半岛投注体育官网最近的神经学问题 http://n.半岛投注体育官网neurology.org 半岛投注体育官网神经病学RSS提要——最近的问题 1526 - 632 x 半岛投注体育官网 0028 - 3878 半岛投注体育官网 http://n.半岛投注体育官网neurology.org/icons/banner/title.gifhttp://n.半岛投注体育官网neurology.org < ![CDATA[急性缺血性中风:不要跳过溶栓前转移血栓切除术]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/643?rss=1 < p >静脉溶栓(溶)合格的标准治疗急性缺血性中风患者(AIS)出版以来国家神经疾病和中风研究所1995年重组组织纤溶酶原激活物试验。当血管内血栓切除术(EVT)被证明是有益的治疗AIS的二级大血管闭塞(LVO),这提高了问题的病人前往EVT是否应该继续治疗与诊断。作为诊断和当时的护理标准,关键试验显示EVT进行,大部分的患者纳入研究EVT之前获得早期诊断。过去2年,4个随机临床试验的相对有效性和安全性评估EVT独自vs溶前EVT在病人中心提供EVT的能力。两种试验遇到他们预定的阈值的非EVT相比联合诊断和EVT <一口> 1,2 < /一口>和2试验不符合他们的非阈值。<一口> 3、4 < /一口> < / p > 克罗宁,c。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206841 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206841 美国神经病学学会半岛投注体育官网 所有脑血管疾病/中风 急性缺血性中风:不要跳过溶栓前转移血栓切除术 2023-04-04 社论 One hundred. 14 643年 644年 hw_mjid:半岛投注体育官网神经病学;100/14/643 < ![CDATA[不良妊娠结局和偏头痛:我们知道我们能做什么]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/645?rss=1 < p >偏头痛头痛和定义的是一种神经系统疾病袭击nonheadache症状。1 It is common, with the highest 3-month prevalence (23.5%) being in women 18–44 years old.2 For them, migraine is also the number 1 cause of disability.3 Pregnancy is a major health and life event with peak birth rates in women of this same age.4 Migraine may affect women's choices to become pregnant, with 20% avoiding pregnancy because they fear that migraine may worsen during pregnancy, make the pregnancy more difficult, or have negative effects on their child.5 Patients are recognizing the intersection of migraine and pregnancy and have concerns. Clinicians need to be informed and ready to respond.

VanderPluym, j . H。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207089 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000207089 美国神经病学学会半岛投注体育官网 偏头痛,队列研究 不良妊娠结局和偏头痛:我们知道我们能做什么 2023-04-04 社论 One hundred. 14 645年 646年 hw_mjid:半岛投注体育官网神经病学;100/14/645
< ![CDATA[生物性别差异与中风危险因素和结果住院成年人在卢萨卡,赞比亚]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/666?rss=1 <秒> <圣>目标< /圣> < p >我们研究性别差异在临床特点和结果与中风住院成年人在赞比亚。< / p > < /秒>Methods

We retrospectively collected information for 324 consecutively hospitalized adults with stroke on the neurology service at the University Teaching Hospital in Lusaka, Zambia, between October 2018 and March 2019. Stroke characteristics were then compared by biological sex.

Results

Female participants constituted 62% (n = 200) of the cohort, were older (61 ± 19 vs 57 ± 16 years, p = 0.06), had fewer hemorrhagic stroke than male participants (22% vs 37%, p = 0.001), and had higher rates of hypertension (84% vs 74%, p = 0.04), diabetes (19% vs 13%, p = 0.04), heart disease (38% vs 27%, p = 0.04), and history of stroke (26% vs 14%, p = 0.01). Male participants had higher rates of alcohol (33% vs 4%, p < 0.001) and tobacco (19% vs 2%, p < 0.001) use. Female participants were less likely to have neuroimaging completed during their hospitalization (82% vs 94%, p = 0.002) and had higher 90 days postdischarge mortality (28% vs 10%, p = 0.002) independent of age and stroke subtype (OR 2.48, 95% CI 1.1–5.58, p = 0.03).

Discussion

Female participants in this Zambian stroke cohort had a higher prevalence of vascular risk factors but were less likely to have neuroimaging completed. Postdischarge mortality was markedly higher among female participants even after adjusting for age and stroke subtype. Our data highlight the need for future studies of social and socioeconomic factors that may influence stroke-related outcomes.

Nutakki,。Chomba, M。、Chishimba l . C。Zimba年代。戈特斯曼,r F。Bahouth, m . N。、塞勒、d R。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201696 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201696 美国神经病学学会半岛投注体育官网 包容、多样性、股本、反种族主义和社会公正(想法) 生物性别差异与中风危险因素和结果住院成年人在卢萨卡,赞比亚 2023-04-04 临床/科学报告 One hundred. 14 666年 669年 hw_mjid:半岛投注体育官网神经病学;100/14/666
< ![CDATA[复杂猴痘感染患者治疗多发性硬化和Fingolimod]] > http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/670?rss=1 < p >一个46岁的人与控制复发缓和多发性硬化(MS)和长期fingolimod治疗开发多个痛苦的皮肤损伤(图一)。门诊皮肤拭子透露猴痘病毒感染。没有检测到发烧,但是这种疾病被延长皮肤的复杂,当然口头和肛周的表现,直肠炎(图B),消化道出血和输血的必要性,小腿蜂窝织炎(图C),淋巴结病、高胆红素血。此外,病人急性尿潴留和血尿。< / p > Müller-Jensen, L., Kriedemann, H., Anvari, K., Huehnchen, P., Siffrin, V. 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206743 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206743 美国神经病学学会半岛投注体育官网 所有感染,临床神经病学、多发性硬化症半岛投注体育官网 复杂的猴痘感染多发性硬化症患者和Fingolimod的治疗 2023-04-04 科学杂志 One hundred. 14 670年 671年 hw_mjid:半岛投注体育官网神经病学;100/14/670 < ![CDATA [NEXMIF癫痫:进行性肌阵挛的另一个原因]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/672?rss=1 < p >一个8岁男孩与广义肌阵挛癫痫紧随其后进步认知衰退出现恶化肌阵挛尽管clobazam符合规定。动作(视频1)与认知状态恶化随着时间的推移是进行性肌阵挛癫痫有关。最初的脑电图捕获肌阵挛性发作频繁寿命与棘波活动(图)。隔夜脑电图显示正常的睡眠结构。他与丙戊酸负载发作停止。基因测试显示一个杂合的致病性变异<我> NEXMIF < / I > (c.2478_2479dup),这是与<我> NEXMIF < / I >脑病。<我> NEXMIF < / I >脑病特征是轻微到严重智力障碍,包括肌阵挛性发作、失神发作,清音的发作。<一口> 1 < /一口> < / p > 切尔尼,l·E。、Nordli d R。•F。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201722 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201722 美国神经病学学会半岛投注体育官网 肌阵挛;看到运动障碍/肌阵挛 NEXMIF癫痫:进行性肌阵挛的另一个原因 2023-04-04 视频的实验 One hundred. 14 672年 673年 hw_mjid:半岛投注体育官网神经病学;100/14/672 < ![CDATA[临床推理:一个23岁的男人进步不对称无力和麻木]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/674?rss=1 < p >我们报告的一个23岁的人看到进步的不对称在他的远端肢体无力和麻木4个月,最初的症状开始几天后冠状病毒2019 (COVID-19)疫苗助推器。最初的神经系统检查是值得注意的的上层和下肢远端弱点更加明显在左边,完成无反射,减少远端感觉针刺和振动没有本体感受的损失。Nerve conduction studies demonstrated a generalized, non–length-dependent, sensorimotor, demyelinating polyneuropathy, with conduction block seen in multiple compound muscle action potentials. Sensory nerve action potentials were normal in absolute terms but had asymmetric amplitudes.

Based on the patient's nerve conduction studies, he was diagnosed with a specific immune-mediated neuromuscular disorder. He was started on intravenous immunoglobulin, but within days of the first infusions experienced a rare and potentially life-threatening complication. He received appropriate treatment and was started on alternative immunotherapy, after which his symptoms improved.

Our case exemplifies the features of a specific subtype of a more common immune-mediated neuromuscular diagnosis with unique elements of history, examination, and nerve conduction studies that required interpretation in the clinical context. We also discuss a rare side effect of a commonly used immunotherapy and its risk factors and comment on the likelihood that this diagnosis may be related to a preceding COVID-19 vaccine booster.

卡普兰,e . H。Torabian, K。爱德华兹,c V。Kaku, m . C。Anand, P。刘,k h V。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206773 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206773 美国神经病学学会半岛投注体育官网 所有免疫学、慢性炎性脱髓鞘多神经病,肌电图 临床推理:一个23岁的男人进步不对称的无力和麻木 2023-04-04 RESIDENT &amp; FELLOW SECTION One hundred. 14 674年 682年 hw_mjid:半岛投注体育官网神经病学;100/14/674
< ![CDATA[教学实验:发作的撅嘴与焦皮质发育不良和额叶癫痫立体深度电极EEG]] > http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/683?rss=1 < p > 65岁的老人出现慢性癫痫耐药。视频脑电图监测显示与发作的癫痫展现撅嘴或者“帽子de宪兵”的迹象。MRI显示焦点在正确的额叶皮质发育不良(图1)。Stereotactic depth electrode EEG (stereo-EEG) showed seizures originating within a cortical sulcus of the right caudal middle frontal gyrus (Figures 1, B–D, and 2). The patient became seizure-free after resection of the seizure onset zone and surrounding area of cortical dysplasia and remains so 9 months after surgery. Ictal pouting has been described as a sign of seizures originating in the frontal lobe, especially in the anterior cingulate1 or anterior insular cortices,2 areas uninvolved in our patient's seizures. Awareness that other frontal lobe areas are part of a common network underlying ictal pouting may be important for interpretation of neuroimaging modalities such as ictal single-photon emission computerized tomography, PET, and magnetoencephalography and for stereo-EEG planning, especially in MRI-negative cases.

品牌,P。Wennberg, R。安德拉德,d . M。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206760 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206760 美国神经病学学会半岛投注体育官网 所有癫痫/发作、脑电图癫痫监控、颅内电极,病灶 教学实验:发作的撅嘴与焦皮质发育不良和额叶癫痫立体深度电极脑电图 2023-04-04 RESIDENT &amp; FELLOW SECTION One hundred. 14 683年 684年 hw_mjid:半岛投注体育官网神经病学;100/14/683
< ![CDATA[教学视频杂志:反向眼摆动呈现特征的脑干海绵状瘤]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/685?rss=1 < p >一个21岁的男人面对oscilopsia,重复的眼睛闪烁,和头痛的20天。他完整的愿景与正常瞳孔反应。虽然水平和垂直凝视完好无损,有异常的共轭垂直运动快速上升阶段之后,缓慢回到midposition暗示逆转眼部摆动(视频1)。出现在四面八方的目光来回摆动,与synkinetic盖动作。成像表明背桥的海绵状瘤(图)。病人选择放射治疗。Omnipause神经背侧脑桥tonically抑制吻侧间隙核内侧纵束破裂神经元(中心垂直跳阅)也间接刺激subnucleus提肌。<一口> 1 < /一口> omnipause神经元损伤或连接可能会导致反向眼摆动synkinetic盖子的动作。不同于眼部摆动,冷漠的水平的目光是完整的,因为靠近中央的桥的网状结构。2 <一口> < / >共舞,有趣的是,反向眼摆动之前已经报道过的代谢脑病,但很少与结构损伤有关。< / p > 辛格,K。Salunke, P。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206756 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206756 美国神经病学学会半岛投注体育官网 所有临床神经学,所有Neu半岛投注体育官网ro-ophthalmology,本篇,振动幻视,所有的教育 教学视频的实验:反向眼摆动脑干海绵状瘤呈现的特点 2023-04-04 RESIDENT &amp; FELLOW SECTION One hundred. 14 685年 686年 hw_mjid:半岛投注体育官网神经病学;100/14/685 < ![CDATA[编者注:长期神经b细胞淋巴瘤患者的安全处理Anti-CD19嵌合抗原受体t细胞疗法]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/687?rss=1 < p >在“长期神经b细胞淋巴瘤患者的安全处理Anti-CD19嵌合抗原受体(汽车)t细胞疗法,“Ursu等人的报告,尽管19 11难治性淋巴瘤患者治疗后急性神经毒性与汽车t细胞疗法和0 19有认知能力的改变或MRI在治疗后2年。卡施尼亚等人注意这些结果必须被谨慎地考虑到小样本大小和缺乏额外的治疗车后t细胞疗法,尤其是考虑到其他数据证明长期视觉空间的认知和神经精神症状在治疗后t细胞疗法。相比之下,棕褐色等人赞扬这项研究方法和引用两个其他的研究类似的结果。讨论了未来的研究使用汽车t细胞疗法的重要性包括长期神经心理测试和一个更大的样本量。< / p > 刘易斯。、Galetta年代。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207208 hwp:资源id:神经病学;10半岛投注体育官网0/14/687 美国神经病学学会半岛投注体育官网 编者注:长期神经b细胞淋巴瘤患者的安全处理Anti-CD19嵌合抗原受体t细胞疗法 2023-04-04 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 14 687年 687年 hw_mjid:半岛投注体育官网神经病学;100/14/687 < ![CDATA[读者反应:长期神经b细胞淋巴瘤患者的安全处理Anti-CD19嵌合抗原受体t细胞疗法]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/687-a?rss=1 < p > Ursu et al。<一口> 1 < /一口>大纲缺乏神经认知赤字和减少焦虑的测量的前瞻性单中心研究淋巴瘤患者接受CD19-directed嵌合抗原受体(汽车)t细胞疗法。尽管汽车研究急性神经毒性t细胞疗法,延迟性认知功能障碍不是关键特征的临床试验。大约60%的汽车t细胞治疗患者出现急性神经症状在某种程度上,假设缺乏长期的后遗症会惊人的鼓励。< / p > 卡施尼亚,P。Rejeski, K。Subklewe, M。冯-鲍姆加滕,L。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207209 hwp:资源id:神经病学;10半岛投注体育官网0/14/687-a 美国神经病学学会半岛投注体育官网 自主神经疾病 读者反应:长期神经b细胞淋巴瘤患者的安全处理Anti-CD19嵌合抗原受体t细胞疗法 2023-04-04 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 14 687年 688年 hw_mjid:半岛投注体育官网神经病学;100/14/687-a < ![CDATA[读者反应:长期神经b细胞淋巴瘤患者的安全处理Anti-CD19嵌合抗原受体t细胞疗法]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/688?rss=1 < p >我们读这篇文章。<一口> 1 < /一口>长期神经sequalae和潜力,特别是认知障碍后车t细胞疗法治疗正在接受更大的关注日益增强的可用性和使用。< / p > Tan J.-W。陈,l l。、谭E.-K。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207210 hwp:资源id:神经病学;10半岛投注体育官网0/14/688 美国神经病学学会半岛投注体育官网 读者反应:长期神经b细胞淋巴瘤患者的安全处理Anti-CD19嵌合抗原受体t细胞疗法 2023-04-04 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 14 688年 688年 hw_mjid:半岛投注体育官网神经病学;100/14/688 < ![CDATA[静脉溶栓开始转移前中风血管内血栓切除术:系统回顾和荟萃分析]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1436?rss=1 <秒> <圣> < /圣> < p >背景和目标静脉溶栓的作用(溶)患者大血管遮挡(LVOs)管理转移之前从主中风研究中心(PSC)综合中风中心(CSC)质疑。< / p > < /秒> <秒> <圣> < /圣> < p >我们方法包括观察性研究的一个LVO患者接受溶在PSC前血管内血栓切除术(EVT)传输与接收EVT孤单。Efficacy outcomes included excellent or good functional outcomes (modified Rankin Scale [mRS] scores of 0–1 or 0–2, respectively) and reduced disability (mRS shift analysis) at 3 months. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 hours and 3-month all-cause mortality. Associations are reported with crude odds ratios (ORs) and adjusted ORs (aORs).

Results

We identified 6 studies, including 1,723 participants (mean age: 71 years, 51% women; 53% treated with IVT at a PSC). The mean onset-to-groin puncture time did not differ between the 2 groups (mean difference: –20 minutes, 95% CI –115.89 to 76.04). Patients receiving IVT before transfer had higher odds of 3-month reduced disability (common OR = 1.98, 95% CI 1.17–3.35), excellent (OR = 1.70, 95% CI 1.28–2.26), and good (OR = 1.62.95% CI 1.15–2.29) functional outcomes, with no increased sICH (OR = 0.87, 95% CI 0.54–1.39) or mortality (OR = 0.55, 95% CI 0.37–0.83) risks. In the adjusted analyses, patients receiving IVT at a PSC had higher odds of excellent functional outcome (aOR = 1.32, 95% CI 1.00–1.74) and a lower probability for mortality (aOR = 0.50, 95% CI 0.27–0.93).

Discussion

Patients with LVO receiving IVT at a PSC before an EVT transfer have a higher likelihood of excellent functional recovery and lower odds of mortality, with no increase in sICH and onset-to-groin puncture times, compared with those transferred for EVT without previously receiving IVT.

Katsanos, a . H。Sarraj,。Froehler, M。Purrucker, J。Goyal, N。Regenhardt, r·W。Palaiodimou, L。Mueller-Kronast, n . H。Lemmens, R。谢林,p D。焦点在于,S。Turc, G。Alexandrov, a . V。Tsivgoulis, G。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206784 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206784 美国神经病学学会半岛投注体育官网 所有脑血管疾病/中风 静脉溶栓开始之前转移中风血管内血栓切除术:系统回顾和荟萃分析 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1436 e1443 hw_mjid:半岛投注体育官网神经病学;100/14 / e1436
< ![CDATA[与年龄相关的缺血性中风的危险因素的作用差异]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1444?rss=1 <秒> <圣> < /圣> < p >背景和目标报告评估协会中风危险因素与事件中风通常假定一个统一的协会在年龄谱级一个假设我们评估报告。< / p > < /秒>Methods

Participants enrolled 2003–2007 in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study who were stroke free at baseline were followed for incident stroke. Associations of traditional stroke risk factors with incident stroke were assessed using (1) proportional hazards analysis based on the baseline age of the participant and (2) Poisson regression analysis assessing associations based on the changing age of the participant during their follow-up (age at exposure). In each analysis, age strata were selected to have a similar number of strokes in each stratum, specifically 45–64, 65–73, and 74+ years for the proportional hazards analysis and 45–69, 70–79, and 80+ years for Poisson regression.

Results

A total of 1,405 ischemic stroke events occurred among 28,235 participants over a median follow-up of 11.3 years, with a total of 276,074 person-years exposure. For both analytic approaches, the magnitude of the association with stroke was significantly less at older ages for diabetes (hazard or relative risk decreasing from 2.0 in younger strata to 1.3 in older strata), heart disease (from 2.0 to 1.3), and hypertension defined at a threshold of 140/90 mm Hg (from 1.80 to 1.50); however, there was no age-related difference in the magnitude of the association for smoking, atrial fibrillation, or left ventricular hypertrophy.

Discussion

Hypertension and diabetes are 2 of the more important risk factors for stroke; however, their association with stroke risk appears substantially less at older ages. That the magnitude of the association for smoking, atrial fibrillation, and left ventricular hypertrophy does not decrease with age suggests their relative importance in determining stroke risk likely increases with age.

霍华德,G。巴拿赫,M。,Kissela B。Cushman, M。Muntner, P。贾德,s E。霍华德,诉J。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206837 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206837 美国神经病学学会半岛投注体育官网 群组研究,梗塞 与年龄相关的差异在缺血性中风的危险因素的作用 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1444 e1453 hw_mjid:半岛投注体育官网神经病学;100/14 / e1444
< ![CDATA[过早心血管疾病和大脑健康中年:贲门研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1454?rss=1 Background and Objectives

To understand the role of premature (defined as ≤ 60 years) cardiovascular disease (CVD) in brain health earlier in life, we examined the associations of premature CVD with midlife cognition and white matter health.

Methods

We studied a prospective cohort in the Coronary Artery Risk Development in Young Adults study, who were 18–30 years at baseline (1985–1986) and followed up to 30 years when 5 cognitive tests measuring different domains were administered. A subset (656 participants) had brain MRI measures of white matter hyperintensity (WMH) and white matter integrity. A premature CVD event was adjudicated based on medical records of coronary heart disease, stroke/TIA, congestive heart failure, carotid artery disease, and peripheral artery disease. We conducted linear regression to determine the associations of nonfatal premature CVD with cognitive performance (z-standardized), cognitive decline, and MRI measures.

Results

Among 3,146 participants, the mean age (57% women and 48% Black) was 55.1 ± 3.6 years, with 5% (n = 147) having premature CVD. Adjusting for demographics, education, literacy, income, depressive symptoms, physical activity, diet, and APOE, premature CVD was associated with lower cognition in 4 of 5 domains: global cognition (–0.22, 95% CI –0.37 to –0.08), verbal memory (–0.28, 95% CI –0.44 to –0.12), processing speed (–0.46, 95% CI –0.62 to –0.31), and executive function (–0.38, 95% CI –0.55 to –0.22). Premature CVD was associated with greater WMH (total, temporal, and parietal lobes) and higher white matter mean diffusivity (total and temporal lobes) after adjustment for covariates. These associations remained significant after adjusting for cardiovascular risk factors (CVRFs) and excluding those with stroke/TIA. Premature CVD was also associated with accelerated cognitive decline over 5 years (adjusted OR 3.07, 95% CI 1.65–5.71).

