Journal of Clinical Neuroscience最新文献

{"title":"Enhancing cerebrospinal fluid clearance in subarachnoid hemorrhage: A systematic review of combined ventricular and lumbar drainage","authors":"Matteo Palermo ,&nbsp;Sonia D’Arrigo ,&nbsp;Alessio Albanese ,&nbsp;Carmelo Lucio Sturiale","doi":"10.1016/j.jocn.2025.111442","DOIUrl":"10.1016/j.jocn.2025.111442","url":null,"abstract":"<div><h3>Introduction</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) is a severe type of stroke associated with high rates of mortality and morbidity. Two major complications following aSAH are acute hydrocephalus and delayed cerebral ischemia (DCI) caused by severe vasospasm. While external ventricular drainage and lumbar drainage (LD) are typically used separately to manage hydrocephalus, the potential benefit of their combined use in reducing vasospasm risk remains underexplored.</div></div><div><h3>Methods</h3><div>We conducted a systematic search on PubMed/MEDLINE and Scopus databases to identify relevant studies discussing double drainage systems in patients with severe aSAH-hydrocephalus. The search algorithm retrieved 1341 results. At the end of the exclusion phase, we included 4 studies in the final analysis.</div></div><div><h3>Results</h3><div>We included 148 patients with post-aSAH hydrocephalus treated using dual CSF drainage. Treatment was reported in about 2/3 of patients and endovascular repair was in most of them. LD was typically placed early, though timing protocols varied. Drainage was maintained on average 0.5–16 days, with continuous drainage being most common. Complication rates varied: ischemia was reported in 18.9 % of patients, while vasospasm occurred in 22.3 % of cases when assessed clinically or angiographically. CSF infection was reported in up to 31.6 % of cases. Functional outcomes were generally favorable, with mean mRS scores at follow-up ranging from 1.0 to 2.4, depending on initial clinical severity.</div></div><div><h3>Conclusion</h3><div>Patients with aSAH may benefit of dual CSF drainage, especially in case of massive bleeding. Preliminary data suggest that it may reduce vasospasm and improve outcomes by enhancing CSF clearance. However, the evidence is still limited by study variability and lack of direct comparisons. Until more data emerge, dual drainage should be reserved for high-risk patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111442"},"PeriodicalIF":1.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey research on the awareness and usage of accessibility features of information and communication technology devices among patients with amyotrophic lateral sclerosis","authors":"Takehisa Hirayama ,&nbsp;Junpei Nagasawa ,&nbsp;Mari Shibukawa ,&nbsp;Harumi Morioka ,&nbsp;Tatsuhiro Yokoyama ,&nbsp;Hiroshi Tsuda ,&nbsp;Kota Bokuda ,&nbsp;Mieko Ogino ,&nbsp;Hiroyuki Takao ,&nbsp;Mitsuya Morita ,&nbsp;Yoshiaki Takahashi ,&nbsp;Ryoichi Nakamura ,&nbsp;Naoki Atsuta ,&nbsp;Makoto Urushitani ,&nbsp;Koji Yamanaka ,&nbsp;Yuishin Izumi ,&nbsp;Osamu Kano","doi":"10.1016/j.jocn.2025.111434","DOIUrl":"10.1016/j.jocn.2025.111434","url":null,"abstract":"<div><div>We aimed to explore perceptions of digital technology and the usage of information and communication technology (ICT) devices among patients with amyotrophic lateral sclerosis (ALS) and their caregivers. In October 2023, we held a nationwide webinar titled “ALS Café” and distributed a self-report questionnaire to patients with ALS and caregivers, including family members, which covered topics such as awareness, usage of accessibility features, and current support for the use of ICT devices. Thirty-one patients with ALS and 24 of their caregivers responded (average age: 57.1 ± 10.1). The ALS Functional Rating Scale-Revised (ALSFRS-R) score was 26.6 ± 14.1. Overall, 69.6 % of respondents were aware of accessibility features, 71.4 % of those under 70, and 50.0 % of those over 70. Frequently used features included browsing assistance (32.1 %), voice operation (30.4 %), mouse or touch pen operation (26.8 %), synthesized voice reading (23.2 %), gaze input operation (19.6 %), and switch operation (14.3 %). Self-help assistance for ICT devices was used by 65.8 % of respondents with an ALSFRS-R score ≥ 20 and 11.8 % with an ALSFRS-R score &lt; 20. Regarding government services, 85 % of respondents were unaware of ICT support centers for persons with disabilities. This study revealed the awareness and usage of accessibility features of ICT devices among patients with ALS and their caregivers. Raising awareness of accessibility features among older adults and improving support systems for those with mild symptoms are necessary.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111434"},"PeriodicalIF":1.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical applicability and generalizability of the SMPSD-RSSF for post-stroke depression","authors":"Atef F. Hulliel","doi":"10.1016/j.jocn.2025.111448","DOIUrl":"10.1016/j.jocn.2025.111448","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111448"},"PeriodicalIF":1.