Journal of Clinical Neurology最新文献

{"title":"Comments on: \"Association of Sleep Hygiene Practice With Disturbed Sleep in Early-Stage Parkinson's Disease\".","authors":"Jialin Niu, Xinyao Wang, Jinxiao Song, Jingru Zhao","doi":"10.3988/jcn.2026.0336","DOIUrl":"10.3988/jcn.2026.0336","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"631-632"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874300","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":"Prospective Study of Botulinum Toxin Effects on Nonmotor Symptoms and Quality of Life in Thai Patients With Craniocervical Dystonia.","authors":"Chanya Wijittongruang, Praween Lolekha","doi":"10.3988/jcn.2025.0698","DOIUrl":"10.3988/jcn.2025.0698","url":null,"abstract":"<p><strong>Background and purpose: </strong>Craniocervical dystonia (CCD) comprises focal and segmental dystonia involving the cranial, facial, and cervical muscles. Beyond abnormal movements, affected patients frequently experience nonmotor symptoms (NMS) that profoundly affect their quality of life (QoL). This study aimed to determine the prevalence of NMS and the therapeutic effects of botulinum toxin (BoNT) injections on NMS and QoL in Thai patients with CCD.</p><p><strong>Methods: </strong>This prospective cohort study included 28 patients with CCD and 29 healthy controls (HC). Demographic data, dystonia severity, NMS, and QoL were assessed before and 1 month after BoNT treatment using the Thammasat University Non-Motor Symptoms Questionnaire (TU-NMSQuest) and the Thai version of the EuroQol-5 Dimension-5 Level (EQ-5D-5L).</p><p><strong>Results: </strong>The reported NMS burden was significantly higher in patients with CCD than in HC (10.89±6.05 vs. 8.00±4.15, mean±standard deviation; <i>p</i>=0.04), with insomnia being the most-prevalent symptom. A higher TU-NMSQuest score was correlated with worse QoL (r_s=0.60, <i>p</i><0.01). The TU-NMSQuest total score improved significantly after BoNT treatment (mean difference=-2.79±4.12, 95% confidence interval [CI]=-4.86 to -0.71, <i>p</i>=0.01), with notable improvements in the sleep and fatigue, cardiovascular disorders and falls, cognition, and sexual domains. The EQ-5D-5L utility index also increased (mean difference=0.09, 95% CI=0.03 to 0.15, <i>p</i><0.01). No significant differences in NMS profiles were observed among dystonia subtypes.</p><p><strong>Conclusions: </strong>NMS are common in CCD and contribute markedly to worse QoL. BoNT therapy provides benefits beyond controlling motor symptoms by alleviating NMS and improving overall well-being. Comprehensive management strategies for CCD should integrate the systematic assessment and treatment of NMS in order to optimize patient outcomes.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"437-445"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412048","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":"Artificial Intelligence That Changes Clinical Neurology Practice: Translating Algorithms Into Actionable Care.","authors":"Yongcheon Kim, Seung-Ah Choe, Seogsong Jeong, Ding Jie, Xinshi Wang, Hwamin Lee, Byung-Jo Kim","doi":"10.3988/jcn.2026.0312","DOIUrl":"10.3988/jcn.2026.0312","url":null,"abstract":"<p><p>Artificial intelligence (AI) has stimulated extensive research in clinical neurology, but relatively few AI systems have meaningfully changed bedside decision-making. This translational gap is not explained solely by inadequate algorithms. More often, AI models in neurology remain outside routine practice because they are trained on unstable labels, validated in narrow or single-center datasets, evaluated primarily by discrimination metrics, disconnected from clinical workflow, and deployed without prospective monitoring, reimbursement frameworks, or accountability. In this review, we propose the NEURAL framework for practice-changing neurological AI: Novel clinical insight, External and prospective validation, Utility over accuracy, Real-time workflow integration, Algorithmic transparency, and Long-term outcome linkage. Using this framework, we examine evidence across acute stroke, epilepsy and electroencephalography (EEG), sleep medicine, neurodegenerative disease, movement disorders, headache, vestibular disorders, neuroimmunology, rehabilitation, and neurocritical care. The most clinically advanced examples come from acute stroke, where imaging-based selection, large-vessel occlusion detection, and automated notification are linked to urgent, pathway-defined interventions. Automated EEG triage, focal cortical dysplasia detection, selected sleep-analysis tools, quantitative biomarker pipelines, and AI-assisted longitudinal monitoring may also become clinically meaningful if tested prospectively in real-world workflows. Many high-performing models for dementia progression, prodromal Parkinson disease, outpatient treatment response, and long-horizon risk prediction remain pre-implementation tools because they do not yet define a validated clinical action. Future neurological AI should therefore be judged less by whether it recognizes complex patterns and more by whether it improves the right decision for the right patient at the right time. A clinically useful AI system must demonstrate not only accuracy, but also actionability, workflow fit, equity, safety, sustainability, and measurable benefit for patients and health systems.