Pub Date : 2026-03-14DOI: 10.1016/j.jocn.2026.111983
Eric M Kunz, Devon T Foster, Abdullah Durrani, Ivelina P Kioutchoukova, Rajvi Thakkar, Caroline Davidson, Marco Foreman, Brandon Lucke-Wold
<p><strong>Background: </strong>High-grade gliomas are especially known for their high rate of recurrence. Despite the current standard of care treatment protocol-including resection, chemotherapy, and radiation-morbidity and mortality are still commonplace amongst patients diagnosed with glioblastoma (GBM).</p><p><strong>Methods: </strong>Phase II/III evidence on active immunotherapies for GBM was synthesized, focusing on dendritic cell (DC) vaccines and adoptive cellular approaches, versus contemporary standard therapy, and to identify effect modifiers (MGMT status, extent of resection, and corticosteroids) that should guide surgical and adjuvant decision-making. Following PRISMA methods, a systematic review of MEDLINE (PubMed), Embase, and Cochrane (2020-2025) for adult GBM trials with a comparator arm was conducted. Outcomes included overall survival (OS), progression-free survival (PFS), safety, and prespecified modifiers.</p><p><strong>Results: </strong>Of 797 records, 13 trials met criteria (9 newly diagnosed, 3 recurrent, 1 mixed).Among active immunotherapies, DC vaccines and adoptive cell therapies showed the most consistent clinical signals. DCVax-L improved median OS versus external controls in newly diagnosed GBM (19.3 vs 16.5 months; 5-year OS 13.0% vs 5.7%). Cytokine-induced killer (CIK) cells prolonged PFS and were an independent predictor of longer OS in pathologically pure GBM (median OS 23.1 vs 14.9 months; PFS 8.1 vs 5.5 months). In contrast, adding PD-1/CTLA-4 inhibition to chemoradiation failed to improve first-line OS/PFS, and at recurrence, bevacizumab outperformed nivolumab for PFS with similar OS; pembrolizumab plus bevacizumab improved 6-month PFS versus pembrolizumab alone. Grade 3 or higher adverse events ranged from approximately 15% to 52% across interventions and were generally manageable. Baseline corticosteroid exposure consistently attenuated the benefit of immunotherapy; maximal safe resection correlated with better outcomes and larger apparent effects of vaccines/adoptive cells. MGMT status displayed modality-specific interactions (i.e., DCVax-L benefit in MGMT-methylated disease; interferon-α signal in unmethylated disease).</p><p><strong>Conclusions: </strong>Immunotherapy in high-grade glioma remains investigational, with randomized evidence to date demonstrating limited benefit for routine checkpoint inhibition in both newly diagnosed and recurrent disease. Selected vaccine and adoptive cellular strategies have shown encouraging survival signals in defined contexts, particularly when integrated following maximal safe resection. Persistent biological barriers, including tumor heterogeneity, antigen escape, low tumor mutational burden, and an immunosuppressive environment, continue to constrain durable responses. Future progress will depend on biologically informed trial design, optimized delivery strategies, and careful patient selection to ascertain the potential efficacy of immunotherapy in treating GBM.</
背景：高级别胶质瘤以其高复发率而闻名。尽管目前的标准治疗方案包括切除、化疗和放疗，但在胶质母细胞瘤（GBM）患者中发病率和死亡率仍然很普遍。方法：合成主动免疫治疗GBM的II/III期证据，重点关注树突状细胞（DC）疫苗和过继细胞方法，与当代标准治疗相比，并确定应指导手术和辅助决策的效果调节剂（MGMT状态，切除范围和皮质类固醇）。采用PRISMA方法，对MEDLINE （PubMed）、Embase和Cochrane（2020-2025）的成人GBM试验进行了系统评价。结果包括总生存期（OS）、无进展生存期（PFS）、安全性和预先指定的调节剂。结果：797例病例中，13例符合标准（新诊断9例，复发3例，混合1例）。在主动免疫疗法中，DC疫苗和过继细胞疗法表现出最一致的临床信号。dcvx - l改善了新诊断GBM患者的中位OS（19.3个月vs 16.5个月；5年OS 13.0% vs 5.7%）。细胞因子诱导的杀伤（CIK）细胞延长了PFS，并且是病理纯GBM中延长OS的独立预测因子（中位OS 23.1 vs 14.9个月；PFS 8.1 vs 5.5个月）。相比之下，在放化疗中加入PD-1/CTLA-4抑制剂未能改善一线OS/PFS，并且在复发时，贝伐单抗在具有相似OS的PFS方面优于纳武单抗；与单独使用派姆单抗相比，派姆单抗联合贝伐单抗改善了6个月的PFS。3级或更高级别的不良事件在干预期间约为15%至52%，并且通常是可控的。基线皮质类固醇暴露持续减弱免疫治疗的益处；最大安全切除与更好的结果和更大的疫苗/过继细胞的明显效果相关。MGMT状态显示模式特异性相互作用（即，在MGMT-甲基化疾病中，DCVax-L获益；在未甲基化疾病中，干扰素-α信号）。结论：免疫疗法对高级别胶质瘤的治疗仍处于研究阶段，随机证据显示常规检查点抑制对新诊断和复发疾病的疗效有限。选定的疫苗和过继细胞策略在特定情况下显示出令人鼓舞的生存信号，特别是在最大安全切除后结合使用时。持续的生物屏障，包括肿瘤异质性、抗原逃逸、低肿瘤突变负担和免疫抑制环境，继续限制持久的反应。未来的进展将取决于生物学知情的试验设计、优化的递送策略和仔细的患者选择，以确定免疫疗法治疗GBM的潜在疗效。
{"title":"Active immunization strategies in glioblastoma - clinical outcomes and effect modifiers for dendritic vaccines and adoptive cell therapies: a systematic review.","authors":"Eric M Kunz, Devon T Foster, Abdullah Durrani, Ivelina P Kioutchoukova, Rajvi Thakkar, Caroline Davidson, Marco Foreman, Brandon Lucke-Wold","doi":"10.1016/j.jocn.2026.111983","DOIUrl":"https://doi.org/10.1016/j.jocn.2026.111983","url":null,"abstract":"<p><strong>Background: </strong>High-grade gliomas are especially known for their high rate of recurrence. Despite the current standard of care treatment protocol-including resection, chemotherapy, and radiation-morbidity and mortality are still commonplace amongst patients diagnosed with glioblastoma (GBM).</p><p><strong>Methods: </strong>Phase II/III evidence on active immunotherapies for GBM was synthesized, focusing on dendritic cell (DC) vaccines and adoptive cellular approaches, versus contemporary standard therapy, and to identify effect modifiers (MGMT status, extent of resection, and corticosteroids) that should guide surgical and adjuvant decision-making. Following PRISMA methods, a systematic review of MEDLINE (PubMed), Embase, and Cochrane (2020-2025) for adult GBM trials with a comparator arm was conducted. Outcomes included overall survival (OS), progression-free survival (PFS), safety, and prespecified modifiers.</p><p><strong>Results: </strong>Of 797 records, 13 trials met criteria (9 newly diagnosed, 3 recurrent, 1 mixed).Among active immunotherapies, DC vaccines and adoptive cell therapies showed the most consistent clinical signals. DCVax-L improved median OS versus external controls in newly diagnosed GBM (19.3 vs 16.5 months; 5-year OS 13.0% vs 5.7%). Cytokine-induced killer (CIK) cells prolonged PFS and were an independent predictor of longer OS in pathologically pure GBM (median OS 23.1 vs 14.9 months; PFS 8.1 vs 5.5 months). In contrast, adding PD-1/CTLA-4 inhibition to chemoradiation failed to improve first-line OS/PFS, and at recurrence, bevacizumab outperformed nivolumab for PFS with similar OS; pembrolizumab plus bevacizumab improved 6-month PFS versus pembrolizumab alone. Grade 3 or higher adverse events ranged from approximately 15% to 52% across interventions and were generally manageable. Baseline corticosteroid exposure consistently attenuated the benefit of immunotherapy; maximal safe resection correlated with better outcomes and larger apparent effects of vaccines/adoptive cells. MGMT status displayed modality-specific interactions (i.e., DCVax-L benefit in MGMT-methylated disease; interferon-α signal in unmethylated disease).