Journal of Clinical Neuroscience最新文献

{"title":"Cerebral cavernous Malformation Surgery: National trends in Volume, Complications, and costs","authors":"Avi A. Gajjar ,&nbsp;Ilayda Kayir ,&nbsp;Alyssa Lee ,&nbsp;Rashad Jabarkheel ,&nbsp;Mohamed M. Salem ,&nbsp;Lun Li ,&nbsp;Joshua Catapano ,&nbsp;Visish M. Srinivasan ,&nbsp;Jan-Karl Burkhardt","doi":"10.1016/j.jocn.2025.111178","DOIUrl":"10.1016/j.jocn.2025.111178","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Cerebral cavernous malformations (CCMs) are vascular anomalies that can lead to significant neurological complications, such as hemorrhage or lesion progression. This study analyzes trends in CCM resections across the United States, focusing on morbidity, mortality, and associated costs.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the National Inpatient Sample who underwent CCM resections from 2016 to 2020. Data were collected from a national database, including patient demographics, outcomes, and costs. Statistical analysis was performed to identify factors associated with in-hospital mortality, complications, length of stay (LOS), and cost.</div></div><div><h3>Results</h3><div>The patient cohort identified 3,300 patients with a mean age of 42.8 years, with a slight female predominance (53.5 %) and a majority identifying as white (66.5 %). Complications occurred in 8.5 % of cases, with acute bleeding significantly increasing the risk of complications (OR = 2.15, p &lt; 0.001), non-home discharge (OR = 2.52, p &lt; 0.001), and extended LOS (OR = 3.21, p &lt; 0.001). Non-elective admissions were associated with higher rates of complications (17.0 % vs. 3.4 %, p &lt; 0.001) and extended LOS (OR = 2.84, p &lt; 0.001). Independent factors for poor outcomes included higher Charlson Comorbidity Index (CCI) scores (OR = 1.417, p &lt; 0.01) and patient demographics such as age and race, with Black race (OR = 6.84, p = 0.0199) and lower household income (OR = 2.17, p &lt; 0.01) being significant predictors of in-hospital mortality.</div></div><div><h3>Conclusion</h3><div>This study highlights the significant impact of acute bleeding and non-elective admissions on complications and outcomes following CCM resection. Further research is warranted to analyze socio-economic factors in improving CCM resection outcomes and explore possible pharmacological treatment approaches in high-risk surgical patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111178"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704245","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":"Non contiguous dual level spinal injuries – A tertiary care centre institutional experience","authors":"Sarvesh Goyal,&nbsp;Mahnaaz Sultana Azeem,&nbsp;Ravi Sharma,&nbsp;Vivek Tandon,&nbsp;Kanwaljeet Garg,&nbsp;Pankaj Kumar Singh,&nbsp;Guru Dutta Satyarthee,&nbsp;Deepak Gupta,&nbsp;Deepak Agrawal,&nbsp;Shashank Sharad Kale","doi":"10.1016/j.jocn.2025.111198","DOIUrl":"10.1016/j.jocn.2025.111198","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Non-contiguous Dual level spine injuries (NDSI) are not uncommon in cases of high energy trauma and can carry very high morbidity if not recognized and treated. There is lack of literature and proper guidelines on such injuries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;In this study, we plan to understand the demographics, clinical characteristics, management, outcome and prognosis of NDSI in patients presenting to our tertiary care trauma centre from 2015 to 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;We retrospectively reviewed the online and offline database of AIIMS to search for cases of NDSI. Total of 38 patients were found whose data were studied.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Statistical analysis&lt;/h3&gt;&lt;div&gt;SPSS version 23 was used to carry out statistical analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;3.01% of total patients with spine injury had NDSI.&lt;/div&gt;&lt;div&gt;28 patients (73.7 %) were male while 10 patients (26.3 %) female. Mean age of patients was 37.86 years (range – 16 years – 60 years).&lt;/div&gt;&lt;div&gt;Out of 38 patients, 22 patients (57.9 percent) had history of Fall from height and 16 patients (42 percent) had history of Road traffic accident (High velocity).