Neurology. Clinical practice最新文献

{"title":"Statins in Genetic Myopathies: A Retrospective Analysis of Safety and Tolerability.","authors":"Brendan Nicholas Putko, Margherita Milone, Teerin Liewluck","doi":"10.1212/CPJ.0000000000200573","DOIUrl":"10.1212/CPJ.0000000000200573","url":null,"abstract":"<p><strong>Objectives: </strong>Statins are widely prescribed lipid-lowering agents, but their safety and tolerability in patients with underlying genetic myopathies remain uncertain. We aimed to study statin safety and tolerability in genetic myopathies using a large retrospective cohort.</p><p><strong>Methods: </strong>We conducted a retrospective study in patients with myotonic dystrophy type 1 (DM1) and type 2 (DM2), facioscapulohumeral dystrophy (FSHD), limb-girdle muscular dystrophy (LGMD), and metabolic or mitochondrial myopathies who were exposed to statins.</p><p><strong>Results: </strong>We included 135 patients (36 with DM1, 46 with DM2, 22 with FSHD, 6 with LGMD, 17 with mitochondrial myopathy, 6 with glycogenosis, and 2 with disorders of fatty acid oxidation or carnitine transport). A total of 44 patients discontinued statins, most often for statin-associated muscle symptoms (SAMS; n = 20). SAMS occurred in 36 of 135 patients (26.67%; 8 with DM1, 10 with DM2, 7 with FSHD, 3 with LGMD, 4 with mitochondrial myopathy, and 4 with metabolic myopathy). Myalgias were the most frequent SAMS (n = 29). Rhabdomyolysis occurred in 4 patients (1 with mitochondrial myopathy and 3 with McArdle disease). Statins unmasked myopathy in 6 of 36 patients. No patient developed immune-mediated necrotizing myopathy.</p><p><strong>Discussion: </strong>SAMS are generally mild and occur at a frequency similar to the general population in common genetic myopathies, except increased rhabdomyolysis in mitochondrial myopathies and McArdle disease. Statins are generally safe, though not well tolerated, and could be used when closely monitored in several genetic myopathies. In mitochondrial and metabolic myopathies, their use should be approached with caution because of the potential risk of rhabdomyolysis.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200573"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271585","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":"Functional Neurologic Symptoms in Multiple Sclerosis: Estimated Prevalence and Associated Comorbidities.","authors":"Luke C Collins, Michelle M Bagster, Lachlan Tamlin, David L Perez, Tamara Kaplan, Farrah Jasmine Mateen, Mark Slee, Stephen Bacchi","doi":"10.1212/CPJ.0000000000200569","DOIUrl":"10.1212/CPJ.0000000000200569","url":null,"abstract":"<p><strong>Background and objectives: </strong>Functional neurologic disorder is a common cause of neurologic symptoms and disability in clinical practice, characterized by motor, sensory, or cognitive difficulties that show internal inconsistency and cannot be explained by structural nervous system damage. Despite growing recognition, research exploring functional neurologic symptoms (FNS) in people with multiple sclerosis (PwMS) remains limited. We aimed to estimate the prevalence of FNS in PwMS and characterize associated clinical features and comorbidities.</p><p><strong>Methods: </strong>We conducted a retrospective convenience cohort study of all adult patients attending an Australian tertiary MS outpatient clinic over 12 months (January-December 2024). Inclusion criteria comprised a confirmed diagnosis of multiple sclerosis, clinically or radiologically isolated syndrome, age 18-64 years, and at least 1 in-person clinic visit. FNS were operationally defined to include (1) neurologist-documented functional neurologic disorder (FND), (2) patients with positive rule-in examination signs, (3) persistent postural-perceptual dizziness, and/or (4) cognitive symptoms inconsistent with MS that demonstrated features of functional cognitive disorder on neuropsychological or clinical assessment. Clinical data were extracted from the electronic medical record. Differences between patients with and without FNS were analyzed.</p><p><strong>Results: </strong>FNS were identified in 62 of 411 PwMS (15.1%, 95% CI 11.8%-18.9%), comprising 20 patients (4.9%) with a chart-documented FND diagnosis, 11 (2.7%) with \"functional overlay,\" and 31 (7.5%) with rule-in signs alone. Overall, 55 PwMS (13.4%) demonstrated at least 1 FND sign in physical examination. PwMS with FNS were more likely to be female (96.8% vs 76.2%, <i>p</i> < 0.001) and to experience cognitive symptoms, fatigue impairing function, chronic pain, migraine, and polypharmacy (all <i>p</i> < 0.001). Psychiatric comorbidities were more prevalent, including anxiety or depression (<i>p</i> < 0.001), post-traumatic stress disorder (<i>p</i> = 0.012), and 3 or more psychiatric diagnoses (<i>p</i> = 0.003). Emergency department use was higher among those with FNS (<i>p</i> = 0.035). Multivariable logistic regression identified female sex, fatigue impairing function, cognitive symptoms, chronic pain, and migraine as factors most strongly associated with FNS.