1
|
Lladós G, Massanella M, Coll-Fernández R, Rodríguez R, Hernández E, Lucente G, López C, Loste C, Santos JR, España-Cueto S, Nevot M, Muñoz-López F, Silva-Arrieta S, Brander C, Durà MJ, Cuadras P, Bechini J, Tenesa M, Martinez-Piñeiro A, Herrero C, Chamorro A, Garcia A, Grau E, Clotet B, Paredes R, Mateu L. Vagus nerve dysfunction in the post-COVID-19 condition: a pilot cross-sectional study. Clin Microbiol Infect 2024; 30:515-521. [PMID: 37984511 DOI: 10.1016/j.cmi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The post-COVID-19 condition (PCC) is a disabling syndrome affecting at least 5%-10% of subjects who survive COVID-19. SARS-CoV-2 mediated vagus nerve dysfunction could explain some PCC symptoms, such as dysphonia, dysphagia, dyspnea, dizziness, tachycardia, orthostatic hypotension, gastrointestinal disturbances, or neurocognitive complaints. METHODS We performed a cross-sectional pilot study in subjects with PCC with symptoms suggesting vagus nerve dysfunction (n = 30) and compared them with subjects fully recovered from acute COVID-19 (n = 14) and with individuals never infected (n = 16). We evaluated the structure and function of the vagus nerve and respiratory muscles. RESULTS Participants were mostly women (24 of 30, 80%), and the median age was 44 years (interquartile range [IQR] 35-51 years). Their most prevalent symptoms were cognitive dysfunction 25 of 30 (83%), dyspnea 24 of 30 (80%), and tachycardia 24 of 30 (80%). Compared with COVID-19-recovered and uninfected controls, respectively, subjects with PCC were more likely to show thickening and hyperechogenic vagus nerve in neck ultrasounds (cross-sectional area [CSA] [mean ± standard deviation]: 2.4 ± 0.97mm2 vs. 2 ± 0.52mm2 vs. 1.9 ± 0.73 mm2; p 0.08), reduced esophageal-gastric-intestinal peristalsis (34% vs. 0% vs. 21%; p 0.02), gastroesophageal reflux (34% vs. 19% vs. 7%; p 0.13), and hiatal hernia (25% vs. 0% vs. 7%; p 0.05). Subjects with PCC showed flattening hemidiaphragms (47% vs. 6% vs. 14%; p 0.007), and reductions in maximum inspiratory pressure (62% vs. 6% vs. 17%; p ≤ 0.001), indicating respiratory muscle weakness. The latter findings suggest additional involvement of the phrenic nerve. DISCUSSION Vagus and phrenic nerve dysfunction contribute to the complex and multifactorial pathophysiology of PCC.
Collapse
Affiliation(s)
- Gemma Lladós
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Marta Massanella
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain
| | - Roser Coll-Fernández
- Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Department of Rehabilitation, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Raúl Rodríguez
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Electra Hernández
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Giuseppe Lucente
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Cristina López
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain
| | - Cora Loste
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - José Ramón Santos
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain
| | - Sergio España-Cueto
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Maria Nevot
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Francisco Muñoz-López
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Sandra Silva-Arrieta
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Christian Brander
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Maria José Durà
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Rehabilitation, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Patricia Cuadras
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Jordi Bechini
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Montserrat Tenesa
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Alicia Martinez-Piñeiro
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Cristina Herrero
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Anna Chamorro
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Anna Garcia
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain
| | - Eulalia Grau
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - Bonaventura Clotet
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain
| | - Roger Paredes
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, Madrid, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain; Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lourdes Mateu
- Department of Infectious Diseases, Germans Trias Long-COVID Unit, Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, Badalona, Spain; Red Española de la Investigación en COVID Persistente (REiCOP), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalonia, Spain.