Discussion

Premature CVD is associated with worse midlife cognition and white matter health, which is not entirely driven by stroke/TIA and even independent of CVRFs. Preventing CVD in early adulthood may delay the onset of cognitive decline and promote brain health over the life course.

江,X。刘易斯,c, E。艾伦:B。西德尼·S。Yaffe, K。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206825 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206825 美国神经病学学会半岛投注体育官网 心脏磁共振成像;看到脑血管疾病/心脏,认知老化,队列研究 在中年过早心血管疾病和大脑健康:贲门研究 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1454 e1463 hw_mjid:半岛投注体育官网神经病学;100/14 / e1454
< ![CDATA[孕前偏头痛、偏头痛表型和不良妊娠结局的风险]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1464?rss=1 <秒> <圣>背景和客观的< /圣> < p >偏头痛是一种非常普遍的神经与血管的紊乱生殖期的女性之一。偏头痛的历史和偏头痛表型是否作为临床产科风险的有用的标记不清楚。本研究的主要目的是检查协会孕前偏头痛和偏头痛表型与不良妊娠结局的风险。< / p > < /秒>Methods

We estimated associations of self-reported physician-diagnosed migraine and migraine phenotype with adverse pregnancy outcomes in the prospective Nurses' Health Study II (1989–2009). Log-binomial and log-Poisson models with generalized estimating equations were used to estimate relative risks (RRs) and 95% CIs for gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension, preterm delivery, and low birthweight.

Results

The analysis included 30,555 incident pregnancies after cohort enrollment among 19,694 participants without a history of cardiovascular disease, diabetes, or cancer. After adjusting for age, adiposity, and other health and behavioral factors, prepregnancy migraine (11%) was associated with higher risks of preterm delivery (RR = 1.17; 95% CI = 1.05–1.30), gestational hypertension (RR = 1.28; 95% CI = 1.11–1.48), and preeclampsia (RR = 1.40; 95% CI = 1.19–1.65) compared with no migraine. Migraine was not associated with low birthweight (RR = 0.99; 95% CI = 0.85–1.16) or GDM (RR = 1.05; 95% CI = 0.91–1.22). Risk of preeclampsia was somewhat higher among participants with migraine with aura (RR vs no migraine = 1.51; 95% CI = 1.22–1.88) than migraine without aura (RR vs no migraine = 1.30; 95% CI = 1.04–1.61; p-heterogeneity = 0.32), whereas other outcomes were similar by migraine phenotype. Participants with migraine who reported regular prepregnancy aspirin use had lower risks of preterm delivery (<2x/week RR = 1.24; 95% CI = 1.11–1.38; ≥2x/week RR = 0.55; 95% CI = 0.35–0.86; p-interaction < 0.01) and preeclampsia (<2x/week RR = 1.48; 95% CI = 1.25–1.75; ≥2x/week RR = 1.10; 95% CI = 0.62–1.96; p-interaction = 0.39); however, power for these stratified analyses was limited.

Discussion

Migraine history, and to a lesser extent migraine phenotype, appear to be important considerations in obstetric risk assessment and management. Future research should determine whether aspirin prophylaxis may be beneficial for preventing adverse pregnancy outcomes among pregnant individuals with a history of migraine.

Purdue-Smithe, a . C。、斯图亚特·J·J。、Farland l . V。康,j . H。,Harriott a . M。瑞奇爱德华j·W。Rexrode, K。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206831 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206831 美国神经病学学会半岛投注体育官网 偏头痛流行病学队列研究、风险因素 孕前偏头痛、偏头痛表型和不良妊娠结局的风险 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1464 e1473 hw_mjid:半岛投注体育官网神经病学;100/14 / e1464
< ![CDATA[雌激素受体基因、认知能力下降和阿尔茨海默病]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1474?rss=1 <秒> <圣> < /圣> < p >背景和目标一生阿尔茨海默病(AD)痴呆的风险有两个高与男性相比,女性在绝经后期和低雌激素水平被认为是一个可能的因素。我们检查了3 ER <我> < / I >(<我> GPER1 < / I >, <我> ER2 < / I >,和<我> ER1 < / I >)变异与广告特征作为一个间接法测试女性雌激素和广告之间的关系。尽管研究重点是女性,在比较中,我们分别研究了ER <我> < / I >分子变异人。< / p > < /秒>Methods

Participants were followed for an average of 10 years in one of the 2 longitudinal clinical pathologic studies of aging. Global cognition was assessed using a composite score derived from 19 neuropsychological tests' scores. Postmortem pathologic assessment included examination of 3 AD (amyloid-β and tau tangles determined by immunohistochemistry, and a global AD pathology score derived from diffuse and neurotic plaques and neurofibrillary tangle count) and 8 non-AD pathology indices. ER molecular genomic variants included genotyping and examining ER DNA methylation and RNA expression in brain regions including the dorsolateral prefrontal cortex (DLPFC) that are major players in cognition and often have AD pathology.

Results

The mean age of women (N = 1711) at baseline was 78.0 (SD = 7.7) years. In women, GPER1 molecular variants had the most consistent associations with AD traits. GPER1 DNA methylation was associated with cognitive decline, tau tangle density, and global AD pathology score. GPER1 RNA expression in DLPFC was related to cognitive decline and tau tangle density. Other associations included associations of ER2 and ER1 sequence variants and DNA methylation with cognition. RNA expressions in DLPFC of genes involved in signaling mechanisms of activated ERs were also associated with cognitive decline and tau tangle density in women. In men (N = 651, average age at baseline: 77.4 [SD = 7.3]), there were less robust associations between ER molecular genomic variants and AD cognitive and pathologic traits. No consistent association was seen between ER molecular genomic variations and non-AD pathologies in either of the sexes.

Discussion

ER DNA methylation and RNA expression, and to some extent ER polymorphisms, were associated with AD cognitive and pathologic traits in women, and to a lesser extent in men.

Oveisgharan, S。杨,J。Yu, L。Burba D。砰的一声,W。、Tasaki年代。,,格罗斯坦医生说F。王,Y。赵,J。De Jager p L。,施耐德,j .。班尼特,d。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206833 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206833 美国神经病学学会半岛投注体育官网 阿尔茨海默病,基因表达研究,包容、多样性、股本、反种族主义、和社会正义(想法),队列研究 雌激素受体基因,认知能力下降,阿尔茨海默病 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1474 e1487 hw_mjid:半岛投注体育官网神经病学;100/14 / e1474
< ![CDATA[抗癫痫药物三联疗法的有效性与难治性癫痫神经胶质瘤患者:一项观察性队列研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1488?rss=1 <秒> <圣> < /圣> < p >背景和目标大约10%的神经胶质瘤患者癫痫需要抗癫痫药物(ASM)三联疗法由于难治性癫痫。本研究的目的是评估是否levetiracetam结合丙戊酸和clobazam (LEV + VPA + CLB),经常开三联疗法,有良好的效果相比其他三联疗法组合神经胶质瘤患者。< / p > < /秒> <秒> <圣> < /圣> < p >方法这是一个多中心回顾性观察性队列研究。主要结果是时间的累积发生率治疗失败的原因,从一开始的ASM三联疗法治疗。二级结果包括累积发生率如下:(1)由于不受控制的癫痫治疗失败时间;(2)治疗失败时间由于副作用;和(3)反复发作的时间。随访的最大持续时间36个月。< / p > < /秒>Results

Of 1,435 patients in the original cohort, 90 patients received ASM triple therapy after second-line ASM treatment failure due to uncontrolled seizures. LEV + VPA + CLB was prescribed to 48% (43/90) and other ASM triple therapy to 52% (47/90) of patients. The cumulative incidence of treatment failure for any reason of LEV + VPA + CLB did not statistically significantly differ from that of other ASM triple therapy combinations (12 months: 47% [95% CI 31%–62%] vs 42% [95% CI 27%–56%], p = 0.892). No statistically significant differences for treatment failure due to uncontrolled seizures (12 months: 12% [95% CI 4%–25%] vs 18% [95% CI 8%–30%], p = 0.445), adverse effects (12 months: 22% [95% CI 11%–36%] vs 15% [95% CI 7%–27%], p = 0.446), or recurrent seizures (1 month: 65% [95% CI 48%–78%] vs 63% [95% CI 47%–75%], p = 0.911) were found.

Discussion

LEV + VPA + CLB might show equivalent effectiveness compared with other ASM triple therapy combinations in patients with glioma.

Classification of Evidence

This study provides Class III evidence that for patients with glioma with refractory epilepsy on triple therapy ASMs, LEV + VPA + CLB demonstrated similar effectiveness and tolerability compared with other ASM triple therapy combinations.

范德梅尔先生,p . B。小说,L。Fiocco, M。Vos, m . J。Kouwenhoven, M . c . M。van den弯曲,m . J。Taphoorn, m·j·B。Koekkoek, j·a·F。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206852 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206852 美国神经病学学会半岛投注体育官网 原发性脑瘤,第三类,所有CBMRT /零假设,队列研究,抗癫痫药物 抗癫痫药物三联疗法的有效性与难治性癫痫神经胶质瘤患者:一项观察性队列研究 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1488 e1496 hw_mjid:半岛投注体育官网神经病学;100/14 / e1488
< ![CDATA[的自然病程和预后主要脊髓胶质母细胞瘤:一项全国性研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1497?rss=1 <秒> <圣> < /圣> < p >背景和目标主要脊髓胶质母细胞瘤(PsGBM)是极为罕见。戏剧性的神经恶化和由PsGBM使它特别禁用恶性肿瘤。因为它是一种罕见的和异构疾病,预后因素的评估仍然是有限的。< / p > < /秒>Methods

PsGBMs were identified from the French Brain Tumor Database and the Club de Neuro-Oncologie of the Société Francaise de Neurochirurgie retrospectively. Inclusion criteria were age 18 years or older at diagnosis, spinal location, histopathologic diagnosis of newly glioblastoma according to the 2016 World Health Organization classification, and surgical management between 2004 and 2016. Diagnosis was confirmed by a centralized neuropathologic review. The primary outcome was overall survival (OS). Therapeutic interventions and neurologic outcomes were also collected.

Results

Thirty-three patients with a histopathologically confirmed PsGBM (median age 50.9 years) were included (27 centers). The median OS was 13.1 months (range 2.5–23.7), and the median progression-free survival was 5.9 months (range 1.6–10.2). In multivariable analyses using Cox model, Eastern Cooperative Oncology Group (ECOG) performance status at 0–1 was the only independent predictor of longer OS (hazard ratio [HR] 0.13, 95% CI 0.02–0.801; p = 0.02), whereas a Karnofsky performance status (KPS) score <60 (HR 2.89, 95% CI 1.05–7.92; p = 0.03) and a cervical anatomical location (HR 4.14, 95% CI 1.32–12.98; p = 0.01) were independent predictors of shorter OS. The ambulatory status (Frankel D–E) (HR 0.38, 95% CI 0.07–1.985; p = 0.250) was not an independent prognostic factor, while the concomitant standard radiochemotherapy with temozolomide (Stupp protocol) (HR 0.35, 95% CI 0.118–1.05; p = 0.06) was at the limit of significance.

Discussion

Preoperative ECOG performance status, KPS score, and the location are independent predictors of OS of PsGBMs in adults. Further analyses are required to capture the survival benefit of concomitant standard radiochemotherapy with temozolomide.

麦洛,。,L.-M梗。,Mathon B。Joubert C。Picart, T。Jecko, V。Bauchet, L。伯纳德·F。卡斯特尔,X。Chenin, L。,厨师,联合。金刚砂,E。Figarella-Branger D。Gauchotte, G。Graillon, T。Jouvet,。Kalamarides, M。、Knafo年代。Lazard,。Lubrano, V。Mokhtari称,K。Rigau, V。, Roualdes, V., Rousseau, A., Seizeur, R., Uro-Coste, E., Voirin, J., Metellus, P., Pallud, J., Zemmoura, I., and the Medullary Glioblastoma study group 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206834 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206834 美国神经病学学会半岛投注体育官网 脊髓肿瘤 的自然病程和预后主要脊髓胶质母细胞瘤:一项全国性的研究 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1497 e1509 hw_mjid:半岛投注体育官网神经病学;100/14 / e1497
< ![CDATA[特点和运动员的缓慢复苏的结果体育脑震荡:保健协会的一项研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1510?rss=1 <秒> <圣> < /圣> < p >背景和目标一些运动员经历一个缓慢复苏后体育运动相关的脑震荡(SRC)。几乎没有达成什么是缓慢复苏,然而,患病率和最小数据,预测或预测。本研究的目标是应用一个实施缓慢复苏的定义和描述这些个人的预测和长期预测。< / p > < /秒> <秒> <圣> < /圣> < p >方法这是一个潜在的多点观察研究的大学生运动员。参与者进行了多通道评估季前赛和5 SRC后额外的时间点。时间从伤病开始回到玩进展(无症状的计算)和从伤病回到玩(RTP)复苏的主要标记。< / p > < /秒> <秒> <圣> < /圣> < p >一千七百五十一结果有脑震荡的男性和女性大学生运动员进行了研究。百分之八十的参与者达到无症状和/或RTP时间点由14天、24日分别。缓慢的复苏就定义为超过1或两种间隔(n = 399)。This group was statistically more likely to be female (41.1% vs 35.6%, p = 0.05), have higher initial postinjury SCAT symptom severity scores (mean [SD]: 36.6 [23.4] vs 25.4 [19.9], p < 0.001), lower postinjury Standardized Assessment of Concussion scores (mean [SD]:25.74 [2.98] vs 26.26 [2.85], p = 0.004), perform worse on the postinjury Balance Error Scoring System (mean [SD]: 17.8 [8.9] vs 15.9 [8.5], p < 0.01), have fewer assessments in the first 14 days after injury (mean [SD]: 48.8 [29.7] vs 67.9 [24.6], p < 0.01), and be injured in practice (70.7% vs 65.1%, p = 0.04). 77.6% of the slow recovery group returned to play within 60 days of injury, and 83.4% (n = 349) returned to play within 90 days of injury. Only 10.6% had not returned to play 6 months postinjury.

Discussion

This study suggests an overall favorable prognosis for slowly recovering athletes and provides data for athletes and medical teams to consider in calibrating RTP expectations and making decisions about medical disqualification vs ongoing engagement in their sport.

麦卡利斯特,t·W。、Broglio s P。Katz, b P。帕金斯,s M。LaPradd, M。周,W。麦克雷博士,m。代表脑震荡的评估、研究和教育(保健)财团 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206853 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206853 美国神经病学学会半岛投注体育官网 所有创伤,脑外伤 特点和运动员的缓慢复苏的结果体育脑震荡:保健协会的一项研究 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1510 e1519 hw_mjid:半岛投注体育官网神经病学;100/14 / e1510
< ![CDATA[剂量长期安全稳定,阿片类药物的功效不宁腿综合症患者在全国RLS阿片类药物注册]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/14/e1520?rss=1 <秒> <圣> < /圣> < p >背景和目标不宁腿综合症(RLS)是一种感觉神经障碍。低剂量的阿片类药物是耐火材料或增强RLS患者规定。长期安全、稳定剂量和疗效RLS的这些药物治疗仍不清楚。在这项研究中,我们报告2年期纵向数据样本RLS阿片类药物患者的社区。< / p > < /秒>Methods

The National RLS Opioid Registry is an observational longitudinal study consisting of individuals taking a prescribed opioid for diagnosed and confirmed RLS, most of whom experienced augmented symptoms from dopamine agonists. Information on opioid dosages, side effects, past and current concomitant RLS treatments, RLS severity, psychiatric symptoms, and opioid abuse risk factors was collected at initial Registry entry and every 6 months thereafter by surveys on REDCap. No feedback or intervention was provided by the study staff to local providers.

Results

Registry participants (n = 448) with 2-year longitudinal data available were mostly White, female, older than 60 years, and, at Registry entry, had been on opioids for a median of 1–3 years at a mean morphine milligram equivalent (MME) of 38.4 (SD = 43.5). No change in RLS severity in the overall cohort was observed over the 2-year follow-up period. The median change in daily opioid dose from baseline to 2 years was 0 MME (interquartile range = 0–10). While 41.1% of participants increased their dose during the follow-up period (median increase = 10 MME), 58.9% decreased their dose or saw no change. Only 8% and 4% saw increases of >25 MME and >50 MME, respectively. Ninety-five percent of those who increased opioid dose >25 or >50 MME had one of the following features: switching opioids, discontinuation of nonopioid RLS treatment medications, at least mild insomnia at baseline, a history of depression, male sex, younger than 45 years, and opioid use for comorbid pain.

Discussion

Low-dose opioid medications continue to adequately control symptoms of refractory RLS over 2 years of follow-up in most of the participants. A minority of patients did see larger dose increases, which were invariably associated with a limited number of factors, most notably changes in opioid and nonopioid RLS medications and opioid use for a non-RLS condition. Continued longitudinal observations will provide insight into the long-term safety and efficacy of opioid treatment of severe, augmented RLS.

Classification of Evidence

This study provides Class IV evidence that opioid doses increase in roughly 40% of patients, in most by small amounts, over a 2-year period when prescribed for adult refractory restless leg syndrome.

温克曼主持,j·W。在制品,B。Zackon, J。 2023 - 04 - 03 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206855 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206855 美国神经病学学会半岛投注体育官网 所有的运动障碍,临床试验观察研究(队列,病例对照),不宁腿综合症,鸦片,四级 剂量长期安全、稳定,阿片类药物的功效不宁腿综合症患者在全国RLS阿片类药物注册表 2023-04-04 半岛体育app苹果下载 One hundred. 14 e1520 e1528 hw_mjid:半岛投注体育官网神经病学;100/14 / e1520
< ![CDATA[生活质量措施代表病人在中风试验结果?]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/597?rss=1 < p >当代中风实践是建立在强大的临床试验的基础。临床试验设计的一个基本方面是选择适当的干预措施的效果,对域评估和成功的标准参数。选择正确的测量结果对试验的成功至关重要,需要考虑人口的实验干预的目标。在选择之间的潜在后果评估,实验必须考虑问题通用的所有试验,如死亡率或心理属性,中风和具体问题,包括评估的可行性。<一口> 1 < /一口>虽然有残疾的共识作为一个适当的结果在急性中风试验中,现有的尺度或定义成功的可能不是适合所有人群。< / p > 奎因,t·J。穆尔,k W。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206840 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206840 美国神经病学学会半岛投注体育官网 所有脑血管疾病/中风 在中风试验代表病人生活质量措施的结果吗? 2023-03-28 社论 One hundred. 13 597年 598年 hw_mjid:半岛投注体育官网神经病学;100/13/597 < ![CDATA[是可溶性ST2颅内出血的一种新型生物标志物?]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/599?rss=1 < p >脑出血(我)是最常见的出血性中风和死亡和残疾的风险高。<一口> 1 < /一口>虽然我从质量效应引起原发性脑损伤、脑实质破坏的二次损伤神经炎症在我发病机理中起着重要的作用。<一口> 2 < /一口>毒性因为血液成分,导致小胶质细胞的激活(住宅在中枢神经系统的免疫细胞和星形胶质细胞),渗透循环免疫细胞包括巨噬细胞和T细胞,随后,释放炎性细胞因子,趋化因子,自由基和其他潜在的有毒化学物质。<一口> 3 < /一口>这个炎症反应导致perihematomal水肿(检)形成通过增加血脑屏障(BBB)通透性血肿周围,反过来,在一个恶性循环,加剧了质量效应和增加细胞凋亡和招聘系统白细胞(包括先天和适应性免疫细胞),最终产生额外的脑组织inflammatory-related受伤。<一口> 2 < /一口>识别和表征的神经免疫相互作用参与板式换热器的形成不仅可以更好地理解病理生理学我也可能有重大的临床意义可靠的生物标志物和靶向治疗的发展。< / p > Nadareishvili, Z。还是,S。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206861 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206861 美国神经病学学会半岛投注体育官网 所有免疫学、脑血管疾病、中风,脑内出血 是可溶性ST2颅内出血的一种新型生物标志物吗? 2023-03-28 社论 One hundred. 13 599年 600年 hw_mjid:半岛投注体育官网神经病学;100/13/599 < ![CDATA[单边聚焦超声波Subthalamotomy帕金森病:长期疗效和安全性]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/601?rss=1 < p >选择最佳的治疗帕金森病(PD)患者对临床医生和病人可能是一个挑战。事实上,临床特征和PD表型、金融或经济问题,治疗特点和可用性和病人的选择极大地影响PD的管理。然而,最近的药物和技术进步扩大了阿森纳更好地管理先进的PD。<一口> 1 < /一口>高级PD,脑深部电刺激(DBS)的丘脑核(STN)和苍白球内肌治疗已经被证明是非常有效的运动迹象,包括电机波动和医学上反应迟钝的震颤。<一口> 1 < /一口>一些开放的研究也报道STN DBS的长期疗效,<一口> 2 < /一口>虽然改进的大小往往下降随着时间的推移,这可能反映了疾病的进展和nondopaminergic的参与途径。然而,DBS疗法仍然是一个复杂和侵入性疗法,它是提供给那些满足严格的入选标准(没有认知能力下降和手术禁忌症,levodopa-responsive迹象,相对年轻的年龄,等等)。此外,DBS疗法需要中心与高度专业化的多学科团队和经验在手术和后续护理(电池更换等)。<一口> 3 < /一口> < / p > 莫罗,E。、Romito l . M。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206896 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206896 美国神经病学学会半岛投注体育官网 帕金森病/震颤麻痹,所有的临床试验,四级 单方面的聚焦超声Subthalamotomy帕金森病:长期的有效性和安全性 2023-03-28 社论 One hundred. 13 601年 602年 hw_mjid:半岛投注体育官网神经病学;100/13/601 < ![CDATA[检测SARS-CoV-2核衣壳和大脑微血管疾病:病例报告]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/624?rss=1 <秒> <圣> < /圣> < p >背景和目标严重急性呼吸系统综合症冠状病毒2 (SARS-CoV-2)感染可引起广泛的神经系统并发症;然而,它在疾病的急性期neuropenetrance是未知的。< / p > < /秒>Methods

Extracellular vesicles were isolated from brain biopsy tissue from a patient undergoing epilepsy surgery using ultracentrifugation and analyzed by Western blot and qPCR for the presence of virus protein and RNA, respectively. Biopsy tissue was assessed by immunohistochemistry for the presence of microvascular damage and compared with 3 other non-COVID surgical epilepsy brain tissues.