</p><p><strong>Discussion: </strong>FNS affected 1 in 7 PwMS in a tertiary outpatient clinic and were associated with a high burden of medical and psychiatric comorbidity, nonmotor symptoms, and greater emergency department use. More research is needed to further characterize and contextualize the clinical occurrence and impact of FNS in PwMS.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200569"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271572","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 Supported by Outcome Information During Discharge Planning of Patients Hospitalized With Stroke.","authors":"J C M Prick, M V Verschueren, I A Deijle, S M van Schaik, R Dahmen, P J A M Brouwers, B J van der Star, P H E Hilkens, M M Garvelink, R Saxena, R A R Gons, E S Schut, M F M Ten Brinck, S H J Keus, N Engels, J W Ankersmid-Matos Miguel, M Q N Hackert, S Teerenstra, C F van Uden-Kraan, P J van der Wees, R M Van den Berg-Vos","doi":"10.1212/CPJ.0000000000200561","DOIUrl":"10.1212/CPJ.0000000000200561","url":null,"abstract":"<p><strong>Background and objectives: </strong>The SHOUT-STROKE study aimed to evaluate the effects of a shared decision-making (SDM) intervention on decision-making, health, and process outcomes during discharge planning of hospitalized patients with stroke. The intervention included a patient decision aid (PtDA) with integrated outcome information, training for health care professionals, and an implementation strategy.</p><p><strong>Methods: </strong>A prospective multiple interrupted time-series study was conducted across 7 Dutch hospitals between November 2019 and March 2022. The study comprised 3 phases: a pre-implementation phase evaluating standard care, a transition phase integrating the PtDA and training into existing stroke care pathways, and a post-implementation phase evaluating the new workflow. Effects per hospital were estimated using segmented autoregression and combined in a meta-analysis to assess the overall effect.</p><p><strong>Results: </strong>Of 635 eligible patients, 462 (73%) completed the primary outcome measure, the SDM-Q-9, a 9-item questionnaire assessing patient-reported levels of SDM (score range 0-100). The overall effect on SDM-Q-9 scores was -4.5 points (95% CI -11.3 to 2.2). No significant overall differences were observed in secondary decision-making outcomes (e.g., decisional conflict) or health outcomes (e.g., quality of life). Knowledge scores improved significantly in 2 hospitals, with an effect of 0.85 points (95% CI 0.08 to 1.6) in Hospital 4 and 0.94 points (95% CI 0.20 to 1.7) in Hospital 6. Of the 234 patients in the post-implementation phase, 137 (59%) received the PtDA, of whom 40% used it. Most patients reported that the PtDA with integrated outcome information was useful for decision-making and indicated that they would recommend the PtDA to other patients.</p><p><strong>Discussion: </strong>The SDM intervention was appreciated by patients but did not significantly improve SDM levels or other decision-making or health outcomes. The significant improvement in patient knowledge scores in 2 hospitals is notable but insufficient to fully empower patients to actively participate in SDM. Future efforts should focus on optimizing the implementation process to achieve more impactful outcomes.</p><p><strong>Clinical trials registration: </strong>The SHOUT-STROKE study was registered in the Dutch Clinical Trial Register and automatically listed in the International Clinical Trial Registry Platform: Registration IDs: NL8375 | NL-OMON21735. Link to the registration: trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON21735.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200561"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850432","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":"Immune Effector Cell-Associated Neurotoxicity Syndrome: A Practical Overview for the General Neurologist.","authors":"Colby Kent Cevering, Hisham Abdel-Azim, Sajad J Khazal, Charles Casassa","doi":"10.1212/CPJ.0000000000200575","DOIUrl":"10.1212/CPJ.0000000000200575","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review was to consolidate the clinical, radiographic, and laboratory findings of patients with immune effector cell-associated neurotoxicity syndrome (ICANS) to give physicians a comprehensive overview of its diagnosis and management.</p><p><strong>Recent findings: </strong>ICANS is a rare but potentially lethal complication of chimeric antigen receptor (CAR) T-cell therapy in patients with hematologic malignancies including leukemia, lymphoma, and multiple myeloma. They often have nonspecific neurologic symptoms, such as language difficulties, encephalopathy, and tremors. Workup may involve brain imaging, EEG, or lumbar puncture, but often, these are normal or nonspecific. Laboratory studies, particularly C-reactive protein and ferritin, can help physicians determine which patients are at risk of developing ICANS and how severe the symptoms may become. While most cases of ICANS resolve spontaneously with supportive measures, studies have shown that steroids play an integral role in treating patients who develop neurotoxicity secondary to CAR T-cell therapy.