Clin. Transl. Neurosci., Volume 7, Issue 1 (March 2023) – 9 articles

There is a general understanding that older adults suffering from a stroke have poorer outcomes and might benefit less from neurorehabilitation. This narrative review analyzes the conflicting evidence for the effect of aging on the success of neurorehabilitation after a stroke. While there is convincing evidence that functional outcomes are negatively impacted by age, functional gains made during rehabilitation are less clearly impacted, and the effect of age seems to be related to other factors such as prestroke independence and therapy intensity, as well as the population studied. There is no evidence that would justify withholding high-intensity neurorehabilitation on the sole basis of age. Full article

There is much controversy about the link between motor symptom progression and the plethora of reported brain atrophy patterns in idiopathic Parkinson’s disease (PD). The main goal of this study is to provide empirical evidence for unique and common contributions of clinical phenotype characteristics on the dynamic changes of brain structure over time. We analyzed the behavioral and magnetic resonance imaging (MRI) data of PD patients (n = 22) and healthy individuals (n = 21) acquired two years apart through the computational anatomy framework of longitudinal voxel-based morphometry (VBM). This analysis revealed a symmetrical bi-hemispheric pattern of accelerated grey matter decrease in PD extending through the insula, parahippocampal gyrus, medial temporal lobes and the precuneus. We observed a hemisphere-specific correlation between the established scores for motor symptoms severity and the rate of atrophy within motor regions, which was further differentiated by the clinical phenotype characteristics of PD patients. Baseline cerebellum anatomy differences between the tremor-dominant and akineto-rigid PD remained stable over time and can be regarded as trait rather than state-associated features. We interpret the observed pattern of progressive brain anatomy changes as mainly linked to insular areas that determine together with basal ganglia the motor and non-motor phenotype in PD. Our findings provide empirical evidence for the sensitivity of computational anatomy to dynamic changes in PD, offering additional opportunities to establish reliable models of disease progression. Full article

Memory disorders are common in clinical practice. This review focuses on the rehabilitation of anterograde amnesia, the inability to learn and retrieve new information, in non-degenerative brain disease. Diverse mnemonic strategies may be helpful in learning specific pieces of information. Their success also depends on the severity of associated cognitive failures, in particular, executive dysfunction. However, unless transfer to everyday activities is specifically trained, such strategies are of limited value in promoting independence in daily life. External memory aids are often necessary to allow for independent living. Learning to use them requires intact capacities such as procedural learning or conditioning. This review further discusses the rehabilitation of confabulation, that is, the emergence of memories of events that never happened. The rehabilitation of memory disorders needs to be tailored to patients’ individual capacities and needs. Full article

This article deals with recommendations on the management of symptoms of MS and on the provision of vaccinations in patients receiving disease-modifying therapies (DMTs). Symptoms of MS, such as fatigue, depression, urinary symptoms, spasticity, impairment of gait, and sexual dysfunction, are common in this population. Recognizing and addressing these symptoms is key to maintaining the quality of life of people with MS. Vaccination status should be reviewed and updated prior to initiation of DMTs. In general, vaccination should be avoided for variable periods after the initiation of some DMTs. Live attenuated vaccines are contraindicated and should be considered on a case-by-case basis. These consensus recommendations will present the best practices for vaccination in Saudi Arabia before, during, and after the COVID-19 pandemic. The recommendations will be updated periodically and as needed as new evidence becomes available. Full article

Multiple sclerosis (MS) is an inflammatory neurological illness common in young adults. The prevalence and incidence of MS are regionally and globally increasing. Recent data from Saudi Arabia (SA) estimate the prevalence to be 40.40 cases per 100,000 population, and 61.95 cases per 100,000 population for Saudi nationals. With the increasing availability of treatment options, new challenges for treatment selection and approaches have emerged. There is a clear need for national guidelines to standardize practice, guide the personalization of decisions, and contain increasing costs. A multidisciplinary expert panel was formed to develop evidence-based Saudi consensus recommendations on the diagnosis and clinical care of MS, to aid healthcare practitioners in advising patients on treatment decisions. The recommendations were agreed upon after a thorough review, an evaluation of existing international guidelines, and the latest emerging evidence. Full article

