Neurological Sciences最新文献

{"title":"Delays in treatment escalation after failure in multiple sclerosis: the role of therapy type and healthcare system.","authors":"Juan I Rojas, Pablo A Lopez, Liliana Patrucco, Edgardo Cristiano, Susana Liwacki, María E Balbuena, Carlos Vrech, Norma Deri, Felisa Leguizamon, Geraldine Luetic, Darío Tavolini, Carolina Mainella, Gisela Zanga, Marcos Burgos, Javier Hryb, Ricardo Alonso, Nora Fernandez Liguori, Debora Nadur, Marina Alonso Serena, Alejandro Caride, Edgar Carnero Contentti","doi":"10.1007/s10072-026-09483-6","DOIUrl":"https://doi.org/10.1007/s10072-026-09483-6","url":null,"abstract":"<p><strong>Background: </strong>Timely treatment optimization after therapeutic failure is essential in multiple sclerosis (MS), particularly when escalation to high-efficacy therapies (HET) is required. However, real-world delays in treatment initiation remain poorly characterized.</p><p><strong>Objective: </strong>To evaluate time to treatment initiation after therapeutic failure in MS according to treatment type and healthcare coverage.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using a real-world registry of patients with relapsing-remitting MS. The first treatment switch due to failure per patient was analyzed. The primary outcome was time from failure identification to initiation of subsequent therapy. Treatments were classified as HET or non-HET and healthcare coverage as public, social security, or private. Multivariable analysis used linear regression with log-transformed time, expressed as time ratios (TR).</p><p><strong>Results: </strong>A total of 288 patients were included. Median time to treatment initiation was 142.0 days (IQR 89.0-247.0). Stratified analyses revealed different patterns across healthcare systems. The longest median time to HET initiation was observed with private insurance (211.0 days), whereas the largest within-system difference between HET and non-HET was observed in the public system (165.0 vs. 66.0 days). In multivariable analysis, the HET coefficient was associated with longer time to initiation (TR 3.8, 95% CI 2.5-5.5; p < 0.001), with a significant HET × public system interaction (TR 1.4, 95% CI 1.0-2.1;p = 0.04).</p><p><strong>Conclusion: </strong>Treatment initiation delays after therapeutic failure were substantial and varied according to treatment category and healthcare coverage. These findings highlight the need to better understand barriers between treatment decisions and effective therapy initiation.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From incidental cerebellar atrophy to progressive motor syndrome: a case within the spectrum of ATXN2-associated neurodegeneration.","authors":"Xin Huang, Yan Ma, Xinran Ma, Kailin Xia, Dongsheng Fan","doi":"10.1007/s10072-026-09404-7","DOIUrl":"10.1007/s10072-026-09404-7","url":null,"abstract":"<p><strong>Background: </strong>Increasing evidence suggests that ATXN2-related disorders represent a clinical spectrum with variable presentations.</p><p><strong>Case presentation: </strong>We report a 70-year-old Chinese man carrying an ATXN2 allele with 34 CAG repeats (20/34 repeats). Cerebellar atrophy was incidentally noted on magnetic resonance imaging (MRI) more than ten years before symptom onset. He later developed bradykinesia and rigidity. After rapid weight loss, he developed a rapidly progressive motor syndrome with clinical upper and lower motor neuron features, followed by type II respiratory failure requiring noninvasive ventilation.</p><p><strong>Conclusions: </strong>These findings support the notion that ATXN2-associated neurodegeneration may represent a clinical continuum.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial metastasis as a mimic of amyloid-related imaging abnormalities.","authors":"Jeongyeon Hwang, Bradley N Delman, Georges Naasan","doi":"10.1007/s10072-026-09449-8","DOIUrl":"10.1007/s10072-026-09449-8","url":null,"abstract":"<p><p>This report describes a 79-year-old woman with biomarker-confirmed Alzheimer's disease who developed progressive vasogenic edema initially interpreted as amyloid-related imaging abnormalities (ARIA) with edema during lecanemab therapy, but was ultimately found to have multifocal intracranial metastases from recurrent papillary thyroid carcinoma. The serial neuroimaging highlights the diagnostic challenge of distinguishing ARIA from alternative causes of vasogenic edema in the era of anti-amyloid monoclonal antibody treatment. In addition, this case raises an important and underexplored question regarding whether anti-amyloid therapies may alter blood-brain barrier integrity in a manner that could influence metastatic spread in susceptible patients.