Results

We demonstrate the presence of viral nucleocapsid protein in extracellular vesicles and microvascular disease in the brain of a patient undergoing epilepsy surgery shortly after SARS-CoV-2 infection. Endothelial cell activation was indicated by increased levels of platelet endothelial cell adhesion molecule-1 and was associated with fibrinogen leakage and immune cell infiltration in the biopsy tissue as compared with control non-COVID surgical epilepsy brain tissues.

Discussion

Despite the lack of evidence of viral replication within the brain, the presence of the nucleocapsid protein was associated with disease-specific endothelial cell activation, fibrinogen leakage, and immune cell infiltration.

DeMarino C。、李M.-H。考恩,M。施泰纳,j . P。、监督检验。沙,a . H。扎格卢勒,k。纳,。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000201682 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201682 美国神经病学学会半岛投注体育官网 COVID-19、癫痫手术 检测SARS-CoV-2核衣壳和大脑微血管疾病:一个案例报告 2023-03-28 临床/科学报告 One hundred. 13 624年 628年 hw_mjid:半岛投注体育官网神经病学;100/13/624
< ![CDATA[皮肤活检用于遗传弥漫性脑白质病的诊断与球状体]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/629?rss=1 < p >世袭弥漫性脑白质病与球状体(高密度脂蛋白)是一种罕见的中枢神经系统的脑白质营养不良。我们报告2例无关家庭与迟发性的高密度脂蛋白。患者1是一个50岁的女人发达模糊言语困难酱48和癫痫和尿失禁1年后。病人2是一个51岁的人口齿不清的10个月历史和认知能力下降。两个病人有几个脑磁共振成像研究显示持久的hyperintensities diffusion-weighted成像图像(图1)。这些成像发现引导我们进行基因测试。我们发现2 c的变体可能致病。2264T>C (p.Leu755Pro) (patient 1) and c.1957T>C (p.Cys653Arg) (patient 2) in the CSF1R gene. Skin biopsy revealed the characteristic swelling of unmyelinated axons (spheroids) (Figure 2). Although brain biopsy is the gold standard for the diagnosis of this condition,1 skin biopsy may be an effective and efficient alternative for diagnosing HDLS.

歌,C。吴,F。刘,Y。,吴X。赵,Y。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000201684 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201684 美国神经病学学会半岛投注体育官网 脑白质营养不良 皮肤活检用于遗传弥漫性脑白质病的诊断与球状体 2023-03-28 科学杂志 One hundred. 13 629年 630年 hw_mjid:半岛投注体育官网神经病学;100/13/629
< ![CDATA[临床推理:一名26岁的女性复发性疼痛,虚弱,和萎缩在双边上肢在妊娠期和产褥期]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/631?rss=1 < p >我们报告的情况下一个26岁的女人,反复发作的剧烈疼痛,虚弱,萎缩在她怀孕期间双边上肢和产褥期。她报道2类似的事件在5岁和10年,之后,她完全恢复。在考试,我们观察到显著萎缩与减少双边上肢肌肉力量。针肌电图(EMG)显示在她的双边上肢神经源性损害。病人的临床表现和辅助检查臂plexopathy建议。代谢和免疫因素可能发生在妊娠期和产褥期。我们也为多种筛选、肿瘤和遗传因素。最后,一种遗传性的疾病被认为是。这种情况下强调早期诊断的重要性,避免触发器。< / p > 曾,T.-f。丁,X。杨,D。、吴c c。谢,D.-D。、张W.-M。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000201705 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201705 美国神经病学学会半岛投注体育官网 临床神经学检查、周半岛投注体育官网围神经病变、神经性疼痛、肌电图、基因连锁 临床推理:一名26岁的女性复发性疼痛,虚弱,和萎缩在双边上肢在妊娠期和产褥期 2023-03-28 RESIDENT &amp; FELLOW SECTION One hundred. 13 631年 637年 hw_mjid:半岛投注体育官网神经病学;100/13/631 < ![CDATA[教学实验:Palmaris短签:线索本地化尺骨神经神经病]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/638?rss=1 < p > 65岁的人持续渗透的基础伤害小鱼际区从钻头。发现严重的弱点尺骨nerve-innervated内在手肌肉正常感觉数字4和5。试图绑架小指头对电阻引起的皱纹的皮肤萎缩palmaris短(图一)。< / p > 艾耶,诉G。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206751 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206751 美国神经病学学会半岛投注体育官网 临床神经学检查,周半岛投注体育官网围神经损伤 教学实验:Palmaris短签:线索本地化尺骨神经神经病变 2023-03-28 RESIDENT &amp; FELLOW SECTION One hundred. 13 638年 639年 hw_mjid:半岛投注体育官网神经病学;100/13/638 < ![CDATA[教学视频杂志:交替倾斜偏差的表现Anti-GAD65-Associated小脑炎]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/640?rss=1 < p >一名53岁妇女出现共济失调、构音障碍、垂直双眼复视左派和右派的目光的,但是却没有在主要的目光。她的症状是进步超过几个月没有明确煽动事件。初始neuro-ophthalmology评估显示微妙的悲观的眼球震颤在初级水平增加的目光注视,符合“大袋”现象。<一口> 1 < /一口> cross-cover测试,她发现有一个交替倾斜偏差(ASD),提高小脑本地化的问题(视频1)。多种病因导致自闭症包括自身免疫性、缺血性中风,和多种的实体。之前的结构成像是模糊的。Serum studies revealed elevated glutamic acid decarboxylase antibody (anti-GAD65) levels (>250.0 IU/mL, normal range 0–5.0 IU/mL). She was subsequently diagnosed with anti-GAD65 cerebellitis. The patient was not screened for a neoplasm because anti-GAD65 is rarely paraneoplastic in nature. Anti-GAD65 interferes with the production of GABA, thereby disrupting supranuclear pathways and has been associated with autoimmune epilepsy and stiff-person syndrome. Intravenous immunoglobulin may improve outcome.2

贝尔,C。德拉蒙德,p S。格罗斯曼,s . N。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206752 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206752 美国神经病学学会半岛投注体育官网 所有Neuro-ophthalmology,眼球震颤 教学视频的实验:交替倾斜偏差的表现Anti-GAD65-Associated小脑炎 2023-03-28 RESIDENT &amp; FELLOW SECTION One hundred. 13 640年 640年 hw_mjid:半岛投注体育官网神经病学;100/13/640
< ![CDATA[编者注:血管内和医疗管理与中风发作前的前后期大血管闭塞残疾:分析清晰和RESCUE-Japan]] > http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/641?rss=1 < p >博士。Siegler and colleagues evaluated outcomes of mechanical thrombectomy (MT) vs medical management in a multinational cohort of 554 patients with a prestroke modified Rankin Scale (mRS) score of 2–4 and anterior circulation large vessel occlusion, treated 6–24 hours from the time last seen well. They found that MT was associated with higher odds of return to prestroke mRS by 90 days. In response, Drs. Bruno and Nichols noted that there is no clear guidance for scoring a baseline or prestroke mRS (indeed, the mRS was originally intended for evaluating poststroke outcomes). They also contend that scoring a 90-day mRS in patients with prestroke disability is not clearly defined. Responding to these comments, the authors agree that the prestroke mRS has important limitations, but point to the fact that this measure has been used in various studies, including in the selection of patients for interventional stroke trials. They correctly note that current guidelines to score the poststroke mRS are intended simply to score how the patient is functioning at the time in question, rather than making judgments about how they are doing in relation to their prestroke status. Overall, this exchange demonstrates important nuances in the assessment of prestroke status and poststroke outcomes in patients with prestroke disability—a population that has been poorly represented in acute stroke trials.

Ganesh,。、Galetta年代。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000207196 hwp:资源id:神经病学;10半岛投注体育官网0/13/641 美国神经病学学会半岛投注体育官网 编者注:血管内和医疗管理与中风发作前的前后期大血管闭塞残疾:清晰和RESCUE-Japan分析 2023-03-28 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 13 641年 641年 hw_mjid:半岛投注体育官网神经病学;100/13/641
< ![CDATA[读者反应:血管内和医疗管理与中风发作前的前后期大血管闭塞残疾:分析清晰和RESCUE-Japan]] > http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/641-a?rss=1 < p >我们对这项研究由Siegler et al . <一口> 1 < /一口>分析机械血栓切除术的潜在好处在急性中风患者先前存在的障碍。我们想大纲的重要限制比较基线(预行程)和卒中后改良Rankin规模(夫人)分数。< / p > 布鲁诺,。尼科尔斯,f . T。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000207197 hwp:资源id:神经病学;10半岛投注体育官网0/13/641-a 美国神经病学学会半岛投注体育官网 读者反应:血管内和医疗管理与中风发作前的前后期大血管闭塞残疾:清晰和RESCUE-Japan分析 2023-03-28 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 13 641年 642年 hw_mjid:半岛投注体育官网神经病学;100/13/641-a < ![CDATA[作者回应:血管内和医疗管理与中风发作前的前后期大血管闭塞残疾:分析清晰和RESCUE-Japan]] > http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/642?rss=1 < p >我们感谢布鲁诺博士和尼科尔斯的深思熟虑的评论我们的清晰和RESCUE-Japan分析后期大血管闭塞的血管内治疗中风发作前的残疾。<一口> 1 < /一口> < / p > Siegler, j·E。内格尔,S。阮,t . N。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000207198 hwp:资源id:神经病学;10半岛投注体育官网0/13/642 美国神经病学学会半岛投注体育官网 作者回复:血管内和医疗管理与中风发作前的前后期大血管闭塞残疾:清晰、RESCUE-Japan分析 2023-03-28 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 13 642年 642年 hw_mjid:半岛投注体育官网神经病学;100/13/642 < ![CDATA [Patient-Reported障碍,解开神经赤字之间的关系和生活质量在缺血性中风后]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1321?rss=1 <秒> <圣> < /圣> < p >背景和目标EuroQol组5-Dimension自我报告的问卷(EQ-5D)是一种行之有效的工具来评估生活质量和健康状态病人的报告生成通用的效用值,来自公众的评估。我们假设语言问题和其他nonmotor赤字不是捕获以及电机赤字由这个系统。我们旨在量化禁用神经赤字之间的关系和EQ-5D维度分数和缺血性中风患者的效用的分数。< / p > < /秒> <秒> <圣> < /圣> < p >方法我们使用第三中风的介入管理试验的数据。由多个归责缺失数据估算。神经赤字之间的关系(个人NIH卒中量表(署)条目分数)和EQ-5D-3L(5三级维度得分和效用的分数)90天评估顺序逻辑回归和托比特书回归,分别。每个模型估计的方差解释Nagelkerke pseudo-R <一口> 2 < /一口>或R <一口> 2 < /一口>。< / p > < /秒> <秒> <圣> < /圣> < p >结果总共包括525幸存的患者。完整的数据在署和EQ-5D为481/525(91.6%)的患者。在90天,161/491(32.8%)患者失语和226/491(46.0%)的患者至少1肢体麻痹性痴呆。肢体麻痹性痴呆、面部瘫痪、感觉丧失、构音障碍解释大部分的方差在所有EQ-5D维度分数和效用的分数。In the utility score, 8.9% of the variance was explained by neglect, 10.0% by aphasia, 10.8% by hemianopia, and 17.5%–24.1% by limb paresis.

Discussion

The impact of neurologic deficits on the EQ-5D in patients with ischemic stroke is mostly due to limb paresis, while the EQ-5D is less sensitive to other nonmotor deficits such as hemianopia, aphasia, and neglect. This may lead to overestimation of quality of life and, consequently, underestimation of the (cost-)effectiveness of treatments and interventions.

Trial Registration Information

ClinicalTrials.gov. Unique identifier: NCT00359424.

范德·n·a . M。den Hartog, s . J。布罗德里克,j . P。Khatri, P。、Visser-Meily j . m。van Leeuwen, N。、Lingsma h F。,Roozenbeek B。因为,d . w . J。第三,IMS调查员 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206747 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206747 美国神经病学学会半岛投注体育官网 其他脑血管疾病/中风,临床试验方法/研究设计,梗塞 把神经赤字之间的联系,Patient-Reported障碍,缺血性中风后的生活质量 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1321 e1328 hw_mjid:半岛投注体育官网神经病学;100/13 / e1321
< ![CDATA[可溶性ST2协会与功能结果,Perihematomal水肿、和免疫反应后Intraparenchymal出血]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1329?rss=1 <秒> <圣> < /圣> < p >背景和目标Perihematomal水肿(检)有助于深intraparenchymal出血后的不良预后显著相关(IPH),特点是存在和大量的外围地派生的先天免疫细胞。我们之前确定可溶性ST2 (sST2)作为候选免疫介导的继发性脑损伤。利用前瞻性收集的军团从2中心,我们试图确定sST2与功能结果,板式换热器,IPH后的免疫反应。< / p > < /秒> <秒> <圣> < /圣> < p >方法深IPH患者登记在36小时内发作,和血液收集sST2和免疫细胞测量。测量血肿体积和板式换热器系列CT扫描。Good outcome was defined as a modified Rankin Scale score of 0–3 at 90 days. Linear mixed-effects models were used to analyze the relationship between sST2 and PHE over time. Flow cytometry was used to identify shifts in immune cell populations associated with sST2. Immunohistochemistry of human brain tissue was used to identify ST2-expressing cells in the perihematomal region.

Results

The 55 included patients had a median admission Glasgow Coma Scale score of 14 (interquartile range [IQR] 9–15), an intracerebral hemorrhage (ICH) score of 1 (IQR 1–2), and a hematoma volume of 8.6 mL (IQR 3.4–13.8 mL). Receiver operating curve analysis found the sST2 level to be predictive of poor outcome with an area under the curve of 0.763 (95% CI 0.632–0.894) and Youden optimum cut point of 61.8 ng/mL (p < 0.001). sST2 remained an independent predictor after adjustment for ICH score (adjusted odds ratio 2.53, 95% CI 1.03–6.19, p = 0.042). Measurement of PHE found those patients with high sST2 to have greater edema volume over time (β = 1.07, 95% CI 0.51–1.63, p < 0.001). High sST2 was associated with a shift toward an innate peripheral immune response (monocytes and natural killer cells; 68.6% ± 5.1% vs 47.5% ± 4.0%; p = 0.003).

Discussion

Our findings demonstrate that elevated sST2 links the peripheral innate immune response to PHE volume and outcome after IPH. This knowledge is relevant to future studies that seek to identify patients with IPH at highest risk for immune-mediated injury or limit injury through targeted interventions.

贝弗,m . B。Booraem C。李,K。Sreekrishnan,。即将,C。要求,g . J。Sheth, k . N。、sans、l . H。金伯利,w . T。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206764 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206764 美国神经病学学会半岛投注体育官网 CT,免疫学,队列研究,脑内出血 可溶性ST2协会与功能结果,Perihematomal水肿,Intraparenchymal出血后的免疫反应 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1329 e1338 hw_mjid:半岛投注体育官网神经病学;100/13 / e1329
< ![CDATA[支持自我管理项目对患有慢性头痛和偏头痛:随机对照试验和经济评价]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1339?rss=1 < <秒> <圣>背景和目标/圣> < p >慢性头痛疾患疼痛和残疾的主要原因。教育和支持自我管理方法可以减少头痛残疾的负担。我们测试了一组教育和支持的有效性为慢性头痛患者自我管理计划。< / p > < /秒> <秒> <圣> < /圣> < p >方法这是一个务实的随机对照试验。Participants were aged 18 years or older with chronic migraine or chronic tension–type headache, with or without medication overuse headache. We primarily recruited from general practices. Participants were assigned to either a 2-day group education and self-management program, a one-to-one nurse interview, and telephone support or to usual care plus relaxation material. The primary outcome was headache related-quality of life using the Headache Impact Test (HIT)-6 at 12 months. The primary analysis used intention-to-treat principles for participants with migraine and both baseline and 12-month HIT-6 data.

Results

Between April 2017 and March 2019, we randomized 736 participants. Because only 9 participants just had tension-type headache, our main analyses were on the 727 participants with migraine. Of them, 376 were allocated to the self-management intervention and 351 to usual care. Data from 586 (81%) participants were analyzed for primary outcome. There was no between-group difference in HIT-6 (adjusted mean difference = –0.3, 95% CI –1.23 to 0.67) or headache days (0.9, 95% CI –0.29 to 2.05) at 12 months. The Chronic Headache Education and Self-management Study intervention generated incremental adjusted costs of £268 (95% CI, £176–£377) (USD383 [95% CI USD252–USD539]) and incremental adjusted quality-adjusted life years (QALYs) of 0.031 (95% CI –0.005 to 0.063). The incremental cost-effectiveness ratio was £8,617 (USD12,322) per QALY gained.

Discussion

These findings conclusively show a lack of benefit for quality of life or monthly headache days from a brief group education and supportive self-management program for people living with chronic migraine or chronic tension–type headache with episodic migraine.

Trial Registration Information

Registered on the International Standard Randomized Controlled Trial Number registry, ISRCTN79708100 16th December 2015 doi.org/10.1186/ISRCTN79708100. The first enrollment was April 24, 2017.

Classification of Evidence

This study provides Class III evidence that a brief group education and self-management program does not increase the probability of improvement in headache-related quality of life in people with chronic migraine.

安德伍德,M。Achana F。,肉体,D。埃尔德里奇,S。、Ellard d R。格里菲思,F。海伍德,K。昭熙,s W。希金斯,H。Mistry D。Mistry, H。牛顿,S。尼科尔斯,V。诺曼,C。Padfield E。帕特尔,S。Petrou S。平卡斯,T。波特,R。Sandhu, H。斯图尔特,K。泰勒,s . j . C。Matharu, m . S。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000201518 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201518 美国神经病学学会半岛投注体育官网 偏头痛、紧张性头痛、随机对照临床试验协议(配偶),二类 支持为慢性头痛和偏头痛患者自我管理项目:一个随机对照试验和经济评价 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1339 e1352 hw_mjid:半岛投注体育官网神经病学;100/13 / e1339
< ![CDATA [Cross-Trait孟德尔随机化研究调查是否偏头痛是多发性硬化的一个危险因素]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1353?rss=1 <秒> <圣> < /圣> < p >背景和目标偏头痛是普遍患有多发性硬化症(MS),但原因不明。我们测试了3猜测这个观察疾病的机制,包括女士偏头痛是一个风险因素,基因变异之间共享的条件,和偏头痛是因为女士< / p > < /秒> <秒> <圣> < /圣> < p >方法数据来自两个来源:公开的汇总统计数据的全基因组关联研究(N = 115748)女士和偏头痛(N = 375752和N = 361141)和病例对照研究招募了女士的Kaiser Permanente北加州健康计划(N = 1991)。对于后者的参与者,偏头痛地位是确定使用电子健康记录偏头痛概率算法或自我报告进行验证。使用公共汇总统计数据,我们使用2-sample孟德尔随机化检验偏头痛遗传工具变量是否与我们使用连锁不平衡得分回归和LOGODetect女士确定女士和偏头痛共享整个基因组的遗传变异和区域。使用加州北部女士队列中,我们使用逻辑回归来确定人们是否女士和偏头痛有不同的临床特点的几率(如MS发病年龄,认为赤字问卷,和抑郁)或MS-specific危险因素(例如,身体质量指数、吸烟状况、和传染性单核细胞增多症状态)而女士没有偏头痛患者。< / p > < /秒> <秒> <圣> < /圣> < p >结果我们没有发现证据支持偏头痛女士作为因果的危险因素(p <我> < / I > = 0.29)。然而,我们确定4主要组织相容性复合体(MHC)基因座之间共享和偏头痛。群女士在加州北部,774年(39%)经历了偏头痛。People with both MS and migraine from this cohort were more likely to ever smoke (odds ratio [OR] = 1.30, 95% CI: 1.08–1.57), have worse self-reported cognitive deficits (OR = 1.04, 95% CI: 1.02–1.06), and ever experience depression (OR = 1.48, 95% CI: 1.22–1.80).

