European Neurology最新文献

{"title":"Living Alone Is Associated With Discontinuation of Levodopa-Entacapone-Carbidopa Intestinal Gel Treatment in Advanced Parkinson's Disease.","authors":"Vili Viljaharju, Tuomas Mertsalmi, K Amande M Pauls, Maija Koivu, Johanna Eerola-Rautio, Marianne Udd, Eero Pekkonen","doi":"10.1159/000548570","DOIUrl":"https://doi.org/10.1159/000548570","url":null,"abstract":"<p><p>Introduction Levodopa-entacapone-carbidopa intestinal gel (LECIG) is a recently introduced device-aided treatment option for advanced Parkinson's disease (PD). Data on long-term outcomes remain limited, with only two published studies to date. This study aimed to report long-term outcomes of LECIG treatment, focusing on safety, adverse events, and treatment adherence. Methods In this retrospective longitudinal observational single-center study the medical records of 27 consecutive patients treated with LECIG at Helsinki University Hospital between 2020 and 2024 were analyzed. Adverse events, treatment discontinuations, and medication changes were assessed during the first two years of treatment. Clinically significant weight loss was defined as weight loss of >5% over 12 months. Fisher's exact test was used to assess the association between living situation and treatment discontinuation. Results Ten patients (37%) discontinued treatment, with six (60%) within the first year. Living alone was significantly associated with discontinuation (p = 0.033) compared to living with a spouse or in an institution. Three patients died during follow-up from causes unrelated to LECIG treatment. Adverse events were frequent, including inner tube complications requiring 41 inner tube replacements. Clinically significant weight loss was observed in 29% of patients. Conclusions In long-term treatment, adverse events with LECIG appear similar to those observed with levodopa-carbidopa intestinal gel (LCIG). However, weight loss and the discontinuation rate appear higher with LECIG. Yet, no direct comparison to LCIG was made in this study. Similar to LCIG, the discontinuation rate is particularly high among patients living alone.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-15"},"PeriodicalIF":2.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Management of Cramping Pain in Patients with Amyotrophic Lateral Sclerosis.","authors":"Hannah Katherine Hall, Elizabeth Austin, Karen Hutchinson, Colleen Cheek, Robyn Clay-Williams","doi":"10.1159/000548820","DOIUrl":"https://doi.org/10.1159/000548820","url":null,"abstract":"<p><strong>Background/introduction: </strong>Pain, particularly cramping, in people living with Amyotrophic Lateral Sclerosis (ALS) is often underrecognized and under-treated. Despite affecting over 70% of people living with ALS (plwALS), cramping pain remains inadequately managed due to its complex nature and the difficulties plwALS face in communicating their symptoms as the disease progresses. This systematic review explores both pharmacological and non-pharmacological treatments for cramping pain in ALS, aiming to assess and compare their efficacy.</p><p><strong>Methods: </strong>The systematic review was conducted following PRISMA guidelines and the protocol was registered with PROSPERO (ID CRD42024521649). A comprehensive search was performed across MEDLINE, Embase, Scopus, and Cochrane databases from inception until February 1, 2024, using specific search terms related to ALS and cramping.</p><p><strong>Results: </strong>The search resulted in the identification of 368 studies. After duplicates were removed, abstracts screened, and full texts reviewed, nine studies were included. Pharmacological interventions such as Mexiletine demonstrated significant reductions in cramp frequency and intensity in several trials, with varying doses showing distinct levels of effectiveness. Other medications like Dronabinol and Levetiracetam were also tested but showed limited efficacy in reducing cramp severity. Among non-pharmacological options, supervised exercise programs, particularly those incorporating stretching and functional mobility, were effective in reducing cramping pain intensity, while unsupervised home exercise programs did not show significant improvements.</p><p><strong>Conclusion: </strong>The review demonstrates the scarcity of high-quality research on cramping pain management in ALS. Mexiletine emerged as the most promising pharmacological intervention, providing notable relief, while supervised exercise therapy demonstrated beneficial effects.