Journal of Neurology, Neurosurgery, and Psychiatry最新文献

{"title":"Biopsy-proven PACNS: results from the large, multicentre cohort of cerebral vasculitis patients.","authors":"Milani Deb-Chatterji, Parnia Aghel, Hans Pinnschmidt, Christina Krüger, Juliane Herm, Julia Layer, Hebun Erdur, Felix J Bode, Christian H Nolte, Tim Magnus","doi":"10.1136/jnnp-2025-335764","DOIUrl":"10.1136/jnnp-2025-335764","url":null,"abstract":"<p><strong>Background: </strong>Reports of primary angiitis of the central nervous system (PACNS) are mainly restricted to clinically suspected cases, but biopsy-proven ones are rare. Here, we present results from a large multicentre cohort of patients with biopsy-proven PACNS (BP-PACNS). In particular, we provide insights into characteristics and treatment responses of PACNS subtypes.</p><p><strong>Methods: </strong>BP-PACNS patients treated between 1999 and 2021 were analysed. The outcome was assessed by the modified Rankin Scale (mRS). Between-group comparisons were performed by Kruskal-Wallis, χ² or Fisher's exact tests.</p><p><strong>Results: </strong>In total, 57 patients were analysed (52% male). Of these, n=37 (65%) had a lymphocytic (L-PACNS), n=9 (16%) an amyloid-beta-related angiitis (ABRA), n=8 (14%) a granulomatous (G-PACNS) and n=3 (5%) a necrotising (N-PACNS) PACNS subtype. At the time of diagnosis, age differed significantly between groups (median age (years) L-PACNS 47, ABRA 64.5, G-PACNS 37, N-PACNS 65; p=0.008). The clinical course was mostly monophasic in L-PACNS and ABRA (65% and 75%, respectively), while relapsing-remitting in G-PACNS (63%). Median mRS at last follow up was 2 (IQR 1.25-4) in the study group. Worst outcome (median mRS 4) and highest mortality (25%) were seen in G-PACNS. Good induction treatment response was achieved in 77% of all BP-PACNS patients but was low in those with G-PACNS (29%).</p><p><strong>Conclusions: </strong>In this large, multicentre series of BP-PACNS patients, G-PACNS had a worse functional outcome, a predominant relapsing-remitting disease and a poorer response to the induction therapy. An optimal first-line treatment regimen for G-PACNS patients should be further examined and established in larger studies to improve the outcome of G-PACNS patients.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"825-831"},"PeriodicalIF":7.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266352","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":"Self-silencing <i>GFAP</i> missense alleles in familial subclinical Alexander disease: implications for therapy.","authors":"Tiziana Bachetti, Stefania Magri, Francesca Balistreri, Francesca Rosamilia, Simona Coco, Camillo Rosano, Marco Moscatelli, Elisa Sarto, Daniela Di Bella, Ettore Salsano, Isabella Ceccherini, Franco Taroni","doi":"10.1136/jnnp-2025-335863","DOIUrl":"10.1136/jnnp-2025-335863","url":null,"abstract":"","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"912-914"},"PeriodicalIF":7.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187186","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":"Impact of fish consumption on disability progression in multiple sclerosis.","authors":"Eva Johansson, Jie Guo, Jing Wu, Tomas Olsson, Lars Alfredsson, Anna Karin Hedström","doi":"10.1136/jnnp-2024-335200","DOIUrl":"10.1136/jnnp-2024-335200","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence indicates that diet, including fish consumption, may play a role in the development and progression of multiple sclerosis (MS). We aimed to investigate the influence of fish consumption on disability progression in MS.</p><p><strong>Methods: </strong>Incident cases from the population-based case-control study Epidemiological Investigation of MS (n=2719), with data on fish intake and Expanded Disability Status Scale (EDSS) outcomes, were categorised by fish consumption and followed up to 15 years post-diagnosis through the Swedish MS registry. A digital follow-up questionnaire in 2021 assessed changes in fish intake over time (n=1719). Cox regression models, adjusted for clinical and demographic variables, were used to evaluate 24-week confirmed disability worsening (CDW), and progression to EDSS 3 and EDSS 4.</p><p><strong>Results: </strong>Higher total consumption of lean and oily fish at diagnosis was associated with a reduced risk of CDW (HR 0.66, 95% CI 0.51 to 0.86), EDSS 3 (HR 0.55, 95% CI 0.39 to 0.79) and EDSS 4 (HR 0.57, 95% CI 0.33 to 0.96) compared with low consumption. These associations showed significant trends and remained consistent after further adjustment for various lifestyle factors. The protective effects were more pronounced among patients who maintained consistent fish consumption during the follow-up period.</p><p><strong>Conclusions: </strong>Our findings suggest that higher fish consumption is associated with more favourable MS disability progression, supporting diet as a potentially modifiable factor. Replication and validation are needed before transfer to practice.