BMJ Neurology Open最新文献

{"title":"Identifying and predicting fast versus slow Parkinson's disease motor progressors using clinical and digital data.","authors":"Timothee Aubourg, Katarina M Gunter, Christine Lo, Jessica Welch, Karolien Groenewald, Johannes C Klein, Jamil Razzaque, Ludo Van Hillegondsberg, Pietro Luca Ratti, Adriana Nastasa, Grace Auld, Rachel Mccomish, Alexa King, Kashfia Chowdhury, Nirosen Vijiaratnam, Christine Girges, Abigail Patrick, Jemma Inches, Camille B Carroll, Thomas Foltynie, Siddharth Arora, Michele T Hu","doi":"10.1136/bmjno-2026-001740","DOIUrl":"10.1136/bmjno-2026-001740","url":null,"abstract":"<p><strong>Background: </strong>Digital health technologies offer high-frequency, objective measures for Parkinson's disease (PD) yet individual stratification is lacking. This study aimed to identify and predict fast versus slow PD motor progressors by integrating longitudinal clinical evaluation with smartphone motor testing.</p><p><strong>Methods: </strong>In this 96-week subgroup analysis of participants in the Exenatide-PD3 trial, motor progression was measured using Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III OFF scores and smartphone testing (baseline, weeks 24, 48, 72, 96). Fast versus slow progressors were identified using data-driven subtyping; linear mixed-effects models assessed longitudinal OFF scores. Baseline clinical and digital features (in-clinic and at-home) were used to predict 96-week motor progression. Model performance was quantified by the area under the receiver operating curve (AUC).</p><p><strong>Results: </strong>Data-driven clustering identified 26.5% (26/98) as fast progressors, with higher baseline OFF scores (+18.16, 95% CI 13.70 to 22.62; adjusted p<0.001) and greater 96-week progression (+8.17, 95% CI 2.75 to 13.60; adjusted p=0.019), undetected by prespecified approaches. Baseline prediction models combining smartphone features, alone or with clinical scores, consistently outperformed the clinical model alone (best AUC=0.78 vs 0.53). Translational value of smartphone assessments was strengthened by high user acceptability (>96% support future in-clinic use) and predictive value in a deployment scenario (AUC 0.80, 95% CI 0.79 to 0.82).</p><p><strong>Conclusion: </strong>Data-driven clustering identified one in four early-to-mid stage PD patients as fast motor progressors. Integrating smartphone-derived features with clinical scores improved baseline motor prediction. High user acceptability supports this approach for individual-level PD stratification, addressing heterogeneity in motor progression that may obscure treatment trial effects.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001740"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392435","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":"Inpatient versus outpatient management of bilateral optic nerve head elevation presentation to a tertiary emergency department.","authors":"Mengchen Suo, Johnny Lo, Fred K Chen","doi":"10.1136/bmjno-2025-001364","DOIUrl":"10.1136/bmjno-2025-001364","url":null,"abstract":"<p><strong>Introduction: </strong>Increased accessibility to fundus cameras has changed the referral pattern for patients with suspected bilateral optic nerve head elevation (BONHE) presenting to emergency departments (EDs). We aim to review the management of these patients to streamline the process.</p><p><strong>Methods: </strong>A retrospective review of patients with suspected BONHE referred to a tertiary centre ED between 2017 and 2022. We collected demographics, referral source, clinical assessment, neuroimaging and retinal imaging results. Final diagnosis and treatment outcomes were compared between those managed as inpatients and those managed as outpatients.</p><p><strong>Results: </strong>100 patients were referred to the ED with a suspected BONHE. Most were referred by optometrists (54) or general practitioners (17). 54 were admitted (group A) and 38 were discharged from ED (group B). The remaining eight had incomplete records, transferred out of a public health system or self-discharged. The median duration of stay in the ED was 5 hours (IQR 3.45-6.12). The most common diagnosis for both groups was idiopathic intracranial hypertension (IIH). 47 patients at follow-up had moderate to severe IIH and other significant pathologies. For these patients, vision impairment at presentation is the only statistically significant predictor on multivariate analysis (p=0.03). Based on the final diagnoses, 26 out of 48 patients (54.2%) in group A were diagnosed with IIH, with a median duration from presentation to diagnosis of 2 days (IQR 1-4 days). In group B, 8 out of 29 patients (27.5%) were diagnosed with IIH on follow-up, and the median duration from first presentation to diagnosis was 16.8 days (IQR 5.8-57 days).