Therapeutic Advances in Neurological Disorders最新文献

{"title":"Implantable vagus nerve stimulation for the treatment of disorders of consciousness with epilepsy: a retrospective propensity score-matched clinical study.","authors":"Jinyi Zuo, Kaiqiang Ma, Zizhang Cheng, Shu Wang, Xiongfei Wang, Weijin Sun, Junhong Pan, Xintao Peng, Wenlong Su, Haoran Zhang, Jian Zhou, Guoming Luan, Yuguang Guan","doi":"10.1177/17562864261452312","DOIUrl":"10.1177/17562864261452312","url":null,"abstract":"<p><strong>Background: </strong>Disorders of consciousness (DoC) have limited effective therapies. Implantable vagus nerve stimulation (VNS) is established for epilepsy but remains underexplored for DoC with comorbid epilepsy.</p><p><strong>Objectives: </strong>To evaluate whether VNS is associated with improved consciousness recovery in DoC patients with epilepsy and to explore factors related to response.</p><p><strong>Design: </strong>Retrospective propensity score-matched cohort study.</p><p><strong>Methods: </strong>Ninety DoC patients with epilepsy received implantable VNS or conservative management. The primary outcome was clinically meaningful improvement at 1 year (Coma Recovery Scale-Revised (CRS-R) increase ⩾3 points). Propensity score matching (1:1) balanced baseline characteristics (23 per group). Longitudinal CRS-R trajectories were assessed using linear mixed-effects models with Type III ANOVA. Logistic regression within the VNS cohort explored factors associated with responder status; adverse events were extracted from operative and follow-up records.</p><p><strong>Results: </strong>The 1-year responder rate was higher with VNS than with conservative management (34.78% vs 4.35%; two-sided Fisher's exact test, <i>p</i> = 0.022). Longitudinal analyses showed a significant group × time interaction (χ² = 43.535, <i>p</i> < 0.001) with greater CRS-R gains from 3 months onward in the VNS group. Within the VNS cohort, responder status was associated with baseline minimally conscious state (aOR = 9.750, 95% confidence interval (CI) 1.592-59.695; <i>p</i> = 0.014) and better seizure control (McHugh classification; aOR = 22.667, 95% CI 3.140-163.629; <i>p</i> = 0.002). Traumatic etiology was not associated with 12-month net CRS-R improvement after adjustment for baseline CRS-R (β = 0.893, 95% CI -1.583 to 3.369; <i>p</i> = 0.466). Five patients reported stimulation-related hoarseness/dysphonia, and two had surgical-site complications; no device removal occurred.</p><p><strong>Conclusion: </strong>Implantable VNS was associated with higher 1-year clinically meaningful improvement and greater longitudinal CRS-R gains than conservative management in DoC patients with epilepsy. Prospective controlled studies are warranted.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261452312"},"PeriodicalIF":4.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876027","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":"The association between BMI and cognition, disability, and quality of life markers in multiple sclerosis: DISCOMS secondary analysis.","authors":"Aliza Bitton Ben-Zacharia, Gary Cutter, Alya Shor, Charity Morgan, Eric Engebretson, John Corboy, Shiela M Strauss","doi":"10.1177/17562864261463625","DOIUrl":"10.1177/17562864261463625","url":null,"abstract":"<p><strong>Background: </strong>The association between body mass index (BMI) and cognition, disability, and quality of life (QoL) is controversial in multiple sclerosis (MS).</p><p><strong>Objectives: </strong>We investigated the association between BMI and cognitive function, disability, and QoL in MS.</p><p><strong>Methods: </strong>A cross-sectional secondary analysis of the DISCOMS trial was performed to study the association between BMI and cognition, disability, and QoL. Cognitive function was measured by the symbol digit modalities test (SDMT) and disability was measured based on the expanded disability status scale (EDSS) and patient determined disability steps (PDDS). QoL markers were measured by the Quality of Life in Neurological Disorders. Descriptive and inferential statistics were used to analyze the association between BMI and cognition, disability, and QoL.