Neurology Asia

Impact of clopidogrel resistance on stroke severity in patients with acute ischemic stroke

2025-01-13T12:02:35+00:00

Background: Prior use of antiplatelet agents is associated with reduced severity in patients with ischemic stroke. However, clopidogrel resistance, which is characterized by a suboptimal platelet response to clopidogrel, diminishes the drug’s efficacy. This study aimed to investigate the impact of clopidogrel resistance on stroke severity in patients receiving clopidogrel.

Methods: A total of 116 patients who developed acute ischemic stroke while on clopidogrel, presented to two hospitals within 72 h of symptom onset, and underwent clopidogrel resistance testing using the VerifyNow assay were enrolled. The relationship between the VerifyNow parameters and stroke severity was analyzed using correlation and multivariable regression analyses.

Results: Among the VerifyNow parameters, percent inhibition showed a significant inverse correlation with National Institutes of Health Stroke Scale (NIHSS) score at admission (r = -0.387, p < 0.001), whereas the P2Y12 reaction unit (PRU) exhibited a significant positive correlation (r = 0.207, p = 0.028). Multivariable analysis confirmed a significant inverse relationship between percent inhibition and NIHSS score at admission (B = -0.107, 95% confidence interval = -0.163 to -0.051; p < 0.001). However, PRU was not significantly associated with NIHSS score at admission in the multivariable analysis.

Conclusions: Clopidogrel resistance, particularly lower percent inhibition, was associated with greater stroke severity in patients receiving clopidogrel.

The importance of panimmune inflammation value and systemic immuno-inflammation index in patients with acute cerebrovascular infarction

2024-12-23T01:46:26+00:00

Background: Stroke is a condition that negatively affects the quality of life in all societies and is one of the leading causes of mortality in adults. It is the second most common cause of death and disability worldwide. Acute ischemic stroke leads to severe physical, social, psychological, and economic devas- tation. Early and accurate diagnosis of these patients in the emergency department is crucial for timely treatment. This study aimed to investigate the course of the pan-immune inflammation value (PIV), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), which has been identified as new inflammatory markers in patients diagnosed with acute stroke.

Methods: This retrospective study compared inflammatory markers obtained from the complete blood count results of patients diagnosed with acute ischemic stroke in the emergency department between 01.01.2022 and 01.03.2024 with those of healthy individuals.

Results: In our study, 201 patients with acute ischemic stroke and 100 healthy individuals were compared. The results demonstrated that inflammatory mar- kers, including the PIV, SII, and SIRI, were significantly higher in the stroke group compared to the control group (p<0.05). Specifically, neutrophil, CRP, PIV, SII, SIRI, and NLR values were elevated in the ischemic stroke group, while lymphocyte and hemoglobin levels were higher in the control group.

Conclusion: This study highlights the potential of PIV, SII, and SIRI as novel biomarkers for predicting inflammation and prognosis in acute ischemic stroke patients. These markers may serve as cost-effecti- ve and practical tools for early diagnosis and risk stratification in clinical settings. Further studies with dynamic evaluations are needed to explore the long-term prognostic value of these markers.

Evaluation of the performance of pan-immune inflammation value in predicting in-hospital mortality in patients with spontaneous intracerebral hemorrhage

2024-11-27T02:02:57+00:00

Background & Objective: Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and poor functional prognosis. This study aimed to evaluate the prognostic significance of the pan-immune inflammation value (PIV) at admission in predicting in-hospital mortality in patients with spontaneous ICH. Additionally, we compared the predictive performance of PIV with other inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII).

Methods: This retrospective study included 102 consecutive patients admitted within 24 hours of the onset of spontaneous ICH. Patients were categorized into two groups: survivors at discharge and those who died in the hospital. The groups were compared based on NLR, PLR, SII index, and PIV. Logistic regression and ROC analyses were performed to evaluate the predictive performance of PIV compared to NLR, PLR, and SII index for in-hospital mortality.

Results: Patients who died in the hospital (n=45) had a higher mean age, higher NIHSS score, larger hematoma volumes, and a higher incidence of diabetes, intraventricular extension, and surgical intervention. Additionally, these patients had higher PIV, NLR, PLR, and SII index values (p<0.05). PIV demonstrated superior performance compared to these three markers in predicting in-hospital mortality.

Conclusion: The results of our study suggest that PIV may serve as a valuable prognostic indicator for predicting in-hospital mortality in patients with spontaneous ICH. This study is the first to evaluate PIV as a potential predictive marker for mortality in ICH patients.

Dynamic changes of systemic immune-inflammation index and systemic inflammation response index after mechanical thrombectomy and their predictive value for functional outcomes in patients with acute ischemic stroke

2025-02-28T10:12:56+00:00

Objective: To investigate the dynamic changes in the systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) after mechanical thrombectomy (MT) and their ability to predict 90-day functional outcomes in acute ischemic stroke (AIS) patients.

Methods: This retrospective cohort study included 423 AIS patients who underwent MT treatment at a single center between January 2018 and February 2024. SII and SIRI were measured at admission, Day 1, and Day 3 post-MT. The primary outcome was poor functional outcome (modified Rankin Scale score > 2) at 90 days. Receiver operating characteristic curve (ROC) analysis and multivariable logistic regression were used to assess the predictive performance and independent associations of SII and SIRI with outcomes. The relationships between SII, SIRI, and 90-day mRS scores were explored using Spearman correlation analysis and multivariable linear regression models.

Results: The poor outcome group had significantly higher SII and SIRI at all time points compared to the good outcome group (all P < 0.001). ROC analysis showed that SII and SIRI on day3 had the strongest predictive power (SII: AUC=0.80; SIRI: AUC=0.82). After adjusting for potential confounders, multivariable logistic regression analysis indicated that SII and SIRI on day3 were independently associated with poor outcomes at 90 days (Both P < 0.001). Multivariable linear regression analysis further confirmed that SII and SIRI on day3 were significantly positively correlated with mRS scores (both P < 0.01).

Conclusion: SII and SIRI levels after MT (especially on day3) can serve as effective predictors of 90-day functional outcomes in AIS patients.

