Neurological Hospital Research Articles

Treatment outcomes and quality of life among patients with chronic pain in a referral hospital in Ethiopia

Background: Chronic pain is a pervasive and complex public health issue that profoundly impacts the quality of life (QoL), mental health, and daily activities. Defined as pain lasting beyond three to six months, it arises from diverse causes, including injuries, medical conditions, and psychological factors. Patients with chronic pain often experience poor QoL. In Ethiopia, the burden is compounded by limited healthcare infrastructure, socioeconomic challenges, and cultural attitudes toward pain management. This study aimed to assess treatment outcomes and QoL among patients with chronic pain attending the Tikur Anbessa Specialized Hospital (TASH) neurology clinic. Methods: A cross-sectional study was conducted at TASH, using the SF-12 questionnaire to assess QoL through patient interviews and clinical data collected from medical records. All patients meeting inclusion criteria and attending the clinic for chronic pain management between March and May 2023 were included. Results: Of the 200 patients included, 64.5% were female, and chronic low back pain was the most common diagnosis (33.5%). Amitriptyline, prescribed for 39.5% of participants, was the most frequently used medication. Despite treatment, 59.5% of patients reported uncontrolled pain, adversely affecting their physical and emotional well-being. Conclusions: Although treatment led to some improvement, the majority of patients continued to experience uncontrolled pain, significantly impairing their QoL. These findings underscore the urgent need for enhanced pain management strategies in Ethiopia.

A computer-assisted rehabilitation program improves self-management, cognition, and quality of life in epilepsy: A randomized controlled trial.

This study aimed to evaluate the impact of a computer-assisted rehabilitation program on self-management, cognitive function, and quality of life in people with epilepsy (PwE). A randomized controlled trial was conducted with 44 PwE (22 intervention, 22 control) at a university hospital's neurology clinic. The intervention group received 12 sessions of the RehaCom program (45min/session, twice a week for six weeks). Data were collected using the "Quality of Life in Epilepsy Inventory (QOLIE)", "Epilepsy Self-Management Scale (ESMS)", and "Moxo test" before and after the intervention. The intervention group showed significant improvements in attention and timing dimensions of the MOXO test and reductions in hyperactivity symptoms compared to the control group (p<0.05). ESMS scores, including overall self-management, information management, lifestyle management, and safety management sub-dimensions, significantly increased. Similarly, QOLIE scores, particularly in cognitive functioning, emotional well-being, and energy/fatigue, improved, while seizure worry scores decreased (p<0.001). The computer-assisted rehabilitation program enhanced self-management, quality of life, attention, and responsiveness while reducing impulsivity and hyperactivity symptoms in PwE.

The impact of ketogenic diet on the frequency of psychogenic non-epileptic seizures (PNES): A feasibility randomized pilot study.

The potential of dietary interventions, particularly the use of the ketogenic diet in patients with Psychogenic Non-Epileptic Seizures (PNES), remains underexplored. This study aimed to assess the feasibility of a 6-week ketogenic diet (Modified Atkins Diet, MAD) intervention in adult patients with PNES and to compare its effects on PNES frequency and other variables against a control healthy diet (CD). A feasibility pilot randomized controlled trial was conducted at a tertiary neurology hospital, enrolling outpatients diagnosed with PNES and assigning them to either MAD or CD. Baseline and follow-up assessments (at 2, 4, and 6 weeks) included evaluation of mental health, PNES frequency, and metabolic measures. Descriptive and inferential methods, including repeated measures ANOVA, were used for statistical analysis. Seventeen patients (mean age 28.23 ± 7.1) were randomly allocated to receive either MAD (n = 12) or CD (n = 5). The entire sample exhibited a significant decrease in monthly PNES frequency (p = 0.01, Hedges ES = 0.618) without differences between groups. The MAD group showed significant improvement in PNES frequency, depression, and anxiety at week six. Results demonstrate that the implementation of MAD is feasible in patients with PNES and suggest that it may reduce seizure frequency and symptoms of depression and anxiety. These findings warrant further investigation in larger, powered studies to demonstrate efficacy. PLAIN LANGUAGE SUMMARY: This study explored the potential benefits of the Modified Atkins Diet (MAD) in reducing the frequency of psychogenic non-epileptic seizures (PNES). The results showed that the diet is safe, well-tolerated, and may decrease the occurrence of PNES, as well as symptoms of depression and anxiety. These findings suggest that dietary modifications could be a helpful complement to PNES treatment, though larger studies are necessary to confirm these outcomes.

