JAMA neurology最新文献

{"title":"Maternal Social Determinants of Health and Risk of Perinatal Hypoxic-Ischemic Encephalopathy.","authors":"Dawn Gano,Michael W Kuzniewicz,Diana Montoya-Williams,Aaron Scheffler,Elena Fuentes-Afflick,Yvonne W Wu,Marie-Coralie Cornet","doi":"10.1001/jamaneurol.2025.1659","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1659","url":null,"abstract":"ImportancePerinatal hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and long-term morbidity. The association between maternal social determinants of health (SDOH) and perinatal HIE has not been established.ObjectiveTo examine the association of maternal race, ethnicity, and other SDOH with perinatal HIE.Design, Setting, and ParticipantsThis cross-sectional study of a birth cohort of insured maternal-neonatal dyads with births between January 1, 2012, and July 31, 2019, examined neonates born at 35 weeks' gestation or later at 15 Kaiser Permanente Northern California hospitals. Data were analyzed from May 12 to August 31, 2024.ExposuresMaternal race and ethnicity were classified by self-report. Other measures of SDOH included the neighborhood deprivation index (NDI), a marker of neighborhood-level socioeconomic disadvantage, and being publicly insured.Main Outcomes and MeasuresThe primary outcome was perinatal HIE, defined as the presence of perinatal acidosis (cord gas pH <7 or base deficit ≥10 mmol/L, or base deficit ≥10 mmol/L on first infant blood gas sample obtained before 2 hours of age), and neonatal encephalopathy, confirmed by medical record review.ResultsOf 290 535 newborns, 51.1% (148 158) were male, and the mean gestational age was 39 weeks; 25.8% (n = 75 011) were Hispanic, 24.6% (n = 71 366) were non-Hispanic Asian or Pacific Islander, 6.4% (n = 18 602) were non-Hispanic Black, 4.2% (n = 12 214) were non-Hispanic multiracial, and 37.6% (n = 109 147) were non-Hispanic White. Maternal race and ethnicity data were missing for 1.4% of newborns (n = 4195). The prevalence of perinatal HIE was higher among newborns of non-Hispanic Asian (0.2%; risk ratio [RR], 1.38 [95% CI, 1.06-1.80]), non-Hispanic Black (0.2%; RR, 1.66 [95% CI, 1.15-2.14]), and non-Hispanic White mothers (0.2%; RR, 1.54 [95% CI, 1.21-1.95]) than newborns of Hispanic mothers (0.1%). Black and Hispanic mothers were more likely to reside in neighborhoods with greater socioeconomic disadvantage and to be publicly insured. After adjustment for NDI, public insurance, and clinical characteristics, neonates of Hispanic mothers had 25% lower odds of HIE compared with neonates of non-Hispanic White mothers (odds ratio, 0.75 [95% CI, 0.60-0.95]; P = .02). The highest tertile of NDI, indicating higher neighborhood deprivation, was independently associated with decreased odds of HIE compared with the middle tertile (odds ratio, 0.78 [95% CI, 0.62-0.98]; P = .03).Conclusions and RelevanceThese findings suggest that there was a lower prevalence of perinatal HIE among newborns of Hispanic mothers and among newborns of mothers who resided in the most socioeconomically disadvantaged neighborhoods. Determining the root causes for the lower risk of perinatal HIE among specific subgroups may inform the development of targeted HIE prevention policies.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"228 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295666","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":"Computed Tomography Perfusion and Angiography for Death by Neurologic Criteria.","authors":"Michaël Chassé, Jai Jai Shiva Shankar, Dean A Fergusson, Shane W English, Sonny Dhanani, François Lauzier, Alexis F Turgeon, Ian Ball, Sultan Darvesh, Joel Neves Briard, Marco Essig, David Boucher-Roy, Polina Titova, Martine Lebrasseur, Philippe Couillard, Andreas Kramer, Frédérick D'Aragon, Mathew Hannouche, Donatella Tampieri, Maureen O Meade, Bijoy K Menon, Robert Green, Andrew J Baker, Karen E A Burns, Ryan Zarychanski, Jason Shahin, J Gordon Boyd, Alexandra Binnie, Andrew Gibson, Han Ting Wang, Sam Shemie","doi":"10.1001/jamaneurol.2025.2375","DOIUrl":"10.1001/jamaneurol.2025.2375","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Accurate and timely confirmation of death by neurologic criteria (DNC) is essential for clinical decision-making and organ-donation processes, yet currently available ancillary tests have suboptimal diagnostic performance or limited validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the diagnostic accuracy, interrater reliability, and safety of brain computed tomography (CT) perfusion and CT angiography as ancillary investigations for DNC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Between April 25, 2017, and March 10, 2021, a prospective, multicenter, blinded diagnostic accuracy cohort study was conducted in 15 adult intensive care units