Clinical Neurology and Neurosurgery最新文献

{"title":"Bridging CGRP mAbs with Gepants: An innovative approach to address the wearing-off phenomenon.","authors":"Taoufik Alsaadi, Fatema Adel, Kareem Alsaffarini, Caline El Jadam, Athra Alkhateri, Beverly Pagdato, Reem Suliman","doi":"10.1016/j.clineuro.2025.109183","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.109183","url":null,"abstract":"<p><strong>Introduction: </strong>The introduction of calcitonin gene-related peptide (CGRP)-targeted therapies, including monoclonal antibodies (mAbs) and gepants, has revolutionized migraine management by reducing attack frequency, severity, and duration. However, concerns have emerged regarding the potential wearing off effect, where treatment efficacy diminishes before the next scheduled dose. This study evaluates the long-term efficacy and safety of bridging CGRP mAbs with gepants across 16 clinic visits over 24 months of follow-up, to manage the wearing-off phenomenon of mAbs.</p><p><strong>Methods: </strong>This was a retrospective, real-world, exploratory study. The participants included in the study were adult (≥ 18 years) patients diagnosed with migraine. Screening for patients who had received CGRP mAbs for a minimum of 12 months was done. Clinical data was collected from electronic medical records. A total of 439 patients with documented follow-up visits while taking CGRP mAbs were identified. Data was collected from one site, the American Center for Psychiatry and Neurology, Abu Dhabi, UAE.</p><p><strong>Results: </strong>Out of the 493 patients, 65 patients had a wear-off effect of CGRP mAbs and were on bridging treatment. Eptinezumab (55.38 %) was the most prescribed CGRP mAb, followed by erenumab (26.15 %) and galcanezumab (18.46 %). Rimegepant (95.38 %) was the primary gepant used for bridging therapy. Weekly headache days (WHD) decreased significantly over the 16 visits, from 4 days at baseline to near zero by visit 16. 41.54 % of patients improved in severity, while 46.15 % remained stable.</p><p><strong>Conclusion: </strong>These findings strongly suggest the effectiveness of gepants in managing the wearing-off phenomenon across patients on mAbs. They also underscore the importance of individualized treatment approaches. While CGRP-targeted treatments remain highly effective, ongoing research is essential to optimize long-term use and minimize fluctuations in efficacy, ultimately improving patient reported outcomes.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"109183"},"PeriodicalIF":1.6,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemifacial spasm in the Middle East: Insights from a high-volume tertiary care center.","authors":"Kiran Waqar, Florian Roser, Moncy Thomas, Yasmin Abdelmajed, Emma De Freitas, Shivam Om Mittal","doi":"10.1016/j.clineuro.2025.109182","DOIUrl":"https://doi.org/10.1016/j.clineuro.2025.109182","url":null,"abstract":"<p><strong>Objective: </strong>To provide the first comprehensive regional profile of hemifacial spasm (HFS) in the Middle East by analyzing patient demographics, clinical features, treatment patterns, and outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed adults (≥18 years) diagnosed with HFS from January 2015 to December 2024. Incomplete records were excluded. Data included demographics, clinical features, imaging, treatments, and outcomes. Severity was rated on a 5-point Likert scale. Chi-square tests determined statistical significance (p < 0.05).</p><p><strong>Results: </strong>Of 240 referred patients, 174 met inclusion criteria. Females accounted for 56 % (male-to-female ratio 1:1.29), with mean age of onset 42 ± 14 years. Left-sided involvement predominated (56.7 %). Primary HFS comprised 64.4 % of cases, secondary HFS correlated with facial pain (p < 0.01) and weakness (p < 0.01). Hypertension showed no association with laterality (p = 0.27). Botulinum toxin injections yielded moderate-to-marked improvement in 92 % of patients, while microvascular decompression achieved sustained relief in 21 of 22 cases. Oral therapy provided modest benefit. Spontaneous remission occurred in 10 patients.