Journal of Clinical Neurology最新文献

{"title":"Clinical Course After a Single Cycle of Rozanolixizumab in Generalized Late-Onset Myasthenia Gravis.","authors":"Shun Aritake, Atsushi Nagai","doi":"10.3988/jcn.2026.0187","DOIUrl":"10.3988/jcn.2026.0187","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"622-624"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Glucagon-Like Peptide-1 Receptor Agonist Use After Transient Ischemic Attack on Risks of Subsequent Ischemic Stroke and Mortality.","authors":"Jay Kakadiya, Pranjal Rai, Girish Bathla, Vidhi Dhaduk, Huanwen Chen, Matthew K McIntyre, Daniel Mandel, Shahrzad Latifi, Brian Connolly, Hamza A Salim, Ahmed Y Azzam, Muhammed Amir Essibayi, Vivek S Yedavalli, Majid Khan, Adam A Dmytriw, David J Altschul, Marco Colasurdo, Ajay Malhotra, Dheeraj Gandhi, Dhairya A Lakhani","doi":"10.3988/jcn.2026.0073","DOIUrl":"10.3988/jcn.2026.0073","url":null,"abstract":"<p><strong>Background and purpose: </strong>A transient ischemic attack (TIA) is associated with a markedly higher risk of subsequent ischemic stroke even when guideline-directed prevention strategies are applied. There is evidence emerging from the LAMP trial that glucagon-like peptide-1 receptor agonists (GLP-1RAs) can help to prevent secondary stroke. We therefore conducted this study to evaluate the association in a real-world cohort.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the TriNetX US Collaborative Network. Adults with TIA who received antithrombotic therapy between 7 days before and 7 days after a TIA diagnosis were included. GLP-1RA use was defined as its initiation between 3 months before to 7 days after a TIA diagnosis. Propensity-score matching (PSM) was performed at a 1:1 ratio to balance covariates. The primary outcomes were ischemic stroke and mortality, while the secondary outcomes were inpatient (IP) admissions and emergency department (ED) visits. Outcomes were assessed over a 5-year follow-up period. Sensitivity analyses stratified by body mass index, hemoglobin-A1c level, and atrial fibrillation status were conducted to generalize the findings.</p><p><strong>Results: </strong>After applying PSM, 5,071 GLP-1RA users and 5,071 GLP-1RA nonusers were included. GLP-1RA use was associated with lower risks of ischemic stroke (6.9% vs. 10.9%, hazard ratio [HR]=0.76, <i>p</i><0.001) and mortality (5.9% vs. 12.3%, HR=0.67, <i>p</i><0.001), as well as fewer IP admissions and ED visits. The results of six sensitivity analyses were consistent with the primary cohort demonstrating the favorable outcomes not being confined to a specific metabolic or vascular risk phenotype.</p><p><strong>Conclusions: </strong>GLP-1RA is associated with lower risks of ischemic stroke, mortality, IP admissions, and ED visits in TIA patients. These preliminary findings suggest that GLP-1RAs can play a role in the secondary prevention of cerebrovascular disease.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"540-551"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Functional Neurological Disorders.","authors":"Jung E Park","doi":"10.3988/jcn.2026.0223","DOIUrl":"10.3988/jcn.2026.0223","url":null,"abstract":"<p><p>Functional neurological disorder (FND) is a common condition characterized by involuntary neurological symptoms. The most common subtypes include functional/dissociative seizures and functional movement disorders, though other presentations such as persistent postural-perceptual dizziness and functional cognitive disorder are increasingly recognized. Patients may present with multiple types of functional neurological symptoms, and comorbid pain, fatigue, and sleep disturbance are common and may substantially affect quality of life. Despite its high prevalence, FND has historically been neglected, and the prognosis remains poor in a substantial proportion of patients. This article provides an overview of current treatment options for FND, including physical therapy, cognitive behavioral therapy, multidisciplinary approaches, and neuromodulation. Ongoing challenges including heterogeneous outcome measures, limited long-term follow-up data, the absence of validated biomarkers, and the need for expanded access to specialist care are also discussed.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"514-528"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health via Behavioral, Optimized, Organized Movement therapy (SUPERBRAIN-BOOM) in Mild Cognitive Impairment: Protocol for a Multicenter, Randomized Controlled Feasibility Trial.","authors":"Da Ae Kim, Sun Min Lee, Kyunghwa Sun, Eun-Joo Kim, Hyun Sook Kim, Soo Hyun Cho, YeShin Kim, Sung Min Kang, Ji Woo Jung, Su Gyeong Kim, Hang Rai Kim, So Young Moon","doi":"10.3988/jcn.2025.0635","DOIUrl":"10.3988/jcn.2025.0635","url":null,"abstract":"<p><strong>Background and purpose: </strong>The SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention (SUPERBRAIN) showed that a multidomain lifestyle intervention targeting vascular risk, cognitive training, physical activity, nutrition, and motivation is feasible in older adults. However, its resource-intensive delivery limited scalability, and conventional aerobic exercise alone may not sufficiently support long-term adherence, cognitive-motor engagement, and cultural acceptability in older adults with mild cognitive impairment (MCI). To address these gaps, we developed the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health via Behavioral, Optimized, Organized Movement therapy (SUPERBRAIN-BOOM) in MCI, a mobile-based multidomain program integrating dance-based movement, nutrition education, and meditation.