cover image European Journal of Neurology

European Journal of Neurology

2019 - Volume 26
Issue 10 | October 2019
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Article first published online:
09 Sep 2019 | DOI: 10.1111/ene.13716

Original Article

Background and purpose

Visualization of phosphorylated α‐synuclein at serine 129 (p‐syn) in skin nerves is a promising test for the diagnosis of synucleinopathies. Here the aim was to establish the intra‐ and inter‐laboratory reproducibility of measurement of intraneural p‐syn immunoreactivity in two laboratories with major expertise (Würzburg and Bologna).

Methods

In total, 43 patients affected by Parkinson's disease (PD 21 patients), dementia with Lewy bodies (DLB 1), rapid eye movement sleep behaviour disorder (RBD 11), multiple system atrophy (MSA‐P 4) and small fibre neuropathy (SFN 6) were enrolled. Skin biopsy was performed at the C7 paravertebral spine region and distal skin sites (thigh or leg). The analysis was standardized in both laboratories and carried out blinded on a single skin section double stained with antibodies to p‐syn and the pan‐axonal marker protein gene product 9.5. Fifty skin sections were randomly selected for the analysis: 25 from C7 and 25 from distal sites. Differently classified sections were re‐evaluated to understand the reasons for the discrepancy.

Results

The intra‐laboratory analysis showed an excellent reproducibility both in Würzburg (concordance of classification 100% of sections;  = 1;  < 0.001) and Bologna (96% of sections;  = 0.92;  < 0.001). Inter‐laboratory analysis showed reproducibility in 45 sections (90%;  = 0.8;  < 0.001) and a different classification in five sections, which was mainly due to fragmented skin samples or weak fluorescent signals.

Conclusions

Analysis of p‐syn showed excellent inter‐ and intra‐laboratory reproducibility supporting the reliability of this technique. The few ascertained discordances were important to further improve the standardization of this technique.

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Authors:
V. Donadio, K. Doppler, A. Incensi, A. Kuzkina, A. Janzen, G. Mayer, J. Volkmann, G. Rizzo, E. Antelmi, G. Plazzi, C. Sommer, R. Liguori and W. H. Oertel
Article first published online:
02 Aug 2019 | DOI: 10.1111/ene.13939

Short Communication

Background and purpose

Adrenomyeloneuropathy (AMN) is the most frequent metabolic hereditary spastic paraplegia. Accordingly, its main site of pathological changes is the spinal cord. It is difficult to quantify AMN progression because commonly used clinical scales have limitations and reliable biomarkers are lacking. The goal was to investigate whether spinal cord and brain quantitative magnetic resonance imaging may assess structural changes in AMN over a relatively short time period.

Methods

In this longitudinal observational study, the total cord areas (TCAs) from the C2–C3 to T2–T3 level and diffusion tensor imaging (DTI) metrics of the cervical spinal cord and brain portion of the corticospinal tracts in six AMN and six age‐matched control subjects at baseline and at a mean follow‐up of 22.6 months were assessed.

Results

A significant reduction of the mean TCA at the T1–T2 level (−3.79%) and a trend of reduction at the lowest cervical levels were observed only in AMN patients. Additionally, DTI metrics revealed significant changes in fractional anisotropy (−8.84%), mean diffusivity (+12.62%) and radial diffusivity (+25.91%) at the C2–C3 level.

Discussion

The study encourages the assessment of TCAs and spinal cord DTI metrics as surrogate outcome measures in AMN, by focusing on the cervical–thoracic junction and the uppermost part of the cervical spinal cord. Despite the limitation of the results due to the small number of investigated subjects, these observations are useful for forthcoming clinical trials in AMN and possibly other hereditary diseases with predominant spinal cord involvement.

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Authors:
L. S. Politi, A. Castellano, N. Papinutto, E. Mauro, D. Pareyson, R. G. Henry, A. Falini and E. Salsano
Article first published online:
02 May 2019 | DOI: 10.1111/ene.13959

Original Article

Background and purpose

The Eastern Mediterranean Region (EMR) is experiencing a demographic shift towards rapid aging at a time of political unrest. We aimed to estimate the burden of neurodegenerative disorders and its relationship with sociodemographic index in the EMR countries from 1990 to 2016.

Methods

Using data from the Global Burden of Disease Study 2016, we calculated country‐specific trends for prevalence, mortality, disability‐adjusted life‐years (DALY), years of life lost and years lived with disability (YLD) for Alzheimer's disease/other dementias and Parkinson's disease in the EMR during 1990–2016.

