Neurology. Clinical practice最新文献

{"title":"Cost Utility of Specialist Physiotherapy for Functional Motor Disorder (Physio4FMD): Economic Analysis of a Pragmatic Randomized Controlled Trial.","authors":"Rachael Maree Hunter, Glenn Nielsen, Marie Le Novere, Louise Marston, Teresa C Lee, Jon Stone, Laura H Goldstein, Alan Carson, Kate Holt, Jonathan Marsden, Irwin Nazareth, Hayley Noble, Markus Reuber, Ann-Marie Strudwick, Beatriz Santana Suarez, Mark J Edwards","doi":"10.1212/CPJ.0000000000200465","DOIUrl":"10.1212/CPJ.0000000000200465","url":null,"abstract":"<p><strong>Background and objectives: </strong>Functional motor disorder (FMD), a motor-dominant variant of functional neurologic disorder, is a disabling condition associated with high health and social care resource use and poor employment outcomes. Specialist physiotherapy presents a possible treatment option, but there is limited evidence for clinical effectiveness and cost-effectiveness. Physio4FMD is a multicenter randomized controlled trial of specialist physiotherapy for FMD compared with treatment as usual (TAU). The aim of the analysis was to conduct a randomized trial based on economic evaluation of specialist physiotherapy compared with TAU.</p><p><strong>Methods: </strong>Eleven centers in England and Scotland randomized participants 1:1 to specialist physiotherapy or TAU (referral to community neurologic physiotherapy). Participants completed the EuroQoL EQ-5D-5L, Client Service Receipt Inventory, and Work Productivity and Activity Impairment Questionnaire at baseline, 6 months, and 12 months. The mean incremental cost per quality-adjusted life year (QALY) for specialist physiotherapy compared with TAU over 12 months was calculated from a health and social care and wider societal perspective. The probability of cost-effectiveness and 95% CIs were calculated using bootstrapping.</p><p><strong>Results: </strong>The analysis included 247 participants (n = 141 for specialist physiotherapy, n = 106 for TAU). The mean cost per participant for specialist physiotherapy was £646 (SD 72) compared with £272 (SD 374) for TAU. Including the costs of treatment, the adjusted mean health and social care cost per participant at 12 months for specialist physiotherapy was £3,814 (95% CI £3,194-£4,433) compared with £3,670 (95% CI £2,931-£4,410) for TAU, with a mean incremental cost of £143 (95% CI £-825 to £1,112). There was no significant difference in QALYs over the 12-month duration of the trial (0.030, 95% CI -0.007 to 0.067). The mean incremental cost per QALY was £4,133 with an 86% probability of being cost-effective at a £20,000 threshold. When broader societal costs such as loss of productivity were taken into consideration, specialist physiotherapy was dominant (incremental cost: £-5,169, 95% CI £-15,394 to £5,056).</p><p><strong>Discussion: </strong>FMD was associated with high health and social care costs. There is a high probability that specialist physiotherapy is cost-effective compared with TAU particularly when wider societal costs are taken into account.</p><p><strong>Trial registration information: </strong>International Standard Randomised Controlled Trial registry, ISRCTN56136713.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 3","pages":"e200465"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795839","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":"Cerebrovascular Health Among Sex- and Gender-Diverse People: A Narrative Review.","authors":"Z Paige L'Erario, Alice Catalano, Fawaz Al-Mufti, Scout Silverstein, Salvatore Giovanni Volpe, Marissa Adams, Jaclyn M Martindale, Darnell K Adrian Williams, Asa E Radix, Mill Etienne, Nicole Rosendale","doi":"10.1212/CPJ.0000000000200450","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200450","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sex and gender diversity includes people who are intersex, transgender, and nonbinary. Americans are identifying as sex and gender diverse (SGD) in increasing numbers. Although data are limited on the diagnosis and management of stroke in SGD communities, the current literature suggests that there may be unique health needs among these marginalized populations.</p><p><strong>Recent findings: </strong>Health disparities and community-specific stressors may influence the frequency of stroke and traditional cerebrovascular disease risk factors among SGD people. In addition, transgender and gender-diverse people have higher rates of atypical stroke risk factors, such as sexually transmitted infections and an increased mental health burden. The adverse effects of some gender-affirming therapies can increase the rates of stroke, particularly in transfeminine people who use long-term estrogen as part of their medical gender transition. Decisions to discontinue hormonal therapy after stroke should be weighed against the psychological risks of doing so. In addition, some commonly prescribed medications for stroke prevention could interact with gender-affirming hormone therapies. Neurologists should collaborate with primary care providers and endocrinologists to screen for and manage cerebrovascular disease risk factors for the primary and secondary prevention of stroke. Limited evidence suggests intersex people may be at higher risk of cerebrovascular disease, particularly those with congenital adrenal hyperplasia (CAH). People diagnosed with CAH have unique risk factors of stroke including treatment with stress-dose corticosteroids or polycythemia due to hyperandrogenism.