</p><p><strong>Conclusion: </strong>This first UAE study provides a detailed HFS profile, confirming high efficacy of botulinum toxin and microvascular decompression. Oral therapy may offer supportive, noninvasive benefit. Observed variations in onset age and etiology suggest potential genetic and environmental influences, highlighting the need for prospective multicenter studies in the region.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"109182"},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and characteristics of cognitive impairment in individuals with calcified neurocysticercosis","authors":"Marco Antonio Juan Vasquez-Baiocchi ,&nbsp;Sofia Sanchez-Boluarte ,&nbsp;S. Mathof Salas ,&nbsp;Juan Galvez-Buccolini ,&nbsp;Carolina Guzman ,&nbsp;Kiran T. Thakur ,&nbsp;Isidro Gonzales ,&nbsp;Herberth Saavedra Pastor ,&nbsp;Javier A. Bustos ,&nbsp;Hector H. Garcia","doi":"10.1016/j.clineuro.2025.109181","DOIUrl":"10.1016/j.clineuro.2025.109181","url":null,"abstract":"<div><h3>Objective</h3><div>Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system (CNS). When NCC calcifies, it causes symptoms including memory impairment. Here we will assess the frequency and characteristics of cognitive impairment using screening tools in patients with calcified NCC.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional study in participants of an ongoing cohort of patients with calcified NCC, who were administered the Mini-Mental State Examination (MMSE) and Memory Alteration Test (MAT) simultaneously. We analyzed these test scores in relation to sociodemographic, clinical, and neuroimaging characteristics.</div></div><div><h3>Results</h3><div>We included 336 individuals, with an average age of 43.6 ± 14.8 years, 56 % of whom were female. The median scores for MMSE and MAT were 27 (IQR 25–28) and 41 (IQR 36–45), respectively. We observed cognitive impairment in 43 (12.8 %) participants with MMSE and 90 (26.8 %) with MAT. Among the 57 participants aged 60 years and older, 17 (29.8 %) had cognitive impairment on MMSE and 29 (50.9 %) on MAT. Lower scores were associated with older age (p &lt; 0.001 for both tests), and the presence of left temporal lobe calcifications (p &lt; 0.001 for both), associations that persisted after multivariate adjustment (p = 0.017 for MMSE and p = 0.043 for MAT).</div></div><div><h3>Conclusion</h3><div>In this cohort, we found that low cognitive scores are frequently observed in patients with calcified NCC (12.8 % by MMSE, 26.8 % by MAT) and are associated with older age and calcifications in the left temporal lobe. Further studies with appropriate control groups are needed to assess these associations beyond screening tools and examine other contributing factors.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109181"},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated vertebral bone quality score measurement on lumbar MRI using deep learning: Development and validation of an AI algorithm.","authors":"Nishantha M Jayasuriya, Emily Feng, Karim Rizwan Nathani, Maliya Delawan, Konstantinos Katsos, Ojas Bhagra, Brett A Freedman, Mohamad Bydon","doi":"10.1016/j.clineuro.2025.109094","DOIUrl":"10.1016/j.clineuro.2025.109094","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bone health is a critical determinant of spine surgery outcomes, yet many patients undergo procedures without adequate preoperative assessment due to limitations in current bone quality assessment methods. This study aimed to develop and validate an artificial intelligence-based algorithm that predicts Vertebral Bone Quality (VBQ) scores from routine MRI scans, enabling improved preoperative identification of patients at risk for poor surgical outcomes.</p><p><strong>Methods: </strong>This study utilized 257 lumbar spine T1-weighted MRI scans from the SPIDER challenge dataset. VBQ scores were calculated through a three-step process: selecting the mid-sagittal slice, measuring vertebral body signal intensity from L1-L4, and normalizing by cerebrospinal fluid signal intensity. A YOLOv8 model was developed to automate region of interest placement and VBQ score calculation. The system was validated against manual annotations from 47 lumbar spine surgery patients, with performance evaluated using precision, recall, mean average precision, intraclass correlation coefficient, Pearson correlation, RMSE, and mean error.