Evaluation of three minimally invasive surgical techniques for hematoma removal in elderly patients with hypertensive intracerebral hemorrhage: A pilot randomized study

2024-11-10T03:03:53+00:00

Objective: To compare the efficacy and safety of three minimally invasive surgical (MIS) techniques— neuroendoscopic hematoma removal, minimally invasive soft channel puncture and drainage, and small bone window microhematoma removal—in elderly patients with hypertensive cerebral hemorrhage.

Methods: A total of 60 elderly patients with hypertensive cerebral hemorrhage were randomly assigned to one of three groups: neuroendoscopic hematoma removal (n=20), minimally invasive soft channel puncture and drainage (n=20), and small bone window microhematoma removal (n=20). Operative parameters (surgical time, intraoperative bleeding), postoperative complications, and long-term neurological outcomes (National Institutes of Health Stroke Scale -- NIHSS and Glasgow Outcome Scale -- GOS scores) were assessed and compared among the groups.

Results: Neuroendoscopic hematoma removal was associated with significantly shorter surgical times (141.3±14.9 minutes) and reduced intraoperative bleeding (119.4±22.1 ml) compared to the other techniques (P<0.01). Postoperative complication rates were lower in the neuroendoscopic group (1.59%) compared to the small bone window (30%) and soft channel groups (15%) (P<0.05). Long-term outcomes, measured by NIHSS and GOS scores, were significantly better in the neuroendoscopic group, indicating improved neurological recovery and functional status (P<0.01).

Conclusion: Neuroendoscopic hematoma removal may offer significant advantages over small bone window microhematoma removal and minimally invasive soft channel puncture and drainage in terms of operative efficiency, reduced complications, and improved long-term neurological outcomes. These findings should be validated in future large sample-sized, multi-center, randomized trials.

Association between baseline cognitive function and motor improvement in subacute hemiplegic stroke patients after 4 weeks of rehabilitation

2023-11-23T02:40:30+00:00

Background & Objectives: Motor function and cognition are crucial for performing daily activities in patients with stroke. However, it remains unclear whether measures of motor function in patients with subacute hemiplegic stroke are related to baseline overall cognitive domains or to specific domains. The aim of this study is to determine which baseline cognitive domains are associated with improvements in motor function in patients with subacute hemiplegic stroke after 4 weeks of rehabilitation.

Method: We retrospectively analyzed data of 129 hemiplegic patients with a first-ever stroke, who were admitted or transferred to the rehabilitation department within 3 months of stroke onset. We assessed patient demographics, baseline cognitive function using Mini-Mental Status Examination (MMSE), Wechsler Adult Intelligence Scale-IV, and Motor-Free Visual Perceptual Test-Revised (MVPT-R). Motor function was evaluated using the Berg Balance Scale, Timed Up and Go Test (TUG), 10 m gait time, and functional reach at baseline and after 4 weeks of rehabilitation. Pearson’s correlation coefficient was used to analyze the correlation between improvements in motor and cognitive functions.

Results: No significant correlation was observed between improvements in motor function and baseline MMSE, full-scale IQ, and MVPT total scores. However, subscale analysis of baseline MVPT demonstrated significant correlations between visual discrimination and all outcome effects. Additionally, visual closure and visual-spatial relationship exhibited significant correlation with TUG and 10 m gait velocity.

Conclusions: This study highlighted the association between improvement in motor function, including balance and gait speed, and initial visual perception skills. Thus, evaluating and enhancing visual perception skills are essential for improving motor function in patients with subacute hemiplegic stroke.

Evaluation of the thalamus volume and cortical thickness in patients with epilepsy and determining the relationship of these measurements with the clinical variables of the disease

2023-08-02T07:55:08+00:00

Background & Objectives: The influence of cortical firing neurons and subcortical structures, especially thalamic networks, has a role in the formation and continuity of epileptic seizure activities. In our study, bilateral thalamus volume and cortex thickness from different regions (frontal, temporal, parietal, occipital) were measured in brain magnetic resonance imaging (MRI) of patients diagnosed with epilepsy (PWE)and compared with the healthy control (HC) group. The relationship between the obtained findings and clinical variables of PWEs is intended to be evaluated.

Methods: Our study was designed as a retrospective cross-sectional study. Between January 2018 and December 2020, 62 PWE were diagnosed by specialist physicians in the neurology outpatient clinic, and 42HC groups were included in the study. Thalamus volume and cortical thickness of frontal, parietal, temporal, and occipital regions were measured by an experienced neuroradiologist and neurologist using a 1.5TMRI device from the 3-DT1sequence of brain MRI examinations of all participants. The measurements of MRI metrics in PWE and HC groups were compared.

Results: The mean age of the PWE were35.7±12.162, and the mean age of the HC was35.7±11.0. The two groups were similar in age (p=0.842) and gender (p=0.812) distribution. Bilateral thalamus volumes (p<0.001) and cortical thickness (p<0.001) of PWE were found to be lower compared to the HC group. As the disease duration of PWE increased, there was a significant decrease in bilateral thalamus volüme (p<0.001) and temporal cortical thickness (p<0.001). In the group with high seizure frequency, there was a significant decrease in bilateral thalamus volüme (p<0.001) and a significant reduction in temporal cortical thickness (right temporal p=0.040; left temporal p=0.013). As MRImetrics were compared according to seizure type in the PWE group, right frontal cortex (p=0.043), bilateral parietal cortex (p=0.033, p=0.022), left occipital cortex thickness (p=0.031) were found to be lower in patients with focal seizures compared to patients with generalised seizures.

Conclusions: In this study, bilateral thalamus volume and cortical thickness were significantly lower in PWE than in the HC group.

The presence of sleep apnoea and evaluation of sleep structures in epilepsy subtypes

2025-01-23T03:13:02+00:00

Background & Objective: Identifying seizure-triggering factors and taking precautions in epilepsy patients are important for seizure control and disease progression. Comorbidity between sleep disorders and epilepsy is frequently observed. The severity of epilepsy may affect the risk of sleep apnoea, and obstructive sleep apnoea is thought to exacerbate epilepsy. We thought that there may be differences in the rate of sleep apnoea, sleep structures and sleep characteristics between focal and generalized epilepsy patients. The aim of this study was to compare sleep apnoea and sleep characteristics between patients diagnosed with focal and generalised epilepsy.

