JAMA neurology最新文献

{"title":"Treatment Response to Antiseizure Medications in People With Newly Diagnosed Focal Epilepsy.","authors":"Sarah N Barnard, Zhibin Chen, Manisha Holmes, Andres M Kanner, Manu Hegde, Ruben Kuzniecky, Daniel Lowenstein, Jacqueline A French","doi":"10.1001/jamaneurol.2025.2949","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2949","url":null,"abstract":"<p><strong>Importance: </strong>Epilepsy affects approximately 65 million people worldwide, and 60% have focal seizures. Predicting seizure response and drug resistance to antiseizure medications (ASMs) in people with focal epilepsy remains difficult.</p><p><strong>Objective: </strong>To describe the expected short- and long-term response to treatment with ASMs in people with focal epilepsy using recognized definitions by the International League Against Epilepsy.</p><p><strong>Design, setting, and participants: </strong>The Human Epilepsy Project is an international, prospective, observational cohort study that followed up people with newly diagnosed focal epilepsy for up to 6 years between 2012 and 2020. Data were analyzed from 2023 to 2024. The Human Epilepsy Project was conducted at 34 tertiary epilepsy centers across the US, Australia, and Europe. Participants with confirmed diagnosis of focal epilepsy aged 12 to 60 years were enrolled within 4 months of treatment initiation with ASM(s). Data were analyzed from February 2024 to July 2024.</p><p><strong>Exposure: </strong>ASM (variable).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was seizure freedom, defined as a period without seizures for 12 months or 3 times the longest pretreatment seizure-free interval, whichever was longer. Treatment response was categorized as sensitive, meaning seizure free receiving 2 or fewer adequate ASM trials; resistant, meaning having 2 or more adequate ASM trials fail; or indeterminate (neither treatment sensitive nor resistant).</p><p><strong>Results: </strong>Among 448 enrolled participants, 267 (59.6%) were female, and median (IQR) participant age was 32 (21-44) years at treatment initiation. Median (IQR) follow-up duration was 3.13 (2.33-3.55) years. Most achieved seizure freedom (267 participants of 448 [59.6%]), largely without relapse (223 [83.5%]). There were 245 treatment-sensitive participants (54.7%), 102 treatment-resistant participants (22.8%), and 101 indeterminate participants (22.5%). Among treatment-sensitive participants, most (217 [89.3%]) responded to monotherapy and half (121 [49.4%], or 27% of total cohort) became seizure free while receiving their first ASM. In the first year of treatment, 251 participants (63%) had ongoing or worsening seizures. Median time to first seizure freedom was 12.1 months (95% CI, 9.7-16.1). This occurred earlier in those who never relapsed (median, 2.2 months; 95% CI, 0.8-3.2) than those who did (median, 7.4 months; 95% CI, 4.0-10.7). Those with infrequent pretreatment seizures were 0.41-fold more likely to be treatment resistant than those with very frequent seizures (relative risk [RR], 0.41; 95% CI, 0.18-0.89; P = .03; HB-corrected P = .02). Participants with self-reported comorbid psychological disorders were 1.78-fold more likely to be treatment resistant than those without (RR, 1.78; 95% CI, 1.26-2.52; P = .001).</p><p><strong>Conclusions and relevance: </strong>In the Human Ep","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954593","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":"Evolving Role of Plasma Phosphorylated Tau 217 in Alzheimer Disease-Time for Tau.","authors":"Sophie N M Binks, Jonathan Graff-Radford","doi":"10.1001/jamaneurol.2025.2972","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2972","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954621","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 Triage of Privilege.","authors":"Fawad A Khan, Rubina H Khan","doi":"10.1001/jamaneurol.2025.2878","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2878","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873202","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 the Results.","authors":"","doi":"10.1001/jamaneurol.2025.3097","DOIUrl":"10.1001/jamaneurol.2025.3097","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873199","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":"Intravenous