Pub Date : 2025-02-01Epub Date: 2024-11-27DOI: 10.1212/CPJ.0000000000200403
Maria Andrea Donahue, Hammad Akram, Julianne D Brooks, Avani C Modi, Jessica Veach, Alison Kukla, Shawna W Benard, Susan T Herman, Kathleen Farrell, David M Ficker, Sahar F Zafar, William H Trescher, Deepa Sirsi, Donald J Phillips, Jacob Pellinen, Jeffrey Buchhalter, Lidia Moura, Brandy E Fureman
Background and objectives: Epilepsy affects approximately 1.2% of the US population, resulting in 3.4 million Americans with active epilepsy. Antiseizure medication (ASM) is considered the mainstay of treatment, effective for two-thirds of people with epilepsy (PWE), while at least one-third experience drug-resistant epilepsy. A significant percentage of PWE who are treated with ASMs report nonadherence to this type of medication, leading to potentially preventable seizures and the potential for being inappropriately classified as having drug-resistant epilepsy. Ongoing seizures are associated with increased morbidity, mortality, and health care costs, among other consequences. Recognizing when PWE struggle with ASM adherence is essential for creating effective interventions and prevention strategies to improve patient outcomes.
Methods: As part of the Epilepsy Learning Healthcare System Registry, we collected data from 2020 through 2023 from 4,917 individuals seen at 8 epilepsy clinics in the United States. In this cross-sectional study, we used logistic regression analysis to examine the relationship between patient-reported seizure control (or provider-reported seizure control for some sites) and endorsed barriers to medication adherence. In addition, we explored potential associations with demographic variables such as sex, race, and ethnicity. The data analysis was conducted using R version 2023.06.1 + 524.
Results: Overall, 18.4% (893/4,848) reported adherence barriers and 37.7% (1,447/3,834) reported seizure control, defined as no seizures for the preceding 12 months or longer. The most prevalent barriers were forgetting to take ASMs (48.2%), experiencing ASM side effects (29.2%), and feeling as if the ASMs were not helping in controlling seizures (21.3%). The PWE who reported adherence barriers had 0.6 lower odds of having seizure control compared with those who did not report barriers (95% CI 0.4-0.7) and 0.6 lower odds of having seizure control after adjusting for race, ethnicity, and sex (95% CI 0.5-0.7).
Discussion: We observed significant barriers to medication adherence and inadequate seizure control among adult PWE across 8 centers in the United States. This study suggests that PWE might benefit from standardized screening for adherence barriers with behavioral strategies to address these barriers offered during clinical encounters to personalize care.
背景和目的:癫痫影响约1.2%的美国人口,导致340万美国人患有活动性癫痫。抗癫痫药物(ASM)被认为是主要的治疗方法,对三分之二的癫痫患者(PWE)有效,而至少三分之一的患者患有耐药性癫痫。在接受抗痉挛药物治疗的PWE中,有相当大比例的人报告不坚持使用这类药物,从而导致本可预防的癫痫发作,并有可能被不恰当地归类为耐药癫痫。持续发作与发病率、死亡率和医疗费用增加以及其他后果有关。认识到PWE与ASM依从性的斗争对于制定有效的干预措施和预防策略以改善患者预后至关重要。方法:作为癫痫学习医疗保健系统注册的一部分,我们收集了2020年至2023年在美国8家癫痫诊所就诊的4,917名患者的数据。在这项横断面研究中,我们使用逻辑回归分析来检验患者报告的癫痫发作控制(或某些地区的提供者报告的癫痫发作控制)与认可的药物依从性障碍之间的关系。此外,我们还探讨了与人口统计学变量(如性别、种族和民族)的潜在关联。数据分析使用R版本2023.06.1 + 524。结果:总体而言,18.4%(893/ 4848)报告了依从性障碍,37.7%(1447 / 3834)报告了癫痫发作控制,定义为在过去12个月或更长时间内没有癫痫发作。最常见的障碍是忘记服用ASM(48.2%),经历ASM副作用(29.2%),感觉ASM对控制癫痫发作没有帮助(21.3%)。报告依从性障碍的PWE与没有报告依从性障碍的PWE相比,癫痫发作控制的几率低0.6 (95% CI 0.4-0.7),在调整种族、民族和性别后,癫痫发作控制的几率低0.6 (95% CI 0.5-0.7)。讨论:我们观察到美国8个中心的成人PWE患者在药物依从性和癫痫发作控制方面存在显著障碍。这项研究表明,PWE可能受益于对依从性障碍的标准化筛查,并采用行为策略来解决临床遇到的个性化护理中提供的这些障碍。
