JAMA neurologyPub Date : 2025-07-14DOI: 10.1001/jamaneurol.2025.1904
Camille P Vaughan,James F Morley,Jessica Lehosit,Gerald McGwin,Lisa Muirhead,Anjali Khakharia,Theodore M Johnson,Marian L Evatt,Taressa Sergent,Kathryn L Burgio,Alayne D Markland
{"title":"Behavioral Compared With Drug Therapy for Overactive Bladder Symptoms in Parkinson Disease: A Randomized Noninferiority Trial.","authors":"Camille P Vaughan,James F Morley,Jessica Lehosit,Gerald McGwin,Lisa Muirhead,Anjali Khakharia,Theodore M Johnson,Marian L Evatt,Taressa Sergent,Kathryn L Burgio,Alayne D Markland","doi":"10.1001/jamaneurol.2025.1904","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1904","url":null,"abstract":"ImportanceOveractive bladder (OAB) symptoms in Parkinson disease (PD) are burdensome, and the adverse effects of drug treatment can worsen PD-associated morbidity. Drug adverse effects are avoided with pelvic floor muscle exercise-based behavioral therapy.ObjectiveTo assess the noninferiority of behavioral compared with solifenacin drug therapy for OAB symptoms in persons with PD.Design, Setting, and ParticipantsThis 12-week randomized noninferiority trial of behavioral therapy compared with solifenacin was conducted between 2018 and 2023 within 4 US Veterans Affairs health care systems. Eligible participants were diagnosed with PD by a movement disorder neurologist and had an International Consultation on Incontinence Questionnaire OAB module (ICIQ-OAB) symptom score of 7 or higher (range, 0-16; higher score indicates worse symptoms) and Montreal Cognitive Assessment (MOCA) score of 18 or higher (range, 0-30). Participants were randomized 1:1 after stratification by sex, recruitment site, OAB severity, and PD motor symptom severity. Analyses were conducted from October 2023 to April 2024.InterventionsBehavioral therapy was implemented by a nurse practitioner and included pelvic floor muscle training and urge suppression strategies. Solifenacin therapy started at 5 mg daily, with titration to 10 mg daily if needed.Main Outcome and MeasuresThe primary outcome was the 12-week ICIQ-OAB score across groups within a 15% noninferiority margin. Adverse events were assessed every 2 weeks for 8 weeks and again at 12 weeks.ResultsA total of 77 persons with PD (65 [84%] male; mean [SD] age, 71.3 [8.9] years; mean [SD] years with PD, 6.6 [5.8]) were randomized to behavioral (n = 36) or drug therapy (n = 41). Seventy-three participants completed the study (4 dropped out in drug group). Baseline characteristics were balanced across groups, including MOCA score (mean [SD], drug, 23.9 [3.1]; behavioral, 24.8 [3.3]) and ICIQ-OAB score (mean [SD], drug, 9.1 [1.7]; behavioral, 8.5 [1.4]). At 12 weeks postrandomization, ICIQ-OAB scores across groups indicated clinically significant improvement and were within the a priori noninferiority margin of 15% (mean [SD] score, drug, 5.8 [2.4]; behavioral, 5.5 [2.0]; P = .02). Dry mouth and falls were reported more frequently in the drug compared with the behavioral group.Conclusions and RelevanceResults of this randomized noninferiority trial suggest that behavioral therapy is noninferior to drug therapy in improving OAB symptoms in PD. These findings may inform clinical guidelines for urinary symptoms in PD to consider behavioral therapy as an initial treatment option.Trial RegistrationClinicalTrials.gov Identifier: NCT03149809.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"19 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622146","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}
JAMA neurologyPub Date : 2025-07-07DOI: 10.1001/jamaneurol.2025.2201
Xiaoting Zheng,Huifang Shang,Ling Liu
{"title":"Isolated Hepatitis B Virus-A Rare Cause of Brain Damage.","authors":"Xiaoting Zheng,Huifang Shang,Ling Liu","doi":"10.1001/jamaneurol.2025.2201","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2201","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"9 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568428","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}
JAMA neurologyPub Date : 2025-07-07DOI: 10.1001/jamaneurol.2025.1897
