Neurology and Therapy最新文献

{"title":"AQP4-IgG Dynamics and Exploratory Assessment of SERA-3 in Neuromyelitis Optica Spectrum Disorder Treated with Satralizumab.","authors":"Miaoxin Yu, Xiang Li, Lei Cui, Jinsong Jiao, Qing Sun, Yeqiong Zhang, Renbin Wang, Dantao Peng, Yang He, Yujuan Jiao, Weihe Zhang","doi":"10.1007/s40120-026-00990-4","DOIUrl":"10.1007/s40120-026-00990-4","url":null,"abstract":"<p><strong>Introduction: </strong>Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune condition driven by aquaporin-4 immunoglobulin G (AQP4-IgG). The current treatment paradigm focuses on mitigating clinical relapses and disability accumulation, leaving the underlying serological activity unaddressed. This study evaluated the capacity of satralizumab to achieve a comprehensive remission, as defined by the Serological, Relapse, and Accumulated-disability Remission (SERA-3) target.</p><p><strong>Methods: </strong>In this multicenter, real-world cohort study, patients with NMOSD from three tertiary centers in China initiating satralizumab were enrolled. AQP4-IgG levels were measured at baseline, 6, and 12 months. Clinical efficacy [annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS)] and safety were evaluated. Heterogeneity in antibody response was analyzed, and baseline characteristics potentially associated with titer reduction were explored.</p><p><strong>Results: </strong>Of the 19 patients who were AQP4-IgG seropositive at baseline, 7 (36.84%) met the strict definition of SERA-3 Complete. Of these, 4 patients achieved seroconversion at month 6 and remained seronegative through month 12, whereas 3 first achieved seroconversion at month 12. An additional 5 (26.32%) showed a reduction in AQP4-IgG titers. Satralizumab treatment was associated with marked clinical benefit. Among 33 patients included in the clinical efficacy analysis, 27 (81.82%) remained relapse-free during follow-up, median ARR decreased from 0.92 (IQR 0.56-1.59) to 0 (IQR 0-0), and EDSS scores remained stable in most patients. Exploratory analyses suggested that patients achieving serological response were older at disease onset (57.42 ± 17.82 versus 42 ± 14.24 years, p = 0.039) and had experienced fewer pre-treatment relapses (median 2 versus 5, p = 0.049). Satralizumab was generally well tolerated, including in older patients.</p><p><strong>Conclusions: </strong>Our findings support SERA-3 as a potential treatment framework for NMOSD. Satralizumab was associated with attainment of serological, relapse, and disability remission in a substantial proportion of patients, supporting further prospective evaluation of SERA-3 as a hypothesis-generating outcome framework.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2747-2760"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining and Measuring Cognitive Decline and Clinical Relevance.","authors":"Carolin Kurz, Paul Newhouse, Kate A Wyman-Chick, James E Galvin, Nicola T Lautenschlager, Marwan Sabbagh","doi":"10.1007/s40120-026-00996-y","DOIUrl":"10.1007/s40120-026-00996-y","url":null,"abstract":"<p><p>Current frameworks for cognitive impairment increasingly incorporate biomarker information, yet clinical classification remains grounded in the demonstration of objective cognitive decline and its functional consequences. This paper examines the balance between biological and clinical definitions and discusses implications for diagnosis, care, and research. Mild cognitive impairment (MCI) or mild neurocognitive disorder represents a clinically meaningful intermediate stage between normal aging and dementia, enabling early detection, timely intervention, and longitudinal monitoring. In routine care, comprehensive neuropsychological testing for all patients is not feasible; instead, a tiered diagnostic approach combining brief screening, clinical assessment, informant information, and targeted referral appears most practical and diagnostically robust. In research settings, outcomes that integrate cognitive performance with functional measures better capture clinically meaningful change than cognition-only endpoints. However, heterogeneity in definitions and outcome measures limits comparability across studies, and challenges remain regarding feasibility, cultural validity, and the integration of patient-relevant outcomes. Clinically useful definitions of cognitive impairment should integrate objective deficits with real-world impact. Pragmatic staged diagnostic pathways are best suited for routine care, while future work should focus on standardization, feasibility, and the alignment of research outcomes with patient-relevant benefits.