{"title":"Barriers to Medication Adherence in People Living With Epilepsy.","authors":"Maria Andrea Donahue, Hammad Akram, Julianne D Brooks, Avani C Modi, Jessica Veach, Alison Kukla, Shawna W Benard, Susan T Herman, Kathleen Farrell, David M Ficker, Sahar F Zafar, William H Trescher, Deepa Sirsi, Donald J Phillips, Jacob Pellinen, Jeffrey Buchhalter, Lidia Moura, Brandy E Fureman","doi":"10.1212/CPJ.0000000000200403","DOIUrl":"10.1212/CPJ.0000000000200403","url":null,"abstract":"<p><strong>Background and objectives: </strong>Epilepsy affects approximately 1.2% of the US population, resulting in 3.4 million Americans with active epilepsy. Antiseizure medication (ASM) is considered the mainstay of treatment, effective for two-thirds of people with epilepsy (PWE), while at least one-third experience drug-resistant epilepsy. A significant percentage of PWE who are treated with ASMs report nonadherence to this type of medication, leading to potentially preventable seizures and the potential for being inappropriately classified as having drug-resistant epilepsy. Ongoing seizures are associated with increased morbidity, mortality, and health care costs, among other consequences. Recognizing when PWE struggle with ASM adherence is essential for creating effective interventions and prevention strategies to improve patient outcomes.</p><p><strong>Methods: </strong>As part of the Epilepsy Learning Healthcare System Registry, we collected data from 2020 through 2023 from 4,917 individuals seen at 8 epilepsy clinics in the United States. In this cross-sectional study, we used logistic regression analysis to examine the relationship between patient-reported seizure control (or provider-reported seizure control for some sites) and endorsed barriers to medication adherence. In addition, we explored potential associations with demographic variables such as sex, race, and ethnicity. The data analysis was conducted using R version 2023.06.1 + 524.</p><p><strong>Results: </strong>Overall, 18.4% (893/4,848) reported adherence barriers and 37.7% (1,447/3,834) reported seizure control, defined as no seizures for the preceding 12 months or longer. The most prevalent barriers were forgetting to take ASMs (48.2%), experiencing ASM side effects (29.2%), and feeling as if the ASMs were not helping in controlling seizures (21.3%). The PWE who reported adherence barriers had 0.6 lower odds of having seizure control compared with those who did not report barriers (95% CI 0.4-0.7) and 0.6 lower odds of having seizure control after adjusting for race, ethnicity, and sex (95% CI 0.5-0.7).</p><p><strong>Discussion: </strong>We observed significant barriers to medication adherence and inadequate seizure control among adult PWE across 8 centers in the United States. This study suggests that PWE might benefit from standardized screening for adherence barriers with behavioral strategies to address these barriers offered during clinical encounters to personalize care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200403"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-08DOI: 10.1212/CPJ.0000000000200373
Amira Salim, Sudipa Biswas, Claire Sonneborn, Olivia Hogue, Elise Hennessy, Maryann Mays, Aarushi Suneja, Zubair Ahmed, Ignacio F Mata
Background and objectives: Despite decreasing prevalence of migraine with advancing age, there remains a significant proportion of individuals aged ≥65 years with migraine. Treatment of this population is difficult and they are often excluded from clinical trials, limiting evidence regarding migraine treatment outcomes. Our objective is to assess the efficacy and tolerability of anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) therapies (erenumab, fremanezumab, and galcanezumab) in patients ≥65 years (O65) compared with patients <65 (U65) with daily or nondaily migraine.