</p><p><strong>Conclusions: </strong>Immunotherapy in high-grade glioma remains investigational, with randomized evidence to date demonstrating limited benefit for routine checkpoint inhibition in both newly diagnosed and recurrent disease. Selected vaccine and adoptive cellular strategies have shown encouraging survival signals in defined contexts, particularly when integrated following maximal safe resection. Persistent biological barriers, including tumor heterogeneity, antigen escape, low tumor mutational burden, and an immunosuppressive environment, continue to constrain durable responses. Future progress will depend on biologically informed trial design, optimized delivery strategies, and careful patient selection to ascertain the potential efficacy of immunotherapy in treating GBM.</","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"148 ","pages":"111983"},"PeriodicalIF":1.8,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463307","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}
Pub Date : 2026-03-14DOI: 10.1016/j.jocn.2026.111959
Weili Cao, Bo Zhu, Xiaotao Jia, Naibing Gu, Quanzeng Zhang, Beilei Wang, Miao Shi, Zhiqin Liu, Zhengli Di
Background: Ischemic stroke (IS) is a leading cause of global morbidity and mortality. While certain drugs are implicated in IS, systematic real-world analyses across all drug classes are scarce.
Objective: To evaluate drug-IS associations using the FDA Adverse Event Reporting System (FAERS) database, identify pharmacological risk factors, and explore temporal onset patterns.
Methods: A retrospective pharmacovigilance study was conducted using FAERS data (Q1 2004-Q1 2025). IS cases were identified using Medical Dictionary for Regulatory Activities (MedDRA) Preferred Terms. Disproportionality analyses employed four algorithms (Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), Multi-item Gamma Poisson Shrinker (MGPS). Drugs with >100 cases, ROR_05 > 1, and False Discovery Rate (FDR)-p < 0.01 were further analyzed using Least Absolute Shrinkage and Selection Operator (LASSO) and multivariate logistic regression to identify independent risk factors. Time-to-onset (TTO) was assessed.
Results: Among 59,869 drug-related IS reports, disproportionality analysis identified 66 significant drugs across 22 categories, most frequently antineoplastics, anticoagulants, and antiplatelets. Multivariate regression confirmed 64 independent risk factors (7 demographic, 57 drugs), including Andexanet alfa (Adjusted Odds Ratio (aOR) = 138.80), Rofecoxib (27.45), and combined oral contraceptives. The prediction model achieved an Area Under the Curve (AUC) of 0.770. The median TTO was 77 days (IQR: 10-365).
Conclusions: This large-scale FAERS analysis systematically characterized drug-IS associations, identifying multiple strong and independent pharmacological risk signals and revealing temporal patterns. The findings provide real-world evidence to guide clinical decision-making and targeted pharmacovigilance.
{"title":"Risk factors for drug-related ischemic stroke: an analysis of the FDA adverse event reporting system (FAERS).","authors":"Weili Cao, Bo Zhu, Xiaotao Jia, Naibing Gu, Quanzeng Zhang, Beilei Wang, Miao Shi, Zhiqin Liu, Zhengli Di","doi":"10.1016/j.jocn.2026.111959","DOIUrl":"https://doi.org/10.1016/j.jocn.2026.111959","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke (IS) is a leading cause of global morbidity and mortality. While certain drugs are implicated in IS, systematic real-world analyses across all drug classes are scarce.</p><p><strong>Objective: </strong>To evaluate drug-IS associations using the FDA Adverse Event Reporting System (FAERS) database, identify pharmacological risk factors, and explore temporal onset patterns.</p><p><strong>Methods: </strong>A retrospective pharmacovigilance study was conducted using FAERS data (Q1 2004-Q1 2025). IS cases were identified using Medical Dictionary for Regulatory Activities (MedDRA) Preferred Terms. Disproportionality analyses employed four algorithms (Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), Multi-item Gamma Poisson Shrinker (MGPS). Drugs with >100 cases, ROR_05 > 1, and False Discovery Rate (FDR)-p < 0.01 were further analyzed using Least Absolute Shrinkage and Selection Operator (LASSO) and multivariate logistic regression to identify independent risk factors. Time-to-onset (TTO) was assessed.</p><p><strong>Results: </strong>Among 59,869 drug-related IS reports, disproportionality analysis identified 66 significant drugs across 22 categories, most frequently antineoplastics, anticoagulants, and antiplatelets. Multivariate regression confirmed 64 independent risk factors (7 demographic, 57 drugs), including Andexanet alfa (Adjusted Odds Ratio (aOR) = 138.80), Rofecoxib (27.45), and combined oral contraceptives. The prediction model achieved an Area Under the Curve (AUC) of 0.770. The median TTO was 77 days (IQR: 10-365).</p><p><strong>Conclusions: </strong>This large-scale FAERS analysis systematically characterized drug-IS associations, identifying multiple strong and independent pharmacological risk signals and revealing temporal patterns. The findings provide real-world evidence to guide clinical decision-making and targeted pharmacovigilance.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"148 ","pages":"111959"},"PeriodicalIF":1.8,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463235","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}
Background: We investigated whether systemic inflammatory indices improve prediction of short-term outcomes in conservatively treated spontaneous basal ganglia hemorrhage (BGH).
