Neurology最新文献

{"title":"Hakuna Matata: How Interventions for Stressful Life Events and Other Social Determinants of Health Intersect With Alzheimer Disease.","authors":"Jonathan P Williams, Ganesh M Babulal","doi":"10.1212/WNL.0000000000213455","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213455","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213455"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753648","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":"Magnitude and Time-Course of Dementia Risk in Stroke Survivors: A Population-Wide Matched Cohort Study.","authors":"Raed A Joundi, Jiming Fang, Peter C Austin, Eric E Smith, Amy Ying Xin Yu, Vladimir Hachinski, Luciano A Sposato, Aravind Ganesh, Mukul Sharma, Moira K Kapral","doi":"10.1212/WNL.0000000000213478","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213478","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213478"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649663","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 Video NeuroImage: Bilateral Hemifacial Spasm and Left Glossopharyngeal Neuralgia Caused by Bilateral Vertebral Artery Displacement.","authors":"Zongli Han, Yanli Du, Siyang Zheng, Guangyuan Wu","doi":"10.1212/WNL.0000000000213456","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213456","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213456"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663476","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":"From Heart to Brain-The Effect of Cardiac Dysfunction on Brain Structure and Cognitive Decline: Insights From a Meta-Analysis.","authors":"Assia Jaillard, Alienor Jaillard","doi":"10.1212/WNL.0000000000213540","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213540","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213540"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730843","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":"Neurotoxicity in Patients With CNS Lymphomas Treated With CAR T-Cell Therapy: A Study From the French Oculo-Cerebral Lymphoma Network.","authors":"Hugo Hernández-Tost, Nicolas Weiss, Sylvain Choquet, Cristina Birzu, Loïc Le Guennec, Sirine Mersali, Natalia Shor, Delphine Leclercq, Véronique Morel, Madalina Uzunov, Laetitia Souchet, Ines Boussen, Marine Baron, Damien Roos-Weil, Valérie Friser, Nathalie Miranda, Magali Le Garff-Tavernier, Carole Soussain, Agusti Alentorn, Khê Hoang-Xuan, Dimitri Psimaras, Caroline Houillier","doi":"10.1212/WNL.0000000000213501","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213501","url":null,"abstract":"<p><strong>Background and objectives: </strong>Several recent studies have shown the promising efficacy of chimeric antigenic receptor (CAR) T cells in treating CNS lymphomas. However, data on neurotoxicity in this setting are limited. The objective of this study was to describe neurotoxicity in patients with CNS lymphoma treated with anti-CD19 CAR T cells and to identify risk factors.</p><p><strong>Methods: </strong>We retrospectively selected adult patients with isolated CNS relapse of B-cell lymphomas treated with CAR T cells at Pitié-Salpêtrière Hospital between January 2020 and January 2024 from the French Oculo-Cerebral Lymphoma network database. We collected clinical, biological, and imaging data before and after CAR T-cell infusion to investigate neurotoxicity. We considered only neurologic deterioration for which causes other than CAR T-cell toxicity were reasonably ruled out.</p><p><strong>Results: </strong>According to the selection criteria, 48 patients (44% female, 28 with primary and 20 with secondary CNS lymphomas) were analyzed. The median age was 62 years (range: 30-82) at the time of CAR T-cell infusion, and the median Montreal Cognitive Assessment (MoCA) score was 23. Twenty-five patients received tisa-cel, 21 received axi-cel, and 2 received brexu-cel. Thirty-one patients (65%) experienced neurotoxicity, including 11 patients with grade 3-4 neurotoxicity (23%). The symptoms started at a median of 5 days (range: 1-10) after CAR T-cell infusion. The symptoms were cognitive disorders (N = 30), balance disorders (N = 18), consciousness disorders (N = 6), tremors (N = 6), seizures (N = 4), and motor deficits (N = 4). Brain MRI revealed pseudoprogression in 7 of 26 patients (27%), and there was a transient increase in CSF IL-10 levels in 7 of 29 patients (24%). Age 65 years or older (<i>p</i> = 0.04, OR: 4.4 [95% CI 1.1-19.3]) and a MoCA score <26 at the time of CAR T-cell infusion (<i>p</i> = 0.04, OR: 12 [95% CI 4-29]) were significantly associated with a greater risk of grade 3-4 neurotoxicity (exploratory analysis). Twenty patients (42%) received steroids. The median duration of neurologic impairment was 100 days (range: 4 days-18 months) in patients with grade 3-4 neurotoxicity.