Impact of a Dynamic Orthosis on Manual Dexterity Among People With Parkinson's Disease: A Randomized Trial.

A dynamic elastomeric fabric orthosis could be a novel nonpharmacological treatment of motor symptoms among people with Parkinson's disease (PD). To evaluate the efficacy of the orthosis in improving manual dexterity among people with PD. A randomized trial with 60 participants (control group, n = 20; experimental group, n = 40). Manual dexterity was assessed in on-off states of the disease, with and without the orthosis. Burgos University Hospital (Burgos, Spain). Consecutive nonprobabilistic sampling. Patients were included if they had been diagnosed with PD, had motor symptoms in at least one upper limb, and attended the hospital's neurology department. Participants were ages 48 to 89 yr, with an average disease duration of 5.38 yr (SD = 4.23). Exclusion criteria were tremor due to another neurological disease or a Montreal Cognitive Assessment score ≤26. The experimental group used the orthosis on the most affected upper limb for 2 mo; the control group participants did not receive the orthosis. Manual dexterity was measured with the Purdue Pegboard Test, Minnesota Manual Dexterity Test, and Square Test. Paired t tests for related samples and analysis of covariance tests were used. Some participants improved on some manual dexterity items while wearing the orthosis. However, it was not sustained when the orthosis was removed after 2 mo of use. The orthosis may improve certain aspects of manual dexterity and functionality among people with PD, but only while it is worn. Plain-Language Summary: The common motor symptoms and declines in manual dexterity that people with Parkinson's disease (PD) experience can significantly affect their ability to perform activities of daily living as well as their quality of life. Manual dexterity is a strong predictor of the level of functional independence for people with PD. This study evaluated the efficacy of an elastomeric fabric orthosis to improve manual dexterity for people with PD. The study found that while wearing the orthosis the motor symptoms of PD were reduced and manual dexterity and upper limb functionality improved. Wearing the orthosis has the potential to enhance functionality, foster greater autonomy, and substantially improve the quality of life of people with PD.

Cryoablation for the Treatment of Post-Tracheostomy Tracheal Stenosis in Neurological Patients.

Post-tracheostomy tracheal stenosis is a clinically relevant late complication of tracheostomy. To date, there is no standardized treatment strategy for post-tracheostomy tracheal stenosis. Contact cryoablation is one of the applicable methods. The aim of the present study was to explore the efficacy and safety of contact cryoablation for the treatment of post-tracheostomy tracheal stenosis. A total of 63 consecutive patients were included in this unicentre, combined retrospective and prospective observational study in an intensive care unit of a German neurological specialist hospital from 30 April 2020 to 21 March 2024. Post-tracheostomy tracheal stenoses were confirmed by tracheoscopy. All eligible patients were primarily treated with contact cryoablation. Primary endpoint was the rate of successful removal of the tracheostomy tube (decannulation) until hospital discharge. Technical success was defined as the absence of an endoscopically relevant residual post-tracheostomy tracheal stenosis, and clinical success was defined as the absence of symptoms, e.g., dyspnoea and stridor, both at discretion of the endoscopist and treating physician. A total of 78 interventions were performed (median: 1 per patient). Cryoablation was applied in 67% of patients at least once. A total of 70% of patients could be decannulated after treatment. Technical success and clinical success were achieved in 88% and 70% of patients, and in only 5% of patients surgical treatment was performed. No complications were observed. Contact cryoablation appears to be an effective, complication-free, simple, and non-surgical treatment option for patients with post-tracheostomy tracheal stenosis. It could be an excellent option for every patient with suitable stenosis morphology. However, other endoscopic modalities must be available or complementarily used for non-suitable stenosis morphologies.