Patrick Landazuri,Jennifer J Cheng,Eric Leuthardt,Albert H Kim,Derek G Southwell,Peter E Fecci,Joseph Neimat,David Sun,Bradley Lega,Fedor Panov,Veronica Chiang,Taylor Abel,Sharona Ben-Haim,David E Piccioni,Jerry J Shih,Viktoras Palys,Analiz Rodriguez,S Kathleen Bandt,Joseph Petronio,Michel Lacroix,James Baumgartner
{"title":"Interstitial Thermal Therapy in Mesial Temporal Lobe Epilepsy.","authors":"Patrick Landazuri,Jennifer J Cheng,Eric Leuthardt,Albert H Kim,Derek G Southwell,Peter E Fecci,Joseph Neimat,David Sun,Bradley Lega,Fedor Panov,Veronica Chiang,Taylor Abel,Sharona Ben-Haim,David E Piccioni,Jerry J Shih,Viktoras Palys,Analiz Rodriguez,S Kathleen Bandt,Joseph Petronio,Michel Lacroix,James Baumgartner","doi":"10.1001/jamaneurol.2025.1897","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1897","url":null,"abstract":"ImportanceLaser interstitial thermal therapy (LITT) is a surgical tool used to ablate epileptic foci and brain tumors. Understanding clinical and procedural outcomes of LITT for mesial temporal lobe epilepsy (MTLE) is relevant to clinicians and patients.ObjectiveTo describe seizure outcomes, procedural outcomes, and safety data of MTLE LITT.Design, Setting, and ParticipantsLaser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN) is a prospective multicenter registry with up to 5 years of follow-up lasting from October 2015 to March 2023 at LAANTERN epilepsy sites, which are all level IV National Association of Epilepsy Centers in the US. Adult and pediatric LAANTERN enrollees undergoing LITT for drug-resistant MTLE with at least 6 months of follow-up were included. Those with epilepsy related to a malignant lesion were excluded.InterventionLITT for drug-resistant MTLE.Main Outcomes and MeasuresDemographic, epilepsy, and seizure characteristics; procedural data; postsurgical seizure outcomes; safety data; and quality of life (QOL) scores were prospectively collected.ResultsFifteen centers enrolled 145 patients (73 [50.3%] female) with MTLE undergoing LITT, with 77 reaching 2-year follow-up. The mean (SD) age was 39.2 (15.4) years at time of LITT with 14 of 145 in the pediatric range (younger than 22 years). The 2 most common etiologies were mesial temporal sclerosis (n = 74) and unknown etiology or magnetic resonance imaging normal (n = 31). Mean (SD) ablation volume was 28.2 (29.8) mL. Mean (SD) surgery duration was 4.3 (2.1) hours, and mean (SD) blood loss was 22 (17.6) mL. Median (IQR) length of stay was 1 (1-3) day, and 33 patients (23%) had no intensive care unit stay postprocedure. Median (IQR) intensive care unit time was 22 (19.2-28.8) hours. Mean (SD) discharge head pain score was 2.1 (2.6) on a 0-10 scale. Most patients (n = 140 [96.6%]) were discharged home. Two-year seizure outcomes were 45 of 77 (58.4%) and 44 of 77 (57.2%) for Engel 1 and International League Against Epilepsy 1/2, respectively. No clinical characteristics were associated with seizure outcome. Adverse events were seen in 24 patients (16.5%), most being mild and transient. Pediatric seizure outcomes were similar to adult outcomes. One-third of patients stopped or decreased their antiseizure medicines. Improvements in QOL scores were seen at almost all time points assessed.ConclusionsIn the largest prospective multicenter MTLE LITT cohort, LITT was found to be well tolerated with clinically meaningful seizure outcomes and QOL improvements. These findings indicate that LITT may be considered as a treatment option for drug-resistant MTLE.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"31 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568427","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":"Higher Educational Attainment and Accelerated Tau Accumulation in Alzheimer Disease.","authors":"Yue Cai,Lili Fang,Jie Yang,Xin Zhou,Lin Liu,Anqi Li,Pan Sun,Guoyu Lan,Zhengbo He,Yalin Zhu,Laihong Zhang,Mingxing Jiang,Xianfeng Yu,Zhen Liu,Tengfei Guo, ","doi":"10.1001/jamaneurol.2025.1801","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.1801","url":null,"abstract":"ImportanceThe impact of educational attainment (EA) on longitudinal tau accumulation remains largely underexplored.ObjectiveTo investigate the