</p><p><strong>Methods: </strong>This multicenter randomized feasibility trial will enroll 45 adults aged 50-85 years with MCI and at least one modifiable dementia risk factor. Participants will be randomized (1:1:1) to a tablet-based multidomain intervention, a smartphone-based multidomain intervention, or a control group receiving no intervention. The 12-week program consists of daily 30-minute home-based sessions (physical activity 20 minutes, nutrition education 5 minutes, meditation 5 minutes) delivered over four 3-week cycles, with assessments at weeks 3, 6, and 9 to adjust difficulty. The primary outcomes focus on feasibility (recruitment, retention, adherence ≥70%, and data completeness), and secondary outcomes include exploratory measures of cognition, physical function, vascular risk, nutrition, mood, quality of life, and motivation.</p><p><strong>Results: </strong>Recruitment and data collection are ongoing.</p><p><strong>Conclusions: </strong>This feasibility trial will inform the design of a future randomized trial evaluating a scalable, personalized mobile multidomain intervention for dementia prevention.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"573-582"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Mechanisms of Aperiodic Alternating Nystagmus.","authors":"Ji-Yun Park, Hyun Ah Kim, Jae-Hwan Choi, Eun Hye Oh, Chang-Hee Kim, Tae-Kyeong Lee, Seokho Choi, Seo Young Choi, Kwang-Dong Choi","doi":"10.3988/jcn.2026.0111","DOIUrl":"10.3988/jcn.2026.0111","url":null,"abstract":"<p><strong>Background and purpose: </strong>Aperiodic alternating nystagmus (AAN) is defined as spontaneous alternating nystagmus in which the direction of nystagmus reverses repeatedly but the reversals do not occur at a consistent cycle interval and the cycle durations and/or peak slow-phase velocities are irregular. The etiologic distribution of vestibular disorders associated with AAN and the underlying mechanisms remain unclear. This study aimed to identify the clinical characteristics and potential underlying mechanisms of AAN.</p><p><strong>Methods: </strong>We analyzed quantitative eye-movement recordings, audiovestibular test results, and neuroimaging results of 22 patients with AAN, and conducted a systematic review of reported cases of AAN in both peripheral and central vestibular disorders.</p><p><strong>Results: </strong>The systematic review identified an additional 29 patients with AAN. Peripheral vestibular causes accounted for 32 (62.7%) of all 51 patients, and comprised acute peripheral vestibulopathy (<i>n</i>=16), Ménière's disease (<i>n</i>=9), vestibular schwannoma (<i>n</i>=3), vestibular paroxysmia (<i>n</i>=2), labyrinthine fistula (<i>n</i>=1), and lateral semicircular canal dysplasia (<i>n</i>=1). Central vestibular disorders (19.6%, <i>n</i>=10) comprised acute infarction (<i>n</i>=6) most commonly involving the medulla, brainstem glioma with concurrent cerebellar damage (<i>n</i>=1), traumatic diffuse brain injury (<i>n</i>=2), and adult-onset Alexander disease (<i>n</i>=1). The remaining 17.6% of cases (<i>n</i>=9) had undetermined causes. Compared with peripheral cases, central vestibular disorders were associated with significantly greater duration asymmetry of AAN (<i>p</i>=0.041), higher prevalence of persistent AAN (<i>p</i>=0.037), and more-frequent abnormal ocular motor findings (<i>p</i><0.001). In contrast, reduced bithermal caloric responses were more prevalent in peripheral than central vestibulopathy (<i>p</i><0.001).</p><p><strong>Conclusions: </strong>AAN can result from various peripheral and central vestibular disorders. Greater duration asymmetry, persistence of AAN, and accompanying ocular motor abnormalities can suggest a central origin, whereas reduced bithermal caloric responses may support a peripheral origin.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"596-606"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Medullary Vein Disruption and Glymphatic Dysfunction Are Associated With Cognitive Impairment and Imaging Burden in Cerebral Small-Vessel Disease.","authors":"Junying Li, Weidong Wang, Jiaojiao Shi, Meiling Ding, Yiman Liu, Wenmin Zhang, Yuan Li, Xiang Chen, Jurong Ding, Xin Ding","doi":"10.3988/jcn.2026.0099","DOIUrl":"10.3988/jcn.2026.0099","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebral small-vessel disease (CSVD) is a major cause of cognitive impairment, but its underlying mechanisms remain incompletely understood. This study investigated the interrelationships among deep medullary vein (DMV) disruption, glymphatic dysfunction as assessed using the diffusion-tensor imaging analysis along the perivascular space (DTI-ALPS) index, CSVD imaging markers, and cognitive impairment.