Neurology. Clinical practice最新文献

{"title":"Dissemination of VMAT-2 Inhibitors: A New Class Drug for Tardive Dyskinesia and Huntington Disease.","authors":"Erica Ma, Emma Krening, Michiko K Bruno","doi":"10.1212/CPJ.0000000000200392","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200392","url":null,"abstract":"<p><strong>Background and objectives: </strong>In 2017, the FDA approved deutetrabenazine (AUSTEDO) for the treatment of tardive dyskinesia (TD) and chorea associated with Huntington disease (HD). Concurrently, valbenazine (INGREZZA) was approved specifically for TD. The adoption of new medications is influenced by various factors, including patient's medical needs, the prescriber's adoption of new practice, and external environmental factors (e.g., cost). Our analysis aims to examine the dissemination of 2 vesicular monoamine transporter 2 (VMAT-2) inhibitors, deutetrabenazine and valbenazine, in the market.</p><p><strong>Methods: </strong>In this cross-sectional study, we conducted a descriptive statistical analysis of the 2017-2020 prescription records for deutetrabenazine and valbenazine using the Centers for Medicare & Medicaid Services Medicare Provider Utilization and Payment Data: Part D Prescriber public use file. In addition, we linked this data set to the Open Payment database to analyze industry payments.</p><p><strong>Results: </strong>We identified a total of 3,706 deutetrabenazine prescribers and 4,895 valbenazine prescribers. Prescription volume (standardized 30-day prescription) increased annually across different specialties for both VMAT-2 inhibitors from 2017 to 2020. Neurologists were the highest contributors to deutetrabenazine prescriptions (N = 50,017; 35.2%), and psychiatrists were the highest contributors to valbenazine prescriptions (N = 77,799; 42.3%). A total of 1,217 deutetrabenazine physician prescribers (47.5%) and 1,509 valbenazine physician prescribers (49.7%) received industry payments from TEVA Pharmaceuticals and Neurocrine Biosciences, respectively. Receipt of industry payments was associated with higher prescription volume for both deutetrabenazine (<i>p</i> < 0.001) and valbenazine (<i>p</i> < 0.001). Approximately three-quarters of the industry payments were used in nonconsulting services, with a median payment value per physician of $18,101 for deutetrabenazine and $25,920 for valbenazine.</p><p><strong>Discussion: </strong>The findings illustrate a yearly increase in Medicare prescription volume for deutetrabenazine and valbenazine after FDA approval, with neurologists and psychiatrists as primary prescribers of deutetrabenazine and valbenazine, respectively. There was a statistical difference in the prescription volume between those who received industry payments and those who did not, suggesting that receipt of payments may be associated with prescription volume. Nonconsulting services constituted the largest sum of industry payments for both medications. Further research exploring the causative factors of new medication uptake is needed to better understand how medications disseminate across the market.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200392"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470867","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":"Prevalence of Neurologic Disease Among Those in Same-Sex Relationships: Evidence from the Medical Expenditure Panel Survey.","authors":"Lennox Byer, Elan L Guterman, Nicole Rosendale","doi":"10.1212/CPJ.0000000000200385","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200385","url":null,"abstract":"<p><strong>Background and objectives: </strong>Prior research has shown several health disparities affecting sexual minority people. Research on the neurologic health of sexual minority people has been limited. Our objective was to characterize the prevalence of neurologic disease and utilization of a neurologist among a population of sexual minority people.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of sexual minority people, using people in same-sex relationships as a proxy for sexual minority status, from the Medical Expenditure Panel Survey (MEPS) from 2016 to 2020. The MEPS is a government-run survey that uses complex sampling to obtain a nationally representative sample. Our primary outcome was a diagnosis of any neurologic disease. We also completed stratified analyses by sex, race, and ethnicity. Our secondary outcome was visit to a neurologist within the past year. Logistic regression was used to compare the odds of both outcomes in those in same-sex relationships and those in different-sex relationships.