Clinical Neurology and Neurosurgery最新文献

{"title":"Efficacy and safety of levetiracetam versus phenobarbitone for neonatal seizures: A systemic review and meta-analysis","authors":"Najwa Salim ,&nbsp;Syeda Iqra Qadri ,&nbsp;Muhammad Aswab Iqbal Chughtai ,&nbsp;Rafia Imran ,&nbsp;Muhammad Haider Sultan ,&nbsp;Efra Abbas ,&nbsp;Javairia Hameed ,&nbsp;Manpreet Moorpani ,&nbsp;Momal Wasim ,&nbsp;Aroosa Roshan ,&nbsp;Zenab Aziz ,&nbsp;Mahrukh Bashir","doi":"10.1016/j.clineuro.2025.109155","DOIUrl":"10.1016/j.clineuro.2025.109155","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal seizures are a common occurrence due to a variety of etiologies such as hypoxic-ischemic encephalopathy, hypoglycemia, infections, or metabolic disorders. Levetiracetam (LEV) and Phenobarbital (PB) have been the primary choices to control seizures and their safety and efficacy have been widely investigated.</div></div><div><h3>Objective</h3><div>To collate studies comparing the efficacy and safety of LEV and PB and conclude on the safety profiles and adverse events of these anti-seizure medications (ASM).</div></div><div><h3>Methods</h3><div>We performed the analysis following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. PubMed, Cochrane Library, and Scopus databases were searched from the date of inception to October 2023. Search words “infant” or “newborn” “neonate”, “seizure” or “epilepsy” or “convulsant” and “anticonvulsant” or “antiepileptic” were used, and studies that fitted our strict inclusion and exclusion were pooled to conclude on the comparative effects of LEV and PB.</div></div><div><h3>Results</h3><div>Of the 15 studies included in the meta-analysis, eight were Randomized Control Trials and seven were Cohorts. Of these studies, nine reported adverse effects with PB whereas only five reported adverse effects with LEV. The most commonly documented adverse effects with both ASM were hypotension and respiratory depression with only one of the studies also reporting sedation with LEV. All fifteen studies included in the meta-analysis reported the primary outcome. There was no significant difference in efficacy between LEV and PB for treating neonatal seizures (OR =1.17 95 % CI 0.76,1.79 P = 0.06).</div></div><div><h3>Conclusion</h3><div>Upon pooling the various studies, no significant difference was found in the efficacies of the two medications compared. However, levetiracetam had a more favorable adverse effect profile in comparison to that PB.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109155"},"PeriodicalIF":1.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096208","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":"Prediction of venous thromboembolism after spontaneous intracerebral hemorrhage based on machine learning","authors":"Yuanyou Li ,&nbsp;Rui Tian ,&nbsp;Kejia Liu ,&nbsp;Fatian Wu ,&nbsp;Tianyu Feng ,&nbsp;Yi Liu ,&nbsp;Chao You ,&nbsp;Rui Guo","doi":"10.1016/j.clineuro.2025.109159","DOIUrl":"10.1016/j.clineuro.2025.109159","url":null,"abstract":"<div><div>This multicenter retrospective study aimed to develop and validate machine learning models for predicting venous thromboembolism (VTE) following spontaneous intracerebral hemorrhage (SICH). The analysis included 988 SICH patients (748 from West China Hospital for model development and 240 from Leshan People's Hospital for external validation), incorporating comprehensive clinical, radiological, and laboratory parameters. Five machine learning algorithms, including XGBoost, were evaluated using a 3:1 training-test split and external validation approach.</div></div><div><h3>Results</h3><div>demonstrated significantly higher VTE incidence in patients with greater anticoagulant exposure (p &lt; 0.05), intraventricular hemorrhage (68.75 % vs 51.32 %), and infratentorial involvement (17.19 % vs 7.6 %). VTE patients exhibited larger hematoma volumes (33.5 ± 7.2 vs 25.0 ± 6.8 mL), tachycardia (88.0 ± 14.2 vs 82.0 ± 12.1 bpm), lower Glasgow Coma Scale (GCS) scores (8.0 ± 3.1 vs 13.0 ± 2.8), and elevated inflammatory markers. External validation confirmed these findings, with older age, larger hematomas, and higher D-dimer levels in VTE cases. XGBoost achieved superior predictive performance (AUC: 0.87 training, 0.81 test, 0.80 validation), with SHapley Additive exPlanations (SHAP) analysis identifying D-dimer, hematoma volume, and neutrophil count as key predictors. Conclusion:‌ XGBoost outperforms conventional methods in predicting post-SICH VTE through multidimensional data integration, providing a robust tool for personalized risk stratification and clinical prevention strategies.