The Lancet Neurology最新文献

{"title":"Personalised therapies for children and adolescents with Dravet syndrome","authors":"Antonella Riva, Pasquale Striano","doi":"10.1016/s1474-4422(26)00128-6","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00128-6","url":null,"abstract":"No Abstract","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of individualised exercise and NAD+ precursor supplementation in patients with Friedreich's ataxia in the USA: a single-centre, 2 × 2 factorial, randomised controlled trial","authors":"Kimberly Y Lin, Anna Bucha, Kara McSweeney, Kristin L Wade, Antoneta Karaj, Jaclyn Tamaroff, Shannon O’Malley, Nicole M Chung, Nicolette A Cilenti, Julianne Wanner, Gabriel K Adzika, Clementina Mesaros, Ian A Blair, Teerapat Rojsajjakul, Suraj Serai, Jennifer Farmer, Kyle Bryant, Yingying Lu, Michael O Harhay, David R Weber, Shana E McCormack","doi":"10.1016/s1474-4422(26)00082-7","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00082-7","url":null,"abstract":"<h3>Background</h3>Friedreich's ataxia is a rare, chronic, progressive, neurodegenerative condition affecting multiple organ systems, including neurological, musculoskeletal, cardiac, and endocrine systems, and is marked by low cardiopulmonary fitness. We tested the effect of exercise and NAD<sup>+</sup> precursor supplementation with nicotinamide riboside, which have each shown benefits in animal and early clinical studies, on cardiopulmonary fitness in individuals with Friedreich's ataxia.<h3>Methods</h3>This 12-week, outpatient, phase 2, single-site (Children's Hospital of Philadelphia, Philadelphia, PA, USA), randomised, 2 × 2 factorial clinical trial recruited individuals aged 10–40 years with an ejection fraction of 45% or greater who were able to exercise. A computer-generated randomisation sequence was developed by the trial statistician. Random allocation was age-stratified (<18 years <em>vs</em> ≥18 years) to one of four groups: placebo and no exercise with attention control (weekly phone calls; henceforth placebo only), nicotinamide riboside and no exercise with attention control (henceforth nicotinamide riboside only), placebo and exercise (exercise only), and nicotinamide riboside and exercise (combination therapy). Individualised exercise plans were developed by the exercise physiologist (three aerobic and two resistance training sessions weekly), performed at the individual's home, and overseen remotely (telephone check-ins by the physiologist). Weight-based dosing of nicotinamide riboside or placebo was 300 mg (1 capsule) for weights of 24 kg up to 48 kg, 600 mg (2 capsules) for weight 48 kg up to 72 kg, and 900 mg (3 capsules) for weights of over 72 kg. The primary outcome was change in peak VO<sub>2</sub> (L/min) during cardiopulmonary exercise testing at 12 weeks versus baseline, and the effect of treatment group was assessed in a statistical model accounting for age (stratification variable), sex, and baseline peak VO<sub>2</sub>. Stage 1 analysis tested the difference between each active treatment versus the control group, and stage 2 analysis (if combination therapy was effective) tested the difference between combination treatment and exercise alone; family-wise type 1 error was maintained <0·05. Analyses were by intention-to-treat. Adverse events were recorded systematically. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (NCT04192136) and is complete.<h3>Findings</h3>Between Sept 3, 2020, and April 23, 2025, we enrolled 74 individuals, of whom 66 met the eligibility criteria and were randomly allocated to the four study groups. All participants completed the study. 33 (50%) were children (aged 10–17 years) and 33 (50%) were adults (aged ≥18 years); 37 (56%) were male and 29 (44%) were female. L","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burden of meningitis, its risk factors, and aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023","authors":"","doi":"10.1016/s1474-4422(26)00101-8","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00101-8","url":null,"abstract":"<h3>Background</h3>Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework.<h3>Methods</h3>GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk–outcome pairs and population attributable fractions.<h3>Findings</h3>In 2023, there were 259 000 (95% uncertainty interval 202 000–335 000) global deaths and 2·54 million (2·20–2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300–149 000]). <em>Streptococcus pneumoniae, Neisseria meningitidis</em>, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (<em>S pneumoniae, N meningitidis, Haemophilus influenzae</em>, and Group B streptococcus) contributed to 98 700 deaths (77 000–127 000) and 594 000 cases (514 000–686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality.