JAMA neurology最新文献

{"title":"Aligning Alzheimer Disease Biology With Care.","authors":"Fred B Ketchum, Nathaniel A Chin, Joshua D Grill","doi":"10.1001/jamaneurol.2024.5154","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5154","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382439","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":"Cognitive Decline After First-Time Transient Ischemic Attack","authors":"Victor A. Del Bene, George Howard, Toby I. Gropen, Michael J. Lyerly, Virginia J. Howard, Russell P. Sawyer, Ronald M. Lazar","doi":"10.1001/jamaneurol.2024.5082","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5082","url":null,"abstract":"ImportancePrior research suggests reduced cognitive function after transient ischemic attack (TIA). Whether this is directly related to the TIA, a function of preexisting risk factors, or prior cognitive decline remains unclear.ObjectiveTo study if a single, diffusion-weighted image–negative, adjudicated TIA is associated with longitudinal declines in cognition, independent of preexisting risk factors.Design, Setting, and ParticipantsThis was a secondary data analysis from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort following up 30 239 Black and White participants for incident cerebrovascular events. The setting consisted of telephone cognitive assessments. Participants were individuals with first-time TIA, first-time stroke, and asymptomatic community control groups with neuroimaging used for adjudication.ExposuresFirst-time TIA and stroke.Main Outcomes and MeasuresVerbal fluency and memory measures administered biannually. Primary outcome was a composite standardized <jats:italic>z</jats:italic> score, with secondary outcomes individual test performances. Adjusted segmented regression models characterized pre-event and postevent cognition and annual cognitive change.ResultsIncluded in the study were 356 individuals with first-time TIA (mean [SD] age, 66.6 [8.7]; 188 female [53%]) and 965 individuals with first-time stroke (mean [SD] age, 66.8 [8.2]; 494 male [51%]). A total of 14 882 individuals (mean [SD] age, 63.2 [8.6] years; 8439 female [57%]) were included in the asymptomatic control group. Overall cognitive composite before index event was lower in the stroke (−0.25; 95% CI, −0.32 to −0.17) than TIA (−0.05; 95% CI: −0.17 to 0.07; <jats:italic>P</jats:italic> = .005) and asymptomatic (0; 95% CI, −0.03 to 0.03; <jats:italic>P</jats:italic> &amp;amp;lt; .001) groups. After the index event, the cognitive composite of the group with stroke significantly declined (−0.14; 95% CI, −0.21 to −0.07) compared with that of the group with TIA (0.01; 95% CI, −0.10 to 0.12; <jats:italic>P</jats:italic> = .02) and controls (−0.03; 95% CI, −0.05 to −0.01; <jats:italic>P</jats:italic> = .003). The annual decline after the index event was faster (<jats:italic>P</jats:italic> = .001) in the group with TIA (−0.05; 95% CI, −0.06 to −0.03) than that for asymptomatic controls (−0.02; 95% CI, −0.02 to −0.02) but not different from the group with stroke (−0.04; 95% CI, −0.05 to −0.03; <jats:italic>P</jats:italic> = .43).Conclusions and RelevanceResults of this cohort study suggest that despite the quick resolution of stroke symptoms in TIA, there was apparently sufficient impact to be associated with long-term cognitive decline. Whether the underlying mechanisms are by direct or secondary injury and/or interaction with concomitant neurodegenerative factors remains to be elucidated.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"120 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375361","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":"Central Retinal Artery Occlusion With Cilioretinal Artery Sparing After Semaglutide Injection","authors":"Julie M. Shabto, Jin Kyun Oh, Tarun Sharma","doi":"10.1001/jamaneurol.2024.5149","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5149","url":null,"abstract":"This case report highlights a temporal relationship between the use of a glucagon-like peptide-1 receptor (GLP-1) agonist and the occurrence of central retinal artery occlusion.