</p><p><strong>Discussion: </strong>Although the rate of neurotoxicity seems acceptable in CNS lymphomas, the risk of unusual prolonged neurologic deterioration is high in patients with grade 3-4 neurotoxicity. Special attention should be given to older patients with cognitive impairment who seem at greater risk of severe forms of neurotoxicity. Larger series are warranted to confirm these results.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213501"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730848","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":"Statin Use and Risk of Intracerebral Hemorrhage in Chinese Population: A Target Trial Emulation Study.","authors":"Dongze Ji, Shujie Dong, Tiansheng Wang, Jingkai Wei, Peng Shen, Hongbo Lin, Luwen Shi, Xiaodong Guan, Yang Xu","doi":"10.1212/WNL.0000000000213489","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213489","url":null,"abstract":"<p><strong>Background and objectives: </strong>Statins have been shown to prevent major vascular events in a wide range of individuals. However, their potential mechanisms-such as impairing fibrinogen cleavage and reducing thrombin generation-raise concerns on increased risk of intracerebral hemorrhage (ICH). Given the inconsistent findings of previous trials and observational studies, this study aims to assess the effect of statins on ICH risk in Chinese population.</p><p><strong>Methods: </strong>Within the framework of target trial emulation, we used data from the Yinzhou Regional Health Care Database covering the years 2011-2020. The study included patients aged 50 years or older with no history of ICH and statin use. After applying inclusion and exclusion criteria, patients were categorized as statin initiators or noninitiators based on their initial treatment regimen during the 1-month enrollment period. Using the sequential trial approach, 60 target trials were emulated each month from 2011 to 2015. Propensity score (PS) matching was applied to balance characteristics between statin initiators and noninitiators within each emulated trial, and these trials were then stacked together into a single data set. Cox proportional hazards models were used to estimate the effects of statin on ICH risk, ICH-related mortality, and all-cause mortality.</p><p><strong>Results: </strong>A total of 53,413 statin initiators and 35,033,455 noninitiators from 60 emulated trials were included in the analysis. Statin initiators were generally older (mean age 65 vs 63 years), less likely to be male (45.5% vs 50.5%), and more likely to have a history of hypertension (69.0% vs 14.1%). After PS matching, all characteristics between the 2 groups were well balanced. With a median follow-up of 6.7 (interquartile range 5.6-8.1) years, the hazard ratio (HR) of ICH for statin initiators compared with noninitiators was 1.18 (95% CI 1.03-1.35). The HRs of ICH-related mortality and all-cause mortality were 1.16 (95% CI 0.91-1.46) and 0.92 (95% CI 0.88-0.97), respectively. Results remained consistent across various subgroup and sensitivity analyses.</p><p><strong>Discussion: </strong>Statin use may increase the risk of ICH in Chinese patients without history of ICH. However, the findings of this study may be limited by residual confounding, particularly the lack of cholesterol-related measurements.</p><p><strong>Classification of evidence: </strong>This study provides Class III evidence that in Chinese populations, initiation of statins may increase the risk of ICH.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213489"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730851","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 Social Vulnerability Index and Incidence of Alzheimer Disease in a Population-Based Sample of Older Adults.","authors":"Pankaja Desai, Jerenda Bond, Anisa Dhana, Ted K S Ng, Kristin R Krueger, Klodian Dhana, Xiaoran Liu, Denis A Evans, Kumar B Rajan","doi":"10.1212/WNL.0000000000213464","DOIUrl":"10.1212/WNL.0000000000213464","url":null,"abstract":"<p><strong>Background and objectives: </strong>The primary study objective was to examine the association between Social Vulnerability index (SVI) and risk of incident Alzheimer disease (AD) and rate of cognitive decline.</p><p><strong>Methods: </strong>This is a secondary analysis of data from the Chicago Health and Aging Project, a population-based cohort study. Participants were recruited through door visits, were at least 65 years of age at enrollment, and lived in one of 4 Chicago communities representing 24 US census tracts. The association of SVI with clinically diagnosed incident AD was examined using a logistic regression model and global cognitive decline using a linear mixed-effects model.