Journal of the Neurological Sciences最新文献

{"title":"Solving gaps in clinical reasoning is the cure to neurophobia in artificial intelligence","authors":"Ethan Meltzer","doi":"10.1016/j.jns.2025.125672","DOIUrl":"10.1016/j.jns.2025.125672","url":null,"abstract":"<div><div>Background and Objectives: This is an observational study that assesses the clinical reasoning of an artificial intelligence chatbot using previously published cases. The primary objective of the study is to assess the unique challenges neurologic cases pose to machine large language models (LLMs) in clinical practice in the context of human errors in clinical reasoning. Methods: This observational study tested the accuracy of GPT-4o, an artificial intelligence-powered chatbot, in generating a differential diagnosis for a series of 29 cases. The cases were presented in two formats, one as the full protocol with all detailed information, and a second clinical syndrome with information distilled via clinical reasoning into core features of pace and localization. The primary outcome was comparison of GPT-4o diagnostic accuracy when given all clinical information versus the distilled clinical syndrome. Results: GPT-4o performed equally as well or better when provided the clinical syndrome versus the full protocol for every of the 29 cases provided. The overall accuracy improved from approximately 76 % to 97 % when given the clinical syndrome, and the overall rank of the correct diagnosis within the differential generated was equal or better for every clinical syndrome compared to the full case protocol. Discussion: Our study demonstrates that clinical reasoning remains a major barrier in diagnostic accuracy in artificial intelligence just as it is mirrored in human trainees. Focusing training not just on knowledge, but on clinical reasoning, has the potential to improve performance of machine LLMs and learners alike dramatically.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 125672"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the letter to the editor: Commentary on “Association between plasma 25-hydroxyvitamin D concentration and incident disabling dementia risk in Japan: A case-cohort study”","authors":"Yukai Lu ,&nbsp;Taiki Yamaji ,&nbsp;Nobufumi Yasuda ,&nbsp;Aya Kuchiba ,&nbsp;Yoko Shimizu ,&nbsp;Shiori Nakano ,&nbsp;Kazumasa Yamagishi ,&nbsp;Manami Inoue ,&nbsp;Shoichiro Tsugane ,&nbsp;Norie Sawada ,&nbsp;Motoki Iwasaki ,&nbsp;the Japan Public Health Center-based Prospective Study Group","doi":"10.1016/j.jns.2025.125660","DOIUrl":"10.1016/j.jns.2025.125660","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 125660"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinically visible but often unperceived: Low awareness of fasciculations in amyotrophic lateral sclerosis","authors":"Keiichi Hokkoku ,&nbsp;Masato Inoue ,&nbsp;Saya Yamada ,&nbsp;Hiroto Namba ,&nbsp;Kiyoshi Matsukura ,&nbsp;Taiji Mukai ,&nbsp;Takashi Chiba ,&nbsp;Yuki Hatanaka ,&nbsp;Shunsuke Kobayashi ,&nbsp;Masahiro Sonoo","doi":"10.1016/j.jns.2025.123764","DOIUrl":"10.1016/j.jns.2025.123764","url":null,"abstract":"<div><h3>Background</h3><div>Fasciculations are a key clinical sign of amyotrophic lateral sclerosis (ALS) but also occur in other conditions such as benign fasciculation syndrome. Patients often present with perceived twitching fearing ALS; however, the extent to which ALS patients themselves perceive fasciculations has not been systematically examined. We therefore aimed to clarify how often ALS patients are aware of fasciculations that are clinically visible.</div></div><div><h3>Methods</h3><div>We prospectively studied 34 ALS patients. First, a structured questionnaire assessed initial symptoms, chief complaints, and awareness of twitching. Then, the frequency and concordance between objective fasciculations and subjective awareness of fasciculations (twitching) were analyzed across five body regions (bilateral upper and lower limbs and trunk) based on simultaneous visual observation and patient reports.</div></div><div><h3>Results</h3><div>In the questionnaire, only one of the 34 patients (3 %) reported twitching as the initial symptom, and none presented with twitching as the chief complaint. More than half (19, 56 %) had never noticed twitching. In the fasciculation analysis, patients showing objective fasciculations without subjective awareness were most common (21/34, 62 %), whereas those with objective fasciculations accompanied by subjective awareness were fewer (10/34, 29 %), indicating relatively low concordance between visible fasciculations and patient awareness. No patient exhibited subjective awareness without objective fasciculations. These findings suggest that the majority of visible fasciculations in ALS are not perceived by patients.