Neurology. Clinical practice最新文献

{"title":"Establishing a Transition Program for Young Adults With Epilepsy.","authors":"Tina Krysiak, LeAnna Bricker, Laura Daniela Fonseca, Amber Cannata, Beth Williams, Gogi Kumar","doi":"10.1212/CPJ.0000000000200651","DOIUrl":"10.1212/CPJ.0000000000200651","url":null,"abstract":"<p><strong>Background and objectives: </strong>Transition of young adults with epilepsy to an adult health care model continues to be challenging because of many barriers. A Quality Improvement project was developed to create a roadmap to assist young adults with epilepsy in successfully transitioning from our pediatric neurology clinic to adult neurology providers for lifetime epilepsy management.</p><p><strong>Methods: </strong>Young adults with epilepsy aged 18-23 years with normal cognitive development were recruited to participate in our program. We conducted 4 interventions, each with 3 Plan-Do-Study-Act cycles from February 2023 to January 2025. The interventions included roadmap development, setting expectations for transition, expansion of patient communication modalities, and transition documentation. The outcome measure was defined as a successful transition from Dayton Children's Hospital (DCH) neurology clinic to an adult neurology clinic and was calculated by the number of patients who completed their first appointment with their adult neurology provider.</p><p><strong>Results: </strong>Of 102 patients enrolled in the program, we tracked 72 (70%) successful transitions with 26 pending further action (i.e., scheduled appointments, referrals pending approval, and unable to reach patients) and 4 dismissed from the department. Barriers in the process included missed appointments, inability to establish communication with patients, and delayed self-management behaviors. The program was adopted as standard practice in our department and continues to be effective 2 years later.</p><p><strong>Discussion: </strong>The DCH neurology team created and maintained a successful transition program for developmentally normal young adults with epilepsy to transition to an adult neurology clinic and assume responsibility for managing their health care needs.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 5","pages":"e200651"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721325","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":"Extending the Treatment Window for Intravenous Thrombolysis in Acute Ischemic Stroke: An Updated Systematic Review and Meta-Analysis.","authors":"Soheil Rahmati, Mohammadreza Alinejadfard, Yasaman Zarinfar, Amir Moradi, Amir Ghabousian, Ali Moradi, Kimia Najafi, Fady Iskander, Azeem Latib, Toshiki Kuno, Preethi Ramchand, Kaveh Hosseini","doi":"10.1212/CPJ.0000000000200654","DOIUrl":"10.1212/CPJ.0000000000200654","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intravenous thrombolysis (IVT) is the standard treatment for acute ischemic stroke within 4.5 hours of onset. However, imaging-based selection may extend the treatment window. This systematic review and meta-analysis evaluated the efficacy and safety of IVT administered beyond 4.5 hours after stroke onset or last known well (LKW) in patients selected based on imaging findings.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Scopus, and Cochrane Library was performed to identify randomized controlled trials comparing IVT with alteplase or tenecteplase (TNK) administered >4.5 hours after stroke onset/LKW vs standard care. Primary outcomes were 3-month excellent (modified Rankin Scale [mRS] 0-1) functional outcome and symptomatic intracranial hemorrhage (sICH). Secondary outcomes included good (mRS 0-2) functional outcome, recanalization, and 3-month mortality. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analysis assessed differences between alteplase and TNK.</p><p><strong>Results: </strong>Fourteen studies involving 4,944 patients were included. The mean age was 69.8 years, 58.2% were male, the median National Institutes of Health Stroke Scale score was 9, and 12.3% received preplanned endovascular thrombectomy (EVT). A total of 2,492 patients received IVT in an extended time window (4.5-24 hours). Compared with standard care, extended IVT was associated with higher odds of achieving an excellent functional outcome (OR: 1.43 [95% CI 1.25-1.63]), a good functional outcome (OR: 1.25 [95% CI 1.11-1.40]), and recanalization (OR: 3.28 [95% CI 2.09-5.16]). There was no difference in 3-month mortality (OR: 1.21 [95% CI 0.95-1.53]). However, IVT increased the risk of sICH (OR: 2.51 [95% CI 1.47-4.28]). Sensitivity analysis excluding patients who received EVT showed no impact on the outcomes. TNK exhibited similar efficacy to alteplase but showed potentially lower odds of sICH (OR: 1.96, 95% CI 1.06-3.64) compared with alteplase (OR: 5.29, 95% CI 1.80-15.57); however, the subgroup difference was not significant (<i>p</i> = 0.11).