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"893-899"},"PeriodicalIF":7.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501931","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":"Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration.","authors":"Jeremy Molad, Kaori Miwa, Philip S Nash, Gareth Ambler, Jonathan Best, Duncan Wilson, Hen Hallevi, Simon Fandler-Höfler, Sebastian Eppinger, Houwei Du, Rustam Al-Shahi Salman, Hans R Jäger, Gregory Y H Lip, Martina B Goeldlin, Morin Beyeler, Philipp Bücke, Marwan El-Koussy, Heinrich Paul Mattle, Leonidas D Panos, Dianne H K van Dam-Nolen, Florian Dubost, Jeroen Hendrikse, M Eline Kooi, Werner Mess, Paul J Nederkoorn, Masayuki Shiozawa, Nicolas Christ, Maximilian Bellut, Sarah Gunkel, Christopher Karayiannis, John Van Ly, Shaloo Singhal, Lee-Anne Slater, Young Dae Kim, Tae-Jin Song, Keon-Joo Lee, Jae-Sung Lim, Hideo Hara, Masashi Nishihara, Jun Tanaka, Masaaki Yoshikawa, Derya Selcuk Demirelli, Zeynep Tanriverdi, Ender Uysal, Shelagh B Coutts, Francesca M Chappell, Stephen Makin, Henry Ka-Fung Mak, Kay Cheong Teo, Debbie Y K Wong, Lisa Hert, Marta Kubacka, Philippe Lyrer, Alexandros A Polymeris, Benjamin Wagner, Annaelle Zietz, Jill M Abrigo, Cyrus Cheng, Winnie C W Chu, Thomas W H Leung, Suk Fung Tsang, Brian Yiu, David J Seiffge, Urs Fischer, Simon Jung, Christian Enzinger, Thomas Gattringer, Daniel Bos, Kazunori Toyoda, Felix Fluri, Thanh G Phan, Velandai Srikanth, Ji Hoe Heo, Hee-Joon Bae, Yusuke Yakushiji, Dilek Necioglu Orken, Eric E Smith, Joanna M Wardlaw, Kui Kai Lau, Stefan T Engelter, Nils Peters, Yannie Soo, David C Wheeler, Robert J Simister, Natan M Bornstein, David J Werring, Einor Ben Assayag, Masatoshi Koga","doi":"10.1136/jnnp-2024-335110","DOIUrl":"10.1136/jnnp-2024-335110","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.</p><p><strong>Methods: </strong>We used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity.</p><p><strong>Results: </strong>11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) -2.10 mL/min/1.73 cm² (95% CI -3.39 to -0.81)) and mixed microbleeds (aMD -2.42 (95% CI -3.70 to -1.15)), but not strictly deep microbleeds (aMD -0.67 (95% CI -1.85 to 0.51)).</p><p><strong>Conclusions: </strong>In patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"842-851"},"PeriodicalIF":7.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006978","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":"Glucagon-like peptide-1 receptor agonists for major neurocognitive disorders.","authors":"Riccardo De Giorgi, Ana Ghenciulescu, Courtney Yotter, Maxime Taquet, Ivan Koychev","doi":"10.1136/jnnp-2024-335593","DOIUrl":"10.1136/jnnp-2024-335593","url":null,"abstract":"<p><p>Disease-modifying treatments for major neurocognitive disorders, including Alzheimer's disease, Parkinson's disease and other cognitive deficits, are among the main unmet needs in modern medicine. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), currently licensed for the treatment of type 2 diabetes mellitus and obesity, offer a novel, multilayered mechanism for intervention in neurodegeneration through intermediate, aetiology-agnostic pathways, likely involving metabolic, inflammatory and several other relevant neurobiological processes. In vitro and animal studies have revealed promising signals of neuroprotection, with preliminary supportive evidence emerging from recent pharmacoepidemiological investigations and clinical trials. In this article, we comprehensively review studies that investigate the impact of GLP-1RAs on the various aetiologies of cognitive impairment and dementia syndromes. Focusing on evidence from human studies, we highlight how brain energy homeostasis, neurogenesis, synaptic functioning, neuroinflammation and other cellular stress responses, pathological protein aggregates, proteostasis, cerebrovascular system and blood-brain barrier dynamics may underlie GLP-1RA putative neuroprotective effects. We then report and appraise evidence from clinical studies, including observational investigations, clinical trials and pooled analyses. Finally, we discuss current challenges and perspectives ahead for research and clinical implementation of GLP-1RAs for the care of people with major neurocognitive disorders, including their individual brain penetrance potential, the need for response biomarkers and disease stage-based indications, their possible non-specific effects on brain health, their profile in terms of adverse events and other unwanted effects, the lack of long-term data for efficacy and safety, and issues surrounding cost and availability of treatment.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"870-883"},"PeriodicalIF":7.