</p><p><strong>Results: </strong>The study included 253 participants, mostly female (83.8%) and white (89.3%). Their mean BMI was 27.27 (SD = 5.6), and 62% were overweight, obese, or very obese. Controlling for age, gender, and disease-modifying therapy duration, BMI as a continuous or as a categorical variable was not associated with cognitive function as measured by the SDMT or disability as measured by the EDSS and/or the PDDS. EDSS as a dichotomous variable was associated with BMI; 1-unit increase in BMI was associated with a 5.7% increase in the odds of having an EDSS score greater than 4 (β = 0.055, <i>p</i> = 0.045). Higher continuous BMI was associated with physical domains dysfunction; worse fatigue (<i>p</i> = 0.009), and worse lower extremities function (<i>p</i> = 0.008), while the very obese group had a higher risk of physical and emotional domain dysfunction than the normal BMI group.</p><p><strong>Conclusion: </strong>The lack of observed associations between BMI and cognitive function or disability in this older MS cohort suggests that the relationship between BMI and clinical outcomes may vary across domains. Nevertheless, the associations identified between BMI and QoL measures emphasize the potential importance of weight management in supporting overall health and well-being among individuals with MS.</p><p><strong>Trial registration of the primary discoms study: </strong>ClinicalTrials.gov NCT03073603.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261463625"},"PeriodicalIF":4.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876025","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":"The impact of concomitant use of rosuvastatin or atorvastatin plus clopidogrel on the platelet inhibition and clinical outcomes in acute large-vessel minor stroke or TIA: A randomized controlled multi-center trial, the ROCATIS-1 trial.","authors":"Mohamed G Zeinhom, Mohamed Gamal Sayed Ismaiel, Mohamed Fouad Elsayed Khalil, Ahmad Galal Elmesallami, Ghada Abd Elwahab Khalil, Ahmed Zaki Omar Akl, Shady S Georgy, Abdelrahman A Abbas, Youssry Salah Shafiq Kerolos, Sabry M Abdeldayem, Enji Hamdy Elsawy Khalil, Emad Mostafa, Tarek Youssif Omar Youssif, Amir Ahmed Elsaeed Egila, Adnan Ghazi Alkhalefeh, Asmaa Mohammed Hassan, Tamer Shaaban Zedan, Ahmed Elsayed Ghoname, Emad Labib Abdelhamid Mahmoud, Asma Mushtaque, Ahmed Mostafa Abdelkhalek, Eman Abdelmonsef Abdelaziz Ghazi, Sherihan Rezk Ahmed","doi":"10.1177/17562864261483407","DOIUrl":"10.1177/17562864261483407","url":null,"abstract":"<p><strong>Background: </strong>Although clopidogrel is commonly used for ischemic stroke secondary prevention, 20-50% of patients experienced clopidogrel failure and recurrence of ischemic events.</p><p><strong>Objectives: </strong>We aimed to evaluate the benefits or hazards of adding atorvastatin or rosuvastatin to clopidogrel on the clopidogrel-induced inhibition of platelet activation and vascular events prevention.</p><p><strong>Design: </strong>Our multi-center, randomized, single-blinded, parallel-group trial was conducted between 10th April 2024 and 10th May 2026.</p><p><strong>Methods: </strong>600 first-ever, large-vessel minor ischemic stroke or TIA patients received 40 mg of atorvastatin or 20 mg of rosuvastatin during the first 24 hours of stroke onset once daily till the 90th day after stroke onset. Both groups received open-label 300 mg loading doses of aspirin and clopidogrel during the first 24 hours after stroke onset, followed by 75 mg clopidogrel and 100 mg aspirin once daily for 3 weeks, then 75 mg clopidogrel only until the end of the follow-up period. We followed up with our patients for 3 months.</p><p><strong>Results: </strong>The change in the percentage of platelet maximum aggregation at 3 months of treatment compared with baseline while using adenosine diphosphate <b>(</b>ADP), 5 µM/L as an agonist was 54.4 (51.0-57.1) in the rosuvastatin group compared with 49.2 (45.5-52.3) in the atorvastatin group with P-value 0.003. 22 (7.3%) patients in the rosuvastatin group and 40 (13.3%) patients in the atorvastatin group experienced a composite of a new stroke, MI, or death due to vascular insults (HR 0.52; 95% CI, 0.33-0.81; P-value= 0.004), moreover, 12 (4.0%) patients in the rosuvastatin group and 19 (6.3%) in the atorvastatin group experienced recurrent stroke either ischemic or hemorrhagic, with (HR 0.60; 95% CI, 0.32-1.10; P-value 0.10).