HMGB1 is a Potential Mediator of Astrocytic TLR4 Signaling Activation following Acute and Chronic Focal Cerebral IschemiaRead the full article
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Structural Equation Modeling of Parkinson’s Caregiver Social Support, Resilience, and Mental Health: A Strength-Based Perspective
Only scant literature has focused on social support in Parkinson’s disease (PD) caregivers, and no studies to date have examined resilience in this population, despite both variables having been shown to be important in other caregiving populations. As a result, the purpose of the current study was to construct and validate a theoretical structural equation model whereby social support is associated with higher levels of resilience in PD caregivers and increased resilience is related to decreased mental health symptoms. Two hundred fifty three PD caregivers from two clinics in the United States and Mexico completed self-report measures of these constructs. Results suggested that the hypothesized pattern was robustly supported with the structural equation model showing generally good fit indices. Higher levels of social support were associated with increased resilience, which in turn was associated with reduced mental health symptoms. Resilience partially mediated social support’s effect on mitigating mental health symptoms. The model explained 11% of the variance in resilience and 35% in mental health symptoms. These findings have implications for future research on the development and tailoring of interventions to improve social support, resilience, and mental health in PD caregivers.
Epidemiology of Epilepsy in Lubumbashi, Democratic Republic of Congo
Background. Epilepsy is one of the most common neurological conditions, but the majority of epilepsy patients in sub-Saharan countries do not receive appropriate treatment. In the Democratic Republic of Congo (DRC), particularly in Lubumbashi, very few epidemiological studies on epilepsy have emerged. This study aims to analyze demographic characteristics, semiology of epileptic seizures, and their etiologies in patients followed in hospital. Methods. This is a prospective descriptive study that enrolled 177 epileptic patients who performed a neurological consultation at the Centre Médical du Centre Ville (CMDC) in Lubumbashi (DRC) from January 1, 2016, to December 31, 2017. Results. The mean age of the patients was 20.0 years (range: 5 months and 86 years). The male sex was predominant (57.1%). The mean age at the seizure onset was 13.1 years, and the mean duration between onset of seizures and consultation was 83.5 months. The family history of epilepsy was present in 27.7%. Generalized tonic-clonic seizures were the most frequent (58.2%), followed by atonic generalized seizures (9.6%) and focal clonic seizures (8.5%). The etiology was found in 68 (38.4%) patients and was dominated by neurocysticercosis (26.5%), meningitis (25%), perinatal pathologies (20.6%), and head injury (20.6%). Conclusion. This study is a useful starting point from which health programs and health professionals can work to improve the diagnosis and quality of epilepsy management in our community.
Nine Hole Peg Test and Transcranial Magnetic Stimulation: Useful to Evaluate Dexterity of the Hand and Disease Progression in Amyotrophic Lateral Sclerosis
Objective. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with involvement of the upper and lower motor neurons. Since the loss of fine motor skills is one of the earliest signs of ALS, the hypothesis was tested if the nine hole PEG test (NHPT) and transcranial magnet stimulation (TMS) with resting-motor threshold (RMT) could be useful in monitoring disease progression. Methods. We examined 28 ALS patients and 27 age-matched healthy controls. ALS patients and healthy controls underwent the nine hole peg test (NHPT) and TMS with RMT. Measurements in patients were repeated after three and six months. Results. At baseline, the median NHPT durations were 1,4-fold longer (), and TMS scores showed a significant 0.8-fold smaller score in ALS patients compared with healthy controls (). The comparison of three and six months versus baseline revealed significant differences for NHPT durations and ALSFRS-R in patients, whereas TMS scores did not significantly differ in the patients. Conclusion. NHPT seems to be a good tool to evaluate dexterity of the hand and the progression of the disease in ALS patients. TMS RMT to the hand muscles seems to be poorly qualified to evaluate the dexterity of the hand function and the course of the disease.
