European Journal of Neurology最新文献

{"title":"GLP-1 Agonists as Potential Neuromodulators in Development of Parkinson's Disease: A Nationwide Cohort Study","authors":"Mads Gamborg,&nbsp;Mia Klinten Grand,&nbsp;Jasmin Arvedsen,&nbsp;Amani Meaidi,&nbsp;Lina Steinrud Mørch","doi":"10.1111/ene.70075","DOIUrl":"https://doi.org/10.1111/ene.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Parkinson's disease is a progressive neurodegenerative disorder with no cure. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may have neuroprotective effects. However, long-term real-world studies are needed to clarify their potential impact on Parkinson's disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This nationwide cohort study included 33,462 patients (16,731 GLP-1RA initiators and 16,731 propensity score-matched dipeptidyl peptidase-4 inhibitor [DPP-4i] initiators) from 2007 to 2018, followed until 2022. Eligible participants were ≥ 50 years, had no prior cancer or Parkinson's disease, and were residents in Denmark for at least 10 years. Patients were followed until Parkinson's diagnosis, death, emigration, treatment discontinuation (no additional prescription within 180 days), switch to the other study drug, or end of follow-up. Additional analyses included comparisons with insulin, competing risk of death, and the main analysis disregarding adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During follow-up, 192 patients developed Parkinson's disease, including 93 during sustained treatment. After 10 years, sustained GLP-1RA users had a lower hazard ratio (HR 0.57 (95% CI 0.37;0.85)) and absolute risk difference (−0.24 (95% CI −0.63 to 0.15)) compared to DPP-4i users. Similar trends were found when using insulin as a comparator. A significant survival advantage was found among sustained users of GLP-1RA (particularly when comparing with insulin). When not accounting for adherence, the results was not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Results were suggestive for a potential neuroprotective effect of GLP-1RAs against Parkinson's disease. Further studies are needed to assess biomarkers of disease progression, and evaluate safety in patients with Parkinson's disease, dosing, and effects when combined with other treatments in neurodegenerative diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380123","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":"Heterozygous PNPT1 Variants Cause a Sensory Ataxic Neuropathy","authors":"Saif Haddad,&nbsp;Christopher J. Record,&nbsp;Eleanor Self,&nbsp;Mariola Skorupinska,&nbsp;Alexander M. Rossor,&nbsp;Matilde Laura,&nbsp;Gordon Ingle,&nbsp;Adnan Manzur,&nbsp;Francesco Muntoni,&nbsp;Julian C. Blake,&nbsp;Mary M. Reilly","doi":"10.1111/ene.70064","DOIUrl":"https://doi.org/10.1111/ene.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Biallelic variants in polyribonucleotide-nucleotidyltransferase-1 (PNPT1) have been associated with a range of phenotypes from syndromic hearing loss to Leigh's syndrome. More recently, heterozygous variants in <i>PNPT1</i>, have been reported in three families with cerebellar ataxia and prominent sensory neuropathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Whole genome sequencing was performed in two families with autosomal dominant sensory ataxic neuropathy (SAN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Segregating heterozygous splice site (c.2014-3C&gt;G) and nonsense (p.Arg715Ter) variants were detected in both families. All patients initially presented with an isolated SAN clinically and neurophysiologically with subsequent variable cerebellar involvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We report two heterozygous <i>PNPT1</i> variants in two families with a predominant SAN, including the novel p.Arg715Ter. This strengthens the argument of <i>PNPT1</i> causing dominant disease and highlights a new cause for dominantly inherited SAN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380489","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":"From Tics to Stabs: Renaming Cluster Tics in Cluster Headache—A Cross-Sectional Study","authors":"May Carney,&nbsp;Marie-Louise Kulas Søborg,&nbsp;Stine Maarbjerg,&nbsp;Nunu Lund,&nbsp;Jacob Worm,&nbsp;Lars Bendtsen,&nbsp;Rigmor Højland Jensen,&nbsp;Anja Sofie Petersen","doi":"10.1111/ene.70053","DOIUrl":"https://doi.org/10.1111/ene.