Acta Neurologica Scandinavica

Introduction. Parkinson’s disease (PD) is a neurodegenerative disease with motor and nonmotor symptoms. Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives. To explore how COVID-19 affects motor, nonmotor, and general health aspects of PD and to map how PD patients perceive their change in symptoms since falling ill with COVID-19. Method. The study was descriptive, case-controlled, and based on both registry and questionnaire data. At baseline, the controls were matched on age, sex, and disease severity. Information on the severity of the disease, nonmotor symptoms, motor symptoms, and general health was retrieved from the Swedish Registry for PD. Registry data from a COVID-19 group () and a control group (), as well as questionnaires from a COVID-19 group () and a control group (), were compared. Results. We did not find that SARS-CoV-2 infection affects any major aspect of nonmotor symptoms, motor symptoms, general health, and perception of change in PD patients’ post-COVID-19. Compared to controls, the COVID-19 group reported a more positive subjective experience of pain and quality of life and a perception of change post-COVID-19 regarding general motor function, sleep quality, and mood (all ). Conclusion. Although SARS-CoV-2 infection does not seem to affect PD symptoms in any major respect, the subjective experience of several aspects of life in PD patients might be slightly improved post-COVID-19 compared to a control group. The findings warrant further investigations due to the small sample size and possible survivorship bias.

Objectives. Recent studies showed only fair agreement between observer and patients’ motor state assessments on the Parkinson’s disease (PD) home diary (HD). This could possibly be explained by the patients’ insufficient knowledge about motor fluctuations. Therefore, the study is aimed at investigating the effect of structured training concerning motor fluctuations on the agreement between observer and HD ratings and daily motor state times. Methods. Participants from a previous validation study of the HD were invited back for a study extension. This interventional study consisted of a screening visit including a structured training concerning motor fluctuations and one day of motor ratings onsite during which observer and patient simultaneously and independently evaluated the patient’s motor state every half hour. Results. Observer and 20 patients completed 316 pairs of motor state assessments. The overall agreement was 68% before training and 76% after training () and Cohen’s κ increased from .438 to .559 (). There was no significant improvement in the correlation/reliability of HD-documented daily motor state time when compared with observer ratings. Moreover, before training, the agreement in observed “on with dyskinesias” was 58%, and after training, it was 80% (). Conclusion. Our structured patient training in motor fluctuations did not significantly improve the agreement between observer and HD or the reliability of daily times spent in the different motor states as an aggregate measure of HD in this PD patient group. However, there are indications of an improvement in the participants’ ability to detect dyskinesias.

Objective. Tuberous sclerosis complex (TSC) is a rare neurodevelopmental disorder often associated with intractable epilepsy, and surgical resection is the effective therapeutic approach to alleviate seizures in TSC patients. Scalp electroencephalogram (EEG) is a noninvasive method used to diagnose epilepsy; however, the relationship between scalp video-EEG findings and postsurgical seizure outcomes has not been fully evaluated in TSC patients. Materials and Methods. The relationship between clinical characteristics and seizure outcomes of TSC patients with 1-year, 5-year, and 10-year follow-ups was retrospectively analyzed. We explored the association of interictal epileptiform discharges (IEDs) with postsurgical seizure outcomes. Further, the differences in clinical characteristics among four IED patterns (focal, lateralized, multifocal, and generalized IEDs) were assessed. Results. A total of 82 patients were enrolled in this study. There were 82 patients with 1-year follow-up, 75 patients with 5-year follow-up, and 57 patients with 10-year follow-up, and the IEDs were associated with the postsurgical outcomes. Patients with focal, lateralized, and generalized IEDs had seizure freedom (SF) in 1-year follow-up, respectively. Intriguingly, patients with lateralized IEDs had long-term SF in 5-year and 10-year follow-ups. Conclusions. A significant association existed between IEDs and long-term postsurgical outcomes in TSC patients. TSC patients with lateralized IEDs often showed long-term SF and mild clinical epileptic characteristics. According to our study, IEDs may guide clinical care for TSC patients with intractable epilepsy.