</p><p><strong>Summary: </strong>By recognizing the signs and symptoms of ICANS, physicians can begin interventions early in the disease course and potentially mitigate any long-term effects. Although most patients recover without residual deficits, rapid progression to death has been reported in a minority of cases. Workup for other etiologies should be performed as clinically indicated, and abnormal findings should be treated according to standard-of-care practices.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200575"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12726352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828219","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":"Advancing Early Detection of Alzheimer Disease in the Primary Care Setting in the United States.","authors":"Michelle M Mielke, H Ricky Kurzman, Yan Helen Hu, Min Cho, Jonathan Liss, Jeffrey M Burns, Thomas O Obisesan, Michael Hornbecker, Arnold I Pallay, Steven R Smith, Lawrence S Honig, Monica W Parker, Joanne Bell, Harald Hampel","doi":"10.1212/CPJ.0000000000200568","DOIUrl":"10.1212/CPJ.0000000000200568","url":null,"abstract":"<p><strong>Background and objectives: </strong>As evidence supporting the robustness of blood-based biomarker (BBM) testing for Alzheimer disease (AD) continues to emerge, understanding the perceptions, drivers, and barriers to the adoption of these tests among primary care physicians (PCPs) in the United States is crucial for improving patient outcomes and advancing clinical management of AD. In this study, we perform a survey of PCPs in the United States to better understand current practices for detecting and diagnosing mild cognitive impairment (MCI) or mild dementia due to AD and to identify drivers and barriers to adopting BBM testing in primary care clinics in the United States.</p><p><strong>Methods: </strong>This was a cross-sectional study involving a self-administered quantitative online survey. An advisory board was convened before and after the survey to advise on the survey design and discuss survey results. The survey was conducted online in the United States between December 2023 and January 2024, excluding Vermont and Maine because of state laws restricting PCP participation in market research. A total of 603 PCPs from the United States completed the survey for their self-reported perception and adoption of BBM tests for early diagnosis of AD, including awareness and/or experience with testing for patients with suspected cognitive/memory issues, and their belief, motivation, and obstacles for ordering BBM tests.</p><p><strong>Results: </strong>Lack of effective diagnostic tools in the primary care setting and recognition of MCI/early AD symptoms were among the top barriers to early diagnosis of MCI/mild dementia due to AD. Although PCPs manage or treat patients with MCI/mild dementia independently, awareness and adoption of AD BBM tests are substantially lower (<15%) compared with standard cognitive assessments and non-AD-specific blood tests (>65%). Despite practice and perception barriers, two-thirds of PCPs reported that they would order a BBM test for patients with cognitive concerns to improve the diagnosis and management of AD. However, concerns were raised regarding testing accuracy, financial burden, and reimbursement.</p><p><strong>Discussion: </strong>Primary care physicians are willing to adopt blood-based biomarker tests for diagnosing MCI and mild dementia due to AD, provided that they receive enhanced education, clear guidelines, and reimbursement support.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 1","pages":"e200568"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12726351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828193","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":"Pregnancy and Fetal Outcomes Following Prenatal Exposure to Modafinil and/or Armodafinil: A 14-Year Registry Study.","authors":"Sigal Kaplan, Nicole Carneal-Frazer, Debra L Braverman, Lea Parsley, Christopher Robinson, Daniel K Benjamin, Jessica D Albano","doi":"10.1212/CPJ.0000000000200551","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200551","url":null,"abstract":"<p><strong>Background and objectives: </strong>An interim analysis of the modafinil/armodafinil Pregnancy Exposure Registry (PER) revealed a potential increased risk of major congenital malformations (MCMs) associated with maternal exposure to these products. To further investigate this safety signal, a 14-year safety update was conducted using the final PER data. The aim of this study was to evaluate pregnancy and fetal outcomes associated with modafinil/armodafinil exposure.</p><p><strong>Methods: </strong>This was a prospective, observational longitudinal cohort study conducted from 2010 to 2024. Women exposed to modafinil/armodafinil during pregnancy or within 6 weeks before becoming pregnant were included. Women enrolled before the knowledge of pregnancy outcome or birth defect detection were classified as prospective, whereas those enrolled after such knowledge were classified as retrospective. MCMs were adjudicated and classified based on the Metropolitan Atlanta Congenital Defects Program (MACDP). Descriptive statistics were used to analyze pregnancy outcomes including births, spontaneous abortions, elective terminations, fetal death, neurodevelopmental abnormalities, low/very low birth weight (LBW/very LBW), small for gestational age (SGA), and intrauterine growth restriction. Follow-up growth measurements were evaluated. MCM prevalence was compared with the MACDP population-based rate.