Neurology最新文献

{"title":"What Is the Function and Relevance of 14-3-3 Proteins in Neurologic Disease?","authors":"Eduardo Benarroch","doi":"10.1212/WNL.0000000000213418","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213418","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e213418"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071058","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":"Do the Right Thing: Carefully Measuring Social Determinants of Health in Neurologic Research.","authors":"H E Hinson","doi":"10.1212/WNL.0000000000213390","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213390","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e213390"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409497","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":"Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee.","authors":"Carmel Armon, Pushpa Narayanaswami, Sonja Potrebic, Gary Gronseth, Misha-Miroslav Bačkonja, Viet L Cai, James Dorman, Christopher Gilligan, Scott A Heller, Heather M Silsbee, Don B Smith","doi":"10.1212/WNL.0000000000213361","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213361","url":null,"abstract":"<p><strong>Background and objectives: </strong>This review systematically evaluates and incorporates evidence for the use of epidural steroid injections (ESIs) in cervical and lumbar spinal stenosis and radiculopathies, assessing short-term (≤3 months) and long-term (≥6 months) improvements in pain and disability.</p><p><strong>Methods: </strong>We searched databases for randomized controlled trials (RCTs) on the efficacy of ESIs published between January 2005 and January 2021. Data analysis was performed by American Academy of Neurology methodologists. A panel of ESI experts was engaged to interpret the evidence in a clinical context. Owing to the great variability in efficacy measures used in the articles, we report differences based on any measure of success: the success rate difference (SRD).</p><p><strong>Results: </strong>Ninety RCTs met inclusion criteria. In cervical and lumbar radiculopathies, ESIs probably reduce short-term pain (SRD -24.0%, 95% CI -34.9 to -12.6, number needed to treat [NNT] 4) and disability (SRD -16.0%, 95% CI -26.6 to -5, NNT 6) and possibly decrease long-term disability (SRD -11.1%, 95% CI -25.3 to 3.6, NNT 9). There is insufficient evidence to determine whether ESIs reduce long-term pain in radiculopathies (SRD -10.3%, 95% CI -27.8 to 7.6). In lumbar spinal stenosis, ESIs possibly reduce short-term (SRD -26.2%, 95% CI -52.4 to 3.6, NNT 4) and long-term (SRD -11.8%, 95% CI -26.9 to 3.8, NNT 8) disability, but not short-term pain (SRD -3.5%, 95% CI -12.6 to 5.6). In lumbar stenosis, there is insufficient evidence to determine whether ESIs reduce long-term pain (SRD -6.5%, 95% CI -22.5 to 9.8). For cervical spinal stenosis, evidence is insufficient to determine the effectiveness of ESIs.</p><p><strong>Discussion: </strong>The review affirms limited efficacy of ESIs in reducing pain and disability in cervical and lumbar radiculopathies and possibly in lumbar spinal stenosis, largely in the short term. The heterogeneity of outcome measures reported preclude presenting integrated data regarding effect size. There is controversy regarding the appropriate choice of inactive comparator treatments as a true placebo in clinical trials of ESIs. The panel recommends that future trials of ESIs use minimal meaningful clinical difference as the measure of efficacy and paraspinal muscle injection of saline as an inactive placebo.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e213361"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409623","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":"Optimal Magnitude of Blood Pressure Reduction and Hematoma Growth and Functional Outcomes in Intracerebral Hemorrhage.","authors":"Qi Li, Xinni Lv, Andrea Morotti, Adnan I Qureshi, Dar Dowlatshahi, Guido J Falcone, Kevin Navin Sheth, Ashkan Shoamanesh, Santosh B Murthy, Anand Viswanathan, Joshua N Goldstein","doi":"10.1212/WNL.0000000000213412","DOIUrl":"10.1212/WNL.0000000000213412","url":null,"abstract":"<p><strong>Background and objectives: </strong>Early intensive systolic blood pressure (SBP) reduction is a promising strategy for intracerebral hemorrhage (ICH), but the optimal magnitude of reduction in the first 2 hours remains uncertain. This study aimed to determine the optimal SBP reduction magnitude to maximize benefit in patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial.