Neurological research and practice最新文献

{"title":"Correction: Diagnostic yield of standardized screening for deep venous thrombosis in patients with acute cerebral ischemia and cardiac right-to-left shunt.","authors":"K M Michael, L P Pallesen, D P O Kaiser, T Siepmann, J Barlinn, A Sedghi, N Weiss, M Weise, S Werth, K Barlinn, Volker Puetz","doi":"10.1186/s42466-025-00402-2","DOIUrl":"https://doi.org/10.1186/s42466-025-00402-2","url":null,"abstract":"","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"43"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478378","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":"Observational quality control study: insourcing multi-PCR-impact on the use of anti-infectives for patients with pleocytosis.","authors":"Jörg Tebben, Bianca Wiebalck, Holger Schmidt","doi":"10.1186/s42466-025-00398-9","DOIUrl":"10.1186/s42466-025-00398-9","url":null,"abstract":"<p><strong>Background: </strong>An analysis of the cerebrospinal fluid (CSF) is essential for diagnosis of meningitis, headache, disturbance of conscience, cranial nerves or autoimmune-related conditions of the CNS. The initial treatment of pleocytosis usually consists of both antiviral therapy and antibiotics until laboratory results enable a more specific approach. Therefore, it is crucial to rapidly and accurately detect pathogens.</p><p><strong>Methods: </strong>In this observatory, monocentric study of quality management data, we studied insourcing of ME-PCR, CXCL 13, Antibody-specific Index (AI) for HSV, VZV (G <math><mmultiscripts><mrow></mrow> <mn>1</mn> <mrow></mrow></mmultiscripts> </math> ) compared with outsourced laboratory measurements (G <math><mmultiscripts><mrow></mrow> <mn>0</mn> <mrow></mrow></mmultiscripts> </math> ) and its benefit for the work-up. Before the implementation of these parameters, data from 150 patients were sampled, followed by 210 after the introduction of ME-PCR, CXCL 13 and AI. Data were collected, anonymized, and analysed afterwards. All were treated in hospital for suspected infections of the Central Nervous System (CNS). The length of hospital stay (LOS), intervals from lumbar puncture, the cumulative dose of anti-infective agents, length of treatment and the potential impact on patients' safety parameters were examined.</p><p><strong>Results: </strong>The G <math><mmultiscripts><mrow></mrow> <mn>1</mn> <mrow></mrow></mmultiscripts> </math> -group showed a significant decrease of LOS (p<0.001), exposure to antiviral, and antibiotic agents decreased significantly (p < 0.001, each). Insourcing of ME-PCR and CXCL 13 shortened the time-span from admission to diagnosis in patients with suspected inflammatory CNS disease from 13.6 (6.6) to 9.7 (6.7) days in mean (SD).</p><p><strong>Conclusion: </strong>The shortened average LOS after changing the diagnostic pathway increased direct costs for test kits. However, these costs were by far outweighed the economical benefit of being able to treat more patients in the same time. This analysis should be replicated in a different Medical Care System than the one in which this analysis has been calculated.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337389","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":"Instrument-supported gait analysis characterizes gait domain changes in patients with suspected normal pressure hydrocephalus.","authors":"Carolin Semmler, Veronika Wunderle, Taylan D Kuzu, Oezguer A Onur, Christian Grefkes, Michael T Barbe, Gereon R Fink, Peter H Weiss","doi":"10.1186/s42466-025-00394-z","DOIUrl":"10.1186/s42466-025-00394-z","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic Normal Pressure Hydrocephalus (iNPH) is a potentially reversible cause of cognitive impairment, urinary incontinence, and gait disturbances, which typically present with a characteristic slow, shuffling, and wide-based gait. Gait velocity, which is reduced relative to healthy controls, improves in iNPH patients following a spinal tap test. This study aimed at evaluating the criterion of a 20% gait velocity improvement in the 10 m walk test to identify responders and non-responders in a cohort of patients with probable iNPH receiving a spinal tap test as well as the added value of instrument-supported gait analysis.