Journal of neurology, neurosurgery, and psychiatry
-
J. Neurol. Neurosurg. Psychiatr. · Mar 2016
Improving fMRI reliability in presurgical mapping for brain tumours.
Functional MRI (fMRI) is becoming increasingly integrated into clinical practice for presurgical mapping. Current efforts are focused on validating data quality, with reliability being a major factor. In this paper, we demonstrate the utility of a recently developed approach that uses receiver operating characteristic-reliability (ROC-r) to: (1) identify reliable versus unreliable data sets; (2) automatically select processing options to enhance data quality; and (3) automatically select individualised thresholds for activation maps. ⋯ We demonstrated ROC-r analysis for identifying reliable fMRI data sets, choosing optimal postprocessing pipelines, and selecting patient-specific thresholds. Data sets with higher reliability also showed closer spatial correspondence to cortical stimulation. ROC-r can thus identify poor fMRI data at time of scanning, allowing for repeat scans when necessary. ROC-r analysis provides optimised and automated fMRI processing for improved presurgical mapping.
-
J. Neurol. Neurosurg. Psychiatr. · Mar 2016
Multicenter StudyClinical outcomes and risk factors for posterior reversible encephalopathy syndrome in systemic lupus erythematosus: a multicentric case-control study.
Posterior reversible encephalopathy syndrome (PRES) is a well-known but rare complication in patients (<1%) with systemic lupus erythematosus (SLE). However, current epidemiological data are quite scant. The aim of the present study was to describe potentially unrecognised risk factors. ⋯ This is the largest reported series of patients with SLE and PRES. We were able to corroborate the known risk factors for of PRES, and found two previously undescribed factors (lymphopenia and dyslipidemia), which suggests that endothelial dysfunction is a key element in PRES pathogenesis in lupus patients.
-
J. Neurol. Neurosurg. Psychiatr. · Mar 2016
ReviewMapping the landscape of cerebral amyloid angiopathy research: an informetric analysis perspective.
To quantitatively analyse the research output and major trends in the field of cerebral amyloid angiopathy (CAA) over six decades, from 1954 to 2014, using advanced informetrics methods, we systematically identified CAA-related articles from PubMed, collected metadata and performed productivity analysis, copublication analysis, and network and content analysis over defined time periods. Linear regression was used to investigate these relationships. Changes in CAA research themes (2000-2014) were defined using a topic modelling technique. ⋯ Content analysis identified 16 major CAA research themes and their differential evolution in the past 15 years, with the following main trends: (A) limited focus on vascular cognitive impairment; (B) a shift in emphasis towards neuroimaging, cerebral microbleeds and diagnostic aspects and away from pathological aspects; and (3) a reduced emphasis on basic biology apart from an increased focus on mouse models and perivascular drainage. Our study reveals the rapidly developing nature of the CAA research landscape, providing a novel quantitative and objective basis for identifying unmet needs and new directions. Our findings support the idea of a collaborative culture in the field, encouraging international research initiatives.
-
J. Neurol. Neurosurg. Psychiatr. · Mar 2016
Identifying who will benefit from non-invasive ventilation in amyotrophic lateral sclerosis/motor neurone disease in a clinical cohort.
Respiratory failure is associated with significant morbidity and is the predominant cause of death in motor neurone disease/amyotrophic lateral sclerosis (MND/ALS). This study aimed to determine the effect of non-invasive ventilatory (NIV) support on survival and pulmonary function decline across MND/ALS phenotypes. ⋯ Between 1991 and 2011, 1198 patients diagnosed with ALS/MND were registered. 929 patients (77.5%) fulfilled the selection criteria and their data were analysed. Median tracheostomy free survival from symptom onset was 28 months in NIV-treated patients compared to 15 months in untreated (Univariate Cox regression HR=0.61 (0.51 to 0.73), p<0.001). The positive survival effect of NIV persisted when the model was adjusted for age, gender, riluzole and percutaneous endoscopic gastrostomy use (HR=0.72 (0.60 to 0.88, p=0.001). In contrast with the only randomised controlled trial, NIV statistically significantly increased survival by 19 months in those with ALS-bulbar onset (Univariate HR=0.50 (0.36 to 0.70), multivariate HR=0.59 (0.41 to 0.83)). These data confirm that NIV improves survival in MND/ALS. The overall magnitude of benefit is 13 months and was largest in those with ALS-bulbar disease. Future research should explore the optimal timing of NIV initiation within phenotypes in order to optimise respiratory function, quality of life and survival.
-
J. Neurol. Neurosurg. Psychiatr. · Mar 2016
Postoperative apathy can neutralise benefits in quality of life after subthalamic stimulation for Parkinson's disease.
Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms of Parkinson's disease, leading to improvement in health-related quality of life (HRQoL). However, an excessive decrease in dopaminergic medication can lead to a withdrawal syndrome with apathy as the predominant feature. The present study aims to assess the impact of postoperative apathy on HRQoL. ⋯ The development of apathy after STN-DBS can cancel out the benefits of motor improvement in terms of HRQoL. Systematic evaluation and management of apathy occurring after subthalamic stimulation appears mandatory.