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109159"},"PeriodicalIF":1.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091215","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":"Prevalence of cardiovascular and cerebrovascular disease in idiopathic intracranial hypertension","authors":"Ilene Trinh ,&nbsp;Jacqueline K. Shaia ,&nbsp;David Kaelber ,&nbsp;Rishi P. Singh ,&nbsp;Katherine E. Talcott ,&nbsp;Devon A. Cohen","doi":"10.1016/j.clineuro.2025.109158","DOIUrl":"10.1016/j.clineuro.2025.109158","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Idiopathic intracranial hypertension (IIH) is a neurometabolic disease that can cause debilitating vision loss and headaches, and is associated with obesity. Recent studies have suggested an increased risk of cardiovascular disease in patients with IIH, although data is scarce. The objective of this study was to investigate the prevalence of cardiovascular and cerebrovascular events and associated risk factors in patients with IIH.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted using a large aggregate multicenter research platform (TriNetX) consisting of 70 healthcare organizations in the United States with over 115 million patients. Prevalence of outcomes including cerebrovascular disease (CVD), myocardial infarction, heart failure, essential hypertension (HTN), and type II diabetes mellitus (DM) were calculated and compared between the IIH group and two controls: the general population and patients with high body mass index (BMI ≥ 30 kg/m²). Chi Square two-sided tests were used to compare groups where a p-value of &lt; 0.01 was deemed significant. Prevalence odds ratios (OR) were performed and 95 % confidence intervals calculated.</div></div><div><h3>Results</h3><div>CVD prevalence was 7.13 % in IIH patients compared to 3.13 % in the total population and 5.47 % in high BMI controls (p &lt; 0.0001). With age stratification, CVD rates were higher in IIH patients at ages 0–70 compared to the total population and high BMI patients (p &lt; 0.0001). IIH patients had 2.38 times increased odds of having CVD compared to the total population (95 % CI, 2.26–2.50) and 1.33 times increased odds compared to high BMI patients (95 % CI 1.26–1.40). Prevalence of HTN was 23.1 % in IIH patients, which was higher compared to the total population (14.48 %) and lower compared to high BMI controls (35.66 %) (p &lt; 0.0001). However, HTN rates were higher in IIH patients at earlier ages (0−60) (p &lt; 0.0001). Compared to high BMI controls, IIH had decreased odds of DM and myocardial infarction (p &lt; 0.01).</div></div><div><h3>Discussion</h3><div>Patients with IIH had significantly higher rates of CVD and HTN in patients ≤ 60 years of age compared to the general and obesity populations in the United States. Therefore, we recommend early screening for these morbidities in the setting of IIH.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109158"},"PeriodicalIF":1.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085263","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":"Trends and outcomes of tenecteplase and alteplase usage for ischemic stroke in the United States","authors":"Mohammad Anadani ,&nbsp;Lina Hamoud ,&nbsp;Bruce Chase ,&nbsp;Chi Wang ,&nbsp;Amin Kassam ,&nbsp;Mohammad H. Akanda ,&nbsp;Adam de Havenon ,&nbsp;Sami Al Kassab ,&nbsp;Benjamin Gory ,&nbsp;Markos G. Kashiouris ,&nbsp;Mouhammad A. Jumaa","doi":"10.1016/j.clineuro.2025.109150","DOIUrl":"10.1016/j.clineuro.2025.109150","url":null,"abstract":"<div><h3>Background</h3><div>Tenecteplase (TNK) has recently become a compelling alternative to alteplase. This study aims to compare the usage trends and outcomes of TNK versus alteplase in acute ischemic stroke.