BMJ Neurology Open最新文献

{"title":"Meningioma regression following depot medroxyprogesterone acetate withdrawal: a case series.","authors":"Byron De John, Richard J Burman, Vishesh Sood, Allan Taylor, David Le Feuvre, Darlene Lubbe","doi":"10.1136/bmjno-2026-001676","DOIUrl":"https://doi.org/10.1136/bmjno-2026-001676","url":null,"abstract":"<p><strong>Background: </strong>Progesterone signalling is a key determinant of meningioma behaviour, particularly in skull base tumours. Cyproterone acetate-associated meningiomas stabilise or regress after withdrawal Whether similar reversibility follows cessation of depot medroxyprogesterone acetate (DMPA), a widely used long-acting injectable contraceptive, is poorly characterised.</p><p><strong>Methods: </strong>Retrospective case series of three women with intracranial meningiomas who discontinued DMPA following neurosurgical assessment, assessed with post-contrast CT (Cases 1 and 2) or magnetic resonance imaging (Case 3).</p><p><strong>Results: </strong>All had prolonged DMPA exposure (approximately 14-27 years) and predominantly skull base disease with WHO grade I meningothelial histology. Each demonstrated measurable regression of enhancing soft-tissue tumour after cessation, despite marked heterogeneity in disease burden and chronicity, including one patient with multifocal meningiomatosis and more than a decade of documented progression. Hyperostotic bone showed no regression, and two patients required optic nerve and orbital decompression for progressive visual loss despite soft-tissue regression.</p><p><strong>Conclusion: </strong>DMPA-associated meningiomas can regress following drug withdrawal, but the response is confined to the soft-tissue component. Persistent hyperostosis may continue to cause compression, and withdrawal should not be assumed to remove the need for surgery. These findings support routine assessment of progestin exposure in patients with meningioma.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001676"},"PeriodicalIF":2.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197802","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":"Epidemiology of progressive cerebellar ataxia in South Yorkshire, UK.","authors":"Emma Foster, Priya Darshni Shanmugarajah, Suzanna Duty, Ewelina Hogg, Marios Hadjivassiliou","doi":"10.1136/bmjno-2026-001799","DOIUrl":"https://doi.org/10.1136/bmjno-2026-001799","url":null,"abstract":"<p><strong>Background: </strong>Cerebellar ataxias are a heterogeneous group of rare neurological disorders characterised by progressive gait instability, limb incoordination, speech and oculomotor impairment. UK prevalence estimates remain rather limited, with the most widely cited population-based study performed in South East Wales over two decades ago. The objective is to estimate the current prevalence of progressive cerebellar ataxia within South Yorkshire using a comprehensive NHS (National Health Service) tertiary ataxia service database and to compare findings with previously published UK data.</p><p><strong>Methods: </strong>A retrospective epidemiological analysis was undertaken using the Sheffield Ataxia Centre NHS clinical database. All alive patients aged over 18 years living in South Yorkshire with confirmed progressive cerebellar ataxia under active or historical follow-up were included, excluding static and structural ataxias where appropriate. Population sizes within South Yorkshire were derived from the 2024 Office for National Statistics (ONS) mid-year population estimates for everyone aged over 18 years and over 65 years.</p><p><strong>Results: </strong>A total of 1204 individuals with progressive cerebellar ataxia were identified as resident in South Yorkshire, corresponding to a frequency prevalence of approximately 106 per 100 000 population (1:942). Prevalence varied by local authority, ranging from 1:647 in Sheffield to 1:1677 in Doncaster.</p><p><strong>Conclusions: </strong>The prevalence of progressive cerebellar ataxia in South Yorkshire is substantially higher than previously reported UK figures, likely reflecting improvements in diagnostic capability, service centralisation and recognition of immune-mediated and new novel genetic ataxias. These figures have important implications for service planning and resource allocation within the NHS.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001799"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118652","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":"Case report of anti-vimentin IgG-associated autoimmune encephalitis: diagnostic challenges and the role of 18F-DPA714 PET/MRI.","authors":"Siqi Tu, Siyu Dong, Sheng Chen, Huanyu Meng","doi":"10.1136/bmjno-2026-001557","DOIUrl":"https://doi.org/10.1136/bmjno-2026-001557","url":null,"abstract":"<p><strong>Background: </strong>Anti-vimentin IgG-associated autoimmune encephalitis (AE) is a recently described autoimmune astrocytopathy characterised by relapsing-remitting cerebellar ataxia, brainstem involvement and pyramidal tract lesions. Nevertheless, several key aspects remain poorly elucidated, including the full clinical phenotypic spectrum (particularly peripheral nervous system (PNS) involvement), the interpretation of serological discrepancies and long-term management outcomes. Additionally, the imaging evidence for neuroinflammation and the evidence regarding evolution following treatment remain insufficient.