Therapeutic Advances in Neurological Disorders最新文献

{"title":"Brivaracetam monotherapy in juvenile myoclonic epilepsy: a safety and efficacy evaluation.","authors":"Jing-Wen Zuo, Ying-Yue Dai, Wen-Jing Liu, Jia-Ying Zhang, Xiao-Qiu Shao, Qun Wang, Rui-Juan Lv","doi":"10.1177/17562864261440217","DOIUrl":"https://doi.org/10.1177/17562864261440217","url":null,"abstract":"<p><strong>Background: </strong>The treatment of juvenile myoclonic epilepsy (JME) is limited, with most patients requiring long-term medication and over half experiencing seizure recurrence upon drug withdrawal. As a third-generation antiseizure medication, brivaracetam (BRV) has emerged as a promising therapeutic option. Its efficacy has been investigated in focal epilepsies and genetic generalized epilepsies (GGEs), with promising results.</p><p><strong>Objectives: </strong>This study aims to evaluate the safety and preliminary efficacy of BRV as an off-label initial monotherapy in patients with newly diagnosed JME, with a specific focus on the control of myoclonic seizures.</p><p><strong>Design: </strong>A prospective, single-center, and observational study.</p><p><strong>Methods: </strong>This study prospectively enrolled drug-naïve patients with JME. All participants received BRV monotherapy. Clinical data were collected at baseline and after a 6-month follow-up period, including demographic characteristics, electroencephalography (EEG), cranial magnetic resonance imaging (MRI), and comprehensive neuropsychological assessments. Changes in seizure frequency, cognitive function, levels of anxiety and depression, sleep quality, and quality of life from baseline to the 6-month follow-up were analyzed and compared.</p><p><strong>Results: </strong>A total of 19 patients were included with a mean age of 20.26 ± 6.88 years (median: 18, interquartile range: 8), and a male-to-female ratio of 12:7. The average age of onset was 14.58 ± 3.42 years, and the average duration of epilepsy prior to BRV treatment was 5.71 ± 7.40 years (median: 2, interquartile range: 5). The mean frequency of myoclonic seizures at baseline was 38.79 ± 45.60 times per month (median: 10, interquartile range: 86). Eighteen patients (94.73%) experienced both generalized tonic-clonic seizures (GTCS) and myoclonic seizures, one patient only experienced myoclonic seizures, The MRI findings were negative in all patients (100%). The EEG of all patients at baseline was abnormal, revealing 3-5.5 Hz generalized spike-and-wave or polyspike-and-wave discharges. At the 6-month evaluation, all patients achieved seizure-free status (<i>p</i> < 0.001), neuropsychological assessments also demonstrated significant improvement, including Montreal Cognitive Assessment (MoCA; <i>p</i> < 0.001), Hamilton Anxiety Scale (HAMA; <i>p</i> < 0.001), Hamilton Depression Scale (HAMD; <i>p</i> < 0.001), Pittsburgh Sleep Quality Index (PSQI; <i>p</i> < 0.001), and Quality of Life in Epilepsy-31 (QOLIE-31; <i>p</i> < 0.001). Only one patient complained of poor sleep after BRV administration.</p><p><strong>Conclusion: </strong>This study suggests that BRV may offer promising efficacy, specifically in controlling myoclonic seizures and favorable tolerability as an off-label initial monotherapy for JME patients. While the evaluation of efficacy against GTCS requires longer follow-up, our findings support the pote","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261440217"},"PeriodicalIF":4.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natalizumab for pediatric multiple sclerosis: a systematic review and meta-analysis.","authors":"Yasin Ebne-Ali-Heydari, Aryana Ramezani, Amirmohammad Jozayi, Mahdi Norouzi, Parto Zohrabi, Hasan Kaveyee","doi":"10.1177/17562864261440657","DOIUrl":"https://doi.org/10.1177/17562864261440657","url":null,"abstract":"<p><strong>Background: </strong>Pediatric-onset multiple sclerosis (POMS) is the onset of MS before the age of 18 and accounts for 3%-5% of all multiple sclerosis (MS) cases. Natalizumab (NTZ) is among the higher-efficacy disease-modifying treatments (HETs) in MS and is increasingly used for POMS.</p><p><strong>Objectives: </strong>In this systematic review and meta-analysis, we aimed to discuss the debate on the efficacy and safety of natalizumab use in POMS, providing quantitative results on relapse rate, disability progression, adverse events (AEs), and JC virus seropositivity.