Cognitive performance is negatively affected by the presence of noise, which is seen as a distractor and a stressor, especially in hazardous occupational environments. The addition of musculoskeletal fatigue that commonly accompanies occupational work due to noise interruption can further elevate risk and compromise safety. The purpose of the study was to investigate the impact of both individual and a combination of noise interference and physical workload on simple and choice response time tasks. Sixteen healthy male and female participants (age: 20 ± 1 years; height: 169.48 ± 8.2 cm; weight: 67.93 ± 12.7 kg) performed a simple (SRT) and choice response task (CRT) with three Blazepod™ light response time systems by striking with the dominant lower extremity from a seated position while listening to noises from a construction site (65–85dB) through headphones. Participants then performed a low-intensity musculoskeletal fatigue task and completed the above measures again. Response times (RT) (ms) from three trials of SRT and CRT, both without and with noise interference, before (PRE) and after the workload (POST), were averaged, and a 2 (Noise) × 2 (workload) × 2 (task) repeated measure ANOVA and a 2 (Noise) × 2 (workload) repeated measure ANOVA were performed for SRT and CRT, respectively, using JASP at an alpha level of 0.05. Results revealed a significant interaction between workload task (p = 0.041), as well as a main effect significance for the workload (p = 0.007) and noise (p = 0.044). The main effect significance also existed for workload in SRT (p = 0.009) and for noise in CRT (p = 0.002). In SRT, RT was significantly faster during the POST fatigue measure, suggesting a possible cognitive arousal and a learning effect improvement rather than a negative fatigue effect. In both SRT and CRT, as well as individually in CRT, RT was significantly slower due to noise interruption, negatively impacting performance, especially in the more challenging CRT compared to SRT. Thus, findings from the current study suggest that the impact of noise interruption is significant when the complexity of the response task is greater, and the potential cognitive arousal due to the workload and potential learning effects may influence response time performances. Finally, a lower extremity cognitive–motor task demonstrates response time behavior similar to such upper extremity cognitive–motor tasks. Full article

Virtual reality (VR) is seen by some as a tool that may greatly improve, or even revolutionize cognitive rehabilitation. VR offers distinct advantages compared to classic rehabilitation using paper-and-pencil or computer-based training, such as immersion, the feeling of presence, embodiment of virtual players, ecological and multisensory stimulation. We here review recent clinical studies examining the effects of VR training in patients with stroke-induced cognitive deficits. Several trials reported evidence that VR training improves general cognition compared to standard cognitive training. However, the evidence remains controversial, as some of these studies had a high risk of bias. Regarding mood, there is some indication that immersive training improves depression scores in stroke patients, but the number of studies examining mood changes is very low. Finally, in the domain of spatial cognition the development of specific intervention techniques such as virtual prism adaptation provide avenues for clinical interventions, though well-controlled clinical trials are lacking. Together, the available evidence suggests that VR has the potential to improve rehabilitation particularly in domains requiring repetitive training in an immersed, ecological setting, or when a mismatch between body frames and the environment is created. Controlled clinical studies are required to examine the specific advantages of VR compared to classic interventions. Full article

Multiple sclerosis (MS), particularly relapsing MS (RMS), has become a treatable disease in recent decades, and immunotherapies are now able to influence long-term disease course. A wide range of disease-modifying drugs are available, which makes the choice of therapy in individual cases considerably more complex. Due to specific regulatory aspects (partly diverging approvals by Swissmedic compared to the European Medicines Agency (EMA), and an independent evaluation process for the Federal Office of Public Health (FOPH) specialities list (SL)), we issued a consensus recommendation regarding specific aspects of immunotherapy for MS in Switzerland in 2019. Here, we present revised recommendations with an update on newly approved drugs and new safety aspects, also in reference to the risk of COVID-19 infection and vaccination. Full article

Patients with cluster headache often report a long diagnostic delay. This study creates and validates a screening test that could help speed up the diagnostic process. We invited patients to enrol in this diagnostic case–control study if a trigeminal autonomic headache had been suspected or confirmed. Patients in whom the diagnosis of a cluster headache was not made were controls. First, all participants answered 22 diagnostic questions with “yes” or “no”. Next, we eliminated questions that did not distinguish well between the groups. Then, the variables entered a regression model with the headache diagnosis as the dependent variable. Finally, we combined the remaining variables into a diagnostic scale and tested its accuracy. Seventy-four patients participated, 45 of whom suffered from a cluster headache. The analyses identified five questions distinguishing cluster headache patients and controls. These addressed smoking, being awakened by the pain, restlessness during the attack, unilateral tearing, and duration of the attack (hence, the “SMARTED” scale). The area under the ROC curve was 0.938; sensitivity and specificity, the positive and negative predictive values were 98%, 65%, 81% and 94%, respectively. The SMARTED scale validly and accurately screens for cluster headache in patients suspected of a trigeminal autonomic headache. Full article