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000001","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":"Predictors of early disability accumulation in newly diagnosed multiple sclerosis: clinical, imaging and cerebrospinal fluid measures.","authors":"Markus Lauerer, Tun Wiltgen, Carolin Brückner, Christina Engl, Katrin Giglhuber, Sebastian Lambrecht, Viola Pongratz, Achim Berthele, Christiane Gasperi, Jan S Kirschke, Claus Zimmer, Bernhard Hemmer, Mark Mühlau","doi":"10.1136/jnnp-2024-335037","DOIUrl":"10.1136/jnnp-2024-335037","url":null,"abstract":"<p><strong>Background: </strong>A growing arsenal of treatment options for relapsing multiple sclerosis (RMS) emphasises the need for early prognostic biomarkers. While evidence for individual markers exists, comprehensive analyses at the time of diagnosis are sparse.</p><p><strong>Methods: </strong>Brain and spinal cord lesion numbers, cerebrospinal fluid parameters, initial symptoms, and Expanded Disability Status Scale (EDSS) score were determined at the time of diagnosis. Confirmed disability accumulation (CDA), defined as a sustained EDSS increase over 6 months, was determined during a 5-year follow-up. All-subsets multivariable logistic regression was performed to identify predictors of CDA. Model performance was assessed via receiver operating characteristic analysis, and individual risks were calculated. Analyses were repeated with progression independent of relapse activity (PIRA) as an outcome.</p><p><strong>Results: </strong>113/417 (27.1%) people with RMS experienced CDA on follow-up. Intrathecal IgG synthesis, a higher number of spinal cord lesions, age and polysymptomatic manifestation were identified as independent predictors of CDA. The resulting prediction model yielded an area under the curve (AUC) of 0.75 with a 95% CI of 0.70 to 0.80. Individuals exceeding the optimal thresholds for the three most significant predictors had a 61.8% likelihood of experiencing CDA, whereas those below all three thresholds had a CDA rate of 4.5%. The only significant baseline predictor differentiating PIRA from relapse-associated worsening was a higher number of spinal cord lesions (AUC=0.64, 95% CI 0.54 to 0.74).</p><p><strong>Conclusions: </strong>Intrathecal IgG synthesis, spinal cord lesion number, age and polysymptomatic manifestation are independent predictors of early CDA in newly diagnosed RMS.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"900-907"},"PeriodicalIF":7.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441192","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":"PACNS: biopsy positive, negative or nought?","authors":"William Powers","doi":"10.1136/jnnp-2025-336655","DOIUrl":"10.1136/jnnp-2025-336655","url":null,"abstract":"","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"823-824"},"PeriodicalIF":7.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266353","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":"From the past to the present: evolving theories in the pathophysiology of normal pressure hydrocephalus.","authors":"Adela Bubenikova, Viktor Procházka, Dominik Vacínek, Kryštof Haratek, Petr Skalický, Martina Laczó, Jan Laczó, Aleš Vlasák, Róbert Leško, Arnošt Mládek, Ondřej Bradáč","doi":"10.1136/jnnp-2025-336076","DOIUrl":"https://doi.org/10.1136/jnnp-2025-336076","url":null,"abstract":"<p><p>Over recent decades, various hypotheses and theoretical frameworks have been advanced to elucidate the aetiology of normal pressure hydrocephalus (NPH). This reversible neurological condition, characterised by the classical clinical triad of gait disturbance, urinary incontinence and cognitive impairment, represents a multifactorial interplay of pathophysiological processes that co-occur, rather than originating from a single, defined cause. Despite extensive research efforts, the precise aetiology and underlying pathophysiological pathways remain indeterminate. Contributory factors such as dysfunction of the glymphatic system, diminished arterial pulsatility, metabolic and osmotic dysregulation, astrogliosis and neuroinflammatory processes are acknowledged as critical in the pathogenesis of NPH. Recent advancements in the understanding of these pathophysiological aberrations have substantially refined the conceptualisation of the NPH phenotype, enhancing the predictive accuracy for cerebrospinal fluid diversion interventions. This review addresses the definition and classification of NPH and emphasises future research directions aimed at further elucidating the molecular and physiological mechanisms underlying the disease. A comprehensive understanding of this syndrome is critical for informed clinical decision-making and optimising therapeutic outcomes. With the global increase in ageing populations, accurately differentiating NPH from other neurodegenerative disorders and managing overlapping comorbidities has become increasingly significant.