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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (31 August 2024) | Viewed by 15266

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Dr. Leonardo Roever

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Guest Editor

1. Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil, MG, Brazil
2. Postgraduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, BA, Brazil
3. Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
Interests: neurodegenerative diseases; psychiatric disorders; neuroimaging; neurobiology; neuroprogression; inflammation; biomarkers; brain mapping; tractography; neurocir-cuits; meta-analyses
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Special Issue Information

Dear Colleagues,

The Special Issue on “Recent Advances in Clinical Neurology” is a compilation of review articles which highlight the most recent and significant developments in the field of clinical neurology. It is designed to provide a comprehensive overview of the latest discoveries and innovations shaping the practice of neurology and improving patient care. This Special Issue seeks to serve as a valuable resource providing information to healthcare professionals, researchers, and students who need to stay up to date on the latest advances in clinical neurology. Additionally, it highlights continued progress in the understanding and treatment of neurological diseases, offering hope for patients and their families.

The topics under consideration include review articles that focus on, but are not limited to, the following potential topics:

Advanced neuroimaging;
Innovative treatments;
Cognitive neurology;
Personalized clinical neurology;
Biomarker assessment;
Artificial intelligence, mobile health in neurology;
Pharmacological intervention in neurology;
Genetics in neurology;
Prognosis according to comorbidities;
Primary and secondary prevention;
Epidemiological in neurology;
Molecular neurology.

Dr. Leonardo Roever
Guest Editor

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Keywords

precision medicine
prevention
prognosis
rehabilitation
treatment

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Published Papers (7 papers)

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Research

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34 pages, 12218 KiB

Open AccessArticle

Validation of a Paralimbic-Related Subcortical Brain Dysmaturation MRI Score in Infants with Congenital Heart Disease

by William T. Reynolds, Jodie K. Votava-Smith, George Gabriel, Vincent K. Lee, Vidya Rajagopalan, Yijen Wu, Xiaoqin Liu, Hisato Yagi, Ruby Slabicki, Brian Gibbs, Nhu N. Tran, Molly Weisert, Laura Cabral, Subramanian Subramanian, Julia Wallace, Sylvia del Castillo, Tracy Baust, Jacqueline G. Weinberg, Lauren Lorenzi Quigley, Jenna Gaesser, Sharon H. O’Neil, Vanessa Schmithorst, Ashok Panigrahy, Rafael Ceschin and Cecilia W. Lo Show full author list Hide full author list

J. Clin. Med. 2024, 13(19), 5772; https://doi.org/10.3390/jcm13195772 - 27 Sep 2024

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Abstract

Background: Brain magnetic resonance imaging (MRI) of infants with congenital heart disease (CHD) shows brain immaturity assessed via a cortical-based semi-quantitative score. Our primary aim was to develop an infant paralimbic-related subcortical-based semi-quantitative dysmaturation score, termed brain dysplasia score (BDS), to detect abnormalities in CHD infants compared to healthy controls and secondarily to predict clinical outcomes. We also validated our BDS in a preclinical mouse model of hypoplastic left heart syndrome. Methods: A paralimbic-related subcortical BDS, derived from structural MRIs of infants with CHD, was compared to healthy controls and correlated with clinical risk factors, regional cerebral volumes, feeding, and 18-month neurodevelopmental outcomes. The BDS was validated in a known CHD mouse model named Ohia with two disease-causing genes, Sap130 and Pchda9. To relate clinical findings, RNA-Seq was completed on Ohia animals. Findings: BDS showed high incidence of paralimbic-related subcortical abnormalities (including olfactory, cerebellar, and hippocampal abnormalities) in CHD infants (n = 215) compared to healthy controls (n = 92). BDS correlated with reduced cortical maturation, developmental delay, poor language and feeding outcomes, and increased length of stay. Ohia animals (n = 63) showed similar BDS findings, and RNA-Seq analysis showed altered neurodevelopmental and feeding pathways. Sap130 mutants correlated with a more severe BDS, whereas Pcdha9 correlated with a milder phenotype. Conclusions: Our BDS is sensitive to dysmaturational differences between CHD and healthy controls and predictive of poor outcomes. A similar spectrum of paralimbic and subcortical abnormalities exists between human and Ohia mutants, suggesting a common genetic mechanistic etiology. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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11 pages, 528 KiB

