Therapeutic Advances in Neurological Disorders最新文献

{"title":"Innovative treatments for migraine: a new era.","authors":"Francesca Pistoia","doi":"10.1177/17562864261428244","DOIUrl":"https://doi.org/10.1177/17562864261428244","url":null,"abstract":"","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261428244"},"PeriodicalIF":4.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12972539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435723","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":"CT perfusion ischemic core predicts PH-2 hemorrhagic transformation following intravenous alteplase bridging treatment prior to endovascular thrombectomy.","authors":"Asaf Honig, Aviva Alpernas, Yoel Schwartzmann, Hen Hallevi, Issa Metanis, Einor Ben-Assayag, Tali Jonas-Kimchi, Udi Sadeh, Hamza Jubran, Oz Haim, Jose Cohen, Ronen R Leker, Jeremy Molad","doi":"10.1177/17562864261425623","DOIUrl":"10.1177/17562864261425623","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis (IVT) administered as a bridging therapy prior to endovascular thrombectomy (EVT) for acute ischemic stroke may increase the risk of hemorrhagic-transformation (HT). CT-perfusion (CTP) imaging enables quantitative assessment of ischemic core and penumbral tissue and may support individualized hemorrhagic risk stratification.</p><p><strong>Objectives: </strong>To assess whether baseline CTP-defined ischemic core parameters are associated with parenchymal-hematoma type 2 (PH-2) following bridging IVT before EVT.</p><p><strong>Design: </strong>Observational-cohort-study.</p><p><strong>Data sources and methods: </strong>Consecutive patients with large-vessel occlusion treated within 4 h of symptom onset at two tertiary stroke centers between 2017 and 2023 were analyzed. All patients underwent baseline CTP imaging. Outcomes were compared between patients treated with IVT plus EVT and those treated with direct-EVT. HT was assessed on 24-h follow-up noncontrast-CT using ECASS-2 criteria. Multivariable logistic regression was performed to identify independent predictors of PH-2.</p><p><strong>Results: </strong>Among 398 patients (50.6% male), 180 received IVT + EVT (mean age 70.2 ± 15.0 years) and 218 underwent direct-EVT (69.5 ± 14.5 years). Baseline characteristics, workflow times, thrombectomy passes, and reperfusion rates were comparable. PH-2 was associated with higher mortality (43.8% vs 11.7%, <i>p</i> < 0.001) and worse 90-day functional outcome (median modified Rankin Score 4 (2-6) vs 3 (1-4), <i>p</i> = 0.002). Bridging-IVT was associated with higher PH-2 rates compared with direct EVT (6.1% vs 2.0%, <i>p</i> = 0.036), without increased symptomatic intracranial-hemorrhage. In sensitivity analyses, bridging-IVT was associated with higher PH-2 rates only in patients with any ischemic core (7.8% vs 1.5%, <i>p</i> = 0.014), core volume >10 mL (8.8% vs 0.8%, <i>p</i> = 0.004), and >20 mL (8.7% vs 1.3%, <i>p</i> = 0.03). Penumbral volume was not associated with PH-2. In multivariable analysis, any ischemic core (odds ratio (OR) 12.67, <i>p</i> = 0.02) and core volume >10 mL (OR 11.12, <i>p</i> = 0.034) independently predicted PH-2.</p><p><strong>Conclusion: </strong>Baseline CTP-defined ischemic core volume is strongly associated with severe HT following bridging intravenous alteplase prior to EVT and may inform individualized risk-benefit assessment of bridging therapy.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261425623"},"PeriodicalIF":4.1,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378601","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":"Positioning siponimod and the post-treatment gap: the unmet needs of SPMS patients in Italian real-world practice.","authors":"Aurora Zanghì, Giovanna Borriello, Matteo Foschi, Assunta Bianco, Elisabetta Signoriello, Maria Cellerino, Paola Sofia Di Filippo, Francesco Baldisseri, Giuseppe Romano, Alessandra Cicia, Giacomo Lus, Matilde Inglese, Massimiliano Mirabella, Carlo Avolio, Emanuele D'Amico","doi":"10.1177/17562864251399560","DOIUrl":"https://doi.org/10.1177/17562864251399560","url":null,"abstract":"<p><strong>Background: </strong>Siponimod, a selective sphingosine-1-phosphate receptor modulator was approved for patients with Secondary progressive Multiple Sclerosis (SPMS) with ongoing disease activity. However, its real-world positioning and management after discontinuation remain challenging.