Prevalence and structure of sleep disorders in neurological, psychiatric and somatic hospitals

Background. Today it is well known that the structure of sleep disorders and frequency of complaints about sleep disorders depend on the diseases profile. Emotional and behavioral features of patients with different disease profile are important factors affecting the development of sleep disorders. Aim. To estimate difference of sleep disorders according to the profile of the disease and to assess the emotional and psychological factors that may influence sleep disorders. Materials and methods. A total of 300 patients participated in the study: 100 from every department (neurological, psychiatric and pulmonological). To assess the quality of sleep Pittsburgh Sleep Quality Index was used; data from the Spielberger anxiety scale, a 5-factor personality questionnaire, and a questionnaire for evaluating coping strategies (coping strategies) were used to assess personal and emotional factors. Results. Patients from the psychotherapeutic group appeared to be more likely to complain of sleep disorders in general. They also had an average Pittsburgh Sleep Quality Index score higher than patients from neurological and somatic hospitals. In the group of patients with a neurological profile loud snoring is more often reason for sleep disturbing. Awakenings due to difficulties in breathing were more often detected in the group of somatic profile. Situational and personal anxiety influenced the structure of sleep disorders regardless of the disease profile. Conclusion. The use of various coping strategies has the greatest impact on the presence of sleep disorders in the group of patients with a somatic profile, to a lesser extent – in the group of neurological profile.

Preeclampsia and the Long-Term Risk of Developing Neurological Disorders Requiring Hospital Admission

Introduction: Preeclampsia is associated with acute neurological complications during pregnancy, but the subsequent risk of developing a neurological disorder is unclear. We determined if preeclampsia was associated with the long-term risk of neurological morbidity. Methods: We conducted a longitudinal cohort study of 1,460,098 pregnant women with and without preeclampsia in QC, Canada, between 1989 and 2023. The main exposure measure was preeclampsia diagnosed in any pregnancy. Outcomes included hospitalization for cerebrovascular disease, epilepsy, and other neurological disorders up to 3 decades after pregnancy. Using Cox regression models adjusted for confounders, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between preeclampsia and neurological disorders during 27,659,555 person-years of follow-up. Results: There were 1,460,098 women in the cohort, including 73,890 (5.1%) with preeclampsia. Women with preeclampsia had a higher incidence of neurological disorders than women without preeclampsia (113.2 vs. 79.3 per 100,000 person-years). Compared with no preeclampsia, preeclampsia was associated with 1.49 times the risk of later neurological hospitalization (95% CI 1.41–1.57). Preeclampsia was primarily associated with cerebrovascular disease (HR 1.89, 95% CI, 1.76–2.03) and epilepsy (HR 1.39, 95% CI, 1.24–1.57). A link with other neuropathology was less apparent, although severe preeclampsia was associated with neurodegenerative disorders. Severe hypertension, including early onset (HR 2.35, 95% CI, 2.06–2.68), recurrent (HR 2.47, 95% CI, 2.13–2.86), and superimposed preeclampsia (HR 2.60, 95% CI, 2.17–3.12), was more strongly associated with neurological hospitalization overall. Conclusion: Preeclampsia is associated with the long-term risk of developing cerebrovascular disease and epilepsy, but associations with other neurological disorders are less prominent.

Gut Microbiota, Bacterial Translocation, and Stroke: Current Knowledge and Future Directions.

Stroke is one of the most devastating pathologies in terms of mortality, cause of dementia, major adult disability, and socioeconomic burden worldwide. Despite its severity, treatment options remain limited, with no pharmacological therapies available for hemorrhagic stroke (HS) and only fibrinolytic therapy or mechanical thrombectomy for ischemic stroke (IS). In the pathophysiology of stroke, after the acute phase, many patients develop systemic immunosuppression, which, combined with neurological dysfunction and hospital management, leads to the onset of stroke-associated infections (SAIs). These infections worsen prognosis and increase mortality. Recent evidence, particularly from experimental studies, has highlighted alterations in the microbiota-gut-brain axis (MGBA) following stroke, which ultimately disrupts the gut flora and increases intestinal permeability. These changes can result in bacterial translocation (BT) from the gut to sterile organs, further contributing to the development of SAIs. Given the novelty and significance of these processes, especially the role of BT in the development of SAIs, this review summarizes the latest advances in understanding these phenomena and discusses potential therapeutic strategies to mitigate them, ultimately reducing post-stroke complications and improving treatment outcomes.

Can serum orexin levels be used as a marker in childhood epilepsy?