Results

In the EMR, the age‐standardized prevalence rate of Alzheimer's disease/other dementias and Parkinson's disease was estimated at 759.8/100 000 (95% uncertainty intervals, 642.9–899.9) and 87.1/100 000 (95% uncertainty intervals, 69.8–108.2) people in 2016, demonstrating 0.01% and 42.3% change from 1990, respectively. Neurodegenerative disorders contributed to 5.4% of total DALY and 4.6% of total YLD among the older EMR population (70 years of age or older in 2016). Age‐standardized DALY due to Parkinson's disease were strongly correlated with the sociodemographic index level ( = 0.823,  < 0.001). The YLD:DALY ratio of neurodegenerative diseases declined during this period in the low‐income but not the high‐income EMR countries.

Conclusions

Our findings demonstrated an increasing trend in the burden of dementias and Parkinson's disease in most EMR countries between 1990 and 2016. With aging of the EMR populations, countries should target the modifiable risk factors of neurodegenerative diseases to control their increasing burden.

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Authors:
S.‐M. Fereshtehnejad, K. Vosoughi, P. Heydarpour, S. G. Sepanlou, F. Farzadfar, A. Tehrani‐Banihashemi, R. Malekzadeh, M. A. Sahraian, S. E. Vollset, M. Naghavi, T. Vos, V. Feigin, C. Murray, A. H. Mokdad and M. Moradi‐Lakeh
Article first published online:
31 May 2019 | DOI: 10.1111/ene.13972

Original Article

Background and purpose

Patients with acute pontine infarcts generally have good short‐term motor outcomes; however, the mechanisms underlying this recovery of function remain unclear.

Methods

Twenty well‐recovered patients with acute pontine infarcts and 20 well‐recovered patients with acute striato‐capsular infarcts were recruited. Fugl‐Meyer assessment and resting‐state functional magnetic resonance imaging were performed 1, 4 and 12 weeks after onset. Patients were further assigned to better and worse recovery subgroups according to the degree of motor recovery at the twelfth week after stroke. Voxel‐wise degree centrality (DC)–behavior correlation analysis was used to identify brain regions related to changes in motor function within 12 weeks after stroke.

Results

A significant correlation was found between DC and Fugl‐Meyer scores within 12 weeks in the ipsilesional cerebellar crus I and crus II in patients with pontine infarction and in the ipsilesional middle temporal gyrus in patients with striato‐capsular infarction (all <0.001, AlphaSim corrected). The mean DC in these areas was higher both in the better and worse recovery subgroups at the fourth than at the first week (all <0.05). In addition, the mean DC values in these areas were higher in patients with better recovery at the twelfth than at the first week (<0.05), but such change was not found in patients with worse recovery.

Conclusions

These results indicate that network changes in the ipsilesional cerebellum are correlated with motor recovery following pontine infarction. Motor recovery mechanisms may vary between pontine and striato‐capsular infarcts, according to lesion location.

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Authors:
G. Liu, S. Tan, K. Peng, C. Dang, S. Xing, C. Xie and J. Zeng
Article first published online:
17 May 2019 | DOI: 10.1111/ene.13974

Original Article

Background and purpose

Neurosarcoidosis is a rare inflammatory disorder of unknown cause. The aim of this study was to evaluate the value of T/B lymphocyte population counts and the concentrations of the cytokines interleukin (IL) 6 and IL‐10 in the cerebrospinal fluid (CSF) of neurosarcoidosis patients.

Methods

A retrospective study CSF biomarkers was conducted in patients with neurosarcoidosis who underwent CSF analysis between 2012 and 2017 as well as various control populations.

Results

Forty‐three patients with neurosarcoidosis, 14 with multiple sclerosis (MS) and 48 with other inflammatory disorders were analyzed. The CSF IL‐6 levels were higher in sarcoidosis patients than in MS patients (median 8 vs. 3 pg/ml, =0.006). The CSF CD4/CD8 ratio was higher in sarcoidosis patients than in MS patients and in patients with other inflammatory disorders (median 3.18 vs. 2.36 and 2.10, respectively, =0.008). The CSF IL‐6 level was higher in patients with active neurosarcoidosis than in non‐active neurosarcoidosis patients (median 13 vs. 3 pg/ml, =0.0005). In patients with neurosarcoidosis, a CSF IL‐6 concentration >50 pg/ml was associated with a higher risk of relapse or progression‐free survival (hazard ratio 3.60; 95% confidence interval 1.78–23.14). A refractory neurosarcoidosis patient was treated with an anti‐IL‐6 monoclonal antibody that produced a complete neurological response.

