Journal of Neurology, Neurosurgery, and Psychiatry最新文献

{"title":"Socioeconomic burden of AQP4-antibody seropositive NMOSD: a nationwide registry-based study.","authors":"Viktoria Papp, Malthe Wandall-Holm, Kristina Bacher Svendsen, Jette Frederiksen, Finn Sellebjerg, Zsolt Illes, Melinda Magyari","doi":"10.1136/jnnp-2024-333790","DOIUrl":"10.1136/jnnp-2024-333790","url":null,"abstract":"<p><strong>Background: </strong>AQP4-antibody seropositive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) may cause reduced work capability due to disability. Here, we evaluated the socioeconomic status of patients with AQP4-Ab+NMOSD in off-label therapy era compared with the general population.</p><p><strong>Methods: </strong>A longitudinal nationwide population-based study including all Danish patients with AQP4-Ab+NMOSD and matched controls from the general population. The cohort was linked to other Danish nationwide population-based databases. The study period was from 1992 to 2021. The main outcomes were loss of income from salary, limited work capability, disability pension and civil status. The longitudinal risks of outcomes were presented in cumulative incidence curves. Fisher's exact test, χ² test or Wilcoxon test were applied for comparison.</p><p><strong>Results: </strong>We included 65 patients with a median follow-up of 8.6 years. Annual income declined significantly after disease onset (index year) compared with the general population. One year after the index year, the median annual income in 2015-indexed Euro for patients averaged 13 285 (IQR: 139 to 36 336) versus controls 33 035 (IQR: 6870 to 45 978); p=0.04. Five years postindex year, the average income for patients further dropped to 276 (IQR: 0 to 23 691) versus controls 22 141 (IQR: 0 to 42 986); p=0.03. At the end of follow-up, significantly higher proportion of patients were either in 'flexjob' (36.9% patients vs 14% controls, p<0.00) or receiving disability pension (16.9% patients vs 4.3% controls, p<0.00).</p><p><strong>Conclusions: </strong>The socioeconomic status of patients with AQP4-Ab+NMOSD deteriorates rapidly following disease onset. A substantial proportion of these patients lose their work capacity leading to increased financial burden on both their families and society.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"184-187"},"PeriodicalIF":8.7,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748436","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":"C5 complement inhibition and FcRn modulation in generalized myasthenia gravis. Fast-acting but short-lived therapies the use of which should prompt assertive escalation of conventional treatments.","authors":"John McConville","doi":"10.1136/jnnp-2024-334584","DOIUrl":"https://doi.org/10.1136/jnnp-2024-334584","url":null,"abstract":"","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971276","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":"Efgartigimod efficacy and safety in refractory myasthenia gravis: UK's first real-world experience.","authors":"Joana Moniz Dionísio, Philip Ambrose, Georgina Burke, Maria Elena Farrugia, Pablo Garcia-Reitboeck, Channa Hewamadduma, Marguerite Hill, Robin S Howard, Saiju Jacob, Dimitri Kullmann, Maria Isabel Leite, James Miller, Ashwin Pinto, Jane Pritchard, Thomas Riswick, Sivakumar Sathasivam, Narmathey Thambirajah, Stuart Viegas, Fiona Norwood, Jennifer Spillane","doi":"10.1136/jnnp-2024-334086","DOIUrl":"https://doi.org/10.1136/jnnp-2024-334086","url":null,"abstract":"<p><strong>Background: </strong>We report our experience of patients with generalised myasthenia gravis (gMG) treated with efgartigimod, an neonatal Fc receptor antagonist, under the Early Access to Medicine Scheme (EAMS) in the UK.</p><p><strong>Methods: </strong>Data from all UK patients treated with efgartigimod under the EAMS July 2022 to July 2023 were collected retrospectively. Efgartigimod was administered as per the ADAPT protocol (consisting of a treatment cycle of four infusions at weekly intervals with further cycles given according to clinical need).