Neurology. Clinical practice最新文献

{"title":"Gait Improvement Following CSF Tap Test in NPH Patients With and Without Striatal Dopaminergic Deficit: A Preliminary Study.","authors":"Minju Kim, Young Ho Park, Yoo Sung Song, Kyunghun Kang, Ki-Su Park, Shin Young Jeong, Sang-Woo Lee, Eunjeong Ji, SangYun Kim, Etsuro Mori","doi":"10.1212/CPJ.0000000000200549","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200549","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent studies have highlighted the occurrence of reduced striatal signal intensity on dopamine transporter (DAT) scans in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of our study was to investigate whether the extent of symptom improvement after a CSF tap test (TT) differs between iNPH patients with reduced striatal DAT uptake and those with normal uptake.</p><p><strong>Methods: </strong>We conducted gait analysis on 44 patients with iNPH who underwent DAT scans at Seoul National University Bundang Hospital (SNUBH) and Kyungpook National University Chilgok Hospital (KNUCH) both before and after a CSF TT. A positive response to the TT was defined as an improvement in walking speed of 10% or greater compared with baseline. We compared TT response rates between iNPH patients with and without striatal dopaminergic deficit using logistic regression models, with the medical institution (SNUBH, KNUCH) as a stratification variable.</p><p><strong>Results: </strong>Among 36 patients without striatal dopaminergic deficit, 22 patients (61.11%) exhibited a response after the TT, whereas among 8 patients with striatal dopaminergic deficit, 5 patients (62.5%) exhibited a response after the TT. The response rate after TT was not significantly different between the iNPH patients with and without striatal dopaminergic deficit (odds ratio 0.46; <i>p</i> value = 0.4048).</p><p><strong>Discussion: </strong>Our findings suggest that gait improvement after a CSF TT in patients with iNPH remains consistent regardless of the presence or absence of reduced striatal DAT uptake. Further research involving a larger cohort is necessary to validate these observations.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200549"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroclinical Characteristics and Prognostic Significance of Postanoxic Oral Automatism: A Case Series and Literature Review.","authors":"Margil Ranpariya, Osman Farooq, Robert L Glover, Natasha Qutab, Jonathan Hanson, Alexus Ludwig, Ping Li","doi":"10.1212/CPJ.0000000000200547","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200547","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postanoxic myoclonus is a well-recognized phenomenon after cardiac arrest and often indicates poor prognosis. Other spontaneous movements, such as tonic eyelid opening, have also been documented, but spontaneous chewing movements remain poorly characterized. The aim of this study was to systematically analyze the electrophysiologic features of postanoxic chewing movements, propose a standardized nomenclature, discuss potential pathophysiology, and evaluate their prognostic significance.</p><p><strong>Methods: </strong>We retrospectively reviewed clinical data from post-cardiac arrest patients who exhibited suspicious chewing movements during continuous video-EEG (vEEG) monitoring between January 2021 and December 2024. Chewing movements were analyzed for duration, frequency, and correlation with EEG findings. Demographic, clinical, management, and outcome data were also collected. A thorough literature review was conducted.</p><p><strong>Results: </strong>Twelve patients (mean age: 62.3 ± 10.5 years) who experienced out-of-hospital cardiac arrest exhibited repetitive chewing movements. Detailed analysis of video recordings and bedside observations identified these movements as rhythmic tongue elevations against the upper palate with minimal jaw activity, producing chewing artifacts on EEG. These episodes lasted 4-5 seconds and were periodic in 2 patients. Video-EEG revealed that in 8 patients, the movements followed EEG bursts by 1-1.5 seconds, whereas in 4 patients, they occurred spontaneously without corresponding cortical activity. The movements were transient, with a median duration of 24 hours, and resolved within 72 hours despite persistent burst-suppression patterns. Brain MRI in 3 patients demonstrated diffuse anoxic/hypoxic cortical injury with relative brainstem preservation. All patients died after cardiac arrest, with a median survival of 5 days.</p><p><strong>Discussion: </strong>We propose the term postanoxic oral automatism (PAOA) to describe a distinct, transient oral motor phenomenon characterized by repetitive, chewing-like tongue movements in comatose patients after cardiac arrest. Unlike previous reports confined to burst-suppression EEG patterns, our findings show that PAOA can occur in both burst-suppression and background-suppression EEG backgrounds. These movements likely result from disinhibition of brainstem central pattern generators responsible for rhythmic orofacial activity and may signify severe cortical dysfunction. Although PAOA is associated with poor prognosis, its independent predictive value remains unclear.