Conclusions

The CSF CD4/CD8 ratio and IL‐6 concentration are increased in neurosarcoidosis compared to MS and other inflammatory disorders. A CSF IL‐6 concentration >50 pg/ml is associated with relapse or progression of neurosarcoidosis. IL‐10 levels may be elevated in neurosarcoidosis.

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Authors:
T. Chazal, M. Costopoulos, E. Maillart, C. Fleury, D. Psimaras, P. Legendre, M. Pineton de Chambrun, J. Haroche, C. Lubetzki, Z. Amoura, M. Legarff‐Tavernier and F. Cohen Aubart
Article first published online:
24 Jun 2019 | DOI: 10.1111/ene.13975

Original Article

Background and purpose

A composite instrument able to rapidly and reliably assess the most relevant motor and non‐motor afflictions suffered by Parkinson's disease (PD) patients in a real world clinic setting is an unmet need. The recently validated PD Composite Scale (PDCS) was designed to fulfil this gap as a quick, comprehensive PD assessment. The objective of this study was extensive evaluation of the PDCS's clinimetric properties using a large international sample.

Methods

This was a cross‐sectional study in which the PDCS, the Movement Disorder Society Unified Parkinson's Disease Rating Scale and the Clinical Impression of Severity Index for PD were applied. Basic clinimetric attributes of the PDCS were analysed.

Results

In total, 776 PD patients were included. The PDCS total score showed negligible floor and ceiling effects. Three factors (54.5% of the variance) were identified: factor 1 included motor impairment, fluctuations and disability; factor 2, non‐motor symptoms; and factor 3, tremor and complications of therapy. Cronbach's alpha was from 0.66 to 0.79. Inter‐rater reliability showed weighted kappa values from 0.79 to 0.98 for items and intraclass correlation coefficient values from 0.95 (Disability) to 0.99 (Motor and total score). The Bland–Altmann method, however, showed irregular concordance. PDCS standard error of measurement and convergent validity with equivalent constructs of other measures were satisfactory (≥0.70). PDCS scores significantly differed by Hoehn and Yahr stage.

Conclusion

Overall, in line with previous findings, the PDCS is a feasible, acceptable, valid, reliable and precise instrument for quickly and comprehensively assessing PD patients.

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Authors:
P. Martinez‐Martin, F. G. Radicati, C. Rodriguez Blazquez, J. Wetmore, N. Kovacs, K. Ray Chaudhuri, F. Stocchi, Vladimira Vuletic, Cristian Falup‐Pecurariu, Ştefania Diaconu, Anders Johansson, Mathias Sundgren, Athima Simitsi, Leonidas Stefanis, Tanya Gurevich, Angel Migirov‐Sanderovich, Adi Ezra, Alla Guekht, Georgy Popov, Maria Stamelou, Nikolaos Giagkou, A. Stefani, R. Cerroni, Massimo Corbo, Andrea Grassi, Dionysia Dellaporta, Magda Tsolaki, Vakirli Ariadne, Zinovia Kefalopoulou, John Ellul, Pablo Mir, Astrid D. Adarmes, Carlota Méndez‐del‐Barrio, Matej Skorvanek, Jan Necpal, Sevasti Bostantjopoulou, Katsarou Zoe, Michal Minar, Mihaela Simu, Cecilia Rosca, Maria Popovici, Vladimir S. Kostić, Maria J. Marti, Lluis Planelles, Zsuzsanna Aschermann, Annamária Juhász and Márk Harmat
Article first published online:
31 May 2019 | DOI: 10.1111/ene.13976

Letter to the Editor

Could arterial spin labelling perfusion imaging uncover the invisible in ‐methyl‐‐aspartate receptor encephalitis?

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Authors:
C. Lapucci, G. Boffa, F. Massa, D. Franciotta, L. Castelletti, A. Uccelli, S. Morbelli, F. Nobili, L. Benedetti and L. Roccatagliata
Article first published online:
17 May 2019 | DOI: 10.1111/ene.13977

Original Article

Background and purpose

To optimize subcutaneous therapy with immunoglobulins, large volume infusion of immunoglobulin G facilitated by pretreatment with hyaluronidase (fSCIG) was compared to conventional infusion of multiple small dosages (cSCIG) in 20 patients with multifocal motor neuropathy.