Methods: We evaluated polysomnography findings, clinical features, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the STOP–BANG tests of patients who were diagnosed with focal and primary generalised epilepsy and normal individuals without a diagnosis of epilepsy. The collected data were compared between the generalized epilepsy, focal epilepsy and control group.

Results: We included 84 individuals (22 patients with generalised epilepsy, 26 patients with focal epilepsy and 36 controls) in our study. The median age was 37 years (range 19-69). The apnoea-hypopnea index (AHI) (p=0.402) and the sleep apnoea percentage (p=0.385) were no significantly difference between the generalised and focal epilepsy groups. Sleep apnoea was detected in 50% of the epilepsy patients. The STOP–BANG score was significantly higher in the sleep apnoea group than in the control (p = 0.021). The most common sleep disturbance symptoms were daytime sleepiness in the generalised and focal epilepsy groups.

Conclusion: The sleep apnoea percentage were no difference between the generalised and focal epilepsy groups. When sleep apnoea is suspected in epilepsy patients, and when polysomnography is not possible, evaluation can be made with the STOP–BANG test.

The prevalence and impacts of psychological disorders in caregivers of Chinese ALS patients

2025-01-05T04:55:42+00:00

Objective: To investigate the prevalence and influential factors of depression, anxiety, suicidal tendency and sleep disorders in caregivers of Chinese amyotrophic lateral sclerosis (ALS) patients.

Methods: A total of 153 ALS caregivers were investigated using the Patient Health Questionnaire-9 (PHQ-9), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), the Nurses’ Global Assessment of Suicide Risk scale (NGASR) and Pittsburgh sleep quality index (PSQI). The risk factors related to psychological disorders in Chinese ALS caregivers were analyzed.

Results: The medians (range) of PHQ-9, SAS, SDS, PSQI were 12 (0-27), 43 (25-80). 55.20% (25.10%-82.11%), 9 (1-21), respectively. A total of 40 (26.14%), 37 (24.18%) and 22 (14.38%) showed moderate, high and extremely high risk of suicide evaluated by NGASR. There was a negative correlation between disease duration of ALS patients and PHQ-9, SAS, SDS, NGASR, PSQI of their caregivers (p<0.05). Onset age of ALS was negatively related to PHQ-9 (p<0.001) and SDS (p=0.003) in ALS caregivers. Bulbar involvement was significantly related to high level of SDS in caregivers (p=0.028). Pet raising and regular reading was significantly associated with low PHQ-9, SDS, NGASR and PSQI (p<0.05). Participation in ALS- related social activities was negatively related to NGASR of ALS caregivers (p<0.001).

Conclusion: Depression, anxiety, poor sleep quality and risk of suicide were commonly reported by ALS caregivers. Early onset, bulbar involvement and rapid progression might exacerbate the psychological distress of ALS caregivers. Regular reading, pet raising and participation in social activities could decrease risk of suicide and improve sleep quality of ALS caregivers.

Early diaphragmatic dysfunction in mild ALS patients: Ultrasound evaluation as a key tool for assessing pulmonary impairment

2025-02-04T02:27:20+00:00

Background: This study aims to evaluate ultrasound-based measures for detecting early diaphragmatic dysfunction in patients with mild amyotrophic lateral sclerosis (ALS), providing valuable indicators for ultrasound assessment.

Methods: A total of 36 ALS patients and 25 healthy controls were included. All participants underwent B-mode diaphragm ultrasound (DUS), recording indices such as diaphragm thickness and excursion. Clinical data, pulmonary function tests, and ALS Functional Rating Scale- Revised (ALSFRS-R) scores were collected for the ALS group. DUS indices were compared between the ALS group and controls, as well as between mild and non-mild ALS patients. Correlation analyses and Receiver Operating Characteristic (ROC) curve analysis were performed.

Results: Compared to the control group, the study group showed significantly lower Tdi-rest, Tdi-ins, Δins-exp, ΔTdi, DE-quiet, and significantly higher ΔTmax (P<0.05). In comparison to healthy controls, the mild ALS group had significantly lower ΔTdi and Δins-exp (P<0.05). The mild ALS group had significantly higher Tdi-rest, Tdi-ins, Δins-exp, ΔTdi, DE-quiet, and DE-max than the non-mild ALS group (P<0.05), while ΔTmax was significantly lower (P<0.05). The indices Tdi-rest, Tdi-ins, Δins-exp, ΔTdi, and DE-max were positively correlated with FVC, MVV, the ALSFRS-R score, and the respiratory subscore (P<0.05). ROC curve analysis demonstrated that these indices had high accuracy in monitoring pulmonary insufficiency (AUC≥0.811, P≤0.003).

Conclusion: DUS can identify pulmonary impairment in ALS patients and assess disease severity. Early pulmonary insufficiency exists in mild ALS patients, primarily assessed by ΔTdi and Δins-exp, with high accuracy in monitoring pulmonary dysfunction.

A multivariate Mendelian randomization study of Parkinson’s disease and coronary heart disease on amyotrophic lateral sclerosis

2025-02-16T02:21:18+00:00

Objective: To investigate the causal relationship between Parkinson’s disease (PD) and coronary heart disease (CHD) on amyotrophic lateral sclerosis (ALS) using genetic methods, and to investigate whether PD and CHD are independent factors influencing ALS.

Method: This study is based on the summary statistics of genome-wide association studies in the IEU Open GWAS database, with PD and CHD as exposure and ALS as outcome. Single-factor Mendelian randomization analysis was used to explore the causal relationship between exposure and results, and sensitivity analysis was performed. We also examined whether there is a reverse causal relationship between exposure and outcome. Finally, multivariate Mendelian randomization analysis was used to explore whether exposure independently affected outcomes.