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Short-lasting paroxysms of facial pain in patients with cluster headache have traditionally been called “cluster tics.” Mostly described as co-occurring trigeminal neuralgia, they remain to be explored as an independent phenomenon. We investigated the prevalence of cluster tics in cluster headache, the clinical differentiation from trigeminal neuralgia, and propose a distinct definition and renaming of cluster tics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, controlled, cross-sectional study using semi-structured interviews of patients with cluster headache at the Danish Headache Center. A comparator cohort of patients with trigeminal neuralgia was included from a previous study. We investigated the lifetime prevalence of cluster tics in the cluster headache group and characterized them according to duration, location, pain-intensity, triggerability, and serial occurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 424 participants with cluster headache (median age 52 years (IQR: 32–72), male–female ratio 3:2) and 576 participants with trigeminal neuralgia (median age 72 years (IQR: 50–94), male–female ratio 1:3). Cluster tics were reported by 200 (47%) cluster headache participants with higher odds for participants of female sex (OR: 1.94, 95% CI: 1.27–2.96, <i>p =</i> 0.002) and participants with chronic cluster headache (OR: 1.74, 95% CI: 1.15–2.63, <i>p =</i> 0.008). Unlike trigeminal neuralgia, cluster tics were not triggerable (OR: 0.02, 95% CI: 0.01–0.04, <i>p</i> &lt; 2e-16) and presented with pain restricted to the first trigeminal division.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cluster tics are prevalent in nearly half of patients with cluster headache, associated to female sex and chronic phenotype. Unlike trigeminal neuralgia, cluster tics occur in the orbital region and are largely non-triggerable. To improve terminology, we propose renaming cluster tics to “cluster stabs.”</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380490","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":"Hippocampal Subfield Volume in Relation to Cerebrospinal Fluid Amyloid-ß in Early Alzheimer's Disease: Diagnostic Utility of 7T MRI","authors":"Oluwatobi F. Adeyemi,&nbsp;Penny Gowland,&nbsp;Richard Bowtell,&nbsp;Olivier Mougin,&nbsp;Akram A. Hosseini","doi":"10.1111/ene.70076","DOIUrl":"https://doi.org/10.1111/ene.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Alzheimer's disease (AD) is a neurodegenerative condition characterised by amyloid plaque accumulation and neurofibrillary tangles. Early detection is essential for effective intervention, but current diagnostic methods that enable early diagnosis in clinical practice rely on invasive or costly biomarker scanning. This study aimed to explore the utility of 7T MRI in assessing hippocampal subfield volumes and their correlation with cerebrospinal fluid (CSF) biomarkers in prodromal AD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-six participants, including AD patients and healthy controls, underwent 7T MRI scanning. Automated segmentation delineated hippocampal subfield volumes, with subsequent normalisation to whole brain volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant differences in hippocampal and subfield volumes were observed in prodromal AD patients, even when they did not exhibit high MTA scores on 3T MRI or show any whole brain volume loss. Additionally, the volume of the entorhinal cortex (ERC) correlated significantly with CSF amyloid-β levels, suggesting ERC's potential as a proxy CSF amyloid-ß measurement. Conversely, no significant associations were found between CSF 181-Phosphorylated-tau or total tau levels and any hippocampal subfield volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These findings show the potential use of 7T MRI, particularly in ERC assessment, as a biomarker for early AD identification. Further validation studies are warranted to confirm these results and elucidate the relationship of ERC volume with CSF biomarkers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362467","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":"Three-Objects-Three-Places Episodic Memory Test to Screen Mild Cognitive Impairment and Mild Dementia: Validation in a Memory Clinic Population","authors":"Federica Ribaldi,&nbsp;Sophie Krug,&nbsp;Daniele Altomare,&nbsp;Valentina Garibotto,&nbsp;Max Scheffler,&nbsp;Augusto J. Mendes,&nbsp;Aurelien Lathuiliere,&nbsp;Frederic Assal,&nbsp;Aldara Vazquez Fernandez,&nbsp;Stefano F. Cappa,&nbsp;Christian Chicherio,&nbsp;Giovanni B. Frisoni","doi":"10.1111/ene.70074","DOIUrl":"https://doi.org/10.1111/ene.