The latest medical research on Neuro Intensive Care

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about neuro intensive care gathered by our medical AI research bot.

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Tolerability and efficacy of adjunctive brivaracetam in adults with focal seizures by concomitant antiseizure medication use: pooled results from three Phase 3 trials.

Epilepsia

Evaluate safety/tolerability and efficacy of adjunctive brivaracetam (BRV) in patients on one or two concomitant antiseizure medications (ASMs) and in patients on one specific concomitant ASM.

Post hoc analysis of double-blind trials (N01252/NCT00490035, N01253/NCT00464269, and N01358/NCT01261325) in adults with focal seizures randomized to BRV (50-200 mg/day; approved therapeutic dose range for adults) or placebo with concomitant ASM regimen unchanged throughout 12-week evaluation period. Outcomes were analyzed in patients on one or two concomitant ASMs, and those on concomitant carbamazepine (CBZ), lamotrigine (LTG), oxcarbazepine (OXC), or valproate (VPA) only.

Patients randomized to BRV with one or two concomitant ASMs, respectively (n=181/557), reported similar incidences of treatment-emergent adverse events (TEAEs; 68.0%/66.4%), drug-related TEAEs (41.4%/41.5%), and TEAEs leading to discontinuation (6.6%/5.4%). Respective values for patients randomized to placebo with one or two concomitant ASMs (n=95/331) were 60.0%/60.7% (TEAEs), 32.6%/30.2% (drug-related TEAEs), and 2.1%/4.5% (TEAEs leading to discontinuation). The incidences of TEAEs, drug-related TEAEs, and TEAEs leading to discontinuation by specific concomitant ASM (CBZ, LTG, OXC, VPA) were similar to the overall incidences in patients taking one concomitant ASM. In patients on one or two concomitant ASMs, respectively, 50% responder rates were numerically higher on BRV (42.3%/36.8% [n=175/511]) vs placebo (18.3%/19.5% [n=93/298]). Patients with one or two ASMs on BRV (n=175/509) vs placebo (n=92/298) also had numerically higher 100% responder rates (BRV: 9.1%/4.5%; placebo: 1.1%/0.3%) and seizure freedom (6.9%/3.7%; 1.1%/0). For patients taking concomitant CBZ, LTG, OXC, or VPA, efficacy was numerically higher with BRV (n=54/30/27/27) vs placebo (n=34/13/10/14-15; 50% responder rates: BRV, 31.5%/30.0%/40.7%/70.4%; placebo, 17.6%/7.7%/20.0%/33.3%; 100% responder rates: BRV, 5.6%/10.0%/11.1%/11.1%; placebo, 0 for all; seizure freedom: BRV, 3.7%/6.7%/7.4%/11.1%; placebo, 0 for all).

Therapeutic doses of BRV were efficacious and well tolerated regardless of the number of concomitant ASMs (one or two) or specific concomitant ASM (CBZ, LTG, OXC, VPA).

Epilepsy Milestones 2.0 - An Updated Framework for Assessing Epilepsy Fellowships and Fellows.

Epilepsia

Accreditation Council for Graduate Medical Education (ACGME) accredited Epilepsy Fellowships like other ACGME accredited training programs use Milestones to establish learning objectives and to evaluate how well trainees are achieving these goals. The ACGME began developing the second iteration of the Milestones six years ago, which are now being adapted to all specialties. Here we describe the process by which Epilepsy Milestones 2.0 were developed and summarize them.

A work group of nine board certified, adult and pediatric epileptologists reviewed Epilepsy Milestones 1.0 and revised them using a modified Delphi approach.

The new Milestones share structural changes with all other specialties including a clearer stepwise progression in professional development and the harmonized Milestones that address competencies common to all medical fields. Much of the Epilepsy specific content remains the same, though a major addition is a set of Milestones focused on reading and interpreting electroencephalograms (EEGs), which the old Milestones lacked. Epilepsy Milestones 2.0 includes a Supplemental Guide to help Program Directors implement the new Milestones. Together, Epilepsy Milestones 2.0 and the Supplemental Guide recognize advances in epilepsy including stereo EEG, neurostimulation, genetics, and safety in Epilepsy Monitoring Units.

