JAMA neurology最新文献

{"title":"Error in Table 1 and Results.","authors":"","doi":"10.1001/jamaneurol.2026.1881","DOIUrl":"10.1001/jamaneurol.2026.1881","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"827"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251420","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":"Clinical Conversations as a Window Into Cognitive Impairment.","authors":"Gabriela Meade, Hugo Botha","doi":"10.1001/jamaneurol.2026.1863","DOIUrl":"10.1001/jamaneurol.2026.1863","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"727-728"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251079","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":"Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke: A Randomized Clinical Trial.","authors":"Pol Camps-Renom, Marina Guasch-Jiménez, Juan Álvarez-Cienfuegos, Nicolás López-Hernández, Ana Rodríguez-Campello, Herbert Tejada-Meza, Luis López-Mesonero, Laura Albert-Lacal, Mari Mar Freijo-Guerrero, Diana Tarruella-Hernández, Alan Flores, Juan Antonio Cabezas-Rodríguez, Joan Miquel Fernández-Vidal, Alejandro Martínez-Domeño, Natalia Pérez de la Ossa, Anna Ramos-Pachón, Ana Aguilera-Simón, Rebeca Marín, Garbiñe Ezcurra-Díaz, Álvaro Lambea-Gil, Yolanda Silva, Diego José Corona-García, Eva Giralt-Steinhauer, Javier Marta-Moreno, Jesús Alberto Vizcaya-Gaona, Ainara Sanz-Monllor, Alain Luna, Mikahela López Morales, Xavier Ustrell, Francisco Moniche, Judit Solà-Roca, Xia Wang, Craig S Anderson, Luis Prats-Sánchez, Joan Martí-Fàbregas","doi":"10.1001/jamaneurol.2026.1706","DOIUrl":"10.1001/jamaneurol.2026.1706","url":null,"abstract":"<p><strong>Importance: </strong>Optimal blood pressure (BP) management after successful endovascular therapy for acute ischemic stroke remains uncertain, as intensive lowering has shown no benefit or potential harm in prior trials.</p><p><strong>Objective: </strong>To determine whether a reperfusion-guided systolic BP control strategy improves functional outcomes compared with guideline-recommended management after successful endovascular therapy for acute ischemic stroke.</p><p><strong>Design, setting, and participants: </strong>This investigator-initiated, multicenter, prospective, randomized, open-label clinical trial with blinded end point assessment was conducted among adults with acute ischemic stroke due to anterior circulation large-vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2b) after endovascular therapy at 11 comprehensive stroke centers in Spain between June 14, 2021, and October 1, 2025, with 90-day follow-up. Data analysis was conducted from February 1 to March 12, 2026.</p><p><strong>Interventions: </strong>Participants were randomly assigned (1:1) to a reperfusion-guided systolic BP strategy (140-160 mm Hg for mTICI score of 2b; 100-140 mm Hg for mTICI score of 2c/3) or guideline-recommended management (systolic BP <180 mm Hg) for 72 hours using antihypertensive agents or vasopressors as needed.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days, assessed in the intention-to-treat population. Of 446 enrolled patients, 440 were included in the intention-to-treat analysis (mean age, 75 years; 53% women); 6 were excluded due to withdrawal or consent withdrawal.</p><p><strong>Results: </strong>Among 440 patients (mean [SD] age, 75 [12] years; 233 [53.0%] women), 215 were assigned to the intervention group and 225 to the control group. At 90 days, 129 patients (60.0%) in the intervention group and 106 (47.1%) in the control group achieved a favorable functional outcome (absolute risk difference, 13.3%; 95% CI, 4.1%-22.6%; P = .005). Hemorrhagic transformation occurred in 48 patients (22.3%) in the intervention group and 71 (31.6%) in the control group (odds ratio, 0.62; 95% CI, 0.41-0.95). The rates of symptomatic intracranial hemorrhage (3.5% vs 3.9%) and 90-day mortality (15.4% vs 15.6%) did not differ between groups. Serious adverse events occurred in 34 patients (15.8%) in the intervention group and 27 (12.0%) in the control group.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, a reperfusion-guided BP strategy improved functional outcomes and reduced hemorrhagic transformation without increasing major safety events, supporting a tailored approach to postthrombectomy BP management.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04892511.