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200547"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerating Medical Record Data Abstraction and Analysis in Muscular Dystrophy: Large Language Models and International Classification of Diseases Codes.","authors":"Huixue Zhou, Geetanjali Rajamani, Jiatan Huang, Magali Jorand-Fletcher, Yara Mohamed, Kody A DeGolier, Annette Xenopoulos-Oddsson, Erjia Cui, Carla D Zingariello, Rui Zhang, Peter B Kang","doi":"10.1212/CPJ.0000000000200542","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200542","url":null,"abstract":"<p><strong>Background and objectives: </strong>Muscular dystrophies are characterized by progressive muscle weakness and degeneration. Identifying cases and abstracting data from electronic medical records (EMRs) is helpful for surveillance and research. However, manual EMR abstraction is laborious. We studied 2 approaches to accelerate EMR abstraction: large language models (LLMs) and International Classification of Diseases (ICD) code meta-analysis.</p><p><strong>Methods: </strong>In our cross-sectional study, EMRs from 22 individuals with Duchenne muscular dystrophy (DMD) and 22 individuals with limb-girdle muscular dystrophy (LGMD) were exported into a data shelter and manually annotated using MedTator. Annotations were guided by a schema focused on 4 key features of muscular dystrophy: first symptoms, ambulatory status, serum creatine kinase (CK) levels, and genetic test results. Five LLMs were fed a series of prompts and examples, and then, clinic notes from each of the 44 cases were inputted for model analysis. Inter-rater agreement (IAA) and F1 scores were calculated for manual annotations, and the F1 score for LLMs compared with manual annotations was calculated. We then analyzed a separate set of 77 DMD and 59 LGMD cases to determine whether the number of health care encounters with a muscular dystrophy-related ICD code could predict diagnostic certainty based on MD STAR<i>net</i> criteria.</p><p><strong>Results: </strong>IAA for manual annotations varied between 80% (for annotation of symptoms) and 100% (for CK values). The highest performing LLM was Llama 3-8b, which yielded the following accuracies: 46.8% for \"first symptoms,\" 56.9% for \"ambulatory status,\" 69.2% for \"CK values,\" and 68.4% for \"genetic test results.\" Among 77 individuals with DMD, all patients with 20 or more encounters linked to relevant ICD codes had definite or probable diagnoses, whereas among 59 individuals with LGMD, all patients with 25 or more encounters linked to relevant ICD codes had definite or probable diagnoses.</p><p><strong>Discussion: </strong>LLMs promise to accelerate EMR abstraction for rare diseases such as muscular dystrophy, but F1 scores for LLMs currently lag manual abstractions for unstructured data. Llama 3-8b demonstrated superior performance to the 4 other models tested. Metadata such as ICD code counts may help prioritize high-yield cases for surveillance and research purposes.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200542"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home-Based Noninvasive Spinal Cord Stimulation Safely Enhances Hand and Arm Function in People With Spinal Cord Injury.","authors":"Candace Tefertiller, Randy D Trumbower, Leslie Morse, Jared Pradarelli, Kristen Gelenitis, Jessica M D'Amico, Chet Moritz, Edelle C Field-Fote","doi":"10.1212/CPJ.0000000000200537","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200537","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Up-LIFT Trial demonstrated that in-clinic rehabilitation augmented by noninvasive spinal cord stimulation (ARC^EX Therapy) safely and effectively improved upper extremity strength and function in people with chronic incomplete cervical spinal cord injury (SCI). As a follow-up study, LIFT Home, a single-arm interventional trial, investigated the safety, usability, and benefits of ARC^EX Therapy during home use.</p><p><strong>Methods: </strong>Seventeen participants from the Up-LIFT Trial continued with ARC^EX Therapy at home for 1 month. Primary endpoints evaluated the safety and feasibility of at-home ARC^EX Therapy. Secondary efficacy outcomes included the Capabilities of Upper Extremity Test (CUE-T); the Graded Redefined Assessment of Strength, Sensation, and Performance; pinch and grasp forces; and global impression of change scores. Additional post hoc analysis examined the effect of different periods of time without treatment, and the potential of home-based therapy to maintain or extend improvements achieved in-clinic. Finally, quality of life and independence were assessed through participant-reported surveys.