across Canada. Consecutive, critically ill adults (aged ≥18 years) with a Glasgow Coma Scale score of 3 and no confounding factors who were at high risk of DNC were included. Data collection and analysis were performed from April 2021 to July 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Contrast-enhanced brain CT perfusion with CT angiography reconstructions performed within 2 hours of a blinded, standardized clinical DNC examination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcomes were the sensitivity and specificity of qualitative and quantitative brainstem CT perfusion for DNC determination, assessed by 2 independent neuroradiologists blinded to clinical findings; the prespecified validation threshold was greater than 98%. Secondary outcomes were the diagnostic accuracy of whole-brain CT perfusion and CT angiography, interrater reliability (Cohen κ), and adverse events associated with imaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 282 patients (mean [SD] age, 57.8 [15.4] years; 133 [47%] female) completed the study protocol and were included in the primary analysis; 204 (72%) of these were ultimately declared deceased by standardized clinical criteria. Qualitative brainstem CT perfusion showed a sensitivity of 98.5% (95% CI, 95.8%-99.7%) and a specificity of 74.4% (95% CI, 63.2%-83.6%); quantitative brainstem CT perfusion was not diagnostically accurate. Qualitative whole-brain CT perfusion yielded a sensitivity of 93.6% (95% CI, 89.3%-96.6%) and a specificity of 92.3% (95% CI, 84.0%-97.1%). CT angiography sensitivity ranged from 75.5% (95% CI, 69.0%-81.2%) to 87.3% (95% CI, 81.9%-91.5%), and its specificity ranged from 89.7% (95% CI, 80.8%-95.5%) to 91.0% (95% CI, 82.4%-96.3%). Interrater reliability was excellent for all ancillary tests (κ ranged from 0.81 [95% CI, 0.73-0.89] to 0.84 [95% CI, 0.78-0.91]). Fourteen patients (5%) experienced minor, self-limited adverse events; no serious adverse events occurred.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;The observed sensitivity and specificity measures for CT perfusion and CT angiography as an ancillary test for DNC did not meet the prespecified validation threshold of greater than 98%. Clinical examination remains the cornerstone of DNC, and ancillary imaging should be int","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284396","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":"A New Dystonia Phenotype in Wilson Disease.","authors":"Yulong Yang, Xiang Li, Wenming Yang","doi":"10.1001/jamaneurol.2025.1639","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1639","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247922","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":"Regional Differences in Dementia Incidence Among US Veterans","authors":"Christina S. Dintica, Amber L. Bahorik, Feng Xia, John Boscardin, Kristine Yaffe","doi":"10.1001/jamaneurol.2025.1536","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1536","url":null,"abstract":"ImportancePrior studies of dementia incidence in the US often focused on narrow regions, leaving regional variation unclear and potential explanatory factors unknown.ObjectiveTo investigate geographic differences in dementia incidence across the US among older adults enrolled in the Veterans Health Administration (VHA) system.Design, Setting, and PopulationCohort study spanning October 1999 to September 2021 with a mean follow-up time of 12.6 years. Data were analyzed from October 2023 to September 2024 among a random sample of 1 268 599 dementia-free veterans aged 65 years or older with available zip code information in locations across the US. We excluded 22 512 with missing zip codes, 265 850 with no follow-up, and 37 370 with prevalent dementia.ExposureGeographical region categories across the US were defined using the Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion definition, which divides the US into 10 regions, each composed of 4 to 7 states.Main Outcomes and MeasuresDementia diagnoses were based on <jats:italic>International Classification of Diseases</jats:italic> codes and calculated for zip codes within the CDC regions. Poisson regression models were used to calculate dementia incidence per 1000 person-years and assess regional differences in incidence rate ratios with several covariate models.ResultsAmong the 1 268 599 participants (mean age, 73.9 [SD, 6.1] years; n = 25 335 [2%] female), dementia incidence rates per 1000 person-years were lowest in the Mid-Atlantic (11.2; 95% CI, 11.1-11.4) and highest in the Southeast (14.0; 95% CI, 13.8-14.2). Compared with the Mid-Atlantic, the regions with the greatest demographically adjusted incidence included the Southeast (rate ratio [RR], 1.25; 95% CI, 1.22-1.28), Northwest (RR, 1.23; 95% CI, 1.20-1.27), Rocky Mountains (RR, 1.23; 95% CI, 1.20-1.26), South (RR, 1.18; 95% CI, 1.15-1.20), Midwest (RR, 1.12; 95% CI, 1.09-1.14), and South Atlantic (RR, 1.12; 95% CI, 1.10-1.14); the remaining regions had similar (&amp;amp;lt;10% difference) incidence. Additional adjustments for rurality and cardiovascular comorbidities and accounting for the competing risk of death produced similar results.Conclusions and RelevanceAmong older adults in the VHA, dementia incidence varied significantly across US regions, independent of key covariates. These findings highlight the need for targeted health care planning, public health interventions, and policy development.