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2377-2392"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative Review: Efficacy, Safety, and Tolerability of Newer Third-Generation Antiseizure Medications for Focal Epilepsy: A New Benchmark in Treatment Outcomes?","authors":"William E Rosenfeld, Pavel Klein, Louis Ferrari, Vicente Villanueva","doi":"10.1007/s40120-026-01013-y","DOIUrl":"10.1007/s40120-026-01013-y","url":null,"abstract":"<p><strong>Introduction: </strong>Focal seizures are the most common form of epilepsy. This narrative review analyzes the efficacy, safety, and tolerability of five newer third-generation antiseizure medications (ASMs) approved for treatment of focal seizures: lacosamide, perampanel, eslicarbazepine acetate, brivaracetam, and cenobamate.</p><p><strong>Methods: </strong>A search of PubMed and ClinicalTrials.gov identified phase 2/3 randomized controlled trials and long-term open-label extension (OLE) studies for the five most recently approved ASMs for focal seizures. Efficacy data were summarized, including median percent reduction in seizure frequency, ≥ 50% responder rates, ≥ 75% responder rates (when reported), and seizure freedom rates. Safety and tolerability were assessed based on treatment-emergent adverse events (TEAEs), serious adverse events, and discontinuation rates. Long-term efficacy, safety, and treatment retention rates were also summarized.</p><p><strong>Results: </strong>All five ASMs had statistically significant efficacy vs. placebo in short-term trials, with cenobamate demonstrating higher median percent seizure reduction (35.5-100%), ≥ 50% responder rates (40-81.6%), and seizure freedom rates (up to 52.4%) compared to the other four third-generation ASMs. In long-term OLEs, cenobamate had ≥ 50% responder rates > 70% and the highest estimated treatment retention rates at 3 years (61-65%) compared to lacosamide (51-53%), perampanel (46%), and brivaracetam (48%). Common TEAEs across all ASMs included dizziness, somnolence, fatigue, and headache. Brivaracetam and lacosamide had favorable profiles in multiple network meta-analyses. Specific safety considerations include psychiatric adverse events for perampanel and brivaracetam, and a risk of drug reaction with eosinophilia and systemic symptoms (DRESS) for cenobamate (significant risk reduction achieved using a gradual titration schedule).</p><p><strong>Conclusion: </strong>All third-generation ASMs were effective adjunctive therapies. Cenobamate was associated with higher responder and seizure freedom rates and higher long-term retention rates. Brivaracetam and lacosamide had favorable tolerability profiles. The notable seizure freedom rates with cenobamate suggest a potential new benchmark in focal seizure treatment. Comparator trials are needed to confirm possible efficacy and tolerability differences among third-generation ASMs.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2217-2254"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Nimodipine in Aneurysmal Subarachnoid Hemorrhage: A Critical Propensity Score-Matched Reevaluation in a Contemporary Cohort.","authors":"Harold F Hounchonou, Merle Hirsch, Josef M Lang, Florian Wild, Omar Abu-Fares, Shadi Al-Afif, Joachim K Krauss","doi":"10.1007/s40120-026-00983-3","DOIUrl":"10.1007/s40120-026-00983-3","url":null,"abstract":"<p><strong>Introduction: </strong>Oral nimodipine is recommended as standard therapy for aneurysmal subarachnoid hemorrhage (aSAH) based on trials from the 1980s. Given major advances in aneurysm treatment and neuro-intensive care, its effectiveness in contemporary settings warrants reevaluation.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients with aSAH treated between 2015 and 2025. Clinical, radiological, and outcome data were extracted from medical records. Patients receiving prophylactic oral nimodipine (Nimo+) were compared with those who did not (Nimo-). Propensity score matching (PSM) was applied to balance baseline characteristics. Primary outcome was neurological function at discharge and at 3 months, assessed with the Glasgow Outcome Scale (GOS). Secondary outcomes included angiographic vasospasm, cerebral infarction, and mortality.