Clinical Neurology and Neurosurgery最新文献

{"title":"Challenges in antiseizure medication discontinuation decisions: A qualitative study of clinicians who see patients with epilepsy","authors":"Samuel W. Terman ,&nbsp;Navya Kalia ,&nbsp;Micaela Dugan ,&nbsp;Jordan M. Silva ,&nbsp;Charlotte van Asch ,&nbsp;James F. Burke ,&nbsp;Shawna N. Smith ,&nbsp;Susanna S. O’Kula ,&nbsp;Chloe E. Hill","doi":"10.1016/j.clineuro.2025.109242","DOIUrl":"10.1016/j.clineuro.2025.109242","url":null,"abstract":"<div><h3>Background</h3><div>Antiseizure medication (ASM) withdrawal can be considered after a period of seizure-freedom for patients with epilepsy. We interviewed clinicians who treat patients with epilepsy about challenges and existing information gaps regarding ASM withdrawal decisions.</div></div><div><h3>Methods</h3><div>We conducted six focus groups of 3–5 clinicians each (N = 25). We used purposive sampling to reach key informants with diversity of geography, specialty, and credentialing, focusing on epilepsy specialists who may have the greatest experience with these scenarios but also seeking non-specialist neurology input. We asked respondents to describe their greatest challenges when discussing ASM withdrawal with patients and making treatment decisions. We then performed thematic qualitative analysis.</div></div><div><h3>Results</h3><div>Twenty (80 %) participants were epileptologists or clinical neurophysiologists, and three (12 %) were physician extenders. Respondents identified many challenges when discussing ASM withdrawal with patients. Estimating an individual patient’s seizure risk was one of the greatest challenges, due to heterogeneity in etiologies, electroclinical syndromes, and other patient characteristics. Additional challenges included weighing the net benefit versus harm of ASM discontinuation, dealing with uncertainty even if one could accurately estimate the chance of another seizure, and questions about optimal use of EEG. Respondents also noted challenges when patient preferences are not aligned with physician recommendations and the feeling of personal responsibility should the patient have a seizure after withdrawal.</div></div><div><h3>Conclusions</h3><div>Many challenges remain in ASM discontinuation decisions after a period of seizure-freedom. Our results encourage future efforts to improve individualized seizure risk prediction and to develop prediction models into seizure risk calculators.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109242"},"PeriodicalIF":1.6,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: Cognitive impairment in calcified neurocysticercosis – Mechanistic and clinical considerations","authors":"Nathkapach K. Rattanapitoon,&nbsp;Patpicha Arunsan,&nbsp;Chutharat Thanchonnang,&nbsp;Schawanya K. Rattanapitoon","doi":"10.1016/j.clineuro.2025.109243","DOIUrl":"10.1016/j.clineuro.2025.109243","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109243"},"PeriodicalIF":1.6,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Komiotis et al. “Genetic perspectives on transient global amnesia: A narrative review”","authors":"Andrew J. Larner","doi":"10.1016/j.clineuro.2025.109241","DOIUrl":"10.1016/j.clineuro.2025.109241","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109241"},"PeriodicalIF":1.6,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The lateral orbitotomy approach: Technical nuances and video-illustration","authors":"Hussam Abou-Al-Shaar ,&nbsp;Tarek Y. El Ahmadieh ,&nbsp;Maximiliano Nuñez ,&nbsp;Vera Vigo ,&nbsp;Ju Hyung Moon ,&nbsp;Juan C. Fernandez-Miranda ,&nbsp;Aaron A. Cohen-Gadol","doi":"10.1016/j.clineuro.2025.109235","DOIUrl":"10.1016/j.clineuro.2025.109235","url":null,"abstract":"<div><div>The lateral orbitotomy approach is a minimally-invasive transorbital technique that was originally developed to address orbital pathologies. With the increased understanding of orbital anatomy and multidisciplinary collaboration between neurosurgeons and oculoplastic surgeons, the approach has been expanded to address various pathologies of the anterior and middle cranial fossae, and intrinsic brain pathologies. Clipping select aneurysms and resecting both intrinsic and extra-axial brain tumors were made possible through a small skin incision around the eye. The lateral orbitotomy offers optimal visualization to pathologies located inferior to the anterior clinoid process, anterior to Meckel’s cave, lateral to the optic nerve, and medial to foramen ovale. In this report, the authors delineate the indications, advantages, and limitations of the lateral orbitotomy approach and discuss related technical nuances and common pitfalls. This report aims to provide a practical educational resource for neurosurgery trainees and junior neurosurgeons through high-quality dissections and 3D 4 K video presentations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109235"},"PeriodicalIF":1.6,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-long term efficacy of dihydroergotoxine mesylate in treatment of sialorrhea in Parkinson's disease","authors":"Huihui Jin ,&nbsp;Ting Huang ,&nbsp;Jing Wu ,&nbsp;Yanan Zhu ,&nbsp;Qing Gao ,&nbsp;Youyong Tian","doi":"10.1016/j.clineuro.2025.109239","DOIUrl":"10.1016/j.clineuro.2025.109239","url":null,"abstract":"<div><h3>Purpose</h3><div>To further assess the mid-long term effects of dihydroergotoxine mesylate (DHM) on salivation in patients with Parkinson’s disease (PD).