</p><p><strong>Objectives: </strong>To evaluate the real-world use of siponimod in Italian real world setting, focusing on discontinuation rates, possible predictors, and post-treatment management.</p><p><strong>Methods: </strong>A retrospective, multicenter study on patients treated with siponimod across six Italian MS centers. Demographics, prior disease modifying therapy (DMTs), reasons for discontinuation, adverse events, and subsequent therapies were collected. Statistical analyses included propensity-adjusted Cox model.</p><p><strong>Results: </strong>A total cohort of 188 patients (63.8% female, median age 52 years) was enrolled, out of them 76(40.4%) discontinued siponimod, with a median treatment duration of 26 months. The main reason for discontinuation was safety concerns (72.4%), particularly persistent lymphopenia (43.6%) and recurrent infections (27.3%). Disease activity accounted for 27.6% of discontinuations. No significant demographic or clinical predictors of discontinuation were identified. After discontinuation, 49 patients (64%) started a new DMT, most commonly ocrelizumab (<i>n</i> = 22) or cladribine (<i>n</i> = 15), while 25 (32.9%) received no further therapy.</p><p><strong>Conclusion: </strong>High discontinuation rates, mainly due to safety, and frequent post-treatment gaps highlight the need for improved, individualized management strategies for SPMS after siponimod.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864251399560"},"PeriodicalIF":4.1,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356424","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":"Emergency use of eculizumab in impending and manifest myasthenic crisis: a retrospective case series.","authors":"Ying Huang, Yihan Xiong, Hui Zhan, Futian Wu, Yichun Jiang, Yaqing Zhang, Jiaxun Chen, Silin Zeng, Ting Zhang, Xiaofeng Xiong, Zhuomin Chen, Fang Yang, Gang Li, Qianhui Xu","doi":"10.1177/17562864261425088","DOIUrl":"https://doi.org/10.1177/17562864261425088","url":null,"abstract":"<p><p>Impending and manifest myasthenic crisis (MC) represent life-threatening neurological emergencies that require immediate intervention. Although eculizumab, a terminal complement C5 inhibitor, has established efficacy in generalized myasthenia gravis, most studies have focused on long-term outcomes, and its potential for rapid onset of effect in acute exacerbations has not been well evaluated. We retrospectively analyzed four acetylcholine receptor (AChR) antibody-positive patients (five acute episodes) who received eculizumab as emergency therapy between January 2024 and July 2025. All patients presented with impending or manifest MC; none had received intravenous immunoglobulin, plasma exchange, or neonatal Fc receptor (FcRn) inhibition within the preceding month. According to the Myasthenia Gravis Foundation of America classification, three patients had class IVb and one had class V. Triggers for exacerbation included COVID-19 infection (<i>n</i> = 2), puerperium (<i>n</i> = 1), PD-1 inhibitor exposure (<i>n</i> = 1), and common infection (<i>n</i> = 1). Within 48 h of eculizumab administration, Quantitative Myasthenia Gravis scores improved from 28.2 ± 4.8 to 15.0 ± 4.1, while Myasthenia Gravis Activities of Daily Living scores decreased from 16.8 ± 2.8 to 6.0 ± 4.3. Notable milestones achieved included arterial blood gas improvement within 7.5 h (one patient), nasogastric tube removal within 48 h (three patients), and successful extubation at 17 h (one patient). No treatment-related adverse events were observed. These preliminary findings suggest that eculizumab may be associated with rapid, temporally related clinical improvement within 48 h with a favorable short-term safety profile in AChR antibody-positive patients with impending or manifest MC, particularly those with complement activation triggers. Larger prospective studies with standardized short-term assessment protocols, including frequent neurological evaluations during the first 48 h, are warranted to further validate its efficacy and define its role as an emergency therapy in the acute management of myasthenic exacerbations.