Pub Date : 2024-08-01DOI: 10.1016/S1474-4422(24)00271-0
Markus Reuber
{"title":"Cognitive function in people with functional seizures.","authors":"Markus Reuber","doi":"10.1016/S1474-4422(24)00271-0","DOIUrl":"10.1016/S1474-4422(24)00271-0","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 8","pages":"759-761"},"PeriodicalIF":45.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S1474-4422(24)00234-5
Pushpa Narayanaswami, Donald B Sanders
{"title":"Azathioprine and mycophenolate mofetil in myasthenia gravis - Authors' reply.","authors":"Pushpa Narayanaswami, Donald B Sanders","doi":"10.1016/S1474-4422(24)00234-5","DOIUrl":"10.1016/S1474-4422(24)00234-5","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 8","pages":"762-763"},"PeriodicalIF":45.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S1474-4422(24)00269-2
Robert van Voren
{"title":"On the new President of the ILAE.","authors":"Robert van Voren","doi":"10.1016/S1474-4422(24)00269-2","DOIUrl":"10.1016/S1474-4422(24)00269-2","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 8","pages":"767"},"PeriodicalIF":45.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S1474-4422(24)00268-0
J Helen Cross
{"title":"On the new President of the ILAE - Reply by the ILAE.","authors":"J Helen Cross","doi":"10.1016/S1474-4422(24)00268-0","DOIUrl":"10.1016/S1474-4422(24)00268-0","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 8","pages":"767"},"PeriodicalIF":45.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-06-13DOI: 10.1016/S1474-4422(24)00206-0
Mark W Parsons, Vignan Yogendrakumar, Leonid Churilov, Carlos Garcia-Esperon, Bruce C V Campbell, Michelle L Russell, Gagan Sharma, Chushuang Chen, Longting Lin, Beng Lim Chew, Felix C Ng, Akshay Deepak, Philip M C Choi, Timothy J Kleinig, Dennis J Cordato, Teddy Y Wu, John N Fink, Henry Ma, Thanh G Phan, Hugh S Markus, Carlos A Molina, Chon-Haw Tsai, Jiunn-Tay Lee, Jiann-Shing Jeng, Daniel Strbian, Atte Meretoja, Juan F Arenillas, Brian H Buck, Michael J Devlin, Helen Brown, Ken S Butcher, Billy O'Brien, Arman Sabet, Tissa Wijeratne, Andrew Bivard, Rohan S Grimley, Smriti Agarwal, Sunil K Munshi, Geoffrey A Donnan, Stephen M Davis, Ferdinand Miteff, Neil J Spratt, Christopher R Levi
<p><strong>Background: </strong>Intravenous tenecteplase increases reperfusion in patients with salvageable brain tissue on perfusion imaging and might have advantages over alteplase as a thrombolytic for ischaemic stroke. We aimed to assess the non-inferiority of tenecteplase versus alteplase on clinical outcomes in patients selected by use of perfusion imaging.</p><p><strong>Methods: </strong>This international, multicentre, open-label, parallel-group, randomised, clinical non-inferiority trial enrolled patients from 35 hospitals in eight countries. Participants were aged 18 years or older, within 4·5 h of ischaemic stroke onset or last known well, were not being considered for endovascular thrombectomy, and met target mismatch criteria on brain perfusion imaging. Patients were randomly assigned (1:1) by use of a centralised web server with randomly permuted blocks to intravenous tenecteplase (0·25 mg/kg) or alteplase (0·90 mg/kg). The primary outcome was the proportion of patients without disability (modified Rankin Scale 0-1) at 3 months, assessed via masked review in both the intention-to-treat and per-protocol populations. We aimed to recruit 832 participants to yield 90% power (one-sided alpha=0·025) to detect a risk difference of 0·08, with an absolute non-inferiority margin of -0·03. The trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000243718, and the European Union Clinical Trials Register, EudraCT Number 2015-002657-36, and it is completed.