Neurology最新文献

{"title":"Association Between Epilepsy and Young-Onset Dementia: Nationwide Data From France and Sweden.","authors":"Quentin Calonge, Amandine Geraudie, Dang Wei, Octave Guinebretiere, Weimin Ye, Léa Aguilhon, Antoine Belloir, Edouard Januel, Fang Fang, Thomas Nedelec, Vincent Navarro","doi":"10.1212/WNL.0000000000218700","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218700","url":null,"abstract":"<p><strong>Background and objectives: </strong>Epilepsy is linked to late-onset dementia, but evidence for young-onset dementia (YOD; <65 years) is limited. We assessed the epilepsy-YOD association in France and Sweden and YOD risk after midlife epilepsy.</p><p><strong>Methods: </strong>We conducted 3 nationwide analyses. A French nested case-control analysis included patients with incident YOD aged 40-64 years, diagnosed between January 1, 2016, and December 31, 2018. Index date was the first YOD-related health care event; controls were risk-set matched on age, sex, and region. A Swedish nested case-control replication included patients with YOD diagnosed between January 1, 1987, and December 31, 2016, with matched controls. In both studies, epilepsy-related diagnoses and antiseizure medication (ASM) dispensations were assessed up to 10 years before index date. Odds ratios (ORs) were estimated with conditional logistic regression. A French retrospective cohort included adults aged 30-55 years with incident epilepsy in 2008, matched to individuals with prevalent epilepsy before 2008 or no epilepsy. The cohort index was the first ASM reimbursement in the incident epilepsy group or the matched date for comparators. Follow-up ended at YOD, death, or 10 years. We estimated 10-year cumulative incidence and adjusted (comorbidities, deprivation) hazard ratios (HRs), treating death as a competing event. Sensitivity analyses included lagged entry up to 5 years.</p><p><strong>Results: </strong>Case-control studies included 11,360 cases and 113,600 controls in France and 16,433 cases and 164,330 controls in Sweden. In France, 12.5% of YOD cases vs 1.2% of controls had previous epilepsy-related codes (adjusted OR 3.76, 95% CI 3.42-4.14), and 27.3% vs 10.3% had ASM dispensations (adjusted OR 1.44, 95% CI 1.36-1.52). The French cohort included 12,901 individuals with incident epilepsy, 64,083 with prevalent epilepsy, and 129,010 without epilepsy (mean age 44.0 years; 55.5% female participants). Ten-year cumulative YOD incidence was 2.20% (95% CI 1.94-2.48) with incident epilepsy (adjusted HR compared with individuals without epilepsy 6.02, 95% CI 4.98-7.26), 1.74% (1.64-1.85) with prevalent epilepsy (adjusted HR 5.38, 95% CI 4.64-6.25), and 0.21% (0.19-0.24) without epilepsy. Associations attenuated with longer lags but persisted beyond 5 years.</p><p><strong>Discussion: </strong>Across 2 countries and complementary designs, epilepsy was strongly associated with YOD. Epilepsy conferred higher YOD risk in midlife, especially with multimorbidity, supporting epilepsy inclusion in YOD risk stratification and prevention.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 10","pages":"e218700"},"PeriodicalIF":8.9,"publicationDate":"2026-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Trajectories of Brain Atrophy in Multiple Sclerosis, MOGAD, and AQP4 + NMOSD: The Role of Disease Activity in MOGAD.","authors":"Rosa Cortese, Alessia Bianchi, Anna de Mauro, Ludovico Luchetti, Giordano Gentile, Maria Pia Amato, Samira Luisa Apóstolos-Pereira, Georgina Arrambide, Alvino Bisecco, Benedetta Bodini, Massimiliano Calabrese, Valentina Camera, Carolina de Medeiros Rimkus, Françoise Durand-Dubief, Massimo Filippi, Antonio Gallo, Claudio Gasperini, Cristina Granziera, Saif Huda, Matilde Inglese, Caterina Lapucci, Andrea Lazzarotto, Yaou Liu, Monica Margoni, Romain Marignier, Silvia Messina, Jannis Müller, Jacqueline Palace, Emilio Portaccio, Maria A Rocca, Chiara Rocchi, Àlex Rovira, Serena Ruggieri, Roger Santana de Araujo, Jaume Sastre-Garriga, Bruno Stankoff, Ahmed T Toosy, Carla Tortorella, Frederik Barkhof, Olga Ciccarelli, Marco Battaglini, Nicola De Stefano","doi":"10.1212/WNL.0000000000218673","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218673","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;Multiple sclerosis (MS), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) are inflammatory demyelinating disorders with distinct mechanisms of tissue injury. MS is characterized by diffuse neurodegeneration, whereas damage in antibody-mediated diseases is considered attack related. In MOGAD, the