Discussion

Our findings do not support migraine as a causal risk factor of MS. Several genetic variants, particularly in the MHC, may account for some of the overlap. It seems likely that migraine within the context of MS is because of MS. Identifying what increases the risk of migraine within MS might lead to an improved treatment and quality of life.

霍顿,m K。,罗宾逊,s . C。邵,X。Quach, H。Quach D。,超,V。Bellesis, k . H。bruno Dorin, P。梅,J。Chinn, T。迈耶斯,t·J。问题,N。马库斯,j·F。Waubant E。Schaefer, c。、Barcellos l F。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206791 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206791 美国神经病学学会半岛投注体育官网 偏头痛,多发性硬化症,流行病学,道德在神经病学/法律问题,所有基因半岛投注体育官网 Cross-Trait孟德尔随机化研究探讨偏头痛是否多发性硬化的一个危险因素 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1353 e1362 hw_mjid:半岛投注体育官网神经病学;100/13 / e1353
< ![CDATA[流行病学的发展和癫痫儿童智力障碍和癫痫的脑病和]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1363?rss=1 <秒> <圣> < /圣> < p >的背景和目标,我们旨在确定发展的以人群为基础的累积发病率和患病率和癫痫脑病(方式)和智力障碍和癫痫儿童(ID + E)。我们分析了累积特定癫痫综合征的发生率。< / p > < /秒>Methods

Children younger than 16 years with a DEE or ID+E were ascertained using EEG records from 2000 to 2016 in the Wellington region of New Zealand. Epilepsy syndromes were diagnosed on medical record and EEG review. Point prevalence and cumulative incidence for children with epilepsy and developmental impairment, DEE and ID+E were calculated. Cumulative incidence for each epilepsy syndrome was calculated.

Results

The cohort comprised 235 children (58% male) with developmental impairment and epilepsy, including 152 (65%) with DEE and 83 (35%) with ID+E. The median age of seizure onset was 15.4 months (range day 1–15 years). The median follow-up from seizure onset was 7.9 years (range 0–18.2 years). Point prevalence for the broad group of children with epilepsy and developmental impairment was 175/100,000 children (95% CI 149–203; DEE 112 and ID+E 63/100,000 children). Cumulative incidence for DEE was 169/100,000 children (95% CI 144–199) and that for ID+E was 125/100,000 children (95% CI 95.4–165). Cumulative incidence per 100,000 children was as follows: infantile epileptic spasms syndrome 58.2 (95% CI 45.0–75.3), epilepsy with myoclonic-atonic seizures 16.4 (95% CI 9.69–27.7), Lennox-Gastaut syndrome 13.2 (95% CI 4.1–41.9), and Dravet syndrome 5.1 (95% CI 2.1–12.2). Fifty/152 (33%) of children with DEE and 70/83 (84%) with ID+E could not be diagnosed with a known epilepsy syndrome.

Discussion

Epilepsy and developmental impairment before the age of 16 years occurs in 1 in 340 children, with 1 in 590 having a DEE and 1 in 800 having ID+E. These individuals require significant health and community resources; therefore, these data will inform complex health service and education planning. Epidemiologic studies have focused on early childhood–onset DEEs. These do not fully reflect the burden of these disorders because 27% of DEEs and 70% of ID+E begin later, with seizure onset after the age of 3 years. Understanding the cumulative incidence of specific syndromes together with the broad group of DEEs is essential for the planning of therapeutic trials. Given trials focus on specific syndromes, there is a risk that effective therapies will not be developed for one-third of children with DEE.

戳,G。斯坦利,J。雅伯,即。、Sadleir l G。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206758 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206758 美国神经病学学会半岛投注体育官网 发展障碍,精神发育迟滞,流行病学,队列研究,所有的癫痫发作 流行病学的发展和癫痫脑病和智力障碍和癫痫的儿童 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1363 e1375 hw_mjid:半岛投注体育官网神经病学;100/13 / e1363
< ![CDATA[安全、疗效和耐受性与耐药性癫痫修改阿特金斯饮食法的人:一个随机对照试验]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1376?rss=1 <秒> <圣> < /圣> < p >背景和目标修改的阿特金斯饮食法(疯狂)已成为一个辅助治疗癫痫耐药(DRE)。大多数研究是儿童;有有限的证据成年人的衣服。本研究旨在探讨是否疯狂与标准药物治疗(SDT)确实是更有效的比SDT独自在减少发作频率和改善心理的结果在6个月与DRE青少年和成年人(非手术)。< / p > < /秒> <秒> <圣> < /圣> < p >方法前瞻性随机对照试验是由三级转诊中心在印度。Persons with DRE aged 10–55 years attending outpatient epilepsy clinics between August 2015 and April 2019, who had more than 2 seizures per month despite using at least 3 appropriate antiseizure medications (ASMs) at their maximum tolerated doses and had not been on any form of diet therapy for the past 1 year, were enrolled. Patients were assessed for the eligibility and randomly assigned to receive SDT plus MAD (intervention arm) or SDT alone (control arm). The primary outcome was >50% reduction in seizure frequency, and the secondary outcomes were quality of life (QOL), behavior, adverse events, and rate of withdrawal at 6 months. Intention-to-treat analysis was performed.

Results

A total of 243 patients were screened for eligibility; 160 patients (80 adults and 80 adolescents) were randomized to either the intervention or control arm. Demographic and clinical characteristics in both groups were comparable at baseline. At 6 months, >50% seizure reduction was seen in 26.2% in the intervention group vs 2.5% in the control group (95% CI 13.5–33.9; p < 0.001). Improvement in QOL was 52.1 ± 17.6 in the intervention group vs 42.5 ± 16.4 in the control group (mean difference, 9.6; 95% CI 4.3 to 14.9, p < 0.001). However, behavior scores could be performed in 49 patients, and improvement was seen in the intervention vs control group (65.6 ± 7.9 vs 71.4 ± 8.1, p = 0.015) at the end of the study. One patient had weight loss; 2 patients had diarrhea.

Discussion

The MAD group demonstrated improvement in all aspects (reduction in seizure frequency and behavioral problems) compared with the control group at the end of the study. MAD is an effective modality in controlling seizures; further research is required to assess its efficacy in terms of biomarkers along with descriptive metabolomics studies.

Trial Registration Information

The clinical trial registry of India: CTRI/2015/07/006048.

Classification of Evidence

This study provides Class III evidence that the MAD increases the probability of seizure reduction in adolescents and adults with DRE.

Manral, M。德维威迪,R。Gulati年代。考尔,K。,国家环保局的,内拉。Pandey, r . M。阿帕德海耶,a D。、Sapra以及年代。特里帕西,M。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206776 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206776 美国神经病学学会半岛投注体育官网 结果研究,随机对照临床试验协议(配偶),神经心理评估,第三类,所有的癫痫发作 修改后的阿特金斯饮食法的安全性、有效性和耐受性与耐药人癫痫:随机对照试验 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1376 e1385 hw_mjid:半岛投注体育官网神经病学;100/13 / e1376
< ![CDATA[认知和功能轨迹与Prediagnostic老年人帕金森病]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1386?rss=1 <秒> <圣> < /圣> < p >背景和目标有越来越多的兴趣描述帕金森病(PD)的早期阶段。然而,很少有研究调查prediagnostic认知和函数的轨迹。我们的目的是描述prediagnostic认知和功能轨迹在PD年长的男性和女性。< / p > < /秒>Methods

We studied 9,595 women and 5,795 men from 2 prospective cohort studies of community-dwelling elders followed up to 20 years. In individuals without prevalent PD, we estimated the associations of incident PD diagnosis with rates of change in cognition and function before and after diagnosis compared with healthy older adults using multivariate mixed-effects models.

Results

Over follow-up, 297 individuals developed incident PD. Interactions between the terms in our model and sex were statistically significant for the 3 outcomes (p < 0.001 for all), so we stratified results by sex. Compared with older men without PD, men who developed PD exhibited faster decline in global cognition (0.04 SD more annual change, p < 0.001), executive function (0.05 SD more annual change, p < 0.001), and functional status (0.06 SD more annual change, p < 0.001) in the prediagnostic period. Women who developed PD compared with women without PD displayed faster decline in executive function (0.02 SD more annual change, p = 0.006) and functional status in the prediagnostic period (0.07 SD more annual change, p < 0.001).

Discussion

Individuals with incident PD exhibit cognitive and functional decline during the prediagnostic phase that exceeds rates associated with normal aging. Better understanding heterogeneity in prodromal PD is essential to enable earlier diagnosis and identify impactful nonmotor symptoms in all subgroups.

一杯啤酒,m·A。Vittinghoff E。Bahorik, a . L。愣,Y。芬克,H。Yaffe, K。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206762 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206762 美国神经病学学会半岛投注体育官网 帕金森病和帕金森症、性别认知老化、痴呆、认知神经心理学评估认知障碍/痴呆 认知和功能的轨迹与Prediagnostic老年人帕金森病 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1386 e1394 hw_mjid:半岛投注体育官网神经病学;100/13 / e1386
< ![CDATA[未来的长期随访的聚焦超声单边Subthalamotomy帕金森病]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1395?rss=1 Background and Objectives

Unilateral magnetic resonance–guided focused ultrasound subthalamotomy (FUS-STN) has been shown to improve the cardinal motor features of Parkinson disease (PD). Whether this effect is sustained is not known. This study aims to report the long-term outcome of patients with PD treated with unilateral FUS-STN.

Methods

We conducted a prospective open-label study of patients with asymmetrical PD who underwent unilateral FUS-STN. All patients were evaluated up to 36 months after treatment. The primary outcome was the difference from baseline to 36 months after FUS-STN in the score of the Movement Disorder Society–Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor part (III) for the treated hemibody in the off-medication state. The safety outcome included all adverse events occurring during follow-up. Secondary outcomes were the change in the MDS-UPDRS III score on-medication; subscores of rigidity, bradykinesia, tremor, and axial features; total MDS-UPDRS III; and the MDS-UPDRS part IV. Functional disability and quality of life were assessed using the MDS-UPDRS II and the PDQ39, respectively. Patient impression of change and satisfaction with the treatment were self-assessed. The Wilcoxon signed-rank test with subsequent Bonferroni's correction was used for data analysis.

Results

Thirty-two patients with PD were evaluated at 36 months after treatment. The mean (±SD) age at baseline was 56.0 ± 10.1 years, with a mean disease duration of 6.8 ± 2.8 years. The MDS-UPDRS III score for the treated hemibody off-medication was improved by 52.3% from baseline to 3 years (score reduction from 19.0 ± 3.2 to 8.9 ± 3.3, 95% CI 8.7 to 11.6, p < 0.001), and all specific motor features were improved from baseline. No disabling or delayed adverse events were reported. The total MDS-UPDRS III off-medication score was 22.9% lower at 3 years than before treatment (36.8 ± 7.4 vs 27.4 ± 6.2, 95% CI 6.0 to 11.5, p < 0.001). The MDS-UPDRS II, IV, and PDQ39 scores and levodopa dose were equivalent to those at baseline.

Discussion

The benefit of unilateral FUS-STN on PD motor features is sustained in the long term. FUS-STN contributes to better clinical control over several years of evolution. NCT02912871/03454425.

Classification of Evidence

This study provides Class IV evidence on the utility of focused ultrasound unilateral subthalamotomy in the treatment of people with Parkinson disease.

Martinez-Fernandez, R。Natera-Villalba E。Manez米罗,j . U。Rodriguez-Rojas, R。玛尔塔德尔白杨,M。Pineda-Pardo, j。阿曼,C。Obeso,我。Mata-Marin D。·赫尔南德斯·费尔南德斯,F。Gasca-Salas C。Matarazzo, M。Alonso-Frech F。Obeso, j。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206771 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206771 美国神经病学学会半岛投注体育官网 核磁共振,帕金森病/帕金森症,临床试验观察研究(队列,病例对照),手术/刺激 潜在的长期随访的聚焦超声单边Subthalamotomy帕金森疾病 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1395 e1405 hw_mjid:半岛投注体育官网神经病学;100/13 / e1395
< ![CDATA[临床亚组和包涵体肌炎患者与进展相关的因素]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1406?rss=1 <秒> <圣> < /圣> < p >背景和目标零星的包涵体肌炎(IBM)是最常见的获得性肌病个人年龄超过50年。障碍正在慢慢进步,尽管许多疗法进行了调查,反应普遍贫穷。临床异质性可能影响治疗反应;然而,关于异构数据在IBM是有限的,往往相互矛盾。我们的目标是确定临床不同的子组内大量IBM队列为疾病进展和预后因素。< / p > < /秒>Methods

Clinical, histologic, radiologic, and electrophysiologic data were analyzed for all patients with IBM and other forms of myositis enrolled in a longitudinal cohort from The Johns Hopkins Myositis Center from 2003 to 2018. Patients with IBM were included if they met at least one of the following criteria: Griggs possible, European Neuromuscular Centre 2011 probable, or Lloyd-Greenberg data-derived criteria for IBM. Univariate, multivariate, and graphical analyses were used to identify prognostic factors in patients with IBM. Thus, linear and logistic regressions were used to adjust for potential confounding variables. The evolution of creatine kinase and muscle strength was studied using multilevel linear regression models. Nonmodifiable risk factors (sex, race, disease duration, and age at the onset of first symptoms) were used as adjusting covariates for the regression analyses.

Results

Among the 335 patients meeting the inclusion criteria for IBM, 64% were male with an average age of disease onset of 58.7 years and delay to diagnosis of 5.2 years. Initial misdiagnosis (52%) and immunosuppressant treatment (42%) were common. Less than half (43%) of muscle biopsies demonstrated all 3 pathologic hallmarks: endomysial inflammation, mononuclear cell invasion, and rimmed vacuoles. Black patients had significantly weaker arm abductors, hip flexors, and knee flexors compared with non-Black patients. Female patients had stronger finger flexors and knee extensors compared with their male counterparts. Younger age (<50 years) at onset was not associated with increased weakness.

Discussion

Our study demonstrates that female and Black patients have distinct clinical phenotypes and trajectories within the overarching IBM clinical phenotype. These subgroups may have different responses to therapies, which may influence the design of future clinical trials in IBM.

米歇尔·e·H。Pinal-Fernandez,我。Casal-Dominguez, M。Albayda, J。沉重的一击,J·J。Tiniakou E。阿德勒,B。Mecoli, c。Danoff,美国K。Christopher-Stine, L。定,a . L。劳埃德,t·E。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206777 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206777 美国神经病学学会半岛投注体育官网 肌肉疾病、包容、多样性、股本、反种族主义、和社会正义(想法),队列研究 临床亚组和包涵体肌炎患者与进展相关的因素 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1406 e1417 hw_mjid:半岛投注体育官网神经病学;100/13 / e1406
< !块状脱髓鞘的簇状[CDATA [MOG Ab-Associated疾病、多发性硬化症、和AQP-4-IgG-Positive Neuromyelitis视谱系障碍]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1418?rss=1 Background and Objectives

Studies on tumefactive brain lesions in myelin oligodendrocyte glycoprotein-immunoglobulin G (IgG)–associated disease (MOGAD) are lacking. We sought to characterize the frequency clinical, laboratory, and MRI features of these lesions in MOGAD and compare them with those in multiple sclerosis (MS) and aquaporin-4-IgG–positive neuromyelitis optica spectrum disorder (AQP4+NMOSD).

Methods

We retrospectively searched 194 patients with MOGAD and 359 patients with AQP4+NMOSD with clinical/MRI details available from the Mayo Clinic databases and included those with ≥1 tumefactive brain lesion (maximum transverse diameter ≥2 cm) on MRI. Patients with tumefactive MS were identified using the Mayo Clinic medical record linkage system. Binary multivariable stepwise logistic regression identified independent predictors of MOGAD diagnosis; Cox proportional regression models were used to assess the risk of relapsing disease and gait aid in patients with tumefactive MOGAD vs those with nontumefactive MOGAD.

Results

We included 108 patients with tumefactive demyelination (MOGAD = 43; AQP4+NMOSD = 16; and MS = 49). Tumefactive lesions were more frequent among those with MOGAD (43/194 [22%]) than among those with AQP4+NMOSD (16/359 [5%], p < 0.001). Risk of relapse and need for gait aid were similar in tumefactive and nontumefactive MOGAD. Clinical features more frequent in MOGAD than in MS included headache (18/43 [42%] vs 10/49 [20%]; p = 0.03) and somnolence (12/43 [28%] vs 2/49 [4%]; p = 0.003), the latter also more frequent than in AQP4+NMOSD (0/16 [0%]; p = 0.02). The presence of peripheral T2-hypointense rim, T1-hypointensity, diffusion restriction (particularly an arc pattern), ring enhancement, and Baló-like or cystic appearance favored MS over MOGAD (p ≤ 0.001). MRI features were broadly similar in MOGAD and AQP4+NMOSD, except for more frequent diffusion restriction in AQP4+NMOSD (10/15 [67%]) than in MOGAD (11/42 [26%], p = 0.005). CSF analysis revealed less frequent positive oligoclonal bands in MOGAD (2/37 [5%]) than in MS (30/43 [70%], p < 0.001) and higher median white cell count in MOGAD than in MS (33 vs 6 cells/μL, p < 0.001). At baseline, independent predictors of MOGAD diagnosis were the presence of somnolence/headache, absence of T2-hypointense rim, lack of T1-hypointensity, and no diffusion restriction (Nagelkerke R2 = 0.67). Tumefactive lesion resolution was more common in MOGAD than in MS or AQP4+NMOSD and improved model performance.

Discussion

Tumefactive lesions are frequent in MOGAD but not associated with a worse prognosis. The clinical, MRI, and CSF attributes of tumefactive MOGAD differ from those of tumefactive MS and are more similar to those of tumefactive AQP4+NMOSD with the exception of lesion resolution, which favors MOGAD.

Cacciaguerra, L。莫里斯,P。托宾,w . O。陈,J·J。、银行、美国。Elsbernd, P。Redenbaugh, V。、Tillema人类。蒙提,F。Sechi E。Lopez-Chiriboga, a。Zalewski, N。郭,Y。罗卡,m。菲利皮主持,M。庄园主匹塔克,美国J。、Lucchinetti c F。弗拉纳根,e . P。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000206820 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206820 美国神经病学学会半岛投注体育官网 核磁共振,多发性硬化症,德维克的综合症 在MOG Ab-Associated Tumefactive脱髓鞘疾病,多发性硬化症,AQP-4-IgG-Positive Neuromyelitis视谱系障碍 2023-03-28 半岛体育app苹果下载 One hundred. 13 e1418 e1432 hw_mjid:半岛投注体育官网神经病学;100/13 / e1418
< ![CDATA[教育和支持自我管理项目治疗慢性头痛]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/13/e1433?rss=1 < p > 2017年至2019年间,736名病人患有慢性头痛,住在英国,参加12个月的研究。大约83%的参与者是女性,99%的经历或慢性偏头痛慢性紧张型头痛发作性偏头痛。< / p > 普雷斯顿,J。 2023 - 03 - 27 - t12:45:28 07:00 信息:doi 10.1212 / / WNL.0000000000207207 hwp:资源id:神经病学;10半岛投注体育官网0/13 / e1433 美国神经病学学会半岛投注体育官网 教育和支持自我管理项目对治疗慢性头痛 2023-03-28 病人的页面 One hundred. 13 e1433 e1435 hw_mjid:半岛投注体育官网神经病学;100/13 / e1433 < ![CDATA[丛集性头痛:更糟的是在女性患者]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/547?rss=1

In the current issue of Neurology®, Fourier et al.1 published one of the most comprehensive studies of sex differences in cluster headache; they confirmed previous epidemiologic suspicions, provided new insights, and raised important questions into sex hormones and the influence of genetic factors. The authors surveyed 874 participants who were diagnosed with cluster headache by neurologists using the criteria of the International Classification of Headache Disorders (ICHD)–3.2 Approximately half were personally assessed by study authors, while the other half were identified through International Classification of Diseases 10 (ICD10) codes and had their charts reviewed by a study neurologist applying ICHD-3 criteria. Participants then completed a questionnaire that included demographics, headache features, and treatments. This questionnaire provided information on prevalence (higher in male participants), incidence (peaks between 20- and 29-year-olds), family aggregation (more common in female participants), and burden of disease (worse in female participants).

