Neurologia最新文献

{"title":"Immune-mediated necrotizing myopathy: an emerging disorder","authors":"S. Portela-Sánchez ,&nbsp;I. Catalina ,&nbsp;S. López Muñoz ,&nbsp;A. Lozano Ros ,&nbsp;A. Sánchez-Soblechero ,&nbsp;E. Sola Vendrell ,&nbsp;P. Sánchez-Mateos ,&nbsp;J.L. Muñoz-Blanco","doi":"10.1016/j.nrleng.2025.09.004","DOIUrl":"10.1016/j.nrleng.2025.09.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the main features and the clinical management of a cohort of patients with immune-mediated necrotizing myopathy (IMNM).</div></div><div><h3>Methods</h3><div>We conducted an observational, monocentric, retrospective study of IMNM patients diagnosed in the Neuromuscular Unit of a tertiary hospital in Madrid (Spain) between 2013 and 2021.</div></div><div><h3>Results</h3><div>Sixteen IMNM cases were diagnosed, with a median age of 71.5 years (range 36−80), nine of whom (56.3%) were female. Thirteen (81.3%) patients had previously been treated with statins. The time from symptom onset to diagnosis was less than six months in eleven (68.8%) patients and the most common clinical symptoms were proximal weakness and myalgia. The only myositis specific autoantibodies detected were anti-3-hydroxy-3-methyl-coenzyme A reductase in thirteen patients. The treatment strategy was based on prednisone, although a combination with other immunosuppressive drugs was required in eight (50%) patients.</div></div><div><h3>Conclusions</h3><div>There has been an increase in the diagnosis of immune-mediated necrotizing myopathies in the last few years. The anti-HMGCR antibodies were the only detected in this sample showing their key role in the diagnosis. Early recognition of the disease facilitate to start treatment as soon as possible, which should be based on the initial response to corticosteroids and usually requires a combination of several drugs.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 729-738"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care in Parkinson's Disease and other Movement Disorders. Recommendations and protocol of a multidisciplinary group of experts","authors":"M. Álvarez Saúco ,&nbsp;I. Legarda Ramírez ,&nbsp;S. Martí Martínez ,&nbsp;F. Carrillo García ,&nbsp;B. González García ,&nbsp;J. Fernández Bueno ,&nbsp;R. García-Ramos ,&nbsp;D. Santos-García","doi":"10.1016/j.nrleng.2025.09.002","DOIUrl":"10.1016/j.nrleng.2025.09.002","url":null,"abstract":"<div><h3>Introduction</h3><div>One of the current challenges in Parkinson's disease (PD) and other movement disorders (MD) is how and when to apply palliative care. Aware of the scarce training and implementation of this type of approach, we propose some consensual recommendations for palliative care (PC) in order to improve the quality of life of patients and their environment.</div></div><div><h3>Material and methods</h3><div>After a first phase of needs analysis through a survey carried out on Spanish neurologists and a review of the literature, we describe recommendations for action structured in: palliative care models, selection of the target population, when, where and how to implement the PC.</div></div><div><h3>Results</h3><div>Models of neuropalliative care are reviewed, advocating for the role of the neurologist as a driving force. The members of the multidisciplinary team are described, as well as the main clinical markers and tools that help the clinician to decide which patients have greater palliative needs; sender and receiver are defined and it is detailed in what evolutionary moment and how to proceed when sending the patient to palliative care. A scheme of steps to follow in any PC protocol, whether basic or specialized, is provided, emphasizing the framework in the shared planning of care and the comprehensive approach.</div></div><div><h3>Conclusions</h3><div>It would be desirable to integrate the PC in the management of PD and other MD and to validate models of neuropalliative care in our environment, analyzing their usefulness through the use of indicators, in order to improve the care and quality of life of our patients.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 717-728"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and factors associated with disability and dependency in patients with Guillain-Barré syndrome in the Region of Murcia: population study for the period 2009–2020","authors":"S. Rueda-Nieto ,&nbsp;M.P. Mira-Escolano ,&nbsp;A. Sánchez-Escámez ,&nbsp;J.M. Cayuela-Fuentes ,&nbsp;L.A. Maceda-Roldán ,&nbsp;P. Ciller-Montoya ,&nbsp;J.A. Palomar-Rodríguez","doi":"10.1016/j.nrleng.2025.09.007","DOIUrl":"10.1016/j.nrleng.