Methods: This observational study uses retrospective data from the electronic medical records of patients who were treated with an anti-CGRP mAb between June 2018 and November 2021. Efficacy was determined through a reduction in monthly migraine days (MMDs) and Headache Impact Test (HIT-6) scores from baseline to posttreatment. Tolerability was examined through the number of adverse events reported per group. Mann-Whitney tests were used to compare the efficacy and tolerability of U65 and O65 patients overall and separated into daily and nondaily migraine groups.
Results: The dataset consisted of U65 (n = 2,707; median [interquartile range]; 45.4 [35.8-53.8] years) or O65 (n = 304; 69.5 [67.3-73.3] years) and further separated into daily (n = 1,303) and nondaily (n = 1,708) migraine. There was no difference (p = 0.57) in the median MMD reduction between U65 (10 days [0.0-17.0]) and O65 (10 days [0.0-16.5]). Similarly, no difference was found among patients with nondaily migraine (p = 0.82) and patients with daily migraine (p = 0.59). HIT-6 scores decreased from severe to moderate/substantial impact for all groups. The daily and nondaily groups showed differences in meeting the 50% improvement threshold (nondaily U65, 67% vs daily U65, 54%, p < 0.0001; nondaily O65, 65% vs daily O65, 49%, p = 0.008). Side effects were reported (829/3,011), with a higher incidence in the U65 (22% O65, 28% U65). The most common side effects for both groups were injection site reaction/rash (40%) and constipation (25%).
Discussion: This retrospective analysis provides real-world evidence that there is no difference in the efficacy and tolerability of treatment with erenumab, fremanezumab, and galcanezumab in patients O65 when compared with patients U65 both with daily or nondaily migraine. These data may help guide the choice of migraine treatment in older populations.
{"title":"Efficacy and Tolerability of Anti-CGRP Monoclonal Antibodies in Patients Aged ≥ 65 Years With Daily or Nondaily Migraine.","authors":"Amira Salim, Sudipa Biswas, Claire Sonneborn, Olivia Hogue, Elise Hennessy, Maryann Mays, Aarushi Suneja, Zubair Ahmed, Ignacio F Mata","doi":"10.1212/CPJ.0000000000200373","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200373","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite decreasing prevalence of migraine with advancing age, there remains a significant proportion of individuals aged ≥65 years with migraine. Treatment of this population is difficult and they are often excluded from clinical trials, limiting evidence regarding migraine treatment outcomes. Our objective is to assess the efficacy and tolerability of anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) therapies (erenumab, fremanezumab, and galcanezumab) in patients ≥65 years (O65) compared with patients <65 (U65) with daily or nondaily migraine.</p><p><strong>Methods: </strong>This observational study uses retrospective data from the electronic medical records of patients who were treated with an anti-CGRP mAb between June 2018 and November 2021. Efficacy was determined through a reduction in monthly migraine days (MMDs) and Headache Impact Test (HIT-6) scores from baseline to posttreatment. Tolerability was examined through the number of adverse events reported per group. Mann-Whitney tests were used to compare the efficacy and tolerability of U65 and O65 patients overall and separated into daily and nondaily migraine groups.</p><p><strong>Results: </strong>The dataset consisted of U65 (n = 2,707; median [interquartile range]; 45.4 [35.8-53.8] years) or O65 (n = 304; 69.5 [67.3-73.3] years) and further separated into daily (n = 1,303) and nondaily (n = 1,708) migraine. There was no difference (<i>p</i> = 0.57) in the median MMD reduction between U65 (10 days [0.0-17.0]) and O65 (10 days [0.0-16.5]). Similarly, no difference was found among patients with nondaily migraine (<i>p</i> = 0.82) and patients with daily migraine (<i>p</i> = 0.59). HIT-6 scores decreased from severe to moderate/substantial impact for all groups. The daily and nondaily groups showed differences in meeting the 50% improvement threshold (nondaily U65, 67% vs daily U65, 54%, <i>p</i> < 0.0001; nondaily O65, 65% vs daily O65, 49%, <i>p</i> = 0.008). Side effects were reported (829/3,011), with a higher incidence in the U65 (22% O65, 28% U65). The most common side effects for both groups were injection site reaction/rash (40%) and constipation (25%).</p><p><strong>Discussion: </strong>This retrospective analysis provides real-world evidence that there is no difference in the efficacy and tolerability of treatment with erenumab, fremanezumab, and galcanezumab in patients O65 when compared with patients U65 both with daily or nondaily migraine. These data may help guide the choice of migraine treatment in older populations.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200373"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-08DOI: 10.1212/CPJ.0000000000200399
[This corrects the article DOI: 10.1212/CPJ.0000000000200345.].
