Journal of Neurology, Neurosurgery & Psychiatry
本篇文献由机器智能翻译
Statin use and long-term risk of recurrent intracerebral haemorrhage: the MUCH-Italy
他汀类药物的使用和复发性脑出血的长期风险: 意大利
Whether statin use after spontaneous intracerebral haemorrhage (ICH) increases the risk of recurrent ICH is uncertain. Statin use appears to be unrelated to the risk of ICH recurrence.
自发性脑出血 (ICH) 后使用他汀类药物是否会增加复发性ICH的风险尚不确定。他汀类药物的使用似乎与ICH复发的风险无关。
REF: Pezzini A, Tarantino B, Zedde ML, et al. Statin use and long-term risk of recurrent intracerebral haemorrhage: the MUCH-Italy. J Neurol Neurosurg Psychiatry. Published online June 27, 2024. doi:10.1136/jnnp-2024-333396 PMID: 38937074
First-ever seizure and eligibility for commercial motor vehicle driving
首次检获商用车及驾驶资格
After a first-ever seizure, 6 months of seizure freedom is usually required before returning to driving a private motor vehicle, after which the annual risk of seizure recurrence has fallen to ≤20%. Stricter criteria apply for commercial driver's licence (CDL) holders, and a longer period of seizure freedom sufficient for the annual risk of recurrence to be <2% is recommended. However, CDL guidelines are based on little data with few studies having long-term follow-up. For unprovoked and acute symptomatic first-ever seizure and CDL, a higher-than-expected annual seizure risk persists beyond the currently recommended seizure-free periods, even in those without risk factors for recurrence. Our data can inform decisions regarding a return to driving for CDL holders after first-ever seizure.
首次癫痫发作后,通常需要6个月的癫痫发作自由才能返回驾驶私家车,此后癫痫发作复发的年度风险降至 ≤ 20%。更严格的标准适用于商业驾驶执照 (CDL) 持有人,并且建议使用更长的扣押自由时间,足以使每年的复发风险 <2%。然而,CDL指南基于很少的数据,很少有长期随访的研究。对于无缘无故和急性症状的首次癫痫发作和CDL,即使在那些没有复发危险因素的患者中,高于预期的年度癫痫发作风险也会持续超过目前推荐的无癫痫发作期。我们的数据可以为首次癫痫发作后CDL持有人恢复驾驶的决策提供依据。
REF: Lawn N, Lee J, Dunne J. First-ever seizure and eligibility for commercial motor vehicle driving. J Neurol Neurosurg Psychiatry. Published online June 26, 2024. doi:10.1136/jnnp-2024-333684 PMID: 38925913
Visuospatial dysfunction predicts dementia-first phenoconversion in isolated REM sleep behaviour disorder
视觉空间功能障碍可预测孤立性REM睡眠行为障碍的痴呆-首次表型转换
While isolated rapid eye movement sleep behaviour disorder (iRBD) is known as a prodrome of α-synucleinopathies, the prediction for its future phenoconversion to parkinsonism-first or dementia-first subtype remains a challenge. This study aimed to investigate whether visuospatial dysfunction predicts dementia-first phenoconversion in iRBD. Visuospatial dysfunction, as reflected mainly by the modified posterior subscore of MoCA, is a predictive factor for dementia-first phenoconversion in iRBD, suggesting its potential for being a biomarker for clinical prognostic prediction and potential neuroprotective trials aiming to delay or prevent dementia.