Open AccessArticle

Resistin and In-Hospital Mortality in Patients with Acute Ischemic Stroke: A Prospective Study

by Ioana Cristina Bârsan, Silvina Iluţ, Nicoleta Tohănean, Raluca Pop, Ştefan Cristian Vesa and Lăcrămioara Perju-Dumbravă

J. Clin. Med. 2024, 13(16), 4889; https://doi.org/10.3390/jcm13164889 - 19 Aug 2024

Cited by 1 | Viewed by 1315

Abstract

Background/Objectives: Understanding the prognostic factors of acute ischemic stroke (AIS) is essential for improving patient outcomes. The aim of this study was to establish the predictive role of plasmatic resistin and leptin on short-term mortality in adult patients with a first episode of AIS. Methods: This study enrolled 277 patients who were consecutively hospitalized for AIS. Demographic data, cardiovascular risk, comorbidities, and laboratory tests were collected. Death was noted if it occurred during hospitalization. Results: Death was recorded in 33 (11.9%) patients. Conducting multivariate analysis, the following variables were independent variables associated with in-hospital mortality: a resistin value of >11 ng/mL (OR 10.81 (95%CI 2.31;50.57), p = 0.002), a lesion volume of >18.8 mL (OR 4.87 (95%CI 1.87;12.67), p = 0.001), a NIHSS score of >7 (OR 5.88 (95%CI 2.01;17.16), p = 0.001), and the presence of IHD (OR 4.33 (95%CI 1.66;11.27), p = 0.003). This study has some limitations: single-center design (which may affect the generalizability of the results) and the potential impact of the COVID-19 pandemic on patient outcomes. Conclusions: This study demonstrated that resistin is a significant predictor of in-hospital mortality in AIS patients. Other established factors, such as a high NIHSS score, large lesion volume, and the presence of IHD, were reaffirmed as important predictors. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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12 pages, 1535 KiB

Open AccessArticle

Variations in Cortical Oxygenation by Near-Infrared Spectroscopy According to Head Position after Acute Stroke: The Preliminary Findings of an Observational Study

by Ilaria Casetta, Anna Crepaldi, Michele Laudisi, Andrea Baroni, Jessica Gemignani, Sofia Straudi, Fabio Manfredini and Nicola Lamberti

J. Clin. Med. 2024, 13(13), 3914; https://doi.org/10.3390/jcm13133914 - 3 Jul 2024

Viewed by 1474

Abstract

Background: After ischemic stroke, there is no general consensus on the optimal position for the head of patients in the acute phase. This observational study aimed to measure the variations in cortical oxygenation using noninvasive functional near-infrared spectroscopy (fNIRS) at different degrees of head positioning on a bed. Methods: Consecutive ischemic stroke patients aged 18 years or older with anterior circulation ischemic stroke within 48 h of symptom onset who could safely assume different positions on a bed were included. A 48-channel fNIRS system was placed in the bilateral sensorimotor cortex. Then, the bed of each patient was moved into four consecutive positions: (1) seated (90° angle between the head and bed surface); (2) lying at 30°; (3) seated again (90°); and (4) lying flat (0°). Each position was maintained for 90 s; the test was conducted 48 h after stroke onset and after 5 ± 1 days. The variations in oxygenated hemoglobin in the global brain surface and for each hemisphere were recorded and compared. Results: Twenty-one patients were included (males, n = 11; age, 79 ± 9 years; ASPECTS, 8 ± 2). When evaluating the affected side, the median oxygenation was significantly greater in the lying-flat (0°) and 30° positions than in the 90° position (p < 0.001 for both comparisons). No significant differences between the supine position and the 30° position were found, although oxygenation was slightly lower in the 30° position than in the supine position (p = 0.063). No differences were observed when comparing recanalized and nonrecanalized patients separately or according to stroke severity. The evaluation conducted 5 days after the stroke confirmed the previous data, with a significant difference in oxygenation at 0° and 30° compared to 90°. Conclusions: This preliminary study suggested that there are no substantial differences in brain oxygenation between the lying-flat head position and the 30° laying position. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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21 pages, 1414 KiB