</div></div><div><h3>Methods</h3><div>We conducted retrospective analysis using the Cosmos Epic database to include ischemic stroke patients treated with intravenous thrombolysis between 1 and 1–2016 and 12–31–2023. The primary outcomes were 1) trend in the usage of alteplase vs. TNK and 2) home discharge. Secondary outcomes included 90-day mortality, in-hospital mortality, and rates of intracranial hemorrhage.</div></div><div><h3>Results</h3><div>The study included 71,150 patients (mean age, 67.46 years; 50.2 % male; mean NIH Stroke Scale score, 4.34; 73 % White). A total of 52591 patients (73 %) were treated with alteplase. Over the study period, the use of alteplase decreased, whereas TNK usage increased, surpassing alteplase by mid-2022. The rate of home discharge was higher in the TNK group (59.3 % vs. 58 %; P = .002), and TNK was associated with home discharge (odds ratio [OR], 1.17; 95 % CI, 1.12–1.22). There was no significant association between TNK and 90-day mortality. Intracranial hemorrhage was more common in the TNK group. In a sensitivity analysis restricted to patients who received endovascular therapy, TNK was associated with higher odds of home discharge, lower odds of in-hospital mortality, and higher odds of intracranial hemorrhage.</div></div><div><h3>Conclusion</h3><div>Since 2022, the utilization of TNK for acute ischemic stroke in the US has increased significantly. TNK was associated with a higher likelihood of home discharge compared to alteplase. These findings support the use of TNK in clinical practice.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109150"},"PeriodicalIF":1.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085242","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":"U-shaped association between serum ferritin and futile recanalization in patients with acute ischemic stroke after mechanical thrombectomy","authors":"Meijuan Dong ,&nbsp;Xijing Chen ,&nbsp;Ruoyu Zhou ,&nbsp;Yongtao Guo ,&nbsp;Song Xu ,&nbsp;Kun An ,&nbsp;MingChao Li","doi":"10.1016/j.clineuro.2025.109153","DOIUrl":"10.1016/j.clineuro.2025.109153","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to investigate the association between serum ferritin levels and futile recanalization (FR) in patients with acute ischemic stroke (AIS) due to large vessel occlusion following mechanical thrombectomy (MT).</div></div><div><h3>Methods</h3><div>Patients with acute ischemic stroke due to large vessel occlusion who underwent mechanical thrombectomy (MT) at Huaian NO.1 People′s Hospital from August 2017 to January 2024 were retrospectively analysed. A total of 609 patients were enrolled in this study and were divided into effective and futile recanalization groups based on mRS scores at 90 days after MT. Multivariate logistic regression analysis was used to investigate the independent predictors of FR. The association between ferritin and FR was analysed after adjustment for confounders. Receiver operating characteristics (ROC) analysis was performed to determine the sensitivity and specificity of the model for predicting FR. Restricted cubic spline was used to describe the dose-response relationship between serum ferritin and FR.</div></div><div><h3>Results</h3><div>Multivariate logistic regression analysis showed that ferritin was independently associated with FR. When serum ferritin was analysed as a continuous variable, there was a 1.048-fold (95 %CI: 1.017–1.080, <em>P</em> = 0.002) increased risk of FR per 20 ng/ml increase in ferritin, after adjustment for confounders. When analyzed by quartiles of ferritin levels, compared to Q2 (127–217 ng/ml) after adjusting for confounding factors, the higher serum ferritin groups Q3 (217–326 ng/ml) and Q4 (≥326 ng/ml) exhibited 2.275-fold (95 % CI: 1.309–3.955, <em>P</em> = 0.004) and 2.911-fold (95 % CI: 1.646–5.150, P &lt; 0.001) increased risks of FR, respectively, while the lower serum ferritin group Q1 (≤127 ng/ml) showed a non-significant 1.586-fold (95 % CI: 0.911–2.760, P = 0.103) increase in risk.</div><div>The AUC-ROC of the model was 0.843 (95 %CI: 0.813–0.874, <em>P</em>＜0.001) with a sensitivity of 66.5 % and a specificity of 86.2 %. Restricted cubic spline analysis showed a U-shaped association between serum ferritin and FR. The lowest risk of FR was observed at a serum ferritin concentration of 162 ng/ml. The risk increased significantly when ferritin levels were either below 62.22 ng/ml or above 272.71 ng/ml (<em>P</em> for nonlinearity = 0.003).