Acta Neurologica Scandinavica最新文献

{"title":"Early Treatment Interventions to Improve Outcome Following Mild Traumatic Brain Injury in Adults Presenting to the Emergency Department: A Systematic Review","authors":"Sophie M. Coffeng, Sacha E. H. Snoeck, Jurre Blaauw, Joukje van der Naalt, Bram Jacobs","doi":"10.1155/ane/6838541","DOIUrl":"https://doi.org/10.1155/ane/6838541","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Most patients with mild traumatic brain injury (mTBI) presenting to the emergency department (ED) do not receive standardized follow-up care or therapy, whereas early interventions may yield beneficial effect on posttraumatic symptoms. The objective of this systematic review was to assess the effect of early interventions, compared with usual care or placebo, on posttraumatic symptoms in patients (≥ 16 years) with mTBI presented at the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Embase, and Cochrane Library, were searched for articles concerning early interventions (started within three months post-injury) after mTBI. Randomized controlled trials (RCTs) and clinical controlled trials were selected. Outcome could be measured in various ways, such as presence of posttraumatic symptoms, functional outcome, and/or quality of life. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently selected studies for inclusion and subsequently extracted the necessary data. The methodological quality of the included studies was assessed using the Risk of Bias Tool 2 for RCTs and Newcastle–Ottawa Scale for clinical controlled trials. Mainly due to heterogeneity of outcome measures, conducting a meta-analysis was not possible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 3202 citations, 111 were potentially relevant and 19 were included involving 3357 participants with mTBI (three studies on physical therapy/exercise, 11 on psychoeducation and five on multidisciplinary interventions). We found no evidence for the improvement of posttraumatic symptoms following physical therapy/exercise or multidisciplinary therapy compared with usual care. A better outcome was demonstrated in four psychoeducation studies, with two providing multiple sessions. Nevertheless, the limited number studies, the small sample sizes, the discrepancies in study design and our concerns about the quality of studies make it difficult to draw solid conclusions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Current evidence on the efficacy of early interventions for patients with mTBI presenting at the ED is limited. Based on the available literature, no clear advice can be provided on which early interventions are effective to prevent posttraumatic symptoms and unfavorable functional outcome in patients with mTBI. Repeated psychoeducation appears to have some potential benefit. We advocate future research focusing on patients at high ris","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/6838541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity and Fitness Levels on Cerebral Hemodynamics: A Systematic Review","authors":"Isabella Bratti-Villalobos,&nbsp;Carlos Cristi-Montero,&nbsp;Humberto Peña-Jorquera,&nbsp;Ricardo Martínez-Flores,&nbsp;Juan Pablo Espinoza-Puelles,&nbsp;Steren Chabert","doi":"10.1155/ane/2205188","DOIUrl":"https://doi.org/10.1155/ane/2205188","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Physical activity (PA) and fitness have been linked to improved cerebrovascular function, yet no comprehensive synthesis has integrated evidence across measurement techniques. This review examines the sustained effects of PA and fitness on cerebral hemodynamics using functional near-infrared spectroscopy (fNIRS), transcranial Doppler (TCD), and magnetic resonance imaging (MRI), focusing on observational designs to capture long-term adaptations rather than acute exercise responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A systematic search was conducted in Web of Science and MEDLINE until September 14, 2024. Studies measuring cerebral hemodynamics in individuals with varying PA and fitness levels were included, whereas those with pathological conditions were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen studies were included. fNIRS studies showed that higher fitness was associated with greater oxyhemoglobin (HbO2) response during cognitive tasks, although effects varied by age and sex. TCD studies indicated elevated middle cerebral artery velocity (MCAv) and cerebrovascular reactivity (CVR) in trained individuals, particularly under hypercapnic conditions, but with mixed findings in older and less active populations. MRI studies revealed that higher aerobic fitness was associated with lower resting cerebral blood flow (CBF), suggesting improved neurovascular efficiency. Across modalities, a convergent pattern emerged linking PA and fitness to favorable cerebral hemodynamic adaptations, modulated by age, sex, exercise type, and measurement techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review shows that PA and fitness are associated with more favorable cerebral hemodynamics, including oxygenation, blood flow, and vascular reactivity, with convergent evidence across fNIRS, TCD, and MRI. However, these effects are modulated by age and sex, and evidence remains concentrated in young and older adults and on aerobic exercise, warranting further research across populations and exercise modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/2205188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epilepsy, Antiseizure Medications, and Reproductive Dysfunction in Males","authors":"Dongmei Wu,&nbsp;Yang Si,&nbsp;Fayuan Ji,&nbsp;Chao He,&nbsp;Hongbin Sun","doi":"10.1155/ane/2384385","DOIUrl":"https://doi.org/10.1155/ane/2384385","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <p>Epilepsy is among the most prevalent neurological disorders, affecting not only seizure activity but also psychiatric, psychological, endocrine, and reproductive health. This review aims to evaluate optimal treatment strategies for adult male epilepsy patients with reproductive concerns by analyzing the existing literature on the impact of epilepsy and various antiseizure medications (ASMs) on sex hormones, semen quality, and sexual function. A comprehensive literature search was conducted up to May 2025 across multiple databases, including Embase, PubMed, MEDLINE, and Wanfang, using the following key terms: “epilepsy”, “antiseizure medications”, “sex hormones”, “sperm/semen”, “sexual function”, and “reproductive function”. The reference lists of the retrieved articles were further screened. The search yielded a number of articles that met the inclusion criteria, which required reporting of at least one of the following outcomes in adult male patients with epilepsy: sexual function, semen quality, or sex hormones. The selected literature encompassed various study designs, including cross-sectional studies, case reports, prospective studies, randomized controlled trials, meta-analyses, as well as animal studies and in vitro experiments. Non-human studies were incorporated to provide complementary evidence supporting the findings from clinical research. The analysis indicates a high prevalence of sexual dysfunction and significantly reduced fertility rates among male patients with epilepsy. This reproductive impairment may stem from the dual effects of seizures themselves and ASM therapy. Regarding ASMs, evidence suggests that traditional enzyme-inducing ASMs (EIASMs, e.g., carbamazepine, phenytoin) and valproic acid may have negative impacts on male sex hormones, semen parameters, and sexual function. Based on current clinical evidence, lamotrigine and oxcarbazepine appear to have relatively favorable profiles, whereas data on other agents (e.g., levetiracetam, topiramate, pregabalin, zonisamide, clobazam, felbamate) are often limited or conflicting, and may suggest potential risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For adult male epilepsy patients with reproductive concerns, treatment selection should prioritize seizure control while minimizing reproductive side effects. Where clinically appropriate, agents such as lamotrigine and oxcarbazepine may be preferable to traditional EIASMs or valproic acid. The use of other ASMs requires careful consideration due to insufficient or concerning evidence regarding reproductive safety. Individual patient factors and vigilant monitoring remain crucial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/2384385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative MicroRNA Expression Profiling Identifies hsa-miR-210-3p and hsa-miR-8075 as Candidate miRNAs Associated With Meningioma Biology","authors":"Worachart Lert-itthiporn,&nbsp;Puttanun Ukhampun,&nbsp;Thanawat Panomroengsak,&nbsp;Thanapong Sereerat","doi":"10.1155/ane/6221482","DOIUrl":"https://doi.org/10.1155/ane/6221482","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Meningiomas are the most common primary intracranial tumors and exhibit variable clinical outcomes. Because current diagnostic tools lack sufficient molecular resolution, novel biomarkers are required to improve disease characterization. MicroRNAs (miRNAs), key post-transcriptional regulators, have emerged as important players in tumor biology. However, their roles in meningiomas remain underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an integrative analysis of two publicly available miRNA expression datasets (GSE126563 and GSE88721) to identify miRNAs consistently dysregulated in primary meningiomas. High-confidence target genes of the most strongly altered miRNAs were predicted using four established databases: miRWalk, miRTarBase, TargetScan, and miRDB. Predicted targets were further assessed at the transcriptomic level using the GSE43290 dataset, and functional enrichment analysis was performed using g:Profiler.