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"80 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144238296","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":"Copathology in Atypical Parkinsonism-The Rule Rather Than the Exception?","authors":"Ivan Martinez-Valbuena, M Carmela Tartaglia, Gabor G Kovacs, Anthony E Lang","doi":"10.1001/jamaneurol.2025.1630","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1630","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247923","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":"White Matter Abnormalities and Cognition in Aging and Alzheimer Disease.","authors":"Christopher Peter, Aditi Sathe, Niranjana Shashikumar, Kimberly R Pechman, Abigail W Workmeister, T Bryan Jackson, Yuankai Huo, Shubhabrata Mukherjee, Jesse Mez, Logan C Dumitrescu, Katherine A Gifford, Corey J Bolton, Leslie S Gaynor, Shannon L Risacher, Lori L Beason-Held, Yang An, Konstantinos Arfanakis, Guray Erus, Christos Davatzikos, Duygu Tosun-Turgut, Mohamad Habes, Di Wang, Arthur W Toga, Paul M Thompson, Panpan Zhang, Kurt G Schilling, Marilyn Albert, Walter Kukull, Sarah A Biber, Bennett A Landman, Barbara B Bendlin, Sterling C Johnson, Julie Schneider, Lisa L Barnes, David A Bennett, Angela L Jefferson, Susan M Resnick, Andrew J Saykin, Paul K Crane, Michael L Cuccaro, Timothy J Hohman, Derek B Archer, Dimitrios Zaras, Yisu Yang, Alaina Durant, Praitayini Kanakaraj, Michael E Kim, Chenyu Gao, Nancy R Newlin, Karthik Ramadass, Nazirah Mohd Khairi, Zhiyuan Li, Tianyuan Yao, Seo-Eun Choi, Brandon Klinedinst, Michael L Lee, Phoebe Scollard, Emily H Trittschuh, Elizabeth A Sanders","doi":"10.1001/jamaneurol.2025.1601","DOIUrl":"10.1001/jamaneurol.2025.1601","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;There has yet to be a large-scale study quantifying the association between white matter microstructure and cognitive performance and decline in aging and Alzheimer disease (AD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the associations between tract-specific white matter microstructure and cognitive performance and decline in aging and AD-related cognitive impairment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prognostic study of aging and AD, a secondary data analysis of multisite cohort studies, acquired data from 9 cohorts between September 2002 and November 2022. Participants were eligible if they had diffusion-weighted magnetic resonance imaging (dMRI) data, domain-specific cognitive composite z scores, demographic and clinical data, were aged 50 years or older, and passed neuroimaging quality control. Demographic and clinical covariates included age, sex, education, race and ethnicity, APOE haplotype status (ε2, ε3, ε4), and clinical status. The present study was conducted from June 2024 to February 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;White matter microstructure and cognitive performance and decline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Clinical diagnosis, imaging measures (dMRI, T1-weighted MRI, and amyloid and tau positron emission tomography), and cognitive tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 4467 participants who underwent 9208 longitudinal cognitive sessions, 2698 (60.4%) were female, and the mean age (SD) was 74.3 (9.2) years; 3213 were cognitively unimpaired, 972 had mild cognitive impairment, and 282 had AD dementia. White matter free water (FW) showed the strongest associations with cross-sectional cognitive performance and longitudinal cognitive decline across all domains, particularly memory. FW in limbic tracts, such as the cingulum, presented the strongest associations with both memory performance (cingulum: β = -0.718; P &lt; .001; fornix: β = -1.069; P &lt; .001) and decline (cingulum: β = -0.115; P &lt; .001; fornix: β = -0.153; P &lt; .001). White matter FW measures interacted with baseline diagnosis, gray matter atrophy, APOE ε4 status, and amyloid positivity to predict poorer cognitive performance and accelerated cognitive decline. Noteworthy interactions include fornix FW and hippocampal volume (β = 10.598; P &lt; .001), cingulum FW and SPARE-AD index (β = -0.532; P &lt; .001), and inferior temporal gyrus transcallosal tract FW and baseline diagnosis (β = -0.537; P &lt; .001), all predicting poorer memory performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;White matter microstructural changes, particularly FW, play a critical role in cognitive decline in aging and AD-related cognitive impairment. These findings highlight the importance of FW correction in dMRI studies and highlight the limbic system, especially the cingulum and fornix, as key regions associated with cognitive decline; the interaction models highlight that integrating FW-corrected ","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289439","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":"Optimal Head-of-Bed Positioning Before Thrombectomy in Large Vessel Occlusion Stroke: A Randomized Clinical Trial.","authors":"Anne W Alexandrov, Anne J Shearin, Pitchaiah Mandava, Gabriel Torrealba-Acosta, Cheran Elangovan, Balaji Krishnaiah, Katherine Nearing, Elizabeth Robinson, Cara Guthrie-Chu, Matthew Holzmann, Bryan Fill, Dharti R Trivedi, Alicia Richardson, Sandy Middleton, Barbara B Brewer, David S Liebeskind, Nitin Goyal, James C Grotta, Andrei V Alexandrov","doi":"10.1001/jamaneurol.2025.2253","DOIUrl":"10.1001/jamaneurol.2025.2253","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Small studies show that 0° head positioning of patients with large vessel occlusion (LVO) stroke improves penumbral blood flow and clinical stability. Understanding whether 0° head position maintains clinical stability would allow for optimal patient positioning before thrombectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine superiority of 0° over 30° head positioning at maintaining clinical stability in patients with LVO before thrombectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a prospective randomized clinical trial with blinding to study enrollment/end points conducted from May 2018 to November 2023. There were 3 planned interim analyses, and the study was conducted at certified thrombectomy hospitals in the US. Included in this analysis were consecutive consenting individuals with computed tomography (CT) angiography-positive anterior or posterior LVO who were candidates for thrombectomy (baseline mRS 0-1) and had viable penumbra (CT perfusion or Alberta Stroke Program Early Computed Tomography Score ≥6) within 24 hours of stroke onset. Enrollment of systemic thrombolysis more than 15 minutes from consent was discouraged to prevent confounding of head position effects; in addition, patients with disabilities who lacked a legal representative could not participate due to lack of consent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Randomization to 0° or 30° head positioning with monitoring every 10 minutes using the National Institutes of Health Stroke Scale (NIHSS) until movement to a catheterization table.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measures: &lt;/strong&gt;The primary outcome was worsening of 2 or more NIHSS points before thrombectomy. Safety outcomes included severe neurologic deterioration (worsening ≥4 NIHSS points) before thrombectomy, hospital-acquired pneumonia (HAP) during hospitalization, and all-cause death within 3 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Planned enrollment included 182 patients. Before data and safety monitoring board study closure, a total of 92 patients (mean [SD] age, 66.6 [14.4] years; 48 male [52.2%]) were randomized: 45 patients to the group with 0° head positioning and 47 patients to the group with 30° head positioning. Patient characteristics were similar between groups; however, patients with head position at 30° experienced worsening on the NIHSS of 2 points or more, whereas patients with head position at 0° showed score stability (hazard ratio [HR], 34.40; 95% CI, 4.65-254.37; P &lt; .001). One patient with 0° head positioning and 20 patients with 30° head positioning experienced worsening on the NIHSS of 4 points or more during positioning (HR, 23.57; 95% CI, 3.16-175.99; P = .002). No patients developed HAP; all-cause death occurred in 2 patients (4.4%) in the 0° group, compared with 10 patients (21.7%; P = .03) in the 30° group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Results suggest that 0° head positioning for patients with acute LVO ","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215845","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":"A Distinctive Inspiratory Noise in IgLON5-Antibody Disease.","authors":"Nicholas Yapp, Donal Skelly, Marko Bogdanovic, Divyanshu Dubey, Michelle F Devine, Sarosh R Irani","doi":"10.1001/jamaneurol.2025.1442","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1442","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199154","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":"Prognostic