</div></div><div><h3>Conclusion</h3><div>Fasciculations in ALS are rarely the initial or presenting symptom and are often unperceived by patients despite being clinically visible.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 123764"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145489055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: Association between plasma 25-hydroxyvitamin D concentration and incident disabling dementia risk in Japan: A case-cohort study","authors":"Xia Zhou ,&nbsp;Shuya Zhou ,&nbsp;Liuying Li","doi":"10.1016/j.jns.2025.125661","DOIUrl":"10.1016/j.jns.2025.125661","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 125661"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tribute to professor mark Hallett, MD (1943–2025): A legacy of science, mentorship, and humanity in global neurology","authors":"Tissa Wijeratne","doi":"10.1016/j.jns.2025.125655","DOIUrl":"10.1016/j.jns.2025.125655","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 125655"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment Letter on: “Clinical features and prognosis of postpartum lower extremity nerve injury: A four-year single-center experience in Israel”","authors":"Yujie Zhang ,&nbsp;Hui Li ,&nbsp;Shuangyang Li ,&nbsp;Xue Bai","doi":"10.1016/j.jns.2025.123736","DOIUrl":"10.1016/j.jns.2025.123736","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 123736"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: The role of blood-based biomarkers in Parkinsonian disorders, Alzheimer's disease and frontotemporal dementia","authors":"Chenyang Zhu ,&nbsp;Jianjiong Fu","doi":"10.1016/j.jns.2025.123749","DOIUrl":"10.1016/j.jns.2025.123749","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 123749"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between benzodiazepines and dementia: A case-control study from Canadian health surveys and medico-administrative databases","authors":"Diego Legrand ,&nbsp;Pasquale Roberge ,&nbsp;Alain Vanasse ,&nbsp;Nathalie Carrier ,&nbsp;Christian Bocti","doi":"10.1016/j.jns.2025.123746","DOIUrl":"10.1016/j.jns.2025.123746","url":null,"abstract":"<div><h3>Background</h3><div>Benzodiazepines (BZDs) are widely prescribed for insomnia and anxiety, but long-term use may accelerate cognitive decline. Evidence is inconsistent because prodromal dementia symptoms can prompt BZD prescriptions, creating reverse-causality bias.</div></div><div><h3>Objective</h3><div>Examine whether BZD exposure, duration and elimination half-life are independently associated with incident dementia, and explore confounding by the prodromal period.</div></div><div><h3>Method</h3><div>We performed a case-control study in the Torsade Cohort, derived from the Canadian Community Health Survey linked to health-administrative databases. BZD exposure, duration and half-life were analyzed with multivariate conditional logistic regression. Model 1 adjusted for dementia risk factors; Model 2 additionally adjusted for potential BZD indications (insomnia, anxiety, depression). To test prodromal effects, the index date was moved 1–10 years before diagnosis. Cases were adults ≥50 years with dementia; controls were matched on sex, age, follow-up and education.</div></div><div><h3>Results</h3><div>Among 1082 cases and 4262 controls, Model 1 showed that any BZD use was associated with dementia (OR 1.65, 95 % CI 1.42–1.93). Risk was higher with long half-life molecules (OR 2.81) than medium half-life (OR 1.57). In Model 2, chronic use (&gt;180 days) was linked to dementia only within four years before diagnosis.</div></div><div><h3>Conclusions</h3><div>BZD exposure is associated with increased dementia risk, strongest for long half-life agents. The restriction of chronic-use associations to the four-year prodrome suggests confounding by indication or reverse causality. These findings stress cautious, time-limited BZD prescribing in older adults.