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty miRNAs were consistently dysregulated across both datasets. Among these, hsa-miR-210-3p was the most significantly upregulated miRNA, whereas hsa-miR-8075 was the only consistently downregulated miRNA. A total of 29 and 125 target genes were predicted for hsa-miR-210-3p and hsa-miR-8075, respectively, and validation revealed inverse expression patterns in GSE43290. Functional enrichment analysis indicated that targets of hsa-miR-210-3p are involved in neuronal ligand transcription and NF-<i>κ</i>B signaling, whereas targets of hsa-miR-8075 were enriched in synaptic signaling and protein binding pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings identify hsa-miR-210-3p and hsa-miR-8075 as candidate miRNAs with opposing expression patterns and potential regulatory relevance in meningioma. These miRNAs represent promising candidates for further mechanistic and clinical validation in meningioma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/6221482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148237714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Edaravone on Short-Term and Long-Term Motor Recovery After Acute Ischemic Stroke in Patients Who Did Not Receive Thrombolytic or Endovascular Treatment","authors":"Mehdi Kazemloo,&nbsp;Fatemeh Shamlouie,&nbsp;Majid Ebrahimi Nejad,&nbsp;Nahid Hosseini Nejad Mir,&nbsp;Danyal Yarahmadi","doi":"10.1155/ane/5558787","DOIUrl":"https://doi.org/10.1155/ane/5558787","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Many patients with acute ischemic stroke (AIS) are ineligible for thrombolysis. Evidence on edaravone in this population is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study is a retrospective cohort study on adults with imaging-confirmed AIS admitted to Shohada-e-Ashayer Hospital (March 2022–February 2023) who did not receive thrombolysis. Patients who received intravenous edaravone within the first day of onset plus standard care were compared with standard care alone. Motor strength was assessed with the Medical Research Council (MRC) scale (0–5) at baseline, 1 week, and 3 months. The primary outcome was 3-month motor function; secondary outcomes included ≥ 2-point improvement from baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Among 160 patients (<i>n</i> = 80 edaravone; <i>n</i> = 80 control), baseline characteristics were similar. At 3 months, the intervention group had higher MRC grades and a higher proportion achieving ≥ 2-grade improvement; 1-week differences were not significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In AIS patients ineligible for thrombolysis, edaravone was associated with better 3-month motor strength; no significant between-group differences were observed at 1 week. Prospective randomized trials are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/5558787","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148237908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"miR-126-3p Inhibits Microglial M1 Polarization via the AKT2/NF-κB Pathway to Alleviate Migraine Pain","authors":"Binjie Tan,&nbsp;Yu Liu,&nbsp;Qianqian Wang,&nbsp;Shilun Zuo","doi":"10.1155/ane/3615132","DOIUrl":"https://doi.org/10.1155/ane/3615132","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Migraine is a debilitating neurological disorder characterized by severe headache and neuroinflammation. This study investigates the role of miR-126-3p in regulating microglial M2 polarization via the AKT2/NF-<i>κ</i>B pathway to alleviate migraine pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We employed the mouse model of migraine induced by nitroglycerin (NTG) and the BV-2 microglial cell model stimulated by lipopolysaccharide (LPS) to examine how miR-126-3p affects microglia and alleviates migraine pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our findings indicate that miR-126-3p promotes the transformation of microglia from the M1 type to the M2 type by inhibiting the AKT2/NF-<i>κ</i>B pathway, thereby reducing the expression of proinflammatory factors. This alleviation of neuroinflammation alleviates the neural pain associated with migraine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>miR-126-3p regulates the polarization morphology of microglia through the AKT2/NF-<i>κ</i>B pathway and plays a crucial role in modulating neuroinflammation in migraine. This discovery may pave the way for developing improved therapeutic strategies to manage migraine pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/3615132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148237504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Awareness and Characteristics in Migraine: Physical, Behavioral, and Psychological Relationships","authors":"Hafize Altay Ilı,&nbsp;Elif Sena Düsgün,&nbsp;Seyda Toprak Celenay","doi":"10.1155/ane/9443801","DOIUrl":"https://doi.org/10.1155/ane/9443801","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Objective</h3>\u0000 \u0000 <p>This study is aimed at investigating the relationship between body awareness and physical, behavioral, and psychological characteristics in migraine patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This study was planned as a cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted with 116 participants aged 18–55 years, diagnosed with migraine. Body awareness, physical characteristics, behavioral characteristics, psychological characteristics, and pain intensity were evaluated using the Body Awareness Questionnaire (BAQ), Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), Patterns of Activity Measure-Pain (POAM-P), State-Trait Anxiety Inventory (STAI), and numerical pain rating scale (NPRS), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No statistical correlations were found between the “BAQ total” score and all CMDQ scores (<i>p</i> &gt; 0.05). The “BAQ total” score showed significant weak positive correlations with “avoidance” (<i>r</i> = 0.249, <i>p</i> = 0.005) and “overdoing” scores (<i>r</i> = 0.263, <i>p</i> = 0.003). The “BAQ total” was moderately and significantly negatively correlated with “trait anxiety” (<i>r</i> = −0.356, <i>p</i> &lt; 0.001). However, its relationship with “state anxiety” was not statistically significant (<i>r</i> = −0.105, <i>p</i> = 0.236).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Body awareness in individuals with migraine is associated with behavioral (avoidance and overdoing) and psychological (trait anxiety) factors, but not with physical characteristics. These findings underscore the complex interplay of sensory, cognitive, and behavioral processes in migraine, highlighting the need for holistic, biopsychosocial interventions, such as mindfulness-based body awareness therapies, to improve pain management and patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/9443801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148237453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apparent Regional Variation in MS Disability Progression in Sweden Reflects Clinic-Level Heterogeneity","authors":"Anna Karin Hedström,&nbsp;Jie Guo,&nbsp;Eva Johansson,&nbsp;Tomas Olsson,&nbsp;Lars Alfredsson","doi":"10.1155/ane/4582085","DOIUrl":"https://doi.org/10.1155/ane/4582085","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Geographic gradients in multiple sclerosis (MS) incidence are well described, but whether long-term disability progression varies across regions, and to what extent clinic-level factors contribute, remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 8260 people with relapsing-onset MS from two nationwide cohorts linked to the Swedish MS registry. Primary analyses focused on incident cases (<i>n</i> = 3160), the full cohort was used for complementary analyses. The primary exposure was healthcare region (Stockholm–Gotland reference). Outcomes were confirmed disability worsening (CDW) and time to EDSS 3 and EDSS 4. Cox models estimated region-specific hazard ratios (HRs) with 95% confidence intervals (CI). Shared-frailty models with clinic as a random effect accounted for within-region clinic heterogeneity. Within-region contrasts compared the three largest clinics in selected regions (anonymized). Two-sided <i>p</i> values &lt; 0.05 were considered statistically significant. Analyses were performed using SAS version 9.4.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In incident cases, the Northern and Western regions showed consistently lower risks of CDW and of reaching EDSS 3 and EDSS 4 than Stockholm–Gotland. The South-Eastern region had a lower risk for CDW (HR 0.74, 95% CI 0.59–0.94). After accounting for clinic-level heterogeneity, regional contrasts attenuated and were no longer significant, as illustrated by the South-Eastern region (HR 0.87, 95% CI 0.59–1.18). The full cohort showed similar geographic patterns. Within-region clinic comparisons revealed substantial heterogeneity despite a shared regional context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Apparent regional variation in long-term MS disability progression in Sweden largely reflects between-clinic differences rather than broad geographic gradients. Observed differences between clinics may reflect contributions from lifestyle-related factors, clinic practices, and other unmeasured influences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/4582085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148174090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Large Language Models in Neurology Multiple-Choice Questions","authors":"Gholamreza Habibi,&nbsp;Omid Kohandel Gargari,&nbsp;Mostafa Hosseini,&nbsp;Kasra Afchangi","doi":"10.1155/ane/5623086","DOIUrl":"https://doi.org/10.1155/ane/5623086","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Navigating neurological disorders is complex due to overlapping symptoms and diverse diagnostic requirements. Large language models (LLMs) offer potential support