Journal of Neurology, Neurosurgery, and Psychiatry最新文献

{"title":"Patients with symmetric Parkinson's disease do poorly with subthalamic stimulation.","authors":"Stefanie Theresa Jost, Camilla Atwani, Philipp Alexander Loehrer, Keyoumars Ashkan, Alexandra Rizos, Jan Niklas Petry-Schmelzer, Jonas Krauss, Jan F Krause, Agni Maria Konitsioti, Roberta Biundo, David J Pedrosa, Julian Evans, Veerle Visser-Vandewalle, Christopher Nimsky, Gereon Rudolf Fink, Monty Silverdale, Alfonso Fasano, Pablo Martinez-Martin, Angelo Antonini, Per Borghammer, K Ray Chaudhuri, Lars Timmermann, Haidar S Dafsari","doi":"10.1136/jnnp-2025-336382","DOIUrl":"10.1136/jnnp-2025-336382","url":null,"abstract":"<p><strong>Background: </strong>Motor asymmetry is a hallmark of Parkinson's disease (PD), but ~20% of patients present with symmetric motor signs, which are associated with faster disease progression and poorer dopaminergic response. The impact of motor symmetry on activities of daily living (ADL) outcomes following subthalamic deep brain stimulation (STN-DBS) remains unclear. We hypothesised that patients with symmetric PD experience less ADL improvement post-STN-DBS than asymmetric PD patients.</p><p><strong>Methods: </strong>This was a prospective, quasi-experimental, non-randomised, controlled, international multicentre study with a 6-month follow-up. The primary outcome was the Scales for Outcomes in Parkinson's Disease-Motor ADL scale. Secondary outcomes included Unified Parkinson's Disease Rating Scale motor examination and Parkinson's Disease Questionnaire-8 (PDQ-8). We defined symmetric PD as a right-to-left hemibody motor score equalling 1. We analysed within-group longitudinal changes, between-group outcome differences, effect size and correlations between PDQ-8 and motor changes. We confirmed results in a propensity-score matched subcohort with well-balanced demographic and clinical parameters.</p><p><strong>Results: </strong>We included 200 patients with asymmetric and 54 with symmetric PD. In symmetric PD, ADL remained stable, which was not associated with the observed PDQ-8 improvement. In contrast, in asymmetric PD, ADL improved with a moderate effect size, which correlated moderately with PDQ-8 improvement. In symmetric PD, the absolute risk of experiencing no clinically relevant postoperative ADL improvement was 23.8% higher.</p><p><strong>Conclusions: </strong>This study provides class IIb evidence of worse ADL outcome of STN-DBS in patients with symmetric compared with asymmetric PD. Clinicians should counsel patients with symmetric PD on their elevated risk of ADL non-response when discussing STN-DBS as a treatment option.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"438-448"},"PeriodicalIF":7.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midlife plasma proteomic profiles indicate altered amyloid and tau processing in former elite rugby players.","authors":"Neil Graham, Karl Zimmerman, Jessica Hain, Erin Rooney, Ying Lee, Martina Del Giovane, Thomas Parker, Mathew Wilson, Maneesh Patel, Elena Veleva, Owen Swann, Amanda J Heslegrave, Lucia M Li, Henrik Zetterberg, Daniel Friedland, Richard Sylvester, David Sharp","doi":"10.1136/jnnp-2025-336593","DOIUrl":"10.1136/jnnp-2025-336593","url":null,"abstract":"<p><strong>Background: </strong>Contact sports, including rugby union, are associated with higher rates of neurodegenerative dementia, due to various underlying pathologies such as Alzheimer's disease (AD) and chronic traumatic encephalopathy (CTE). New ultrasensitive multiplexed immunoassays may clarify disease mechanisms after repetitive head impacts (RHI) and traumatic brain injury, potentially aiding risk-stratification, early diagnosis and dementia treatment.</p><p><strong>Methods: </strong>Midlife participants in the ABHC cohort underwent plasma biomarker quantification (NULISA - NUcleic acid Linked Immuno-Sandwich Assay; n=124 markers), 3T MRI, trauma exposure ascertainment and phenotyping. Regressions quantified exposure-specific protein expression, relationship to trauma (including position) and brain atrophy, using cluster analysis to test correlates of traumatic encephalopathy syndrome (TES).</p><p><strong>Results: </strong>197 former elite rugby players and 33 controls were assessed. 