</p><p><strong>Results: </strong>The YOLOv8 model demonstrated high accuracy in vertebral body detection (precision: 0.9429, recall: 0.9076, mAP@0.5: 0.9403, mAP@[0.5:0.95]: 0.8288). Strong interrater reliability was observed with ICC values of 0.95 (human-human), 0.88 and 0.93 (human-AI). Pearson correlations for VBQ scores between human and AI measurements were 0.86 and 0.9, with RMSE values of 0.58 and 0.42 respectively.</p><p><strong>Conclusion: </strong>The AI-based algorithm accurately predicts VBQ scores from routine lumbar MRIs. This approach has potential to enhance early identification and intervention for patients with poor bone health, leading to improved surgical outcomes. Further external validation is recommended to ensure generalizability and clinical applicability.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"109094"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial distribution of enlarged perivascular spaces as a potential biomarker for distinguishing vascular dementia from Alzheimer's disease in older adults.","authors":"Wanhu Liu, Wei Bu, Linghui Meng, Weigang Luo, Cuicui Liu, Xiaohui Li, Wenjun Li, Huiling Ren","doi":"10.1016/j.clineuro.2025.109098","DOIUrl":"10.1016/j.clineuro.2025.109098","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to examine the potential value of enlarged perivascular space (EPVS) volume as a biomarker for distinguishing between Alzheimer's disease (AD) and vascular dementia (VD) in older people.</p><p><strong>Methods: </strong>A total of 93 patients with Alzheimer's disease and 122 patients with vascular dementia, all aged > 65 years and diagnosed via clinical and neuropsychological assessments, were enrolled in this study. A deep learning model based on VB-Net was utilized to automatically quantify the EPVS volume in four brain regions: the basal nuclei (BN), centrum semiovale (CSO), temporal lobe (T), and midbrain (MB). Univariate analysis was conducted to compare the clinical data and EPVS volume characteristics across different regions between patients with Alzheimer's disease and vascular dementia. Multivariate analysis was employed to identify independent factors for distinguishing AD from VD, and the discriminative ability was evaluated using the area under the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Univariate analysis revealed that, in comparison with the AD group, the VD group had a higher proportion of patients with hypertension, hyperlipidemia, and lacune, along with a higher Fazekas score for white matter hyperintensities, an increased volume of BN-EPVS, and decreased volumes of CSO-EPVS and T-EPVS (all p < 0.05). Logistic regression analysis showed that BN-EPVS, CSO-EPVS, and T-EPVS volumes were independent factors influencing the differentiation of dementia subtypes (all p < 0.05). Furthermore, ROC curve analysis revealed that the areas under the curve for BN-EPVS, CSO-EPVS, and T-EPVS volumes in distinguishing dementia subtypes were 0.791, 0.712, and 0.700, respectively.</p><p><strong>Conclusion: </strong>There exist spatial disparities in the volumetric distribution of EPVS between AD and VD. The volume of EPVS at various locations can serve as a reliable imaging biomarker for the differential diagnosis of these two dementia subtypes.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"109098"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effects of greater occipital nerve blockage versus combined greater occipital nerve and supraorbital nerve blockage therapy on sleep, pain, anxiety, depression, and quality of life in chronic migraine.","authors":"Ayşegül Şeyma Sarıtaş, Eylül Ceren Çağ, Berfin Cansel Atıcı, Yağmur İnalkaç Gemici, Melike Batum, Hikmet Yılmaz, Ayşın Kısabay Ak","doi":"10.1016/j.clineuro.2025.109092","DOIUrl":"10.1016/j.clineuro.2025.109092","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate and compare the effects of isolated greater occipital nerve (GON) blockage, combined GON with supraorbital nerve (SON) blockage and control group on sleep quality, pain severity, anxiety and depression, and health-related quality of life (QoL) in individuals with chronic migraine (CM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;At our clinic, bilateral GON and SON blockage is routinely recommended as a standard treatment for CM patients who either fail to benefit from an effective