Result: Genetically predicted IVW results showed CHD ( ID=ieu-a-7; OR=1.018 ; 95%CI=1.004-1.043; P=0.015) and PD (ID=ieu-b-7; OR=1.025; 95%CI=1.012-1.038; P<0.001) had a significant causal relationship with ALS. Multivariate Mendelian randomization analysis showed that CHD and PD were independent risk factors for ALS (P<0.05).

Conclusion: Our Mendelian randomization results show that the increased risk of PD and CHD has a negative impact on ALS and there is a significant causal relationship, which may provide new insights into the pathogenesis and treatment of ALS.

Mini-open versus conventional open carpal tunnel release: A detailed comparison of efficacy, feasibility, and complications

2025-02-16T01:01:07+00:00

Backgrounds: In surgical treatment of carpal tunnel syndrome, both conventional open carpal tunnel release technique (COT) and mini-open technique with KnifeLight (MOT-K) are effective and safe. However, there is a need for a detailed study comparing outcome, feasibility, complications, and time to return to daily activities/work, supported by itemized electrophysiological evidence.

Methods: Patients with carpal tunnel syndrome were enrolled into COT and MOT-K groups. Preoperative and postoperative characteristics such as Boston Symptom Severity Scale, Boston Functional Status Scale, patient global assessment, physical examination findings, grip strength, and electrophysiological findings were compared between groups. Groups were also compared in terms of duration of the procedure, incision length, time to return to daily activities and work, edema, scar tenderness, scar hypertrophy, pillar pain, and patient satisfaction.

Results: There were no differences in demographics and baseline clinical and electrophysiological characteristics between patients undergoing COT or MOT-K procedures. Both groups showed significant postoperative improvements in terms of symptoms and functional scores. In terms of electrophysiological parameters, improvements in distal motor latency were observed in both groups and in sensory amplitudes only in the MOT-K group. The MOT-K group had a shorter operation time, a shorter incision length, and a faster return to daily activities and work. The incidence of oedema, scar tenderness, and scar hypertrophy was also lower in the MOT-K group.

Conclusions: Although both COT and MOT-K have similar efficacy, MOT-K seems more advantageous in terms of minor complications and return to daily activities/work.

Consensus statement on the diagnosis and treatment of autoimmune nodopathies from the Peripheral Neuropathy Association of the Chinese Society of Neurology

2025-02-16T01:38:27+00:00

Autoimmune nodopathis are a group of immune-mediated peripheral neuropathy, with antibodies to Ranvier nodal regions that includes anti-NF155, contactin1 (CNTN1), and contactin-associatedprotein1 (Caspr1) antibodies. Clinical features, neurophysiology, cerebrospinal fluid test, peripheral nerve imaging, sural neuropathology and antibody detection, diagnostic criteria were summarized in this consensus, as well as suggested principles of treatment with rituximab, glucocorticoids, plasma exchange and other immunotherapy medicines.

Physiological and psychological function differences in the formation of dynapenia, pre-sarcopenia and sarcopenia

2025-01-05T05:44:23+00:00

Background & Objectives: The clinical significance of interaction between muscle strength and mass in sarcopenia is not clear. This cross-sectional study aimed to evaluate the characteristics between people with dynapenia, pre-sarcopenia and sarcopenia.

Methods: Three hundred individuals aged ≥55 years were recruited from rural communities in Yunlin, Taiwan. Grip/leg strength and the skeletal muscle index were used for grouping. Socioeconomic status, chronic disease, the Short Portable Mental State Questionnaire (SPMSQ), the Brief Symptom Rating Scale (BSRS-5), the Chinese Happiness Inventory (CHI), the World Health Organization Quality of Life Brief Version (WHOQOL–BREF) questionnaire and the Mini-Nutritional Assessment Short Form (MNA-SF) were investigated by analysis of variance and multinomial logistic regression.

Results: The pre-sarcopenia and sarcopenia groups had lower body mass index. The score on the SPMSQ was highest in the sarcopenia group. There were no significant differences in the BSRS-5 or the CHI. In the WHOQOL-BREF, the dynapenia group had lower overall and physiological scores and the sarcopenia group had lower physiological and environmental scores. The sarcopenia group had a lower score on the MNA-SF. In the regression model, key factors for the dynapenia group included age, the SPMSQ score, and the physiological score on the WHOQOL-BREF. For the pre-sarcopenia group, the key factors were age, gender, and BMI. Most of these factors were associated with sarcopenia, with the additional factor of gastrointestinal problems.

Conclusions: Our study revealed that physiological factors were more prominent in pre-sarcopenia and that cognitive function had more impact in dynapenia.

Utility of the Patient Acceptable Symptom State (PASS) and Single Simple Question (SSQ) in a Malaysian myasthenia gravis cohort

2024-12-15T04:07:44+00:00

Background & Objective: Assessing myasthenia gravis (MG) can be challenging and multiple outcome measures have been developed to evaluate disease severity. Both the Patient Acceptable Symptom State (PASS) and the Single Simple Question (SSQ) are validated patient-reported outcome measures, but they assess different dimensions of MG. In this study, we aimed to assess the utility of PASS and SSQ in a Malaysian cohort of patients with MG.

Methods: In this cross-sectional study, patients with MG followed-up at the neurology clinic of University Malaya Medical Centre from July 2023 to October 2023 were invited to participate. Data on demographic and clinical characteristics were collected. Patients were required to complete the PASS, SSQ, Myasthenia Gravis Activities of Daily Living (MG-ADL) and Myasthenia Gravis 15-item Quality of Life Revised (MG-QOL15R) questionnaires. Additionally, the Myasthenia Gravis Composite Scale (MGCS) was scored by the physicians during their review.

