JAMA neurology最新文献

{"title":"Do Neurologists Need a Goldwater Rule?","authors":"Farrah J. Mateen","doi":"10.1001/jamaneurol.2025.0642","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0642","url":null,"abstract":"This Viewpoint examines whether neurologists, like psychiatrists, should adopt a Goldwater Rule, an ethical principle prohibiting comments about and diagnoses of public persons they have not personally examined.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"25 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884697","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":"Aspirin Continuation or Discontinuation in Surgically Treated Chronic Subdural Hematoma: A Randomized Clinical Trial.","authors":"Maria Kamenova,Lea Pacan,Christian Mueller,Michael Coslovsky,Katharina Lutz,Serge Marbacher,Manuel Moser,Anne-Katrin Hickmann,Christian Zweifel,Raphael Guzman,Luigi Mariani,Jehuda Soleman,","doi":"10.1001/jamaneurol.2025.0850","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0850","url":null,"abstract":"ImportanceDiscontinuation of low-dose acetylsalicylic acid (ASA) during the perioperative phase of treatment for chronic subdural hematoma (cSDH) may reduce recurrence rates but may also increase the risk of cardiovascular or thromboembolic events. However, the efficacy and safety of discontinuing ASA in this patient population remain unclear.ObjectiveTo assess the risk of recurrence of cSDH and cardiovascular events in patients undergoing surgical treatment of cSDH with continuous vs discontinuous ASA treatment.Design, Setting, and ParticipantsThe SECA (Surgical Evacuation of Chronic Subdural Hematoma and Aspirin) trial was an investigator-initiated, multicenter, placebo-controlled randomized clinical trial conducted from February 2018 to June 2023 at 6 neurosurgical centers in Switzerland. Adults undergoing burr hole drainage for cSDH and receiving ASA treatment prior to cSDH onset were included. Of 1363 screened patients, 155 were included. Both assessors and participants were blinded to the treatment arms.InterventionParticipants were randomized 1:1 to receive either continuous ASA or placebo for 12 days during the perioperative phase.Main Outcome and MeasuresThe main outcome was the recurrence rate of cSDH necessitating reoperation within 6 months. An intention-to-treat analysis was performed, calculating risk differences. Secondary outcomes were cardiovascular or thromboembolic events, other bleeding events, and mortality.ResultsOf 155 participants, 78 were assigned to continuous ASA and 77 to placebo treatment. The mean (SD) participant age was 77.9 (8.2) years and 77.6 (9.7) years for the ASA and placebo groups, respectively, and 25 participants (16.1%) were female. A primary outcome event occurred in 13.9% of participants for the ASA group and 9.5% for the placebo group (weighted risk difference, 4.4%; 95% CI, -7.2% to 15.9%; P = .56). The incidence of any cardiovascular or thromboembolic event was 0.27 per person half-year in the ASA group and 0.28 in the placebo group. The incidence of a cardiovascular event indicating ASA treatment was 0.02 per person half-year in the ASA group and 0.06 in the placebo group. Other bleeding events showed an incidence of 0.10 per person half-year in the ASA group and 0.08 in the placebo group. All-cause mortality occurred at an incidence of 0.06 per person half-year in the ASA group and 0.03 in the placebo group.Conclusions and RelevanceThe SECA randomized clinical trial suggests that discontinuing ASA treatment did not reduce the recurrence rate of surgically treated cSDH within 6 months. Recurrence risk estimates for continuous ASA treatment in this trial were distinctly lower than previously reported.Trial RegistrationClinicalTrials.gov Identifier: NCT03120182.