Neurology最新文献

{"title":"Medical Big Data for Studying Cerebral Amyloid Angiopathy: New Opportunities, Familiar Challenges.","authors":"Craig S Anderson","doi":"10.1212/WNL.0000000000213974","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213974","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 4","pages":"e213974"},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691081","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 Changes in White Matter Volume Detected With Diffusion Tensor-Based Morphometry and Motor Recovery After Stroke.","authors":"Matthew A Edwardson, Amritha Nayak, M Okan Irfanoglu, Marie L Luby, Lawrence L Latour, Carlo Pierpaoli","doi":"10.1212/WNL.0000000000213827","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213827","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 4","pages":"e213827"},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699122","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":"Grief and Economic Stressors by Sex, Gender, and Education: Associations With Alzheimer Disease-Related Outcomes.","authors":"Eleni Palpatzis, Muge Akinci, Marina Garcia-Prat, Kaj Blennow, Henrik Zetterberg, Clara Quijano-Rubio, Gwendlyn Kollmorgen, Norbert Wild, Juan Domingo Gispert, Marc Suárez-Calvet, Oriol Grau-Rivera, Karine Fauria, Anna Brugulat-Serrat, Gonzalo Sanchez-Benavides, Eider M Arenaza-Urquijo","doi":"10.1212/WNL.0000000000214053","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214053","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 4","pages":"e214053"},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691079","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":"Lamotrigine and Cardiac Arrhythmias: A Target Trial Approach.","authors":"Samuel W Terman, Colin Bruce Josephson, Parag Goyal, Arturo Gonzalez-Izquierdo, Jean Morrison, Spiros Denaxas, Samuel Wiebe","doi":"10.1212/WNL.0000000000214054","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214054","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 4","pages":"e214054"},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691080","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":"Editors' Note: Effect of Immunosuppression in Risk of Developing Generalized Symptoms in Ocular Myasthenia Gravis: A Retrospective Cohort Study.","authors":"James E Siegler, Steven L Galetta","doi":"10.1212/WNL.0000000000213926","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213926","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 4","pages":"e213926"},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663970","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":"Clinical Reasoning: A 69-Year-Old Woman With Ophthalmoplegia.","authors":"Hongxuyang Yu, Jessica Frey","doi":"10.1212/WNL.0000000000214030","DOIUrl":"https://doi.org/10.1212/WNL.0000000000214030","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 4","pages":"e214030"},"PeriodicalIF":7.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691078","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":"Real-World Evidence of Brexpiprazole Use and 6-Month Mortality, Hospitalization, and Emergency Department Visits Among Persons With Dementia.","authors":"Julie Zissimopoulos, Johanna Thunell, Mireille Jacobson, Sidra Haye, Bryan Tysinger, Patricia Ferido, Geoffrey Joyce","doi":"10.1212/WNL.0000000000213717","DOIUrl":"10.1212/WNL.0000000000213717","url":null,"abstract":"<p><strong>Background and objectives: </strong>Alzheimer disease and other dementias are accompanied by depression and agitation and other behavioral and neuropsychiatric symptoms. In 2023, brexpiprazole became the first antipsychotic approved by the US Food and Drug Administration to treat agitation in persons with Alzheimer disease, but, like all atypical antipsychotics, it includes a black box warning of an increased risk of mortality among persons with dementia. This study provides real-world evidence of mortality in a heterogeneous sample of brexpiprazole users to understand effects in the population.</p><p><strong>Methods: </strong>We used a 100% sample of Medicare claims data Parts A, B, and D from 2014 to 2023. Our sample was limited to beneficiaries with diagnosed dementia, who were continuously enrolled for at least 2 years and were new users of the atypical antipsychotics brexpiprazole or aripiprazole in a given year. We used matching and logistic regression to estimate the relationship between incident use of brexpiprazole, compared with aripiprazole, and mortality, emergency department (ED) visits, and hospitalization within 6 months.