虽然孤立的快速眼动睡眠行为障碍 (iRBD) 被称为 α-突触核蛋白病的前驱症状,但预测其未来表型转化为帕金森综合征优先或痴呆优先亚型仍然是一个挑战。这项研究旨在调查视觉空间功能障碍是否可以预测iRBD中痴呆优先的表型转换。视觉空间功能障碍主要由MoCA的改良后子评分反映,是iRBD中痴呆首次表型转换的预测因素,表明其可能成为临床预后预测的生物标志物和旨在延迟或预防痴呆的潜在神经保护试验。
REF: Wang J, Huang B, Zhou L, et al. Visuospatial dysfunction predicts dementia-first phenoconversion in isolated REM sleep behaviour disorder. J Neurol Neurosurg Psychiatry. Published online June 26, 2024. doi:10.1136/jnnp-2024-333865 PMID: 38925912
Most SOD1 mutations are pathogenic, and their identification can lead to early access to treatment
大多数SOD1突变是致病的,它们的识别可以导致早期获得治疗
ALS is a neurodegenerative disease affecting motor neurons, leading to progressive loss of bulbar and limb motor function, respiratory insufficiency and death in a median of 3 years. About 10% to 20% of ALS are familial (fALS), meaning that at least one other member of the family is affected by the disease. In these families, a genetic cause is identified in 48% of cases within populations of European origin. However, sporadic forms of ALS are also found to be undermined by genetic mutations, the most frequent being the C9ORF72 GGGGCC-repeat expansion in intron 1A, followed by mutations in superoxide dismutase type 1 (SOD1) in Caucasian populations. Coding mutations in the gene encoding SOD1 were found to co-segregate with disease in fALS cases in 1993, and since then, over 230 mutations in SOD1 have been reported in ALS showing heterogeneity in disease penetrance and phenotype. The suspected mechanism by which the SOD1 mutated protein causes ALS is by gain of a novel toxic function which includes the generation of prion-like SOD1 species. Establishing whether all SOD1 mutations are pathogenic for ALS and disease risk for carriers of pathogenic variants are of crucial importance for genetic counselling, as well as access to innovative and promising precision medicines aiming at reducing the expression of SOD1.
ALS是一种影响运动神经元的神经退行性疾病,导致球部和肢体运动功能的进行性丧失,呼吸衰竭和死亡中位数为3年。大约10% 至20% 的ALS是家族性的 (fALS),这意味着该家族的至少一个其他成员受到该疾病的影响。在这些家族中,在欧洲血统人群中的48% 病例中确定了遗传原因。然而,遗传突变也破坏了ALS的零星形式,最常见的是内含子1A中的C9ORF72 GGGGCC重复扩增,其次是高加索人群中超氧化物歧化酶1型 (SOD1) 的突变。1993年,在fALS病例中发现编码SOD1的基因中的编码突变与疾病共分离,从那时起,在ALS中已报道了超过230个SOD1突变,显示出疾病外显率和表型的异质性。SOD1突变蛋白引起ALS的可疑机制是通过获得新的毒性功能,包括产生朊病毒样SOD1物种。确定是否所有SOD1突变都是ALS的致病性和致病变异携带者的疾病风险对于遗传咨询以及获得旨在减少SOD1表达的创新和有前途的精准药物至关重要。
REF: De La Cruz E, Esselin F, Polge A, Mouzat K, Guissart C. Most SOD1 mutations are pathogenic, and their identification can lead to early access to treatment. J Neurol Neurosurg Psychiatry. Published online June 26, 2024. doi:10.1136/jnnp-2024-333939 PMID: 38925911
Neurocognitive and psychiatric outcomes associated with postacute COVID-19 infection without severe medical complication: a meta-analysis
无严重医学并发症的急性后新型冠状病毒肺炎感染的神经认知和精神结局: 一项荟萃分析
Cognitive symptoms are often reported by those with a history of COVID-19 infection. No comprehensive meta-analysis of neurocognitive outcomes related to COVID-19 exists despite the influx of studies after the COVID-19 pandemic. This study meta-analysed observational research comparing cross-sectional neurocognitive outcomes in adults with COVID-19 (without severe medical/psychiatric comorbidity) to healthy controls (HCs) or norm-referenced data. Mild cognitive deficits are associated with COVID-19 infection, especially as detected by cognitive screeners and processing speed tasks. We failed to observe clinically meaningful cognitive impairments (as measured by standard neuropsychological instruments) in people with COVID-19 without severe medical or psychiatric comorbidities.
