Neurology. Clinical practice最新文献

{"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":"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":"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":"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":"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}

{"title":"National Trends in Stroke Presentation, Treatments, and Outcomes During the First 2 Years of the COVID-19 Pandemic.","authors":"Cyrus Ayubcha, Peter Smulowitz, James O'Malley, Lidia Moura, Lawrence Zaborski, J Michael McWilliams, Bruce E Landon","doi":"10.1212/CPJ.0000000000200436","DOIUrl":"10.1212/CPJ.0000000000200436","url":null,"abstract":"<p><strong>Background and objectives: </strong>Early presentation and acute treatment for patients presenting with ischemic stroke are associated with improved outcomes. The onset of the COVID-19 pandemic was associated with a large decrease in patients presenting with ischemic stroke, but it is unknown whether these changes persisted.</p><p><strong>Methods: </strong>This study analyzed emergency department (ED) stroke presentations (n = 158,060) to all nonfederal hospitals in the 50 states and Washington, D.C., from 2019 through 2021 using administrative claims data of traditional fee-for-service Medicare enrollees aged 66 years or older. Patients presenting with stroke were identified using the ICD-10 CM (I63.X). We examined the number of beneficiaries presenting with ischemic stroke to the ED, both overall and by demographic categories (race, age, sex, region, Medicaid eligibility, comorbidity status), admission rates conditional on presentation, use of neurovascular interventions, thirty-day mortality, intensive care unit and mechanical ventilation use, length of stay, and discharge destination.</p><p><strong>Results: </strong>With the onset of the pandemic in March 2020, there was a drop of 32.1% in ED stroke presentations compared with March 2019 levels, and by December 2021, the rate remained 17.7% lower than baseline levels in December 2019. Relative to the prepandemic period, there were decreases in the proportions of those dually eligible for Medicaid (-0.8%, <i>p</i> < 0.0001) or Black (-0.8%, <i>p</i> < 0.0001), as well as those with atrial fibrillation (-1.1%, <i>p</i> < 0.0001), hypertension (-0.7%, <i>p</i> < 0.0001), and chronic obstructive pulmonary disease (-1.8%, <i>p</i> < 0.0001). Admitted patients were more often discharged to home as opposed to postacute care settings (+3.5%, <i>p</i> < 0.0001). The percentage of patients receiving intravenous thrombolysis changed minimally while those receiving intracranial mechanical thrombectomy (+17.8%, <i>p</i> < 0.0001) and carotid interventions (+6.9%, <i>p</i> < 0.0001) increased from baseline throughout the pandemic. Adjusted thirty-day mortality or referral to hospice increased (+1.81%, <i>p</i> < 0.0001) with larger increases seen among Black beneficiaries and those dually eligible for Medicaid.</p><p><strong>Discussion: </strong>After an initial sharp decline, stroke presentations remained substantially lower than at baseline through the end of 2021, especially among racial minority and those dually eligible for Medicaid. The observed increased mortality rates for those presenting with stroke may have resulted from later time of presentation after the onset of symptoms or preferential presentation of more vs less severe strokes.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200436"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008877","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":"Consensus Recommendations for the Management of Neurosarcoidosis: A Delphi Survey of Experts Across the United States.","authors":"Giovanna Sophia Manzano, James Eaton, Michael Levy, Justin R Abbatemarco, Allen J Aksamit, Pria Anand, Denis T Balaban, Paula Barreras, Robert P Baughman, Shamik Bhattacharyya, Roberto Bomprezzi, Tracey A Cho, Bart Chwalisz, Stacey Lynn Clardy, David B Clifford, Eoin P Flanagan, Jeffrey M Gelfand, George Kyle Harrold, Spencer K Hutto, Siddharama Pawate, Noellie Rivera Torres, Lama Abdel-Wahed, Steven Richard Dunham, Rajesh Kumar Gupta, Brandon Moss, Carlos A Pardo, Rohini D Samudralwar, Nagagopal Venna, Aram Zabeti, Ilya Kister","doi":"10.1212/CPJ.0000000000200429","DOIUrl":"10.1212/CPJ.0000000000200429","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neurosarcoidosis poses a diagnostic and management challenge due to its rarity, phenotypic variability, and lack of randomized controlled studies to guide treatment selection. Recommendations for management based on expert opinion are useful in clinical practice and provide a framework for designing prospective studies.