Factors for Multiple Sclerosis Symptoms in Radiologically Isolated Syndrome.","authors":"Nicolás Fissolo, Sabine Schaedelin, Luisa M Villar, Jan D Lünemann, Jorge Correale, Konrad Rejdak, Nicholas Schwab, Andreu Vilaseca, Friederike Held, Antonio García-Merino, Stefan Bittner, María Trojano, Roberto Furlan, Hayrettin Tumani, Francisco Pérez-Miralles, Igal Rosenstein, Daniela Galimberti, Gary Álvarez-Bravo, Eric Thouvenot, Sara Llufriu, Samia J Khoury, Robert Hoepner, Sergio Martínez-Yélamos, Harald Hegen, Jelena Drulovic, Neus Téllez-Lara, Michael Khalil, Johanna Oechtering, Ángel Pérez-Sempere, Alfredo Rodríguez-Antigüedad, José Enrique-Martínez, Eva Strijbis, Joep Killestein, Sara Eichau, Elena Colombo, Jonas Schaller-Nagengast, Luciana Midaglia, Antonio J Sánchez-López, Enric Monreal, Andrew Chan, Friedemann Paul, Àlex Rovira, Mar Tintoré, Jan Lycke, Frauke Zipp, Bernhard Hemmer, Jens Kuhle, Xavier Montalban, Manuel Comabella, Uwe K Zettl, Simon Falk, Lucía Gutiérrez, Magda Gasior, José Luis Veiga González, Roser Ferrer, Ana Quiroga-Varela, Franziska Bachhuber, Lucienne Costa-Frossard","doi":"10.1001/jamaneurol.2025.1481","DOIUrl":"10.1001/jamaneurol.2025.1481","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the risk factors for symptom development will allow clinicians to stratify people with radiologically isolated syndrome (pwRIS) more effectively and tailor their management strategies accordingly.</p><p><strong>Objective: </strong>To identify prognostic factors at radiologically isolated syndrome (RIS) diagnosis associated with the development of multiple sclerosis (MS) symptoms.</p><p><strong>Design, setting, and participants: </strong>This cohort study was performed in samples collected between July 2004 and September 2022 and included 33 MS centers. All pwRIS who meet the 2017 McDonald criteria for dissemination in space with a sample collected near the diagnostic magnetic resonance imaging were included. No patients who met eligibility criteria were excluded. The data were analyzed from July 2024 to November 2024.</p><p><strong>Exposure: </strong>Body fluid biomarkers and environmental factors in pwRIS.</p><p><strong>Main outcomes and measures: </strong>The main outcome was the development of MS symptoms. Analyses involved univariable and multivariable Cox proportional hazards models, including age, sex, and treatment following RIS diagnosis, as additional independent variables.</p><p><strong>Results: </strong>The study included 273 pwRIS (mean age, 38.6 [SD 11.6] years; 207 women [75.8%] and 66 men [24.2%]) with a median follow-up of 5.0 [IQR, 2.5-7.7] years. A total of 101 pwRIS developed MS symptoms (37.0%). The presence of immunoglobulin G oligoclonal bands (OBs) (hazard ratio [HR], 5.09; 95% CI, 2.36-10.97; P < .001), immunoglobulin M OBs (HR, 2.58; 95% CI, 1.61-4.14; P < .001), and a κ free light chain index of 6.1 or more (HR, 2.79; 95% CI, 1.37-5.67; P = .005) were associated with MS symptoms. High cerebrospinal fluid neurofilament light chain (NfL) levels (HR, 1.31; 95% CI, 1.18-1.45; P < .001) and high serum NfL z scores (HR, 1.42; 95% CI, 1.16-1.72; P = .005) were also associated with an increased risk of MS symptoms. In contrast, high anti-cytomegalovirus titers (HR, 0.59; 95% CI, 0.38-0.93; P = .02) and high ultraviolet radiation exposure in the year before (HR, 0.52; 95% CI, 0.37-0.74; P < .001) and the year after (HR, 0.54, 95% CI, 0.38-0.75; P < .001) diagnosis reduced the risk of MS symptoms. For all these prognostic factors, the multivariable analysis yielded similar results. The combination of high serum NfL z scores and positive immunoglobulin G OBs conferred a 5-year risk of clinical symptoms of 58.3% (95% CI, 45.9-67.9). This risk increased to 81.6% (95% CI, 60.9-91.4) in pwRIS who were younger and positive for immunoglobulin M OBs.</p><p><strong>Conclusions and relevance: </strong>The study elucidates the prognostic factors that significantly impact the risk of developing MS symptoms in pwRIS at diagnosis, thereby, enhancing the potential for tailored clinical interventions.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199061","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":"Antithrombotic Therapy After Burr Hole Evacuation of Chronic Subdural Hematoma: A Post Hoc Analysis of 2 Randomized Clinical Trials.","authors":"Anders Schack, Frantz Rom Poulsen, Birgit Debrabant, Thorbjørn Søren Rønn Jensen, Rares Miscov, Mette Haldrup, Lejla Islamagic, Ann Kathrine Sindby, Kåre Fugleholm, Bo Bergholt, Carsten Reidies Bjarkam, Anders Rosendal Korshøj, Mads Hjortdal Grønhøj","doi":"10.1001/jamaneurol.2025.1433","DOIUrl":"10.1001/jamaneurol.2025.1433","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199155","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}