</p><p><strong>Methods: </strong>We performed a post hoc analysis of the ATACH-2 trial. Participants with baseline SBP ≥180 mm Hg were randomized within 4.5 hours from onset and assigned to the intensive or standard group. The magnitude of SBP reduction was calculated as admission SBP minus minimum SBP at 2 hours. Eligible participants were divided into 5 groups by 15 mm Hg stratum: <40, 40-55, 55-70, 70-85, and ≥85 mm Hg. Poor functional outcome was defined as the modified Rankin Scale score at 3-6 and hematoma expansion (HE) as a relative increase of >33% from baseline to 24 hours. Multivariable logistic regression assessed associations between SBP reduction and outcomes.</p><p><strong>Results: </strong>Our study included 925 patients, of whom 360 (38.9%) were female. The median age was 62 years (IQR: 53-71). The median hematoma volume was 10.2 mL (IQR: 5.1-18.4), and the median magnitude of SBP reduction was 68 mm Hg (IQR: 48-88). Of those, 209 (22.6%) experienced HE, 122 (13.2%) experienced acute kidney injury (AKI), and 516 (55.8%) had poor outcome. Hematoma expansion decreased linearly as the magnitude of blood pressure reduction increased in 5 SBP reduction groups (<i>p</i> < 0.001). After multivariable adjustment, patients with a greater degree of SBP reduction (≥70 mm Hg) were less likely to experience HE and a SBP reduction ≥55 mm Hg was associated with a lower risk of poor outcomes (odds ratio [OR] 0.49, 95% CI 0.28-0.85). However, a SBP reduction ≥85 mm Hg increased AKI risk compared with <40 mm Hg (OR, 2.00; 95% CI 1.01-3.94).</p><p><strong>Discussion: </strong>Targeting a SBP reduction within the range of 55-85 mm Hg during the first 2 hours seems to be associated with optimal outcomes in patients with mild-to-moderate ICH, balancing the need to limit hematoma growth while avoiding adverse effect. Further study focusing on severe ICH is warranted.</p><p><strong>Trial registration information: </strong>Clinical trial registration number: NCT01176565.</p><p><strong>Classification of evidence: </strong>This post hoc analysis of the ATACH-2 trial provides Class III evidence that SBP reduction of 55-85 mm Hg during the initial 2 hours is associated with lower frequency of HE and better functional outcomes in patients with acute cerebral hemorrhage.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e213412"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365348","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":"Association of Social Determinants of Health With Genetic Test Request and Completion Rates in Children With Neurologic Disorders.","authors":"Jordan Janae Cole, Jonathan P Williams, Angela D Sellitto, Laura Rosa Baratta, Julia B Huecker, Dustin Baldridge, Thomas Kannampallil, Christina A Gurnett, Joyce E Balls-Berry","doi":"10.1212/WNL.0000000000210275","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210275","url":null,"abstract":"<p><strong>Background and objectives: </strong>Genetic testing is critical for optimal diagnosis and management of pediatric neurology patients, but access is challenging. We investigated whether social determinants of health (SDOH) were associated with genetic testing among pediatric neurology patients in a retrospective observational study.</p><p><strong>Methods: </strong>Electronic health record data were extracted from pediatric outpatients (0-18 years) evaluated at a single tertiary care institution between July 2018 and January 2020. Genetic testing requests, insurance denials, and test completion rates were compared among non-Hispanic single-racial or multiracial Black (Black) vs non-Hispanic single-racial White (White) patients. SDOH and clinical variables including ethnoracial identity, insurance type, Area Deprivation Index, rural urban commuting area, sex, age, diagnoses, and number of neurology visits were evaluated to identify associations with chromosomal microarray (CMA), multigene panel (MGP), and exome/genome sequencing (ES/GS) test completion.