</p><p><strong>Results: </strong>48 patients with acetylcholine receptor antibody-positive gMG were treated in 12 centres. Most (75%) were female and most had a disease duration of over 10 years. The average MG-Activities of Daily Living (ADL) score at baseline was 11.2. Most (72.9%) patients had undergone thymectomy. 77.0% were taking prednisolone at baseline. All patients had used non-steroidal immunosuppressant treatments, the average number tried was 2.6 (range 1-6). 51% had received rituximab. 54.2% of patients required regular intravenous immunoglobulin/plasma exchange.75% of patients had a mean reduction in the MG-ADL of≥2 points in the first cycle and this remained stable throughout the study. The mean intracycle reduction in the MG-ADL score in the first, second, third and fourth cycles were -4.6 to -3.9, -3.4 and -4.2, respectively. Side effects were generally mild. No rescue treatments were required. At the end of the study, 96% of patients remained on efgartigimod.</p><p><strong>Conclusion: </strong>Efgartigimod is a safe and effective treatment for patients with refractory, treatment-resistant gMG.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971253","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":"C5 complement inhibition versus FcRn modulation in generalised myasthenia gravis.","authors":"Niklas Huntemann, Lea Gerischer, Meret Herdick, Christopher Nelke, Frauke Stascheit, Sarah Hoffmann, Menekse Öztürk, Christina B Schroeter, Sophie Lehnerer, Maike Stein, Charlotte Schubert, Christiane Schneider-Gold, Steffen Pfeuffer, Heidrun H Krämer, Franz Felix Konen, Thomas Skripuletz, Marc Pawlitzki, Stefanie Glaubitz, Jana Zschüntzsch, Valerie Scherwietes, Andreas Totzeck, Tim Hagenacker, Sven G Meuth, Andreas Meisel, Tobias Ruck","doi":"10.1136/jnnp-2024-334404","DOIUrl":"https://doi.org/10.1136/jnnp-2024-334404","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions, leading to fluctuating muscle weakness. While many patients respond well to standard immunosuppression, a substantial subgroup faces ongoing disease activity. Emerging treatments such as complement factor C5 inhibition (C5IT) and neonatal Fc receptor (FcRn) antagonism hold promise for these patients. However, the current landscape is hindered by a paucity of comparative data that is crucial for treatment decisions.</p><p><strong>Objective: </strong>This study aims to compare the effectiveness and safety of C5IT and FcRn antagonists in a real-world setting.</p><p><strong>Methods: </strong>A retrospective analysis of 153 MG patients from 8 German specialised MG centres receiving either C5IT (26 eculizumab, 80 ravulizumab) or efgartigimod (47 patients) was conducted. Propensity score matching (PSM) was employed to compare changes in MG-specific outcome parameters within the first 6 months after treatment initiation, along with safety profiles and concomitant MG therapy.</p><p><strong>Results: </strong>Both treatment strategies led to rapid clinical improvements and substantial reductions in prednisolone doses. However, insufficient response was noted in 20%-49.1% of patients based on Quantitative MG and MG Activities of Daily Living (MG-ADL) scores. We did not identify any new safety concerns. After PSM, 40 patients remained in each group. In both cohorts, reductions in MG-ADL as prespecified primary study endpoint were comparable. Moreover, analyses of secondary outcome parameters demonstrated similar results for C5IT versus FcRn.</p><p><strong>Conclusion: </strong>In contrast to current meta-analyses and indirect comparisons of clinical trial data, our real-world study demonstrates comparable efficacy and safety of C5IT and FcRn antagonism in MG.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971278","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":"Depression and dementia: interrogating the causality of the relationship.","authors":"Alvar Paris, Guru Amirthalingam, Tasvee Karania, Isabelle F Foote, Ruth Dobson, Alastair J Noyce, Charles R Marshall, Sheena Waters","doi":"10.1136/jnnp-2024-334675","DOIUrl":"https://doi.org/10.1136/jnnp-2024-334675","url":null,"abstract":"<p><strong>Background: </strong>Depression is often cited as a major modifiable risk factor for dementia, though the relative contributions of a true causal relationship, reverse causality and confounding factors remain unclear. This study applied a subset of the Bradford Hill criteria for causation to depression and dementia including strength of effect, specificity, temporality, biological gradient and coherence.