European Journal of Neurology最新文献

{"title":"Cognitive Impairment Beyond Neurodegenerative Dementias: New Frontiers for Cognition in Neurological Disease.","authors":"Paulo Caramelli, Isabel Pavão Martins","doi":"10.1111/ene.70614","DOIUrl":"10.1111/ene.70614","url":null,"abstract":"","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 5","pages":"e70614"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Population-Based Study of Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome During Pregnancy and Puerperium.","authors":"Vest Teresa, Verho Liisa, Rantanen Kirsi, Aarnio Karoliina, Korhonen Aino, Richardt Anna, Gissler Mika, Tikkanen Minna, Laivuori Hannele, Ijäs Petra","doi":"10.1111/ene.70615","DOIUrl":"10.1111/ene.70615","url":null,"abstract":"<p><strong>Background: </strong>Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are related neurovascular conditions, with pregnancy as a shared risk factor. In this study, we aimed to describe shared and distinctive risk factors and outcomes in patients with pregnancy-associated PRES and/or RCVS.</p><p><strong>Methods: </strong>In this retrospective, nationwide, population-based cohort study, the national healthcare registers were utilized to identify women with PRES and/or RCVS during pregnancy or puerperium during 1987-2016. Subsequent pregnancies, vascular events, and deaths until 2022 were identified. Medical records were reviewed to classify cerebrovascular events and collect clinical details.</p><p><strong>Results: </strong>In total, 27 patients had pregnancy-associated PRES and/or RCVS (18 PRES; 5 PRES + RCVS; 4 RCVS) during 1987-2016, resulting in an incidence of 1.52 per 100,000 (95% Cl 1.02-2.18) deliveries. All patients with PRES ± RCVS had preeclampsia with severe features during late pregnancy or early puerperium. In contrast, isolated RCVS showed a weaker association to preeclampsia and occurred in late puerperium, with a median puerperal day of 26 (IQR 11-45). Altogether, 40.7% of all patients had a stroke, 90.9% of which were hemorrhagic. Preeclampsia was diagnosed in 90.9% of stroke patients. Maternal mortality was 3.7%, whereas perinatal mortality was 7.4%. At 3 months, 92.3% had a good recovery (mRS 0-2). During follow-up, stroke recurrence was 3.7% and 33.3% had subsequent uneventful, full-term pregnancies.</p><p><strong>Conclusions: </strong>Pregnancy-associated PRES and RCVS are potentially life-threatening, rare conditions that can result in hemorrhagic stroke. PRES ± RCVS is strongly associated with preeclampsia with severe features, whereas puerperal RCVS seems to be a separate, later-occurring condition.</p>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 5","pages":"e70615"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Stroke Mimics: Patient Characteristics, CT-Based Multimodal Imaging and Long-Term Outcome in a Comparative Cohort Study.","authors":"Filipa Bastos, Davide Strambo, Alexander Salerno, Vincent Dunet, Selma Aybek, Patrik Michel","doi":"10.1111/ene.70617","DOIUrl":"10.1111/ene.70617","url":null,"abstract":"<p><strong>Background and purpose: </strong>Functional stroke-like episodes (FSMs) are an increasingly recognised stroke mimic with demographic and clinical characteristics that differ from acute ischaemic strokes (AISs) but have unclear long-term outcomes.</p><p><strong>Materials and methods: </strong>We report retrospective data on consecutive patients with FSM who underwent acute perfusion-CT (PCT) admitted to Lausanne University Hospital (2003-2017). We compared them to all contemporaneous AISs undergoing PCT from the Acute-STroke-Registry-and-Analysis-of-Lausanne (ASTRAL).</p><p><strong>Results: </strong>Twenty-five FSMs and 3201 control-AISs were included. FSM patients were significantly younger (median 43 vs. 73 years, adjusted odds ratio (OR_adj) 0.92), had a higher incidence of psychiatric disorders (OR_adj 5.33/17.07), and over half had a prior history of neurological and non-neurological functional disorders. FSM patients more often presented decreased vigilance (OR_adj = 9.28) and sensory deficits (OR_adj = 3.87), and less visual field defects (OR_adj = 0.14) and dysarthria (OR_adj = 0.20). FSM patients showed no significant changes on plain-CT and PCT. Acute revascularisation rates were similar in both groups (48% vs. 43%). Follow-up at 3-months revealed significant handicap in 41% of patients, similar to the control group in propensity-score-matched analysis, and lower mortality (0% vs. 20%, p_adj 0.04). After a median of 9 years follow-up, FSM patients failed to functionally improve further and 55% experienced additional functional neurological events.</p><p><strong>Conclusion: </strong>In this single-centre cohort of consecutive FSMs undergoing acute PCT, we identified distinctive demographic and clinical features, normal CT-based neuroimaging, but still a high thrombolysis rate. Long-term observation revealed a high rate of recurrent functional events and persistent disability, suggesting the need for more effective treatment and regular follow-up.