</p><p><strong>Results: </strong>Of the 312 patients eligible for inclusion in this study, 102 received oral nimodipine and 210 did not. After PSM, 102 patients were included per group with no differences in baseline characteristics. Nimodipine was associated with lower rates of angiographic vasospasm (43% vs 64%; p < 0.001) and delayed infarction (38% vs 58%; p = 0.008) and with better GOS score at discharge (p = 0.047) and at 3 months (p = 0.008). Mortality did not differ between the two groups. Subgroup analysis showed benefits in terms of angiographic vasospasm, infarction, and functional outcome among patients receiving nimodipine ≥ 14 days, whereas shorter administration only reduced angiographic vasospasm.</p><p><strong>Conclusion: </strong>In this contemporary propensity score-matched cohort, oral nimodipine therapy reduced vasospasm and delayed infarction and improved neurological outcome without having an impact on mortality. Sustained administration for at least 14 days appears to be crucial to achieve benefit, favoring full-course nimodipine therapy in aSAH management.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2671-2688"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Preferences Toward CGRP-Targeting Preventive Migraine Treatments in Japan: Discrete Choice Experiment.","authors":"Hisaka Igarashi, Toru Yamazaki, Keigo Hanada, Hitomi Onomura, Hiroyuki Hozawa, Tatsunori Murata","doi":"10.1007/s40120-026-01015-w","DOIUrl":"10.1007/s40120-026-01015-w","url":null,"abstract":"<p><strong>Introduction: </strong>To date, no Japanese study on migraine has evaluated how treatment characteristics affect patient preferences between novel gepants and subcutaneous or novel intravenous calcitonin gene-related peptide (CGRP) monoclonal antibodies. A survey using a discrete choice experiment (DCE) was therefore conducted to identify treatment preferences for CGRP-targeting preventive therapies in this population.</p><p><strong>Methods: </strong>Preventive-treatment attributes and levels were identified via a literature review, pivotal clinical trials, and international regulatory documents. These levels included those of CGRP-targeting therapies under development in Japan. A five-patient focus group was conducted to confirm patient understanding of the attribute descriptions and identify other potential attributes. Results from the focus group interview and from clinician input informed a questionnaire, which was revised following a pilot survey (N = 39), then an online main survey was conducted in May-June 2025 with eligible patients. A DCE was used to quantify patient preferences, and a conditional logit model was used to calculate preference weights and 95% confidence intervals.</p><p><strong>Results: </strong>The questionnaire included six attributes: 50% reduction rate of migraine frequency, speed of effect, effect on impairment of daily activities, frequency of side effects, frequency of injection-site reactions, and administration method. The main survey included 324 patients (79% women; mean age 47 years) who experienced an average of eight migraine days per month. The survey revealed that effect on impairment of daily activities was the most important attribute, followed by administration method, and frequency of injection-site reactions. Regarding attribute levels, oral CGRP-targeting formulations were preferred over injectables within the specific attribute combinations used in this DCE.</p><p><strong>Conclusions: </strong>These findings suggest that, under the design conditions used in this DCE, participants with migraine in Japan favored non-invasive oral CGRP-targeting treatments that effectively reduce impairment of daily activities.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2527-2549"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Treatment Levels of Inflammatory Biomarkers as Predictors of Reperfusion Outcomes in Acute Ischemic Stroke: A Systematic Review and Meta-analysis.","authors":"István Szegedi, Zsolt Barnabás Éles, Attila Nagy, Zsuzsa Bagoly","doi":"10.1007/s40120-026-00995-z","DOIUrl":"10.1007/s40120-026-00995-z","url":null,"abstract":"<p><strong>Introduction: </strong>Acute ischemic stroke (AIS) remains a major cause of disability and death despite effective reperfusion therapies, intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). Systemic inflammation critically shapes ischemic injury and recovery, but the prognostic value of inflammatory biomarkers in reperfused patients is unclear, and previous reviews have not consistently addressed pre-treatment inflammatory markers in patients treated with IVT or MT.