Methods

A randomized, non‐inferiority and observer‐blinded cross‐over design was applied with a treatment period of 24 weeks for each therapy.

Results

In 18 patients fSCIG was feasible, two patients leaving the study due to side‐effects. The primary study variable, isometric strength, was unchanged, being 100.8% [95% confidence interval (CI) 94.8%–107.1%) in fSCIG and 105.9% (95% CI 99.8%–112.0%) in cSCIG. Secondary end‐points of disability, functions, impairments and quality of life showed no differences between the two treatments. Mild and short‐lasting generalized side‐effects were similar in the two groups, whereas the relative frequency of localized side‐effects at the injection site was increased after fSCIG [0.63 (95% CI 0.23–1.00) vs. 0.09 (95% CI 0.00–0.22),  = 0.005]. The preference of the patients favoured fSCIG for two out of five visual analogue scale scores as well as the total mean score of all preferences ( = 0.03).

Conclusions

Facilitated SCIG seems effective, feasible and safe. In addition, it is preferred by patients but is accompanied by a higher frequency of short‐lasting localized side‐effects.

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Authors:
A. Al‐Zuhairy, J. Jakobsen, H. Andersen, S. H. Sindrup and L. K. Markvardsen
Article first published online:
31 May 2019 | DOI: 10.1111/ene.13978

Original Article

Background and purpose

Low‐density‐lipoprotein‐receptor‐associated protein 4 (LRP4) autoantibodies have recently been detected in myasthenia gravis (MG), but little is known about the clinical characteristics associated with this serological type. In this study, the clinical features of Chinese patients with anti‐LRP4 antibody‐positive MG were characterized.

Methods

A total of 2172 MG serum samples were collected from patients in various parts of China. An enzyme‐linked immunosorbent assay was used to detect acetylcholine receptor (AChR) antibody and titin antibody, and cell‐based assays were used to detect muscle‐specific kinase antibody and LRP4 antibody. Clinical data for patients with MG were collected from different provinces in China.

Results

In total, 16 (0.8%) patients with LRP4‐MG were found amongst 2172 total patients, including three patients with AChR/LRP4‐MG. Additionally, 13 (2.9%) patients with LRP4‐MG were found amongst 455 patients with double seronegative MG. The ratio of males to females for these 13 patients was 1:1.6, and 53.8% patients were children. A total of 91.7% of cases exhibited initial ocular involvement, and 58.3% of cases exhibited simple eye muscle involvement. Responses to acetylcholinesterase inhibitors and prednisone were observed.

Conclusion

The expanded sample confirmed that the positive rate of LRP4 antibodies in China is lower than that in western countries. Our results highlighted the differences between LRP4‐MG and other antibody groups. Children and female patients with LRP4‐MG have a higher prevalence, often involving the ocular muscles and limb muscles. The clinical symptoms are mild, and satisfactory responses to treatment are often achieved.

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Authors:
M. Li, J. Han, Y. Zhang, J. Lv, J. Zhang, X. Zhao, L. Ren, H. Fang, J. Yang, Y. Zhang, X. Cui, Q. Zhang, Q. Li, Y. Du and F. Gao
Article first published online:
02 Jun 2019 | DOI: 10.1111/ene.13979

Original Article

Background and purpose

The clinical characteristics of cluster headache (CH) are based mainly on retrospective attack descriptions of ‘usual’ attacks, but whether these reports are reliable is uncertain. The aim was to compare retrospective and prospective attack descriptions and describe the within‐ and between‐patient variability of attacks.

Method

Fifty‐seven CH patients underwent a semi‐structured interview obtaining a retrospective account of usual CH attacks. Patients thereafter prospectively recorded the clinical characteristics of up to 10 attacks per patient in a headache diary. Four different attack characteristics were investigated: (i) severity, (ii) duration, (iii) number of autonomic symptoms and (iv) number of migrainous symptoms. Retrospective and prospective data were compared. Within‐ and between‐patient variability of attacks was assessed.

Results

Retrospective attack descriptions ( = 57) were significantly longer ( = 0.046) and more severe ( < 0.0001) for untreated attacks compared with prospective reports ( = 500). The number of autonomic symptoms was significantly higher in the retrospective reports compared to the prospective reports ( < 0.0001). Within‐patient variability for attack duration, pain severity and number of autonomic and migrainous symptoms was low. Compared to men, more women reported longer ( = 0.026) and more severe ( = 0.028) attacks with more migrainous symptoms ( = 0.033).