</p>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 5","pages":"e70617"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable Artificial Intelligence to Predict Neurocognitive Disorder Progression in Multiple Sclerosis Using MRI and Clinical Data.","authors":"Loredana Storelli, Damiano Mistri, Alice Mastropasqua, Marta Grosselle, Paolo Preziosa, Lucrezia Rossi, Massimo Filippi, Maria A Rocca","doi":"10.1111/ene.70568","DOIUrl":"https://doi.org/10.1111/ene.70568","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is common in multiple sclerosis (MS), yet the application of diagnostic frameworks of Neurocognitive Disorders (NCDs) is limited. Additionally, the integration of multimodal data for predicting cognitive outcomes using artificial intelligence (AI) remains underexplored. This study aimed to characterize NCDs in MS and predict cognitive worsening using an explainable deep learning model trained on MRI and clinical data.</p><p><strong>Methods: </strong>Two-hundred twenty-four MS patients and 115 healthy controls (HC) underwent 3.0 T MRI and clinical assessment at baseline. MS patients also completed neuropsychological testing, including estimation of z-cognitive reserve, at baseline and after a median follow-up of 3.4 (interquartile range = [2.0; 6.1]) years. MS patients were classified as Mild or Major NCD according to the Diagnostic and Statistical Manual of Mental Disorders criteria at baseline, and as \"stable\" or \"worsened\" based on cognitive changes at follow-up. A deep learning model was trained on baseline T1-weighted MRI, demographic, clinical, and brain volumetric data to predict cognitive decline, with explainability methods used to interpret the model's decisions.</p><p><strong>Results: </strong>At baseline, 4% of patients had Mild and 11% Major NCD. At follow-up, 12% showed cognitive decline. The deep learning model predicted follow-up cognitive status with 90% accuracy. Explainability models identified the most relevant predictors, in order of importance: cortical gray matter volume, age, thalamic and hippocampal volumes, T2 lesion volume, and z-cognitive reserve.</p><p><strong>Conclusions: </strong>The proposed multimodal AI approach demonstrated robust performance and highlighted relevant brain regions associated with cognitive worsening, underscoring its potential for personalized cognitive assessment and monitoring in MS.</p>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 5","pages":"e70568"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and Functional Characterization of Novel and Recurrent NTRK1 Variants in Chinese Families With Congenital Insensitivity to Pain With Anhidrosis: A Combined Clinical, Genetic, and Functional Study.","authors":"Yaqiong Ren, Yue Cao, Fangfang Cheng, Jin Dai, Yuan Zhang, Xinxin Wang, Jiali Chen, Lijun Zhou, Xiaoxiang Song, Hongying Wang","doi":"10.1111/ene.70610","DOIUrl":"https://doi.org/10.1111/ene.70610","url":null,"abstract":"<p><strong>Background: </strong>Congenital insensitivity to pain with anhidrosis (CIPA) is an autosomal recessive disorder caused by variants in the NTRK1 gene (encoding TrkA). The identification and functional analysis of these variants are essential for elucidating the genetic basis of the disease and improving diagnostic efficiency. In this study, we investigated four unrelated Chinese families with CIPA.</p><p><strong>Methods: </strong>We employed next-generation sequencing to identify the causative genetic variants in 13 individuals (5 affected and 8 unaffected) from four unrelated Chinese families. A comprehensive bioinformatics and in vitro functional analyses were subsequently performed to assess the pathogenicity of the identified variants.</p><p><strong>Results: </strong>We identified seven variants in the NTRK1 gene, including two novel variants (c.2285C > A and c.1990_1993delinsTGCT). Functional characterization of five variants (four missense: c.632 T > A, c.1942C > T, c.2122G > A and c.2285C > A; and one indel: c.1990_1993delinsTGCT) revealed that they disrupted distinct steps within the nerve growth factor (NGF)-TrkA pathway, including TrkA glycosylation and phosphorylation, NGF-TrkA binding, and downstream signaling pathway.</p><p><strong>Conclusions: </strong>Our findings expand the mutational spectrum of NTRK1 with two novel variants associated with CIPA and delineate the specific step(s) within the NGF-TrkA pathway affected by each variant, thereby establishing a link between genotype and the observed phenotypic severity. This study provides a crucial theoretical and experimental foundation for the future development of personalized therapies for CIPA patients.