BMJ Neurology Open最新文献

{"title":"DIAGnosis using NOvel technology for Subtypes In Stroke (DIAGNOSIS study): performance evaluation protocol.","authors":"Ibrahim Alghamdi, Mohammed Almubayyidh, Edoardo Gaude, David A Jenkins, Adrian R Parry-Jones","doi":"10.1136/bmjno-2026-001575","DOIUrl":"10.1136/bmjno-2026-001575","url":null,"abstract":"<p><strong>Introduction: </strong>Timely and accurate identification of stroke subtypes, particularly intracerebral haemorrhage (ICH) and large vessel occlusion (LVO), is essential for improving stroke outcomes. Biomarkers have shown potential in identifying these subtypes. Glial fibrillary acidic protein (GFAP), which is elevated in ICH, and D-dimer, which is associated with LVO, are promising for rapid, point-of-care identification. This study evaluates whether combining GFAP and D-dimer with clinical features improves the diagnostic accuracy for ICH and LVO.</p><p><strong>Methods and analysis: </strong>This is a multicentre, observational diagnostic accuracy study recruiting a minimum of 257 patients with suspected stroke within 6 hours of symptom onset from two UK hyperacute stroke centres. The study will integrate clinical features and point-of-care biomarker results using the LVOne test (GFAP and D-dimer) to develop diagnostic models that differentiate ICH and LVO from other stroke presentations. Patients will be identified on hospital arrival, and clinical variables and blood samples collected immediately, with the final diagnosis recorded prior to discharge. Statistical analyses will assess discrimination, calibration and clinical utility, with sensitivity, specificity and predictive values reported. Model development and reporting will follow the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis+Artificial Intelligence and the Standards for Reporting of Diagnostic Accuracy Studies guidelines.</p><p><strong>Ethics and dissemination: </strong>The study is registered with ISRCTN (ISRCTN35174477). Ethical approval has been obtained from the Yorkshire & The Humber - Leeds West Research Ethics Committee (25/YH/0102) and the Health Research Authority. Results will be disseminated via open-access peer-reviewed journals, presentations at national and international conferences and summaries for patient and public contributors.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001575"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908193","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":"Moving beyond monitoring: wearable technology (PKG) for the diagnosis of Parkinson's disease.","authors":"Michael William Hayes, Niroshan Jeyakumar, James Burrell","doi":"10.1136/bmjno-2026-001689","DOIUrl":"10.1136/bmjno-2026-001689","url":null,"abstract":"<p><strong>Background: </strong>The use of wearable technology results in objective and reliable monitoring of motor activity in Parkinson's disease (PD) but its utility as a diagnostic aid has not been assessed.</p><p><strong>Objectives: </strong>To assess whether a Personal KinetiGraph (PKG) performed at baseline and again following a long-form levodopa (LD) challenge (increasing to 300 mg daily over a minimum of 6 weeks) is a useful discriminator in those with parkinsonism but diagnostic uncertainty.</p><p><strong>Methods: </strong>Over a 10-year period, 26 patients with parkinsonism in whom there was diagnostic uncertainty due to clinical complexity or conflicting evidence were tested with a PKG, recording bradykinesia and tremor before and after formalised treatment with LD. Patients were followed for a median of 46.5 months (mean 49.8) to establish a 'final' clinical diagnosis.</p><p><strong>Results: </strong>Of the 15/26 diagnostically uncertain patients with a 'final' diagnosis of PD, the PKG demonstrated bradykinesia (mean bradykinesia score ≥25) at baseline in 14/15; in 12/15, bradykinesia improved with LD and, when present, tremor was similarly reduced. In the 11/26 patients who had a final diagnosis other than PD, the PKG recorded bradykinesia in 3/11 with improved bradykinesia and reduced tremor in only 1/11. PKG-defined bradykinesia coupled with LD responsiveness was 88% sensitive (95% CI 57% to 98%) and 89% specific (95% CI 52% to 99%) for a 'final' PD diagnosis in this select group. Additionally, PKG-defined tremor and LD responsiveness had a sensitivity of 85% (95% CI 55% to 98%) and specificity of 89% (95% CI 52% to 99%).</p><p><strong>Conclusion: </strong>PKG-defined bradykinesia and tremor coupled with LD responsiveness appear to be predictive of an eventual PD diagnosis in diagnostically challenging cases. Larger studies are required to verify these conclusions.