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of Guillain-Barré syndrome (GBS) is variable and is still unknown in our geographical area. Poor prognostic factors have been studied, but few have analysed those that influence long-term results. The objective of this study is to know the incidence, characteristics and factors associated with disability and dependency in these patients from a population registry.</div></div><div><h3>Subjects and methods</h3><div>Observational study in patients diagnosed with GBS from 2009 to 2020 and registered in the Rare Disease Information System of the Region of Murcia (SIER). The crude and adjusted rates for age, sex and year of the period were calculated and the associations between disability and/or dependency with the rest of the variables were analysed.</div></div><div><h3>Results</h3><div>During the study period, 250 incident cases were diagnosed. The standardised incidence rate (SIR) was 1.52/100,000 person-years, higher in men and increasing with age in both sexes. The disease was more frequent after respiratory infections (46.4%) and in the cold months (56.4%), and the predominant variant was AIDP (54.3%). Greater disability and/or dependence were observed in patients with prolonged hospital stay (OR = 13.19; 95% CI: 3.81–45.67), ICU admission (OR = 2.37; 95% CI: 1.11-5.06) and affected by axonal variants (OR = 3.54; 95% CI: 1.64-7.69) (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>The regional SIR is consistent with that reported in the national and international literature. 18.4% of the cases have recognised dependency and/or disability, associated with the axonal forms of the disease. Studies based on population registries offer representative and updated information and allow us to discover characteristics associated with a worse prognosis.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 777-789"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of fasting during Ramadan on migraine in the Algerian population","authors":"E. Goufa ,&nbsp;A. Chentouf ,&nbsp;S. Belabbas ,&nbsp;W. Boughrara","doi":"10.1016/j.nrleng.2025.09.010","DOIUrl":"10.1016/j.nrleng.2025.09.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Muslims all over the world practice fasting during Ramadan yearly. A plethora of studies have reported severe worsening of migraine attacks cases due to fasting. The aim is to investigate the effect of Ramadan fasting on migraine frequency and severity among practicing Muslim migraine sufferers.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study conducted during the month of Ramadan of the year 2021. This research project has included adult patients meeting the migraine criteria of “International Classification of Headache Disorders, 3rd edition”. The frequency and severity of migraine headache were compared to the month preceding Ramadan. In order to analyse the factors associated with breaking the fast motivated by migraine headache during Ramadan, a logistic regression analysis was performed.</div></div><div><h3>Results</h3><div>The study has included 101 migraine sufferers with a clear female predominance. The average duration of migraine was 9<!--> <!-->±<!--> <!-->2 years. Compared to the month of Shaban, we noted an increase in the number of attacks, the number of headache days, and the number of days with analgesic medication taken to relieve the attacks. However, the severity and duration of headache did not change significantly between the two months. Most patients changed their eating and sleeping habits during Ramadan. Twenty-two patients broke the fast for several days due to headaches. Ramadan fasting aggravates the frequency of migraine attacks among practicing Algerian Muslims.</div></div><div><h3>Conclusion</h3><div>Physicians should educate their migraine patients on the importance of lifestyle measures to better manage their headaches during Ramadan.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 762-767"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological resilience mediates the relationship between perceived neuropsychological impairment and quality of life in a sample of patients with multiple sclerosis","authors":"Y. Broche-Pérez ,&nbsp;R.M. Jiménez-Morales ,&nbsp;L.O. Monasterio-Ramos ,&nbsp;J. Bauer","doi":"10.1016/j.nrleng.2025.09.009","DOIUrl":"10.1016/j.nrleng.2025.09.009","url":null,"abstract":"<div><h3>Introduction</h3><div>The impact of subjective cognitive concerns (SCCs) on the quality of life (QoL) of patients with multiple sclerosis (PwMS) has practically not been studied.