JAMA neurology最新文献

{"title":"Tirofiban for Branch Atheromatous Disease-Related Stroke: The STRATEGY Randomized Clinical Trial.","authors":"Yicong Wang, Xiaoling Liao, Shuo Feng, Yuesong Pan, Xuan Wang, Hui Qu, Yuetong Liu, Cong Gao, Xinru Liu, Qianqian Yang, Meiyang Zhang, Zhangxinyi Liu, Jinyi Ye, Yuke Mao, Weiqi Chen, Lingling Jiang, Philip M Bath, S Claiborne Johnston, Guillaume Turc, Xingquan Zhao, Yongjun Wang, Yilong Wang","doi":"10.1001/jamaneurol.2026.2855","DOIUrl":"10.1001/jamaneurol.2026.2855","url":null,"abstract":"<p><strong>Importance: </strong>Patients with branch atheromatous disease (BAD)-related stroke are predisposed to early neurological deterioration (END) and disability. However, large-scale clinical trials focused on the prevention of the deterioration and recurrent stroke in this population are currently lacking.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of intensive antiplatelet therapy combining the tirofiban with aspirin for patients with BAD-related stroke.</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial was the multicenter, double-blind, randomized, placebo-controlled STRATEGY trial, conducted across 38 hospitals in China. Participants were patients with BAD-related acute ischemic stroke confirmed by magnetic resonance imaging within 48 hours of symptom onset were eligible for enrollment. Enrollment occurred from November 15, 2022, to November 19, 2024, with a 90-day follow-up period for all participants. Investigators, patients, and outcome assessors were blinded to treatment assignment.</p><p><strong>Interventions: </strong>Eligible participants were randomized to receive either intravenous tirofiban or placebo (0.4 µg/kg/min for 30 minutes followed by 0.1 µg/kg/min for 24 hours). All patients received a 300-mg loading dose of aspirin on the day of randomization, followed by 100 mg daily until day 90.</p><p><strong>Main outcomes and measures: </strong>The primary efficacy end point was END within 7 days or new stroke within 90 days. The primary safety end point was moderate or severe bleeding.</p><p><strong>Results: </strong>Of 1378 patients with acute ischemic stroke screened for eligibility, 408 were excluded for ineligible imaging findings, other exclusion criteria, lack of consent, or additional reasons, leaving 970 participants who underwent randomization (486 assigned to tirofiban plus aspirin, 484 to placebo plus aspirin). The median (IQR) age was 63.0 (56.0-70.0) years; 607 patients (62.6%) were male and 363 (37.4%) female. The incidence of the primary efficacy end point was 79 patients (17.1%) in the tirofiban group and 89 (19.6%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.65-1.19; P = .39). The incidence of the primary safety end point was 1 of 486 patients (0.2%) in the tirofiban group and 0 patients in the placebo group (P > .99).</p><p><strong>Conclusions and relevance: </strong>This study found that in patients with BAD-related stroke, intravenous tirofiban combined with aspirin did not significantly reduce the risk of END or stroke compared with aspirin alone, nor was it associated with an increased risk of moderate or severe bleeding.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05310968.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"956-964"},"PeriodicalIF":23.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865034","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":"Treatment Discontinuation in MOGAD-One Size Does Not Fit All.","authors":"Su-Hyun Kim, Ho Jin Kim","doi":"10.1001/jamaneurol.2026.2936","DOIUrl":"10.1001/jamaneurol.2026.2936","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"1029"},"PeriodicalIF":23.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864989","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":"Complete Remission of Cavin-4 Immunoglobulin G Rippling Muscle Disease After Rituximab Therapy.","authors":"Tony Zhang, William J Litchy, Divyanshu Dubey","doi":"10.1001/jamaneurol.2026.1519","DOIUrl":"10.1001/jamaneurol.2026.1519","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"1023-1024"},"PeriodicalIF":23.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138103","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":"Conceptual Recognition of TDP-43-Associated Neurodegenerative Disease-Are We There Yet?","authors":"Mark A Terrelonge, Peter T Nelson, Ian R Mackenzie","doi":"10.1001/jamaneurol.2026.2811","DOIUrl":"10.1001/jamaneurol.2026.2811","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"953-955"},"PeriodicalIF":23.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812979","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":"MRI Characteristics of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Review.","authors":"Eoin P Flanagan, Brenda L Banwell, Laura Cacciaguerra, Edgar Carnero Contentti, John J Chen, Rosa Cortese, Giulia Fadda, Kazuo Fujihara, Ruth Geraldes, Yael Hacohen, Ho Jin Kim, Maciej Jurynczyk, Michael Levy, Kshitij Mankad, Romain Marignier, Silvia Messina, Friedemann Paul, Sudarshini Ramanathan, Alex Rovira, Elia Sechi, Silvia Tenembaum, Jacqueline Palace","doi":"10.1001/jamaneurol.2026.3196","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3196","url":null,"abstract":"<p><strong>Importance: </strong>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a demyelinating disease distinct from multiple sclerosis (MS) and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). Magnetic resonance imaging (MRI) is central to confirming attacks, defining lesion distribution, and excluding alternative diagnoses and is a key component of the 2023 MOGAD diagnostic criteria. However, its imaging spectrum and lesion evolution remain underrecognized in practice, and variability in imaging parameters can contribute to delayed diagnosis and suboptimal treatment.