association of EA with tau accumulation in Alzheimer disease (AD).Design, Setting, and ParticipantsThis cohort study used 3 independent samples: the Alzheimer's Disease Neuroimaging Initiative (ADNI; October 2015-July 2022, mean follow-up: 3.0 years), Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease study (A4; 2014-2022, mean follow-up: 4.7 years), and Greater-Bay-Area Healthy Aging Brain Study (GHABS; July 2021-August 2024, mean interval from plasma collection to tau positron emission tomography [PET]: 1.0 years). The ADNI and GHABS represent Northern American and Southern Chinese populations, respectively. A4 is a multicenter trial. Participants with amyloid β (Aβ) and subsequent tau PET were included from ADNI, A4, and GHABS, and a subset had plasma phosphorylated tau (p-tau) 217 (p-tau217) and resting-state functional magnetic resonance imaging (RS-fMRI) data. Data were analyzed from July 2022 to January 2025.ExposuresEA, Aβ-PET, tau-PET, plasma p-tau217, and RS-fMRI.Main Outcomes and MeasuresParticipants were classified as high EA and low EA based on median years of EA. Longitudinal tau changes were compared across Aβ-PET positivity and EA groups. Interactions of EA status with Aβ burden, entorhinal tau, and plasma p-tau217 on tau accumulation were investigated in Aβ-positive (Aβ+) individuals. Connectivity-associated tau spread was compared across different Aβ/EA groups. Whether or not Aβ-targeting treatment attenuated tau accumulation in Aβ+ high-EA individuals was also evaluated.ResultsThis study included 887 participants: 377 from ADNI (mean [SD] age, 73.3 [7.2] years; 191 female [50.7%]), 395 from A4 (mean [SD] age, 71.9 [4.8] years; 223 female [56.5%]), and 115 from GHABS (mean [SD] years, 66.0 [7.4] years; 76 female [66.1%]). In the Aβ-negative group, high-EA individuals exhibited slower tau accumulation than low-EA individuals (right middle temporal gyrus: estimate = -0.002; 95% CI, -0.003 to -0.0002; P = .03). Conversely, higher EA in the Aβ+ group was correlated with accelerated tau accumulation (left middle temporal gyrus: estimate = 0.003; 95% CI, 0.0003-0.005; P = .03) and stronger Aβ-associated (left visual region: estimate = 0.38; 95% CI, 0.11-0.65; P = .006), entorhinal tau-associated (left middle temporal gyrus: estimate = 0.35; 95% CI, 0.08-0.63; P = .01), and plasma p-tau217-associated tau accumulation (left inferior temporal gyrus: estimate = 0.46; 95% CI, 0.02-0.90; P = .04), as well as increased connectivity-associated tau spread compared with lower EA (estimate = 0.33; 95% CI, 0.003-0.67; P = .048). Aβ-targeting treatment appeared to mitigate plasma p-tau217-associated tau accumulation in patients with AD and higher EA (estimate = -0.52; 95% CI, -0.80 to -0.24; P < .001).Conclusions and RelevanceResults of this cohort study suggest that higher EA was associated with fa","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"93 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568377","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}
JAMA neurologyPub Date : 2025-07-05DOI: 10.1001/jamaneurol.2025.2036
Xianhua Hou, Jiacheng Huang, Li Wang, Yuxuan He, Jiaxing Song, Changwei Guo, Shihai Yang, Xiaolei Shi, Lin Chen, Qu Liu, Junfeng Su, Lin Zeng, Maojun Jiang, Boyu Chen, Xiangping Cheng, Shengli Chen, Honghua Pan, Xiaoping Shen, Youlin Wu, Xionglin Tang, Jian Wang, Shibo Han, Tianqiang Pu, Changchuan Wu, Fengguang Li, Lunxue Qu, Zhong Fu, Hua Liu, Yu Li, Bin Mei, Yanbo Cheng, Zicheng Hu, Haochun Zhang, Tao Lv, Min Wu, Ruchuang Xu, Qinglin Ye, Liangbo Kong, Shuai Mi, Junhua Wu, Yu Wang, Zhenxuan Tian, Wenzhe Sun, Jinfu Ma, Xu Xu, Yazhou Wu, Duolao Wang, Raul G. Nogueira, Thanh N. Nguyen, Jeffrey L. Saver, Wenjie Zi, Zhenhua Zhou