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Three-Objects-Three-Places (3O3P) test is a 5-min screen for episodic memory impairment due to Alzheimer's disease, known for its briefness and easy administration, culture- and language-free nature, and the absence of specific equipment. However, no studies have validated its potential in memory clinic cohorts. The aim of this study was to test its convergent, discriminant, and known-group validities and to define thresholds for its clinical use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 2062 cognitively unimpaired (CU), mild cognitive impairment (MCI) and dementia patients from the Geneva Memory Center cohort who underwent the 3O3P test in the context of clinical practice. Convergent and discriminant validities were assessed using an exploratory factor analysis. The known-group validity was assessed in CU vs. MCI and dementia using the area under the curve (AUC). 3O3P test scores vs. amyloid and tau positivity, neurodegeneration, and cognition (ATNC) were assessed using the Kruskal-Wallis test. The 3O3P test cut-offs were calculated using sensitivity, specificity, PPV, NPV, and accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age was 72 years (SD = 11), 60% were female, mean education was 13 years (SD = 4), and mean MMSE was 25 (SD = 5). The 3O3P and Delayed Total Recall tests loaded strongly on the “memory” factor and weakly on “non-memory” factors. The 3O3P test can discriminate CU vs. MCI (AUC = 0.71) and dementia (AUC = 0.92). Higher 3O3P scores were associated with lower prevalence of ATNC (<i>p</i> &lt; 0.001). A 3O3P value of 7 can detect MCI and dementia patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 3O3P test has demonstrated good convergent, discriminant, and known-group validity in a large memory clinic population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362468","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":"Epilepsy Management in Transgender Population: More Research for Better Treatment","authors":"Bruna Nucera,&nbsp;Francesco Pasini,&nbsp;Gennarina Arabia,&nbsp;Marianne de Visser,&nbsp;Stephan Rueegg,&nbsp;Bernhard Steinhoff,&nbsp;Isabella Colonna,&nbsp;the European Academy of Neurology (EAN) Scientific Panel Epilepsy and Coordinating Panel on Diversity, Equity and Inclusion in Neurology","doi":"10.1111/ene.70065","DOIUrl":"https://doi.org/10.1111/ene.70065","url":null,"abstract":"&lt;p&gt;The global transgender population is estimated at approximately 25 million individuals [&lt;span&gt;1&lt;/span&gt;]. If epilepsy prevalence in this group mirrors that of the general population, there could be 150,000–450,000 transgender persons with epilepsy worldwide [&lt;span&gt;1&lt;/span&gt;]. Despite this significant number, research on this community is notably lacking [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This research gap raises concerns about the adequacy of epilepsy treatment for transgender patients, as many aspects of management remains unclear due to the scarcity of observational studies or evidence-based recommendations.&lt;/p&gt;&lt;p&gt;Hormonal changes throughout a woman's life, as well as hormone therapy, may play an important role in the pathogenesis of seizures. However, the limited studies addressing this issue involved cisgender women using hormone therapy for contraception or perimenopausal treatment often with different dosing than that used in gender-affirming hormone therapies (GAHT) [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Additionally, significant bidirectional interactions between antiseizure medications (ASMs) and GAHT must be considered in transgender patient treatment [&lt;span&gt;1, 2&lt;/span&gt;]. Clinicians should be aware of potential interference from enzyme-inducing ASMs with hormone therapy. Serum levels of lamotrigine or valproic acid should also be monitored when initiating or adjusting estrogen doses, as estrogen can induce the metabolism of these drugs [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Transgender individuals with epilepsy also face increased risks for certain comorbidities, including bone mineral density