Epilepsy is one of the most common neurological diseases in the pediatric population. Orexins are excitatory peptides and associated with energy homeostasis, eating and drinking behaviors, sleep regulation, sleep-wake periods, analgesia, and cognitive activities such as attention, learning, and memory. The aim of this study was to reveal the relationship between plasma orexin levels and seizures in pediatric epilepsy patients with seizures, epilepsy patients in remission, and healthy control group with similar demographic characteristics. The study was conducted between December 2021 and December 2022 in the Department of Pediatric Neurology of a tertiary hospital. 30 epilepsy patients who had a seizure in the last 24h, 30 epilepsy patients in remission, and 17 healthy controls were included in the study. The Human Orexin-A Enzyme-Linked Immunosorbent Assay Kit was used to measure serum orexin-A level. In the ERG and CG, blood samples were obtained during routine controls. No statistically significant difference was found between serum orexin levels of acute seizure group (ASG), epilepsy in remission group (ERG), and control group (CG). In the ASG, no significant difference was found when orexin levels were compared according to the time of blood sampling after seizure (0-8h, 8-16h, 16-24h). In patients with seizures, the orexin levels of patients with focal seizures were compared with those of patients with generalized seizures. There was no statistically significant difference between the groups. Patients with seizures were evaluated according to electroencephalography (EEG) and cranial magnetic resonance imaging (MRI) findings, and no statistically significant difference was found between orexin levels between the groups. Our study is the first to evaluate orexin levels in children with epilepsy. Further research is needed to evaluate the role of orexins in the pathophysiology of epilepsy. With the clear relationship between orexin and epilepsy, antiorexinergic drugs can be used in the treatment of epilepsy.

“Frailty” in patients with Parkinsonian Spectrum Disorders: an observation from a tertiary care teaching hospital

Patients with movement disorders are in a pre-frail state due to the physical limitation or reduction in tolerance to physical stress. The study was conducted in the Department of Neurology of a tertiary care teaching hospital in Northern-east Rajasthan with 50 patients. Inclusion criteria: patients with parkinsonian features aged &gt;18 years; and willing to give consent regarding participation in the study. Exclusion criteria: patients with age &lt;18 years; not willing to participate in the study; and exclusion of alternative diagnosis. Frailty and pre-frailty states were assessed using the Fried’s criteria. Modified Frailty Index (MFI) was used to classify it as mild, moderate, and severe. Unified Parkinson's Disease Rating Scale (UPDRS), Multisystem Atrophy Rating Scale (MSARS), and Progressive Supranuclear Palsy Rating Scale (PSPRS) were used for respective disorders. The data was compiled using an MS Excel sheet, and SPSS 20 was used for statistical analysis. Thirty-nine patients fulfilled the criteria for “frailty-phenotype”; only 9 were “pre-frail”, and 2 were non-frail. On the MFI, patients with atypical parkinsonism had severe frailty with a mean index score of 0.54, where the mean scores were higher in the progressive supranuclear palsy (PSP) group (0.57) than in the multisystem atrophy (MSA) group (0.5). Patients with idiopathic Parkinson’s disease (IPD) had mild to moderate frailty with a mean score of 0.29 (Range 0.17-0.51). With a higher UPDRS score, the frailty index score in IPD patients was also higher, as was PSPRS in patients with PSP and UMSARS in patients with MSA. The mean MMSE score was also lower in the group with a higher frailty index. The levodopa dose requirement was higher in the frail group than in the non-frail or prefrail group (125mg/day vs. 625mg/day; p&lt;0.05). Frailty is part and parcel of neurodegenerative movement disorders, including movement disorders, and adds to the burden of disease.

Exome sequencing in Nigerian children with early-onset epilepsy syndromes.

Nigeria, along with other Sub-Saharan African countries, bears the highest burden of epilepsy worldwide. This high prevalence is attributed to a combination of factors, including a significant incidence of infectious diseases, perinatal complications, and genetic etiologies. Genetic testing is rarely available and is not typically included in the routine diagnostic work-up for individuals with infantile and childhood epilepsy syndromes in these regions. Exome sequencing (ES) offers a diagnostic yield of 24%-62%, but these figures primarily reflect data from high-income countries (HICs) and may not be applicable to low- and middle-income countries (LMICs). In this study, we employed ES to investigate the genetic basis of early-onset epilepsy in 22 affected children from Nigeria. The study involved sampling of patients diagnosed with early-onset epilepsy syndromes at the Lagos State University Teaching Hospital (LASUTH) Neurology clinic. Venous blood samples were collected, and genomic DNA was isolated and purified. Molecular analysis included DNA fragmentation, ligation, target enrichment, library preparation, and whole-exome sequencing. Computational analysis involved variant calling, curation, and classification using specialized tools and databases. Pathogenic variants were identified in 6 out of 22 individuals, equaling a diagnostic yield of 27.3% and comprising variants in BPTF, NAA15, SCN1A, TUBA1A and twice in CACNA1A. In this study, we present the first exome study on early-onset epilepsy syndromes from West Africa, facilitated by a Nigerian-German research collaboration. Our findings reveal a genetic diagnostic yield comparable to that of HICs. The integration of genomic medicine into epilepsy management in Nigeria holds promising prospects for improving patient care and reducing mortality rates. This study represents the first published exome findings in Nigerian children with early-onset epilepsy, revealing a genetic diagnosis in 27% of cases. Pathogenic variants were identified in five genes amongst 6 of 22 patients, underscoring the potential of genetic testing to enhance epilepsy management in developing nations like Nigeria.