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"85 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375362","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":"Transient Ischemic Attack-Not So Transient After All!","authors":"Eric E Smith, Babak B Navi","doi":"10.1001/jamaneurol.2024.5090","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5090","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382441","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":"Research Priorities in Neuropalliative Care","authors":"Winnie K. Lau, Corey R. Fehnel, Zachary A. Macchi, Ambereen K. Mehta, Manon Auffret, Jori F. Bogetz, Jori E. Fleisher, Jerome J. Graber, Heather E. Leeper, Heena R. Manglani-Terranova, Susanne Muehlschlegel, Emily L. Mroz, Elizabeth J. Pedowitz, Usha Ramanathan, Max Sarmet, Nathan A. Shlobin, Leonard Sokol, Susan Allyson Weeks, Jiayun Xu, Helen Bundy Medsger, Claire J. Creutzfeldt, Ana-Maria Vranceanu, Darin B. Zahuranec, David Y. Hwang","doi":"10.1001/jamaneurol.2024.4932","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4932","url":null,"abstract":"ImportanceThe integration of palliative care in neurology, or neuropalliative care, is an emerging area of practice focused on holistically improving quality of life and reducing the burden of suffering for people living with serious neurologic disease and their care partners. Major neurology and palliative care societies have recognized the need to advance primary and specialty palliative care services for people with neurologic disease. However, research to support this work is in its early stages.ObservationsThe International Neuropalliative Care Society Research Committee convened an interdisciplinary panel of experts, including clinicians, scientists, people with neurologic disease, and care partners, to identify priority research areas for the advancement of neuropalliative care as a field. Three priority areas highlighted in this review include (1) patient- and care partner–centered symptoms and outcomes specific to neurologic illness and tools for their assessment, (2) development of effective neuropalliative care interventions and delivery models, and (3) methods to support the ability to foster, deliver, and measure goal-concordant care over time.Conclusions and RelevanceThis Special Communication outlines some of the most pressing neuropalliative care research needs, the advancement of which will best serve patients of all ages living with serious neurologic diseases and their care partners. Research funding mechanisms are needed to support and sustain impactful work in this field.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"10 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077158","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":"Neuromodulation for Children With Hemiparesis and Perinatal Stroke","authors":"Alicia J. Hilderley, Mary Dunbar, John Andersen, Darcy Fehlings, Megan Metzler, Helen L. Carlson, Ephrem Zewdie, Jacquie Hodge, Kathleen O’Grady, Lisa Carsolio, Nomazulu Dlamini, Adrianna Giuffre, Lauran Cole, Hsing-Ching Kuo, Anna Bourgeois, Asha Hollis, Meghan Maiani, Patrick Ciechanski, Zeanna Jadavji, Brandon Craig, Dion Kelly, Joanna Keough, James Wrightson, Linda Fay, Lauren Switzer, Maya Pajevic, Alana Ramsey, Michael Sametz, Brian L. Brooks, Maryna Yaskina, Jesse Batara, Michael D. Hill, Adam Kirton","doi":"10.1001/jamaneurol.2024.4898","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4898","url":null,"abstract":"ImportanceCurrent upper-extremity therapies provide inconsistent outcomes for children with unilateral cerebral palsy. Noninvasive brain stimulation, specifically transcranial direct current stimulation, may enhance motor gains when combined with therapy.ObjectiveTo determine whether the addition of neurostimulation to upper-extremity therapy enhances motor function in children with perinatal stroke and unilateral cerebral palsy.Design, Setting, and ParticipantsThis multicenter, randomized, sham-controlled phase 3 trial was conducted from July 2017 through March 2023. Investigators, treating therapists, outcome assessors, parents, and participants were blinded to intervention allocation. The study took place at 3 tertiary care Canadian pediatric rehabilitation hospitals. From a population-based sample of children 6 to 18 years old with perinatal stroke and disabling unilateral cerebral palsy, 196 children were approached and 107 were excluded.InterventionParticipants were randomly assigned in permuted blocks of 2 (1:1) to receive daily sham or cathodal stimulation to the contralesional motor cortex during 10 days of high-dose, child-centered intensive upper-extremity therapy.Main Outcomes