BMJ Neurology Open最新文献

{"title":"Relationship between personality and poststroke functional outcomes: a systematic review.","authors":"Desson Au-Yeung, Simon Matthews, Jonathan Hewitt, Benjamin Jelley","doi":"10.1136/bmjno-2025-001284","DOIUrl":"https://doi.org/10.1136/bmjno-2025-001284","url":null,"abstract":"<p><strong>Background: </strong>Factors such as age and stroke severity are commonly used to predict poststroke functional outcomes and tailor stroke rehabilitation therapy. However, the role of personality in stroke rehabilitation and its influence on functional outcomes is unclear. This review aims to assess whether an association exists between personality and poststroke functional outcomes.</p><p><strong>Methods: </strong>We searched Medline, AMED, APA PsychINFO, CENTRAL, CINAHL and Scopus for studies published between database inception and 22 October 2024. Studies were included if they recruited adults with stroke, used a validated method to assess personality and poststroke functional outcomes and were published in a peer-reviewed journal.</p><p><strong>Results: </strong>Five studies were identified (n=424): four cohort and one cross-sectional. There were no major concerns regarding risk of bias. Methods of assessing personality and poststroke functional outcome both varied, with Eysenck's Personality Questionnaire and Barthel Index being the most frequently used. Extroversion, openness and lie-tendency were associated with improved poststroke functional outcomes, while type D personality was negatively associated with poststroke functional outcomes.</p><p><strong>Conclusions: </strong>There is some evidence for an association between personality and poststroke functional outcomes, but this is limited by the small number of relevant studies and small sample sizes. Further studies are needed to investigate this potential relationship.</p><p><strong>Prospero registration number: </strong>CRD42024592518.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001284"},"PeriodicalIF":2.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and design of 'StAtins in Frail oldEr patients with ischemic Stroke or Transient ischemic attack-the Randomized Controlled Trial' (SAFEST-RCT).","authors":"Susanna Rosa Prins, Birgit A Damoiseaux-Volman, Sarah E Vermeer, Patrick M M Bossuyt, Rik Van Eekelen, Judith E Bosmans, Eveline P Van Poelgeest, Fabrice M A C Martens, Marielle H Emmelot-Vonk, Esther Verstraete, Majon Muller, Eric P Moll Van Charante, Michiel Lindhout, Nathalie Van Der Velde, Renske M Van Den Berg-Vos","doi":"10.1136/bmjno-2025-001297","DOIUrl":"https://doi.org/10.1136/bmjno-2025-001297","url":null,"abstract":"<p><strong>Introduction: </strong>Statin therapy is known to reduce subsequent cardiovascular events in patients who had an ischaemic stroke and transient ischaemic attack (TIA). However, its effectiveness and safety in frail older adults with a recent stroke or TIA are uncertain, leading to variations in clinical practice. 'StAtins in Frail oldEr patients with ischemic Stroke or Transient ischemic attack-the Randomized Controlled Trial' (SAFEST-RCT) aims to investigate the effectiveness of initiating versus not initiating statin therapy in this vulnerable population, to optimise secondary prevention strategies.</p><p><strong>Methods and analysis: </strong>This multicentre, prospective, randomised, open-label study aims to enrol 612 frail adults ≥70 years with a recent acute ischaemic stroke or TIA across 22 Dutch hospitals. The study compares prescribing versus not prescribing statins in terms of health-related quality of life, major adverse cardiovascular event-free survival and societal costs over a 2-year follow-up period.</p><p><strong>Ethics and dissemination: </strong>The SAFEST-RCT protocol was approved by the Ethics Committee of Amsterdam UMC. It complies with the Declaration of Helsinki and is classified as a healthcare evaluation. Recruitment began in March 2025. Results will be published in open access journals, presented at conferences, shared via the Dutch Brain Injury Association and integrated into national guidelines to support implementation in routine care.</p><p><strong>Trial registration number: </strong>NCT06785727.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001297"},"PeriodicalIF":2.