Objectives Individuals with spinal cord injury are at risk of secondary health conditions (SHC) that develop as a consequence of autonomic dysfunction, prolonged oxidative stress and inflammation, and physical inactivity coupled with inadequate energy and nutritional intake. SHC can be debilitating and even life-threatening, and its prevention remains one of the major challenges in the continuum of medical care of aging SCI population. An unhealthy diet is a major driver of inflammation, oxidative stress, and unfavourable metabolic status and may be a practical preventive target to tackle increased SHC risk post-injury. Aims To provide a catalogue of dietary interventions beneficial in prevention of SHC among individuals with SCI by conducting a systematic review of the literature on dietary interventions and dietary supplementation in promoting health and well-being after the injury. In addition, we aimed to provide a summary of observational studies exploring the association between habitual diet (macro- and micronutrients intake and dietary patterns) and health patterns following the injury. Method This review was registered at PROSPERO (University of York) with registration number CRD42022373773. Four medical databases (EMBASE.com, MEDLINE [Ovid], Cochrane CENTRAL, and Web of Science Core Collection) and Google Scholar were searched from inception until 11th July 2022. Studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. Based on strength of the study design and risk of bias assessment (using the NIH tool), we classified studies from Level 1 (most reliable studies) to Level 4 (least reliable studies). Results Of 12,313 unique citations, 47 articles (based on 43 original studies) comprising 32 interventional (22 RCTs, 3 NRCT, and 7 pre-post studies) and 11 observational studies (2 cohort studies, 2 case-control, 1 post-intervention follow-up study, and 6 cross-sectional studies) were included in the present systematic review. Twenty studies (46.5%) were classified as Level 1 or 2, indicating high/moderate methodological quality. Based on those studies, dietary strategies including high protein diet, intermittent fasting, balanced diet in combination with physical conditioning and electrical stimulation, and dietary supplementation including alpha-lipoic acid, creatine, vitamin D, and cranberry-derived supplements and probiotics were mapped as the most promising in prevention of SHC among individuals with SCI. Conclusions To develop timely and effective preventive strategies targeting major SHC (e.g., cardiometabolic diseases, urinary tract infections) in SCI, further research is warranted to confirm the effectiveness of dietary strategies/interventions identified through the current systematic review of the literature.

BACKGROUND:Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS:Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS:Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION:Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.

Background and purpose Whether the reported association between migraine with aura (MA) and cardioembolic stroke may be explained by a higher rate of atrial fibrillation (AF) or by other potential cardiac sources of cerebral embolism remains to be determined. Methods In the setting of a single centre cohort study of consecutive patients with acute brain ischaemia stratified by migraine status, the association between AF as well as patent foramen ovale (PFO) and migraine was explored. Results In all, 1738 patients (1017 [58.5%] men, mean age 67.9 ± 14.9 years) qualified for the analysis. Aging was inversely associated with migraine, whilst women had a >3‐fold increased disease risk (odds ratio [OR] 3.82, 95% confidence interval [CI] 2.58–5.66). No association between AF and history of migraine or its pathogenic subtypes was detected. Conversely, migraine was associated with PFO, both in the entire cohort (OR 1.84, 95% CI 1.07–3.16) and in patients aged ≤55 years (OR 2.21, 95% CI 1.16–4.22). This association was significant for MA (OR 2.92, 95% CI 1.32–6.45 in the entire cohort; OR 2.92, 95% CI 1.15–7.41 in patients aged ≤55 years) and in women (OR 8.23, 95% CI 2.06–32.77), but not for migraine without aura. Conclusions In patients with brain ischaemia migraine is not associated with AF. Conversely, there is a probable relation between migraine, especially MA, and PFO in patients who are younger and have a more favourable vascular risk factor profile, and in women.

