Neurological research and practice最新文献

{"title":"Endovascular treatment in ischemic stroke with active cancer: retrospective analysis of university stroke center data.","authors":"Athina-Maria Aloizou, David-Dimitrios Chlorogiannis, Daniel Richter, Theodoros Mavridis, Dimitra Aloizou, Carsten Lukas, Ralf Gold, Christos Krogias","doi":"10.1186/s42466-025-00392-1","DOIUrl":"10.1186/s42466-025-00392-1","url":null,"abstract":"<p><strong>Introduction: </strong>Active cancer (AC) associates strongly with ischemic stroke (IS). Intravenous thrombolysis (IVT) is often contraindicated in AC, and endovascular treatment (EVT) is considered the gold treatment standard, although data on its safety and efficacy is scarce.</p><p><strong>Methods: </strong>Digital records of patients receiving EVT in a tertiary university hospital with comprehensive stroke center from 2016 to 2022 were assessed. Demographic, clinical, and laboratory parameters were extracted and compared between patients with and without AC. In-hospital mortality was set as the primary outcome.</p><p><strong>Results: </strong>39 AC and 297 non-AC patients were included. No significant differences were reported in demographic and baseline stroke parameters (NIHSS, mRS, stroke etiology). In-hospital mortality did not differ between groups (11/39 vs. 57/297, p > 0.99). Successful recanalization, change in mRS and NIHSS from admission to discharge, periinterventional complications, and stroke-related mortality were also comparable. Significantly fewer AC patients received IVT. In the binary logistic regression analysis (adjusting for confounder variables), older age, large artery atherosclerosis, unsuccessful recanalization, and higher admission NIHSS were independent predictors of all-cause in-hospital mortality (aOR): 1.04, 95% confidence interval (CI): 1.01-1.08; OR: 3.21, 95% CI: 1.03-9.92, OR: 7.28, 95% CI: 3.61-15.1, OR: 1.07, 95% CI: 1.01-1.14, p-value < 0.05, respectively).</p><p><strong>Conclusions: </strong>EVT was shown as safe and effective in AC patients as in non-AC patients. Long-term functional outcomes are often poorer in AC, due to the cancer itself, but given how oncological treatment depends on functional status, AC patients should be considered for EVT.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096541","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":"Real-world disease burden and planned treatment optimization after MANAGE-PD implementation in Germany: a cross-sectional study.","authors":"Martin Südmeyer, David J Pedrosa, Frank Siebecker, Carolin Arlt, Jaakko Kopra, Wolfgang H Jost","doi":"10.1186/s42466-025-00383-2","DOIUrl":"https://doi.org/10.1186/s42466-025-00383-2","url":null,"abstract":"<p><strong>Background: </strong>In Germany, the approach to treatment optimization for patients with advanced Parkinson's disease (PD) is considered somewhat conservative. The MANAGE-PD tool ( www.managepd.eu ) was developed to help identify patients with advanced PD and to facilitate treatment decision making and appropriate allocation of patients to device-aided therapies (DAT). This prospective, non-interventional study aimed to investigate the real-world disease burden of PD and treatment optimization after MANAGE-PD implementation.</p><p><strong>Methods: </strong>Adult PD patients (N = 278) visited specialist clinics and neurologist's practices in Germany in 2022. Disease burden was assessed using the Unified PD rating scale (UPDRS parts II-IV), the non-motor symptoms scale (NMSS) and the 8-item Parkinson's disease Questionnaire (PDQ-8). Data on planned treatment changes were collected. Data were analyzed by disease control categories according to the MANAGE-PD tool.</p><p><strong>Results: </strong>Mean scores for motor and non-motor symptoms, quality of life, and comorbidity burden were worse in patients with lower disease control measured by MANAGE-PD. For 52.8% of patients in Category 2 (inadequately controlled-might benefit from oral optimization), no change in oral treatment was planned. No change in oral treatment and no DAT initiation was planned for 37.9% and 65.0% of patients in Category 3 (inadequately controlled-might benefit from DAT). Patient refusal and needing more time to decide were the most common reasons for not making treatment changes.</p><p><strong>Conclusions: </strong>This study supports the validity of MANAGE-PD by showing its high association with disease burden and emphasizes the importance of timely provision of necessary information to enable informed decisions about treatment optimization.