<h3>Interpretation</h3>Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as <em>S pneumoniae</em> and <em>N meningitidis</em> and to emerging non-bacterial pathogens such as <em>Candida</em> spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings.<h3>Funding</h3>Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147523933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global burden of meningitis: progress, gaps, and priorities","authors":"Merijn W Bijlsma","doi":"10.1016/s1474-4422(26)00125-0","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00125-0","url":null,"abstract":"No Abstract","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"472 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Neurol 2024; 23: 1119–32","authors":"","doi":"10.1016/s1474-4422(26)00043-8","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00043-8","url":null,"abstract":"<em>Montalban X, Vermersch P, Arnold DL, et al. Safety and efficacy of evobrutinib in relapsing multiple sclerosis (evolutionRMS1 and evolutionRMS2): two multicentre, randomised, double-blind, active-controlled, phase 3 trials.</em> Lancet Neurol <em>2024; <strong>23:</strong> 1119–32</em>—In this Article, the fourth column of table 2 for row “Adjusted mean number of lesions per scan” should have been 0·31 (0·26 to 0·37), the second sentence of the eighth paragraph in Results should read “Most patients (999 [88%] of 1131) exceeded the target exposure of 400 ng/mL × h”, and the appendix has been corrected. Belgin Petek Balcı should have been included in the EvolutionRMS2 investigator list. These corrections have been made to the online version as of March 18, 2026.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"146 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Marine neurology","authors":"Mark Weatherall","doi":"10.1016/s1474-4422(26)00081-5","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00081-5","url":null,"abstract":"No Abstract","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurootologists' role as piano technicians | The Great Balancing Act, Jeffrey D Sharon, An Insider's Guide to the Human Vestibular System, Columbia University Press (2025), p. 264, £25·00, ISBN: 9780231218634","authors":"Diego Kaski","doi":"10.1016/s1474-4422(26)00096-7","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00096-7","url":null,"abstract":"No Abstract","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand prostheses with somatosensory feedback: functional and clinical benefits","authors":"Solaiman Shokur, Michela Bassolino, Norbert Kang, Rochelle Ackerley, Silvestro Micera","doi":"10.1016/s1474-4422(25)00493-4","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00493-4","url":null,"abstract":"The loss of a hand can disrupt body movements, perception of self and the surrounding world, and the emotional fabric of touch. Advances in neuroprosthetics now make restoration of tactile, proprioceptive, and thermal sensations feasible through interfaces with peripheral nerves, the spinal cord, or skin. These somatosensory neuroprostheses not only improve the manipulation of objects and motor learning after amputation, but can also reduce phantom limb pain and enhance embodiment of the artificial limb. The combination of multiple sensory channels—such as touch and temperature—can resemble a natural and emotionally resonant experience for prosthetic users, supporting both their agency and social connection. However, clinical translation remains insufficient. Progress will depend on accessible, cost-effective, and user-centred solutions that are validated through clinical trials. By restoring the sensory richness of the human hand, multimodal feedback can shift prosthetic care beyond mechanical replacement towards truly restoring the sense of self and connection that touch provides.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of direct versus conventional transfer to angiography suite in patients with severe acute stroke treated with thrombectomy (DIRECT ANGIO) in France: a multicentre, open-label, blinded-endpoint, randomised controlled trial","authors":"Benjamin Gory, Benjamin Maïer, Raoul Pop, Valérie Wolff, Sébastien Soize, Solène Moulin, Arturo Consoli, Bertrand Lapergue, Vincent Costalat, Caroline Arquizan, Gaultier Marnat, Igor Sibon, Ariel Pablo Lebedinsky, Francis Vuillemet, Raphaël Blanc, Candice Sabben, Louis Veunac, Stéphanie Bannier, Johann Sebastian Richter, Hélène Castagnet, Raluca Marasescu","doi":"10.1016/s1474-4422(26)00056-6","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00056-6","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Direct transfer to angiography suite (DTAS) for patients with suspected stroke primarily admitted to an endovascular-capable centre could accelerate in-hospital workflow and improve outcome. We aimed to assess the safety and efficacy of DTAS for patients with acute severe neurological deficit highly suggestive of ischaemic stroke due to a large vessel occlusion (ASND-LVO).