</p>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 5","pages":"e70610"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene–Environment Interactions for Alzheimer's Disease Pathology in Cognitively Normal Adults: The CABLE Study","authors":"Ze-Xin Guo,&nbsp;Xiao-Yu He,&nbsp;Yi-Jun Ge,&nbsp;Bing Zhao,&nbsp;Liang-Yu Huang,&nbsp;Shi-Dong Chen,&nbsp;Yan Fu,&nbsp;Pei-Yang Gao,&nbsp;Ze-Hu Sheng,&nbsp;Yi-Ming Huang,&nbsp;Qiong-Yao Li,&nbsp;Lan Tan","doi":"10.1111/ene.70558","DOIUrl":"10.1111/ene.70558","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Characterizing the gene–environment interactions with early pathological changes in Alzheimer's disease (AD) is critical to precision medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited 1007 cognitively normal participants from the Chinese Alzheimer's Biomarker and LifestylE (CABLE) study. Multiple linear regression models were applied to explore the associations between polygenic risk scores (PRSs) and cerebrospinal fluid (CSF) biomarkers of AD, the interactions between PRSs and potentially modifiable risk factors, and the relationships between lifestyle categories and CSF AD biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A higher AD-PRS was associated with more severe amyloidosis, as indicated by pTau/Aβ42 (<i>β</i> = 0.091, <i>p</i> = 0.005) and tTau/Aβ42 (<i>β</i> = 0.092, <i>p</i> = 0.004). There were significant interactions between AD-PRS and three modifiable risk factors (anemia, gingivitis, and anxiety) in AD biomarker ratios. Stratified analyses by AD-PRS indicated that anemia was associated with higher pTau/Aβ42 and tTau/Aβ42 in the first and second quartiles, while gingivitis and anxiety correlated with amyloidosis in the fourth quartile (all <i>p</i> &lt; 0.05). Additionally, a favorable lifestyle was associated with milder amyloidosis in the high genetic risk group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AD-PRS was associated with amyloidosis severity. The associations between modified risk factors (anemia, gingivitis, and anxiety) and biomarker ratios differed by genetic risk strata. Moreover, a healthy lifestyle was associated with less amyloid burden in individuals with high genetic risk. These findings can be used to generate hypotheses for future longitudinal studies to investigate whether targeted management of these factors influences AD pathological progression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Older Adults, Anti-Amyloid Therapy, and Frailty: What Oncology Can Teach Us","authors":"Miguel Germán Borda,&nbsp;Kevin O'Hara-Veintimilla,&nbsp;Dag Aarsland","doi":"10.1111/ene.70567","DOIUrl":"10.1111/ene.70567","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anti-amyloid therapies, such as lecanemab or donanemab, represent the first disease-modifying treatments approved for early Alzheimer's disease (AD) in individuals with confirmed amyloid pathology. Their implementation in routine care raises important challenges, particularly in older adults with heterogeneous functional reserve and multimorbidity. We address the role of frailty in refining clinical decision-making for anti-amyloid therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This short communication presents a conceptual discussion informed by geriatric oncology, where frailty assessment and comprehensive geriatric assessment (CGA) are routinely used to individualize treatment in heterogeneous older populations. We describe how similar principles may be applied to anti-amyloid monoclonal antibodies once regulatory eligibility has been established, and outline a frailty-informed conceptual framework to support clinical decision-making in routine care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This conceptual analysis proposes a stepwise, frailty-informed clinical framework that integrates regulatory eligibility assessment with brief frailty screening and targeted comprehensive geriatric assessment. The framework defines differentiated clinical pathways for robust, pre-frail, and frail individuals, linking frailty status to specific decisions regarding treatment initiation, need for prehabilitation, intensity of monitoring, and consideration of treatment deferral. By embedding frailty assessment within routine clinical workflows, the framework operationalizes evaluation of physiological reserve, anticipates treatment burden and monitoring feasibility, and provides a structured approach to individualized risk–benefit appraisal for anti-amyloid therapies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Frailty-informed frameworks may offer a pragmatic and ethically grounded approach to support real-world implementation of anti-amyloid therapies, guiding treatment selection as well as longitudinal decisions on monitoring, continuation, and reassessment over time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality From Amyotrophic Lateral Sclerosis in Finland 1987–2022","authors":"Milla Laine,&nbsp;Jani Raitanen,&nbsp;Anssi Auvinen","doi":"10.1111/ene.70586","DOIUrl":"10.1111/ene.70586","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. We assessed changes in the mortality from ALS in Finland from 1987 to 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Numbers of deaths caused by ALS (ICD-10 code G12.2) and population sizes by sex, age group, and year were obtained from Statistics Finland. Crude and age-standardized mortality rates were calculated. The