</div></div><div><h3>Conclusions</h3><div>In patients with AIS due to large vessel occlusion, serum ferritin within a specific concentration range is physiologically essential, while both hypoferritinemia and hyperferritinemia are independently associated with an increased risk of FR, demonstrating a significant nonlinear U-shaped relationship.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109153"},"PeriodicalIF":1.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046349","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":"Failure to correct the fractional curve in adult spinal deformity surgery is associated with rod fractures","authors":"Harsh Jain ,&nbsp;Omar Zakieh ,&nbsp;Hani Chanbour ,&nbsp;Julian G. Lugo-Pico ,&nbsp;Amir M. Abtahi ,&nbsp;Byron F. Stephens ,&nbsp;Scott L. Zuckerman","doi":"10.1016/j.clineuro.2025.109152","DOIUrl":"10.1016/j.clineuro.2025.109152","url":null,"abstract":"<div><h3>Introduction</h3><div>Coronal malalignment (CM) remains an understudied and challenging problem in adult spinal deformity (ASD) surgery, and the impact of the lumbosacral fractional curve (LSF) correction on postoperative outcomes remains poorly understood. In patients undergoing ASD surgery with preoperative CM, we sought to determine the impact of LSF correction on: 1) radiographic variables, 2) mechanical complications, and 3) patient-reported outcome measures (PROMs).</div></div><div><h3>Methods</h3><div>A retrospective cohort study (2011–21) included patients undergoing ASD surgery with preoperative CM (coronal vertical axis, CVA&gt;3 cm), ≥ 5-level fusion, instrumented to ilium, and ≥ 2-year follow-up. Primary exposure variables were preoperative/postoperative LSF. LSF correction was defined as an improvement of ≥ 5°. Postoperative outcomes included mechanical complications, reoperations, and PROMs. Bivariate and multivariable analyses controlling for age, sex, osteoporosis, preoperative maximum Cobb angle and lumbar interbody fusion were performed.</div></div><div><h3>Results</h3><div>Of 52 patients undergoing ASD surgery with preoperative CM, instrumented to pelvis (68.2 ± 11.1 years, 23.1 % males), mean instrumented levels were 11.8 ± 3.6. Mean LSF preoperatively was 11.1 ± 8.4º vs. 6.9 ± 6.4º postoperatively (p &lt; 0.001), with a mean correction of 4.2 ± 6.2º. Moreover, only 24 (46.2 %) patients had an improved LSF. Similar postoperative CVA or maximum Cobb angle were seen between the groups. Patients with an improved LSF had reduced rate of rod fractures (12.5 % vs. 39.3 %,p = 0.030), with no difference in other mechanical complications, reoperations, or PROMs. The association between LSF correction and reduced rod fractures was confirmed on multivariable logistic regression analysis (OR=0.18, 95 %CI:0.04–0.86,p = 0.031).</div></div><div><h3>Conclusion</h3><div>In patients undergoing ASD surgery with CM, 54 % patients failed to show a ≥ 5° improvement in LSF. Failure to correct LSF resulted in higher rates of rod fracture, with no impact on other mechanical complications or PROMs. Though the current pilot, preliminary study represents a small sample size in a single institution, meticulous attention to correcting the LSF may mitigate the risk of rod fracture and the potential need for reoperation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109152"},"PeriodicalIF":1.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039241","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":"Delayed detection of in-hospital acute ischemic stroke: The impact of MRI and inpatient departments","authors":"Jun Karakama ,&nbsp;Sakyo Hirai ,&nbsp;Ryoichi Hanazawa ,&nbsp;Masataka Yoshimura ,&nbsp;Yohei Sato ,&nbsp;Naoki Taira ,&nbsp;Keigo Shigeta ,&nbsp;Kana Sawada ,&nbsp;Yoshihisa Kawano ,&nbsp;Yoshiki Obata ,&nbsp;Yosuke Ishii ,&nbsp;Mariko Ishikawa ,&nbsp;Mutsuya Hara ,&nbsp;Motoshige Yamashina ,&nbsp;Tadahiro Ishiwada ,&nbsp;Hirotaka Sagawa ,&nbsp;Satoru Takahashi ,&nbsp;Hikaru Wakabayashi ,&nbsp;Kyohei Fujita ,&nbsp;Jiro Aoyama ,&nbsp;Kazutaka Sumita","doi":"10.1016/j.clineuro.2025.109151","DOIUrl":"10.1016/j.clineuro.2025.109151","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigated the characteristics of in-hospital acute ischemic stroke (iHAIS) and factors associated with poor outcomes.