JAMA neurology最新文献

{"title":"AI Devices in Neurology-Moving From Diagnosis to Prognosis.","authors":"James M Hillis, Edward R Scheffer Cliff, Kerstin N Vokinger","doi":"10.1001/jamaneurol.2024.3835","DOIUrl":"10.1001/jamaneurol.2024.3835","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"117-118"},"PeriodicalIF":20.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647929","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":"Spinal Cerebrospinal Fluid Leak Mimicking a Cerebellopontine Angle Tumor.","authors":"Wouter I Schievink, Ferdinand K Hui","doi":"10.1001/jamaneurol.2024.4322","DOIUrl":"10.1001/jamaneurol.2024.4322","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"200-201"},"PeriodicalIF":20.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828486","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":"Cardiovascular Safety of Anti-CGRP Monoclonal Antibodies in Older Adults or Adults With Disability With Migraine.","authors":"Seonkyeong Yang, Yulia Orlova, Haesuk Park, Steven M Smith, Yi Guo, Benjamin A Chapin, Debbie L Wilson, Wei-Hsuan Lo-Ciganic","doi":"10.1001/jamaneurol.2024.4537","DOIUrl":"10.1001/jamaneurol.2024.4537","url":null,"abstract":"<p><strong>Importance: </strong>Monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) or its receptor (anti-CGRP mAbs) offer effective migraine-specific preventive treatment. However, concerns exist about their potential cardiovascular risks due to CGRP blockade.</p><p><strong>Objective: </strong>To compare the incidence of cardiovascular disease (CVD) between Medicare beneficiaries with migraine who initiated anti-CGRP-mAbs vs onabotulinumtoxinA in the US.</p><p><strong>Design, setting, and participants: </strong>This retrospective, sequential cohort study was conducted among a nationally representative population-based sample of Medicare claims from May 2018 through December 2020. Data analysis was performed from August to December 2023. This study included fee-for-service Medicare beneficiaries aged 18 years or older with migraine who initiated either anti-CGRP mAbs or onabotulinumtoxinA. Beneficiaries who had a history of myocardial infarction (MI), stroke, cluster headache, malignant cancer, or hospice service within a 1-year baseline period prior to treatment initiation were excluded. To minimize channeling bias from new drug introductions and time-related bias due to the COVID-19 pandemic, 5 cohorts were established, representing sequential 6-month calendar intervals based on the initial prescription or date of index anti-CGRP mAbs or onabotulinumtoxinA use.</p><p><strong>Exposure: </strong>Anti-CGRP mAbs vs onabotulinumtoxinA.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was time to first MI or stroke. Secondary outcomes included hypertensive crisis, peripheral revascularization, and Raynaud phenomenon. The inverse probability of treatment-weighted Cox proportional hazards models were used to compare outcomes between the 2 treatment groups.</p><p><strong>Results: </strong>Among 266 848 eligible patients with migraine, 5153 patients initiated anti-CGRP mAbs (mean [SD] age, 57.8 [14.0] years; 4308 female patients [83.6%]) and 4000 patients initiated onabotulinumtoxinA (mean [SD] age, 61.9 [13.7] years; 3353 female patients [83.8%]). Use of anti-CGRP mAbs was not associated with an increased risk of composite CVD events (adjusted hazard ratio [aHR], 0.88; 95% CI, 0.44-1.77), hypertensive crisis (aHR, 0.46; 95% CI, 0.14-1.55), peripheral revascularization (aHR, 1.50; 95% CI, 0.48-4.73), or Raynaud phenomenon (aHR, 0.75; 95% CI, 0.45-1.24) compared with onabotulinumtoxinA. Subgroup analyses by age group and presence of established non-MI or stroke CVD showed similar findings.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, despite initial concerns regarding the cardiovascular effects of CGRP blockade, anti-CGRP mAbs were not associated with an increased risk of CVD compared with onabotulinumtoxinA among adult Medicare beneficiaries with migraine, who were predominantly older adults or individuals with disability. Future studies with longer follow-up periods and in other ","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"132-141"},"PeriodicalIF":20.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931710","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":"Gestational Hypertension, Preeclampsia, and Eclampsia and Future Neurological Disorders.","authors":"Therese Friis, Lina Bergman, Susanne Hesselman, Linda Lindström, Katja Junus, Catherine Cluver, Carlos Escudero, Anna-Karin Wikström","doi":"10.1001/jamaneurol.2024.4426","DOIUrl":"10.1001/jamaneurol.2024.4426","url":null,"abstract":"<p><strong>Importance: </strong>Gestational hypertension, preeclampsia, and eclampsia are established risk factors for stroke and dementia later in life. Whether these pregnancy complications are associated with an increased risk of new-onset neurological disorders within months to years after giving birth is not known.</p><p><strong>Objective: </strong>To explore whether gestational hypertension, preeclampsia, and eclampsia are associated with new-onset migraine, headache, epilepsy, sleep disorder, or mental fatigue within months to years after giving birth.