| |
Collapse
|
2
|
Corral-Juan M, Casquero P, Giraldo-Restrepo N, Laurie S, Martinez-Piñeiro A, Mateo-Montero RC, Ispierto L, Vilas D, Tolosa E, Volpini V, Alvarez-Ramo R, Sánchez I, Matilla-Dueñas A. OUP accepted manuscript. Brain Commun 2022; 4:fcac030. [PMID: 35310830 PMCID: PMC8928420 DOI: 10.1093/braincomms/fcac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/20/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Spinocerebellar ataxias consist of a highly heterogeneous group of inherited movement disorders clinically characterized by progressive cerebellar ataxia variably associated with additional distinctive clinical signs. The genetic heterogeneity is evidenced by the myriad of associated genes and underlying genetic defects identified. In this study, we describe a new spinocerebellar ataxia subtype in nine members of a Spanish five-generation family from Menorca with affected individuals variably presenting with ataxia, nystagmus, dysarthria, polyneuropathy, pyramidal signs, cerebellar atrophy and distinctive cerebral demyelination. Affected individuals presented with horizontal and vertical gaze-evoked nystagmus and hyperreflexia as initial clinical signs, and a variable age of onset ranging from 12 to 60 years. Neurophysiological studies showed moderate axonal sensory polyneuropathy with altered sympathetic skin response predominantly in the lower limbs. We identified the c.1877C > T (p.Ser626Leu) pathogenic variant within the SAMD9L gene as the disease causative genetic defect with a significant log-odds score (Zmax = 3.43; θ = 0.00; P < 3.53 × 10−5). We demonstrate the mitochondrial location of human SAMD9L protein, and its decreased levels in patients’ fibroblasts in addition to mitochondrial perturbations. Furthermore, mutant SAMD9L in zebrafish impaired mobility and vestibular/sensory functions. This study describes a novel spinocerebellar ataxia subtype caused by SAMD9L mutation, SCA49, which triggers mitochondrial alterations pointing to a role of SAMD9L in neurological motor and sensory functions.
Collapse
Affiliation(s)
- Marc Corral-Juan
- Functional and Translational Neurogenetics Unit, Department of Neuroscience, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Badalona, Barcelona, Spain
| | - Pilar Casquero
- Neurology and Neurophysiology Section, Hospital Mateu Orfila, Mahón, Menorca, Spain
| | | | - Steve Laurie
- Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Alicia Martinez-Piñeiro
- Neuromuscular and Functional Studies Unit, Neurology Service, University Hospital Germans Trias i Pujol (HUGTiP), Universitat Autònoma de Barcelona-Can Ruti Campus, Badalona, Barcelona, Spain
| | | | - Lourdes Ispierto
- Neurodegenerative Diseases Unit, Neurology Service, Department of Neuroscience, University Hospital Germans Trias i Pujol (HUGTiP), Universitat Autònoma de Barcelona-Can Ruti Campus, Badalona, Barcelona, Spain
| | - Dolores Vilas
- Neurodegenerative Diseases Unit, Neurology Service, Department of Neuroscience, University Hospital Germans Trias i Pujol (HUGTiP), Universitat Autònoma de Barcelona-Can Ruti Campus, Badalona, Barcelona, Spain
- Parkinson Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Spain
| | - Eduardo Tolosa
- Parkinson Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Spain
| | | | - Ramiro Alvarez-Ramo
- Neurodegenerative Diseases Unit, Neurology Service, Department of Neuroscience, University Hospital Germans Trias i Pujol (HUGTiP), Universitat Autònoma de Barcelona-Can Ruti Campus, Badalona, Barcelona, Spain
| | - Ivelisse Sánchez
- Functional and Translational Neurogenetics Unit, Department of Neuroscience, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Badalona, Barcelona, Spain
| | - Antoni Matilla-Dueñas
- Functional and Translational Neurogenetics Unit, Department of Neuroscience, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona-Can Ruti Campus, Badalona, Barcelona, Spain
- Correspondence to: Dr Antoni Matilla-Dueñas Head of the Neurogenetics Unit Health Sciences Research Institute Germans Trias i Pujol (IGTP) Ctra. de Can Ruti, Camí de les Escoles s/n 08916 Badalona, Barcelona, Spain E-mail:
| |
Collapse
|
3
|
Lucente G, Corral J, Rodríguez-Esparragoza L, Castañer S, Ortiz H, Piqueras A, Broto J, Hernández-Pérez M, Domenech S, Martinez-Piñeiro A, Serra J, Almendrote M, Parés D, Millán M. Current Incidence and Risk Factors of Fecal Incontinence After Acute Stroke Affecting Functionally Independent People. Front Neurol 2021; 12:755432. [PMID: 34790163 PMCID: PMC8591097 DOI: 10.3389/fneur.2021.755432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Previously published retrospective series show a high prevalence of fecal incontinence (FI) in stroke patients. We aimed to analyze in a prospective series the current incidence of FI in acute stroke in functionally independent patients and its evolution over time and the patient characteristics associated with the appearance of FI in acute stroke. Methods: We included consecutive patients with acute stroke admitted in our stroke unit who fulfilled the following inclusion criteria: a first episode of stroke, aged >18 