Neurology. Clinical practice最新文献

{"title":"A Systematic Review of Sleep Disturbance in Idiopathic Intracranial Hypertension.","authors":"Sabrina Kentis, Jacob S Shaw, Lisa N Richey, Lisa Young, Natalia Kosyakova, Barry R Bryant, Aaron I Esagoff, Luis F Buenaver, Rachel Marie E Salas, Matthew E Peters","doi":"10.1212/CPJ.0000000000200372","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200372","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sleep disturbances, particularly obstructive sleep apnea (OSA), may have a significant impact on the outcomes of patients with idiopathic intracranial hypertension (IIH). We conducted a PRISMA-compliant systematic literature review to study sleep disturbance in adult patients with IIH.</p><p><strong>Recent findings: </strong>The current literature on the relationship between IIH and sleep is quite limited. Research has found that sleep disturbances are associated with lower quality of life and may worsen several symptoms associated with IIH, such as headache, cognitive deficits, and neuropsychiatric issues.</p><p><strong>Summary: </strong>OSA was more prevalent in patients with IIH than in healthy controls. Several studies found that OSA was associated with worse IIH symptoms and treatment of OSA helped improve these parameters. Limitations included available literature and heterogeneity in sleep metrics and OSA diagnostic criteria between studies. Overall, further study of sleep disturbances in patients with IIH may encourage earlier screening, improved treatment options, and long-term improvements in quality of life.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470859","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":"Functional Connectivity Relationships to Longitudinal Motor Outcomes Differ in Very Preterm Children With and Without Brain Injury.","authors":"Peppar E P Cyr, Rachel E Lean, Jeanette K Kenley, Sydney Kaplan, Dominique Meyer, Jeffrey J Neil, Dimitrios Alexopoulos, Rebecca G Brady, Joshua S Shimony, Thomas L Rodebaugh, Cynthia E Rogers, Christopher D Smyser","doi":"10.1212/CPJ.0000000000200397","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200397","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children born very preterm (VPT) have high rates of motor disability, but mechanisms for early identification remain limited, especially for children who fall behind in early childhood. This study examines the relationship between functional connectivity (FC) measured at term-equivalent age and motor outcomes at 2 and 5 years.</p><p><strong>Methods: </strong>In this longitudinal observational cohort study, VPT children (gestational age 30 weeks and younger) with and without high-grade brain injury underwent FC MRI at term-equivalent age. Motor development was assessed using the Bayley Scales of Infant Development, Third Edition, at corrected age 2 years and Movement Assessment Battery for Children, Second Edition, at age 5 years. Logistic and negative binomial/Poisson regression models examined relationships between FC measures and 5-year task scores, with and without 2-year scores as covariates. Infants were categorized as \"injured\" or \"uninjured\" based on structural MRI findings at term-equivalent age.</p><p><strong>Results: </strong>In the injured group (n = 34), each 1 SD decrease in neonatal left-right motor cortex FC was related to approximately 4× increased odds of being unable to complete a fine motor task at age 5 (log odds = -1.34, <i>p</i> < 0.05). In the uninjured group (n = 41), stronger basal ganglia-motor cortex FC was related to poorer fine motor scores (Est = -0.40, <i>p</i> < 0.05) and stronger cerebellum-motor cortex FC was related to poorer balance and fine motor scores (Est = -0.05 to -0.23, <i>p</i> < 0.05), with balance persisting with adjustment for 2-year scores.</p><p><strong>Discussion: </strong>In VPT children with brain injury, interhemispheric motor cortex FC was related to motor deficits at 5-year assessment, similar to previous findings at 2 years. In uninjured children, FC-measured disruption of the motor system during the neonatal period was associated with motor planning/coordination difficulties that were not apparent on 2-year assessment but emerged at 5 years, suggesting that the neural basis of these deficits was established very early in life. Subsequently, 2-year follow-up may not be sufficient to detect milder motor deficits in VPT children, and they should be monitored for motor difficulties throughout the preschool years. For all VPT children, FC at term-equivalent age has the potential to improve our ability to predict disability before it presents behaviorally.