Acta Neurologica Scandinavica

Introduction. Cervical dystonia (CD) is viewed as a circumscribed movement disorder. However, beyond motor symptoms, it can imply subtle cognitive change, among others with respect to theory of mind (ToM) capacities. Here, affective and cognitive ToM performances and potential relations to other mental functions were investigated to refine the concept of social cognitive dysfunction in CD. Methods. 20 persons with CD were clinically assessed, together with 20 healthy controls engaged in overview cognitive testing, executive function (EF) tasks, and the Faux Pas Recognition Test (FPRT) as well as the Reading the Mind in the Eyes Tests (RMET) addressing cognitive and affective ToM functions, respectively. Results. Persons with CD showed lower cognitive, but not affective ToM performance than controls. Further, they had abnormally low word production in verbal fluency (VF) tasks, imposing high EF demands. Generally, ToM performance correlated with VF and, further, with the decreased quality of life score in persons with CD. Conclusion. Cognitive ToM deficits seem to occur in the context of executive dysfunction in CD. They belong to an underrecognized spectrum of nonmotor symptoms of likely clinical relevance.

Objectives. Obstructive sleep apnea (OSA) is associated with a variety of health issues. Both OSA and sarcopenia are associated with metabolic disorders; however, there is limited literature assessing the correlation between them. Therefore, we aimed to investigate sarcopenia using temporal muscle thickness (TMT) in patients with obstructive sleep apnea (OSA) and the association between sarcopenia and hypoxia. Methods. We enrolled patients with OSA and healthy controls. Both groups underwent brain magnetic resonance imaging (MRI) scans, including three-dimensional T1-weighted imaging. TMT, a marker for sarcopenia, was obtained based on the T1-weighted imaging and compared between the groups. Additionally, we analyzed the correlation between TMT and clinical factors in patients with OSA. Results. In total, 40 patients with OSA and 52 healthy controls were evaluated. There was no difference in TMT between patients with OSA and healthy controls ( vs.  mm, ). In the correlation analysis, age was negatively correlated with TMT (, ), and lowest oxygen saturation (, ) in patients with OSA. Conclusion. Our results demonstrated negative correlations between TMT and lowest oxygen saturation in the patients with OSA. These findings suggest potential relationships between sarcopenia and hypoxia in patients with OSA. Thus, these results underline the importance of maintaining oxygen saturation in patients with OSA by implementing active treatment. This study also demonstrates the feasibility of sarcopenia assessment by measuring TMT through conventional head MRI in patients with various neurological disorders.

Purpose. Brivaracetam (BRV), an antiseizure medication indicated for focal-onset seizures, has shown efficacy in the treatment of focal to bilateral tonic-clonic seizures (FBTCS). We aimed to determine the effectiveness and safety of BRV in patients with FBTCS and generalized tonic-clonic seizures (GTCS). Methods. We performed a multicenter, retrospective, longitudinal study in adult patients with epilepsy who experienced at least one FBTCS or GTCS before starting BRV (baseline visit). Data were collected from consecutive outpatient visits over a 4-year period. All patients had been followed for at least 3 months before the baseline visit and completed a minimum follow-up of 3 months after starting BRV. Response (≥50% reduction in FBTCS/GTCS frequency) and retention rates, as well as seizure freedom and presence of adverse events at 3, 6, and 12 months, were recorded as outcome measures. Results. 114 patients were included (mean age years, 52% male, 36.6% genetic generalized epilepsy); 94 had a 12-month follow-up period. At 12 months’ follow-up, the response rate was 83%, and 73.4% of patients were FBTCS/GTCS-free. Retention was 79% at 12 months. Adverse events occurred in 29.8% of patients, the most common being drowsiness (14.9%). No significant differences were found in response rates between FBTCS and GTCS. Drug resistance was independently associated with lower response and seizure freedom rates at follow-up. The absence of a titration period predicted seizure freedom and response at 3 months. Conclusions. BRV is an effective and well-tolerated treatment in patients with focal to bilateral tonic-clonic seizures and generalized tonic-clonic seizures.