</p><p><strong>Observations: </strong>This article summarizes the hallmark MRI features of optic nerve, brain, and spinal cord involvement in MOGAD, including key findings from the 2023 diagnostic criteria, supported by illustrative figures and detailed tables. The characteristic evolution of MRI abnormalities in MOGAD is highlighted, including radiologic lag, lesion dynamics during acute attacks, and frequent T2-lesion resolution, contrasting with the persistent lesions typical of MS. A recommended MRI protocol for acute attacks is proposed, and the timing and utility of rebaselining MRI (ie, repeating the MRI to establish a new baseline) after onset are reviewed. The clinical course of MOGAD is of attack-related neuroinflammation evident clinically and radiologically, and asymptomatic radiological activity is rare, suggesting that surveillance MRI has less clinical utility than in MS and less value as a surrogate biomarker in clinical trials. MRI features that differentiate MOGAD from MS and AQP4+NMOSD are summarized and imaging red flags suggestive of alternative diagnoses are highlighted. Finally, emerging advanced imaging, artificial intelligence in MOGAD imaging, and the link between imaging and immunopathogenesis are reviewed.</p><p><strong>Conclusions and relevance: </strong>MRI is central to MOGAD evaluation, and recognition of the characteristic imaging features and lesion dynamics outlined in this review can aid diagnosis. Application of the standardized MRI protocol summarized here can optimize use in clinical practice and promote harmonization across research studies. Future imaging and artificial intelligence applications may improve diagnosis, disease monitoring, and understanding of MOGAD pathogenesis.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074653","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":"Left Atrial Appendage Occlusion-Is the Case Now Closed?","authors":"David Seiffge, Richard A Bernstein, Rod S Passman, Charlotte Cordonnier","doi":"10.1001/jamaneurol.2026.3292","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3292","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074557","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":"Hearing Intervention for Older Adults With Mild Cognitive Impairment: The CHOICE Randomized Clinical Trial.","authors":"Ying Chen, Haibo Shi, Mingliang Xiang, Xia Li, Zhili Wang, Wen Lu, Yilin Shen, Yuan Fang, Jie Chen, Lei Guan, Feifan Zhao, Zaichao Wu, Rong Tian, Qiongfei Yu, Kun Han, Haibin Sheng, Shengqi Chen, Jiayu Sun, Guangyu Liu, Hao Wu","doi":"10.1001/jamaneurol.2026.3395","DOIUrl":"10.1001/jamaneurol.2026.3395","url":null,"abstract":"<p><strong>Importance: </strong>Hearing loss is a significant modifiable risk factor for cognitive decline, but the effectiveness of hearing intervention for cognition stabilization or improvement still remains controversial.</p><p><strong>Objective: </strong>To investigate whether hearing intervention could reduce dementia-level impairment incidence in older adults with coexisting hearing loss and mild cognitive impairment (MCI).</p><p><strong>Design, setting, and participants: </strong>This multicenter, parallel-group, open-label randomized clinical trial was conducted between September 2021 and February 2024, with the 24-month follow-up completed in February 2026. This study was conducted at 3 tertiary otology outpatient clinics and 3 CHOICE cohort community health stations in Shanghai, China. Of 21 908 adults aged 60 years or older assessed for eligibility, 703 participants with coexisting MCI (Clinical Dementia Rating [CDR] global score of 0.5) and moderate to severe hearing loss were enrolled and randomized. These data were analyzed from February 2026 to July 2026.</p><p><strong>Interventions: </strong>Participants were randomized 1:1 to receive either hearing aid intervention (n = 353) or hearing care education (n = 350).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the conversion rate from MCI to dementia-level impairment over 24 months, defined as a CDR global score 1 or more. Key prespecified secondary outcomes comprised rate of cognitive improvement (CDR = 0) and CDR global and domain scores.</p><p><strong>Results: </strong>Among 703 randomized patients (mean [SD] age, 74.53 [7.16] years; range, 60-96 years; 250 female [35.56%] and 452 male [64.44%]), 610 (86.77%) completed the trial. No significant difference was observed in the primary outcome, in which the conversion rate from MCI to dementia-level impairment was 3.09% (95% CI, 1.62%-5.74%) in the intervention group vs 4.74% (95% CI, 2.60%-8.29%) in the control group (risk difference [RD], -2.07%; 95% CI, -4.74% to 0.61%; relative risk [RR], 0.59; 95% CI, 0.25-1.38; P = .23). Meanwhile, prespecified secondary analysis demonstrated that hearing intervention increased the rate of cognitive improvement (15.34%; 95% CI, 11.84%-19.62% vs 2.36%; 95% CI, 0.99%-5.22%; RD, 12.00%; 95% CI, 8.79%-15.21%; RR, 5.94; 95% CI, 2.46-14.37). No study-related adverse events were reported.</p><p><strong>Conclusions and relevance: </strong>In this study, among older adults with mild cognitive impairment and coexisting hearing loss, a hearing aid intervention did not significantly reduce the incidence of dementia-level impairment at 24 months.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR2000036139.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074602","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":"Targeting Cancer Workup After a First Seizure.","authors":"Koichiro Yuji, Wakako Yuji","doi":"10.1001/jamaneurol.2026.3295","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3295","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074559","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":"Targeting Cancer Workup After a First Seizure-Reply.","authors":"Andreas Lund Pedersen, Holly Elser, Henrik Toft Sørensen","doi":"10.1001/jamaneurol.2026.3298","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3298","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074581","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":"Error in Abstract.","authors":"","doi":"10.1001/jamaneurol.2026.3672","DOIUrl":"10.1001/jamaneurol.2026.3672","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074398","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}