</p><p><strong>Results: </strong>There were no serious adverse events related to the device or major usability issues that interfered with home-based treatment. Compliance with the prescribed therapy was high and mirrored in-clinic therapy dosages, with participants completing 12.3 ± 2.9 sessions each lasting 59 ± 10 minutes on average. Average CUE-T scores and pinch forces significantly improved (Δ2.2 ± 4.1, <i>p</i> = 0.025 and Δ6.9 N ± 15.5, <i>p</i> = 0.020, respectively), as did pain interference with day-to-day activities (International SCI Pain Data Set subscore Δ<b>-</b>0.6 ± 1.2, <i>p</i> = 0.019), psychological health (World Health Organization Quality of Life-BREF subscore Δ3.4 ± 5.8, <i>p</i> = 0.025), and self-care ability (Spinal Cord Independence Measure III subscore Δ0.2 ± 0.4, <i>p</i> = 0.042). Improvements were most apparent in individuals who responded to prior in-clinic ARC ^EX Therapy. Notably, post hoc analysis revealed that functional decline following periods of inactivity can be reversed, and in-clinic progress can be further enhanced with at-home ARC^EX Therapy.</p><p><strong>Discussion: </strong>This study suggests ARC^EX Therapy can be safely used at home to continue to improve strength and function. It is important that at-home therapy may be essential to maintain intervention-related in-clinic gains.</p><p><strong>Trial registration information: </strong>The LIFT Home Trial was registered on clinicaltrials.gov (NCT05284201, clinicaltrials.gov/study/NCT05284201) on September 03, 2022. The first participant was enrolled on March 03, 2022.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200537"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the Out-of-Pocket Costs of Disease-Modifying Therapies for Medicare Beneficiaries With Multiple Sclerosis.","authors":"Pengxiang Li, John K Lin, Matthew J Klebanoff, Riya Palkar, Salim Chahin, Jalpa A Doshi","doi":"10.1212/CPJ.0000000000200536","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200536","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Inflation Reduction Act (IRA) introduced major reforms to Medicare Part D, including an annual out-of-pocket (OOP) maximum and the Medicare Prescription Payment Plan (MPPP), which allows beneficiaries to spread OOP costs over monthly payments. The IRA's Part D provisions, as well as wider use of direct-to-consumer (DTC) pharmacies, could reduce OOP costs for self-administered disease-modifying therapies (DMTs) among Medicare beneficiaries with multiple sclerosis (MS). This study estimated OOP costs for self-administered DMTs under the IRA's Part D provisions and through DTC pharmacies.</p><p><strong>Methods: </strong>We calculated OOP costs for brand-name and generic DMTs under Part D in the pre-IRA (2023) and post-IRA (2025) periods. We also assessed the impact of voluntary enrollment in the MPPP in 2025. Finally, we examined OOP costs for generic DMTs purchased through DTC pharmacies.</p><p><strong>Results: </strong>Before the IRA (2023), annual OOP costs ranged from $6,275 to $8,883 for brand-name DMTs; after the IRA (2025), annual OOP costs decreased by 68%-77% because all brand-name DMT users reached the annual OOP maximum ($2,000 in 2025). OOP costs were heavily frontloaded as lumpsum payments unless beneficiaries enrolled in the MPPP, which could lead to monthly payments as low as $167 for DMTs in 2025 (a reduction of over 90% in monthly OOP costs for January). Generic DMTs had annual OOP costs ranging from $212 to $7,855 before the IRA (2023) and $212 to $2,000 after the IRA (2025). Purchasing generic DMTs through DTC pharmacies resulted in annual OOP costs ranging from $133 to $39,984 and could lead to lower costs for some beneficiaries.</p><p><strong>Discussion: </strong>Annual OOP costs for self-administered DMTs among Medicare beneficiaries with MS decreased significantly beginning January 1, 2025, because of the IRA's annual OOP maximum. Beneficiaries who voluntarily enroll in the MPPP will also be able to spread OOP costs over more manageable monthly payments. Direct cash purchase of some generic DMTs through DTC pharmacies could lead to lower OOP costs, but these payments will not count toward beneficiaries' deductible or annual OOP maximum. Neurologists have a critical role in ensuring that their Medicare patients with MS are aware of the option to enroll in the MPPP and the possibility of obtaining generic DMTs through DTC pharmacies.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200536"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Intervention for Children With Epilepsy and Autism Spectrum Disorder Admitted for EEG: A New Standard of Care.","authors":"Mary Wojnaroski, Emily Newton, Anup D Patel, Ryan S Bode, Robert Gajarski, James Gallup, Megan E Rose, Mahmoud Abdel-Rasoul, Nancy Auer","doi":"10.1212/CPJ.0000000000200543","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200543","url":null,"abstract":"<p><strong>Background and objectives: </strong>Approximately one-third of children with epilepsy develop intractable epilepsy and require multiple-day hospital admission for EEG and neuroimaging to determine other interventions for seizure reduction (Phase 1). Of note, children with epilepsy are at increased risk of autism spectrum disorder (ASD); however, prolonged hospitalization may be difficult due to developmental delays, sensory sensitivities, and challenging behavior. Challenging behavior during or reluctance to complete admission may lead to delayed or incomplete information about seizures and interfere with treatment. To address this need, we created a multidisciplinary team and a novel program, the Phase 1 ASD and epilepsy intervention program. We used quality improvement (QI) methodology, and our aim was to increase the percentage of patients with ASD and epilepsy who participated in a treatment program before Phase 1 admission from 0% to 80% in the first year.