for clinicians by processing vast amounts of textual data. This study evaluates the performance of four advanced LLMs—GPT-4, GPT-3.5, Clinical Camel, and MedALPACA—in answering neurology-based multiple-choice questions (MCQs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study utilized 170 MCQs from the <i>Comprehensive Review in Clinical Neurology</i> book. Questions were divided into the body and answer choices, stored separately in an Excel spreadsheet. The models were prompted to select the correct answers. Generative Pretrained Transformer (GPT) models were accessed via OpenAI′s API, whereas Clinical Camel and MedALPACA were downloaded from Hugging Face. Accuracy was calculated by the number of correct answers over total questions, with subgroup analysis based on subject headings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>GPT-4 achieved the highest accuracy at 84.7%, significantly outperforming GPT-3.5 (58.8%), Clinical Camel (52.9%), and MedALPACA (40%). GPT-4′s performance was significantly better (<i>p</i> &lt; 0.001). The difference between GPT-3.5 and Clinical Camel was not significant (<i>p</i> = 0.27), but both outperformed MedALPACA. Response similarity was highest between GPT-4 and GPT-3.5 (64.1%) and lowest between GPT-4 and MedALPACA (41.2%). In subgroup analysis, GPT-4 was superior across all topics, achieving full scores in six topics and its lowest in vascular neurology (40%). GPT-3.5 performed best in eight topics, Clinical Camel in three topics, and MedALPACA was the weakest in all but two topics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GPT-4 demonstrated the highest accuracy in answering neurology MCQs, outperforming GPT-3.5, Clinical Camel, and MedALPACA. Clinical Camel′s comparable performance to GPT-3.5 highlights the potential of specialized medical models. External evaluation datasets remain essential to avoid data leakage and ensure fair benchmarking. Further research is needed to expand topic coverage, assess reasoning processes, and include human comparison to support safe and effective clinical integration of medical LLMs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/5623086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148173862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RFC1 Spectrum Disorder in a Norwegian CANVAS Cohort","authors":"Sjur Prestsæter,&nbsp;Jeanette Koht,&nbsp;Siren Berland,&nbsp;Helle Høyer,&nbsp;Kaja Kristine Selmer,&nbsp;Christian Alexander Vedeler,&nbsp;Iselin Wedding,&nbsp;Kristin Nielsen Varhaug,&nbsp;Trude Morken Carlsen,&nbsp;Per Knappskog,&nbsp;Siri Lynne Rydning","doi":"10.1155/ane/6613732","DOIUrl":"https://doi.org/10.1155/ane/6613732","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Late-onset cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a progressive neurodegenerative disorder defined by sensory neuropathy, cerebellar ataxia, and bilateral vestibulopathy. While each symptom impairs balance, their combination causes substantial disability. The most common cause is a biallelic intronic repeat expansion in <i>RFC1</i>, now recognized as a frequent etiology of late-onset cerebellar ataxia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to describe the phenotype, clinical course, and genetic profile of a Norwegian cohort with genetically confirmed CANVAS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with late-onset progressive ataxia, without a prior molecular diagnosis, and with at least one additional CANVAS-associated feature were screened for the <i>RFC1</i> (AAGGG) repeat expansions. Individuals with confirmed biallelic expansions underwent detailed clinical evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 162 patients tested, 44 (27%) carried biallelic <i>RFC1</i> expansions. Thirty-two were clinically assessed, and one additional patient with compound heterozygosity (expansion plus truncating variant) was included. All but one (32/33) exhibited the characteristic triad. Mean age at symptom onset was 50.3 years (range 40–70). All demonstrated additional features beyond the triad, most commonly chronic cough (97%), bulbar dysfunction (85%), and dysautonomia (70%). Limb dystonia, not previously associated with <i>RFC1</i>-related disease, occurred in two patients (6%). Aspiration pneumonia was the predominant cause of death (7/9, 80%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results shed light on the clinical course of CANVAS and expand its phenotypic spectrum. They underscore frequent bulbar dysfunction, dysautonomia, and the risk of aspiration pneumonia, while identifying limb dystonia as a novel manifestation of <i>RFC1</i>-related disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6939,"journal":{"name":"Acta Neurologica Scandinavica","volume":"2026 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/ane/6613732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148174695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}