</div></div><div><h3>Objectives</h3><div>In this study, the relationship between subjective cognitive concerns and quality of life in PwMS was explored. Furthermore, to explore whether psychological resilience acts as a mediator in the relationship between SCCs and QoL.</div></div><div><h3>Methods</h3><div>A total of 214 PwMS were surveyed using the Multiple Sclerosis Quality of Life Inventory, the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) and the Connor-Davidson Resilience Scale.</div></div><div><h3>Results</h3><div>Our results showed that, SCCs is a predictor of levels of perceived QoL in PwMS. Patients who report higher scores on the MSNQ also showed a worse quality of life in global terms. The results also showed that resilience mediates the relationship between SCCs and QoL, both for the physical dimension of quality of life (physical health composite) and for the mental health dimension (mental health composite). In our patients, as resilience levels increase, the negative impact of SCCs on QoL decreases.</div></div><div><h3>Conclusions</h3><div>Considering that resilience is a modifiable protective factor, the implementation of interventions aimed at enhancing resilience can have a favorable impact on the psychological well-being and quality of life of patients with multiple sclerosis.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 753-761"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taxonomy of paradigms for neuropsychological assessment of body representation based on a critical review","authors":"J.F. Mozo ,&nbsp;J.M. Ruiz-Sánchez de León","doi":"10.1016/j.nrleng.2025.09.003","DOIUrl":"10.1016/j.nrleng.2025.09.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The concept of body representation overlaps with others, such as body schema, body image, body semantics, structural description, body description or body map. A taxonomy is proposed that classifies body schema, body structural description and body semantics. The aim of this narrative review is to analyze the supply of instruments for neuropsychological assessment of body representation and to propose a classification of their paradigms.</div></div><div><h3>Method</h3><div>A total of 1,109 articles were obtained and reduced to a total of 71 references by inclusion and exclusion criteria.</div></div><div><h3>Results</h3><div>A total of 66 instrument names were found, of which 22 were related to body schema, 32 to structural description of the body and 12 to body semantics. Forty five instruments about clinical manifestations not commonly related to neurological etiology (e.g., anorexia, bulimia, hypochondria or schizophrenia) were discarded.</div></div><div><h3>Discussion</h3><div>A synthesis and classification of paradigms and instruments of interest to the clinic is presented. The need for the creation of validated consensus protocols and their implications are discussed.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 790-806"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral thalamotomy with high-intensity focused ultrasound in refractory tremor. First results of a public hospital in Spain","authors":"G. Fernández-Pajarín ,&nbsp;M. Blanco-Ulla ,&nbsp;E. Arán ,&nbsp;B. Ares ,&nbsp;P. Román-Pena ,&nbsp;A.J. Mosqueira ,&nbsp;I. Jiménez-Martín ,&nbsp;M. Gelabert-González ,&nbsp;J.M. Prieto-González ,&nbsp;Á. Sesar","doi":"10.1016/j.nrleng.2025.09.005","DOIUrl":"10.1016/j.nrleng.2025.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Unilateral high-intensity focused ultrasound (HIFU) thalamotomy is a novel and efficient treatment for refractory tremor. In the most recent studies, the tremor is reduced by at least 70%. The objective of this study is to analyse the results of the first series of cases treated in a public hospital in Spain.</div></div><div><h3>Methods</h3><div>In our centre, from March 2021 to March 2022, 46 patients have undergone a HIFU thalamotomy. The treatment area was predetermined on the inferior surface of the ventral intermediate nucleus of the thalamus using automatic anatomical segmentation on an individual basis. The data of 44 patients six months after the procedure have been analysed.</div></div><div><h3>Results</h3><div>The mean age of the treated patients was 70.5 ± 14.4 years, and 68% were male. The most common diagnosis was essential tremor (40 cases). Prior to HIFU treatment, the <em>Clinical Rating Scale for Tremor</em> of the treated body side (CRST A + B) was 22.4 ± 5.9, and tremor-related disability (CRST C) was 18.3 ± 4.8. The mean number of sonications was 6.8 ± 1.7. Six months after treatment, CRST scales were 4.5 ± 5.6 and 4.2 ± 5.2, respectively (<em>P</em> &lt; 0.0001). Twenty patients had head tremor. We observed a significant improvement with HIFU (1.9 ± 0.7 to 0.7 ± 0.8, <em>P</em> &lt; 0.0001). Only four patients presented adverse effects at six months, all of them mild.