and MeasuresThe primary end points were changes from baseline to 6 months posttherapy in affected hand function and attainment of child-identified functional goals assessed by the Assisting Hand Assessment and Canadian Occupational Performance Measure. Safety was assessed, including any decrease in the function of either hand. Analysis was intention to treat.ResultsEighty-nine children were enrolled with 45 randomized to sham (62% male, 38% female; mean [SD] age, 10.7 [2.8] years) and 44 to stimulation (52% male, 48% female; mean [SD] age, 10.7 [2.1] years). Eighty-three participants had complete outcome data (42 sham, 41 stimulation). High proportions of children in both groups demonstrated significant functional gains sustained at 6 months (&lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001) with large effect size (Cohen &lt;jats:italic&gt;d&lt;/jats:italic&gt; &amp;amp;gt; 1). There were no differences between groups for mean (SD) change in hand function (5.2 [5.3] vs 4.6 [5.7]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .63) or goal attainment (3.0 [2.0] vs 3.6 [2.3]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .25). Procedures were safe and well tolerated with no serious adverse events.Conclusions and RelevanceIn this study, results showed that patient-centered intensive motor learning programs could produce marked and sustained improvements in upper-extremity function in children with perinatal stroke and unilateral cerebral palsy. The addition of 1 milliampere contralesional motor cortex transcranial direct current stimulation did not improve outcomes compared with sham stimulation.Trial RegistrationClinicalTrials.gov Identifier: &lt;jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT03216837?term=NCT03216837&amp;amp;amp;rank","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"27 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077162","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 Attempted and Completed Suicide in Persons Diagnosed With Headache","authors":"Holly Elser, Dóra Körmendiné Farkas, Cecilia Hvitfeldt Fuglsang, Sissel Toft Sørensen, Henrik Toft Sørensen","doi":"10.1001/jamaneurol.2024.4974","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4974","url":null,"abstract":"ImportanceAlthough past research suggests an association between migraine and attempted suicide, there is limited research regarding risk of attempted and completed suicide across headache disorders.ObjectiveTo examine the risk of attempted and completed suicide associated with diagnosis of migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia (TAC).Design, Setting, and ParticipantsThis was a population-based cohort study of Danish citizens from 1995 to 2020. The setting was in Denmark, with a population of 5.6 million people. Persons 15 years and older who were diagnosed with headache were matched by sex and birth year to persons without headache diagnosis with a ratio of 5:1. Data analysis was conducted from May 2023 to May 2024.ExposuresFirst-time headache diagnoses identified from inpatient hospitalizations, emergency department visits, and outpatient specialty clinic visits using <jats:italic>International Statistical Classification of Diseases and Related Health Problems, Tenth Revision </jats:italic>(<jats:italic>ICD-10</jats:italic>) codes.Main Outcomes and MeasuresDiagnostic codes from the <jats:italic>ICD-10</jats:italic> were used to identify attempted suicide from the Danish National Patient Registry and the Danish Psychiatric Central Research Register and completed suicides from the Danish Register of Causes of Death. Absolute risks (ARs) and risk differences (RDs) for attempted and completed suicide were calculated using the cumulative incidence function. Hazard ratios (HRs) for attempted and completed suicide associated with headache diagnosis were computed adjusting for age, sex, year, education, income, baseline comorbidities, and accounting for competing risk of death.ResultsIn total, 119 486 persons (83 046 female [69.5%]) diagnosed with headache were identified and matched with 597 430 persons (415 230 female [69.5%]) drawn from the general population. Participants’ median (IQR) age was 40.1 (29.1-51.6) years. The 15-year AR of attempted suicide among persons diagnosed with headache was 0.78% (95% CI, 0.72%-0.85%) vs 0.33% (95% CI, 0.31%-0.35%) in the comparison cohort (RD, 0.45%; 95% CI, 