Neurology. Clinical practice最新文献

{"title":"Likelihood and Predictors of Acute Findings on CTA Head and Neck for Neurologic Presentations to the Emergency Department.","authors":"Rahul Gaini, Stephanie L Reyes, Tanziyah Muqeem, Shakthi Unnithan, Hussein Al-Khalidi, Peter G Kranz, Joel C Morgenlander","doi":"10.1212/CPJ.0000000000200596","DOIUrl":"10.1212/CPJ.0000000000200596","url":null,"abstract":"<p><strong>Background and objectives: </strong>CT angiography of the head and neck (CTAHN) is commonly obtained in the emergency department (ED) for patients with acute neurologic symptoms to guide interventions. There are limited data on which clinical characteristics predict these changes. The primary objective of this study was to assess the yield of CTAHN across common neurologic ED presentations and identify patient and clinical factors associated with CTAHN findings that result in acute management change.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 1,445 ED patients at an academic Level 1 trauma center who underwent CTAHN in 2023 for 5 common neurologic presentations: stroke code, headache, dizziness, altered mental status, and vision changes. Multivariable logistic regression models with LASSO variable selection were used to identify predictors of acute management change. Odds ratios (OR), 95% CIs, and <i>p</i> values were reported for each independent predictor.</p><p><strong>Results: </strong>Overall, 216 of 1,445 CTA head and neck sudies (CTAHNs; 14.9%) resulted in acute management change. The highest yield of CTAHN acute management change was for stroke codes (21.2%) and vision changes (14.7%), and the lowest for dizziness (4.0%). For stroke codes, independent predictors included abnormal CT head (OR 2.84, <i>p</i> = 0.0001), focal neurologic deficit (OR 2.2, <i>p</i> = 0.0119), new vs recurring symptoms (OR 2.39, <i>p</i> = 0.0272), maximal symptom severity at onset (OR 3.95, <i>p</i> = 0.0011), and tobacco use (OR 2.02, <i>p</i> = 0.0016). National Institutes of Health Stroke Scale (NIHSS) scores of 10-14 had the highest likelihood of CTAHN acute management change. Previous neurologic disorder was protective (OR 0.66, <i>p</i> = 0.0317). For headache, abnormal CT head (OR 4.98, <i>p</i> = 0.0303) and thunderclap presentation (OR 5.31, <i>p</i> = 0.0276) were associated with CTAHN acute management change. Only univariate trends could be identified for dizziness, altered mental status, and vision changes. CTAHN was most useful in those presenting with vision loss or diplopia, but not cases of blurry vision or positive visual phenomena. Abnormalities on the preceding CT head increased the yield for altered mental status, while CTAHNs were low yield for isolated dizziness.</p><p><strong>Discussion: </strong>These results highlight specific, obtainable clinical predictors that can guide judicious use of CTAHN in the ED. Recognizing these predictors can inform emergency physicians' and neurologists' clinical judgment, optimize imaging utilization, improve resource allocation, and reduce patient burden.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 2","pages":"e200596"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378006","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":"Changes in List and Net Prices for Multiple Sclerosis Disease-Modifying Therapy, 2013 to 2021.","authors":"Daniel M Hartung, Nico Gabriel, Walid F Gellad, Teresa Cameron, Noah M Feder, Inmaculada Hernandez","doi":"10.1212/CPJ.0000000000200597","DOIUrl":"10.1212/CPJ.0000000000200597","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to evaluate changes in net and list prices of branded multiple sclerosis (MS) disease-modifying therapies (DMTs) between 2013 and 2021.</p><p><strong>Methods: </strong>Using several pharmaceutical pricing and utilization data sources, we estimated list and net (after rebates and discounts) prices for branded monoclonal antibody (MAb) and oral DMTs. We calculated the inflation-adjusted list and net prices for each DMT, the manufacturer discount as a percentage of list price, the average annual change (AAC) in prices, and the cumulative change in list price offset by discounts.</p><p><strong>Results: </strong>From 2013 to 2021, oral DMT list prices increased from $73,924 to $104,372 (5.3% AAC) while net prices rose from $69,187 to $82,181 (1.5% AAC) because of increasing manufacturer discounts (6.4%-21.2%). From 2014 to 2021, MAb DMT list prices increased from $70,320 to $92,109 (4.1% AAC), with net prices rising from $55,109 to $79,396 (3.0% AAC). Discounts offset 51%-86% of cumulative list price increases for oral DMTs (fingolimod, teriflunomide) vs 0%-35% for MAb DMTs.