</div></div><div><h3>Methods</h3><div>Thirty-nine participants were enrolled in a 24-week, open, self-controlled study. After baseline assessments of salivation, swallowing, and motor and cognitive function, the participants were given DHM. The primary outcome was the difference in the Sialorrhea Clinical Scale for Parkinson’s disease (SCS-PD) scores of salivation before and after treatment. The secondary outcomes included ≥ 30 % improvement in the SCS-PD score at each posttreatment visit and changes in the scores from other scales.</div></div><div><h3>Results</h3><div>A total of 39 participants were included in this study, and 4 participants dropped out. Finally, 35 patients completed all the visits. Salivation: After treatment for 1 week, the primary outcome, namely, the median SCS-PD score, decreased from 9.0 (IQR 5.0–12.0) at baseline to 7.0 (IQR 4.7–10.0) (<em>P</em> = 0.03). This effect persisted at 24 weeks, and the median score at 24 weeks was 5.0 (IQR 2.0–8.0) (<em>P</em> &lt; 0.001 compared with baseline). For the Drooling Severity and Frequency Scale (DSFS) scale, the median baseline score was 6.0 (IQR 5.0–7.0). After two weeks of treatment, the median score decreased from baseline to 5.0 (IQR 4.0–6.0) (<em>P</em> &lt; 0.001), and the median score at the final visit was 4.0 (IQR 3.7–6.0) (<em>P</em> &lt; 0.001). The second term of the second part of the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-2.2) showed a trend that was consistent with that of the DSFS scale, and significant differences started to emerge at 2 weeks after treatment was initiated. Within one week of treatment, 25.64 % of the patients had improved SCS-PD scores, reaching improvements of 30 % or more. At 2–12 weeks, the proportion of patients with improved SCS-PD scores exceeded 50 %, and this proportion reached 64.10 % at 24 weeks. Swallowing function: The Eating Assessment Tool-10 (EAT-10) revealed that the median scores at 4–24 weeks were 1.0 (IQR 0–3.0), 1.0 (IQR 0–2.2) and 1.0 (IQR 0–3.0), which were significantly different from the baseline score of 2.0 (IQR 0.7–4.0) (<em>P</em> &lt; 0.05). After 2 weeks of treatment, the median score of the Swallowing Disturbance Questionnaire for Parkinson’s Disease (SDQ-PD) decreased from 22.0 (IQR 18.0–27.0) at baseline to 19.0 (IQR 17.0–23.2) (<em>P</em> = 0.001). However, motor and cognitive function did not significantly change in this study. Moreover, only 7.69 % of patients experienced mild and transient adverse effects.</div></div><div><h3>Conclusion</h3><div>DHM can significantly ameliorate salivation in PD patients over 24 weeks, with fewer adverse effects.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109239"},"PeriodicalIF":1.6,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying poor prognostic factors in patients with spontaneous spinal epidural hematoma: Insights from 47 cases at a single institution","authors":"Michiru Katayama ,&nbsp;Yasufumi Ohtake ,&nbsp;Masaaki Mikamoto ,&nbsp;Makoto Senoo ,&nbsp;Hirohiko Nakamura","doi":"10.1016/j.clineuro.2025.109238","DOIUrl":"10.1016/j.clineuro.2025.109238","url":null,"abstract":"<div><h3>Objective</h3><div>To identify clinical and perioperative factors associated with poor neurological outcomes in spontaneous spinal epidural hematoma (SSEH).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 47 consecutive SSEH patients treated from 1995 to 2024 at two centers. Neurological status was graded using the ASIA Impairment Scale (AIS). Good outcome was defined as AIS D/E at final follow-up; poor outcome as AIS A–C. Demographic characteristics, comorbidities, symptoms, imaging findings, treatment, and perioperative variables were statistically compared between outcome groups.</div></div><div><h3>Results</h3><div>The cohort comprised 20 men and 27 women (median age 69 years). Twenty-six patients underwent surgery and 21 were managed conservatively. All conservatively managed patients and 22/26 surgically treated patients achieved good outcomes. In the surgical group, perioperative hypotension requiring continuous catecholamines and a history of cardiovascular disease (CVD) were significantly associated with poor outcome (p = 0.00154 and p = 0.0278, respectively). Age, sex, lifestyle comorbidities, admission severity, hematoma extent, and canal occupancy ratio were not significantly associated. Time to surgery trended longer in the poor-outcome subgroup.