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"788-797"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198930","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":"Methodological Considerations for Quantile Aggregation in Alzheimer Disease Trials.","authors":"Michael D Flanders, Michelle Caunca, Renaud La Joie, Lon S Schneider, Sarah F Ackley","doi":"10.1001/jamaneurol.2026.1240","DOIUrl":"10.1001/jamaneurol.2026.1240","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"821-823"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13184777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963706","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":"Acoustic Analysis of Primary Care Patient-Clinician Conversations to Screen for Cognitive Impairment.","authors":"Joseph T Colonel, Jacqueline Becker, Lili Chan, Cara Faherty, Katherine Hackett, Fernando Carnavali, Tielman T Van Vleck, Laura Curtis, Juan Wisnivesky, Alex Federman, Baihan Lin","doi":"10.1001/jamaneurol.2026.1868","DOIUrl":"10.1001/jamaneurol.2026.1868","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Cognitive impairment (CI) is often underdetected in primary care due to time and resource constraints. Passive analysis of clinical dialogue may offer an accessible approach for screening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess whether audio recordings of patient-physician dialogue during routine primary care visits can be used to identify CI using acoustic speech features and machine learning (ML).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This diagnostic study, conducted from August 2020 through December 2021 among older primary care patients, involved audio recording primary care visits using a microphone and portable device. An external validation cohort was recruited in a separate city to assess reproducibility of findings. Analysis was performed from January 2025 through June 2025. The study was conducted in primary care practices in New York, New York, with additional participants recruited from primary care practices in Chicago, Illinois, for validation. Eligible patients were recruited from primary care practices during routine visits with no prior diagnosis of mild CI or dementia. The study included English-speaking patients aged 55 years and older without documented history of dementia or mild CI. For validation, patients meeting the same eligibility criteria were recruited from primary care practices in Chicago.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Multiple 30-second speech segments were extracted from recordings. Acoustic features were derived using foundation models (Whisper, HuBERT, wav2vec 2.0) and expert-defined methods (eGeMAPS, prosody).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome, CI, was defined as Montreal Cognitive Assessment score 1.0 or more standard deviations below age- and education-adjusted norms. ML classifiers were trained to predict CI status from audio recordings. Area under the receiver operating characteristic curve (AUROC) and maximum F1 score (Fmax) were calculated for identifying participants with CI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 787 English-speaking patients aged 55 years and older without documented history of dementia or mild CI and an additional 179 patients meeting the same eligibility criteria for validation. In total, 966 participants were recruited, among whom 530 (55%) were female, mean (SD) age was 67.2 (8.1) years, and CI prevalence was 21%. Models using Whisper-derived acoustic features performed best (AUROC, 0.733; 95% CI, 0.714-0.752; Fmax[CI], 0.502; 95% CI, 0.471-0.533). Results generalized to the external site with similar performance (AUROC, 0.727; 95% CI, 0.714-0.740; Fmax[CI], 0.459; 95% CI, 0.441-0.477). Model interpretation identified pitch, timing, and variability features as key predictors. When used for screening, the algorithm achieved positive predictive value of 30.4% (95% CI, 28.7%-32.1%), sensitivity of 68.2% (95% CI, 61.8%-74.6%), and specificity of 63.6% (95% CI, 59.8%-67.4%) on th","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"729-738"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251530","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":"Cortical Temporal Stroke Presenting With Delayed Hemichorea-Dystonia.","authors":"Alice Calarco, Angelo Tiziano Cimmino, Marta Garbuglia","doi":"10.1001/jamaneurol.2026.0972","DOIUrl":"10.1001/jamaneurol.2026.0972","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"819-820"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815362","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":"Middle Meningeal Artery Embolization With n-Butyl Cyanoacrylate in Patients With Chronic Subdural Hematoma: A Randomized Clinical Trial.","authors":"Christopher P Kellner, Ansaar T Rai, Hazem Shoirah, Visish M Srinivasan, Rishi Gupta, Robert M Starke, Fawaz Al-Mufti, Charles C Matouk, Benjamin Yim, Matthew R Fusco, Jieqing Wan, Elizabeth Liptrap, Parita Bhuva, Ramesh Grandhi, Russell Cerejo, Jesse J Liu, Jacob Cherian, Qingrong Zhang, Ian Kaminsky, Charles J Prestigiacomo, Emanuele Orru', Eugene Lin, Jay Howington, Avery Evans, Tapan Mehta, SoHyun Boo, Ira Finch, Tao Liu, Rohan Chitale, Shahram Majidi, Brian T Jankowitz","doi":"10.1001/jamaneurol.2026.1542","DOIUrl":"10.1001/jamaneurol.2026.1542","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Middle meningeal artery embolization (MMAE) is a minimally invasive adjunctive treatment for chronic subdural hematoma (cSDH). The TRUFILL n-butyl cyanoacrylate (n-BCA) liquid embolic system is indicated for embolization of cerebral arteriovenous malformations for presurgical devascularization and may be appropriate for MMAE in patients with cSDH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate safety and effectiveness of the study device for MMAE plus standard of care vs standard of care alone in patients with cSDH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;The Middle Meningeal Artery Embolization for the Treatment of Subdural Hematomas With TRUFILL n-BCA (MEMBRANE) trial was a prospective, multicenter, open-label, randomized clinical trial conducted from May 27, 2021, to February 6, 2024, at 30 hospitals (28 in the United States and 2 in China). Participants aged 18 to 90 years with symptomatic cSDH and a modified Rankin Scale score of 3 or less were enrolled.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Site physicians determined whether each patient required surgical or nonsurgical management. Participants in the surgical and nonsurgical cohorts were then randomized 1:1 to receive MMAE plus standard of care or standard of care alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary effectiveness end point was residual or re-accumulation of hematoma (&gt;10 mm; assessed by an independent core laboratory) at 6 months or requiring a surgical procedure on the cSDH within 6 months (conducted as an intention-to-treat analysis). The primary safety end point was incidence of adverse events through 6 months (conducted as an as-treated analysis).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 376 participants (188 in MMAE plus standard of care and 188 in standard of care alone) were included. In the MMAE plus standard of care and standard of care alone groups, the mean (SD) age was 70.9 (10.6) and 70.3 (12.1) years, and 45 (23.9%) and 49 (26.1%) were female, respectively. Primary effectiveness end point events occurred in 17 of 146 participants receiving MMAE plus standard of care (11.6%) and 29 of 131 receiving standard of care alone (22.1%) (final estimate of common odds ratio: 0.53 [90% CI, 0.31-0.91]; P = .04), indicating statistically significant benefit for MMAE plus standard of care vs standard of care alone. Adverse events occurred in 130 of 181 participants in the MMAE plus standard of care group (71.8%) and 124 of 190 in the standard of care alone group (65.3%) through 6 months. MMAE plus standard of care treatment was noninferior to standard of care alone based on analysis of good functional outcome at 3 months, as assessed by the modified Rankin Scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this randomized clinical trial, MMAE plus standard of care significantly reduced rates of recurrence and reoperation vs standard of care alone, without a significant increase in adverse events.&lt;","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"749-758"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251590","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":"Pathology and Genetics in a Global Cohort of Parkinsonian Disorders.","authors":"Lesley Y Wu, Tessa du Toit, Tatiana Georgiades, Eleanor J Stafford, Kristin Levine, Zih-Hua Fang, Simona Jasaityte, Ana-Luisa Gil Martinez, Patrick Cullinane, Eduardo De Pablo-Fernandez, Cornelis Blauwendraat, Andrew B Singleton, Sonja W Scholz, Bryan J Traynor, Nicholas Wood, John Hardy, Patrick Chinnery, Henry Houlden, Richard Cain, Claire Troakes, Viorica Chelban, Geidy E Serrano, Djordje Gveric, Catriona McLean, Seth Love, Andrew King, Andrew C Robinson, Federico Roncaroli, Claire Shepherd, Glenda Halliday, Laura Parkkinen, Christopher M Morris, Colin Smith, Thomas G Beach, Steve Gentleman, Thomas T Warner, Tammaryn Lashley, Zane Jaunmuktane, Raquel Real, Huw R Morris","doi":"10.1001/jamaneurol.2026.1634","DOIUrl":"10.1001/jamaneurol.2026.1634","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Accurate diagnosis of neurodegenerative movement disorders is challenging because of a lack of in vivo biomarkers, overlapping clinical features, and a delay in the emergence of pathognomonic features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate clinicopathological correlation, diagnostic accuracy, genetic association with pathology, and ancestry-related differences in a multiancestry brain bank cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a multicenter, retrospective, autopsy-confirmed cross-sectional brain bank study on donors enrolled between 1985 and 2024. Included were donors from 11 academic brain banks in the UK, US, and Australia. Among brain donors with available genetic data from participating brain banks, included were individuals with clinical diagnoses of Parkinson disease, Parkinson disease dementia, dementia with Lewy bodies (DLB), progressive supranuclear palsy, corticobasal syndrome, multiple system atrophy, or neurologically normal controls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Genetic variant carrier status and clinical diagnostic category.