&lt;/div&gt;&lt;div&gt;Most common injury pattern was Cervicothoracic (15 patients, 39.5 %) followed by thoracolumbar (13 patients, 34.2 %), cervicocervical (4 patients, 10%), cervicolumbar (2 patient, 5.3 %). Associated injuries included head injury finding in 5 patients, chest injuries in 15, extremity injuries in 7 and abdominal injuries in 2.&lt;/div&gt;&lt;div&gt;Out of 38, 30 patients had total of 2 noncontigous segment involvement, 6 had 3 and 2 had 4 non-contiguous segment involvement. Out of 38, 16 patients were managed with fixation aimed at 1 segment, whereas 21 patients required fixation of both the non-contiguous segments.&lt;/div&gt;&lt;div&gt;Surgical management of unstable cervical, thoracic, and lumbar fractures involved stabilization through spinal fusion, decompression to relieve pressure on neural elements, and instrumentation with screws, rods, or plates. Procedures done included Anterior odontoid screw for odontoid fracture, ACDF (Anterior cervical discectomy and fusion), ACCF (Anterior cervical corpectomy and fusion), posterior LMSRF (Lateral mass screw rod fixation) for cervical fractures, and posterior decompression and pedicle screw fixation for unstable thoracic and lumbar fractures. Minor injuries and stable compression fractures were managed conservatively. The approach depends on fracture type, location, clinical neurology of patient, finally aiming to restore alignment, stabilize the spine, and prevent neurological deficits.&lt;/div&gt;&lt;div&gt;At admission, 13 patients (34%) were ASIA A, 4 ASIA B(10.5%), 6 ASIA C(15.8%), 5 ASIA D (13.2%) and 10 ASIA E(26.3%).&lt;/div&gt;&lt;div&gt;10 patients required tracheostomy. 4 patients developed pneumonia during their hospital course. 36 patients were discharged, but 2 patients died due to associated sepsis, dyselectrolytemia, pneumonia.&lt;/div&gt;&lt;","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111198"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704248","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 creatine kinase dynamics in amyotrophic lateral sclerosis: Predictive role of male sex, limb onset, and intermediate disease duration for stratified monitoring","authors":"Tao Jiang ,&nbsp;Weijiang Ding ,&nbsp;Xueming Li","doi":"10.1016/j.jocn.2025.111203","DOIUrl":"10.1016/j.jocn.2025.111203","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate serum creatine kinase (CK) levels in amyotrophic lateral sclerosis (ALS) patients and their associations with disease characteristics, exploring its utility as a biomarker for disease progression.</div></div><div><h3>Methods</h3><div>This retrospective study included 81 definitive ALS patients and 99 matched controls. Serum CK levels were analyzed against sex, age, onset site, disease duration, and ALSFRS-R scores using Mann-Whitney U tests, Kruskal-Wallis tests, and multivariate regression.</div></div><div><h3>Results</h3><div>ALS patients exhibited significantly elevated CK levels compared to controls (233.92 ± 216.91 vs. 101.81 ± 34.28 IU/L, P &lt; 0.05), with 65.43 % exceeding gender-specific ranges. Multivariate analysis identified male sex (β = 0.32, 95 % CI: 0.21–0.43; P &lt; 0.05), limb onset (vs. bulbar: β = 0.41, 95 % CI: 0.29–0.53; P &lt; 0.05), and intermediate disease duration (1–3 years: β = 0.32, P &lt; 0.05) as independent predictors. CK levels peaked in limb-onset patients (lower limb: 342.40 ± 283.53 IU/L vs. bulbar: 96.20 ± 49.39 IU/L; P &lt; 0.05). Higher CK was associated with moderate disease severity (ALSFRS-R 36–40 vs. ≤ 35: P &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Serum CK elevation in ALS is strongly linked to male sex, limb onset, and intermediate disease duration (1–3 years), though long-duration cases (&gt;3 years) were underrepresented (n = 4). These findings highlight CK’s potential as a cost-effective biomarker for personalized monitoring, particularly in limb-onset males with moderate functional impairment. Further validation in larger cohorts is warranted.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111203"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704246","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":"Functional outcomes following endovascular treatment of vasospasm secondary to aneurysmal subarachnoid Hemorrhage: A Single center retrospective analysis","authors":"Kyle McGrath ,&nbsp;Grace Hey ,&nbsp;Andrew MacNeil ,&nbsp;Tamara Wahbeh ,&nbsp;Brandon Lucke-Wold ,&nbsp;Muhammad Abdul Baker Chowdhury ,&nbsp;Shawna Amini ,&nbsp;Matthew Koch ,&nbsp;Nohra Chalouhi ,&nbsp;Brian Hoh","doi":"10.1016/j.jocn.2025.111205","DOIUrl":"10.1016/j.jocn.2025.111205","url":null,"abstract":"<div><h3>Introduction</h3><div>Endovascular treatment of post-hemorrhagic cerebral vasospasm (PHCV) has the potential to improve functional outcomes but there continues to be limited data reported in the literature.