Results: A total of 71 patients were included. One-third (32.4%) of patients were dissatisfied (PASS-negative) with their current MG symptom state. Of note, significantly more Indians (26.1%) responded ‘No’ to PASS, while more Chinese (81.3%) responded ‘Yes’. Patients with a PASS-negative response had lower SSQ scores (59.1±22.4% vs 80.4±19.0%, p<0.001) and higher MG-ADL (3.9±3.4 vs 1.8±2.0, p=0.011) and MG-QOL15R (11.2±7.3 vs 4.3±4.8, p<0.001). SSQ also showed significant correlations with MG-ADL (r=–0.53, p<0.001), MG-QOL15R (r=–0.40, p=0.001) and MGCS (r=–0.39, p=0.001). An SSQ score of ≥62.5% had 89.6% sensitivity in classifying patients as PASS-positive. PASS thresholds for MG-ADL, MG-QOL15R and MGCS were ≤3.5, ≤6.5 and ≤2.0 points, respectively.

Conclusion: PASS and SSQ are closely associated, and an SSQ threshold of ≥62.5% predicts an acceptable MG state. Both PASS and SSQ are feasible, valid measures and may be easily incorporated into routine MG clinical assessment.

Exploring 31P-MRS changes in skeletal muscle of riboflavin-responsive lipid storage myopathy patients: Clinical value and implications

2025-03-02T03:53:57+00:00

Objective: To investigate the characteristics of skeletal muscle changes observed through 31phosphorus- magnetic resonance spectroscopy (31P-MRS) in patients with riboflavin-responsive lipid storage myopathy (RR-LSM), and to explore the clinical value of these changes in assisting the diagnosis and evaluating the efficacy of LSM treatment.

Methods: A total of 12 RR-LSM patients underwent 31P-MRS scans pre- and post-treatment, alongside 11 healthy controls. Spectral data were analyzed to derive key metabolite levels, including inorganic phosphate (Pi), phosphocreatine (PCr), and adenosine triphosphate (ATP). Ratios such as Pi/ATP, PCr/ATP, and Pi/PCr were calculated, alongside values for intracellular pH (pHint), adenosine diphosphate (ADP), and phosphorylation potential (PP). Comparative analyses were conducted among three groups: RR - LSM patients before treatment, RR - LSM patients after treatment, and the control group.

Results: Pre-treatment, RR-LSM patients exhibited significantly lower levels of PCr, PCr/ATP, and PP compared to controls (P < 0.05). Conversely, elevated levels of Pi/PCr and ADP were observed (P < 0.05). No significant differences were noted in Pi, Pi/ATP, and intracellular pH (pHint) between groups (P > 0.05). Post-treatment, significant increases in PCr, PCr/ ATP, and PP were observed (P < 0.05), while ADP levels decreased markedly (P < 0.05). However, Pi, Pi/ATP, Pi/PCr, and pHint remained unchanged after treatment (P > 0.05). Post-treatment ADP and 1/PP remained elevated compared to controls (P<0.05).

Conclusion: Our study identifies distinct metabolic alterations in RR-LSM patients, particularly in PCr, PCr/ATP, PP, Pi/PCr, and ADP levels, which serve as valuable biomarkers for diagnosis in RR-LSM. The observed improvements in PCr and related ratios post-treatment highlight the utility of 31P-MRS in tracking metabolic recovery and evaluating the efficacy of riboflavin therapy. These findings underscore the potential of 31P-MRS as a non-invasive tool for clinical management of RR-LSM.

Factors affecting short-term prognosis of patients with hemifacial spasm who received botulinum toxin type A injection in the Philippines

2025-03-18T03:51:29+00:00

Background & Objectives: Hemifacial spasm (HFS) is a chronic disease characterized by unilateral tonic and clonic contractions of the facial muscles innervated by the facial nerve. The persistent attacks can significantly impact patients’ daily lives. The most efficacious therapy has been reported to be botulinum toxin (BTX). This study aims to investigate the factors that affect the short-term prognosis of HFS patients treated with BTX type A therapy, as well as to determine the clinic-demographic profile of such patients.

Methods: This is a retrospective cohort study of patients with HFS who were treated with BTX at the Movement Disorders Clinic of Makati Medical Center (MMC). The HFS Score was used to assess the severity and frequency of the eye and cheek spasms, and the degree of suffering in health-related quality of life (HRQOL) parameters.

Results: Sixty-four participants were included in the study. The patients’ characteristics were the following: mean age of 50.18 years; female predominance; most without comorbidities; mean disease duration of 7.83 years; eye as the most common location of initial spasm (96.88%); disease progression of 22.85 months; majority were previously treated with BTX (79.69%); and mean interval of 10.96 months from last BTX session. Regression analysis revealed that there were factors which influenced the short-term prognosis after treatment: (1) history of prior BTX therapy was associated with better clinical parameters, while (1) history of prior BTX therapy, (2) disease duration, and (3) location of initial spasm were associated with improvement of specific HRQOL parameters.

Conclusion: BTX therapy has been established as efficacious in improving the clinical, functional and psychosocial aspects of HFS patients. The factors which influenced the botulinum response were different compared to other papers, highlighting potential differences in predictor variables across populations.

Freezing of gait in patients with Parkinson’s disease: Provoking conditions and risk factors

2024-07-25T11:59:47+00:00

Background & Objective: Freezing of gait (FOG) in Parkinson’s disease (PD) significantly impacts patients’ quality of life. Determining whether a patient has FOG is a clinical challenge. We aimed to investigate an improved rapid clinical assessment method to detect FOG and its risk factors in PD patients.

Methods: This cross-sectional study involved 103 PD patients performing a walking trial designed to provoke FOG, which included tasks like 180-degree turns, navigating narrow corridors with obstacles, and 360-degree turns, both with and without a dual cognitive task of counting down from 100. Video recordings were examined to document freezers and non-freezers. Univariate analysis and multivariate logistic regression were used to determine risk factors. Receiver operating characteristic (ROC) curves were computed to obtain sensitivity and specificity of predictors of FOG.

Results: Turning 360 degrees counterclockwise while counting down from 100 provoked FOG in all patients with FOG. Freezers (26.2%) had significantly longer disease duration, higher disability, and greater use of levodopa (LEDD). Independent risk factors included Hoehn & Yahr stage >2.5 (OR=4.32; 95% CI: 1.16-16.09), motor fluctuation (OR=5.93; 95% CI: 1.86-18.88), and MDS-UPDRS part II (OR=1.10; 95% CI: 1.00-1.20). MDS-UPDRS part II cut off of 17 can predict FOG with a sensitivity of 55.6 % and specificity of 86.8 %.