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes included clinical diagnostic accuracy, Lewy body and Alzheimer disease pathology burden, survival, association with genetic variants, and genetically inferred ancestry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 5648 brain donors with available genetic data, a total of 3353 eligible donors (mean [SD] age at death, 76.8 [10.6] years; 2072 male [61.8%]) were included. Misdiagnosis rates for movement disorders ranged approximately from 10% to 20%. Clinical diagnoses of dementia with parkinsonism (ie, Parkinson disease dementia and DLB) were more strongly associated with Lewy body pathology than Parkinson disease without dementia (odds ratio [OR], 1.96; 95% CI, 1.30-3.04; P = 7.2 × 10-4). Lewy pathology was identified in 33 of 745 of neurologically normal controls (4.4%). Alzheimer disease copathology was present in 426 of 1064 cases (40.0%) with Lewy body disease. Carriers of the GBA1 variant exhibited greater Lewy body burden compared with noncarriers (OR, 1.94; 95% CI, 1.24-3.03; P = .01) or carriers of the LRRK2 variant (OR, 7.44; 95% CI, 2.16-25.64; P = .01). Pathological diagnoses differed by ancestry, with South Asian donors more likely to have progressive supranuclear palsy pathology and Ashkenazi Jewish donors more likely to have Lewy body disease (χ22 = 35.5; P &lt; .001), independent of GBA1 and LRRK2 variant status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Findings of this cross-sectional brain bank study highlight the value of integrating genetic and pathological data to improve diagnostic accuracy. The high prevalence of Alzheimer disease copathology and ancestry-associated differences in pathology point to the need for biologically informed diagnostic tools. These results suggest supporting the integration of genetically and pathologically stratified approaches","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"798-807"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198909","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":"Neurological Manifestations in Adult Survivors of Ebola Virus Disease.","authors":"Bridgette Jeanne Billioux, Cavan Reilly, Collin van Ryn, Bryan Smith, Helen Tarfeh-Burnette, Joseph Dorbor, Korlia Bonarwolo, Victor Taryor, Matthew K Schindler, Lauren Bowen Reoma, Shila Azodi, Joan Ohayon, Yoshimi Enose-Akahata, Rachel Bishop, Elizabeth Higgs, H Clifford Lane, Kumblytee Johnson, Michael C Sneller, Mosoka Fallah, Avindra Nath","doi":"10.1001/jamaneurol.2026.2112","DOIUrl":"10.1001/jamaneurol.2026.2112","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Ebola virus disease (EVD) causes multiorgan damage and is highly fatal. EVD's neurological impact among survivors remains poorly characterized due to limited neurological assessment capabilities in the remote regions where most outbreaks occur.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize neurological sequelae in EVD survivors over more than 7 years' longitudinal follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Under the Ebola Natural History Study (PREVAIL III; PIII), the Neurology Study of PIII was a prospective longitudinal cohort study in Liberia of adult Ebola survivors and control individuals conducted from September 2015 to March 2023 at the Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) site at John F. Kennedy Medical Center in Monrovia, Liberia. Data were analyzed from April 2023 to September 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Neurological evaluations were performed by trained neurologists biannually. Questionnaire and neurological examination data were collected on case report forms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Neurological symptom prevalence and neurological examination scores were compared to those of control individuals. Tests for differences between survivors and control individuals were conducted using generalized linear mixed-effects models controlling for age and sex. Overdispersed Poisson models were used to test for computed neurological examination score differences. Neurological examination scores were developed for this study, representing the cumulative abnormalities on neurological examinations, denoted on standardized case report forms, with the general neurological examination score representing all examination abnormalities and the central nervous system score representing the central nervous system-specific abnormalities on examination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analysis after serologic testing included 148 Ebola antibody-positive survivors (mean [SD] age, 34.8 [10.5] years; 74 [50%] female) and 81 antibody-negative contacts (mean [SD] age, 35.8 [12.6] years; 41 [51%] female). During acute infection, survivors reported headaches, altered mental status, and