</p><p><strong>Methods: </strong>We assessed pace, rhythm, variability, postural control, and force in 59 patients with clinically suspected iNPH undergoing a spinal tap test, applying the 10 m walk test and an instrument-supported gait analysis. The change in gait velocity assessed in the 10 m walk test was used to differentiate patients with a positive response to the spinal tap (> 20% improvement, responders) from those with no relevant response (< 20% improvement, non-responders). Group differences were analyzed using chi-square tests, independent sample t-tests, Mann-Whitney-U tests and repeated measure ANOVAs.</p><p><strong>Results: </strong>Unlike non-responders (n = 39), responders (n = 20) showed significant changes in the gait domain pace in the 10 m walk test. Moreover, instrument-supported gait analyses revealed additional improvements in the gait domains variability, rhythm, postural control and force in responders only.</p><p><strong>Interpretation: </strong>This study confirmed the clinical utility of the 20% gait velocity improvement criterion for differentiating responders and non-responders in a cohort of patients with mostly probable iNPH, in whom clinical parameters alone were insufficient for classification. Notably, instrument-supported gait analysis validated this criterion by providing a more comprehensive characterization of gait disturbances compared to the 10 m walk test. However, further-especially longitudinal-studies are needed to reveal the full potential of the instrument-supported gait analysis in patients with (early/probable) iNPH.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311139","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":"Correction: The impact of white matter lesions on seizure recurrence after first epileptic seizures in the elderly: a prospective study.","authors":"Jenny Weil, Louise Linka, Mariana Gurschi, Seyyid Abdulkerim Kidik, Alena Fuchs, Rebecca Schoenfeldt, Felix Zahnert, Leona Möller, Katja Menzler, André Kemmling, Susanne Knake, Lena Habermehl","doi":"10.1186/s42466-025-00397-w","DOIUrl":"10.1186/s42466-025-00397-w","url":null,"abstract":"","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12160098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277100","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":"Admission glucose is a significant outcome predictor in anterior circulation stroke: approaching the sweet spot.","authors":"Alexandra Filipov, Martin Andermann, Guilherme Lepski, Analía Arévalo, Tim Hilgenfeld, Silvia Schönenberger, Christoph Gumbinger, Markus Möhlenbruch, Peter Arthur Ringleb, Jessica Jesser","doi":"10.1186/s42466-025-00393-0","DOIUrl":"10.1186/s42466-025-00393-0","url":null,"abstract":"<p><strong>Background: </strong>Admission glycemia has emerged as an important outcome predictor in the context of mechanical thrombectomy (MT) for large vessel occlusions (LVO) in ischemic stroke. However, a clinically relevant threshold of glucose levels to identify patients at risk for poor functional outcome has yet to be established.</p><p><strong>Methods: </strong>We conducted a retrospective, monocentric, consecutive registry-based analysis of patients who underwent MT for anterior circulation LVO. Good outcome was defined as functional independence after 90 days (90d mRS < 3) or no deterioration from premorbid mRS. We performed a multiple logistic regression analysis to assess the association between admission glucose levels and functional outcome, including for well-established outcome predictors, i.e. age, NIHSS, Alberta Stroke Program Early CT Score (ASPECTS), time to reperfusion, unsuccessful recanalization, presence of bleeding, and diabetes. In addition, we conducted a receiver operating characteristic (ROC) analysis to determine the optimal admission glucose threshold that best discriminates patients at risk for poor outcome, maximizing sensitivity and specificity.</p><p><strong>Results: </strong>We analyzed 509 patients (mean age = 74.3 ± 12.6 years, median previous mRS = 1.5, 48% male). 194 patients (38.1%) had good outcome and 315 (61.9%) had poor outcome. According to the logistic regression admission glucose (p = 0.012, OR 1.009 95% CI [1.002 1.016]) contributed to predicting poor outcome, while known diabetes did not show a significant contribution. The ROC analysis revealed an admission glucose of 117 mg/dL (59.7% sensitivity; 58% specificity) to be the optimal cut-off value to discriminate patients at risk for poor outcome with an OR of 2.3.