0.39%-0.53%). The 15-year AR of completed suicide among persons diagnosed with headache was 0.21% (95% CI, 0.17%-0.24%) vs 0.15% (95% CI, 0.13%-0.16%) in the comparison cohort (RD, 0.06%; 95% CI, 0.02%-0.10%). The hazards of attempted suicide (HR, 2.04; 95% CI, 1.84-2.27) and completed suicide (HR, 1.40; 95% CI, 1.17-1.68) were elevated among persons with headache vs comparison cohort members. Findings were consistent across headache types, with stronger associations for TACs and posttraumatic headache.Conclusions and RelevanceResults of this cohort study revealing the robust and persistent association of headache diagnoses with attempted and completed suicide suggest that behavioral health evaluation and treatment may be important for these patients.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"15 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077161","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":"Quality Improvement Intervention for Reducing Acute Treatment Times in Ischemic Stroke: A Cluster Randomized Clinical Trial.","authors":"Daniël Hansen, Sanne J den Hartog, Nikki van Leeuwen, Jelis Boiten, Wouter Dinkelaar, Pieter J van Doormaal, Frank Eijkenaar, Bart J Emmer, Adriaan C G M van Es, H Zwenneke Flach, Rob Gons, M Heleen den Hertog, Farshad Imani, Paula M Janssen, Hans Kortman, Nyika D Kruyt, Laurien S Kuhrij, Christiaan van der Leij, T H Rob Lo, Aad van der Lugt, Geert Lycklama À Nijeholt, Jasper M M Martens, Paul J Nederkoorn, Jurgen Piet, Michel J M Remmers, Yvo B W E M Roos, Suzanne M Silvis, Lotte J Stolze, Wouter Stomp, Julia H van Tuijl, Martine T B Truijman, Sarah E Vermeer, Marianne A A van Walderveen, Ido R van den Wijngaard, H Bart Van der Worp, Lonneke Yo, Diederik W J Dippel, Hester F Lingsma, Bob Roozenbeek","doi":"10.1001/jamaneurol.2024.4304","DOIUrl":"10.1001/jamaneurol.2024.4304","url":null,"abstract":"<p><strong>Importance: </strong>Efficient care processes are crucial to minimize treatment delays and improve outcome after endovascular thrombectomy (EVT) in patients with ischemic stroke. A potential means to improve care processes is performance feedback.</p><p><strong>Objective: </strong>To evaluate the effect of performance feedback to hospitals on treatment times for EVT.</p><p><strong>Design, setting, and participants: </strong>This cluster randomized clinical trial was conducted from January 1, 2020, to June 30, 2022. Participants were consecutive adult patients with ischemic stroke who underwent EVT in 13 Dutch hospitals. No patients were excluded. Data analysis took place from March to May 2023.</p><p><strong>Intervention: </strong>The intervention consisted of feedback on hospital performance using structure, process, and outcome indicators. Indicator scores were based on data from a national quality registry and compared with a benchmark. Performance feedback was provided through a dashboard for local quality improvement teams who developed and implemented improvement plans based on the feedback. Every 6 months, 3 to 4 randomly selected hospitals switched to the intervention condition.</p><p><strong>Main outcome and measures: </strong>The primary outcome was time from door to groin puncture for all patients treated with EVT. Secondary outcomes included door-to-needle time, National Institutes of Health Stroke Scale (NIHSS) score at day 2, expanded Treatment in Cerebral Infarction (eTICI) score, and modified Rankin Scale (mRS) score at 3 months. The effect of the intervention was estimated with multivariable linear mixed models.</p><p><strong>Results: </strong>A total of 4747 patients were included (intervention: 2431; control: 2316). Their mean (SD) age was 72 (13) years; 2337 (49.2%) were female and 2410 (50.8%) were male. The median (IQR) baseline NIHSS score was 14 (8-19). Median (IQR) door-to-groin puncture time under the intervention condition was 47 (25-71) minutes, compared with 52 (29-75) minutes under the control condition. The adjusted absolute reduction was 5 minutes (β = -4.8; 95% CI, -9.5 to -0.1; P = .04), corresponding to a relative reduction of 9.2% (95% CI, -18.3% to -0.2%).</p><p><strong>Conclusion and relevance: </strong>This study found that performance feedback provided through a dashboard used by local quality improvement teams reduced door-to-groin puncture time for EVT. Implementation of performance feedback in hospitals providing EVT can improve the quality of care for ischemic stroke.