dose of medical prophylaxis (≥3 months) and discontinue it, or who are unable or unwilling to undergo such treatment. Bilateral application is preferred due to the migratory nature of migraine-type headache localization.Due to the risk/potential of marked tenderness in the forehead region during the procedure or more frequent development of redness and ecchymosis afterward, isolated bilateral GON blockage was performed in patients who did not consent to the SON blockage. Following ethical approval, 80 patients with CM were prospectively assigned to either the GON blockage group (n = 40) or the combined GON and SON blockage group (n = 40). A control group (n = 40) consisting of age- sex- and education- matched healthy individuals was also included. Blockages were performed weekly during the first month and then monthly during the second and third months. All participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Visual Analog Scale for Sleep Quality (VAS-Sleep), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pre-Sleep Arousal Scale (PSAS), Morningness-Eveningness Questionnaire (MEQ), International Restless Legs Syndrome Study Group Rating Scale (IRLSSGS), Visual Analog Scale for Pain (VAS-Pain), Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS), and the 36-Item Short Form Health Survey (SF-36) at baseline and post-intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In patients who underwent GON blockage, significant improvements were observed in PSQI, ISI, VAS-Sleep, PSAS, VAS-Pain, PCS, MIDAS, HIT-6, HADS, and the SF-36 domains of role limitations-physical, energy/vitality/fatigue, mental health, bodily pain as well as MFIS scores (p &lt; 0.001). Significant improvements compared to baseline were also observed in DBAS, IRLSSGS, and the SF-36 domains of physical functioning, role limitations-emotional, social functioning, physical health, and change in health parameters (p = 0.009, 0.004, 0.002, 0.001, 0.001, 0.005, and 0.001, respectively). In patients who underwent combined GON and SON blockage, significant improvements were observed in ESS, DBAS and the SF-36 domains of physical functioning and role limitations-physical (p = 0.001, 0.031, 0.003, and 0.012, respectively). Additionally, significant im","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"109092"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune checkpoint inhibitor-induced encephalitis mimicking Wernicke encephalopathy - A case report.","authors":"Youjiang Tan, Wilson Shijie Chan, Xiaomin Mu","doi":"10.1016/j.clineuro.2025.109091","DOIUrl":"10.1016/j.clineuro.2025.109091","url":null,"abstract":"<p><p>Immune checkpoint inhibitors have revolutionized the treatment of many cancers since their introduction in the early 2010s. Consequently, immune checkpoint inhibitor-induced encephalitis (ICI-iE) is increasingly reported in scientific literature, but its diagnosis can be challenging due to the non-specific clinico-radiological features. Herein, we report the case of an elderly man with metastatic renal cell carcinoma, who developed ICI-iE slightly over a year into his pembrolizumab treatment. However, radiological abnormalities involving bilateral mamillary bodies, medial thalami, and the periaqueductal grey mimicked those seen in Wernicke encephalopathy, resulting in misdiagnosis and treatment delays. Furthermore, concerns over misdiagnosing ICI-iE and inappropriately withholding pembrolizumab, which up to that point had been effective and well-tolerated, further contributed to the delay. This case illustrates the challenges in diagnosing ICI-iE, and emphasizes the importance of a high index of suspicion when neurocognitive deficits develop in those receiving immune checkpoint inhibitors.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"109091"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure and psychosocial outcomes in patients with DBS for intractable epilepsy.","authors":"Marley B Sternberg, Ellen Air, Jason Schwalb, Gregory L Barkley, Jules E C Constantinou, Brien J Smith, Vibhangini S Wasade","doi":"10.1016/j.clineuro.2025.109096","DOIUrl":"10.1016/j.clineuro.2025.109096","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates seizure outcomes in patients with intractable epilepsy treated with Deep Brain Stimulation (DBS) and explores correlations with demographic and psychosocial factors.