</p><p><strong>Discussion: </strong>Among patients selected based on imaging, 4.5-24 hours after stroke onset/LKW, IVT improves outcomes despite an increased risk of sICH. TNK showed similar efficacy to alteplase, with a possible lower risk of sICH; however, direct comparisons in future trials are needed.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 5","pages":"e200654"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945443","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":"The Menopause Transition and Epilepsy: A Focus on Therapeutics.","authors":"Kelsey M Smith, Stephanie S Faubion, Lata Vadlamudi, Marie Christakis, Barbara Mostacci, Emanuele Cerulli Irelli, Gloria Ortiz-Guerrero, Jennifer Cavitt, P Emanuela Voinescu, Esther Bui","doi":"10.1212/CPJ.0000000000200650","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200650","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Perimenopause and menopause are reproductive stages marked by fluctuating and subsequent permanent loss of ovarian estrogen and progesterone production. There are important considerations in these life stages for people with epilepsy including the influence of hormonal changes and use of menopausal hormone therapy (HT) on seizure control and on antiseizure medication (ASM) metabolism. This narrative review summarizes the currently available information about this topic to increase provider awareness and identify gaps in knowledge for future research.</p><p><strong>Recent findings: </strong>Menopause is associated with symptoms that can negatively affect quality of life, including vasomotor and genitourinary symptoms, mood and sleep disturbances, and cognitive changes. HT is the most effective treatment for menopause symptoms, but data on HT use in women with epilepsy are limited. HT may influence seizure control and the metabolism of some ASMs, such as lamotrigine. These observations and the limited available data may be a deterrent to the use of HT in women with epilepsy.</p><p><strong>Summary: </strong>Data are largely lacking to guide the management of epilepsy during perimenopause and menopause. This review summarizes existing data and discusses HT and nonhormone therapies for management of menopause symptoms, highlighting unique considerations for those with epilepsy during the menopause transition.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 5","pages":"e200650"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760088","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":"Delayed Surgical Evaluation After Drug-Resistant Epilepsy Diagnosis Worsens Outcomes in Children: A Multicenter Study.","authors":"Debopam Samanta, Avery Robert Caraway, Andrew T Knox, Michael Ciliberto, Shifteh Sattar, Cemal Karakas, Krista Eschbach, Kristen Arredondo, Fernando N Galan, Janelle Wagner, Daniel W Shrey, Kurtis I Auguste, Ahmad Marashly, Adam P Ostendorf, Taylor J Abel, Lily Wong-Kisiel, Pilar D Pichon, Derryl J Miller, M Scott Perry","doi":"10.1212/CPJ.0000000000200641","DOIUrl":"10.1212/CPJ.0000000000200641","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite its proven effectiveness, epilepsy surgery for drug-resistant epilepsy (DRE) remains underutilized and frequently delayed. Previous studies of epilepsy duration before surgery-using variable delay thresholds (2-20 years)-were small, single-center cohorts focused mainly on temporal/frontal lobe epilepsy, showed better seizure freedom with earlier surgery, but did not distinguish total epilepsy duration from DRE duration. As contemporary epilepsy surgery now includes broader indications and emphasizes faster evaluation, the timing and impact of evaluation across this wider population remain unclear. We examined factors associated with evaluation timing from DRE diagnosis and its effect on surgical outcomes in a large multicenter cohort.</p><p><strong>Methods: </strong>Using a prospective database across 29 US centers, we analyzed associations between patient and epilepsy factors and DRE-to-evaluation interval-defined as the interval from DRE diagnosis to phase 1 video-EEG admission, categorized as shorter (<1 year) or longer (≥1 year)-and compared seizure freedom between groups using multivariable logistic regression adjusted for etiology, seizure type, neuroimaging, and surgical factors.