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Sustainable Interventions for Improving Standards of Care in Neurology

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A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neuro-otology and Neuro-ophthalmology".

Deadline for manuscript submissions: closed (10 December 2021) | Viewed by 17091

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Special Issue Editors

Prof. Dr. Dafin Fior Muresanu

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Guest Editor

1. Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
2. RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
Interests: cerebrovascular diseases; neurodegenerative diseases; traumatic brain injury; brain protection and recovery; neurorehabilitation; neuroimmunology
Special Issues, Collections and Topics in MDPI journals

Dr. Adina Turcu-Stiolica

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Guest Editor

Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
Interests: quality of life; cost–effectiveness analysis; cost–utility analysis; medication adherence; stroke; Parkinson’s disease; multiple sclerosis

Special Issue Information

Dear Colleagues,

In the past decade, significant breakthroughs in fundamental, clinical, and behavioural research have pushed forward real innovation in medicines, medical devices, and procedures, as well as tailored individual or population-based interventions for improving health. Despite tremendous progress being made across all fields of medicine, most healthcare systems face difficulties with affordability and sustainability in their attempt to translate scientific breakthroughs and transfer innovation into clinical practice. These challenges have recently become barriers for appropriate care, given the societal impact of the novel coronavirus pandemic. Health services for non-COVID-19 patients, of which individuals with neurological conditions are a significant proportion, have been profoundly disrupted.

In this Special Issue of Brain Sciences, we aim to present a collection of manuscripts on a variety of topics related to diagnosis, acute care, neurorehabilitation and long-term support for patients with neurological disorders. Findings shall be integrated to showcase sustainable options for improving standards of care in neurology and related fields. We hope to ultimately facilitate enhancing the health-related quality of life of individuals suffering from neurological conditions in the post-pandemic healthcare paradigm.

Prof. Dr. Dafin Fior Muresanu
Dr. Adina Turcu-Stiolica
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Value-based healthcare
Patient-centred care
Multidisciplinary care
Health-related quality of life (HRQoL)
Quality of care
Burden of disease
Comparative effectiveness
Health systems research
Acute care
Neurorehabilitation
Secondary prevention
Clinical outcomes
Cognitive rehabilitation
Motor rehabilitation
Pharmacological intervention
Artificial intelligence
Patient-reported/subjective outcomes

Published Papers (6 papers)

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Research

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19 pages, 1468 KiB

Open AccessEditor’s ChoiceArticle

A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study

by Aviva Beit Yosef, Jeremy Michael Jacobs, Jeffrey Shames, Isabella Schwartz and Yafit Gilboa

Brain Sci. 2022, 12(2), 213; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12020213 - 03 Feb 2022

Cited by 10 | Viewed by 2633

Abstract

This pilot study aimed to investigate the initial effect of a remotely delivered performance-based client-centered intervention on activity performance and participation among adults in the chronic phase after acquired brain injury (ABI). Sixteen participants living at home with little to no assistance in basic daily activities were allocated into intervention or waitlist control groups. Assessments were conducted at the baseline, after the 3-month intervention/wait period, and at a 3-month follow-up. The primary outcomes were activity performance using the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) and participation using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). The intervention included weekly videoconferencing sessions using the Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP). The participants identified five functional goals, of which three were directly addressed. Wilcoxon signed-ranks test results showed no significant improvements in the control group at the end of the 3-month wait period. Pooled data from both groups showed significant improvements in COPM scores for trained and untrained goals following the intervention. Significant improvements were also found in the PQRS and MPAI-4 scores. Improvements were partially maintained at follow-up. Our preliminary results suggest that tele-CO-OP may positively impact the lives of adults after ABI who are coping with long-term disability. Full article

(This article belongs to the Special Issue Sustainable Interventions for Improving Standards of Care in Neurology)

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13 pages, 1480 KiB

Open AccessArticle

Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

by Cristina Daia, Cristian Scheau, Aura Spinu, Ioana Andone, Cristina Popescu, Corneliu Toader, Ana Maria Bumbea, Madalina Codruta Verenca and Gelu Onose

Brain Sci. 2021, 11(8), 1044; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci11081044 - 06 Aug 2021

Cited by 3 | Viewed by 1879

Abstract

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI. Full article

(This article belongs to the Special Issue Sustainable Interventions for Improving Standards of Care in Neurology)

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11 pages, 1087 KiB

Open AccessArticle

Can Incobotulinumtoxin-A Treatment Improve Quality of Life Better Than Conventional Therapy in Spastic Muscle Post-Stroke Patients? Results from a Pilot Study from a Single Center

by Adina Turcu-Stiolica, Mihaela-Simona Subtirelu and Ana-Maria Bumbea

Brain Sci. 2021, 11(7), 934; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci11070934 - 15 Jul 2021

Cited by 4 | Viewed by 1967

Abstract

Post-stroke spasticity frequently occurs in patients with stroke, and there is a need for more quality-of-life assessments for different therapies. We evaluated for the first time in Romania the quality of life among patients with post-stroke spasticity, comparing two therapies over a 6-month period: botulinum toxin type A (BOT) with conventional therapy (CON). We also assessed the reduction of spasticity and functionality secondary to the increase in the mobility in upper limbs. This study was based on a prospective, randomized design, including subjects with post-stroke spasticity (N = 34; 34–80 years of age): in the CON arm, patients received therapy against muscle spasticity and physiotherapy, and, in the BOT arm, patients received incobotulinumtoxin-A and additionally conventional treatment, if required. Among 34 treated subjects in the two arms, the quality of life was significantly higher after BOT therapy (p < 0.001), represented by improvement in movement (p < 0.001), usual activities (p = 0.018), and distress (p < 0.001). Improvements in muscle tone (Ashworth Scale) over 6 months of treatment period were greater in the BOT arm (100%) than in the CON arm (11.8%). These preliminary results suggested that incobotulinumtoxin-A increased quality of life by improving movement, daily activities, mental health, and muscle tone more effectively than conventional therapy and could form a basis for future comparator studies. Full article