</p><p><strong>Conclusions: </strong>IIH is the most common diagnosis among ED presentations of suspected BONHE in our study. We proposed a triage system for prompt management of BONHE to optimise triage and timely management of patients in the ED.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001364"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392431","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":"Recruitment strategies in a diverse Parkinson's disease cohort: lessons from the East London Parkinson's Disease Project.","authors":"Kamalesh C Dey, Essa Bhadra, Alexandra Zirra, Ellen Camboe, Brook Huxford, Rhiannon Laban, Viktoria Azoidou, David A Gallagher, Thomas Boyle, Caroline Budu, Shafaq Hussain-Ali, Charles R Marshall, Laura J Smith, Alastair J Noyce","doi":"10.1136/bmjno-2026-001732","DOIUrl":"10.1136/bmjno-2026-001732","url":null,"abstract":"","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001732"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392490","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 of coronary artery bypass with cognitive impairment in coronary artery disease across APO (ε) genotypes in AllofUS.","authors":"Praveen Hariharan, Minoo Bagheri, Emelia Asamoah, Ioana Voiculescu, Purnima Singh, Tafadzwa Machipisa, Tess Pottinger, Antone Opekun","doi":"10.1136/bmjno-2026-001584","DOIUrl":"10.1136/bmjno-2026-001584","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass graft (CABG) is a widely performed procedure for coronary artery disease (CAD), yet its association with impaired cognition (IC), that is, mild-cognitive impairment or all-cause dementia, while accounting for apolipoprotein E (APO (ε)) genotype, remains unclear.</p><p><strong>Methods: </strong>We analysed AllofUS participants with CAD (age ≥60 years) from 2017 to 2023. We defined CAD as a history of angina/myocardial infarction/chronic ischaemic heart disease or having percutaneous coronary intervention/CABG, and IC as mild cognitive impairment or all-cause dementia using International Classification of Diseases (ICD)/systematized nomenclature of medicine (SNOMED) codes. We performed logistic regression analyses to assess the association between CABG and IC, adjusting for clinical factors (age, sex, hypertension, diabetes, hyperlipidaemia, depression, stroke, smoking, alcohol use, statin/antihypertensive/antidiabetic use), social determinants (self-reported race/ethnicity, income, employment) and APO (ε) genotypes. We further performed stratified analyses across APO (ε) genotypes (ε2/ε2, ε2/ε3, ε3/ε3, ε2/ε4, ε3/ε4, ε4/ε4). We defined significance at p≤0.05.</p><p><strong>Results: </strong>We included 22 349 with CAD and identified 908 with IC after CAD until 2023. 40% were females, 70% were White, 12% were Black and 9% were Hispanic. The proportion of IC was higher (5.1% vs 3.5%, p=1e-08) in CABG (n=8135) vs non-CABG (n=14 214). After adjusting for clinical factors, social determinants and APO (ε) genotypes, CABG (1.23; 1.06-1.41, p=0.005) was associated with IC. In APO (ε) stratified analysis, the association of CABG with IC was strongest in the APO ε2/ε3 group (1.91; 1.21-3.02, p=0.005).</p><p><strong>Conclusion: </strong>In the AllofUS cohort, we observed an association between CABG and IC in CAD participants, with the strongest association in the APO ε2/ε3 group.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001584"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392406","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":"Executive functions and cognitive disengagement syndrome as predictors of suicidal behaviour: the mediating role of psychotic-like experiences.","authors":"Karim Abdolmohamadi","doi":"10.1136/bmjno-2025-001438","DOIUrl":"10.1136/bmjno-2025-001438","url":null,"abstract":"<p><strong>Background: </strong>Suicidal behaviour remains one of the leading causes of mortality and disability worldwide, yet the cognitive processes associated with suicidality are not fully understood. Although affective disorders have been extensively examined, comparatively less attention has been paid to cognitive factors such as executive functioning difficulties and cognitive disengagement syndrome (CDS). This study examined the associations between executive functioning difficulties, CDS and suicidal behaviour among adolescents and explored the potential mediating role of psychotic-like experiences (PLEs).