</div></div><div><h3>Conclusion</h3><div>In SSEH, perioperative hypotension and CVD comorbidity are associated with worse neurological recovery. Vigilant hemodynamic management—especially around anesthetic induction—may help preserve spinal cord perfusion and improve outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109238"},"PeriodicalIF":1.6,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145511869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in pregnancy and postpartum: Etiology, incidence, and risk factors in a tertiary care cohort","authors":"Adalet Göçmen ,&nbsp;Murat Çekiç ,&nbsp;Mehmet İncebıyık ,&nbsp;Dilek Ağırcan ,&nbsp;Tülin Gesoğlu Demir ,&nbsp;Özlem Öz ,&nbsp;Özlem Ethemoğlu","doi":"10.1016/j.clineuro.2025.109237","DOIUrl":"10.1016/j.clineuro.2025.109237","url":null,"abstract":"<div><h3>Background</h3><div>Stroke during pregnancy and the puerperium is rare but potentially devastating, contributing substantially to maternal morbidity, mortality, and adverse fetal outcomes. Data on incidence, etiology, and modifiable risk factors in low- and middle-income countries remain limited.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed medical records of women ≥ 18 years admitted with ischemic stroke (arterial or cerebral venous thrombosis) or hemorrhagic stroke during pregnancy or up to 12 weeks postpartum at Harran University Hospital between January 2013 and October 2024. Clinical features, neuroimaging findings, laboratory parameters, thrombophilia/genetic testing, and obstetric complications were analyzed. A control group comprised age-matched pregnant/postpartum women hospitalized for obstetric indications without stroke. Risk factors were compared between groups, and center-based incidence was calculated per 100,000 deliveries.</div></div><div><h3>Results</h3><div>Eighty-three women were included (25 pregnant, 58 postpartum). Ischemic stroke predominated over hemorrhagic events. Cerebral venous thrombosis was the most frequent subtype, particularly postpartum and within 6 weeks of delivery. Preeclampsia/eclampsia and anemia were significantly more common in cases than controls (p &lt; 0.01). Laboratory abnormalities included higher urea, creatinine, glucose, low-density lipoprotein cholesterol, C-reactive protein, erythrocyte sedimentation rate, red cell distribution width, and platelet counts, with lower hemoglobin, ferritin, albumin, thyroid-stimulating hormone, and mean corpuscular volume. Thrombophilia testing revealed higher frequencies of methylenetetrahydrofolate reductase C677T/A1298C, prothrombin G20210A, and Factor V Leiden variants among cerebral venous thrombosis patients. The incidence of pregnancy-associated stroke at our center was 57.8 per 100,000 deliveries.</div></div><div><h3>Conclusions</h3><div>Pregnancy-associated stroke, especially postpartum CVT, remains an important cause of maternal morbidity. Hypertensive disorders and anemia emerged as key modifiable correlates. Early postpartum surveillance, blood pressure control, treatment of anaemia, and risk-tailored thromboprophylaxis may reduce the burden of maternal stroke.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109237"},"PeriodicalIF":1.6,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145511981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes and hospitalization cost associated with flow diversion versus coil embolization for unruptured aneurysms: A national assessment","authors":"Jonathan Dallas ,&nbsp;Michelle Lin ,&nbsp;David J. Cote ,&nbsp;Anadjeet S. Khahera ,&nbsp;Li Ding ,&nbsp;Frank J. Attenello ,&nbsp;William J. Mack","doi":"10.1016/j.clineuro.2025.109236","DOIUrl":"10.1016/j.clineuro.2025.109236","url":null,"abstract":"<div><h3>Objective</h3><div>The use of flow diversion (FD) has rapidly increased over the last decade, particularly for treatment of complex aneurysms not amenable to conventional coil embolization (CE). We aimed to compare national outcomes and healthcare utilization associated with FD and CE of unruptured aneurysms.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample (2019–2022) was used to identify patients with unruptured intracranial aneurysms who underwent CE or FD (patients undergoing both FD+CE were classified as FD). Pediatric patients, non-elective admissions, and patients with subarachnoid hemorrhage were excluded. Variables included sociodemographics (e.g., age, race, gender), hospital factors (e.g., size, ownership, teaching status, location), and basic clinical variables in bivariate and multivariable regression. Outcomes included in-hospital mortality, stroke, discharge disposition (favorable/unfavorable), length of stay, and total cost of hospitalization.