</p><p><strong>Conclusion: </strong>Compared with combining atorvastatin with clopidogrel in African large-vessel minor stroke or TIA, combining rosuvastatin with clopidogrel yielded higher rates of clopidogrel-induced platelet aggregation inhibition, significantly lower rates of a composite of recurrent stroke, MI, and death due to vascular events at three months. There were no significant differences between rosuvastatin and atorvastatin regarding drug-related side effects. Our findings are hypothesis-generating and require confirmation in a double-blinded, multinational randomized trial before they can inform practice.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261483407"},"PeriodicalIF":4.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840757","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":"Implementing the 2024 revision of the McDonald diagnostic criteria for multiple sclerosis in Germany: Practical considerations and consensus recommendations.","authors":"Mike P Wattjes, Antonios Bayas, Stefan Bittner, Birte Elias-Hamp, Ralf Linker, Daniela Rau, Thomas Skripuletz, Ralf Gold","doi":"10.1177/17562864261481602","DOIUrl":"10.1177/17562864261481602","url":null,"abstract":"<p><p>Early and reliable diagnosis of multiple sclerosis (MS) is critical for initiating an appropriate disease-modifying therapy (DMT). The 2024 revisions of the McDonald diagnostic criteria incorporate novel fluid and imaging biomarkers aiming to facilitate an accurate and timely diagnosis. The aim of this point-of-view paper is to discuss the implementation of the 2024 McDonald criteria in the clinical routine setting in context of the German Health care system and provide consensus recommendations by an interdisciplinary expert panel. A multidisciplinary panel of nine experts in the field of diagnosis and treatment of MS convened to discuss the potential advances and challenges of the clinical implementation of the 2024 McDonald criteria and develop consensus recommendations. The panel identified implementation challenges regarding limited specialized resources for the suggested additional imaging markers such as the detection of optic nerve (ON) lesions, paramagnetic rim lesions (PRLs) and the demonstration of lesions with a central vein sign (CVS) as well as the implementation of kappa free light chains (kFLC) in Germany. We advocate a stratified diagnostic approach: cerebrospinal fluid (CSF) analysis remains essential. The consideration of ON lesions, PRLs and lesions with a CVS should be reserved for diagnostic situations in which the diagnosis cannot be established with conventional MRI protocols or other methods for examination of the optic nerve. To minimize misdiagnosis and to address the complexity of treating radiologically isolated syndrome, there is a necessity of continuous professional training and nuanced, patient-centered therapeutic strategies, especially for individuals with radiologically isolated syndrome but also for atypical presentations. In conclusion, the 2024 revisions of the McDonald criteria aim to facilitate an accurate and early diagnosis of MS potentially enabling earlier MS therapy initiation. However, the routine implementation, particularly regarding the new imaging markers, requires an expansion of resources and expertise limiting the general applicability in the German healthcare system.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261481602"},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840103","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":"OnabotulinumtoxinA for chronic migraine: A real-life multicenter study of 479 patients.","authors":"Marta Waliszewska-Prosół, Karol Marschollek, Małgorzata Paczkowska, Jarosław Sławek, Marta Bott-Karoń, Magdalena Hellmann, Bartosz Karaszewski, Krzysztof Wierzbicki, Monika Adamczyk-Sowa, Magdalena Konieczna-Brazis, Milena Świtońska, Sylwia Kujawa, Andrzej Fabian, Paulina Lange, Edyta Leśniewska-Furs, Joanna Bielewicz, Kinga Caban-Ułanek, Konrad Rejdak, Iwona Rościszewska-Żukowska, Ilona Malska, Anna Bieniasiewicz, Beata Łabuz-Roszak, Elżbieta Gradek-Kwinta, Małgorzata Smyczyńska, Małgorzata Boroń, Sławomir Budrewicz","doi":"10.1177/17562864261476132","DOIUrl":"10.1177/17562864261476132","url":null,"abstract":"<p><strong>Background: </strong>Chronic migraine (CM) is a neurological disorder that poses significant treatment challenges, particularly when complicated by medication-overuse headache (MOH).