Clin. Transl. Neurosci., Volume 7, Issue 3 (September 2023) – 14 articles

The primary target was an investigation of the factors predicting a good clinical outcome of patients with acute ischemic stroke after treatment with mechanical thrombectomy. Additionally, we compared the treatment results in known and unknown symptom onset time groups. We retrospectively analyzed the data from 2012 to 2020 and divided 240 patients into the known and unknown symptom onset time groups. We looked for the variables predicting a good clinical outcome (NIHSS 0–4 at discharge) in both groups. In both groups, there was no statistically significant difference in good clinical outcomes (43% in the known symptom onset time group vs. 33.3% in the unknown symptom onset time group, p = 0.203). Factors predicting a good clinical outcome in both groups were lower NIHSS scores at admission, the presentation of pial arterial collaterals on admission CT angiography, and bridging intravenous thrombolysis. In the known symptom onset time group, lower age was also a factor predicting good outcome. Our clinical results of treatment by using mechanical thrombectomy were comparable in the known and unknown symptom onset time groups. Full article

Nearly 25 years have passed since the ground-breaking discovery that hypocretin deficiency underlies human narcolepsy with cataplexy. Over time, it has become increasingly evident that hypocretin deficiency goes beyond the conventional core symptoms, or pentad, traditionally associated with narcolepsy. The emergence of hypocretin receptor 2 agonists presents an exciting opportunity, prompting us to explore the role of receptor 2 in the complete spectrum of NT1 symptoms. In this review, several clinical manifestations beyond the core symptoms will be discussed. We will outline what is currently known about the involvement of hypocretin receptors to reflect on what we expect with current knowledge from treatment with specific receptor agonists. Full article

Insomnia is characterized by frequent and persistent difficulties initiating and maintaining sleep, along with impaired daytime functioning. Blended treatments are increasingly popular for treating psychological disorders such as depression. Blended treatments combine elements of face-to-face therapy and online interventions. A single-arm pre-post study investigated the feasibility of a blended treatment combining face-to-face cognitive behavioral therapy for insomnia and internet-based cognitive behavioral therapy for insomnia (SLEEPexpert+). The findings show that the therapists have a positive attitude toward blended CBT-I (b-CBT-I) and that they feel supported by the online components of the treatment. Possible barriers to implementing blended treatments are integrating the online materials into the face-to-face sessions and adapting one’s therapeutic style to the blended treatment approach. No definitive statements about the effectiveness of the b-CBT-I treatment can be made. However, of the six presented cases, five patients showed notably higher sleep efficiency and fewer insomnia symptoms at the end of the therapy. Program usage data indicate that participants mainly used the online components at the beginning of their treatment. Future studies should investigate the effectiveness of b-CBT-I with a sufficiently powered randomized controlled trial comparing b-CBT-I with an adequate control group in routine care. Full article

Introduction. Spinal cord ischemia (SCI) accounts for less than 1% of all strokes, and mostly affects the anterior cord. The ascending aorta (AA) is the rarest site of localization for aortic thrombi (5%). We report a singular case of posterior SCI due to a floating thrombus in the AA. Case presentation. A 75-year-old male with acute left hemiparesis and left tactile and proprioceptive sensory loss below the C5 dermatome (NIHSS 3) is presented. Spinal cord MRI showed a C4–C6 ischemic lesion, involving the left lateral posterior hemi-cord. CT angiography showed a 6 mm floating thrombus in the AA. According to cardiovascular surgeons, dual antiplatelet therapy and high-dose statin were started. After seven days, the patient was discharged with mild left distal hemiparesis and an unchanged sensory deficit. Conclusions. Posterior SCI is rarer than anterior ischemia and potentially unilateral. Its clinical presentation is mainly sensory with possible, but not systematic, weakness of the homolateral limbs. SCI is often caused by aortic pathologies in the elderly, but the incidence rate of non-aneurysmal aortic mural thrombus is about 0.45% and the AA represents a very rare location. In similar cases, conservative medical treatment is preferred despite the high-risk rates of embolic recurrences. Full article

This systematic review and meta-analysis of global peer-reviewed neuroimaging findings preliminarily assessed the magnitude of effect sizes (ES) of the influences of family poverty/low socioeconomic status (SES) on children’s neurocognition and whether these were consistently detrimental. The literature search (Web of Science; PUBMED; MEDLINE: PSYCNET; GOOGLE SCHOLAR; SCIENCEDIRECT) included 66 studies from 1988 to 2022; 85% of the studies included were conducted in Western, high-income nations. Bayesian models, corrected by study sizes and variances, revealed ESs were heterogeneous across countries and measurements. Bayesian and standard hypothesis testing indicated high and low SES groups showed similar behavioral performances in neuroimaging-concurrent tasks. Except for Magnetic Resonance Imaging studies, ESs were small-to-intermediate with modest reliability. The strongest ESs were found for attention, mathematical performance, language, and cortical volume, followed by intermediate ESs for reading and socioemotional processes. Differentials in resting activity and connectivity, working memory, and executive functions yielded small effects. A bibliometric analysis showed a significant proportion of the literature attributed neurocognitive deficits to low SES, despite overlooking the under-representativity of non-Western and low-income countries, potential influences of racial/ethnic differences, and measurement sensitivity/specificity discrepancies. To reach United Nations Sustainable Development Goals, policies and interventions should consider regional, structural, or environmental ecologies beyond the individual, critically probing implicit deficit attributions. Full article