Burish, m . J。立顿,r . B。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206807 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206807 美国神经病学学会半岛投注体育官网 丛集性头痛,患病率研究,发病率的研究 丛集性头痛:在女性患者 2023-03-21 社论 One hundred. 12 547年 548年 hw_mjid:半岛投注体育官网神经病学;100/12/547
< ![CDATA[脑成像深度学习算法:从黑盒到临床工具箱?]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/549?rss=1 < p >人工智能(AI)和机器学习的进步导致成功的应用程序的自动化医学图像分析。深度学习算法、机器学习的一个子集,特别适合学习复杂的模式在数据自动预测的新图像。<一口> 1 < /一口>几个研究已经证明,深入学习算法应用于医学图像可能未来临床应用广泛。<一口> 2、3 < /一口>如果成功嵌入在未来的医疗保健系统,人工智能可能减少成本和时间相关的阅读和解释大脑扫描。然而,使用这些工具在临床实践中由于种种原因难以捉摸。<一口> 4、5 < /一口> < / p > 海特,t·J。Eshaghi,。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206808 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206808 美国神经病学学会半岛投注体育官网 蛛网膜下腔出血 大脑成像深度学习算法:从黑盒到临床工具箱? 2023-03-21 社论 One hundred. 12 549年 550年 hw_mjid:半岛投注体育官网神经病学;100/12/549 < ![CDATA[脑Microbleeds或皮质铁尘肺患者的抗凝治疗:这是禁忌吗?]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/551?rss=1 < p >临床医生开始溶栓和抗凝治疗患者的脑淀粉样血管病(CAA),一个条件特点是大脑microbleeds (CMBs)和皮质脑铁尘肺(CSS),可能会增加的担忧intraparenchymal出血(IPH)的风险。<一口> 1、2 < /一口> CMBs与静脉内溶栓后IPH增加风险。<一口> 1,3 < /一口> < / p > 施耐克,m . J。开帐单,J。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206818 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206818 美国神经病学学会半岛投注体育官网 所有脑血管疾病/中风 脑Microbleeds或皮质铁尘肺患者的抗凝治疗:这是禁忌吗? 2023-03-21 社论 One hundred. 12 551年 552年 hw_mjid:半岛投注体育官网神经病学;100/12/551 < ![CDATA[小脑在睡眠期间的参与是什么?]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/572?rss=1 < p >与进步的说明脑干和下丘脑的角色在清醒和睡眠的控制阶段,1 <一口> < /一口>小脑的功能在睡眠时保持相对未开发。2 <一口> < /一口>然而,活动在小脑与大脑皮层的变化在不同的睡眠阶段,如图所示,例如,同时重新编码的睡眠脑电图和区域血流量或fMRI信号在人类小脑。<一口> 2 - 10 < /一口>电生理学的研究表明浦肯野的放电频率的变化根据皮层和小脑核细胞睡眠阶段。<一口> < /一口> 11 - 15号最近的研究显示hippocampal-cerebellar交互在非快速眼动(非快速眼动)和快速眼动睡眠<一口> 16 < /一口>,表明小脑贡献在大脑皮层睡眠纺锤波的生成。<一口> 15 < /一口>有几个潜在的协调途径与小脑皮层和海马区域活动在睡眠中(图)。这种互惠交流可能提供一个潜在的依据运动学习和其他认知功能的整合。<一口> 17-22 < /一口>小脑的影响在一些疾病与睡眠障碍有关。<一口> < /一口>然而,小脑的贡献的正常调节睡眠和睡眠障碍的作用仍不完全清楚。阐明小脑的角色在唤醒和睡眠周期的控制具有潜在的临床和治疗影响。< / p > Benarroch E。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207161 hwp:资源id:神经病学;10半岛投注体育官网0/12/572 美国神经病学学会半岛投注体育官网 所有的睡眠障碍 小脑在睡眠期间的参与是什么? 2023-03-21 基础科学的诊所 One hundred. 12 572年 577年 hw_mjid:半岛投注体育官网神经病学;100/12/572 < ![CDATA[注释:2035年引入神经学教育]]>半岛投注体育官网 http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/578?rss=1 < p >企业固有的前瞻性,临床教育有一些奇怪的过去的痕迹。Coat-length层次结构。学徒学习模型。寻呼机。< / p > 琼斯,l·K。总值,r。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206792 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206792 美国神经病学学会半岛投注体育官网 所有教育 备注:2035年引入神经学教育半岛投注体育官网 2023-03-21 CONTEMPORARY ISSUES IN PRACTICE, EDUCATION, &amp; RESEARCH One hundred. 12 578年 578年 hw_mjid:半岛投注体育官网神经病学;100/12/578 < ![CDATA[半岛投注体育官网2035年神经学教育:神经学的未来预测系列]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/579?rss=1 < p >在过去的十年里,已经有了巨大的变化在神经学护理的各个方面,与此同时,神经学教育改变了。半岛投注体育官网这些变化已经影响到整个教育连续教育的各个方面,包括学习者、教师、教育工作者、内容,交付方法,评估,和结果。卫生系统科学、卫生人文、多样性、公平、包容和健康差异变得神经学课程的核心组件,而且,在未来,将被纳入我们的教育任务的方方面面。半岛投注体育官网材料是教和学的方式一直受到技术创新和不断增长的对科学的理解学习。我们预计这一趋势将持续下去,学习者选择电子资源与数组的基本主题,让一线临床教师花更多的时间支持批判性推理和教学生如何学习。已经被越来越多的教育角色的分化(即。、教师、教育工作者和学者)。我们预测,这些角色将变得更加明显,每个都有一个个性化的模式的支持和期望。评估变得更加符合学习者的工作,和越来越多的人呼吁更加关注病人护理教育计划的影响。我们预测会有增加强调教育成果和公共问责制培训项目。在本文中,我们回顾在神经学和医学教育的历史探索神经学的现状预测未来教育和讨论的方式我们可以准备。< / p >半岛投注体育官网 Moeller, J。萨拉斯,r·m·E。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201669 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201669 美国神经病学学会半岛投注体育官网 所有的教育,教育的方法 半岛投注体育官网2035年神经学教育:神经学的未来预测系列 2023-03-21 CONTEMPORARY ISSUES IN PRACTICE, EDUCATION, &amp; RESEARCH One hundred. 12 579年 586年 hw_mjid:半岛投注体育官网神经病学;100/12/579 < ![CDATA[珍珠和Oy-sters:三叉神经囊性神经鞘瘤呈现寄养肯尼迪综合症,第六神经麻痹,和焦发作]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/587?rss=1 < p >培养肯尼迪综合症是指发现视神经萎缩的一只眼睛直接压迫视神经的软组织肿块和侧视神经乳头水肿nonatrophic视神经造成增加颅内压。当fundoscopy发现并不是因为直接压缩质量,使用术语pseudo-Foster肯尼迪综合症;这可能造成的任何过程或过程,导致一只眼视神经萎缩和视神经盘水肿。识别培养肯尼迪综合症病人要求的神经影像寻找颅内病变。在本文中,我们提出一个病人出现视力丧失和福斯特肯尼迪综合症谁被发现有一个很大的三叉神经囊性神经鞘瘤。While several other accompanying symptoms were not evident from the patient complaint, a careful history and physical examination revealed additional localizing clues: unilateral sensory changes in the face and pterygoid and masseter atrophy, unilateral cranial nerve VI palsy, and episodes of intense déjà vu sensation, which were presumed to represent temporal lobe–onset focal aware seizures. Trigeminal schwannomas are a rare entity, and they are even more rarely cystic. This case highlights an unusual scenario where a slow expansion of the tumor ultimately resulted in vision loss and presentation of the patient to medical attention.

Mahjoub Y。湾,M。苏,S。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201700 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201700 美国神经病学学会半岛投注体育官网 临床神经学历史,临半岛投注体育官网床神经学检查,所有Neuro-ophthalmology,视神经 珍珠和Oy-sters:三叉神经囊性神经鞘瘤呈现寄养肯尼迪综合症,第六神经麻痹,和焦发作 2023-03-21 RESIDENT &amp; FELLOW SECTION One hundred. 12 587年 590年 hw_mjid:半岛投注体育官网神经病学;100/12/587
< ![CDATA[右脑:你离去的]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/591?rss=1 < p >这首诗描述了作者的经验执行她的第一个考试脑死亡作为神经病学的居民。半岛投注体育官网作者希望这个工作可能会促使读者思考类似的经历。医生经常处理沉重的诊断和严重的情况。内省可能激发同情心和善良来改善一个如何提供照顾病人和与家庭。< / p > 公园,美国K。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201721 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201721 美国神经病学学会半岛投注体育官网 脑死亡 右脑:你已经一去不复返了 2023-03-21 RESIDENT &amp; FELLOW SECTION One hundred. 12 591年 592年 hw_mjid:半岛投注体育官网神经病学;100/12/591 < ![CDATA[编者注:饮食习惯之间的关系在中年与老年痴呆发病率在20年期间]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/593?rss=1

In a 2-decade prospective population-based study from Sweden, Dr. Glans and colleagues investigated the association between adherence to conventional dietary recommendations or to a modified Mediterranean diet and subsequent risk of developing all-cause dementia, Alzheimer disease (AD), vascular dementia (VaD), or accumulation of AD-related β-amyloid pathology in the CSF, among 28,025 participants. They concluded that these dietary habits were not significantly associated with a reduced risk for developing all-cause dementia, AD dementia, VaD, or AD pathology. In response, Dr. Kawada cites a previous study that found significant interactions between dietary patterns and APOE-4 status in relation to incident dementia, with a healthy dietary pattern being associated with lower dementia incidence in 4 noncarriers and a Western dietary pattern associated with higher dementia incidence in 4 carriers. Dr. Kawada argues that studies examining the long-term effect of dietary patterns on incident dementia should consider the contribution of genetic factors. In another response, Dr. Hoffman notes that the researchers' use of a modified Mediterranean diet score does not explicitly measure for extra virgin olive oil (EVOO), which may be an important component for maintaining cognitive health, citing epidemiologic and animal studies in this regard. He contends that it is important to consider the role of EVOO as part of a Mediterranean diet for cognitive health to better inform the implementation of this diet in non-Mediterranean countries. Responding to these comments, the authors note that they did not find any significant interaction effects between conventional dietary recommendations or a modified Mediterranean diet and APOE-4 status with respect to subsequent dementia but do not comment about the role of extra virgin olive oil. Overall, this exchange highlights enduring uncertainties about the role of specific dietary factors in mitigating the long-term risk of dementia.

Ganesh,。、Galetta年代。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207162 hwp:资源id:神经病学;10半岛投注体育官网0/12/593 美国神经病学学会半岛投注体育官网 编者注:饮食习惯之间的关系在20年内中年与老年痴呆发病率 2023-03-21 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 12 593年 593年 hw_mjid:半岛投注体育官网神经病学;100/12/593
< ![CDATA[读者反应:饮食习惯之间的关系在中年与老年痴呆发病率在20年期间]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/593-a?rss=1

Glans et al.1 investigated the association between dietary habits and subsequent development of all-cause dementia, Alzheimer disease, vascular dementia, or increased CSF Aβ42. The adjusted hazard ratio (HR) of a conventional diet and a modified Mediterranean diet for dementia-related indicators did not become significant. Regarding the lack of association by the follow-up over a 20-year period, I present information regarding the significance of genetic interaction with dietary habits.

Kawada, T。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207163 hwp:资源id:神经病学;10半岛投注体育官网0/12/593-a 美国神经病学学会半岛投注体育官网 读者反应:饮食习惯之间的关系在中年与老年痴呆发病率在20年期间 2023-03-21 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 12 593年 594年 hw_mjid:半岛投注体育官网神经病学;100/12/593-a
< ![CDATA[读者反应:饮食习惯之间的关系在中年与老年痴呆发病率在20年期间]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/594?rss=1 < p >像许多地中海饮食的研究在non-Mediterranean国家(地中海饮食),龟头的研究等。<一口> 1 < /一口>使用修改后的地中海饮食得分不明确措施特级初榨橄榄油(EVOO)。这可能会影响评价,因为一些研究表明EVOO地中海饮食的重要组成部分来保持健康的认知能力。< / p > 霍夫曼,r . M。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207164 hwp:资源id:神经病学;10半岛投注体育官网0/12/594 美国神经病学学会半岛投注体育官网 读者反应:饮食习惯之间的关系在中年与老年痴呆发病率在20年期间 2023-03-21 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 12 594年 594年 hw_mjid:半岛投注体育官网神经病学;100/12/594 < ![CDATA[作者回应:饮食习惯之间的关系在中年与老年痴呆发病率在20年期间]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/595?rss=1 < p >感谢Kawada博士和霍夫曼博士他们的评论在我们的研究中,我们分析了饮食习惯和APOE-4之间的联系。<一口> 1 < / >共舞,我们并没有发现任何显著的交互作用之间的传统饮食建议或修改地中海饮食和APOE-4状态(eTables 13和14,< a HREF = " http://links.lww.com/WNL/C345 " >links.lww.com/WNL/C345 < / >)。<一口> 1 < /一口> < / p > 龟头,我。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000207165 hwp:资源id:神经病学;10半岛投注体育官网0/12/595 美国神经病学学会半岛投注体育官网 作者回复:饮食习惯之间的关系在20年内中年与老年痴呆发病率 2023-03-21 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 12 595年 595年 hw_mjid:半岛投注体育官网神经病学;100/12/595 < ![CDATA[性别差异在临床特征、治疗和生活方式因素丛集性头痛患者]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1207?rss=1 <秒> <圣> < /圣> < p >背景和目标丛集性头痛被认为是男性主导的障碍,但我们曾提出,女性患者可能显示一个更严重的表型。丛集性头痛的研究性别差异冲突;因此,这项研究中,最大的验证丛集性头痛材料目前,给更多的见解性别特征的疾病。本研究的目的是描述病人人口的性别差异,临床表型,生物钟学、触发器、治疗、和生活方式在瑞典人口丛集性头痛。< / p > < /秒>Methods

Study participants were identified by screening medical records from 2014 to 2020, requested from hospitals and neurology clinics in Sweden for the ICD-10 code G44.0 for cluster headache. Each study participant answered a detailed questionnaire on clinical information and lifestyle, and all variables were compared with regard to sex.

Results

A total of 874 study participants with a verified cluster headache diagnosis were included. Of the participants, 575 (66%) were male and 299 (34%) were female, and biological sex matched self-reported sex for all. Female participants were to a greater extent diagnosed with the chronic cluster headache subtype compared with male participants (18% vs 9%, p = 0.0002). In line with this observation, female participants report longer bouts than male participants (p = 0.003) and used prophylactic treatment more often (60% vs 48%, p = 0.0005). Regarding associated symptoms, female participants experienced ptosis (61% vs 47%, p = 0.0002) and restlessness (54% vs 46%, p = 0.02) more frequently compared with male participants. More female than male study participants had a positive family history of cluster headache (15% vs 7%, p = 0.0002). In addition, female participants reported diurnal rhythmicity of their attacks more often than male participants (74% vs 63%, p = 0.002). Alcohol as a trigger occurred more frequently in male participants (54% vs 48%, p = 0.01), whereas lack of sleep triggering an attack was more common in female participants (31% vs 20%, p = 0.001).

Discussion

With this in-depth analysis of a well-characterized cluster headache population, we could demonstrate that there are significant differences between male and female participants with cluster headache, which should be regarded at the time of diagnosis and when choosing treatment options. The data suggest that female patients generally may be more gravely affected by cluster headache than male patients.

傅里叶,C。跑,C。斯坦伯格,。, Sjöstrand, C., Waldenlind, E., Belin, A. C. 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201688 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201688 美国神经病学学会半岛投注体育官网 所有头痛、包容、多样性、股本、反种族主义、和社会正义(想法),性别、病例对照研究 性别差异在临床特征、治疗丛集性头痛患者和生活方式因素 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1207 e1220 hw_mjid:半岛投注体育官网神经病学;100/12 / e1207
< ![CDATA[脑脊液和血清神经丝协会光和胶质原纤维酸性蛋白,损伤程度、和结果在脊髓损伤))> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1221?rss=1 <秒> <圣> < /圣> < p >背景和目标创伤性脊髓损伤(SCI)高度异构,和工具,以更好地描述病理生理学和恢复是必要的。我们的目标是2生物标记物的反应,神经丝灯(NF-L)和胶质原纤维酸性蛋白(GFAP)、急性SCI患者的血清和CSF评价能够客观地描述损伤严重程度和预测神经复苏。< / p > < /秒>Methods

Blood and CSF samples were obtained from prospectively enrolled patients with acute SCI through days 1–4 postinjury, and the concentration of NF-L and GFAP was quantified using Simoa technology. Neurologic assessments defined the ASIA Impairment Scale (AIS) grade and motor score (MS) at presentation and 6 months postinjury.

Results

One hundred eighteen patients with acute SCI (78 AIS A, 20 AIS B, and 20 AIS C) were enrolled, with 113 (96%) completing 6-month follow-up. NF-L and GFAP levels were strongly associated between paired serum and CSF specimens, were both increased with injury severity, and distinguished among baseline AIS grades. Serum NF-L and GFAP were significantly (p = 0.02 to <0.0001) higher in AIS A patients who did not improve at 6 months, predicting AIS grade conversion with a sensitivity and specificity (95% CI) of 76% (61, 87) and 77% (55, 92) using NF-L and 72% (57, 84) and 77% (55, 92) using GFAP at 72 hours, respectively. Independent of clinical baseline assessment, a serum NF-L threshold of 170 pg/mL at 72 hours predicted those patients who would be classified as motor complete (AIS A/B) compared with motor incomplete (AIS C/D) at 6 months with a sensitivity of 87% (76, 94) and specificity of 84% (69, 94); a serum GFAP threshold of 13,180 pg/mL at 72 hours yielded a sensitivity of 90% (80, 96) and specificity of 84% (69, 94).

Discussion

The potential for NF-L and GFAP to classify injury severity and predict outcome after acute SCI will be useful for patient stratification and prognostication in clinical trials and inform communication of prognosis.

Classification of Evidence

This study provides Class I evidence that higher serum NF-L and GFAP are associated with worse neurological outcome after acute SCI.

Trial Registration Information

Registered on ClinicalTrials.gov: NCT00135278 (March 2006) and NCT01279811 (January 2012).

架斯图卡俯冲轰炸机,S。库珀,J。吉尔,J。Fallah, N。Skinnider, m。Belanger, L。里奇,L。曾荫权,。盾,K。Streijger F。、街道、J。Paquette年代。Ailon, T。Dea, N。Charest-Morin, R。费舍尔,c·G。贝利,c . S。迪豪,S。、Mac-Thiong人类。威尔逊,j . R。克里斯蒂,S。德沃夏克,m F。惠灵顿,c . L。Kwon b K。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206744 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206744 美国神经病学学会半岛投注体育官网 预后,类我 脑脊液和血清神经丝协会光和胶质原纤维酸性蛋白,受伤严重,在脊髓损伤的结果 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1221 e1233 hw_mjid:半岛投注体育官网神经病学;100/12 / e1221
< ![CDATA[临床和神经生理表型与BRAT1新生儿脑病]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1234?rss=1 < <秒> <圣>背景和目标/圣> < p > <我> BRAT1 < / I >脑病是一件常染色体隐性新生儿脑病。我们描述新生儿electroclinical表型表示,为早期诊断提供见解。< / p > < /秒>Methods

Through a multinational collaborative, we studied a cohort of neonates with encephalopathy associated with biallelic pathogenic variants in BRAT1 for whom detailed clinical, neurophysiologic, and neuroimaging information was available from the onset of symptoms. Neuropathologic changes were also analyzed.

Results

We included 19 neonates. Most neonates were born at term (16/19) from nonconsanguineous parents. 15/19 (79%) were admitted soon after birth to a neonatal intensive care unit, exhibiting multifocal myoclonus, both spontaneous and exacerbated by stimulation. 7/19 (37%) had arthrogryposis at birth, and all except 1 progressively developed hypertonia in the first week of life. Multifocal myoclonus, which was present in all but 1 infant, was the most prominent manifestation and did not show any EEG correlate in 16/19 (84%). Video-EEG at onset was unremarkable in 14/19 (74%) infants, and 6 (33%) had initially been misdiagnosed with hyperekplexia. Multifocal seizures were observed at a median age of 14 days (range: 1–29). During the first months of life, all infants developed progressive encephalopathy, acquired microcephaly, prolonged bouts of apnea, and bradycardia, leading to cardiac arrest and death at a median age of 3.5 months (range: 20 days to 30 months). Only 7 infants (37%) received a definite diagnosis before death, at a median age of 34 days (range: 25–126), and almost two-thirds (12/19, 63%) were diagnosed 8 days to 12 years postmortem (median: 6.5 years). Neuropathology examination, performed in 3 patients, revealed severely delayed myelination and diffuse astrogliosis, sparing the upper cortical layers.

