Neurology. Clinical practice最新文献

{"title":"Spinal Muscular Atrophy Update in Best Practices: Recommendations for Treatment Considerations.","authors":"Mary K Schroth, Jennifer Deans, Diana X Bharucha Goebel, W Bryan Burnette, Basil T Darras, Bakri H Elsheikh, Marcia V Felker, Andrea Klein, Jena Krueger, Crystal M Proud, Aravindhan Veerapandiyan, Robert J Graham","doi":"10.1212/CPJ.0000000000200374","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200374","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by biallelic variants of the <i>Survival Motor Neuron 1</i> gene (<i>SMN1</i>) that affects approximately 1 in 15,000 live births. Availability of 3 SMN-enhancing treatments for SMA has led to urgency to review how clinicians and patients use these treatments for SMA, while additional research and real-world data and experience are being collected. This work describes important factors to assist with decision-making for SMN-enhancing treatments.</p><p><strong>Methods: </strong>A systematic literature review was conducted on SMN-enhancing treatments for SMA and related studies. A working group of American and European health care providers with expertise in SMA care identified barriers and developed recommendations through a modified Delphi technique with serial surveys and feedback through virtual meetings to fill gaps for information where evidence is limited. A community working group of an individual living with SMA and caregivers provided insight and perspective on SMA treatments and support through a virtual meeting to guide recommendations.</p><p><strong>Results: </strong>The health care provider working group and the community working group agreed that when determining whether to start, change, add, or discontinue a treatment, essential considerations include patient and family/caregiver perspective, and treatment safety and side effects. When initiating treatment for patients newly diagnosed with SMA, important patient characteristics are age and <i>Survival Motor Neuron 2</i> gene <i>(SMN2)</i> copy number. Furthermore, when initiating, changing, or adding treatment, current clinical status and comorbidities drive decision-making. When considering a medication or treatment plan change, unless there is an urgent indication, a treatment and associated patient outcomes should be monitored for a minimum of 6-12 months. When determining a treatment plan with an adolescent or adult with SMA, consider factors such as quality of life, burden vs benefit of treatment, and reproductive issues. Access to care coordination and interdisciplinary/multidisciplinary care are essential to treatment success.</p><p><strong>Discussion: </strong>Sharing information about current knowledge of treatments and shared decision-making between health care providers and patients living with SMA and caregivers are essential to overcoming barriers to providing SMN-enhancing treatments.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200374"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470882","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":"Distinguishing Prodromal Dementia With Lewy Bodies From Prodromal Alzheimer Disease: A Longitudinal Study.","authors":"Kathryn A Wyman-Chick, Tanis J Ferman, Daniel Weintraub, Melissa J Armstrong, Bradley F Boeve, Ece Bayram, Ella Chrenka, Matthew J Barrett","doi":"10.1212/CPJ.0000000000200380","DOIUrl":"10.1212/CPJ.0000000000200380","url":null,"abstract":"<p><strong>Background and objectives: </strong>It can be clinically challenging to differentiate dementia with Lewy bodies (DLB) and Alzheimer disease (AD). As potential therapies emerge with the goal of slowing or halting misfolded protein aggregation, it is imperative to be able to identify individuals before the disease becomes disabling. Differentiating between DLB and AD in the preclinical or prodromal phase of DLB and AD becomes more important. Studies are needed to validate the proposed criteria for prodromal DLB.</p><p><strong>Methods: </strong>Longitudinal data were obtained from the Uniform Data Set of the National Alzheimer's Coordinating Center. Included participants had a baseline diagnosis of normal or mild cognitive impairment and a consecutive 2-year follow-up diagnosis of DLB or AD. We examined whether core DLB clinical features, supportive neuropsychiatric features, and neuropsychological data in the 2 years preceding the dementia diagnosis distinguished DLB from AD.</p><p><strong>Results: </strong>We identified 143 participants with DLB and 429 age-matched/sex-matched participants with AD. The presence of 2 or more core DLB features in the year before dementia diagnosis yielded the greatest AUC (0.793; 95% CI 0.748-0.839) in distinguishing prodromal DLB from prodromal AD. Sleep disturbances, hallucinations, and a cognitive profile of worse processing speed, attention, and visuoconstruction performance were evident at least 2 years before the dementia diagnosis in DLB compared with AD.