Methods: We retrospectively analyzed 137 patients (2020-2023) and classified 90-day outcomes as good (mRS 0-2, n = 73) or poor (mRS 3-5, n = 64). A Basic model (age, hematoma volume, NIHSS, IVH) and an Inflammation model (Basic + CAR + NLR) were developed. Discrimination (ROC/DeLong) and calibration (Hosmer-Lemeshow) were assessed; Patients with mRS = 6 were excluded from the primary analysis but included in a prespecified sensitivity analysis. A nomogram was internally validated (1,000 bootstrap) with Brier score and decision curve analysis (DCA).
Results: The Inflammation model outperformed the Basic model (AUC 0.823 [95%CI 0.754-0.892] vs 0.658 [0.568-0.749]; DeLong Z = 3.375, P = 0.001) with acceptable calibration (HL P = 0.896 vs 0.451). In sensitivity analyses including deaths, performance remained superior (AUC 0.815 [0.747-0.882] vs 0.656 [0.568-0.745]; Z = 3.238, P = 0.001). The nomogram showed good internal validity (C-index 0.794; Brier 0.1899) and net benefit across thresholds 0.05-0.95.
Conclusions: Adding CAR and NLR to a clinical model significantly improves short-term outcome prediction after conservatively treated spontaneous BGH and supports individualized risk stratification.
背景：我们研究了系统性炎症指数是否能改善保守治疗的自发性基底神经节出血（BGH）的短期预后预测。方法：我们回顾性分析了137例患者（2020-2023），并将90天的预后分为良好（mRS 0-2, n = 73）和较差（mRS 3-5, n = 64）。建立基础模型（年龄、血肿体积、NIHSS、IVH）和炎症模型（基础+ CAR + NLR）。判别（ROC/DeLong）和校准（Hosmer-Lemeshow）进行评估；mRS = 6的患者被排除在初步分析之外，但纳入了预先指定的敏感性分析。用Brier评分和决策曲线分析（DCA）对nomogram进行内部验证（1000 bootstrap）。结果：炎症模型优于Basic模型（AUC 0.823 [95%CI 0.754-0.892] vs 0.658 [0.568-0.749]; DeLong Z = 3.375, P = 0.001），标度可接受（HL P = 0.896 vs 0.451）。在包括死亡在内的敏感性分析中，表现仍然优越（AUC为0.815 [0.747-0.882]vs 0.656 [0.568-0.745]; Z = 3.238, P = 0.001）。nomogram显示出良好的内部效度（C-index 0.794; Brier 0.1899），净效益跨阈值0.05 ~ 0.95。结论：在临床模型中加入CAR和NLR可显著改善保守治疗自发性BGH后的短期预后预测，并支持个体化风险分层。
{"title":"A practical nomogram incorporating inflammatory markers for predicting short-term prognosis in conservatively managed basal ganglia hemorrhage.","authors":"Jiandong Wang, Shiqiang Hou, Xinwei Li, Beitian Shi, Chunwang Xie, Chunjing Jin","doi":"10.1016/j.jocn.2026.111984","DOIUrl":"https://doi.org/10.1016/j.jocn.2026.111984","url":null,"abstract":"<p><strong>Background: </strong>We investigated whether systemic inflammatory indices improve prediction of short-term outcomes in conservatively treated spontaneous basal ganglia hemorrhage (BGH).</p><p><strong>Methods: </strong>We retrospectively analyzed 137 patients (2020-2023) and classified 90-day outcomes as good (mRS 0-2, n = 73) or poor (mRS 3-5, n = 64). A Basic model (age, hematoma volume, NIHSS, IVH) and an Inflammation model (Basic + CAR + NLR) were developed. Discrimination (ROC/DeLong) and calibration (Hosmer-Lemeshow) were assessed; Patients with mRS = 6 were excluded from the primary analysis but included in a prespecified sensitivity analysis. A nomogram was internally validated (1,000 bootstrap) with Brier score and decision curve analysis (DCA).</p><p><strong>Results: </strong>The Inflammation model outperformed the Basic model (AUC 0.823 [95%CI 0.754-0.892] vs 0.658 [0.568-0.749]; DeLong Z = 3.375, P = 0.001) with acceptable calibration (HL P = 0.896 vs 0.451). In sensitivity analyses including deaths, performance remained superior (AUC 0.815 [0.747-0.882] vs 0.656 [0.568-0.745]; Z = 3.238, P = 0.001). The nomogram showed good internal validity (C-index 0.794; Brier 0.1899) and net benefit across thresholds 0.05-0.95.</p><p><strong>Conclusions: </strong>Adding CAR and NLR to a clinical model significantly improves short-term outcome prediction after conservatively treated spontaneous BGH and supports individualized risk stratification.</p>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"148 ","pages":"111984"},"PeriodicalIF":1.8,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147457578","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}
Pub Date : 2026-03-01Epub Date: 2026-01-02DOI: 10.1016/j.jocn.2025.111828
Ibrahim Khalil , Sajjad Ghanim Al-Badri , Md.Imran Hossain , Mahmuda Akter , Lota Halder , Sunjida Amin Promi , Md Abu Sayed , Arindam Das Joy
Background
Stroke imposes a substantial burden in the Africa, amplified by epidemiological transitions and limited healthcare resources. Despite global declines, sex-specific trends in incidence, prevalence, years lived with disability (YLDs), and years of life lost (YLLs) remain underexplored. This study analyzes temporal patterns in stroke burden and subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) across the African Union and regions from 1990 to 2023 using Global Burden of Disease (GBD) 2023 data.
Methods
Data were extracted from GBD 2023, providing age-standardized rates (ASRs) for incidence, prevalence, YLDs, and YLLs, stratified by sex and region (Central, Eastern, Northern, Southern, Western Africa). Temporal trends were quantified using estimated annual percentage changes (EAPCs) with 95% confidence intervals (CIs).