relationship between disease activity and brain atrophy remains unclear. We aimed to compare longitudinal trajectories of global and regional brain atrophy across MS, MOGAD, and AQP4 + NMOSD and investigate whether atrophy in MOGAD is associated with disease course and lesion dynamics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this retrospective multicenter Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) study, patients fulfilling the following criteria were enrolled: (1) age 18 years or older, (2) MS/MOGAD/AQP4 + NMOSD diagnosis, (3) ≥2 same-scanner brain MRIs ≥6 months apart and ≥3 months postattack, (4) concurrent Expanded Disability Status Scale, and (5) disease course information. White matter lesions were segmented using the Lesion Segmentation Toolbox. Longitudinal brain volumes were quantified on lesion-filled T1-weighted images using Sequence Adaptive Multimodal SEGmentation (SAMSEG) with a within-subject template approach. In MOGAD, lesion dynamics were classified as stable/new lesions/lesion resolution. Linear mixed-effects models adjusted for age, sex, baseline volume, and center estimated atrophy rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 489 participants from 15 centers were included (98 MS [mean age 39.79 years, 68.37% female], 72 MOGAD [42.14 years, 66.67%], 41 AQP4 + NMOSD [51.25 years, 87.80%], and 278 healthy controls [42.94 years, 61.87%]). The mean follow-up was MS: 2.44 ± 1.55 years, MOGAD: 2.57 ± 1.85, and AQP4 + NMOSD: 3.22 ± 2.42. Compared with controls, MS showed accelerated global brain atrophy (β = -2.027 cm&lt;sup&gt;3&lt;/sup&gt; per year, 95% CI -3.430 to -0.623). MOGAD demonstrated white matter volume loss (β = -0.989, 95% CI -1.889 to -0.090) and ventricular enlargement (lateral: β = 0.219, 95% CI 0.089-0.350; third ventricle: β = 0.009, 95% CI 0.003-0.015). AQP4 + NMOSD showed pallidal volume reduction (β = -0.008, 95% CI -0.014 to -0.001). Within MOGAD, relapsing patients (62.5%) exhibited greater third ventricular expansion than MS (β = 0.009, 95% CI 0.001-0.017). MOGAD with new lesions (22.22%) had greater ventricular enlargement than controls (lateral: β = 0.359, 95% CI 0.147-0.572; third ventricle: β = 0.016, 95% CI 0.006-0.025), MS, and AQP4 + NMOSD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Each inflammatory demyelinating disease exhibits a characteristic pattern of brain atrophy. In MOGAD, neuroaxonal loss seems associated with inflammatory activity and lesion accrual, supporting an event-driven pattern of tissue injury rather than diffuse neurodegeneration. Limitatio","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 10","pages":"e218673"},"PeriodicalIF":8.9,"publicationDate":"2026-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Systemic Fluoroquinolones and Risk of Peripheral Neuropathy.","authors":"Jeremy P Brown, Kevin Wing, Kathryn E Mansfield, Stephen J W Evans, Clémence Leyrat, Liam Smeeth, Angel Y S Wong, Nicholas W Galwey, Ian J Douglas","doi":"10.1212/WNL.0000000000218699","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218699","url":null,"abstract":"<p><strong>Background and objectives: </strong>Fluoroquinolone use has been associated with peripheral neuropathy in case reports, but there have been few noninterventional studies validating this association, and causality is unclear. The aim of this study was to estimate the association between systemic fluoroquinolone prescription and incident peripheral neuropathy relative to a comparator class of antibiotics, cephalosporins, using multiple databases to increase precision and assess the robustness of the results.</p><p><strong>Methods: </strong>Cohort studies were conducted using data from 2 databases of UK electronic primary care records, Clinical Practice Research Datalink Aurum and GOLD, from April 1, 1997, to December 31, 2019. Among adults (age ≥18 years) without diabetes mellitus or previously recorded peripheral neuropathy prescribed systemic fluoroquinolones or cephalosporins, hazard ratios were estimated between fluoroquinolone prescription and incident peripheral neuropathy within 60 days of prescription using stabilized inverse probability of treatment weighted Cox regression. Hazard ratios were similarly estimated for a positive control outcome of incident tendon rupture within 60 days of prescription. Risk differences for peripheral neuropathy were estimated using a weighted Aalen-Johansen estimator. Estimates were pooled across databases using fixed-effects meta-analysis.