Journal of Clinical Neuroscience最新文献

{"title":"Acidosis-dependent inverse association between partial pressure of arterial carbon dioxide and mortality in acute ischemic stroke","authors":"Zicheng Cheng ,&nbsp;Lili Ma ,&nbsp;Meiqi Zhao ,&nbsp;Tong Xu ,&nbsp;Jianing Wang ,&nbsp;Xinxia Zhu ,&nbsp;Zhenxiang Zhan ,&nbsp;Zhao Han","doi":"10.1016/j.jocn.2025.111464","DOIUrl":"10.1016/j.jocn.2025.111464","url":null,"abstract":"<div><h3>Background</h3><div>Acute ischemic stroke (AIS) is a major global health concern with significant economic consequences. While various neuroprotective treatments have been explored, a promising but under-investigated approach involves manipulating partial pressure of arterial carbon dioxide (PaCO₂) levels. Experimental studies suggest that CO₂ may exert neuroprotective effects through mechanisms such as anti-inflammatory and antioxidant roles. However, the clinical relationship between PaCO₂ and mortality in AIS, particularly in relation to acidosis, remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the Medical Information Mart for Intensive Care-IV database to analyze data from adult patients diagnosed with AIS between 2008 and 2019. Patients were grouped based on the first 24-h PaCO₂ quartiles, and 30-day mortality was the primary outcome. Secondary outcomes included in-hospital mortality and intensive care unit (ICU) length of stay. Multivariable Cox regression models, restricted cubic spline (RCS) analyses, and subgroup analyses based on arterial blood potential of hydrogen (pH) were used to assess the associations between PaCO₂ levels and clinical outcomes.</div></div><div><h3>Results</h3><div>PaCO₂ levels were lower in patients who died within 30 days or during hospitalization compared to survivors. In multivariable analysis, patients in the highest PaCO₂ quartile (Q4: &gt; 43.0 mmHg) had a 39 % reduced risk of 30-day mortality (hazard ratio [HR]: 0.61, 95 % confidence interval [CI]: 0.39–0.95) and a marginally reduced risk of in-hospital mortality (HR: 0.63, 95 % CI: 0.39–1.01). A non-significant association was found between PaCO₂ and ICU length of stay. In subgroup analyses, the association was significant only in patients with acidosis (pH &lt; 7.35), where PaCO₂ &gt; 43.0 mmHg reduced 30-day mortality by 70 % (HR: 0.30, 95 % CI: 0.12–0.75).</div></div><div><h3>Conclusions</h3><div>Increased PaCO₂ levels were associated with lower 30-day mortality in patients with AIS, particularly in those with acidosis. These findings provide preliminary evidence supporting further investigation of CO₂ inhalation as a potential therapeutic strategy for AIS in randomized controlled trials.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111464"},"PeriodicalIF":1.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557340","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":"Transitional care into adulthood: Management of adolescent idiopathic scoliosis","authors":"Aashka Sheth,&nbsp;Jasmine Omair,&nbsp;David Freeman,&nbsp;Thomas Altstadt,&nbsp;Maxwell Boakye,&nbsp;Nicholas Dietz","doi":"10.1016/j.jocn.2025.111453","DOIUrl":"10.1016/j.jocn.2025.111453","url":null,"abstract":"<div><div>Adolescent idiopathic scoliosis (AIS) represents a frequently encountered pathology in pediatric neurosurgical clinics that involve complex surgical counselling and intervention into adulthood. Transition of care strategies to monitor these patients over time and determine optimal care frameworks for surgical, medical, and psychosocial management, however, has not been uniformly integrated into adult healthcare systems. Further, limited studies discuss models of transitional care for pediatric spinal pathologies that discuss management trees for postoperative pediatric patients or those newly diagnosed with AIS in adulthood. The purpose of this review is to identify challenges these patients may face transitioning into adult healthcare systems, including 1) postoperative care and complication surveillance 2) new diagnoses in adulthood 3) indications and options for operative intervention and 4) health-related quality of life (HRQoL) with psychosocial domain outcomes. We analyzed the natural history and adulthood management for AIS using PRIMSA guidelines through PubMed and Ovid databases to identify studies that met our search criteria. A total of 15 studies met inclusion criteria for both searches and were incorporated into final analysis. Reoperation was observed in as high as 20% of patients. Five studies found that adult surgical intervention was associated with higher rates of complications, longer operative times, longer hospital stays, and more neurologic complications when compared with adolescent operation. Satisfaction scores were also higher for those with AIS who were treated surgically in adolescence compared to those who were braced or observed. Adolescent idiopathic scoliosis patients should be monitored into adulthood to screen for neurological deterioration, postoperative complications, and indications for surgical intervention. Neurosurgeons should engage multidisciplinary care teams for medical management of functional and mental health domains, and counsel surgical intervention based on individual radiographic, clinical, and assessments of HRQoL.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111453"},"PeriodicalIF":1.