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504827","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":"Association Between LACE+ Index Risk Category and 90-Day Mortality After Stroke.","authors":"Adalia Jun-O'Connell, Brian Silver, Eliza Grigoriciuc, Akanksha Gulati, Kimiyoshi J Kobayashi, Nils Henninger","doi":"10.1212/CPJ.0000000000200363","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200363","url":null,"abstract":"<p><strong>Background and objectives: </strong>A higher LACE+ index risk category (defined as LACE+ score ≥78) typically calculated before hospital discharge has been associated with increased risk of unplanned 30-day hospital readmissions and early death after hospital discharge. However, its utility to predict poststroke mortality is unknown. Here, we examined whether the LACE+ index risk category assessed at both discharge (dLACE+) and admission (aLACE+) was associated with 90-day mortality after stroke.</p><p><strong>Methods: </strong>We retrospectively analyzed 2,729 consecutive patients who presented with ischemic or hemorrhagic strokes, included in an institutional stroke registry between January 2018 and December 2021. The primary outcome of interest was 90-day mortality after the index hospitalization. Patients were categorized as high-risk (≥78), medium-to-high-risk (59-77), and low-to-medium-risk (0-58) according to the LACE+ as automatically calculated at admission and discharge. Analyses were performed on the entire cohort, as well as stratified according to acute ischemic stroke and hemorrhagic stroke diagnosis.</p><p><strong>Results: </strong>Among patients who completed 90-day follow-up, the mortality rate was 24.3% (576/2368). In the Kaplan-Meier analysis, the high-risk aLACE+ group had the highest 90-day mortality rate as compared with low-to-medium-risk and medium-to-high-risk groups (<i>p</i> < 0.001). In a fully adjusted multivariable Cox-regression, the 90-day hazards of death were significantly greater among participants in a high-risk aLACE+ (aHR 1.7, 95% CI 1.080-2.742, <i>p</i> = 0.022) and medium-to-high-risk aLACE+ categories (aHR 1.4, 95% CI 1.141-1.778, <i>p</i> = 0.002) as compared with participants in the low-to-medium-risk aLACE+ category. Results were overall similar for dLACE+.</p><p><strong>Discussion: </strong>The LACE+ calculated at both admission and discharge admission identified patients with stroke at increased risk for 90-day mortality. Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for death.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470863","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":"Anti-Myelin-Associated Glycoprotein Neuropathy: Recent Developments.","authors":"Jennifer Morganroth, Chafic Karam","doi":"10.1212/CPJ.0000000000200368","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200368","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this review is to give an update on myelin-associated glycoprotein (MAG) neuropathy.</p><p><strong>Recent findings: </strong>There are several recent developments in anti-MAG neuropathy, with the major one being the retrospective analysis of 50 clinical trials that showed that at least a 50% reduction in anti-MAG levels is associated with a therapeutic response. Other updates address antibody levels needed for a positive test, response, and exacerbations to therapy and the type of antibody more associated with malignancy.</p><p><strong>Implications for practice: </strong>Anti-MAG neuropathy is heterogeneous, and the natural history of the disease continues to be refined. Treatment options are being explored for refractory disease.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470861","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":"Clinical Implementation of fMRI and EEG to Detect Cognitive Motor Dissociation: Lessons Learned in an Acute Care Hospital.","authors":"Yelena G Bodien, Matteo Fecchio, Holly J Freeman, William R Sanders, Anogue Meydan, Phoebe K Lawrence, John E Kirsch, David Fischer, Joseph Cohen, Emily Rubin, Julian H He, Pamela W Schaefer, Leigh R Hochberg, Otto Rapalino, Sydney S Cash, Michael J Young, Brian L Edlow","doi":"10.1212/CPJ.0000000000200390","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200390","url":null,"abstract":"<p><strong>Background: </strong>Cognitive motor dissociation (CMD) occurs when patients with severe brain injury follow commands on task-based functional MRI or EEG assessment despite demonstrating no behavioral evidence of language function. Recognizing the value of identifying patients with CMD, evidence-based guidelines published in the United States and Europe now recommend that these assessments are conducted as part of clinical care for select patients.