</p><p><strong>Design: </strong>The primary endpoint for meta-analysis was the mean difference (MD) in annualized relapse rate (ARR) after natalizumab compared to before treatment. Secondary outcomes were the MD of Expanded Disability Status Scale (EDSS) and the proportion of POMS patients experiencing AEs and JC virus seropositivity after natalizumab treatment.</p><p><strong>Data sources and methods: </strong>We performed a comprehensive search of PubMed, Embase, Web of Science, and Scopus between January 1, 1991 and May 1, 2025.</p><p><strong>Results: </strong>In this systematic review, 18 non-randomized interventional studies including 922 patients with POMS were included. Natalizumab therapy was associated with a mean reduction in ARR of -1.962 relapses per patient-year from baseline (95% confidence interval (CI): -2.449 to -1.475; <i>p</i> < 0.001). The drug was also associated with a statistically significant improvement in disability, with a mean change in EDSS of -0.807 from baseline (95% CI: -1.078 to -0.536; <i>p</i> < 0.001). After treatment, 18% of patients experienced AEs (95% CI: 0.11-0.25), and JC virus seropositivity was observed in 12% (95% CI: 0.07-0.17). No case of progressive multifocal leukoencephalopathy was reported among the 922 natalizumab-treated patients.</p><p><strong>Conclusion: </strong>Natalizumab may represent a viable therapeutic option for POMS patients exhibiting highly active disease or serves as an effective alternative in those with inadequate response to initial treatment. The safety profile remains acceptable, with most AEs being manageable.</p><p><strong>Registration: </strong>PROSPERO (CRD42024583911). This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261440657"},"PeriodicalIF":4.1,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of apomorphine in the treatment of Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.","authors":"Moaz Elsayed Abouelmagd, Abdallah Abbas, Obai Yousef, Atef Abdelrahman Hassan, Omar Kassar, Khalid Sarhan, Asmaa Zakria Alnajjar, Haneen Sabet, Mohamed Ahmed Zanaty, Hoda Awad, Muataz Kashbour, Fakhruddin Almuzghi, Matthew J Barrett, Brian Berman, Ahmed Negida","doi":"10.1177/17562864261436541","DOIUrl":"https://doi.org/10.1177/17562864261436541","url":null,"abstract":"<p><strong>Background: </strong>Motor fluctuations and OFF episodes are common complications of long-term levodopa therapy in Parkinson's disease (PD) and significantly impair quality of life. Apomorphine, a short-acting dopamine agonist, is available in multiple formulations for on-demand symptom relief; however, comparative evidence across administration routes remains limited.</p><p><strong>Objectives: </strong>To evaluate the efficacy and safety of apomorphine across various routes of administration in patients with PD.</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomized controlled trials and randomized crossover trials.</p><p><strong>Data sources and methods: </strong>A comprehensive search of PubMed, Scopus, Web of Science, CENTRAL, and Embase was conducted from inception to December 28, 2025. Eligible studies included randomized controlled or crossover trials assessing apomorphine versus placebo in PD. Primary outcomes were motor improvement measured by Unified Parkinson's Disease Rating Scale III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III) and OFF time. Safety outcomes included treatment-related adverse events. Risk of bias was assessed using the Cochrane RoB 2 tool. Pooled analyses were conducted using standardized mean differences (SMD), mean differences (MD), and risk ratios (RR) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Thirteen studies involving 557 patients were included. Apomorphine significantly improved motor symptoms across multiple administration routes. Intermittent subcutaneous (SC) injection showed the greatest efficacy (SMD: -2.19, 95% CI: (-3.32, -1.05), <i>p</i> < 0.0001). The inhalation and sublingual routes also showed significant improvement (SMD: -1.11, 95% CI: (-1.52, -0.7), <i>p</i> < 0.0001, <i>I</i> ² = 0%), (SMD: -1.69, 95% CI: (-1.99, -1.38), <i>p</i> < 0.0001, <i>I</i> ² = 0%) respectively. Intermittent SC injections also significantly reduced OFF time (MD = -1.62 h; 95% CI = (-2.59, -0.65); <i>p</i> < 0.00001). Adverse events were more frequent with apomorphine (RR 1.50, 95% CI = 1.09-2.06), particularly nausea, vomiting, dyskinesia, somnolence, yawning, and rhinorrhea.</p><p><strong>Conclusion: </strong>Apomorphine is an effective on-demand therapy for reducing motor symptoms and OFF time in PD, particularly when administered as intermittent SC injection. Although associated with increased mild-to-moderate adverse events, treatment choice should be individualized.