</p><p><strong>Design, setting, and participants: </strong>In this register-based cohort study, exposures were identified in the Swedish Medical Birth Register from 2005 to 2018. Follow-up was conducted using the National Patient Register, containing diagnoses from specialized inpatient and outpatient care. Follow-up started 42 days after delivery and continued until the first event, death, emigration, or the end of the follow-up period (2019). The risk was calculated with Cox regression analysis and expressed as adjusted hazard ratio (aHR) with a 95% CI. Through the Swedish Medical Birth Register, 659 188 primiparous women with singleton pregnancies between 2005 and 2018 were identified. Women with a diagnosis of chronic hypertension (n = 4271) or a prepregnancy neurological disorder (n = 6532) were excluded. The final study population included 648 385 women. Data analyses were conducted in 2023.</p><p><strong>Exposures: </strong>Gestational hypertension, preeclampsia, and eclampsia.</p><p><strong>Main outcome: </strong>The primary outcome was a composite neurological outcome of migraine, headache, epilepsy, sleep disorder, or mental fatigue.</p><p><strong>Results: </strong>The study included 648 385 women with a mean age of 28.5 (SD, 5.0) years at the time of their first pregnancy. Women with gestational hypertension (n = 11 133), preeclampsia (n = 26 797), and eclampsia (n = 625) all had an association with increased risk for a new-onset neurological disorder compared with women with normotensive pregnancies. The aHR for gestational hypertension was 1.27 (95% CI, 1.12-1.45), 1.32 (95% CI, 1.22-1.42) for preeclampsia, and 1.70 (95% CI, 1.16-2.50) for eclampsia. When exploring individual outcomes, women with eclampsia were associated with more than a 5 times increased risk of epilepsy (aHR, 5.31; 95% CI, 2.85-9.89).</p><p><strong>Conclusion and relevance: </strong>In this study, gestational hypertension, preeclampsia, and eclampsia were associated with an increased risk of new-onset migraine, headache, epilepsy, sleep disorder, or mental fatigue within months to years after giving birth. Guidelines recommend follow-up after delivery for women with gestational hypertension and preeclampsia for their increased risk of cardiovascular disease. At these visits, caregivers should also pay attention to persisting or new-onset of neurological symptoms, since this group of women appears to be vulnera","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"142-151"},"PeriodicalIF":20.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876776","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":"Integrating N-of-1 Trials Into Learning Health Care Systems.","authors":"Julia E H Brown, Winston Chiong, Nora Hutchinson","doi":"10.1001/jamaneurol.2024.4674","DOIUrl":"10.1001/jamaneurol.2024.4674","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046734","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":"Autoimmune Inflammatory Astrocytopathies-Is the Spectrum Expanding?","authors":"Samuel J Pleasure,Ari J Green","doi":"10.1001/jamaneurol.2024.4749","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4749","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"10 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991686","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":"A 61-Year-Old Man With Weakness and Gait Dysfunction.","authors":"Felipe J S Jones,Christyn Edmundson,Jennifer Orthmann-Murphy","doi":"10.1001/jamaneurol.2024.4600","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4600","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"37 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991687","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":"Novel Meningoencephalomyelitis Associated With Vimentin IgG Autoantibodies.","authors":"Dongshan Wan,Shufang Zhao,Chen Zhang,Fang Xu,Huizi Wang,Shaoxin Tao,Zhandong Qiu,Hao Jiang,Dawei Li,Fei Wang,Dong Li,Jiahao Chen,Yan Wang,Yao Yan,Yan Zhao,Xiaohan Gao,Bingxue Jin,Di Liu,Mengyao Zhang,Jingjing Feng,Shiyue Hou,Mingyang Wang,Teng Chen,Ming Lin,Jinming Han,Xinmei Wen,Wei Jiang,Liang Liu,Youming Long,Yinan Zhao,Jun-Ichi Kira,Zheng Liu,Guoliang Chai,Junwei Hao","doi":"10.1001/jamaneurol.2024.4763","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4763","url":null,"abstract":"ImportanceAutoantibodies targeting astrocytes, such as those against glial fibrillary acidic protein (GFAP) or aquaporin protein 4, are crucial diagnostic markers for autoimmune astrocytopathy among central nervous system (CNS) autoimmune disorders. However, diagnosis remains challenging for patients lacking specific autoantibodies.ObjectiveTo characterize a syndrome of unknown meningoencephalomyelitis associated with an astrocytic autoantibody.Design, Setting, and ParticipantsThis retrospective case series study included samples collected from April 2021 to May 2024 at a tertiary referral hospital among patients with uncharacterized CNS autoimmune disorders and similar clinical and radiological features. Single-cell RNA sequencing (scRNA-seq) was performed on cerebrospinal fluid (CSF) cells of 2 index patients to identify the putative target antigen of the clonally expanded B cells. A comprehensive screening for additional patients was