Clinical characteristics of children with MT-TK gene m.8344A>G variation

Objective: To summarize the clinical characteristics of children carrying the m.8344A>G variant of MT-TK gene. Methods: A case series study was conducted to retrospectively collect data of 22 children with mitochondrial disease caused by MT-TK gene m.8344A>G variation who were treated at the Department of Neurology of Beijing Children's Hospital of Capital Medical University from January 2012 to January 2024. Their clinical data, laboratory tests, muscle pathology, genetic testing, and the follow-up results were analyzed. Pearson correlation analysis was used for correlation analysis. Results: Among the 22 children, there were 13 boys and 9 girls. The age of onset was 5.00 (2.75, 9.00) years. Fifteen children had myoclonic epilepsy with ragged-red fibers (MERRF), 3 had Leigh syndrome (LS), and 4 had LS-MERRF overlap syndrome (LS-MERRF). Myoclonus presented and worsened progressively in all 15 MERRF children, with 10 as the initial symptom and 5 developing progressively during the disease course. Myoclonus was predominantly focal, worsening with fine motor tasks or stress. Electroencephalogram monitoring in the 15 MERRF children revealed myoclonic seizures in 10 children, with 6 classified as myoclonic epilepsy, and 4 as subcortical myoclonus. Two children had generalized myoclonic seizures, and 1 each had absence seizures and generalized seizures. Twelve children had cerebellar ataxia, 10 children exhibited exercise intolerance, and 8 children had muscle weakness. Magnetic resonance imaging (MRI) revealed periventricular white matter involvement in 1 child and bilateral hippocampal involvement in 1 child, likely due to frequent seizures. All 3 children with LS exhibited developmental regressions, accompanied with 2 symptoms include cerebellar ataxia, muscle weakness, and dysphagia. The clinical manifestations of 4 LS-MERRF overlap children presented with combined features of MERRF and LS. Cranial MRI in the 7 LS and LS-MERRF children showed brainstem involvement (all affecting the midbrain) in 6 children and basal ganglia involvement in 4 children. Among the 22 children, 12 had m.8344A>G variant levels >90%, 3 had >80%-90%, 4 had >70%-80%, and 3 had >60%-70%. Higher variant level correlated with the LS phenotype and earlier onset age (r=0.47, -0.50; P=0.018 and 0.029, respectively). Sanger sequencing in 19 mothers revealed m.8344A>G variations in 18, with 4 showing exercise intolerance. Follow-up of 13 children on antimyoclonic treatment showed>75% reduction in seizures with levetiracetam monotherapy in 2 children, with combination therapy required in others. Most achieved >50% seizures reduction within 2 years, but the effectiveness declined with disease progression. Conclusions: The m.8344A>G variant is rare, with MERRF being the most common phenotype, while LS and LS-MERRF are less common. Children with higher ratio of the m.8344A>G variant are more likely to present LS phenotype. Myoclonus, primarily focal, is a key feature, with levetiracetam as the first-line treatment and benzodiazepines recommended for refractory cases.