</p><p><strong>Trial registration: </strong>PROSPERO (CRD42024548330).</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261436541"},"PeriodicalIF":4.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrovascular fibromuscular dysplasia.","authors":"Marion Boulanger, Ahmad Nehme, Emmanuel Touzé","doi":"10.1177/17562864251386246","DOIUrl":"https://doi.org/10.1177/17562864251386246","url":null,"abstract":"<p><strong>Background: </strong>Cerebrovascular fibromuscular dysplasia (FMD), that is, involving the cervical or intracranial arteries, is frequently overlooked despite its association with several neurological manifestations.</p><p><strong>Objectives: </strong>To describe cerebrovascular FMD.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Data sources and methods: </strong>We searched PubMed, Embase, and Medline up to December 2024. We identified additional studies by handsearching the bibliographies of relevant studies. We included articles describing at least one aspect of epidemiology, manifestations, prognosis, and management of cerebrovascular FMD and preferentially focused on studies including ⩾15 patients. The quality of evidence was rated according to the Oxford Centre for Evidence-Based Medicine levels of evidence.</p><p><strong>Results: </strong>We included 119 studies. Cerebrovascular FMD predominantly affects women around 50 years of age and most frequently involves the cervical arteries. Cerebrovascular FMD is frequently asymptomatic and incidentally diagnosed. The most common presenting symptoms are headache (8%-52%) and pulsatile tinnitus (17%-23%). Patients with FMD have a higher prevalence of cervical artery dissection (7%-17%) and intracranial saccular aneurysm (7%) compared to the general population. The main complications of cerebrovascular FMD are ischemic stroke (7%-10%), transient ischemic attack (5%-12%), subarachnoid hemorrhage (2%-3%), and intracerebral hemorrhage (0.01%). Webs are the predominant form of FMD in Black populations. Consensus-based recommendations have been summarized in the first international consensus statement on the diagnosis and management of FMD. Imaging of all arteries from brain-to-pelvis is recommended to detect asymptomatic lesions. Antiplatelet therapy is reasonable for patients with cerebrovascular FMD to prevent thromboembolic complications. Endovascular treatment can be considered in patients with risk factors for rupture of an unruptured intracranial aneurysm and in those with recurrent ischemic events despite medical management.</p><p><strong>Conclusion: </strong>Existing cross-sectional studies have improved the understanding of the manifestations of cerebrovascular FMD. However, knowledge gaps remain regarding the genetics, pathophysiology, management, and prognosis of cerebrovascular FMD, which should be addressed in future research.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864251386246"},"PeriodicalIF":4.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary observations on the efficacy of efgartigimod in anti-LGI1-associated autoimmune encephalitis.","authors":"Jing-Wen Zuo, Ying-Yue Dai, Wen-Jing Liu, Jia-Ying Zhang, Xiao-Qiu Shao, Qun Wang, Rui-Juan Lv","doi":"10.1177/17562864261437004","DOIUrl":"https://doi.org/10.1177/17562864261437004","url":null,"abstract":"<p><strong>Background: </strong>Leucine-rich glioma-inactivated 1 (LGI-1) antibodies are the second most common cause of autoimmune encephalitis, which is characterized by frequent seizures, memory loss, and psychiatric symptoms. Although most patients respond well to immunotherapy, treatment is often delayed or insufficient, resulting in a 14%-35% relapse rate and persistent neurological deficits. Therefore, exploring fast-acting and targeted therapies is crucial.</p><p><strong>Objectives: </strong>To present a series of cases involving anti-LGI1 encephalitis treated with efgartigimod, and to assess the efficacy and safety of this therapeutic approach in managing this condition.</p><p><strong>Design: </strong>A prospective, multicenter, and observational study.</p><p><strong>Methods: </strong>This study prospectively enrolled patients with anti-LGI1 encephalitis treated with efgartigimod and conducted a systematic review of the literature on the use of efgartigimod for anti-LGI1 encephalitis. The clinical outcomes before and 2 weeks after treatment were then compared.