</p><p><strong>Methods: </strong>A total of 491 557 participants in UK Biobank aged between 40 and 69 at enrolment and followed up for a mean duration of 12.4 years were studied. Diagnoses of depression and dementia were ascertained from linked health records, self-reports and death certificate registration. Depressive symptoms were measured at enrolment using a combination of questions based on the Patient Health Questionnaire-9 depression screening questionnaire. Regional grey matter volumes were measured using T1-weighted MRI in 41 929 participants.</p><p><strong>Results: </strong>Depression was a strong risk factor for incident dementia with an OR of 1.76 (95% CI 1.63 to 1.90), a relationship which was found to be specific to depression rather than commonly proposed confounders. Depressive symptoms increased rapidly in the 10 years prior to dementia diagnosis. The severity of depressive symptoms showed a dose-response relationship with dementia risk. Depression at older ages correlated with reduced grey matter volume in an Alzheimer's pattern whereas younger onset depression was associated with reduced grey matter volume in the frontal lobes and cerebellum.</p><p><strong>Conclusions: </strong>This study provides evidence that the link between depression and dementia is due to reverse causation with a smaller component of causation with clear evidence of both mechanisms driving the association.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971280","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":"Real-world multicentre cohort study on choices and effectiveness of immunotherapies in NMOSD and MOGAD.","authors":"Vivien Häußler, Corinna Trebst, Daniel Engels, Hanna Pellkofer, Joachim Havla, Ankelien Duchow, Patrick Schindler, Carolin Schwake, Thivya Pakeerathan, Katinka Fischer, Marius Ringelstein, Gero Lindenblatt, Martin W Hümmert, Daria Tkachenko, Franziska Bütow, Katrin Giglhuber, Martina Flaskamp, Insa Schiffmann, Mirjam Korporal-Kuhnke, Sven Jarius, Eva Dawin, Lisa Revie, Makbule Senel, Mariella Herfurth, Annette Walter, Mosche Pompsch, Ingo Kleiter, Klemens Angstwurm, Matthias Kaste, Matthias Grothe, Jonathan Wickel, Paulus Stefan Rommer, Jörn Peter Sieb, Markus Krämer, Florian Then Bergh, Hayrettin Tumani, Luisa Klotz, Brigitte Wildemann, Orhan Aktas, Ilya Ayzenberg, Judith Bellmann-Strobl, Friedemann Paul, Tania Kümpfel, Tim Friede, Achim Berthele, Jan-Patrick Stellmann","doi":"10.1136/jnnp-2024-334764","DOIUrl":"10.1136/jnnp-2024-334764","url":null,"abstract":"<p><strong>Background: </strong>Recurrent attacks in neuromyelitis optica spectrum disorders (NMOSDs) or myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can lead to severe disability. We aimed to analyse the real-world use of immunotherapies in patients with NMOSD and MOGAD, focusing on changes in treatment strategies, effects on attack rates (ARR) and risk factors for attacks.</p><p><strong>Methods: </strong>This longitudinal registry-based cohort study included 493 patients (320 with aquaporin-4 immunoglobulin G (AQP4-IgG) seropositive NMOSD (65%), 44 with AQP4-IgG seronegative NMOSD (9%) and 129 MOGAD (26%)) with 1247 treatments from 19 German and one Austrian centre from the registry of the neuromyelitis optica study group (NEMOS). We analysed unadjusted ARR and implemented survival analyses and Cox proportional hazard regression to assess efficiency and risk factors for subsequent attacks over time.</p><p><strong>Results: </strong>Rituximab and azathioprine are the most widely used immunotherapies in NMOSD as well as in MOGAD, with changes in distribution over the last decade. Immunotherapy demonstrated significant therapeutic effects in NMOSD but less pronounced effects in MOGAD. Risk factors for attacks included younger age and prior attacks under the same therapy. Efficacy varied among the different immunotherapies, with azathioprine, rituximab and eculizumab showing significant risk reductions in AQP4-IgG seropositive NMOSD.