Open AccessArticle

by Ovidiu Lucian Băjenaru, Cătălina Raluca Nuță, Lidia Băjenaru, Alexandru Balog, Alexandru Constantinescu, Octavian Andronic and Bogdan Ovidiu Popescu

J. Clin. Med. 2024, 13(12), 3403; https://doi.org/10.3390/jcm13123403 - 11 Jun 2024

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Abstract

Background/Objectives: Dystonia is a neurological movement disorder characterized by involuntary muscle contractions that lead to abnormal movements and postures; it has a major impact on patients’ health-related quality of life (HRQoL). The aim of this study was to examine the HRQoL of Romanian patients with dystonia using the EQ-5D-5L instrument. Methods: Responses to the EQ-5D-5L and the visual analogue scale (VAS) were collected alongside demographic and clinical characteristics. Health profiles were analyzed via the metrics of the EQ-5D-5L, severity levels, and age groups. Using Shannon’s indexes, we calculated informativity both for patients’ health profile as a whole and each individual dimension. Level sum scores (LSS) of the EQ-5D-5L were calculated and compared with scores from the EQ-5D-5L index and VAS. The HRQoL measures were analyzed through demographic and clinical characteristics. Descriptive statistics, Spearman correlation, and non-parametric tests (Mann–Whitney U or Kruskall–Wallis H) were used. The level of agreement between HRQoL measures was assessed using their intraclass correlation coefficient (ICC) and Bland–Altman plots. Results: A sample of 90 patients was used, around 75.6% of whom were female patients, and the mean age at the beginning of the survey was 58.7 years. The proportion of patients reporting “no problems” in all five dimensions was 10%. The highest frequency reported was “no problems” in self-care (66%), followed by “no problems” in mobility (41%). Shannon index and Shannon evenness index values showed higher informativity for pain/discomfort (2.07 and 0.89, respectively) and minimal informativity for self-care (1.59 and 0.68, respectively). The mean EQ-5D-5L index, LSS, and VAS scores were 0.74 (SD = 0.26), 0.70 (SD = 0.24), and 0.61 (SD = 0.21), respectively. The Spearman correlations between HRQoL measures were higher than 0.60. The agreement between the EQ-5D-5L index and LSS values was excellent (ICC = 0.970, 95% CI = 0.934–0.984); the agreement was poor-to-good between the EQ-5D-5L index and VAS scores (ICC = 683, 95% CI = 0.388–0.820), and moderate-to-good between the LSS and VAS scores (ICC = 0.789, 95% CI = 0.593–0.862). Conclusions: Our results support the utilization of the EQ-5D-5L instrument in assessing the HRQoL of dystonia patients, and empirical results suggest that the EQ-5D-5L index and LSS measure may be used interchangeably. The findings from this study highlight that HRQoL is complex in patients with dystonia, particularly across different age groups. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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Review

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21 pages, 1391 KiB

Open AccessReview

Global Insights on Prehospital Stroke Care: A Comprehensive Review of Challenges and Solutions in Low- and Middle-Income Countries

by Elvan Wiyarta, Marc Fisher, Mohammad Kurniawan, Rakhmad Hidayat, Iskandar Purba Geraldi, Qaisar Ali Khan, I Putu Eka Widyadharma, Aliena Badshah and Jeyaraj Durai Pandian

J. Clin. Med. 2024, 13(16), 4780; https://doi.org/10.3390/jcm13164780 - 14 Aug 2024

Cited by 4 | Viewed by 3034

Abstract

Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the limited therapeutic window for thrombolytic treatments, which may greatly improve recovery chances when initiated early after stroke onset. These delays are caused by a lack of public understanding of stroke symptoms, sociodemographic and cultural variables, and insufficient healthcare infrastructure. This review discusses these issues in detail, emphasizing the disparities in stroke awareness and reaction times between locations and socioeconomic classes. Innovative options for reducing these delays include the deployment of mobile stroke units and community-based educational campaigns. This review also discusses how technology improvements and personalized educational initiatives might improve stroke awareness and response in LMICs. The primary goal is to give a thorough assessment of the challenges and potential remedies that might serve as the foundation for policy reforms and healthcare improvements in LMICs, eventually improving stroke care and lowering disease-related mortality and disability. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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47 pages, 3569 KiB