</p><p><strong>Objectives: </strong>This study aimed to evaluate the effectiveness of onabotulinumtoxin A (BoNT-A) in a large cohort of Polish patients within national reimbursement program and to identify clinical predictors of treatment response.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Methods: </strong>This was a retrospective multicenter observational study of 479 patients (88.9% female, mean age 43.6±11.6 years) treated with BoNT-A (195 U, PREEMPT protocol) across 12 tertiary headache centers. All patients had failed at least two prior oral preventive therapies. Effectiveness was assessed after three treatment cycles (9 months). Uni- and multivariable logistic regression analyses were performed to evaluate factors associated with treatment response, defined as a ≥50% reduction in monthly headache days (MHD).</p><p><strong>Results: </strong>At baseline, the mean MHD was 19.1±4.4. After 9 months, the mean reduction in MHD was 5.9±5.4 days, and the Migraine Disability Assessment Scale (MIDAS) score improved by an average of 52.7±48.3 points. At the 9-month follow-up, 27.3% of patients achieved a ≥50% reduction in MHD, and 23.2% were partial responders (25-49% reduction). Notably, 41.6% of patients with concomitant MOH at baseline no longer met the criteria for MOH after treatment. Multivariable analysis identified a positive family history of migraine (OR=0.55; 95% CI 0.36-0.84; p=0.005) and ≥4 prior preventive medication failures (OR=0.61; 95% CI 0.37-0.98; p=0.04) as independent predictors of a poorer response. However, the model demonstrated low discriminative ability (AUC=0.605; cross-validated AUC=0.54).</p><p><strong>Conclusions: </strong>BoNT-A is an effective and safe treatment for CM in a real-world setting, significantly reducing headache burden and MOH rates. While high treatment resistance and genetic predisposition were statistically associated with a poorer response, the poor predictive ability of the clinical model suggests that standard clinical phenotypes alone are insufficient to predict BoNT-A outcomes. These findings highlight the challenges of managing highly refractory populations within strict programmatic frameworks.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261476132"},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840741","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":"Preserved neurovascular coupling in early multiple sclerosis is associated with reduced white matter lesion burden.","authors":"Cristina Duque, João Sargento-Freitas, Roumen Balabanov, Bruce Cohen, Farzaneh Sorond","doi":"10.1177/17562864261481753","DOIUrl":"10.1177/17562864261481753","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by inflammation, demyelination and axonal degeneration of the central nervous system. Whether these pathological changes impact neurovascular coupling (NVC), which can be compromised in various neurodegenerative disorders, remains unclear in MS.</p><p><strong>Objectives: </strong>To investigate the relationship between NVC, clinical characteristics and neuroimaging measures in patients with MS.</p><p><strong>Design: </strong>We conducted a cross-sectional study of patients with MS recruited from the Comprehensive Multiple Sclerosis Clinic at Northwestern Medicine, Chicago, USA.</p><p><strong>Methods: </strong>Seventy-six patients with MS underwent NVC assessment using transcranial Doppler (TCD) ultrasound in the middle cerebral artery (MCA) and posterior cerebral artery (PCA) territories. Clinical assessment included manual dexterity, cognitive function and gait. Brain magnetic resonance imaging (MRI) quantified white matter hyperintensity (WMH), gray matter (GM) and white matter (WM) volumes. Associations were examined using multivariate linear regression, adjusting for demographic and vascular risk factors, and stratified by disability and cognitive performance.