JAMA neurology最新文献

{"title":"Recent Advances and Future Prospects in Gene Delivery Platforms for Glioblastoma","authors":"Alexander F. Haddad, Rithvik Ramesh, Jorge Armando Peña Agudelo, Christopher Salha, Pranav Prakash, Shreya R. Aghi, James S. Trippett, Maria G. Castro, Manish K. Aghi","doi":"10.1001/jamaneurol.2026.2131","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.2131","url":null,"abstract":"Importance Glioblastoma (GBM) remains a disease with high mortality despite treatment with maximal safe surgical resection, radiation, and temozolomide. Standard of care for GBM has remained unchanged for decades. Gene therapies using both viral and nonviral platforms have the potential to significantly improve outcomes but have faced challenges related to delivery, intratumoral heterogeneity, and immunologic limitations. Observations This review discusses the most recent progress in genetic therapies for gliomas, with a focus on clinical platforms and those nearing clinical translation. Oncolytic and nonlytic replicating viral therapies remain the most clinically advanced, with adeno-associated virus and nonviral systems approaching clinical translation. Treatment efficacy has been variable across trials, platforms, and payloads. Oncolytic herpes simplex virus (G47Δ, teserpaturev) has been conditionally approved for the treatment of gliomas in Japan, while next-generation constructs show a potential association between immunologic activation and survival. Common challenges include the verification and quantification of delivery efficiency, the balance between antivector and antitumor immunity, appropriately designed clinical trials, relevant modeling of vector behavior in the preclinical setting, regulatory clearance, and manufacturing. Conclusions and Relevance Understanding the potential and limitations of gene therapies for gliomas is vital in navigating the path forward for these promising therapies. The future of these treatments will focus on improved clinical trial design with rapid confirmation and tracking of delivery, biomarker feedback and assay optimization, and combination strategies. A focus on delivery platform development can compress iteration cycles and lead to therapeutic benefit for patients with gliomas and other solid tumors.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"37 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429044","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}

{"title":"Trends in Dementia Prevalence Across Latin America and the Caribbean","authors":"Jorge J. Llibre-Guerra, Yu-Tzu Wu, Issac Acosta, Chris Soria, Ana Luisa Sosa, Daisy Acosta, Ivonne Z. Jiménez-Velázquez, Mariella Guerra, Aquiles Salas, Ruijin Lu, Juan J. Llibre-Rodriguez, Matthew Prina","doi":"10.1001/jamaneurol.2026.2305","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.2305","url":null,"abstract":"Importance Reliable estimates of dementia prevalence trends are essential for health policy planning. Latin America is undergoing rapid population aging, yet it remains unclear whether dementia prevalence mirrors declining patterns reported in high-income countries. Objective To examine 2-decade trends in dementia prevalence across 5 Latin American and Caribbean sites participating in the 10/66 Dementia Research Group. Design, Setting, and Participants This cross-sectional, population-based study included data from 5 population-based catchment areas participating in the 10/66 study: Cuba, the Dominican Republic, Mexico, Peru, and Puerto Rico. Data were collected at 2 time points: 2003 to 2006 and 2016 to 2020. Participants were community-dwelling adults aged 65 years or older, identified through exhaustive door-to-door enumeration across 2 survey waves. Data were analyzed between March 2025 and May 2026. Exposures Survey wave (2003-2006 vs 2016-2020) was the primary temporal comparison. Secondary exposures included modifiable dementia risk factors from the Lancet Commission on dementia prevention. Main Outcomes and Measures The main outcome was crude and age- and sex-standardized dementia prevalence using the 10/66 dementia diagnostic algorithm. Adjusted prevalence differences between waves were estimated using Poisson regression with sequential adjustment for education, health behaviors, and health risk factors. Results Of 23 709 eligible individuals identified, 5892 declined or could not be traced and 17 817 were assessed. After excluding participants with missing dementia diagnosis or data, the analytic sample included 16 950 participants (wave 1: n = 10 374; wave 3: n = 6576; mean [SD] age, 76.0 [7.5] years; 63.7% women). Pooled crude prevalence increased from 10.6% (95% CI, 10.0%-11.2%) at 2003 to 2006 to 16.9% (95% CI, 15.9%-17.8%) at 2016 to 2020. After age and sex standardization to 2025 United Nations population structures, prevalence remained stable in Cuba and the Dominican Republic but increased substantially in Mexico (4.9 percentage points [pp]; 95% CI, 3.0-6.8 pp), Peru (4.1 pp; 95% CI, 1.9-6.4 pp), and Puerto Rico (5.0 pp; 95% CI, 1.8-8.2 pp). Increasing trends in Mexico (adjusted difference: 6.3%; 95% CI, 4.1%-8.5%) and Puerto Rico (7.2%; 95% CI, 3.8%-10.6%) persisted after full adjustment for health behaviors and risk factors. Conclusions and Relevance This study found that dementia prevalence has increased over 2 decades across several Latin American 10/66 catchment sites, contrasting with declining trends reported in high-income countries. These findings, while specific to the 5 studied sites, highlight the growing and uneven burden of dementia in the region and underscore the need for strengthened surveillance, risk reduction strategies, and investment in dementia care infrastructure.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"28 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429048","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}