Clinical features of KCNB1 gene variation related developmental and epileptic encephalopathy

Objective: To summarize the clinical features of epilepsy and (or) developmental delay associated with KCNB1 gene variants in children. Methods: A case series study was conducted on 24 children with KCNB1 gene variants associated with epilepsy and (or) developmental delay who were treated at the Children's Medical Center of Peking University First Hospital and the Department of Neurology of Shenzhen Children's Hospital from July 2015 to June 2024. The manifestations of seizures, electroencephalogram (EEG) and genetic test results of those children were analyzed. Results: All the KCNB1 gene variants were de novo, involving 20 different variation, including 15 missense variations, 3 frameshift variations and 2 nonsense variations. There were 7 novel variations. Among the 24 developmental and epileptic encephalopathy children, there were 14 boys and 10 girls. The last follow-up age ranged from 9 months to 13 years and 9 months. Seizures were present in 21 children (88%), with onset ranging from 1 month to 7 years, and 76% (16/21) began before 2 years of age. The seizure types included focal seizures in 15 children (71%), epileptic spasms, myoclonic seizures, and generalized tonic-clonic seizures in 6 children respectively, atypical absence seizures in 4 children, and myoclonic atonic seizures in 1 child. Seventeen children (81%) had a cluster of seizures and 5 had a history of focal status epilepticus with impaired consciousness. All 24 children had varying degrees of developmental delay, with 3 presenting solely developmental delay. EEG abnormalities were present in all the 21 children with seizures, including focal or multifocal discharges in 20 children, generalized discharges in 10 children, hypsarrhythmia in 2 children, and electrical status epilepticus during sleep in 3 children. Magnetic resonance imaging abnormalities were found in 5 of the 24 children. Among the 21 children with seizures, 57% (12/21) achieved seizure control. Conclusions: KCNB1 gene variants are predominantly de novo missense variation. Most affected children present with epilepsy, though some may exhibit only developmental delay. Epilepsy often begins before 2 years of age, with focal seizures being the most common type. About 80% of patients experience clustered seizures. Although most patients achieve seizure control, they still exhibit varying degrees of developmental delay, consistent with developmental epileptic encephalopathy.

Abstract 211: Building a Stroke Program in Urban Tanzania: Needs Assessment and a Plan to Move Forward

Introduction Stroke is a leading cause of morbidity and mortality globally with high social and economic burden that disproportionately effects low‐ and middle‐income countries (LMICs). Mechanical thrombectomy (MT) is an effective treatment for stroke but is not available in the majority of LMICs. Tanzania (TZ) lacks MT and has limited access to thrombolytics with very few patients receiving any intervention for acute ischemic stroke (AIS). Key stakeholders in TZ are motivated to build a stroke program and provide treatment of AIS, including MT. Here we present the initial needs assessment and model for developing a system of stroke care in TZ. Methods A needs assessment was performed in TZ through discussion with a multidisciplinary team. Key leaders from the national hospital leadership, Emergency Medicine, Neurology, Neurosurgery, Radiology, Interventional Radiology, and international stroke teams were involved in discussions regarding current stroke management and goals for the future. Key stakeholders provided insight into the current state of stroke management within their health system, including the referral system within TZ, review of data from an existing stroke registry, review of standard operating procedures (SOPs) in place for patients presenting with AIS. Recommendations for improving access to acute stroke treatment were identified and discussed. Results Existing infrastructure and systems within TZ designed to care for patients with AIS include: two newly established, thrombolysis ready stroke units; AIS registry which involves 8 referral hospitals. The barriers to providing AIS treatment include: delayed presentation to healthcare due to lack of public awareness; lack of affordable and rapid access to appropriate imaging; lack of established consulting service between emergency physicians and stroke neurology; lack of epidemiological data as to the true incidence of AIS at the district level, lack of access to endovascular treatment. A model to develop AIS program in TZ was identified consisting of three partially overlapping avenues and targeted at the public, healthcare systems and medical teams. Public: sensitization of the public with media campaigns and education will be focused on identification of stroke symptoms and knowledge about treatments. Healthcare systems: development of a formalized consultation service between district emergency teams and stroke neurology; development and implementation of new SOPs for diagnosis and access to imaging at the district level; expansion of stroke registry to include district level hospitals. Medical teams: continued mentorship through the World Stroke Organization for neurology on identification and acute management of patients with stroke; development of the first endovascular neuro‐intervention training program in collaboration with Mission Thrombectomy 2020. Conclusions There is significant need for a system of stroke care for patients in TZ. Key stakeholders are motivated to establish this system and bring acute interventions, including thrombolysis and MT. to patients suffering from AIS in TZ. This endeavor will require significant effort by many groups, but concurrent efforts in these three domains can help bring this important care to the people of TZ.