{"title":"Intra-Arterial Tenecteplase After Successful Reperfusion in Large Vessel Occlusion Stroke","authors":"Xianhua Hou, Jiacheng Huang, Li Wang, Yuxuan He, Jiaxing Song, Changwei Guo, Shihai Yang, Xiaolei Shi, Lin Chen, Qu Liu, Junfeng Su, Lin Zeng, Maojun Jiang, Boyu Chen, Xiangping Cheng, Shengli Chen, Honghua Pan, Xiaoping Shen, Youlin Wu, Xionglin Tang, Jian Wang, Shibo Han, Tianqiang Pu, Changchuan Wu, Fengguang Li, Lunxue Qu, Zhong Fu, Hua Liu, Yu Li, Bin Mei, Yanbo Cheng, Zicheng Hu, Haochun Zhang, Tao Lv, Min Wu, Ruchuang Xu, Qinglin Ye, Liangbo Kong, Shuai Mi, Junhua Wu, Yu Wang, Zhenxuan Tian, Wenzhe Sun, Jinfu Ma, Xu Xu, Yazhou Wu, Duolao Wang, Raul G. Nogueira, Thanh N. Nguyen, Jeffrey L. Saver, Wenjie Zi, Zhenhua Zhou","doi":"10.1001/jamaneurol.2025.2036","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.2036","url":null,"abstract":"ImportanceThe optimal dose, safety, and efficacy of intra-arterial tenecteplase after successful reperfusion by endovascular thrombectomy for large vessel occlusion (LVO) is unknown.ObjectiveTo evaluate the dose-dependent adverse events and signals of efficacy of intra-arterial tenecteplase in LVO after successful reperfusion with thrombectomy, defined as an Extended Treatment in Cerebral Infarction score of 2b-3.Design, Setting, and ParticipantsThis open-label, blinded-outcome assessment trial, incorporating a 14 + 8 dose-escalation (phase 1b, nonrandomized) and dose-expansion (phase 2a, randomized) design, was conducted in China between 2023 and 2024, with follow-up continuing through November 2024. This was a multicenter clinical trial including patients with LVO and successful reperfusion within 24 hours of last known well.InterventionsIn phase 1b, intra-arterial tenecteplase, 0.0313, 0.0625, 0.1250, 0.1875 mg/kg; in phase 2a, intra-arterial tenecteplase 0.0313 or 0.0625 mg/kg, or control (without intra-arterial thrombolysis).Main Outcomes and MeasuresThe primary outcome in phase 1b was symptomatic intracranial hemorrhage (sICH) within 24 hours. The primary outcome in phase 2a was 90-day no-disability outcome (modified Rankin Scale score 0-1).ResultsA total of 205 patients (phase 1b: 48, phase 2a: 157) were enrolled and analyzed. The median (IQR) age was 71 (60-77) years, and 113 (55.1%) were male. In phase 1b, 1 of 14 and 2 of 22 patients with sICH were observed at dose tiers 0.0313 and 0.0625 mg/kg, respectively. Three of 12 patients had sICH at dose tier 0.1250 mg/kg, exceeding the prespecified safety threshold (<jats:italic>P</jats:italic> = .04). In phase 2a, eligible patients were randomly assigned to receive tenecteplase, 0.0313 mg/kg (n = 46) and 0.0625 mg/kg (n = 46), and 65 patients composed the control group. The primary outcome occurred in 22 of 65 patients (33.8%) in the control group, 17 of 46 patients (37.0%) in the tenecteplase, 0.0313 mg/kg, group (adjusted risk ratio [RR] vs control, 0.85; 95% CI, 0.54-1.35; <jats:italic>P</jats:italic> = .50), and 20 of 46 patients (43.5%) in the tenecteplase, 0.0625 mg/kg, group (adjusted RR, 1.15; 95% CI, 0.73-1.80; <jats:italic>P</jats:italic> = .55). No significant difference in the safety outcomes was observed among the 3 groups.Conclusions and RelevanceResults of this phase 1 and 2 randomized clinical trial reveal that adjunctive intra-arterial tenecteplase dosages of 0.0313 mg/kg or 0.0625 mg/kg after successful reperfusion in patients with anterior circulation LVO showed adequate safety to advance to larger trials to determine the potential therapeutic benefits.Trial RegistrationChiCTR.org.cn Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.chictr.org.cn/showprojEN.html?proj=202219\">ChiCTR2300073787</jats:ext-link> and <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"1 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565680","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}
JAMA neurologyPub Date : 2025-07-01DOI: 10.1001/jamaneurol.2025.1481
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
{"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":"722-733"},"PeriodicalIF":21.3,"publicationDate":"2025-07-01","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}
JAMA neurologyPub Date : 2025-07-01DOI: 10.1001/jamaneurol.2025.0908
Catherine S Hwang
{"title":"Beyond the Cure.","authors":"Catherine S Hwang","doi":"10.1001/jamaneurol.2025.0908","DOIUrl":"10.1001/jamaneurol.2025.0908","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"639-640"},"PeriodicalIF":20.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967428","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}