</p><p><strong>Conclusion: </strong>Admission hyperglycemia is an independent predictor of poor outcome after MT for LVO in the anterior circulation. We hypothesize, that optimal glucose values in patients undergoing MT will likely be in the low normoglycemic range. Prospective controlled studies with targeted glucose values will be needed for validation.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"39"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268292","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":"Diagnostic yield of standardized screening for deep venous thrombosis in patients with acute cerebral ischemia and cardiac right-to-left shunt.","authors":"K M Michael, L P Pallesen, D P O Kaiser, T Siepmann, J Barlinn, A Sedghi, N Weiss, M Weise, S Werth, K Barlinn, Volker Puetz","doi":"10.1186/s42466-025-00396-x","DOIUrl":"10.1186/s42466-025-00396-x","url":null,"abstract":"<p><strong>Background: </strong>Paradoxical embolism is a potential pathophysiology in patients with acute ischemic stroke or transient ischemic attack (TIA) and patent foramen ovale (PFO) or atrial septal defect (ASD). We sought to determine the frequency of deep vein thrombosis (DVT) detection by standardized lower extremity venous compression ultrasound (LE-CUS) in patients with acute cerebral ischemia and cardiac right-to left shunt due to PFO or ASD on transoesophageal echocardiogram (TEE).</p><p><strong>Methods: </strong>We analysed consecutive patients (01/2015-12/2020) with acute cerebral ischemia and PFO or ASD on TEE, who received DVT screening by LE-CUS per institutional standard. We determined clinical baseline variables including shunt-size categorized as small, medium or large, and analysed the frequency of DVT. We performed multivariable analysis to identify predictors for presence of DVT on LE-CUS.</p><p><strong>Results: </strong>Among 1564 patients with acute ischemic stroke (n = 1326) or TIA (n = 238) who received TEE, 390 patients had PFO and 10 patients ASD, of whom 274 were screened for DVT by LE-CUS (153 [55.8%] female, age 64 years [51-76], NIHSS score 4 [1-9.5]). Of these, 55 patients (20.1%) had DVT on LE-CUS. Among patients with DVT, 23 of 76 patients (30.3%) who received LE-CUS within 72 h from admission compared to 32 of 198 patients (16.2%) who received LE-CUS at later time points had presence of DVT (p = 0.012). The percentage of patients with DVT tended to be higher among patients with cryptogenic ischemic stroke compared to patients with other stroke etiologies (21.8% [49 of 225] vs. 12.2% [6 of 49]; p = 0.168). Presence of DVT was associated with female sex (OR 2.24, 95%CI 1.09-4.62), NIHSS score (OR 1.06, 95%CI 1.03-1.10), Wells score (OR 1.54, 95%CI 1.11-2.13) and shunt size (OR 3.32, 95%CI 1.86-5.91).</p><p><strong>Conclusions: </strong>Our data suggest a high diagnostic yield (> 20%) of standardized screening for DVT with LE-CUS in patients with acute cerebral ischemia and PFO or ASD. This particularly applies to females, patients with more severe baseline deficits and large right-to-left shunt. These findings may not be generalizable to all patients with PFO or ASD and need prospective validation.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251666","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":"A real-world study of the efficacy and tolerability of fremanezumab in migraine patients with a median follow-up of 14 months.","authors":"Shiho Suzuki, Keisuke Suzuki, Yasuo Haruyama, Hiroaki Fujita, Tomohiko Shiina, Saro Kobayashi, Mukuto Shioda, Ryotaro Hida, Koichi Hirata","doi":"10.1186/s42466-025-00395-y","DOIUrl":"10.1186/s42466-025-00395-y","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the long-term efficacy and safety of fremanezumab over a 2-year period in a real-world setting.</p><p><strong>Methods: </strong>This retrospective, observational, single-center cohort study included 165 patients with episodic migraine (EM) or chronic migraine (CM) who received fremanezumab treatment. The primary endpoint was the change in monthly migraine days (MMDs) from baseline to months 1-24. The secondary endpoints included changes in Migraine Disability Assessment (MIDAS) scores, adverse events, response rates, predictors for responders, and treatment persistence.