Neurology. Clinical practice最新文献

{"title":"Reach of Palliative Care in Parkinson Disease: Progress and Gaps After a National Team-Based Implementation Project.","authors":"Sandhya Seshadri, Umer Akbar, Peggy Auinger, Nicole Andrea Lessard, Megan Dini, Sally A Norton, Hillary D Lum, Jodi Summers Holtrop, Janis M Miyasaki, Christina L Vaughan, Benzi M Kluger","doi":"10.1212/CPJ.0000000000200628","DOIUrl":"10.1212/CPJ.0000000000200628","url":null,"abstract":"<p><strong>Background and objectives: </strong>The value of palliative care (PC) is increasingly recognized in the care of people with Parkinson disease (PWP) and their carepartners. While clinical trials demonstrate PC improves quality of life for PWP and carepartners, little is known about the impact of PC on their experiences of receiving care in real-world settings. We designed and implemented a national outpatient PC project at the Parkinson's Foundation US-based Centers of Excellence (COEs) between August 2021 and November 2023. We aimed to assess preimplementation vs postimplementation changes in perceptions and experiences of PWP and carepartners related to the receipt of PC.</p><p><strong>Methods: </strong>Between September and October 2023, an electronic survey was distributed through the Parkinson's Foundation to PWP and carepartners who received care at US-based COEs and non-COEs. Survey questions assessed knowledge, perceptions, and experiences related to PC. Preimplementation and postimplementation data were compared.</p><p><strong>Results: </strong>Surveys were distributed to 12,946 PWP and carepartners; 1,778 participants (1,247 PWP, 531 carepartners) responded. At COEs, PWP reported significant increases in non-motor symptom (NMS) assessment (76.5%-86.7%, <i>p</i> = 0.001) and pain management (45.1%-57.6%, <i>p</i> = 0.01). Emotional and spiritual needs were addressed more frequently (33.3%-44.7%, <i>p</i> = 0.01). Advance care planning (ACP) discussions rose from 18.7% to 27.9% (PWP, <i>p</i> = 0.01) and ACP documentation from 8% to 18.1% (<i>p</i> = 0.001). At non-COEs, similar gains were observed in NMS assessment (65.5%-73.7%, <i>p</i> < 0.001), pain management (31.5%-45.1%, <i>p</i> < 0.001), emotional/spiritual discussions (25.3%-33.6%, <i>p</i> = 0.001), and assessment of carepartner needs (21.6%-29.7%, <i>p</i> = 0.002). Carepartners reported similar improvements. Communication ratings and knowledge of PC were high (>85%) and stable across surveys.</p><p><strong>Discussion: </strong>PWP and carepartners' perceptions and experiences of care were stronger postimplementation in many, but not all, aspects of PC. As changes were seen in both COEs and non-COEs, it is unclear to what degree findings relate to direct or indirect impacts of team-based implementation of PC vs other broader temporal trends, such as community-level increased awareness of PC. Findings highlight progress and gaps, underscoring the need for continued efforts for cultural and systemic changes to integrate PC into routine PD care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200628"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Time to Seizure Treatment in a Pediatric Intensive Care Unit Through Quality Improvement Methodology: Seizure to Rescue.","authors":"Chelsey Ortman, Thara R Bala, James J Riviello, Jennifer Erklauer, Jon A Cokley, Sukru Aras, Duc T Nguyen, Stacy Pedigo, Leigh A Ligas, Lisa B Rhodes, Sonali Sen","doi":"10.1212/CPJ.0000000000200622","DOIUrl":"10.1212/CPJ.0000000000200622","url":null,"abstract":"<p><strong>Background and objectives: </strong>Delays in administration of antiseizure medications (ASMs) are common and may be associated with increased morbidity and mortality, as well as adverse long-term neurologic outcomes. There are multiple barriers to adequate and timely dosing of ASMs. Quality improvement methodology was used to determine key drivers of delayed administration of rescue medication in the pediatric intensive care unit (PICU) at Texas Children's Hospital. Targeted interventions were implemented with the goal of reducing the median time to first-line ASM administration for patients meeting rescue treatment (RT) criteria in the PICU by at least 25% within 1 year.