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753617","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":"Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years.","authors":"Jodie I Roberts, Sifat Sharmin, Dana Horakova, Eva Kubala Havrdova, Serkan Ozakbas, Alessandra Lugaresi, Valentina Tomassini, Raed Alroughani, Katherine Buzzard, Olga Skibina, Cavit Boz, Recai Turkoglu, Davide Maimone, Bassem Yamout, Samia Joseph Khoury, Daniele Spitaleri, Jeannette Lechner-Scott, Marc Girard, Pierre Duquette, Abdullah Al-Asmi, Radek Ampapa, Matteo Foschi, Andrea Surcinelli, Francesco Patti, Vincent Van Pesch, Cristina Ramo-Tello, José Luis Sánchez-Menoyo, Ayse Altintas, Pierre Grammond, Elisabetta Cartechini, Tunde Csepany, Guy Laureys, Barbara Willekens, Izanne Roos, Tomas Kalincik, MSBase Study Group","doi":"10.1136/jnnp-2025-336343","DOIUrl":"https://doi.org/10.1136/jnnp-2025-336343","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroid treatment of multiple sclerosis (MS) relapses is assumed to improve the speed of relapse recovery, without modifying long-term disability risk. We aimed to re-evaluate this assumption in a large cohort of individuals with MS.</p><p><strong>Methods: </strong>Individuals with clinically definite MS and ≥3 Expanded Disability Status Scale (EDSS) measurements over ≥12 months were identified within the international neuroimmunology registry MSBase. Individuals were required to have ≥1 relapse, with complete information on relapse treatment, phenotype and severity for all documented relapses. The primary outcome was disability worsening confirmed over 12 months. The association of the cumulative number of steroid-treated and untreated relapses (as a time-varying exposure) with disability worsening was evaluated with Cox proportional hazards.</p><p><strong>Results: </strong>In total, 3673 individuals met the inclusion criteria (71% female, mean age 38 years, mean disability EDSS step 2); 5809 relapses (4671 treated/1138 untreated) were captured (annualised relapse rate 0.19). Over the study period (total 30 175 person-years), 32.7% reached the outcome of confirmed disability worsening (median survival time 5.2 years). Non-treated relapses were associated with a higher risk of disability worsening (HR 1.72, 95% CI 1.57 to 1.88) than steroid-treated relapses (HR 1.50, 95% CI 1.43 to 1.57). This association was modified by the efficacy of disease-modifying therapy at the time of relapse.</p><p><strong>Conclusions: </strong>Our results suggest that a lack of steroid treatment of MS relapses is associated with a higher risk of future disability worsening. Hence, corticosteroid treatment of MS relapses may impact not only the speed of recovery but also the severity of residual structural damage.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731848","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":"Early post-deep brain stimulation psychiatric adverse events in Parkinson's disease: a narrative review.","authors":"Arteen Ahmed, Matthew Butler, Camille Wratten, Keyoumars Ashkan, David Okai, Michael Samuel, Paul Shotbolt","doi":"10.1136/jnnp-2024-335649","DOIUrl":"https://doi.org/10.1136/jnnp-2024-335649","url":null,"abstract":"<p><p>Deep brain stimulation (DBS) is a surgical treatment for medication-resistant motor symptoms in Parkinson's disease (PD), involving the implantation of electrodes in subcortical targets, primarily the subthalamic nucleus (STN) and internal globus pallidus (GPi). While DBS is effective for motor control, psychiatric factors significantly impact postoperative quality of life. This narrative review aimed to summarise early (<2 weeks) psychiatric adverse events (AEs) following DBS in PD, addressing the prevalence of these events, their effects on pre-existing psychiatric symptoms and the influence of targeting and DBS parameters on these symptoms. A comprehensive search was performed across multiple databases, identifying 148 relevant studies, among which 55 focused on early psychiatric outcomes. Methodological diversity was noted, with 97% of studies concentrating on bilateral STN DBS. Our findings indicate that early postoperative psychiatric AEs are common, primarily occurring within days postsurgery and often transient. These AEs show improvement with parametric adjustments or the introduction of psychiatric medications. Notably, the role of the STN and GPi extends beyond motor control to emotional regulation, emphasising the importance of monitoring psychiatric outcomes in DBS patients. This review highlights the need for increased awareness and management strategies for early psychiatric complications in the context of DBS therapy, ultimately contributing to enhanced patient care and outcomes in advanced PD stages. Future studies should focus on standardising the evaluation of psychiatric AEs and exploring preventive strategies to minimise their occurrence post-DBS. PROSPERO registration number CRD42020184000.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707804","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}