Results
Overall stroke incidence declined (EAPC −0.920; 95% CI −1.028 to −0.811), with females (−1.055; 95% CI −1.168 to −0.943) outperforming males (−0.779; 95% CI −0.883 to −0.675). Intracerebral hemorrhage incidence dropped sharply (−1.719; 95% CI −1.863 to −1.575), ischemic modestly (−0.448; 95% CI −0.548 to −0.349), and subarachnoid modestly (−0.541; 95% CI −0.605 to −0.476). Prevalence declined (−0.365; 95% CI −0.400 to −0.330), with female advantage (−0.478 vs. −0.254). YLDs decreased (−0.352; 95% CI −0.387 to −0.318), with females leading (−0.478 vs. −0.223). YLLs declined robustly (−1.059; −95% CI 1.122 to −0.996), with minimal sex difference. Northern Africa showed steepest declines (incidence EAPC −1.200; YLLs −1.989), while Southern and Central exhibited shallower trends or increases in subarachnoid subtypes.
Conclusions
The African Union’s stroke burden shows modest declines, offset by regional inequities and sex disparities favoring females. Targeted interventions addressing modifiable risks and disparities are essential for equitable patient care.
{"title":"Epidemiological trends and sex-specific disparities in stroke incidence, prevalence, years lived with disability (YLDs), and years of life lost (YLLs) across the African Union: insights from the Global Burden of Disease Study (1990–2023)","authors":"Ibrahim Khalil , Sajjad Ghanim Al-Badri , Md.Imran Hossain , Mahmuda Akter , Lota Halder , Sunjida Amin Promi , Md Abu Sayed , Arindam Das Joy","doi":"10.1016/j.jocn.2025.111828","DOIUrl":"10.1016/j.jocn.2025.111828","url":null,"abstract":"<div><h3>Background</h3><div>Stroke imposes a substantial burden in the Africa, amplified by epidemiological transitions and limited healthcare resources. Despite global declines, sex-specific trends in incidence, prevalence, years lived with disability (YLDs), and years of life lost (YLLs) remain underexplored. This study analyzes temporal patterns in stroke burden and subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) across the African Union and regions from 1990 to 2023 using Global Burden of Disease (GBD) 2023 data.</div></div><div><h3>Methods</h3><div>Data were extracted from GBD 2023, providing age-standardized rates (ASRs) for incidence, prevalence, YLDs, and YLLs, stratified by sex and region (Central, Eastern, Northern, Southern, Western Africa). Temporal trends were quantified using estimated annual percentage changes (EAPCs) with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Overall stroke incidence declined (EAPC −0.920; 95% CI −1.028 to −0.811), with females (−1.055; 95% CI −1.168 to −0.943) outperforming males (−0.779; 95% CI −0.883 to −0.675). Intracerebral hemorrhage incidence dropped sharply (−1.719; 95% CI −1.863 to −1.575), ischemic modestly (−0.448; 95% CI −0.548 to −0.349), and subarachnoid modestly (−0.541; 95% CI −0.605 to −0.476). Prevalence declined (−0.365; 95% CI −0.400 to −0.330), with female advantage (−0.478 vs. −0.254). YLDs decreased (−0.352; 95% CI −0.387 to −0.318), with females leading (−0.478 vs. −0.223). YLLs declined robustly (−1.059; −95% CI 1.122 to −0.996), with minimal sex difference. Northern Africa showed steepest declines (incidence EAPC −1.200; YLLs −1.989), while Southern and Central exhibited shallower trends or increases in subarachnoid subtypes.</div></div><div><h3>Conclusions</h3><div>The African Union’s stroke burden shows modest declines, offset by regional inequities and sex disparities favoring females. Targeted interventions addressing modifiable risks and disparities are essential for equitable patient care.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111828"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882396","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}
Pub Date : 2026-03-01Epub Date: 2026-01-15DOI: 10.1016/j.jocn.2026.111865
Tiago Pedro , Carolina Silva , Pedro Simão , Osvaldo Sousa , Vasco Carvalho , Patrícia Polónia , António Vilarinho , Pedro Alberto Silva , Maria Luís Silva , Luís Albuquerque
Introduction
Management of unruptured intracranial aneurysms (UIAs) is challenging when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving patients in a therapeutic “gray zone”. This study compared one-year outcomes between conservative and interventional management in patients with UIAs and inconclusive UIATS scores.
Methods
We retrospectively reviewed 149 adults with angiographically confirmed saccular UIAs and inconclusive UIATS scores treated at a tertiary center (2018–2024). Patients were stratified by management strategy: conservative (68 patients) or interventional (81 patients, endovascular or surgical). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. One-year outcomes included aneurysm rupture, procedural complications, ischemic and hemorrhagic events, retreatment, and functional status (mRS).
Results
After IPTW, the weighted pseudo-population comprised 125 patients managed conservatively and 143 treated. Intervention was associated with better functional outcomes (aOR 2.526, 95 % CI 1.075–5.935, p = 0.033) versus conservative management. Among patients managed conservatively, the aneurysm rupture rate was 4.0 %.
Conclusions
Active treatment in patients with unruptured intracranial aneurysms and inconclusive UIATS guidance yielded better functional results at one year, highlighting the need to improve current decision strategies through broader future research.
Key messages
What is already known on this topic: Management of unruptured intracranial aneurysms is uncertain when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving clinicians without clear guidance. Evidence directly comparing conservative and interventional strategies in this subgroup is limited.
What this study adds: In patients with inconclusive UIATS recommendations, interventional management was associated with better one-year functional outcomes compared with conservative care.
How this study might affect research, practice or policy: These findings support consideration of active treatment even when UIATS is indeterminate, emphasizing individualized, multidisciplinary decision-making.