</p><p><strong>Summary: </strong>Creating affirming environments and increasing knowledge of health care for SGD communities may lead to improved equitable treatment of SGD patients with stroke by increasing community trust in health providers and incorporating use of best practices in clinical care and research settings. Limited data exist on stroke clinical presentations and how stroke is experienced and treated among SGD people, particularly among those with multiple marginalized identities, those presenting with acute stroke, and those requiring secondary stroke prevention.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200450"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648190","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":"Herpes Zoster Infections With Multiple Sclerosis Disease-Modifying Therapies: A Real-World Pharmacovigilance Study.","authors":"Alexandra Balshi, Grace Leuenberger, John Dempsey, Nova Manning, Ursela Baber, Jacob A Sloane","doi":"10.1212/CPJ.0000000000200462","DOIUrl":"10.1212/CPJ.0000000000200462","url":null,"abstract":"<p><strong>Background and objectives: </strong>Immunosuppressive multiple sclerosis (MS) disease-modifying therapies (DMTs) may increase the risk of opportunistic infections such as herpes zoster (HZ). We sought to evaluate the risk of HZ across various MS DMTs using publicly available pharmacovigilance reporting data.</p><p><strong>Methods: </strong>We queried the Food and Drug Administration Adverse Event Reporting System (FAERS) and OpenVigil 2.1 for reports of HZ involving immunosuppressive MS DMTs (ocrelizumab [OCR], ofatumumab [OFT], rituximab [RTX], natalizumab [NTZ], alemtuzumab, dimethyl fumarate and diroximel fumarate [DRF], fingolimod [FING], siponimod [SIP], ozanimod [OZ], mitoxantrone [MITO], cladribine [CLAD], and teriflunomide [TERF]) and calculated reporting odds ratios and their 95% CIs.</p><p><strong>Results: </strong>We identified 4,210 total reports of HZ across these MS DMTs. All had disproportionally higher RORs compared with all other FAERS medications. Alemtuzumab had the greatest reporting risk (ROR; 95% CI) (11.1; 9.7-12.6), followed by OCR (9.3; 8.6-10.0), FING (5.6; 5.2-6.0), CLAD (5.3; 3.7-4.2), NTZ (4.0; 3.7-4.2), RTX (3.8; 3.5-4.1), SIP (3.2; 2.4-4.2), DRF (3.1; 2.4-4.1), OFT (3.0; 2.6-3.6), dimethyl fumarate (2.5; 2.3-2.8), OZ (2.5; 1.8-3.6), MITO (2.4; 1.6-3.6), and TERF (1.6; 1.3-1.9).</p><p><strong>Discussion: </strong>Immunosuppressive MS DMTs are associated with greater HZ reporting in the FAERS. These findings emphasize the importance of pre-DMT HZ vaccination because of avoidable HZ infections.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200462"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625472","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":"Disproportionately Enlarged Subarachnoid-Space Hydrocephalus on MRI in Pathologically Confirmed Progressive Supranuclear Palsy.","authors":"Miki Kawazoe, Shunsuke Koga, Hiroaki Sekiya, Keith Anthony Josephs, Neill R Graff-Radford, Dennis W Dickson","doi":"10.1212/CPJ.0000000000200431","DOIUrl":"10.1212/CPJ.0000000000200431","url":null,"abstract":"<p><strong>Background and objective: </strong>Several studies have shown that idiopathic normal-pressure hydrocephalus (iNPH) can mimic other neurodegenerative disorders, particularly progressive supranuclear palsy (PSP). In this study, we investigated iNPH clinical and neuroimaging features in patients with autopsy-confirmed PSP or Lewy body disease (LBD) by assessing the normal pressure hydrocephalus (NPH) triad of symptoms and imaging features of disproportionately enlarged subarachnoid-space hydrocephalus (DESH) and Evans index (EI) on antemortem MRI scans.</p><p><strong>Methods: </strong>Among our study participants (N = 190), the mean (SD) age was 76.8 (9.2) years and 134 (70.5%) were male. The patients had been followed at Mayo Clinic and had autopsy diagnosis of either PSP or LBD. Patients were excluded if they had Alzheimer disease or a history of a disorder that could cause hydrocephalus, such as chronic meningitis or neoplasia. The study included 101 patients with PSP and 89 with LBD. The frequency of DESH and a high EI on brain MRI were analyzed in PSP and LBD with logistic regression analyses, adjusting for age, sex, and brain weight. The NPH triad of symptoms was assessed relative to imaging findings.