</p><p><strong>Recent findings: </strong>We describe our institutionally supported approach for clinical assessment of CMD and report lessons learned so that other centers can more easily implement these evaluations. Among the key lessons are the need to consider ethical implications of CMD assessment; establish standardized local protocols for patient selection, data acquisition, analysis, and interpretation; and develop effective strategies for communication of test results.</p><p><strong>Implications for practice: </strong>Independent validation of methods to assess CMD is not available. Our approach for clinical CMD assessment is intended to be flexible, allowing for iterative improvements as the evidence base grows.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546527","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":"Assessing Communication Impairments in a Rare Neurodevelopmental Disorder: The <i>SCN2A</i> Clinical Trials Readiness Study.","authors":"Anne T Berg, Amanda N Nili, Lindsey Evans, Katherine C Paltell, Ariela J E Kaiser, Erica L Anderson, Shawn M Egan, Aaron J Kaat, Gerry Nesbitt, Leah S Myers","doi":"10.1212/CPJ.0000000000200391","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200391","url":null,"abstract":"<p><strong>Background and objectives: </strong><i>SCN2A</i>-related disorders (<i>SCN2A</i>-RDs) entail severe impairments in multiple domains that could serve as nonseizure outcomes in clinical trials. This study evaluated the fitness for purpose of several clinical instruments with both standardized and alternative scoring and with some measures used out of their intended age range for assessing communication in <i>SCN2A</i>-affected participants.</p><p><strong>Methods: </strong>Parents of <i>SCN2A</i>-affected children were recruited through FamilieSCN2A Foundation outreach for a combined cross-sectional and longitudinal study. They completed assessments of their children at study entry and 6 and 12 months later. Assessments included the Vineland Adaptive Behavior Scale (VABS-3), Adaptive Behavior Assessment System (ABAS), Communication Matrix, and Communication and Symbolic Behavior Scale (CSBS). Analyses examined floor and ceiling effects, inter-rater and test-retest reliability, discrimination among different levels of functional impairment, and sensitivity to clinical aspects of <i>SCN2A</i>-RDs.</p><p><strong>Results: </strong>Of 65 participants (28 females, median age 6.4 years, IQR 4.1-10.5), 56 (86%) had epilepsy. Eleven (17%) used speech as their primary communication mode; 84% were considered ineffective communicators. The mean Vineland composite standardized score (SS) was 34 (IQR 26-46). Cross-sectionally, standardized scores decreased with increasing age. There were substantial floor effects for receptive (75%) and expressive (83%) communication. SSs discriminated poorly between verbal vs nonverbal and communicative vs noncommunicative participants and were not sensitive to features reflecting epilepsy severity (e.g., epileptic spasms and number of current medications). By contrast, Vineland growth scale value (GSV) and ABAS, Matrix, and CSBS raw scores had minimal floor effects; most increased with age. These alternative scores distinguished clearly between participants with different levels of communication and were sensitive to aspects of epilepsy severity. Longitudinally, SSs decreased, but other scores remained relatively stable over a year.</p><p><strong>Discussion: </strong><i>SCN2A</i>-RD is characterized by severe-to-profound impairment with a SS <4 SDs of the norm-referenced mean. Owing to severe floor effects and their insensitivity to markers of communication function, age-standardized scores (e.g., Vineland SS) are not fit for purpose in clinical trials or other settings for evaluating nonseizure outcomes such as communication. GSVs and alternative scoring and assessments have much better measurement profiles in all these regards and should be considered in future precision medicine trials for <i>SCN2A</i>-RDs and other similar rare diseases.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504826","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":"Theta-Alpha Variability on EEG Is Associated With Acute Brain Injury in Children and Young Adults With Liver Failure.","authors":"Jacqueline Barnes, Allan Fong, Sarika Bharil, Nathan M Kattapuram, Taymour Hashemzadeh, Earn Chun Christabel Lee, Alexander Andrews","doi":"10.1212/CPJ.0000000000200389","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200389","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with liver failure experience long hospitalizations and acute neurologic complications. Encephalopathy limits the bedside examination, rendering presenting signs of acute brain injury less specific. Seizures are common. Brain MRI is the gold standard for detecting acute brain injury, but intensive medical needs may preclude immediate transfer for imaging. EEG is a bedside test applied in cases of seizure or encephalopathy. We hypothesized that EEG variables can predict MRI signs of acute brain injury in children hospitalized with liver failure.