n?=?10) for the first 6?months (blinded phase)。 During the next six months (open phase)， both groups received active stimulation。 Neuropsychiatric assessment was conducted before implantation (T1)， at the end of the blinded period (T2)， and 1?year after implantation (T3)。 Results Comparing preoperative status (T1) and 12?months (T3)， postoperative outcome in all patients did not show significant differences between the two groups for any of the applied tests。 Groupwise comparisons across the two first time points (the blinded period， representing the randomized controlled trial) showed no significant differences between the two groups in any of the neuropsychiatric parameters studied。 Comparing test results after 6?months of stimulation in both groups (sum of ON group T1 to T2 and OFF group T2 to T3) did not show significant changes for any of the psychiatric assessments。 Conclusions Our results indicate that ANT‐DBS has limited effect concerning psychiatric issues。 Subjective side effects were， however， reported in individual patients。
Bernhard J. SteinhoffElinor Ben‐MenachemChristian BrandtIrene García Morales...
11页
查看更多>>摘要：Objectives Cenobamate is an antiseizure medication (ASM) approved in Europe as adjunctive therapy for adults with inadequately controlled focal seizures。 This post hoc analysis reports onset of efficacy and characterizes time to onset， duration， and severity of the most common treatment‐emergent adverse events (TEAEs) during cenobamate titration。 Materials & Methods Adult patients with uncontrolled focal seizures taking 1 to 3 concomitant ASMs were randomized to receive adjunctive cenobamate or placebo (double‐blind studies C013 and C017) or cenobamate (open‐label study C021)。 Outcome assessments included efficacy (median percentage change in seizure frequency and onset [studies C013 and C017]) and safety (onset， duration， and severity of TEAEs [all studies])。 Results Onset of efficacy was observed by Weeks 1 to 4 of titration in studies C013 and C017 which used a faster titration schedule than study CO21。 In study C013， the median percentage seizure frequency reduction was 36。7% in patients receiving cenobamate versus 16。3% in those taking placebo (p?=?。002); in study C017， significant differences in seizure frequency emerged in Week 1 and continued throughout titration between all cenobamate groups and placebo (p?<?。001)。 The most commonly reported TEAEs were somnolence， dizziness， fatigue， and headache， with first onset of each reported as early as Week 1; however， the majority resolved。 Conclusions Reductions in seizure frequency occurred during titration with initial efficacy observed prior to reaching the target dose。 These reductions were regarded as clinically meaningful because they may indicate early efficacy at lower doses than previously expected and had a considerable impact on patient quality of life。 Long‐term treatment with adjunctive cenobamate was generally safe and well‐tolerated。
查看更多>>摘要：Objectives The novel concept of subjective cognitive decline (SCD) in Parkinson's disease (PD) refers to subjective cognitive impairment without concurrent objective cognitive deficits。 This study aimed to determine the prevalence and affective correlates of SCD in de novo PD patients。 Materials and Methods A total of 139 de novo PD patients underwent comprehensive neuropsychological evaluation。 PD patients with SCD (PD‐SCD) did not meet the diagnostic criteria for mild cognitive impairment in PD (PD‐MCI) based on the Movement Disorder Society Level II Criteria and were defined by a Domain‐5 Score?≥1 on the Non‐Motor Symptoms Questionnaire。 Affective symptoms were measured using the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA)。 Results In de novo PD cohort， the prevalence of SCD was 28。1%。 PD‐SCD patients performed significantly better than PD‐MCI patients on tests of five cognitive domains。 The more commonly affected domains in PD‐SCD patients were memory (28。2%) and attention/working memory (25。6%)。 Multivariable linear regression analysis revealed that PD‐SCD was significantly associated with both HAMD (β?=?4。518， 95% CI?=?0。754–8。281， p?=?。019) and HAMA scores (β?=?4。259， 95% CI?=?1。054–7。464， p?=?。010)。 Furthermore， binary logistic regression analysis revealed that higher HAMD (OR?=?1。128， 95% CI?=?1。019–1。249， p?=?。020) and HAMA scores (OR?=?1。176， 95% CI?=?1。030–1。343， p?=?。017) increased the risk of PD‐SCD。 Conclusions Our findings suggest that SCD is highly prevalent in de novo PD patients。 The presence of PD‐SCD is suggestive of an underlying affective disorder。
查看更多>>摘要：Objectives Early withdrawal from work is common among people with multiple sclerosis (PwMS)。 However， little is known about how this is influenced by the type of employment。 The aims were to explore the distributions of self‐employed and other types of employment (employed or no earnings from work) before and after MS diagnosis and its associations with sickness absence (SA) and disability pension (DP) among PwMS and matched references without MS。 Materials & Method A 6‐year longitudinal cohort study of 2779 individuals diagnosed with MS in 2008–2012 when aged 20–59 and of 13，863 matched individuals without MS from Sweden's population was conducted。 Hazard ratios (HR) of >180 SA and/or DP days/year were compared by employment status among PwMS and references using Cox proportional hazard models with 95% confidence intervals (CI)。 Results Most had no SA or DP。 Nevertheless， PwMS had higher SA and DP levels compared with references。 PwMS had a higher likelihood to reach >180?days of SA (HR?=?4。89， 95% CI?=?4。43–5。40) or days of DP (HR?=?6。31， 95% CI?=?5。46–7。30)， irrespective of the employment status。 Self‐employed references had less likelihood for >180 SA days than employed references。 However， self‐employed and employed PwMS had a similar likelihood for >180 SA days。 Transitions of employees to self‐employment were infrequent among PwMS (1。7%) and references (2。6%)。 Conclusions PwMS transit to SA and DP to a higher extent than references。 In contrast to individuals without MS， self‐employed PwMS had similar SA levels to employed PwMS。 Switching to self‐employment was not a predominant choice for people recently diagnosed with MS。
NSTL
Wiley