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261425088"},"PeriodicalIF":4.1,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327130","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":"Plain Language Summary of a Phase 2b Randomized Controlled Trial of Ecopipam and Its 12-Month Open-Label Extension in Children and Adolescents With Tourette Syndrome.","authors":"Donald L Gilbert, David J B Kim, Meredith M Miller, Sarah D Atkinson, George B Karkanias, Frederick E Munschauer, Stephen P Wanaski, Timothy M Cunniff","doi":"10.1177/17562864261424987","DOIUrl":"https://doi.org/10.1177/17562864261424987","url":null,"abstract":"<p><p>What is this summary about? The purpose of this summary is to explain the results from two studies that looked at the safety and effects of an investigational drug called ecopipam. \"Investigational\" means that the drug has not been approved by the United States Food and Drug Administration (FDA) yet. The studies tested if ecopipam could safely improve symptoms and quality of life in children and adolescents with Tourette syndrome. Please note that ecopipam is not currently approved to treat Tourette syndrome.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261424987"},"PeriodicalIF":4.1,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327158","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":"Vedolizumab and the gut-CNS axis in multiple sclerosis: considering T cell licensing pathways.","authors":"Afsaneh Shirani, Olaf Stuve","doi":"10.1177/17562864261423751","DOIUrl":"https://doi.org/10.1177/17562864261423751","url":null,"abstract":"<p><strong>Background: </strong>The role of gut-mediated T cell licensing in multiple sclerosis (MS) remains incompletely understood.</p><p><strong>Objective: </strong>We hypothesized that T cell licensing in the gut contributes to MS pathogenesis and evaluated whether vedolizumab-an anti-α4β7 integrin, gut-selective monoclonal antibody approved for inflammatory bowel disease (IBD)-is associated with MS prevalence.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>Using Epic Cosmos, a large deidentified U.S. electronic health record platform, we identified individuals with Crohn's disease (CD) or ulcerative colitis (UC) and a concomitant MS diagnosis between August 2010 and August 2025.</p><p><strong>Results: </strong>Among 1,027,704 CD and 1,294,362 UC patients, 8,098 (0.79%; 95%CI:0.77%-0.81%) and 9,564 (0.74%; 95%CI:0.73%-0.76%) had MS, respectively. In contrast, among vedolizumab-treated patients, only 125 with CD (0.22%; 95%CI:0.18%-0.26%) and 109 with UC (0.17%; 95%CI:0.14%-0.20%) developed MS within five years of treatment.</p><p><strong>Conclusion: </strong>While causality cannot be inferred, our findings highlight an opportunity to further explore whether vedolizumab-associated differences in MS prevalence may relate to gut-associated immune processes.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261423751"},"PeriodicalIF":4.1,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12923930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271752","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":"Differential response to ofatumumab in anti-AChR and anti-MuSK positive myasthenia gravis patients: a single-center retrospective study.","authors":"Qian Zhou, Yuzhen Ouyang, Fei Jiang, Qiuming Zeng, Ting He, Zeyi Wen, Guanzhong Shi, Xiaohua Dong, Haobing Cai, Wei Xiang, Miao Su, Kailin Li, Huan Yang","doi":"10.1177/17562864261421717","DOIUrl":"https://doi.org/10.1177/17562864261421717","url":null,"abstract":"<p><strong>Background: </strong>Ofatumumab (OFA), a humanized anti-CD20 monoclonal antibody, shows potential in myasthenia gravis (MG) with antibody against acetylcholine receptor (AChR-Ab), but comparative efficacy across AChR and muscle-specific kinase (MuSK) subtypes remains uncharacterized.</p><p><strong>Objectives: </strong>To evaluate OFA's clinical and immunological effects in AChR-MG versus MuSK-MG, identify predictors of minimal symptom expression (MSE), and explore the dynamics of B-cell repopulation.</p><p><strong>Design: </strong>A retrospective study in a single center.