</p><p><strong>Results: </strong>Among 153,313 MEPS participants, there were 61,645 (40.2%) participants in relationships who were included in our sample. Of those, 822 (1.33%) participants were in same-sex relationships. Participants were, on average, aged 51 years (median 50 years, IQR 38-63); nearly 50% reported female sex and mostly non-Hispanic White (67.81%). Among those in same-sex relationships, 22.7% reported a neurologic diagnosis compared with 18.1% of those in different-sex relationships (OR 1.33; 95% CI 1.04-1.71). This difference was maintained with adjustment for age, sex, education, and insurance (OR 1.48; 95% CI 1.15-1.91). There was no significant difference in visit to a neurologist (adjusted OR 1.38; 95% CI 0.91-2.10).</p><p><strong>Discussion: </strong>In this nationally representative sample, neurologic disease was more prevalent among those in same-sex relationships compared with those in different-sex relationships. Limited sample size and absent measurements of minority stress limited the etiologic search for factors driving this disparity. There was no significant difference in visit to a neurologist, and both groups reported their overall health as being similar. There is a need for more routine measurement of sexual orientation in neurologic research. This will allow us to detail differences in neurologic disease risk factors, prevalence, and outcomes. The end goal is the identification of opportunities for intervention and advancement of neurologic health equity.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200385"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470879","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":"Randomized Trial of Telegenetic Counseling for Gene Testing in Huntington Disease.","authors":"Deborah A Hall, Marc Rosenbaum, Jacob Hawkins, Bichun Ouyang, Christa Cooper, Neepa Patel","doi":"10.1212/CPJ.0000000000200394","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200394","url":null,"abstract":"<p><strong>Background and objectives: </strong>The purpose of the study was to determine the feasibility and patient satisfaction of telegenetic counseling, or counseling done by video, for Huntington disease (HD). Background: Genetic counseling is necessary for presymptomatic or symptomatic HD genetic testing, but the lack of access to counseling because of geography or expense is a critical gap for many patients. The hypothesis of this study was that there would be no difference in patient satisfaction between telegenetic counseling (tele-GC) or in-person counseling (in-person GC) for HD testing.</p><p><strong>Methods: </strong>This was a prospective, randomized, unblinded study of either tele-GC or in-person GC for HD gene testing. Participants had standardized genetic counseling in the clinic or through a Health Insurance Portability and Accountability Act (HIPAA) appropriate telemedicine platform first and then crossed over. A study coordinator interviewed the participant using a telehealth survey after each encounter.</p><p><strong>Results: </strong>A total of 19 in-person GC and 15 tele-GC participants were included: 68% women, 41 ± 15 years, 80% White, 10% Hispanic, and +CAG repeat length = 45 ± 4.4 (n = 15) (<i>p</i> > 0.1). All participants were satisfied with their initial counseling experience when asked to rate on a scale of 1-10 (median 10/10, <i>p</i> = 0.94). The majority of symptomatic HD participants (5/7) preferred in-person GC. The main advantage of tele-GC was reduction in travel time for both in-person GC first (n = 16) and tele-GC first (n = 11) participants. Technical challenges were encountered in many of the participants. Visually seeing the genetic counselor improved understanding for in-person GC (n = 10) and tele-GC (n = 8) participants. Participants felt they were able to pick up on emotional cues (n = 33) and felt comfortable asking questions (n = 34) using the tele-GC format.</p><p><strong>Discussion: </strong>Telegenetic counseling is a feasible option for HD gene testing, if patients are able to overcome technical issues. Having a video visit with both audio and video components, rather than an audio-only phone call, should be considered when using telegenetic counseling for HD. Finally, in-person counseling may be preferred to increase understanding of the genetic counseling materials in patients, especially in motor manifest HD.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200394"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546528","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":"REM Sleep Behavior Disorder Diagnostic Code Accuracy and Implications in the Real-World Setting.","authors":"Lana M Chahine, Deena Ratner, Aaron Palmquist, Gayatri Dholakia, Anne B Newman, Richard D Boyce, Caterina Rosano, Maria Brooks","doi":"10.1212/CPJ.0000000000200387","DOIUrl":"10.1212/CPJ.0000000000200387","url":null,"abstract":"<p><strong>Background and objectives: </strong>Isolated REM sleep behavior disorder (iRBD) carries increased risk of neurodegenerative parkinsonian disorder or dementia (NPD) but is difficult to accurately screen for in the community. Health care data offer the opportunity to identify large numbers of iRBD cases among outpatients. We aimed to determine the positive predictive value (PPV) of an RBD <i>International Classification of Disorders</i> (ICD) code for actual iRBD based on manual review of the electronic health record (EHR), examine risk of NPD diagnosis, and explore whether a statistical model developed using selected EHR data can identify individuals with the RBD ICD code who have high probability for actual iRBD.