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064597","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":"Neuropsychiatric changes following striatal stroke- results from the observational PostPsyDis study.","authors":"Anna Kufner, Ana Sofía Ríos, Benjamin Winter, Uchralt Temuulen, Ahmed Khalil, Ulrike Grittner, Johanna Schöner, Asli Akdeniz, Ulrike Lachmann, Golo Kronenberg, Arno Villringer, Karen Gertz, Matthias Endres","doi":"10.1186/s42466-025-00390-3","DOIUrl":"https://doi.org/10.1186/s42466-025-00390-3","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke can lead to neuropsychiatric sequelae such as depression and post-traumatic stress disorder (PTSD), resulting in poorer functional outcomes. The POST-stroke PSYchological DIStress PostPsyDis; NCT01187342) study aimed to investigate whether ischemic lesions in the striatum increase the risk of depression and PTSD after stroke.</p><p><strong>Methods: </strong>This monocenter, observational, case-control study included 84 ischemic stroke patients with striatal (n = 54) and non-striatal ischemic brain lesions (n = 30). Primary study endpoints included symptoms of depression (assessed via the Geriatric Depression Scale; GDS-30) and PTSD (assessed via the Posttraumatic Symptom Scale; PTSS-10) 90 days post-stroke. A normative functional connectome was used to obtain a measure of striatal connectivity to the rest of the brain (\"striatal network\"). Network damage scores were used to estimate damage of each lesion to the striatal network.</p><p><strong>Results: </strong>Patients with striatal lesions had higher GDS-30 scores at 90 days post-stroke (median 5.6 vs. 3.0; Cohen's d = 0.39; p = 0.057), indicating a small to moderate effect. However, no meaningful group differences were observed in the incidence of depression or PTSD. In multivariable regression analyses, striatal infarction had an adjusted beta coefficient (β) of 1.9 (95%CI 0.19-3.7; p = 0.076) for GDS-10 and 1.8 (95%CI -1.9-5.5; p = 0.25) for PTSS-10 scores after 90 days. Only female sex was independently associated with PTSD severity (adjusted β = 5.1, 95% CI 1.3-8.8; p = 0.008). Analyzing lesion connectivity to the striatal network did not change these findings.</p><p><strong>Conclusions: </strong>Taken together, the PostPsyDis study suggests a high rate of psychiatric morbidity in stroke patients. Moreover, the study suggests increased neuropsychiatric symptoms in patients with striatal lesions. There is a clear need for larger studies to investigate the role of the striatum in post-stroke neuropsychiatric disorders.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT01187342) Registered 23 August 2009, https://clinicaltrials.gov/study/NCT01187342 .</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059644","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":"Exploring the relationship of clinical walking tests with 8-months inertial measurement unit (IMU)-based real world mobility tracking in stroke and spinal cord injury survivors.","authors":"Andreas Hug, Tamara Spingler, Viola Pleines, Laura Heutehaus, Mircea Ariel Schoenfeld, Björn Hauptmann, Jürgen Moosburger, Roland Thietje, Oliver Pade, Wolfgang Rössy, Klaus Stecker, Jochen Klucken, Tiziana Daniel, Michel Wensing, Cornelia Hensel, Rüdiger Rupp, Norbert Weidner","doi":"10.1186/s42466-025-00386-z","DOIUrl":"https://doi.org/10.1186/s42466-025-00386-z","url":null,"abstract":"<p><strong>Background: </strong>Mobility is crucial for participation and quality of life in individuals with sensorimotor impairments, yet scientific evidence on its course in real-world settings is limited. So-called wearables for measuring physical activity might help to overcome this knowledge gap allowing daily measurements of mobility. The aim of the present study is to examine the relationship between clinical walking tests and inertial measurement unit-based mobility tracking in the community setting of stroke and spinal cord injury (SCI) survivors.</p><p><strong>Methods: </strong>At a single observational time point, the precision of the activity tracker was evaluated in a standardized parcours in healthy subjects and stroke or SCI survivors (n=57). This was followed by a multicenter observational cohort study (n=116 participants), in which the mobility of stroke and SCI survivors was assessed over 8 months immediately after discharge from acute inpatient rehabilitation. Daily distances covered in the community setting were recorded using the activity tracker. Established walking tests-including the 10-meter walk test (10MWT) and the timed up and go test (TUG)-were conducted at baseline, as well as at 4- and 8-month follow up visits. The relationship between daily distances in the ambulatory setting and 10MWT or TUG performance at discrete study visits (baseline, 4 months (midterm), and 8 months (final) after hospital discharge) was analyzed using regression models.