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment outcomes in functional neurological disorder: a systematic review and meta-analysis exploring the influence of symptom chronicity.","authors":"Sarah T Thomas, Elizabeth T Thomas, Emily Schembri, Alexander C Lehn, David Dg Palmer","doi":"10.1136/bmjno-2025-001150","DOIUrl":"https://doi.org/10.1136/bmjno-2025-001150","url":null,"abstract":"<p><strong>Background: </strong>Functional neurological disorder (FND) is a common cause of neurological disability with symptoms spanning motor, sensory and cognitive domains. While effective treatments exist, the impact of symptom chronicity on treatment outcomes is unclear. This systematic review and meta-analysis investigated whether longer symptom duration influences treatment outcomes across FND phenotypes: functional movement disorders, functional/dissociative seizures (FDS) and mixed presentations.</p><p><strong>Methods: </strong>MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO and grey literature were systematically searched till 29 June 2024. Studies were included if they involved adult FND participants undergoing any intervention and evaluated symptom change, function and health-related quality of life (HrQoL). Studies were excluded with <10 participants, missing symptom duration data or irrelevant outcomes. Two reviewers independently extracted data and assessed risk of bias. Meta-analyses used random effects models, subgroup analyses and univariate meta-regression to examine associations with symptom chronicity.</p><p><strong>Results: </strong>63 studies met inclusion criteria; 27 studies (885 participants) were meta-analysed. Longer symptom duration modestly reduced improvements in motor symptoms (-3.24 points/year, scale: 0-100) and physical HrQoL (-1.2 points/year, scale: 0-100). Global improvements (mean Clinical Global Impression-Change 2.43, 95% CI: 2.28 to 2.59, scale: 1-7) and mental HrQoL gains (mean Short Form-Mental Component Summary +5.04 points, 95% CI: 1.67 to 8.41) were observed irrespective of chronicity. FDS frequency reduced after psychotherapy in eight of nine studies, even with prolonged symptoms.</p><p><strong>Conclusions: </strong>Symptom chronicity modestly reduced motor and physical HrQoL improvements, but did not negate meaningful gains across a range of outcomes. Early diagnosis and treatment are critical for better outcomes, but remain beneficial in chronic stages.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001150"},"PeriodicalIF":2.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subgroup analysis of tumefactive demyelinating lesions: clinical, imaging features and outcomes.","authors":"Yuqi Tang, Zhandong Qiu, Yingyue Ding, Zheng Liu, Huiqing Dong, Dawei Li","doi":"10.1136/bmjno-2025-001252","DOIUrl":"10.1136/bmjno-2025-001252","url":null,"abstract":"<p><strong>Background: </strong>Tumefactive demyelinating lesions (TDLs) are rare, large demyelinating lesions of the central nervous system that can mimic brain tumours in radiological appearance. They have been observed across multiple demyelinating diseases. Previous studies have suggested that antibody profiles may correlate with distinct clinical or imaging characteristics, but detailed comparisons between antibody-defined subgroups in TDLs remain limited.</p><p><strong>Methods: </strong>We retrospectively analysed 30 patients with confirmed TDLs. Demographic, clinical, imaging and laboratory data were collected, and patients were stratified by myelin oligodendrocyte glycoprotein (MOG) and N-methyl-D-aspartic acid receptor (NMDAR) antibody results. Lesion characteristics were evaluated on brain MRI, and outcomes were assessed by modified Rankin Scale at last follow-up. Statistical comparisons were made between antibody-positive and antibody-negative subgroups.</p><p><strong>Results: </strong>Among TDLs subgroups, MOG+ patients had elevated cerebrospinal fluid white cell counts and showed greater lesion volume reduction on follow-up MRI than MOG- patients. NMDAR+ patients showed elevated levels of systemic inflammatory markers compared with NMDAR- counterparts. Regardless of antibody status, most TDLs patients responded well to immunotherapy, with 86.7% achieving a favourable outcome.</p><p><strong>Conclusions: </strong>TDLs represent a heterogeneous inflammatory syndrome. MOG and NMDAR antibodies influence the clinical and laboratory characteristics of TDL patients but have limited impact on prognosis.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001252"},"PeriodicalIF":2.