</p><p><strong>Methods: </strong>In this retrospective cohort study, a search of the EHR at a single health care system was conducted to identify outpatients who received the ICD9 or ICD10 RBD code in 2011-2021. The EHR for each case was manually reviewed. Secondary RBD cases were excluded. Remaining cases were classified as no iRBD or actual iRBD (possible, probable, or definite). Incident cases of NPD were identified. PPV of presence of the RBD ICD code for actual iRBD was calculated. Cumulative incidence of NPD with death as a competing event was compared in those with vs without iRBD. Least absolute shrinkage and selection operator (LASSO) regression was used to build a prediction model for iRBD, and the model was validated in an independent data set.</p><p><strong>Results: </strong>Among 1,130 cases with the RBD ICD code, 499 had secondary causes of RBD. For the remaining 628 cases, EHR review indicated no iRBD in 168 (26.8%). PPV of the RBD ICD code was 73.25%. Over a median follow-up of 4.7 years, compared with the no iRBD group, the iRBD group had a higher risk of NPD (subdistribution hazard ratio = 10.4 [95% CI 2.5-43.1]). The LASSO prediction model for iRBD had an area under the receiver operating characteristic curve of 0.844 (95% CI 0.806-0.880).</p><p><strong>Discussion: </strong>PPV of an RBD ICD code is moderate. In the real-world setting, patients with iRBD had a high risk of incident diagnosis of NPD over 4.7 years. Results indicate feasibility of using statistical models developed using EHR data to accurately predict iRBD.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200387"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624854","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":"Burnout in Practicing Neurologists: A Systematic Review and Meta-Analysis.","authors":"Janet Guo, Senay Gokcebel, Parneet Grewal, Sasha Alick-Lindstrom, Kelly Holder, Mathew J Gregoski, Neishay Ayub","doi":"10.1212/CPJ.0000000000200422","DOIUrl":"10.1212/CPJ.0000000000200422","url":null,"abstract":"<p><strong>Purpose of review: </strong>Burnout is a context-dependent, global issue among physicians in the medical field who often face job-related stressors, high workloads, and limited or lack of social support or autonomy. Within medicine, neurology is a specialty with high levels of burnout and low levels of work-life satisfaction. We, therefore, conducted this study to evaluate burnout rates among neurologists globally and identify the tools used to evaluate it.</p><p><strong>Recent findings: </strong>Among the 14 articles analyzed, the mean burnout prevalence rate among neurologists ranged from 18.1% to 94% (N = 8,735) across 6 countries (the United States, China, Philippines, Spain, Greece, and Brazil). Assessment of burnout using the Maslach Burnout Inventory (MBI) revealed that almost two-thirds (65.9%) of neurologists (N = 7,816) report experiencing burnout. Ten studies (71.4%) assessed burnout by using the MBI; the other 4 studies used the Copenhagen Burnout Inventory, a survey questionnaire generated by the American Academy of Neurology Stroke Practice Resources Workgroup, the Mini-Z survey, and a single question from the Physician Work Life Study. Among the 5 studies that used the same tool for measuring burnout (22-item MBI) and burnout criteria cutoff (emotional exhaustion [EE] ≥ 27 and/or depersonalization (DP) ≥ 10 subscale), the mean burnout rate ranged from 45% to 67% (<i>p</i> < 0.05, N = 7,816) across 3 countries (China, the United States, and Brazil). Of the studies that used the MBI and reported the 3 subscales of EE, DP, and personal accomplishment (PA), only the mean EE score was statistically different between studies. There were no significant differences detected in burnout rates among residents, among attending physicians, or residents compared with attendings.</p><p><strong>Summary: </strong>This meta-analysis of burnout among practicing neurologists reveals that available published data span different levels of training, different sample sizes, and different survey tools with different cutoffs used for burnout within the same tool. Although burnout rates among neurologists were found to differ by country, it is evident from this systematic review that a great deal of neurology physicians are experiencing burnout across the globe. This systematic review may inform future approaches to reduce burnout among neurologists.