</p><p><strong>Methods: </strong>A cross-sectional, correlational design was employed. The sample consisted of 2196 adolescents aged 15-20 years recruited through a multistage cluster sampling approach across several major cities in Iran, with additional convenience and snowball sampling within clusters, both in-person and online. Participants completed the Executive Skills Questionnaire-Revised (higher scores indicate greater executive functioning difficulties), Adult Concentration Inventory, Prodromal Questionnaire-Brief and the Suicidal Behaviour Assessment Scale (SENTIA). Pearson correlations and structural equation modelling (SEM) were conducted using AMOS software.</p><p><strong>Results: </strong>Executive functioning difficulties and CDS were significantly associated with suicidal behaviour. Higher CDS levels showed a stronger association with suicidal behaviour, whereas executive functioning difficulties showed a smaller but significant association. PLEs were significantly associated with suicidal behaviour and statistically mediated the associations between executive functioning difficulties and suicidal behaviour (Z=4.45), as well as between CDS and suicidal behaviour (Z=4.63). The final SEM demonstrated acceptable fit indices (Comparative Fit Index (CFI)=0.94, Root Mean Square Error of Approximation (RMSEA)=0.05) and accounted for 24% of the variance in suicidal behaviour. Using gender-specific 95th percentile thresholds, 11.57% of participants showed markedly elevated SENTIA scores.</p><p><strong>Conclusions: </strong>The findings suggest that executive functioning difficulties and cognitive disengagement are meaningfully associated with suicidal behaviour in adolescents, with PLEs emerging as an important correlational pathway linking these cognitive factors to suicidality. These results highlight the potential relevance of cognitive and perceptual experiences in understanding adolescent suicidal behaviour, while underscoring the need for longitudinal research to clarify temporal and causal relationships.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001438"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392331","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 acute-phase glycaemic metrics and stroke-associated pneumonia in patients with acute ischaemic stroke.","authors":"Ki-Woong Nam, Hyung-Min Kwon, Yong-Seok Lee","doi":"10.1136/bmjno-2025-001505","DOIUrl":"10.1136/bmjno-2025-001505","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in acute ischaemic stroke (AIS) care, stroke-associated pneumonia (SAP) remains a common infectious complication. In this study, we evaluated the relationship between SAP and acute-phase glycaemic variability in patients with AIS.</p><p><strong>Methods: </strong>We analysed 297 consecutive patients with AIS who underwent blood glucose monitoring four times daily for a minimum of 5 days. SAP was defined based on the modified Centers for Disease Control and Prevention criteria. The mean of all glucose measurements was 'BG_mean'. Glycaemic variability was assessed using several metrics, including the SD of glucose values (BG_SD), coefficient of variation (BG_CV), time in range, hyperglycaemia ratio and mean amplitude of glycaemic excursion (MAGE).</p><p><strong>Results: </strong>SAP occurred in 51 individuals (17.2%) of the 297 patients. In the multivariable logistic regression analysis, BG_mean (adjusted OR (aOR)=1.47, 95% CI 1.17 to 1.84) remained a significant predictor of SAP after adjusting for confounders. BG_SD (aOR=1.54, 95% CI 1.10 to 2.15), hyperglycaemia ratio (aOR=1.03, 95% CI 1.01 to 1.05) and MAGE (aOR=1.24, 95% CI 1.04 to 1.49) were strongly associated with SAP, independently of BG_mean. To improve the predictive power of the original A2DS2 score for SAP, we developed new predictive models by assigning additional points based on the cut-off values of individual glycaemic metrics. Among these models, only the model incorporating MAGE showed a significant improvement compared with the original A2DS2 score (p=0.03).</p><p><strong>Conclusions: </strong>Elevated acute-phase glucose levels and glycaemic variability are associated with SAP in patients with AIS.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001505"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392321","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":"Leucocytosis and outcomes in older ICU patients after ischaemic stroke: a binational multicentre cohort study.","authors":"Je Min Suh, Jerry Lim, Kyle Williams, Steven Lin, Nattaya Raykateeraroj, Fawaz Prem Navaz, David Pilcher, Dong-Kyu Lee, Laurence Weinberg","doi":"10.1136/bmjno-2025-001538","DOIUrl":"10.1136/bmjno-2025-001538","url":null,"abstract":"<p><strong>Background: </strong>White blood cell count (WCC) is a recognised prognostic and systemic inflammatory marker in ischaemic stroke, with higher counts associated with increased tissue damage, secondary complications and mortality. However, its value in the very elderly remains unclear despite the increased burden of ischaemic stroke with age. We aimed to investigate the association between admission WCC and mortality and length of stay (LOS) among nonagenarians and centenarians admitted to intensive care unit (ICU) with ischaemic stroke.