Epilepsy Milestones 2.0 address the shortcomings of the old Milestones and should facilitate the assessment of Epilepsy Fellowships and fellows by Program Directors, faculty, and fellows themselves.

Statins as antiepileptogenic drugs: analysing the evidence and identifying the most promising statin.

Epilepsia

Many brain insults and injuries are 'epileptogenic': they increase the risk of developing epilepsy. It is desirable to identify treatments that are...

Diagnostic yield and limitations of in-hospital documentation in patients with epilepsy.

Epilepsia

To determine the diagnostic yield of in-hospital video-EEG monitoring to document seizures in epilepsy patients.

Retrospective analysis of electronic seizure documentation at the University Hospital Freiburg (UKF) and at King´s College London (KCL). Statistical assessment of the role of the duration of monitoring, and subanalyses on presurgical patient groups and patients undergoing antiseizure medication reduction.

Out of over 4.800 patients with epilepsy undergoing in-hospital recordings at the two institutions since 2005, 43 % (KCL) and 73 % (UKF) had a seizure documented. Duration of monitoring was highly significantly associated with seizure recordings (p<0.0001), and presurgical patients as well as patients with drug reduction had a significantly higher diagnostic yield (p<00001). Recordings with a duration of >5 days only lead to additional new seizure documentation in less than 10% of patients.

There is a need for the development of new ambulatory monitoring strategies to document seizures for diagnostic and monitoring purposes for a relevant subgroup of epilepsy patients in whom in-hospital monitoring fails to document seizures.

Drivers of US Healthcare Spending for Persons with Seizures and/or Epilepsies, 2010-2018.

Epilepsia

To characterize spending for persons classified with seizure or epilepsy and determine if spending has increased over time.

In this cross-sectional study we pooled data from the Medical Expenditure Panel Survey (MEPS) household component files for 2010 to 2018. We matched cases to controls on age and sex of a population-based sample of MEPS respondents (community-dwelling persons of all ages) with records associated with a medical event (e.g., outpatient visit; hospital inpatient) for seizure, epilepsy, or both. Outcomes were weighted to be representative of the civilian, non-institutionalized population. We estimated the treated prevalence of epilepsy and seizure, healthcare spending overall and by site of care, and trends in spending growth.

We identified 1,078 epilepsy cases, and 2,344 seizure cases. Treated prevalence was 0.38% (95% CI =0.34-0.41) for epilepsy, 0.76% (95% CI=0.71-0.81) for seizure, and 1.14% (95% CI: 1.08-1.20) for epilepsy or seizure. The difference in annual spending for cases compared to controls was $4,580 (95% CI: $3,362-$5,798) for epilepsy, $7,935 (95% CI: $6,237-$9,634) for seizure, and $6,853 (95% CI: $5,623-$8,084) for epilepsy or seizure, translating into aggregate costs of $5.4 billion, $19.0 billion, and $24.5 billion. From 2010 to 2018, the annual growth rate in total spending incurred for seizures and/or epilepsies was 7.6% compared to 3.6% among controls.

U.S. economic burden of seizures and/or epilepsies is substantial and warrants interventions focused on their unique and overlapping causes.

Effects of Semaglutide on Stroke Subtypes in Type 2 Diabetes: Post Hoc Analysis of the Randomized SUSTAIN 6 and PIONEER 6.

Stroke

URL: https://www.