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 123746"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of cerebral vasospasm therapy on nimodipine exposure in subarachnoid hemorrhage: A population pharmacokinetic study","authors":"Adrien Foucher ,&nbsp;Matthieu Gregoire ,&nbsp;Jérôme E. Dauvergne ,&nbsp;Elodie Boissier ,&nbsp;Bertrand Rozec ,&nbsp;Guillaume Deslandes ,&nbsp;Karim Lakhal","doi":"10.1016/j.jns.2025.125666","DOIUrl":"10.1016/j.jns.2025.125666","url":null,"abstract":"<div><h3>Background</h3><div>To prevent delayed cerebral ischemia (DCI) following non-traumatic subarachnoid hemorrhage (SAH), nimodipine is often administered to adults at a fixed dosage, irrespective of potentially influencing clinical factors. This prospective observational study examined whether hemodynamic augmentation (induced arterial hypertension with or without IV-milrinone), used to prevent or treat vasospasm-related DCI, alters nimodipine plasma concentration ([Nimodipine]_plasma) − an unexplored pharmacokinetic aspect.</div></div><div><h3>Methods</h3><div>Adult patients with SAH receiving IV nimodipine for ≥12 h were prospectively included. Population pharmacokinetic analysis identified covariates influencing [Nimodipine]_plasma.</div></div><div><h3>Results</h3><div>Sixty-one patients were analyzed corresponding to 212 [Nimodipine]_plasma measurements: 51 patients (128 measurements) before potential vasospasm and 30 (84 measurements) during hemodynamic augmentation. Creatinine clearance was high and was even higher during hemodynamic augmentation therapy than before potential vasospasm (180 mL/min [IQR:134; 207] vs. 151 mL/min [IQR:120;184], <em>p</em> = 0.02). However, hemodynamic augmentation did not significantly affect total plasma protein level or [Nimodipine]_plasma.</div><div>Only body surface area (BSA), and mean arterial pressure (MAP) were retained as final covariates influencing [Nimodipine]_plasma in the final pharmacokinetic model, with BSA exerting a stronger and more consistent effect than MAP. Beyond MAP's own limited effect, hemodynamic augmentation therapy per se had no significant influence on nimodipine clearance.</div></div><div><h3>Conclusions</h3><div>Hemodynamic augmentation therapy per se did not significantly affect [Nimodipine]_plasma in contrast to patient's BSA, and, to a clinically irrelevant extent, MAP level.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 125666"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early improvement in vertigo intensity after subacute infratentorial infarction relates to vestibulocerebellar network damage and balance recovery: A retrospective disconnectome study","authors":"Shingo Hirano ,&nbsp;Tatsuya Igarashi ,&nbsp;Atsushi Kawaguchi ,&nbsp;Maiko Sakamoto ,&nbsp;Hisato Nakazono ,&nbsp;Takanori Taniguchi ,&nbsp;Hiroyuki Inooka ,&nbsp;Tsubasa Mitsutake","doi":"10.1016/j.jns.2025.125663","DOIUrl":"10.1016/j.jns.2025.125663","url":null,"abstract":"<div><h3>Background</h3><div>Central vertigo frequently occurs in patients with stroke and is associated with impaired activities of daily living and fall risk. However, the neural substrates underlying recovery, their relationship with balance, and longitudinal changes remain unclear. We applied structural disconnectome analysis to clarify whether improvement in vertigo relates to infratentorial white-matter tract damage and balance gains.</div></div><div><h3>Methods</h3><div>We retrospectively studied 30 inpatients with subacute infratentorial ischemic stroke who reported vertigo (Numeric Rating Scale [NRS] ≥1) at admission (12 men, mean age 68.5 ± 14.2 years). Diffusion-weighted imaging at admission quantified percent damage across 17 infratentorial white-matter tracts using the Lesion Quantification Toolkit. Vertigo severity (NRS) and balance (Berg Balance Scale [BBS]) were measured at admission and at 1 month; NRS improvement and BBS change (ΔBBS) were calculated. Patients were classified as improved-vertigo (NRS = 0 at 1 month; <em>n</em> = 15) or residual-vertigo (NRS ≥1; n = 15).</div></div><div><h3>Results</h3><div>Relative to the improved-vertigo group, the residual-vertigo group showed higher percent damage in the cerebellar vermis, cerebellar hemispheres, and inferior cerebellar peduncle. Damage in the vermis and hemispheres correlated positively with NRS at admission and follow-up and negatively with NRS improvement. Inferior cerebellar peduncle damage correlated positively with admission NRS and negatively with NRS improvement. Within the residual-vertigo group, NRS improvement correlated positively with ΔBBS.</div></div><div><h3>Conclusions</h3><div>Greater damage within the vestibulocerebellar network and cerebellar hemispheres may be correlated with recovery of vertigo. In patients with residual vertigo, the degree of vertigo is related to balance gains. These findings may inform rehabilitation planning and prognosis after infratentorial stroke.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"479 ","pages":"Article 125663"},"PeriodicalIF":3.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}