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001689"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908244","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":"Australian Paediatric Acute Code Stroke study: study protocol for a quasi-experimental trial measuring the impact of Code Stroke protocols on time to diagnosis and access to reperfusion therapies.","authors":"Mark T Mackay, Belinda Stojanovski, Nicola Fearn, Michael Fahey, Ian Andrews, Christopher Troedson, Richard Webster, Christina Miteff, Adriane Sinclair, Claire Pridmore, Snehal Shah, Claire G Spooner, Leonid Churilov, Bruce C V Campbell, Lan Gao, Dominique Cadilhac, Franz E Babl, Dee Banks, Lisa Murphy","doi":"10.1136/bmjno-2026-001582","DOIUrl":"10.1136/bmjno-2026-001582","url":null,"abstract":"<p><strong>Introduction: </strong>Childhood stroke leads to long-term neurological impairment, impacts on quality of life and has substantial economic costs. Coordinated systems of care are required to streamline rapid diagnosis and treatment of stroke. The primary aim is to investigate the effect of Code Stroke protocols on increasing the proportion of children with stroke diagnosed within the 4.5-hour time window for reperfusion therapies.</p><p><strong>Methods and analysis: </strong>Prospective, multicentre, quasi-experimental interventional study in nine Australian and New Zealand children's hospitals from 2020 to 2026. Children aged 1 month to <18 years with stroke symptoms are eligible for inclusion. A staged pre-implementation and post implementation study design will investigate effects of (1) Code Stroke protocols to streamline diagnosis and treatment, (2) decision support tools to improve diagnostic accuracy and (3) perfusion imaging to quantify brain at risk of infarction. Presenting characteristics, timelines of care, treatments, functional and health economic outcomes will be collected. The primary outcome is the proportion of children with stroke diagnosed within 4.5 hours, estimated using a mixed-effect logistic regression model, with the dichotomous variable time to diagnosis as the dependent variable, implementation phase as the independent fixed effect and hospitals as random effects. Sample size calculation estimates that 98 patients with radiologically confirmed stroke per phase will yield 80% power to detect change from 15% to 40% in the proportion of children diagnosed within 4.5 hours.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001582"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908083","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":"Novel predictors of postoperative delirium after awake subthalamic nucleus deep brain stimulation for Parkinson's disease.","authors":"Meng-Wu Chung, Chiung-Chu Chen, Mun-Chun Yeap, Yi-Chieh Chen, Po-Lin Chen, Chih-Hua Yeh, Chin-Song Lu, Po-Hsun Tu","doi":"10.1136/bmjno-2026-001742","DOIUrl":"10.1136/bmjno-2026-001742","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common complication of deep brain stimulation (DBS) in patients with Parkinson's disease, leading to worsened outcomes. However, predictive factors remain unclear. This study aimed to identify predictors of POD following subthalamic nucleus (STN) DBS, with a focus on preoperative radiographic assessment and caudate nucleus (CN) transgression.</p><p><strong>Methods: </strong>We retrospectively reviewed 122 patients who underwent awake STN DBS from June 2017 to August 2024. Clinical, laboratory and imaging variables were assessed including postoperative classification of CN transgression. Two Firth logistic regression models were constructed for analysis, with model 1 including and model 2 excluding the Movement Disorder Society Non-Motor Rating Scale.</p><p><strong>Results: </strong>POD occurred in 16.4% of the patients. Model 2 (n=62, area under the curve (AUC)=0.904) showed superior performance to model 1 (n=122, AUC=0.884). History of lumbar TPS (trans-pedicle screw fixation) surgery (OR 6.21) and higher preoperative score of Unified Parkinson's Disease Rating Scale (UPDRS) part II (off-medication) (OR 1.13) were independent predictors. A higher medial temporal lobe atrophy (MTA) score (OR 3.481) showed marginal significance (p=0.054). CN transgression by the electrode or postoperative perilead oedema (PLE) was not associated with an increased risk.</p><p><strong>Conclusions: </strong>In this study, a higher preoperative UPDRS II score (off-medication) and history of lumbar TPS surgery are independent predictors of POD following STN DBS. A higher MTA score is marginally significant in predicting POD. In contrast, CN transgression or postoperative PLE appears to be unrelated. These findings may aid in risk stratification and surgical planning.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001742"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908226","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":"Complementary biomarkers or conflicting signals? DaT SPECT and synuclein skin biopsy in parkinsonian syndromes.","authors":"A Enrique Martinez-Nunez, Nur Walker-Pizarro, Aparna Wagle Shukla, Adolfo Ramirez-Zamora, Nikolaus R McFarland","doi":"10.1136/bmjno-2026-001759","DOIUrl":"10.1136/bmjno-2026-001759","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosing Parkinson's disease (PD) and related synucleinopathies in patients with early or atypical features remains challenging. Dopamine transporter single-photon emission CT (DaT SPECT) imaging and phosphorylated alpha-synuclein (p-Syn) skin biopsy are increasingly used, but their concordance and combined value in diagnostically uncertain, real-world patients are unknown. We evaluated whether these two biomarkers provide complementary rather than redundant diagnostic information.