</p><p><strong>Trial registration: </strong>The Netherlands Trial Register: NL9090.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"160-167"},"PeriodicalIF":20.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828321","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":"Blood-Based Biomarkers for Identifying Disease Activity in AQP4-IgG-Positive Neuromyelitis Optica Spectrum Disorder.","authors":"Su-Hyun Kim, Ana Beatriz Ayroza Galvão Ribeiro Gomes, Patrick Schindler, Jae-Won Hyun, Ki Hoon Kim, Dong-Eun Lee, Vinicius Andreoli Schoeps, Aline de Moura Brasil Matos, Natalia Trombini Mendes, Samira Luisa Dos Apóstolos-Pereira, Dagoberto Callegaro, Jasmine Lerner, Pascal Benkert, Jens Kuhle, Klemens Ruprecht, Friedemann Paul, Anne-Katrin Pröbstel, Ho Jin Kim","doi":"10.1001/jamaneurol.2024.4400","DOIUrl":"10.1001/jamaneurol.2024.4400","url":null,"abstract":"<p><strong>Importance: </strong>The temporal dynamics of serum glial fibrillary acidic protein (sGFAP) and serum neurofilament light chain (sNfL) as biomarkers of disease activity for neuromyelitis optica spectrum disorder (NMOSD) remain underexplored.</p><p><strong>Objective: </strong>To determine optimal timing for assessing sGFAP and sNfL, establish cutoff values differentiating between attacks and remissions in NMOSD, and evaluate these findings across independent cohorts.</p><p><strong>Design, setting, and participants: </strong>This retrospective, longitudinal, multicenter cohort study was conducted among patients with aquaporin-4 antibody (AQP4-IgG)-positive NMOSD. Patients with available stored serum samples were included, totaling 181 patients with 625 samples. Discovery cohort samples were collected from February 2008 to October 2023 and validation cohort samples were collected from January 2013 to October 2023. A combined analysis of both cohorts was conducted from November 2023 to March 2024.</p><p><strong>Exposures: </strong>sNfL and sGFAP concentrations, measured by a single-molecule array assay.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were the optimal timing of assessing sGFAP and sNfL and the adjusted cutoff values for evaluating disease activity in NMOSD.</p><p><strong>Results: </strong>The discovery cohort consisted of 366 samples from 78 Korean patients (median [IQR] age, 35 [30-42] years; 73 female patients [95%]), while the validation cohort included 190 samples from 34 German patients (median [IQR] age, 54 [39-61] years; 32 female patients [94%]) and 69 samples from 69 Brazilian patients (median [IQR] age, 46 [35-55] years; 62 female patients [90%]). Six-month postattack temporal biomarker dynamics were analyzed in 202 samples from 74 patients in the discovery cohort: sGFAP levels peaked within the first week and sNfL levels peaked at 5 weeks postattack. The optimal time frames for evaluating attacks were within 1 week for sGFAP and from 1 to 8 weeks for sNfL, with remission defined as at least 6 months postattack. z Score cutoffs of 3.0 for sGFAP and 2.1 for sNfL effectively distinguished between attack and remission phases, indicated by area under the curve values of 0.95 (95% CI, 0.88-1.02) and 0.87 (95% CI, 0.82-0.91), respectively. The discovery cohort time frames and cutoff values were applied to the validation cohort, achieving 71% sensitivity and 94% specificity for sNfL and 100% sensitivity and specificity for sGFAP in the German and Brazilian cohorts.</p><p><strong>Conclusions and relevance: </strong>This longitudinal cohort study established optimal timing and thresholds for sGFAP and sNfL, which were consistent in independent cohorts, supporting these biomarkers' effectiveness in distinguishing NMOSD attacks from remission.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"168-175"},"PeriodicalIF":20.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876775","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":"Improved Measurement of Treatment Effect in Multiple Sclerosis Clinical Trials.","authors":"Alessio Signori, Francesca Bovis, Maurizio Fedriga, Noemi Montobbio, Marta Ponzano, Irene Schiavetti, Maria Pia Sormani","doi":"10.1001/jamaneurol.2024.4396","DOIUrl":"10.1001/jamaneurol.2024.4396","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"204-206"},"PeriodicalIF":20.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876858","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}