</p><p><strong>Methods: </strong>Time from seizure onset to initial ASM was tracked for patients on continuous EEG (cEEG) who met RT criteria in the Texas Children's Hospital PICU. Baseline data were collected from 23 patients, which demonstrated a median treatment time of 57 minutes. For patients in status epilepticus (SE), the baseline median treatment time was 55 minutes. A key driver diagram was used to determine contributors to delayed ASM administration, including but not limited to challenges with seizure identification, weaknesses in communication, anticipatory RT plans, and staff education, among others. Four Plan-Do-Study-Act (PDSA) cycles were executed with the goal of streamlining our cEEG workflow as well as optimizing medication administration.</p><p><strong>Results: </strong>After our first PDSA cycle, the median time to rescue ASM decreased by 26.3%, meeting our primary aim. At the end of the fourth PDSA cycle, we observed a 40.4% reduction in median treatment time, down to 34 minutes. For patients in SE, treatment time was reduced by 45.5%, down to 30 minutes. Furthermore, the percentage of patients meeting criteria for SE decreased from a baseline of 47.8% down to 35%.</p><p><strong>Discussion: </strong>Reduction in median time to treatment was seen after a change to our cEEG workflow and implementation of an order set mandating ASM orders on initiation of cEEG. A decrease in the percentage of patients meeting criteria for SE suggests that these interventions had a clinically meaningful outcome. Given the ubiquitous nature of this issue, adopting similar changes at other institutions may allow more timely delivery of ASM to critically ill patients.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200622"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974046","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":"Real-World Practice in Secondary Stroke Prevention Following Embolic Stroke of Undetermined Source: Secondary Analysis of the CASPR Registry.","authors":"Hassan Aboul-Nour, James Ernest Siegler, Sean L Thompson, Patrick A Glover, Jean-Philippe Auguste Daniel, Mary Penckofer, Matthew M Smith, Shadi Yaghi, Jennifer Ro, Lucia Chen, Marissa D'Souza, Farid Khasiyev, Deborah Kerrigan, Richa Sharma, Yasmin Ninette Aziz, Kaitlyn Kirchhoffer, Wayneho Kam, Emiliya Melkumova, Kelly L Sloane, Christina Marie Lineback, Neeharika Thottempudi, Sharon Heaton, Guillermo Linares, Eesha Singh, Eyad Almallouhi, Christoph Stretz, Camilo Jose Albert Fernandez, Oana M Dumitrascu, Collin J Culbertson, Cheran Elangovan, Anna Bowman, Camelia Valhuerdi Porto, Dalia Chahien, Franziska Herpich, Mudassir Farooqui, Jieun Kang, Adam de Havenon, Ashley Nelson, Mahan Shahrivari, Brian Stamm, Nicole Khezri, Skylar Lewis, Anvitha Sathya, Lester Y Leung, Kelsey Eklund, Diana Rojas-Soto, Simona Nedelcu, Sami Al Kasab, Russell J Van Coevering, Jesse Thon, Dinesh V Jillella, Fadi B Nahab","doi":"10.1212/CPJ.0000000000200631","DOIUrl":"10.1212/CPJ.0000000000200631","url":null,"abstract":"<p><strong>Background and objectives: </strong>Multiple clinical trials have failed to show benefit of anticoagulation over antiplatelets in preventing recurrent stroke among patients with embolic stroke of undetermined source (ESUS). However, there are limited data on antithrombotic prescribing patterns and clinical outcomes in a real-world setting.</p><p><strong>Methods: </strong>This is a subgroup analysis of a multicenter retrospective observational cohort of consecutive adults with ESUS (admitted between 2015 and 2023). Patients were categorized according to antithrombotic initiation by day 7 after stroke or discharge, whichever was sooner: single antiplatelet therapy (SAPT), combination antiplatelet therapy (CAPT) without anticoagulation (AC), or AC with or without antiplatelet therapy (AP) initiated within the first 7 days of index stroke. Differences in treatment strategies were compared between patients admitted between 2015-2018 and 2019-2023 approximating the publication of RESPECT ESUS and NAVIGATE ESUS trials. The primary composite outcome of recurrent ischemic stroke, major bleeding, intracerebral hemorrhage, or death was assessed using unadjusted and adjusted Cox proportional hazards regression.