</p><p><strong>Results: </strong>The precision of the activity tracker in measuring covered distance in a standardized parcours varied by mobility type. The highest precision was achieved in manual wheelchair users (deviation from zero: -1.5±1.03% (p=0.15) while the least favorable precision was observed in participants with SCI and significant walking impairment (-14.6±2% (p<0.001). The widely used 10MWT speed showed a relationship with the ambulatory daily distance. The regression coefficients [m/(1m/s)] were: 874 (95% CI: 578-1171) at baseline (p<0.001), 895 (95% CI: 614-1176) at midterm (p<0.001), and 824 (95% CI: 537-1112) at the final visit (p<0.001). Interestingly, in the category of good walkers with the most favorable walking speeds the daily covered distance unmasked distinct subgroups with shorter and longer daily distances.</p><p><strong>Conclusions: </strong>For SCI and stroke survivors, especially medium to fast walkers, activity tracking in real-world settings adds valuable insight beyond clinical walking tests. Clinical studies on rehabilitative interventions for mobility improvement should consider real-life daily distance as a key endpoint.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060677","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":"Switch to tenecteplase for intravenous thrombolysis in stroke patients: experience from a German high-volume stroke center.","authors":"Alexander Sekita, Gabriela Siedler, Jochen A Sembill, Manuel Schmidt, Ludwig Singer, Bernd Kallmuenzer, Lena Mers, Anna Bogdanova, Stefan Schwab, Stefan T Gerner","doi":"10.1186/s42466-025-00388-x","DOIUrl":"https://doi.org/10.1186/s42466-025-00388-x","url":null,"abstract":"<p><strong>Background: </strong>Tenecteplase (TNK) offers promising efficacy and safety data for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) and pharmacological advantages over alteplase (rt-PA), justifying its gradual adoption as primary thrombolytic agent. At our tertiary care center, we transitioned from rt-PA to TNK, providing valuable real-world insights into this process, including its use beyond the 4.5-hour time window.</p><p><strong>Methods: </strong>We retrospectively analyzed our stroke registry to compare clinical and procedural data from AIS patients treated with rt-PA (up to 6 months before transition) and those treated with TNK (up to 6 months after transition, starting June 2024). Primary endpoints included treatment metrics, such as door-to-needle (DTN), door-to-imaging (DTI), imaging-to-needle (ITN), door-to-groin and door-to-recanalization times. Safety outcomes comprised rate of any intracranial hemorrhage (ICH), symptomatic ICH (sICH), parenchymatous hematoma type 2 (PH 2) and post-thrombolysis angioedema. A semiquantitative questionnaire evaluated satisfaction with TNK and changes in lysis behavior among nurses and physicians 3 months post-implementation.</p><p><strong>Results: </strong>During the twelve-month period (December 1, 2023 - November 30, 2024), 276 patients underwent IVT. Median DTN times were significantly shorter with TNK (n = 138) compared to rt-PA (n = 138) (TNK 27 min [IQR 19-39] vs. rt-PA 34 min [IQR 25-62]; p = 0.011). No significant differences were observed in safety outcomes, including any ICH (TNK 9% vs. rt-PA 6%; p = 0.30), sICH (2% vs. 1%; p = 0.31), PH 2 rates (1% in both groups), or angioedema (3% vs. 1%; p = 0.18). Staff satisfaction with TNK was high, citing advantages in preparation, administration, and time efficiency. Importantly, no changes in lysis behavior were reported following the transition.</p><p><strong>Conclusions: </strong>Transitioning to TNK in routine practice at a tertiary care center seems feasible with reduced ITN and consequently DTN times. Functional outcomes at discharge were comparable without significant difference in the rate of (s)ICH. Overall, the transition to TNK was well-received by medical staff, highlighting TNK's practical advantages in acute stroke care.</p><p><strong>Trial registration: </strong>N.A.