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1"},"PeriodicalIF":2.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circadian Rhythms in Ischemic Stroke: From Molecular Pathways to Chronotherapeutic Strategies.","authors":"Shramana Deb, Ritwick Mondal, Vramanti Sarkar, Gourav Shome, Rumela Mete, Subhajit Sarkar, Sourav Das, Jayanta Roy, Julián Benito-León","doi":"10.1159/000548456","DOIUrl":"https://doi.org/10.1159/000548456","url":null,"abstract":"<p><strong>Background: </strong>Circadian rhythms-endogenous 24‑hour oscillations-shape the risk, pathophysiology, and recovery of ischemic stroke. Diurnal variation in stroke onset, severity, and treatment responsiveness reflects clock control over cardiovascular tone, hemostasis, immune activity, neurovascular integrity, and metabolic homeostasis. After a stroke, circadian misalignment can blunt repair programs, amplify neuroinflammation, and accelerate cognitive decline.</p><p><strong>Summary: </strong>We synthesize how circadian mechanisms act across the neurovascular unit to modulate neuronal excitability, receptor and transport cycles, glial reactivity, endothelial barrier function, hemostasis/fibrinolysis, and glymphatic clearance. Particular emphasis is placed on the ischemic penumbra, where intrinsic (BAX/BCL‑2-regulated) and extrinsic death‑receptor pathways show time‑of‑day sensitivity that influences salvageability. We link post-stroke circadian disruption to proteostasis and amyloid-β handling, providing a mechanistic bridge to long-term cognitive impairment. We also reconcile treatment-timing data, including biological phase (e.g., PAI‑1/tPA rhythms, blood-brain barrier permeability), and operational factors jointly shape outcomes for thrombolysis and endovascular therapy. Finally, we outline chronotherapeutic avenues-light, melatonin, time‑targeted pharmacology, personalized rehabilitation-and candidate biomarkers to guide timing.</p><p><strong>Key messages: </strong>The circadian phase is a key determinant of stroke susceptibility, tissue vulnerability, and recovery potential. Integrating chronobiology into prevention, reperfusion, and rehabilitation enables time-tailored strategies that align interventions with intrinsic rhythms, thereby improving outcomes and reducing disability.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-23"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.1159/000547960","DOIUrl":"10.1159/000547960","url":null,"abstract":"","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1"},"PeriodicalIF":2.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Woman Physician at the Salpêtrière: A First-Hand Account by the American Homeopath Stella Hunt (1860-1925).","authors":"Francesco Brigo","doi":"10.1159/000548474","DOIUrl":"https://doi.org/10.1159/000548474","url":null,"abstract":"<p><p>This article examines a rare 1894 letter by American homeopath Stella Hunt (1860-1925), recounting her 1892 visit to Jean-Martin Charcot's clinics at the Salpêtrière Hospital in Paris. As one of the few female physicians of her time, Hunt offers a unique perspective on Charcot's teaching, the clinical environment, and the reception of women in French medical institutions. The article also provides biographical insights into Hunt's career and explores the intersections between homeopathy and neurology at the close of the 19th century.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-8"},"PeriodicalIF":2.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jean-Martin Charcot and the Clinical Foundations of Amyotrophic Lateral Sclerosis: A Historical Case Revisited.","authors":"Emmanuel Drouin, Patrick Hautecoeur, Arnaud Kwiatkowski","doi":"10.1159/000548249","DOIUrl":"https://doi.org/10.1159/000548249","url":null,"abstract":"<p><p>We revisit a landmark clinical case recorded by Jean-Martin Charcot in 1877-78, describing a patient with bulbar-onset amyotrophic lateral sclerosis (ALS). This case offers a rich window into Charcot's observational method, clinical reasoning, and early neuropathological insights. We discuss the methodological rigor of Charcot's case analysis and place it in dialogue with modern understandings of ALS pathophysiology, diagnosis, and care. This historical reflection highlights how 19th-century neurology laid the foundation for current multidisciplinary approaches to managing neurodegenerative diseases.