</p><p><strong>Results: </strong>A total of 191 pregnancies (83.2% prospective and 16.8% retrospective) were enrolled. The mean maternal age was 31 years (SD = 4.5), and 182 (95.3%) had exposure during the first trimester. Outcomes were known for 179 pregnancies (93.7%). Among 156 prospective fetuses with known outcomes (83.0%), 137 (87.8%) resulted in live births, 17 (10.9%) in spontaneous abortions, and 2 (1.3%) in elective terminations. Among prospective live births, the prevalence of MCM was 13.1% (18/137, 95% CI, 8.0-20.0) overall and 13.7% after first trimester exposure, compared with the MACDP population-based rate of 3%. Other reported outcomes included 23 (16.8%) minor congenital malformations, 14 (10.2%) preterm births, 3 (2.2%) cases of IUGR, and 11 (8.0%) cases of LBW/VLBW; all were within the expected range of background rates. SGA was not reported. Growth parameters were within normal limits.</p><p><strong>Discussion: </strong>This 14-year prospective study of pregnant women exposed to modafinil/armodafinil reveals a higher prevalence of MCMs among live births compared with the general population. The study limitations and conflicting results across the literature highlight the need for future research to further investigate the potential teratogenic risks of modafinil/armodafinil.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200551"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12507443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258617","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":"Gait Improvement Following CSF Tap Test in NPH Patients With and Without Striatal Dopaminergic Deficit: A Preliminary Study.","authors":"Minju Kim, Young Ho Park, Yoo Sung Song, Kyunghun Kang, Ki-Su Park, Shin Young Jeong, Sang-Woo Lee, Eunjeong Ji, SangYun Kim, Etsuro Mori","doi":"10.1212/CPJ.0000000000200549","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200549","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent studies have highlighted the occurrence of reduced striatal signal intensity on dopamine transporter (DAT) scans in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of our study was to investigate whether the extent of symptom improvement after a CSF tap test (TT) differs between iNPH patients with reduced striatal DAT uptake and those with normal uptake.</p><p><strong>Methods: </strong>We conducted gait analysis on 44 patients with iNPH who underwent DAT scans at Seoul National University Bundang Hospital (SNUBH) and Kyungpook National University Chilgok Hospital (KNUCH) both before and after a CSF TT. A positive response to the TT was defined as an improvement in walking speed of 10% or greater compared with baseline. We compared TT response rates between iNPH patients with and without striatal dopaminergic deficit using logistic regression models, with the medical institution (SNUBH, KNUCH) as a stratification variable.</p><p><strong>Results: </strong>Among 36 patients without striatal dopaminergic deficit, 22 patients (61.11%) exhibited a response after the TT, whereas among 8 patients with striatal dopaminergic deficit, 5 patients (62.5%) exhibited a response after the TT. The response rate after TT was not significantly different between the iNPH patients with and without striatal dopaminergic deficit (odds ratio 0.46; <i>p</i> value = 0.4048).</p><p><strong>Discussion: </strong>Our findings suggest that gait improvement after a CSF TT in patients with iNPH remains consistent regardless of the presence or absence of reduced striatal DAT uptake. Further research involving a larger cohort is necessary to validate these observations.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200549"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137935","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 Gender-Based Variation in Determinants of Academic Neurologist Well-Being: A Mixed-Methods Study.","authors":"Alexis Amano, Nikitha K Menon, Hanhan Wang, Tait D Shanafelt, Mickey T Trockel, Xi Zhu","doi":"10.1212/CPJ.0000000000200562","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200562","url":null,"abstract":"<p><strong>Background and objectives: </strong>Physician burnout is a major challenge for health systems, with some evidence suggesting that women physicians experience higher levels of burnout and lower professional fulfillment compared with men. However, findings on gender disparities in well-being outcomes have been inconsistent. The aim of this study was to quantitatively and qualitatively explore gender-based differences in the determinants of occupational well-being among academic faculty neurologists.