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12051303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045525","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":"Neurological disorders caused by recreational use of nitrous oxide-a retrospective study from a German metropolitan area and review of the literature.","authors":"Asya Tshagharyan, Se-Jong You, Christian Grefkes, Elke Hattingen, Joachim P Steinbach, Pia S Zeiner, Marcel Hildner, Iris Divé","doi":"10.1186/s42466-025-00385-0","DOIUrl":"https://doi.org/10.1186/s42466-025-00385-0","url":null,"abstract":"<p><strong>Background: </strong>The recreational use of nitrous oxide (N₂O) has seen a worldwide rise in the recent years, resulting in an increased incidence of neurological complications due to N₂O-induced functional vitamin B₁₂ deficiency. Here, we report on a cohort of patients admitted to a tertiary care center with neurological symptoms in the context of recreational N₂O use between 2020 and 2024.</p><p><strong>Methods: </strong>We screened the database of the University Hospital Frankfurt for patients ≥ 18 years of age who presented with neurological deficits and a history of N₂O consumption between January 2020 and December 2024. We analyzed the spectrum of neurological deficits as well as radiological and laboratory findings.</p><p><strong>Results: </strong>We identified a total of 20 patients, 16 males and 4 females, with a median age of 21 years. We found a steady increase in the number of cases, with no cases in 2020 and 2021 and a definite peak in 2024. The mean daily N₂O consumption was 2500 g. All patients reported sensory deficits; 85% had gait disturbances and 70% had motor deficits. Less frequent symptoms included pain, bladder or bowel dysfunction, fatigue and spasticity. The median score on the modified Rankin scale (mRS) was 2, with some patients being wheelchair-bound. The most frequently observed lesion pattern was combined myelo-polyneuropathy. T2-hyperintense myelon lesions were observed in 11 of 15 patients (73.3%). Surprisingly, laboratory work-up revealed normal vitamin B₁₂ levels in nearly all patients (95%), whereas homocysteine and methylmalonic acid levels were prominently elevated in all patients (100%). In addition, 13 patients (65%) presented with hematological abnormalities. All of the patients who presented for follow-up (20%) reported continued use of N₂O. There was no neurological improvement in any of these cases.</p><p><strong>Conclusions: </strong>Our study confirms that the increasing incidence of N₂O-induced neurotoxicity reported in other countries can also be observed in Germany. Therefore, it underlines the relevance of the current debate on health policies. In addition, our study highlights the pitfalls of vitamin B12 laboratory testing and emphasizes the need to address substance addiction in treatment.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047608","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":"Motor phenotypes of amyotrophic lateral sclerosis - a three-determinant anatomical classification based on the region of onset, propagation of motor symptoms, and the degree of upper and lower motor neuron dysfunction.","authors":"Thomas Meyer, Matthias Boentert, Julian Großkreutz, Patrick Weydt, Sarah Bernsen, Peter Reilich, Robert Steinbach, Annekathrin Rödiger, Joachim Wolf, Ute Weyen, Albert C Ludolph, Jochen Weishaupt, Susanne Petri, Paul Lingor, René Günther, Wolfgang Löscher, Markus Weber, Christoph Münch, André Maier, Torsten Grehl","doi":"10.1186/s42466-025-00389-w","DOIUrl":"https://doi.org/10.1186/s42466-025-00389-w","url":null,"abstract":"<p><strong>Background: </strong>In amyotrophic lateral sclerosis (ALS), heterogeneity of motor phenotypes is a fundamental hallmark of the disease. Distinct ALS phenotypes were associated with a different progression and survival. Despite its relevance for clinical practice and research, there is no broader consensus on the classification of ALS phenotypes.</p><p><strong>Methods: </strong>An expert consensus process for the classification of ALS motor phenotypes was performed from May 2023 to December 2024. A three-determinant anatomical classification was proposed which is based on the (1) region of onset (O), (2) the propagation of motor symptoms (P), and (3) the degree of upper (UMN) and/or lower motor neuron (LMN) dysfunction (M). Accordingly, this classification is referred to as the \"OPM classification\".