</p><p><strong>Methods: </strong>Fifty CSVD patients were enrolled from Chengdu Second People's Hospital between January 2022 and December 2024, while 29 healthy controls (HCs) were recruited from the local community. DMV disruption was assessed using susceptibility-weighted imaging, while glymphatic function was evaluated using the DTI-ALPS index. Clinical characteristics, Mini-Mental State Examination (MMSE) scores, and CSVD imaging markers were collected, and regression and mediation analyses were performed.</p><p><strong>Results: </strong>Compared with HCs, CSVD patients showed significantly lower DTI-ALPS indices, higher DMV scores, and worse cognition (all <i>p</i><0.05). Higher DMV scores were independently associated with lower MMSE scores (<i>p</i>=0.006) and greater CSVD burden. Lower DTI-ALPS indices were associated with greater CSVD burden and showed a tendency toward an association with MMSE scores (<i>p</i>=0.070). DMV scores were negatively correlated with DTI-ALPS indices (<i>p</i>=0.024). The mediation analyses showed that glymphatic dysfunction did not exert a significant indirect effect on the relationship between DMV disruption and cognition, whereas there was a significant direct effect of DMV disruption on cognition.</p><p><strong>Conclusions: </strong>This study found that DMV disruption and glymphatic dysfunction were associated with the CSVD imaging burden. Cognitive impairment was strongly associated with DMV disruption but weakly associated with glymphatic dysfunction. Combined assessments may provide complementary imaging markers for the CSVD severity and cognitive decline.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"529-539"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Central Nervous System Histiocytic Sarcoma During Neuromyelitis Optica Spectrum Disorder.","authors":"Naoko Saito-Sato, Yuan Bae, Hideji Hashida","doi":"10.3988/jcn.2026.0095","DOIUrl":"10.3988/jcn.2026.0095","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"619-621"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Heterogeneity in Vestibular Migraine Diagnosed Using Bárány Society Criteria: Differences According to Caloric-Test-Based Evidence of Peripheral Vestibular Dysfunction.","authors":"Yang Wang, Yifan Liang, Xia Ling, Qianqian Wang, Kangzhi Li, Siru Xue, Ziming Zhu, Xu Yang, Ping Gu","doi":"10.3988/jcn.2026.0091","DOIUrl":"10.3988/jcn.2026.0091","url":null,"abstract":"<p><strong>Background and purpose: </strong>Vestibular migraine (VM) is a common cause of episodic vertigo with heterogeneous presentations. Some VM patients show caloric abnormalities suggestive of peripheral vestibular dysfunction (PVD). This study compared clinical symptoms and vestibulo-ocular function between VM patients with caloric canal paresis (CP) >25% (VM-CP+), which was used as an operational definition of evidence of PVD, and those without caloric CP >25% (VM-CP-).</p><p><strong>Methods: </strong>We enrolled 181 patients diagnosed with VM according to the Bárány Society criteria: 47 in the VM-CP+ group and 134 in the VM-CP- group. All patients underwent videonystagmography and caloric testing, while the video head impulse test (vHIT), vestibular-evoked myogenic potential (VEMP) measurements, and subjective visual horizontal (SVH) and subjective visual vertical (SVV) assessments were performed in available subsets.</p><p><strong>Results: </strong>Compared with VM-CP- patients, those with VM-CP+ showed higher frequencies of external vertigo, rotational vertigo, spontaneous nystagmus, unidirectional horizontal positional nystagmus, horizontal head-shaking nystagmus, abnormal cervical VEMPs, and abnormal upright SVH/SVV. The vHIT findings were abnormal only in VM-CP+ patients with available data. Conversely, a history of motion sickness and a family history of migraine were more common in VM-CP-. Multivariable regression showed that rotational vertigo, external vertigo, and unidirectional horizontal positional nystagmus were independently associated with VM-CP+, whereas a history of motion sickness and a family history of migraine were negatively associated with VM-CP+.</p><p><strong>Conclusions: </strong>VM-CP+ and VM-CP- patients showed different clinical and vestibulo-ocular patterns, suggesting the presence of clinical heterogeneity within VM. VM-CP+ patients may show a phenotype related to peripheral vestibular asymmetry. Whether this reflects a comorbid or additive effect of migraine and PVD or a migraine-related functional state should be investigated in future prospective studies.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"583-595"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Glucagon-Like Peptide-1 Receptor Agonists Suitable for Secondary Stroke Prevention?","authors":"Hyuk Sung Kwon, Seong-Ho Koh","doi":"10.3988/jcn.2026.0463","DOIUrl":"10.3988/jcn.2026.0463","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"495-497"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fulminant Pulmonary Edema Triggered by Phenylephrine-Induced Hypertension for Early Neurological Deterioration in Ischemic Stroke.","authors":"Sung-Hwan Kim, Jun-Ho Choi, ByoungChul Choi, Chulho Kim","doi":"10.3988/jcn.2026.0055","DOIUrl":"10.3988/jcn.2026.0055","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"610-612"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}