</div></div><div><h3>Objective</h3><div>To retrospectively review our institution’s experience treating PHCV endovascularly and report clinical outcome data.</div></div><div><h3>Methods</h3><div>Patients who experienced nontraumatic subarachnoid hemorrhage (SAH) and were treated with endovascular therapy were identified using ICD and CPT codes. Demographic, clinical, and outcome variables were then collected via review of electronic medical records. The primary outcome measure was rate of modified Rankin Score (mRS) ≤ 2 at discharge as well as 1, 3, and 6 months after discharge. Discharge disposition, angiographic response to treatment, and complication rates were secondary outcomes. A subgroup analysis was performed on patients treated with retrievable stents.</div></div><div><h3>Results</h3><div>In a 12.5 year period, 1396 patients with nontraumatic SAH were treated, and of these 82/1396 (5.9 %) were treated endovascularly for vasospasm. 200 total interventions were performed on 82 patients. 29.7 % of patients had radiographic delayed cerebral ischemia. The complication rates were 3.5 % per procedure and 4.9 % per patient. 40.7 % of patients had good neurologic outcomes (mRS ≤ 2) at any time point. In-hospital mortality was 11 % and 6-month mortality was 21 %. Higher presenting Glasgow Coma Score (GCS) predicted good neurologic outcome in univariable logistic regression (OR = 1.33, p = 0.026). Patients that underwent mechanical angioplasty were significantly younger than those who did not (46 years vs 53 years, p = 0.003). 11 cases of retrievable stent angioplasty were performed, yielding a complication rate of 9 % which was comparable to the complication rate of patients treated with balloon angioplasty (4.3 %, p = 0.54).</div></div><div><h3>Conclusions</h3><div>Our experience with endovascular treatment of PHCV results in similar functional outcomes and complication rates to the literature. Better presenting GCS predicts good functional outcomes in patients with PHCV treated endovascularly. Patients undergoing mechanical angioplasty tended to be younger. Retrievable stents produced similar rates of complications and good functional outcomes to balloon angioplasty patients.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111205"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704247","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":"Associations between serum Homocysteine, vitamin B9, and vitamin B12 levels and the formation of intracranial Aneurysms: A systematic review and meta-analysis","authors":"Luiz Phelipe Tavares Rodrigues ,&nbsp;Gabriel da Costa Medeiros de Souza ,&nbsp;Mateus de Souza Ribeiro ,&nbsp;Nicollas Nunes Rabelo ,&nbsp;João Paulo Mota Telles ,&nbsp;Bipin Chaurasia ,&nbsp;Eberval Gadelha Figueiredo","doi":"10.1016/j.jocn.2025.111190","DOIUrl":"10.1016/j.jocn.2025.111190","url":null,"abstract":"<div><div>Cardiovascular diseases, including cerebrovascular diseases, represent a major global public health challenge, contributing significantly to morbidity and mortality rates worldwide. Intracranial aneurysms (IAs) are a concerning manifestation due to the risk of rupture and subsequent subarachnoid hemorrhage, which carries a high risk of mortality and long-term disability. Hyperhomocysteinemia, a condition often associated with low levels of vitamins B9 (folic acid or folate) and B12 (cobalamin), has been investigated as a potential risk factor for the formation and rupture of IAs. The present study aimed to conduct a systematic review and <em>meta</em>-analysis to analyze the relationships between serum levels of vitamins B9 and B12, homocysteine, and the formation of IAs.<!--> <!-->The search included the PubMed/MEDLINE, Scielo, EMBASE, LILACS, and Web of Science databases, and the ROBINS-E tool was used to assess the risk of bias.<!--> <!