</p><p><strong>Discussion: </strong>Data from this multisite, longitudinal, well-characterized research North American cohort support the validity of the recently published criteria for prodromal DLB. In the prodromal stage, patients who subsequently develop DLB are more likely to have core DLB clinical features and worse attention, processing speed, and visuospatial performance than those who go on to develop AD. Differentiation of DLB and AD before dementia emerges provides an opportunity for early, disease-specific intervention and overall management.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200380"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470868","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":"Do I Have ADHD? Diagnosis of ADHD in Adulthood and Its Mimics in the Neurology Clinic.","authors":"Susanna B Mierau","doi":"10.1212/CPJ.0000000000200433","DOIUrl":"10.1212/CPJ.0000000000200433","url":null,"abstract":"<p><p>Attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder that causes difficulties with sustained attention, executive functioning, impulsivity, hyperactivity, and/or emotional regulation. Although many people are diagnosed with ADHD in childhood, others seek diagnosis in adulthood. Many adults have already reviewed available clinical scales or screening tools for ADHD and are referred for evaluation of attention problems by their primary care providers. Key features of the history and examination in a clinic visit can differentiate ADHD from other causes of attention problems in adults. Treatment with stimulant or nonstimulant medications for ADHD can be life-changing for adults with ADHD, increasing productivity at home and work, reducing anxiety and impulsive behaviors, and improving interpersonal and community relationships. This article aids neurologists in differentiating ADHD from other causes of attention and executive functioning problems in adults and in initiating treatment.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200433"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854717","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- and Caregiver-Reported Impact of Symptoms in Alzheimer Disease, Mild Cognitive Impairment, and Dementia.","authors":"Jamison Seabury, Jennifer Weinstein, Anika Varma, Spencer James Rosero, Charlotte Engebrecht, Abigail Arky, Christine Zizzi, Nuran Dilek, Abigail Mathewson, Susan Salem-Spencer, Elizabeth J Santos, Chad Rydel Heatwole","doi":"10.1212/CPJ.0000000000200418","DOIUrl":"10.1212/CPJ.0000000000200418","url":null,"abstract":"<p><strong>Background and objectives: </strong>In preparation for future clinical trials involving individuals with Alzheimer disease (AD), mild cognitive impairment (MCI), and dementia, it is important to ascertain the widespread impact of symptoms from the direct perspectives of patients and caregivers. In this study, we performed cross-sectional surveys using large-scale patient and caregiver data to identify the prevalence and average impact of symptoms and symptomatic themes experienced by adults with AD, MCI, and dementia. Subsequent analyses were used to determine which demographic and disease-specific factors are associated with more severe disease.</p><p><strong>Methods: </strong>Fifteen adults with AD (6), MCI (8), and dementia (1) and 15 caregivers of adults with AD (7), MCI (6), and dementia (2) participated in qualitative interviews providing 1,166 and 1,097 unique quotes pertaining to symptom burden. Using open-ended questions from a comprehensive interview guide, participants were asked to identify the symptoms of AD that have the greatest effect on their lives or the lives of the individual for whom they provide care. A cross-sectional survey was then implemented inquiring about the potential symptoms of importance identified during preliminary qualitative interviews. Four-hundred thirty-three individuals (patients and caregivers) participated in the cross-sectional survey, providing more than 35,000 symptom rating responses. Subsequent analyses were conducted to determine how demographic and disease-specific characteristics correlate with symptomatic theme prevalence.</p><p><strong>Results: </strong>The most frequent symptomatic themes reported by individuals with AD, MCI, and dementia in the cross-sectional survey were memory problems (99.0%), problems thinking (90.3%), and communication difficulties (80.4%). Patients identified decreased satisfaction in social situations (1.45), fatigue (1.45), and memory problems (1.41) as the most impactful symptomatic themes (range 0-4). Patient-reported symptomatic theme prevalence was strongly associated with the Modified Rankin Scale (mRS) for neurologic disability.