European Journal of NeurologyVolume 24, Issue 3 p. e12-e14 Letter to the Editor Screening for Fabry disease in patients with ischaemic stroke at young age: the Italian Project on Stroke in Young Adults L. Poli, L. Poli Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorM. Zedde, M. Zedde S.C. Neurologia, Arcispedale 'Santa Maria Nuova – IRCCS', Reggio EmiliaSearch for more papers by this authorA. Zini, A. Zini Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile 'S. Agostino Estense', AUSL, ModenaSearch for more papers by this authorM. Del Sette, M. Del Sette Unità di Neurologia, Ospedale Galliera, GenovaSearch for more papers by this authorC. Lodigiani, C. Lodigiani Centro Trombosi, IRCCS Humanitas Research Hospital, Rozzano-MilanoSearch for more papers by this authorA. Spalloni, A. Spalloni Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università 'La Sapienza', RomaSearch for more papers by this authorF. Di Lisi, F. Di Lisi Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università 'La Sapienza', RomaSearch for more papers by this authorA. Toriello, A. Toriello U.O.C. Neurologia, A.O. Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', SalernoSearch for more papers by this authorV. Piras, V. Piras Stroke Unit, Azienda Ospedaliera 'G. Brotzu', CagliariSearch for more papers by this authorC. Stilo, C. Stilo Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, MessinaSearch for more papers by this authorG. Tomelleri, G. Tomelleri UO Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, VeronaSearch for more papers by this authorL. Tancredi, L. Tancredi U.O. Neurologia, ASST Lariana – Ospedale Sant'Anna, ComoSearch for more papers by this authorM. Paciaroni, M. Paciaroni Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, PerugiaSearch for more papers by this authorG. Silvestrelli, G. Silvestrelli Stroke Unit, Dipartimento di Neuroscienze, Azienda Ospedaliera Carlo Poma, MantovaSearch for more papers by this authorA. Adami, A. Adami Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, VeronaSearch for more papers by this authorP. Costa, P. Costa Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorA. Morotti, A. Morotti Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorV. De Giuli, V. De Giuli Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorF. Caria, F. Caria Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorM. Gamba, M. Gamba Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, BresciaSearch for more papers by this authorG. Malferrari, G. Malferrari S.C. Neurologia, Arcispedale 'Santa Maria Nuova – IRCCS', Reggio EmiliaSearch for more papers by this authorA. M. Simone, A. M. Simone Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile 'S. Agostino Estense', AUSL, ModenaSearch for more papers by this authorR. Musolino, R. Musolino Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, MessinaSearch for more papers by this authorE. Giorli, E. Giorli Unità di Neurologia, Ospedale S. Andrea, La SpeziaSearch for more papers by this authorE. Banfi, E. Banfi Centro Trombosi, IRCCS Humanitas Research Hospital, Rozzano-MilanoSearch for more papers by this authorS. Marcheselli, S. Marcheselli Neurologia d'Urgenza and Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano-MilanoSearch for more papers by this authorM. Rasura, M. Rasura Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università 'La Sapienza', RomaSearch for more papers by this authorN. Pugliese, N. Pugliese U.O.C. Neurologia, A.O. Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', SalernoSearch for more papers by this authorM. Melis, M. Melis Stroke Unit, Azienda Ospedaliera 'G. Brotzu', CagliariSearch for more papers by this authorP. Bovi, P. Bovi UO Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, VeronaSearch for more papers by this authorA. Padovani, A. Padovani Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorA. Burlina, A. Burlina Neurologia, Dipartimento di Medicina Interna, Ospedale San Bassiano, Bassano del Grappa, ItalyThese two authors should be considered co-senior authors.Search for more papers by this authorA. Pezzini, Corresponding Author A. Pezzini ale_pezzini@hotmail.com alessandro.pezzini@unibs.it Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaThese two authors should be considered co-senior authors.Correspondence: A. Pezzini, Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P. le Spedali Civili 1, 25123 Brescia, Italy (tel.: +39 030 3384086; fax: +39 030 3384086; e-mails: ale_pezzini@hotmail.com; alessandro.pezzini@unibs.it).Search for more papers by this author