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, Web of Science, and Scopus were searched through November 30, 2024, for studies assessing associations between circulating inflammatory biomarkers measured before IVT or MT and 3-month functional outcome (modified Rankin Scale, mRS). Data were pooled using random-effects models, with odds ratios (OR) and 95% confidence intervals (CI) calculated for poor outcome (mRS 3-6).</p><p><strong>Results: </strong>Thirty-seven studies (8780 patients) met inclusion criteria; ten contributed to meta-analysis. Four biomarkers were evaluable in IVT-treated cohorts. Higher pre-treatment interleukin-6 (IL-6) predicted poor outcome (pooled OR 1.80, 95% CI 1.42-2.28), as did osteopontin (pooled OR 3.36, 95% CI 1.95-5.80). Tumor necrosis factor-α (TNF-α) showed a borderline association (pooled OR 1.05, 95% CI 1.00-1.10), whereas C-reactive protein (CRP) was not predictive (pooled OR 1.02, 95% CI 0.99-1.06). Evidence in MT cohorts was limited and heterogeneous.</p><p><strong>Conclusion: </strong>Among patients with AIS treated with IVT, pre-treatment IL-6 showed the most consistent association with poor 3-month functional outcome, whereas CRP showed no reliable prognostic association. Osteopontin emerged as a promising but preliminary candidate biomarker based on limited evidence, and TNF-α showed only modest prognostic relevance. Evidence in patients undergoing MT remains insufficient for quantitative conclusions. Larger standardized prospective studies are needed to validate inflammatory biomarkers and determine their added prognostic value beyond established clinical and imaging predictors.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2417-2447"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Intermittent Negative Pressure Treatment on Spasticity and Spasticity-Related Symptoms in Patients with Multiple Sclerosis: A Two-Arm Randomized Trial.","authors":"Jesper Nørregaard, Henrik Hoel, Iacob Mathiesen, Sarah Haghighi, Marie Kierkegaard, Fredrik Piehl, Morten Blinkenberg, Kjell Morten Myhr","doi":"10.1007/s40120-026-00985-1","DOIUrl":"10.1007/s40120-026-00985-1","url":null,"abstract":"<p><strong>Introduction: </strong>To compare the efficacy of treatment with two different levels of intermittent negative pressure (INP), applied to the lower limb, on self-reported spasticity and pain in patients with multiple sclerosis (MS).</p><p><strong>Methods: </strong>A randomized, two-arm multicenter trial enrolled patients with spasticity in the leg ≥ 4 on the numeric rating scale (NRS). Patients were randomized to treatment with -10 mmHg INP (low-dose group [LDG]) or -40 mmHg INP (high-dose group [HDG]) on the most affected leg, using the FlowOx 2.0 device (Otivio AS, Oslo, Norway). The device applies alternating cycles of 10 s of negative pressure and 7 s of ambient pressure via a sealed pressure chamber around the lower leg, for 1 h daily for 4 weeks.</p><p><strong>Results: </strong>There was no difference in the change in NRS spasticity and pain score between the two groups after 4 weeks (estimated treatment effect 0.72; 95% CI [-0.17, 1.61]; p = 0.114, and 1.09; 95% CI [-0.35, 2.53]; p = 0.138, respectively). Both HDG and LDG experienced a statistically significant decrease in NRS spasticity compared with baseline (mean change -1.0; 95% CI [-1.6, -0.4]; p = 0.001, and mean change -1.6; 95% CI [-2.5, -0.6]; p = 0.002, respectively), and both groups had a significant decrease in NRS pain score compared with baseline (mean change -1.5; 95% CI [-2.6, -0.5]; p = 0.007, and mean change -3.0; 95% CI [-5.0, -1.0]; p = 0.006, respectively). No improvements in objective walking tests were observed. Treatment compliance was high, and device-related adverse events were mild to moderate.</p><p><strong>Conclusion: </strong>There was no difference between treatment with a high and a low INP level in spasticity and pain. Both pressure levels led to significant improvements in spasticity and pain compared with baseline. INP treatment appears safe and may represent a useful non-pharmacological treatment option for spasticity in patients with MS.