{"title":"Interleukin 6 Receptor Blockade for Relapse Prevention in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.","authors":"Andreu Vilaseca,Philippe A Bilodeau,Georgios Gakis,Andrea Savransky,Joao Mahler Ferreira Oliveira,Linda Nguyen,Sam I Hooshmand,Sammita Satyanarayan,Carson E Moseley,Leah Haley,Chantal Roy-Hewitson,Mariano Marrodan,Adriana Casallas,Analisa Manin,Haiwen Chen,Yoji Hoshina,Aniela Grzezulkowska,Edgar Carnero Contentti,Lorna Galleguillos,Margaret Upchurch,Caitlin S Jackson-Tarlton,Joanne Chu-Yueh Guo,Michelle Fabian,Akash Virupakshaiah,Georgina Arrambide,César Caparó-Zamalloa,Rafael Paterno,Emmanuelle Waubant,Laura Ordoñez Boschetti,Jorge Correale,Andres M Villa,Brenda Banwell,Romain Marignier,Sean J Pittock,Benjamin Greenberg,Jeffrey L Bennett,Tracey Cho,Stacey Clardy,Andrew J Solomon,Ilya Kister,Scott S Zamvil,Jeffrey M Gelfand,Pavle Repovic,Ahmed Z Obeidat,Kyle Blackburn,Silvia Tenembaum,John J Chen,Elias S Sotirchos,Michael Levy,Eoin P Flanagan, ,Fabian Murillo,Stephanie B Syc-Mazurzek,Laura Cacciaguerra,Mulan Jiang,Nathane Braga da Silva Rezende,Dean M Wingerchuk,Susan E Horsman","doi":"10.1001/jamaneurol.2026.2220","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.2220","url":null,"abstract":"ImportanceMyelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) lacks proven relapse-preventive therapies. While clinical trials are ongoing, safety data may be limited and approved drugs are costly. Studies of interleukin 6 receptor blocker (IL-6RB) in MOGAD are limited by small numbers and no comparative studies, contributing to low use.ObjectiveTo evaluate the impact of IL-6RB therapy on relapse rates in MOGAD and compare relapse frequency with intravenous immunoglobulin (IVIG).Design, Setting, and ParticipantsThis international, multicenter, retrospective cohort study (January 1, 2015, through December 31, 2025) included a historical IVIG-treated cohort of varying doses. The study took place across sites in North and South America (US, Canada, Mexico, Argentina, Brazil, Chile, Colombia, and Peru). Patients with MOGAD (n = 116, no excluded patients) who received at least 1 dose of an IL-6RB were included. These data were analyzed in January 2026.ExposuresTocilizumab or satralizumab.Main Outcomes and MeasuresAnnualized relapse rate (ARR) during IL-6RB therapy, time to next relapse after treatment initiation, and adverse events. Outcomes were compared with the IVIG cohort using inverse probability of treatment weighting (IPTW) adjusted for age, sex, prior ARR, and concomitant therapies.ResultsA total of 116 patients with MOGAD (89% relapsing) receiving IL-6RB (tocilizumab, 104 [90%] and satralizumab, 12 [10%]) were included; overall, 60.3% were female, 39.7% were male, and 18% were younger than 18 years. The median (IQR) IL-6RB treatment follow-up was 1.4 (0.7-2.5) years and 23 relapses occurred during 241.8 person-years of IL-6RB therapy. The ARR decreased from 0.64 (95% CI, 0.58-0.70) for relapsing MOGAD before IL-6RB to 0.09 (95% CI, 0.06-0.14) during IL-6RB treatment (incidence rate ratio, 0.08; 95% CI, 0.04-0.16). Adverse events occurred in 58 patients (50%), most commonly mild infections, although 10 (9%) had severe infections. In the IVIG cohort (n = 59), 30 relapses occurred over 133.8 person-years (ARR, 0.22; 95% CI, 0.15-0.32). After IPTW, IL-6RB was associated with a lower hazard ratio (HR) than the group who underwent IVIG therapy less than 1 g/kg every 4 weeks (HR, 4.5; 95% CI, 2.0-9.8), with no significant difference vs the group who underwent IVIG 1 g/kg or more every 4 weeks (HR, 2.0; 95% CI, 0.8-4.5).Conclusions and RelevanceIn this multicenter observational cohort, IL-6RB use in MOGAD was associated with low relapse rates and a favorable safety profile, though severe infections occurred occasionally. Relapse rates were lower than the group who underwent IVIG less than 1 g/kg every 4 weeks but not significantly different from the group who underwent IVIG 1 g/kg or more every 4 weeks. This supports IL-6RB as a potential relapse-prevention therapy in MOGAD; the wide availability and relative affordability of tocilizumab may enable broad global use.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"60 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429051","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}