Conclusions: A rapid clinical assessment involving a 360-degree counterclockwise turn with a cognitive task is effective for FOG detection. This method provides a quick, reliable screening tool in clinical practice, especially for patients with Hoehn & Yahr stage >2.5 and motor fluctuations.

Treatment satisfaction and quality of life among neuropathic pain patients: A cross-sectional study

2025-01-27T02:10:03+00:00

Objective: This study aimed to evaluate treatment satisfaction and quality of life in neuropathic pain patients.

Methods: This cross-sectional study, carried out over eight months at a tertiary care hospital, employed four various tools: patient-reported demographic and clinical data, the Medication Adherence Rating Scale for adherence measurement, the Visual Analogue Scale (VAS) for evaluating pain discomfort, and the Treatment Satisfaction Questionnaire for Medication.

Results: Among 300 participants, 264 fulfilled the inclusion criteria, with an average age of 39.27 years (± 45.25) and 62.12% being male; 50.38% were aged 56 to 75. Diabetes mellitus was the most prevalent comorbidity (32.20%), while 9.47% were obese and 26.51% were overweight. Medication usage indicated that 51.65% of patients were on a combination of pregabalin, nortriptyline, and methylcobalamin, with 11.36% on pregabalin plus nortriptyline. Adherence rates showed that 198 patients had high adherence (75%), while 66 had low adherence (25%). Quality of life assessments revealed significant impacts across SF-36(Short Form Health Survey) domains (p < 0.001), affecting physical functioning, emotional well-being, and social functioning. Additionally, higher treatment satisfaction scores (>50) correlated with improved overall quality of life and general health (p = 0.039).

Conclusion: The study highlights the importance of addressing patient-reported physical and mental challenges, as these factors are closely linked to medication adherence, treatment satisfaction, and overall quality of life. Highly satisfied patients are more likely to adhere to their medication regimen and experience an improved quality of life.

Lower urinary tract symptoms in male migraineurs

2025-03-19T02:34:08+00:00

Objective: To investigate the severity and risk factors of lower urinary tract symptoms (LUTS) in male migraine patients.

Methods: A total of 137 male migraine patients were enrolled as the case group, and 137 healthy males were selected as the control group. The Core Lower Urinary Tract Symptom Score (CLSS), Numeric Rating Scale (NRS) for pain, Self-Rating Somatic Symptom Scale (SSS), Pittsburgh Sleep Quality Index (PSQI), and Generalized Anxiety Disorder-7 (GAD-7) score were used to assess related symptoms. Prostate volume was measured via ultrasound.

Results: Compared to the control group, the case group exhibited significantly higher scores in impaired sleep quality, anxiety, depression, and LUTS (P < 0.05). Univariate analysis revealed that smoking, aura, headache severity, headache duration, headache frequency, headache attack duration, sleep quality, anxiety, and somatic symptom scores were significant factors influencing LUTS in male migraine patients (P < 0.05). Multivariate linear regression analysis indicated that smoking, aura, headache severity, headache duration, headache frequency, headache attack duration, sleep quality, anxiety, and somatic symptom scores were independent risk factors for LUTS in male migraine patients.

Conclusion: LUTS are common in male migraine patients. Smoking, aura, headache severity, headache duration, headache frequency, headache attack duration, sleep quality, anxiety, and somatic symptoms are significant risk factors for LUTS in this population.

Auditory processing skills of school-age children diagnosed with dyspraxia

2025-01-20T01:48:11+00:00

Objective: We aimed to analyse the auditory processing skills of children with developmental dyspraxia (DD) and verify the potential relationships between DD and central auditory processing disorder.

Methods: 40 children between the ages of 6-8 years, 20 children diagnosed with DD and 20 children with normal development, were included in the study. After the demographic information forms for children were filled out, all participants were given a hearing test. To evaluate the auditory processing skills, filtered words(FW), auditory figured ground (AFG), competing words (CW), and competing sentence (CS) tests, which are the sub-steps of the SCAN-C test, were applied.

Results: The Scan-C test FW, AFG, CW, CS tests were applied to the groups separately and dichotically for the right and left ears. The number of correct answers was higher in the normally developing control group. A statistically significant difference was found between the FW Right; FW Left; CW Right; CW Left and CS Right; CS Left groups (p<0.05).

Conclusion: A delay experienced at the stages of transmission, processing, and perception of the incoming stimuli may lead to functional problems such as attention, learning, and motor and psychosocial effects. To prevent problems to be encountered in the later periods of life, early diagnosis should be made through appropriate tests, and early intervention is necessary to eliminate problems and prevent developmental delays. A multidisciplinary team interaction can be useful for an integrated treatment plan.

Evaluation of circulating IL-35, IL-39, and oncostatin M as potential biomarkers in relapsing-remitting multiple sclerosis

2024-12-02T05:40:28+00:00

Background: Multiple sclerosis (MS) is an immune-mediated, chronic inflammatory demyelinating disease of the central nervous system (CNS). Hence, there is a need to identify more biomarkers that may assist in developing new therapeutic strategies. This study aims to compare the levels of interleukin (IL)-35, IL-39, and oncostatin M (OSM) in patients with relapsing-remitting MS (RRMS) and healthy controls.

Methods: Blood samples were collected from 38 patients with RRMS and 36 healthy individuals who served as a control group to measure the levels of the cytokines under study. The plasma levels of IL-35, IL-39, and OSM were measured and compared between the two groups using enzyme-linked immunosorbent assay (ELISA). Additionally, the expression of these cytokines was evaluated using reverse transcription polymerase chain reaction (RT-PCR).

Results: Our results showed that RRMS is associated with higher levels of OSM and IL-39 and lower levels of IL-35 compared to healthy subjects. The results demonstrated that the levels of OSM and IL-39 in RRMS patients were significantly reduced by IFN-β therapy. EDSS scores and IL-35 levels were found to be negatively correlated, while OSM levels and EDSS scores showed a positive and significant correlation. Statistical analysis revealed no significant relationship between IL-35, IL-39, and OSM plasma levels and factors such as age, gender, education level, and job.

