JAMA neurology最新文献

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High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS. 50 岁及以上非活动性多发性硬化症患者停用高效疗法与继续使用高效疗法的比较
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0395
Guillaume Jouvenot, Guilhem Courbon, Mathilde Lefort, Fabien Rollot, Romain Casey, Emmanuelle Le Page, Laure Michel, Gilles Edan, Jérome de Seze, Laurent Kremer, Kevin Bigaut, Sandra Vukusic, Guillaume Mathey, Jonathan Ciron, Aurélie Ruet, Elisabeth Maillart, Pierre Labauge, Hélène Zephir, Caroline Papeix, Gilles Defer, Christine Lebrun-Frenay, Thibault Moreau, David Axel Laplaud, Eric Berger, Bruno Stankoff, Pierre Clavelou, Eric Thouvenot, Olivier Heinzlef, Jean Pelletier, Abdullatif Al-Khedr, Olivier Casez, Bertrand Bourre, Philippe Cabre, Abir Wahab, Laurent Magy, Jean-Philippe Camdessanché, Ines Doghri, Solène Moulin, Haifa Ben-Nasr, Céline Labeyrie, Karolina Hankiewicz, Jean-Philippe Neau, Corinne Pottier, Chantal Nifle, Nicolas Collongues, Anne Kerbrat
{"title":"High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS.","authors":"Guillaume Jouvenot, Guilhem Courbon, Mathilde Lefort, Fabien Rollot, Romain Casey, Emmanuelle Le Page, Laure Michel, Gilles Edan, Jérome de Seze, Laurent Kremer, Kevin Bigaut, Sandra Vukusic, Guillaume Mathey, Jonathan Ciron, Aurélie Ruet, Elisabeth Maillart, Pierre Labauge, Hélène Zephir, Caroline Papeix, Gilles Defer, Christine Lebrun-Frenay, Thibault Moreau, David Axel Laplaud, Eric Berger, Bruno Stankoff, Pierre Clavelou, Eric Thouvenot, Olivier Heinzlef, Jean Pelletier, Abdullatif Al-Khedr, Olivier Casez, Bertrand Bourre, Philippe Cabre, Abir Wahab, Laurent Magy, Jean-Philippe Camdessanché, Ines Doghri, Solène Moulin, Haifa Ben-Nasr, Céline Labeyrie, Karolina Hankiewicz, Jean-Philippe Neau, Corinne Pottier, Chantal Nifle, Nicolas Collongues, Anne Kerbrat","doi":"10.1001/jamaneurol.2024.0395","DOIUrl":"10.1001/jamaneurol.2024.0395","url":null,"abstract":"<p><strong>Importance: </strong>A recent randomized clinical trial concluded that discontinuing medium-efficacy therapy might be a reasonable option for older patients with nonactive multiple sclerosis (MS), but there is a lack of data on discontinuing high-efficacy therapy (HET). In younger patients, the discontinuation of natalizumab and fingolimod is associated with a risk of rebound of disease activity.</p><p><strong>Objective: </strong>To determine whether discontinuing HET in patients 50 years and older with nonactive MS is associated with an increased risk of relapse compared with continuing HET.</p><p><strong>Design, setting, and participants: </strong>This observational cohort study used data from 38 referral centers from the French MS registry (Observatoire Français de la Sclérose en Plaques [OFSEP] database). Among 84704 patients in the database, data were extracted for 1857 patients 50 years and older with relapsing-remitting MS treated by HET and with no relapse or magnetic resonance imaging activity for at least 2 years. After verification of the medical records, 1620 patients were classified as having discontinued HET or having remained taking treatment and were matched 1:1 using a dynamic propensity score (including age, sex, disease phenotype, disability, treatment of interest, and time since last inflammatory activity). Patients were included from February 2008 to November 2021, with a mean (SD) follow-up of 5.1 (2.9) years. Data were extracted in June 2022.</p><p><strong>Exposures: </strong>Natalizumab, fingolimod, rituximab, and ocrelizumab.</p><p><strong>Main outcomes and measures: </strong>Time to first relapse.