</p><p><strong>Results: </strong>A total of eight patients and two additional cases from the literature were included in the study, with a mean age of 55.6 ± 15.88 years and a male-to-female ratio of 6:4. The predominant clinical manifestations among the patients included seizures, psychiatric and behavioral abnormalities, and memory decline. Following treatment with efgartigimod, the modified Rankin scale (<i>p</i> = 0.006; 95% confidence interval (CI) 2-2.5), Clinical Assessment Scale in Autoimmune Encephalitis (<i>p</i> = 0.008; 95% CI 2.5-9.5), and Mini-Mental State Examination scores (<i>p</i> = 0.042; 95% CI 0-14) significantly improved. In addition, a significant reduction was observed in both serum IgG levels (<i>p</i> < 0.001; 95% CI 4.66-6.81) and antibody titers (<i>p</i> = 0.004) post-treatment, indicating that the degree of antibody decline is negatively correlated with clinical severity. No adverse events were reported for any of the patients in this study.</p><p><strong>Conclusion: </strong>This study suggests that efgartigimod may offer promising efficacy and safety for patients with anti-LGI1 encephalitis. Further randomized controlled trials involving larger cohorts and extended follow-up periods are required to validate these findings.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261437004"},"PeriodicalIF":4.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world effectiveness and safety of ofatumumab in multiple sclerosis: a longitudinal study integrating clinical, cognitive, and MRI outcomes.","authors":"Stefano Ziccardi, Damiano Marastoni, Pietro Biasi, Agnese Tamanti, Francesca Benedetta Pizzini, Milena Calderone, Valentina Camera, Maddalena Bertolazzo, Alice Daldosso, Bianca Milocco, Roberta Magliozzi, Massimiliano Calabrese","doi":"10.1177/17562864261434351","DOIUrl":"https://doi.org/10.1177/17562864261434351","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of several disease-modifying therapies for multiple sclerosis (MS) patients, the optimal strategy remains debated. High-efficacy therapies may better prevent subclinical disease activity and long-term disability; however, escalation remains frequent in real-world practice. Ofatumumab, an anti-CD20 monoclonal antibody, demonstrated robust efficacy and safety in clinical trials; however, real-world data are also essential.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of ofatumumab in relapsing MS (RMS), comparing outcomes between treatment-naïve and previously treated patients, and identify predictors of suboptimal response.</p><p><strong>Design: </strong>Prospective longitudinal observational study of RMS patients followed at the Verona MS Center.</p><p><strong>Methods: </strong>Clinical assessments, annual 3.0T brain MRI, and comprehensive neuropsychological testing were performed throughout follow-up. Treatment effectiveness was evaluated using no evidence of disease activity (NEDA), progression independent of relapse activity (PIRA), and cognitive PIRA. Safety was assessed by recording adverse events and treatment discontinuations.</p><p><strong>Results: </strong>Eighty-nine RMS patients (68.5% female, mean age 38.0 ± 10.4 years) were followed for a mean of 3 years. Overall, 91% achieved NEDA-3, with one relapse and one case of MRI activity. Seven patients (7.9%) developed PIRA, six of whom also fulfilled criteria for cognitive PIRA. Among 46 NEDA-3 patients who underwent longitudinal cognitive assessment, 37 (80.4%) did not exhibit cognitive worsening during follow-up and were classified as NEDA-4, indicating stability across clinical, radiological, and cognitive domains. In general, among patients with longitudinal cognitive data, 37 of 54 (68.5%) were NEDA-4. Naïve and previously treated patients showed comparable outcomes. Patients who failed to maintain NEDA-3 were older and had higher baseline disability, whereas in multivariable analyses, baseline Expanded Disability Status Scale (EDSS) was the only factor independently associated with NEDA-3 loss. When cognitive outcomes were included, associations between baseline clinical variables and NEDA-4 loss were attenuated. Ofatumumab was well-tolerated, with mostly mild transient injection-related reactions and 2 (2.2%) treatment discontinuations due to adverse events.