loss and mental health issues, such as depression and suicide [&lt;span&gt;1&lt;/span&gt;]. One study revealed that 41% of transgender respondents had attempted suicide, a rate over 25 times higher than that of the general population [&lt;span&gt;1&lt;/span&gt;]. Substance abuse is another serious concern, with a meta-analysis showing that 26.7% of transgender women reported illicit drug use, while 43.7% reported alcohol abuse [&lt;span&gt;1&lt;/span&gt;]. Moreover, transgender women frequently exhibit low bone density [&lt;span&gt;2&lt;/span&gt;]. Eventually, given the increased fracture risk in epilepsy patients and the effects of GAHT and ASMs on bone density, ongoing monitoring and optimization of bone health in this population should be particularly considered [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The HIV is a significant concern for transgender, with prevalence rates reaching 12%–16%, higher than in general population [&lt;span&gt;1&lt;/span&gt;]. Although data on transgender individuals with both HIV and epilepsy are limited, interactions between antiretroviral therapy and ASMs have been reported [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Stigma within healthcare settings presents another challenge. Limited available data indicate that 70% of transgender individuals in the United States have reported discrimination, and 73% hesitate to disclose their identity due to fear of bias [&lt;span&gt;4&lt;/span&gt;], potentially leading to significant iatrogenic harm and increased risk","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362462","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":"MEPs and MRI Motor Band Sign as Potential Complementary Markers of Upper Motor Neuron Involvement in Amyotrophic Lateral Sclerosis","authors":"Francesca Calvi,&nbsp;Andrea Fortuna,&nbsp;Luca Bello,&nbsp;Mariagiulia Anglani,&nbsp;Diego Cecchin,&nbsp;Daniele Sabbatini,&nbsp;Cinzia Andrigo,&nbsp;Marcello Ferullo,&nbsp;Susanna Ruggero,&nbsp;Marco Falda,&nbsp;Elena Pegoraro,&nbsp;Gianni Sorarù","doi":"10.1111/ene.70055","DOIUrl":"https://doi.org/10.1111/ene.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Amyotrophic lateral sclerosis (ALS) is characterized by the degeneration of both upper and lower motor neurons (UMNs and LMNs). Recognizing the involvement of UMNs is challenging because of the absence of reliable biomarkers beyond clinical evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To identify a reliable marker of UMN damage in a cohort of patients with ALS referring to the Motor Neuron Disease Clinic of the University Hospital of Padova.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated the clinical records of 79 patients with ALS and compared the results of various investigations, including the motor-evoked potentials (MEPs), positron emission tomography–magnetic resonance imaging (MRI) and light neurofilaments (NfLs), with the degree of UMN clinical involvement, as assessed by the Penn Upper Motor Neuron Score (PUMNS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MEPs, considering the central motor conduction time (CMCT) values in both the upper and lower limbs, showed a significant correlation with the relative PUMNS subscores (<i>p</i> = 0.01, <i>ρ</i> = 0.4; and <i>p</i> = 0.005, <i>ρ</i> = 0.45, respectively). Additionally, there was a positive correlation between NfLs and PUMNS values (<i>p</i> = 0.04, <i>ρ</i> = 0.33). The presence of the motor band sign on MRI was associated with higher PUMNS values. Receiver operating characteristic analysis revealed that PUMNS accurately predicted abnormalities in CMCT values (specificity 86%, sensitivity 62%) and the presence of the motor band sign (specificity 58%, sensitivity 80%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>In our cohort of patients with ALS, CMCT values proved to be the most reliable test for assessing UMN involvement, albeit the presence of the motor band sign on MRI showed higher sensitivity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362408","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":"Bridging the Gaps: Addressing Inequities in Neurological Care for Underserved Populations","authors":"Olivier Uwishema,&nbsp;Paul Boon","doi":"10.1111/ene.70073","DOIUrl":"https://doi.org/10.1111/ene.70073","url":null,"abstract":"&lt;p&gt;With over 3 billion individuals affected globally, disorders of the nervous