Neurology最新文献

{"title":"An Ounce of Prevention: The Growing Need for Preventive Neurologists.","authors":"Behnam Sabayan, Bernadette Boden-Albala, Natalia S Rost","doi":"10.1212/WNL.0000000000213785","DOIUrl":"10.1212/WNL.0000000000213785","url":null,"abstract":"<p><p>The global burden of neurologic disorders is rising, driven by aging populations and improved survival following acute neurologic events. As a result, more individuals are living with long-term disabilities from conditions such as stroke, dementia, and other neurodegenerative diseases. Despite significant advances in neurology, there remains an urgent need for a preventive approach to mitigate these trends. Growing evidence highlights the effectiveness of preventive strategies, including lifestyle modifications and risk factor management, in preserving brain health and reducing the risk of stroke, neurodegenerative conditions, and cognitive decline. Preventive neurology operates within a multilevel framework, ranging from direct patient-centered interventions to systemic policy actions requiring organizational and societal support. Neurologists are uniquely positioned as advocates for brain health, promoting preventive strategies in line with the American Academy of Neurology's Brain Health Initiative. This article explores how neurologists can drive change across individual, family, community, and policy levels by leveraging their clinical expertise, community engagement, and health policy influence. Sustainable progress in brain health will also require system-level changes that integrate preventive goals into the fabric of health care delivery, public health infrastructure, and policy frameworks. Special attention is given to underserved populations, who bear a disproportionate burden of neurologic diseases. Through targeted interventions, public health initiatives, and collaborative care models, preventive neurologists can shape brain health outcomes across the lifespan. Training neurologists with a preventive focus will integrate brain health promotion into standard neurology practice, complementing disease management. By addressing the root causes and risk factors of neurologic conditions, preventive neurology provides a pathway to improving quality of life while reducing the global health care burden.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213785"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285811","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":"Un-Bound.","authors":"Heather Finlay-Morreale","doi":"10.1212/WNL.0000000000213765","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213765","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213765"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266912","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":"Iron Hemostasis in Patients With Subarachnoid Hemorrhage and the Role of Early CSF Drainage.","authors":"Tianshu Bi, Henner Koch, Benedikt Kremer, Anke Höllig","doi":"10.1212/WNL.0000000000213767","DOIUrl":"10.1212/WNL.0000000000213767","url":null,"abstract":"<p><p>Early brain injury and delayed cerebral ischemia are combined intricate processes, and they represent the principal cause of subarachnoid hemorrhage (SAH)-related morbidity and mortality worldwide. Recent studies have shown that early lumbar CSF drainage can be used to decrease the incidence of delayed cerebral ischemia and improve long-term outcome. This approach has provided novel insights into post-SAH management that lessened the burden of secondary infarction and decreased the rate of unfavorable outcome. Given that the evaluation of this approach is contingent on prospective trial and early-stage randomized clinical trial, we review insights from studies that have elucidated the mechanisms underlying deterioration in SAH. We explore the role of iron homeostasis in the restoration of normal CSF circulation and the stabilization of optimal cerebral physiology to alleviate early brain injury and delayed neurologic impairment after SAH to advance the current understanding of SAH management.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213767"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258562","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":"Risk of Ventricular Arrhythmia and Sudden Cardiac Arrest Among Older Patients Using Lamotrigine for Epilepsy.","authors":"Gloria Y F Ho, Daniel B Horton, Parin J Patel, Tobias Gerhard, Chintan V Dave","doi":"10.1212/WNL.0000000000213643","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213643","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lamotrigine, an antiseizure medication, blocks the activation of voltage-gated sodium channels and reduces the excitability of cardiomyocytes in vitro. Based on concerns for QT prolongation and case reports of arrhythmias among lamotrigine users, the US Food and Drug Administration placed a safety warning on lamotrigine's label in 2020. However, limited evidence exists on the cardiac risk of lamotrigine in patients with epilepsy. This study assessed whether lamotrigine users with epilepsy had an increased risk of ventricular arrhythmia and sudden cardiac arrest (VA/SCA) compared with users of levetiracetam.