</p><p><strong>Conclusion: </strong>Ofatumumab provided sustained multidimensional disease control, high NEDA-4 rates, and excellent tolerability. Baseline EDSS was the primary predictor of suboptimal response, underscoring the importance of early intervention. These findings support early anti-CD20 therapy as an effective strategy to preserve neurological function and limit long-term progression.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261434351"},"PeriodicalIF":4.1,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of chronic subdural hematoma-new insights.","authors":"Misa Trieu, Ajith J Thomas","doi":"10.1177/17562864261435399","DOIUrl":"https://doi.org/10.1177/17562864261435399","url":null,"abstract":"<p><p>Chronic subdural hematoma (CSDH) is an increasingly common disorder characterized by persistent accumulation of blood products and inflammatory exudate within the dural border cell (DBC) layer. Its pathogenesis represents a self-sustaining cycle of inflammation, pathological angiogenesis, and impaired resolution. Injury of the head, which may be traumatic or nontraumatic, initiates cleavage of the DBC layer, leading to fibroproliferative membrane formation mediated by collagen synthesis and TGF-β1/SMAD signaling. The resulting outer membrane develops fragile neovasculature, driven primarily by vascular endothelial growth factor, facilitating recurrent microhemorrhage and fibrinolysis perpetuating hematoma expansion. Chronic inflammation sustains disease progression through macrophage polarization, cytokine release, and increased vascular permeability, processes amplified by age-related immune dysregulation and hypoxia-induced factor-1alpha signaling. Impaired tissue repair due to metabolic deficits further limits resolution. Concurrent dysfunction of meningeal lymphatic drainage and fibrotic arachnoid granulations compromises clearance of blood degradation products and inflammatory mediators, while matrix remodeling and cerebrospinal fluid ingress contribute to hematoma persistence. This narrative review presents a pathophysiologic framework highlighting CSDH as a dynamic inflammatory-angiogenic disorder. Pharmacological strategies targeting inflammation, angiogenesis, fibrinolysis, hypoxia, and matrix remodeling hold potential as complements or alternatives to established treatments, including surgical drainage and middle meningeal artery embolization. As the burden of CSDH on healthcare systems rises, translational research and controlled clinical trials will be critical to developing mechanism-driven, multimodal management paradigms.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261435399"},"PeriodicalIF":4.1,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroglial markers of damage in autoimmune neurology.","authors":"Alessandro Dinoto, Sara Mariotto","doi":"10.1177/17562864261433329","DOIUrl":"https://doi.org/10.1177/17562864261433329","url":null,"abstract":"<p><p>The advancements in assays for the detection of neuroglial markers of damage, such as neurofilament light chain and glial fibrillary acid protein, have led to a growing interest in their investigation in neurological disorders. In this review, we aim to summarize evidence regarding the role of biomarkers of neuroglial damage in autoimmune neurological disorders of the central nervous system, including myelin oligodendrocyte glycoprotein antibody-associated disease, neuromyelitis optica spectrum disorder, autoimmune encephalitis, and paraneoplastic neurological syndromes. We will discuss how these biomarkers can help our understanding of disease mechanisms and how these results can be potentially translated into clinical practice, helping clinicians in the differential diagnosis, in prognostication, and prediction of the risk of relapse.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261433329"},"PeriodicalIF":4.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Delphi consensus on integrating novel therapies into the management of generalized myasthenia gravis.","authors":"John Vissing, Fritz Zimprich, Sari Atula, Andrew Chan, Henning Andersen, Raffi Topakian, Martijn R Tannemaat, Konrad P Weber, Hakan Cetin, Christoph Neuwirth, Hanna Kuusisto, Wolfgang N Loescher","doi":"10.1177/17562864261429176","DOIUrl":"https://doi.org/10.1177/17562864261429176","url":null,"abstract":"<p><strong>Background: </strong>The treatment landscape for myasthenia gravis (MG) has evolved with the introduction of novel therapies. An international consensus on patient selection criteria and optimal time to initiate these therapies could improve clinical outcomes and reduce delays for likely beneficiaries.