</p><p><strong>Results: </strong>Of 1620 included patients, 1175 (72.5%) were female, and the mean (SD) age was 54.7 (4.8) years. Among the 1452 in the HET continuation group and 168 in the HET discontinuation group, 154 patients in each group were matched using propensity scores (mean [SD] age, 57.7 [5.5] years; mean [SD] delay since the last inflammatory activity, 5.6 [3.8] years; mean [SD] follow-up duration after propensity score matching, 2.5 [2.1] years). Time to first relapse was significantly reduced in the HET discontinuation group compared with the HET continuation group (hazard ratio, 4.1; 95% CI, 2.0-8.5; P < .001) but differed between HETs, with a hazard ratio of 7.2 (95% CI, 2.1-24.5; P = .001) for natalizumab, 4.5 (95% CI, 1.3-15.5; P = .02) for fingolimod, and 1.1 (95% CI, 0.3-4.8; P = .85) for anti-CD20 therapy.</p><p><strong>Conclusion and relevance: </strong>As in younger patients, in patients 50 years and older with nonactive MS, the risk of relapse increased significantly after stopping HETs that impact immune cell trafficking (natalizumab and fingolimod). There was no significant increase in risk after stopping HETs that deplete B-cells (anti-CD20 therapy). This result may inform decisions about stopping HETs in clinical practice.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Microbleeds in Heterozygous HTRA1-Related Cerebral Small Vessel Disease. 杂合子 HTRA1 相关脑小血管疾病中的微出血。
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0113
Yu Guo, Qing Peng, Chen Ling
{"title":"Microbleeds in Heterozygous HTRA1-Related Cerebral Small Vessel Disease.","authors":"Yu Guo, Qing Peng, Chen Ling","doi":"10.1001/jamaneurol.2024.0113","DOIUrl":"10.1001/jamaneurol.2024.0113","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke: The ATAMIS Randomized Clinical Trial. 急性轻度至中度卒中患者服用氯吡格雷加阿司匹林与单用阿司匹林的对比:ATAMIS 随机临床试验。
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0146
Hui-Sheng Chen, Yu Cui, Xin-Hong Wang, Yu-Tong Ma, Jing Han, Ying-Jie Duan, Jiang Lu, Li-Ying Shen, Yong Liang, Wei-Zhong Wang, Hui Wang, Yong Zhao, Jin-Tao Zhang, Yu-Lin Song, Xiao-Mei He, Run-Hui Li, Ding-Bo Tao, Jing Li, Shu-Man Huang, Ni Wang, Mei Hong, Chong Meng, Wei Zhang, Duo-Lao Wang, Thanh N Nguyen
{"title":"Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke: The ATAMIS Randomized Clinical Trial.","authors":"Hui-Sheng Chen, Yu Cui, Xin-Hong Wang, Yu-Tong Ma, Jing Han, Ying-Jie Duan, Jiang Lu, Li-Ying Shen, Yong Liang, Wei-Zhong Wang, Hui Wang, Yong Zhao, Jin-Tao Zhang, Yu-Lin Song, Xiao-Mei He, Run-Hui Li, Ding-Bo Tao, Jing Li, Shu-Man Huang, Ni Wang, Mei Hong, Chong Meng, Wei Zhang, Duo-Lao Wang, Thanh N Nguyen","doi":"10.1001/jamaneurol.2024.0146","DOIUrl":"10.1001/jamaneurol.2024.0146","url":null,"abstract":"<p><strong>Importance: </strong>Dual antiplatelet therapy has been demonstrated to be superior to single antiplatelet in reducing recurrent stroke among patients with transient ischemic attack or minor stroke, but robust evidence for its effect in patients with mild to moderate ischemic stroke is lacking.</p><p><strong>Objective: </strong>To evaluate whether dual antiplatelet therapy is superior to single antiplatelet among patients with mild to moderate ischemic stroke.</p><p><strong>Design, setting, and participants: </strong>This was a multicenter, open-label, blinded end point, randomized clinical trial conducted at 66 hospitals in China from December 20, 2016, through August 9, 2022. The date of final follow-up was October 30, 2022. The analysis was reported on March 12, 2023. Of 3065 patients with ischemic stroke, 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were enrolled, after excluding 65 patients who did not meet eligibility criteria or had no randomization outcome.</p><p><strong>Interventions: </strong>Within 48 hours after symptom onset, patients were randomly assigned to receive clopidogrel plus aspirin (n = 1541) or aspirin alone (n = 1459) in a 1:1 ratio.