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200422"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864911","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":"A Systematic Review of Sleep Disturbance in Idiopathic Intracranial Hypertension.","authors":"Sabrina Kentis, Jacob S Shaw, Lisa N Richey, Lisa Young, Natalia Kosyakova, Barry R Bryant, Aaron I Esagoff, Luis F Buenaver, Rachel Marie E Salas, Matthew E Peters","doi":"10.1212/CPJ.0000000000200372","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200372","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sleep disturbances, particularly obstructive sleep apnea (OSA), may have a significant impact on the outcomes of patients with idiopathic intracranial hypertension (IIH). We conducted a PRISMA-compliant systematic literature review to study sleep disturbance in adult patients with IIH.</p><p><strong>Recent findings: </strong>The current literature on the relationship between IIH and sleep is quite limited. Research has found that sleep disturbances are associated with lower quality of life and may worsen several symptoms associated with IIH, such as headache, cognitive deficits, and neuropsychiatric issues.</p><p><strong>Summary: </strong>OSA was more prevalent in patients with IIH than in healthy controls. Several studies found that OSA was associated with worse IIH symptoms and treatment of OSA helped improve these parameters. Limitations included available literature and heterogeneity in sleep metrics and OSA diagnostic criteria between studies. Overall, further study of sleep disturbances in patients with IIH may encourage earlier screening, improved treatment options, and long-term improvements in quality of life.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200372"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470859","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 Prodrome (Premonitory Phase) in Migraine: Results From the PRODROME Trial Screening Period.","authors":"Todd J Schwedt, Richard B Lipton, Peter J Goadsby, Chia-Chun Chiang, Brad C Klein, Cory Hussar, Chengcheng Liu, Sung Yun Yu, Michelle Finnegan, Joel M Trugman","doi":"10.1212/CPJ.0000000000200359","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200359","url":null,"abstract":"<p><strong>Background and objective: </strong>Limited data are available describing the frequency, severity, and consistency of prodromal symptoms followed by headache. This analysis of the PRODROME trial screening period characterized prodromal symptoms in people with migraine, including the most common symptoms and their severity, and the frequency and consistency with which prodromal symptoms were followed by headache.</p><p><strong>Methods: </strong>PRODROME was a multicenter, randomized, double-blind, placebo-controlled, crossover trial conducted in the United States that enrolled adults with 2-8 migraine attacks per month who stated they could identify prodromal symptoms that were reliably followed by a headache. The trial included a 60-day screening period designed to test the predictive validity of \"qualifying prodrome events\" before the onset of headache. Participants used an eDiary to report qualifying prodrome events, defined as prodromal symptoms whereby the participant was confident a headache would follow within 1-6 hours. This analysis evaluated common prodromal symptoms and their severity, time from prodrome onset to headache onset, and the percentage of participants who identified prodromal symptoms that were followed by a headache ≥75% of the time over the 60-day screening period.</p><p><strong>Results: </strong>A total of 920 participants entered eDiary data, with a mean of 5.2 qualifying prodrome events during the 60-day screening period. A total of 4,802 qualifying prodrome events were recorded. The most common prodromal symptoms identified were sensitivity to light (57.2%; 2,748/4,802), fatigue (50.1%; 2,408/4,802), neck pain (41.9%; 2,013/4,802), sensitivity to sound (33.9%; 1,630/4,802), either difficulty thinking or concentrating (30.0%; 1,442/4,802), and dizziness (27.8%; 1,333/4,802). Of all qualifying prodrome events reported, 81.5% (3,913/4,802) were followed by headache of any intensity within 1-6 hours. For each participant, a mean of 84.4% of their qualifying prodrome events were followed by a headache within 1-6 hours, with 76.9% of participants identifying qualifying prodrome events that were followed by headache within 1-6 hours ≥75% of the time.</p><p><strong>Discussion: </strong>Participants were able to identify migraine attacks in which prodromal symptoms were reliably followed by a headache within 1-6 hours. These findings suggest the potential for initiating treatment during the prodrome to prevent headache.