[此处更正了文章 DOI:10.1212/CPJ.0000000000200345]。
{"title":"Erratum: A General Neurologist's Practical Diagnostic Algorithm for Atypical Parkinsonian Disorders: A Consensus Statement.","authors":"","doi":"10.1212/CPJ.0000000000200399","DOIUrl":"10.1212/CPJ.0000000000200399","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200345.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200399"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-08DOI: 10.1212/CPJ.0000000000200370
Andrea Van Steenis, Mehmet N Cizmeci, Floris Groenendaal, Marianne Thoresen, Frances M Cowan, Linda S de Vries, Sylke J Steggerda
Background and objectives: To determine whether post-rewarming brain MRI enables individualized domain-specific prediction of neurodevelopmental outcomes at 2 years of age in infants treated with hypothermia for hypoxic-ischemic brain injury.
Methods: We conducted a retrospective multicenter study of infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. Brain MRI abnormalities and the prediction of domain-specific 2-year neurodevelopmental outcomes were scored independently by 2 investigators after which consensus was reached for both imaging findings and outcome prediction. Neuroimaging patterns were categorized as normal, white matter (WM)/watershed-predominant, deep gray matter (DGM)-predominant, and near-total injury. Outcomes were predicted separately for mortality, cerebral palsy (CP) type and severity, cognitive delay, epilepsy, cerebral visual impairment (CVI), and feeding difficulties; these outcomes were predicted as highly unlikely, possible, probable, or highly likely.
Results: Of the 152 study infants, 27 (18%) died. The neurodevelopmental outcome at 2 years was available in all 125 survivors. CP was seen in 21 of 125 surviving infants (17%). No infants in the highly unlikely category developed CP while 90% in the highly likely category did. When CP was predicted as possible, 40% developed CP; all were mild and ambulatory. When CP was predicted as probable, 67% developed CP of whom 40% were severe and nonambulatory. Cognitive scores were available in 104 of 125 infants (83%). Cognitive delay was seen in 23 of 104 infants (22%) (15% mild and 7% severe). When cognitive delay was predicted as highly unlikely, 92% did not develop cognitive delay and the delay was mild in those who did. When cognitive delay was considered highly likely, this developed in 100%. When epilepsy, CVI, and feeding problems were predicted as highly unlikely, 98% did not develop epilepsy; for CVI and feeding problems, this was 100% and 97%, respectively. In 27 of 152 infants (18%), the investigators reached consensus that the overall injury was severe enough to consider redirection of care; 21 of 27 infants (78%) died. Of the survivors, 5 infants developed severe CP and 1 had a mild dyskinetic CP with swallowing problems and CVI.
Discussion: Individualized domain-specific categorical neuroprognostication mainly based on brain MRI is feasible, reliable, and highly accurate in infants with HIE.