{"title":"To treat or not to treat? An inverse probability weighting analysis of intracranial aneurysms with inconclusive UIATS scores","authors":"Tiago Pedro , Carolina Silva , Pedro Simão , Osvaldo Sousa , Vasco Carvalho , Patrícia Polónia , António Vilarinho , Pedro Alberto Silva , Maria Luís Silva , Luís Albuquerque","doi":"10.1016/j.jocn.2026.111865","DOIUrl":"10.1016/j.jocn.2026.111865","url":null,"abstract":"<div><h3>Introduction</h3><div>Management of unruptured intracranial aneurysms (UIAs) is challenging when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving patients in a therapeutic “gray zone”. This study compared one-year outcomes between conservative and interventional management in patients with UIAs and inconclusive UIATS scores.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 149 adults with angiographically confirmed saccular UIAs and inconclusive UIATS scores treated at a tertiary center (2018–2024). Patients were stratified by management strategy: conservative (68 patients) or interventional (81 patients, endovascular or surgical). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. One-year outcomes included aneurysm rupture, procedural complications, ischemic and hemorrhagic events, retreatment, and functional status (mRS).</div></div><div><h3>Results</h3><div>After IPTW, the weighted pseudo-population comprised 125 patients managed conservatively and 143 treated. Intervention was associated with better functional outcomes (aOR 2.526, 95 % CI 1.075–5.935, p = 0.033) versus conservative management. Among patients managed conservatively, the aneurysm rupture rate was 4.0 %.</div></div><div><h3>Conclusions</h3><div>Active treatment in patients with unruptured intracranial aneurysms and inconclusive UIATS guidance yielded better functional results at one year, highlighting the need to improve current decision strategies through broader future research.</div></div><div><h3>Key messages</h3><div><strong>What is already known on this topic:</strong> Management of unruptured intracranial aneurysms is uncertain when the Unruptured Intracranial Aneurysm Treatment Score (UIATS) is inconclusive, leaving clinicians without clear guidance. Evidence directly comparing conservative and interventional strategies in this subgroup is limited.</div><div><strong>What this study adds:</strong> In patients with inconclusive UIATS recommendations, interventional management was associated with better one-year functional outcomes compared with conservative care.</div><div><strong>How this study might affect research, practice or policy:</strong> These findings support consideration of active treatment even when UIATS is indeterminate, emphasizing individualized, multidisciplinary decision-making.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111865"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979136","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}
Pub Date : 2026-03-01Epub Date: 2026-01-16DOI: 10.1016/j.jocn.2026.111862
Kyle Bennett , Yi Chen Zhao , James King
{"title":"Meningitis secondary to clival communication with the sphenoid sinus","authors":"Kyle Bennett , Yi Chen Zhao , James King","doi":"10.1016/j.jocn.2026.111862","DOIUrl":"10.1016/j.jocn.2026.111862","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111862"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979139","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}
Pub Date : 2026-03-01Epub Date: 2026-01-09DOI: 10.1016/j.jocn.2026.111858
Leyla Salimli Mirzayeva , Murat Uçar , Emetullah Cindil , Sümeyye Nur Budak , Pelin Kuzucu
Objective
To evaluate the prevalence, distribution, and clinical significance of additional MRI findings in Chiari types 0–1.5 and their association with Chiari subtypes.
Methods
In this study, 147 patients who underwent comprehensive brain and whole-spine MRI for suspected Chiari deformity were categorized as Chiari 0, 0.5, 1, or 1.5 based on tonsillar descent and obex localization. Imaging review included assessment of syringomyelia (location, diameter, length, number), conus level, lumbosacral transitional vertebrae (LSTV), partial empty sella (PES), basilar invagination, block vertebrae, and hydrocephalus.
Results
Subtype distribution was Chiari 0 (16.3 %), 0.5 (6.8 %), 1 (40.1 %), and 1.5 (36.7 %). Syrinx morphology did not differ significantly among subtypes. A subforaminal obex was associated with higher syrinx prevalence (p = 0.04), whereas LSTV was more common when the obex was at or above the foramen magnum (p = 0.003). Additional findings included PES (13.6 %), basilar invagination (10.8 %), block vertebra (2.7 %), and paraspinal lipoma (0.7 %). PES was enriched in Chiari 1 (p = 0.02), and basilar invagination was enriched in Chiari 1.5 (p = 0.02). Syringomyelia occurred in 30.6 % overall and was positively correlated with hydrocephalus (5.4 % overall; p = 0.01; r = 0.23).
Conclusions
Additional craniospinal anomalies show subtype-specific patterns within the Chiari 0–1.5 spectrum: LSTV associates with a normal/high obex, PES with Chiari 1, and basilar invagination with Chiari 1.5. A significant syringomyelia–hydrocephalus association supports shared CSF dynamic disturbances. It is also thought that case-specific practices, such as hormonal screening in Chiari cases presenting with PES and dynamic flexion–extension screenings in Chiari 1.5 cases with basilar invagination, improve disease management.
{"title":"Characterization of additional MRI findings in patients with Chiari spectrum disorders: focus on Chiari 0–1.5 subtypes","authors":"Leyla Salimli Mirzayeva , Murat Uçar , Emetullah Cindil , Sümeyye Nur Budak , Pelin Kuzucu","doi":"10.1016/j.jocn.2026.111858","DOIUrl":"10.1016/j.jocn.2026.111858","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the prevalence, distribution, and clinical significance of additional MRI findings in Chiari types 0–1.5 and their association with Chiari subtypes.</div></div><div><h3>Methods</h3><div>In this study, 147 patients who underwent comprehensive brain and whole-spine MRI for suspected Chiari deformity were categorized as Chiari 0, 0.5, 1, or 1.5 based on tonsillar descent and obex localization. Imaging review included assessment of syringomyelia (location, diameter, length, number), conus level, lumbosacral transitional vertebrae (LSTV), partial empty sella (PES), basilar invagination, block vertebrae, and hydrocephalus.</div></div><div><h3>Results</h3><div>Subtype distribution was Chiari 0 (16.3 %), 0.5 (6.8 %), 1 (40.1 %), and 1.5 (36.7 %). Syrinx morphology did not differ significantly among subtypes. A subforaminal obex was associated with higher syrinx prevalence (p = 0.04), whereas LSTV was more common when the obex was at or above the foramen magnum (p = 0.003). Additional findings included PES (13.6 %), basilar invagination (10.8 %), block vertebra (2.7 %), and paraspinal lipoma (0.7 %). PES was enriched in Chiari 1 (p = 0.02), and basilar invagination was enriched in Chiari 1.5 (p = 0.02). Syringomyelia occurred in 30.6 % overall and was positively correlated with hydrocephalus (5.4 % overall; p = 0.01; r = 0.23).</div></div><div><h3>Conclusions</h3><div>Additional craniospinal anomalies show subtype-specific patterns within the Chiari 0–1.5 spectrum: LSTV associates with a normal/high obex, PES with Chiari 1, and basilar invagination with Chiari 1.5. A significant syringomyelia–hydrocephalus association supports shared CSF dynamic disturbances. It is also thought that case-specific practices, such as hormonal screening in Chiari cases presenting with PES and dynamic flexion–extension screenings in Chiari 1.5 cases with basilar invagination, improve disease management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111858"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922583","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}