</p><p><strong>Methods: </strong>Participants included children with ASD and epilepsy who were referred for Phase 1 at a large children's hospital with a level 4 epilepsy center. After referral, caregivers were called to complete an intake and gather information about the child's development, preferences, and needs for admission. The program includes individualized planning for admission based on the child's needs, team communication about patient characteristics and needs, and behavior intervention. The intervention was implemented and monitored using QI methodology.</p><p><strong>Results: </strong>All children with ASD referred for Phase 1 were enrolled in the program, and we achieved a centerline shift in the first 2 years, which has been sustained for 5 years (68 of 81 participants, 83.9%). The age of patients ranged from 2 to 18, with a mean age of 10.7 years. Seventy percent were male, and 66.7% were White. All children who participated completed the multiple-day EEG and all required medical procedures.</p><p><strong>Discussion: </strong>Our work demonstrates the feasibility of the program, which is now standard of care at our hospital. Similar interventions can be implemented for Phase 2 admissions or other medical procedures. Children with ASD who participate in a multidisciplinary intervention program can successfully complete potentially challenging hospital admissions, allowing them equitable access to critical care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200543"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Improving Access in Academic Neurology.","authors":"Jaya Trivedi, Amber Salter, Debra Clamp, Alan Kramer, Chelsea Landon","doi":"10.1212/CPJ.0000000000200528","DOIUrl":"10.1212/CPJ.0000000000200528","url":null,"abstract":"<p><p>Neurologic disorders, now a leading cause of disease burden globally, have further added to the growing concerns of access to care, especially given the anticipated 19% shortfall of neurologists. There is a pressing need to improve access and decrease appointment wait times. We led a departmental initiative to bridge the access gap. We focused on template management, leveraging advanced practice providers (APPs), and provision of timely access for new patients. Over 2 years, the total patient volume and the new patient volume increased by 34% and 32%, respectively. Visits per clinic session grew by 21% for APPs. The number of new patients seen within 10 days grew from 19% to 42% (123% increase) for internal referrals and from 21% to 43% (100% increase) for all referrals. This article reviews our strategies in improving patient access.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 5","pages":"e200528"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic Factors Associated With Migraine Medication Prescription at a Tertiary Headache Center: A Retrospective Cohort Analysis.","authors":"Arathi S Nandyala, Kenneth Tan, Benjamin Africk, Anna Graber-Naidich, Niushen Zhang, Zihuai He, Leon S Moskatel","doi":"10.1212/CPJ.0000000000200517","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200517","url":null,"abstract":"<p><strong>Background and objectives: </strong>The socioeconomic and demographic factors affecting the prescription of migraine medications are underexplored. Understanding these factors is critical to addressing health. We used our tertiary headache center's prescription database to assess the demographic and socioeconomic factors associated with the prescription of acute and preventive migraine medications and the factors affecting the rollout of novel migraine medications.</p><p><strong>Methods: </strong>We performed a retrospective cohort analysis using aggregated deidentified data of patients who had received care through the Stanford Headache Clinic using data adapted from the Stanford deidentified instance of the Observational Medical Outcomes Partnership Common Data Model. We included patients in California who had received a diagnosis of chronic migraine and had received at least 1 prescription from our clinic between 2018 and 2022. The types and volumes of prescriptions were assessed, as well as demographic factors (age, sex, race ethnicity, and zip code income quartile).