{"title":"Individualized Neuroprognostication in Neonates With Hypoxic-Ischemic Encephalopathy Treated With Hypothermia.","authors":"Andrea Van Steenis, Mehmet N Cizmeci, Floris Groenendaal, Marianne Thoresen, Frances M Cowan, Linda S de Vries, Sylke J Steggerda","doi":"10.1212/CPJ.0000000000200370","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200370","url":null,"abstract":"<p><strong>Background and objectives: </strong>To determine whether post-rewarming brain MRI enables individualized domain-specific prediction of neurodevelopmental outcomes at 2 years of age in infants treated with hypothermia for hypoxic-ischemic brain injury.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study of infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. Brain MRI abnormalities and the prediction of domain-specific 2-year neurodevelopmental outcomes were scored independently by 2 investigators after which consensus was reached for both imaging findings and outcome prediction. Neuroimaging patterns were categorized as normal, white matter (WM)/watershed-predominant, deep gray matter (DGM)-predominant, and near-total injury. Outcomes were predicted separately for mortality, cerebral palsy (CP) type and severity, cognitive delay, epilepsy, cerebral visual impairment (CVI), and feeding difficulties; these outcomes were predicted as highly unlikely, possible, probable, or highly likely.</p><p><strong>Results: </strong>Of the 152 study infants, 27 (18%) died. The neurodevelopmental outcome at 2 years was available in all 125 survivors. CP was seen in 21 of 125 surviving infants (17%). No infants in the highly unlikely category developed CP while 90% in the highly likely category did. When CP was predicted as possible, 40% developed CP; all were mild and ambulatory. When CP was predicted as probable, 67% developed CP of whom 40% were severe and nonambulatory. Cognitive scores were available in 104 of 125 infants (83%). Cognitive delay was seen in 23 of 104 infants (22%) (15% mild and 7% severe). When cognitive delay was predicted as highly unlikely, 92% did not develop cognitive delay and the delay was mild in those who did. When cognitive delay was considered highly likely, this developed in 100%. When epilepsy, CVI, and feeding problems were predicted as highly unlikely, 98% did not develop epilepsy; for CVI and feeding problems, this was 100% and 97%, respectively. In 27 of 152 infants (18%), the investigators reached consensus that the overall injury was severe enough to consider redirection of care; 21 of 27 infants (78%) died. Of the survivors, 5 infants developed severe CP and 1 had a mild dyskinetic CP with swallowing problems and CVI.</p><p><strong>Discussion: </strong>Individualized domain-specific categorical neuroprognostication mainly based on brain MRI is feasible, reliable, and highly accurate in infants with HIE.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200370"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-08DOI: 10.1212/CPJ.0000000000200381
Sami Al Kasab, Eyad Almallouhi, Liqi Shu, Kimberly P Kicielinski, Setareh Salehi Omran, David S Liebeskind, Adeel S Zubair, Maria C Vedovati, Maurizio Paciaroni, Kateryna Antonenko, Mirjam R Heldner, Adam de Havenon, Nils Henninger, Shadi Yaghi
Background and objectives: Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depends on the underlying etiology. This study aims to identify prevalence, risk factors, and recurrent venous thromboembolism (VTE) rates among patients with idiopathic (cryptogenic) CVT and CVT provoked by transient (peripartum, hormonal treatment, infection, trauma) and persistent (cancer, thrombophilia) factors.
Methods: We used the ACTION-CVT retrospective database which included consecutive patients who were treated for CVT in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. We compared baseline characteristics and outcomes of patients with cryptogenic, transient provoked (TP) and those with persistent provoked (PP) CVT. Baseline characteristics was compared between the groups using χ2 test, t test, or Mann-Whitney U test as appropriate, followed by multivariable regression. We used Kaplan-Meier survival analysis to assess outcome occurrence. We used interaction analysis and Cox regression to assess the risks of recurrent VTE in patients with CVT.
Results: Among 1,025 included participants with CVT, 510 (49.8%) had no identified risk factor (cryptogenic), 363 (35.4%) had at least one transient provoking factor, and 152 (14.8%) had a persistent provoking factor. Patients with TP CVT were younger (p = 0.003) and more likely to be female patients (p < 0.001). When compared with patients with TP CVT, the risk of recurrent VTE was greater in patients with PP CVT (HR 2.59, 95% CI 1.29-5.22, p = 0.008) and nonsignificantly elevated in patients with cryptogenic CVT (HR 1.85. 95% CI 0.98-3.59, p = 0.059). In the interaction analysis, there was a trend toward higher rate of recurrent VTE in female patients with cryptogenic CVT and male patients with PP CVT.
