by Viktoria Papp
Each month the EANpages editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for May 2023 (for our Paper of the Month for May, see here).
1. Positron emission tomography with [18F]-DPA-714 unveils a smoldering component in most multiple sclerosis lesions which drives disease progression
This prospective longitudinal study of patients with multiple sclerosis (MS) compared to healthy controls investigated the predictive value of MS lesion phenotypes and the diffuse neuroinflammation on brain atrophy and disability progression over two years. A novel classification for lesion phenotype was established by performing position emission tomography (PET) with radiotracers targeting the 18-kDA translocator protein that can trace and locate the innate immune cells. In this way, it was possible to define “homogeneously-active” (53%), “rim-active” (6%) and “non-active” (41%) lesions among the 1335 non-enhancing lesions identified by MRI. The authors found that a surprising number of lesions (59%) were characterised by a smoldering component which was completely invisible on conventional MRI scan. The number of “homogenously-active” lesions correlated strongest with brain atrophy and clinical progression. This finding shows high presence of chronic neuroinflammatory smoldering component of lesions that are inactive on MRI but plays an important role in neurodegeneration and clinical progression.
2. Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma
This international, multicentre, randomised clinical trial compared the effect of craniotomy and decompressive craniectomy on the clinical outcome and life quality of adult patients with traumatic acute subdural haematoma. There were 228 patients enrolled in the craniotomy group and 222 patients in the decompressive craniectomy group. The primary outcome of the Extended Glasgow Coma Scale at 6 months and 12 months was not significantly different in the two treatment groups. At 12 months, death occurred in 30.2% of the craniotomy group and in 32.2% of the craniectomy group; a vegetative state occurred in 2.3% and 2.8%, respectively. Life quality scores, EQ-5D-5L, scores were similar in the two groups at 12 months. There was no significant difference in the occurrence of procedure-related adverse events in the two treatment arms (craniotomy group: 26.3% vs. decompressive craniectomy group: 25.7%; p=0.44).
3. Endovascular thrombectomy for basilar artery occlusion: translating research findings into clinical practice
This important rapid review included the latest four randomised trials completed between 2020 and 2022 on the efficacy of endovascular thrombectomy versus standard medical treatment for basilar artery occlusion within 24 hours. The trials, BASICS, BEST, ATTENTION, BAOCHE, differ in several aspects: 1) patients included (ethnicity, age, stroke severity determined as NIHSS), 2) time to treatment, and 3) utilisation of imaging selection criteria. In summary, the results of these trials underline the benefit of endovascular thrombectomy in patients with basilar artery occlusion presenting with moderate to severe symptoms (NIHSS≥10). However, the benefit is more uncertain in cases with NIHSS<10. Higher risk of symptomatic intracerebral hemorrhage was observed in the endovascular thrombectomy groups compared to the medical care.