</p><p><strong>Conclusions: </strong>This study provides insights into the evolving treatment landscape and effectiveness of immunotherapies in NMOSD and MOGAD. Established off-label therapies continue to play an important role, especially for patients with stable disease, with emerging evidence supporting newly approved therapies. Future studies are needed to refine treatment algorithms and address the ongoing uncertainties in MOGAD management.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895447","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":"Long-term exposure to multiple air pollutants and risk of Parkinson's disease: a population-based multipollutant model study.","authors":"Szu-Ju Chen, Shih-Chun Pan, Chih-Da Wu, Hsun Li, Yue Leon Guo, Chin-Hsien Lin","doi":"10.1136/jnnp-2024-334825","DOIUrl":"10.1136/jnnp-2024-334825","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests brain-first Parkinson's disease (PD) may start from the olfactory system, indicating potential inhalational exposure to causal agents. We investigated the impact of long-term exposure to various air pollutants on PD incidence using both single- and multi-pollutant models to account for interactions between pollutants.</p><p><strong>Methods: </strong>This retrospective population study used data from Taiwan's National Health Insurance Research Database (2006 and 2018) and included individuals aged 40-65 without PD. Personal exposure levels to various air pollutants, including PM_2.5, PM₁₀, NO₂, O₃, SO₂ and CO, were calculated using the hybrid Kriging/land-use regression method. Cox regression models were used to analyse the association between pollutants and PD incidence, adjusting for covariates.</p><p><strong>Results: </strong>A total of 5 113 322 individuals without PD (mean age 50.1±6.9 years, 47.3% men) were followed for an average of 11.2±2.4 years, during which 20 694 incident cases of PD were identified. In the single-pollutant model, exposure to PM_2.5 (HR 2.65 (95% CI 2.59 to 2.72)), PM₁₀ (HR 3.13 (3.04 to 3.22)), NO₂ (HR 1.74 (1.68 to 1.80)) and SO₂ (HR 1.68 (1.65 to 1.71)) was associated with an increased risk of PD. These associations remained robust in the multipollutant model. A positive association between exposure to O₃ and an increased risk of PD (HR 1.29 (1.25-1.33)) was observed after adjusting for co-pollutants.</p><p><strong>Conclusions: </strong>This nationwide cohort study employing multiple-pollutant models for considering the interaction effects revealed an association between exposure to multiple air pollutants and the risk of PD, emphasising the need for early prevention strategies.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895443","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":"Left atrial appendage occlusion in patients with atrial fibrillation and intracerebral haemorrhage associated with cerebral amyloid angiopathy: a multicentre observational study and pooled analysis of published studies.","authors":"Kitti Thiankhaw, Jonathan Best, Sonal Srivastava, Ishika Prachee, Smriti Agarwal, Serena Tan, Patrick A Calvert, Asim Chughtai, Richard Ang, Oliver R Segal, David J Werring","doi":"10.1136/jnnp-2024-334718","DOIUrl":"https://doi.org/10.1136/jnnp-2024-334718","url":null,"abstract":"<p><strong>Background: </strong>Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO.</p><p><strong>Methods: </strong>We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis.</p><p><strong>Results: </strong>We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35-74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively.</p><p><strong>Conclusions: </strong>LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population.</p><p><strong>Prospero registration number: </strong>CRD42023415354.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854476","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":"How well do plasma Alzheimer's disease biomarkers reflect the CSF amyloid status?","authors":"Jemma Hazan, Emily Abel, Miguel Rosa Grilo, Deborah Alawode, Ines Laranjinha, Amanda J Heslegrave, Kathy Y Liu, Jonathan M Schott, Robert Howard, Henrik Zetterberg, Nick C Fox","doi":"10.1136/jnnp-2024-334122","DOIUrl":"https://doi.org/10.1136/jnnp-2024-334122","url":null,"abstract":"<p><strong>Background: </strong>Can plasma biomarkers as well as cerebrospinal fluid (CSF) perform in the separation of amyloid-beta-positive (Aβ+) vs amyloid-beta-negative (Aβ-) groups across an age range seen in an NHS cognitive disorder clinic?