Conclusion: Elevated levels of OSM and IL-39 and decreased levels of IL-35 in RRMS patients suggest their potential as biomarkers for disease activity and progression. The correlation between these cytokines and EDSS scores further supports their relevance. Future research should focus on further elucidating the roles of these cytokines in RRMS and exploring their potential as therapeutic targets.

Distinct white matter lesion patterns associated with previous relapse activity in multiple sclerosis and neuromyelitis optica spectrum disorder

2024-12-03T09:35:01+00:00

Background: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are both chronic inflammatory demyelinating diseases of the central nervous system, but they have distinct pathophysiological features that distinguish their clinical phenotypes and lesion characteristics. The objective of this study was to investigate the correlation between white matter (WM) lesion location and previous relapse activity, as well as disease duration, in these two diseases.

Methods: This study included 64 patients with relapsing-remitting MS and 49 with NMOSD. We used the voxel-based lesion-symptom mapping (VLSM) method to determine the correlations of the presence of WM lesions with the number of attacks and the disease duration in each disease group.

Results: We found that WM lesions were correlated with the number of attacks; the deep WM of the right parietotemporal region including parts of the superior longitudinal fasciculus in MS patients and the right superior corona radiata, corticospinal tract, and inferior fronto-occipital fasciculus in NMOSD patients. However, there were no specific locations associated with disease duration in patients with either disease.

Conclusion: Our VLSM analysis confirmed that prior relapse activity was associated with distinct WM lesion locations in MS and NMOSD, respectively. In contrast, disease duration, independent of disease activity, showed no association with specific lesion patterns in either disease.

Sequential screenings improve prediction in obstructive sleep apnoea severity

2024-12-30T12:57:39+00:00

Objectives: Sleep apnoea syndrome (SAS) poses serious health risks and requires Polysomnography (PSG) for diagnosis. Due to PSG’s labour-intensive process and long waiting times, there’s a need for predictive models to prioritize severe SAS cases for early PSG.

Methods: We retrospectively reviewed PSG cases from the University Malaya Medical Centre’s ENT clinic (January-December 2023). Data included demographics, anthropometrics, sleep patterns, STOP-BANG questionnaire, Epworth Sleepiness Scale (ESS), and upper airway assessments, analysed for their relationship with AHI. All variables that exhibited statistical significance were categorised into two sets of combined variables: Clinical Examination Score (CES) and ENT Examination Score (EES).

Results: We studied 201 cases, with an average age of 47.8±15.4 years (range: 16–89). Of these, 125 (62.2%) were male, with a mean AHI of 49.0±33.5. Severe sleep apnoea (AHI≥30) was diagnosed in 127 (63.2%) cases. Significant differences in AHI (p<0.05) were found based on gender, snoring, apnoea, nocturia, drooling, BMI>35kg/m², neck circumference > 40cm, Q1 of ESS (r=0.17), Q3 of ESS (r=0.23), Q6 of ESS (r=0.17), total ESS score (r=0.20), Modified Mallampati (r=0.26), Palatine Tonsil grade (r=0.27), Retropalatal grade (r=0.29), and Retrolingual grade (r=0.29). Hierarchical Multiple Regression analysis explained 33.0% of the variance in AHI, F(12,188)=7.2, p<0.01. CES had the highest correlation with AHI (R=0.475) and AUC (0.735) in ROC analysis, showing high sensitivity (82.7%) and moderate specificity (50.0%); combined with EES, specificity improved to 72.5%.

Conclusion: The CES and EES help prioritize moderate and severe OSA patients for early diagnosis and treatment. This reduces complications, eases healthcare workload, and shortens diagnostic wait times.

Evaluation of the effect of polysomnography sleep variables on the development of morning headaches in obstructive sleep apnea syndrome

2024-12-03T01:59:07+00:00

Background & Objective: This study aimed to investigate the relationship between sleep variables in patients with obstructive sleep apnea syndrome (OSAS) with associated morning headaches and to determine the characteristic features of these headaches.

Methods: Among the 546 patients evaluated in the sleep laboratory, 154 individuals who were not diagnosed as having OSAS were excluded from the study. Sleep variables of 160 patients with morning headache and 232 patients without morning headache were compared.

Results: The mean Epworth Sleepiness Scale (ESS) scores (12.17±5.71) (p<0.001), mean Apnea-Hypnea Index (AHI) (36.48±24.47) (p=0.019), mean AHI during rapid eye movement (REM) sleep (AHI-REM) (37.45±28.83), and mean Oxygen Desaturation Index (ODI) (52.36±30.96) (p=0.015) were significantly higher in patients with morning headaches. The mean oxygen saturation (SpO2) of patients with headaches was (89.83±4.62) (p=0.038), and their mean lowest SpO2 (70.37±14.87) was significantly lower (p=0.049). It was observed that 87.5% of the patients with morning headaches had bilateral pain, 60% had mild pain, 65% had pain lasting 2 to 3 hours, and 72% had oppressive-compressive pain, 68% had a frequency of attacks of 5 to 15 per month, and 70% had no additional neurological symptom.

Conclusions: Our results suggest that the AHI is significantly increased during REM sleep in patients with OSAS with morning headaches. This suggests that the pathogenesis of headaches is due to the effects of apnea during REM sleep. Moreover, the fact that the ODI was higher, and oxygen saturations were lower in the headache group emphasizes that hypoxia should be considered in the pathophysiologic process.

Exploring coping mechanisms among traumatic brain injury survivors: A phenomenological study

2024-12-02T16:05:04+00:00

Objective: The goal of this study was to investigate and comprehend the coping strategies used by traumatic brain injury (TBI) survivors to adjust to the changes that occur after the injury in an Asian rehabilitation set up.

Methods: The study used a qualitative phenomenological design. Twenty participants, including TBI survivors and their family members, were recruited using purposive sampling. In-depth semi-structured interviews were used to gather data, and thematic analysis was used for analysis.