</div></div><div><h3>Conclusions</h3><div>The clinical benefit after HIFU thalamotomy reaches an 80% reduction in tremor and has a low rate of adverse effects six months after the procedure. The target localisation method used allowed for fewer sonications.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 739-745"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral hack sign not necessarily implies paraparesis","authors":"J. Finsterer ,&nbsp;F.A. Scorza ,&nbsp;A.C.G. Almeida","doi":"10.1016/j.nrleng.2025.09.011","DOIUrl":"10.1016/j.nrleng.2025.09.011","url":null,"abstract":"","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 8","pages":"Pages 810-811"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing","authors":"D. Gonzalez-Calle ,&nbsp;L. Nombela-Franco ,&nbsp;H. Gutierrez-Garcia ,&nbsp;V. Peral ,&nbsp;J. Mesnier ,&nbsp;G. Tirado-Conde ,&nbsp;A. Barrero-Mier ,&nbsp;A. Morcuende Gonzalez ,&nbsp;G. O’Hara ,&nbsp;L. López-Mesonero ,&nbsp;P. Salinas ,&nbsp;L. Sanchís ,&nbsp;P. Cepas-Guillén ,&nbsp;A. Laffond ,&nbsp;X. Freixa ,&nbsp;I. Amat-Santos ,&nbsp;P.L. Sanchez ,&nbsp;J. Rodes-Cabau ,&nbsp;I. Cruz-Gonzalez","doi":"10.1016/j.nrleng.2025.07.009","DOIUrl":"10.1016/j.nrleng.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHA₂DS₂-VASc ≥<!--> <!-->2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously.</div></div><div><h3>Objective</h3><div>To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA₂DS₂-VASc ≥<!--> <!-->2) and to determine adequate timing of its performance.</div></div><div><h3>Methods</h3><div>This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (<em>n</em> <!-->=<!--> <!-->31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (<em>n</em> <!-->=<!--> <!-->97; 75.8%), after 90 days.</div></div><div><h3>Results</h3><div>Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHA₂DS₂-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9<!--> <!-->±<!--> <!-->34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group.</div></div><div><h3>Conclusions</h3><div>Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 668-675"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding stroke mortality trends in Spain: A comprehensive age-period-cohort and joinpoint analysis","authors":"L. Cayuela ,&nbsp;E. Zapata-Arriaza ,&nbsp;A. de Albóniga-Chindurza ,&nbsp;A. González García ,&nbsp;A. Cayuela","doi":"10.1016/j.nrleng.2025.07.011","DOIUrl":"10.1016/j.nrleng.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to update and evaluate the age-period-cohort (A-P-C) effects on stroke mortality in Spain over the period 1982–2021.</div></div><div><h3>Methods</h3><div>Data on stroke mortality and population by age and sex were obtained from the database of the National Institute of Statistics for the years 1982–2021. Joinpoint trend analysis software from the US National Cancer Institute was used to estimate the rates and their time trends. The effects of age, period, and cohort were estimated using a log-linear Poisson model with a likelihood penalty function to address the problem of identifiability.</div></div><div><h3>Results</h3><div>For both sexes (−4.3% for men and −4.6% for women), age-standardized mortality rates (all ages) decreased over the study period. With the exception of the 30–64 age group, where rates for women have been stable since 2012, the rate of decline has slowed in recent years for both sexes.</div><div>Since the beginning of the 20th century, the estimated relative risk in birth cohorts for both sexes followed a steady downward trend for all birth cohorts. However, the decline in risk has slowed down for women born between 1947 and 1962. Both men and women have experienced a decline in RR, which has stabilized (women) or slowed down (men) in the last decade.</div></div><div><h3>Conclusions</h3><div>Both period and cohort effects are present in the decline in Spanish stroke mortality between 1982 and 2021. It is unlikely that the decrease in mortality has offset the possible increase in incidence in younger cohorts. This has led to a slowing (in men) or stagnation (in women) of the current decline in stroke mortality. Therefore, we must continue to focus on prevention.</div></div>","PeriodicalId":94155,"journal":{"name":"Neurologia","volume":"40 7","pages":"Pages 676-685"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}