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive assessment of patients with post-COVID olfactory dysfunction and impaired domains.","authors":"David Dylan García-Meléndez, Daniel Maroto Navas, José Piernagorda Copado, Rocío Martín Álvarez, María Del Río Ruiz, María Isabel Morales-Casado","doi":"10.1007/s10072-026-09446-x","DOIUrl":"10.1007/s10072-026-09446-x","url":null,"abstract":"<p><strong>Background: </strong>Persistent olfactory dysfunction is a common symptom of post-COVID syndrome (PCS), particularly among younger patients who experienced mild COVID-19. Recent functional neuroimaging studies suggest that persistent olfactory impairment may be associated with cognitive deficits. However, few studies have characterised cognition in this subgroup using standardised neuropsychological assessment.</p><p><strong>Objectives: </strong>To assess the prevalence of cognitive deficits and their characteristics in patients with persistent post-COVID olfactory symptoms.</p><p><strong>Methods: </strong>This multicentre study included 55 patients with PCS and persistent olfactory dysfunction following COVID-19 onset before February 2021. Participants underwent olfactory evaluation using the Sniffin' Sticks test and a comprehensive battery of neuropsychological assessments.</p><p><strong>Results: </strong>The mean age was 43.9 years (SD 10.1), with a mean disease duration of 46.1 months (SD 6.5). According to a domain-based criterion, 67.3% of patients showed cognitive impairment. Domain-specific impairment was observed in attention/working memory (67.3%), executive function (50.9%), and episodic memory (56.4%). The Montreal Cognitive Assessment (MoCA) detected abnormalities in only 9.1% of patients. Exploratory comparisons between hyposmic and anosmic patients showed no univariate differences after false discovery rate (FDR) correction, despite a marginal post-hoc multivariate effect. Continuous olfactory performance showed inverse correlations with two executive measures after FDR correction, but no consistent dose-response relationship across cognitive measures.</p><p><strong>Conclusion: </strong>In this selected cohort, a high prevalence of multidomain cognitive alterations was observed. These findings highlight the limitations of brief cognitive screening tools and suggest a complex relationship between persistent olfactory dysfunction and cognition. Further longitudinal studies are warranted.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric symptoms as early indicators in multiple sclerosis: clinical features and implications for disability progression.","authors":"C Esposto, T Guerra, D Paolicelli, P Iaffaldano","doi":"10.1007/s10072-026-09469-4","DOIUrl":"10.1007/s10072-026-09469-4","url":null,"abstract":"","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor concerning \"Neuromodulatory effects of repetitive transcranial magnetic stimulation on post-stroke urinary retention: insights from neuroelectrophysiological assessment\".","authors":"Ruirui Fan, Ziwen Chen, Guanhua Hou","doi":"10.1007/s10072-026-09445-y","DOIUrl":"10.1007/s10072-026-09445-y","url":null,"abstract":"","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-generation pharmacological strategies for Parkinson's disease: a systematic literature review of symptom management and disease modification.","authors":"Rajan Rajabalaya, Arul Kiruba N Mary, Dinesh Kumar Chellappan, Anil Philip Kunnath, Jestin Chellian","doi":"10.1007/s10072-026-09466-7","DOIUrl":"10.1007/s10072-026-09466-7","url":null,"abstract":"<p><p>Parkinson disease is an ongoing neurodegenerative disorder, and both motor and non-motor symptoms are involved with the existing therapies having minimal effects on the disease but only symptom alleviation. The goal of this systematic literature review was to generalize up-to-date evidence on the next-generation pharmacological strategies to manage the symptoms and the disease in a patient with Parkinson disease. The review was based on PRISMA 2020 and included the analysis of peer-reviewed studies of human research published in 