Pub Date : 2026-03-01Epub Date: 2025-12-31DOI: 10.1016/j.jocn.2025.111821
Jake Nowicki , Edoardo Aromataris
<div><h3>Background</h3><div>A ruptured intracranial aneurysm is a devastating pathology that is associated with significant morbidity and mortality. The anterior communicating artery (ACOM) is the most common location to have an intracranial aneurysm form and rupture. The two management options for ruptured intracranial aneurysms include microsurgical clipping and endovascular coiling. The clinical outcomes of microsurgical clipping and endovascular coiling for ruptured ACOM aneurysms remains unclear. The aim of this review was to investigate the clinical outcomes, including functional outcomes, treatment efficacy and safety of microsurgical clipping and endovascular coiling for the management of ruptured ACOM aneurysms.</div></div><div><h3>Methods</h3><div>A search for published and unpublished literature included PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, International Clinical Trial Registry, Australia and New Zealand Clinical Trial Registry Search Strategy and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>. Studies were included if they explored the functional outcomes and/or safety of microsurgical clipping and endovascular coiling for ruptured ACOM aneurysms. Eligible studies were critically appraised by two reviewers to assess methodological qualitied. Where possible, data from included studies was <em>meta</em>-analysed using a random effects Mantel-Haenszel model. Effect measures included odds ratio and risk difference where no events were recorded.</div></div><div><h3>Results</h3><div>The search yielded 818 records. Following screening of titles and abstracts against the review inclusion criteria, 25 articles were retrieved for full-text screening. Of these, 11 studies, all of which were non-randomised studies (2 quasi-experimental and 9 retrospective cohort studies), were included.</div><div>For the primary outcome (favourable functional outcomes), analysis revealed overall no statistically significant difference between microsurgical clipping and endovascular coiling (79.4 % versus 73.6 %, OR 1.11, 95 % CI 0.78 – 1.57, p = 0.56). Results from the quasi-experimental studies demonstrated favourable outcomes in the clipping group were non-significantly higher than the coiling group (86.2 % versus 80.4 %, OR 2.26, 95 % CI 0.6–8.52, p = 0.23). In cohort studies, favourable outcomes in the clipping group were non-significantly higher than the coiling group (78.9 % versus 72.3 %, OR 1.05, 95 % CI 0.71–1.53, p = 0.23). For the secondary outcomes of recurrence and complications, overall no statistically significant difference was found between clipping versus coiling (recurrence − 4.6 % versus 5.7 %, RD 0.00, 95 % CI −0.06 – 0.06, p = 0.47; complications- 21.6 % versus 14.2 %, OR 1.00 95 % CI 0.49 – 2.05, p = 1.00). Occlusion was found to be significantly higher in the clipping group compared to coiling (95 % versus 75 %, OR 7.01, 95 % CI 2.82 – 17.45, p=<0.0001).</div></div><div><h3>Concl
背景：颅内动脉瘤破裂是一种毁灭性的病理，与显著的发病率和死亡率相关。前交通动脉（ACOM）是颅内动脉瘤形成和破裂最常见的位置。颅内动脉瘤破裂的两种治疗方法包括显微手术夹闭和血管内盘绕。显微外科夹闭和血管内盘绕治疗破裂的ACOM动脉瘤的临床结果尚不清楚。本综述的目的是探讨显微外科夹持和血管内盘绕治疗破裂的ACOM动脉瘤的临床结果，包括功能结局、治疗效果和安全性。方法检索PubMed、Embase、Scopus、Cochrane Central Register of Controlled Trials、International ClinicalTrial Registry、Australia and New Zealand ClinicalTrial Registry search Strategy和ClinicalTrials.gov等已发表和未发表的文献。如果研究探讨了破裂的ACOM动脉瘤的显微外科夹闭和血管内盘绕的功能结局和/或安全性，则纳入研究。符合条件的研究由两位审稿人进行严格评价，以评估方法学的合格性。在可能的情况下，使用随机效应Mantel-Haenszel模型对纳入研究的数据进行meta分析。效果测量包括未记录事件的优势比和风险差异。结果搜索得到818条记录。根据综述纳入标准筛选标题和摘要后，检索到25篇文章进行全文筛选。其中纳入了11项非随机研究（2项准实验研究和9项回顾性队列研究）。对于主要结局（良好的功能结局），分析显示显微手术夹持和血管内盘绕之间总体上无统计学差异（79.4% vs 73.6%, OR 1.11, 95% CI 0.78 - 1.57, p = 0.56）。准实验研究的结果显示，夹钳组的良好结果不显著高于卷取组（86.2%对80.4%,OR 2.26, 95% CI 0.6-8.52, p = 0.23）。在队列研究中，夹持组的良好预后无显著性高于夹持组（78.9%对72.3%,OR 1.05, 95% CI 0.71-1.53, p = 0.23）。对于复发和并发症的次要结局，夹钳和卷取之间总体上无统计学差异（复发率- 4.6%比5.7%,RD 0.00, 95% CI - 0.06 - 0.06, p = 0.47；并发症- 21.6%比14.2%,OR 1.00 95% CI 0.49 - 2.05, p = 1.00）。夹持组的闭塞程度明显高于夹持组（95% vs 75%, OR 7.01, 95% CI 2.82 - 17.45, p=<0.0001）。结论显微手术夹持术与血管内盘绕术治疗ACOM动脉瘤破裂同样有效、安全。在处理这种病理的患者时，应考虑这两种选择。
{"title":"Clinical outcomes of microvascular clipping compared to endovascular coiling for ruptured anterior communicating artery aneurysms","authors":"Jake Nowicki , Edoardo Aromataris","doi":"10.1016/j.jocn.2025.111821","DOIUrl":"10.1016/j.jocn.2025.111821","url":null,"abstract":"<div><h3>Background</h3><div>A ruptured intracranial aneurysm is a devastating pathology that is associated with significant morbidity and mortality. The anterior communicating artery (ACOM) is the most common location to have an intracranial aneurysm form and rupture. The two management options for ruptured intracranial aneurysms include microsurgical clipping and endovascular coiling. The clinical outcomes of microsurgical clipping and endovascular coiling for ruptured ACOM aneurysms remains unclear. The aim of this review was to investigate the clinical outcomes, including functional outcomes, treatment efficacy and safety of microsurgical clipping and endovascular coiling for the management of ruptured ACOM aneurysms.</div></div><div><h3>Methods</h3><div>A search for published and unpublished literature included PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, International Clinical Trial Registry, Australia and New Zealand Clinical Trial Registry Search Strategy and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>. Studies were included if they explored the functional outcomes and/or safety of microsurgical clipping and endovascular coiling for ruptured ACOM aneurysms. Eligible studies were critically appraised by two reviewers to assess methodological qualitied. Where possible, data from included studies was <em>meta</em>-analysed using a random effects Mantel-Haenszel model. Effect measures included odds ratio and risk difference where no events were recorded.</div></div><div><h3>Results</h3><div>The search yielded 818 records. Following screening of titles and abstracts against the review inclusion criteria, 25 articles were retrieved for full-text screening. Of these, 11 studies, all of which were non-randomised studies (2 quasi-experimental and 9 retrospective cohort studies), were included.</div><div>For the primary outcome (favourable functional outcomes), analysis revealed overall no statistically significant difference between microsurgical clipping and endovascular coiling (79.4 % versus 73.6 %, OR 1.11, 95 % CI 0.78 – 1.57, p = 0.56). Results from the quasi-experimental studies demonstrated favourable outcomes in the clipping group were non-significantly higher than the coiling group (86.2 % versus 80.4 %, OR 2.26, 95 % CI 0.6–8.52, p = 0.23). In cohort studies, favourable outcomes in the clipping group were non-significantly higher than the coiling group (78.9 % versus 72.3 %, OR 1.05, 95 % CI 0.71–1.53, p = 0.23). For the secondary outcomes of recurrence and complications, overall no statistically significant difference was found between clipping versus coiling (recurrence − 4.6 % versus 5.7 %, RD 0.00, 95 % CI −0.06 – 0.06, p = 0.47; complications- 21.6 % versus 14.2 %, OR 1.00 95 % CI 0.49 – 2.05, p = 1.00). Occlusion was found to be significantly higher in the clipping group compared to coiling (95 % versus 75 %, OR 7.01, 95 % CI 2.82 – 17.45, p=<0.0001).</div></div><div><h3>Concl","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111821"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882456","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}
