European Journal of Neurology最新文献

{"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}

{"title":"Plasma Phosphorylated Tau 217 as a Discriminative Biomarker for Cerebral Amyloid Angiopathy","authors":"Pei-Feng Hsieh,&nbsp;Hsin-Hsi Tsai,&nbsp;Chia-Ju Liu,&nbsp;Bo-Ching Lee,&nbsp;Ya-Chin Tsai,&nbsp;Ruoh-Fang Yen,&nbsp;Jiann-Shing Jeng,&nbsp;Li-Kai Tsai","doi":"10.1111/ene.70066","DOIUrl":"10.1111/ene.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Blood-based biomarkers may offer a non-invasive approach to diagnose cerebral amyloid angiopathy (CAA), especially in early-stage. We evaluated the ability of plasma phosphorylated tau-217 (p-tau 217) to differentiate CAA from Alzheimer's disease (AD) and deep perforator arteriopathy (DPA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with AD (age 73.7 ± 8.1 years), probable CAA (74.8 ± 6.9 years), or DPA (66.1 ± 10.4 years) were enrolled from memory and stroke clinics at a medical center in Taiwan. All participants received amyloid and tau PET scans. Plasma biomarkers were measured via a SIMOA immunoassay platform. The diagnostic utility of p-tau 217 was assessed using ROC analyses and the Youden cutoff. Associations between plasma p-tau 217 and neuroimaging variables in CAA were explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with CAA had lower plasma p-tau 217 (0.69 ± 0.76 vs. 1.28 ± 0.97 pg/mL, <i>p</i> &lt; 0.001) and a lower p-tau 217/Aβ40 ratio (0.003 ± 0.002 vs. 0.006 ± 0.003, <i>p</i> &lt; 0.001) than the AD group but higher levels than the DPA group (p-tau 217, 0.27 ± 0.13 pg/mL, <i>p</i> = 0.001; p-tau 217/Aβ40, 0.001 ± 0.0005, <i>p</i> &lt; 0.001), although adjustment attenuated the difference in p-tau 217 between CAA and DPA. Plasma Aβ40, Aβ42, and Aβ40/Aβ42 were not significantly different between groups. Plasma p-tau 217 had moderate to good diagnostic utility to differentiate CAA vs. AD (sensitivity, 64.4%; specificity, 89.5%; AUC, 0.809) and CAA vs. DPA (sensitivity, 67.8%; specificity, 100%; AUC, 0.855). In CAA, p-tau 217 significantly correlated with the severity of CAA, amyloid PET signal intensity, and lobar microbleed count (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Plasma p-tau 217 may represent a non-invasive biomarker for distinguishing cerebral amyloid angiopathy (CAA) from other conditions, including AD and DPA.</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.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188692","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":"Multifaceted Biomarkers Suggest a Similar Profile of CNS Pathology in Relapsing and Progressive MS","authors":"Katelijn M. Blok,&nbsp;Romy A. M. Klein Kranenbarg,&nbsp;Kirtana Ananth,&nbsp;Hendrik J. Engelenburg,&nbsp;Aletta van den Bosch,&nbsp;Lucia A. A. Giannini,&nbsp;Janet de Beukelaar,&nbsp;Harro Seelaar,&nbsp;Inge Huitinga,&nbsp;Ari Green,&nbsp;Beatrijs Wokke,&nbsp;Ahmed Abdelhak,&nbsp;Joost Smolders","doi":"10.1111/ene.70052","DOIUrl":"10.1111/ene.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Relapsing–remitting (RR) and primary progressive (PP) multiple sclerosis (MS) have distinct clinical courses, but underlying pathophysiological differences remain unclear. We compared pathological components between RRMS, PPMS, and other inflammatory and neurodegenerative disorders, leveraging soluble biomarkers and post-mortem pathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Serum and cerebrospinal fluid (CSF) of people diagnosed with (pw) PPMS (<i>n</i> = 104), RRMS (<i>n</i> = 38), Alzheimer's disease (AD, <i>n</i> = 22), neuromyelitis optica spectrum disorder (NMOSD, <i>n</i> = 10), and myelin oligodendrocyte glycoprotein–associated disease (MOGAD, <i>n</i> = 10) were collected. B-cell maturation antigen (BCMA), soluble CD27 (sCD27), osteopontin (OPN), chitinase-3-like-1 (CHI3L1), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL) and synaptosomal-associated protein-25 (SNAP25) were measured. Lymphocytes (CD20⁺, CD138⁺, CD3⁺) and pyramidal-tract axonal density in RR-onset (<i>n</i> = 86) and PPMS (<i>n</i> = 45) post-mortem brain