Conclusions

Important differences were found between prospectively and retrospectively reported attacks with duration and severity of untreated attacks overestimated in retrospective attack descriptions. CH attacks display low within‐patient variability, but the presentation of CH attacks varies between patients. The high prevalence of symptoms typically associated with migraine should raise more diagnostic awareness for CH, especially in women who are more often misdiagnosed as having migraine.

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Authors:
A. H. Snoer, N. Lund, R. H. Jensen, E. S. Kristoffersen, M. Barloese and J. M. Hansen
Article first published online:
02 Jun 2019 | DOI: 10.1111/ene.13980

Original Article

Background and purpose

Ischaemic stroke frequently has a cardioembolic (CE) source. Clinical and echocardiographic parameters associated with CE stroke were evaluated.

Methods

In all, 93 consecutive ischaemic stroke patients who underwent a transthoracic echocardiogram were retrospectively analysed; strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Echocardiographic parameters related to CE stroke, including left atrial volumes and function, were compared to 73 healthy controls.

Results

Of 93 patients (mean age 66.1 years, 56% male), nine (10%) had large artery atherosclerosis, 38 (41%) CE stroke, two (2%) small vessel disease, two (2%) other and 42 (45%) undetermined aetiology. Left atrial (LA) maximum volumes (LAVI) and minimum volumes (LAVI) were larger in the CE group than the non‐CE group (45 vs. 32 ml/m, 32 vs. 13 ml/m, respectively,  < 0.001), whilst LA function indices including LA emptying fraction and LA function index (LAFI) were lower in the CE group (34% vs. 55%, and 0.12 vs. 0.35, respectively,  < 0.001). Adjusting for clinical characteristics, LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3,  = 0.001). Additionally, LAVI and LAVI were larger (61 vs. 44 and 32 vs. 24 ml/m respectively,  < 0.01) and LAFI significantly lower (0.34 vs. 0.52,  < 0.001) in the undetermined aetiology group versus healthy controls.

Conclusions

Left atrial enlargement with reduced LA function was associated with CE stroke and LAFI was the best independent predictor. LA parameters were also altered in the undetermined aetiology group, suggesting an underlying LA myopathy in this subset.

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Authors:
A. Ferkh, P. Brown, E. O'Keefe, M. Zada, A. Duggins, A. Thiagalingam, M. Altman, A. Boyd, K. Byth, E. Kizana, A. R. Denniss and L. Thomas
Article first published online:
31 May 2019 | DOI: 10.1111/ene.13981

Original Article

Background and purpose

The aim was to determine the electroclinical findings in benign childhood focal epilepsy with vertex spikes (BEVS) with epileptic negative myoclonus (ENM) restricted to the lower limbs.

Methods

The electroencephalogram database of Peking University First Hospital and medical records of patients with BEVS and ENM restricted to the lower limbs were reviewed.

Results

Twenty‐seven patients with BEVS had ENM restricted to the lower limbs. Twelve started as ENM restricted to the lower limbs. The age at seizure onset ranged from 1.5 to 4.8 years. During the course, half of the 12 patients developed focal sensorimotor seizures and then were diagnosed as benign childhood epilepsy with centrotemporal spikes (BECTS), with BEVS (four cases) and without BEVS (two cases). Five of them had electrical status epilepticus during sleep (ESES) and met the diagnostic criteria of atypical benign partial epilepsy (ABPE). Fifteen of the 27 patients had ENM restricted to the lower limbs during the course. The age at seizure onset ranged from 1.3 to 9.8 years. All had ESES and were diagnosed as ABPE, 11 as ABPE with BEVS and four as ABPE evolving into BEVS.

Conclusions

Benign childhood focal epilepsy with vertex spikes (BEVS) might represent a specific epileptic syndrome of the continuum of benign childhood focal epilepsy. ENM restricted to the lower limbs was a special phenomenon in BEVS. BEVS could overlap with BECTS or evolve into BECTS and further into ABPE and vice versa. Ignorance of vertex spikes with associated ENM restricted to the lower limbs might lead to a misunderstanding of BEVS, a specific type of benign childhood focal epilepsy.