Results: Twenty participants were interviewed, 16 were TBI survivors, 6 were relatives of the survivors. Two primary themes emerged: emotion-focused coping (e.g., seeking social support, religious practices) and problem-focused coping (e.g., physical aids, behavioural modifications). The individuals’ reactions to the changes and difficulties they faced were reflected in these coping mechanisms.

Conclusion: The integration of religious and spiritual coping strategies in the rehabilitation phase is particularly important in a cohort of Asian TBI survivors.

Effect of amantadine in comatose patients: Traumatic brain injury versus post-cardiac resuscitation syndrome

2024-11-10T03:07:45+00:00

Background & Objective: Amantadine is considered to be effective in facilitating awakening from a coma both after traumatic brain injury (TBI) and following the return of spontaneous circulation (ROSC) after cardiac arrest. The aim of this study is to share our observations of TBI and ROSC patients in the intensive care unit (ICU) who were administered amantadine to enhance wakefulness.

Methods: This retrospective study involved patients treated in a tertiary ICU. The patients were divided into two groups: TBI group and ROSC group. Demographic data such as age, gender, reason for hospital admission, and comorbidities were recorded. The outcomes assessed included length of ICU stay, duration of hospital stay, mortality rates, and discharge rates.

Results: TBI group had a mortality rate of 23.4% and a survival rate of 76.6%, while the ROSC group had a mortality rate of 46.4% and a survival rate of 53.6%, with TBI group experiencing significantly better outcomes. Regarding patients’ GCS scores at the start and end of amantadine treatment, in TBI group, the average GCS was 5.7 on the first day and 9 on the last day of treatment (p <0.001). In ROSC group, the average GCS was 5 on the first day and 7.1 on the last day of treatment (p <0.001). These changes were found to be statistically significant.

Conclusion: This study demonstrated that amantadine treatment effectively improved GCS scores in both TBI and ROSC patients. However, this study also showed that TBI patients experienced better outcomes than ROSC patients.

A case of anterior cerebral artery infarction stemming from arterial dissection was observed in a pregnant COVID-19 patient

2024-10-13T12:12:32+00:00

A 34-year-old pregnant woman at 18 weeks gestation presented with left hemiparesis and speech difficulties following a COVID-19 infection. Neuroimaging revealed acute infarcts in the right anterior cerebral artery (ACA) territory with subtle subarachnoid hemorrhage. Follow-up imaging confirmed right ACA dissection. The patient's medical history included diabetes, hypertension, and previous pre-eclampsia. Strict blood pressure management and intensive physical therapy led to improved neurological outcomes. This case highlights the potential link between COVID-19 infection, arterial dissection, and stroke risk in pregnant patients with pre-existing vascular risk factors. It underscores the importance of rigorous blood pressure control and infection management during pregnancy, especially in the context of COVID-19.

Cryptic clues: Hemichorea, hypersomnolence, and bilateral thalamic pulvinar calcification in cryptococcal meningoencephalitis

2025-01-06T07:31:30+00:00

Cryptococcal meningoencephalitis (CME) is a severe fungal infection which although common, is challenging to identify in its early stages particularly in resource limited settings. This case report aims to enhance clinicians’ ability to recognise atypical signs of CME, facilitating early diagnosis and treatment. We report here a 63-year-old male with an atypical presentation of CME including subacute hemichorea which eventually became generalised; hypersomnolence, and bilateral pulvinar calcifications. Initial misinterpretation of these findings led to a delay in diagnosis. Despite receiving appropriate treatment, the patient ultimately succumbed to the infection. In conclusion, this case highlights the diagnostic challenges in CME, particularly in patients without classical symptoms like fever or headache. Additionally, it also highlights the potential link between pulvinar calcifications and CME, emphasising the need for further investigation into the potential role of this sign as a diagnostic clue.

Unusual presentations of Creutzfeldt-Jakob disease: A case series and literature review

2025-03-17T12:29:23+00:00

Transmissible spongiform encephalopathies are uncommon neurodegenerative diseases caused by misfolded prion protein deposition. Creutzfeldt-Jakob disease (CJD), the commonest human spongiform encephalopathy, has an average survival of 5 months. Common presenting symptoms are rapid cognitive decline, psychiatric disturbances, cerebellar ataxia, visual deficits, and movement disorders including myoclonus and parkinsonism. CJD may also present in atypical and nonspecific ways, hampering diagnosis. We present 3 pathologically verified cases with unusual onset and a review of recent literature on early clinical features of CJD. MRI and CSF biomarkers are generally less sensitive in patients with atypical presentations, and in such cases the disease course may be longer than in typical CJD.

First presentation of multiple sclerosis: eight and a half plus syndrome

2025-03-07T12:56:18+00:00

Isolated cranial nerve palsy as the first clinical relapse in multiple sclerosis is very rare. In multiple involvement, the abducens and facial nerve are most commonly affected together. Herein, we report a newly diagnosed case of multiple sclerosis presenting as eight and a half plus syndrome, which is very rare and involving the facial colliculus and its neighbourhood as the first clinical relapse.

Factors affecting aquaporin-4 and its regulatory mechanisms in Alzheimer’s disease

2024-12-02T16:03:52+00:00

Alzheimer’s disease (AD) is a common neurodegenerative disorder, with its core pathological features being the excessive deposition of amyloid-beta (Aβ) protein and the abnormal phosphorylation of tau protein. This review introduces the crucial role of aquaporin-4 (AQP4) in AD, particularly in the glymphatic system, where it facilitates the clearance of Aβ and other metabolic waste. It describes the structure and function of AQP4, its involvement in AD, and the factors affecting it, including Aβ, tau protein, glutamate transporters, adenosine, exercise, sleep, and diet. The article reviews the relationship between the loss of AQP4 polarity and the reduced efficiency of Aβ clearance and summarizes potential therapeutic strategies to restore AQP4 polarity to enhance waste clearance. The authors point out that AQP4 holds great potential as a therapeutic target for AD, propose the possibility of restoring AQP4 function through drug interventions and lifestyle adjustments, and suggest that further research into AQP4 regulatory mechanisms will provide new directions and insights for the prevention and treatment of AD.