On behalf of the Italian Project on Stroke in Young Adults (IPSYS) Investigators, the Italian Project on Stroke in Young Adults (IPSYS) InvestigatorsItalian Project on Stroke in Young Adults (IPSYS) Investigators are in Appendix 1.Search for more papers by this author L. Poli, L. Poli Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorM. Zedde, M. Zedde S.C. Neurologia, Arcispedale 'Santa Maria Nuova – IRCCS', Reggio EmiliaSearch for more papers by this authorA. Zini, A. Zini Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile 'S. Agostino Estense', AUSL, ModenaSearch for more papers by this authorM. Del Sette, M. Del Sette Unità di Neurologia, Ospedale Galliera, GenovaSearch for more papers by this authorC. Lodigiani, C. Lodigiani Centro Trombosi, IRCCS Humanitas Research Hospital, Rozzano-MilanoSearch for more papers by this authorA. Spalloni, A. Spalloni Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università 'La Sapienza', RomaSearch for more papers by this authorF. Di Lisi, F. Di Lisi Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università 'La Sapienza', RomaSearch for more papers by this authorA. Toriello, A. Toriello U.O.C. Neurologia, A.O. Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', SalernoSearch for more papers by this authorV. Piras, V. Piras Stroke Unit, Azienda Ospedaliera 'G. Brotzu', CagliariSearch for more papers by this authorC. Stilo, C. Stilo Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, MessinaSearch for more papers by this authorG. Tomelleri, G. Tomelleri UO Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, VeronaSearch for more papers by this authorL. Tancredi, L. Tancredi U.O. Neurologia, ASST Lariana – Ospedale Sant'Anna, ComoSearch for more papers by this authorM. Paciaroni, M. Paciaroni Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, PerugiaSearch for more papers by this authorG. Silvestrelli, G. Silvestrelli Stroke Unit, Dipartimento di Neuroscienze, Azienda Ospedaliera Carlo Poma, MantovaSearch for more papers by this authorA. Adami, A. Adami Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, VeronaSearch for more papers by this authorP. Costa, P. Costa Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorA. Morotti, A. Morotti Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorV. De Giuli, V. De Giuli Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorF. Caria, F. Caria Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorM. Gamba, M. Gamba Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, BresciaSearch for more papers by this authorG. Malferrari, G. Malferrari S.C. Neurologia, Arcispedale 'Santa Maria Nuova – IRCCS', Reggio EmiliaSearch for more papers by this authorA. M. Simone, A. M. Simone Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile 'S. Agostino Estense', AUSL, ModenaSearch for more papers by this authorR. Musolino, R. Musolino Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, MessinaSearch for more papers by this authorE. Giorli, E. Giorli Unità di Neurologia, Ospedale S. Andrea, La SpeziaSearch for more papers by this authorE. Banfi, E. Banfi Centro Trombosi, IRCCS Humanitas Research Hospital, Rozzano-MilanoSearch for more papers by this authorS. Marcheselli, S. Marcheselli Neurologia d'Urgenza and Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano-MilanoSearch for more papers by this authorM. Rasura, M. Rasura Stroke Unit, Azienda Ospedaliera Sant'Andrea, Università 'La Sapienza', RomaSearch for more papers by this authorN. Pugliese, N. Pugliese U.O.C. Neurologia, A.O. Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', SalernoSearch for more papers by this authorM. Melis, M. Melis Stroke Unit, Azienda Ospedaliera 'G. Brotzu', CagliariSearch for more papers by this authorP. Bovi, P. Bovi UO Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, VeronaSearch for more papers by this authorA. Padovani, A. Padovani Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaSearch for more papers by this authorA. Burlina, A. Burlina Neurologia, Dipartimento di Medicina Interna, Ospedale San Bassiano, Bassano del Grappa, ItalyThese two authors should be considered co-senior authors.Search for more papers by this authorA. Pezzini, Corresponding Author A. Pezzini ale_pezzini@hotmail.com alessandro.pezzini@unibs.it Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, BresciaThese two authors should be considered co-senior authors.Correspondence: A. Pezzini, Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P. le Spedali Civili 1, 25123 Brescia, Italy (tel.: +39 030 3384086; fax: +39 030 