</p><p><strong>Discussion: </strong>Individuals with AD, MCI, and dementia experience a variety of symptoms that significantly affect their daily lives. These symptoms, many underrecognized, are of variable importance to individuals with these diseases and may inform potential targets for future therapeutic intervention as well as facilitate the development and validation of disease-specific outcome measures.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200418"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885981","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":"Outcomes and Recurrence Rates Among Patients With Provoked and Cryptogenic Cerebral Venous Thrombosis: Analysis of the ACTION CVT.","authors":"Sami Al Kasab, Eyad Almallouhi, Liqi Shu, Kimberly P Kicielinski, Setareh Salehi Omran, David S Liebeskind, Adeel S Zubair, Maria C Vedovati, Maurizio Paciaroni, Kateryna Antonenko, Mirjam R Heldner, Adam de Havenon, Nils Henninger, Shadi Yaghi","doi":"10.1212/CPJ.0000000000200381","DOIUrl":"10.1212/CPJ.0000000000200381","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depends on the underlying etiology. This study aims to identify prevalence, risk factors, and recurrent venous thromboembolism (VTE) rates among patients with idiopathic (cryptogenic) CVT and CVT provoked by transient (peripartum, hormonal treatment, infection, trauma) and persistent (cancer, thrombophilia) factors.</p><p><strong>Methods: </strong>We used the ACTION-CVT retrospective database which included consecutive patients who were treated for CVT in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. We compared baseline characteristics and outcomes of patients with cryptogenic, transient provoked (TP) and those with persistent provoked (PP) CVT. Baseline characteristics was compared between the groups using χ² test, <i>t</i> test, or Mann-Whitney <i>U</i> test as appropriate, followed by multivariable regression. We used Kaplan-Meier survival analysis to assess outcome occurrence. We used interaction analysis and Cox regression to assess the risks of recurrent VTE in patients with CVT.</p><p><strong>Results: </strong>Among 1,025 included participants with CVT, 510 (49.8%) had no identified risk factor (cryptogenic), 363 (35.4%) had at least one transient provoking factor, and 152 (14.8%) had a persistent provoking factor. Patients with TP CVT were younger (<i>p</i> = 0.003) and more likely to be female patients (<i>p</i> < 0.001). When compared with patients with TP CVT, the risk of recurrent VTE was greater in patients with PP CVT (HR 2.59, 95% CI 1.29-5.22, <i>p</i> = 0.008) and nonsignificantly elevated in patients with cryptogenic CVT (HR 1.85. 95% CI 0.98-3.59, <i>p</i> = 0.059). In the interaction analysis, there was a trend toward higher rate of recurrent VTE in female patients with cryptogenic CVT and male patients with PP CVT.</p><p><strong>Discussion: </strong>In this multicenter study, we found that outcomes of CVT differed depending on the underlying etiology. The risk of recurrent VTE in the PP and cryptogenic CVTs may be influenced by sex.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200381"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470878","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":"Imaging-Guided Subthalamic Nucleus Deep Brain Stimulation Programming for Parkinson Disease: A Real-Life Pilot Study.","authors":"Mickael Aubignat, Alexis Berro, Mélissa Tir, Michel Lefranc","doi":"10.1212/CPJ.0000000000200326","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200326","url":null,"abstract":"<p><strong>Background and objectives: </strong>Deep brain stimulation (DBS) is a well-established treatment for Parkinson disease (PD), with programming methods continually evolving. This study aimed to compare the efficacy and patient burden between conventional ring-mode programming (CP-RM) and image-guided volume of tissue activated (IG-VTA) programming for subthalamic nucleus (STN) DBS in PD.</p><p><strong>Methods: </strong>In this retrospective study, patients with PD who underwent STN-DBS between 2011 and 2014 (CP-RM group) and 2019 and 2021 (IG-VTA group) were evaluated. The primary outcome was the improvement in the UPDRS III score from preoperative OFF to postoperative ON state without medication at one-year follow-up. Secondary outcomes included hospital stay duration and programming sessions.</p><p><strong>Results: </strong>A total of 26 patients were analyzed (IG-VTA: n = 12, CP-RM: n = 14). Both groups showed similar improvements in UPDRS III scores (IG-VTA: 43.62, CP-RM: 41.29). However, the IG-VTA group experienced shorter immediate postoperative hospital stays and fewer hospitalizations after discharge.</p><p><strong>Discussion: </strong>IG-VTA programming preserved the clinical efficacy of STN-DBS over 1 year and reduced the patient and clinician burden of hospital stay and programming sessions. However, conclusions drawn must consider the limitations of retrospective design, differing time epochs, and evolving clinical practices. Further multicentric and prospective studies are warranted to validate these findings in the evolving field of neurostimulation.