European Journal of Neurology最新文献

{"title":"Systematic Review and Meta-Analysis of Secondary Treatment Failure and Immunogenicity With Botulinum Neurotoxin A in Multiple Indications","authors":"Uwe Walter,&nbsp;Phillipp Albrecht,&nbsp;Warner Carr,&nbsp;Harald Hefter","doi":"10.1111/ene.70289","DOIUrl":"https://doi.org/10.1111/ene.70289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Botulinum neurotoxin A (BoNT-A) is recommended for the treatment of cervical dystonia (CD), spasticity, and blepharospasm. Some patients treated with BoNT-A have been reported to develop neutralizing antibodies (NAbs) against BoNT-A, which may result in reduced efficacy and, in some cases, secondary treatment failure (STF). Our aim was to investigate the incidence of STF and NAb positivity after treatment with one of three commercially-available BoNT-A formulations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis of STF and/or NAb positivity after treatment with abobotulinumtoxinA, incobotulinumtoxinA, or onabotulinumtoxinA in patients with CD, spasticity, or blepharospasm was conducted using PubMed, Embase, and Google Scholar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine unique studies reported in 29 publications assessed NAb positivity and were included. The meta-analysis showed that the proportions of patients developing STF were significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. Depending on the antibody test used, the proportions of patients developing NAbs were also significantly higher after treatment with abobotulinumtoxinA or onabotulinumtoxinA than with incobotulinumtoxinA for CD or spasticity. When data for all indications were pooled, proportions of NAb-positive patients were numerically higher with increasing mean doses of abobotulinumtoxinA or onabotulinumtoxinA. No patients treated exclusively with incobotulinumtoxinA were found to have developed immunogenic STF or persistent NAbs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of developing STF and NAbs appears to vary with indication and BoNT-A formulation. When the efficacy and safety of formulations are comparable, incobotulinumtoxinA may be recommended to avoid developing STF and immunogenicity, particularly for patients requiring higher doses and repeated treatments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716917","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":"Small Fiber Morphology and Function in Inclusion Body Myositis—A Multimodal Assessment Including Confocal Corneal Microscopy","authors":"Dietrich Sturm,&nbsp;Anne-Katrin Güttsches,&nbsp;Matthias Vorgerd,&nbsp;Peter Schwenkreis,&nbsp;Andrea Westermann,&nbsp;Tineke Greiner,&nbsp;Jan Vollert,&nbsp;Lynn Eitner,&nbsp;Christoph Maier,&nbsp;Johannes Forsting,&nbsp;Elena Enax-Krumova","doi":"10.1111/ene.70294","DOIUrl":"https://doi.org/10.1111/ene.70294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The extent of peripheral nerve involvement in inclusion body myositis (IBM) remains a topic of ongoing scientific discussion. In this study, we aimed to explore the involvement of small nerve fibers in IBM using a range of diagnostic methods, including, for the first time, corneal confocal microscopy (CCM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nineteen clinic-pathologically or clinically defined IBM patients underwent comprehensive clinical and electrophysiological examinations. A multimodal small fiber examination was performed, including a skin biopsy of the thigh and lower leg, quantitative sensory testing of the feet, and CCM. Pain levels and quality of life were also assessed using standardized questionnaires (Small Fiber Neuropathy Screening List, PainDETECT, Brief Pain Inventory, Short Form-36).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The motor and sensory neurography identified large fiber neuropathy in 67% of cases. Regarding small fibers evaluation, skin biopsy revealed pathological findings in 72% of cases and CCM in 32% of cases. Quantitative sensory testing results predominantly indicated large fiber damage (61%), with small fiber pathology identified in only 12% of cases. Questionnaire responses suggested a slight pain-related impact on patients' quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Small nerve fiber pathology is a frequent finding in skin biopsies of IBM patients. However, noninvasive methods like CCM appear less sensitive than skin biopsy for diagnosing small fiber pathology in IBM patients. Further studies are needed to refine diagnostic approaches and better understand the role of small fiber involvement in IBM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716931","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":"Beyond