Discussion

BRAT1 encephalopathy is a neonatal-onset, rapidly progressive neurologic disorder. Neonates are often misdiagnosed as having hyperekplexia, and many die undiagnosed. The key phenotypic features are multifocal myoclonus, an organized EEG, progressive, persistent, and diffuse hypertonia, and an evolution into refractory multifocal seizures, prolonged bouts of apnea, bradycardia, and early death. Early recognition of BRAT1 encephalopathy allows for prompt workup, appropriate management, and genetic counseling.

Carapancea E。,M.-C短号。Milh, M。,德Cosmo, L。、黄、e·J。都灵,T。Striano, P。,Ceulemans B。斯坦,。Morris-Rosendahl D。孔蒂,G。密特拉,N。雷蒙德,f . L。Rowitch, d . H。Solazzi, R。Vercellino F。,德Liso P。,D 'Onofrio, G。Boniver C。Danhaive, O。Carkeek, K。Salpietro, V。, Weckhuysen, S., Fedrigo, M., Angelini, A., Castellotti, B., Lederer, D., Benoit, V., Raviglione, F., Guerrini, R., Dilena, R., Cilio, M. R. 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206755 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206755 美国神经病学学会半岛投注体育官网 肌阵挛;看到运动障碍/肌阵挛,脑电图,新生儿癫痫发作 临床和神经生理表型与BRAT1脑病新生儿 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1234 e1247 hw_mjid:半岛投注体育官网神经病学;100/12 / e1234
< ![CDATA[风险知觉技能和驾驶行为患者的神经功能紊乱]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1248?rss=1 <秒> <圣> < /圣> < p >背景和目标驱动患者神经功能紊乱(曾经)是一个重大的问题,但是目前的指导方针(存在)是基于专家共识只有由于缺乏相关的经验证据。本研究旨在提供这样的证据,与健康对照组比较司机和曾经的驾驶性能和行为的重要方面崩溃的风险,包括风险感知技能。< / p > < /秒>Methods

Participants completed validated self-report questionnaires of driving behaviors (assessing lapses, errors, violations, and attentional issues) and 2 computer-based measures of hazard perception skill (both known to be associated with crash risk).

Results

We compared 43 patients who experience dissociative attacks or functional motor symptoms and 43 healthy controls. Patients with FND self-reported significantly more driving lapses and driving errors compared with healthy controls. However, there were no significant between-group differences in self-reports of ordinary violations, aggressive violations, or attention-related errors. Participants in the FND group and healthy controls exhibited a similar performance on a response time hazard perception test (6.27 vs 5.51 seconds, p = 0.245). However, participants with FND remarkably outperformed the controls in the number of plausible predictions they made in a verbal response hazard prediction test (1.55 vs 1.18 predictions per clip, p = 0.006).

Discussion

Our findings suggest that the ability of drivers with FND to predict traffic hazards in between attacks or flares is not worse than that of healthy individuals, with the possibility that it might even be better under some circumstances. Further studies with various populations are needed to replicate our findings.

Lagrand, t·J。Vaezipour,。山,。Horswill, m . S。,黄祖辉,a . C。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206757 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206757 美国神经病学学会半岛投注体育官网 患者安全、立法事务,癫痫发作的/,Nonepileptic发作 风险知觉技能和司机行为患者的神经系统功能紊乱 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1248 e1256 hw_mjid:半岛投注体育官网神经病学;100/12 / e1248
< ![CDATA[开发和外部验证的学习算法来识别和定位蛛网膜下腔出血CT扫描]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1257?rss=1 <秒> <圣> < /圣> < p >背景和目标在医学成像,数量有限的深度学习训练算法外部验证,公开发布。我们假设深学习算法可以被训练识别和定位蛛网膜下腔出血(SAH)头部电脑断层扫描(CT)扫描和训练模式时执行令人满意地使用外部和真实数据进行了测试。< / p > < /秒> <秒> <圣> < /圣> < p >方法我们使用头部CT图像的病人承认赫尔辛基大学医院在2012年和2017年之间。我们手动分割(即。,划定)长官在90头CT扫描和使用分割CT扫描在一起22负(SAH)控制CT扫描在训练一个开源卷积神经网络(U-Net)来识别和定位长官。然后我们测试训练算法的性能通过使用外部数据集(137 SAH和1242控制情况下)中收集2国外也通过创建一个数据集的连续紧急头部CT扫描(8 SAH和511例)控制在5种不同表现在待命时间国内医院2021年9月。我们评估了算法的能力来识别SAH病人通过计算限制电平性能指标,如敏感性和特异性。< / p > < /秒>Results

In the external validation set of 1,379 cases, the algorithm identified 136 of 137 SAH cases correctly (sensitivity 99.3% and specificity 63.2%). Of the 49,064 axial head CT slices, the algorithm identified and localized SAH in 1845 of 2,110 slices with SAH (sensitivity 87.4% and specificity 95.3%). Of 519 consecutive emergency head CT scans imaged in September 2021, the algorithm identified all 8 SAH cases correctly (sensitivity 100.0% and specificity 75.3%). The slice-level (27,167 axial slices in total) sensitivity and specificity were 87.3% and 98.8%, respectively, as the algorithm identified and localized SAH in 58 of 77 slices with SAH. The performance of the algorithm can be tested on through a web service.

Discussion

We show that the shared algorithm identifies SAH cases with a high sensitivity and that the slice-level specificity is high. In addition to openly sharing a high-performing deep learning algorithm, our work presents infrequently used approaches in designing, training, testing, and reporting deep learning algorithms developed for medical imaging diagnostics.

Classification of Evidence

This study provides Class III evidence that a deep learning algorithm correctly identifies the presence of subarachnoid hemorrhage on CT scan.

Thanellas,。Peura, H。Lavinto, M。Ruokola, T。Vieli, M。、Staartjes诉E。、Winklhofer年代。塞拉,C。Regli, L。Korja, M。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201710 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201710 美国神经病学学会半岛投注体育官网 CT,第三类、脑出血、蛛网膜下腔出血 开发和外部验证的学习算法来识别和定位蛛网膜下腔出血CT扫描 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1257 e1266 hw_mjid:半岛投注体育官网神经病学;100/12 / e1257
< ![CDATA[中风风险和抗血栓形成的治疗在缺血性中风患者的随访和皮质表面铁尘肺]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1267?rss=1 <秒> <圣> < /圣> < p >背景和目标对缺血性中风患者(是)或短暂性脑缺血发作(TIA)和皮质表面铁尘肺(cSS),有一些数据关于未来脑血管事件的风险也关于福利和安全的抗血栓形成的二级预防药物。我们调查了cSS和中风协会最近是或TIA患者的风险。< / p > < /秒>Methods

We retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events (intracranial hemorrhage [ICrH], IS, or any stroke [ICrH or IS]), and mortality. We calculated incidence rates (IRs) and performed univariable and multivariable Cox regression analyses.

Results

Of 12,669 patients (mean age 70.4 ± 12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24 ± 17 months, IS was more frequent than ICrH in both cSS (IR 57.1 vs 14.6 per 1,000 patient-years) and non-cSS (33.7 vs 6.3 per 1,000 patient-years) groups. Compared with the non-cSS group, cSS was associated with any stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14–2.28; p = 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90–60.63; p = 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03–12.44; p < 0.001) compared with the non-cSS group.

Discussion

Patients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.

Marti-Fabregas, J。Camps-Renom, P。最好,j·G。Ramos-Pachon,。Guasch-Jimenez, M。Martinez-Domeno,。Guisado-Alonso D。Gomez-Anson, b . M。Ambler, G。威尔逊,D。、李K.-J。Lim, js。Bae周宏儒。Shiozawa, M。四郎,M。丰田章男,K。、Hennerici m·G。Chabriat, H。Jouvent E。黄,d . y . K。麦,H。刘,K . K。金,y D。、歌曲、T.-J。Heo黄永发。, Eppinger, S., Gattringer, T., Uysal, E., Demirelli, D. S., Bornstein, N., Ben Assayag, E., Hallevi, H., Molad, J. A., Nishihara, M., Tanaka, J., Hara, H., Yakushiji, Y., Coutts, S. B., Smith, E., Polymeris, A. A., Wagner, B., Seiffge, D., Lyrer, P. A., Peters, N., Engelter, S. T., Al-Shahi Salman, R., Jäger, H. R., Lip, G. Y. H., Goeldlin, M., Panos, L., Karayiannis, C. C., Phan, T. G., Srikanth, V. K., Christ, N., Gunkel, S., Fluri, F., Leung, T. W., Soo, Y. O. Y., Chu, W., Abrigo, J., Barbato, C., Browning, S., Simister, R., Mendyk, A.-M., Bordet, R., Hilal, S., Gyanwali, B., Chen, C., Jung, S., Necioglu Orken, D., Werring, D., Prats-Sanchez, L., and Microbleeds International Collaborative Network (MICON) 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000201723 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201723 美国神经病学学会半岛投注体育官网 中风的预防、脑血管疾病/中风,队列研究,脑出血、蛛网膜下腔出血 中风的危险和抗血栓形成的治疗在缺血性中风患者的随访和皮层表面的铁尘肺 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1267 e1281 hw_mjid:半岛投注体育官网神经病学;100/12 / e1267
< ![CDATA[年龄和性别趋势并发症急性缺血性中风后在美国]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1282?rss=1 <秒> <圣> < /圣> < p >背景和目标来测试假设的年龄和性别患病率感染(肺炎、败血症、尿路感染(UTI))和非传染性的(深静脉血栓形成(DVT),肺栓塞(PE),急性肾功能衰竭(ARF),急性心肌梗塞(AMI)和消化道出血[直布罗陀])并发症住院治疗急性缺血性中风(AIS)后增加在美国从2007年到2019年。< / p > < /秒>Methods

We conducted a serial cross-sectional study using the 2007–2019 National Inpatient Sample. Primary AIS admissions in adults (aged 18 years or older) with and without complications were identified using International Classification of Diseases codes. We quantified the age/sex-specific prevalence of complications and used negative binomial regression models to evaluate trends over time.

Results

Of 5,751,601 weighted admissions, 51.4% were women. 25.1% had at least 1 complication. UTI (11.8%), ARF (10.1%), pneumonia (3.2%), and AMI (2.5%) were the most common complications, while sepsis (1.7%), GIB (1.1%), DVT (1.2%), and PE (0.5%) were the least prevalent. Marked disparity in complication risk existed by age/sex (UTI: men 18–39 years 2.1%; women 80 years or older 22.5%). Prevalence of UTI (12.9%–9.7%) and pneumonia (3.8%–2.7%) declined, but that of ARF increased by 3-fold (4.8%–14%) over the period 2007–2019 (all p < 0.001). AMI (1.9%–3.1%), DVT (1.0%–1.4%), and PE (0.3%–0.8%) prevalence also increased (p < 0.001), but that of sepsis and GIB remained unchanged over time. After multivariable adjustment, risk of all complications increased with increasing NIH Stroke Scale (pneumonia: prevalence rate ratio [PRR] 1.03, 95% CI 1.03–1.04, for each unit increase), but IV thrombolysis was associated with a reduced risk of all complications (pneumonia: PRR 0.80, 85% CI 0.73–0.88; AMI: PRR 0.85, 95% CI 0.78–0.92; and DVT PRR 0.87, 95% CI 0.78–0.98). Mechanical thrombectomy was associated with a reduced risk of UTI, sepsis, and ARF, but DVT and PE were more prevalent in MT hospitalizations compared with those without. All complications except UTI were associated with an increased risk of in-hospital mortality (sepsis: PRR 1.97, 95% CI 1.78–2.19).

Discussion

Infectious complications declined, but noninfectious complications increased after AIS admissions in the United States in the last decade. Utilization of IV thrombolysis is associated with a reduced risk of all complications.

艾哈迈德,R。Mhina C。菲利普·K。帕特尔,S。D., Aneni, E., Osondu, C., Lamikanra, O., Akano, E. O., Anikpezie, N., Albright, K. C., Latorre, J. G., Chaturvedi, S., Otite, F. O. 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206749 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206749 美国神经病学学会半岛投注体育官网 所有医疗/系统性疾病,患病率研究,梗塞 年龄和性别趋势并发症急性缺血性中风后在美国 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1282 e1295 hw_mjid:半岛投注体育官网神经病学;100/12 / e1282
< ![CDATA[调查的长期影响怀孕在多发性硬化的过程中使用因果推论]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1296?rss=1 <秒> <圣> < /圣> < p >背景和目标的长期安全怀孕的问题是一个大问题在多发性硬化(MS)患者,但其研究是有偏见的反向因果关系(更高的残疾的女性不太可能经历怀孕)。使用因果推论方法,我们旨在估计的无偏长期影响女士怀孕患者残疾和复发的风险,其次是短期内影响perpartum和产后期间(年)和延迟效应(交付后发生超出1年)。< / p > < /秒>Methods

We conducted an observational cohort study with data from patients with MS followed in the Observatoire Francais de la Sclérose en Plaques registry between 1990 and 2020. We included female patients with MS aged 18–45 years at MS onset, clinically followed up for more than 2 years, and with ≥3 Expanded Disease Status Scale (EDSS) measurements. Outcomes were the mean EDSS score at the end of follow-up and the annual probability of relapse during follow-up. Counterfactual outcomes were predicted using the longitudinal targeted maximum likelihood estimator in the entire study population. The patients exposed to at least 1 pregnancy during their follow-up were compared with the counterfactual situation in which, contrary to what was observed, they would not have been exposed to any pregnancy. Short-term and delayed effects were analyzed from the first pregnancy of early-exposed patients (who experienced it during their first 3 years of follow-up).

Results

We included 9,100 patients, with a median follow-up duration of 7.8 years, of whom 2,125 (23.4%) patients were exposed to at least 1 pregnancy. Pregnancy had no significant long-term causal effect on the mean EDSS score at 9 years (causal mean difference [95% CI] = 0.00 [–0.16 to 0.15]) or on the annual probability of relapse (causal risk ratio [95% CI] = 0.95 [0.93–1.38]). For the 1,253 early-exposed patients, pregnancy significantly decreased the probability of relapse during the perpartum year and significantly increased it during the postpartum year, but no significant delayed effect was found on the EDSS and relapse rate.

Discussion

Using a causal inference approach, we found no evidence of significantly deleterious or beneficial long-term effects of pregnancy on disability. The beneficial effects found in other studies were probably related to a reverse causation bias.

Gavoille,。我,F。凯西,R。Debouverie, M。,页面,E。Ciron, J。,德Seze, J。Ruet,。Maillart E。Labauge, P。Zephir, H。Papeix C。推迟,G。Lebrun-Frenay C。男人味儿,T。Laplaud, d。伯杰E。,Stankoff B。Clavelou, P。Thouvenot E。Heinzlef, O。佩尔蒂埃,J。艾尔Khedr,。Casez, O。,Bourre B。Cabre, P。华,。Magy, L。, Camdessanche, J.-P., Maurousset, A., Moulin, S., Ben, N. H., Boulos, D. D., Hankiewicz, K., Neau, J.-P., Pottier, C., Nifle, C., Rabilloud, M., Subtil, F., Vukusic, S., on behalf of Observatoire Francais de la Sclerose en Plaques (OFSEP) Investigators 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206774 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206774 美国神经病学学会半岛投注体育官网 所有CBMRT /零假设,多发性硬化症,队列研究 调查的长期影响怀孕在多发性硬化的过程中使用因果推论 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1296 e1308 hw_mjid:半岛投注体育官网神经病学;100/12 / e1296
< ![CDATA[口服抗凝血剂和非瓣膜性房颤患者痴呆的风险:以人群为基础的队列研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/12/e1309?rss=1 <秒> <圣> < /圣> < p >背景和目标非瓣膜性心房颤动(NVAF)与老年痴呆症的风险增加相关。口服抗凝剂(OACs) NVAF中风的预防至关重要,而研究表明老年痴呆症可能的保护作用。然而,结果不一致,由于方法论上的局限。因此,我们评估是否使用OACs与NVAF患者减少老年痴呆症的发病率。此外,我们的累积时间的影响进行了探讨OAC用于老年痴呆症的发病率。< / p > < /秒>Methods

Using the UK Clinical Practice Research Datalink, we formed a cohort of all patients aged 50 years or older with an incident diagnosis of NVAF between 1988 and 2017 and no prior OAC use, with a follow-up until 2019. Patients were considered unexposed until 6 months after their first OAC prescription for latency considerations and exposed thereafter until the end of follow-up. We used time-dependent Cox regression models to estimate hazard ratios (HRs), adjusted for 54 covariates, with 95% CIs for dementia associated with OAC use, compared with nonuse. We also assessed whether the risk varied with the cumulative duration of OAC use, compared with nonuse, by comparing prespecified exposure categories defined in a time-varying manner and by modeling the HR using a restricted cubic spline.

Results

The cohort included 142,227 patients with NVAF, with 8,023 cases of dementia over 662,667 person-years of follow-up (incidence rate 12.1, 95% CI 11.9–12.4 per 1,000 person-years). OAC use was associated with a decreased risk of dementia (HR 0.88, 95% CI 0.84–0.92) compared with nonuse. A restricted cubic spline also indicated a decreased risk of dementia, reaching a low at approximately 1.5 years of cumulative OAC use and stabilizing thereafter. Moreover, OAC use decreased the risk in patients aged 75 years and older (HR 0.84, 95% CI 0.80–0.89), but not in younger patients (HR 0.99, 95% CI 0.90–1.10).

Discussion

In patients with incident NVAF, OACs were associated with a decreased risk of dementia, particularly in elderly individuals. This warrants consideration when weighing the risks and benefits of anticoagulation in this population.

Classification of Evidence

This study provides Class II evidence that in patients with NVAF, OAC use (vs nonuse) is associated with a decreased risk of dementia.

拉赫曼,A。米肖德,J。、DellAniello年代。穆迪,e·e·M。Brophy, j . M。杜兰,M。哈德角海恩尼斯主街Guertin, j . R。、Boivin肯尼迪。Renoux C。 2023 - 03 - 20 - t12:45:25 07:00 信息:doi 10.1212 / / WNL.0000000000206748 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206748 美国神经病学学会半岛投注体育官网 中风预防、痴呆认知障碍/ II级,所有流行病学队列研究 口服抗凝血剂和非瓣膜性房颤患者痴呆的风险:以人群为基础的队列研究 2023-03-21 半岛体育app苹果下载 One hundred. 12 e1309 e1320 hw_mjid:半岛投注体育官网神经病学;100/12 / e1309
< ![CDATA[我们应该测试免疫球蛋白抗体MOG疑似患者的血清和CSF MOGAD ?]] > http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/497?rss=1 < p >髓少突细胞糖蛋白(MOG),一个跨膜蛋白表达表面的少突胶质细胞和髓鞘的最外层表面,曾经被认为是多发性硬化(MS)的潜在生物标志物抗体。1 <一口> < / >共舞,然而,更可靠的发展和特定的细胞化验(cba)检测血清免疫球蛋白G MOG的自身抗体(MOG-IgG)和增加可用性使我们认识到,他们的特点是不同的疾病在中枢神经系统炎性脱髓鞘谱)。2 This condition is now known as MOG antibody–associated disease (MOGAD).3 The typical phenotypes of MOGAD include optic neuritis, acute disseminated encephalomyelitis, transverse myelitis, and, less commonly, cerebral cortical encephalitis or other brain manifestations, either alone or in combination.3 Initially, MOGAD was considered a subset of neuromyelitis optica spectrum disorder (NMOSD) because MOG-IgG was detected in many patients fulfilling the diagnosis for aquaporin-4–IgG (AQP4-IgG) seronegative NMOSD. However, it is important to exclude MOGAD when diagnosing NMOSD. Despite some overlapping features, there are clinical, radiologic, and pathologic findings that distinguish MOGAD from MS and AQP4-IgG seropositive NMOSD.3 Given the therapeutic and prognostic differences between these diseases, an accurate and timely diagnosis is of utmost importance.