</p><p><strong>Findings: </strong>Recruitment ceased early following the announcement of other trial results showing non-inferiority of tenecteplase versus alteplase. Between March 21, 2014, and Oct 20, 2023, 680 patients were enrolled and randomly assigned to tenecteplase (n=339) and alteplase (n=341), all of whom were included in the intention-to-treat analysis (multiple imputation was used to account for missing primary outcome data for five patients). Protocol violations occurred in 74 participants, thus the per-protocol population comprised 601 people (295 in the tenecteplase group and 306 in the alteplase group). Participants had a median age of 74 years (IQR 63-82), baseline National Institutes of Health Stroke Scale score of 7 (4-11), and 260 (38%) were female. In the intention-to-treat analysis, the primary outcome occurred in 191 (57%) of 335 participants allocated to tenecteplase and 188 (55%) of 340 participants allocated to alteplase (standardised risk difference [SRD]=0·03 [95% CI -0·033 to 0·10], one-tailed p<sub>non-inferiority</sub>=0·031). In the per-protocol analysis, the primary outcome occurred in 173 (59%) of 295 participants allocated to tenecteplase and 171 (56%) of 306 participants allocated to alteplase (SRD 0·05 [-0·02 to 0·12], one-tailed p<sub>non-inferiority</sub>=0·01). Nine (3%) of 337 patients in the tenecteplase group and six (2%) of 340 in the alteplase group had symptomatic intracranial haemorrhage (unadjusted risk differe
背景：静脉注射替奈普酶可增加灌注成像显示有可挽救脑组织的患者的再灌注，作为缺血性卒中的溶栓药物，它可能比阿替普酶更具优势。我们旨在评估替奈普酶与阿替普酶对通过灌注成像筛选出的患者的临床疗效的非劣效性：这项国际多中心、开放标签、平行分组、随机临床非劣效性试验招募了来自 8 个国家 35 家医院的患者。参试者年龄在 18 岁或以上，缺血性中风发病或最后一次已知病程在 4-5 小时之内，未考虑进行血管内血栓切除术，并符合脑灌注成像的靶点不匹配标准。患者通过中央网络服务器随机分配（1:1）至静脉注射替奈普酶（0-25 毫克/千克）或阿替普酶（0-90 毫克/千克）。主要结果是患者在3个月后无残疾（改良Rankin量表0-1）的比例，在意向治疗和按协议治疗人群中均通过蒙面审查进行评估。我们的目标是招募 832 名参与者，以获得 90% 的力量（单侧α=0-025）来检测 0-08 的风险差异，绝对非劣效差为-0-03。该试验已在澳大利亚-新西兰临床试验注册中心（ACTRN12613000243718）和欧盟临床试验注册中心（EudraCT编号2015-002657-36）注册，目前已完成：结果：在其他试验结果显示替奈普酶与阿替普酶相比无劣效性后，招募工作提前停止。2014年3月21日至2023年10月20日期间，680名患者入组并被随机分配到替奈普酶（n=339）和阿替普酶（n=341），所有患者均纳入意向治疗分析（对5名患者缺失的主要结果数据采用多重归因）。74名参与者违反了协议，因此按协议治疗的患者有601人（替奈替普酶组295人，阿替普酶组306人）。参与者的中位年龄为 74 岁（IQR 为 63-82），美国国立卫生研究院卒中量表基线评分为 7 分（4-11），260 人（38%）为女性。在意向治疗分析中，335名接受替奈普酶治疗的患者中有191人（57%）出现了主要结果，340名接受阿替普酶治疗的患者中有188人（55%）出现了主要结果（标准化风险差异[SRD]=0-03 [95% CI -0-033 to 0-10]，单尾p非劣效性=0-031）。在按协议分析中，295名接受替奈普酶治疗的患者中有173人（59%）出现了主要结果，306名接受阿替普酶治疗的患者中有171人（56%）出现了主要结果（SRD 0-05 [-0-02 to 0-12]，单尾p非劣效性=0-01）。替奈普酶组337名患者中有9人（3%）和阿替普酶组340名患者中有6人（2%）出现症状性颅内出血（未调整风险差异=0-01 [95% CI -0-01 to 0-03]），335名患者中有23人（7%）和340名患者中有15人（4%）在开始治疗后90天内死亡（SRD 0-02 [95% CI -0-02 to 0-05]）：我们的研究结果进一步证明了替奈普酶不劣于阿替普酶，尤其是在使用灌注成像确定符合再灌注条件的卒中患者时。虽然在按协议治疗人群中达到了非劣效性，但在意向治疗分析中却没有达到，这可能是由于样本量的限制。尽管如此，在早期时间窗大规模实施灌注CT以帮助选择静脉溶栓患者的做法已被证明是可行的：澳大利亚国家健康医学研究委员会；勃林格殷格翰公司。
{"title":"Tenecteplase versus alteplase for thrombolysis in patients selected by use of perfusion imaging within 4·5 h of onset of ischaemic stroke (TASTE): a multicentre, randomised, controlled, phase 3 non-inferiority trial.","authors":"Mark W Parsons, Vignan Yogendrakumar, Leonid Churilov, Carlos Garcia-Esperon, Bruce C V Campbell, Michelle L Russell, Gagan Sharma, Chushuang Chen, Longting Lin, Beng Lim Chew, Felix C Ng, Akshay Deepak, Philip M C Choi, Timothy J Kleinig, Dennis J Cordato, Teddy Y Wu, John N Fink, Henry Ma, Thanh G Phan, Hugh S Markus, Carlos A Molina, Chon-Haw Tsai, Jiunn-Tay Lee, Jiann-Shing Jeng, Daniel Strbian, Atte Meretoja, Juan F Arenillas, Brian H Buck, Michael J Devlin, Helen Brown, Ken S Butcher, Billy O'Brien, Arman Sabet, Tissa Wijeratne, Andrew Bivard, Rohan S Grimley, Smriti Agarwal, Sunil K Munshi, Geoffrey A Donnan, Stephen M Davis, Ferdinand Miteff, Neil J Spratt, Christopher R Levi","doi":"10.1016/S1474-4422(24)00206-0","DOIUrl":"10.1016/S1474-4422(24)00206-0","url":null,"abstract":"<p><strong>Background: </strong>Intravenous tenecteplase increases reperfusion in patients with salvageable brain tissue on perfusion imaging and might have advantages over alteplase as a thrombolytic for ischaemic stroke. We aimed to assess the non-inferiority of tenecteplase versus alteplase on clinical outcomes in patients selected by use of perfusion imaging.