-->Four studies, encompassing a total of 11,377 participants, met the inclusion criteria and were included in the final analysis. The <em>meta</em>-analysis revealed a positive association between elevated homocysteine levels and the formation of IAs. Only one study evaluated the relationship with vitamins B9 and B12, suggesting a potential protective effect, but further research is warranted to confirm this association. Our findings reinforce the potential link between hyperhomocysteinemia and the development of IAs. A deeper understanding of the risk factors and underlying mechanisms involved in aneurysm formation is crucial for the development of effective preventive and therapeutic strategies, ultimately aiming to reduce the incidence associated with this condition.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111190"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697186","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":"Mask-based vs. frame-based stereotactic radiosurgery: A systematic review","authors":"Wilson Hoyt ,&nbsp;Spencer Oslin ,&nbsp;Ozer Algan ,&nbsp;Tyler Gunter ,&nbsp;Ian F. Dunn ,&nbsp;Christopher S Graffeo","doi":"10.1016/j.jocn.2025.111195","DOIUrl":"10.1016/j.jocn.2025.111195","url":null,"abstract":"<div><div>Stereotactic radiosurgery (SRS) has been demonstrated over more than 30 years to be a safe and effective treatment for a variety of central nervous system disorders, including brain metastases. Traditionally, SRS delivery has required placement of a Leksell frame prior for treatment planning. Although highly accurate, frame placement introduces issues in workflow and patient comfort. In response to these constraints, a new innovative SRS delivery system—Gamma Knife Icon—was developed to support a frameless mask-based technique. The relative benefits of frame- or mask-based SRS remain incompletely understood. Mask- or frame-based SRS were the compared treatment modalities. Tumor control was the primary outcome; adverse radiation effects (AREs; e.g., radiation necrosis) and dosimetric parameters were the secondary outcomes. PRISMA-compliant systematic review of three databases (PubMed, Google Scholar, OVID Medline) from inception through 12/31/2022. Predetermined inclusion criteria were quantitative data analysis, direct comparison between mask- and frame-based SRS techniques, and outcomes including either tumor control or AREs. To limit confounding by fractionation scheme, inclusion was also limited to cohorts with separate explicit data on single-fraction treatment plans. Abstract screening yielded 24 candidate manuscripts for full-text review; 5 publications met all criteria and were included. All 5 studies failed to detect a difference in tumor control or AREs between mask- and frame-based SRS techniques. Mask-based SRS may offer a more convenient treatment for brain metastases, with comparable efficacy to frame-based SRS. Given the congruent findings between preceding observational data, one RCT, and the present <em>meta</em>-data, mask-based SRS may be considered the front-line technique for brain metastases.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111195"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686336","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":"Exploring the link between iron dysregulation, ferroptosis, and cognitive dysfunction in intracerebral hemorrhage patients","authors":"Liang Hao ,&nbsp;Aobo Zhang ,&nbsp;Dongsheng Lv ,&nbsp;Mingming Gao ,&nbsp;Wei Guo ,&nbsp;Zhigang Yao","doi":"10.1016/j.jocn.2025.111194","DOIUrl":"10.1016/j.jocn.2025.111194","url":null,"abstract":"<div><h3>Objective</h3><div>The present study aimed to investigate the association between iron metabolism, ferroptosis, cerebrospinal fluid (CSF) iron ion levels, and cognitive impairment in patients with intracerebral hemorrhage (ICH).</div></div><div><h3>Methods</h3><div>A total of 80 ICH patients treated at the Department of Neurology and Emergency Department of our hospital were included in the study. Additionally, 36 patients with external brain injury (without intracerebral hemorrhage) were recruited as a control group. Magnetic resonance imaging (MRI) was used to assess the location and extent of intracerebral bleeding in the observation group (ICH group).