2015-2026 and retrieved in the key databases, such as PubMed, Scopus, Web of Science, and Cochrane Library. This included 30 eligible studies consisting of randomized studies, observational studies, and early clinical trials. The results show that, although dopaminergic treatment continues to play a central role in managing motor symptoms, new methods such as gene therapy, gene editing, stem cell-based regeneration, nanomedicine delivery systems, repurposed drugs, artificial intelligence-based precision medicine approaches have a good neuroprotective and disease-modifying potential. Nonetheless, the majority of new interventions are still in preclinical or first line clinical phase, with a defined subset of emerging gene-, cell-, and nanotechnology-based approaches evaluated only in animal or in-vitro models rather than in PD patients and associated with small sample size, invasive delivery, limited follow-up and lack of long-term safety information. In general, the review concludes by stating that there has been significant advancement in diversification of therapeutic targets and mechanisms, but rigorous large-scale biomarker-directed clinical trials are needed to translate these advances to effective and sustainable treatment of the Parkinson disease.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term trends in selected neurological disorders in Italy (1990-2023): analysis of the global burden of disease (GBD) 2023 data.","authors":"Francesco Brigo, Gianni Turcato, Arian Zaboli, Simona Lattanzi","doi":"10.1007/s10072-026-09457-8","DOIUrl":"10.1007/s10072-026-09457-8","url":null,"abstract":"<p><strong>Background: </strong>Neurological disorders are major contributors to disability and premature mortality. We examined long-term trends in selected neurological, cerebrovascular, central nervous system (CNS) infectious, headache, and brain and CNS cancer causes in Italy from 1990 to 2023.</p><p><strong>Methods: </strong>Age-standardized disability-adjusted life year (DALY), years of life lost (YLL), and years lived with disability (YLD) rates were obtained from the GBD 2023 Results Tool. Causes were grouped into clinically coherent clusters. EAPCs were estimated using log-linear models with Newey-West HAC standard errors (lag 1), and Joinpoint regression characterized non-linear patterns. Sex-specific trends, descriptive uncertainty widths, and YLL/YLD ratios were evaluated.</p><p><strong>Results: </strong>Overall DALY rates declined (EAPC - 1.01%, 95% CI -1.13 to -0.89). Cerebrovascular and CNS infectious causes showed the largest reductions, whereas multiple sclerosis, Parkinson's disease, idiopathic epilepsy, and motor neuron disease increased. Joinpoint regression identified multi-phase patterns. Migraine, multiple sclerosis, and dementia showed higher female burden, whereas stroke, Parkinson's disease, and brain and CNS cancer showed higher male burden. Uncertainty widths varied across causes; cluster summaries represent mean constituent-cause widths, not uncertainty intervals for aggregated cluster rates. YLL/YLD ratios showed marked heterogeneity between fatal and disability-driven conditions.</p><p><strong>Conclusions: </strong>Italy experienced substantial declines in age-standardized DALY rates across several selected causes from 1990 to 2023, driven predominantly by reductions in cerebrovascular causes, alongside increasing burdens from several chronic neurological conditions. The relative contributions of premature mortality and non-fatal disability varied markedly across individual causes and clusters.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizing healthcare delivery in the era of disease-modifying therapies for Alzheimer's Disease: an Italian RAND/UCLA consensus.","authors":"Alessandro Padovani, Mattia Altini, Giuseppe Bellelli, Marco Bozzali, Ovidio Brignoli, Annachiara Cagnin, Antonio Cherubini, Manuele Iannacci, Raffaele Lodi, Giancarlo Logroscino, Camillo Marra, Carlo Nicora, Simone Parretti, Anna Sacco, Patrizia Spadin, Mario Zappia","doi":"10.1007/s10072-026-09452-z","DOIUrl":"10.1007/s10072-026-09452-z","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease (AD) poses a growing clinical and organizational challenge, requiring coordinated, multidisciplinary care models. In Italy, significant regional variability in resources and access to diagnostic services persists, while the implementation of community-based care models, the expanding role of biomarkers, and the advent of disease-modifying therapies (DMTs) further highlight the need for a more coordinated and equitable dementia care network.