</p><p><strong>Results: </strong>Among 1,310 children, 720 (55%) had shorter and 590 (45%) longer DRE-to-evaluation intervals. Shorter interval was associated with lesional epilepsy (OR 1.65, 95% CI 1.30-2.08), focal seizures (2.80, 2.13-3.70), and normal neurologic exams (1.86, 1.49-2.33). Structural congenital and acquired etiologies were linked to shorter interval, while genetic etiologies (1.73, 1.30-2.32) were linked to longer interval. Among 624 surgical patients (357 shorter, 267 longer), seizure freedom occurred in 53% vs 27% (3.04, 2.17-4.29; <i>p</i> < 0.01). After adjustment, longer interval remained independently associated with lower seizure freedom (0.59, 0.35-1.00; <i>p</i> = 0.0497). DRE-to-evaluation interval, not total epilepsy duration, predicted outcomes.</p><p><strong>Discusion: </strong>In this first large multicenter study across diverse epilepsy types applying a 1-year benchmark, nearly half of pediatric patients experienced delays, particularly those with MRI-negative, generalized, or genetic epilepsies. Delays from DRE diagnosis were independently associated with reduced seizure freedom, supporting presurgical evaluation within 1 year as an evidence-based quality benchmark.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 5","pages":"e200641"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549866","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":"Harmonizing Multi-Institutional Clinical Documentation Using Natural Language Processing in Neurofibromatosis Type 1.","authors":"Stephanie M Morris, Levi Kaster, Saki Amagai, Carolyn Raski, Kelly Regan-Fendt, Yuan Luo, Marc Rosenman, Carlos E Prada, Robert Listernick, Philip R O Payne, David H Gutmann, Aditi Gupta","doi":"10.1212/CPJ.0000000000200648","DOIUrl":"10.1212/CPJ.0000000000200648","url":null,"abstract":"<p><strong>Background and objectives: </strong>Machine learning (ML) and natural language processing (NLP) approaches are increasingly used to support nuanced phenotyping, surveillance, and trial readiness using electronic health records (EHRs) in neurologic disease. However, inconsistent clinical documentation limits data harmonization and model performance, particularly in complex heterogeneous disorders such as neurofibromatosis type 1 (NF1). The primary research question was whether physician-authored EHR documentation of NF1-related features demonstrates systematic lexical variation that may impede computational phenotyping. The primary objective was to characterize lexical variation and documentation completeness for core NF1 features, while a secondary objective aimed to develop a standardized, data-informed clinical lexicon aligned with contemporary clinical practice and terminology standards.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of outpatient progress notes from pediatric patients with NF1 evaluated at 2 large tertiary care programs serving similar patient populations in the Midwest. A rule-based NLP algorithm was developed to identify 10 core NF1 features and extract the range of terms used to document each feature. Lexical variants and documentation frequency were quantified across institutions, providers, and time. Based on observed usage patterns, a standardized clinical lexicon was developed and mapped to existing terminology standards.</p><p><strong>Results: </strong>A total of 5,393 outpatient notes representing 1,661 individual pediatric patients were analyzed. Substantial lexical variation was observed for most NF1 features, including variation within and across individual providers. Clinically significant features, such as optic pathway glioma, were documented using numerous nonstandard terms, with preferred terminology appearing in a minority of notes. Cutaneous neurofibromas demonstrated higher internal consistency but lagged behind current clinical trial nomenclature, while plexiform neurofibromas and attention-deficit/hyperactivity disorder were documented more consistently. Documentation completeness also varied across providers and over time, with many previously documented features absent from later follow-up notes.</p><p><strong>Discussion: </strong>Physician-authored EHR documentation of NF1-related features demonstrates substantial lexical variation and incomplete longitudinal capture, which limit the accuracy and generalizability of NLP-based and ML-based phenotyping. Establishing a standardized, data-informed clinical lexicon aligned with current care and research practices represents a scalable strategy to improve interoperability, phenotypic consistency, and readiness for clinical trials and real-world evidence generation in NF1 and other complex neurologic disorders.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 5","pages":"e200648"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723340","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":"Characterizing Persistent CNS MRI Enhancement in Patients With Treated Neurosarcoidosis.","authors":"Natalya Patrick, Morgan Sosniuk, Ronak K Kapadia, Katayoun Alikhani, Aurore Fifi-Mah, Christopher Hahn","doi":"10.1212/CPJ.0000000000200653","DOIUrl":"10.1212/CPJ.0000000000200653","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to quantify the relative percentage of patients with neurosarcoidosis who demonstrate persistent gadolinium enhancement on MRI, despite apparent clinical remission.