SUSTAIN 6 (Trial to Evaluate Cardiovascular and Other Long-Term Outcomes With Semaglutide in Subjects With Type 2 Diabetes) and PIONEER 6 (Peptide Innovation for Early Diabetes Treatment) were randomized cardiovascular outcome trials of subcutaneous and oral semaglutide in people with type 2 diabetes at high cardiovascular risk, respectively. Time to first stroke and stroke subtypes were analyzed using a Cox proportional hazards model stratified by trial with pooled treatment as a factor. The impact of prior stroke, prior myocardial infarction or stroke, age, sex, systolic blood pressure, estimated glomerular filtration rate, and prior atrial fibrillation on treatment effects was assessed using interaction P values. Risk of major adverse cardiovascular event was analyzed according to prior stroke.

gov; Unique identifier: NCT01720446 and NCT02692716.

Semaglutide reduced incidence of any first stroke during the trials versus placebo in people with type 2 diabetes at high cardiovascular risk, primarily driven by small-vessel occlusion prevention. Semaglutide treatment, versus placebo, lowered the risk of stroke irrespective of prior stroke at baseline.

Post-mortem correlates of Virchow-Robin spaces detected on in vivo MRI.

J Cereb Blood

The purpose of our study is to quantify the extent to which Virchow-Robin spaces (VRS) detected on in vivo MRI are reproducible by post-mortem MRI....

Transdural Revascularization by Multiple Burrhole After Erythropoietin in Stroke Patients With Cerebral Hypoperfusion: A Randomized Controlled Trial.

Stroke

URL: https://www.

This prospective, randomized, blinded-end point trial recruited patients with acute ischemic stroke with a perfusion impairment of grade ≥2 within 14 days of symptom onset, steno-occlusive mechanisms on imaging examinations, and absence of transdural collaterals on transfemoral cerebral angiography. Patients were randomly assigned to receive MBH + EPO or MBH alone. The primary and secondary outcomes were revascularization success (trans-hemispheric and trans-burr hole) at 6 months and adverse events, respectively.

gov; Unique identifier: NCT02603406.

The combination of MBH and EPO is safe and feasible for reinforcing transdural revascularization in acute steno-occlusive patients with perfusion impairments.

Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke.

Stroke

Reperfusion therapies (thrombolysis and thrombectomy) are of paramount importance for the recovery after ischemic stroke. We aimed to investigate if socioeconomic status (SES) was associated with the chance of receiving reperfusion therapy for ischemic stroke in a country with tax-funded health care.

This nationwide register-based cohort study included patients with ischemic stroke registered in the Danish Stroke Registry between 2015 and 2018. SES was determined by prestroke educational attainment, income level, and employment status. Data on SES was obtained from Statistics Denmark and linked on an individual level with data from the Danish Stroke Registry. Risk ratios (RR) for receiving reperfusion therapies were calculated using univariate and multivariable Poisson regression with robust variance.

A total of 37 187 ischemic stroke patients were included. Low SES, as defined by education, income and employment status, was associated with lower treatment rates. The socioeconomic gradient was most pronounced according to employment status, with intravenous thrombolysis rates of 23.7% versus 15.8%, and thrombectomy rates of 5.1% versus 2.8% for employed versus unemployed patients. When the analyses were restricted to patients with timely hospital arrival, and adjusted for age, sex and immigrant status, low SES according to income and employment remained unfavorable for the likelihood of receiving intravenous thrombolysis: adjusted RR, 0.90 (95% CI, 0.86-0.95) for low versus high income, and adjusted RR, 0.77 (95% CI, 0.71-0.84) for unemployed versus employed patients. Similarly, low SES according to income and employment status remained unfavorable for the likelihood of receiving thrombectomy: adjusted RR, 0.83 (95% CI, 0.72-0.95) for low versus high income and adjusted RR, 0.68 (95% CI, 0.53-0.88) for unemployed versus employed patients.

Socioeconomic inequalities in reperfusion treatment rates among ischemic stroke patients prevail, even in a country with tax-funded universal health care.

Influence of Minimum Alveolar Concentration and Inhalation Duration of Sevoflurane on Facial Nerve Electromyography in Hemifacial Spasm: A Randomized Controlled Trial.