the Surface: Investigating the Potential Mechanisms of Non-Motor Symptoms in Myasthenia Gravis","authors":"Benqiao Wang,&nbsp;Dan Liu,&nbsp;Yingying Yang,&nbsp;Ruixia Zhu","doi":"10.1111/ene.70309","DOIUrl":"https://doi.org/10.1111/ene.70309","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction (NMJ), driven by T cells, mediated by B cells, and dependent on autoantibodies. In addition to the typical motor symptoms of fluctuating weakness, the non-motor symptoms are also prevalent among MG patients. This review aims to present the non-motor symptoms of MG and their potential pathogenesis, hoping to contribute to personalized diagnosis and treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review elaborates the non-motor symptoms of MG and systematically detail, for the first time, their potential pathogenic mechanisms, offering a new perspective for clinical evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The non-motor symptoms of MG include autonomic disorders (urinary, gastrointestinal, cardiovascular and ocular dysfunction), sensory disability (olfactory abnormalities, gustatory reduction and headaches), cognitive impairment, sleep disturbances, psychological problems (depression and anxiety), and TAMG-associated specific syndromes. Due to their insidious onset and lack of awareness, these symptoms are often overlooked. We review the non-motor symptoms of MG and first provide a systematic and detailed discussion on their potential mechanisms, including the influence of MG-specific antibodies (cross-reactivity of AChR-Ab, expression of MuSK-Ab, and striational antibodies at related functional sites), dysregulation of inflammatory factors and immune cells, collateral effects of motor symptoms, impacts of MG comorbidities, and paraneoplastic syndromes caused by thymoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Non-motor symptoms are common in MG patients. Given a series of potential mechanisms probably involved exploring these non-motor symptoms will not only enhance our understanding of MG but also aid in diagnosis and the development of precise, personalized treatments, ultimately improving the overall life quality of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716916","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":"Unreactive EEG Background Is Associated With Unfavorable Outcome in Patients With Disorders of Consciousness of Various Etiologies: An Adult Cohort Study","authors":"Sarah Benghanem,&nbsp;Jan Novy,&nbsp;Kaspar A. Schindler,&nbsp;Stephan Rüegg,&nbsp;Vincent Alvarez,&nbsp;A. O. Rossetti","doi":"10.1111/ene.70312","DOIUrl":"https://doi.org/10.1111/ene.70312","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Prognostication of neurological outcome in critically ill patients presents significant challenges. While EEG reactivity may be associated with outcome in hypoxic–ischemic brain injury (HIBI), it has received scarce attention in other etiological conditions. Our objective was to investigate the association of EEG reactivity to clinical outcome in patients with disorders of consciousness of various etiologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This is an ancillary study of the randomized CERTA trial (NCT03129438), which included adults with disorders of consciousness randomized to continuous EEG for 30–48 h or two routine EEGs (20–30 min). We explored the association between EEG characteristics and neurological outcome at 6 months, a modified Rankin Scale (mRS) 3–6 being considered unfavorable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 364 patients were included. Among them, 112 patients had HIBI, 85 intracranial hemorrhage (ICH), 28 ischemic stroke, 48 traumatic brain injury (TBI), 23 toxic-metabolic encephalopathy, 7 encephalitis, and 114 had unknown or other etiologies. In the overall cohort, abnormal background continuity (OR 2.33, 95% CI [1.15–4.76], <i>p</i> = 0.019), ictal–interictal continuum features (OR 2.78, 95% CI [1.16–6.67], <i>p</i> = 0.021) and unreactive background (OR 10.9, 95% CI [1.97–58.82], <i>p</i> = 0.006) were independently associated with unfavorable outcome. In the overall cohort, unreactive EEG had specificity of 97.3% (95% CI [94.3–100]) and sensitivity of 22.1% (95% CI [17–27.2]) for unfavorable outcome. In HIBI, specificity was 97% (95% CI [91.1–100]) and sensitivity 46.8% (95% CI [35.8–57.8]); in ICH, specificity was 94.1% (95% CI [83–100]) and sensitivity 8.8% (95% CI [2.05–15.55]); in TBI, specificity was 94.1% (95% CI [83–100]) and sensitivity 22.6% (95% CI [7.8–37.3]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this etiologically mixed cohort of critically