</p><p><strong>Case presentation: </strong>We reported a man in his late 40s who developed a core triad of cerebellar ataxia, pyramidal signs and peripheral neuropathy. Conventional MRI was unremarkable, but cerebrospinal fluid analysis revealed anti-vimentin IgG positivity (titre 1:10) with type III oligoclonal bands while serum was negative. ¹⁸F-DPA714 positron emission tomography/MRI showed elevated tracer uptake in the mesial temporal lobe, frontal lobe and brainstem, correlating with clinical signs. After intravenous immunoglobulin induction and ofatumumab maintenance therapy, the patient showed clinical improvement (modified Rankin Scale from 2 to 1) at 3-month follow-up, paralleled by reduced tracer uptake.</p><p><strong>Conclusions: </strong>This first reported middle-aged male case expands the demographic and phenotypic spectrum of anti-vimentin IgG-associated AE to include PNS involvement. This case highlights the diagnostic value of antibody detection and advanced imaging modalities in atypical presentations of anti-vimentin IgG-associated AE.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001557"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118705","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":"Chimeric antigen receptor T cell therapy in autoimmune neurological disease: current status of efficacy and safety.","authors":"Peter Bradhurst, Todd A Hardy, Sean Riminton","doi":"10.1136/bmjno-2026-001611","DOIUrl":"https://doi.org/10.1136/bmjno-2026-001611","url":null,"abstract":"<p><p>Autoimmune neurological diseases affecting the central nervous system, peripheral nervous system and neuromuscular junction are frequently refractory to conventional B-cell-depleting therapies such as CD20-directed monoclonal antibodies, highlighting a need for more effective treatment approaches. Chimeric antigen receptor T (CAR-T) cell therapy, initially developed for haematological malignancy, has been repurposed to more comprehensively deplete pathogenic B-cell and plasma cell populations in autoimmune disease, raising the possibility of durable, treatment-free remission. This scoping review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-ScR guidelines, examined published clinical studies from January 2023 to January 2026 in which CAR-T cells targeting CD19, CD20 or B-cell maturation antigen were used to treat autoimmune neurological disease, identifying 19 eligible studies. Efficacy signals were most consistent in refractory acetylcholine receptor antibody-positive generalised myasthenia gravis and Aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder, with encouraging but more preliminary results reported in multiple sclerosis, Lambert-Eaton myasthenic syndrome, myelin oligodendrocyte glycoprotein antibody-associated disease, chronic inflammatory demyelinating polyneuropathy, stiff-person syndrome and autoimmune encephalitis. Relapse was reported across several conditions, with follow-up generally limited to under two years. The safety profile compared favourably with that seen in oncological CAR-T use, with lower rates of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, although cytopenias, infection and prolonged hypogammaglobulinaemia remain clinically significant, and local immune effector cell-associated toxicity syndrome is an emerging concern not yet formally reported in this population. Current evidence remains limited to small, largely uncontrolled studies with heterogeneous outcome reporting. Adequately powered, longer-term controlled trials are needed before CAR-T therapy can be recommended more broadly in the management of refractory autoimmune neurological disease.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001611"},"PeriodicalIF":2.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118699","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":"Stroke reperfusion in Aotearoa New Zealand: 5-year trends and a comparison of stroke clot retrieval and non-stroke clot retrieval centre presenters.","authors":"Morgan Lam, Alicia Ls Tyson, Martin N Punter, P Alan Barber, Matthew Cl Phillips, Teddy Wu, John Fink, Anne Ranta","doi":"10.1136/bmjno-2026-001704","DOIUrl":"https://doi.org/10.1136/bmjno-2026-001704","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis (IVT) and stroke clot retrieval (SCR) are effective stroke reperfusion treatments with historical underuse and reported access disparities.