Argatroban or Eptifibatide in Patients Undergoing Mechanical Thrombectomy: A Subgroup Analysis of the MOST Randomized Clinical Trial.","authors":"Ian Rines, Opeolu Adeoye, Andrew D Barreto, Joseph Broderick, Janice Carrozzella, Hui Chen, Mauricio Concha, Jordan Elm, James C Grotta, Adam S Jasne, Pooja Khatri, Akash Roy, Achala Vagal, Max Wintermark, Albert J Yoo, Colin P Derdeyn","doi":"10.1001/jamaneurol.2025.2794","DOIUrl":"10.1001/jamaneurol.2025.2794","url":null,"abstract":"<p><strong>Importance: </strong>The addition of direct thrombin inhibitors or glycoprotein platelet inhibitors to intravenous thrombolysis in patients undergoing endovascular thrombectomy for acute ischemic stroke may improve reperfusion rates and clinical outcomes.</p><p><strong>Objective: </strong>To investigate the safety and efficacy of these agents.</p><p><strong>Design, setting, and participants: </strong>This was a preplanned cohort analysis from the Multi-Arm Optimization of Stroke Thrombolysis (MOST) randomized clinical trial, which lasted from 2019 to 2023 with a 90-day follow-up. Centrally read outcomes were assessed blinded to treatment. The MOST study was a multicenter, multiarm, adaptive, single-blind, phase 3 trial that included patients with acute ischemic stroke who were selected for thrombectomy per standard of care.</p><p><strong>Interventions: </strong>Patients were randomized to placebo, argatroban, or eptifibatide within 75 minutes of intravenous thrombolysis.</p><p><strong>Main outcomes and measures: </strong>The 90-day utility-weighted modified Rankin Scale (UW-mRS) score (range, 0-10, with higher scores reflecting better outcomes) was used as the primary outcome measure. Reperfusion rates and safety (hemorrhage rates) were also assessed, where good reperfusion was defined as a Thrombolysis in Cerebral Infarction score of 2b/2c/3 on the completion angiogram.</p><p><strong>Results: </strong>A total of 5376 patients were assessed for eligibility. Of these individuals, 4332 did not meet inclusion criteria, 251 eligible patients did not have consent obtained, 279 were excluded for other reasons, and 514 were randomized in the MOST trial. A total of 254 were planned for thrombectomy (110 in the placebo group, 31 in the argatroban group, and 113 in the eptifibatide group). Mean (SD) age was 68 (14.3) years, and 134 (53%) were female. Of these patients, 219 received thrombectomy: 94 in the placebo group, 27 in the argatroban group, and 98 in the eptifibatide group. There was no effect of treatment on outcome (mean UW-mRS score: eptifibatide, 6.47; 95% CI, 5.79-7.15; argatroban, 5.35; 95% CI, 4.13-6.58; placebo, 6.68; 95% CI, 5.98-7.39). Rates of good reperfusion were similar between groups (83 of 92 in the placebo group [83%]; 17 of 27 in the argatroban group [63%], and 82 of 98 in the eptifibatide group [84%]). The proportion of symptomatic intracranial hemorrhage was similar between groups.</p><p><strong>Conclusions and relevance: </strong>Results of this secondary analysis of the MOST randomized clinical trial reveal that the addition of argatroban or eptifibatide to intravenous thrombolysis was not associated with better reperfusion rates or clinical outcomes in patients undergoing endovascular thrombectomy. Future investigations of these agents as intravenous adjuncts to thrombectomy should focus on populations who are ineligible for intravenous thrombolysis.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Iden","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873200","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":"Brain Abnormalities in Children Exposed Prenatally to the Pesticide Chlorpyrifos.","authors":"Bradley S Peterson, Sahar Delavari, Ravi Bansal, Siddhant Sawardekar, Chaitanya Gupte, Howard Andrews, Lori A Hoepner, Wanda Garcia, Frederica Perera, Virginia Rauh","doi":"10.1001/jamaneurol.2025.2818","DOIUrl":"10.1001/jamaneurol.2025.2818","url":null,"abstract":"<p><strong>Importance: </strong>Chlorpyrifos (CPF) is one of the most widely used insecticides throughout the world. Preclinical and clinical studies have suggested that prenatal CPF exposure is neurotoxic, but its effects on the human brain are unknown.</p><p><strong>Objective: </strong>To identify the associations of prenatal CPF exposure with brain structure, function, and metabolism in school-aged children.