</p><p><strong>Results: </strong>Of 11,371 patients (mean age 9.25 years; 46.1% female), 554 (4.9%) completed ≥1 genetic test in the study interval, with White patients nearly twice as likely to have completed ≥1 genetic test compared with Black patients (aOR 1.88, 95% CI 1.41-2.51). Outpatient pediatric neurology was the most common specialty through which testing was completed. Neurology provider request rates for genetic testing did not differ by patient ethnoracial identity, but insurance denial rates after neurology request were lower for White vs Black patients (relative rate ratio [RR] 0.44, 95% CI 0.27-0.73), and those with public insurance were less likely to complete genetic testing after it was requested through neurology (aOR 0.59, 95% CI 0.35-0.97). However, when considering individual genetic test types completed through any specialty, insurance type was significantly associated only with MGP completion (public vs private OR 0.56, 95% CI 0.40-0.77), not CMA or ES/GS.</p><p><strong>Discussion: </strong>Marked ethnoracial disparities in genetic testing completion were identified despite equivalent rates of genetic testing requests by neurologists. While Black patients had higher rates of insurance denials, insurance type itself accounted for the disparity in MGP but not CMA or ES/GS completion. Other unmeasured barriers stemming from systemic racism likely affected genetic testing among Black patients.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e210275"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409550","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 Lifestyle at Different Life Periods and Brain Integrity in Older Adults.","authors":"Anne-Laure Turpin, Francesca Felisatti, Léa Chauveau, Sacha Haudry, Florence Mézenge, Brigitte Landeau, Denis Vivien, Vincent De La Sayette, Gaël Chételat, Julie Gonneaud","doi":"10.1212/WNL.0000000000213347","DOIUrl":"10.1212/WNL.0000000000213347","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lifestyle behaviors, including engagement in complex mental activities, have been associated with dementia risk and neuroimaging markers of aging and Alzheimer disease. However, the life period(s) at which lifestyle factors have the greatest influence on brain health remains unclear. Our objective was to determine the relative influence of lifestyle (i.e., engagement in complex mental activities) at different life periods on older adults' brain health.</p><p><strong>Methods: </strong>This observational study included community-dwelling cognitively unimpaired seniors (older than 65 years) from the Age-Well randomized controlled trial (Caen, France). All participants completed at baseline the Lifetime of Experiences Questionnaire, assessing engagement in complex mental activities during young adulthood (13-30 years: LEQ-young), midlife (30-65 years: LEQ-midlife), and late-life (older than 65 years: LEQ-late). LEQ scores were divided into specific and non-specific activities. Multiple regressions were conducted including LEQ scores at the 3 life periods (same model) to predict gray matter volume (GMv; structural-MRI), glucose metabolism (fluorodeoxyglucose-PET), perfusion (early-Florbetapir-PET), or amyloid burden (late-Florbetapir-PET), both in AD-signature regions and voxel-wise (significance for voxel-wise analyses: <i>p</i> < 0.005_uncorrected, k > 100). Correlations between LEQ and neuroimaging outcomes were then compared between (1) life periods and (2) specific and non-specific activities. Analyses were controlled for age and sex.</p><p><strong>Results: </strong>In 135 older adults (mean age = 69.3 years; women = 61.5%), no associations were found within AD-signature regions (all <i>p</i> > 0.25). Voxel-wise analyses revealed no association between LEQ-young and neuroimaging. LEQ-midlife showed stronger voxel-wise associations than the other periods with GMv, notably in the anterior cingulate cortex, and with amyloid burden in the precuneus. These correlations were stronger for the LEQ-midlife specific (i.e., occupation) than the non-specific subscore (GMv: z = 3.25, <i>p</i> < 0.001, 95% CI [0.1292-0.5135]; amyloid: z = -1.88, <i>p</i> < 0.05, 95% CI [-0.3810 to -0.0113]). LEQ-late showed stronger voxel-wise associations than the other periods with perfusion and glucose metabolism in medial frontal regions. The correlation of perfusion with LEQ-late was stronger for non-specific than specific subscore (z = 2.88, <i>p</i> < 0.01, 95% CI [0.0894-0.4606]).