&lt;h3&gt;Methods&lt;/h3&gt;We did an open-label, multicentre, randomised controlled trial in ten comprehensive stroke centres in France. We enrolled adult patients (age ≤85 years) with ASND-LVO (unilateral motor deficit with a score ≥5 plus a cortical symptom with a score ≥1 based on the National Institues of Health Stroke Scale) admitted within 5 h of symptom onset. Patients were randomly assigned (1:1) with a web-based system to DTAS or conventional pathway (ie, imaging followed by transfer to the angiography suite for endovascular treatment if eligible). The primary outcome was functional independence defined as a modified Rankin Scale score 0 to 2 at 90 days in the intention-to-treat population—ie, all randomly assigned patients in their originally assigned treatment groups, irrespective of diagnosis, imaging findings, or treatments received. Symptomatic intracranial haemorrhage and all-cause mortality at 90 days were the main safety outcomes. This study was registered on &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; (&lt;span&gt;&lt;span&gt;NCT03969511&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;).&lt;h3&gt;Findings&lt;/h3&gt;Between July 9, 2020, and April 18, 2023, 115 patients were randomly assigned to the DTAS group (n=57) or the conventional group (n=58). An interim analysis was done on Sept 27, 2023. The trial steering committee permanently stopped the trial on Dec 1, 2023, for safety reasons after unmasking and analysis of the data. In the intention-to-treat analysis, the risk of symptomatic intracranial haemorrhage was increased in the DTAS group compared with the conventional group (five [15%] of 34 &lt;em&gt;vs&lt;/em&gt; zero [0%] of 42; adjusted odds ratio [OR] 11·0 [95% CI 1·28–1406]). All-cause mortality did not differ significantly between groups (ten [18%] of 56 &lt;em&gt;vs&lt;/em&gt; six [11%] of 53; adjusted OR 1·65 [95% CI 0·52–5·55]). Functional independence was reached in 20 [36%] of 56 participants in the DTAS group &lt;em&gt;vs&lt;/em&gt; 22 [42%] of 53 in the conventional group (adjusted OR 0·73 [95% CI 0·32–1·69]).&lt;h3&gt;Interpretation&lt;/h3&gt;DTAS for patients with ASND-LVO was associated with an increased risk of symptomatic intracranial haemorrhage without evidence of a beneficial effect on functional outcome at 90 days. However, because the tria","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"12 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in China: advances in prevention and management on the path to a healthy China","authors":"Simiao Wu, Yanan Wang, Junfeng Liu, Craig S Anderson, Zhengming Chen, Peter A G Sandercock, Thanh N Nguyen, Xunming Ji, Yongjun Wang, Jinsheng Zeng, Bin Peng, Xinfeng Liu, Zhouping Tang, Qingwu Yang, Yun Xu, Bo Wu, Ming Liu","doi":"10.1016/s1474-4422(26)00009-8","DOIUrl":"https://doi.org/10.1016/s1474-4422(26)00009-8","url":null,"abstract":"The incidence and mortality of stroke have decreased in China in the past decade; however, the prevalence of stroke continues to rise because of population ageing. In alignment with the Healthy China 2030 blueprint, there has been a strategic reorientation of health-care services towards the prevention of major diseases, including stroke. Along with the establishment of a nationwide network of stroke centres to enhance the delivery of stroke care and research, progress has also been made in understanding stroke aetiology, screening for and control of risk factors, and promoting early diagnosis and treatment. Evidence from high-quality randomised trials in China supports the wide adoption of reperfusion therapies for ischaemic stroke, early blood pressure lowering after intracerebral haemorrhage, individualised approaches to secondary prevention, and the research evaluation of traditional Chinese medicine and neuroprotective agents. Future efforts should focus on promoting a healthy lifestyle, public education on awareness of stroke prevention and timely access to stroke services, training of stroke clinicians on evidence-based stroke care, and improvements in both pre-hospital and post-hospital stroke services.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}