</p><p><strong>Methods: </strong>This was a retrospective cohort study among Medicare-insured individuals aged 65 years or older with epilepsy (2007-2019). We identified new users of lamotrigine and levetiracetam without inpatient or emergency VA/SCA diagnosis in the 12-month continuous enrollment baseline period before initiation of treatment. Using inverse probability of treatment weighting derived from propensity scores based on baseline covariates, we compared adjusted incidence rates of inpatient or emergency VA/SCA events in lamotrigine vs levetiracetam users and estimated adjusted hazard ratios (HRs) with 95% CIs using Cox proportional hazard regression.</p><p><strong>Results: </strong>The study cohort (mean age 77.6 years and 60.5% female) consisted of 11,786 new lamotrigine users and 147,130 new levetiracetam users. At baseline, lamotrigine users were younger and less likely to have cardiovascular and noncardiovascular comorbidities than the levetiracetam users. The incidence and HR of VA/SCA were not statistically higher among lamotrigine users (7.0 vs 8.2 per 1,000 person-years for the lamotrigine and levetiracetam users, respectively; HR 0.84, 95% CI 0.67-1.06). Secondary analyses stratified by baseline cardiac abnormalities showed significantly reduced risk among lamotrigine users in subgroups with baseline arrhythmia (HR 0.51, 95% CI 0.32-0.80) or use of antiarrhythmic drugs (HR 0.67, 95% CI 0.50-0.91).</p><p><strong>Discussion: </strong>In older adults with epilepsy, lamotrigine was not associated with an increased risk of VA/SCA compared with levetiracetam, including among those with underlying heart disease. Our findings do not support the reported cardiac risks associated with lamotrigine or the recent changes to its safety label.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213643"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275468","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":"Treating Seizures With Lamotrigine: Arrhythmia Risks Reconsidered.","authors":"Leah J Blank","doi":"10.1212/WNL.0000000000213841","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213841","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213841"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275469","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":"Nicotine, Alcohol Consumption, and Risk of Myasthenia Gravis: Results From the Swedish Nationwide GEMG Study.","authors":"Malin Petersson, Daniel Jons, Amalia Feresiadou, Andreea Ilinca, Fredrik Lundin, Rune Johansson, Anna Budzianowska, Anna-Karin Roos, Viktor Kagstrom, Martin Gunnarsson, Peter Sundström, Lars Klareskog, Tomas Olsson, Ingrid Kockum, Fredrik Piehl, Lars Alfredsson, Susanna Brauner","doi":"10.1212/WNL.0000000000213771","DOIUrl":"10.1212/WNL.0000000000213771","url":null,"abstract":"<p><strong>Background and objectives: </strong>Myasthenia gravis (MG), an autoimmune disease characterized by fluctuating muscle weakness, is believed to result from complex gene-environment interactions, yet few risk factors have been identified. The objective of this study was to determine the effect of nicotine and alcohol on MG disease risk.</p><p><strong>Methods: </strong>The Genes and Environment in Myasthenia Gravis study is a Swedish, nationwide cross-sectional case-control study where prevalent patients with MG were invited to submit an extensive questionnaire on lifestyle and environment. Data collection took place between November 2018 and August 2019, and cases were matched by sex and year of birth to population controls. Year of disease onset was used as index year. Associations between use of alcohol, tobacco smoke, Swedish snuff, and MG risk were investigated using multivariable logistic regression.</p><p><strong>Results: </strong>A total of 1,067 patients with MG (mean age at onset 48 (SD 21) years, 53% female) were matched to 2,087 controls. Any alcohol consumption was associated with a lower MG risk compared with not drinking at all (odds ratio [OR] 0.48, 95% CI 0.39-0.59, <i>p</i> < 0.001, exposed cases n = 616). Effects were observed in a similar direction across disease subtypes, with the strongest association in the late-onset MG group (onset ≥50 years). Although neither cigarette smoke nor use of Swedish snuff affected the disease risk of the whole group, subset specific effects were observed. Smoking at onset was associated with an increased risk of early-onset MG (EOMG, onset 18-49 years; OR 1.60, 95% CI 1.17-2.20, <i>p</i> = 0.003, n = 133), which was accentuated in acetylcholine receptor antibody-positive EOMG (OR 2.08, 95% CI 1.34-3.25, <i>p</i> = 0.001, n = 74). Use of Swedish snuff, which contains high levels of nicotine, at disease onset was also associated with an increased risk of EOMG (OR 1.61, 95% CI 1.02-2.54, <i>p</i> = 0.039, n = 43).</p><p><strong>Discussion: </strong>We observed an inverse correlation of MG risk and alcohol consumption. Furthermore, smoking and the use of Swedish snuff at disease onset were positively associated with EOMG. We recognize limitations related to retrospective data and limited number of available controls. However, multiple sensitivity analyses were performed supporting the robustness of our results.