</div></div><div><h3>Results</h3><div>The protein expressions of GPX4 and FSP1 were found to be elevated in the ICH group (P &lt; 0.05). Similarly, the expressions of iron metabolism-related proteins, including transferrin, ferritin, and ferritransporters, were significantly higher in the brain tissue of the ICH group (P &lt; 0.05). Malondialdehyde (MDA) levels were also elevated in the ICH group (MDA: 4.45 ± 0.47 vs. 3.31 ± 0.35 nmol/ml). Furthermore, the level of iron ions in the CSF was higher in the ICH group (P &lt; 0.05). Cognitive assessments showed that MMSE and MoCA scores in the ICH group were significantly lower than those in the control group (P &lt; 0.05), indicating more severe cognitive impairment in the observation group. Moreover, MMSE and MoCA scores were negatively correlated with iron metabolism-related proteins (transferrin, ferritin, and ferritransporters), ferroptosis markers (GPX4 and FSP1), and CSF iron ion levels (P &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Disturbances in iron metabolism, the occurrence of ferroptosis, and increased CSF iron ion levels in ICH patients appear to be closely associated with cognitive impairment.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111194"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686380","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":"Critique of \"Risk factors for residual dizziness after successful repositioning in elderly patients with benign paroxysmal positional vertigo\".","authors":"Abdullah Qureshi, Iftikhar Khan, Hadia Kashif, Nayab Zahid","doi":"10.1016/j.jocn.2025.111202","DOIUrl":"https://doi.org/10.1016/j.jocn.2025.111202","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":" ","pages":"111202"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719373","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":"Unusual aneurysm mimicker; fenestration of the supraclinoid segment of the internal carotid artery","authors":"Hayri Ogul ,&nbsp;Sanem Sarsilmaz","doi":"10.1016/j.jocn.2025.111161","DOIUrl":"10.1016/j.jocn.2025.111161","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111161"},"PeriodicalIF":1.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686381","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":"Characterization and treatment patterns of patients treated with immediate-release sodium oxybate for narcolepsy: A propensity score–matched cohort study","authors":"Melissa C. Lipford ,&nbsp;Shahir Asfahan ,&nbsp;Gajinder Pal Singh ,&nbsp;J. Layne Moore ,&nbsp;Maja Tippmann-Peikert ,&nbsp;Praveen Kumar-M ,&nbsp;Wui Ip ,&nbsp;Samir Awasthi ,&nbsp;Jennifer Gudeman ,&nbsp;Lois Krahn","doi":"10.1016/j.jocn.2025.111185","DOIUrl":"10.1016/j.jocn.2025.111185","url":null,"abstract":"<div><h3>Background</h3><div>Sodium oxybate (SXB) is strongly recommended for narcolepsy treatment. Comorbidities and treatment patterns of patients with narcolepsy treated vs not treated with SXB are unknown.</div></div><div><h3>Methods</h3><div>An electronic health record-based search identified first-time Mayo Clinic patients with ≥ 1 narcolepsy-specific International Classification of Diseases 9th/10th Revision code and ≥ 1 diagnostic mention of narcolepsy in clinical notes (1975–2020). Common comorbidities were compared between age/sex matched cohorts with and without SXB treatment using odds ratios. Reasons for SXB therapy not being continued or taken as directed were identified using manual chart review.</div></div><div><h3>Results</h3><div>Of the 4387 patients with narcolepsy identified, 8 % (n = 351) received SXB treatment and 92 % (n = 4036) did not. The most common comorbidities (&gt;20 % overall population) were insomnia, fatigue, depression, hypertension, hyperlipidemia, obstructive sleep apnea, diabetes mellitus, arrhythmia, and idiopathic hypersomnia. In the cohorts of 351 matched patients, no significant differences between cohorts were observed for any comorbidity at any time point (overall, 5 years before or after diagnosis). Among patients who received SXB, 113 had clinical notes indicating discontinuation of SXB, with a reason documented for 71 (most common: lack of efficacy [n = 11]). Of the 24 recorded reasons for patients missing the second nightly SXB dose, the most frequent was the inability to wake up, with consequences noted the next day of increased symptoms.</div></div><div><h3>Conclusions</h3><div>No significant differences in comorbidities were observed between cohorts. Although SXB is a highly effective treatment for narcolepsy, this study highlights challenges patients face while taking twice-nightly SXB, which may result in underuse/misuse and suboptimal treatment.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"135 ","pages":"Article 111185"},"PeriodicalIF":1.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}