</p><p><strong>Results: </strong>In the entire cohort, the MMD changes from baseline at 3, 6, 12, and 24 months were  - 7.2 ± 4.7,  - 8.1 ± 6.3,  - 8.4 ± 5.1, and  - 9.6 ± 6.0 days, respectively (p < 0.001). After 3, 6, 12, and 24 months, the ≥ 50% response rates were 57.0%, 63.6%, 63.5%, and 69.0%, respectively. The MIDAS score significantly decreased in the total sample and the EM and CM groups. No significant difference in efficacy was found between the monthly and quarterly dosing groups. Adverse events, mainly injection site reactions, occurred in 13.3% of the patients, and 2.4% of the participants discontinued treatment due to side effects. There were different clinical backgrounds between non-responders, and early and ultra-late responders, including psychiatric complications, medication overuse headache, and pulsatile headache. The treatment continuation rates at 12, 18, and 24 months were 73.5%, 65.4%, and 58.0%, respectively, with higher persistence in patients who received quarterly dosing than in those who received monthly dosing (p < 0.001).</p><p><strong>Conclusion: </strong>Fremanezumab is effective and well tolerated for long-term migraine prophylaxis.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217977","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":"The impact of white matter lesions on seizure recurrence after first epileptic seizures in the elderly: a prospective study.","authors":"Jenny Weil, Louise Linka, Mariana Gurschi, Seyyid Abdulkerim Kidik, Alena Fuchs, Rebecca Schoenfeldt, Felix Zahnert, Leona Möller, Katja Menzler, André Kemmling, Susanne Knake, Lena Habermehl","doi":"10.1186/s42466-025-00391-2","DOIUrl":"10.1186/s42466-025-00391-2","url":null,"abstract":"<p><strong>Background: </strong>Despite considerable previous research, to what degree white matter lesions (WML) may be epileptogenic remains unclear. Therefore, the decision of initiating treatment with antiseizure medication (ASM) can be challenging in patients with only WML on neuroimaging. In this prospective study we assessed whether the prevalence, localization or severity of WML impact the risk of seizure recurrence in patients aged 60 years or older after first-time seizures.</p><p><strong>Methods: </strong>Data was analyzed from 168 patients, aged ≥ 60 years-old who had experienced a previous unprovoked seizure and had either a potentially epileptogenic lesion or WML on neuroimaging. The frequency of seizure recurrence was documented after 6, 12, and 24 months. Pearson´s chi-square test of independence (categorical variables) and the independent Student´s t-test (continuous variables) were used to analyze intergroup differences. Binary logistic regressions were calculated to examine the influence of WML locations as a predictor of seizure recurrence. Kaplan-Meier survival analyses and log-rank statistics were performed to determine the cumulative recurrence rates between the groups.</p><p><strong>Results: </strong>Fifteen patients had only potentially epileptogenic lesions on neuroimaging (EPI) and 93 showed WML only (OWML). Sixty patients showed both of them on neuroimaging (EWML). Frontal and parieto-occipital were the predominant WML locations. Neither severity nor location of WML had a significant impact on recurrence rates. The two-year cumulative probability of becoming seizure-free was significantly lower in the EPI group compared to the EWML (χ² [1] = 4.425, p = 0.035) and the OWML group (χ² [1] = 13.094, p < 0.001). A significant association between interictal epileptiform discharges in EEG and seizure recurrence was found in OWML patients (p = 0.004).</p><p><strong>Conclusion: </strong>We could not find any association between prevalence, severity or location of WML and seizure recurrence after first seizures in the elderly. Therefore, treatment with ASM should be started with caution in those patients. Our results show a trend of WML not having epileptogenic potential, but further studies are needed to get better evidence.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Protocol Registration and Results, NCT06836687, AZ 199/17, release: 03/19/2024 retrospectively registered. https://register.</p><p><strong>Clinicaltrials: </strong>gov/prs/beta/studies/S000EBC700000025/recordSummary.