Relevance of 123I-FP-CIT SPECT prescriptions for the diagnosis of parkinsonian syndromes

123I-FP-CIT SPECT enables the detection of presynaptic dopaminergic denervation. It allows to differentiate degenerative parkinsonian syndromes from secondary parkinsonian syndromes or essential tremor, and patients with suspected dementia with Lewy bodies from those with other dementia subtypes. The aim of our study was to evaluate the appropriateness of 123I-FP-CIT SPECT prescriptions, identify prescriber profiles and analyze changes in prescriptions over a decade in the Neurology department of Avicenne University hospital. This retrospective study included all patients who underwent 123I-FP-CIT SPECT between February 2009 and May 2019 (n = 723). Clinical and paraclinical data were compared between three groups based on the relevance of 123I-FP-CIT SPECT prescription: “inappropriate”, “uncertain” and “relevant”. We showed that inappropriate indications accounted for 37.5% of 123I-FP-CIT SPECT requests. Hospital neurologists and neurologists with mixed practice accounted for 74.1% of 123I-FP-CIT SPECT requests, hospital movement disorders specialists being more likely to prescribe appropriately (67.1%) than hospital non-movement disorders specialists (33.3%). Following the replacement of the neuro-oncology team with a team including movement disorders specialists, the percentage of relevant SPECT 123I-FP-CIT prescriptions rose from 37.5% to 81.0%. These observations suggest that seeking the expertise of a movement disorders specialist would be more relevant than the systematic prescription of 123I-FP-CIT SPECT.

Post-stroke fatigue and its correlation with family functioning in patients who have experienced a first episode of stroke.

This study aimed to analyse the relevant factors that may affect post-stroke fatigue (PSF) in patients with stroke and further explore the correlation between family functioning and PSF. Patients who had experienced a first episode of stroke and were admitted to the Department of Neurology of the First Affiliated Hospital of Wenzhou Medical University were rigorously screened. The general data and family functioning of the patients on admission were collected, and their family adaptation, partnership, growth, affection and resolve scores and their PSF on the 5th day of admission were collected using the fatigue severity scale (FSS). Multiple linear regression analysis was then utilized to explore the factors affecting PSF in patients with stroke. A total of 220 questionnaires were distributed, and 220 were returned, with 212 valid questionnaires and a valid return rate of 96.4%. These 212 patients had a family functioning score of 6.58 ± 2.00 and an FSS score of 36.62 ± 10.96. Spearman's correlation analysis showed negative correlations between the FSS scores and the adaptation, partnership, growth, affection, resolve and family functioning scores (r = -0.380, -0.505, -0.470, -0.303, -0.281 and -0.712, respectively; p < 0.001). Furthermore, multiple linear regression analysis showed that family functioning (β' = -0.516), marital status (β' = -0.244), household income (β' = -0.185), literacy (β' = -0.181) and activities of daily living (β' = -0.084) were influential factors for PSF in patients with stroke (p < 0.05). There is a significant negative correlation between family functioning and PSF, suggesting that better family functioning may help mitigate the severity of post-stroke fatigue. Healthcare providers should identify interventions to help patients and families address fatigue, boost disease recovery, promote patients' physical and mental health and improve their quality of life.

Episodic syndromes associated with migraine (clinical and epidemiological study in pediatric practice)

Migraine in children can manifest itself in non-pain clinical phenotypes, among which several episodic syndromes associated with migraine (ESAM) are identified. A significant association with the later development of migraine was found for infantile colic syndrome, benign torticollis, abdominal migraine (AM), cyclic vomiting syndrome (CVS) and benign paroxysmal vertigo (BPV).Objective: to identify the clinical and epidemiological characteristics of childhood ESAM and its association with migraine.Material and methods. The study was conducted in Tambov Children's Clinical Hospital. A total of 250 children were included in the study: 120 (48%) girls and 130 (52%) boys aged 5 to 18 years (mean age 13±2.9 years, median age 13 [11; 15] years) with headache complaints. The diagnosis of ESAM was made according to the ICHD-3 criteria.Results. ESAM was observed in 95 (38%) patients aged 5–18 years. An analysis of the prevalence of ESAM in the different age groups showed that in children aged 5–10 years CVS (n=12; 4.8%) was more common than AM (n=6; 2.4%) and BPV (n=5; 2%). In the group of 11–14 year-old children, the frequency of AM clearly predominated (n=11; 4.4%), while in the group of 15–18 year-old adolescents, BPV (n=15; 6%) was observed more frequently compared to CVS (n=9; 3.5%) and AM (n=5; 2%).Conclusion. The results of the study indicate a high incidence of ESAM in child and adolescent patients of somatic and neurological hospitals. The data obtained show the importance of timely diagnosis and correct treatment of ESAM.