</p><p><strong>Results: </strong>Higher NVC in the PCA territory correlated with lower WMH burden (r=-0.32, p=0.02), particularly in patients with lower disability (Expanded Disability Status Scale <2). This association remained significant after adjustment (β=-0.071, 95% CI [-0.135, -0.007], p=0.031). Higher NVC PCA was also associated with lower WMH in patients with better executive (β=-0.104, 95% CI [-0.176, -0.033], p=0.007) and global cognitive scores (β=-0.116, 95% CI [-0.222, -0.009], p=0.035). No association was found with GM volume.</p><p><strong>Conclusion: </strong>Preserved PCA neurovascular function is associated with lower WM lesion burden, measured using conventional MRI, in MS patients with lower disability and better cognition, a finding that may inform risk stratification and guide future therapeutic targets.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261481753"},"PeriodicalIF":4.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819542","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 siponimod use in secondary progressive multiple sclerosis: the RESYZE study.","authors":"Celia Oreja-Guevara, Irene Gómez-Estévez, Laura Agüado García, Jesus Martín Martínez, Montserrat Gómez Gutiérrez, Francisco Gascón Giménez, Eduardo Agüera Morales, Virginia Meca-Lallana, Francisco Javier Barrero Hernández, Vicente González Quintanilla, Lucía Romero Pinel, Virginia Delgado Gil, Eduardo Durán Ferreras, Rosario Blasco Quílez, Jose Meca-Lallana, Lamberto Landete Pascual, Yolanda Aladro-Benito, Sabas Boyero Durán, Julia Gracia Gil, Ana Belén Caminero Rodríguez, Antonio Tomás Cano Orgaz, Sara Eichau Madueño, María Rosa Querol Pascual, María Otano Martínez, Ana María Alonso Torres, Carmen Calles Hernández, Ana López Real, Adrián Ares Luque, Jose Ramón Lorenzo González, Lidia Gómez Vicente, María Díaz Sánchez","doi":"10.1177/17562864261472650","DOIUrl":"https://doi.org/10.1177/17562864261472650","url":null,"abstract":"<p><strong>Background: </strong>Siponimod is approved in Europe for active secondary progressive multiple sclerosis (SPMS), but real-world data on its treatment patterns and outcomes in people with SPMS (pwSPMS) is limited.</p><p><strong>Objective: </strong>To assess the demographic and clinical characteristics, effectiveness, and safety of siponimod in pwSPMS in a real-world setting.</p><p><strong>Design: </strong>Non-interventional/observational, retrospective, multicenter study (28 centers).</p><p><strong>Methods: </strong>Patients (⩾18 years) with active SPMS treated with siponimod in routine care were included. Retrospective clinical, radiological, and laboratory data were collected for patients up to 24 months before and 12 months after siponimod treatment.</p><p><strong>Results: </strong>In total, 210 participants were included (mean age: 52.5 ± 8.6 years; females: 71.0%). At treatment initiation, the mean Expanded Disability Status Scale (EDSS) score was 5.7 ± 1.2. The mean time since multiple sclerosis diagnosis and the median time since active SPMS diagnosis were 16.7 ± 8.9 years and 1.3 (0.3; 4.4) years, respectively. Common comorbidities included psychiatric disorders and dyslipidemia (20.6%, each). Regarding working status, 55.9% with available information showed incapacity for work. Prior to siponimod, 44.3% received highly effective therapies: fingolimod (20.5%), rituximab (9.5%), ocrelizumab (5.2%), natalizumab (4.8%), and alemtuzumab (2.4%). After 1 year, 82.8% of the patients remained stable in terms of disability progression, 94.3% were free of relapses, and 85.7% did not present radiological disease activity; 46.2% experienced adverse events, 8.6% experienced serious adverse events, and 26 (12.4%) patients discontinued permanently.</p><p><strong>Conclusion: </strong>In the study cohort, pwSPMS had high disability scores and comorbidities; more than half were unable to work, and over 40% had previously received high-efficacy therapies. After 1 year of siponimod treatment, most pwSPMS showed no signs of disease activity, with stabilized EDSS scores and relapses and new T2 or gadolinium-T1 lesions, as well as a favorable safety profile.