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT05562453.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2659-2670"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurologists' Views on the Management of Uncontrolled Epilepsy in Spain: A Preliminary Survey.","authors":"Luis Lobato, Javier Riancho, David García-Azorín, Paloma Pérez-Domper, Ángel Aledo-Serrano, Juan J Poza","doi":"10.1007/s40120-026-00993-1","DOIUrl":"10.1007/s40120-026-00993-1","url":null,"abstract":"<p><strong>Introduction: </strong>Uncontrolled epilepsy is a major societal burden with significant impacts on patients' health and quality of life. This study evaluated neurologists' practices and perceptions in managing uncontrolled epilepsy in Spain.</p><p><strong>Methods: </strong>In this observational study, an anonymous, online, 23-item, qualitative survey was distributed to neurologists practising in Spain. Topics included demographics, perceptions of seizure control, knowledge of antiseizure medications (ASM) and clinical practices. Responses were analysed using descriptive statistics.</p><p><strong>Results: </strong>A total of 127 participants (33 epilepsy specialists, 94 non-specialists) completed the survey; 114 of the 127 respondents (90%) had at least 5 years' experience in managing people with epilepsy. Among the 127 respondents, 76% (88% of specialists; 71% of non-specialists) defined controlled epilepsy as freedom from all seizures and 60% considered persistence of some seizures to be acceptable-at least to some extent. Ninety respondents (71%) reported having 16-30 min available for initial consultations with patients and 89 (70%) had 0-15 min available for follow-up consultations; 125 (98%) indicated that time constraints in consultations impact follow-up care. In terms of clinical experience/familiarity with ASM, epilepsy specialists were significantly more familiar with perampanel (p < 0.05), clobazam (p < 0.001), zonisamide (p < 0.05), cenobamate (p < 0.001), ethosuximide (p < 0.001), cannabidiol (p < 0.001), rufinamide (p < 0.001) and fenfluramine (p < 0.001) than non-specialists. The main challenges reported by the respondents when selecting a drug for uncontrolled epilepsy included 'adverse events' (57%), 'a preference for drugs in which they have more experience' (53%) and 'difficulty in keeping up to date with new medicines' (31%).</p><p><strong>Conclusion: </strong>There is a discrepancy between neurologists' treatment goals and their acceptance of persistent seizures in Spanish neurological practice. Several factors may be limiting the achievement of early seizure freedom, including short patient consultations and a lack of familiarity with new treatments, especially among epilepsy non-specialists. Addressing these barriers could improve outcomes for people with uncontrolled epilepsy.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2707-2722"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Multi-Analyte Protein Assay to Distinguish Multiple Sclerosis Clinical Relapse from Pseudoexacerbation.","authors":"Darin T Okuda, Tatum M Moog, Morgan C McCreary, Isabella J Huddleston, Crystal M Wright, Katy W Burgess, Jose R Santoyo, Peter V Sguigna, Olaf Stüve, Diem H Tran","doi":"10.1007/s40120-026-00984-2","DOIUrl":"10.1007/s40120-026-00984-2","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple sclerosis (MS) is a chronic neuroimmunological condition associated with acute relapses. Differentiating between acute symptom development related to autoimmune inflammatory demyelination versus pseudoexacerbation remains challenging. We aimed to evaluate the utility of a commercially available multi-analyte protein assay in (1) assessing acute patient-reported symptoms suggestive of clinical exacerbations by comparing the acquired proteomic results to the corresponding MRI findings, and (2) examining the role in the surveillance of disease in individuals exposed and non-exposed to FDA-approved disease-modifying therapies.