</div></div><div><h3>Methods</h3><div>This retrospective, multicenter, observational cohort study included patients with pre-stroke modified Rankin Scale (mRS) 0–2 who underwent mechanical thrombectomy for iHAIS between April 2014 and August 2023. Focused on stroke detection to imaging (DTI) and stroke detection to groin puncture (DTP), we examined the association between these workflows and clinical outcomes and the factors associated with delayed DTI and DTP. Clinical outcomes were evaluated using the mRS at discharge, with mRS 3–6 defined as poor clinical outcomes.</div></div><div><h3>Results</h3><div>Overall, 110 (78.0 %) of 141 patients with iHAIS had poor clinical outcomes at discharge. Statistical analyses revealed that DTP tended to be associated with poor outcomes (odds ratio, 2.22 [95 % confidence interval (CI), 0.93–5.30], p = 0.072). Magnetic resonance imaging (MRI) diagnosis was associated with prolonged DTP (HR, 0.52 [95 % CI, 0.36–0.75], p = 0.001) and the hospitalization in the neurology or neurosurgery department tended to have prolonged DTP (HR, 0.61 [95 % CI, 0.38–1.01], p = 0.053).</div></div><div><h3>Conclusions</h3><div>In patients with iHAIS, MRI diagnosis and hospitalization in the neurology or neurosurgery department were associated with delayed DTP, which is linked to poor outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109151"},"PeriodicalIF":1.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060793","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":"Comparative efficacy and safety of tricyclic antidepressants vs. serotonin-norepinephrine reuptake inhibitors for migraine prophylaxis: A systematic review and meta-analysis","authors":"Sufyan Shahid ,&nbsp;Minahil Iqbal ,&nbsp;Umna Bhatti ,&nbsp;Syed Ibrahim Ali ,&nbsp;Abdullah Farooq ,&nbsp;Ayesha Batool ,&nbsp;Humza Saeed ,&nbsp;Hasiba Karimi ,&nbsp;Muneeb Saifullah ,&nbsp;Shayan Marsia","doi":"10.1016/j.clineuro.2025.109149","DOIUrl":"10.1016/j.clineuro.2025.109149","url":null,"abstract":"<div><h3>Introduction</h3><div>Migraine is a leading cause of global disability, yet research on prophylactic interventions remains limited due to unclear underlying mechanisms. We performed a systematic review and meta-analysis to evaluate the comparative efficacy and safety of tricyclic antidepressants (TCAs) versus serotonin-norepinephrine reuptake inhibitors (SNRIs) for migraine prophylaxis.</div></div><div><h3>Methods</h3><div>A systematic review was executed in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane Central databases were searched from inception to December, 2024 for randomized controlled trials (RCTs) comparing selective norepinephrine reuptake inhibitors (SNRIs) with tricyclic antidepressants (TCAs) in migraine patients. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the RoB 2 tool. A random-effects model was applied to pool effect estimates, reporting mean differences (MD) and risk ratios (RR) with 95 % confidence intervals (CIs), using Review Manager v.5.4.</div></div><div><h3>Results</h3><div>Out of 4253 screened articles, a total of three randomized trials met the inclusion criteria, encompassing 333 patients (mean age 32.4 years, 68 % female) with a mean follow-up of 10 weeks. Both SNRI and TCA groups reduced monthly migraine days (MMD) compared to baseline, with no significant difference between them (MD = −0.03, 95 % CI: −0.67–0.61; p = 0.93). However, SNRIs demonstrated a marginally greater reduction in migraine attack duration (MD = −0.71, 95 % CI: −1.41 to −0.01; p = 0.05) and a significantly lower incidence of adverse events compared to TCAs (RR = 0.68, 95 % CI: 0.51–0.91; p = 0.009).</div></div><div><h3>Conclusion</h3><div>SNRIs demonstrated comparable efficacy to TCAs in reducing monthly migraine days, with shorter attack duration and fewer adverse events.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109149"},"PeriodicalIF":1.