</p><p><strong>Methods: </strong>This international, multicentre, open-label, parallel-group, randomised, clinical non-inferiority trial enrolled patients from 35 hospitals in eight countries. Participants were aged 18 years or older, within 4·5 h of ischaemic stroke onset or last known well, were not being considered for endovascular thrombectomy, and met target mismatch criteria on brain perfusion imaging. Patients were randomly assigned (1:1) by use of a centralised web server with randomly permuted blocks to intravenous tenecteplase (0·25 mg/kg) or alteplase (0·90 mg/kg). The primary outcome was the proportion of patients without disability (modified Rankin Scale 0-1) at 3 months, assessed via masked review in both the intention-to-treat and per-protocol populations. We aimed to recruit 832 participants to yield 90% power (one-sided alpha=0·025) to detect a risk difference of 0·08, with an absolute non-inferiority margin of -0·03. The trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000243718, and the European Union Clinical Trials Register, EudraCT Number 2015-002657-36, and it is completed.</p><p><strong>Findings: </strong>Recruitment ceased early following the announcement of other trial results showing non-inferiority of tenecteplase versus alteplase. Between March 21, 2014, and Oct 20, 2023, 680 patients were enrolled and randomly assigned to tenecteplase (n=339) and alteplase (n=341), all of whom were included in the intention-to-treat analysis (multiple imputation was used to account for missing primary outcome data for five patients). Protocol violations occurred in 74 participants, thus the per-protocol population comprised 601 people (295 in the tenecteplase group and 306 in the alteplase group). Participants had a median age of 74 years (IQR 63-82), baseline National Institutes of Health Stroke Scale score of 7 (4-11), and 260 (38%) were female. In the intention-to-treat analysis, the primary outcome occurred in 191 (57%) of 335 participants allocated to tenecteplase and 188 (55%) of 340 participants allocated to alteplase (standardised risk difference [SRD]=0·03 [95% CI -0·033 to 0·10], one-tailed p<sub>non-inferiority</sub>=0·031). In the per-protocol analysis, the primary outcome occurred in 173 (59%) of 295 participants allocated to tenecteplase and 171 (56%) of 306 participants allocated to alteplase (SRD 0·05 [-0·02 to 0·12], one-tailed p<sub>non-inferiority</sub>=0·01). Nine (3%) of 337 patients in the tenecteplase group and six (2%) of 340 in the alteplase group had symptomatic intracranial haemorrhage (unadjusted risk differe","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":" ","pages":"775-786"},"PeriodicalIF":45.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S1474-4422(24)00275-8
Federico Massa, Nicolas Villain, Matteo Cotta Ramusino, Giovanni B Frisoni
{"title":"Clinical versus biomarker-based diagnosis of neurocognitive disorders - Authors' reply.","authors":"Federico Massa, Nicolas Villain, Matteo Cotta Ramusino, Giovanni B Frisoni","doi":"10.1016/S1474-4422(24)00275-8","DOIUrl":"10.1016/S1474-4422(24)00275-8","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 8","pages":"766-767"},"PeriodicalIF":45.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S1474-4422(24)00262-X
Virginia Newcombe
{"title":"Detection of awareness after brain injury: time for change.","authors":"Virginia Newcombe","doi":"10.1016/S1474-4422(24)00262-X","DOIUrl":"10.1016/S1474-4422(24)00262-X","url":null,"abstract":"","PeriodicalId":17989,"journal":{"name":"Lancet Neurology","volume":"23 8","pages":"757-759"},"PeriodicalIF":45.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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