</p><p><strong>Main outcomes and measures: </strong>The primary end point was early neurologic deterioration at 7 days, defined as an increase of 2 or more points in National Institutes of Health Stroke Scale (NIHSS) score, but not as a result of cerebral hemorrhage, compared with baseline. The superiority of clopidogrel plus aspirin to aspirin alone was assessed based on a modified intention-to-treat population, which included all randomized participants with at least 1 efficacy evaluation regardless of treatment allocation. Bleeding events were safety end points.</p><p><strong>Results: </strong>Of the 3000 randomized patients, 1942 (64.6%) were men, the mean (SD) age was 65.9 (10.6) years, median (IQR) NIHSS score at admission was 5 (4-6), and 1830 (61.0%) had a stroke of undetermined cause. A total of 2915 patients were included in the modified intention-to-treat analysis. Early neurologic deterioration occurred in 72 of 1502 (4.8%) in the dual antiplatelet therapy group vs 95 of 1413 (6.7%) in the aspirin alone group (risk difference -1.9%; 95% CI, -3.6 to -0.2; P = .03). Similar bleeding events were found between 2 groups.</p><p><strong>Conclusions and relevance: </strong>Among Chinese patients with acute mild to moderate ischemic stroke, clopidogrel plus aspirin was superior to aspirin alone with regard to reducing early neurologic deterioration at 7 days with similar safety profile. These findings indicate that dual antiplatelet therapy may be a superior choice to aspirin alone in treating patients with acute mild to moderate stroke.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02869009.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10928538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Male Carrier of X-Linked Adrenal Leukodystrophy Due to 47, XXY Karyotype. 47、XXY 染色体型导致的 X 连锁肾上腺白质营养不良症男性携带者。
IF 20.4 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0061
Yu Ni, Chen Liu, Liang Tan
{"title":"Male Carrier of X-Linked Adrenal Leukodystrophy Due to 47, XXY Karyotype.","authors":"Yu Ni, Chen Liu, Liang Tan","doi":"10.1001/jamaneurol.2024.0061","DOIUrl":"10.1001/jamaneurol.2024.0061","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":20.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Discussion on the Application of Rapid Immunoblot Assay for AQP4-IgG Detection. 探讨快速免疫印迹分析法在 AQP4-IgG 检测中的应用。
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0299
Yang Su, Minjin Wang
{"title":"Discussion on the Application of Rapid Immunoblot Assay for AQP4-IgG Detection.","authors":"Yang Su, Minjin Wang","doi":"10.1001/jamaneurol.2024.0299","DOIUrl":"10.1001/jamaneurol.2024.0299","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early Use of Erenumab vs Nonspecific Oral Migraine Preventives: The APPRAISE Randomized Clinical Trial. 早期使用艾伦单抗与非特异性口服偏头痛预防药的对比:APPRAISE 随机临床试验》。
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0368
Patricia Pozo-Rosich, David Dolezil, Koen Paemeleire, Adam Stepien, Philipp Stude, Josefin Snellman, Michal Arkuszewski, Tracy Stites, Shannon Ritter, Cristina Lopez Lopez, Jeff Maca, Matias Ferraris, Raquel Gil-Gouveia
{"title":"Early Use of Erenumab vs Nonspecific Oral Migraine Preventives: The APPRAISE Randomized Clinical Trial.","authors":"Patricia Pozo-Rosich, David Dolezil, Koen Paemeleire, Adam Stepien, Philipp Stude, Josefin Snellman, Michal Arkuszewski, Tracy Stites, Shannon Ritter, Cristina Lopez Lopez, Jeff Maca, Matias Ferraris, Raquel Gil-Gouveia","doi":"10.1001/jamaneurol.2024.0368","DOIUrl":"10.1001/jamaneurol.2024.0368","url":null,"abstract":"<p><strong>Importance: </strong>Patients with migraine often cycle through multiple nonspecific preventive medications due to poor tolerability and/or inadequate efficacy leading to low adherence and increased disease burden.