</p><p><strong>Discussion: </strong>The divergent net pricing trends between oral and MAb DMTs may reflect increasing brand and generic competition among oral DMTs and a lack of biosimilar options among MAb DMTs.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 2","pages":"e200597"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12912193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220639","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":"Trends in Industry-Sponsored Research Payments and General Payments to Neurologists: Open Payments Program 2015-2023.","authors":"Tyler S Garman, Zeyad Hammadeh, Misop Han, Joon Y Kang","doi":"10.1212/CPJ.0000000000200595","DOIUrl":"10.1212/CPJ.0000000000200595","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to characterize trends in industry-sponsored research payments (ISRPs) and general payments to neurologists.</p><p><strong>Methods: </strong>Payments to neurologists from 2015 to 2023 were examined using the Open Payments Program database. Primary outcomes were ISRPs and general payments to covered entities and noncovered entities (NCEs), with a neurologist principal investigator (PI) adjusted to 2023 USD. Payments to multiple PIs were attributed to the primary PI. Trends were tested using linear models.</p><p><strong>Results: </strong>From 2015 to 2023, there were $2.8 billion of ISRPs, around 80% of which went to NCEs where a neurologist was a PI, and $1 billion of general payments. The median general payment value per physician has decreased by $26 per year (95% CI -$42 to -$10; <i>p</i> < 0.01), and the maximum payment per physician has increased by $1.57 million per year (95% CI $0.69-$2.43 million; <i>p</i> < 0.01).</p><p><strong>Discussion: </strong>This study found that most of the ISRPs are paid to NCEs where a neurologist was a PI instead of a covered entity, which opacifies the industry-neurology relationship and highlights the need for increased transparency. The median general payment to a neurologist decreased over time; however, the maximum payment increased, suggesting a consolidation of funding to fewer neurologists who are paid the most by industry.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 2","pages":"e200595"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213700","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":"Epilepsy and Alzheimer Disease: Epidemiologic, Clinical, Molecular, and Neuropathologic Convergences and Divergences.","authors":"Orrin Devinsky, Dominique F Leitner, Anita Kamondi, Thomas Wisniewski","doi":"10.1212/CPJ.0000000000200589","DOIUrl":"10.1212/CPJ.0000000000200589","url":null,"abstract":"<p><strong>Purpose of review: </strong>Alzheimer disease (AD) and epilepsy are major causes of neurologic disability and are reciprocally related: epileptiform discharges, subclinical seizures, and epilepsy are more prevalent in patients with AD compared with controls; progressive cognitive impairment commonly afflicts epilepsy patients; and late-onset epilepsy patients have higher rates of new-onset dementia.</p><p><strong>Recent findings: </strong>Epidemiologic studies support shared risk factors (e.g., genetic variants, vascular disease, sleep disorders, microbiome) with notable divergences. AD and epilepsy have some overlapping anatomic (e.g., hippocampus, entorhinal, and association cortex), clinical (e.g., memory, attentional, and executive) impairments, and neuropathologic (e.g., amyloid, tau, neurofibrillary tangles) features. Shared clinical and translational challenges include underlying mechanisms (e.g., genetic variants, neuroinflammation, metabolic and mitochondrial dysfunction, excitatory/inhibitory imbalance, microbiome, and sociodemographic factors) and identifying valid and reliable biomarkers (e.g., total tau and phosphorylated tau (p-tau), amyloid deposition, Aβ42/Aβ40 ratio) to assess disease progression, predict outcomes, and assess potentially disease-modifying interventions.</p><p><strong>Summary: </strong>Identifying convergences and divergences between epilepsy and AD may inform our understanding. The clinical, neurophysiologic, neuropathologic, and molecular pathologic changes in AD and epilepsy may reveal pathophysiologic insights and therapeutic opportunities.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 2","pages":"e200589"},"PeriodicalIF":3.