</p><p><strong>Trial registration information: </strong>ClinicalTrials.gov NCT04492020. Submitted: July 27, 2020; First patient enrolled: August 21, 2020. clinicaltrials.gov/study/NCT04492020.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200359"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470864","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: Missing Full Disclosures.","authors":"","doi":"10.1212/CPJ.0000000000200416","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200416","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/cpj.0000000000200192.][This corrects the article DOI: 10.1212/cpj.0000000000200200.][This corrects the article DOI: 10.1212/cpj.0000000000200184.][This corrects the article DOI: 10.1212/cpj.0000000000200201.][This corrects the article DOI: 10.1212/cpj.0000000000200206.][This corrects the article DOI: 10.1212/cpj.0000000000200198.][This corrects the article DOI: 10.1212/cpj.0000000000200195.][This corrects the article DOI: 10.1212/cpj.0000000000200204.][This corrects the article DOI: 10.1212/cpj.0000000000200213.][This corrects the article DOI: 10.1212/cpj.0000000000200203.][This corrects the article DOI: 10.1212/cpj.0000000000200207.][This corrects the article DOI: 10.1212/cpj.0000000000200194.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200416"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770748","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 Connectivity Relationships to Longitudinal Motor Outcomes Differ in Very Preterm Children With and Without Brain Injury.","authors":"Peppar E P Cyr, Rachel E Lean, Jeanette K Kenley, Sydney Kaplan, Dominique Meyer, Jeffrey J Neil, Dimitrios Alexopoulos, Rebecca G Brady, Joshua S Shimony, Thomas L Rodebaugh, Cynthia E Rogers, Christopher D Smyser","doi":"10.1212/CPJ.0000000000200397","DOIUrl":"10.1212/CPJ.0000000000200397","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children born very preterm (VPT) have high rates of motor disability, but mechanisms for early identification remain limited, especially for children who fall behind in early childhood. This study examines the relationship between functional connectivity (FC) measured at term-equivalent age and motor outcomes at 2 and 5 years.</p><p><strong>Methods: </strong>In this longitudinal observational cohort study, VPT children (gestational age 30 weeks and younger) with and without high-grade brain injury underwent FC MRI at term-equivalent age. Motor development was assessed using the Bayley Scales of Infant Development, Third Edition, at corrected age 2 years and Movement Assessment Battery for Children, Second Edition, at age 5 years. Logistic and negative binomial/Poisson regression models examined relationships between FC measures and 5-year task scores, with and without 2-year scores as covariates. Infants were categorized as \"injured\" or \"uninjured\" based on structural MRI findings at term-equivalent age.</p><p><strong>Results: </strong>In the injured group (n = 34), each 1 SD decrease in neonatal left-right motor cortex FC was related to approximately 4× increased odds of being unable to complete a fine motor task at age 5 (log odds = -1.34, <i>p</i> < 0.05). In the uninjured group (n = 41), stronger basal ganglia-motor cortex FC was related to poorer fine motor scores (Est = -0.40, <i>p</i> < 0.05) and stronger cerebellum-motor cortex FC was related to poorer balance and fine motor scores (Est = -0.05 to -0.23, <i>p</i> < 0.05), with balance persisting with adjustment for 2-year scores.</p><p><strong>Discussion: </strong>In VPT children with brain injury, interhemispheric motor cortex FC was related to motor deficits at 5-year assessment, similar to previous findings at 2 years. In uninjured children, FC-measured disruption of the motor system during the neonatal period was associated with motor planning/coordination difficulties that were not apparent on 2-year assessment but emerged at 5 years, suggesting that the neural basis of these deficits was established very early in life. Subsequently, 2-year follow-up may not be sufficient to detect milder motor deficits in VPT children, and they should be monitored for motor difficulties throughout the preschool years. For all VPT children, FC at term-equivalent age has the potential to improve our ability to predict disability before it presents behaviorally.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200397"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504827","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: Dysphagia in Epilepsy Patients: The Silent Enemy.","authors":"","doi":"10.1212/CPJ.0000000000200423","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200423","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200362.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200423"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624852","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}