tissue were quantified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Soluble and post-mortem tissue biomarkers did not differ between pwRRMS and pwPPMS. Compared to AD, MS had higher CSF sCD27 (<i>p</i> &lt; 0.001) but lower serum CHI3L1 and GFAP, and CSF OPN and SNAP25 (all <i>p</i> &lt; 0.05). Serum OPN was lower in RRMS than NMOSD (<i>p</i> = 0.013). Principal component analyses and K-means clustering showed substantial overlap of RRMS and PPMS biomarkers, distinct from AD. In all pwMS, serum NfL and CSF BCMA correlated with clinical/radiological disease activity, CSF BCMA and sCD27 with inflammatory parameters, and serum GFAP, CSF GFAP, and CSF NfL with Expanded Disability Status Scale (EDSS) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Serum and CSF soluble biomarker profiles and post-mortem pathology do not differentiate RRMS from PPMS diagnoses but reflect the extent of inflammation and tissue damage. Detailed assessment of MS-associated inflammation and tissue damage may enhance classification and therapeutic strategies.</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.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188689","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":"Pitfalls in Calculating the Incidence of Guillain-Barre Syndrome During the Pandemic","authors":"Josef Finsterer","doi":"10.1111/ene.70071","DOIUrl":"https://doi.org/10.1111/ene.70071","url":null,"abstract":"&lt;p&gt;We read with interest the article by Blanco-Ruiz et al. on a retrospective study of the prevalence of Guillain–Barre syndrome (GBS) in Spain in 2018–2021 to assess whether or not it has increased during the pandemic [&lt;span&gt;1&lt;/span&gt;]. The total number of Spanish GBS cases in 2018, 2019, 2020, and 2021 was 832, 861, 670 and 784, respectively [&lt;span&gt;1&lt;/span&gt;]. It was concluded that the incidence of GBS before and during the pandemic was similar to other countries and that the incidence decreased during the pandemic [&lt;span&gt;1&lt;/span&gt;]. The study is appealing, but some points should be discussed.&lt;/p&gt;&lt;p&gt;The first point is that only a single ICD code (G61.0) was used to filter out patients diagnosed with GBS during the observation period [&lt;span&gt;1&lt;/span&gt;]. However, GBS is only a generic term for several subspecifications. These include acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor and sensory axonal neuropathy (AMSAN), Miller–Fisher syndrome (MFS), pharyngo-cervico-brachial (PCB) GBS, GBS with involvement of one or more cranial nerves, flail arm/leg syndrome, and Bickerstaff brainstem encephalitis (BBE) [&lt;span&gt;2&lt;/span&gt;]. These entities can be coded by ICD codes other than G61.0. Possible other codes are G61.9 (polyradiculitis), radiculopathy (M54.1), and polyneuropathy (G62.9). Is it conceivable that the prevalence figures calculated for the years of interest are inaccurate because they do not include these alternative ICD codes? Is it conceivable that the clinical presentation of GBS during the pandemic is different from before, which may be why these patients were not coded as G61.0? Assuming that some of the GBS diagnoses were missed, it would be interesting to repeat the analysis including the alternative ICD codes and compare it with the results of the index study.&lt;/p&gt;&lt;p&gt;The second point is that a decrease in prevalence in 2020 and 2021 does not necessarily mean that GBS due to SC2I predominates or that SC2I has not increased the prevalence of GBS. Theoretically, it is conceivable that the number of patients with GBS due to triggers other than SARS-CoV-2 has decreased in 2020 and 2021 due to the reduced opportunities for transmission due to the lockdowns, social distancing and other protective measures, and that the majority of cases registered in 2020 and 2021 are actually due to SC2I or SC2V. As temporary visits to restaurants or mass events had become impossible, infections with these pathogens are also likely to have decreased. The most common infectious triggers of GBS are &lt;i&gt;Campylobacter