</p><p><strong>Methods: </strong>As part of the routine diagnostic investigation of 111 clinic patients who had contemporaneous blood and CSF samples taken, patients were categorised into Aβ+ and Aβ- groups based on their CSF in an Aβ42/40 ratio. We then evaluated four single molecule array (Simoa) Quanterix assays, quantifying single plasma analytes and ratios (p-tau217, p-tau217/Aβ42 ratio, p-tau181, p-tau181/Aβ42 ratio and Aβ42/40 ratio) in their ability to distinguish between these groups and the effect of age.</p><p><strong>Results: </strong>The median (range) age of participants was 66 (55-79) years with 48 females (43.2%). The areas under the curve (AUC), not accounting for age, for the ability to discriminate Aβ+ from Aβ- groups were plasma p-tau217 AUC=0.94, Aβ42/40 AUC=0.78 and p-tau181 AUC=0.77. Combining p-tau217/Aβ42 increased the AUC to 0.97. The difference between the groups was influenced by age with less separation in older individuals: a significant negative interaction term between age and group for plasma p-tau217 concentrations (-0.037, p=0.013) and p-tau217/Aβ42 ratio (-0.007, p=0.008).</p><p><strong>Conclusions: </strong>There was variable performance of plasma biomarkers to recapitulate the CSF assay. Both p-tau217 and p-tau217/Aβ42 showed excellent promise as surrogates of CSF amyloid status, although with slightly reduced performance in older individuals. There was poorer discriminatory ability for p-tau181 and Aβ42/40. Further research is needed to address potential age-related confounds.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854456","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":"Optical coherence tomography in secondary progressive multiple sclerosis: cross-sectional and longitudinal exploratory analysis from the MS-SMART randomised controlled trial.","authors":"Floriana De Angelis, James R Cameron, Arman Eshaghi, Richard Parker, Peter Connick, Jonathan Stutters, Domenico Plantone, Anisha Doshi, Nevin John, Thomas Williams, Alberto Calvi, David MacManus, Frederik Barkhof, Siddharthan Chandran, Christopher J Weir, Ahmed Toosy, Jeremy Chataway","doi":"10.1136/jnnp-2024-334801","DOIUrl":"https://doi.org/10.1136/jnnp-2024-334801","url":null,"abstract":"<p><strong>Background: </strong>Optical coherence tomography (OCT) inner retinal metrics reflect neurodegeneration in multiple sclerosis (MS). We explored OCT measures as biomarkers of disease severity in secondary progressive MS (SPMS).</p><p><strong>Methods: </strong>We investigated people with SPMS from the Multiple Sclerosis-Secondary Progressive Multi-Arm Randomisation Trial OCT substudy, analysing brain MRIs, clinical assessments and OCT at baseline and 96 weeks. We measured peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses. Statistical analysis included correlations, multivariable linear regressions and mixed-effects models.</p><p><strong>Results: </strong>Of the 212 participants recruited at baseline, 192 attended at 96 weeks follow-up. Baseline pRNFL and GCIPL thickness correlated with Symbol Digit Modalities Test (SDMT) (respectively, r=0.33 (95% CI 0.20 to 0.47); r=0.39 (0.26 to 0.51)) and deep grey matter volume (respectively, r=0.21 (0.07 to 0.35); r=0.28 (0.14 to 0.41)).pRNFL was associated with Expanded Disability Status Scale (EDSS) score change (normalised beta (B)=-0.12 (-0.23 to -0.01)). Baseline pRNFL and GCIPL were associated with Timed 25-Foot Walk change (T25FW) (respectively, B=-0.14 (-0.25 to -0.03); B=-0.20 (-0.31 to -0.10)) and 96-week percentage brain volume change (respectively, B=0.14 (0.03 to 0.25); B=0.23 (0.12 to 0.34)). There were significant annualised thinning rates: pRNFL (-0.83 µm/year) and GCIPL (-0.37 µm/year).</p><p><strong>Conclusions: </strong>In our cohort of people with SPMS and long disease duration, OCT measures correlated with SDMT and deep grey matter volume at baseline; EDSS, T25FW and whole brain volume change at follow-up.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854480","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}