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum homocysteine levels affect functional outcomes in younger acute ischemic stroke patients receiving intravenous thrombolysis","authors":"Chengfeng Xing ,&nbsp;Huawei Su ,&nbsp;Wenxin Xie ,&nbsp;Jijun Teng ,&nbsp;Liang Zhang ,&nbsp;Lijun Liu","doi":"10.1016/j.jocn.2025.111420","DOIUrl":"10.1016/j.jocn.2025.111420","url":null,"abstract":"<div><h3>Objective</h3><div>The study explores the effect of age on the association between serum homocysteine (Hcy) levels and functional outcomes at 3 months in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 240 consecutive AIS patients who underwent intravenous thrombolysis and were followed-up at 3 months post-AIS. The likelihood ratio test in the multivariable logistic regression model was performed to evaluate the potential interaction between age and serum Hcy levels on 3-month functional outcomes in these patients. Subsequently, we conducted age-stratified multivariable logistic regression analyses to examine the differential associations between serum Hcy concentrations and 3-month adverse outcomes across distinct age groups.</div></div><div><h3>Results</h3><div>The study cohort consisted of 175 male patients (72.92 %) and 65 female patients, with a median age of 64 years. During the 3-month follow-up period, 59 patients (24.58 %) experienced unfavorable functional outcomes. Patients with unfavorable outcomes had significantly higher serum Hcy levels compared to those with favorable outcomes (median: 16.00 μmol/L vs. 10.60 μmol/L, <em>P</em> &lt; 0.001). Notably, a significant interaction effect between age and serum Hcy levels was identified for 3-month adverse outcomes in AIS patients receiving intravenous thrombolysis (<em>P</em> for interaction = 0.014). After multivariable adjustment, elevated serum Hcy levels were independently associated with 3-month unfavorable outcomes specifically in intravenous thrombolysis-treated AIS patients aged &lt; 64 years (OR = 1.424, 95 % CI = 1.204–1.683, <em>P</em> &lt; 0.001), whereas this association was not statistically significant in patients aged ≥ 64 years (OR = 1.132, 95 % CI = 0.997–1.284, <em>P</em> = 0.056).</div></div><div><h3>Conclusions</h3><div>Elevated serum Hcy levels demonstrate age-dependent prognostic significance for 3-month functional outcomes in AIS patients receiving intravenous thrombolysis, acting as an independent predictor of unfavorable outcomes exclusively in younger patients. Further research is warranted to validate this age-stratified effect and to elucidate the underlying pathophysiological mechanisms.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111420"},"PeriodicalIF":1.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs of multiple sclerosis in Serbia","authors":"Jovana Ivanovic ,&nbsp;Jovan Mihajlovic ,&nbsp;Marko Andabaka ,&nbsp;Vanja Jovicevic ,&nbsp;Gorica Maric ,&nbsp;Aleksa Jovanovic ,&nbsp;Sarlota Mesaros ,&nbsp;Tatjana Pekmezovic ,&nbsp;Jelena Drulovic","doi":"10.1016/j.jocn.2025.111437","DOIUrl":"10.1016/j.jocn.2025.111437","url":null,"abstract":"<div><div>The value of economic studies for decision making in health care has been widely recognized. The aim of this study was to estimate the annual costs of multiple sclerosis (MS) in Serbia. This is a cross-sectional study in which data on resource consumption and work capacity, and health-related quality of life (HRQoL) in MS patients, at the Clinic of Neurology, UCCS in Belgrade, were collected. A total of 356 patients (mean age, 42 years), out of which 271 treated with interferon beta agents, and the remaining 85 untreated, participated in this study. Ninety eight percent were below retirement age, and out of these, 54 % were employed. Employment decreased rapidly with advancing disability; 66 % of patients with Expanded Disability Status Scale (EDSS) 0–3.5 were employed, 31 % of those with EDSS 4.0–6.5, and 11 % with EDSS 7.0 and above. All HRQoL domains included in the EQ-5D displayed disturbances for a large number of patients: pain/discomfort for 67 %, usual activities 61 %, mobility 64 %, anxiety and depression 72 % and self-care 21 %. Total annual costs for patients treated with DMTs were 8,860 EUR and for the untreated 9,519 EUR, increasing significantly with worsening disability. This study describes the burden of MS in Serbian patients and provides data that are important for development of health policies.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111437"},"PeriodicalIF":1.