</p><p><strong>Results: </strong>Among the 41,871 beneficiaries with dementia, 71.7% of brexpiprazole and 69.7% of aripiprazole users were women with a mean age of 75.7 and 78.0 years, respectively. Among persons living with dementia (PLWD), 6-month mortality was statistically lower among new users of brexpiprazole based on estimates from logistic regression and a matched sample of new users of brexpiprazole or aripiprazole (OR 0.49, [95% CI 0.37-0.65]).There was no statistical difference between the incident use of brexpiprazole and aripiprazole use for ED visits or hospitalization within 6 months of use initiation. Adjustment for potential unobserved confounding used two-stage least squares estimation and found no statistically significant differences in six-month mortality, ED visits, or hospitalizations between the 2 groups.</p><p><strong>Discussion: </strong>Brexpiprazole use is not associated with differential mortality risk compared with aripiprazole use among PLWD. Brexpiprazole offers a treatment option which is important given the heterogeneity of effects of antipsychotics on persons. A two-stage least squares method is used to eliminate bias on estimates because of observed and unobserved differences between the 2 groups, but the small sample size is a limitation.</p><p><strong>Classification of evidence: </strong>This study provides Class III evidence that brexpiprazole does not increase the risk of mortality at 6 months compared with aripiprazole in PLWD.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213717"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the HERMES-24 Score for Outcome Prediction Post Large Vessel Occlusion Treatment in Later Time Window.","authors":"Koji Tanaka, Scott Brown, Gregory W Albers, Tudor G Jovin, Maarten G Lansberg, Raul G Nogueira, Mayank Goyal, Michael D Hill, Bijoy K Menon, Ashutosh P Jadhav, Diogo C Haussen, Sheila C O Martins, Leticia C Rebello, Marc Ribo, Aquilla S Turk, Adnan H Siddiqui, David S Liebeskind, Jeremy J Heit, Michael P Marks, Andrew M Demchuk","doi":"10.1212/WNL.0000000000213796","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213796","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES)-24 score is highly predictive of outcomes after anterior circulation large vessel occlusion (LVO) treatment, irrespective of intervention in the early time window. Recent evidence has further broadened the eligibility of endovascular therapy (EVT) to patients with late presentation or unwitnessed onset including those with stroke-on-awakening. We aimed to investigate the prediction ability of the HERMES-24 score in patients with anterior circulation LVO and small ischemic core presenting in the late time window from last seen normal.</p><p><strong>Methods: </strong>Data are from the Analysis of Pooled Data from Randomized Studies of Thrombectomy More Than 6 Hours After Last Known Well collaboration, a patient-level meta-analysis of 6 randomized trials of EVT beyond 6 hours after last known well, with an enrollment period from September 2014 to March 2019. Patients who were also part of the HERMES collaboration data set were excluded from the analyses. The HERMES-24 score was calculated as the sum of the patient's age/10 and NIH Stroke Scale (NIHSS) score at 24 hours after randomization. The predictive ability of the score for a 90-day outcome (modified Rankin Scale [mRS] scores ≤2 and ≤3, ordinal mRS score, and mortality) was investigated.</p><p><strong>Results: </strong>Among 435 patients (48.5% men, median age 71 years), the median onset-to-randomization time was 654 (interquartile range 516-849) minutes and the median baseline NIHSS score was 16 (interquartile range 13-21). The HERMES-24 score was predictive of 90-day mRS scores ≤2 and ≤3, ordinal mRS score, and mortality in both the EVT arm (n = 223, <i>c</i>-statistic [95% CI] 0.917 [0.875-0.944], 0.895 [0.853-0.938], 0.820 [0.745-0.891], and 0.849 [0.776-0.922], respectively) and the control arm (n = 212, <i>c</i>-statistic [95% CI] 0.921 [0.872-0.969], 0.879 [0.827-0.930], 0.805 [0.746-0.852], and 0.805 [0.738-0.871], respectively).</p><p><strong>Discussion: </strong>The HERMES-24 score was highly predictive of 90-day outcome among patients with stroke due to LVO and small ischemic core for those presenting in the late time window, irrespective of intervention. This score must be further validated in a real-world clinical setting if it is applicable to all patients with LVO admitted in late time windows.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213796"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560617","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":"Subcutaneous Ocrelizumab in Patients With Multiple Sclerosis: Results of the Phase 3 OCARINA II Study.","authors":"Scott D Newsome, Ewa Krzystanek, Krzysztof W Selmaj, Michal Dufek, Lawrence Goldstick, Carlo Pozzilli, Catarina Figueiredo, Ben Townsend, Heidemarie Kletzl, Oscar Bortolami, Dusanka Zecevic, Caroline Giacobino, Susanne Clinch, Yun-An Shen, Gurpreet Deol Bhullar, Hans-Martin Schneble, Diego Centonze","doi":"10.1212/WNL.0000000000213909","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213909","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213909"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554032","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":"Outcomes