</p><p><strong>Results: </strong>In total, 2,933,982 individuals prescribed fluoroquinolones or cephalosporins in Aurum (63.7% [n = 1,868,793] female; median age 49.5 years [interquartile range (IQR) 34.1-67.5]) and 995,457 in GOLD (63.5% [n = 632,033] female, median age 51.5 years [IQR 35.6-68.0]) were included. Of these individuals, at first treatment episode, 1,002,004 (34.2%) in Aurum and 381,734 (38.3%) in GOLD were prescribed fluoroquinolones. The estimated association between fluoroquinolones and peripheral neuropathy was close to the null at first treatment episode (pooled adjusted hazard ratio [aHR] 0.96, 95% CI 0.77-1.20) and over all treatment episodes (pooled aHR 1.05, 95% CI 0.92-1.20). Hazard ratios were elevated for a positive control outcome of tendon rupture at first treatment episode (pooled aHR 1.98, 95% CI 1.55-2.53) and over all treatment episodes (1.76, 95% CI 1.52-2.04).</p><p><strong>Discussion: </strong>Findings were not indicative of a substantive difference in risk of peripheral neuropathy between those prescribed fluoroquinolones and cephalosporins. Potential residual confounding is a study limitation. Study results provide some reassurance to clinicians regarding risk of peripheral neuropathy with fluoroquinolones relative to a comparator antibiotic.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 10","pages":"e218699"},"PeriodicalIF":8.9,"publicationDate":"2026-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Imbalance Syndrome vs Acute Vestibular Syndrome: Clinical and Topographical Differentiation.","authors":"Ken Möhwald, Hristo Hadzhikolev, Laurenz Eberle, Patricia Jaufenthaler, Michael Strupp, Klaus Jahn, Julian Conrad, Andreas Zwergal","doi":"10.1212/WNL.0000000000218624","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218624","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;Stroke is a major differential diagnosis in patients with acute vertigo/dizziness or imbalance. Current diagnostic algorithms such as head impulse test, gaze-evoked nystagmus, and test of skew are optimized for presentations with spontaneous nystagmus (SPN), traditionally called acute vestibular syndrome (AVS). However, in recent studies, a relevant proportion of patients with stroke-related vertigo/dizziness had no SPN, but rather postural or gait imbalance, a phenotype lately termed acute imbalance syndrome (AIS). We aimed to outline the pathoanatomical differences of stroke-related AIS vs AVS and its clinical implications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with MRI-proven stroke-related acute vertigo/dizziness or imbalance were included in this emergency department (ED) cohort study at LMU Hospital prospectively. Vestibular, ocular motor, and postural signs were documented (including SPN presence/intensity by video oculography, postural imbalance by posturography). Patients were classified as suffering from AIS or AVS based on the presence of SPN. Stroke lesion distribution was depicted in Montreal Neurological Institute space and supplemented by structural disconnectome mapping from the lesion cores. Multivariate lesion symptom-mapping based on support-vector regression and disconnectome mapping was applied for SPN intensity and sway path as surrogate markers for AVS and AIS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 75 patients (age: 65.7 ± 13.3 years, 40% female), 58.7% were diagnosed with AIS, 38.7% with AVS, and 2.7% with central positional vertigo. In AIS, the lesion core was located in the anterior cerebellar lobe and deep cerebellar nuclei (superior cerebellar artery/posterior inferior cerebellar artery territory) connecting to the bilateral pontomesencephalic tegmentum through the superior cerebellar peduncle. AVS stroke lesions were mostly located in the posterior cerebellar/flocculonodular lobe (posterior inferior cerebellar artery/anterior inferior cerebellar artery territory) and connected to the ipsilesional vestibular nucleus (VN) and bilateral medial longitudinal fascicle (MLF) through the inferior cerebellar peduncle. SPN intensity correlated with voxels in the cerebellar lobules VI-IX connecting to VN and MLF. Postural sway was associated with a small local cluster in the cerebellar Crus I.