</p><p><strong>Methods: </strong>We retrospectively analysed patients evaluated at a tertiary movement disorders centre (January 2022-March 2025) who presented with parkinsonism or tremor not meeting established criteria for PD, multiple system atrophy or dementia with Lewy bodies. 86 patients underwent p-Syn skin biopsy; 52 also underwent DaT SPECT. Using the treating neurologist's final clinical diagnosis as the reference standard, we calculated sensitivity, specificity, predictive values and concordance for each test and for combined ('either-positive') testing and compared clinical features between concordant and discordant groups.</p><p><strong>Results: </strong>DaT SPECT and p-Syn biopsy showed similar sensitivity (79.0% and 79.0%) and specificity (74.0% and 81.0%) for synucleinopathy. Combined testing increased sensitivity to 95.6% but reduced specificity to 59.9%. Results were discordant in 30.8% of dual-tested patients; +DaT/-p-Syn patients more often reported hyposmia, whereas -DaT/+p Syn patients more often reported REM sleep behaviour disorder. Almost half of discordant cases ultimately met criteria for idiopathic PD.</p><p><strong>Conclusions: </strong>DaT SPECT and p-Syn skin biopsy provide complementary, not redundant, diagnostic information. The high discordance, with eventual PD diagnosis in many cases, is consistent with the dual-origin (brain-first vs body-first) model of alpha-synuclein propagation. Both are best used as rule-in tests in early or diagnostically uncertain disease, where a negative result does not exclude a synucleinopathy; in advanced disease meeting full clinical criteria, they may have greater rule-out value. Combined testing improves early detection at a cost to specificity, with implications for trial enrolment and for interpreting biomarkers alongside symptom evolution.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001759"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908229","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":"Enhancing the cognitive, psychological, and social outcomes of adults undergoing surgery for focal drug-resistant epilepsy: protocol for a scoping review.","authors":"Evelyn E Harvey, Honor Coleman, Deepa Bapat, Gloria Brigiari, Francesco Brigo, Sarah Brown, Sean M D Carnegie, Dario Englot, Michael W K Fong, Heather M Francis, Isabella Hogan, Nathalie Jetté, Andres Kanner, Aileen McGonigal, Bryce P Mulligan, Didier Vincent Oxenham, Piero Perucca, Sarah J Wilson","doi":"10.1136/bmjno-2026-001616","DOIUrl":"10.1136/bmjno-2026-001616","url":null,"abstract":"<p><strong>Introduction: </strong>Achieving seizure control remains a primary objective of epilepsy surgery but other important patient-centred outcomes should not be overlooked. Despite the need for more holistic approaches supporting well-being over and above seizure control, scant empirical research has identified effective interventions aimed at improving adults' cognitive, psychological, and/or social outcomes following epilepsy surgery. This novel scoping review will be the first to map the evidence in this landscape.</p><p><strong>Methods and analysis: </strong>The review will be conducted with reference to the Joanna Briggs Institute Manual for Evidence Synthesis and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Databases searched will include MEDLINE, Embase, and CINAHL. Interventions of interest may be delivered preoperatively and/or postoperatively, and primary outcomes will be specific to cognitive, psychological, and social functioning after either resective or ablative epilepsy surgery conducted in adulthood. No limitations will be imposed on publication date, language, or country/region of origin. Selection will be based on title and abstract examination followed by full-text review. Data will be charted in duplicate and the results of descriptive and qualitative analyses will be presented using tabular and graphical formats, along with a narrative summary of the findings.</p><p><strong>Ethics and dissemination: </strong>Ethics approval is not required for this review. The final review will be submitted for peer review in a medical journal and considered for dissemination via the International League Against Epilepsy (ILAE). This review is intended as a first step towards informing the development of ILAE consensus-based recommendations on enhancing cognitive, psychological, and social outcomes after epilepsy surgery in adulthood.