</p><p><strong>Methods: </strong>A retrospective observational study was conducted within a single academic neuroimmunology clinic among individuals with an existing diagnosis of MS who had paired Octave^® Multiple Sclerosis Disease Activity (MSDA) Test and MRI results prior to glucocorticosteroid exposure. Participants were evaluated in two cohorts: (1) individuals with acute clinical symptoms concerning for an exacerbation and (2) individuals seen for routine disease surveillance. The timing of the MSDA Test and MRI studies were quantified along with the association between the MSDA composite score and MRI-confirmed relapses.</p><p><strong>Results: </strong>Sixty-six individuals with relapsing-remitting MS were included, with 33 being evaluated for acute neurological symptoms and 33 for routine disease surveillance. Among symptomatic individuals, MSDA testing preceded MRI in 79% of cases. Across both cohorts, a Disease Activity Score (DAS) ≥ 6.0-10.0 was highly sensitive and specific for predicting gadolinium-enhancing lesions. Elevated concentrations of myelin oligodendrocyte glycoprotein (p = 0.013) and neurofilament light (NfL) (p < 0.0001), and reduced B-cell activating factor levels (p < 0.0001), were observed in participants with gadolinium enhancement. The DAS predicted enhancement more accurately than NfL alone (area under the curve = 98.06% vs. 82.75%; p = 0.0061).</p><p><strong>Conclusion: </strong>The use of blood-based biomarkers may enable more timely and precise assessment of acute disease activity, improving clinical decision-making. Additionally, the MSDA Test demonstrated greater accuracy than NfL for identifying MRI-confirmed relapses.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2761-2774"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Migraine-Related Outcomes and Functioning at 1 Year: Results of the Longitudinal OVERCOME (US) Study.","authors":"Dawn C Buse, Richard B Lipton, Ali Sheikhi Mehrabadi, Anthony J Zagar, Armen Zakharyan, Sait Ashina, Robert E Shapiro, Gilwan Kim, Robert A Nicholson, E Jolanda Muenzel","doi":"10.1007/s40120-026-00946-8","DOIUrl":"10.1007/s40120-026-00946-8","url":null,"abstract":"<p><strong>Introduction: </strong>Migraine is a common neurological disorder that can severely diminish quality of life. Quantifying migraine-related changes in a real-world population over time can increase understanding of the natural history of migraine and improve clinical care of individuals with migraine.</p><p><strong>Methods: </strong>The Observational survey of the Epidemiology, treatment, and Care Of MigrainE (OVERCOME) is a web-based study that longitudinally assessed migraine-related outcomes in a demographically representative adult population with migraine in the United States. Migraine disease status was classified as \"overall improved,\" \"overall worsened,\" or \"no net change\" based on changes in monthly headache days (MHDs), the Migraine Disability Assessment Scale (MIDAS) score, and the Migraine-Specific Quality-of-Life Questionnaire-Role Function-Restrictive (MSQ-RFR) domain score over 1 year. Migraine-related characteristics and patient-reported outcomes were evaluated for each group.</p><p><strong>Results: </strong>Among 11,634 individuals with migraine who completed the baseline and 1-year follow-up surveys, 40.4% were classified as having \"overall improved,\" 24.1% as having \"overall worsened,\" and 35.5% as having \"no net change\" migraine status at 1 year. The \"overall improved\" group reported decreases in MHDs [mean change from baseline (SD), -3.2 (5.0)] and MIDAS score [-15.4 (26.2)] and improvements in MSQ-RFR score [+ 13.7 (21.6)]. Additionally, the impact of migraine on work decreased, there was less stigma, and this group was less likely to overuse acute medications. The \"overall worsened\" group experienced more MHDs [+ 3.4 (5.7)], increased MIDAS score [+ 18.8 (29.0)], and worsening MSQ-RFR score [-14.1 (21.1)]. Migraine had a greater negative impact on their working lives, and they had a greater need for acute and preventive medications for migraine.</p><p><strong>Conclusion: </strong>MHD, MIDAS score, and MSQ-RFR score together provide a robust characterization of overall change in migraine over time. This study demonstrates the profound effect of improvement or worsening of migraine symptoms on workplace productivity, migraine-related stigma, physical function, and need for treatment.</p>","PeriodicalId":19216,"journal":{"name":"Neurology and Therapy","volume":" ","pages":"2617-2641"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}