ill adults, unreactive EEG predicted unfavorable outcome at 6 months with high specificity. EEG reactivity may reduce prognostic uncertainty not only for patients with HIBI, but also for other types of acute brain injury, such as TBI and ICH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714923","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":"Frequency and Relevance of MYD88L256P Mutation in Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Multifocal Motor Neuropathy","authors":"Alexandre Guérémy,&nbsp;John Boudjarane,&nbsp;Emilie Alazard,&nbsp;Etienne Fortanier,&nbsp;José Boucraut,&nbsp;Norman Abbou,&nbsp;Aude-Marie Grapperon,&nbsp;Ludivine Kouton,&nbsp;Annie Verschueren,&nbsp;Emmanuelle Salort-Campana,&nbsp;Shahram Attarian,&nbsp;Emilien Delmont","doi":"10.1111/ene.70310","DOIUrl":"https://doi.org/10.1111/ene.70310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The myeloid differentiation primary response 88 (MYD88) protein is involved in immune processes through the activation of the toll-like receptors and the interleukin-1 receptor. The acquired MYD88^L256P mutation enhances its activity and promotes inflammatory pathways and autoimmune diseases. Our aim was to determine the frequency of the MYD88^L256P mutation in chronic inflammatory demyelinating polyradiculoneuropathies (CIDP) and multifocal motor neuropathy with conduction blocks (MMN) and to assess its potential effect on the phenotype of the neuropathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MYD88^L256P mutation was tested in the peripheral blood mononuclear cells of 79 CIDP, 35 MMN, and 57 controls with nonimmune mediated disorders. Disease severity was assessed on disability scores, neurofilament light chain dosages, motor unit counts, and sums of the sensory and motor amplitudes on electrodiagnostic tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The MYD88^L256P mutation was more frequent in MMN patients (12/35, 34%; odds ratio 28 [95% confidence interval 4–1262]; <i>p</i> &lt; 0.001) and in CIDP patients (15/79, 19%; OR 13 [95% confidence interval 2–561]; <i>p</i> &lt; 0.001) than in controls (1/57, 2%). Patients with the MYD88^L256P mutation were more likely to have an IgM monoclonal gammopathy (13/27 vs. 8/87, <i>p</i> = 0.001). The MYD88^L256P mutation remains more frequent in CIDP and MMN patients, even if patients with IgM monoclonal gammopathy were excluded. All the other characteristics were similar, especially the severity of the disease and the efficacy of intravenous immunoglobulins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The MYD88^L256P mutation is frequent in CIDP and MMN patients, suggesting new pathophysiological hypotheses and new therapeutic approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714912","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":"Thrombolysis After Thrombectomy? Revisiting Intra-Arterial Therapy in the EVT Era","authors":"Diana Aguiar de Sousa","doi":"10.1111/ene.70315","DOIUrl":"https://doi.org/10.1111/ene.70315","url":null,"abstract":"&lt;p&gt;Three decades after the NINDS trial established intravenous thrombolysis (IVT) as the cornerstone of acute ischemic stroke treatment [&lt;span&gt;1&lt;/span&gt;], the field has made remarkable advances. Endovascular thrombectomy (EVT) has revolutionized care for large vessel occlusion (LVO) strokes. Evidence supports the continued use of IVT before EVT even in the mothership setting [&lt;span&gt;2&lt;/span&gt;]. However, as EVT becomes more refined and widely implemented, new questions emerge: When successful recanalization has already been achieved, is there a role for adjunctive thrombolysis?&lt;/p&gt;&lt;p&gt;Intra-arterial thrombolysis (IAT), once a primary method of reperfusion [&lt;span&gt;3&lt;/span&gt;], fell out of favor with the rise of stent retrievers and aspiration techniques. Nonetheless, the observation that technically successful EVT does not always lead to favorable clinical outcomes has rekindled interest in IAT as a potential adjunct to improve the recanalization of distal vessels and microvascular perfusion.&lt;/p&gt;&lt;p&gt;In this systematic review and meta-analysis, Palaiodimou et al. [&lt;span&gt;4&lt;/span&gt;] assess the available evidence on the efficacy and safety of adjunctive IAT following successful EVT. Drawing on data from seven randomized controlled trials involving over 2000 patients, the authors report that IAT was associated with a higher likelihood of excellent functional outcomes at 90 days. A modest benefit was also seen in mRS score shift analysis, indicating reduced overall disability. Importantly, there were no significant differences in rates of symptomatic intracranial hemorrhage, mortality, or good functional outcome. The effect was consistent across subgroups, including patients who received IVT and those with complete or near-complete angiographic reperfusion (eTICI 2c/3).