</p><p><strong>Results: </strong>Of the 2,328 included patients, 1,537 (66.0%) were prescribed SAPT, 561 (24.1%) CAPT, and 230 (9.9%) AC ± AP. Compared with other treatment groups, patients treated with CAPT <i>were less likely to be female, but more likely to have atherosclerotic risk factors and presented with milder symptoms</i>. Patients treated with AC ± AP were younger, more likely to have a prior stroke, a higher NIHSS, a large vessel occlusion, and reduced left ventricular ejection fraction. Compared with patients admitted from 2015 to 2018, those admitted between 2019 and 2023 were more frequently prescribed AC ± AP (11.3% vs 5.9%) or CAPT (26.7% vs 17.2%) and less frequently prescribed SAPT (62.0% vs 76.9%, <i>p</i> < 0.001). Compared with SAPT, neither CAPT nor AC were associated with any significant difference in the primary composite outcome. Of the secondary outcomes, CAPT was associated with lower risk of death vs SAPT in unadjusted and adjusted models (aHR 0.69, 95%CI, 0.48-0.98).</p><p><strong>Discussion: </strong>In this large multicenter cohort study, there was an increased frequency of discharge on AC in ESUS patients after the publication of ESUS randomized trials. Treatment with CAPT or AC ± AP was not associated with a reduced risk of recurrent stroke compared with SAPT.</p><p><strong>Trial registration information: </strong>The study is registered on ClinicalTrials.gov (NCT06398366).</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200631"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422581","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 Onset Limit and Surgical Outcome Factors in Type II Focal Cortical Dysplasia-Related Epilepsy.","authors":"Nathan T Cohen, Xiaotong Li, Hua Xie, Ahmet Esat Imal, Jason W Schroeder, Chima O Oluigbo, Peter N Taylor, John S Duncan, William D Gaillard","doi":"10.1212/CPJ.0000000000200640","DOIUrl":"10.1212/CPJ.0000000000200640","url":null,"abstract":"<p><strong>Objectives: </strong>To clarify the upper limit of epilepsy onset in focal cortical dysplasia (FCD) Type II (FCD)-related epilepsy and to investigate factors affecting long-term surgical outcomes from an open-source database.</p><p><strong>Methods: </strong>Patients with FCD Type II pathology were included from the Imaging Database for Epilepsy And Surgery. The primary outcome measure was the incidence of adult-onset FCD-drug resistant epilepsy (DRE). Secondary analyses focused on factors affecting long-term seizure-free outcomes after resective epilepsy surgery for FCD-DRE.</p><p><strong>Results: </strong>Thirty-nine FCD-DRE patients were identified. Pathology was Type IIB (n = 30), Type IIA (n = 8), and Type II Not Otherwise Specified (n = 1). Only 5% had adult-onset DRE; 95% had onset before 15 years. Surgery was associated with 71.4% 5-year International League Against Epilepsy Class I outcome. FCD Type IIB was associated with high rate of seizure-free outcome (OR 13.0, 95% CI [1.36-124], <i>p</i> = 0.03). Focal-to-bilateral-tonic-clonic seizures, focal impaired consciousness seizures, prior status epilepticus, sex, hemisphere, age of epilepsy onset, and age of surgery were not associated with 5-year seizure-free outcome.</p><p><strong>Discussion: </strong>Prior data show that ∼5% of FCDs are discovered incidentally. This study elucidates that the majority of FCD-DRE (including those patients treated as adults) is childhood-onset. These data demonstrate that FCD Type II (especially Type IIB) is associated with high rates of durable postsurgical seizure-free outcome.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200640"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369383","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":"Genetic Testing for Epilepsy in Adults: How Do We Close the Gap?","authors":"Marissa A Kellogg","doi":"10.1212/CPJ.0000000000200639","DOIUrl":"10.1212/CPJ.0000000000200639","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200639"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405337","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":"Genetic Testing in Adult Patients With Epilepsy: Genetic Risk Index for Seizure Etiology for Identifying Optimal Candidates.","authors":"Yi Li, David Lee, Cynthia Peng, Jacqueline E Summers Stromberg, Carly E Siskind, Kimford J Meador, Scheherazade Le, Babak Razavi","doi":"10.1212/CPJ.0000000000200624","DOIUrl":"10.1212/CPJ.0000000000200624","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although genetic testing is recommended as a standard component of the diagnostic evaluation for epilepsies with unknown etiology, its optimal application in adult populations remains poorly defined. The aim of this study was to assess the diagnostic yield of genetic testing in adult patients with epilepsy, identify associated risk factors, and develop a clinical score to guide patient selection for testing.