</p><p><strong>Methods: </strong>We analyzed data from patients who underwent Medtronic-DBS implantation between 2018 and 2023 at our institution. Collected variables included sex, age, epilepsy type, prior epilepsy surgeries, age at diagnosis and DBS implantation, DBS lead location, seizure outcomes, anti-seizure medication (ASM) use, employment, Patient Reported Outcomes Measurement Information System (PROMIS) Depression T-scores pre- and post-DBS, antidepressant use, and driving status. Patients were classified as Total Responders (TR) if they achieved ≥ 50 % seizure reduction. Associations between responder status and assessed factors were analyzed using chi-square and Mann-Whitney U tests.</p><p><strong>Results: </strong>Seventeen patients (five males, twelve females; mean age 37.1 years, SD=10.7) were included, with an average epilepsy duration of 24.3 years (SD=13.1) before DBS. Leads were placed in the anterior thalamus (88 %) and centro-median nuclei (12 %). Fourteen patients (82 %) had multifocal epilepsy, while three (18 %) had symptomatic generalized epilepsy. TR status was achieved in 59 % of patients at a mean follow up of 32 months. Responder status correlated with higher ASM burden but not with other psychosocial factors.</p><p><strong>Conclusion: </strong>DBS therapy resulted in > 50 % seizure reduction in 59 % of patients with intractable epilepsy, with responders exhibiting a higher median ASM burden. While psychosocial factors were not significantly linked to seizure outcomes, TR patients demonstrated a relative worsening of Depression T-scores compared to non-responders, warranting further investigation.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"109096"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to Editor: Langerhans cell histiocytosis of the spine in adults: A rare and controversial disorder: A systematic review.","authors":"G Lakshmi Prasad","doi":"10.1016/j.clineuro.2025.109093","DOIUrl":"10.1016/j.clineuro.2025.109093","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"109093"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute stroke reperfusion therapies for Down syndrome patients: Nationwide utilization rates and hospitalization outcomes.","authors":"Huanwen Chen, Diya Gandhi","doi":"10.1016/j.clineuro.2025.109090","DOIUrl":"10.1016/j.clineuro.2025.109090","url":null,"abstract":"<p><strong>Background: </strong>Down syndrome (DS) is a common chromosomal disorder, and life expectancy has drastically increased over the last several decades. While DS is known to be associated with an increased risk of acute ischemic stroke (AIS), the utilization rate and outcomes of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) for DS patients presenting with AIS are unknown.</p><p><strong>Methods: </strong>This was a retrospective cohort study of the 2016-22 Nationwide Readmissions Database. Adult patients admitted for AIS were identified, and patients with DS were matched with non-DS controls using propensity score matching (PSM). Utilization rates of IVT and EVT were determined, as were hospitalization outcomes, including discharge to home and in-hospital death.</p><p><strong>Results: </strong>3435,097 stroke admissions were identified; after PSM 1161 DS patients and 2174 matched non-DS controls remained. DS patients were less likely to receive IVT (7.5 % vs. 19.4 %, p < 0.001) and EVT treatment (6.6 % vs. 12.2 %, p < 0.001), and DS patients also had a lower rate of discharge to home (61.6 % vs. 66.4 %, p < 0.001) and higher rate of mortality (6.4 % vs. 4.1 %, p = 0.027). Among non-DS patients, both IVT and EVT were associated with significantly higher odds of home discharge (adjusted OR 2.13 [95 %CI 1.23-3.67], p = 0.007 and 2.40 [95 %CI 1.21-4.79], p = 0.013, respectively); however, among DS patients, neither IVT nor EVT were associated with different odds of excellent outcomes (both p > 0.05).</p><p><strong>Conclusions: </strong>Compared to matched controls, DS patients with AIS were less likely to receive IVT and EVT, had worse outcomes, and derived smaller clinical benefits from IVT and EVT.</p>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"109090"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}