years, with no previous functional dependency [modified Rankin Scale (mRS) ≤ 2] and without previous known FI. FI was assessed by a multidisciplinary trained team using dedicated questionnaires at 72 ± 24 h (acute phase) and at 90 ± 15 days (chronic phase). Demographic, medical history, clinical and stroke features, mortality, and mRS at 7 days were collected. Results: Three hundred fifty-nine (48.3%) of 749 patients (mean age 65.9 ± 10, 64% male, 84.1% ischemic) fulfilled the inclusion criteria and were prospectively included during a 20-month period. FI was identified in 23 patients (6.4%) at 72 ± 24 h and in 7 (1.9%) at 90 days ± 15 days after stroke onset. FI was more frequent in hemorrhagic strokes (18 vs. 5%, p 0.007) and in more severe strokes [median National Institute of Health Stroke Scale (NIHSS) 18 (14-22) vs. 5 (3-13), p < 0.0001]. No differences were found regarding age, sex, vascular risk factors, or other comorbidities, or affected hemisphere. Patients with NIHSS ≥12 (AUC 0.81, 95% CI 0.71 to 0.89) had a 17-fold increase for the risk of FI (OR 16.9, IC 95% 4.7-60.1) adjusted for covariates. Conclusions: At present, the incidence of FI in acute stroke patients without previous functional dependency is lower than expected, with an association of a more severe and hemorrhagic stroke. Due to its impact on the quality of life, it is necessary to deepen the knowledge of the underlying mechanisms to address therapeutic strategies.
Collapse
Affiliation(s)
- Giuseppe Lucente
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Javier Corral
- General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis Rodríguez-Esparragoza
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Castañer
- Institut de Diagnostic per Imatge (IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Hector Ortiz
- Department of Project and Construction Engineering (EPC), Universitat Politècnica de Catalunya, Barcelona, Spain
- Department of Engineering Design, Universitat Politècnica de Barcelona, Barcelona, Spain
| | - Anna Piqueras
- General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquim Broto
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - María Hernández-Pérez
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sira Domenech
- Institut de Diagnostic per Imatge (IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alicia Martinez-Piñeiro
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jordi Serra
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Miriam Almendrote
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - David Parés
- General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mònica Millán
- Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| |
Collapse
|
4
|
Garcia-Armengol R, Martinez-Piñeiro A, Menendez B, Mekkaoui K, Hostalot C, Rimbau JMD. 300 Usefulness of Intraoperative Visual Function Monitoring During Neurosurgical Procedures. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
Martinez-Martinez L, Lleixà MC, Boera-Carnicero G, Cortese A, Devaux J, Siles A, Rajabally Y, Martinez-Piñeiro A, Carvajal A, Pardo J, Delmont E, Attarian S, Diaz-Manera J, Callegari I, Marchioni E, Franciotta D, Benedetti L, Lauria G, de la Calle Martin O, Juárez C, Illa I, Querol L. Anti-NF155 chronic inflammatory demyelinating polyradiculoneuropathy strongly associates to HLA-DRB15. J Neuroinflammation 2017; 14:224. [PMID: 29145880 PMCID: PMC5691853 DOI: 10.1186/s12974-017-0996-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/06/2017] [Indexed: 12/02/2022] Open
Abstract
Background The aim of the research is to study the human leukocyte antigen (HLA) class II allele frequencies in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with anti-neurofascin 155 (NF155) antibodies. Methods Thirteen anti-NF155+ and 35 anti-NF155 negative (anti-NF155neg) CIDP patients were included in a case-control study. The frequencies of the DRB1 HLA allele were analyzed in all patients while DQ frequencies were only studied in patients sharing the DRB1*15 allele. In silico HLA-peptide binding and NF155 antigenicity, predictions were performed to analyze overlap between presented peptides and antigenic regions. Results DRB1*15 alleles (DRB1*15:01 and DRB1*15:02) were present in 10 out of 13 anti-NF155+ CIDP patients and in only 5 out of 35 anti-NF155neg CIDP patients (77 vs 14%; OR = 20, CI = 4.035 to 99.13). DRB1*15 alleles appeared also in significantly higher proportions in anti-NF155+ CIDP than in normal population (77 vs 17%; OR = 16.9, CI = 4.434 to 57.30). Seven anti-NF155+ CIDP patients (53%) and 5 anti-NF155neg CIDP patients had the DRB1*15:01 allele (OR = 7, p = 0.009), while 3 anti-NF155+ CIDP patients and none of the anti-NF155neg CIDP patients had the DRB1*15:02 allele (OR = 23.6, p = 0.016). In silico analysis of the NF155 peptides binding to DRB1*15 alleles showed significant overlap in the peptides presented by the 15:01 and 15:02 alleles, suggesting functional homology. Conclusions DRB1*15 alleles are the first strong risk factor associated to a CIDP subset, providing additional evidence that anti-NF155+ CIDP patients constitute a differentiated disease within the CIDP syndrome. Electronic supplementary material The online version of this article (10.1186/s12974-017-0996-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Laura Martinez-Martinez