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"392-407"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411954","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":"Hemiparkinsonism Associated With Possible Moyamoya Vasculopathy: The Role of Early Perfusion Imaging Using ¹⁸F-FP-CIT PET.","authors":"Hayoung Choi, Hye Seon Jeong, Eungseok Oh, Hee Jin Chang","doi":"10.3988/jcn.2025.0735","DOIUrl":"10.3988/jcn.2025.0735","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"489-491"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412124","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":"Role of Physical Activity in Protecting Against Dementia According to Menopausal Status.","authors":"Eun Ye Lim, Kyungdo Han, A-Hyun Cho","doi":"10.3988/jcn.2025.0615","DOIUrl":"10.3988/jcn.2025.0615","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study evaluated the impact of physical activity on dementia risk in females while considering their menopausal status and body mass index (BMI) as potential modifiers.</p><p><strong>Methods: </strong>This population-based retrospective cohort study utilized the Korean National Health Insurance Service database, and stratified 2,163,842 females aged ≥40 years who underwent health examinations in 2009 into pre- and postmenopausal groups. Cox proportional-hazards models were used to estimate the adjusted hazard ratios (aHRs) for all-cause dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) according to physical activity levels. Interaction terms were used to assess effect modification by BMI.</p><p><strong>Results: </strong>Regular physical activity was associated with a reduced risk of all-cause dementia and AD, but not VaD in premenopausal females (aHR=0.830, 95% confidence interval [CI]=0.739-0.931) and a reduced risk of all-cause dementia, AD, and VaD in postmenopausal females (e.g., aHR=0.884, 95% CI=0.868-0.900). The association between physical activity and dementia risk was largely consistent across BMI categories. However, a modest interaction was observed for light physical activity (LPA) (<i>p</i>=0.046), with a significant risk reduction in postmenopausal women with BMI ≥25.0 kg/m² (aHR=0.942, 95% CI=0.921-0.964).</p><p><strong>Conclusions: </strong>Physical activity is associated with a lower risk of dementia in both pre- and postmenopausal females. Among postmenopausal females, even LPA such as walking may confer protective benefits, particularly in those with higher BMIs.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"427-436"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412067","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":"Confirmatory Molecular Diagnosis of <i>RFC1</i> Expansion in a Korean CANVAS Case Using Nanopore Cas9-Targeted Sequencing.","authors":"Jee Min Kim, Narae Kim, Seungbok Lee, Jangsup Moon","doi":"10.3988/jcn.2026.0093","DOIUrl":"10.3988/jcn.2026.0093","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"477-479"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412090","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":"Prolonged Functional Flaccid Paraplegia With Rapid Reversibility During Sensorimotor Facilitation.","authors":"Qamar Mahmood","doi":"10.3988/jcn.2025.0758","DOIUrl":"10.3988/jcn.2025.0758","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"486-488"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412076","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":"Association Between Statin Initiation and Myasthenia Gravis Crisis.","authors":"Woo Hyeon Yoo, Yunha Noh, Seung Woo Kim, Ha Young Shin, Ju-Young Shin, Hyesung Lee","doi":"10.3988/jcn.2025.0622","DOIUrl":"10.3988/jcn.2025.0622","url":null,"abstract":"<p><strong>Background and purpose: </strong>Statins are widely prescribed for preventing cardiovascular disease, but concerns remain that they may trigger or exacerbate myasthenia gravis (MG). We evaluated whether statin initiation increases the risk of an MG crisis using a self-controlled case series (SCCS) design.