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"48 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885496","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":"Acute Blood Pressure Lowering and Risk of Ischemic Lesions on MRI After Intracerebral Hemorrhage","authors":"Ken S. Butcher, Brian Buck, Dar Dowlatshahi, Laura C. Gioia, Mahesh Kate, Ana C. Klahr, Ashwin Sivasubramaniam, Ashfaq Shuaib, Alan Wilman, Vijay K. Sharma, Georgios Tsivgoulis, Christos Krogias, Ashkan Shoamanesh","doi":"10.1001/jamaneurol.2025.0586","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0586","url":null,"abstract":"ImportanceDiffusion-weighted imaging (DWI) lesions have been demonstrated in patients with subacute intracerebral hemorrhage (ICH), suggesting ischemic injury, which may be related to blood pressure (BP) reduction.ObjectiveTo test the hypothesis that acute intensive BP lowering is associated with DWI lesions after ICH.Design, Setting, and ParticipantsThe Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial 2 (ICHADAPT-2) was a multicenter, randomized, open-label, blinded–end point trial. Between November 2012 and August 2022, patients with ICH presenting within 6 hours of onset were randomized to a systolic BP (SBP) target of less than 140 mm Hg or less than 180 mm Hg. The trial was conducted at 3 comprehensive stroke centers in Canada and Australia, including 1 telestroke referral hub and 1 community stroke hospital. A total of 162 patients with acute ICH were randomized. The primary analysis population was restricted to those undergoing DWI at 48 hours.InterventionPatients were randomly assigned to an acute SBP target of less than 140 mm Hg or less than 180 mm Hg.Main Outcome and MeasureThe primary end point was the incidence of acute DWI lesions on brain magnetic resonance imaging obtained 48 ± 12 hours after randomization.ResultsDWI was obtained in 79 (48% female) patients with a mean (SD) age of 71 (13) years and median baseline ICH volume of 11.2 (range, 0.5-122.2) mL. The median times from onset to randomization and DWI were 3.17 (range, 0.7-14.6) hours and 51.6 (range, 17.0-121.4) hours, respectively. Mean (SD) baseline SBP was 183 (22) mm Hg in the less than 140 mm Hg target group and 181 (28) mm Hg in the less than 180 mm Hg target group. Mean SBP was lower over the 48-hour period after randomization in the less than 140 mm Hg group (mean difference, 18.9 mm Hg [95% CI, 17.6-20.2]; <jats:italic>P</jats:italic> &amp;amp;lt; .001). DWI lesions were detected in 13 of 42 patients (31%) in the less than 140 mm Hg group and 14 of 37 patients (38%) in the less than 180 mm Hg group (odds ratio, 0.74 [95% CI, 0.12-4.64]; <jats:italic>P</jats:italic> = .32). The median number of DWI lesions (1 [95% CI, 1-10] vs 1.5 [95% CI, 1-10]; <jats:italic>P</jats:italic> = .26) and total DWI lesion volume (0.1 [95% CI, 0.01-41.3] mL vs 0.3 [95% CI, 0.02-2.03] mL; <jats:italic>P</jats:italic> = .17) were not different in the less than 140 mm Hg and less than 180 mm Hg groups.Conclusions and RelevanceDWI lesion frequency and volume were unaffected by intensive antihypertensive therapy. These results support the safety of early BP reduction in acute ICH.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"8 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853529","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":"Do the Benefits of Blood Pressure Control in ICH Outweigh the Risks?","authors":"Jessica Magid-Bernstein,Santosh B Murthy","doi":"10.1001/jamaneurol.2025.0238","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0238","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"36 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857195","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":"IWG and AA Criteria-Where the Differences Matter.","authors":"Andrew M Kiselica,Leslie S Gaynor,Kelly J Atkins","doi":"10.1001/jamaneurol.2025.0775","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0775","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"66 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857198","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":"IWG and AA Criteria-Where the Differences Matter.","authors":"Clifford R Jack,Maria C Carrillo,Reisa A Sperling","doi":"10.1001/jamaneurol.2025.0778","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0778","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"28 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857196","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":"IWG and AA Criteria-Where the Differences Matter-Reply.","authors":"Bruno Dubois,Nicolas Villain,Howard H Feldman","doi":"10.1001/jamaneurol.2025.0772","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0772","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"110 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857238","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":"\"I'm as Mad as Hell and I'm Not Going to Take This Anymore!