</p><p><strong>Trial registration information: </strong>The trial is registered on clinicaltrials.gov (NCT05103072).</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"14 6","pages":"e200326"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11396028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292112","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":"An Interprofessional Team for Disease-Modifying Therapy in Alzheimer Disease Implementation.","authors":"Katherine W Turk, Mark D Knobel, Alexandra Nothern, Garrett Friedman, Hannah Noah, Brendan Campbell, Diana C Anderson, Andreas Charidimou, Andrew Mills, Vanessa Coronel, Nacha Pierre, Beverly V Reynolds, Caroline Wagner, Leanne M Varga, John Roefaro, Laura Triantafylidis, Andrew E Budson","doi":"10.1212/CPJ.0000000000200346","DOIUrl":"10.1212/CPJ.0000000000200346","url":null,"abstract":"<p><strong>Background: </strong>Lecanemab and other new amyloid-targeting immunotherapies for Alzheimer disease show notable promise but may also pose significant risk for patients.</p><p><strong>Recent findings: </strong>To facilitate the implementation and monitoring of lecanemab infusions at our tertiary medical center, we convened an interprofessional team. The team created a number of resources including patient handouts and medical documentation templates as well as systems and processes that are likely to be useful to other clinical care settings and centers.</p><p><strong>Implications for practice: </strong>It is our intent to widely share the resources and processes developed.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"14 6","pages":"e200346"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054135","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":"Uncertainties Regarding Cerebral Palsy Diagnosis: Opportunities to Clarify the Consensus Definition.","authors":"Bhooma R Aravamuthan, Darcy L Fehlings, Iona Novak, Paul Gross, Noor Alyasiry, Ann H Tilton, Michael I Shevell, Michael C Fahey, Michael C Kruer","doi":"10.1212/CPJ.0000000000200353","DOIUrl":"10.1212/CPJ.0000000000200353","url":null,"abstract":"<p><strong>Background and objectives: </strong>We have established that physicians, including neurologists, variably diagnose cerebral palsy (CP) when using the most recent CP definition from 2006. We also know that child neurologists and neurodevelopmentalists view themselves to be optimally suited to diagnose CP based on their training backgrounds. Therefore, to reduce variability in CP diagnosis, our objective was to elucidate uncertainties child neurologists and neurodevelopmentalists may have regarding practical application of the 2006 definition.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of child neurologists and neurodevelopmentalists built into a discussion seminar at the 2022 Child Neurology Society (CNS) Annual Meeting, the largest professional meeting of these specialists in North America. Seminar attendees were provided the 2006 definition and asked whether they had any uncertainties about the practical application of the definition across 4 hypothetical clinical vignettes. A group of national and international CP leaders then processed these data through iterative discussions to develop recommendations for clarifying the 2006 definition.</p><p><strong>Results: </strong>The seminar was attended by 50% of all conference attendees claiming CME (202/401). Of the 164 closing survey respondents, 145 (88%) expressed uncertainty regarding the clinical application of the 2006 definition. These uncertainties focused on 1) age, both regarding the minimum and maximum ages of brain disturbance or motor symptom onset (67/164, 41%), and 2) interpretation of the term \"nonprogressive\" (48/164, 29%). Almost all respondents (157/164, 96%) felt that we should revise the 2006 consensus definition of CP.</p><p><strong>Discussion: </strong>To address the most common CP diagnostic uncertainties we identified, we collectively propose 4 points of clarification to the 2006 definition: 1) motor symptoms/signs should be present by 2 years old; 2) CP can and should be diagnosed as early as possible; 3) the clinical motor disability phenotype should be nonprogressive through 5 years old; and 4) a CP diagnosis should be re-evaluated if motor disability is progressive or absent by 5 years old. We anticipate that clarifying the 2006 definition of CP in this manner could address the uncertainties we identified among child neurologists and neurodevelopmentalists and reduce the diagnostic variability that currently exists.