24 (12.2%) met criteria for TES but none had dementia. Ex-players returned reduced plasma glial fibrillary acidic protein (GFAP), kallikrein-6 (KLK6) and synaptosomal-associated protein 25 (SNAP25). Ex-forwards specifically showed reduced plasma beta-site amyloid precursor protein cleaving enzyme 1 (BACE1), amyloid beta-38 (Aβ38), and increased phospho-tau₁₈₁ (p-tau₁₈₁). KLK6 was lower in ex-backs than controls. No biomarkers related to career duration, concussion load or regional brain volume, nor did clustering relate to TES.</p><p><strong>Conclusions: </strong>Ex-players showed distinctive plasma biomarker changes, more prominently in ex-forwards, possibly reflecting greater RHI exposure. Plasma KLK6, an endothelial serine protease, was reduced across the ex-player group, with potential diagnostic or prognostic utility in future. Reduced GFAP and SNAP25 in ex-forwards has an uncertain basis, while elevated p-tau-₁₈₁ more so than p-tau₂₁₇ points towards non-AD tau pathology. Our findings motivate longitudinal characterisation, including comparison with other neurodegenerative diseases.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"393-397"},"PeriodicalIF":7.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of natalizumab and anti-CD20 monoclonal antibodies in relapsing-remitting multiple sclerosis: a real-world propensity-score matched study.","authors":"Bassem Yamout, Raed Alroughani, Samar Frouk Ahmed Mohamed, Akram M Al-Mahdawi, Samia Joseph Khoury, Nabil El Ayoubi, Jihad Inshasi, Jabir Alkhaboori, Abdullah Al-Asmi, Riadh Gouider, Salman Aljarallah, Nuha Alkhawajah, Yaser Al Malik, Ahmad Abulaban, Seraj Makkawi, Osama Khojah, Taghrid El-Hajj, Joelle Massouh, Husam AlSalamat, Hani Dimassi, Amal Al-Hajje, Pascale Salameh, Farid Boumediene, Maya Zeineddine","doi":"10.1136/jnnp-2024-335704","DOIUrl":"10.1136/jnnp-2024-335704","url":null,"abstract":"<p><strong>Background: </strong>Head-to-head randomised trials or real-world studies comparing the safety and efficacy of natalizumab and anti-CD20 monoclonal antibodies are limited. This study aimed to compare the effectiveness and safety of natalizumab versus ocrelizumab/rituximab in a real-world cohort of relapsing-remitting multiple sclerosis (RRMS) patients using data from the Middle East and North Africa Committee for the Treatment and Research in Multiple Sclerosis (MENACTRIMS) registry.</p><p><strong>Methods: </strong>This registry-based, retrospective, multicentre study was carried out in seven Middle Eastern countries by analysing data from the MENACTRIMS registry. All adults RRMS patients treated with natalizumab, rituximab or ocrelizumab and maintained on treatment for at least 12 months were included. Patients were matched using propensity scores. Primary outcomes were annualised relapse rate (ARR), confirmed disability progression and improvement and MRI activity.</p><p><strong>Results: </strong>A total of 1954 patients met the inclusion criteria, with 1277 receiving anti-CD20 therapy (768 on rituximab and 509 on ocrelizumab) and 677 natalizumab. Natalizumab significantly reduced ARR compared with anti-CD20 therapies (0.062 vs 0.092, p=0.001). Confirmed disability progression rates, MRI outcomes and no evidence of disease activity (NEDA-3) were similar between the two groups. However, natalizumab demonstrated higher rates of disability improvement compared with anti-CD20 therapies (9.3% vs 5.5%, p=0.03). Adverse events were more frequent in the anti-CD20 group (36.4% vs 27.5% for natalizumab, p=0.001).</p><p><strong>Conclusion: </strong>In this large, real-world cohort, natalizumab was associated with lower ARR, greater likelihood of disability improvement, lesser adverse events, but lower persistence compared with anti-CD20 therapies. These findings provide valuable insights into the comparative efficacy and safety of these RRMS therapies, aiding clinicians in personalised treatment decisions.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"398-404"},"PeriodicalIF":7.