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326719","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":"Sustaining Progress in Reducing Door-In-Door-Out Times for Stroke Transfers.","authors":"Robin Novakovic-White","doi":"10.1212/CPJ.0000000000200571","DOIUrl":"10.1212/CPJ.0000000000200571","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200571"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768717","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":"Albendazole-Praziquantel Dual Therapy Compared With Albendazole Monotherapy in Neurocysticercosis: A Systematic Review and Meta-Analysis of RCTs.","authors":"Jorge Resende Gondim Jasmineiro Pitanga, Murilo Marmori Cruccioli, Pedro Henrique Teixeira Carneiro, Yasmin Bastos Faller, Letícia Torres da Silva, Marla Resende Gondim Jasmineiro Pitanga, Filipe P Sarmento","doi":"10.1212/CPJ.0000000000200567","DOIUrl":"10.1212/CPJ.0000000000200567","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neurocysticercosis is the most common parasitic infection of the CNS and remains a significant, yet often neglected, public health issue in endemic regions. High-quality evidence suggests that albendazole monotherapy leads to superior clinical outcomes compared with placebo or praziquantel. However, there is still insufficient evidence regarding the efficacy and safety of combined albendazole-praziquantel therapy. This systematic review and meta-analysis aims to compare combined antiparasitic therapy with albendazole and praziquantel with albendazole monotherapy, evaluating whether dual therapy offers superior therapeutic benefits in the management of neurocysticercosis while maintaining an acceptable safety profile.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) published until April 2024 that compared combined albendazole-praziquantel therapy with albendazole monotherapy for the treatment of neurocysticercosis. Statistical analysis was performed using Review Manager 5.4.1, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. A random-effects model was applied to all end points. The risk of bias was assessed for each study, and the certainty of evidence was evaluated using the GRADE approach.</p><p><strong>Results: </strong>Five RCTs were included, comprising a total of 320 patients, 49% of whom received combined therapy. Complete cyst resolution was significantly more frequent in patients treated with combined albendazole-praziquantel therapy compared with albendazole monotherapy (OR = 3.06; 95% CI [1.81-5.19]; <i>p</i> = 0.0001; <i>I</i> ² = 5%; high-certainty evidence). In a subgroup analysis restricted to patients with 1-2 cysts (248 patients), no statistically significant difference in complete cyst resolution was observed (OR = 1.98; 95% CI [0.92-4.27]; <i>p</i> = 0.08; <i>I</i> ² = 34%; very-low-certainty evidence). There was no significant difference in seizure recurrence between treatment strategies (OR = 1.28, 95% CI [0.56-2.91], <i>p</i> = 0.55, <i>I</i> ² = 0%; moderate-certainty evidence). Similarly, the incidence of adverse effects did not differ significantly between groups (OR = 1.40, 95% CI [0.72-2.72], <i>p</i> = 0.30, <i>I</i> ² = 0%; moderate-certainty evidence).</p><p><strong>Discussion: </strong>This systematic review and meta-analysis demonstrated a threefold increase in complete cyst resolution among patients receiving combined therapy, suggesting its superiority over albendazole monotherapy for the management of neurocysticercosis. In addition, no significant differences were observed between treatment strategies regarding seizure or adverse events.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200567"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12726353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828188","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":"Brain Emergency Management Initiative (BEMI-S): Assessment of Embolectomy Transfer Times Using a Novel Stroke System Transfer Protocol.","authors":"Carla N Wood, Dawn M Meyer, Ben Shifflett, Royya Modir, Harjot Hansra, Claire Davila, Julia Bu, Brett C Meyer, Reza Bavarsad Shahripour","doi":"10.1212/CPJ.0000000000200566","DOIUrl":"10.1212/CPJ.0000000000200566","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent studies of national stroke door-in-door-out (DIDO) times found that most transfers for acute interventions are not completed within the recommended time frame. There is a critical need for effective emergent transfer protocols to improve outcomes. The Brain Emergency Management Initiative (BEMI) is a stroke transfer protocol connecting patients with acute stroke at spoke sites to a hub center for embolectomy. BEMI has been shown to significantly reduce transfer time metrics through rapid transit activation, CT head/CTA bundling, digital image sharing, standardized documentation, and remote patient admission. In this study, we evaluated the sustainability of BEMI's impact on reduction of these transfer metrics.