\"","authors":"David N Korones","doi":"10.1001/jamaneurol.2025.0782","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0782","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"108 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857194","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":"Risk of Poststroke Epilepsy Among Young Adults With Ischemic Stroke or Intracerebral Hemorrhage","authors":"Esmée Verburgt, Lina Fellah, Merel S. Ekker, Mijntje M. I. Schellekens, Esther M. Boot, Maikel H. M. Immens, Mayte E. van Alebeek, Paul J. A. M. Brouwers, Renate M. Arntz, Gert W. van Dijk, Rob A. R. Gons, Inge W. M. van Uden, Tom den Heijer, Julia H. van Tuijl, Karlijn F. de Laat, Anouk G.W. van Norden, Sarah E. Vermeer, Marian S. G. van Zagten, Robert J. van Oostenbrugge, Marieke J. H. Wermer, Paul J. Nederkoorn, Henk Kerkhoff, Fergus A. Rooyer, Frank G. van Rooij, Ido R. van den Wijngaard, Anil M. Tuladhar, Jamie I. Verhoeven, Nina A. Hilkens, Frank-Erik de Leeuw","doi":"10.1001/jamaneurol.2025.0465","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0465","url":null,"abstract":"ImportancePoststroke epilepsy (PSE) is a major complication among young adults and is associated with problems with functional recovery and daily life. Although scores have been developed to predict risk of PSE, they have not been validated among patients with stroke at a young age.ObjectivesTo investigate both the risk of and risk factors for PSE at a young age and validate current PSE risk scores among a cohort of young adults.Design, Setting, and ParticipantsThis cohort study used data from ODYSSEY (Observational Dutch Young Symptomatic Stroke Study), a prospective cohort study conducted among 17 hospitals in the Netherlands between May 27, 2013, and March 3, 2021, with follow-up until February 28, 2024. Participants included 1388 consecutive patients aged 18 to 49 years with neuroimaging-proven ischemic stroke or intracerebral hemorrhage (ICH) and without a history of epilepsy. Statistical analysis took place between June and August 2024.ExposureFirst-ever neuroimaging-proven ischemic stroke or ICH.Main Outcomes and MeasuresPoststroke epilepsy was defined as at least 1 remote symptomatic seizure (&amp;amp;gt;7 days). Cumulative incidence functions were used to calculate the 5-year risk of PSE. Fine-Gray regression models were used to identify risk factors associated with PSE (age, sex, clinical stroke, and neuroimaging variables). The performances of the SeLECT (severity of stroke, large-artery atherosclerosis, early seizure, cortical involvement, and territory of middle cerebral artery) 2.0 risk score (for ischemic stroke) and the CAVE (cortical involvement, age, bleeding volume, and early seizure) risk score (for ICH) were assessed with C statistics and calibration bar plots.ResultsThis study included 1388 patients (ischemic stroke, 1231 [88.7%]; ICH, 157 [11.3%]; median age, 44.1 years [IQR, 38.0-47.4 years]; 736 men [53.0%]; median follow-up, 5.3 years [IQR, 3.4-7.4 years]), of whom 57 (4.1%) developed PSE. The 5-year cumulative risk of PSE was 3.7% (95% CI, 0.2%-4.8%) after ischemic stroke and 7.6% (95% CI, 3.5%-11.8%) after ICH. Factors associated with PSE after ischemic stroke were an acute symptomatic seizure (&amp;amp;lt;7 days) (hazard ratio [HR], 10.83 [95% CI, 2.05-57.07]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .005) and cortical involvement (HR, 5.35 [95% CI, 1.85-15.49]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .002). The only factor associated with PSE after ICH was cortical involvement (HR, 8.20 [95% CI, 2.22-30.25]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .002). The C statistic was 0.78 (95% CI, 0.71-0.84) for the SeLECT 2.0 risk score and 0.83 (95% CI, 0.76-0.90) for the CAVE risk score, and calibration was good for both scores.ConclusionThis study suggests that the risk of PSE among young adults is relatively low and that the factors that were associated with PSE were similar to variables included in the existing risk scores, which can therefore also be applied for young adults after stroke. Future clinical trials should investigate the optimal prima","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"26 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827725","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":"Standardized Definition of Progression Independent of Relapse Activity (PIRA) in Relapsing-Remitting Multiple Sclerosis.","authors":"Jannis Müller,Sifat Sharmin,Johannes Lorscheider,Serkan Ozakbas,Rana Karabudak,Dana Horakova,Bianca Weinstock-Guttman,Vahid