Neuronavigation Combined With Intraoperative Ultrasound and Intraoperative Magnetic Resonance Imaging Versus Neuronavigation Alone in Diffuse Glioma Surgery

This study aimed to integrate intraoperative ultrasound and magnetic resonance imaging (IMRI) with neuronavigation (NN) to create a multimodal surgical protocol for diffuse gliomas. Clinical outcomes were compared to the standard NN-guided protocol. Adult patients with diffuse gliomas scheduled for gross total resection (GTR) were consecutively enrolled to undergo either NN-guided surgery (80 patients, July 2019-January 2022) or multimodal-integrated surgery (80 patients, February 2022-August 2023). The primary outcomes were the extent of resection (EOR) and GTR. Additional outcomes included operative time, blood loss, length of hospital stay, and patient survival. GTR was achieved in 69% of patients who underwent multimodal-integrated surgery, compared to 43% of those who received NN-guided surgery (P= 0.002). Residual tumor was detected by IMRI in 53 patients (66%), and further GTR was achieved in 28 of these cases. The median EOR was 100% for the multimodal group and 95% for the NN-guided group (P= 0.001), while the median operative time was 8hours versus 5hours (P < 0.001). Neurological deficits, blood loss, and hospital stay durations were comparable between 2 groups. Multimodal-integrated surgery resulted in greater EOR and higher GTR rates in contrast-enhancing gliomas, gliomas in eloquent regions, and large gliomas (≥50mm). GTR in glioblastomas and other contrast-enhancing gliomas contributed to improved overall survival. Compared to standard NN-guided surgery, multimodal-integrated surgery using NN, IMRI, and intraoperative ultrasound significantly increased the EOR and GTR rates for diffuse gliomas.

Effect of mindfulness training program on well-being and leadership skills of psychiatric nurses

BackgroundNursing leaders need mindfulness, which is an effective intervention for reducing stress, promoting well-being, and enhancing their leadership skills. PurposeTo explore the effect of a mindfulness training program on the well-being and leadership skills of head nurses. MethodsA quasi-study design was used and conducted in a psychiatric and neurological university hospital on a convenience sample of 40 head nurses. Using the cognitive and affective mindfulness scale, the mindful attention awareness scale, the leadership skills questionnaire, and the mindfulness program. FindingsThe findings resulted in a significant difference in the effect of the mindfulness program before and after training when applied to leadership skills, especially conceptual and administrative skills. DiscussionManagers must adopt a mindfulness program, integrate it into nursing intervention protocols, and circulate it to all nursing staff because it has a noticeable impact if it is practiced seriously and its results are benefited from.

Immunohistochemical investigation of SOX2 expression in Iraqi patients with high-grade glioma

Background. Gliomas, particularly high-grade gliomas, are aggressive brain tumors with poor prognosis. Sex-determining region Y-box 2 (SOX2) is a transcription factor responsible for stem cell maintenance and differentiation and has been implicated in glioma progression and recurrence. The present study investigated SOX2 expression in Iraqi patients with high-grade glioma and assessed its potential as a diagnostic and prognostic biomarker. Methods. Sixty-four paraffin-embedded samples from the Neurological Hospital in Baghdad were analyzed, including 34 high-grade glioma cases (21 males and 13 females) and 13 benign controls (10 males and 3 females). Immunohistochemical staining for SOX2 was performed, and staining levels were categorized using a scoring system. Statistical analyses were conducted to evaluate differences in SOX2 expression between genders and between patient and control groups. Results. There were highly significant differences in SOX2 expression between patients and controls (p ≤0.01). However, no significant difference was observed between male and female patients (p ≤0.01). Additionally, there were significant differences in SOX2 expression distribution between genders, with p-values of 0.0022 for males and 0.0061 for females. The highest distribution percentages for males were at scores 2 and 3, with values of 38.10 and 47.62%, respectively. In contrast, females had distribution ratios only at scores 2 and 3, with values of 30.77 and 69.23%, respectively. Conclusion. SOX2 is highly expressed in high-grade gliomas, supporting its potential as a diagnostic and prognostic marker. Future studies with larger cohorts and detailed sex-specific analyses are needed to elucidate SOX2's role in glioma pathogenesis and its potential as a therapeutic target.