</p><p><strong>Methods: </strong>We assessed data for patients transferred for embolectomy in our stroke system. Patients were compared across 3 groups: before the protocol (\"pre-BEMI\"), the initial year of protocol implementation (\"BEMI\"), and the contemporaneous 5 years of protocol usage (\"BEMI-S\") to assess for sustainability. Time metrics assessed include DIDO time, time from treatment decision to groin puncture (TDGP), and a safety outcome of symptomatic ICH (sICH) rate.</p><p><strong>Results: </strong>Four hundred twenty-nine transfers were evaluated, with a final sample size of 271 patients (pre-BEMI n = 31, BEMI n = 32, BEMI-S n = 208). A significantly shorter median DIDO time was found in the BEMI groups (pre-BEMI median = 143 minutes vs BEMI = 118 minutes, <i>p</i> = 0.015; vs BEMI-S = 97 minutes, <i>p</i> = 2.1e-07). DIDO time also improved significantly from BEMI to BEMI-S groups (118 vs 97 minutes; <i>p</i> = 0.0005). TDGP was significantly reduced in the BEMI and BEMI-S groups compared with the pre-BEMI group (pre-BEMI median = 155 minutes vs BEMI = 130 minutes, <i>p</i> = 0.01; vs BEMI-S = 125 minutes, <i>p</i> = 4.15e-13) but was similar between the BEMI and BEMI-S groups (130 vs 125 minutes, <i>p</i> = 0.89). Symptomatic ICH rates were similar before and immediately after BEMI implementation but significantly reduced in the BEMI-S group (pre-BEMI 12.9%, vs BEMI 15.6%, <i>p</i> = 1, vs BEMI-S 2.4%, <i>p</i> = 0.037; BEMI vs BEMI-S <i>p</i> = 0.014).</p><p><strong>Discussion: </strong>The BEMI protocol significantly improved transfer (DIDO) time by 46 minutes and treatment time (TDGP) by 25 minutes in our stroke network, showing continuous sustainability. sICH rates significantly lowered by over 10% with continued use of the BEMI protocol. Our protocol builds on similar rapid transfer stroke protocols through incorporating unique features such as air transit, video telestroke specialist evaluation, and rapid on-loading protocols with uniform documentation.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200566"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768708","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":"Shared Decision-Making in Stroke Discharge Planning: Insights From SHOUT-STROKE.","authors":"Tatjana Rundek, Carolina Marinovic Gutierrez","doi":"10.1212/CPJ.0000000000200570","DOIUrl":"10.1212/CPJ.0000000000200570","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200570"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271575","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":"Nonmydriatic Ocular Fundus Imaging in Consecutive Patients With Headache in an Emergency Department.","authors":"Kevin Yan, George Alencastro Landim, Mung Yan Lin, Andrew M Pendley, Nithya Shanmugam, Jessica G McHenry, Stuart Duffield, Daniel V Adamkiewicz, Duyen T Vo, Jordan Prosky, Matthew T Keadey, David W Wright, Michael Dattilo, Andrew F Fischer, Nancy J Newman, Valerie Biousse","doi":"10.1212/CPJ.0000000000200576","DOIUrl":"10.1212/CPJ.0000000000200576","url":null,"abstract":"<p><strong>Background and objectives: </strong>Ocular fundus findings such as papilledema are red flags in the evaluation of headache but are often missed in emergency departments (EDs), where ocular fundus examination is rarely performed. Our goal was to determine how often nonmydriatic ocular fundus photographs with optical coherence tomography (NMFP-OCT) show relevant ocular fundus findings in a consecutive cohort of patients with headaches in our ED.</p><p><strong>Methods: </strong>This was a quality improvement project conducted prospectively over 16 consecutive days/nights. NMFP-OCT OU (tabletop Maestro2/Topcon-Japan) was ordered for all patients presenting to our ED with active headache or a headache history and were classified into the following categories: group 1: isolated headache evaluation/treatment; group 2: neurologic/neurosurgical issue with associated active headache; group 3: non-neurologic issue with active headache; group 4: headache history but no active headache. Demographic information, headache classification, final diagnosis, and NMFP-OCT findings were collected.</p><p><strong>Results: </strong>Of 1,838 ED visits over 16 days/nights, 194 patients had headaches or a history of headaches and 149 (76.4%) underwent NMFP-OCT in the ED. In group 1, of the 46 total patients, 40 had NMFP-OCT performed in the ED (1 with papilledema, 1 with dilated vessels from carotid-cavernous fistula, 2 with nonrelevant findings). Group 2 included 46 patients overall, and 37 had NMFP-OCT performed in the ED (4 with papilledema, 4 with relevant retinopathies, 3 with optic atrophy, 7 with nonrelevant findings). Group 3 included 77 patients overall, and 52 had NMFP-OCT performed in the ED (none with papilledema). Group 4 included 25 patients overall (3 with neurologic or neurosurgical issue, 22 with non-neurologic/neurosurgical issue), and 20 had NMFP-OCT performed in the ED (no papilledema, 1 with optic atrophy).