</p><p><strong>Methods: </strong>This SCCS study analyzed nationwide Korean claims data from 2007 to 2023. We included patients in whom statin therapy was initiated after an MG diagnosis and who experienced at least one MG crisis during a 730-day period spanning from 365 days before to 365 days after statin initiation. The primary outcome was an MG crisis during a 365 days follow-up. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were estimated using conditional Poisson regression models.</p><p><strong>Results: </strong>Among 16,268 patients with MG in the claims database, 45 patients meeting the study inclusion criteria were included in the SCCS analysis. The risk of an MG crisis was higher during the first 30 days following statin initiation (IRR=3.60, 95% CI=1.50-8.64), but not during later periods (31-90 days: IRR=1.00, 95% CI=0.34-2.95; 91-180 days: IRR=0.87, 95% CI=0.34-2.23; 181-365 days: IRR=0.73, 95% CI=0.32-1.67). Subgroup analyses showed that the risk was higher in patients aged ≥65 years (IRR=10.31, 95% CI=2.59-41.05) and females (IRR=3.71, 95% CI=1.18-11.66). The findings were consistent across the sensitivity analyses.</p><p><strong>Conclusions: </strong>Statin initiation was associated with an increased risk of an MG crisis during the early postinitiation period, with no evidence of an elevated risk during longer-term use. Close monitoring is recommended during the early phase of statin therapy in patients with MG, particularly in the elderly, females, and users of lipophilic statins or concomitant beta blockers.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"419-426"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411951","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":"Subtle Neurological Manifestations With Unexpected Lesion Extension After High-Dose Methylprednisolone in Neuromyelitis Optica Spectrum Disorder.","authors":"Gohei Yamada, Kenji Okita, Tomoyuki Kuno, Eiichi Katada","doi":"10.3988/jcn.2026.0041","DOIUrl":"10.3988/jcn.2026.0041","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"480-482"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412100","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":"Diagnostic Value and Clinical Significance of Temporopolar White-Matter Hyperintensities in CADASIL and Sporadic Small-Vessel Disease.","authors":"Wen-Yu Ou Yang, Shao-Lun Hsu, Chih-Ping Chung, Feng-Chi Chang, Yi-Chung Lee, Yi-Chu Liao","doi":"10.3988/jcn.2025.0746","DOIUrl":"10.3988/jcn.2025.0746","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by <i>NOTCH3</i> variants, and is the leading hereditary cerebral small-vessel disease (SVD). Temporopolar white-matter hyperintensities (WMH) are characteristic imaging features of CADASIL, but their diagnostic accuracy across different <i>NOTCH3</i> variants and their relationship with the disease severity remain uncertain.</p><p><strong>Methods: </strong>We analyzed 385 CADASIL patients and 191 sporadic SVD patients in whom no pathogenic mutations were identified in the next-generation sequencing of 183 genes. CADASIL patients were stratified into high-, medium-, and low-risk epidermal growth factor-like repeat (HR-, MR-, and LR-EGFr) categories according to the variant locations. The severity of temporopolar WMH was scored using Scheltens' scale, and disability was assessed using the modified Rankin Scale (mRS). Logistic and ordinal regression models were used to evaluate the associations between temporopolar WMH, clinical severity, and neuroimaging markers.</p><p><strong>Results: </strong>Temporopolar WMH were detected in 94.7%, 54.4%, and 33.3% of CADASIL patients carrying HR-, MR-, and LR-EGFr variants, respectively, compared with in 31.9% of the sporadic SVD patients. The sensitivity for distinguishing HR-EGFr carriers from sporadic SVD was high (95%), but lower for MR-EGFr (54%) and LR-EGFr (33%) carriers. In the CADASIL patients, temporopolar WMH independently predicted greater disability (mRS score >3), and they were correlated in a dose-dependent manner with the total WMH volume, Fazekas scores, and number of lacunes. Similar associations were observed in sporadic SVD.</p><p><strong>Conclusions: </strong>The diagnostic accuracy of temporopolar WMH varies with the <i>NOTCH3</i> risk category and warrants cautious interpretations, particularly in Asian populations in whom MR-EGFr founder variants are prevalent. The temporopolar WMH severity is associated with the functional status and radiological burden across hereditary and sporadic SVD.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 4","pages":"408-418"},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412043","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}