The influence of diabetes and associated sex differences on cerebral white matter lesions (WML) is unclear. We used data from a cross-sectional study uploaded to the DATADRYAD website by Shinkawa et al. to investigate differences in the association between hemoglobin A1c (HbA1c) levels and cerebral WML between men and women. The average age of all participants was years old, and approximately 51.89% of them were men. A linear relationship between HbA1c and cerebral WML was detected in men. Fully adjusted binary logistic regression showed no association of HbA1c with cerebral WML in men. A nonlinear relationship between HbA1c and cerebral WML was detected in women, whose cutoff point was 5.6%. The effect sizes and confidence intervals of the left and right sides of the inflection point were (95% CI 0.06, 0.69, ) and (95% CI 1.50, 8.15, ), respectively. In the higher HbA1c group, further subgroup analysis showed a stronger association between HbA1c and cerebral WML in women (, 95% CI 1.68, 8.72 ) than in men (, 95% CI 0.76, 1.36 ) ( for interaction with sex was 0.0004). A stronger effect of HbA1c on the risk of cerebral WML in women than in men was found in the higher HbA1c group.

To investigate whether glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and 12 cytokines can serve as serum biomarkers of olfactory identification dysfunction in patients with Parkinson’s disease (PD). GFAP and NFL levels were measured in 75 patients with PD and 36 healthy controls (HCs). The levels of 12 cytokines were assayed in 41 patients with PD. The 16-item Sniffin’ Sticks test and the Mini-Mental State Examination (MMSE) were used to assess olfactory identification ability and cognitive function, respectively. Linear regression models were applied to control for confounding effects. Receiver operating characteristic curves were used to examine the diagnostic accuracy of serum NFL, GFAP, and interleukin-6 (IL-6) levels. The cut-off value for the SS-16 test in diagnosing dysosmia was equal to 9.5 points. Serum GFAP levels were higher in patients with PD with olfactory identification dysfunction than in those without. GFAP, NFL, and IL-6 levels were correlated with SS-16 scores. Moreover, combining these three biomarkers yielded the best-fitting model for distinguishing patients with PD with or without dysosmia. We found a prominent indirect effect of GFAP on MMSE scores through its contribution to SS-16 scores. GFAP, NFL, and IL-6 can serve as serum biomarkers for olfactory identification dysfunctions in PD. We inferred that astrogliosis might promote the occurrence of dysosmia by releasing proinflammatory factors and causing neuronal damage and may indirectly impair cognition through its effect on olfactory function.

Diagnoses in patients with disorders of consciousness are prone to misdiagnosis; thus, research has sought approaches to increase reliability, for instance, with functional MRI. By applying a motor imagery task, patients showing covert command following despite the absence of behavioural signs of awareness can be identified as being in a cognitive motor dissociation. This study seeks to determine the proportion of patients, with unresponsive wakefulness syndrome and minimally conscious state, who display covert command following. Moreover, the prognostic value of the improved diagnosis and different methodical approaches to analyse the functional MRI data were evaluated. 73 disorder of consciousness patients (35 unresponsive, 35 minimally conscious, and three already recovered) underwent weekly standardized behavioural assessments with the coma-recovery scale—revised and one functional MRI examination comparing their brain activations in the supplementary motor area between phases of imaging playing tennis and rest. 27 healthy controls served as a control group. The data was evaluated using different region-of-interest analyses (one- and two-tailed small-volume correction and region-of-interest exploration approaches) and a whole-brain analysis. Based on the one-tailed small volume correction data, seven patients, all of nontraumatic aetiology, showed covert command following. The one-tailed region-of-interest exploration identified three additional responders. 10 patients showed significantly more activation during rest than during the imagery paradigm (negative responders). 40% of patients (minimally conscious patients being three times more likely) showed significant activations in the whole brain analysis. Besides, no significant further associations were found between covert command following and clinical parameters. The analyses showed that the tennis paradigm could identify patients with cognitive motor dissociation with a nontraumatic aetiology, but our data failed to show any short-term prognostic validity. The relevance of negative responders and activated regions outside of the region of interest should be further investigated.