system are now a major contributor to both economic burden and morbidity. The global burden of neurological disorders is estimated to be 43% according to the most recent Global Burden of Disease Study. Neurological disorders are the main drivers of disability-adjusted life-years and mortality in the non-communicable disease category. In addition, according to the systematic review by Lanza et al. disparities in the management of neurological disorders exist, disproportionately affecting underprivileged groups [&lt;span&gt;1-3&lt;/span&gt;] With the majority of research concentrating within high-income countries (HICs) when compared to their counterpart low- and middle-income countries (LMICs), this study elucidates glaring discrepancies based on socioeconomic position, geographic location, and structural impediment.&lt;/p&gt;&lt;p&gt;This oversight is conspicuously evident in Africa, where healthcare systems often contend with the dualistic burden of communicable and non-communicable diseases [&lt;span&gt;2&lt;/span&gt;]. Inequities circumventing healthcare surrounding neurological disorders, compounded by limited access and availability of resources, a dearth in primary clinical and research infrastructure, and a lack of trained medical and nursing personnel, remain a pressing but underexplored issue [&lt;span&gt;3, 4&lt;/span&gt;]. The time to act is now. Addressing these inequities is not merely a public health imperative but a moral one, requiring dynamic global collaboration and context-sensitive solutions. (See Figure 1).&lt;/p&gt;&lt;p&gt;While Lanza and colleagues (2024) meticulously documented inequities evident in the healthcare of neurological disorders worldwide [&lt;span&gt;1&lt;/span&gt;], the study inadvertently mirrors the ever-growing fissure in research it so critiques: the absence of robust data from LMICs. Of the 49 studies reviewed, only one was conducted in Africa [&lt;span&gt;1&lt;/span&gt;]. This disparity is a testament to the systemic absence of LMICs from the global research agenda, perpetuating a vicious cycle of neglect.&lt;/p&gt;&lt;p&gt;In LMICs, neurological care inequities are exacerbated by structural deficiencies. For example, patients living with epilepsy in rural Africa often rely on traditional healers due to sticking to traditional values and beliefs and, in addition, to the lack of neurologists and allied healthcare professionals, resulting in delayed or inadequate therapy [&lt;span&gt;5&lt;/span&gt;]. In Guinea, a study found that 79% of epilepsy patients had consulted traditional healers, with 71% seeking their services before approaching medical providers, leading to delays in receiving appropriate treatment. Stroke survivors, disproportionately affected by comorbidities pertaining to hypertension and diabetes mellitus [&lt;span&gt;3, 4, 6&lt;/span&gt;], face limited access to rehabilitation services [&lt;span&gt;7&lt;/span&gt;]. These disparities affect not just access to care but also healthcare advocacy, data, and knowledge (See Figure 2).&lt;/p&gt;&lt;p&gt;The Wor","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248828","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":"Associations of Mid- and Late-Life Fasting Blood Glucose Levels With Dementia Risk Among Patients With Diabetes: Framingham Heart Study","authors":"Jinlei Li,&nbsp;Chunyu Liu,&nbsp;Ting Fang Alvin Ang,&nbsp;Rhoda Au","doi":"10.1111/ene.70062","DOIUrl":"https://doi.org/10.1111/ene.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diabetes is an established risk factor for dementia. However, the association has been less consistent at the population level and may vary over the lifespan. The impacts may be influenced by glucose fluctuation over lifetime.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the Framingham Offspring cohort to evaluate the dementia risk associated with fasting blood glucose (FBG) across age ranges. Cox proportional hazards regression models were fitted to investigate the association of diabetes status at each examination with dementia risk, and the associations between FBG levels and dementia across age spans. Group-based trajectory models were used to create FBG trajectories from mid to late-life for comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher FBG level at midlife was not associated with an increased risk of dementia. For participants with diabetes, higher FBG at age 60 and 70 years was associated with subsequent dementia (HR: 1.72, 95% CI: 1.07–2.75; HR: 1.91, 95% CI: 1.24–2.91). Diabetic participants with first midlife increasing and then late-life declining patterns of FBG were at greater increased risk of dementia compared to participant without diabetes. (HR: 2.00, 95% CI: 1.04–3.85).