&lt;/p&gt;&lt;p&gt;While the biological rationale is sound, as residual distal occlusions or impaired microvascular flow may persist after EVT [&lt;span&gt;5, 6&lt;/span&gt;], several limitations must temper interpretation. First, the included trials have considerable variability in patient selection, thrombolytic agent, and dose. Although statistical heterogeneity was low, clinical heterogeneity was notable and may affect generalizability. Second, subgroup analyses revealed no clear dose–response effect or difference across reperfusion grades, raising questions about which patients derive the most benefit. Third, as the authors acknowledge, the analysis is based on aggregate-level data, limiting the ability to explore individual-level modifiers of treatment response.&lt;/p&gt;&lt;p&gt;Given the heterogeneity in study populations and treatment protocols, routine implementation of IAT after EVT cannot yet be recommended. Importantly, ongoing randomized trials, such as TECNO (NCT05499832), CHOICE-2 (NCT05797792), and IA-SUCCESS (NCT06768138), are expected to refine our understanding of the potential role of adjunctive IAT and how best to implement it. Until their results become available, clinical practice should prioritize enrollment ","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705689","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":"Gaps in Guidelines on Long-Term Management Strategies for Post-Stroke Dysphagia","authors":"Anel Karisik,&nbsp;Bendix Labeit,&nbsp;Alois Josef Schiefecker,&nbsp;Simon Sollereder,&nbsp;Oliver Galvan,&nbsp;Simone Graf,&nbsp;Stefan Kiechl,&nbsp;Michael Knoflach,&nbsp;Lukas Mayer-Suess","doi":"10.1111/ene.70307","DOIUrl":"https://doi.org/10.1111/ene.70307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Post-stroke dysphagia (PSD) is a frequent yet overlooked complication of stroke with significant implications for rehabilitation. While international guidelines provide structured recommendations for early screening and management, guidance on long-term care remains inconsistent. This position paper synthesizes existing guidelines, identifies critical gaps, and highlights the need for standardized long-term management strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Guidelines on PSD management were identified through a two-step approach. Fourteen guidelines were included from a previous systematic review (2014–2023), and two additional guidelines were identified through a systematic PubMed search (2014–2025). Inclusion criteria mandated guidelines of moderate-to-high quality (AGREE II assessment) that were published in peer-reviewed journals and provided specific recommendations for managing PSD during acute, subacute, and chronic phases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis of 10 moderate-to-high quality guidelines revealed strong consensus on acute-phase screening and early interventions. All recommend dysphagia screening within 24 h of admission, with nine advising nil-per-os status until screening completion. There is consensus on instrumental assessments (videofluoroscopy, endoscopy), though application criteria vary. Management strategies include dietary modifications, nutritional support, oral health care, behavioral interventions, neurostimulation, and pharmacological therapies. While acute-phase recommendations are well defined, structured long-term follow-up guidance remains limited, with only one guideline specifying reassessment intervals beyond hospital discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The absence of standardized long-term PSD management likely reflects limited availability of high-quality evidence on long-term care. Further research is needed to establish optimal reassessment intervals, high-risk subgroups, and long-term rehabilitation strategies to improve care for stroke survivors with persistent dysphagia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 8","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695808","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":"“Letter to the Editor: A Transfer Strategy Utilizing a Helicopter and a Ground Ambulance Together Does Not Prolong Door-In-Door-Out Times in Thrombectomy Patients: A Retrospective Analysis”","authors":"Noor Un Nisa,&nbsp;Umar Aziz,&nbsp;Shah Jahan","doi":"10.1111/ene.70306","DOIUrl":"https://doi.org/10.1111/ene.70306","url":null,"abstract":"&lt;p&gt;We read with great interest the article written by Vuorinen et al. titled “A Transfer Strategy Utilizing a Helicopter and a Ground Ambulance Together Does Not Prolong Door-In- Door Out Times in Thrombectomy Patients: A Retrospective Analysis” [&lt;span&gt;1&lt;/span&gt;], which evaluates the logistics of stroke transfers utilizing a hybrid transport approach. While the study significantly advances the field, we would like to highlight a few limitations and contradictions that, if addressed, could enhance the robustness of the study.