有新型冠状病毒肺炎感染史的人经常报告认知症状。尽管新型冠状病毒肺炎大流行后大量研究涌入,但尚无与新型冠状病毒肺炎相关的神经认知结果的综合荟萃分析。这项研究对观察性研究进行了荟萃分析,比较了新型冠状病毒肺炎成年人 (无严重的医学/精神病合并症) 与健康对照 (HCs) 或正常参考数据的横断面神经认知结果。轻度认知缺陷与新型冠状病毒肺炎感染有关,尤其是通过认知筛查器和处理速度任务检测到的。我们未能在没有严重医学或精神病合并症的新型冠状病毒肺炎患者中观察到具有临床意义的认知障碍 (通过标准神经心理学工具测量)。
REF: Knapp SAB, Austin DS, Aita SL, et al. Neurocognitive and psychiatric outcomes associated with postacute COVID-19 infection without severe medical complication: a meta-analysis. J Neurol Neurosurg Psychiatry. Published online June 24, 2024. doi:10.1136/jnnp-2024-333950 PMID: 38914455
Association between heavy alcohol consumption and cryptogenic ischaemic stroke in young adults: a case–control study
年轻人大量饮酒与隐源性缺血性卒中的关系: 一项病例对照研究
The underlying risk factors for young-onset cryptogenic ischaemic stroke (CIS) remain unclear. This multicentre study aimed to explore the association between heavy alcohol consumption and CIS with subgroup analyses stratified by sex and age. Heavy alcohol consumption, particularly binge drinking, appears to be an independent risk factor in young men with CIS.
年轻发病的隐源性缺血性卒中 (CIS) 的潜在危险因素仍不清楚。这项多中心研究旨在通过按性别和年龄分层的亚组分析来探讨重度饮酒与CIS之间的关联。大量饮酒,尤其是暴饮暴食,似乎是CIS年轻男性的独立危险因素。
REF: Martinez-Majander N, Kutal S, Ylikotila P, et al. Association between heavy alcohol consumption and cryptogenic ischaemic stroke in young adults: a case-control study. J Neurol Neurosurg Psychiatry. Published online June 21, 2024. doi:10.1136/jnnp-2024-333759 PMID: 38906694
First-trimester use of antiseizure medications and the risk of miscarriage: a population-based cohort study
孕早期使用抗癫痫药物与流产风险: 一项基于人群的队列研究
Antiseizure medications (ASMs) during the first trimester of pregnancy have been associated with an increased risk of miscarriage. We found no clear evidence to suggest that first-trimester ASM use increased the risk of miscarriage. Taken together, our analyses suggest that apparent associations between first-trimester ASM use and miscarriage may be the result of confounding by the presence of a bipolar disorder or associated unmeasured variables.
怀孕前三个月的抗癫痫药物 (asm) 与流产风险增加有关。我们没有发现明确的证据表明妊娠早期使用ASM会增加流产的风险。总之,我们的分析表明,妊娠早期使用ASM与流产之间的明显关联可能是双相情感障碍或相关的未测量变量混杂的结果。
REF: Forbes H, Madley-Dowd P, Ahlqvist V, et al. First-trimester use of antiseizure medications and the risk of miscarriage: a population-based cohort study. J Neurol Neurosurg Psychiatry. Published online June 14, 2024. doi:10.1136/jnnp-2023-333149 PMID: 38777577
Predicting how many people might receive treatment with new therapies for Alzheimer’s disease
预测有多少人可能接受阿尔茨海默病新疗法的治疗
One hundred and seventeen years after Alzheimer described the condition that bears his name, the first treatments have been identified which appear to modify its course. These treatments are monoclonal antibodies which clear one of the presumed pathogenic proteins (amyloid) from the brain. This is welcome progress, but it has come with concerns including the extent of benefits and risks of potentially significant harm. Further concerns are the potential economic impact and whether health services can deliver these treatments given the number of people living with Alzheimer’s disease. Estimates of the numbers of people who might receive them are vital to inform preparation of services. The JNNP paper by Dobson et al is therefore welcome. Previous work has applied the exclusion criteria used in trials to clinic populations to estimate demand. Dobson et al extend this. They report data from a general National Health Service memory service and not just specialist clinics which may not be representative of most practice. Second, they consider factors which other studies have not always included, including anticoagulation as a contraindication and Rockwood clinical frailty scores as a proxy for whether individuals might tolerate repeated imaging and intravenous infusions. They conducted their study to consider both general and specialist clinics, both of which are included in a service model proposed for use in the UK. This is important as planning needs to account not just for those receiving treatment but for those who will need further investigation to assess amyloid positivity via positron emission tomography (PET) scanning or cerebrospinal fluid (CSF) analysis.