</p><p><strong>Methods: </strong>Data from 39 patients with neurosarcoidosis were collected retrospectively for use in electronic chart analysis. Data were anonymized, and patient data (demographics, clinical presentation, radiographic characteristics, and treatment profile) were collected. Standard descriptive statistics were performed, comparing populations with and without persistent gadolinium enhancement.</p><p><strong>Results: </strong>There was no significant difference in disease and treatment data between patient groups with and without persistent gadolinium enhancement. Persistent gadolinium enhancement was common and not associated with clinical disease activity in patients with neurosarcoidosis. There was no correlation between radiographic and clinical improvements.</p><p><strong>Discussion: </strong>Our study demonstrates that persistent gadolinium enhancement is common and does not necessarily correspond to active disease. Given that neurosarcoidosis is commonly monitored with serial MR imaging, these data suggest that persistent enhancement alone should not be used to guide treatment and needs to be taken in the context of the patients' clinical status, previous imaging findings, and examination.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 5","pages":"e200653"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892231","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":"Professional Fulfillment as a Strategic Imperative for Brain Health in Neurology.","authors":"Lidia M V R Moura","doi":"10.1212/CPJ.0000000000200657","DOIUrl":"10.1212/CPJ.0000000000200657","url":null,"abstract":"<p><p>The American Academy of Neurology has prioritized brain health through prevention, early detection, and longitudinal care. However, these goals depend on a stable and engaged neurology workforce. This article examines professional fulfillment as a structural determinant of workforce stability, continuity of care, and system performance. Emerging evidence demonstrates that burnout and professional fulfillment are related but distinct constructs. While burnout reflects occupational distress, fulfillment is associated with meaningful work, recognition, supportive leadership, and alignment between professional values and daily practice. Structural factors including work design, administrative burden, leadership quality, and psychological safety influence both outcomes. Approximately one-third of neurologists report intent to leave their organization within 2 years, raising concerns about workforce sustainability. Efforts to improve neurologic care must therefore extend beyond burnout mitigation to actively promote fulfillment. Measuring and improving professional fulfillment may strengthen retention, preserve continuity of care, and support long-term brain health initiatives in neurology.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 5","pages":"e200657"},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920798","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":"The National Association of Epilepsy Centers Accreditation Criteria Should Include Care for People With Functional/Dissociative Seizures.","authors":"Jared J Woodward","doi":"10.1212/CPJ.0000000000200635","DOIUrl":"10.1212/CPJ.0000000000200635","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200635"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278151","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":"Comprehensive Care Goals in Myasthenia Gravis: Expert Consensus Recommendations Using the RAND/UCLA Appropriateness Method.","authors":"Pushpa Narayanaswami, Renato Mantegazza, Carolina Barnett-Tapia, Elena Cortés-Vicente, Miriam L Freimer, Nils Erik Gilhus, Ali A Habib, James F Howard, Anna Kostera-Pruszczyk, M Isabel Leite, Andreas Meisel, Mamatha Pasnoor, Sabrina Sacconi, Nicholas J Silvestri, Julia Stevens, Shigeaki Suzuki, Akiyuki Uzawa, Gil I Wolfe, Kimiaki Utsugisawa","doi":"10.1212/CPJ.0000000000200644","DOIUrl":"10.1212/CPJ.0000000000200644","url":null,"abstract":"<p><strong>Background and objectives: </strong>Goals for comprehensive care are important in the management of individualized treatment for patients with myasthenia gravis (MG), a disease with variable presentation and degrees of severity. Yet there is limited guidance on how comprehensive care should be achieved and implemented. We present global consensus recommendations for comprehensive care of patients with MG.