</p><p><strong>Objective: </strong>To compare the efficacy, tolerability, patient adherence, and patient satisfaction between erenumab and nonspecific oral migraine preventive medications (OMPMs) in patients with episodic migraine (EM) who had previously failed 1 or 2 preventive treatments.</p><p><strong>Design, setting, and participants: </strong>The 12-month prospective, interventional, global, multicenter, active-controlled, randomized clinical trial comparing sustained benefit of 2 treatment paradigms (erenumab qm vs oral prophylactics) in adult episodic migraine patients (APPRAISE) trial was a 12-month open-label, multicenter, active-controlled, phase 4 randomized clinical trial conducted from May 15, 2019, to October 1, 2021. This pragmatic trial was conducted at 84 centers across 17 countries. Overall, participants 18 years or older with a 12-month or longer history of migraine, and 4 or more but fewer than 15 monthly migraine days (MMDs) were included.</p><p><strong>Interventions: </strong>Patients were randomized (2:1) to receive erenumab or OMPMs. Dose adjustment was permitted (label dependent).</p><p><strong>Main outcomes and measures: </strong>The primary end point was the proportion of patients completing 1 year of the initially assigned treatment and achieving a reduction of 50% or greater from baseline in MMDs at month 12. Secondary end points included the cumulative mean change from baseline in MMDs during the treatment period and the proportion of responders according to the Patients' Global Impression of Change (PGIC) scale at month 12 for patients taking the initially assigned treatment.</p><p><strong>Results: </strong>A total of 866 patients were screened, of whom 245 failed the screening and 621 completed the screening and baseline period. Of the 621 randomized patients (mean [SD] age, 41.3 [11.2] years; 545 female [87.8%]; 413 [66.5%] in the erenumab group; 208 [33.5%] in the OMPM group), 523 (84.2%) completed the treatment phase, and 98 (15.8%) discontinued the study. At month 12, significantly more patients assigned to erenumab vs OMPM achieved the primary end point (232 of 413 [56.2%] vs 35 of 208 [16.8%]; odds ratio [OR], 6.48; 95% CI, 4.28-9.82; P <.001). Compared with OMPMs, treatment with erenumab showed higher responder rate (314 of 413 [76.0%] vs 39 of 208 [18.8%]; OR, 13.75; 95% CI, 9.08-20.83; P <.001) on the PGIC scale (≥5 at month 12). Significant reduction in cumulative average MMDs was reported with erenumab treatment vs OMPM treatment (-4.32 vs -2.65; treatment difference [SE]: -1.67 [0.35] days; P < .001). Substantially fewer patients in the erenumab arm compared with the OMPM arm switched medication (9 of 413 [2.2%] vs 72 of 208 [34.6%]) and discontinued treatment due to adverse events ","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment of Refractory Status Epilepticus With Continuous Intravenous Anesthetic Drugs: A Systematic Review. 持续静脉注射麻醉药物治疗难治性癫痫状态:系统回顾。
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0108
Yu Kan Au, Mohammed F Kananeh, Rahul Rahangdale, Timothy Eoin Moore, Gregory A Panza, Nicolas Gaspard, Lawrence J Hirsch, Andres Fernandez, Syed Omar Shah