- Immunology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ma Cinta Lleixà
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Gemma Boera-Carnicero
- Immunology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Cortese
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy.,MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK
| | - Jérôme Devaux
- Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille - CRN2M, UMR 7286, CNRS, Aix-Marseille Université, Marseille, France
| | - Ana Siles
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Yusuf Rajabally
- Regional Neuromuscular Clinic, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - Alicia Martinez-Piñeiro
- Neurology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Julio Pardo
- Department of Neurology, Hospital Clínico de Santiago, Santiago de Compostela, Spain
| | - Emilien Delmont
- Centre de Recherche en Neurobiologie et Neurophysiologie de Marseille - CRN2M, UMR 7286, CNRS, Aix-Marseille Université, Marseille, France.,Referral Center for ALS and Neuromuscular Diseases, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Shahram Attarian
- Referral Center for ALS and Neuromuscular Diseases, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Jordi Diaz-Manera
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Ilaria Callegari
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy.,Neuroscience Consortium, Monza Policlinico and Pavia Mondino, University of Pavia, Pavia, Italy
| | - Enrico Marchioni
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy
| | - Diego Franciotta
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Guiseppe Lauria
- Neuroalgology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Oscar de la Calle Martin
- Immunology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cándido Juárez
- Immunology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Illa
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain.,Centro para la Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Luis Querol
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain. .,Centro para la Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain.
| |
Collapse
|
6
|
Martinez-Piñeiro A, Almendrote M, Ramos-Fransi A, Lucente G, Lopez-Cancio E, Perez de la Ossa N, Remollo S, Castaño C, Coll-Canti J, Davalos A. Abstract TP7: Somatosensory Evoked Potentials and Dramatic Recovery After Mechanical Thrombectomy in Patients With Acute Ischemic Stroke and Anterior Large Vessel Occlusion. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypothesis:
Somatosensory evoked potentials (SEPs), as surrogate of cerebral blood flow, may predict immediate and long term clinical outcome in patients with acute ischemic stroke undergoing mechanical thrombectomy.
Methodology:
Median nerve SEPs were monitored before and continously during mechanical trhombectomy in acute ischemic stroke patients with proximal anterior large vessel occlusion. The target signal was the patency of the N20 wave ipsilateral to the stroke site. Dramatic recovery was defined as improvement ≥ 10 or NIHSS score 0-1 at 24 hours and good functional outcome as modified Rankin scale 0-2 at 90 days.
Results:
A total of 41 patients were monitored with SEPs. Six patients were excluded because of traces artifacts. At the beginning of the procedure, patent N20 was observed in 25 patients and absence of N20 wave in 10 patients. Age, gender, median NIHSS score (17 vs 17), site of vessel occlusion, IV tPA use, ASPECTS score and onset-to-groin puncture time were comparable between patients with patent and absent N20 wave. Patent N20 group showed better median NIHSS score at 24 hours (6 [2-18] vs 18 [11-24], p=0.031) and a no significant trend to a higher rate of dramatic recovery (52% vs 25%, p=0.087). At the end of the procedure, patent N20 was found in 25 patients (3 recovered N20 and 3 lost N20 wave). Complete revascularization (TICI 2b,3) was achieved in 22/25 patent N20 group and 4/10 no patent N20 group. Patent N20 at the end of the procedure was significantly associated with dramatic recovery (60% vs 0%, p=0,001) and good functional outcome (68% vs 0%, p=0,001)
Conclusions:
SEPs recording is a non-invasive and feasible test that provides real time data in the angiosuite, even in patients under general anesthesia in which neurological deficit cannot be evaluated. Patency of SEP at the beginning but especially at the end of the procedure is related with immediate and long term outcome, despite achieving complete revascularization.
Collapse
Affiliation(s)
| | | | | | - Giuseppe Lucente
- Neurology, Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Carlos Castaño
- Neurology, Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jaume Coll-Canti
- Neurology, Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antoni Davalos
- Neurology, Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| |
Collapse
|