</p><p><strong>Methods: </strong>Twenty-one refractory MG patients (13 MuSK+, 8 AChR+) received individualized OFA induction (Regimen 1: two 20 mg doses ⩾2 weeks apart; Regimen 2: single 20 mg dose) and maintenance (20 mg upon CD19 + B counts ⩾5 cells/μL repopulation or clinical exacerbation). Outcomes included time-to-MSE, Quantitative Myasthenia Gravis Score (QMGS) dynamics, prednisone reduction, and serial immunophenotyping (B-cell activating factor (BAFF), a proliferation-inducing ligand (APRIL), soluble CD40L (sCD40L), microphage migration inhibitory factor (MIF), and immunoglobulin).</p><p><strong>Results: </strong>MuSK-MG achieved faster MSE (median time: 6 vs 15 months, log-rank <i>p</i> = 0.164, age-adjusted Cox <i>p</i> = 0.027), and a higher 3-month improvement (92.3% vs 50.0%; <i>p</i> = 0.047). Earlier achievement of MSE was associated with shorter disease duration (<i>p</i> = 0.038) and concomitant corticosteroid therapy (<i>p</i> = 0.030). Prednisone doses decreased significantly over 6 months (<i>p</i> = 0.029) without difference between groups (<i>p</i> = 0.109). MuSK-MG showed synchronized BAFF/APRIL declines while AChR-MG presents transient BAFF elevation and sustained APRIL. BAFF levels showed a significant positive correlation with QMGS in MuSK-MG, while IgM/IgG positively correlated with QMGS in both subtypes. Median B cell-repopulation time was 47.7 days.</p><p><strong>Conclusion: </strong>OFA demonstrates superior efficacy in MuSK-MG with distinct immunological modulation. AChR-MG requires combinatorial strategies targeting compensatory pathways.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261421717"},"PeriodicalIF":4.1,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12921211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271665","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":"Management of tandem occlusions in acute ischaemic stroke.","authors":"João Duarte, Mariana B Morais, Isabel Fragata, Diana Aguiar de Sousa","doi":"10.1177/17562864251413757","DOIUrl":"10.1177/17562864251413757","url":null,"abstract":"<p><p>Intra- and extracranial tandem occlusions (TOCs) in acute ischaemic stroke (AIS) are defined by the coexistence of an intracranial anterior or posterior circulation large vessel occlusion together with an ipsilateral extracranial occlusion or significant stenosis in the corresponding proximal vascular axis. They represent a distinct subgroup of AIS requiring tailored diagnostic and therapeutic strategies and are commonly divided into anterior (ATOCs) and posterior (PTOCs) forms. This narrative review synthesises the current evidence base regarding diagnosis, management (medical and interventional) and prognosis of TOCs. ATOCs account for around 20% of anterior circulation large-vessel occlusions, while PTOCs appear proportionally more frequent in posterior circulation stroke. Atherosclerosis is the predominant mechanism (around 70%), followed by arterial dissection (around 20%-25%), with cardioembolism and rarer causes playing a smaller role. Diagnosis can be challenging, particularly due to pitfalls such as carotid pseudo-occlusion. Endovascular thrombectomy (EVT) is the cornerstone of treatment for TOCs. In ATOCs, emerging evidence suggests that emergent carotid artery stenting improves outcomes in selected patients, with large observational cohorts such as CERES-TANDEM reporting higher functional independence without increased bleeding risk. In PTOCs, EVT is feasible and technically effective, but evidence remains limited. Vertebral stenting may be beneficial in selected cases, though morbidity and mortality remain high. Periprocedural antithrombotic therapy varies widely between centres, and high-quality data are lacking. Bridging therapy with intravenous thrombolysis appears safe and should be performed in eligible patients with tandem lesions. Prognosis has improved substantially for patients with ATOCs in the EVT era, whereas outcomes in PTOCs are less well defined. Continued efforts to generate higher-quality evidence, particularly for PTOCs, will be essential to guide treatment strategies and improve patient outcomes.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864251413757"},"PeriodicalIF":4.