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"14 6","pages":"e200353"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081050","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 Utility of CSF Correction Factors for Traumatic Lumbar Puncture in Adults.","authors":"Ryan W Zhou, Kamala Sangam, Adrian Budhram","doi":"10.1212/CPJ.0000000000200350","DOIUrl":"10.1212/CPJ.0000000000200350","url":null,"abstract":"<p><strong>Objectives: </strong>To identify indicators of false pleocytosis in adults with traumatic lumbar puncture (LP), and determine specificities and sensitivities of commonly used CSF correction factors.</p><p><strong>Methods: </strong>Adults who underwent 4-tube CSF collection were reviewed. Study inclusion required elevated tube 1 red blood cell (RBC) count, tube 1 pleocytosis, and normalized tube 4 RBC count. Tube 4 white blood cell (WBC) count served as the reference standard. Specificities and sensitivities of 3 correction factors (1 WBC:500 RBC, 1 WBC:1000 RBC, and 1 WBC:1500 RBC) were calculated.</p><p><strong>Results: </strong>One hundred ninety-five adults were included. Among them, 106 (54%) had false tube 1 pleocytosis; these patients had a significantly higher median CSF RBC count and lower median CSF WBC count than those with true tube 1 pleocytosis. Specificities and sensitivities of correction factors ranged from 71.7% to 29.2% and 84.3% to 97.8%, respectively; 1 WBC:500 RBC had highest specificity for pleocytosis, while 1 WBC:1500 RBC had highest sensitivity. Irrespective of correction factor used, false-positive and false-negative determinations of pleocytosis were usually mild (≤20 WBCs/μL).</p><p><strong>Discussion: </strong>Indicators of false pleocytosis in adults with traumatic LP include bloodier CSF and milder pleocytosis, suggesting that correction factors are most useful in such cases. Across correction factors, an expected specificity/sensitivity tradeoff is observed. Corrected CSF WBC counts suggesting only mild pleocytosis should be interpreted cautiously.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"14 6","pages":"e200350"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056158","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":"Geographic Access to High-Volume Mechanical Thrombectomy Centers in Florida, 2019.","authors":"Liza Solovey, Renee Y Hsia, Yu-Chu Shen, Elan L Guterman, Jay Chol Choi, Anthony S Kim","doi":"10.1212/CPJ.0000000000200337","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200337","url":null,"abstract":"<p><strong>Background and objectives: </strong>Mechanical thrombectomy (MT) improves outcomes for acute ischemic stroke (AIS) due to large vessel occlusion, but is time sensitive and requires specialized infrastructure. Professional organizations and certification bodies have promulgated minimum procedural volume standards for centers and for individual proceduralists but it is unclear whether enforcing these requirements would decrease geographic access to MT. Therefore, we sought to evaluate the potential impact of applying a minimum procedural volume threshold on geographic access to MT.</p><p><strong>Methods: </strong>We identified all hospital discharges for stroke where an MT procedure was performed at any nonfederal hospital in Florida in 2019 using statewide hospital discharge data. We then generated geographic service area maps based on prespecified ground transport distances for the subset of hospitals that performed at least 1 MT and for those that performed at least 15 MTs that year, the minimum volume threshold required for thrombectomy capable and comprehensive stroke centers by the Joint Commission. Then, using zip code centroids and patient-level discharge hospital data, we computed the proportion of patients with AIS who lived within each of the generated service areas.</p><p><strong>Results: </strong>A total of 105 of 297 hospitals performed MT; of those, 51 (17%) were low-volume centers (1-14 MTs/year) and 54 (18%) were high-volume centers (≥15 MTs/year). High-volume centers accounted for nearly 95% of all MTs performed in the state. Most patients hospitalized with AIS (87%) lived within 20 miles (or an estimated as a 1-hour driving time) of a hospital that performed at least 1 MT, and all (100%) lived within 115 miles (or estimated as 3-hour driving time). Setting a minimum MT volume threshold of 15 would decrease the proportion of stroke patients living within 1-hour driving time of an MT center from 87% to 77%.</p><p><strong>Discussion: </strong>In 2019, most Florida stroke patients lived within a 1-hour ground transport time to a center that performed at least 1 MT and all lived within 3-hour driving time of an MT center, irrespective of whether a minimum procedural volume threshold of 15 cases per year was applied or not.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"14 6","pages":"e200337"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11396029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292111","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}