</p><p><strong>Results: </strong>Onset phenotypes differentiate the site of first motor symptoms: O1) head onset; O2d) distal arm onset; O2p) proximal arm onset; O3r) trunk respiratory onset; O3a) trunk axial onset; O4d) distal leg onset; O4p) proximal leg onset. Propagation phenotypes differentiate the temporal propagation of motor symptoms from the site of onset to another, vertically distant body region: PE) earlier propagation (within 12 months of symptom onset); PL) later propagation (without propagation within 12 months of symptom onset), including the established phenotypes of \"progressive bulbar paralysis\" (O1, PL), \"flail-arm syndrome\" (O2p, PL), and \"flail-leg syndrome\" (O4d, PL); PN) propagation not yet classifiable as time since symptom onset is less than 12 months. Phenotypes of motor neuron dysfunction differentiate the degree of UMN and/or LMN dysfunction: M0) balanced UMN and LMN dysfunction; M1d) dominant UMN dysfunction; M1p) pure UMN dysfunction (\"primary lateral sclerosis\", PLS); M2d) dominant LMN dysfunction; M2p) pure LMN dysfunction (\"progressive muscle atrophy\", PMA); M3) dissociated motor neuron dysfunction with dominant LMN and UMN dysfunction of the arms and legs (\"brachial amyotrophic spastic paraparesis\"), respectively.</p><p><strong>Conclusion: </strong>This consensus process aimed to standardize the clinical description of ALS motor phenotypes in clinical practice and research - based on the onset region, propagation pattern, and motor neuron dysfunction. This \"OPM classification\" contributes to specifying the prognosis, to defining the inclusion or stratification criteria in clinical trials and to correlate phenotypes with the underlying disease mechanisms of ALS.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004184","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":"Diagnosis, pathomechanisms and therapy of cerebral amyloid angiopathy-related inflammation (CAA-ri).","authors":"Rebecca M Seifert, Randolf Klingebiel, Wolf-Rüdiger Schäbitz","doi":"10.1186/s42466-025-00382-3","DOIUrl":"https://doi.org/10.1186/s42466-025-00382-3","url":null,"abstract":"<p><strong>Background: </strong>Research of the past years has refined our perception of cerebral amyloid angiopathy-related inflammation (CAA-ri) as a subacute autoimmune encephalopathy, which is presumably caused by elevated CSF concentrations of anti-amyloid β (Aβ) autoantibodies. A broad understanding of the pathophysiological mechanisms and diagnostic criteria of CAA-ri may lay the foundation for improved immunosuppressive treatment of the disease.</p><p><strong>Main text: </strong>Spontaneous CAA-ri mainly occurs in elderly patients but might also be evoked iatrogenically by modern treatment with amyloid-modifying therapies in Alzheimer's disease (AD). On a histopathological level, CAA-ri is characterized by microglial activation and the formation of vasogenic edemas. Clinically, the disease frequently presents with progressive cognitive decline, focal neurological deficits, headache and epileptic seizures. While brain biopsy has formerly represented the gold standard in the diagnosis of CAA-ri, its importance has been increasingly replaced by clinical as well as radiological diagnostic criteria and the relevance of anti-Aβ autoantibodies in the CSF of affected patients. Though relevant progress has been achieved in immunosuppressive treatment of CAA-ri, the protocols lack standardization as well as decision criteria for the choice of the respective immunosuppressive agent.</p><p><strong>Conclusions: </strong>CAA-ri gains increasing interest as a spontaneous human model of iatrogenic edematous amyloid-related imaging abnormalities (ARIA-E) in the context of amyloid-modifying therapies. In near future, screening of AD patients for the presence of CAA-ri using CSF anti-Aβ autoantibodies might play a decisive role in the risk stratification as well as dosage finding of amyloid-modifying therapies, as they show high specificity for CAA-ri. The clinical and radiological diagnostic criteria by Auriel et al. allow diagnosis of probable resp. possible CAA-ri with high accuracy. Though only tested in small, specialized patient cohorts to date, additional imaging modalities (¹¹C-PK11195 PET) might play a future role in the clinical monitoring of CAA-ri. Therapy of CAA-ri frequently encompasses initial steroid treatment, whereby different schemes, dosages as well as substances are used. Choice of immunosuppressive agents with higher potency still requires objective decision criteria, which should be established in future studies involving larger CAA-ri patient cohorts.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030140","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":"Should we stay or should we go? Recent insights on drug discontinuation in multiple sclerosis.","authors":"Anne Mrochen, Sven G Meuth, Steffen Pfeuffer","doi":"10.1186/s42466-025-00379-y","DOIUrl":"https://doi.org/10.1186/s42466-025-00379-y","url":null,"abstract":"<p><strong>Background: </strong>The decision to discontinue disease-modifying therapies (DMTs) in patients with multiple sclerosis (PwMS) is a critical clinical challenge. Historically, DMTs were discontinued due to side effects, treatment limitations, or progression to secondary progressive MS. However, advancements in MS therapies, particularly high-efficacy DMTs (HE-DMTs) and the increased knowledge on disease courses and phenotypes have resulted in more personalized treatment approaches and introduced discussion on scheduled DMT discontinuation. This review explores the current evidence on DMT discontinuation, focusing on its implications for aging populations and the interplay between cardiovascular diseases (CVD) and MS.