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001616"},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908269","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":"Clinicoradiological range dissociation as a clue to spinal dural arteriovenous fistula.","authors":"Yui Sanpei, Keita Yasuda, Akira Hanazono","doi":"10.1136/bmjno-2026-001761","DOIUrl":"10.1136/bmjno-2026-001761","url":null,"abstract":"<p><strong>Background: </strong>Spinal dural arteriovenous fistula (sdAVF) is treatable but may be overlooked when MRI shows a longitudinally extensive T2-hyperintense lesion without clear flow voids. We assessed whether mismatch between MRI lesion extent and bedside sensory mapping could prompt reconsideration of sdAVF.</p><p><strong>Methods: </strong>We retrospectively analysed eight confirmed sdAVF cases from a consecutive single-centre cohort of 10 patients with spinal AVF between January 2013 and December 2024. Pretreatment MRI lesion and sensory deficit ranges were converted to myelomeres, and strength in selected bilateral lower limb muscles was summarised descriptively.</p><p><strong>Results: </strong>MRI lesion range exceeded sensory deficit range in six of eight patients. Median MRI lesion length was 12.0 myelomeres (IQR 9.75-15.5) vs 6.0 myelomeres (IQR 3.5-8.5) for sensory deficit length; the median paired difference was 7.0 myelomeres (range -4 to 13). Despite long lesions, five of eight patients had total Medical Research Council scores of 26/30 or higher across selected bilateral lower limb muscles.</p><p><strong>Conclusions: </strong>We observed clinicoradiological range dissociation in sdAVF. This finding may prompt reconsideration of sdAVF when the initial evaluation is inconclusive.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001761"},"PeriodicalIF":2.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908128","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 systems of care: evaluating disparities after stroke legislation implementation in Rhode Island.","authors":"Abigail A Teshome, Joshua R Feler, Mazen Taman, Carl Michael Porto, Elizabeth Perelstein, Mark Cort, Elias Shaaya, Krisztina Moldovan, Radmehr Torabi, Dylan N Wolman, Mahesh V Jayaraman, Jeffrey Proulx","doi":"10.1136/bmjno-2026-001647","DOIUrl":"10.1136/bmjno-2026-001647","url":null,"abstract":"<p><strong>Introduction: </strong>The Rhode Island Stroke Prevention and Treatment Act aimed to establish a standardised system of care for stroke patients through designated stroke centres, revise emergency medical services (EMS) protocols, and establish a centralised stroke database. While Stroke Systems of Care (SSOC) laws have proven effective in reducing overall stroke mortality, their benefits among racial minorities and economically disadvantaged groups remain unclear. This study investigates the impact of the Act and its amendment on stroke mortality rates across different racial groups.</p><p><strong>Methods: </strong>Data from the Rhode Island Department of Labor and Training, Centers for Disease Control Atlas of Heart Disease and Stroke, and US Census Bureau for 2006-2019 were analysed. A linear regression model analysed mortality rates among White, Black and Hispanic residents before and after the Act's implementation. Trends were further validated using a segmented regression and mixed-effects model.</p><p><strong>Results: </strong>Difference-in-differences analysis showed SSOC implementation reduced statewide all-stroke mortality by 8.56 deaths per 100 000 (95% CI -10.56 to -6.56; p<0.001). White and Hispanic groups declined, but the Black population diverged significantly from White (+20.80; 95% CI 4.83 to 36.77; p=0.011). Interrupted time series confirmed higher Black baseline mortality (β=9.70; 95% CI 2.00 to 17.40; p=0.014) and an abrupt post-implementation increase (β=29.14; 95% CI 16.64 to 41.63; p<0.001), followed by annual decline (β=-6.98; 95% CI -10.24 to -3.61; p<0.001). After amendment, Black mortality rose immediately (+19.80; 95% CI 2.15 to 37.44; p=0.028) and annually (+8.40; 95% CI 1.33 to 15.47; p=0.020). White and Hispanic groups showed no significant amendment-period changes.</p><p><strong>Conclusion: </strong>While SSOC significantly reduced overall stroke mortality in Rhode Island, the benefits were not equitably distributed across racial groups. These findings underscore the need for future stroke legislation to incorporate culturally competent, evidence-based strategies addressing social determinants of health to reduce disparities and ensure equitable care.