在阿尔茨海默氏症描述了以他的名字命名的病症一百一十七年后,已经确定了似乎改变其病程的第一种治疗方法。这些治疗是从脑中清除一种假定的致病蛋白 (淀粉样蛋白) 的单克隆抗体。这是值得欢迎的进展,但也带来了一些担忧,包括潜在重大伤害的收益和风险。进一步的担忧是潜在的经济影响,以及鉴于阿尔茨海默病患者的数量,卫生服务能否提供这些治疗。估计可能接受这些服务的人数对于告知服务准备工作至关重要。因此,Dobson等人的JNNP论文受到欢迎。先前的工作已将试验中使用的排除标准应用于临床人群以估计需求。Dobson等人对此进行了扩展。他们报告的数据来自一般国家卫生服务记忆服务,而不仅仅是专科诊所,这可能不能代表大多数实践。其次,他们考虑了其他研究不总是包括的因素,包括抗凝作为禁忌症和Rockwood临床虚弱评分作为个体是否可以耐受重复成像和静脉输注的代理。他们进行了研究,以考虑普通诊所和专科诊所,这两种诊所都包含在建议在英国使用的服务模型中。这很重要,因为计划不仅需要考虑接受治疗的患者,还需要考虑需要进一步调查以通过正电子发射断层扫描 (PET) 扫描或脑脊液 (CSF) 分析评估淀粉样蛋白阳性的患者。
REF: Underwood BR. Predicting how many people might receive treatment with new therapies for Alzheimer's disease. J Neurol Neurosurg Psychiatry. Published online June 11, 2024. doi:10.1136/jnnp-2024-333941 PMID:
Eligibility for antiamyloid treatment: preparing for disease-modifying therapies for Alzheimer’s disease
抗淀粉样蛋白治疗的资格: 为阿尔茨海默病的疾病改善疗法做准备
Disease-modifying therapies (DMTs) for Alzheimer's disease (AD) have early evidence of efficacy. Widespread delivery of DMTs will require major service reconfiguration. Treatment pathways will need to include triaging for eligibility, regular infusions and baseline and follow-up MRI scanning. A critical step in planning is provision of real-world estimates of patients likely to be eligible for triaging, but these are challenging to obtain. While a sizeable proportion of patients attending memory clinics may be referred for triaging for DMTs for AD, only a minority are likely to be suitable for these, as demonstrated in patients seen in specialist cognitive services. This will need to be considered when designing pathways for DMT delivery.
阿尔茨海默病 (AD) 的疾病改善疗法 (dmt) 具有疗效的早期证据。Dmt的广泛交付将需要主要的服务重新配置。治疗途径将需要包括资格的分诊,定期输注以及基线和后续MRI扫描。规划的关键步骤是提供可能符合分诊条件的患者的真实世界估计,但这些都是具有挑战性的。虽然可以将相当大比例的参加记忆诊所的患者转诊为AD的dmt,但只有少数人可能适合这些,正如在专业认知服务中看到的患者所证明的那样。当设计用于DMT递送的途径时,将需要考虑这一点。
REF: Dobson R, Patterson K, Malik R, et al. Eligibility for antiamyloid treatment: preparing for disease-modifying therapies for Alzheimer's disease. J Neurol Neurosurg Psychiatry. Published online June 11, 2024. doi:10.1136/jnnp-2024-333468 PMID: 38862265
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