Pub Date : 2026-03-01Epub Date: 2026-01-17DOI: 10.1016/j.jocn.2026.111863
Nan Xue , Wan Zhang , Xinyan Guo , Tianyu Ma , Mengwen Lu , Xinyi Ye , Min Jiang , Li Sun , Mingjin Yang , Xiaoyu Huang , Yong Zhang , Zhouao Zhang , Yanbo Wang , Ying Sheng
Background
Sleep disorder is increasingly recognized in myasthenia gravis (MG). However, its specific link to bulbar muscle weakness and short-term outcomes is not well established. This study aimed to investigate the prevalence of subjective sleep disorder (based on Pittsburgh Sleep Quality Index [PSQI] score) in a cohort of acetylcholine receptor (AChR) antibody-positive MG patients, and to explore its associations with bulbar muscle weakness, disease severity, and its value for the short-term outcome of MG.
Methods
We conducted a prospective cohort study of 163 AChR-MG patients. Subjective sleep quality was assessed using the PSQI score. Disease severity was evaluated with MG Specific Activities of Daily Living (MG-ADL) score, the Quantitative MG (QMG) score, and Myasthenia Gravis Foundation of America (MGFA) classification. Univariate and multivariable logistic regression were used to identify independent risk factors and establish prediction model for outcome. The predictive values were evaluated by receiver operating characteristic (ROC) curves. Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed.
Results
The median PSQI score was 7.0 (5.0, 9.0) and the prevalence of sleep disorder (PSQI > 5) was 73.6 %. Patients with bulbar weakness had significantly higher PSQI scores than those without (P < 0.001). PSQI score showed significant positive correlations with MG-ADL (r = 0.319, P < 0.001),QMG (r = 0.356, P < 0.001) in MG patients. A higher baseline PSQI score was identified as an independent risk factor for poor outcome at 6 months (odds ratio: 1.642 [95 % CI: 1.340–2.014], P < 0.001), with a area under curve (AUC) of 0.797. A predictive model combining PSQI score, bulbar weakness, and female gender demonstrated good discrimination, with a AUC of 0.840, a sensitivity of 0.688, and a specificity of 0.870.
Conclusion
Poor sleep quality is highly prevalent in AChR-MG and was more serious in patients with bulbar weakness. PSQI score was an independent risk factor for poor short-term outcome. Routine assessment of sleep may aid in risk stratification and personalized management.
背景：睡眠障碍在重症肌无力（MG）中得到越来越多的认识。然而，其与球肌无力和短期预后的具体联系尚不明确。本研究旨在调查主观睡眠障碍（基于匹兹堡睡眠质量指数[PSQI]评分）在乙酰胆碱受体（AChR）抗体阳性MG患者队列中的患病率，并探讨其与球肌无力、疾病严重程度的关系，及其对MG短期预后的价值。方法对163例AChR-MG患者进行前瞻性队列研究。主观睡眠质量采用PSQI评分进行评估。采用MG特定日常生活活动（MG- adl）评分、定量MG （QMG）评分和美国重症肌无力基金会（MGFA）分级评估疾病严重程度。采用单因素和多因素logistic回归识别独立危险因素，建立预后预测模型。采用受试者工作特征（ROC）曲线评价预测价值。对模型进行了标定分析和决策曲线分析（DCA）。结果PSQI评分中位数为7.0(5.0,9.0)，睡眠障碍患病率（PSQI > 5）为73.6%。有球无力的患者PSQI评分明显高于无球无力的患者（P < 0.001）。MG患者PSQI评分与MG- adl （r = 0.319, P < 0.001）、QMG （r = 0.356, P < 0.001）呈显著正相关。较高的基线PSQI评分被确定为6个月预后不良的独立危险因素（优势比：1.642 [95% CI: 1.340-2.014], P < 0.001），曲线下面积（AUC）为0.797。结合PSQI评分、球无力和女性性别的预测模型具有良好的鉴别能力，AUC为0.840，敏感性为0.688，特异性为0.870。结论睡眠质量差在AChR-MG患者中普遍存在，且在球无力患者中更为严重。PSQI评分是短期预后不良的独立危险因素。常规睡眠评估有助于风险分层和个性化管理。
{"title":"Association of sleep disorder with bulbar weakness and short-term outcomes in myasthenia gravis","authors":"Nan Xue , Wan Zhang , Xinyan Guo , Tianyu Ma , Mengwen Lu , Xinyi Ye , Min Jiang , Li Sun , Mingjin Yang , Xiaoyu Huang , Yong Zhang , Zhouao Zhang , Yanbo Wang , Ying Sheng","doi":"10.1016/j.jocn.2026.111863","DOIUrl":"10.1016/j.jocn.2026.111863","url":null,"abstract":"<div><h3>Background</h3><div>Sleep disorder is increasingly recognized in myasthenia gravis (MG). However, its specific link to bulbar muscle weakness and short-term outcomes is not well established. This study aimed to investigate the prevalence of subjective sleep disorder (based on Pittsburgh Sleep Quality Index [PSQI] score) in a cohort of acetylcholine receptor (AChR) antibody-positive MG patients, and to explore its associations with bulbar muscle weakness, disease severity, and its value for the short-term outcome of MG.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study of 163 AChR-MG patients. Subjective sleep quality was assessed using the PSQI score. Disease severity was evaluated with MG Specific Activities of Daily Living (MG-ADL) score, the Quantitative MG (QMG) score, and Myasthenia Gravis Foundation of America (MGFA) classification. Univariate and multivariable logistic regression were used to identify independent risk factors and establish prediction model for outcome. The predictive values were evaluated by receiver operating characteristic (ROC) curves. Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed.</div></div><div><h3>Results</h3><div>The median PSQI score was 7.0 (5.0, 9.0) and the prevalence of sleep disorder (PSQI > 5) was 73.6 %. Patients with bulbar weakness had significantly higher PSQI scores than those without (P < 0.001). PSQI score showed significant positive correlations with MG-ADL (r = 0.319, P < 0.001),QMG (r = 0.356, P < 0.001) in MG patients. A higher baseline PSQI score was identified as an independent risk factor for poor outcome at 6 months (odds ratio: 1.642 [95 % CI: 1.340–2.014], P < 0.001), with a area under curve (AUC) of 0.797. A predictive model combining PSQI score, bulbar weakness, and female gender demonstrated good discrimination, with a AUC of 0.840, a sensitivity of 0.688, and a specificity of 0.870.</div></div><div><h3>Conclusion</h3><div>Poor sleep quality is highly prevalent in AChR-MG and was more serious in patients with bulbar weakness. PSQI score was an independent risk factor for poor short-term outcome. Routine assessment of sleep may aid in risk stratification and personalized management.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111863"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979137","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}
Pub Date : 2026-03-01Epub Date: 2026-01-10DOI: 10.1016/j.jocn.2026.111857
Romil Kukadiya , Arth Shah , Soaham Desai
Background
Subacute Encephalopathy with Seizures in Alcoholics (SESA) syndrome is an underrecognized neurological complication among chronic alcohol users, characterized by subacute encephalopathy, seizures, focal neurological deficits, and distinctive EEG and neuroimaging findings. Despite advancements, gaps remain in standardized diagnosis, therapeutic management, and long-term outcomes.