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;AIS accounts for more than half of patients with stroke-related vertigo/dizziness or imbalance. AIS lesions were located in the anterior cerebellar lobe, disturbing cerebellar-pontomesencephalic networks for posture and gait control. AVS lesions affected the posterior cerebellar/flocculonodular lobe and associated vestibulo-ocular reflex networks. Recognition of both clinical phenotypes is essential to identify all strokes among patients with vertigo/dizziness in the emergency setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration information: &lt;/strong&gt;DRKS00008992; U1111","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218624"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Braak and Clinical Stage in Autopsy-Confirmed Parkinson Disease: A UK Brain Bank Study.","authors":"Lazzaro di Biase, Pasquale Maria Pecoraro, Francesco Bugamelli, Martina Di Carluccio, Luca Marsili, Alberto J Espay","doi":"10.1212/WNL.0000000000218469","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218469","url":null,"abstract":"<p><strong>Background and objectives: </strong>The gold standard for Parkinson disease (PD) diagnosis is postmortem examination, based on the presence and distribution of pathologic α-synuclein (Lewy pathology) across brain regions. Whether pathologic α-synuclein Braak staging reflects clinical disease progression remains uncertain. We examined the relationship between Braak stage with clinical indices of PD progression in an autopsy-proven cohort.</p><p><strong>Methods: </strong>We performed a retrospective clinicopathologic analysis of autopsy-confirmed PD cases from the Parkinson's UK Brain Bank (Imperial College London). Clinical records were systematically reviewed to extract age at symptom onset, disease duration, brain weight, Hoehn and Yahr (H&Y) stage at death, and key clinical features. Normality was assessed using Shapiro-Wilk tests; comparisons across Braak stages used Kruskal-Wallis tests. Correlations with Braak stage were examined using Spearman correlation with 95% CIs. Prevalence of major copathologies was summarized descriptively.</p><p><strong>Results: </strong>Of 119 clinically diagnosed PD cases, we included all 61 with autopsy confirmation and available Braak staging. Mean ± SD age at death was 79.1 ± 7.4 years, disease duration was 13.5 ± 5.8 years, H&Y stage at death was 4.0 ± 0.8, and brain weight was 1,234.2 ± 108 g. Braak stage was not correlated with H&Y at death (ρ = 0.146, 95% CI -0.11 to 0.39, <i>p</i> = 0.262), age at death (ρ = -0.210, 95% CI -0.47 to 0.07, <i>p</i> = 0.104), disease duration (ρ = 0.035, 95% CI -0.23 to 0.29, <i>p</i> = 0.787), or brain weight (ρ = 0.2, 95% CI -0.07 to 0.42, <i>p</i> = 0.139). There were no differences across Braak stages in disease duration (<i>p</i> = 0.925), age at death (<i>p</i> = 0.356), brain weight (<i>p</i> = 0.279), or H&Y stage (<i>p</i> = 0.603). By contrast, brain weight correlated negatively with age at death (ρ = -0.352, 95% CI -0.57 to -0.09, <i>p</i> = 0.005). Copathologies were common, including entorhinal/allocortical tau (B1-B2) in 82%, small vessel disease in 60%, β-amyloid (Thal ≥1) in 58%, and cerebral amyloid angiopathy in 25%. The prevalence of copathologies did not differ across Braak stages.</p><p><strong>Discussion: </strong>Braak stage was not associated with H&Y at death, disease duration, age at death, or brain weight in autopsy-proven PD patients. These findings provide evidence that pathologic α-synuclein-based staging does not represent a model of clinical progression in PD. The quantification of both monomeric and pathologic α-synuclein may be needed to overcome the clinical limitations of pathology-based staging.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218469"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rural Hospital Crisis Is a Neurologic Crisis: Advancing Equity in Neurology.","authors":"Joshua Amit Budhu","doi":"10.1212/WNL.0000000000218696","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218696","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218696"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dancing Dorsal Quadrilateral Syndrome: Clinical, Ultrasound, and Electromyographic Features.","authors":"Peyman Roomizadeh, Samane Masoudi, Ayushi Chugh","doi":"10.1212/WNL.0000000000218619","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218619","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218619"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Neurology</i> Journal Club: Characteristics and Outcomes of Patients With IDH-Mutant Grade 2 and 3 Gliomas After Deferred or Adjuvant Radiotherapy.","authors":"Kimberly Wang, Jordan L Smith, Anh Huan Vo, Lindsey Sloan, Lawrence R Kleinberg, Sushant Puri","doi":"10.1212/WNL.0000000000218666","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218666","url":null,"abstract":"<p><p>This journal club article reviews the strengths