3384086; e-mails: ale_pezzini@hotmail.com; alessandro.pezzini@unibs.it).Search for more papers by this author On behalf of the Italian Project on Stroke in Young Adults (IPSYS) Investigators, the Italian Project on Stroke in Young Adults (IPSYS) InvestigatorsItalian Project on Stroke in Young Adults (IPSYS) Investigators are in Appendix 1.Search for more papers by this author First published: 16 February 2017 https://doi.org/10.1111/ene.13254Citations: 6 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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Objectives-To investigate the safety and efficacy of ultrasound guided botulinum toxin type A (BTX-A) injections into salivary glands for the treatment of sialorrhoea in patients with neurological disorders.Methods-The parotid and submandibular glands of 10 patients were injected with BTX-A using ultrasound guidance. Before injection, the baseline rate of salivation was assessed using a visual analogue scale. Postinjection, assessments were repeated at regular intervals for up to 1 year.Results-Of the 10 patients treated, nine (90%) reported a subjective reduction in salivation post-treatment and one patient (10%) found no improvement. Visual analogue scale scores showed a reduction of 55% in the mean rate of salivation for all patients and a reduction of 60.8% for the group of responders. No serious adverse events occurred and no procedure related complications were reported.Conclusions-This is the first study to report (1) the injection of BTX-A (BO-TOX(R)) into both parotid and submandibular glands, and (2) the use of ultrasound guidance during the administration of BTX-A into salivary glands. The results suggest that the technique is safe and that BTX-A injections are effective for the treatment of sialorrhoea in patients with neurological disorders.

High titers of anti-GD1a antibodies have been found in patients with Guillain-Barre syndrome or motor neuropathy. To determine the possible diagnostic relevance of these antibodies, we measured serum anti-GD1a IgG and IgM antibodies by enzyme-linked immunosorbent assay in 195 patients with different motor syndromes and in 335 control subjects. Moderately high antibody titers (1/1,280-1/5,120) were occasionally found in patients with chronic inflammatory demyelinating polyneuropathy (5%), multifocal motor neuropathy (18%), lower motor neuron disease (3.8%), or amyotrophic lateral sclerosis (1.8%) and in immunological control subjects (1.2%), while titers of 1/20,480 or higher were only found in 2 patients with Guillain-Barre syndrome (IgG in both) and 2 with motor neuropathy and IgM lambda monoclonal gammopathy improving with immunotherapy. In both motor neuropathy patients and the Guillain-Barre syndrome patient who were retested during recovery, anti-GD1a titers decreased concomitantly with clinical improvement. High anti-GD1a antibody titers may be found in several motor syndromes but only markedly increased anti-GD1a titers are strictly associated with potentially treatable dysimmune neuropathies.

We investigated the negative chronotropic and vasodilating properties of new selective A1 and A2 adenosine agonists such as 2-chloro-N6-cyclopentyladenosine (CCPA) and 2-hexynyl-5′-N-ethyl-carboxamidoadenosine (2-hexynyl-NECA) as compared with reference adenosine analogues. The potency of these compounds on heart rate was assessed in the rat atrial preparation and their activity on the vascular tone was determined in both rat aorta and bovine coronary artery. CCPA was found to be the most potent At agonist of those currently available in producing negative chronotropic effects (EC50 = 8.2 nM). The A1 antagonist 8-cyclopentyl-1,3-dipropyl-xanthine (DPCPX) blocked CCPA activity in a dose-dependent manner. There was also a significant correlation between its biological effect and the affinity for A1 receptors as measured in the rat brain by [3H]-N6-cyclohexyladenosine (3[H]-CHA) binding. The A2 selective agonist 2-hexynyl-NECA showed vasodilating properties comparable with those observed with the reference compounds, CGS 21680 and NECA. EC50 values were 596 and 569 nM in rat aorta and bovine coronary artery, respectively. Moreover, the rank order of potency was similar in the two vascular districts examined, suggesting that the rat aorta is a useful model for studying the effects of adenosine derivatives on vascular tone. In addition, the potency of the compounds in inducing vasodilation was found to be correlated with their affinity for A2 receptors as measured in the rat striatum by 3[H]-CGS 21680 binding.