{"title":"Antisense Oligonucleotide Tofersen Distribution in the Central Nervous System of SOD1-ALS Autopsy Tissue Donors.","authors":"Amanda J Guise,Monica Thanawala Sellon,Shanu F Roemer,Michael Monine,Nicole T Comfort Harris,Dan Bartlett,Eric David,Shanqin Xu,Luke Jandreski,Sohail Malek,Steve Garafalo,Ivan Nestorov,Margaret D Ireland,Andrew King,Robert P Bowser,Vladislav Korobeynikov,John Ravits,Pamela J Shaw,J Robin Highley,Toby A Ferguson,Stephanie Fradette,Danielle L Graham,Eric J Sorenson,Björn Oskarsson,R Ross Reichard,Dennis W Dickson,Sabrina Paganoni,Suma Babu,Derek H Oakley,Matthew P Frosch,Timothy M Miller,Robert C Bucelli,Richard J Perrin,Cindy V Ly,Edward D Plowey","doi":"10.1001/jamaneurol.2026.2195","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.2195","url":null,"abstract":"ImportanceTofersen is a disease-modifying antisense oligonucleotide therapeutic for people living with SOD1-amyotrophic lateral sclerosis (SOD1-ALS). Autopsy tissue donors have provided the first opportunity to study the distribution of intrathecally administered tofersen in human central nervous system tissues.ObjectivesTo determine the tissue distribution of tofersen and to provide the first estimates of SOD1 reduction in human somatic motor systems tissues.Design, Setting, and ParticipantsThis was a cross-sectional autopsy tissue case series conducted between 2018 and 2026. Autopsies were performed at 3 US academic medical institutions. Tissue samples from 8 deceased patients who lived with SOD1-ALS, participated in tofersen clinical trials (ClinicalTrials.gov Identifiers NCT02623699 [An Efficacy, Safety, Tolerability, Pharmacokinetics and Pharmacodynamics Study of BIIB067 (Tofersen) in Adults With Inherited Amyotrophic Lateral Sclerosis (ALS)] and NCT03070119 [Long-Term Evaluation of BIIB067 (Tofersen)]) or the Expanded Access Program, and whose families authorized autopsies were eligible for this study. All autopsy tissue donors known at the time of this study were included (none were excluded). Analyses were conducted between August 2020 and January 2026.ExposuresParticipants received multiple intrathecal 20- to 100-mg tofersen doses.Main Outcomes and MeasuresTofersen tissue concentrations were measured using hybridization enzyme-linked immunosorbent assay (ELISA). SOD1 messenger RNA (mRNA) and protein reduction estimates, defined as percentage SOD1 levels in this study's recently treated autopsy tissue donors compared to a cohort of samples from tofersen-naive SOD1-ALS autopsy tissue donors, were measured using quantitative reverse transcription polymerase chain reaction (PCR) and ELISA. Histological localization of tofersen and SOD1 transcripts were studied using immunohistochemistry and in situ hybridization assays.ResultsIn 8 tofersen-treated autopsy tissue donors (5 male and 3 female donors; age range, 42-66 years), spinal cord and motor cortical tissue tofersen concentrations strongly correlated with predictions based on individual dosing histories and a preclinical pharmacokinetic model. For 3 recently treated autopsy tissue donors, reductions in lumbar spinal cord tissue SOD1 mRNA and protein levels ranged from 45% to 84% despite not having been administered 1 to 2 scheduled doses before autopsy. Residual somatic motor neurons demonstrated tofersen transduction and low SOD1 mRNA probe hybridization. Misfolded SOD1 protein inclusions were detected in residual motor neurons of tofersen-naive SOD1-ALS tissue donor controls and tofersen-treated tissue donors. Meningeal and perivascular lymphocytic immune responses were observed in 5 recently treated tissue donors but were not apparent in tissue donors with remote final tofersen doses.Conclusions and RelevanceThis case series presents the first emerging autopsy tissue data confirming the","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"40 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388596","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}