Objectives. Tube feeding is an effective way to provide nutritional support for amyotrophic lateral sclerosis (ALS) patients with severe dysphagia. Currently, the predictors of tube feeding and the survival affected by tube feeding were poorly studied in Chinese ALS patients. Therefore, we aimed to explore predictive factors and establish a prediction model to quantitatively predict the risk of tube feeding. Furthermore, we explored the survival benefit provided by tube feeding. Methods. In this longitudinal, prospective cohort study, we included patients diagnosed with ALS using the Awaji criteria at the ALS clinic in Huashan Hospital. Follow-up was conducted by telephone interview from January 1, 2019, to December 30, 2021, or until death. All statistical analyses were performed using R software. Results. Overall, 218 patients were recruited for the study. The multivariate Cox regression analysis showed a high ALSFRS-R slope (adjusted hazard ratio (95% confidence interval (95% CI: 2.26-10.81), ), low bulbar score ( (95% CI: 0.69-0.96), ), history of ischemic stroke ( (95% CI: 1.3-24.82), ), and bulbar involvement ( (95% CI: 1.42-99.31), ) as independent risk factors of tube feeding. The nomogram model was established with moderate discrimination and calibration. Among 71 ALS patients with tube feeding indication, 33.8% accepted gastrostomy suggestion and 14.1% had nasogastric tube (NGT) insertion. However, gastrostomy and NGT did not accelerate disease progression ( (95% CI: 0.20-1.67), and (95% CI: 0.43-6.88), , respectively). Conclusions. We developed a nomogram that could be a prediction tool to predict individual timing of tube feeding for ALS patients. In addition, we found that gastrostomy and NGT did not affect ALS patients’ survival.

Objective. Histopathological examinations will diminish as minimally invasive epilepsy surgery increasingly replaces open surgery. The objective of this study was to test if visual and computer-aided quantitative analyses of presurgical high-quality 3 Tesla MRIs complying with the International League Against Epilepsy (ILAE) Neuroimaging Task Force recommendations can inform on histopathological diagnosis. Methods. Ninety-two patients from Copenhagen and Oslo University Hospitals fulfilled patient-, imaging-, and histopathological inclusion criteria: 69 patients were diagnosed with hippocampal sclerosis (HS) ILAE type 1 or 2, and 23 patients had normal appearing hippocampi or other histopathology than HS (no-HS). MRIs from 52 healthy controls (HC) were included. Image processing was performed in FreeSurfer v.6.0 with the built-in cross-sectional hippocampal subfield segmentation tool and multimodal MRI input. Volume outputs were used to calculate volume asymmetry ratios (VARs) for whole hippocampus (WH) and subfields. Results. HS patients had significantly larger WH VARs compared to no-HS patients and HC, with a and for histopathological HS diagnosis. Visual MRI assessment yielded a and for histopathological HS diagnosis. CA1 and CA4 VARs and the number of seizure-free patients were not significantly different in HS ILAE type 1 compared to type 2 patients. Significance. FreeSurfer analyses of presurgical MRIs are excellent at separating patients histopathologically diagnosed with HS from patients with other pathology or normal appearing hippocampi. Using the FreeSurfer hippocampal subfield segmentation tool did not allow for separating HS ILAE subtypes.

Evidence for the management of asymptomatic carotid stenosis and possibly symptomatic nonstenosing carotid artery disease is limited. In contrary to calcified plaques, soft plaques are considered vulnerable and prone to rupture. Shear wave elastography (SWE), a novel ultrasound technique which uses acoustic wave force to propagate shear wave in tissues, can quantify tissue stiffness through the estimation of Young’s modulus (YM) in kPa or shear wave velocity in meter/second. This systematic review is aimed at evaluating the feasibility of SWE in carotid plaque risk stratification in relation to ischemic stroke (PROSPERO registration: CRD42022309709). 18 studies, obtained via search on PubMed, Cochrane, and Embase from inception until November 1, 2022, assessed SWE’s feasibility in carotid plaque risk stratification in humans (13 studies) and phantom models (5 studies). Human studies showed heterogeneity with respect to SWE devices, acquisition settings, and methodology, which consequently reflected in the between-study variability of YM values used for distinguishing vulnerable/symptomatic (27–52 kPa) and stable/asymptomatic (28–115 kPa) carotid plaques. However, within-study assessment of all human studies indicated SWE’s feasibility in carotid plaque risk stratification. Furthermore, four out of five carotid plaque phantom studies showed the potential of SWE to discriminate tissues of different stiffness comparable to the carotid vessel wall, soft and hard plaques, and with good reproducibility. SWE may potentially offer a bedside risk stratification tool for identifying patients with vulnerable carotid plaques, who may benefit from carotid surgery, stenting, or prolonged dual antiplatelet therapy. Patients with stable carotid plaques could be spared the risks of potentially harmful treatments and complications. However, available data are not enough to facilitate the immediate clinical application of SWE, and therefore, larger prospective clinical are warranted.