Discussion: In this multicenter study, we found that outcomes of CVT differed depending on the underlying etiology. The risk of recurrent VTE in the PP and cryptogenic CVTs may be influenced by sex.
{"title":"Outcomes and Recurrence Rates Among Patients With Provoked and Cryptogenic Cerebral Venous Thrombosis: Analysis of the ACTION CVT.","authors":"Sami Al Kasab, Eyad Almallouhi, Liqi Shu, Kimberly P Kicielinski, Setareh Salehi Omran, David S Liebeskind, Adeel S Zubair, Maria C Vedovati, Maurizio Paciaroni, Kateryna Antonenko, Mirjam R Heldner, Adam de Havenon, Nils Henninger, Shadi Yaghi","doi":"10.1212/CPJ.0000000000200381","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200381","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depends on the underlying etiology. This study aims to identify prevalence, risk factors, and recurrent venous thromboembolism (VTE) rates among patients with idiopathic (cryptogenic) CVT and CVT provoked by transient (peripartum, hormonal treatment, infection, trauma) and persistent (cancer, thrombophilia) factors.</p><p><strong>Methods: </strong>We used the ACTION-CVT retrospective database which included consecutive patients who were treated for CVT in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. We compared baseline characteristics and outcomes of patients with cryptogenic, transient provoked (TP) and those with persistent provoked (PP) CVT. Baseline characteristics was compared between the groups using χ<sup>2</sup> test, <i>t</i> test, or Mann-Whitney <i>U</i> test as appropriate, followed by multivariable regression. We used Kaplan-Meier survival analysis to assess outcome occurrence. We used interaction analysis and Cox regression to assess the risks of recurrent VTE in patients with CVT.</p><p><strong>Results: </strong>Among 1,025 included participants with CVT, 510 (49.8%) had no identified risk factor (cryptogenic), 363 (35.4%) had at least one transient provoking factor, and 152 (14.8%) had a persistent provoking factor. Patients with TP CVT were younger (<i>p</i> = 0.003) and more likely to be female patients (<i>p</i> < 0.001). When compared with patients with TP CVT, the risk of recurrent VTE was greater in patients with PP CVT (HR 2.59, 95% CI 1.29-5.22, <i>p</i> = 0.008) and nonsignificantly elevated in patients with cryptogenic CVT (HR 1.85. 95% CI 0.98-3.59, <i>p</i> = 0.059). In the interaction analysis, there was a trend toward higher rate of recurrent VTE in female patients with cryptogenic CVT and male patients with PP CVT.</p><p><strong>Discussion: </strong>In this multicenter study, we found that outcomes of CVT differed depending on the underlying etiology. The risk of recurrent VTE in the PP and cryptogenic CVTs may be influenced by sex.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200381"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-08DOI: 10.1212/CPJ.0000000000200374
Mary K Schroth, Jennifer Deans, Diana X Bharucha Goebel, W Bryan Burnette, Basil T Darras, Bakri H Elsheikh, Marcia V Felker, Andrea Klein, Jena Krueger, Crystal M Proud, Aravindhan Veerapandiyan, Robert J Graham
Background and objectives: Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by biallelic variants of the Survival Motor Neuron 1 gene (SMN1) that affects approximately 1 in 15,000 live births. Availability of 3 SMN-enhancing treatments for SMA has led to urgency to review how clinicians and patients use these treatments for SMA, while additional research and real-world data and experience are being collected. This work describes important factors to assist with decision-making for SMN-enhancing treatments.
Methods: A systematic literature review was conducted on SMN-enhancing treatments for SMA and related studies. A working group of American and European health care providers with expertise in SMA care identified barriers and developed recommendations through a modified Delphi technique with serial surveys and feedback through virtual meetings to fill gaps for information where evidence is limited. A community working group of an individual living with SMA and caregivers provided insight and perspective on SMA treatments and support through a virtual meeting to guide recommendations.