of Patients With Embolic Stroke of Undetermined Source Treated With Antiplatelet Agents or Anticoagulation: A Multicenter Cohort Study.","authors":"James Ernest Siegler, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Shadi Yaghi, Christoph Stretz, Christina M Lineback, Brian Stamm, Shani Peter, Marissa D'Souza, F Garrett Conyers, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul-Nour, Richa Sharma, Fadi B Nahab, Patrick Glover, Sean L Thompson, Qasem N Alshaer, Neeharika Thottempudi, Adam de Havenon, Collin J Culbertson, Emiliya Melkumova, Rafail A Chionatos, Dinesh V Jillella, Jean-Philippe Auguste Daniel, Jennifer Ro, Michael R Frankel, Oana M Dumitrascu, Samantha Brown, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Jieun Kang, Kaitlyn Kirchhoffer, Anna Bowman, Matthew M Smith, James R Brorson, Aaron Asabere, Mahan Shahrivari, Cheran Elangovan, Nazanin Sheibani, Balaji Krishnaiah, Elizabeth Gaudio, Kelly L Sloane, Aaron Rothstein, Muhammad M Alvi, Saketh Annam, Curtis Amankwah, Wayneho Kam, Nandini Abburi, Mudassir Farooqui, Diana Rojas-Soto, Amir Molaie, Nicole Khezri, Adeel S Zubair, Mehdi Abbasi, Russell J Van Coevering, Lucia Chen, Simona Nedelcu, Franziska Herpich, Dalia Chahien, Siddharth Sehgal, David S Liebeskind, Guillermo Linares, Alicia Zha, Monica Sarkar, Romi Xi, Ashley Nelson, Ahmad Abu Qdais, Sami Al Kasab, Eesha Singh, Vivek Patel, Yasmin Ninette Aziz, Prachi Mehndiratta, Alexis DeMarco, Anjail Sharrief, Brett Cucchiara, Setareh Salehi Omran, Thanh N Nguyen, Michael Dubinski, Jiyoun Ackerman, Jesse Thon","doi":"10.1212/WNL.0000000000213876","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213876","url":null,"abstract":"<p><strong>Background and objectives: </strong>Embolic stroke of undetermined source (ESUS) can be attributed to a variety of potential embolic sources, with differential response to anticoagulation.</p><p><strong>Methods: </strong>A multicenter, retrospective observational cohort study (27 sites) of consecutive adult patients with acute ischemic stroke due to ESUS (admitted 2015-2024) was conducted. The aim was to compare outcomes after antiplatelet(s) vs anticoagulant (±antiplatelet) treatment in patients with ESUS across potential embolic sources. The time from admission to the primary composite outcome of recurrent stroke, major bleeding, or death was assessed using adjusted Cox proportional hazard regression (clustered by site) and propensity score (PS) matching with (1) inverse probability of treatment weighting (IPTW) and (2) 10:1 nearest-neighbor matching with replacement, adjusting for age, stroke severity, and potential embolic sources (e.g., left ventricular injury and patent foramen ovale). Recurrent stroke, major bleeding, and death were also assessed as secondary outcomes, with stratification by potential embolic sources.</p><p><strong>Results: </strong>Of the 2,328 included patients (n = 230 treated with anticoagulation), the median age was 65 years (interquartile range [IQR] 54-75), 50% were female, and the median NIH Stroke Scale score was 4 (IQR 2-11). Compared with patients treated using antiplatelet(s) therapies, those treated with anticoagulants were not at a lower risk of the primary outcome in the adjusted Cox model (adjusted hazard ratio [aHR] 1.00, 95% CI 0.69-1.45), adjusted IPTW regression model (aHR 1.15, 95% CI 0.79-1.66), or 10:1 PS-matched regression model (aHR 1.00, 95% CI 0.70-1.44). In patients with left ventricular injury, anticoagulation was associated with a lower rate of the primary outcome (aHR 0.35, 95% CI 0.16-0.77; <i>p</i>-interaction <0.01) and trended toward a lower rate of recurrent ischemic stroke (aHR 0.22, 95% CI 0.05-1.08; <i>p</i>-interaction = 0.04) when compared with patients treated with antiplatelet(s).</p><p><strong>Discussion: </strong>These real-world data validate randomized trial results in ESUS, which reported no net benefit of anticoagulation over antiplatelet therapy. These data suggest possible benefit of anticoagulation in patients with left ventricular injury, as in previous cohort studies, although the findings are limited by the small number of patients treated with anticoagulation. Future trials should evaluate treatment differences in this subgroup.</p><p><strong>Trial registration information: </strong>Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence; registration ID: NCT06398366. Registered on May 3, 2024.</p><p><strong>Classification of evidence: </strong>This study provides Class III evidence that in patients with ESUS, anticoagulation was not superior to antiplatelet therapy in reducing the risk of recurrent stroke, bleeding, or death.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213876"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560615","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}