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LVO TRUST EMS – Large vessel occlusion triage and routing utilized for long-distance stroke transports by emergency medical services","authors":"Rafail A. Chionatos,&nbsp;Camelia Valhuerdi Porto,&nbsp;Katelyn Skeels,&nbsp;Devin Zebelean,&nbsp;Noor Tarim Fahim,&nbsp;Lester Y. Leung","doi":"10.1016/j.jocn.2025.111440","DOIUrl":"10.1016/j.jocn.2025.111440","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Endovascular treatment (EVT) is the most effective therapy in acute ischemic stroke (AIS) with large vessel occlusion (LVO) but its practice is limited to Comprehensive Stroke Centers (CSC). Previous studies have suggested that trained Emergency Medical Services (EMS) professionals can successfully detect LVO cases using a validated screening tool. We aimed to assess the diagnostic accuracy of trained community-based EMS.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study from 01/01/2018–12/31/2022 of patients with suspected stroke transported by EMS providers from 14 community agencies in Southeastern Massachusetts. When stroke was suspected, EMS providers applied the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score to assess severity. Bypass of local community hospitals for direct transport to CSC was generally considered for patients with FAST-ED ≥ 4 and approval of the Region V EMS Medical Director.</div></div><div><h3>Results</h3><div>Among the 166 patients triaged for direct transport to the CSC, 57.2 % were diagnosed with AIS, of whom 56.8 % had LVO, and 64.8 % of those received EVT. There was a higher proportion of AIS or intracranial hemorrhage (ICH) in cases with higher FAST-ED scores. Only 23.5 % of the cases were diagnosed with stroke mimics, associated with lower FAST-ED scores. In total, 36.9 % of patients with AIS received EVT: thrombectomy with standard window tPA (21.1 %) or late-presenter window tPA (LKW ≥ 4.5 h, 1.1 %), and without tPA (14.7 %).</div></div><div><h3>Conclusions</h3><div>A diverse group of community-based EMS services in Southeastern Massachusetts using a prehospital tool can identify patients with severe stroke, i.e. AIS due to LVO or ICH, with acceptable diagnostic accuracy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111440"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microlesion and stimulation effects on motor symptom fluctuations in Parkinson’s disease following subthalamic deep brain stimulation","authors":"Bin Wu ,&nbsp;Yuting Ling ,&nbsp;Changming Zhang ,&nbsp;Simin Wang ,&nbsp;Qianqian Guo ,&nbsp;Baoshu Xie ,&nbsp;Wenbiao Xian ,&nbsp;Ling Chen ,&nbsp;Nan Jiang ,&nbsp;Jinlong Liu","doi":"10.1016/j.jocn.2025.111441","DOIUrl":"10.1016/j.jocn.2025.111441","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to investigate motor symptom fluctuations associated with microlesion effects (MLE) and stimulation in the short term following subthalamic deep brain stimulation (STN-DBS) surgery for Parkinson’s disease (PD).</div></div><div><h3>Materials and Methods</h3><div>A total of 54 PD patients who underwent bilateral STN-DBS surgery were included in this study. Total motor symptoms were evaluated preoperatively, one week postoperatively, and one month postoperatively. These scores were analyzed to evaluate motor symptom fluctuations due to microlesion and stimulation effects, along with associated factors.</div></div><div><h3>Results</h3><div>Among the participants, 48 patients (88.89%) exhibited MLE-related improvements in motor symptoms one week after surgery, with an average symptom improvement of 45.92%. At one month post-surgery, 27 patients (50.00%) demonstrated MLE-related improvements in motor symptoms, with an average improvement of 27.08%. Multivariate linear regression analysis revealed that preoperative tremor subscores were positively correlated with MLE at both one week and one month, while the preoperative Parkinson’s Disease Sleep Scale (PDSS) score was positively correlated with MLE at one week. Stimulation effects, measured one month postoperatively with the stimulator activated, resulted in an overall motor symptom improvement of 35.21%. No significant differences were observed in stimulation-induced improvements between patients with and without MLE at one week or one month.</div></div><div><h3>Conclusions</h3><div>This case series demonstrated that the efficacy of stimulation one month postoperatively was not correlated with postoperative MLE in PD patients who underwent STN-DBS surgery. However, patients with more severe preoperative tremor symptoms exhibited greater MLE at both one week and one month postoperatively.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111441"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does optic nerve sheath fenestration alleviate headaches in patients with idiopathic intracranial hypertension? A retrospective study","authors":"Hüseyin Nezih Özdemir ,&nbsp;Neşe Çelebisoy ,&nbsp;Figen Gökçay ,&nbsp;Anıl Yakut ,&nbsp;Meltem Söylev Bajin ,&nbsp;Aylin Yaman","doi":"10.1016/j.jocn.2025.111447","DOIUrl":"10.1016/j.jocn.2025.111447","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate headache course after optic nerve sheath fenestration (ONSF) in idiopathic intracranial hypertension (IIH) patients.