</p><p><strong>Aims: </strong>This study describes trends in stroke reperfusion treatment between 2020 and 2024 in New Zealand and compares outcomes between patients first presenting to SCR and non-SCR centres.</p><p><strong>Methods: </strong>This observational registry-study uses data from the National Stroke Register for patients receiving reperfusion therapy. Outcomes include treatment rates, time delays, mortality and complications.</p><p><strong>Results: </strong>In 2020, 1021 of 7333 (13.9%) patients who had an ischaemic stroke had reperfusion therapy, increasing to 1237 of 6867 (18.0%) in 2024 (p<0.001). The greatest increases in therapy rates were among non-SCR centre first presenters. IVT rates increased from 11.2% in 2020 to 12.4% in 2024 (p=0.038), with reduced rates of symptomatic intracranial haemorrhage (3.2% to 1.5%; p=0.0272) and day-7 mortality (8.5% to 5.6%; p<0.001). SCR rates increased from 5.3% in 2020 to 9.7% in 2024 (p<0.001), with no change in patient outcomes. Between 2020 and 2024, national median door-to-needle time increased from 60 to 74 min (p<0.001). Patients first presenting to SCR centres were more likely to be treated with IVT within 60 min (48.4% vs 31.7%; p<0.001; adjusted OR of 2.8 (95% CI 2.0 to 4.0)).</p><p><strong>Conclusion: </strong>New Zealand stroke reperfusion therapy rates are rising, especially at non-SCR centres, and outcomes following IVT are improving. IVT treatment delays are worsening suggesting more resources are needed to maintain workflow efficiencies as case complexity is rising.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001704"},"PeriodicalIF":2.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118712","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":"Prognostic value of the SPICE score for 1-year functional outcomes in patients with acute stroke requiring mechanical ventilation.","authors":"Tharcisse Mabiala, Mikael Mazighi, Magalie Collet, Vincent Degos, Jacques Duranteau, Charles Grégoire, Tarek Sharshar, David Cortier, Berthe Barhayiga, Médard Bula Bula, Gilbert Mananga Lelo, Jean-François Timsit, Romain Sonneville, Etienne de Montmollin","doi":"10.1136/bmjno-2026-001709","DOIUrl":"https://doi.org/10.1136/bmjno-2026-001709","url":null,"abstract":"<p><strong>Background: </strong>Approximately 15 million people suffer from strokes each year and accurate prognostication is crucial for care management. This study evaluated the performance of the Stroke Prognosis in Intensive CarE (SPICE) score to predict functional outcomes at 1 year in patients who underwent mechanical ventilation following a stroke.</p><p><strong>Methods: </strong>Ancillary analysis of the SPICE prospective multicentre cohort study conducted from 2017 to 2019 in 33 intensive care units (ICUs) of the Greater Paris area. All patients requiring mechanical ventilation on ICU admission and within 7 days of a non-traumatic stroke were included. The primary outcome was poor functional prognosis at 1 year (severe disability or death: modified Rankin Scale score of 4-6). Variables independently associated with the outcome were used to compute a prognostic score (SPICE score).</p><p><strong>Results: </strong>Retained variables were stroke subtype, time between stroke diagnosis and initiation of mechanical ventilation, age, the Charlson Comorbidity Index and the Glasgow Coma Score (GCS) at ICU admission. The median SPICE score of the 364 patients of the cohort was 15 (IQR 11-19) and demonstrated acceptable predictive power (area under the receiver operating characteristic curve (AUROC) of 0.752) for poor outcome and outperformed GCS (AUROC 0.658) and Sequential Organ Failure Assessment (AUROC 0.655) scores. A threshold of >18 points on the SPICE score had a sensitivity of 35.7% and a specificity of 95% for poor outcome prediction, yielding a positive predictive value of 93.5% (95% CI 86.5% to 97.6%) and a positive likelihood ratio of 7.16 (95% CI 3.22 to 15.9).</p><p><strong>Conclusions: </strong>For mechanically ventilated patients after a stroke, the SPICE score showed adequate predictive power for poor functional outcome at 1 year. Validation of the SPICE score in an external cohort is needed.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001709"},"PeriodicalIF":2.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118687","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":"Incorporating genetics and genetic counselling in neurology clinics: a survey of neurologists' perceptions and current practices.","authors":"Madeline Gorman, Lauren Maynard, Holli Horak, Valerie Schaibley","doi":"10.1136/bmjno-2026-001780","DOIUrl":"10.1136/bmjno-2026-001780","url":null,"abstract":"<p><strong>Introduction: </strong>Neurogenetics has grown significantly in recent years, yet advances have not always been incorporated into clinical practice. In previous studies, neurologists reported limited confidence in ordering and interpreting genetic tests, implying a gap between genetic advances and their application in neurology. Genetic counsellors are uniquely trained to facilitate genetic testing, interpret results and provide psychosocial support, ultimately improving patient care.