</p><p><strong>Methods: </strong>We conducted a binational retrospective cohort study of patients aged ≥90 years admitted to an Australian or New Zealand ICU with ischaemic stroke between 2010 and 2024, using data from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation. Multivariable regression assessed associations between WCC, analysed as a continuous and categorical variable, and all clinical outcomes. Logistic regression evaluated ICU and in-hospital mortality, and linear regression assessed ICU and hospital LOS.</p><p><strong>Results: </strong>615 nonagenarian and centenarian patients with ischaemic stroke were included: 444 (72%) with normal WCC (4-11×10⁹/L), 7 (1%) with leucopenia (<4×10⁹/L) and 164 (27%) with leucocytosis (>11×10⁹/L). Compared with a normal WCC, leucocytosis was an independent predictor of ICU mortality (adjusted odds ratio 2.33, 95% CI 1.11 to 4.96, p=0.026) and hospital mortality (aOR 2.01, 95% CI 1.29 to 3.13, p=0.002). Each one-unit WCC increase was associated with higher ICU mortality (aOR 1.21, 95% CI 1.03 to 1.41; p=0.018) and hospital mortality (aOR 1.11, 95% CI 1.02 to 1.21; p=0.015). Additionally, leucocytosis was associated with a 15% longer ICU stay (exp 1.15, 95% CI 1.00 to 1.32, p=0.043), but not hospital LOS.</p><p><strong>Conclusion: </strong>Early leucocytosis was independently associated with both increased mortality and ICU LOS in nonagenarians and centenarian patients admitted to ICU with ischaemic stroke, supporting its use as a readily available prognostic biomarker to inform risk stratification and decision-making.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 2","pages":"e001538"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392495","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 risk in patients with hypertensive retinopathy: a systematic review and meta-analysis.","authors":"Jing Zhang, Xiaorong Zhang, Yong Liu, Haiping Lian, Haipeng Tang, Xiaodong Wang, Ying Wang","doi":"10.1136/bmjno-2026-001648","DOIUrl":"10.1136/bmjno-2026-001648","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive retinopathy (HTRP) is a complication of hypertension and is recognised as hypertension-mediated target-organ damage. Hypertension is also the leading risk factor for stroke. This systematic review and meta-analysis evaluated the stroke risk in patients with HTRP to determine whether HTRP is associated with stroke.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science and the Cochrane Library were searched from inception to 13 December 2025. Pooled risk ratios with 95% CIs were calculated. For the proportions of HTRP and stroke among patients with hypertension, risk differences and standard errors were calculated. Subgroup analyses were conducted according to HTRP severity (mild and severe) and stroke type (ischaemic and haemorrhagic).</p><p><strong>Results: </strong>This meta-analysis included 10 studies involving 26 776 participants. The proportions of HTRP and stroke among all the participants were 0.42 (95% CI 0.23 to 0.61) and 0.15 (0.11 to 0.18), respectively. The proportion of stroke in participants with HTRP was 0.20 (0.14 to 0.27). The pooled risk ratio for stroke in patients with HTRP compared with those without HTRP was 1.87 (1.42 to 2.45). Compared with patients with mild HTRP and those without HTRP, patients with severe HTRP had higher risk of stroke, with risk ratios of 1.88 (1.51 to 2.34) and 3.10 (1.91 to 5.05), respectively. The risk ratios for ischaemic and haemorrhagic stroke in patients with HTRP compared with those without HTRP were 1.79 (1.20 to 2.67) and 1.39 (0.86 to 2.26), respectively.</p><p><strong>Conclusions: </strong>HTRP is associated with an increased stroke risk, particularly ischaemic stroke. These findings suggest that HTRP can serve as an important biomarker for stroke-risk stratification, and that periodic retinal examinations can contribute to stroke prevention.