</p><p><strong>Methods: </strong>A single-center cross-sectional study was conducted at Stanford University. The Stanford electronic health record cohort discovery tool and manual chart review were used to identify eligible patients aged ≥18 years who were evaluated between 2018 and 2024. Multivariable logistic regression analysis was used to investigate the association between the clinical phenotypes and the probability of detecting pathogenic genetic variants, which served as the basis for the Genetic Risk Index for Seizure Etiology (Gen-RISE).</p><p><strong>Results: </strong>A total of 508 patients were included. A significant delay in genetic testing after seizure onset (11.2 ± 11.1 years) was observed, with no significant difference between those with and without a genetic etiology (<i>p</i> = 0.89). Pathogenic variants were identified in 32.9% of patients, with 2.6% having unrelated pathogenic variants as secondary findings. Low-frequency (<1%) pathogenic variants in the cohort accounted for over 50% of positive findings. Exome sequencing had the highest yield (41.7%), followed by genetic panels (30.3%) and microarray testing (21.8%). Intellectual disability/developmental delay (OR, 3.41, 95% CI [2.18-5.32]), seizure onset before age 3 years (OR, 1.96, 95% CI [1.27-3.02]), and abnormal EEG findings (OR, 1.29, 95% CI [1.00-1.26]) were associated with the diagnosis of genetic epilepsy. Subsequently, we developed Gen-RISE, a clinical tool to estimate the probability of a pathogenic variant related to epilepsy. Gen-RISE above 0 predicted a >50% likelihood of identifying a pathogenic variant, with a sensitivity of 98.6% in an independent literature-based validation cohort.</p><p><strong>Discussion: </strong>Genetic testing for epilepsy is underused, evidenced by marked testing delays. It should be considered for adult epilepsy patients with unknown or suspected genetic etiology because approximately one-third may have identifiable genetic variants. We developed Gen-RISE, a novel and practical, publicly available tool to identify optimal candidates for genetic testing, enhancing diagnostic efficiency and patient care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200624"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405342","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 Differentiation of Self-Limited Epilepsy With Autonomic Seizures (Panayiotopoulos Syndrome) and Childhood Migraine.","authors":"Eva Berg, Niels K N Focke, Knut Brockmann","doi":"10.1212/CPJ.0000000000200630","DOIUrl":"10.1212/CPJ.0000000000200630","url":null,"abstract":"<p><strong>Background and objectives: </strong>Migraine is the most common single cause of health loss among children and adolescents. A specific type of pediatric benign focal epilepsy, i.e., self-limited epilepsy with autonomic seizures (SeLEAS), formerly called Panayiotopoulos syndrome, is often accompanied by ictal or postictal headache, which can sometimes be indistinguishable from migraine. To date, no studies have provided estimates of the proportion of misdiagnoses in this context. This study aimed to assess the proportion of pediatric patients labeled as having \"migraine\" or \"headache\" who actually have SeLEAS.</p><p><strong>Methods: </strong>A retrospective review was conducted of EEG findings and physicians' letters from 186 patients aged 3 to 14 years, referred over a 2-year period to a tertiary care university hospital's pediatric neurology department for \"migraine\" or \"headache.\"</p><p><strong>Results: </strong>Based on clinical history, EEG results, and the clear efficacy of antiseizure medication (ASM), 6.5% (n = 12) of the children were ultimately diagnosed with SeLEAS. An additional 3 patients showed no improvement with pharmacotherapy using only 1 antiseizure substance. Furthermore, 12.4% (n = 23) of children and adolescents presenting with headache attacks met the clinical and EEG criteria for SeLEAS but did not receive ASM. Reasons included that the diagnosis was not recognized during consultation (n = 16) or that medication was either not recommended by the physician or not initiated by the family (n = 4). In total, 18.8% (n = 35) of pediatric patients initially diagnosed with \"migraine\" or \"headache\" received a possible, probable, or definite diagnosis of benign focal epilepsy with autonomic seizures.