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lecanemab appropriate use recommendations for clinical practice in the UK.","authors":"Catherine J Mummery, Jill Rasmussen, Dan Blackburn, Elizabeth Coulthard, R Rhys Davies, Rachel Dorsey, Nick C Fox, Akram A Hosseini, Chineze Ivenso, Matthew Jones, Sean P Kennelly, Christopher Kipps, Daniel Lashley, Graham Mackay, Rashi Negi, Ramin Nilforooshan, Peter Anthony Passmore, Richard Perry, Vanessa Raymont, James Benedict Rowe, Tom C Russ, John-Paul Taylor, Alistair Burns","doi":"10.1136/jnnp-2025-336597","DOIUrl":"10.1136/jnnp-2025-336597","url":null,"abstract":"<p><p>Lecanemab is an anti-amyloid monoclonal antibody, recently approved in the UK as a treatment for mild cognitive impairment (MCI) and mild dementia due to Alzheimer's disease (AD) in adults who are apolipoprotein E ε4 gene (<i>APOE4</i>) heterozygotes or non-carriers.A group of UK neurologists, old age psychiatrists and geriatricians with expertise in AD convened to agree appropriate use recommendations for lecanemab in UK clinical practice. The primary focus of these recommendations is safety.Eligibility criteria for lecanemab in the UK include (a) a clinical diagnosis of MCI or mild dementia due to AD, (b) the presence of amyloid-β pathology, confirmed using approved methods (ie, an amyloid positron emission tomography scan or cerebrospinal fluid assay) and (c) <i>APOE4</i> heterozygous or non-carrier status. Eligibility screening should be conducted in secondary care and those identified as being potentially eligible for lecanemab should be referred to a specialist centre for confirmation of the likely pathological diagnosis, <i>APOE4</i> counselling and testing and a multidisciplinary consensus decision regarding treatment eligibility. Lecanemab is administered as an intravenous infusion every 2 weeks, and those eligible for treatment should have brain magnetic resonance imaging (MRI) scans prior to the 1st, 5th, 7th and 14th infusions. Specific guidance is provided for safety monitoring and management of potential adverse reactions, including amyloid-related imaging abnormalities and infusion-related reactions.The introduction of lecanemab into UK clinical practice provides an important opportunity to improve services for all people living with dementia, not just those eligible for lecanemab treatment.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"372-384"},"PeriodicalIF":7.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinically reported covert cerebrovascular disease and risk of neurological disease: a whole-population cohort of 367 988 people using natural language processing.","authors":"Matthew Henry Iveson, Mome Mukherjee, Emma M Davidson, Huayu Zhang, Laura Sherlock, Emily L Ball, Grant Mair, Alice Hosking, Heather Whalley, Michael T C Poon, Joanna M Wardlaw, David M Kent, Richard Tobin, Claire Grover, Beatrice Alex, William Whiteley","doi":"10.1136/jnnp-2025-337689","DOIUrl":"10.1136/jnnp-2025-337689","url":null,"abstract":"<p><strong>Background: </strong>The relevance of covert cerebrovascular disease (CCD) in practice is uncertain, partly because estimation of risk in whole clinical populations is difficult. Studies have had success extracting CCD from clinical text using natural language processing (NLP), though they have been limited to specific CCD phenotypes. Here, we used NLP to measure multiple clinically-reported CCD phenotypes in a large clinical cohort and estimated subsequent disease risk in health record data.</p><p><strong>Methods: </strong>From all people with brain imaging in Scotland (2010-2018), we selected people with no prior hospitalisation for neurological disease (n=367 988). NLP of imaging reports identified: white matter hypoattenuation or hyperintensities (WMH), lacunes, cortical infarcts and cerebral atrophy. Adjusted HRs (aHRs) were estimated between each phenotype and stroke, dementia and Parkinson's disease (conditions previously associated with CCD), epilepsy and colorectal cancer (control conditions).</p><p><strong>Results: </strong>For each phenotype, the aHR of stroke was WMH 1.4 (95% CI 1.3-1.4), lacunes 1.6 (1.5-1.6), cortical infarct 1.8 (1.7-1.9) and cerebral atrophy 1.1 (1.0-1.1). The aHR of dementia was WMH 1.3 (1.3-1.3), lacunes 1.0 (0.9-1.0), cortical infarct 1.1 (1.1-1.2) and cerebral atrophy 1.7 (1.7-1.8). The aHR of Parkinson's disease was WMH 1.1 (1.0-1.2), lacunes 1.1 (0.9-1.2), cortical infarct 0.7 (0.6-0.9) and cerebral atrophy 1.4 (1.3-1.5). The aHRs between CCD phenotypes and epilepsy and colorectal cancer were around the null.</p><p><strong>Conclusion: </strong>CCD and atrophy have implications for future disease risk and can be identified at scale using NLP of clinical reports. Prevention of neurological disease in people with CCD should be a priority for healthcare policy makers.