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057363","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":"Role for long term treatment in NMOSD induced by the immune checkpoint inhibitor cemiplimab","authors":"Fien Oelbrandt ,&nbsp;Romain Marignier ,&nbsp;Bénédicte Dubois","doi":"10.1016/j.clineuro.2025.109120","DOIUrl":"10.1016/j.clineuro.2025.109120","url":null,"abstract":"<div><div>We present the case of a 54-year-old patient treated with cemiplimab, an immune checkpoint inhibitor (ICI), for multiple basal cell carcinomas in the context of Gorlin Goltz syndrome. Gorlin Goltz syndrome is an autosomal dominant multisystem disorder characterized, among other features, by multiple early-onset basal cell carcinomas (BCCs). After receiving Cemiplimab, she developed aquaporin-4 antibody (AQP4-Ab) positive neuromyelitis optica spectrum disorder (NMOSD). While several case reports have documented NMOSD induced by other ICIs, this is the first case associated with cemiplimab. Although guidelines exist for the acute treatment of a first relapse of ICI-induced NMOSD, long-term management to prevent new relapses remains challenging. We believe that these patients require maintenance therapy to prevent future relapses and propose rituximab or tocilizumab as suitable options.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"257 ","pages":"Article 109120"},"PeriodicalIF":1.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996672","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":"Impact of traumatic brain injury severity on anterior pituitary function: A prospective study","authors":"R. Midhunraj ,&nbsp;Saifullah Khalid ,&nbsp;Mohd. Khalid ,&nbsp;Hamid Ashraf ,&nbsp;Abul Bashar Mohammad Kamrul-Hasan","doi":"10.1016/j.clineuro.2025.109148","DOIUrl":"10.1016/j.clineuro.2025.109148","url":null,"abstract":"<div><h3>Introduction</h3><div>India experiences the highest number of road traffic fatalities globally. Acquired hypopituitarism is a common sequela in patients who sustain traumatic brain injury (TBI). This study aimed to investigate the prevalence and imaging characteristics of hypopituitarism in patients with TBI at a tertiary care centre in North India.</div></div><div><h3>Materials and methods</h3><div>Our prospective study included 76 patients with TBI (mild, moderate, or severe), whom we followed for 24 weeks at a tertiary care centre in North India. All included subjects underwent assessments of anterior pituitary hormones (LH, FSH, TSH, T4, cortisol, testosterone, estrogen) at baseline and again at 24 weeks, as well as an MRI. Those who had low cortisol level were subjected to glucagon stimulation test and cortisol and growth hormone was measured after stimulation in these subjects. We recorded the severity of traumatic brain injury, findings from CT scans such as skull fractures, and imaging characteristics of pituitary gland in all the patients by magnetic resonance imaging (MRI). Appropriate statistical analyses, including logistic regression, were utilized to determine the determinants of hypopituitarism.</div></div><div><h3>Results</h3><div>Among the 76 patients, the prevalence of hypopituitarism was 11.84 % in the acute stage and 2.63 % at 24 weeks. Hypopituitarism significantly correlated with injury severity (p &lt; 0.001) and imaging abnormalities observed on MRI. The main imaging findings on MRI were heterogeneous signal intensity, subacute haemorrhage in the anterior pituitary, and reduced pituitary height. A statistically significant decrease was observed in LH (p = 0.009) and FSH levels (p = 0.039) from baseline to 24 weeks. The severity of the injury and the presence of base skull fractures were significantly associated with hypopituitarism (p &lt; 0.001).</div></div><div><h3>Discussion</h3><div>Our results highlight the importance of checking pituitary function in TBI patients, particularly those with moderate to severe injuries and skull base fractures, to quickly find and treat hormonal deficiencies, which can improve long-term results. Future studies should concentrate on longer follow-up periods and more sophisticated imaging methods to gain a more profound understanding of the mechanisms underlying post-traumatic hypopituitarism.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"258 ","pages":"Article 109148"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996975","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}