</p><p><strong>Methods: </strong>In this Delphi survey study, specialists with experience in managing patients with neurosarcoidosis were invited to anonymously complete 2 surveys about key elements of evaluation, diagnosis, treatment, monitoring, and long-term management of neurosarcoidosis. Expert consensus recommendations were adopted if >80% threshold of agreement was reached.</p><p><strong>Results: </strong>Of the 41 invited expert clinicians across the United States, 32 (78%) participated in the study. All round 1 respondents self-identified as neuroimmunologists (except for 1 pulmonologist). Consensus was reached regarding the need to consider neurosarcoidosis phenotype and severity to guide the choice of initial immunosuppression in both the acute (relapse) and maintenance phases. Experts endorsed the use of TNF-α inhibitors as first-line agents in selected phenotypes with poor prognosis. Neuroimaging was recommended to complement clinical surveillance for treatment response.</p><p><strong>Discussion: </strong>There was agreement on several key issues, most importantly on the need to consider neurosarcoidosis phenotype and severity when deciding initial treatment. No consensus was achieved on the dosing and duration of specific immunosuppressants, nor regarding the management of the peripheral nervous system manifestation of neurosarcoidosis. These topics warrant further investigation.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200429"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008874","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":"Unlocking the Potential of Telemedicine in Epilepsy: Noninferiority Analysis of Efficacy and Identifying Patient Preferences.","authors":"Ruta Yardi, Christopher J McLouth, Ana M Roman Guzman, Rani Priyanka Vasireddy, Sally V Mathias, Lara Jehi","doi":"10.1212/CPJ.0000000000200459","DOIUrl":"10.1212/CPJ.0000000000200459","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study was undertaken to compare the effectiveness of telemedicine visits with traditional in-person visits for epilepsy care and simultaneously attempts to identify patient demographics favoring telehealth.</p><p><strong>Methods: </strong>We retrospectively collected demographic and clinical data from all adult epilepsy clinic visits at the University of Kentucky between July 2021 and September 2022. A propensity model using inverse probability of treatment weighting was constructed to examine the association between these variables and the choice of telemedicine vs in-person visits. The study investigated the effect of visit type on 5 specific clinical outcomes, using stabilized weights derived from the propensity model to adjust for confounding. Noninferiority analyses were conducted to compare telemedicine and in-person visits, with a predefined noninferiority margin set at a difference in proportions of 0.10.</p><p><strong>Results: </strong>Among 442 encounters included in the final analysis, 155 (35.1%) were in-person, while 287 (64.9%) were virtual. Telemedicine was noninferior to in-person visits for making antiseizure medication (ASM) regimen changes, discussing epilepsy surgery, and in postvisit emergency department visits for breakthrough seizures. The incidence of postvisit seizures and abnormalities on neurologic examination between visit modalities differed but did not meet the criteria for noninferiority. A propensity model identified 3 key variables influencing the decision to choose telehealth-age, distance to the clinic, and presence of a significant other. The likelihood of preferring telehealth increased by 42% for every 10-year decrease in age. Similarly, with every 50 miles an individual had to drive, their preference for a telemedicine visit increased by 33%. Finally, individuals in a relationship were more likely to prefer telehealth visits.</p><p><strong>Discussion: </strong>Telemedicine proves to be an effective and noninferior alternative to in-person appointments, proving particularly beneficial in overcoming geographic barriers to access. A hybrid model of mixed visit types can help overcome the limitations of conducting a thorough neurologic examination. Younger individuals, those facing long travel distances, and patients with significant others prefer current telemedicine technology. This emphasizes the need for future advancements in more user-friendly and affordable technology tailored toward diverse demographic needs.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 2","pages":"e200459"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720848","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}