&lt;/p&gt;&lt;p&gt;The study appropriately focuses on process efficiency, that is, the DIDO (Door-In-Door-Out) time. However, it does not address its clinical outcomes, whether reducing DIDO time improved patient survival, neurological recovery, functional status (mRS ≤ 2), or quality of life. Such costly healthcare decisions, such as deploying helicopters, must be based on patient-centered clinical outcomes. Another study evaluated the significant impact of reduced DIDO time on functional clinical outcomes in patients having large vessel occlusion strokes and undergoing thrombectomy [&lt;span&gt;2&lt;/span&gt;]. Including such outcome analysis would increase the clinical relevance and applicability of the study.&lt;/p&gt;&lt;p&gt;Secondly, the study analyzes whether using both ground ambulances and helicopters to move thrombectomy patients causes a delay in the DIDO time at the primary stroke center.&lt;/p&gt;&lt;p&gt;However, the study does not stratify or analyze patients according to their estimated travel times or distance from the thrombectomy center. Regardless of time travel or distance, it treats every patient in equal measure. HEMS' importance usually varies greatly with distance. A helicopter might not save enough time to be worth using if the patients are transferred straight from the scene or over short distances [&lt;span&gt;3&lt;/span&gt;]. Moreover, HEMS is costly and may not be helpful if the patients live far from the thrombectomy center. McMeekin et al. (2021) concluded that helicopter transfers are only cost-effective if they save at least 60 min compared to ground transport [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Moreover, since DIDO time directly affects the results for patients requiring thrombectomy, it is often recognized as an important indicator in acute stroke therapy. Established clinical protocols emphasize that reducing DIDO is essential because delays can have a major impact on recovery from stroke. However, this study shows no association between the period of DIDO and the administration of thrombolysis (&lt;i&gt;p&lt;/i&gt; = 0.64). This result contrasts with other studies, such as Prabhakaran et al. (Ann Emerg Med. 2021), which found that thrombolysis improves in-hospital workflow and typically cuts DIDO by 28 to 45 min [&lt;span&gt;5&lt;/span&gt;]. The research does not address potential reasons for this divergence, even though local methods, workflow variations, or sample size may impact these findings. To achieve optimal stroke transfer methods and enhance patient outcomes, we encourage t","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 7","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681250","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":"Author Response: “A Transfer Strategy Utilizing a Helicopter and a Ground Ambulance Together Does Not Prolong Door-In-Door-Out Times in Thrombectomy Patients: A Retrospective Analysis”","authors":"Pauli Vuorinen,&nbsp;Joonas Kiili,&nbsp;Markku Grönroos,&nbsp;Ilkka Virkkunen,&nbsp;Heini Huhtala,&nbsp;Piritta Setälä,&nbsp;Sanna Hoppu","doi":"10.1111/ene.70303","DOIUrl":"https://doi.org/10.1111/ene.70303","url":null,"abstract":"&lt;p&gt;We appreciate the interest of Un Nisa et al. in our study “A Transfer Strategy Utilizing a Helicopter and a Ground Ambulance Together Does Not Prolong Door-In-Door-Out Times in Thrombectomy Patients: A Retrospective Analysis” [&lt;span&gt;1&lt;/span&gt;] and their insightful comments regarding potential additional analyses and perspectives.