</p><p><strong>Results: </strong>We found that DESH and high EI were similar between PSP and LBD. The mean age at death (PSP: 74.0 [8.2]; LBD: 80.0 [9.2]) and brain weight (PSP: 1,190 [123]; LBD: 1,300 [150]) were greater in LBD compared with PSP (<i>p</i> < 0.001 for each). The frequency of DESH was greater in LBD than PSP (13% vs 3%, <i>p</i> = 0.004), while a high EI was similar in PSP and LBD (36% vs 32%, <i>p</i> = 0.500). The adjusted odds ratios for DESH and high EI were similar between the 2 groups (DESH: adjusted ORs 0.3, 95% CI 0.06-1.25, <i>p</i> = 0.119; high EI: adjusted ORs 1.8, 95% CI 0.86-4.06, <i>p</i> = 0.120).</p><p><strong>Discussion: </strong>These findings suggest that DESH and high EI, often considered biomarkers for iNPH, may lack specificity and may be found in a subset of patients with PSP or LBD leading to unnecessary neurosurgery for iNPH.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200431"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502871","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":"Practice-Pattern Variation in Neurocritical Care Blood Pressure Control Reveals Opportunities for Improved Long-Term Hypertension Control.","authors":"Megan Kennelly, Andrew J Webb, Sophie E Ack, Gloria Hyunjung Kwak, Jonathan Rosand, Eric S Rosenthal","doi":"10.1212/CPJ.0000000000200453","DOIUrl":"10.1212/CPJ.0000000000200453","url":null,"abstract":"<p><strong>Background and objectives: </strong>Uncontrolled hypertension is a risk factor of heart attack, stroke, dementia, and other conditions. In outpatients with hypertension, blood pressure (BP) may be controlled at only 30%-50% of visits depending on the population studied. Hospital admission is ideal for achieving guideline-directed BP targets, given the resource-intensive environment. We evaluated the relationship between BP control performance during neurocritical care and hospital admission and rates of uncontrolled hypertension at discharge and over the subsequent 2 years.</p><p><strong>Methods: </strong>This two-center retrospective cohort included adults admitted with any neurologic illness to an neurosciences intensive care unit (NeuroICU) from April 2016 to December 2022, transferred to a neurology general care unit, and then discharged to home or rehabilitation. Hypertension was defined as systolic BP (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg. The primary outcomes were rates of hypertension at hospital discharge through 2 years after discharge. Multivariable logistic and generalized additive models were developed to assess the association between NeuroICU BP control and persistent hypertension, adjusting for baseline covariates, NeuroICU length of stay, performance measures quantifying BP goals, and antihypertensive medication intensity on transferring from the NeuroICU.</p><p><strong>Results: </strong>Of 13,711 admissions, 10,836 met inclusion criteria and 3,075 (28.3%) were hypertensive at hospital discharge. Each 10-mm Hg SBP increase at NeuroICU transfer was associated with 1.60-fold increased odds of uncontrolled hypertension at discharge (95% CI 1.56-1.64). In multivariate analysis controlling for covariates, hypertension at transfer remained independently associated with hypertension at discharge (adjusted odds ratio 3.85, 95% CI 3.47-4.28). The association persisted through 24 months after discharge, even among those without a history of hypertension, among those admitted to the hospital normotensive, or when adjusting for antihypertensive therapy intensity. The association persisted across a range of principal diagnoses and across institutions, although practice-pattern variation yielded significant differences between institutions.</p><p><strong>Discussion: </strong>Hypertension at NeuroICU transfer was independently associated with uncontrolled hypertension through hospital discharge and the subsequent 2 years, independent of patient diagnosis, medical history, institution, and treatment intensity. The initial hospitalization represents an opportunity to achieve and maintain guideline-directed BP targets to reduce secondary cerebrovascular events, dementia, and cardiovascular complications. Further studies are needed to determine whether improving rates of BP control at NeuroICU transfer and discharge leads to long-term improvements in BP control.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200453"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720847","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":"2023-2024: A Message from the Editors to Our Reviewers.","authors":"Luca Bartolini, Kathryn Kvam, Amanda Jagolino-Cole, John Ney, Belinda A Savage-Edwards, Jack W Tsao","doi":"10.1212/CPJ.0000000000200439","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200439","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200439"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692766","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":"uSINE-PAMS Artificial Intelligence-Driven, Ultrasound-Guided Lumbar Puncture to Improve Procedural Accuracy: A Pilot Study Report.","authors":"Xuling Lin, Mei Lyn Carissa Lam, Ding Fang Chuang, Joanne Yong Ern