Neurología

Peripheral nerve block in patients with medication-overuse headache : systematic review and meta-analysis

2026-02-07T00:00:00Z

Peripheral nerve block in patients with medication-overuse headache : systematic review and meta-analysis Arias-Tello, Piero A.; Coronado-Caceres, Carlos F.; Serrano-Sablich, Mario E.; Mantilla, Guillemo; Goicochea, María Teresa; Alarcon-Ruiz, Christoper A. BACKGROUND: Medication-overuse headache (MOH) is a disabling condition, particularly in settings with limited access to advanced preventive therapies. Peripheral nerve blocks (PNB) may offer a pragmatic option to reduce headache burden during MOH management. We aimed to assess the efficacy and safety of PNB in adults with MOH. METHODS: We conducted a systematic review in January 2025 using Scopus, PubMed, Embase, Web of Science, and the Cochrane Library. Randomized clinical trials comparing PNB with standard of care or other active interventions in adults with MOH were eligible. Primary outcomes included headache frequency, headache intensity, successful detoxification, and adverse effects. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0. Random-effects meta-analyses were conducted when appropriate, and certainty of evidence was evaluated using the GRADE approach. RESULTS: Three randomized clinical trials involving 249 adults with MOH were included. All trials evaluated bilateral greater occipital nerve blocks, with variability in anesthetic agents, number of sessions, and use of additional nerve block sites. Standard of care consisted of medication withdrawal, hydration, and preventive therapy. Follow-up ranged from 1 to 4 months. Compared with standard of care alone, a single PNB session significantly reduced headache frequency (–4.56 days/month; 95%CI: − 7.46 to − 1.66) and monthly rescue medication use (–2.30 doses of medication/month; 95%CI: − 2.71 to − 1.89), without significant effects on headache intensity or detoxification success. Multiple PNB sessions were associated with greater reductions in headache frequency (–9.00 days/month; 95%CI: − 9.45 to − 8.55), headache intensity (–2.65 units in visual analog scale; 95%CI: − 2.77 to − 2.53), and monthly rescue medication use (–6.70 doses of medication/month; 95%CI: − 7.10 to − 6.30), with low to moderate certainty of evidence. Compared with topiramate, a single PNB session did not reduce headache frequency (+ 1.50 days/month; 95%CI: +1.21 to + 1.79), with no differences in headache intensity (very low certainty). Adverse effects were only reported by one trial, with no significant differences compared with topiramate. CONCLUSION: PNB, particularly when administered in multiple sessions, may reduce headache frequency and intensity in adults with MOH when other therapies are unavailable. However, given the limited evidence and low certainty, further high-quality trials are needed to define optimal protocols and long-term effectiveness and safety.

Tratamiento del deterioro neurológico temprano en el ictus lacunar

2026-01-07T00:00:00Z

Tratamiento del deterioro neurológico temprano en el ictus lacunar Alet, Matías Javier; Zavattieri, Agustina; Rodríguez Lucci, Federico; Ameriso, Sebastián Francisco Objetivo El deterioro neurológico temprano (DNT) en infartos lacunares constituye una complicación frecuente, especialmente durante los primeros días de hospitalización, y aún carece de un abordaje terapéutico estandarizado. El objetivo de este estudio fue describir su presentación clínica, factores predictores y estrategias terapéuticas implementadas, así como evaluar su impacto sobre la evolución funcional de los pacientes. Pacientes y métodos Se realizó un estudio observacional, retrospectivo y unicéntrico que incluyó a 269 pacientes con diagnóstico de infarto lacunar internados entre 2013 y 2023. El DNT fue definido como fluctuación o progresión clínica dentro de los primeros cinco días del evento. Se analizaron variables clínicas, imagenológicas, terapéuticas y funcionales, incluyendo datos de seguimiento a 90 días. Se efectuó un análisis multivariado para identificar factores asociados de forma independiente con la aparición de DNT. Resultados El DNT ocurrió en el 11,9% de los pacientes. Las lesiones localizadas en la cápsula interna, el núcleo lenticular y el síndrome lacunar sensitivo-motor fueron factores predictivos independientes. En la mayoría de los casos se utilizó doble antiagregación plaquetaria (aspirina y clopidogrel) y tratamiento hemodinámico dirigido, con buena respuesta clínica. Al seguimiento a 90 días, el 83,4% de los pacientes presentó buen resultado funcional (mRS ≤2), con baja recurrencia (1,9%) y baja mortalidad (0,4%). Conclusiones El DNT en ictus lacunar representa un fenómeno clínico relevante. Las estrategias terapéuticas observadas podrían ser útiles, pero se requieren de estudios prospectivos que evalúen nuevas técnicas diagnósticas como biomarcadores o perfusión cerebral y tratamientos individualizados para mejorar los resultados en esta población.