&lt;/p&gt;&lt;p&gt;First and foremost, we wish to highlight the most important conclusion in our study: a thrombectomy candidate in a primary stroke center (PSC) should not remain waiting for a prolonged time the information whether the air transfer is available. The transfer should commence as soon as possible by ground and a helicopter emergency medical service (HEMS) unit should join the mission and continue the air transfer on route when suitable. Wong et al. [&lt;span&gt;2&lt;/span&gt;] showed that air transfer increases the DIDO and is feasible only when the travel distance exceeds 250 km. Our transfer protocol had no impact on the DIDO and decreased the travel time when the driving distance from the PSC to our endovascular center was circa 180 km [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We agree with Un Nisa et al.: patients with large vessel occlusion are not interested in one detail of the care pathway such as door-in-door-out time. Only their functional outcome matters. Since our previous study [&lt;span&gt;3&lt;/span&gt;] already reported the outcomes and travel times of the patients from South Ostrobothnia, we wanted this study to concentrate solely on investigating the change the transfer protocol modification caused to the in-hospital workflow. To overcome the possibility of the Hawthorne effect, we decided to compare DIDOs from two similar PSCs.&lt;/p&gt;&lt;p&gt;Which minutes are worth saving? The costs of helicopter emergency services units are mostly fixed. Adding a few flight hours causes only minimal increments to the costs. Implementing helicopter transports to stroke care pathway is a feasible solution to improve cost-effectiveness [&lt;span&gt;4&lt;/span&gt;]. Naturally, a pragmatic local assessment needs to be done when an air transfer protocol for stroke patients is considered. One must keep in mind that local ambulance preparedness is preserved when the ground EMS is able to return earlier to their own station after patient handover to HEMS [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Why we were not able to replicate the expediting effect of thrombolysis on DIDO? [&lt;span&gt;2, 6, 7&lt;/span&gt;] Similarly to our results, Choi et al. [&lt;span&gt;8&lt;/span&gt;] showed equivalent DIDOs in patients treated with thrombolysis and in patients with a contraindication for it. The studies showing faster DIDOs with thrombolysis present markedly slower DIDOs than ours or the ones published by Choi et al. We encourage PSCs to collaborate with local EMS to revise the thrombectomy candidates' transfer protocol thoroughly with and without thrombolysis.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Pauli Vuorinen:&lt;/b&gt; conceptualization, writing – original draft, writing – review and editing. &lt;b&gt;Joonas Kiili:&lt;/b&gt; conceptualization, writing – review and editing. &lt;","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 7","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681249","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":"The Phenomenology of Tics in Adults: Data From the Calgary and Paris Adult Tic Disorders Registry","authors":"Christelle Nilles,&nbsp;Yulia Worbe,&nbsp;Andreas Hartmann,&nbsp;Davide Martino,&nbsp;Julian Fletcher,&nbsp;Naoual Serari,&nbsp;Catherine Deans,&nbsp;Isabella Davenport,&nbsp;Emmanuel Roze,&nbsp;Tamara Pringsheim","doi":"10.1111/ene.70252","DOIUrl":"https://doi.org/10.1111/ene.70252","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study investigated the phenomenology of tics in adults with primary tic disorders (Tourette syndrome, persistent motor or phonic tic disorders) and how these features are influenced by sex. It also examined the prevalence of comorbid psychiatric conditions and psychotropic medication use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted on 227 adults with primary tic disorders from the Calgary and Paris Adult Tic Registry. Data collected included demographics, tic characteristics (using the Yale Global Tic Severity Scale), psychiatric comorbidities, and medication use. Statistical analyses were performed to compare data between sexes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sex ratio was 1.8 males to 1 female. The most common motor tics were simple (eye blinking, simple head movements), and the most common phonic tic was throat clearing. There were no significant sex differences in tic phenomenology or severity. Generalized anxiety disorder (49.5%) and attention deficit hyperactivity disorder (ADHD) (35.8%) were the most common comorbidities. A lower proportion of women were diagnosed with ADHD, while a higher proportion were diagnosed with obsessive compulsive disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The male predominance of tic disorders is less marked in adulthood compared to childhood. Tic phenomenology and severity do not significantly differ between sexes. These findings provide valuable insights into the clinical presentation of tic disorders in adults. Future research will explore severity of comorbid mental health conditions, how these influence tic severity, treatment outcomes and quality of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 7","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70252","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681469","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}