</p><p><strong>Objective: </strong>Develop system-level recommendations to optimise the organisation of AD care delivery in Italy in anticipation of DMTs introduction.</p><p><strong>Methods: </strong>Using the RAND/UCLA Appropriateness Method, a multidisciplinary panel rated 55 statements across nine domains, evaluating appropriateness in two rounds and priority of implementation in a third round.</p><p><strong>Results: </strong>Consensus was achieved for all statements, with high appropriateness and priority ratings. The statements outline a regional, network-based model organised across territorial services, Spoke and Hub centres, with formal governance responsible for pathway definition and monitoring. Referral pathways from primary care are based on cognitive and frailty assessment, with non-frail patients referred to Spoke for clinical, neuropsychological and neuroradiological evaluation. Patients potentially eligible for DMTs are referred to Hub centres, where diagnostic confirmation is completed and multidisciplinary teams assess treatment eligibility. When authorised, Hub centres are responsible for DMTs prescription and administration. The statements emphasise the need for standardised neuropsychological and neuroradiological protocols for amyloid-related imaging abnormalities (ARIA) monitoring, alongside the progressive adoption of plasma biomarkers, telemedicine, and structured communication with patients and caregivers.</p><p><strong>Conclusion: </strong>This consensus provides a pragmatic framework to support the reorganisation of AD care in Italy, ensuring that every patient is directed to the most appropriate level of care across a flexible regional network.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 11","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel oxidative-inflammatory biomarker for Parkinson's disease: clinical utility of the uric acid-to-albumin ratio.","authors":"Wenbo Xiu, Gao Zhang, Yang Chen, Chaonan Sun, Yanping Gao, An Li, Haiping Zhang, Ping Shuai, Jing Cheng, Jinxia Wang, Xiao Xiao, Bolin Deng","doi":"10.1007/s10072-026-09415-4","DOIUrl":"10.1007/s10072-026-09415-4","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence highlights the contribution of systemic inflammation and oxidative stress to the pathogenesis and progression of Parkinson's disease (PD). Accordingly, blood-based biomarkers that capture these processes are of increasing clinical interest. This study evaluated the association between PD and serum uric acid, serum albumin, and their integrated index-the uric acid-to-albumin ratio (UAR)-to determine their potential utility as biomarkers of systemic inflammation, oxidative stress, and disease progression.</p><p><strong>Methods: </strong>A total of 153 patients with PD and 291 healthy controls were included. Serum uric acid, albumin, and UAR were measured through standardized biochemical assays. Group comparisons and multivariable logistic regression were performed to assess associations with PD, and analyses stratified by Hoehn and Yahr stage examined relationships with disease severity.</p><p><strong>Results: </strong>Uric acid, albumin, and UAR levels were significantly lower in patients with PD compared with healthy controls (all p < 0.001). After adjustment for age, sex, hypertension, and diabetes, UAR remained independently associated with PD, with lower UAR corresponding to higher odds of disease (OR = 0.72, 95% CI: 0.63-0.82, p < 0.001). Stratified analyses showed that UAR reductions were most prominent in early and middle PD stages, whereas advanced-stage values approximated those of controls. ROC analysis demonstrated moderate discriminative ability of UAR for PD overall (AUC = 0.630) and for early-to-middle stage disease (AUC = 0.620 and 0.644, respectively).</p><p><strong>Conclusion: </strong>UAR is significantly reduced in PD and associated with early-middle disease stages, supporting its potential as an accessible biomarker for PD monitoring, though larger longitudinal studies are needed for validation.</p>","PeriodicalId":19191,"journal":{"name":"Neurological Sciences","volume":"47 10","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}