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 1","pages":"e001648"},"PeriodicalIF":2.6,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632884","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":"Working years lost in people with epilepsy according to underlying aetiology: a population-based cohort study.","authors":"Julie Werenberg Dreier, Betina B Trabjerg, Kasper Lolk, Oleguer Plana-Ripoll, Jakob Christensen","doi":"10.1136/bmjno-2025-001484","DOIUrl":"10.1136/bmjno-2025-001484","url":null,"abstract":"<p><strong>Background: </strong>We quantify the loss of working years for people with epilepsy according to underlying aetiology and compare to the general population.</p><p><strong>Methods: </strong>This population-based cohort study included all individuals aged 18-65 years living in Denmark from 1995 to 2018. Using nationwide registers from 1977 onward, we identified people with epilepsy and grouped them by presumed aetiology (secondary: infection, perinatal insult, congenital malformation, brain tumour, traumatic brain injury, stroke or unknown) and obtained annual data on primary income source during 1995-2020. The main outcome was working years lost comparing people with epilepsy to the general population, reflecting losses of working life from permanent (death, disability pension, early retirement) and temporary (unemployment, sick leave) factors.</p><p><strong>Results: </strong>The study included 5 466 144 individuals, with 48 223 (0.9%) having epilepsy of unknown aetiology and 26 754 (0.5%) with secondary epilepsy. Compared with the general population, post-traumatic epilepsy was associated with the greatest average loss of working life (10.2 years, 95% CI 9.9 to 10.4), whereas brain tumour-related epilepsy was associated with a reduction of 9.1 years (95% CI 8.8 to 9.4) and post-stroke epilepsy with a reduction of 6.6 years (95% CI 6.4 to 6.8). Epilepsy of unknown aetiology was associated with a 5.4-year loss (95% CI 5.2 to 5.5). Across all epilepsy types, most reductions in working life resulted from higher rates of disability pension and premature death.</p><p><strong>Conclusions: </strong>Epilepsy, especially when secondary to an underlying brain insult, was associated with significant loss of working life from both disability and premature death. More support is needed to help people with epilepsy secure and retain employment.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 1","pages":"e001484"},"PeriodicalIF":2.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347178","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":"Correlation of Gray-to-White matter ratio on Non-Contrast CT with neurological outcome in Post-Cardiac arrest syndrome.","authors":"Zeinab El Mawla, Jida Mulki, Mahmoud Hassoun, Ahmad Aoude","doi":"10.1136/bmjno-2026-001659","DOIUrl":"10.1136/bmjno-2026-001659","url":null,"abstract":"<p><strong>Introduction: </strong>Post-cardiac arrest syndrome (PCAS) is a major cause of mortality and neurological disability. Early prognostication is essential for clinical decision-making, but variability in interpretation of Non-Contrast CT (NCCT)) Gray to White Matter Ratio (GWR) measurement techniques limits its clinical standardisation. This study evaluated the association between the Gray-to-White Matter Ratio (GWR) on early non-contrast CT (NCCT) and 6 -month neurological outcomes, and compared manual versus automated GWR measurements.</p><p><strong>Methodology: </strong>A retrospective cohort of 120 patients who are comatose with PCAS patients with return of spontaneous circulation (ROSC) was analysed. NCCT scans (6-24 hours post-ROSC) were used to calculate GWR across basal ganglia, supratentorial cortex, and cerebellum using both manual and automated methods. Outcomes were classified using the Cerebral Performance Category (CPC). Prognostic performance was evaluated using receiver operating characteristic (ROC) analysis, and multivariable modelling was performed using Firth logistic regression.</p><p><strong>Results: </strong>Higher GWR values were significantly associated with favourable neurological outcomes across all regions and measurement methods (p<0.001). Automated global GWR demonstrated the highest prognostic accuracy (AUCarea under the curve=0.869; sensitivity 84.2%, specificity 84.1%) and was an independent predictor of poor outcome. Manual measurements showed moderate-to-good inter-rater reliability.</p><p><strong>Conclusion: </strong>GWR is a robust prognostic biomarker for neuroprognostication after cardiac arrest. Automated GWR measurement improves reproducibility and supports the standardisation of imaging-based prognostic assessment, with potential implications for clinical decision-making in post-cardiac arrest care.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"8 1","pages":"e001659"},"PeriodicalIF":2.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347355","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}