strokelike symptoms or meningoencephalitis (rarely). Survivors had significant neurological sequelae involving the entire neuraxis: cognitive dysfunction (83 [56.1%]), persistent headaches (98 [66.2%]), sleep abnormalities (40 [27.0%]), depression (73 [49.3%]), sexual dysfunction (48 [32.4%]), tremor (18 [20.3%]), fatigue (71 [51.1%]), cranial nerve abnormalities (60 [40.5%]), and sensory abnormalities (45 [30.4%]). Over 7 years' follow-up, most survivors demonstrated improvement in neurological status. The final visit included 115 survivors (77.7%) and 61 close contacts (75.3%). Persistent symptoms at final evaluation in survivors compared to contacts were memory loss (66 [57.4%] vs 16 [26.2%], respectively; P &lt; .001), irritability (42 [36.5%","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"739-748"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217506","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":"Standard-Dose Tenecteplase vs Low-Dose Alteplase for Acute Ischemic Stroke From Large-Vessel Occlusion: A Randomized Clinical Trial.","authors":"Manabu Inoue, Teruyuki Hirano, Mayumi Fukuda-Doi, Hiroyuki Kawano, Kenta Tanaka, Nobuyuki Sakai, Masatoshi Koga, Koji Iwasaki, Tomohide Yoshie, Naruhiko Kamogawa, Masafumi Ihara, Tsuyoshi Ohta, Masaki Chin, Naoto Kimura, Kazumi Kimura, Yohei Tateishi, Tadashi Terasaki, Taketo Hatano, Takahiro Kuwashiro, Shinichi Yoshimura, Toshihiro Ueda, Eiichiro Nagata, Yoshinari Nagakane, Shinichi Takahashi, Fumio Miyashita, Kazutaka Sonoda, Kenji Fukuda, Kanta Tanaka, Yoshiko Une, Shigetaka Kobari, Takehiko Nagao, Makoto Sasaki, Haruko Yamamoto, Kazunori Toyoda","doi":"10.1001/jamaneurol.2026.1590","DOIUrl":"10.1001/jamaneurol.2026.1590","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Tenecteplase has advantages over standard-dose alteplase for acute ischemic stroke. A low-dose alteplase regimen (0.6 mg/kg) remains the standard in Japan and is commonly used in several Asian countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether standard-dose tenecteplase at 0.25 mg/kg achieves a higher rate of recanalization on the initial angiogram than low-dose alteplase at 0.6 mg/kg in patients scheduled for mechanical thrombectomy. It is inevitable to generate evidence required to support potential regulatory approval of tenecteplase in Japan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This investigator-initiated, multicenter, randomized, controlled, open-label, superiority trial was conducted from August 19, 2022, through March 13, 2025, with 3-month follow-up and was the first ever to compare tenecteplase (0.25 mg/kg) with alteplase (0.6 mg/kg) for acute ischemic stroke. Participants included patients with large-vessel-occlusion stroke eligible for intravenous thrombolysis within 4.5 hours of symptom onset followed by mechanical thrombectomy. A total of 221 patients were randomized and 218 who received trial drugs were included in the full analysis set (107 tenecteplase; 111 alteplase). These data were analyzed from July 2025 to December 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Patients were randomly assigned in a 1:1 ratio to receive either intravenous tenecteplase or alteplase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was substantial reperfusion (modified Treatment in Cerebral Ischemia grade 2b to 3 or no retrievable thrombus) on the initial angiogram. Secondary outcomes included the 90-day modified Rankin Scale. Safety outcomes were symptomatic intracranial hemorrhage within 24 to 36 hours and mortality at 90 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 218 patients (mean [SD] age, 77.1 [12.0] years; 92 female and 126 male) who received trial drugs were included in the full analysis set (107 tenecteplase; 111 alteplase). Substantial reperfusion occurred in 10.3% of the standard-dose tenecteplase group vs 3.6% of the low-dose alteplase group (absolute difference, 6.5 percentage points; 90% CI, 0.89-12.1), meeting the prespecified success criterion. The estimated common odds ratio for a shift toward better 90-day functional outcome with tenecteplase was 1.47 (95% CI, 0.92-2.35). Rates of symptomatic intracranial hemorrhage (2.8% vs 1.8%) and mortality (6.5% vs 9.9%) were similar between tenecteplase and alteplase groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this study, standard-dose tenecteplase (0.25 mg/kg) prior to thrombectomy resulted in a higher rate of early substantial reperfusion compared with low-dose alteplase (0.6 mg/kg), with comparable functional and safety outcomes. Standard-dose tenecteplase is a promising thrombolytic option in regions where low-dose alteplase is currently the standard of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Tri","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"769-777"},"PeriodicalIF":23.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138081","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}