{"title":"Treatment of Refractory Status Epilepticus With Continuous Intravenous Anesthetic Drugs: A Systematic Review.","authors":"Yu Kan Au, Mohammed F Kananeh, Rahul Rahangdale, Timothy Eoin Moore, Gregory A Panza, Nicolas Gaspard, Lawrence J Hirsch, Andres Fernandez, Syed Omar Shah","doi":"10.1001/jamaneurol.2024.0108","DOIUrl":"10.1001/jamaneurol.2024.0108","url":null,"abstract":"<p><strong>Importance: </strong>Multiple continuous intravenous anesthetic drugs (CIVADs) are available for the treatment of refractory status epilepticus (RSE). There is a paucity of data comparing the different types of CIVADs used for RSE.</p><p><strong>Objective: </strong>To systematically review and compare outcome measures associated with the initial CIVAD choice in RSE in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</p><p><strong>Evidence review: </strong>Data sources included English and non-English articles using Embase, MEDLINE, PubMed, and Web of Science (January 1994-June 2023) as well as manual search. Study selection included peer-reviewed studies of 5 or more patients and at least 1 patient older than 12 years with status epilepticus refractory to a benzodiazepine and at least 1 standard antiseizure medication, treated with continuously infused midazolam, ketamine, propofol, pentobarbital, or thiopental. Independent extraction of articles was performed using prespecified data items. The association between outcome variables and CIVAD was examined with an analysis of variance or χ2 test where appropriate. Binary logistic regressions were used to examine the association between outcome variables and CIVAD with etiology, change in mortality over time, electroencephalography (EEG) monitoring (continuous vs intermittent), and treatment goal (seizure vs burst suppression) included as covariates. Risk of bias was addressed by listing the population and type of each study.</p><p><strong>Findings: </strong>A total of 66 studies with 1637 patients were included. Significant differences among CIVAD groups in short-term failure, hypotension, and CIVAD substitution during treatment were observed. Non-epilepsy-related RSE (vs epilepsy-related RSE) was associated with a higher rate of CIVAD substitution (60 of 120 [50.0%] vs 11 of 43 [25.6%]; odds ratio [OR], 3.11; 95% CI, 1.44-7.11; P = .006) and mortality (98 of 227 [43.2%] vs 7 of 63 [11.1%]; OR, 17.0; 95% CI, 4.71-109.35; P < .001). Seizure suppression was associated with mortality (OR, 7.72; 95% CI, 1.77-39.23; P = .005), but only a small subgroup was available for analysis (seizure suppression: 17 of 22 [77.3%] from 3 publications vs burst suppression: 25 of 98 [25.5%] from 12 publications). CIVAD choice and EEG type were not predictors of mortality. Earlier publication year was associated with mortality, although the observation was no longer statistically significant after adjusting SEs for clustering.</p><p><strong>Conclusions and relevance: </strong>Epilepsy-related RSE was associated with lower mortality compared with other RSE etiologies. A trend of decreasing mortality over time was observed, which may suggest an effect of advances in neurocritical care. The overall data are heterogeneous, which limits definitive conclusions on the choice of optimal initial CIVAD in RSE treatment.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
JAMA Neurology-The Year in Review, 2023. 美国医学会杂志神经病学--2023 年回顾》。
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0239
S Andrew Josephson
{"title":"JAMA Neurology-The Year in Review, 2023.","authors":"S Andrew Josephson","doi":"10.1001/jamaneurol.2024.0239","DOIUrl":"10.1001/jamaneurol.2024.0239","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Magnetic Resonance Imaging Characteristics of LGI1-Antibody and CASPR2-Antibody Encephalitis. LGI1-抗体和 CASPR2-抗体脑炎的磁共振成像特征
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.0126
Mark J Kelly, Eleanor Grant, Andrew G Murchison, Sophie Binks, Sudarshini Ramanathan, Sophia Michael, Adam E Handel, Lahiru Handunnetthi, Christopher E Uy, John N Soltys, Divyanshu Dubey, Gregory S Day, A Sebastian Lopez-Chiriboga, Eoin P Flanagan, Fintan Sheerin, Sarosh R Irani