{"title":"The Machine Is Just as Loud: On Privilege, Fear, and the Duty to Advocate.","authors":"Sasha Zitter","doi":"10.1001/jamaneurol.2026.2065","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.2065","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"39 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388574","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}

{"title":"Amateur Soccer Heading and Acute Elevations in Blood-Based p-Tau217 and S100B.","authors":"Marloes I Hoppen, Marsh Königs, Charlotte E Teunissen, Inge M W Verberk, Jos Twisk, Jaap Oosterlaan, Everard G B Vijverberg","doi":"10.1001/jamaneurol.2026.1224","DOIUrl":"10.1001/jamaneurol.2026.1224","url":null,"abstract":"<p><strong>Importance: </strong>Former professional soccer players have increased risk of neurodegenerative disease, potentially due to cumulative exposure to repetitive head impacts such as heading. However, the acute effects of heading on neural integrity remain unclear.</p><p><strong>Objective: </strong>To assess the acute association of real-life heading with blood biomarkers of neural damage before and after soccer matches.</p><p><strong>Design, setting, and participants: </strong>In this prospective population-based case-control study, soccer players participated in organized matches (August-December 2024). Blood samples were collected prematch and immediately and delayed postmatch (<1 and 24-48 hours, respectively). Video analysis quantified heading exposure, including frequency and intensity. Exercise intensity was monitored using local position monitoring and heart rate analysis. Players from higher-level amateur soccer competitions were recruited through communication channels of the Royal Dutch Football Association and screened for eligibility. Inclusion criteria included the following: male sex, age older than 18 years, and no history of a neurological condition.</p><p><strong>Exposure: </strong>Real-life heading exposure during a single amateur soccer match.</p><p><strong>Main outcomes and measures: </strong>Blood biomarkers of neural damage were measured and included the following: phosphorylated tau 217 (p-tau217), brain-derived tau (BD-tau), neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), S100B calcium-binding protein (S100B), and neuron-specific enolase (NSE). The main outcome was the association between heading exposure and change in biomarker concentration, assessed with linear mixed models while correcting for exercise intensity.</p><p><strong>Results: </strong>A total of 389 soccer players were screened for eligibility. Among the 302 players participating in 1 of the 11 matches (mean [SD] age, 24.6 [5.2] years), 216 (72%) had heading exposure. Mean (SD) exposure was 2.0 (2.1) headers per player per match, and 48% of players had high-impact heading exposure (ball trajectories >20 m; 80 players [26%] with exposure to a single high-impact header; 65 players [22%] with exposure to multiple high-impact headers). Players exposed to heading showed significantly greater immediate postmatch increases in S100B concentration (n = 299, P = .03; Cohen d = 0.29) compared with unexposed players. Exposure to more headers was associated with greater increases in S100B (n = 299, P = .02; Cohen d = 0.07 per header) and p-tau217 concentration (n = 296, P = .01; Cohen d = 0.09 per header). High-impact headers were also associated with greater increases in p-tau217 (n = 148, P = .03; Cohen d = 0.40) and S100B concentration (n = 149, P = .02; Cohen d = 0.43) compared with no exposure. Observed biomarker elevations normalized within 24 to 48 hours. No other significant associations were found. Results were robust to sensitiv","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"635-644"},"PeriodicalIF":23.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963680","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}

{"title":"Genetic Testing by Age at Onset in Parkinson Disease.","authors":"Alexander Balck, Eva-Juliane Vollstedt, Ana Westenberger, Lara M Lange, Joanne Trinh, Meike Kasten, Katja Lohmann, Norbert Brüggemann, Claudia Trenkwalder, Brit Mollenhauer, Roy Alcalay, Kamalini Ghosh Galvelis, James C Beck, Peter Bauer, Christine Klein, Inke R König","doi":"10.1001/jamaneurol.2026.1112","DOIUrl":"10.1001/jamaneurol.2026.1112","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"711-713"},"PeriodicalIF":23.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868377","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}