Yuen, Liqing Fu, Valerie Jun Zhi Teh, Aynul Marliya, Seyed Ehsan Saffari, Christen Sheng Jie Lim, Yu-Lin Wong, Ying Hao Christopher Seet","doi":"10.1212/CPJ.0000000000200447","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200447","url":null,"abstract":"<p><strong>Background: </strong>Traditional lumbar punctures (LPs) often fail, leading to diagnostic delays and increased risks. Ultrasound guidance provides improved success rates but faces adoption barriers due to neuraxial-ultrasound training and implementation challenges. The Ultrasound-Guided Spinal Landmark Identification With Needle Navigation System and Position and Angular Marking System (uSINE-PAMS) were designed to address these issues: uSINE is a machine-learning software for neuraxial-ultrasound guidance; PAMS is a hardware that translates ultrasound data for accurate needle insertion.</p><p><strong>Recent findings: </strong>A pilot study with 10 patients showed that uSINE-PAMS-guided LP achieved an 80% first-pass success rate with no complication; the median patient age was 43 years, and the median body mass index was 24.5 kg/m². The uSINE-PAMS system showed feasibility.</p><p><strong>Implications for practice: </strong>This pilot study showed that uSINE-PAMS-guided LP is feasible with a promising first-pass success rate at 80%. An ongoing phase 2 study (NCT05824546) of uSINE-PAMS may alter future standard of practice for LPs.</p><p><strong>Trial registration information: </strong>This pilot study is registered under ClinicalTrials.gov (ID: NCT05824546).</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200447"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811951","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":"Erratum: Where Does Visual Aura Belong-Epilepsy or Migraine?: A Historical Perspective.","authors":"Gagandeep Singh, Debashish Chowdhury, Tissa Wijeratne, Josemir W Sander","doi":"10.1212/CPJ.0000000000200401","DOIUrl":"10.1212/CPJ.0000000000200401","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200343.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200401"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692774","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":"Revised Diagnostic Criteria for Huntington Disease: What's It Gonna Take?","authors":"Jane S Paulsen, Deven K Burks","doi":"10.1212/CPJ.0000000000200430","DOIUrl":"10.1212/CPJ.0000000000200430","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200430"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080416","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":"Understanding Patient Referral Practices and Perceptions of Mental Health Professionals Among Neurologists.","authors":"Margaret T Gopaul, Sirikanya Chiraroekmongkon, Hamada Hamid Altalib","doi":"10.1212/CPJ.0000000000200455","DOIUrl":"10.1212/CPJ.0000000000200455","url":null,"abstract":"<p><strong>Background and objectives: </strong>To examine neurologists' practices in managing mental health care. The study aims to identify gaps in coordination between neurology and mental health care and to assess neurologists' perspectives on integrating mental health services into neurology clinics.</p><p><strong>Methods: </strong>A mixed-methods approach was used, combining survey data and qualitative interviews of key informants. The survey assessed management strategies for psychiatric comorbidities through 3 hypothetical cases and questions regarding referral patterns, accessibility of mental health professionals, and perceived effectiveness of mental health care. Chi-square tests were conducted to compare responses by location (the United States vs international) and specialty (general neurology, subspecialist neurology, and neuropsychiatry).</p><p><strong>Results: </strong>Significant differences in follow-up plans (χ² = 11.025, <i>p</i> = 0.026) and referral frequency for functional neurologic disorders (χ² = 24.943, <i>p</i> < 0.001) were observed, with US physicians more likely to comanage patients with mental health professionals. US neurologists also report referring patients with psychiatric comorbidities more frequently (χ² = 8.424, <i>p</i> = 0.038). No significant difference in the accessibility of mental health professionals was reported by location (χ² = 1.364, <i>p</i> = 0.968) or specialty (χ² = 2.939, <i>p</i> = 0.568). Neurologists in the United States were more likely than neurologists from other countries to perceive mental health professionals to be highly effective (χ² = 8.590, <i>p</i> = 0.035).</p><p><strong>Discussion: </strong>Most neurologists favor integrating mental health services within neurology clinics, underscoring the need for better care coordination. Despite the global effort to integrate mental health in primary care, these findings suggest a need to consider alternative models in coordinating mental health care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200455"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468582","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}