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563428","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":"Deep brain stimulation within a multi-center US-based healthcare system – A descriptive epidemiologic review from 2010 through 2021","authors":"Mark F. Sedrak ,&nbsp;Richard N. Chang ,&nbsp;Patrick Pezeshkian ,&nbsp;Chelsea E. Reyes ,&nbsp;Heather A. Prentice ,&nbsp;Elizabeth W. Paxton ,&nbsp;Monica A. Skordilis ,&nbsp;Patrick T. Hickey ,&nbsp;Siddharth Srivastava ,&nbsp;Ross Anderson","doi":"10.1016/j.jocn.2025.111428","DOIUrl":"10.1016/j.jocn.2025.111428","url":null,"abstract":"<div><h3>Background</h3><div>Given recent advancements in deep brain stimulation (DBS), practice variation and outcomes in large, community-based practices are important to understand. We sought to describe a well-defined cohort of patients who underwent DBS placement within a US-based integrated healthcare system on the West Coast and including Hawaii, over 12 years.</div></div><div><h3>Methods</h3><div>Patients who underwent initial DBS placement were identified using Kaiser Permanente’s electronic health record (2010–2021). Crude cumulative implantable pulse generator (IPG) replacement, reoperation, and mortality probabilities were calculated as 1 minus the Kaplan-Meier estimator. 90-day incidence of emergency department (ED) visits and readmissions was calculated as the number of patients with the event of interest over the number of patients at risk.</div></div><div><h3>Results</h3><div>1,158 patients had a complete DBS system placed by 12 surgeons across 7 facilities in the healthcare system. 769 patients received bilateral systems (674 with 2 leads and 1 IPG and 95 with 2 leads and 2 IPG), while 389 received unilateral systems. Following DBS placement, 14.3 %, 8.5 %, and 1.2 % had a 90-day ED visit, readmission, and infection, respectively. Median time to IPG replacement was 3.5 years. At 3-years follow-up, 14.5 % had an IPG replacement and 18.1 % had a reoperation; 5-year mortality was 9.3 %.</div></div><div><h3>Conclusion</h3><div>This study highlights the sum of practices over a decade in a large community-based healthcare system. In particular, original implantation techniques varied, and utilization of rechargeable systems increased over time. Given the incidence of readmissions, ED visits, and reoperations, future study is needed to understand modifiable risk factors to mitigate unwanted outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111428"},"PeriodicalIF":1.9,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563317","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":"Awake craniotomy vs general anesthesia for brain metastases in eloquent areas: neurological and survival outcomes","authors":"Alon Moore Galindo ,&nbsp;Amit Azriel ,&nbsp;Doron Pasternak ,&nbsp;Simon Esbit ,&nbsp;Aya Mudrik ,&nbsp;Elad Avraham ,&nbsp;Yuval Sufaro ,&nbsp;Amichay Meirovitz","doi":"10.1016/j.jocn.2025.111457","DOIUrl":"10.1016/j.jocn.2025.111457","url":null,"abstract":"<div><div>Brain metastases (BMs) occur in 10–20 % of cancer patients and significantly impact mortality in adults. While awake craniotomy (AC) is established as safe for primary brain tumors in eloquent areas, evidence for its use in BMs remains limited. This study evaluates AC versus general anesthesia (GA) for surgical resection of BMs in eloquent brain regions. This retrospective cohort study analyzed 77 patients who underwent surgical resection of BMs at Soroka University Medical Center between 2015–2022. Patients were divided into AC (n = 16) and GA (n = 61) groups. A secondary analysis examined outcomes across three groups: AC, GA with neuromonitoring (n = 21), and GA without neuromonitoring (n = 40). Primary outcomes included postoperative neurological status, overall survival, and hospital length of stay (LOS). The AC group demonstrated significantly better neurological improvement rates at 14 days (93.8 % vs 21.3 %, p &lt; 0.001) and six weeks post-surgery (56.3 % vs 1.6 %, p &lt; 0.001) compared to the GA group. Mean LOS was shorter in the AC group (4.25 vs 7.18 days, p = 0.072), with lower mortality rates (62.5 % vs 83.6 %, p = 0.085). In the three-group analysis, AC showed superior neurological outcomes, with improvement rates at six weeks being 56.3 % for AC, 4.8 % for GA with neuromonitoring, and 0 % for GA without neuromonitoring (p &lt; 0.001). Awake craniotomy demonstrates superior outcomes for resecting BMs in eloquent areas, with significantly better neurological recovery and trends toward shorter LOS and lower mortality. Neuromonitoring improves surgical outcomes, particularly in GA cases. These findings support AC as a preferred approach for appropriately selected patients with BMs in eloquent regions.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111457"},"PeriodicalIF":1.9,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557258","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":"Transforaminal endoscopic lumbar discectomy (TELD) via trans-superior articular process (SAP) approach: a stepwise video guide","authors":"Eu Xuan Bryan Lim ,&nbsp;Andrew J. Berg ,&nbsp;Prashanth J. Rao","doi":"10.1016/j.jocn.2025.111454","DOIUrl":"10.1016/j.jocn.2025.111454","url":null,"abstract":"<div><div>This video article demonstrates the authors’ approach in performing a uniportal transforaminal endoscopic lumbar discectomy (TELD) via a Trans-Superior Articular Process (SAP) approach.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"139 ","pages":"Article 111454"},"PeriodicalIF":1.9,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549851","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":"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}