Prevalence and Correlates of Neurocognitive Disorders among HIV Patients on Antiretroviral Therapy at a Kenyan Hospital
Background. HIV-associated neurocognitive disorders (HAND) represent a spectrum of cognitive abnormalities affecting attention, concentration, learning, memory, executive function, psychomotor speed, and/or dexterity. Our objectives in this analysis are to determine the prevalence of HAND and the covariates in a Kenyan population. Methods. We conducted a cross-sectional study in a convenient sample of people living with HIV on antiretroviral therapy (ART) attending routine care visits at the Kenyatta National Hospital HIV clinic between July and August 2015. Baseline demographics were obtained using interviewer-administered questionnaires; clinical data were abstracted from patient records. Trained research clinicians determined the neurocognitive status by administration of the International HIV Dementia Scale (IHDS), the Montreal Cognitive Assessment (MOCA) scale, and the Lawton Instrumental Activities of Daily Living (IADL) scale. Cognitive impairment was defined as a score of ≤26 on the MOCA and ≤10 on the IHDS. Descriptive analysis and logistic regression to determine predictors of screening positive for HAND were done with the significance value set at <0.05. Results. We enrolled 345 participants (202 men; 143 women). The mean age of the study population was 42 years (±standard deviation (SD) 9.5). Mean duration since HIV diagnosis and mean duration on ART were 6.3 (±SD 3.7) and 5.6 years (±SD 3.4), respectively. Median CD4 count at interview was 446 cells/mm3 (interquartile range (IQR) 278–596). Eighty-eight percent of participants screened positive for HAND, of whom 87% had asymptomatic neurocognitive impairment (ANI) and minor neurocognitive disorders (MND) grouped together while 1% had HIV-associated dementia (HAD). Patients on AZT/3TC/EFV were 3.7 times more likely to have HAND (OR = 3.7, ) compared to other HAART regimens. In the adjusted analysis, women were more likely to suffer any form of HAND than men (aOR = 2.17, 95% CI: 1.02, 4.71; ), whereas more years in school and a higher CD4 count (aOR = 0.58, 95% CI: 0.38, 0.88; ), (aOR = 0.998, 95% CI 0.997, 0.999; ) conferred a lowered risk. Conclusion. Asymptomatic and mild neurocognitive impairment is prevalent among people living with HIV on treatment. Clinical care for HIV-positive patients should involve regular screening for neurocognitive disorders while prioritizing women and those with low education and/or low CD4 counts.
Utilization of a Parental Approach to Informed Consent in Intravenous Tissue Plasminogen Activator Administration Decision-Making: Patient Preference and Ethical Considerations
Objective. While administration of intravenous tissue plasminogen activator (IV-tPA) is the standard of care in acute ischemic stroke and has been shown to have statistically significant benefit, there can also be potentially life-threatening complications; however, there is no standard informed consent approach. The purpose of this study was to present a parental, technical, and general model of informed consent for IV-TPA and to determine which approach was preferred. Methods. Survey respondents were asked to hypothetically decide whether or not to provide consent for their family member to receive IV-tPA. Respondents were presented with 3 informed consent models: one emphasizing parental qualities, one emphasizing statistical data, and one representing a general consent statement. After being presented each model, the respondents had to select their preferred consent model, as well as rate their level of agreeability toward their family member receiving the medication following each approach. Results. The results of 184 surveys showed respondents were equally as likely to give consent for their family member to receive IV-TPA following all three approaches; however, respondents were significantly more likely to prefer the parental approach compared to a technical or general approach. Conclusion. Our results indicate that while paternalism is generally discouraged in the medical community, some degree of parental language may be preferred by patients in tough decision-making situations toward consent to receive medical interventions.
Practice Variations in the Use of Novel Oral Anticoagulants for Nonvalvular Atrial Fibrillation-Related Stroke among Stroke Neurologists in Saudi Arabia
Clinical trials have demonstrated that novel oral anticoagulants (NOACs) are noninferior to warfarin in preventing nonvalvular atrial fibrillation- (nvAF-) related stroke and systemic embolism. However, in these trials, NOACs initiation was delayed for a variable period after stroke. Herein, we aimed to investigate the variability in early initiation of NOACs after nvAF-related stroke among stroke neurologists in Saudi Arabia. A standardized questionnaire was distributed electronically to all the stroke neurologists and fellows in Saudi Arabia. The questionnaire primarily focused on the timing of NOACs initiation after an nvAF-related stroke, according to stroke size (small, medium, and large) and location (anterior or posterior circulation). Thirty-six (85.7%) of the 42 stroke neurologists, who were contacted, participated in the survey. All participants would initiate NOACs in the first 3 days after a TIA; most of them initiate NOACs within 7 days after a small stroke, 4–14 days after a medium stroke, and ≥12 days after a large stroke, regardless of stroke location. Presence of a symptomatic intracranial hemorrhage further delayed initiation of NOACs. Additionally, 77.8% of the participants would bridge with antiplatelets before initiation of NOACs, and 55.6% would use a single antiplatelet agent. In conclusion, the practice of stroke neurologists is consistent with and supports the available evidence from observational studies on the time of initiation of NOACs. Our findings provide a guide for clinicians who manage nvAF-related stroke until more robust evidence from randomized controlled trials is available.