(This article belongs to the Special Issue Sustainable Interventions for Improving Standards of Care in Neurology)

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12 pages, 594 KiB

Open AccessArticle

Predictive Value of Cough Frequency in Addition to Aspiration Risk for Increased Risk of Pneumonia in Dysphagic Stroke Survivors: A Clinical Pilot Study

by Anna Maria Pekacka-Egli, Radoslaw Kazmierski, Dietmar Lutz, Stefan Tino Kulnik, Katarzyna Pekacka-Falkowska, Adam Maszczyk, Wolfram Windisch, Tobias Boeselt and Marc Spielmanns

Brain Sci. 2021, 11(7), 847; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci11070847 - 25 Jun 2021

Cited by 5 | Viewed by 3153

Abstract

Background: Post-stroke dysphagia leads to increased risk of aspiration and subsequent higher risk of pneumonia. It is important to not only diagnose post-stroke dysphagia early but also to evaluate the protective mechanism that counteracts aspiration, i.e., primarily cough. The aim of this study was to investigate the predictive value of cough frequency in addition to aspiration risk for pneumonia outcome. Methods: This was a single-center prospective observational study. Patients with first-ever strokes underwent clinical swallowing evaluation, fibreoptic endoscopic evaluation of swallowing (FEES), and overnight cough recording using LEOSound^® (Löwenstein Medical GmbH & Co. KG, Bad Ems, Germany ). Penetration–Aspiration Scale (PAS) ratings and cough frequency measurements were correlated with incidence of pneumonia at discharge. Results: 11 women (37%) and 19 men (63%), mean age 70.3 years (SD ± 10.6), with ischemic stroke and dysphagia were enrolled. Correlation analysis showed statistically significant relationships between pneumonia and PAS (r = 0.521; p < 0.05), hourly cough frequency (r = 0,441; p < 0.05), and categories of cough severity (r = 0.428 p < 0.05), respectively. Logistic regression showed significant predictive effects of PAS (b = 0.687; p = 0.014) and cough frequency (b = 0.239; p = 0.041) for pneumonia outcome. Conclusion: Cough frequency in addition to aspiration risk was an independent predictor of pneumonia in dysphagic stroke survivors. Full article

(This article belongs to the Special Issue Sustainable Interventions for Improving Standards of Care in Neurology)

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12 pages, 1485 KiB

Open AccessArticle

Societal Cost of Ischemic Stroke in Romania: Results from a Retrospective County-Level Study

by Stefan Strilciuc, Diana Alecsandra Grad, Vlad Mixich, Adina Stan, Anca Dana Buzoianu, Cristian Vladescu and Mihaela Adela Vintan

Brain Sci. 2021, 11(6), 689; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci11060689 - 24 May 2021

Cited by 6 | Viewed by 3359

Abstract

Background: Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Methods: The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). Conclusions: Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability. Full article

(This article belongs to the Special Issue Sustainable Interventions for Improving Standards of Care in Neurology)

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Other

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16 pages, 487 KiB

Open AccessSystematic Review

Is It Time to Test the Antiseizure Potential of Palmitoylethanolamide in Human Studies? A Systematic Review of Preclinical Evidence

by Riccardo Bortoletto, Matteo Balestrieri, Sagnik Bhattacharyya and Marco Colizzi

Brain Sci. 2022, 12(1), 101; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12010101 - 12 Jan 2022

Cited by 6 | Viewed by 2832

Abstract

Antiseizure medications are the cornerstone pharmacotherapy for epilepsy. They are not devoid of side effects. In search for better-tolerated antiseizure agents, cannabinoid compounds and other N-acylethanolamines not directly binding cannabinoid receptors have drawn significant attention. Among these, palmitoylethanolamide (PEA) has shown neuroprotective, anti-inflammatory, and analgesic properties. All studies examining PEA’s role in epilepsy and acute seizures were systematically reviewed. Preclinical studies indicated a systematically reduced PEA tone accompanied by alterations of endocannabinoid levels. PEA supplementation reduced seizure frequency and severity in animal models of epilepsy and acute seizures, in some cases, similarly to available antiseizure medications but with a better safety profile. The peripheral-brain immune system seemed to be more effectively modulated by subchronic pretreatment with PEA, with positive consequences in terms of better responding to subsequent epileptogenic insults. PEA treatment restored the endocannabinoid level changes that occur in a seizure episode, with potential preventive implications in terms of neural damage. Neurobiological mechanisms for PEA antiseizure effect seemed to include the activation of the endocannabinoid system and the modulation of neuroinflammation and excitotoxicity. Although no human study was identified, there is ground for testing the antiseizure potential of PEA and its safety profile in human studies of epilepsy. Full article

(This article belongs to the Special Issue Sustainable Interventions for Improving Standards of Care in Neurology)

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