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender differences in depression, anxiety, and quality of life in Parkinson's disease before and after deep brain stimulation surgery: a multicentre cohort study.","authors":"Molly G Abbott, Arteen Ahmed, Nicola Pavese, Antonella Macerollo, Edward J Newman, Jibril Osman Farah, Nagaraja Sarangmat, Anjum Misbahuddin, David Ledingham, Michelle GIbbs, Russell Mills, Keyoumars Ashkan, Monty Silverdale, Michael Samuel, David Okai, Paul Shotbolt","doi":"10.1136/bmjno-2025-001246","DOIUrl":"10.1136/bmjno-2025-001246","url":null,"abstract":"<p><strong>Background: </strong>Disproportionately fewer females with Parkinson's disease (PD) undergo deep brain stimulation surgery (DBS). Some data show worse depression, anxiety, and quality of life (QOL) in females with PD. Investigations into these gender disparities, or the effect of DBS on these non-motor symptoms, remain limited.</p><p><strong>Methods: </strong>61 PD patients across seven UK DBS centres were recruited for the Clinical Response of Impulsive behaviours to deep brain Stimulation in PD (CRISP) prospective cohort study. Questionnaires measured primary outcomes of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and QOL (Parkinson's Disease Questionnaire-39) before and 6 months after bilateral subthalamic nucleus DBS, and secondary outcomes of predictors of postoperative changes in mood.</p><p><strong>Results: </strong>Females were disproportionately under-referred for DBS (28% of cohort). Baseline depression and anxiety were similar between genders. While DBS significantly improved overall anxiety (p<0.001), females reported significantly more postoperative anxiety than males (median score 7 vs 1.5<i>,</i> Cohen's <i>d</i>=0.33, p=0.009). Postoperatively, only males experienced a significant reduction in moderate depression, by 29% (p=0.004) (12% in females). QOL improved significantly by similar proportions, thus significantly worse QOL in females preoperatively was sustained as 9.12% worse postoperatively (Cohen's d<i>=</i>0.75, p=0.02). Preoperatively, females reported significantly worse mobility, social support, and pain; postoperatively, the significant difference in mobility was sustained. Longer PD duration, worse QOL, and mobility predicted postoperative depression (R² <i>=</i>0.156<i>,</i> p=0.003), while female gender and reduced social support predicted postoperative anxiety (R²=0.23, p<0.001).</p><p><strong>Conclusions: </strong>DBS showed clinical efficacy for non-motor PD symptoms across genders, evidencing the need to close the gender gap in DBS. Analysis by gender highlighted significant disparities and postoperative predictors that provide impetus for tailored DBS counselling.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001246"},"PeriodicalIF":2.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic nerve as a 5th location in the revised McDonald diagnostic criteria for multiple sclerosis: limitations of OCT in the acute phase.","authors":"Valentina Annamaria Mauceri, Marco Puthenparampil, Paolo Gallo, Axel Petzold","doi":"10.1136/bmjno-2025-001118","DOIUrl":"10.1136/bmjno-2025-001118","url":null,"abstract":"<p><strong>Background: </strong>The updated International Panel's diagnostic criteria for multiple sclerosis (2024 revision of McDonald criteria) have for the first time included the optic nerve as the fifth location for dissemination in space (DIS) criterion. The new requirement consists of evidence of significant retinal asymmetry. However, this can be challenging in the acute phase in absence of optic disc swelling. Here, we have investigated the sensitivity of retinal asymmetry over time, from the acute to the chronic phase of optic neuritis.</p><p><strong>Methods: </strong>This observational study analysed longitudinal optical coherence tomography (OCT) images of 25 patients with optic neuritis and 5 healthy controls. Spectral domain OCT scans were obtained from the macula and optic disc. The peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell (mGCL) and inner plexiform layers (mIPL) were measured in the acute (≤7 days), subacute (between 1 and 12 weeks) and chronic (>3 months) phase.</p><p><strong>Results: </strong>The OCT measurements showed progressive thinning in pRNFL and mGCIPL layers as the disease progressed. In the acute phase, the sensitivity of the pRNFL was 69% (due to optic disc swelling) and for the mGCPL 27%. In the chronic phase, sensitivity levels increased up to 76% (pRNFL) and 88% (mGCIPL) due to atrophy.</p><p><strong>Conclusions: </strong>A clear understanding of the temporal dynamics of diagnostic findings is important. For OCT, the highest diagnostic sensitivity is achieved for the mGCIPL in the chronic phase. This should be taken into account for timing the test in patients where the acquisition of optic nerve involvement is essential for DIS.