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-8"},"PeriodicalIF":2.4,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol use and types and ischemic stroke: a systematic review and meta-analysis.","authors":"Ahmad A Toubasi, Thuraya N Al-Sayegh","doi":"10.1159/000547945","DOIUrl":"https://doi.org/10.1159/000547945","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis was conducted to investigate the association between alcohol use pattern and ischemic stroke risk.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Web of Sciences, Embase and CENTRAL up to the 1st of June, 2024. Studies were included if they were articles that assessed the impact of alcohol drinking pattern on the risk of ischemic stroke. The random effect model was utilized to combine the results. Data analysis was performed using Meta XL, version 5.3.</p><p><strong>Results: </strong>The total number of included participants was 21,293,471 from 125 studies. The model that investigated the association between light alcohol use and ischemic stroke risk showed no association [relative risk (RR) =0.97, 95% confidence interval (CI) 0.89-1.05]. Moderate alcohol use was associated with significant decrease in ischemic stroke risk (RR=0.87; 95% CI 0.83-0.92) while heavy alcohol use was associated with significant increase in ischemic stroke risk (RR=1.31; 95% CI 1.19-1.44). Sub-group analysis among males showed results similar to the primary analysis while among females, only moderate alcohol drinking was significantly associated with ischemic stroke (RR=0.50; 95% CI 0.33-0.75). Moderate and heavy wine use was associated with significant reduction in ischemic stroke risk (RR=0.61; 95% CI 0.45-0.84¸ RR=0.77; 95% CI 0.63- 0.93).</p><p><strong>Conclusions: </strong>Our analysis provided a strong and robust evidence that there was a significant association between moderate and heavy alcohol use with ischemic stroke risk. However, this association varied by several variables including type of alcohol with the effect being more protective among people who use wine. This study was registered in PROSPERO (CRD42023437946).</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-20"},"PeriodicalIF":2.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive Antihypertensive Treatment and Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis of Randomised Clinical Trials.","authors":"Ziwei Liao, Liping Cheng, Yining Wang, Yanjuan Yang, Xiaoxian Lv, Ping Gu","doi":"10.1159/000547434","DOIUrl":"10.1159/000547434","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is a significant risk factor for the development of cerebral small vessel disease (SVD). This study was performed to evaluate the impact of intensive antihypertensive treatment on the progression of imaging markers and cognitive function of SVD.</p><p><strong>Methods: </strong>Two independent reviewers searched for randomised controlled trials (RCTs) that investigated the associations between intensive antihypertensive treatment and the progression of imaging markers of SVD, including white matter hyperintensities (WMHs), brain atrophy, lacunes, or microbleeds and cognitive function scores. Fixed-effects models were used to pool the data for WMHs, brain atrophy, and severe adverse events, whereas cognitive function scores were synthesised with a random-effects model and were measured as standardised mean differences (SMDs) and odds ratios (ORs).</p><p><strong>Results: </strong>A total of 8 RCTs were included in this meta-analysis, involving 2,891 participants with a follow-up period of 24 to 49 months. Compared with standard blood pressure treatment, intensive antihypertensive treatment was observed to be more effective at delaying WMH progression (SMD = -0.33, 95% CI: -0.44, -0.21) but was associated with greater brain volume loss (SMD = 4.06, 95% CI: 1.97, 6.15). No increased risk of incident lacunes (OR = 1.11, 95% CI: 0.57, 2.19) or significant association with cognitive function changes (SMD = -0.08, 95% CI: -0.23, 0.06) was observed. However, the pooled analysis of cerebral microbleeds was limited by the small number of eligible studies included in this meta-analysis.</p><p><strong>Conclusion: </strong>Antihypertensive treatment (particularly intensive therapy) is associated with reductions in the progression of WMH volume and total brain volume. However, no significant association was observed between antihypertensive therapy and either the incidence of new lacunes or changes in cognitive function.