Objectives
This scoping review aims to synthesize published evidence on the clinical presentation, EEG and neuroimaging findings, management strategies, and outcomes of SESA syndrome, while proposing refined diagnostic criteria and a severity grading scale.
Methods
Studies reporting adult patients with chronic alcohol abuse presenting with SESA syndrome, as defined by the co-occurrence of encephalopathy, seizures, and focal deficits with supporting EEG or neuroimaging findings, were included. All study designs were eligible; reviews, commentaries, and editorials without original data were excluded. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, relevant grey literature, and conference abstracts from January 1981 to April 2025. Reference lists of included articles were manually screened. Data were extracted independently into standardized forms for demographics, clinical features, diagnostics, management, and outcomes. Quality appraisal used the Joanna Briggs Institute checklist.
Results
Forty-five patient cases from 29 studies were included. SESA syndrome presents with a consistent triad, varied seizure types, hallmark EEG LPDs, and reversible MRI abnormalities. Proposed criteria and severity scale may facilitate early recognition and guide management.
Conclusions
SESA syndrome requires heightened awareness and multidisciplinary management. Future research should validate proposed diagnostic tools and elucidate pathophysiology and long-term outcomes.
背景：亚急性脑病伴酒精发作（SESA）综合征是慢性酒精使用者中未被充分认识的神经系统并发症，其特征为亚急性脑病、癫痫发作、局灶性神经功能缺损以及独特的脑电图和神经影像学表现。尽管取得了进步，但在标准化诊断、治疗管理和长期结果方面仍存在差距。目的：本综述旨在综合已发表的关于SESA综合征的临床表现、脑电图和神经影像学表现、治疗策略和结局的证据，同时提出完善的诊断标准和严重程度分级量表。方法纳入了报告以SESA综合征为表现的成年慢性酒精滥用患者的研究，SESA综合征的定义为脑病、癫痫发作和局灶性缺陷的共同出现，并伴有EEG或神经影像学的支持。所有的研究设计都是合格的；没有原始数据的评论、评论和社论被排除在外。系统检索1981年1月至2025年4月的PubMed/MEDLINE、Embase、Web of Science、相关灰色文献和会议摘要。人工筛选纳入文章的参考文献列表。数据被独立提取为人口统计学、临床特征、诊断、管理和结果的标准化形式。质量评估使用了乔安娜布里格斯研究所的检查表。结果纳入29项研究的45例患者。SESA综合征表现为一致的三联征、不同的发作类型、标志性的脑电图lpd和可逆性MRI异常。建议的标准和严重程度可以促进早期识别和指导管理。结论ssesa综合征需要提高认识和多学科管理。未来的研究应验证提出的诊断工具，阐明病理生理学和长期结果。
{"title":"SESA syndrome: synthesizing evidence and proposing diagnostic criteria and severity grading—a scoping review","authors":"Romil Kukadiya , Arth Shah , Soaham Desai","doi":"10.1016/j.jocn.2026.111857","DOIUrl":"10.1016/j.jocn.2026.111857","url":null,"abstract":"<div><h3>Background</h3><div>Subacute Encephalopathy with Seizures in Alcoholics (SESA) syndrome is an underrecognized neurological complication among chronic alcohol users, characterized by subacute encephalopathy, seizures, focal neurological deficits, and distinctive EEG and neuroimaging findings. Despite advancements, gaps remain in standardized diagnosis, therapeutic management, and long-term outcomes.</div></div><div><h3>Objectives</h3><div>This scoping review aims to synthesize published evidence on the clinical presentation, EEG and neuroimaging findings, management strategies, and outcomes of SESA syndrome, while proposing refined diagnostic criteria and a severity grading scale.</div></div><div><h3>Methods</h3><div>Studies reporting adult patients with chronic alcohol abuse presenting with SESA syndrome, as defined by the co-occurrence of encephalopathy, seizures, and focal deficits with supporting EEG or neuroimaging findings, were included. All study designs were eligible; reviews, commentaries, and editorials without original data were excluded. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, relevant grey literature, and conference abstracts from January 1981 to April 2025. Reference lists of included articles were manually screened. Data were extracted independently into standardized forms for demographics, clinical features, diagnostics, management, and outcomes. Quality appraisal used the Joanna Briggs Institute checklist.</div></div><div><h3>Results</h3><div>Forty-five patient cases from 29 studies were included. SESA syndrome presents with a consistent triad, varied seizure types, hallmark EEG LPDs, and reversible MRI abnormalities. Proposed criteria and severity scale may facilitate early recognition and guide management.</div></div><div><h3>Conclusions</h3><div>SESA syndrome requires heightened awareness and multidisciplinary management. Future research should validate proposed diagnostic tools and elucidate pathophysiology and long-term outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111857"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922421","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}
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