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202540","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":"Ischemic stroke complicated by intracerebral hemorrhage in patients with hypereosinophilic syndrome: a case series.","authors":"Masaoki Hidaka, Satomi Mezuki, Mio Yokoi, Masato Osaki, Tomoaki Akiyama, Shinya Yamaguchi, Tetsuro Sayama, Tetsuro Ago, Shuji Arakawa","doi":"10.1177/17562864261416619","DOIUrl":"10.1177/17562864261416619","url":null,"abstract":"<p><p>Patients with hypereosinophilic syndrome (HES) suffer from thrombotic events including ischemic stroke. Simultaneous occurrence of stroke and intracerebral hemorrhage (ICH) in such patients have rarely been reported. Here, we describe two patients with HES who suffered from ischemic stroke complicated by ICH. In case 1, we used a recombinant tissue plasminogen activator for acute ischemic stroke without treating hypereosinophilia; consequently, ICH occurred. In case 2, the patient had an ischemic stroke and ICH upon admission. In both cases, we used glucocorticoids to control hypereosinophilia, and no additional ischemic stroke or ICH occurrence was observed. These cases suggest that patients with HES can experience both ischemic and hemorrhagic strokes simultaneously and emphasize the importance of early control of eosinophilia to reduce the risk of cerebrovascular complications.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261416619"},"PeriodicalIF":4.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202360","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":"Association of atherogenic index of plasma and post-stroke epilepsy in patients with ischemic stroke: a multicenter retrospective study in China.","authors":"Xichen Wan, Ye Xiong, Peng Wang, Maoqi Wang, Lianghua Huang, Yunliang Tang","doi":"10.1177/17562864261416789","DOIUrl":"10.1177/17562864261416789","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke epilepsy (PSE) is a common complication after ischemic stroke (IS) that worsens prognosis and quality of life. The atherogenic index of plasma (AIP) is an emerging biomarker for cardiovascular and metabolic diseases, but its link with PSE is unknown.</p><p><strong>Objective: </strong>This study aimed to evaluate the association between AIP and the risk of PSE in patients with IS.</p><p><strong>Design: </strong>A multicenter retrospective cohort study.</p><p><strong>Methods: </strong>We analyzed data from 21,459 IS patients in Southwest China (2017-2023). AIP was calculated as log10(triglycerides/high-density lipoprotein cholesterol) from baseline lipid profiles. The primary outcome was PSE occurrence within 1 year post-stroke. The relationship between AIP and PSE was assessed using multivariable logistic regression and restricted cubic spline (RCS) models, adjusting for demographic, clinical, and laboratory covariates. Subgroup and sensitivity analyses were performed to test robustness.</p><p><strong>Results: </strong>Among 21,459 participants, 936 (4.36%) developed PSE. Higher AIP levels were significantly associated with increased PSE risk. After full adjustment, each 1-standard deviation increase in AIP was associated with a 1.56-fold higher PSE risk (odds ratio = 1.56; 95% confidence interval: 1.44-1.68). Patients in the highest AIP quartile (<i>Q</i>4) had a 3.89-fold increased risk compared to the lowest quartile (<i>Q</i>1). RCS analysis revealed a nonlinear dose-response relationship, with an inflection point at AIP = 0.193. Subgroup analyses indicated stronger associations in patients without diabetes, coronary artery disease, or specific subcortical lesions.</p><p><strong>Conclusion: </strong>Elevated AIP is independently associated with an increased risk of PSE in IS patients, following a nonlinear dose-response pattern. AIP may serve as a valuable clinical tool for PSE risk stratification, facilitating early identification and preventive management. Prospective studies are warranted for validation.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261416789"},"PeriodicalIF":4.1,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12901856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202101","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}