</p><p><strong>Objective: </strong>This Delphi consensus was undertaken by MG specialists from selected European countries to explore gaps in the application of national guidelines and elicit expert opinion in practice.</p><p><strong>Design: </strong>A mixed-method approach was used; qualitative and quantitative study phases were combined to explore key concepts and reach consensus.</p><p><strong>Methods: </strong>The qualitative first phase involved seven healthcare professionals (HCPs) and two patient advocacy group representatives who participated in idea generation. Findings from this phase supported the development of a Delphi survey, which was completed by 16 HCPs in two rounds. This constituted the quantitative second phase of the study. Consensus was defined as ⩾70% agreement or disagreement on a 6-point Likert scale.</p><p><strong>Results: </strong>In total, 65% of statements achieved consensus. Key findings include-HCPs highly regard international guidelines but find critical discrepancies between the \"ideal\" scenario and current clinical practices. Consensus was achieved on the importance of incorporating patient-related quality of life in decision-making, despite limited current methods. Consensus was obtained on steroid tapering and treatment-switch criteria based on steroid dose and duration. Consensus was also achieved on suitable patient profiles, including those with persistent symptoms, severe side effects, or needing rapid control.</p><p><strong>Conclusion: </strong>This study recognized that guidelines offer valuable direction but do not replace individualized treatment decisions. This study identified the areas of alignment and opportunities to refine patient selection criteria and treatment-switch categories, particularly to integrate novel therapy use in MG management, highlighting a path to a more patient-centric approach.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261429176"},"PeriodicalIF":4.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glymphatic dysfunction in drug-resistant epilepsy and its association with vagus nerve stimulation outcomes: a DTI-ALPS study.","authors":"Ziao Xu, Xiaofeng Wang, Bohang Liu, Xuefei Ji, Ming Shan, Hongwei Cheng, Lei Ye","doi":"10.1177/17562864261436543","DOIUrl":"https://doi.org/10.1177/17562864261436543","url":null,"abstract":"<p><strong>Background: </strong>The glymphatic system (GS) is critical for interstitial fluid clearance and has been implicated in various neurological disorders. However, its role in drug-resistant epilepsy (DRE) and response to vagus nerve stimulation (VNS) remains unclear.</p><p><strong>Objectives: </strong>This study aimed to assess GS function in patients with DRE using diffusion tensor image analysis along the perivascular space (DTI-ALPS) and to explore its association with VNS outcomes.</p><p><strong>Design: </strong>Data from patients with DRE who underwent VNS were retrospectively analyzed at a single center.</p><p><strong>Methods: </strong>Forty patients with DRE and 30 healthy controls were enrolled. ALPS indices were calculated for the left (ALPS-L), right (ALPS-R), and bilateral (ALPS-B) hemispheres. The clinical outcomes after VNS were classified using McHugh outcome classification. Statistical comparisons and logistic regression were used to examine group differences and the predictive value of ALPS indices.</p><p><strong>Results: </strong>Compared to controls, patients with DRE exhibited significantly reduced ALPS-L (<i>p</i> < 0.001) and ALPS-B (<i>p</i> = 0.005) indices. Among patients with DRE, responders to VNS had significantly higher ALPS-R (<i>p</i> = 0.021) and ALPS-B (<i>p</i> = 0.027) indices than nonresponders. ALPS-L exhibited a positive trend (<i>p</i> = 0.073). In logistic regression analyses, ALPS-R and ALPS-B were significantly associated with favorable VNS outcomes in univariate and multivariate models. After adjusting for age, sex, and disease duration, ALPS-L (<i>p</i> = 0.028, odds ratio (OR) = 2.739), ALPS-R (<i>p</i> = 0.020, OR = 2.802), and ALPS-B (<i>p</i> = 0.020, OR = 3.241) all emerged as independent predictors of VNS response.</p><p><strong>Conclusion: </strong>Glymphatic dysfunction is present in DRE and may influence responsiveness to VNS. Higher ALPS indices predicted better treatment outcomes, supporting ALPS potential as a noninvasive imaging biomarker for presurgical stratification in epilepsy.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261436543"},"PeriodicalIF":4.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}