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147458174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric comorbidities cluster early after onset in MOGAD: a cross-sectional comparative study with MS and NMOSD.","authors":"Moritz Niederschweiberer, Cicek Bakir, Nisa Vorasoot, Laura Cacciaguerra, Jan-Mendelt Tillema, Andreu Vilaseca, Smathorn Thakolwiboon, Albert Aboseif, Stephanie B Syc-Mazurek, William A Rees, Michael R Basso, A Sebastian Lopez-Chiriboga, Dean M Wingerchuk, W Oliver Tobin, Paul E Croarkin, Jessica Sagen, Sean J Pittock, John J Chen, Eoin P Flanagan","doi":"10.1136/jnnp-2025-338335","DOIUrl":"https://doi.org/10.1136/jnnp-2025-338335","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric comorbidities are increasingly recognised in demyelinating diseases, yet their frequency and timing in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are not well defined. We aimed to characterise the spectrum and temporal pattern of psychiatric illness in MOGAD and compare to multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) with aquaporin-4 antibody (AQP4-IgG).</p><p><strong>Methods: </strong>We conducted a cross-sectional study of patients with MOGAD (n=388), age-matched and sex-matched MS (n=257) and AQP4-IgG-positive NMOSD (n=58) evaluated at Mayo Clinic (1991-2025). Psychiatric diagnoses, timing relative to the first attack and patient-reported outcomes were extracted from electronic health records (EHRs). Complementary analyses were conducted using the NeuroBlu real-world EHR database.</p><p><strong>Results: </strong>Among 388 patients with MOGAD, 54.8% had ≥1 psychiatric disorder, most commonly anxiety (47.7%), depression (36.6%) and attention-deficit/hyperactivity disorder (ADHD, 9%). After the first attack, 33.3% of patients with MOGAD developed a new psychiatric disorder, often within the first year. MOGAD showed a lower frequency of depression versus MS (36.6% vs 47.5%, p=0.02) but similar rates of anxiety and ADHD. Temporal patterns differed: psychiatric disorders often appeared years before onset in MS but clustered shortly after onset in MOGAD. NeuroBlu analyses supported high rates of psychiatric disorders across the three conditions.</p><p><strong>Conclusion: </strong>Psychiatric comorbidities are common in MOGAD, particularly depression and anxiety, typically emerging close after onset, whereas in MS they often preceded onset by years. These findings underscore the need for routine psychiatric screening in MOGAD and highlight unresolved questions regarding whether, and to what extent, MOG-IgG-mediated inflammatory demyelination contributes to psychiatric vulnerability.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy surgery outcomes and their determinants: a systematic review and individual patient data meta-analysis.","authors":"Tamir Avigdor, Alyssa Ho, Matthew Moye, William Davalan, Erica Minato, Sana Hannan, Tamzin Holden, Tasha Bouchet, Yingqi Laetitia Wang, Kassem Jaber, Mays Khweileh, Samantha Kaplan, Vojtech Travnicek, David Carlson, Birgit Frauscher","doi":"10.1136/jnnp-2025-337158","DOIUrl":"https://doi.org/10.1136/jnnp-2025-337158","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in epilepsy surgery, seizure freedom is achieved in only ~50-70% of cases, highlighting the need to better understand factors driving surgical success.</p><p><strong>Methods: </strong>A preregistered systematic review and individual patient data meta-analysis was conducted on studies reporting clinical outcomes in epilepsy surgery, based on a comprehensive literature search through August 2024. Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Unique patient data from 385 studies were pooled, yielding 5588 patients with outcomes, localisation, demographics, pathology and other findings. Surgical success rates (% Engel 1/ILAE 1-2) were reported with 95% Wald CIs. Associations with patient- and disease-specific factors were assessed using chi-squared tests (p<0.05), effect sizes with Cramer's V, and post hoc comparisons adjusted using the false discovery rate.