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001118"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing hospital length of stay with criteria-led transfer from the acute stroke unit to inpatient rehabilitation.","authors":"Peishan Cai, Karen Stephens, Jane D'Souza, Louisa Soh, Emily Schembri, Philip Mc Choi","doi":"10.1136/bmjno-2025-001316","DOIUrl":"10.1136/bmjno-2025-001316","url":null,"abstract":"<p><strong>Background: </strong>Criteria-led transfer allows transfer of select stroke patients to inpatient rehabilitation without rehabilitation physician review, which may be a barrier for timely transfers.</p><p><strong>Objective: </strong>Primary: determine the proportion of patients transferred via criteria-led transfer and waitlist time. Secondary: determine the number of unplanned 30-day acute hospital representations and readmissions from inpatient rehabilitation, and number of daily allied health contacts while waitlisted.</p><p><strong>Method: </strong>A single-centre retrospective analysis was conducted on all patients transferred from the acute stroke unit to inpatient rehabilitation in 2023.</p><p><strong>Results: </strong>178 (79%) patients successfully used criteria-led transfer, 22 (9.5%) did not meet criteria and the remainder attended inpatient rehabilitation via a separate pathway. Median waitlist time (in days) was shorter for criteria led transfer patients compared with those who did not meet criteria (3 (1-5) vs 5 (3-8), p=0.005). Emergency department representation rates were lower in the criteria-led transfer cohort (30 (16.9%) vs 8 (36.3%), p=0.03) compared with those who did not meet criteria. No difference in readmission rates was seen (p=0.22). Waitlisted patients received 1 (0.5-1.5) allied health reviews daily.</p><p><strong>Conclusions: </strong>Criteria-led transfer is associated with shorter waitlist times for transfer to rehabilitation without increased adverse events. Further research is needed to determine result generalisability.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001316"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world use of disease-modifying therapy in persons with multiple sclerosis aged 55 and over.","authors":"Mina Stanikić, Anke Salmen, Christian P Kamm, Patrick Roth, Pasquale Calabrese, Chiara Zecca, Claudio Gobbi, Claudia Baum, Benjamin Victor Ineichen, Viktor von Wyl","doi":"10.1136/bmjno-2025-001108","DOIUrl":"10.1136/bmjno-2025-001108","url":null,"abstract":"<p><strong>Background: </strong>As the average age of multiple sclerosis (MS) population rises globally, unclear guidelines on disease-modifying therapy (DMT) use in older persons with MS (pwMS) contribute to increased variability in clinical practice. The factors driving DMT utilisation in this population are not well understood. We explored DMT utilisation patterns in pwMS aged 55 and older enrolled in the Swiss MS Registry (SMSR), a nationwide observational study with voluntary participation.</p><p><strong>Methods: </strong>We conducted an exploratory analysis using data from SMSR participants who had reported DMT status in the most recent follow-up survey and at least once within the previous 3 years. Participants were categorised and compared by current and past DMT use: <i>No DMT</i> (no use), <i>Stopped</i> (prior use), <i>Continued</i> (same DMT), <i>Switcher</i> (changed DMT) and <i>New</i> (initiated DMT). Log-binomial regression identified factors associated with non-use, grouping participants as No DMT (<i>No DMT</i>, <i>Stopped</i>) and DMT (<i>Continued, Switcher, New</i>).</p><p><strong>Results: </strong>Among 378 participants (mean age 63.2±6.7 years), 206 (54.5%) reported DMT use: 176 (46.6%) continued the same DMT, 20 (5.3%) switched and 10 (2.6%) newly initiated DMT. Among non-users, 54 (14.3%) had stopped treatment, while the rest did not use DMT during the study period. In participants with regular neurological care, longer MS duration (relative risk (RR)=1.018, 95% CI 1.008 to 1.028) and older age (RR=1.016, 95% CI: 1.001 to 1.032) were associated with higher likelihood of DMT non-use, and participants with primary (RR=1.736, 95% CI: 1.175 to 2.565) and secondary progressive MS (RR=1.423, 95% CI: 1.023 to 1.981) were more likely not to use DMTs compared with relapsing-remitting MS. No significant associations were observed in participants without regular neurological follow-up.</p><p><strong>Conclusions: </strong>Despite unclear efficacy and safety, many older pwMS continue DMT use. Use is primarily associated with relapsing-remitting MS, while age and disease duration show only modest or no association.