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113100","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":"Long-term outcomes of community-based intensive care treatment following neurological early rehabilitation- results of a multicentric German study.","authors":"Bernadette Einhäupl, Danae Götze, Stephanie Reichl, Lina Willacker, Romy Pletz, Thomas Kohlmann, Esther Henning, Lena Schmeyers, Andreas Straube, Rebekka Süss, Steffen Fleßa, Simone Schmidt, Jens D Rollnik, Friedemann Müller, Aukje Bartsch-de Jong, Svenja Blömeke, Jennifer Hartl, Nuria Vallejo, Daniel Liedert, Thomas Olander, Volker Ziegler, Renate Weinhardt, Felix Schlachetzki, Tatjana Groß, Susanne Hirmer, Lea Dillbaner, Lisa Kleinlein, Thomas Platz, Andreas Bender","doi":"10.1186/s42466-025-00384-1","DOIUrl":"10.1186/s42466-025-00384-1","url":null,"abstract":"<p><strong>Background: </strong>Weaning from mechanical ventilation (MV) and tracheal cannula (TC) during neurological early rehabilitation (NER) is mostly successful. However, some patients leave NER with TC/MV, requiring home-based specialized intensive care nursing (HSICN). Data on medical and demographic characteristics and long-term outcomes of these patients are limited.</p><p><strong>Methods: </strong>A multicentric retrospective observational study across five German NER hospitals collected data from neurological patients with TC/MV at discharge. The study aimed to assess patients' health status at NER discharge, and to identify predictors of post-discharge survival. Survival rates were analyzed using Kaplan-Meier estimates; further predictors of survival post-discharge were analyzed using Cox regression.</p><p><strong>Results: </strong>Among 312 patients, the one-year survival rate was 61.9%, decreasing to 38.1% after approximately 4 years. Older age, higher overall morbidity and discharge with MV were associated with an increased likelihood of death, while a longer stay in NER correlated with survival.</p><p><strong>Conclusions: </strong>Patients requiring HSICN after discharge from NER have a high mortality rate. Identifying survival predictors may help to identify patients at risk, and thus could be integrated into the decision-making process for NER discharge. The high mortality post-discharge warrants an evaluation of the current post-hospital care model. Optimizing therapeutic care in the HSICN setting may have the potential to reduce mortality and neuro-disability, and enhance the quality of life in these neurologically severely affected patients.</p><p><strong>Trial registration: </strong>The trial OptiNIV - Retrospective study of post-hospital intensive care in neurological patients has been retrospectively registered in the German Clinical Trials Register (DRKS) since 28.10.2022 with the ID DRKS00030580.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From routine to selective: how updated MRI guidelines reshape gadolinium use in Germany.","authors":"Marc Pawlitzki, Alexander Stahmann, Niklas Frahm, Mathia Kirstein, Melanie Peters, Peter Flachenecker, Tim Friede, Kerstin Hellwig, Dagmar Krefting, Michaela Mai, Clemens Warnke, Uwe K Zettl, David Ellenberger","doi":"10.1186/s42466-025-00387-y","DOIUrl":"10.1186/s42466-025-00387-y","url":null,"abstract":"<p><p>Magnetic resonance imaging (MRI) is a critical diagnostic tool and monitoring modality for multiple sclerosis (MS), frequently employing gadolinium-based contrast agents (Gd). However, concerns regarding the accumulation of Gd have prompted international guidelines (MAGNIMS-CMSC-NAIMS, 2021) to advocate for the limitation of Gd utilization. Consequently, we assessed of the impact of the 2021 guidelines on the use of Gd in MRI in MS patients in Germany by conducting a retrospective analysis of MRI data from 12,833 MS patients in the German MS Register (2019-2024). Generalized additive models were employed to analyze Gd use trends over time by MRI type (cranial, spinal, combined). From 2020 to 2024, a significant decline in Gd use was observed, with percentages dropping from 74.2 to 41.2% in cranial MRI, from 78.2 to 39.2% in spinal MRI and from 81.8 to 59.0% in combined MRI (p < 0.001). The most substantial decline occurred within the initial five years of MS. Gd use in MS MRI scans has significantly decreased in line with the updated guidelines. Nevertheless, its persistent utilization in over one-third of cases necessitates further examination.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096543","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}