Shaygannejad,Masoud Etemadifar,Raed Alroughani,Francesco Patti,Sara Eichau,Alexandre Prat,Alessandra Lugaresi,Valentina Tomassini,Allan G Kermode,Maria Pia Amato,Recai Turkoglu,Ayse Altintas,Katherine Buzzard,Aysun Soysal,Anneke van der Walt,Helmut Butzkueven,Yolanda Blanco,Oliver Gerlach,Samia J Khoury,Michael Barnett,Nevin John,Jeannette Lechner-Scott,Matteo Foschi,Andrea Surcinelli,Vincent van Pesch,Julie Prevost,Maria Jose Sa,Davide Maimone,Marie D'hooghe,Stella Hughes,Suzanne Hodgkinson,Chris McGuigan,Elisabetta Cartechini,Bruce Taylor,Daniele Spitaleri,Mark Slee,Pamela McCombe,Bassem Yamout,Pascal Benkert,Jens Kuhle,Ludwig Kappos,Izanne Roos,Tomas Kalincik,,Eva Kubala Havrdova,Marc Girard,Pierre Duquette,Marzena Fabis-Pedrini,William M Carroll,Olga Skibina,Riadh Gouider,Saloua Mrabet,Cristina Ramo-Tello,Claudio Solaro,Mario Habek,Bart Van Wijmeersch,Radek Ampapa,Richard Macdonell,Celia Oreja-Guevara,Koen de Gans,Guy Laureys,Jiwon Oh,Justin Garber,Orla Gray,Eduardo Agüera-Morales,Jose Luis Sanchez-Menoyo,Tamara Castillo-Triviño,Nikolaos Grigoriadis,Thor Petersen,Todd A Hardy,Steve Vucic,Stephen Reddel,Sudarshini Ramanathan,Abdullah Al-Asmi,Mihaela Simu,Seyed Mohammad Baghbanian,Dieter Poehlau,Talal Al-Harbi,Juan Ignacio Rojas,Norma Deri,Patrice Lalive,Melissa Cambron,Tunde Csepany,Neil Shuey,Barbara Willekens,Cameron Shaw,Danny Decoo,Jennifer Massey,Özgür Yaldizli,Tobias Derfuss,Cristina Granziera","doi":"10.1001/jamaneurol.2025.0495","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0495","url":null,"abstract":"ImportanceProgression independent of relapse activity (PIRA) is a significant contributor to long-term disability accumulation in relapsing-remitting multiple sclerosis (MS). Prior studies have used varying PIRA definitions, hampering the comparability of study results.ObjectiveTo compare various definitions of PIRA.Design, Setting, and ParticipantsThis cohort study involved a retrospective analysis of prospectively collected data from the MSBase registry from July 2004 to July 2023. The participants were patients with MS from 186 centers across 43 countries who had clinically definite relapsing-remitting MS, a complete minimal dataset, and 3 or more documented Expanded Disability Status Scale (EDSS) assessments.ExposureThree-hundred sixty definitions of PIRA as combinations of the following criteria: baseline disability (fixed baseline with re-baselining after PIRA, or plus re-baselining after relapses, or plus re-baselining after improvements), minimum confirmation period (6, 12, or 24 months), confirmation magnitude (EDSS score at/above worsening score or at/above threshold compared with baseline), freedom from relapse at EDSS score worsening (90 days prior, 90 days prior and 30 days after, 180 days prior and after, since previous EDSS assessment, or since baseline), and freedom from relapse at confirmation (30 days prior, 90 days prior, 30 days before and after, or between worsening and confirmation).Main Outcome and MeasureFor each definition, we quantified PIRA incidence and persistence (ie, absence of a 3-month confirmed EDSS improvement over ≥5 years).ResultsAmong 87 239 patients with MS, 33 303 patients fulfilled the inclusion criteria; 24 152 (72.5%) were female and 9151 (27.5%) were male. At the first visits, the mean (SD) age was 36.4 (10.9) years; 28 052 patients (84.2%) had relapsing-remitting MS, and the median (IQR) EDSS score was 2.0 (1.0-3.0). Participants had a mean (SD) 15.1 (11.9) visits over 8.9 (5.2) years. PIRA incidence ranged from 0.141 to 0.658 events per decade and persistence from 0.753 to 0.919, depending on the definition. In particular, the baseline and confirmation period influenced PIRA detection. The following definition yielded balanced incidence and persistence: a significant disability worsening compared with a baseline (reset after each PIRA event, relapse, and EDSS score improvement), in absence of relapses since the last EDSS assessment, confirmed with EDSS scores (not preceded by relapses within 30 days) that remained above the worsening threshold for at least 12 months.Conclusion and RelevanceIncidence and persistence of PIRA are determined by the definition used. The proposed standardized definition aims to enhance comparability among studies.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"121 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831613","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}