Detection of sequelae from acute meningitis during clinical review by a healthcare provider : a systematic review and meta-analysis

2026-02-28T00:00:00Z

Detection of sequelae from acute meningitis during clinical review by a healthcare provider : a systematic review and meta-analysis Alviz, Luisa F.; Kim, Carla Y.; Monette, Lauren E.; Harrer, Caroline E.; Benevides Tadinac, Ana Claudia; Roberts, Jackson A.; Varela, Francisco José; Hwang, Soonmyung A.; Gebresilassie, Blen M.; Balcarce, Pilar; Prasad, Manya; Usseglio, John; Kothari, Kavita U.; Venuti, Francesco; Schiess, Nicoline; Binello, Nicolò; Brohan, Elaine; Dua, Tarun; Thakur, Kiran T. Background: Neurological sequelae from acute meningitis are estimated to affect more than 30% of survivors worldwide, though often underreported or undetected due to inadequate follow-up, limited access to healthcare services, and diagnostic challenges. The aim of this systematic review and meta-analysis is to assess the time of administered health assessments for the detection of meningitis-related sequelae associated with acute meningitis diagnosis in adult and pediatric populations. Methods: A literature review was conducted in three databases. Studies documenting the time frame of sequelae detection after an acute episode of all-cause meningitis were included. Descriptive analysis and meta-analysis of pooled prevalence for neurological outcomes were performed, with subgroup analysis per timepoint of healthcare assessment. Results: A total of 89 studies met inclusion criteria, reporting 9311 adult and 18,658 pediatric meningitis cases. Among adults, 7301 (78.4%) underwent sequelae assessment, with 1339 (18%) diagnosed. The most frequently reported sequelae were hearing loss, followed by focal neurological deficits, psychological after-effects, neurocognitive impairments, seizures, hydrocephalus, speech disorders, vision impairment, and limb loss. While more were assessed before discharge (5270 vs. 2711), the proportion of sequelae diagnoses was higher post-discharge. The pooled prevalence of sequelae was 24.8% (95% CI 20.5-29.2%) at discharge, compared to 41.5% (95% CI 25.7-57.3%) within 3 months and 31.9% (95% CI 18.5-45.3%) beyond 3 months post-discharge. In children, 14,826 (79%) were assessed, and 3484 (24%) had sequelae, with the most common sequelae being hearing loss, followed by focal neurological deficits, seizures, neurocognitive, and neurodevelopmental impairments. More were assessed post-discharge (8298 vs. 7180), with a higher pooled prevalence of sequelae diagnoses post-discharge. At discharge, the pooled prevalence of sequelae was 28.9% (95% CI 20.8-37%), compared to 29.9% (95% CI 19-40.8%) within 3 months and 38.2% (95% CI 30.3-46.1%) beyond 3 months after discharge. Conclusions: Meningitis-related sequelae significantly impact quality of life. This review highlights variability and critical gaps in their evaluation, detection, and management, underscoring the need for routine monitoring from discharge through consistent follow-up assessments, as recommended by the new WHO guidelines on meningitis diagnosis, treatment, and care.

Gait Speed is Associated with Executive Function in Latin American Older Adults from LatAmFINGERS

2025-12-01T00:00:00Z

Gait Speed is Associated with Executive Function in Latin American Older Adults from LatAmFINGERS Gutiérrez, Myriam; Marroig, Alejandra; Delgado, Carolina; Slachevsky, Andrea; Charamelo, Ana; Aguillon Niño, David Fernando; Crivelli, Lucía Dementia prevalence is increasing with aging worldwide, a leading cause of disability in Latin American Countries (LAC). Interestingly, physical performance has been reported as a predictor of cognitive decline, and gait speed has emerged as a potential clinical marker of executive dysfunction. However, evidence of the association between physical and cognitive measures remains scarce, especially in LAC older adults. This study examined the association between gait speed and executive function in older adults from 12 LAC countries. A cross-sectional study including 1,243 participants aged 60 to 77 years from the LatAm-FINGERS randomized multicenter cohort at baseline. Sociodemographic, lifestyle, and health data were collected. Physical performance was assessed using the Short Physical Performance Battery (SPPB), with gait speed measured by a standardized 4-meter walk test. Executive and processing speed were evaluated with the Trail Making Test A and B, Stroop interference index (SII), semantic and phonological fluency, and Concept Shifting Test motor speed (CST-MS). Linear regressions and composite scores were computed. The preliminary results indicate that participants’ mean age was 67.5 ± 4.7 years (67.5% female). Faster gait speed was significantly associated with better Stroop C (p < 0.00001), Stroop P (p = 0.001), semantic fluency (p = 0.02), and higher Mini-Mental State Examination (MMSE) scores. Associations with CST-MS and TMT tests were not statistically significant. This study is the first effort in LAC to associate gait speed with executive tests, contributing to the understanding of a useful functional measure as gait speed, and its potential future preventive applications in LAC.