</p><p><strong>Methods: </strong>An international panel of experts was formed, and a targeted literature review was conducted to inform the recommendations. A steering committee selected relevant topics and draft recommendations were developed for each topic. Formal consensus was achieved using the RAND/UCLA appropriateness method. Seventeen panelists from North America, Europe, and Asia rated statements online from 1 (\"extremely inappropriate\") to 9 (\"extremely appropriate\") and provided comments and suggestions for modifications. The methodologist modified statements for further rating, based on panel scores and feedback. Statements achieving agreement as appropriate by 4 rounds of rating were accepted.</p><p><strong>Results: </strong>Consensus was achieved for 21 statements. Statement 1 defined the ongoing treatment goal: \"to work toward, achieve, and sustain minimal symptoms and treatment-related adverse events, with a patient-acceptable quality of life (using validated measures)\". Subsequent statements described implementation of this goal and covered: early control of symptoms; establishing and sustaining a treatment goal; vaccination and screening for infection; family planning/pregnancy; management of fatigue and comorbidities; and management of impending crisis and crisis.</p><p><strong>Discussion: </strong>Expert consensus was achieved on a series of global recommendations for comprehensive care goals, which has implications for improved disease outcomes and health-related quality of life for patients with MG. These recommendations will require updating as treatment paradigms evolve.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200644"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422337","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":"Outcomes and Cost-Effectiveness of an Interdisciplinary Clinic for Functional Neurologic Disorders.","authors":"Sravan Anne, Matthew J Lennon, Emily Swift, Noni Jervis, Whitney Harris, Kate Gow, Ishan C Walpola, Michael Connors, Rebecca Moss, John D Crawford, Perminder S Sachdev, Adith Mohan","doi":"10.1212/CPJ.0000000000200638","DOIUrl":"10.1212/CPJ.0000000000200638","url":null,"abstract":"<p><strong>Background and objectives: </strong>Functional neurologic disorder (FND) is a common and disabling condition associated with diagnostic delays, poor outcomes, and fragmented care. Evidence for interdisciplinary models within public health systems is limited. We evaluated outcomes and cost-effectiveness of an interdisciplinary FND clinic in a public hospital.</p><p><strong>Methods: </strong>We conducted a prospective observational cohort study of 101 individuals referred to a public interdisciplinary FND clinic in Sydney, Australia. All patients received neuropsychiatric assessment and multidisciplinary team discussion involving psychology, physiotherapy, and occupational therapy to guide ongoing care. Forty-two patients in addition completed a 6-week structured psycho-behavioral group program. Outcomes were assessed at intake, 1-week, 3-month, and 6-month follow-up using measures of functioning (World Health Organization Disability Assessment Scale total score 2.0), quality of life (EQ-5D-5L, SF-36), psychological distress (K10), somatic symptom burden Patient Health Questionnaire-15 (PHQ-15), and clinical severity (CGI-S/I, HoNOS). Mixed-effects models were used to assess repeated longitudinal change. Cost-effectiveness was evaluated using EQ-5D utilities and incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>Across the full cohort, CGI-S improved by -1.02 points at 6 months (95% CI -1.28 to -0.77; d = 0.95). In adjusted observational analyses, between-group differences were examined across clinical, functional, and economic outcomes. Compared with standard care, the intervention group showed greater CGI-S improvement at 3 months (B = -0.81, 95% CI -1.19 to -0.43; d = 0.92) and 6 months (B = -0.88, 95% CI -1.35 to -0.41; d = 0.99). SF-36 social functioning scores improved at 6 months (+17.1, 95% CI + 6.2 to +28.1; d = 0.68). PHQ-15 scores decreased (-2.1, 95% CI -4.1 to -0.1). The intervention generated an estimated +0.16 quality-adjusted life year (QALYs) over 12 months (95% CI 0.08 to 0.23), corresponding to an ICER of AU$9,093 per QALY (95% CI $6,077.88 to $18,332.89).</p><p><strong>Discussion: </strong>Participation in an interdisciplinary FND clinic with an embedded brief psycho-behavioral program was associated with clinically meaningful improvements and favorable cost-effectiveness estimates. Findings support consideration of interdisciplinary, psychologically informed FND services within public health systems.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200638"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422376","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}