Neuromuscular disorders (NMDs) encompass a highly diverse group of conditions that affect the skeletal muscles, peripheral nervous system, or motor endplate. Depending on the underlying disease, common characteristics include progressive muscle weakness and sensory disturbances, both of which can contribute to sleep disruption. Disorders of sleep are extremely frequent in NMDs and substantially co-determine overall morbidity, quality of life, and survival. As many NMDs currently lack a cure, supportive therapy is mandatory and includes appropriate management of sleep-related symptoms. Specific sleep disorders that may arise in NMDs include insomnia due to pain or leg muscle cramps, restless legs syndrome, and sleep-disordered breathing, notably obstructive sleep apnea and hypoventilation. This review article aims to comprehensively outline the clinical spectrum of sleep disorders and sleep properties associated with NMDs. Full article

Study objectives: Sleep and circadian rhythms disorders are frequent in the acute stroke. Sleep modifications are likely to contribute to the development of stroke-related delirium, a common neuropsychiatric complication of acute stroke. This systematic review aimed to clarify the association between sleep modifications and the occurrence of delirium in patients with acute stroke. Methods: The current systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was performed on PubMed and Scopus databases. Only studies that provided data concerning sleep, or pre-existing sleep disorders, in acute stroke and performed a formal evaluation of delirium were included. Results: The literature search enabled the identification of 15 studies, which exhibited high heterogeneity in terms of study design, settings, sleep assessments, delirium measures, and types of sleep intervention. In the study quality assessment, the majority of the studies were rated as weak or moderate. In most of the cases, sleep was subjectively assessed by the patients or rated by clinicians. None of the studies performed polysomnography for the evaluation of sleep. Only four of the studies assessed the impact of a sleep intervention on delirium, suggesting the potentially protective role of sleep promotion in reducing the prevalence and severity of stroke-related delirium. Conclusions: The evidence arising from the present systematic review supports that sleep disruption is a potential promoting factor for stroke-related delirium. We suggest that a formal sleep assessment and sleep promotion should be included in routine stroke care. Full article

Severe traumatic brain injury (TBI) may cause disorders of consciousness (DoC) in the form of coma, unresponsive wakefulness syndrome (UWS), or minimally conscious state (MCS). Despite significant advancements made over the last two decades in detecting, predicting, and promoting the recovery of consciousness in TBI patients with DoC, the available diagnostic and treatment choices remain limited. In cases of severe TBI, the dissolution of consciousness both in the acute and post-acute phases constitutes one of the major clinical findings and challenges. In clinical settings, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate, and inappropriate care. Recent studies refer to network-based mechanisms of consciousness as a more promising method to predict outcomes and functional recovery. A further goal is the modulation of neural networks underlying awareness and arousal as the main components of consciousness. This review centers on the difficulties in characterizing individuals experiencing post-traumatic DoC and on the recent advancements made in the identification and prognostication of consciousness recovery through the utilization of advanced neuroimaging and electrophysiological techniques as well as biomarkers. Moreover, we discuss new treatment approaches and summarize recent therapeutic recommendations. Full article

Background: The relationship between sleep and creativity is a topic of much controversy. General benefits of napping have been described not only in sleep-deprived individuals and in shift workers, but also in people with sufficient night sleep. However, only few studies have investigated the relationship between nap and creativity. Methods: Forty-two native German speakers (29 females, mean age = 24 years, SD = 3.3 years) took part in two experimental sessions (i.e., baseline and intervention). In both sessions, divergent and convergent verbal and figural creativity tasks were administered at the same time of the day. While the baseline session was identical for all the participants, in the second session participants were randomized into either a sixty-minute nap or a sixty-minute rest group. Results: No significant group differences were found for neither divergent nor convergent creativity thinking tasks, suggesting that the interventions had similar effects in both groups. Interestingly, the analysis of the pooled data (i.e., pooled nap and rest groups) indicated differential effects of figural versus verbal creativity tasks, such that significant post-intervention improvements were found for the figural, but not for the verbal divergent and convergent thinking tasks. Conclusions: While further studies are needed to confirm these findings, to the best of our knowledge, such a dissociation between performance of verbal and figural creativity tasks after nap/rest interventions has not been described to date. Full article