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The relationship between FBG and dementia risk was heterogeneous across the adult age range. Diabetes at midlife is a risk factor for dementia, but high glucose levels at 60–70 years followed by a decline suggests that less controlled diabetes during high age risk for dementia onset may represent another prodromal risk factor and presymptomatic metabolic indicator of dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248651","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":"Reassessing the Role of the Neurofilament Light Chain in Guillain-Barre Syndrome: Issues in Diagnosis and Subgroup Classification","authors":"Hung Youl Seok,&nbsp;Mi-Yeon Eun","doi":"10.1111/ene.70060","DOIUrl":"https://doi.org/10.1111/ene.70060","url":null,"abstract":"&lt;p&gt;We found the paper by Afzali et al. insightful, particularly the demonstration that serum neurofilament light chain (NfL) levels can differentiate acute inflammatory axonal polyneuropathy (AIAP) and predict disease severity [&lt;span&gt;1&lt;/span&gt;]. However, there are several issues that need to be addressed before fully accepting the findings.&lt;/p&gt;&lt;p&gt;First, there are issues with the diagnosis and subgroup classification of Guillain-Barre syndrome (GBS) patients in this study. The authors state that GBS was diagnosed using the National Institute of Neurological Disorders and Stroke (NINDS) and Brighton criteria, with patients classified into subgroups (acute inflammatory demyelinating polyneuropathy [AIDP], AIAP, and Miller Fisher syndrome [MFS]) based on electrodiagnostic criteria by Rajabally et al. [&lt;span&gt;1&lt;/span&gt;]. However, both the NINDS and Brighton criteria require symmetrical flaccid weakness for a GBS diagnosis [&lt;span&gt;2&lt;/span&gt;]. However, table 1 in the paper by Afzali et al. shows that 15.15% of AIDP patients and 12.5% of AIAP patients have no motor weakness [&lt;span&gt;1&lt;/span&gt;]. This raises the question: can these patients really be classified as having classic GBS?&lt;/p&gt;&lt;p&gt;Additionally, although the authors used Rajabally's criteria to classify AIDP, AIAP, and MFS [&lt;span&gt;1&lt;/span&gt;], these criteria were designed to differentiate AIDP from axonal GBS, not to classify MFS [&lt;span&gt;3&lt;/span&gt;]. Therefore, applying Rajabally's criteria to MFS is methodologically incorrect. MFS diagnosis should follow the NINDS and Brighton criteria, which require a triad of ophthalmoplegia, ataxia, and decreased reflexes without limb weakness [&lt;span&gt;2&lt;/span&gt;]. However, table 1 in the paper by Afzali et al. shows that 53.33% of MFS patients have limb weakness [&lt;span&gt;1&lt;/span&gt;], suggesting an MFS–GBS overlap syndrome rather than pure MFS. This discrepancy undermines the results regarding NfL in MFS, especially since previous studies show increased NfL levels in both axonal GBS and MFS [&lt;span&gt;4&lt;/span&gt;], contrary to this study's findings. Therefore, the MFS subgroup classification needs clarification, and further research on NfL's role in MFS is needed.&lt;/p&gt;&lt;p&gt;Second, the authors did not provide detailed data on nerve conduction studies (NCS), which are critical to understanding neuroaxonal damage in this cohort. Rajabally's classification distinguishes axonal from demyelinating pathology [&lt;span&gt;3&lt;/span&gt;], but does not assess the extent of axonal damage. Correlating NCS findings with NfL levels would provide a clearer understanding of the relationship between axonal damage and NfL levels. Given that more than half of the MFS patients may have MFS–GBS overlap syndrome, NCS results should be examined to determine how many meet the criteria for axonal GBS in MFS patients.&lt;/p&gt;&lt;p&gt;Finally, while the study suggests that serum NfL is a useful biomarker for axonal GBS, the authors may inadvertently imply that NfL is only relevant in this disease, with limited applicability in other diseas","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248650","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}