Journal of Neurosurgical Anesthesiology

The lateral spread response (LSR) is an electromyography feature of hemifacial spasm; intraoperative reduction in the LSR is associated with positive surgical outcomes. This study examined the effects of different minimum alveolar concentrations (MACs) and durations of sevoflurane inhalation on the LSR.

Eighty patients undergoing microvascular decompression surgery for hemifacial spasm were randomly allocated to receive propofol-remifentanil total intravenous anesthesia alone or in combination with sevoflurane at 0.5, 0.75, or 1 MAC. The LSR and orbicularis oculi muscle wave were recorded before and at 15 and 30 minutes after the start of sevoflurane administration.

Sevoflurane reduced the LSR amplitude in a dose-dependent and duration-dependent manner. The curve representing the LSR amplitude preservation ratio change according to sevoflurane concentration is best fitted by regression analysis using a cubic model, as the cubic equations had the largest coefficient of determination; at 15 minutes (R2=0.76, F=78.36, P<0.05) and at 30 minutes (R2=0.882, F=189.94, P<0.05). The inhibitory effect of sevoflurane on the LSR amplitude was greater in the first 15 minutes than in the second 15 minutes of sevoflurane administration. Sevoflurane at 1 MAC for 30 minutes mildly decreased the amplitude of the orbicularis oculi muscle wave. The latencies of the LSR and the orbicularis oculi muscle wave were not affected by sevoflurane at all MACs studied.

The combination of intravenous propofol-remifentanil anesthesia with 0.5 MAC sevoflurane allows reliable intraoperative LSR monitoring in hemifacial spasm patients. Our findings support the central rather than peripheral hypothesis of the LSR.

Correlation between FDG-PET brain hypometabolism and PTSD symptoms in temporal lobe epilepsy.

Epilepsia

The relationship between post-traumatic stress disorder (PTSD) and focal epilepsy is poorly understood. It has been hypothesized that there is a co...

Automatic Segmentation in Acute Ischemic Stroke: Prognostic Significance of Topological Stroke Volumes on Stroke Outcome.

Stroke

Stroke infarct volume predicts patient disability and has utility for clinical trial outcomes. Accurate infarct volume measurement requires manual segmentation of stroke boundaries in diffusion-weighted magnetic resonance imaging scans which is time-consuming and subject to variability. Automatic infarct segmentation should be robust to rotation and reflection; however, prior work has not encoded this property into deep learning architecture. Here, we use rotation-reflection equivariance and train a deep learning model to segment stroke volumes in a large cohort of well-characterized patients with acute ischemic stroke in different vascular territories.

In this retrospective study, patients were selected from a stroke registry at Houston Methodist Hospital. Eight hundred seventy-five patients with acute ischemic stroke in any brain area who had magnetic resonance imaging with diffusion-weighted imaging were included for analysis and split 80/20 for training/testing. Infarct volumes were manually segmented by consensus of 3 independent clinical experts and cross-referenced against radiology reports. A rotation-reflection equivariant model was developed based on U-Net and grouped convolutions. Segmentation performance was evaluated using Dice score, precision, and recall. Ninety-day modified Rankin Scale outcome prediction was also evaluated using clinical variables and segmented stroke volumes in different brain regions.

Segmentation model Dice scores are 0.88 (95% CI, 0.87-0.89; training) and 0.85 (0.82-0.88; testing). The modified Rankin Scale outcome prediction AUC using stroke volume in 30 refined brain regions based upon modified Rankin Scale-relevance areas adjusted for clinical variables was 0.80 (0.76-0.83) with an accuracy of 0.75 (0.72-0.78).

We trained a deep learning model with encoded rotation-reflection equivariance to segment acute ischemic stroke lesions in diffusion- weighted imaging using a large data set from the Houston Methodist stroke center. The model achieved competitive performance in 175 well-balanced hold-out testing cases that include strokes from different vascular territories. Furthermore, the location specific stroke volume segmentations from the deep learning model combined with clinical factors demonstrated high AUC and accuracy for 90-day modified Rankin Scale in an outcome prediction model.