conducted using blinded cell-based and tissue-based assay. Candidate patients were followed up for a median (range) duration of 23 (5-31) months.ExposuresscRNA-seq, autoantibody characterization, and testing.Main Outcomes and MeasuresDetection of the autoantibody and characterization of the associated autoimmune meningoencephalomyelitis.ResultsFourteen candidate patients (10 [71%] female; median [IQR] age, 33 [23-41] years) were identified. Initially, CSF from 2 female patients with unknown encephalomyelitis showed astrocytic reactivity on rat tissue but was negative for GFAP IgG. A total of 17 of 37 clonally expanded B cell clonotypes (46%) in their CSF expressed IgG autoantibodies targeting the astrocytic intermediate filament protein vimentin. Subsequent screening identified 12 additional patients. These 14 patients shared a unique clinical profile characterized by relapsing courses and symptoms prominently involving the cerebellum, brainstem, and corticospinal tract (CST). All patients also exhibited elevated CSF protein and cells, intrathecal immunoglobulin synthesis, and magnetic resonance imaging (MRI) showing bilateral lesions on CST. Notably, 8 of 12 patients (67%) who received first-line immunotherapy at their first episode responded well. At the last follow-up, 11 patients (79%) experienced significant disability (modified Rankin Scale ≥3).Conclusions and RelevanceIn this case series, autoantibodies targeting the astrocytic intermediate filament protein vimentin were identified in patients with previously undifferentiated meningoencephalomyelitis and common radiographic features.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"205 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining Care and Research for Amyotrophic Lateral Sclerosis.","authors":"Suma Babu,Joshua M Sharfstein,Eva L Feldman","doi":"10.1001/jamaneurol.2024.4757","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4757","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"81 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991690","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":"Prourokinase vs Standard Care for Patients With Mild Ischemic Stroke: The PUMICE Randomized Clinical Trial.","authors":"Yunyun Xiong,Xia Meng,Aoming Jin,Bruce C V Campbell,Anding Xu,Qiang Dong,Yun Xu,Yuesong Pan,Yong Jiang,Siying Niu,Zhiliang Li,Xianbo Zhuang,Na Guo,Zhimei Yuan,Zhenyu Kong,Lixia Zong,Chunmiao Duan,Zhixin Cao,Liyuan Wang,Manjun Hao,Shuangzhe Wu,Xueyan Feng,Hao Li,Na Wu,Zixiao Li,Xingquan Zhao,Yongjun Wang,","doi":"10.1001/jamaneurol.2024.4688","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4688","url":null,"abstract":"ImportanceTrials have not demonstrated superiority of alteplase or tenecteplase vs standard care in patients with mild stroke and have raised safety concerns. Prourokinase is an alternative fibrinolytic that may have a favorable safety profile, and the benefit-risk profile of prourokinase in mild stroke is unknown.ObjectiveTo investigate the efficacy and safety of prourokinase in mild ischemic stroke within 4.5 hours of symptom onset.Design, Setting, and ParticipantsThis was a multicenter, prospective, open-label, blinded-end point randomized clinical trial conducted from November 2022 through December 2023 with 3 months of follow-up. The trial was conducted at 89 hospitals in China. Patients with a baseline National Institutes of Health Stroke Scale score of 5 or less (scores range from 0-42, with higher scores indicating more severe neurological deficit) within 4.5 hours from the time the patient was last known to be well. Patients with intention to proceed to endovascular treatment were excluded.InterventionsEligible patients were randomly assigned in a 1:1 ratio to receive prourokinase, 35 mg (15-mg bolus + 20-mg infusion over 30 minutes) or standard care, including antiplatelet or anticoagulant therapy, at the discretion of local investigators.Main Outcomes and MeasuresThe primary outcome was modified Rankin Scale score of 0 or 1 (range, 0-6, with higher scores indicating greater disability) at day 90. Safety outcomes were symptomatic intracranial hemorrhage and death.ResultsOf 3836 patients who underwent screening, 1446 (37.7%) were enrolled in the trial. Median (IQR) age was 65.9 (57.7-72.7) years, and 948 were male (65.5%). A total of 723 patients were assigned to prourokinase and 723 to standard care. The primary outcome occurred in 639 patients (88.5%) in the prourokinase group and 658 (91.0%) in the standard care group (relative risk, 0.97; 95% CI, 0.94-1.01; 2-sided P = .12). Symptomatic intracranial hemorrhage was 0.7% (5 of 723 patients) with prourokinase and 0% with standard care, and mortality at 90 days was 2.3% and 1.4%, respectively.Conclusions and RelevanceResults of this randomized clinical trial demonstrate that prourokinase was not superior to standard care to improve the functional outcomes for patients with mild ischemic stroke within 4.5 hours after symptom onset but had a similar safety profile.Trial RegistrationClinicalTrials.gov Identifier: NCT05507645.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"58 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991688","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}