</p><p><strong>Design, setting, and participants: </strong>This prospective, longitudinal pregnancy cohort study was conducted from January 1998 to July 2015, with data analysis from February 2018 to November 2024 in a community in northern Manhattan and South Bronx, New York. Of 727 pregnant women of African American or Dominican descent in the original community cohort, 512 had CPF levels measured at delivery. Offspring 6 years and older were approached for magnetic resonance imaging (MRI) scanning.</p><p><strong>Exposure: </strong>Prenatal CPF exposure.</p><p><strong>Main outcomes and measures: </strong>Anatomical MRI measures of cortical thickness and local white matter volumes, diffusion tensor imaging indices of tissue microstructure, MR spectroscopy indices of neuronal density, arterial spin labeling measures of regional cerebral blood flow, and cognitive performance measures. Prespecified hypotheses before data collection included CPF-related structural abnormalities in frontotemporal cortices, basal ganglia, and white matter pathways interconnecting them, and reduced neuronal density.</p><p><strong>Results: </strong>Participants included 270 youths (123 boys and 147 girls) aged 6.0 to 14.7 years (mean [SD] age, 10.38 [1.12] years) with self-identified Dominican or African American mothers. Progressively higher prenatal CPF exposure levels associated significantly in childhood with progressively thicker frontal, temporal, and posteroinferior cortices; reduced white matter volumes in the same regions; higher fractional anisotropy and lower diffusivity in internal capsule white matter; lower regional blood flow throughout the brain; lower indices of neuronal density in deep white matter tracts; and poorer performance on fine motor (β, -0.30; t261 = -5.0; P < .001) and motor programming (β, -0.27; t261 = -4.36; P < .001) tasks.</p><p><strong>Conclusions and relevance: </strong>Prenatal CPF exposure was associated with altered differentiation of neuronal tissue into cortical gray and white matter, increased myelination of the internal capsule, poorer motor performance, and profoundly impaired neuronal metabolism throughout the brain. CPF is known to increase oxidative stress and inflammation and in turn impair mitochondrial functioning, neuronal development, and maturation of the oligodendrocyte precursor cells responsible for axonal myelination. These molecular and cellular effects of CPF likely account at least in part for the observed associations of CPF with poorer long-term brain and motor outcomes.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873197","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":"Self-Reported Hearing Aid Use and Risk of Incident Dementia.","authors":"Lily Francis, Sudha Seshadri, Lauren K Dillard, Sharon G Kujawa, D Bradley Welling, Richard L Alcabes, Alexa S Beiser","doi":"10.1001/jamaneurol.2025.2713","DOIUrl":"10.1001/jamaneurol.2025.2713","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873201","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":"Chronic Immune Peripheral Nerve Myelinopathies-A Plea for Precision.","authors":"Jesse Crayle, Alan Pestronk","doi":"10.1001/jamaneurol.2025.2709","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2709","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":21.3,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873198","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":"Anterior Segmental Optic Nerve Lesion Following Methanol Poisoning.","authors":"Naiqing Cai,Miao Zhao,Jiting Zhu","doi":"10.1001/jamaneurol.2025.2665","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2665","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"12 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813062","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":"Reimagining the Treatment of Distal and Medium Vessel Occlusion Strokes.","authors":"Huanwen Chen,Jin Soo Lee,Bernard Yan,Seemant Chaturvedi","doi":"10.1001/jamaneurol.2025.2628","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2628","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"738 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813060","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}