{"title":"Football-Specific On-Pitch Concussion Assessment Protocol—International Consensus Recommendations","authors":"Kerry Peek, Andy Massey, Ruairi Connolly, Mark Fulcher, Margot Putukian, Zoran Bahtijarević, Claus Reinsberger, Edwin Goedhart, Stephen Kara, George Chiampas, Haruo Nakayama, Mike Clarke, Yemisi Takwoingi, Jorge Pagura, Nils Calderón, Alassane Drave, Soueilem Mohamed Bouya, Andreas Serner","doi":"10.1001/jamaneurol.2026.2298","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.2298","url":null,"abstract":"Importance Concussion is a high-profile and important brain injury, yet the on-pitch assessment of concussion in football (soccer) remains challenging due to the absence of a standardized, evidence-based assessment protocol that can be completed within a time-restrained on-pitch football-match environment. The objective of this study was to develop a football-specific, standardized on-pitch concussion assessment protocol informed by research evidence and expert opinion using an international consensus process and steering committee deliberation, which included medical experts from each of the 6 football confederations. Observations Nominated global medical representatives with experience in the on-pitch assessment of concussion in football (≥5 assessments within previous year) from Fédération Internationale de Football Association (FIFA)–member associations completed a 2-round Delphi questionnaire to score all identified assessment items that have been used to assess an athlete with a suspected concussion within an on- or off-pitch environment (in any sport) along with expert recommendations. Consensus (≥80% agreement) was required for assessment items to be included in a football-specific on-pitch concussion assessment protocol. Results demonstrated that from 101 identified assessment items, 41 achieved greater than or equal to 80% agreement for inclusion in round 1, and 6 additional items achieved greater than or equal to 80% agreement in round 2. Four items (scoring 75%-79%) were added after steering committee review. Twelve items were merged to avoid duplication of items that assess the same issue. This resulted in the final Football-Specific Standardized On-Pitch Concussion Assessment Protocol (FOCUS) comprising 45 items categorized into 11 domains as follows: player medical history, mechanism of injury, visible signs, level of consciousness, cervical spine assessment, symptoms, orientation, balance, proprioception, oculomotor function, and activity-based assessment, with each structured for rapid on-pitch evaluation. Conclusions and Relevance FOCUS provided a standardized, evidence-informed protocol for the on-pitch assessment of a suspected concussion during football match play, addressing a critical gap in player health and safety. Adoption of FOCUS has the potential to harmonize concussion management globally; however, implementation feasibility and diagnostic accuracy require further evaluation.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"24 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148356268","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}

{"title":"Missing Funding/Support and Role of the Funder Statement.","authors":"","doi":"10.1001/jamaneurol.2026.1890","DOIUrl":"10.1001/jamaneurol.2026.1890","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"713"},"PeriodicalIF":23.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198890","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}

{"title":"Effect of Electroacupuncture on Postherpetic Neuralgia: A Randomized Clinical Trial.","authors":"Lu Chen, Qianyan Liu, Lixia Pei, Hao Geng, Yongtao Liu, Zhengming Yang, Min Ding, Rongrong Shen, Min Chen, Jin Lu, Dongfang You, Xiaoliang Wu, Junling Zhou, Linyan Hu, Benjie Guo, Shuting Sun, Feiyi Chen, Zhanhao Zhao, Yining Zhai, Zhuolin Chen, Zhenan Li, Wenping Yao, Hua Feng, Chunxia Lu, Yanfang Liu, Juanjuan Shi, Jing Guo, Jianhua Sun","doi":"10.1001/jamaneurol.2026.1443","DOIUrl":"10.1001/jamaneurol.2026.1443","url":null,"abstract":"<p><strong>Importance: </strong>Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.</p><p><strong>Objective: </strong>To determine whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluate its safety in patients with PHN.</p><p><strong>Design, setting, and participants: </strong>This multicenter, randomized, sham-controlled clinical trial took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial.</p><p><strong>Intervention: </strong>Twenty sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.</p><p><strong>Results: </strong>Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (-1.52) than the sham electroacupuncture group (-0.99) with an adjusted mean difference of -0.53 (95% CI, -0.61 to -0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.</p><p><strong>Conclusions and relevance: </strong>Among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04560361.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"667-676"},"PeriodicalIF":23.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030495","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}