</p><p><strong>Methods and analysis: </strong>In this study, we assessed the utilisation of genetic testing and genetic counselling in neurology practice as well as neurologists' perceived value of genetic counsellors. We emailed a cross-sectional survey to board-certified neurologists practising in Arizona. Out of the 28 completed responses, most respondents had practised for more than 15 years and worked in urban settings, yet 68% did not have a genetic counsellor embedded into their clinic. We found that neurologists with more genetics training were more likely to order genetic testing and felt more comfortable performing genetic counselling roles (p=0.739, p=3.66×10⁻⁵). Additionally, greater years of experience in practice correlated with increased comfort performing genetic counselling roles (p=0.519, p=0.005). However, we found no significant relationship between physicians' level of genetics training or comfort performing genetic counselling roles and their perceived value of having a genetic counsellor in neurology settings, suggesting that many neurologists value genetic counsellors' role in neurology clinics. These results highlight the need for increased integration of genetic counsellors in neurology settings to enhance patient care.</p><p><strong>Ethics and dissemination: </strong>The University of Arizona Institutional Review Board approved this study (STUDY00004930). Participation was voluntary, informed consent was obtained electronically, and all responses were anonymous.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001780"},"PeriodicalIF":2.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992358","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":"Functional recovery trajectories in post-acute stroke care: rethinking the length of stay.","authors":"Chao-Hung Yu, Ya-Wen Lee, Chih-Hao Lin, Hui-Yi Yang, Ying-Lin Hsu, Mu-Chien Sun, Chun-Yi Lin, Hao-Chih Yin, Hsiao-Fen Sun, Hui-Chun Tu, Pi-Ju Hsiao, Chih-Ming Lin","doi":"10.1136/bmjno-2025-001533","DOIUrl":"10.1136/bmjno-2025-001533","url":null,"abstract":"<p><strong>Background: </strong>Post-acute care (PAC) restores function after stroke, but the optimal length of stay (LOS) is undefined, particularly in high-intensity rehabilitation settings, causing practice variation and resource-allocation challenges.</p><p><strong>Objective: </strong>To examine the association between PAC LOS and functional outcomes after stroke using propensity score-based adjustment for baseline functional severity and to characterise recovery trajectories across rehabilitation durations.</p><p><strong>Methods: </strong>In a retrospective cohort of patients enrolled in Taiwan's PAC stroke programme (January 2018-December 2023), functional outcomes were assessed using the modified Rankin scale (mRS) and Barthel Index (BI). Associations between prolonged LOS (>6 weeks) and outcomes were examined using multivariable logistic regression and an inverse probability of treatment weighting model incorporating baseline functional status into the propensity score. Exploratory analyses evaluated weekly LOS cut-offs and stroke subtypes.</p><p><strong>Results: </strong>Among 610 patients, prolonged PAC LOS was associated with higher odds of mRS improvement (OR 1.75, 95% CI 1.20 to 2.57), lower odds of mRS non-improvement (0.57, 0.39 to 0.84) and lower odds of discharge BI≤60 (0.37, 0.25 to 0.55). Lower odds of BI non-improvement were also observed but rested on very few events (penalised-likelihood (Firth) estimation) and warrant caution. The decline in mRS non-improvement continued with longer LOS and differed by subtype, persisting beyond 6 weeks in ischaemic stroke.</p><p><strong>Conclusions: </strong>After adjustment for baseline functional status, prolonged PAC LOS remained associated with more favourable outcomes, but this should not be interpreted as evidence that longer rehabilitation independently causes better recovery. LOS appears to reflect individual recovery trajectories, whose timing differed by stroke subtype. These findings argue against a single uniform duration threshold and support individualised, subtype-aware reassessment.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001533"},"PeriodicalIF":2.