</p><p><strong>Discussion: </strong>When evaluating children and adolescents with headache, clinicians should give greater consideration to SeLEAS as a differential diagnosis than in the past, especially due to its significant therapeutic implications.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200630"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148331491","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":"Global Access to Diagnostic Paraclinical Testing Incorporated in the 2024 Revised McDonald Criteria: Disparities and Opportunity.","authors":"Andrew J Solomon, Magd Zakaria, Deanna R Saylor, Shanthi Viswanathan, Dominika Czarnota-Szałkowska, Brenda L Banwell, Timothy Coetzee, Xavier Montalban, Noah Hillman, Russell T Shinohara, Nicholas Rijke, Anne E Helme, Rachel King","doi":"10.1212/CPJ.0000000000200633","DOIUrl":"10.1212/CPJ.0000000000200633","url":null,"abstract":"<p><strong>Background and objectives: </strong>Paraclinical testing incorporated within multiple sclerosis (MS) diagnostic criteria over time have facilitated earlier diagnosis, yet global implementation is largely unknown. Lack of \"specialist medical equipment or diagnostic tests\" was a barrier to early diagnosis of MS endorsed by a third of 107 countries surveyed in the recent Multiple Sclerosis International Federation Atlas of MS Third Edition. This study assessed global access to paraclinical testing incorporated in MS diagnostic criteria.</p><p><strong>Methods: </strong>Survey development included stakeholders with varied expertise and perspectives from all World Health Organization regions and World Bank (WB) country economy income categories. The survey assessed availability, routine use, and barriers to routine use of MRI, CSF testing, evoked potentials, optical coherence tomography, and serum aquaporin-4 immunoglobulin G and myelin oligodendrocyte glycoprotein immunoglobulin G antibody testing. Opinions regarding anticipated 2024 criteria revisions and preferences regarding the dissemination of MS guidelines were surveyed. The survey was available from April 11, 2024, to September 2, 2024.</p><p><strong>Results: </strong>One hundred twenty-two of 149 (82%) of country coordinators participated. No paraclinical test was available across all countries. All 10 tests were available in only 41% of countries. Availability of paraclinical testing did not guarantee routine use in the diagnostic evaluation for MS. Cost and lack of expertise for performance or interpretation were frequent barriers to routine use. Such barriers were present even in WB high-income countries, but low- and low-middle-income countries reported significantly more limited availability of paraclinical testing and significantly diminished routine use to aid diagnosis of MS.</p><p><strong>Discussion: </strong>This study highlights worldwide barriers and disparities in access to paraclinical testing that can expedite the diagnosis of MS. Creative approaches are urgently needed to address cost and required expertise for these paraclinical tests to improve worldwide access. Our data suggest that targeted educational efforts surrounding 2024 McDonald criteria revisions can reduce barriers to implementation. There was enthusiasm that the incorporation of these new approaches to paraclinical testing within the criteria would improve access to early MS diagnosis. This study will provide valuable baseline data to inform future assessments of global access to paraclinical testing for the diagnosis MS.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200633"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339631","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":"CSF Testing for Neuroinvasive West Nile Virus and Measures to Improve Guideline Adherence.","authors":"Carson M Quinn, Karan Singh, Arjun Singh, Sarah E Turbett, Sanjat Kanjilal, George Kyle Harrold, Isaac H Solomon, Nagagopal Venna, Daniel M Pastula, Lakshmi Chauhan, Erik Klontz, Shibani S Mukerji","doi":"10.1212/CPJ.0000000000200634","DOIUrl":"10.1212/CPJ.0000000000200634","url":null,"abstract":"<p><strong>Background and objectives: </strong>Diagnosis of West Nile virus (WNV) neuroinvasive disease, an important cause of neurologic disability in endemic areas, requires appropriate testing given its often nonspecific presentation. Guidelines recommend CSF testing of WNV-specific immunoglobulin M (IgM) in all patients, with additional reverse transcription-polymerase chain reaction (RT-PCR) testing only in those who are unable to mount a humoral response due to significant immunosuppression. WNV testing is known to be underused, but real-world guideline adherence has not been described.