</p><p><strong>Methods: </strong>In this retrospective cohort analysis, records were collected for patients admitted to a MedStar hospital between 2014 and 2022 with ICD-9/10 codes related to liver failure, who underwent brain MRI and EEG testing during the same admission. Exclusion criteria included age older than 24 years and >7 days elapsing between EEG and MRI testing. Clinical data of interest from chart review, reinterpreted MRI scans, reinterpreted EEG tracings, and quantitative EEG variables were compiled into a database. Quantitative EEG variables were processed using MNE-Python.</p><p><strong>Results: </strong>Of 746 records screened, 52 patients met inclusion criteria comprising 63 EEG-MRI pairs. Univariate analysis of all quantitative EEG variables of interest showed depressed theta-alpha variability (TAV) when paired MRI involved abnormal restricted diffusivity in cortical or deep gray matter structures (TAV 0.705, SD 0.310; <i>p</i> < 0.001) compared with MRI with no abnormal restricted diffusivity (TAV 0.895, SD 0.095). Multilinear regression analysis including potential confounders demonstrated independent association of depressed TAV with this MRI finding, with an odds ratio of 4.0317 (95% CI 1.3868-11.7165; AUROC 0.83).</p><p><strong>Discussion: </strong>Depressed TAV on EEG is associated with increased odds of abnormal restricted diffusivity in gray matter on brain MRI in children and young adults hospitalized with liver failure. This MRI finding is seen in scenarios where changes to medical management are time-sensitive (i.e., acute stroke and PRES) or where prognostic discussion may be influenced by MRI findings (hypoxic-ischemic injury). TAV thus has a potential role as an automated, bedside decision support tool for clinicians deciding on the urgency of brain MRI in critically ill patients.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470884","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":"Radiographic Horizontal Conjugate Gaze Deviation: Clinical Correlates.","authors":"Shervin Badihian, Elias Samaha, David E Newman-Toker, David S Zee, Jorge C Kattah","doi":"10.1212/CPJ.0000000000200375","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200375","url":null,"abstract":"<p><strong>Purpose of review: </strong>The potential diagnostic value of radiographic, horizontal, conjugate gaze deviation (Rad h-CGD) was first recognized in 2003 by Simon et al. Thereafter, interest grew related to its potential use as a marker of different neurologic and vestibular disorders. Over the past 20 years, we have identified clinical correlates of Rad h-CGD including those caused by supratentorial and infratentorial lesions. We propose clinicians and radiologists will better diagnose and manage patients by knowing the different diagnostic possibilities for Rad h-CGD.</p><p><strong>Findings: </strong>We report different clinical correlates of Rad h-CGD relevant for localizing and lateralizing lesions. We measured the angle of deviation and correlated it with the clinical findings and underlying mechanisms. We then reviewed important data from the previous literature relevant to the localization of each lesion and combined it with our experience into the design of a practical algorithm to interpret Rad h-CGD.</p><p><strong>Summary: </strong>Using Rad h-CGD provides useful information about the diagnosis and localization and may reveal subtle ocular findings not clear on physical examination. However, Rad h-CGD alone cannot distinguish between supratentorial and infratentorial lesions, and therefore, the clinical context is critical. Moreover, although Rad h-CGD occurs with strokes due to large vessel occlusion, it could also be seen with an acute vestibular syndrome, secondary to a peripheral vestibular neuritis. Other possibilities include ischemic events in the cerebellum, brainstem, and labyrinth.