</p><p><strong>Discussion: </strong>Lifestyle at different life periods may have complementary benefits on brain health in regions related to reserve/resilience in aging. While past (midlife) engagement could promote resistance against structural/pathologic alterations, current (late-life) engagement could enhance cognitive reserve. Future larger longitudinal studies should explore mechanisms by which lifestyle promotes reserve.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e213347"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370804","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":"Author Response: A Preponderance of Evidence: A Call for a Randomized Trial in Posterior Circulation Stroke.","authors":"Paul A Nyquist, Junaid Ansari","doi":"10.1212/WNL.0000000000209785","DOIUrl":"https://doi.org/10.1212/WNL.0000000000209785","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e209785"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070790","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":"Author Response: Functional Outcome and Hemorrhage Rates After Bridging Therapy With Tenecteplase or Alteplase in Patients With Large Ischemic Core.","authors":"Gaspard Gerschenfeld, Sonia Alamowitch","doi":"10.1212/WNL.0000000000209917","DOIUrl":"https://doi.org/10.1212/WNL.0000000000209917","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e209917"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256134","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":"Rapid Evolution of an Iatrogenic Cerebral Amyloid Angiopathy.","authors":"Thomas Courret, Megane Le Quang, Pauline Renou, Guillaume Penchet, Thomas Tourdias","doi":"10.1212/WNL.0000000000213402","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213402","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e213402"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365316","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":"α-Synuclein Seed Amplification Assay Amplification Parameters and the Risk of Progression in Prodromal Parkinson Disease.","authors":"David G Coughlin, Ben Shifflett, Carly M Farris, Yihua Ma, Douglas Galasko, Steven D Edland, Brit Mollenhauer, Michael C Brumm, Kathleen L Poston, Kenneth Marek, Andrew D Siderowf, Claudio Soto, Luis Concha-Marambio","doi":"10.1212/WNL.0000000000210279","DOIUrl":"10.1212/WNL.0000000000210279","url":null,"abstract":"<p><strong>Objectives: </strong>Tools are needed to evaluate the risk of developing Parkinson disease (PD) in at-risk populations. In this study, we examine differences in alpha-synuclein seed amplification assay (αSyn-SAA) qualitative results and amplification parameters between nonmanifesting carriers (NMCs) of PD-related pathogenic variants, prodromal PD, and PD and the risk of developing a synucleinopathy in participants with prodromal PD.</p><p><strong>Methods: </strong>Cross-sectional and longitudinal CSF αSyn-SAA results from participants in the Parkinson's Progression Markers Initiative were analyzed. αSyn-SAA positivity and amplification parameters (maximum fluorescence [Fmax], time-to-threshold [TTT], time-to-50% Fmax [T50], and area under the curve [AUC]) were compared between NMCs, participants with prodromal PD, and participants with PD, and their relationship with the likelihood of phenoconversion in participants with prodromal PD was investigated.</p><p><strong>Results: </strong>Samples from 1,027 participants were analyzed (159 healthy controls [HCs], 247 NMCs, 96 participants with prodromal PD, and 525 participants with PD). TTT and T50 were faster, and AUC was higher in αSyn-SAA+ participants with prodromal PD and PD than αSyn-SAA+ NMCs and HC participants (Kruskal-Wallis χ² = 4.15-13.96, <i>p</i> < 0.0002-0.04). Participants with prodromal PD with positive αSyn-SAA tests and faster TTT had higher rates of phenoconversion (log-rank <i>p</i> = 0.001 and log-rank test-for-trend <i>p</i> < 0.0001). There were no changes in 48 participants with prodromal PD with longitudinal assays.</p><p><strong>Discussion: </strong>αSyn-SAA positivity and faster seed amplification are associated with a greater risk of developing PD in at-risk individuals and may aid in predicting phenoconversion.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 5","pages":"e210279"},"PeriodicalIF":7.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365367","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}