{"title":"Magnetic Resonance Imaging Characteristics of LGI1-Antibody and CASPR2-Antibody Encephalitis.","authors":"Mark J Kelly, Eleanor Grant, Andrew G Murchison, Sophie Binks, Sudarshini Ramanathan, Sophia Michael, Adam E Handel, Lahiru Handunnetthi, Christopher E Uy, John N Soltys, Divyanshu Dubey, Gregory S Day, A Sebastian Lopez-Chiriboga, Eoin P Flanagan, Fintan Sheerin, Sarosh R Irani","doi":"10.1001/jamaneurol.2024.0126","DOIUrl":"10.1001/jamaneurol.2024.0126","url":null,"abstract":"<p><strong>Importance: </strong>Rapid and accurate diagnosis of autoimmune encephalitis encourages prompt initiation of immunotherapy toward improved patient outcomes. However, clinical features alone may not sufficiently narrow the differential diagnosis, and awaiting autoantibody results can delay immunotherapy.</p><p><strong>Objective: </strong>To identify simple magnetic resonance imaging (MRI) characteristics that accurately distinguish 2 common forms of autoimmune encephalitis, LGI1- and CASPR2-antibody encephalitis (LGI1/CASPR2-Ab-E), from 2 major differential diagnoses, viral encephalitis (VE) and Creutzfeldt-Jakob disease (CJD).</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study involved a retrospective, blinded analysis of the first available brain MRIs (taken 2000-2022) from 192 patients at Oxford University Hospitals in the UK and Mayo Clinic in the US. These patients had LGI1/CASPR2-Ab-E, VE, or CJD as evaluated by 2 neuroradiologists (discovery cohort; n = 87); findings were validated in an independent cohort by 3 neurologists (n = 105). Groups were statistically compared with contingency tables. Data were analyzed in 2023.</p><p><strong>Main outcomes and measures: </strong>MRI findings including T2 or fluid-attenuated inversion recovery (FLAIR) hyperintensities, swelling or volume loss, presence of gadolinium contrast enhancement, and diffusion-weighted imaging changes. Correlations with clinical features.</p><p><strong>Results: </strong>Among 192 participants with MRIs reviewed, 71 were female (37%) and 121 were male (63%); the median age was 66 years (range, 19-92 years). By comparison with VE and CJD, in LGI1/CASPR2-Ab-E, T2 and/or FLAIR hyperintensities were less likely to extend outside the temporal lobe (3/42 patients [7%] vs 17/18 patients [94%] with VE; P < .001, and 3/4 patients [75%] with CJD; P = .005), less frequently exhibited swelling (12/55 [22%] with LGI1/CASPR2-Ab-E vs 13/22 [59%] with VE; P = .003), and showed no diffusion restriction (0 patients vs 16/22 [73%] with VE and 8/10 [80%] with CJD; both P < .001) and rare contrast enhancement (1/20 [5%] vs 7/17 [41%] with VE; P = .01). These findings were validated in an independent cohort and generated an area under the curve of 0.97, sensitivity of 90%, and specificity of 95% among cases with T2/FLAIR hyperintensity in the hippocampus and/or amygdala.</p><p><strong>Conclusions and relevance: </strong>In this study, T2 and/or FLAIR hyperintensities confined to the temporal lobes, without diffusion restriction or contrast enhancement, robustly distinguished LGI1/CASPR2-Ab-E from key differential diagnoses. These observations should assist clinical decision-making toward expediting immunotherapy. Their generalizability to other forms of autoimmune encephalitis and VE should be examined in future studies.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Error in Figure. 图中错误。
IF 29 1区 医学
JAMA neurology Pub Date : 2024-05-01 DOI: 10.1001/jamaneurol.2024.1377
{"title":"Error in Figure.","authors":"","doi":"10.1001/jamaneurol.2024.1377","DOIUrl":"10.1001/jamaneurol.2024.1377","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":null,"pages":null},"PeriodicalIF":29.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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