</p><p><strong>Methods: </strong>We analyzed testing patterns for suspected neuroinvasive WNV in a retrospective analysis of 1,304 adult patients in a Boston hospital network who underwent CSF testing for WNV-specific IgM or WNV RNA using RT-PCR between 2016 and 2023. Both CSF IgM and RT-PCR were available to order during the duration of the study. Relevant clinical, laboratory, and demographic data were extracted from the electronic health record.</p><p><strong>Results: </strong>The median age in our cohort was 63 years, and 46% of patients were female. Sole testing with CSF RT-PCR was performed in 73% of patients, and WNV testing guidelines were adhered to in only 25% of cases. Elevated CSF protein, CSF lymphocytic pleocytosis, admission to a neurology service, immunocompetence, race, and hospital site were significantly associated with improved adherence. WNV tests were positive in 26 patients, and patients whose CSF testing patterns adhered to guidelines were 12 times more likely to receive a WNV diagnosis.</p><p><strong>Discussion: </strong>The existence of guidelines for appropriate diagnostic testing may not be sufficient to encourage appropriate CSF WNV IgM testing when the RT-PCR test, which is not recommended in immunocompetent patients, remains readily available for ordering. Differential guideline adherence based on institutional factors suggests that systems-level changes may play an important role in shaping provider behavior regarding appropriate use of diagnostic testing.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200634"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405301","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":"Patient-Reported Symptom Burden in Individuals With Parkinson Disease.","authors":"Jamison Seabury, Jennifer Weinstein, Spencer James Rosero, Anika Varma, Abigail Arky, Christine Zizzi, Nuran Dilek, John M Heatwole, E Ray Dorsey, Chad Rydel Heatwole","doi":"10.1212/CPJ.0000000000200632","DOIUrl":"10.1212/CPJ.0000000000200632","url":null,"abstract":"<p><strong>Background and objectives: </strong>To better understand Parkinson disease (PD) burden and advance the clinical management of patients, it is important to ascertain the most significant symptoms directly from individuals with PD. This research used patient-reported data to identify the most prevalent and impactful symptoms experienced by individuals with PD and determine the demographic and clinical characteristics that are associated with higher symptomatic burden.</p><p><strong>Methods: </strong>We conducted semistructured qualitative interviews of 20 individuals with self-reported PD, obtaining 2,978 quotes regarding potential symptoms of importance. Findings from these interviews informed the development of a cross-sectional survey study designed to asess the impact of these symptoms in a larger cohort. Four-hundred four participants with self-reported PD participated in the survey study, providing the prevalence and relative importance (0-4 scale) of 301 symptoms representing 14 symptomatic themes. We subsequently performed subgroup analysis to identify demographic and clinical characteristics that were associated with a higher prevalence of symptomatic burden in PD.</p><p><strong>Results: </strong>The most prevalent symptomatic themes identified by participants were sleep disturbances and daytime sleepiness (87.0%) and fatigue (84.7%). The symptomatic themes with the greatest impact (0-4) on participants' lives were fatigue (1.34) and sleep disturbances and daytime sleepiness (1.29). A higher prevalence of disease burden across all symptomatic themes was most strongly associated with speech impairment, gait freezing, and a duration of tremor greater than 5 years.</p><p><strong>Discussion: </strong>The impact of PD on the lives of those living with this disease is multisystemic, reaching beyond the cardinal motor symptoms. Fatigue, sleep disturbances, and daytime sleepiness are highly prevalent and important to this population.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200632"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339626","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}