annual percentage change was estimated using Poisson regression, and joinpoint regression was used to identify changes in trend during the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mortality from ALS increased in Finland from 1987 to 2022. The age-standardized ALS mortality in the entire population was 2.24/100,000 in 1987 and 4.21/100,000 in 2022. The male: female ratio in mortality was 1.18. The age-standardized mortality increased on average by 1.7% (95% CI 1.5%–2.0%) annually. In men, the age-standardized mortality increased on average by 1.2% (95% CI 0.9%–1.6%) annually and in women by 2.0% (95% CI 1.6%–2.3%). The largest increase occurred in the oldest age group (70+ years), with an average annual increase of 2.4% (95% CI 2.0%–2.8%). In joinpoint regression, no changes in trend were identified overall or in men, but in women, the annual percentage change (APC) was 5.5% (95% CI 3.0%–8.0%) in 1987–1997 and 1.0% (95% CI 0.5%–1.4%) during 1997–2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Similar to some other countries, mortality from ALS has increased in Finland, nearly doubling in 35 years. Further research on possible reasons is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care in Europe: Safeguarding Compassion Amidst Changing End-of-Life Policies and Expanding Access to Medically Assisted Dying Position Statement on behalf of the European Academy of Neurology, the European Federation of Neurological Associations and OneNeurology","authors":"Katarina Rukavina,&nbsp;Marianne de Visser,&nbsp;Elena Moro,&nbsp;Kailash Bhatia,&nbsp;Paul Boon,&nbsp;Jana Midelfart-Hoff,&nbsp;Matilde Leonardi,&nbsp;Irena Rektorova,&nbsp;Gereon R. Fink,&nbsp;Nathalie Nasr,&nbsp;Alicia Gonzalez-Martinez,&nbsp;Claudio L. A. Bassetti,&nbsp;Ulf Kallweit,&nbsp;Michael Crean,&nbsp;Patrick Cras,&nbsp;Ludo Vanopdenbosch,&nbsp;Astri Arnesen,&nbsp;Joke Jaarsma,&nbsp;Alexander Bernhard Kowski,&nbsp;Simone Veronese,&nbsp;David Oliver,&nbsp;the European Academy of Neurology, the European Federation of Neurological Associations, OneNeurology","doi":"10.1111/ene.70591","DOIUrl":"10.1111/ene.70591","url":null,"abstract":"<p>Across Europe, there is a growing trend toward legislation allowing or expanding access to medically assisted dying. This term generally covers two practices: euthanasia, where a physician intentionally carries out an action to end a person's life, and physician-assisted suicide, where medical professionals provide the necessary means or support for a person to end their own life, with the final act carried out by the person. Various forms of medically assisted dying are already permitted in Austria, Belgium, Luxembourg, the Netherlands, Spain, and Switzerland. In addition, Germany is currently drafting legislation to regulate physician-assisted suicide, following a 2020 ruling by the Federal Constitutional Court that established a constitutional right to a self-determined death. In the United Kingdom, ongoing parliamentary debates and recent legislative initiatives indicate a possible shift toward permitting assisted dying under defined legal safeguards.</p><p>While public opinion remains divided, and we do not seek to make a moral or political judgment on medically assisted dying itself, we emphasize the significant clinical, ethical, and societal implications such legislation carries—particularly for individuals living with long-term neurological conditions (LTNC).</p><p>In light of these considerations, we strongly advocate for unrestricted access to high-quality palliative care for people living with LTNC. Palliative care provides essential relief from suffering, supports patients and their families in an integrated manner, and ensures dignity and quality of life throughout the disease trajectory. Medically assisted dying must never be introduced as a response to deficiencies in care provision or as an alternative to comprehensive, well-organized support.</p><p><b>Jana Midelfart-Hoff:</b> writing – review and editing. <b>Alicia Gonzalez-Martinez:</b> writing – review and editing. <b>Claudio L. A. Bassetti:</b> writing – review and editing. <b>Irena Rektorova:</b> writing – review and editing. <b>Paul Boon:</b> writing – review and editing. <b>Nathalie Nasr:</b> writing – review and editing. <b>Ulf Kallweit:</b> writing – review and editing. <b>Patrick Cras:</b> writing – review and editing, conceptualization, writing – original draft, supervision. <b>Michael Crean:</b> writing – review and editing. <b>David Oliver:</b> conceptualization, writing – original draft, writing – review and editing, supervision. <b>Simone Veronese:</b> conceptualization, writing – original draft, writing – review and editing, supervision. <b>Astri Arnesen:</b> writing – review and editing. <b>Alexander Bernhard Kowski:</b> writing – review and editing. <b>Marianne de Visser:</b> conceptualization, writing – original draft, supervision, writing – review and editing.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"33 4","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}