金,h·J。宫,J。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000206805 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206805 美国神经病学学会半岛投注体育官网 自身免疫性疾病,所有的脱髓鞘疾病(中枢神经系统) 我们应该测试免疫球蛋白抗体MOG疑似患者的血清和CSF MOGAD吗? 2023-03-14 社论 One hundred. 11 497年 498年 hw_mjid:半岛投注体育官网神经病学;100/11/497
< ![CDATA[自杀在癫痫:常见的各种情绪和焦虑障碍]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/499?rss=1 < p >在超过2年的研究表明焦虑和抑郁是常见的癫痫患者和与贫困的风险增加相关的结果,包括自杀。在美国积极监测数据显示,每年的自杀死亡率癫痫患者比一般人群高22%。<一口> 1 < /一口>其他人群为基础的病例对照研究了3倍或更高的自杀风险比控制癫痫。2 <一口> < /一口>双向关系已经被记载在这些患者的风险增加自杀之前和之后癫痫的发作,癫痫发作后不久就自杀风险是最高的。<一口> 2、3 < /一口>这些发现已经导致了一些人呼吁神经病学家来识别和管理这些患者的抑郁和焦虑,包括河畔一个质量指标筛查焦虑和抑郁在每个诊所访问,<一口> 4 < /一口>和最近出版的国际抗癫痫联盟实践建议癫痫抑郁症管理。<一口> 5 < /一口> < / p > 芒格鼠尾草属的植物,H。Gilliam F。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000206839 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206839 美国神经病学学会半岛投注体育官网 所有精神障碍、抑郁、部分癫痫发作 自杀在癫痫:常见的各种情绪和焦虑障碍 2023-03-14 社论 One hundred. 11 499年 500年 hw_mjid:半岛投注体育官网神经病学;100/11/499 < ![CDATA [Hyperacute灌注成像在儿科血栓切除术:一步]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/501?rss=1 < p >使用先进的神经影像技术,确定缺血性核心和半影(周围脑组织,复苏的潜力)已经成功的关键的多中心随机对照试验hyperacute疗法旨在恢复灌注,减少损伤大血管闭塞中风相关的成年人。然而,在童年的急性设置中风,灌注成像的实现已经受到发展(老年性脑血流量差异),临床(诊断,中风病因和颅内动脉病),技术(对比交付在急性设置和软件)的可用性挑战。< / p > 支顶木材,N。Dlamini, N。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000206819 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206819 美国神经病学学会半岛投注体育官网 童年中风,所有成像,儿科中风;看到脑血管疾病/儿童中风 Hyperacute灌注成像在儿科血栓切除术:更近一步 2023-03-14 社论 One hundred. 11 501年 502年 hw_mjid:半岛投注体育官网神经病学;100/11/501 < ![CDATA[脊髓性肌肉萎缩症的流行疾病修饰治疗的时代:一个意大利全国性调查]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/522?rss=1 <秒> <圣>目标< /圣> < p >脊髓性肌萎缩(SMA)是一种神经退行性疾病由SMN1基因的突变引起的。本研究的目的是评估在意大利SMA的患病率和治疗处方。< / p > < /秒>Methods

An online survey was distributed to 36 centers identified by the Italian government as referral centers for SMA. Data on the number of patients with SMA subdivided according to age, type, SMN2 copy number, and treatment were collected.

Results

One thousand two hundred fifty-five patients with SMA are currently followed in the Italian centers with an estimated prevalence of 2.12/100,000. Of the 1,255, 284 were type I, 470 type II, 467 type III, and 15 type IV with estimated prevalence of 0.48, 0.79, 0.79 and 0.02/100,000, respectively. Three patients with SMA 0 and 16 presymptomatic patients were also included. Approximately 85% were receiving one of the available treatments. The percentage of treated patients decreased with decreasing severity (SMA I: 95.77%, SMA II: 85.11%, SMA III: 79.01%).

Discussion

The results provide for the first time an estimate of the prevalence of SMA at the national level and the current distribution of patients treated with the available therapeutical options. These data provide a baseline to assess future changes in relation to the evolving therapeutical scenario.

Coratti G。里奇,M。卡帕索,。D中保,。,桑松,V。布鲁诺,C。墨西拿,S。里奇,F。Mongini, T。Coccia, M。西西里岛舞蹈,G。Pegoraro E。Turri, M。Filosto, M。Comi, G。马森,R。美极,L。布鲁诺,我。D ' angelo, m·G。Trabacca,。Vacchiano, V。Donati, M。西蒙,我。,鲁杰罗,L。瓦伦,。, Verriello, L., Berardinelli, A., Agosto, C., Pini, A., Maioli, M. A., Passamano, L., Brighina, F., Carboni, N., Garibaldi, M., Zuccarino, R., Gagliardi, D., Siliquini, S., Previtali, S., Taruscio, D., Boccia, S., Pera, M. C., Pane, M., Mercuri, E., on behalf of ITASMAC working group 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201654 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201654 美国神经病学学会半岛投注体育官网 所有神经肌肉疾病,小儿,患病率研究,发病率的研究 脊髓性肌肉萎缩症的流行疾病修饰治疗的时代:一个意大利全国性调查 2023-03-14 临床/科学报告 One hundred. 11 522年 528年 hw_mjid:半岛投注体育官网神经病学;100/11/522
< ![CDATA[显要的地位]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/529?rss=1 科顿,。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201683 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201683 美国神经病学学会半岛投注体育官网 急救护理,姑息治疗 有太阳的地方 2023-03-14 人文学科在神经学半岛投注体育官网 One hundred. 11 529年 529年 hw_mjid:半岛投注体育官网神经病学;100/11/529 < ![CDATA[临床推理:一个60岁的老男人不对称的弱点和持续发烧]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/530?rss=1 < p >周边神经病变,特别是那些非典型特征,仍然是一个诊断挑战。在这种情况下,一位60岁的病人出现急性发作时的弱点从右手然后按顺序包括左腿,左手,右腿在5天。不对称的弱点是伴随着持续发烧和炎症标志物升高。后续发展皮疹结合仔细审查的历史让我们最后的诊断和有针对性的治疗。这种情况下强调临床模式识别的帮助下电生理学的研究周围神经病变,提供快捷键缩小鉴别诊断的范围。我们从历史也说明了重要的缺陷采取辅助检测在诊断周围神经病变的罕见但治疗的原因(eFigure 1, < A HREF = " http://links.lww.com/WNL/C541 " >links.lww.com/WNL/C541 < / >)。< / p > 郑,Y。、香、j j。、张x。张,S。、丁M.-P。黄,J。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201697 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201697 美国神经病学学会半岛投注体育官网 临床神经生理学,免疫学,血管炎,肌电图 临床推理:一个60岁的老男人不对称的弱点和持续发烧 2023-03-14 RESIDENT &amp; FELLOW SECTION One hundred. 11 530年 536年 hw_mjid:半岛投注体育官网神经病学;100/11/530 < ![CDATA[右脑:紫色的围巾和皮质]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/537?rss=1 < p >可能根据大量患者病(CJD)以前高功能金融分析师仍是完全独立的,尽管她的家人担心她的安全。作为一个有限的实习经验在领导这些艰难的对话,这神经病学居民描述了她的经验协调自己的观点,病人,和她的家人。半岛投注体育官网她反映能力重塑这种微妙的谈话从一个失去独立的迅速进步,患者神经退行性条件的安全,安全,照顾她的家人。< / p > 傅,K。Acosta, l . M。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201698 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201698 美国神经病学学会半岛投注体育官网 所有认知障碍/痴呆 右脑:紫色的围巾和皮质丝带 2023-03-14 RESIDENT &amp; FELLOW SECTION One hundred. 11 537年 539年 hw_mjid:半岛投注体育官网神经病学;100/11/537 < ![CDATA[教学视频杂志:Wernekink连合综合症]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/540?rss=1 < p >一个62岁的女人面对突发性蹒跚步态和构音障碍。神经系统检查发现四肢躯干和四肢的运动失调和小脑构音障碍(视频1),轻微放缓的内部右眼旋转在左方的目光,并在绑架左眼眼球震颤。深部腱反射正常。Diffusion-weighted成像显示高信号中线病变在正确的中脑(图)。我们诊断Wernekink连合综合症患者中脑梗塞所致。Wernekink连合综合征是一种罕见的双边性共济失调综合征和眼球运动的功能障碍引起的尾靠近中央的中脑病变。<一口> 1、2 < /一口>负责的船被认为是劣质靠近中央的中脑的动脉,源于远端基动脉和大脑后动脉、小脑上动脉近端。2 <一口> < /一口>这病变包括上级小脑总花梗,十字交叉,内侧纵向纤维束。2 <一口> < /一口>临床医生应该考虑中脑病变患者急性发作时双边共济失调。< / p > 中村,T。上野,T。混合,R。时候,,。巴巴,M。,Tomiyama M。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201706 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201706 美国神经病学学会半岛投注体育官网 核磁共振,其它脑血管疾病/中风,所有临床神经学、脑血管疾病/中风梗塞半岛投注体育官网 教学视频的实验:Wernekink连合综合症 2023-03-14 RESIDENT &amp; FELLOW SECTION One hundred. 11 540年 541年 hw_mjid:半岛投注体育官网神经病学;100/11/540 < ![CDATA[编者注:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/542?rss=1

In their multicenter randomized controlled clinical trial of patients with idiopathic intracranial hypertension (IIH), Mollan et al. sought to determine the amount of weight loss necessary to achieve physiologic remission (intracranial pressure [ICP] ≤25 cm CSF). The investigators not only found that greater weight loss was achieved with bariatric surgery over community weight management but patients who underwent surgery experienced greater and more rapid reduction in ICP. Furthermore, only patients in the surgical arm achieved a fall in ICP to ≤25 cm, which was associated with a mean weight loss of approximately 24% from their baseline weight. Dr. Ramsamy and colleagues highlight that surgery was not associated with statistically significant improvement in visual outcomes or headache, which are the most disabling symptoms of IIH. In response, Dr. Mollan and their coinvestigators note the study was powered to demonstrate a treatment effect for the primary outcome of ICP reduction (as a biomarker of disease remission), rather than for secondary outcomes regarding visual or other symptoms of IIH. That said, the investigators admit there remains no consensus definition for clinical remission in IIH. Dr. Brenner also comments on the potential adjuvant use of caffeine in weight loss for patients with IIH and the benefits of optic nerve sheath fenestration when vision loss occurs. The investigators cite their original manuscript (published in JAMA Neurology), which reported a rapid and significant fall in ICP within 2 weeks of bariatric surgery. It is possible that acute hormonal changes after surgery such as a rapid rise in gut neuropeptide glucagon-like peptide-1 may have played a larger role in ICP reduction than weight loss alone.

Siegler, j·E。、Galetta年代。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000207118 hwp:资源id:神经病学;10半岛投注体育官网0/11/542 美国神经病学学会半岛投注体育官网 编者注:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压 2023-03-14 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 11 542年 542年 hw_mjid:半岛投注体育官网神经病学;100/11/542
< ![CDATA[读者反应:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/542-a?rss=1 < p > Mollan等人报告说,减肥手术优于社区体重管理(CWM)关于体重的下降,降低颅内压(ICP),疾病缓解期,女性的生活质量与特发性颅内高血压(IIH)。<一口> 1、2 < /一口>他们建议临床医生有低阈值的推荐减肥手术。<一口> 1 < /一口> < / p > Ramsamy, S。Singhal年代。帕特尔,R。格伦,a . M。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000207119 hwp:资源id:神经病学;10半岛投注体育官网0/11/542-a 美国神经病学学会半岛投注体育官网 读者反应:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压 2023-03-14 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 11 542年 543年 hw_mjid:半岛投注体育官网神经病学;100/11/542-a < ![CDATA[作者回应:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/543?rss=1 < p >我们感谢Ramsamy等人的评论。特发性颅内高血压(IIH)是一种全身性代谢疾病和与肥胖协会成立。颅内高压症的生活质量造成不利影响,因为大多数接受经验头痛。<一口> 1 < /一口> < / p > Mollan, s P。辛克莱,a·J。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000207120 hwp:资源id:神经病学;10半岛投注体育官网0/11/543 美国神经病学学会半岛投注体育官网 作者回复:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压 2023-03-14 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 11 543年 543年 hw_mjid:半岛投注体育官网神经病学;100/11/543 < ![CDATA[读者反应:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/544?rss=1 < p >我读这篇文章Mollan et al . <一口> 1 < /一口>关于减肥和颅内高血压(IH)。胃旁路手术的结果减少二羰基应激(DS)。<一口> 2 < /一口> DS-related化合物,如methylgloxal,与血脑屏障的破坏,<一口> 3 < /一口>见IH通过生物分子的糖化和生产先进的糖化终端产品(年龄)。<一口> 3、4 < /一口>抑制semicarbazide-sensitive胺氧化酶,导致DS,咖啡因可能会导致体重增加和减少年龄。<一口> 5 < /一口> < / p > 布伦纳,s R。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000207121 hwp:资源id:神经病学;10半岛投注体育官网0/11/544 美国神经病学学会半岛投注体育官网 读者反应:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压 2023-03-14 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 11 544年 544年 hw_mjid:半岛投注体育官网神经病学;100/11/544 < ![CDATA[作者回应:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/544-a?rss=1 < p >我们欢迎Brenner博士的假设关于如何减肥的机制降低颅内压(ICP)。减肥手术已经被证明可以显著降低ICP与减肥,在颅内高压症,<一口> 1 < /一口> roux - en - y胃旁路手术后最引人注目(RYGB)。<一口> 2 < /一口> < / p > Mollan, s P。辛克莱,a·J。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000207122 hwp:资源id:神经病学;10半岛投注体育官网0/11/544-a 美国神经病学学会半岛投注体育官网 作者回复:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压 2023-03-14 DISPUTES &amp; DEBATES: EDITORS' CHOICE One hundred. 11 544年 545年 hw_mjid:半岛投注体育官网神经病学;100/11/544-a < ![CDATA[认知结果在临床前和临床相关的变化有前驱症状的认知阶段:对临床老年试验]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/545?rss=1 < p >研究篇题为半岛体育app苹果下载“认知结果在临床前和临床相关的变化有前驱症状的认知阶段:对临床试验”老年痴呆症的宝蓝et al ., <一口> 1 < /一口>在认知测试部分,句子“进一步解释的测试,评估,以及如何描述的点是计算是eMethods。”应该包括以下链接到eMethods: < A HREF = " http://links.lww.com/WNL/C167 " >links.lww.com/WNL/C167 < / >。出版商遗憾遗漏。< / p > 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000206876 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206876 美国神经病学学会半岛投注体育官网 认知结果在临床前和临床相关的变化有前驱症状的认知阶段:对临床老年试验的影响 2023-03-14 修正 One hundred. 11 545年 545年 hw_mjid:半岛投注体育官网神经病学;100/11/545 < ![CDATA[青少年肌阵挛癫痫癫痫发作后25年:以人群为基础的研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/545-a?rss=1 < p >研究篇题为半岛体育app苹果下载“青少年肌阵挛癫痫癫痫发作后25年:以人群为基础的研究”通过Camfield et al ., <一口> 1 < /一口>第二句抽象的讨论应该读,“所有青少年肌阵挛癫痫发作类型(期刊)解决在26%,和13%,肌阵挛坚持。”In addition, the third sentence of the Discussion section should read, "All seizure types remit in approximately 26%, and in 13%, only myoclonic seizures persist for up to 22 years after stopping AEDs." The authors regret the errors.

2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000206877 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206877 美国神经病学学会半岛投注体育官网 青少年肌阵挛癫痫癫痫发作后25年:以人群为基础的研究 2023-03-14 修正 One hundred. 11 545年 545年 hw_mjid:半岛投注体育官网神经病学;100/11/545-a
< ![CDATA[脑脊液中髓少突细胞糖蛋白抗体的意义:回顾性多中心研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1095?rss=1 <秒> <圣> < /圣> < p >背景和目标尽管诊断髓少突细胞糖蛋白antibody-associated疾病(MOGAD)是基于血清MOG抗体(MOG-Abs)积极性,患者共存或限制MOG-Abs CSF已报告。本研究的目的是描述的相关性CSF MOG-Abs积极性在临床实践中。< / p > < /秒>Methods

Eleven medical centers retrospectively collected clinical and laboratory data of adult and pediatric patients with suspected inflammatory CNS disease and MOG-Abs positivity in serum and/or CSF using live cell-based assays. Comparisons were performed using parametric or nonparametric tests, as appropriate. Potential factors of unfavorable outcomes were explored by Cox proportional hazard models and logistic regression.

Results

The cohort included 255 patients: 139 (55%) women and 132 (52%) children (i.e., <18-year-old). Among them, 145 patients (56.8%) had MOG-Abs in both serum and CSF (MOG-Abs seropositive and CSF positive), 79 (31%) only in serum (MOG-Abs seropositive and CSF negative), and 31 (12%) only in CSF (MOG-Abs seronegative and CSF positive). MOG-Abs seronegative and CSF positive predominated in adults (22% vs 3% of children), presented more commonly with motor (n = 14, 45%) and sensory symptoms (n = 13, 42%), and all but 4 (2 multiple sclerosis, 1 polyradiculoneuritis, and 1 Susac syndrome) had a final diagnosis compatible with MOGAD. When comparing seropositive patients according to MOG-Abs CSF status, MOG-Abs seropositive and CSF positive patients had a higher Expanded Disability Status Scale (EDSS) at nadir during the index event (median 4.5, interquartile range [IQR] 3.0–7.5 vs 3.0, IQR 2.0–6.8, p = 0.007) and presented more commonly with sensory (45.5% vs 24%, p = 0.002), motor (33.6% vs 19%, p = 0.021), and sphincter symptoms (26.9% vs 7.8%, p = 0.001) than MOG-Abs seropositive and CSF negative. At the last follow-up, MOG-Abs seropositive and CSF positive cases had more often persistent sphincter dysfunction (17.3% vs 4.3%, p = 0.008). Compared with seropositive patients, those MOG-Abs seronegative and CSF positive had higher disability at the last follow-up (p ≤ 0.001), and MOG-Abs seronegative and CSF positive status were independently associated with an EDSS ≥3.0.

Discussion

Paired serum and CSF MOG-Abs positivity are common in MOGAD and are associated with a more severe clinical presentation. CSF-only MOG-Abs positivity can occur in patients with a phenotype suggestive of MOGAD and is associated with a worse outcome. Taken together, these data suggest a clinical interest in assessing CSF MOG-Abs in patients with a phenotype suggestive of MOGAD, regardless of the MOG-Abs serostatus.

的法令,S。Cobo卡尔沃,。Armangue, T。Saiz,。莱希,C。Rostasy, K。Breu, M。鲍曼,M。, Höftberger, R., Ayzenberg, I., Schwake, C., Sepulveda, M., Martinez-Hernandez, E., Olive-Cirera, G., Arrambide, G., Tintore, M., Bernard-Valnet, R., Du Pasquier, R., Brilot, F., Ramanathan, S., Schanda, K., Gajofatto, A., Ferrari, S., Sechi, E., Flanagan, E. P., Pittock, S. J., Redenbaugh, V., Reindl, M., Marignier, R., Mariotto, S. 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201662 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201662 美国神经病学学会半岛投注体育官网 所有的脱髓鞘疾病(中枢神经系统),视神经炎;看到Neuro-ophthalmology /视神经、急性播散性脑脊髓炎、横向脊髓炎 脑脊液中髓少突细胞糖蛋白抗体的意义:回顾性多中心研究 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1095 e1108 hw_mjid:半岛投注体育官网神经病学;100/11 / e1095
< ![CDATA[造血干细胞移植患者积极继发型多发性硬化]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1109?rss=1 <秒> <圣> < /圣> < p >背景和目标控制的证据表明,自体造血干细胞移植(AHSCT)可以有效地活跃继发型多发性硬化患者(spm)。在这项研究中,我们比较AHSCT的效果与其他抗炎疾病修饰治疗(儿童)在活跃的spm长期残疾恶化。< / p > < /秒> <秒> <圣> < /圣> < p >方法我们收集的数据从意大利骨髓移植研究集团和意大利多发性硬化症登记。患者被认为是合格的,如果治疗后开始spm的诊断。残疾恶化是评估患者6个月的累积比例确认残疾进展(CDP)根据扩大残疾状态量表(eds)评分。关键二次端点eds时间治疗后开始和残疾的流行趋势改善随着时间的推移。时间第一CDP比例风险Cox回归模型的评估手段。线性混合模型和时间<字体= " arial, helvetica " > x < / FONT >治疗组相互作用被用来评估纵向eds时间趋势。流行的改进估计使用修改后的kaplan meier估计和比较各组引导曲线下的面积。< / p > < /秒>Results

Seventy-nine AHSCT-treated patients and 1975 patients treated with other DMTs (beta interferons, azathioprine, glatiramer-acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, teriflunomide, cyclophosphamide, dimethyl fumarate, and alemtuzumab) were matched to reduce treatment selection bias using propensity score and overlap weighting approaches. Time to first CDP was significantly longer in transplanted patients (hazard ratio [HR] = 0.50; 95% CI = 0.31–0.81; p = 0.005), with 61.7% of transplanted patients free from CPD at 5 years. Accordingly, EDSS time trend over 10 years was higher in patients treated with other DMTs than in AHSCT-treated patients (+0.157 EDSS points per year compared with –0.013 EDSS points per year; interaction p < 0.001). Patients who underwent AHSCT were more likely to experience a sustained disability improvement: 34.7% of patients maintained an improvement (a lower EDSS than baseline) 3 years after transplant vs 4.6% of patients treated by other DMTs (p < 0.001).

Discussion

The use of AHSCT in people with active SPMS is associated with a slowing of disability progression and a higher likelihood of disability improvement compared with standard immunotherapy.

Classification of Evidence

This study provides Class III evidence that autologous hematopoietic stem cell transplants prolonged the time to CDP compared with other DMTs.