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261472650"},"PeriodicalIF":4.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766448","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":"Current practices in delirium prevention and treatment after acute stroke: results of a multicentre survey.","authors":"Markus Kneihsl, Annerose Mengel, Stefan Sumerauer, Natalie Berger, Margherita Cavalieri, Thomas Gattringer, Christian Enzinger, Wilfried Lang, Michael Knoflach, Mira Katan, Else Sandset, Robert Fleischmann, Julia Ferrari","doi":"10.1177/17562864261464310","DOIUrl":"10.1177/17562864261464310","url":null,"abstract":"<p><strong>Background: </strong>Delirium affects 10-30% of acute stroke patients, is associated with poor outcomes and places a substantial burden on healthcare staff. Evidence-based prevention and treatment strategies are limited, resulting in heterogeneous and poorly standardised delirium management in acute stroke care.</p><p><strong>Objectives: </strong>We aimed to describe real-world delirium management in German and Austrian stroke units (SUs) and to delineate the extent of practice variation in prevention and treatment.</p><p><strong>Design: </strong>We conducted a cross-sectional, web-based survey of stroke neurologists working at SUs in Austria and Germany.</p><p><strong>Methods: </strong>The 30-item questionnaire assessed professional background, delirium prevention and pharmacological treatment approaches. Descriptive statistics and exploratory subgroup analyses were performed.</p><p><strong>Results: </strong>Seventy responses from 63 SUs were analysed (median physician SU experience, 14.5 years). Delirium was estimated to affect 20% of patients and was perceived as highly burdensome for both physicians and nurses (median score, 9/10 each). Delirium prevention measures were established in 42 (67%) SUs but routinely applied to all patients in only 12 (19%), mainly due to staffing shortages (nurses, 48%; physicians, 25%). Pharmacological delirium treatment was reported by all respondents. Benzodiazepines were preferred for alcohol withdrawal delirium (60%) and antipsychotics for hyperactive or mixed delirium (59%). α2-Agonists were the most common escalation therapy across these subtypes (46%-67%).</p><p><strong>Conclusion: </strong>Delirium management in German and Austrian SUs is highly heterogeneous, limited by staffing constraints and strongly relies on non-evidence-based pharmacological strategies. These findings highlight critical gaps in care and call for enhanced staffing and stroke-specific trials to inform evidence-based delirium management.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261464310"},"PeriodicalIF":4.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723715","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":"Relapse risk and functional outcomes in anti-LGI1 encephalitis: A multicenter retrospective analysis.","authors":"Chun-Hong Shen, Bo Jin, Ye Du, Wen-Jing Shen, Rui Li, Yin-Xi Zhang, Qi-Lun Lai, Hao Song, Shan Wang, Mei-Ping Ding, Shuang Wang, Yi Guo, Meng-Ting Cai","doi":"10.1177/17562864261477197","DOIUrl":"10.1177/17562864261477197","url":null,"abstract":"<p><strong>Background: </strong>Anti-leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis presents relapse risk and potential functional impairment, with no established maintenance treatment guidelines.</p><p><strong>Objectives: </strong>The study aimed to uncover prognostic signatures, and identify predictors of relapse and poor outcome using real-world evidence.</p><p><strong>Design: </strong>This multicenter retrospective study included anti-LGI1 encephalitis patients from five tertiary hospitals in Eastern China between January 2015 and January 2024, with ≥ 24-month follow-up.</p><p><strong>Methods: </strong>Relapse was defined as the presence of new or worsening clinical features after at least 3 months of stability or improvement. Poor outcome was defined as a modified Rankin Scale score > 2 at last follow-up.