</p><p><strong>Results: </strong>A total of 6,781 participants were in this study, with a mean age of 72 years, representing over 60% Black participants and over 60% female participants, and with a mean of 12 years of education. Over 90% of Black participants were in tracts above 50% or higher SVI, and approximately 87% of White participants were in tracts with SVI 50% or less. Participants in tracts with SVI above 50th to 75th percentiles had OR = 2.23 (95% CI 1.23-4.05) for clinical AD, and participants in tracts greater than the 75th percentile had OR = 2.04 (95% CI 1.03-4.04). Participants in more vulnerable tracts had greater incident AD risk than participants in less vulnerable tracts. The annual rate of global cognitive decline was 0.055 SD units (SDU) for participants below the 25th SVI percentile. The annual rate of global cognitive decline was faster by 0.010 SDU (approximately 18% faster, <i>p</i> = 0.025) in those above the 50th-75th percentile and by 0.014 SDU (approximately 25% faster, <i>p</i> = 0.005) in participants above the 75th percentile than in participants below the 25th SVI percentile.</p><p><strong>Discussion: </strong>Most Black participants who lived in areas with higher SVI that had over twice the risk of incident AD than most White participants who lived in areas with lower SVI, showing a higher social burden in Black older adults. There was no statistically significant race difference in incident AD after adjusting for SVI. SVI should be accounted for when examining race differences in AD.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213464"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730903","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":"Demographic and Geographic Trends in Myasthenia Gravis-Related Mortality in the United States, 1999-2022.","authors":"Ali Al-Salahat, Ali Bin Abdul Jabbar, Rohan Sharma, Yu-Ting Chen, Evanthia Bernitsas","doi":"10.1212/WNL.0000000000213505","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213505","url":null,"abstract":"<p><strong>Background and objectives: </strong>The prevalence and incidence of myasthenia gravis (MG) have been increasing, globally and in the United States. The literature lacks data on MG-related mortality (MGRM) and its trends in the United States. We aimed to examine nationwide demographic and geographic trends of MGRM from 1999 to 2022.</p><p><strong>Methods: </strong>This retrospective population-based study used data regarding MG-related deaths (MGRD) from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality records. The International Classification of Diseases (ICD) code, G70.0, was used to identify MG. We stratified deaths by sex, age groups (25-64 years and older than 64 years), race and ethnicity, and geographical location. Joinpoint regression was performed to examine trends in age-adjusted mortality rates (AAMRs). Sensitivity analysis was performed using MG as an underlying cause of death (UCD).</p><p><strong>Results: </strong>During the study period, there were 37,075 MGRD (89.6% were older than 64 years, and 44.7% were female individuals). From 1999 to 2022, the MG-related AAMR increased significantly from 6.21 (95% CI 5.58-6.58) per 1 million population to 9.51 (95% CI 9.14-9.88) per 1 million population, with an average annual percent change of +2.42 (95% CI 1.98-2.87). The increase in MGRM was observed regardless of age group, sex, region, or race and ethnicity. The MG-related AAMR increased by 66.3% in male individuals and 29.6% in female individuals over the study period. For individuals aged 65 years or older, there was a concerning increase in MG-related AAMR by 82.35% from 28.23 to 47.36. There was a peak in MGRM during the coronavirus disease 2019 pandemic (2020-2022), and sensitivity analysis revealed that the trend in MGRM remained consistent as both UCD and contributing cause of death.</p><p><strong>Discussion: </strong>The rising MGRM over the 23-year period is concerning and warrants investigation into the underlying causes for this trend. This increase was most prominent in older and male individuals. The growing burden of MG in the United States and globally might pose a serious challenge to health care in the future. Limitations of this study include reliance on ICD codes. Future work needs to take these trends and disparities into consideration and focus on improving MGRM.