</p><p><strong>Results: </strong>A total of 4,213 patients met inclusion criteria, of whom 3,349 (79.5%) were women and 863 (20.5%) were men, with a mean age of 44.6 ± 14.7 years. Our group was predominantly White and non-Hispanic/non-Latino (2,381/4213, 56.5%) and came from zip codes whose median income ranged from $77,250 to $236,912 (2046/3298, 62.0%). Age, sex, and race-ethnicity were all found to be statistically significant factors in the selection of both acute and preventive medications for patients. Zip code income quartile played a limited role in prescription variation for both acute and preventive medications. Race-ethnicity was also a statistically significant factor for those who received a prescription for a calcitonin gene-related peptide (CGRP) monoclonal antibody and a gepant. Similarly, sex, race-ethnicity, and zip code income quartile were all factors in the rollout of the CGRP monoclonal antibodies and gepants (all <i>p</i> < 0.05), but age was not (<i>p</i> = 0.722 and <i>p</i> = 0.057, respectively). The second and third zip code income quartiles had the lowest prescription rates of the CGRP monoclonal antibodies and gepants during their rollout.</p><p><strong>Discussion: </strong>Disparities in sex, race-ethnicity, and zip code income quartile were found among those who received medications and which acute and preventive migraine medications were prescribed. This may reflect that some groups may have received less headache-specific care before establishing with our clinic. Future research will seek to better illuminate the underlying reasons for this more clearly to enable solutions and ensure equitable care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 5","pages":"e200517"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12307023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Psychosis in Parkinson Disease: A Retrospective Study on 24-Hour Continuous Subcutaneous Infusion of Foslevodopa/Foscarbidopa.","authors":"Lindun Ge, Yasuyoshi Kimura, Keita Kakuda, Kotaro Ogawa, Yuta Kajiyama, Kanako Asai, Seira Taniguchi, Goichi Beck, Yoshiyuki Nishio, Jee Hyun Kim, Kensuke Ikenaka, Hideki Mochizuki","doi":"10.1212/CPJ.0000000000200534","DOIUrl":"10.1212/CPJ.0000000000200534","url":null,"abstract":"<p><strong>Background and objectives: </strong>Atypical psychosis, characterized by severe delusions, paranoia, and auditory or somatic hallucinations, is a notable complication of continuous subcutaneous infusion (CSCI) of foslevodopa/foscarbidopa therapy in Parkinson disease (PD). The aim of this study was to identify clinical predictors of CSCI-induced psychosis to understand its potential mechanisms and evaluate predictive measures for early detection and management.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with PD treated with CSCI (n = 23) and an independent PD database cohort (n = 94) from Osaka University Hospital. In the CSCI cohort, clinical data such as psychosis information and answers from Parkinson's Disease Questionnaire (PDQ39) and the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Current Symptoms (QUIP-CS) were collected. Statistical analyses included independent <i>t</i> tests and linear regression to identify predictors of atypical psychosis within a year of CSCI initiation. In the PD database cohort, potential relationships between QUIP-CS scores and other clinical parameters were explored using correlational analyses.</p><p><strong>Results: </strong>Among the 23 patients, 6 developed atypical psychosis, all occurring within 6 months, with 4 of them discontinuing CSCI. Patients who developed atypical psychosis had significantly higher QUIP-CS scores before CSCI (adjusted <i>p</i> = 0.0032). Linear regression identified QUIP-CS as the sole predictor of atypical psychosis onset (coefficient = 0.199, <i>p</i> < 0.001). Among the PDQ39 subitems, item 27 showed a significant correlation with QUIP-CS scores (<i>r</i> = 0.722, adjusted <i>p</i> = 0.0128). Furthermore, a composite score comprising PDQ39 items 20, 27, 29, 31, and 36 (PDQ39_sub5) showed an even stronger correlation with QUIP-CS scores (<i>r</i> = 0.770, <i>p</i> = 0.0000704). This association was independently confirmed in the PD database cohort (<i>r</i> = 0.415, <i>p</i> = 0.00003). Finally, PDQ39_sub5 effectively stratified survival curves for psychosis onset in the CSCI cohort (<i>p</i> = 0.008).</p><p><strong>Discussion: </strong>CSCI-induced psychosis is distinct from visual hallucinations observed in typical PD psychosis and likely involves mechanisms in mesolimbic circuits and impulsive-compulsive behaviors associated with dopamine dysregulation. While QUIP-CS is rarely used in clinical practice, widely used PDQ39_sub5 offers a practical way to identify individual psychosis risk. These findings potentially offer tailored strategies to predict and manage atypical psychosis in patients with PD receiving advanced dopaminergic therapies.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 5","pages":"e200534"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus on Neuro-Irritability in Pediatric Patients: Why We All Need Palliative Care Skills.","authors":"Jennifer P Rubin","doi":"10.1212/CPJ.0000000000200531","DOIUrl":"10.1212/CPJ.0000000000200531","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 5","pages":"e200531"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}