</p><p><strong>Current evidence and interplay with cvd: </strong>Randomized trials such as DISCOMS and DOT-MS have provided insights into discontinuing DMTs in stable patients. In summary, both randomized clinical trials highlight the risk of disease reactivation following treatment discontinuation. Due to the limited sample size, neither study was able to conduct subgroup analyses based on age groups. Additionally, DOT-MS was terminated prematurely, direct comparisons with other studies should be avoided. While older studies and observational data (e.g., OFSEP) have shown relapse risks associated with discontinuation, particularly for drugs like natalizumab and fingolimod, there is limited data on HE-DMT discontinuation outcomes. Comorbidities, particularly CVDs, further complicate decisions regarding the continuation of DMTs in older adults. MS patients bear a higher burden of CVD, which is also associated with unfavorable disease courses. While optimizing cardiovascular risk profiles appears advisable, it remains unclear whether DMTs themselves have a positive impact on CVDs.</p><p><strong>Conclusion: </strong>Given the complexities associated with discontinuing DMTs in MS patients, it is essential to balance the avoidance of polypharmacy with the potential risks of disease reactivation and the impact of comorbidities, especially CVDs, on disease progression. The interplay between MS and CVD highlights the importance of a holistic risk assessment when considering DMT discontinuation.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048625","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":"Low blood flow velocity in the left atrial appendage in sinus rhythm as a predictor of atrial fibrillation: results of a prospective cohort study with 3 years of follow-up.","authors":"Gero Klinger, Lea Schettler, Greta Schettler, Mathias Bähr, Gerd Hasenfuß, Mark Weber-Krüger, Jan Liman, Marlena Schnieder, Marco Robin Schroeter","doi":"10.1186/s42466-025-00381-4","DOIUrl":"https://doi.org/10.1186/s42466-025-00381-4","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a common cause of cardioembolic stroke and can lead to severe and recurrent cerebrovascular events. Thus, identifying patients suffering from cardioembolic events caused by undetected AF is crucial. Previously, we found an association between increasing stroke severity and a decreasing left atrial appendage (LAA) blood flow velocity below 60 cm/s.</p><p><strong>Methods: </strong>This was a prospective single-center cohort study including hospitalized patients who underwent a transesophageal echocardiography (TEE) in sinus rhythm. The participants were divided into two groups (≥ 60 cm/s;<60 cm/s) based on their maximum LAA blood flow velocity. The results of the cardiovascular risk assessment and 24- to 72-hour ECG Holter were recorded. Follow-up appointments were scheduled at 3, 6, 12, 24 and 36 months. The primary endpoint was new-onset AF. The statistics included a Cox-proportional-hazard-model and a binary logistic regression. Numerical data or categorical data were analyzed with the Mann-Whitney U test or chi-square test.</p><p><strong>Results: </strong>A total of 166 patients were recruited. The median LAA blood flow velocity was 64 cm/s. New-onset AF was diagnosed in 22.9% of the patients. An LAA blood flow velocity ≤ 60 cm/s was associated with a threefold increased risk of new-onset AF (35.8% vs. 11.5%; HR3.56; CI95%1.70-7.46; p < 0.001), independently according to a multivariate analysis (p = 0.035). Furthermore, a decreasing LAA blood flow velocity was associated with an increased risk of new-onset AF (OR1.043; CI95%1.021-1.069; p < 0.001).</p><p><strong>Conclusion: </strong>A low LAA blood flow velocity (≤ 60 cm/s) in sinus rhythm is prospectively associated with an increased risk of new-onset AF. Additional simple LAA-TEE examinations could help to identify patients who benefit from more accurate cardiac rhythm monitoring.</p>","PeriodicalId":94156,"journal":{"name":"Neurological research and practice","volume":"7 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061790","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}