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Authors:
P. Gong, J. Xue, P. Qian, H. Yang, X. Liu, Y. Zhang, Y. Jiang and Z. Yang
Article first published online:
12 Jul 2019 | DOI: 10.1111/ene.13982

Original Article

Background and purpose

Data suggest a relationship between sexual dysfunction, mainly erectile dysfunction in men, and worse disease progression in Parkinson's disease (PD). There is scant evidence on the correlates of sexual activity in PD patients. By involving a subgroup of 355 patients from the PRIAMO (Parkinson Disease Non Motor Symptoms) study, the present 24‐month longitudinal prospective analysis aims to demonstrate that the presence of active sexual life is associated with disease progression in early PD.

Methods and results

Multivariable mixed‐effect logistic regression models showed that gastrointestinal symptoms [odds ratio 0.56, 95% confidence interval (CI) 0.39–0.82, = 0.003] and apathy (odds ratio 0.42, 95% CI 0.29–0.63,  < 0.001) were less likely to be associated with sexual activity in men. Analysis also demonstrated that sexual activity in men was associated with lower motor disability (coefficient −2.881, 95% CI −4.732 to −1.030,  = 0.002), better quality of life (coefficient −24.196, 95% CI −44.884 to −3.508,  = 0.022; coefficient 0.083, 95% CI 0.023–0.143,  = 0.006) and lower depression scores (coefficient −1.245, 95% CI −2.104 to −0.387,  = 0.004). No association was shown in women.

Conclusions

This is the first prospective longitudinal study involving a large cohort of PD patients suggesting that sexual activity is associated with lower motor and non‐motor disability as well as with better quality of life in men. These findings should prompt movement disorders specialists to periodically inquiry about their patients’ sexual life.

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Authors:
M. Picillo, R. Palladino, R. Erro, C. Colosimo, R. Marconi, A. Antonini and P. Barone
Article first published online:
02 Jul 2019 | DOI: 10.1111/ene.13983

Original Article

Background and purpose

C‐type lectin‐like receptor 2 (CLEC‐2) has prominent involvement in platelet activation, which is increased in coronary heart disease and acute ischaemic stroke (AIS) and is associated with stroke progression and stroke prognosis. Here, the aim was to examine the prognostic value of CLEC‐2 in death and vascular event recurrence in AIS patients.

Methods

In all, 352 patients with AIS were studied prospectively. All patients were followed up for 1 year. Death for all vascular events and a combination of death and vascular diseases (recurrent stroke, myocardial infarction, hospitalized and treated angina, hospitalized and treated peripheral arterial disease) were recorded.

Results

During 1 year of follow‐up, 46 patients (14.2%) experienced death or combined end‐points (23 death and 46 combined end‐points). Plasma CLEC‐2 (pCLEC‐2) was significantly associated with an increased risk of death and combined events of death and vascular diseases after adjusting for age, sex, history of hypertension, diabetes mellitus and coronary artery disease, and National Institutes of Health Stroke Scale scores. Each 1 SD higher log‐transformed pCLEC‐2 was associated with a 4.27‐fold (hazard ratio 4.27, 95% confidence interval 1.71–10.65) increased risk for death and a 2.42‐fold increased risk for combined end‐points (hazard ratio 2.42, 95% confidence interval 1.52–3.86). The optimal cut‐off point of pCLEC‐2 for predicting death was 184.38 pg/ml.

Conclusions

Higher pCLEC‐2 levels at admission were associated with increased risk of death and combined events of death and vascular diseases in patients with AIS, which indicated that pCLEC‐2 is an important prognostic factor for AIS.

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Authors:
X. Wu, W. Zhang, H. Li, S. You, J. Shi, C. Zhang, R. Shi, Z. Huang, Y. Cao and X. Zhang
Article first published online:
17 Jun 2019 | DOI: 10.1111/ene.13984

Letter to the Editor

Combined brain positron emission tomography/magnetic resonance imaging in GABA receptor encephalitis

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Authors:
V. Vacchiano, M. P. Giannoccaro, R. P. Napolitano, R. Liguori, V. Allegri, R. Rinaldi and L. Spinardi
Article first published online:
13 Jun 2019 | DOI: 10.1111/ene.14004

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Article first published online:
09 Sep 2019 | DOI: 10.1111/ene.14065

Corrigendum

Norms for standard neuropsychological tests from the French CONSTANCES cohort

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Article first published online:
09 Sep 2019 | DOI: 10.1111/ene.14078