REM sleep behavior disorder (RBD) is a parasomnia in which the customary generalized skeletal muscle atonia of REM sleep, “REM-atonia”, is compromised, allowing for the injurious acting-out of dreams. RBD can be idiopathic/isolated (iRBD) or symptomatic of neurological disorders, and can be triggered by most antidepressants. RBD mainly affects middle-aged and older adults, and is strongly linked with alpha-synucleinopathies, mainly Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). iRBD is now known to be the earliest and strongest predictor of future PD/DLB, which has stimulated a major international clinical and basic science research effort to enroll iRBD patients for upcoming neuroprotective/disease-modifying trials and to identify the most promising interventions to test in these cohorts. This review will provide the latest pertinent information on the rapidly expanding field of RBD. The methods included a PubMed literature search that included PubCrawlers, which utilizes the NCBI (National Center for Biotechnology Information) E-utils tools for publication retrieval, using the keywords “REM sleep behavior disorder” and “RBD”. The results yielded the latest updates on iRBD as prodromal PD/DLB, with the most promising biomarkers for phenoconversion provided, along with a presentation of three clinical research consortiums that are systematically gathering patients in preparation for enrollment in upcoming clinical trials: (i) The International RBD Study Group; (ii) The North American Prodromal Synucleinopathy (NAPS and NAPS2) Consortium; and (iii) The FARPRESTO Italian multicenter RBD research consortium. In addition, updates on the Parasomnia Overlap Disorder (RBD + NREM parasomnia) and on narcolepsy-RBD are provided, along with new epidemiologic data, the latest RBD management guidelines, and updates on animal models of RBD. Emerging areas of critical RBD research are also highlighted. In conclusion, RBD is a notable example of clinical and translational neuroscience research. Full article

In the last few years, restless sleep has been described as the key element of many clinical issues in childhood, leading to the recognition of “restless sleep disorder” (RSD) as a new proposed diagnostic category. The essential aid of video-polysomnographic recordings enables detection and quantification of the “large muscle group movements” (such as limb movements and repositioning) frequently described by parents of children with RSD. Strong evidence links iron deficiency to the pathophysiology of sleep-related movement disorders such as RSD, restless legs syndrome, periodic limb movement disorder, and attention deficit hyperactivity disorder (ADHD) due to the important role played by the brain dopamine production system. Serum ferritin is the main parameter used to evaluate iron deficiency in patients with sleep-related movement disorders. Iron supplementation is recommended when the serum ferritin level is <50 ng/mL, since the literature emphasizes the correlation between lower levels of serum ferritin, serum iron, and cerebrospinal fluid ferritin, and increased symptom severity. Moreover, several studies report an improvement in symptoms when ferritin levels are kept above 50 ng/mL. In this narrative review, we discuss the role of iron in sleep-related movement disorders, as well as ADHD, highlighting not only the connection between these two conditions, but also the relevance of iron supplementation for symptom improvement. Full article

Headaches can be nociplastic, neuropathic, and nociceptive. Pain related to the latter two categories occurs in the presence of nerve lesions and nociceptive stimuli; attributing pain to the last category requires a list of potential causes and arguments supporting the causal claim. Taking a history and examining patients serves to assess diagnostic criteria and screen for disorders whose diagnosis requires additional examinations. Screening information occurs in two types: one indicates that patients have a headache due to another condition; the other suggests they are at risk. Aspiring to make causal claims for a headache is reasonable because if underlying disorders appear independently and randomly, it is probable that there is only one cause. Thus, having found a cause often implies having found the cause. The prerequisites for causal claims are temporal sequencing, correlation, and elimination of alternate causes. Mechanistic, manipulative, and probabilistic evidence supports the second criterion. The importance of headaches lies in their frequent appearance as an early symptom of an incipient disorder (“sentinel symptom”). Hence, they provide the opportunity to diagnose early diseases with potentially deleterious consequences. Thus, it is sensible to assess each attack carefully and systematically. Full article

Background: The clinical evaluation of a patient complaining of excessive daytime sleepiness is of crucial importance for the diagnosis of narcolepsy. The Swiss Narcolepsy Scale (SNS) was developed in 2004 as a screening tool for patients with narcolepsy and shown in three different studies to have a high sensitivity and specificity for narcolepsy type 1 (NT1). The aim of this study was to assess the validity and reliability of the Turkish version of SNS (SNS-TR). Patients and Methods: Twenty-one healthy controls, 26 patients with idiopathic hypersomnia, and 27 patients with narcolepsy were recruited from five accredited sleep centers in Turkey. Pearson’s correlation coefficient and degree of freedom were used to determine the validity of each question. Cronbach’s alpha was calculated to assess the internal consistency or reliability of Likert-type questions. The inter-rater reliability was tested using Cohen’s kappa analysis, and the intra-class correlation coefficient (ICC) was used to evaluate the validity and reliability between two evaluations with a one-month interval. Results: Sensitivity and specificity of SNS-TR were 90.5% and 100%, respectively, for diagnosing NT1. Cronbach’s alpha was 0.976, showing a highly reliable level of internal consistency. The inter-rater reliability of the questions and the validity and reliability between two evaluations were moderate or above. Conclusion: This study provides evidence for the validity and reliability of SNS-TR in diagnosing and discriminating NT1 from other disorders of hypersomnolence with a very high sensitivity and specificity. Full article