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470880","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":"Dysphagia in Epilepsy Patients: The Silent Enemy.","authors":"James W Wheless, Brooke Richardson, Clio Rubinos, Raymond Faught, Marry Vuong","doi":"10.1212/CPJ.0000000000200362","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200362","url":null,"abstract":"<p><strong>Purpose of review: </strong>Dysphagia, or difficulty swallowing, affects several individuals globally and can contribute to a reduced quality of life and partial medication adherence, especially in patients with epilepsy. There is also a lack of awareness and understanding of dysphagia among both health care providers and patients. This review examines the interplay between dysphagia and epilepsy treatment and the potential for optimizing diagnosis and intervention.</p><p><strong>Recent findings: </strong>Dysphagia, although a prevalent condition, is often underdiagnosed or misdiagnosed. Managing dysphagia involves patient and caregiver education on medication management techniques, lifestyle changes, and collaboration with a multidisciplinary health care team. There are also several modalities to screen and evaluate for dysphagia by using technology, using questionnaires, and asking probing questions. In patients with epilepsy, dysphagia can make swallowing certain formulations of antiseizure medications (ASMs) difficult or impossible-so, there is a need for tailored management strategies if discontinuing the medication is not feasible. Alternative formulations such as soluble, liquid, granular, or powder alternatives have been recognized as valuable options in addressing partial adherence due to dysphagia.</p><p><strong>Summary: </strong>Patients with dysphagia may have varying symptoms, making it challenging for clinicians to accurately identify the condition. To address this issue, various questionnaires and assessments have been developed to uncover swallowing difficulties. Administration of alternate ASM formulations must consider options available for each individual.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470869","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":"Advancing Patient Education in Idiopathic Intracranial Hypertension: The Promise of Large Language Models.","authors":"Qais A Dihan, Andrew D Brown, Ana T Zaldivar, Muhammad Z Chauhan, Taher K Eleiwa, Amr K Hassan, Omar Solyman, Ryan Gise, Paul H Phillips, Ahmed B Sallam, Abdelrahman M Elhusseiny","doi":"10.1212/CPJ.0000000000200366","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200366","url":null,"abstract":"<p><strong>Background and objectives: </strong>We evaluated the performance of 3 large language models (LLMs) in generating patient education materials (PEMs) and enhancing the readability of prewritten PEMs on idiopathic intracranial hypertension (IIH).</p><p><strong>Methods: </strong>This cross-sectional comparative study compared 3 LLMs, ChatGPT-3.5, ChatGPT-4, and Google Bard, for their ability to generate PEMs on IIH using 3 prompts. Prompt A (control prompt): \"Can you write a patient-targeted health information handout on idiopathic intracranial hypertension that is easily understandable by the average American?\", Prompt B (modifier statement + control prompt): \"Given patient education materials are recommended to be written at a 6th-grade reading level, using the SMOG readability formula, can you write a patient-targeted health information handout on idiopathic intracranial hypertension that is easily understandable by the average American?\", and Prompt C: \"Given patient education materials are recommended to be written at a 6th-grade reading level, using the SMOG readability formula, can you rewrite the following text to a 6th-grade reading level: [<i>insert text</i>].\" We compared generated and rewritten PEMs, along with the first 20 googled eligible PEMs on IIH, on readability (Simple Measure of Gobbledygook [SMOG] and Flesch-Kincaid Grade Level [FKGL]), quality (DISCERN and Patient Education Materials Assessment tool [PEMAT]), and accuracy (Likert misinformation scale).</p><p><strong>Results: </strong>Generated PEMs were of high quality, understandability, and accuracy (median DISCERN score ≥4, PEMAT understandability ≥70%, Likert misinformation scale = 1). Only ChatGPT-4 was able to generate PEMs at the specified 6th-grade reading level (SMOG: 5.5 ± 0.6, FKGL: 5.6 ± 0.7). Original published PEMs were rewritten to below a 6th-grade reading level with Prompt C, without a decrease in quality, understandability, or accuracy only by ChatGPT-4 (SMOG: 5.6 ± 0.6, FKGL: 5.7 ± 0.8, <i>p</i> < 0.001, DISCERN ≥4, Likert misinformation = 1).</p><p><strong>Discussion: </strong>In conclusion, LLMs, particularly ChatGPT-4, can produce high-quality, readable PEMs on IIH. They can also serve as supplementary tools to improve the readability of prewritten PEMs while maintaining quality and accuracy.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470860","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}