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, IIH patients’ data who had undergone ONSF due to progressive visual field loss despite medical treatment or advanced visual field loss at onset, including age, sex, cerebrospinal fluid (CSF) opening pressure, laterality of ONSF (unilateral or bilateral), best corrected visual acuity (BCVA), visual field mean deviation (MD) preoperatively and after ONSF in the worse and fellow eyes, were noted. Headache severity assessed using the visual analog scale, and headache frequency defined as the number of headache days per month before and after surgery were considered.</div></div><div><h3>Results</h3><div>20 patients (17 females, 3 males) with a mean age of 32.4 years and a mean CSF opening pressure of 492.79 mm H2O were studied. ONSF was unilateral in 12 (60 %) and bilateral in 8 (40 %) patients. Median LogMAR BCVA and MD in the worse eye improved significantly after surgery (p = 0.04 and p = 0.02, respectively), whereas improvement in the fellow eye was not significant (p &gt; 0.05). Though headache severity and frequency decreased after surgery (p = 0.01 and p = 0.001, respectively) it was still present in 12 patients (60 %). Age, sex, CSF opening pressure, uni/bilateral ONSF, BCVA or MD in the worse or fellow eye had no effect on the course of headache severity or frequency.</div></div><div><h3>Conclusion</h3><div>Specific headache treatment is essential in IIH, since lowering intracranial pressure by ONSF is not associated with headache relief in over half of the patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111447"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between gait profile and spino-pelvic alignment in patients with adolescent idiopathic scoliosis of Lenke type 1 and 5","authors":"Minjun Choi,&nbsp;Tae Sik Goh,&nbsp;Jung Sub Lee","doi":"10.1016/j.jocn.2025.111444","DOIUrl":"10.1016/j.jocn.2025.111444","url":null,"abstract":"<div><div>Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional structural deformity of the spine. While studies have reported gait abnormalities in AIS patients and their impact on patients’ quality of life, the interrelationship between the sagittal spino-pelvic alignment and gait kinematics has not yet been elucidated. The purpose of this study is to investigate the association between gait profile and sagittal alignment in AIS patients, especially with Lenke type 1 and 5 curve deformities.</div><div>The study group consisted of 111 AIS patients and sixty healthy controls. Standing spinal radiographs and gait analysis were performed for all participants. Gait parameters included gait speed, step length, stance phase, cadence, single leg support, double legs support, gait asymmetry (GA), and phase coordination index (PCI). Radiographic parameters included pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), Cobb’s major curve angle, sagittal vertical axis (SVA), and coronal balance (CB).</div><div>There were statistically significant differences between the AIS group and the control in gait speed, step length, cadence, single leg support, double legs support, GA, PT, TK, SVA, and CB. However, no significant difference was observed between the groups in stance phase, PCI, SS, PI, and LL (<em>p</em> &gt; 0.05). In addition, correlation analysis revealed significant relationships between the following pairs of gait and sagittal alignment parameters in the AIS patients; step length was related with SS, PT, and LL, PCI with CB, GA with TK and CB. Multiple regression analysis of gait and sagittal profile also indicated that PT and SS are accurate predictors of step length and CB is a predictor of GA.</div><div>In conclusion, our findings demonstrated that there are significant differences in gait kinematics and sagittal spino-pelvic alignment between the AIS patients and healthy population and that these parameters are closely correlated in the AIS patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111444"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimizing financial toxicity of neurological care in low and middle income countries","authors":"Gaurav Nepal ,&nbsp;Rajeev Ojha","doi":"10.1016/j.jocn.2025.111446","DOIUrl":"10.1016/j.jocn.2025.111446","url":null,"abstract":"<div><div>Neurological diseases in low- and middle-income countries (LMICs) are increasingly associated with financial toxicity (FT), where the high costs of diagnosis and treatment create severe economic burdens for patients and their families. Unlike high-income countries (HICs), where publicly funded or insurance-based systems mitigate these costs, LMICs often lack such financial safety nets, leading to FT. As a result, only wealthier individuals can afford treatment, deepening health inequities. This paper discusses potential solutions to alleviate FT.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111446"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}