</p><p><strong>Results: </strong>Surgical success varied by lobar anatomy (χ²=52, p<0.001, V=0.12), with the highest success rates in temporal (68.6% (67.0% to 70.1%)) and insular lobes (66.2% (55.4% to 77.0%)). Multilobar resections had lower success rates, with outcomes varying by lobar combination (χ²=25, p=0.02, V=0.22). Variability in outcomes was influenced by histopathology and MRI findings (χ²=121, p<0.001, V=0.16; highest success in tumours (78.2% (74.9% to 81.6%))) and by surgical intervention (χ²=30.5, p<0.001, V=0.07; lowest success with corpus callosotomy (43.4% (35.4% to 51.5%))). Overall surgical success rates remained stable over time (r=0.25, p=0.13), despite surgery being extended to more complex patients.</p><p><strong>Conclusions: </strong>These findings inform surgical planning for drug-resistant epilepsy, emphasising individual patient characteristics to guide personalised treatment, improve outcomes and reflect the growing complexity of intersecting factors.</p><p><strong>Prospero registration number: </strong>CRD42024530397.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steroids or immunoglobulin for CIDP first-line treatment: why not both?","authors":"Ryan Yann Shern Keh, Aisling S Carr","doi":"10.1136/jnnp-2026-338723","DOIUrl":"https://doi.org/10.1136/jnnp-2026-338723","url":null,"abstract":"","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of neuropsychological side effects between contemporary radiofrequency ablative neurosurgery for psychiatric disorders and conventional neurosurgical procedures: systematic review and meta-analysis.","authors":"Osvaldo Vilela-Filho, Matheus A Bannach, Adriano M Lino-Filho, Clement Hamani, Bart Nuttin, Marwan Hariz, Michael Schulder, Benjamin David Greenberg, Rees Cosgrove, Ricardo De Oliveira-Souza, Andreas Horn, Sameer A Sheth, Cynthia Kubu, Sherif Salem, Alice J Zaccariotti, Naraiana O Tavares, Benito Pereira Damasceno, Helen S Mayberg, Andres M Lozano, Veerle Visser-Vandewalle, Jens Kuhn, Peter Falkai, Konstantin Slavin, Paresh Doshi, Antonio C Lopes, Edoardo Fq Vattimo, Terry Coyne, Harith Akram, Hiroki Toda, Casey H Halpern, Volker Arndt Coenen, Alessandra Augusta Gorgulho, Pablo Andrade, Patric Blomstedt, Hemmings Wu, Ludvic Zrinzo, Bomin Sun, Joao L De Quevedo, Paulo Belmonte-De-Abreu, Paul Cosyns, Nicole Mclaughlin, Ahmed Alkhani, James Giordano, Michael Berk, Lakshmi N Yatham, Stephan Chabardes, Najia E Abbadi, Antonio Afonso Ferreira De Salles, Nico Enslin, Marcelo B De Sousa, José Oswaldo Oliveira, Rodrigo Labruna, Alexandre Macdonald Reis, Fiacro Jiménez-Ponce, Maria A Ferragut, Jin Woo Chang, Jean Régis, Cristina V Torres, Takaomi Taira, Nir Lipsman, Juan A Barcia, Ali Rezai, Rick Schuurman, Roberto Martinez-Alvarez, Darin D Dougherty, Giovanni Broggi, Daniel Huys, Chris Bervoets, Paulo M Oliveira, Paulo Cesar Ragazzo, Peter Giacobbe, Gabriel Lazaro-Munoz, Mircea Polosan, Matilda Naesström, Viktoria Johansson, Thomas Schlaepfer, Telma Mc Ribeiro, Kendall H Lee, Joseph S Neimat, Mojgan Hodaie, Andrey Sitnikov, Atilla Yilmaz, Fadi Almahariq, Adriana L Lopez Rios, António Gonçalves-Ferreira","doi":"10.1136/jnnp-2025-337800","DOIUrl":"https://doi.org/10.1136/jnnp-2025-337800","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric disorders are increasingly contributing to global disability. Despite advances in conservative management, the prevalence of treatment-resistant cases remains high. Meanwhile, neurosurgery for psychiatric disorders (NPD) remains underused, largely due to strict regulations and historical concerns, particularly those related to neuropsychological side effects (NPSE).</p><p><strong>Objective: </strong>To address this issue, we conducted a systematic review with meta-analysis to compare NPSE associated with radiofrequency ablative NPD to those observed in neuro-oncological, neurovascular and epilepsy surgeries.</p><p><strong>Methods: </strong>PubMed, Embase and LILACS databases were searched in April 2024 for articles published in English/Spanish from 1990 to 2022, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.