</p><p><strong>Methods: </strong>We conducted a convergent mixed-methods study using both survey and semistructured interview data. The quantitative component included data from the 2021 Professional Well-being Academic Consortium survey, which measures burnout, professional fulfillment, and hypothesized well-being determinants. The survey was completed by 539 neurologists from multiple academic medical centers. We used generalized regression models to assess gender differences in occupational well-being outcomes (i.e., burnout and professional fulfillment) including interaction terms to explore whether the relationship between each determinant and well-being outcomes differed by gender. The qualitative component involved interviews with 33 neurologists to explore gender-specific drivers of well-being and burnout, using thematic analysis to identify key patterns.</p><p><strong>Results: </strong>While no significant differences in mean burnout or professional fulfillment scores were observed between men and women, there were gender-based differences in the determinants of occupational well-being outcomes. For men, negative impact of work on personal relationships, sleep-related impairment, and personal-organizational values alignment were more strongly associated with professional fulfillment, suggesting that these factors play a larger role in men's well-being. Perceived gratitude, although a protective factor for both genders, had a weaker buffering effect against burnout for women. Qualitatively, women reported facing unique drivers of burnout, including greater responsibilities at home, barriers to integrating responsibilities at work with those at home, and gender-based discrimination.</p><p><strong>Discussion: </strong>Gender-based disparities in occupational well-being outcomes are, to some degree, driven by different determinants for men and women. While well-being was more affected by measurable factors in men, in women, well-being was shaped by broader sociocultural dynamics, making their challenges more difficult to capture with conventional workplace metrics. Interventions targeting relational aspects of work and improving work-life integration-especially for women in the early stages of their careers-may support neurologist well-being.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200562"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505888","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":"Modified 2HELPS2B Score Predicts Failure to Wean From Anesthetics in Refractory and Super-Refractory Status Epilepticus.","authors":"Eleonora Matteo, Charlotte Damien, Nathan Torcida Sedano, Benjamin Legros, Nicolas Gaspard","doi":"10.1212/CPJ.0000000000200550","DOIUrl":"10.1212/CPJ.0000000000200550","url":null,"abstract":"<p><strong>Objectives: </strong>Up to 40% of wean attempts from continuous intravenous anesthetic drugs (CIVADs) are associated with status epilepticus (SE) recurrence. Few features are known to be associated with successful wean from CIVADs. The 2HELPS2B score, designed to stratify the risk of electrographic seizures in critically ill patients, could be used for this purpose.</p><p><strong>Methods: </strong>This was a single-center retrospective case-control study of nonanoxic adult patients treated with CIVADs for refractory SE. Clinical and EEG variables were collected. The original and modified 2HELPS2B scores were compared.</p><p><strong>Results: </strong>We included 102 patients. Thirty-six attempts (35%) failed. Failure was associated with a higher STESS (3 [3-5] vs 3 [2-3], <i>p</i> = 0.03), super-refractoriness (81% vs 16%; <i>p</i> < 0.001), longer CIVAD therapy before weaning (37 vs 21 hours, <i>p</i> = 0.028), more CIVADs at the time of weaning [1 (1-2) vs 1 (1-1), <i>p</i> = 0.005), breakthrough seizures any time before the attempt (62% vs 35%, <i>p</i> = 0.025), and electrographic seizures during the hour before the attempt (11% vs 0%, <i>p</i> = 0.014). The modified 2HELPS2B score was more accurate than the original score (AUROC 0.79 [0.74-0.83] vs 0.72 [0.67-0.77]; <i>p</i> = 0.024), and a modified score ≥3 had 95% specificity for failure.</p><p><strong>Discussion: </strong>In patients treated with CIVADs for refractory status epilepticus, a modified 2HELPS2B score could be used to guide weaning from CIVADs.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200550"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12598878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496271","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 Effect of GLP-1RA on the Motor Function of Patients With Parkinson Disease: A Systematic Review and Meta-Analysis.","authors":"Giovanna Ristori Costa, Luís Fernando Ferreira Cavalcante, Sophia Massafelli Battistuta, Pedro Faria Makabe, Isadora Silva Fanucci Bueno, Bruno Yuamoto, Felipe Endrigo Gonçalves Vilela, Luís Guilherme Giacon Meloni, Danilo Donizete de Faria, Renato Anghinah, Diogo Haddad Santos","doi":"10.1212/CPJ.0000000000200548","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200548","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 6","pages":"e200548"},"PeriodicalIF":3.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293143","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}