and limitations of a 2025 study by Lanman et al., investigating outcomes-particularly overall survival-in patients with isocitrate dehydrogenase mutant (IDHmt) WHO grade 2 and 3 gliomas who received either adjuvant postsurgical radiotherapy (aXRT) or deferred radiotherapy (dXRT). Despite unclear evidence of survival benefit, current standardized guidelines recommend aXRT-after surgery but before progression-as first-line treatment for high-risk patients defined by higher grade, older age, and subtotal resection. This study demonstrated that although aXRT delayed tumor progression in this cohort, it was associated with worse overall survival. This retrospective, dual-institution analysis highlights a discrepancy between current guidelines and real-world clinical outcomes, emphasizing the need for prospective studies evaluating dXRT in patients with IDH-mutant gliomas.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218666"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching NeuroImage: Neuromyelitis Optica Spectrum Disease Presenting as a Tumefactive Thalamic Lesion.","authors":"YuQing Xu, Dimitrios C Ladakis, Elias S Sotirchos","doi":"10.1212/WNL.0000000000218601","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218601","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218601"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contraceptive and Enzyme-Inducing Antiseizure Medication Coprescription Among US Medicaid Beneficiaries With Epilepsy.","authors":"Elizabeth Harrison, Laura Kirkpatrick, Caryn Dutton, Wesley T Kerr, Scott Rothenberger, Samuel W Terman, Page B Pennell","doi":"10.1212/WNL.0000000000218679","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218679","url":null,"abstract":"<p><strong>Background and objectives: </strong>People with epilepsy of child-bearing potential (PWECP) require access to highly effective contraception, yet many antiseizure medications (ASMs) can reduce the effectiveness of some hormonal methods by inducing hepatic enzymes. In this retrospective cohort study, we aimed to identify the proportion of PWECP prescribed a susceptible hormonal contraceptive method who were concurrently prescribed an interacting ASM and patient characteristics associated with coprescription.</p><p><strong>Methods: </strong>We obtained Medicaid claims data from 2016 to 2021 for female beneficiaries and defined a cohort of people with epilepsy on ASMs prescribed at least 1 method of hormonal contraception susceptible to hepatic enzyme induction. Using prescription fill dates and contraceptive procedure dates, we identified periods of inducing ASM and susceptible contraceptive overlap lasting at least 14 days. We used descriptive statistics to calculate the proportion experiencing overlap and median days of overlap. We used logistic regression to identify associated patient characteristics with any 14-day period of overlap and binominal regression to identify characteristics associated with greater proportion of overlap days.</p><p><strong>Results: </strong>Our cohort included 110,976 PWECP (median age 24 [interquartile range 18-30] years, 54.8% White non-Hispanic). Of those, 21,923 were prescribed a susceptible contraceptive method from 2018 to 2021. In that group, 7,154 (32.6%) had at least a 14-day period of overlap with an enzyme-inducing ASM. The median days of overlap for this group were 218 days (interquartile range 74-511). Patient characteristics associated with both any period of overlap and longer periods of overlap included intellectual disability (any overlap: adjusted odds ratio [aOR] 2.33, 95% CI 2.19-2.48; longer overlap: 2.27, 95% CI 2.05-2.53), drug-resistant epilepsy (any overlap: aOR 1.73, 95% CI 1.62-1.84; longer overlap: 1.27, 95% CI 1.14-1.41), and age older than 35 years compared with 19-34 years (any overlap: 1.45, 95% CI 1.32-1.59; longer overlap: 1.51, 95% CI 1.29-1.75).</p><p><strong>Discussion: </strong>Drug interactions with ASMs leading to reduced contraceptive effectiveness are common among PWECP prescribed susceptible hormonal contraception. Certain populations, including those with intellectual disability, drug-resistant epilepsy, or age older than 35 years, were more likely to experience these drug interactions. Limitations include that our data set lacks information on adherence, counseling, pregnancy intentions, sexual orientation and activity, and barrier use.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 9","pages":"e218679"},"PeriodicalIF":8.9,"publicationDate":"2026-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}