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-11"},"PeriodicalIF":2.4,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Chatbots and Narcolepsy: Friend or Foe for Patient Information?","authors":"Francisco Henriques, Christine Costa, Bárbara Oliveiros, Joana Barbosa Melo, Claúdia Santos, Joana Jesus-Ribeiro","doi":"10.1159/000547034","DOIUrl":"10.1159/000547034","url":null,"abstract":"<p><strong>Introduction: </strong>Narcolepsy is a rare sleep disorder with a complex clinical picture, which may affect the daily functioning of patients. Artificial intelligence (AI) has emerged as a promising tool in healthcare, potentially offering valuable support to patients. However, its accuracy in specific medical domains remains inadequately assessed. This study aimed to evaluate and compare the accuracy, completeness, and readability of responses from ChatGPT, Gemini, and Perplexity to queries about narcolepsy.</p><p><strong>Methods: </strong>This study was a cross-sectional study. A set of 28 common patient questions was selected and entered into the three chatbots. Responses were independently reviewed by three sleep physicians. Accuracy and completeness were rated on predefined 5-point and 3-point scales, respectively. Readability was evaluated using six validated formulas.</p><p><strong>Results: </strong>All chatbots showed median accuracy ranging from \"more correct than incorrect\" to \"completely correct,\" with no significant performance differences. The topics with the lowest scores were \"treatment and prognosis\" for ChatGPT and Perplexity and \"diagnosis\" for Gemini. Gemini responses were significantly less complete compared to ChatGPT and Perplexity, with median completeness scores for ChatGPT and Perplexity ranging from \"nearly complete\" to \"complete\" and for Gemini ranging from \"incomplete\" to \"nearly complete.\" All chatbots' responses required an advanced reading level, with Perplexity showing lower readability in five metrics.</p><p><strong>Conclusion: </strong>Our findings highlight the potential of AI chatbots to deliver mostly accurate responses to narcolepsy-related queries. However, these tools have limitations, including text accessibility, as the readability of the responses did not align with the recommended standards for health information. Therefore, their use should be integrated with appropriate guidance from healthcare professionals to avoid potential misunderstandings.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-7"},"PeriodicalIF":2.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choroid Plexus Calcifications and Biomarkers of Systemic Inflammation: A Population Study Focused on Their Potential Association.","authors":"Oscar H Del Brutto, Robertino M Mera, Denisse A Rumbea, Emilio E Arias, Kleber Arriaga, Pablo R Castillo, Vishal Patel","doi":"10.1159/000547491","DOIUrl":"10.1159/000547491","url":null,"abstract":"<p><strong>Introduction: </strong>While small-scale studies have linked calcifications to functional impairment of the choroid plexus, their association with systemic inflammation remains uncertain. This study investigates the relationship between choroid plexus calcifications (CPCs) and the systemic immune-inflammation index (SII), a reliable biomarker of systemic inflammation, in middle-aged and older adults.</p><p><strong>Methods: </strong>A cross-sectional, population study of 814 adults aged ≥40 years quantified CPC volumes using CT and automated segmentation. SII was calculated from blood cell counts. Nonparametric and linear regression models assessed the association between CPC and SII.</p><p><strong>Results: </strong>Participants had a mean age of 54.5 ± 11.6 years (59% women), with mean CPC volume of 651.2 ± 373.3 µL, and mean SII of 446.8 ± 247.2 × 109 L. Nonparametric regression indicated a weak negative association between CPC volume and SII. All models showed nonsignificant negative coefficients, suggesting CPC may reflect a resolved inflammatory state rather than active dysfunction.</p><p><strong>Conclusions: </strong>Study results challenge prior assumptions linking calcifications to choroid plexus dysfunction and systemic inflammation. Although CPC volume was not associated with SII, further research incorporating advanced imaging and broader biomarkers is needed to clarify the role of CPC in inflammatory processes.</p>","PeriodicalId":12065,"journal":{"name":"European Neurology","volume":" ","pages":"1-5"},"PeriodicalIF":2.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}