</p><p><strong>Results: </strong>A total of 48 articles with 2678 participants were included. The frequency of transient and permanent NPSE in the NPD group ranged from 0.94% to 11.50% and 0.94% to 2.03%, respectively, comparable to the other surgical groups (epilepsy: 0.31-11.70%; vascular: 0.52-22.90%; oncology: 0.94-17.60% for transient NPSE; epilepsy: 0.31-12%; vascular: 0.40-1.96% and oncology: 0.84-1.48% for permanent NPSE). Regarding permanent NPSE, arguably the most critical consideration, the NPD group showed better outcomes in memory, language and social cognition than the epilepsy group, but worse outcomes in executive and perceptual-motor functions. Compared with the vascular group, the NPD group had better executive function but worse complex attention. Finally, the NPD group had fewer permanent deficits than the oncology group in executive function, complex attention and perceptual-motor domains, although language performance was lower.</p><p><strong>Conclusions: </strong>Contemporary NPD apparently carries a similar risk of NPSE as other conventional neurosurgical procedures, challenging misconceptions and this unjustified barrier to its broader use.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an artificial intelligence-driven triage system on workflow and transfer efficiency: stratified analysis of 4548 admissions to four thrombectomy hubs receiving transfers from sixty spokes.","authors":"Mohamed F Doheim, Matthew Starr, Nirav R Bhatt, Marcelo Rocha, Alhamza R Al-Bayati, Abdullah Sultany, Charles Romero, Cynthia L Kenmuir, Stephanie Henry, Raul G Nogueira","doi":"10.1136/jnnp-2025-337903","DOIUrl":"https://doi.org/10.1136/jnnp-2025-337903","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;We aimed to evaluate the impact of implementing an artificial intelligence (AI)-enabled acute ischaemic stroke triage system on workflow efficiency and transfer optimisation in a large academic healthcare network.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospectively maintained database was reviewed comparing equivalent time periods before and after AI-enabled triage platform implementation (January 2021-December 2022). The primary analysis compared workflow metrics between AI-enabled and non-AI spokes during the same calendar period (2022) to control for temporal confounding. Benjamini-Hochberg correction was applied for multiple comparisons, and analyses were adjusted for age and baseline National Institutes of Health Stroke Scale. Evaluated outcomes included door-in-door-out (DIDO) times, door-to-puncture (DTP) times, endovascular therapy (EVT) utilisation rates, cost analysis and clinical outcomes at discharge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 4548 admissions with 844 EVT patients (394 pre-implementation, 450 post-implementation) across four hub centres. In the primary same-period analysis (2022), AI-enabled spokes demonstrated significantly shorter DIDO times compared with non-AI spokes (median 103 (92-118) vs 134 (103-162) min; adjusted difference -41.6 min (95% CI -60.9 to -24.1); p&lt;0.001, Q&lt;0.001) and shorter DTP times (21 (14-43) vs 40 (18-65) min; adjusted difference -10.9 min (95% CI -17.9 to -3.7); p=0.003, Q=0.009). A difference-in-differences analysis demonstrated that DIDO improvements were specific to AI-enabled spokes (-27 min; 95% CI -62 to -4; p=0.029). EVT utilisation was also significantly higher in AI-enabled versus non-AI spokes where AI-enabled spokes had increased EVT rates by +17.8% (39.3% to 57.1%) compared with +1.1% in non-AI spokes (41.3% to 42.4%, P&lt;sub&gt;interaction&lt;/sub&gt;=0.006). DTP improvements were more pronounced at community hubs (86 (48-108) to 51 (22-77) min; adjusted difference -24.9 min; p=0.021, Q=0.041) compared with academic hubs (60 (23-87) to 55 (22-73) min; adjusted difference -15.5 min; p&lt;0.001, Q=0.002). Subgroup analyses demonstrated consistent DIDO benefits across age, stroke severity and sex strata with no significant treatment effect heterogeneity (all P-interaction &gt;0.05). Probabilistic cost analysis estimated savings of $3.6 million (95% CI $1.5M to $6.1M) per 1000 AI-enabled spoke transfers. Clinical outcomes, including functional status and mortality at discharge, were similar between groups (all Q&gt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Implementation of an AI-enabled triage platform was associated with significant reductions in workflow times and increased EVT utilisation, with effects specific to AI-enabled spokes rather than secular trends alone. The proportion of transfers who did not proceed to EVT decreased in AI-enabled spokes, though counterfactual outcomes for non-transferred patients remain unknown. Clinical outcomes at discharge were u","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}