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001647"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882378","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":"Factors influencing functional recovery in posterior circulation stroke following mechanical thrombectomy: a systematic review and meta-analysis.","authors":"Elvan Wiyarta, Rakhmad Hidayat, Mohammad Kurniawan, Iskandar Purba Geraldi, Gideon Hot Partogi Sinaga, Gamaliel Wibowo Soetanto, Gilang Nispu Saputra, Nyoman Angga Krishna Pramana","doi":"10.1136/bmjno-2025-001524","DOIUrl":"10.1136/bmjno-2025-001524","url":null,"abstract":"<p><strong>Introduction: </strong>Posterior circulation stroke (PCS) in the vertebrobasilar system carries high morbidity and mortality. While mechanical thrombectomy (MT) is effective in selected patients, functional recovery after MT for PCS remains variable and may be influenced by clinical, imaging and procedural factors.</p><p><strong>Objectives: </strong>To summarise clinical, imaging and procedural factors associated with functional recovery, defined as modified Rankin Scale 0-2 at 90 days, after MT in PCS.</p><p><strong>Methods: </strong>This systematic review and meta-analysis searched EMBASE, MEDLINE, PubMed, EBSCO, Scopus, CNKI, SSRN, bioRxiv and medRxiv from inception until 31 December 2025. Inclusion criteria were adult patients with PCS who underwent MT in clinical trials or observational studies. Risk Of Bias In Non-randomised Studies-of-Exposure was assessed. Meta-analysis used a random-effects model to pool ORs with 95% CIs, assessing heterogeneity via I² and Cochran's Q test (PROSPERO: CRD42024626263).</p><p><strong>Results: </strong>We analysed 12 094 patients from 75 studies. Predictors of favourable outcomes included higher posterior circulation-Alberta Stroke Programme Early CT Score (OR=1.80, 95% CI 1.59 to 2.03, p<0.001, I²=0.0%), intravenous thrombolysis (OR=1.66, 95% CI 1.31 to 2.1, p<0.001, I²=21.7%), first-pass effect (OR=2.36, 95% CI 1.84 to 3.03, p<0.001, I²=9.28%) and modified thrombolysis in cerebral infarction 2b/3 (OR=3.58, 95% CI 2.31 to 5.55, p<0.001, I²=58.43%). Poor outcomes were associated with higher baseline National Institutes of Health Stroke Scale (OR=0.92, 95% CI 0.89 to 0.95, p<0.001, I²=85.09%), diabetes mellitus (OR=0.56, 95% CI 0.43 to 0.72, p<0.001, I²=24.63%), hypertension (OR=0.73, 95% CI 0.59 to 0.91, p=0.010, I²=0.0%) and general anaesthesia use (OR=0.56, 95% CI 0.36 to 0.89, p=0.010, I²=64.53%).</p><p><strong>Conclusions: </strong>Stroke severity, imaging scores and procedural success are factors consistently reported to be associated with functional outcomes in PCS after MT. Although the independence of these factors cannot be determined from this analysis, these findings may help summarise current evidence on reported prognostic factors and support future prospective validation using standardised protocols.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001524"},"PeriodicalIF":2.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882465","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":"Association between probable postictal psychosis and subsequent diagnosis of primary psychotic disorders: a retrospective cohort study.","authors":"Varsha Nandwana, Geetika Bajpai, Ching-Fang Sun, Anita S Kablinger, Aashit K Shah","doi":"10.1136/bmjno-2025-001473","DOIUrl":"10.1136/bmjno-2025-001473","url":null,"abstract":"<p><strong>Rationale: </strong>Postictal psychosis (PIP) is a transient psychiatric phenomenon characterised by psychotic symptoms following a seizure. While its immediate manifestations have been well documented, there is limited understanding of its long-term implications, particularly its relationship with subsequent primary psychotic disorders.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using de-identified patient data from the TriNetX database (2006-2026). Individuals aged 18-65 years with a diagnosis of probable PIP (International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): F06.0, F06.2) or brief psychotic disorder within 7 days of the epileptic disorder diagnosis (ICD-10-CM: F23) were propensity-score matched 1:1 with controls without PIP based on age, sex, race, ethnicity and relevant psychiatric and chronic physical comorbidities. We excluded individuals with prior psychotic disorders or delirium. The primary outcome was any psychotic disorder diagnosis within a 5-year follow-up period. Kaplan-Meier survival analyses and HRs were calculated to assess the differences in survival probabilities.</p><p><strong>Results: </strong>A total of 1275 individuals were identified and matched for analysis. Patients with probable PIP were at significantly higher risk for subsequent psychotic disorders (HR=10.78, 95% CI 6.21 to 18.70, p=0.002). The 5-year survival probability for developing any psychotic disorder was 85.79% in the probable PIP group compared with 98.21% in controls (log-rank test, χ²=112.25; p<0.0001).</p><p><strong>Conclusions: </strong>Probable PIP is associated with a heightened risk of subsequent primary psychotic disorders, including interictal forms, within 5 years.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001473"},"PeriodicalIF":2.6,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882390","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}