Boffa G。夫人,。Massacesi, L。Mariottini,。E。, -斯布拉基亚、Cottone年代。阿马托,m . P。Gasperini C。Moiola, L。、Meletti年代。Repice, a . M。布雷西亚猜拳,V。生活,G。帕蒂·F。菲利皮主持,M。德卢卡,G。逻辑单元,G。, Zaffaroni, M., Sola, P., Conte, A., Nistri, R., Aguglia, U., Granella, F., Galgani, S., Caniatti, L. M., Lugaresi, A., Romano, S., Iaffaldano, P., Cocco, E., Saccardi, R., Angelucci, E., Trojano, M., Mancardi, G. L., Sormani, M. P., Inglese, M., on behalf of the Italian BMT-MS Study Group and the Italian MS Register, Capobianco, M., Zimatore, G. B., Frau, J., Scarpini, E., Meucci, G., Guidetti, D., Gualandi, F., Varaldo, R., Raiola, A. M., Innocenti, C., Zoli, V., Ciceri, F., Greco, R., Scim`e, R., De Gobbi, M., Barilaro, A. 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000206750 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206750 美国神经病学学会半岛投注体育官网 临床试验观察研究(队列,病例对照),第三类,多发性硬化症 造血干细胞移植的人活跃的二级进展型多发性硬化症 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1109 e1122 hw_mjid:半岛投注体育官网神经病学;100/11 / e1109
< ![CDATA[心境和焦虑障碍患者和自杀倾向新确诊癫痫灶:分析一个复杂疾病]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1123?rss=1 <秒> <圣> < /圣> < p >背景和目标的情绪,焦虑障碍和自杀倾向更频繁的癫痫患者比一般人群。然而,其患病率和心境和焦虑障碍与自杀倾向有关的类型的癫痫诊断并不成立。我们试图回答这些问题在新诊断患者局部癫痫和评估他们的协会与自杀意念和尝试。< / p > < /秒> <秒> <圣> < /圣> < p >方法数据来自人类癫痫项目研究。A total of 347 consecutive adults aged 18–60 years with newly diagnosed focal epilepsy were enrolled within 4 months of starting treatment. The types of mood and anxiety disorders were identified with the Mini International Neuropsychiatric Interview, whereas suicidal ideation (lifetime, current, active, and passive) and suicidal attempts (lifetime and current) were established with the Columbia Suicidality Severity Rating Scale (CSSRS). Statistical analyses included the t test, 2 statistics, and logistic regression analyses.

Results

A total of 151 (43.5%) patients had a psychiatric diagnosis; 134 (38.6%) met the criteria for a mood and/or anxiety disorder, and 75 (21.6%) reported suicidal ideation with or without attempts. Mood (23.6%) and anxiety (27.4%) disorders had comparable prevalence rates, whereas both disorders occurred together in 43 patients (12.4%). Major depressive disorders (MDDs) had a slightly higher prevalence than bipolar disorders (BPDs) (9.5% vs 6.9%, respectively). Explanatory variables of suicidality included MDD, BPD, panic disorders, and agoraphobia, with BPD and panic disorders being the strongest variables, particularly for active suicidal ideation and suicidal attempts.

Discussion

In patients with newly diagnosed focal epilepsy, the prevalence of mood, anxiety disorders, and suicidality is higher than in the general population and comparable to those of patients with established epilepsy. Their recognition at the time of the initial epilepsy evaluation is of the essence.

Kanner, a . M。Saporta, a。金,d . H。巴里,J·J。Altalib, H。Omotola, H。Jette, N。O ' brien, t·J。还,S。、Winawer m R。斯珀林,M。、法语、j . A。,Abou-Khalil B。,Alldredge B。Bebin, M。、Cascino g D。,科尔,a . J。,厨师,m . J。Detyniecki, K。Devinsky, O。Dlugos D。Faught E。菲克,D。、字段。,Gidal B。Gelfand, M。格林,S。, Halford, J. J., Haut, S., Hegde, M., Holmes, M. G., Kalviainen, R., Kang, J., Klein, P., Knowlton, R. C., Krishnamurthy, K., Kuzniecky, R., Kwan, P., Lowenstein, D. H., Marcuse, L., Meador, K. J., Mintzer, S., Pardoe, H. R., Park, K., Penovich, P., Singh, R. K., Somerville, E., Szabo, C. A., Szaflarski, J. P., Lin Thio, K. L., Trinka, E., Burneo, J. G., and the Human Epilepsy Project 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201671 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201671 美国神经病学学会半岛投注体育官网 躁狂、抑郁、部分癫痫发作、复杂部分发作 患者的情绪和焦虑性障碍和自杀倾向新确诊癫痫灶:分析一个复杂的疾病 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1123 e1134 hw_mjid:半岛投注体育官网神经病学;100/11 / e1123
< ![CDATA[脆弱和抗癫痫药物耐受性之间的联系在老年人癫痫]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1135?rss=1 <秒> <圣>背景和客观的< /圣> < p >脆弱是生物老化的一个重要方面,指的是增加的脆弱性与脆弱个体生理和心理压力。而老年人癫痫是一个重要和独特的临床组,没有弱点的数据在这个人口。我们假设脆弱与癫痫发作频率,尤其是抗癫痫药物的耐受性(asm)老年人癫痫。< / p > < /秒> <秒> <圣> < /圣> < p >方法我们招募个体60岁以上与癫痫活动从4加拿大医院中心。我们报道发作频率在3个月前的采访中,尽管ASM耐受性量化使用利物浦不良事件概要文件(LAEP)。我们应用3脆弱的措施:握力测量的身体虚弱,1自报分数(埃德蒙顿虚弱得分(EFS)),和1规模完成医疗专业(临床脆弱规模(CFS))。我们也管理标准化的问卷测量水平的焦虑、抑郁、功能残疾和生活质量和获得相关的临床和人口统计数据。< / p > < /秒>Results

Forty-three women and 43 men aged 60–93 years were recruited, 87% of whom had focal epilepsy, with an average frequency of 3.4 seizures per month. Multiple linear regression and zero-inflated negative binomial regression models showed that EFS and CFS scores were associated with decreased ASM tolerability, each point increase leading to 1.83 (95% CI: 0.67–4.30) and 2.49 (95% CI: 1.27–2.39) point increases on the LAEP scale, respectively. Neither the EFS and CFS scores nor grip strength were significantly associated with seizure frequency. The EFS was moderately correlated with depression, anxiety, quality of life, and functional disability, demonstrating the best construct validity among the 3 tested measures of frailty.

Discussion

The EFS was significantly, both statistically and clinically, associated with ASM tolerability. It also showed multiple advantages in performance while assessing for frailty in older adults with epilepsy, when compared with the 2 other measures of frailty that we tested. Future studies must focus on what role the EFS during epilepsy diagnosis may play in ASM selection among older adults with epilepsy.

Vary-O奥尼尔,。、Miranzadeh年代。Husein, N。Holroyd-Leduc, J。Sajobi, T . T。、Wiebe年代。执事,C。Tellez-Zenteno, j·F。约瑟夫森,c, B。、Keezer m R。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201701 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201701 美国神经病学学会半岛投注体育官网 所有癫痫发作的/ 脆弱和抗癫痫药物耐受性之间的联系在老年人癫痫 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1135 e1147 hw_mjid:半岛投注体育官网神经病学;100/11 / e1135
< ![CDATA [Hyperacute灌注成像在儿科血栓切除术:拯救孩子的分析研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1148?rss=1 <秒> <圣> < /圣> < p >背景和目标灌注成像能够识别成人脑组织可抢救的患者将受益于血栓切除术在以后的时间窗口。获得hyperacute灌注的可行性序列在儿科中风是未知的。本研究的目的是确定是否对比灌注成像延迟时间治疗和评估灌注概要文件在儿童大血管闭塞中风。< / p > < /秒>Methods

The Save ChildS retrospective cohort study (January 2000–December 2018) enrolled children (1 month–18 years) with stroke who underwent thrombectomy from 27 European and U.S. stroke centers. This secondary analysis included patients with anterior circulation occlusion and available imaging for direct review by the neuroimaging core laboratory. Between-group comparisons were performed using the Wilcoxon rank-sum exact test for continuous variables or Fisher exact test for binary variables. Given the small number of patients, evaluation of perfusion imaging parameters was performed descriptively only.

Results

Of 33 patients with available neuroimaging, 15 (45.4%) underwent perfusion (CT perfusion n = 6; MR perfusion n = 9); all were technically adequate. The median time from onset to recanalization did not differ between groups {4 hours (interquartile range [IQR] 4–7.5) perfusion+; 3.4 hours (IQR 2.5–6.5) perfusion-, p = 0.158}. Target mismatch criteria were met by 10/15 (66.7%) patients and did not correlate with reperfusion status or functional outcome. The hypoperfusion intensity ratio (HIR) was favorable in 11/15 patients and correlated with older age but not NIHSS, time to recanalization, or stroke etiology. Favorable HIR was associated with better functional outcome at 6 months (Pediatric Stroke Outcome Measure 1.0 [IQR 0.5–2.0] vs 2.0 [1.5–3.0], p = 0.026) and modified Rankin Scale 1.0 [0–1] vs 2.0 [1.5–3.5], p = 0.048) in this small sample.

Discussion

Automated perfusion imaging is feasible to obtain acutely in children and does not delay time to recanalization. Larger prospective studies are needed to determine biomarkers of favorable outcome in pediatric ischemic stroke and to establish core and penumbral thresholds in children.

李,S。Mlynash, M。克里斯坦森,S。江,B。Wintermark, M。, Sträter, R., Broocks, G., Grams, A., Nikoubashman, O., Morotti, A., Trenkler, J., Möhlenbruch, M., Fiehler, J., Wildgruber, M., Kemmling, A., Psychogios, M., Sporns, P. B. 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201687 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201687 美国神经病学学会半岛投注体育官网 童年中风、核磁共振、脑血管疾病/中风 Hyperacute灌注成像在儿科血栓切除术:拯救孩子的分析研究 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1148 e1158 hw_mjid:半岛投注体育官网神经病学;100/11 / e1148
< ![CDATA[基因预测缺血性中风后睡眠特征和功能结果:孟德尔随机化研究]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1159?rss=1 <秒> <圣> < /圣> < p >背景和目标的睡眠特征可以在观察性研究对缺血性中风恢复。本研究的目的是探索基因预测睡眠之间的关系特征和卒中后功能与孟德尔随机化(先生)方法的结果。< / p > < /秒> <秒> <圣> < /圣> < p >工具变量方法对失眠和睡眠时间从全基因组关联研究数据采用欧洲血统的人。缺血性中风后功能结果的汇总数据从缺血性中风的基因功能检索结果网络。反变量采用加权的方法为主要分析。替代先生的方法被用于敏感性分析。我2 <一口> < /一口>和Q值统计数据被用来评价基因变异之间的异质性。< / p > < /秒>Results

In univariable analysis, genetic liability to insomnia was significantly associated with worse functional outcome (modified Rankin Scale ≥3) after ischemic stroke (odds ratio [OR] = 1.30; 95% CI: 1.10–1.54, p = 0.002). Genetic liability to short sleep, long sleep, and continuous sleep duration were not associated with poststroke functional outcome (all p > 0.05). Sensitivity analyses without adjustment for stroke severity also supported that insomnia was causally associated with poor functional outcome (OR = 1.25; 95% CI: 1.08–1.44, p = 0.003). In the multivariable MR analysis adjusting for potentially confounding traits including body mass index, depression, type 2 diabetes, smoking, and alcohol consumption, the overall patterns between genetic liability to insomnia and poststroke outcome remained (all p < 0.05).

Discussion

This MR study supports potential adverse effects of liability to insomnia on functional outcome after ischemic stroke. Interventions that address insomnia may offer a therapeutic target to improve recovery after ischemic stroke and warrant exploration in a clinical context.

张,Z。王,M。吉尔,D。、朱、W。刘,X。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000206745 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000206745 美国神经病学学会半岛投注体育官网 结果研究,所有脑血管疾病/中风,在流行病学危险因素 基因预测缺血性中风后睡眠特征和功能结果:孟德尔随机化研究 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1159 e1165 hw_mjid:半岛投注体育官网神经病学;100/11 / e1159
< ![CDATA[高级大脑年龄和慢性卒中后失语严重程度]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1166?rss=1 < <秒> <圣>背景和目标/圣> < p >慢性卒中后语言障碍通常是更糟的是老年人和那些有大量中风病灶。然而,有无法解释的方差,可能取决于完整组织以外的病变。脑年龄是一个新兴的概念,这是部分独立于时间年龄。先进的大脑年龄与健康老年人认知能力的下降;因此,我们的目的是探讨与中风失语症的关系。我们假设先进的大脑年龄是一个重要因素与慢性卒中后语言障碍,超越时间年龄、病变特征。< / p > < /秒>Methods

This cohort study retrospectively evaluated participants from the Predicting Outcomes of Language Rehabilitation in Aphasia clinical trial (NCT03416738), recruited through local advertisement in South Carolina (US). Primary inclusion criteria were left hemisphere stroke and chronic aphasia (≥12 months after stroke). Participants completed baseline behavioral testing including the Western Aphasia Battery–Revised (WAB-R), Philadelphia Naming Test (PNT), Pyramids and Palm Trees Test (PPTT), and Wechsler Adult Intelligence Scale Matrices subtest, before completing 6 weeks of language therapy. The PNT was repeated 1 month after therapy. We leveraged modern neuroimaging techniques to estimate brain age and computed a proportional difference between chronologic age and estimated brain age. Multiple linear regression models were used to evaluate the relationship between proportional brain age difference (PBAD) and behavior.

Results

Participants (N = 93, 58 males and 35 females, average age = 61 years) had estimated brain ages ranging from 14 years younger to 23 years older than chronologic age. Advanced brain age predicted performance on semantic tasks (PPTT) and language tasks (WAB-R). For participants with advanced brain aging (n = 47), treatment gains (improvement on the PNT) were independently predicted by PBAD (T = –2.0474, p = 0.0468, 9% of variance explained).

Discussion

Through the application of modern neuroimaging techniques, advanced brain aging was associated with aphasia severity and performance on semantic tasks. Notably, therapy outcome scores were also associated with PBAD, albeit only among participants with advanced brain aging. These findings corroborate the importance of brain age as a determinant of poststroke recovery and underscore the importance of personalized health factors in determining recovery trajectories, which should be considered during the planning or implementation of therapeutic interventions.

巴斯比,N。Wilmskoetter, J。Gleichgerrcht E。Rorden C。罗斯,R。Newman-Norlund, R。希利斯,a E。凯勒,美国。,德Bezenac C。、Kristinsson年代。福里森,J。Bonilha, L。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201693 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201693 美国神经病学学会半岛投注体育官网 核磁共振,脑血管疾病/中风、失语、认知老化 先进的大脑年龄和慢性卒中后失语严重程度 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1166 e1176 hw_mjid:半岛投注体育官网神经病学;100/11 / e1166
< ![CDATA[临时安全性可行性研究的“神经接口系统]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1177?rss=1 <秒> <圣> < /圣> < p >背景和目标脑-机接口(bci)正在开发恢复流动性,沟通,和功能独立的人瘫痪。虽然在几十年的临床前数据的支持下,长期植入微电极阵列bci在人类身上的安全性是未知的。我们报告安全潜在的结果,非盲、非随机叫“大脑之门”的可行性研究(NCT00912041),最大、持续时间最长的BCI植入的临床试验。< / p > < /秒>Methods

Adults aged 18–75 years with quadriparesis from spinal cord injury, brainstem stroke, or motor neuron disease were enrolled through 7 clinical sites in the United States. Participants underwent surgical implantation of 1 or 2 microelectrode arrays in the motor cortex of the dominant cerebral hemisphere. The primary safety outcome was device-related serious adverse events (SAEs) requiring device explantation or resulting in death or permanently increased disability during the 1-year postimplant evaluation period. The secondary outcomes included the type and frequency of other adverse events and the feasibility of the BrainGate system for controlling a computer or other assistive technologies.

Results

From 2004 to 2021, 14 adults enrolled in the BrainGate trial had devices surgically implanted. The average duration of device implantation was 872 days, yielding 12,203 days of safety experience. There were 68 device-related adverse events, including 6 device-related SAEs. The most common device-related adverse event was skin irritation around the percutaneous pedestal. There were no safety events that required device explantation, no unanticipated adverse device events, no intracranial infections, and no participant deaths or adverse events resulting in permanently increased disability related to the investigational device.

Discussion

The BrainGate Neural Interface system has a safety record comparable with other chronically implanted medical devices. Given rapid recent advances in this technology and continued performance gains, these data suggest a favorable risk/benefit ratio in appropriately selected individuals to support ongoing research and development.

Trial Registration Information

ClinicalTrials.gov Identifier: NCT00912041.

Classification of Evidence

This study provides Class IV evidence that the neurosurgically placed BrainGate Neural Interface system is associated with a low rate of SAEs defined as those requiring device explantation, resulting in death, or resulting in permanently increased disability during the 1-year postimplant period.

鲁宾,d . B。的例子,a B。,光着脚,L。出版,M。现金,S S。陈,D。多诺霍,j . P。Eskandar, e . N。Friehs, G。格兰特,C。亨德森,j . M。樱桃白兰地,r F。Marujo, R。马苏德,M。Mernoff, s T。米勒,j . P。Mukand, j。佩恩,r D。Shefner, J。谢诺,k V。Simeral, j . D。、甜,j . A。沃尔特,b . L。威廉姆斯,z . M。业务,,l·R。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201707 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201707 美国神经病学学会半岛投注体育官网 肌萎缩性脊髓侧索硬化症,所有临床试验,所有康复,所有的脊髓,四级 临时的安全性“大脑之门”神经接口系统的可行性研究 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1177 e1192 hw_mjid:半岛投注体育官网神经病学;100/11 / e1177
< ![CDATA [Mirogabalin中央脊髓损伤后神经性疼痛:一项随机、双盲、安慰剂对照,3期研究在亚洲]]> http://n.半岛投注体育官网neurology.org/cgi/content/short/100/11/e1193?rss=1 <秒> <圣> < /圣> < p >背景和目标脊髓损伤(SCI)患者通常经验中枢神经性疼痛(CNeP),这是具有挑战性的治疗。对周围神经性疼痛Mirogabalin是有效的,但缺乏CNeP的证据。< / p > < /秒>Methods

This randomized, double-blind, placebo-controlled, phase 3 study investigated mirogabalin efficacy and safety for the treatment of CNeP in patients with traumatic SCI. Adult patients from 120 sites throughout Japan, Korea, and Taiwan were randomized (1:1) to receive placebo or mirogabalin (5 mg twice daily [BID] for 1 week, 10 mg BID for 1 week, and 10 or 15 mg BID for 12 weeks). Patients with moderate renal impairment received half the dosage. The primary efficacy endpoint was change from baseline in the weekly average daily pain score (ADPS) at week 14. The secondary endpoints included ADPS responder rates, the Short-Form McGill Pain Questionnaire (SF-MPQ), average daily sleep interference score (ADSIS), and Neuropathic Pain Symptom Inventory (NPSI). Adverse events were monitored for safety.

Results

Each treatment group comprised 150 patients. Mirogabalin elicited a statistical and clinically relevant improvement in change from baseline in the weekly ADPS at week 14 (least-squares mean difference [95% CI] vs placebo –0.71 [–1.08 to –0.34], p = 0.0001). Responder rates at week 14 were higher for mirogabalin than those for placebo (odds ratio [95% CI] 1.91 [1.11–3.27] for the ≥30% responder rate; 2.52 [1.11–5.71] for the ≥50% responder rate). Statistical improvements (i.e., least-squares mean difference [95% CI] vs placebo) were also observed in the SF-MPQ (–2.4 [–3.8 to –1.1]), ADSIS –0.71 (–1.04 to –0.38), and NPSI –7.7 (–11.1 to –4.4) scores. Most treatment-emergent adverse events were mild; no serious adverse drug reactions were reported.

Discussion

Mirogabalin elicited clinically relevant decreases in pain and was well tolerated, suggesting that mirogabalin is a promising treatment for patients with CNeP due to SCI.

Trial Registration Information

ClinicalTrials.gov (NCT03901352); first submitted April 3, 2019; first patient enrolled March 14, 2019; available at clinicaltrials.gov/ct2/show/NCT03901352.

Classification of Evidence

This study provides Class I evidence that in adult patients with CNeP due to traumatic SCI, mirogabalin, 10 or 15 mg BID, effectively improves weekly ADPS at week 14.

Ushida, T。片,Y。Hiasa, Y。Nishihara, M。日本田岛,F。、Katoh年代。田中,H。Maeda, T。Furusawa, K。理查森,M。Kakehi, Y。Kikumori, K。Kuroha, M。 2023 - 03 - 13 - t12:45:34 07:00 信息:doi 10.1212 / / WNL.0000000000201709 hwp: master-id半岛投注体育官网:神经病学;WNL.0000000000201709 美国神经病学学会半岛投注体育官网 随机对照临床试验(配偶协议),中央疼痛、神经性疼痛,脊髓创伤;看到创伤/脊髓创伤、脊髓创伤,我班 Mirogabalin中央脊髓损伤后神经性疼痛:一项随机、双盲、安慰剂对照,第三阶段研究在亚洲 2023-03-14 半岛体育app苹果下载 One hundred. 11 e1193 e1206 hw_mjid:半岛投注体育官网神经病学;100/11 / e1193
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