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001108"},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Density of routinely collected neurology data depends on patient visit type: an investigation using the observational medical outcomes partnership common data model.","authors":"Fran Biggin, Laura M White, Quinta Ashcroft, Timothy Howcroft, Vishnu Vardhan Chandrabalan, Hedley Emsley, Jo Knight","doi":"10.1136/bmjno-2025-001202","DOIUrl":"10.1136/bmjno-2025-001202","url":null,"abstract":"<p><strong>Background: </strong>The Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) is a standardised framework for organising healthcare data. This study uses data in the OMOP CDM format to analyse information on neurology patients.</p><p><strong>Methods: </strong>Routinely collected data harmonised to OMOP at a large referral hospital in England were used. A study cohort was defined as patients who attended at least one neurology outpatient appointment between 01 April 2022 and 31 March 2023 (n=23 862). Data collected at all visits to the hospital made by this cohort between 01 April 2021 and 31 March 2024 were extracted. The cohort was then divided into four subcohorts according to appointment types attended: outpatient appointment(s) only (n=15 2); outpatient appointment(s) and inpatient stay(s) (n=2750); outpatient appointment(s) and emergency department attendance(s) (n=1658); outpatient appointment(s), inpatient stay(s) and emergency department attendance(s) (n=4199).</p><p><strong>Results: </strong>We found there to be more data available for patients who had at least one inpatient stay or emergency department attendance than for those with only outpatient appointments. Notably, an average of 0 out of 100 patients in the outpatient only subcohort had a record of a condition, compared with 100 out of 100 patients in the subcohort with outpatient appointments, emergency attendances and inpatient stays.</p><p><strong>Conclusions: </strong>Neurology outpatients have far less data recorded than inpatients or patients attending emergency departments. This disparity arises from the lack of outpatient diagnostic coding and impairs the advancement of research in this area. Using the OMOP CDM structure makes it easy to highlight these differences.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001202"},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public and professional attitudes towards deceptive and open-label placebo in functional neurological disorder and wider neurological practice.","authors":"Anne-Catherine M L Huys, Kailash P Bhatia, Mark J Edwards","doi":"10.1136/bmjno-2025-001171","DOIUrl":"10.1136/bmjno-2025-001171","url":null,"abstract":"<p><strong>Background: </strong>Placebo effects are powerful and have been suggested to be particularly relevant in certain neurological conditions, including functional neurological disorder (FND).</p><p><strong>Methods: </strong>A survey on attitudes towards and current practice of deceptive placebo treatments and ethical alternatives, notably positive suggestion, trust and open-label placebo was performed among health professionals and lay people with and without neurological diagnoses.</p><p><strong>Results: </strong>116 healthcare professionals and 631 lay people (176 FND, 332 with other neurological diagnoses, 61 with medical diagnoses, 62 healthy controls) completed the survey.71% of lay people but only 46% of healthcare professionals were in favour of deceptive placebo treatments. Among lay people, healthy individuals were most in favour (87%), and people with FND were least in favour (62%). All groups were sceptical towards open-label placebo, yet neurologists were most open to this practice.Placebo was considered more effective for functional than non-functional disorders by healthcare professionals, but not by patients. Healthcare professionals reported only rarely using placebo in clinical practice, and if so, mainly in the diagnosis or treatment of FND.</p><p><strong>Conclusions: </strong>This is the first survey on opinions and current practice of placebo treatments in neurological practice. The results show a mixed picture, with deceptive placebos being perceived as effective and acceptable by most lay people (though strongly opposed by some, particularly by some patients with FND) and mostly considered more negatively by healthcare professionals. Ethically acceptable alternatives of harnessing the power of placebo without deception were considered with scepticism by all respondents, but least so by neurologists.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 2","pages":"e001171"},"PeriodicalIF":2.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}