</div></div><div><h3>Results</h3><div>7370 patients were identified, of which 4280 were CE and 3090 were FD. Given the elective nature of intervention, rates of mortality (0.19 %), unfavorable discharge disposition (2.77 %), and stroke (0.83 %) were low. On multivariable analysis, use of flow diversion was not associated with unfavorable discharge (OR 0.80, P = 0.211) or stroke (OR 0.91, P = 0.753). FD trended toward, but did not reach, statistical significance for elevated length of stay (IRR 1.04, P = 0.150); however, it did lead to a significantly higher overall cost (ß=$1260.98, P = 0.049)</div></div><div><h3>Conclusion</h3><div>Nationally, short-term outcomes are similar between FD and CE, although use of FD does imbue a mildly higher hospitalization cost. Further work is needed to characterize large-scale, long-term outcome differences, particularly as FD use increases for more complex aneurysms not amenable to CE.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109236"},"PeriodicalIF":1.6,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periventricular and deep white matter changes as predictors of major acute ischemic stroke outcome","authors":"Ying-Sheng Li ,&nbsp;Chung-Yao Hsu ,&nbsp;Meng-Ni Wu ,&nbsp;Yin-Chun Chen ,&nbsp;Yi-On Fong ,&nbsp;Poyin Huang","doi":"10.1016/j.clineuro.2025.109232","DOIUrl":"10.1016/j.clineuro.2025.109232","url":null,"abstract":"<div><h3>Objective</h3><div>Cerebral white matter changes (WMC) are considered indicative of small vessel diseases and are strongly associated with ischemic stroke outcomes in minor stroke populations. WMC are categorized into periventricular WMC (PVWMC) and deep subcortical WMC (DWMC), but their roles in major strokes remain unclear. Our study aims to investigate the specific roles of PVWMC and DWMC in predicting outcomes for major ischemic strokes.</div></div><div><h3>Methods</h3><div>We enrolled a total of 316 patients with ischemic stroke admitted to the intensive care unit of the stroke center. Utilizing the Fazekas scale, we assessed PVWMC and DWMC scores and analyzed their association with changes in NIHSS scores and mortality rates. Additionally, we collected information on vascular risk factors to compare among groups with different Fazekas scores.</div></div><div><h3>Results</h3><div>Among patients with major ischemic strokes, higher PVWMC scores, rather than DWMC scores, were significantly associated with changes in NIHSS scores (grading 2 and grading 3 to the mild PVWMC: OR 3.227, 95 % CI: 1.658, 6.280, P = 0.001; OR 6.090, 95 % CI: 2.296, 16.150, P &lt; 0.001, respectively) and the mortality rate (grading 2 and grading 3 to the mild PVWMC: OR 14.244, 95 % CI: 2.040, 99.474, P = 0.007; OR 40.691, 95 % CI: 4.537, 364.928, P = 0.001, respectively). Aging, diabetes mellitus, hypertension, atrial fibrillation, a history of cerebrovascular accidents, and high NIHSS scores were linked to high-grade PVWMC.</div></div><div><h3>Conclusions</h3><div>In patients with major ischemic stroke, PVWMC serves as an independent predictor of in-hospital mortality and stroke progression, while DWMC does not. These findings enhance our understanding of the distinct roles of PVWMC and DWMC and contribute to the development of models for predicting major stroke outcomes.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109232"},"PeriodicalIF":1.6,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From rodents to algorithms: The rise of virtual animals in drug development and neuroscience","authors":"Alireza Minagar,&nbsp;Mohammad Ali Sahraian","doi":"10.1016/j.clineuro.2025.109234","DOIUrl":"10.1016/j.clineuro.2025.109234","url":null,"abstract":"<div><div>Animal models have long been the foundation of biomedical research and experimentation. However, the utility of animal models in both research and preclinical testing of drugs has been challenged by the insufficiency and cost of such methods, including the fact that over 90 % of preclinically successful compounds ultimately fail in human trials, as well as concerns about irreproducibility, scalability, and ethics in animal studies; their limitations are increasingly recognized. Advances in artificial intelligence (AI) now offer a promising complementary approach through the creation of “virtual animals.” Recent examples include the U.S. Food and Drug Administration's AnimalGAN to predict toxicology outcomes in thousands of virtual rats, and Google DeepMind's virtual fruit fly, an anatomically accurate model that can reproduce locomotion and sensorimotor behavior. In these examples, AI systems may not replace, but rather support traditional experimentation, by increasing accuracy, reducing the number of animals needed for studies, and accelerating translational insight. Potential early applications in neurology and neurosurgery are just now emerging, such as neural-circuit simulation, prediction of neurotoxicity, and modeling of movement disorders. Legislative acts such as FDA Modernization Act 2.0, as well as European initiatives to implement the 3Rs, now include AI-based virtual testing as a possible evidentiary basis. Virtual organisms represent a potentially significant ethical and methodological shift that may influence the future of experimental neurology and drug development, while still upholding scientific rigor.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"260 ","pages":"Article 109234"},"PeriodicalIF":1.6,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}