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992102","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":"From brain to heart: a single-centre study of ictal and post-ictal asystole in epilepsy.","authors":"Abhishek Gohel, Belinda Philip, Akshaya Raman, Rutul Shah, Tejas Shivarthi, Mahima Sriram, Ashok Pillai, Ramaiah Rajeshkannan, Talal Almashaikhi, Navin Mathew, Siby Gopinath","doi":"10.1136/bmjno-2026-001733","DOIUrl":"10.1136/bmjno-2026-001733","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to explore ictal asystole (IA), a neurocardiogenic phenomenon occurring during epileptic seizures, and its implications in patients with epilepsy. The study aims to describe the clinical presentations, diagnostic challenges and management approaches of IA to contribute to the existing knowledge and improve patient care.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 15 578 patients undergoing prolonged video-electroencephalogram monitoring over a period of 115 months. Clinical features, electrophysiology, neuroimaging, interventions and outcomes were assessed.</p><p><strong>Results: </strong>Eight patients (0.05%) exhibited IA (six females; mean age: 36.5 years; range: 26-45 years). The mean age at seizure onset was 20.5±11.73 years and mean disease duration from seizure onset was 16±10.66 years. Six patients gave a history of hypomotor features (75%), one exhibited automotor features (12.5%) and one exhibited sensorimotor features (12.5%). Of the 127 ictal events analysed, 47 (37%) progressed to asystole and 80 (63%) had bradycardia without asystole. Bradycardia preceded 95.7% of asystolic events. A significant direct correlation was observed between average duration of IA and average seizure duration (p=0.015). IA was predominantly observed in temporal lobe epilepsy. Falls and myoclonus were observed during asystolic events. All patients survived without requiring resuscitation. Six patients underwent surgical intervention for epilepsy, with varying degrees of success. One patient underwent permanent pacemaker implantation.</p><p><strong>Conclusion: </strong>Clinicians should consider IA in patients with epilepsy presenting with unexplained syncope or sudden falls, especially when associated with recent changes in seizure semiology. A high index of suspicion is essential to enable timely diagnosis and prevent injury.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001733"},"PeriodicalIF":2.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991954","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":"Inflammatory biomarkers as predictors of paradoxical reaction in tubercular meningitis: a prospective observational study.","authors":"Satinder Deswal, Abdul Qavi, Ajai Kumar Singh, Pradeep Kumar Maurya, Dinkar Kulshreshtha, Arshi Ansari","doi":"10.1136/bmjno-2026-001750","DOIUrl":"10.1136/bmjno-2026-001750","url":null,"abstract":"<p><strong>Introduction: </strong>Tubercular meningitis (TBM) is associated with high morbidity and mortality due to intense inflammatory responses causing basal exudates, vasculitic infarcts, hydrocephalus and cranial nerve palsies. Paradoxical reaction (PR) occurs in nearly 30% of patients and contributes to clinical deterioration during treatment. Dysregulated inflammatory mediators in serum and cerebrospinal fluid (CSF) have been implicated in PR and adverse outcomes in TBM.</p><p><strong>Objective: </strong>This study evaluated baseline serum and CSF inflammatory biomarkers for predicting PR and vasculitic infarcts in newly diagnosed TBM patients.</p><p><strong>Methods: </strong>In this prospective observational study, 151 treatment-naïve TBM patients fulfilling Marais consensus criteria were enrolled. Baseline clinical, radiological, serum and CSF inflammatory markers were assessed and repeated during PR/stroke. Serum markers included high-sensitivity C reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), ferritin, albumin, D-dimer, neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index. CSF analysis included adenosine deaminase, NLR, protein, glucose and leucocyte count.</p><p><strong>Results: </strong>Among 151 patients (mean age 32.7±14.5 years), 43 (28.4%) developed PR, most commonly within 1-2 months of antitubercular therapy initiation. Altered sensorium (58.1%) and progression of hydrocephalus (60.5%) were common manifestations. Higher baseline ESR, hsCRP, LDH, ferritin, D-dimer and lower serum albumin were significantly associated with PR. Serum ferritin showed the best predictive accuracy (area under the curve 0.910; cut-off ≥451 µg/L; sensitivity 88.4%, specificity 88.9%). On multivariable analysis, serum ferritin (OR 1.004; p=0.001) and ESR (OR 1.020; p=0.033) remained independent predictors.</p><p><strong>Conclusions: </strong>Serum inflammatory markers, particularly ferritin and ESR, may serve as useful predictors of PR in TBM. These findings support an immune-mediated mechanism underlying paradoxical worsening and may help identify high-risk patients who could benefit from early anti-inflammatory or immune-modulatory therapy.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001750"},"PeriodicalIF":2.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992295","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}