jejuni&lt;/i&gt;, &lt;i&gt;Haemophilus influenzae&lt;/i&gt;, cytomegalyvirus, and &lt;i&gt;Mycoplasma pneumoniae&lt;/i&gt; [&lt;span&gt;3&lt;/span&gt;]. The increase in incidence in 2021 compared to 2020 could be due to the fact that isolation and protective measures were abandoned after the introduction of SC2V. Is it also conceivable that the incidence of GBS has decreased because less severe cases were not hospitalized due to the restric","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111643","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":"Tirofiban Benefits the Outcome of Stroke Patients With Large Artery Atherosclerosis Achieving Full Reperfusion and High NIHSS Scores","authors":"Adrià Arboix,&nbsp;Olga Parra","doi":"10.1111/ene.70070","DOIUrl":"https://doi.org/10.1111/ene.70070","url":null,"abstract":"&lt;p&gt;The current intra-arterial reperfusion therapies allow high rates of recanalization and favorable clinical outcomes with low complication rates, but sufficient reperfusion following endovascular therapies is unsuccessful in about 30% of stroke patients [&lt;span&gt;1&lt;/span&gt;]. Platelet aggregation stimulated by mechanical thrombectomy instruments may be a contributing factor for reperfusion failure. Tirofiban—a selective and rapidly activated antagonist of the platelets non-peptide glycoprotein IIb/IIIa receptors—can reversibly suppress platelet aggregation and may inhibit platelet-mediated thrombus formation in acute stroke [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In clinical practice, however, experience with the use of intravenous tirofiban regarding efficacy and safety in ischemic stroke patients have yielded conflicting results. In a systematic review and meta-analysis of seven randomized controlled trials (RCTs) with 2088 stroke patients, tirofiban as compared with control of regular treatment regimen or endovascular thromboembolectomy, was associated with a significant increase in the number of patients with Modified Rankin Scale (mRS) = 0 (no symptoms at all) after 90 days and a significant decrease in National Institutes of Health Stroke Scale (NIHSS) score after 7 days [&lt;span&gt;3&lt;/span&gt;]. Regarding safety outcomes, tirofiban did not raise the risk of symptomatic intracranial hemorrhage (sICH) or death within 90 days, but the rate of radiological ICH was significantly higher in the tirofiban group than in controls [&lt;span&gt;3&lt;/span&gt;]. Other meta-analyses reported that tirofiban besides not improving functional outcome, raised the occurrence of fatal ICH especially via intra-arterial administration [&lt;span&gt;4&lt;/span&gt;], or found that tirofiban reduced mortality with no increase of sICH or any ICH [&lt;span&gt;2, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Recent studies have drawn attention to the variable efficacy of tirofiban in different clinical scenarios. In a pooled analysis of data from the EVT trial (Direct Endovascular Treatment for Large Vessel Occlusion Stroke) and the RESCUE BT trial (Intravenous Tirofiban Before Endovascular Thrombectomy for Acute Ischemic Stroke) and RESCUE BT Trials among patients with intracranial large vessel occlusion within 4.5 h of onset, tirofiban plus endovascular therapy was comparable to alteplase bridging with endovascular therapy regarding the efficacy and safety outcomes [&lt;span&gt;6&lt;/span&gt;]. In a large multicenter trial of patients with ischemic stroke without occlusion of large or medium-sized vessels, the percentage of patients with a score of 0 or 1 on the modified Rankin scale at 90 days was significantly higher with tirofiban than with aspirin, although there was a low but slightly higher incidence of sICH in the tirofiban group [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;It is plausible that a more precise definition of candidates for tirofiban targeted treatment could yield more homogeneous results of the benefits of this platelet aggregation inhibitor in the acute stroke ","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111642","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}