</p><p><strong>Discussion: </strong>NMFP-OCT obtained in our ED for 129 consecutive patients presenting with active headaches (groups 1-3) allowed for rapid diagnosis of papilledema in 5 patients (3.9%), and other relevant findings in 8 patients (6.2%), with 40 patients (23.6%) not undergoing NMFP-OCT. Among the patients who presented to the ED for non-neurologic reasons with active headaches or those patients with only a history of headaches (groups 3-4), none had papilledema. NMFP-OCT enabled prompt and accurate rule-out of papilledema in patients with headaches presenting to our ED and facilitated rapid and reliable examination of the ocular fundus.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200576"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271607","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":"Status Epilepticus Management in Resource-Limited Settings: An International Expert Survey.","authors":"Aayesha J Soni, R Grace Couper, Manqoba Gule, John Angelo Luigi Santiago Perez, Belal Aldabbour, Jo Wilmshurst, Gagandeep Singh, Elma Paredes-Aragón, Maria Del Carmen Garcia, Sa'ad Lahri, Ivan Andrew Joubert, Melody Tunsubilege Asukile, Gwendoline Kandawasvika, Daniel Gams Massi, Hendry R Sawe, Jayantee Kalita, Gunchan Paul, Vrajesh Udani, Maria Pilar Vicuna, Luis Carlos Mayor-Romero, Jorge Carrizosa, Mwiche Chiluba, Theresia Edgar Lutufyo, Amina Chentouf, Nirmeen Adel Kishk, Rajesh Mahajan, Alejandro L Escalaya, Rio Carla Pineda, Junette A M Mbengono, Nicolas M Ciarrocchi, Bilal Irfan, Jorge G Burneo","doi":"10.1212/CPJ.0000000000200572","DOIUrl":"10.1212/CPJ.0000000000200572","url":null,"abstract":"<p><strong>Background and objectives: </strong>Status epilepticus (SE) is a neurologic emergency with disproportionate mortality and morbidity in low- and middle-income countries. Existing SE guidelines are largely based on high-income country contexts, limiting applicability in settings with diagnostic, therapeutic, and infrastructural constraints. We aimed to examine expert clinician perspectives on SE management across recourse-limited settings to identify common barriers and context-specific strategies.</p><p><strong>Methods: </strong>This study used a convergent parallel mixed methods approach, interconnecting quantitative and qualitative data collected from an online survey. Experts in SE management were purposively sampled to balance clinical expertise across 3 physician disciplines (neurology, emergency medicine, and critical care) and geographic locations. Invitations to participate were sent to 48 experts from 22 different countries. Qualitative data using thematic analysis and descriptive statistics for quantitative analysis was used.</p><p><strong>Results: </strong>We received responses from 28 clinical experts, spanning 15 countries across 4 continents. Over 96% (27/28) agreed on the importance of guidelines or relevant subsections applicable to resource-limited settings. Experts highlighted inadequate SE education at multiple levels, but less than half (12/28) reported discussing SE management during routine clinic visits. A common theme was a lack of access to anti-seizure medications (ASMs), with 86% (24/28) agreeing that oral ASMs should be included in SE guidelines, although there was no consensus on what these should be. Only 39% (11/28) of experts had consistent access to electroencephalography (EEG), and there was little agreement about the duration and frequency of serial intermittent EEGs in the absence of continuous EEG. Nearly all experts (27/28) agreed that multicenter international efforts are essential to understand current practices and to improve patient outcomes. Other proposed solutions included implementing locally adapted practices to improve care, such as remote tele-monitoring and improving SE education and training.</p><p><strong>Discussion: </strong>This study provides the most geographically diverse expert insight to date on SE care in recourse-limited settings, underscoring systemic barriers that transcend clinical decision-making. Inclusive, context-sensitive frameworks and implementation strategies are urgently needed. Our findings provide expert-informed priorities to guide future policy, research, and clinical practice for equitable SE care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200572"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271622","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}