</p><p><strong>Results: </strong>A total of 104 patients were included (median age 56.5 years, 60.6% male). Following the acute phase, the majority (66.3%) received prolonged corticosteroid treatment (≥6 months) without steroid-sparing maintenance immunotherapy (SSMI), whereas 16.3% received SSMI. Twelve patients (11.5%) experienced relapse. Hyponatremia at diagnosis was more common in relapsing patients (<i>p</i> = 0.017), and was significantly associated with an increased risk of relapse in Cox regression (hazard ratio = 4.67, 95% confidence interval [CI] = 1.41-15.53, <i>p</i> = 0.012). Poor outcome was observed in 17 patients (16.3%), with male sex (odds ratio [OR] = 5.12, 95% CI = 1.27-34.48, <i>p</i> = 0.041) and hyponatremia (OR = 4.69, 95% CI = 1.54-15.47, <i>p</i> = 0.008) as potential risk factors.</p><p><strong>Conclusion: </strong>This study suggests that hyponatremia is associated with an increased risk of relapse and poor outcome in anti-LGI1 encephalitis. These findings may facilitate individualized risk stratification, but further validation in larger prospective cohorts is needed.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261477197"},"PeriodicalIF":4.0,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702295","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":"Evaluating the cognitive efficacy of marine-derived drugs in Alzheimer's disease: A systematic review and Bayesian network meta-analysis.","authors":"Zhaoming Song, Yun Xie, Hanmo Zhu, Jian Li, Chen Yang, Yanao Guo, Xun Nong, Zhanchi Zhu, Zhouqing Chen, Zhong Wang","doi":"10.1177/17562864261476868","DOIUrl":"10.1177/17562864261476868","url":null,"abstract":"<p><strong>Background: </strong>In recent years, marine-derived drugs for Alzheimer's disease (AD) have attracted growing attention, but their comparative cognitive efficacy and safety remain uncertain because of inconsistent findings across studies.</p><p><strong>Objectives: </strong>To compare the efficacy and safety of marine-derived interventions for Alzheimer's disease.</p><p><strong>Design: </strong>Systematic review and Bayesian network meta-analysis of randomized controlled trials conducted in accordance with PRISMA 2020.</p><p><strong>Data sources and methods: </strong>We systematically searched PubMed and the Cochrane Library for randomized controlled trials (RCT) of marine-derived drugs in patients with AD. Continuous outcomes were synthesized as mean differences (MD) in change-from-baseline, and dichotomous outcomes were synthesized as odds ratios (OR), each with 95% credible intervals (CI).</p><p><strong>Results: </strong>A total of 16 eligible RCTs involving 4,158 patients were included. For the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), GV-971 (vs placebo; MD -1.85, 95% CI -2.89 to -0.82) and tramiprosate (vs placebo; MD -0.83, 95% CI -1.63 to -0.02) significantly improved cognitive function. For the Mini-Mental State Examination (MMSE), rifampicin (vs placebo; MD 1.90, 95% CI 0.25 to 3.56) was associated with greater improvement in MMSE scores, whereas tramiprosate (vs placebo; MD -2.40, 95% CI -4.67 to -0.09) was associated with poorer cognitive performance. No statistically significant differences among drugs were observed for the Clinical Dementia Rating-Sum of Boxes (CDR-SB) or for the incidence of adverse events. Overall, treatment effects were outcome-dependent, with significant benefits observed mainly in ADAS-Cog and MMSE, whereas no intervention demonstrated consistent superiority across all cognitive outcomes.</p><p><strong>Conclusion: </strong>Marine-derived drugs showed generally acceptable safety and potential cognitive benefits in selected outcomes. GV-971 and tramiprosate improved ADAS-Cog scores, while rifampicin therapy showed a possible MMSE benefit. However, no intervention was consistently superior across cognitive outcomes, and the antibiotic finding was based on a single small trial. Current evidence is therefore insufficient to identify the optimal marine-derived therapy for AD, highlighting the need for larger, adequately powered RCTs.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261476868"},"PeriodicalIF":4.0,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702203","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}