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213771"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266911","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":"Mobile Stroke Units: An Investment, Not a Luxury.","authors":"Natalia Pérez De La Ossa","doi":"10.1212/wnl.0000000000213960","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213960","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"33 1","pages":"e213960"},"PeriodicalIF":9.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586571","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":"Left Spontaneous Basal Ganglia Hemorrhage With Transcommissural Extension Via the Canal of Gratiolet and Left-Sided Dystonia: A Case Report.","authors":"Juan Francisco Garcia Granado, María Del Pino Pérez García, Ayoze Nauzet González Hernández","doi":"10.1212/WNL.0000000000213740","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213740","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213740"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258563","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":"Cancer Health Disparities Affecting Glioblastoma Survival in Ontario, Canada: A Population-Based Study.","authors":"Abdelsimar T Omar, Jose Danilo Bengzon Diestro, Vivian Aghanya, Anna J Dare, Julian Spears, David Gomez","doi":"10.1212/WNL.0000000000213742","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213742","url":null,"abstract":"<p><strong>Background and objectives: </strong>The role of cancer health disparities in a non-screen-detectable, high-mortality cancer such as glioblastoma (GBM) remains uncertain. We investigated the association between socioeconomic factors and overall survivorship and receipt of adjuvant treatment among patients with GBM.</p><p><strong>Methods: </strong>This population-based cohort study used linked provincial administrative databases in Ontario, Canada, and was conducted among adult patients with GBM who underwent surgery from 2006 to 2022. Our exposures were neighborhood-based material deprivation index, immigration status, and residence rurality index. The primary outcomes were overall survival (OS) and receipt of adjuvant treatment within 6 months. Secondary outcomes were cancer-specific survival (CSS) and the number of emergency department visits in the year preceding surgery, used as a proxy for potential management delay. Kaplan-Meier survival analysis and multivariable Cox proportional hazard models were used to assess OS and CSS while logistic regression and Poisson regression were applied for receipt of adjuvant treatment and emergency department visits, respectively.</p><p><strong>Results: </strong>Among 7,232 patients included in the cohort, patients residing in the most deprived neighborhoods had worse overall survival (median: 228 days vs 294 days, adjusted hazard ratio [aHR] 1.167, 95% CI 1.078-1.229, <i>p</i> < 0.001) and cancer-specific survival (aHR: 1.216, 95% CI 1.112-1.329, <i>p</i> < 0.001) compared with patients in least deprived areas. They also had 26% decreased adjusted odds of receiving adjuvant treatment (77.9% vs 83.0% in the most vs least deprived neighborhoods; adjusted odds ratio [aOR]: 0.741, 95% CI 0.608-0.902, <i>p</i> = 0.003) compared with patients in least deprived neighborhoods. Immigration status was significantly associated with OS and CSS, shown to be longer among remote immigrants (aHR for OS: 0.875, 95% CI 0.794-0.964, <i>p</i> = 0.007; aHR for CSS: 0.816, 95% CI 0.730-0.912, <i>p</i> < 0.001) and recent immigrants (aHR for OS: 0.746 95% CI 0.566-0.982, <i>p</i> = 0.037; aHR for CSS: 0.705, 95% CI 0.517-0.961, <i>p</i> = 0.027) compared with nonimmigrants. Higher material resource dimension index (<i>p</i> = 0.015) and rural residence (<i>p</i> < 0.001) were also associated with more ED visits before surgery.</p><p><strong>Discussion: </strong>These findings suggest that cancer health disparities persist for GBM in Ontario, Canada, despite a single-payer, publicly financed system that guarantees universal health coverage of cancer services. This highlights the need for targeted interventions to address disparities and improve outcomes in marginalized populations.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213742"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258560","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":"Pearls & Oy-sters: Eagle Syndrome in a Patient With Neurologic Deficit Upon Head Rotation.","authors":"Britt Schuurman, Werner H Mess, Alida Annechien Postma, Julie Staals, Stijn van Weert","doi":"10.1212/WNL.0000000000213764","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213764","url":null,"abstract":"<p><p>Transient neurologic symptoms are a commonly observed problem within neurology. It is less typical for these symptoms to be triggered by a certain movement. This case describes a 57-year-old man with a history of hypertension who presented for evaluation of posture-dependent left-sided weakness. After extensive examination, the patient was found to have an elongated styloid process causing symptoms. After surgical removal of the elongated styloid process, the patient was completely symptom-free. This report describes the diagnosis of Eagle syndrome including key diagnostic tools. Eagle syndrome should be considered in patients with posture-dependent stroke symptoms.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213764"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208996","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}