Open AccessReview

Intersecting Pathways: The Role of Metabolic Dysregulation, Gastrointestinal Microbiome, and Inflammation in Acute Ischemic Stroke Pathogenesis and Outcomes

by Jarosław Nuszkiewicz, Beata Kukulska-Pawluczuk, Katarzyna Piec, Dorian Julian Jarek, Karina Motolko, Karolina Szewczyk-Golec and Alina Woźniak

J. Clin. Med. 2024, 13(14), 4258; https://doi.org/10.3390/jcm13144258 - 21 Jul 2024

Cited by 2 | Viewed by 2502

Abstract

Acute ischemic stroke (AIS) remains a major cause of mortality and long-term disability worldwide, driven by complex and multifaceted etiological factors. Metabolic dysregulation, gastrointestinal microbiome alterations, and systemic inflammation are emerging as significant contributors to AIS pathogenesis. This review addresses the critical need to understand how these factors interact to influence AIS risk and outcomes. We aim to elucidate the roles of dysregulated adipokines in obesity, the impact of gut microbiota disruptions, and the neuroinflammatory cascade initiated by lipopolysaccharides (LPS) in AIS. Dysregulated adipokines in obesity exacerbate inflammatory responses, increasing AIS risk and severity. Disruptions in the gut microbiota and subsequent LPS-induced neuroinflammation further link systemic inflammation to AIS. Advances in neuroimaging and biomarker development have improved diagnostic precision. Here, we highlight the need for a multifaceted approach to AIS management, integrating metabolic, microbiota, and inflammatory insights. Potential therapeutic strategies targeting these pathways could significantly improve AIS prevention and treatment. Future research should focus on further elucidating these pathways and developing targeted interventions to mitigate the impacts of metabolic dysregulation, microbiome imbalances, and inflammation on AIS. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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29 pages, 1577 KiB

Open AccessReview

Alzheimer’s Disease and Epilepsy: Exploring Shared Pathways and Promising Biomarkers for Future Treatments

by Athanasios-Christos Kalyvas, Maria Dimitriou, Panagiotis Ioannidis, Nikolaos Grigoriadis and Theodora Afrantou

J. Clin. Med. 2024, 13(13), 3879; https://doi.org/10.3390/jcm13133879 - 1 Jul 2024

Cited by 4 | Viewed by 2970

Abstract

Background: Alzheimer’s disease (AD) and epilepsy represent two complex neurological disorders with distinct clinical manifestations, yet recent research has highlighted their intricate interplay. This review examines the association between AD and epilepsy, with particular emphasis on late-onset epilepsy of unknown etiology, increasingly acknowledged as a prodrome of AD. It delves into epidemiology, pathogenic mechanisms, clinical features, diagnostic characteristics, treatment strategies, and emerging biomarkers to provide a comprehensive understanding of this relationship. Methods: A comprehensive literature search was conducted, identifying 128 relevant articles published between 2018 and 2024. Results: Findings underscore a bidirectional relationship between AD and epilepsy, indicating shared pathogenic pathways that extend beyond traditional amyloid-beta and Tau protein pathology. These pathways encompass neuroinflammation, synaptic dysfunction, structural and network alterations, as well as molecular mechanisms. Notably, epileptic activity in AD patients may exacerbate cognitive decline, necessitating prompt detection and treatment. Novel biomarkers, such as subclinical epileptiform activity detected via advanced electroencephalographic techniques, offer promise for early diagnosis and targeted interventions. Furthermore, emerging therapeutic approaches targeting shared pathogenic mechanisms hold potential for disease modification in both AD and epilepsy. Conclusions: This review highlights the importance of understanding the relationship between AD and epilepsy, providing insights into future research directions. Clinical data and diagnostic methods are also reviewed, enabling clinicians to implement more effective treatment strategies. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Clinical Neurology)

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