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213505"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735998","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":"Risk Factors of Aneurysmal Subarachnoid Hemorrhage Including Analysis by Sex: A Systematic Review and Meta-Analysis.","authors":"Mariam Ali, Maaike J A van Eldik, Stijn Rietkerken, Jan W Schoones, Nyika D Kruyt, Gabriel J E Rinkel, Marieke J H Wermer, Sanne Peters, Ynte M Ruigrok","doi":"10.1212/WNL.0000000000213511","DOIUrl":"10.1212/WNL.0000000000213511","url":null,"abstract":"<p><strong>Background and objectives: </strong>A 2005 review identified smoking, hypertension, and excessive alcohol intake as the most important risk factors of aneurysmal subarachnoid hemorrhage (aSAH), but data on other factors remained inconclusive. While aSAH is more prevalent in female participants, evidence on sex differences and female-specific factors remains limited. Comprehensive identification of all risk factors, including potential sex differences and female-specific factors, is essential for improving prevention and accurately assessing aSAH risk. We aimed to determine whether there is now greater certainty around previously inconclusive risk factors, identify any new emerging factors, and explore sex differences in both established and emerging risk factors.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of cohort and case-control studies on prevalent lifestyle exposures, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. These exposures included smoking, hypertension, alcohol abuse, oral contraception, hormone replacement therapy, hypercholesterolemia, rigorous physical activity, lean body mass index, and diabetes. We calculated pooled sex-specific relative risks (RRs) and odds ratios (ORs) with 95% CIs for overall risk and female-to-male ratios of RRs (RRRs) and ORs (RORs) for sex comparisons.</p><p><strong>Results: </strong>We included 67 studies (34 cohort [8 with sex-specific data], 33 case-control [6 with sex-specific data]; n = 5,743,262; 57% female). A sex-specific association was found for current smoking (RRR 1.53, 95% CI 1.05-2.23), but not for hypertension (RRR 1.50, 95% CI 0.78-2.89) or excessive alcohol intake (RRR 0.46, 95% CI 0.13-1.63). Regular rigorous exercise (RR 0.74, 95% CI 0.53-1.04; OR 0.69, 95% CI 0.57-0.83) and diabetes (RR 0.75, 95% CI 0.55-1.02; OR 0.52, 95% CI 0.41-0.65) were associated with reduced risk, without sex-specific associations. Data on hypercholesterolemia (RR 1.24, 95% CI 0.97-1.58; OR 0.52, 95% CI 0.37-0.74) and lean BMI (RR 1.31, 95% CI 1.15-1.50; OR 1.39, 95% CI 0.74-2.60) were inconsistent and showed no sex-specific associations. Hormone replacement therapy (RR 1.03, 95% CI 0.72-1.48) and oral contraceptive use (RR 5.40, 95% CI 0.68-42.57) were limited to female patients, with current users compared with never users. Most studies contained potential sources of bias.</p><p><strong>Discussion: </strong>Current smoking, but not hypertension or excessive alcohol, has a stronger association with aSAH in female patients than in male patients. Regular exercise and diabetes are associated with a reduced risk, with no sex-specific associations. Data on female-specific factors remain inconsistent. Targeted smoking prevention may particularly benefit female patients. Large-scale studies are needed to clarify the role of female-specific factors in explaining the higher incidence of aSAH in female patients.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213511"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736005","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":"Patient Perspectives: Patient as Teacher: The Impact of Listening to a Patient With Stiff-Person Syndrome on Her Disease Course.","authors":"Aaron S Zelikovich, Barbara Zamorska, Nara Miriam Michaelson","doi":"10.1212/WNL.0000000000213433","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213433","url":null,"abstract":"<p><p>We highlight a memorable encounter with a patient who provided us with insight into her diagnosis of stiff-person syndrome (SPS) by helping us understand what it means to truly live with this rare disease. By actively imagining ourselves in a patient's position and trying to learn who they are as individuals, we can help them share their stories, empower them to participate in decisions, and determine their own definitions of successful outcomes. In our patient's case, she ultimately felt empowered to serve as a public advocate and spread greater awareness and deeper understanding of this rare disease. In this case-based narrative, we highlight key educational teaching points of SPS, including important symptoms, treatments, comorbidities, laboratory findings, and related electromyography results. We also compare the physician and patient perspectives to remind trainees to keep in mind the person behind every diagnosis. Small gestures of compassion such as creating space in clinic to listen to a patient's story can lead to stronger patient-physician therapeutic alliances and improved quality of life.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 8","pages":"e213433"},"PeriodicalIF":7.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670430","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}