Results: The health care provider working group and the community working group agreed that when determining whether to start, change, add, or discontinue a treatment, essential considerations include patient and family/caregiver perspective, and treatment safety and side effects. When initiating treatment for patients newly diagnosed with SMA, important patient characteristics are age and Survival Motor Neuron 2 gene (SMN2) copy number. Furthermore, when initiating, changing, or adding treatment, current clinical status and comorbidities drive decision-making. When considering a medication or treatment plan change, unless there is an urgent indication, a treatment and associated patient outcomes should be monitored for a minimum of 6-12 months. When determining a treatment plan with an adolescent or adult with SMA, consider factors such as quality of life, burden vs benefit of treatment, and reproductive issues. Access to care coordination and interdisciplinary/multidisciplinary care are essential to treatment success.
Discussion: Sharing information about current knowledge of treatments and shared decision-making between health care providers and patients living with SMA and caregivers are essential to overcoming barriers to providing SMN-enhancing treatments.
背景和目的:脊髓性肌萎缩症(SMA)是一种常染色体隐性遗传疾病,由存活运动神经元 1 基因(SMN1)的双偶变异引起,每 15,000 名活产婴儿中约有 1 人患病。目前已有 3 种 SMN 增强疗法可用于治疗 SMA,这使得临床医生和患者迫切需要重新审视如何使用这些疗法治疗 SMA,同时正在收集更多的研究和实际数据与经验。本研究描述了有助于SMN增强疗法决策的重要因素:方法:对SMA的SMN增强疗法及相关研究进行了系统的文献综述。一个由具有 SMA 护理专业知识的美国和欧洲医疗保健提供者组成的工作组通过改良的德尔菲技术(Delphi technique)确定了障碍并提出了建议,同时通过虚拟会议进行连续调查和反馈,以填补证据有限的信息空白。由一名 SMA 患者和护理人员组成的社区工作组通过虚拟会议提供了有关 SMA 治疗和支持的见解和观点,以指导建议的制定:结果:医疗服务提供者工作组和社区工作组一致认为,在决定是否开始、改变、增加或中止一种治疗方法时,基本考虑因素包括患者和家属/护理者的观点以及治疗的安全性和副作用。在对新确诊的 SMA 患者开始治疗时,重要的患者特征是年龄和生存运动神经元 2 基因 (SMN2) 拷贝数。此外,在开始、改变或增加治疗时,当前的临床状态和并发症也会影响决策。在考虑更换药物或治疗方案时,除非有紧急适应症,否则应至少监测 6-12 个月的治疗效果和相关的患者预后。在为患有 SMA 的青少年或成人确定治疗方案时,应考虑生活质量、治疗负担与收益以及生育问题等因素。获得护理协调和跨学科/多学科护理对治疗成功至关重要:讨论:在医疗服务提供者和 SMA 患者及护理者之间分享有关当前治疗知识的信息并共同决策,对于克服提供 SMN 增强治疗的障碍至关重要。
{"title":"Spinal Muscular Atrophy Update in Best Practices: Recommendations for Treatment Considerations.","authors":"Mary K Schroth, Jennifer Deans, Diana X Bharucha Goebel, W Bryan Burnette, Basil T Darras, Bakri H Elsheikh, Marcia V Felker, Andrea Klein, Jena Krueger, Crystal M Proud, Aravindhan Veerapandiyan, Robert J Graham","doi":"10.1212/CPJ.0000000000200374","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200374","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by biallelic variants of the <i>Survival Motor Neuron 1</i> gene (<i>SMN1</i>) that affects approximately 1 in 15,000 live births. Availability of 3 SMN-enhancing treatments for SMA has led to urgency to review how clinicians and patients use these treatments for SMA, while additional research and real-world data and experience are being collected. This work describes important factors to assist with decision-making for SMN-enhancing treatments.</p><p><strong>Methods: </strong>A systematic literature review was conducted on SMN-enhancing treatments for SMA and related studies. A working group of American and European health care providers with expertise in SMA care identified barriers and developed recommendations through a modified Delphi technique with serial surveys and feedback through virtual meetings to fill gaps for information where evidence is limited. A community working group of an individual living with SMA and caregivers provided insight and perspective on SMA treatments and support through a virtual meeting to guide recommendations.</p><p><strong>Results: </strong>The health care provider working group and the community working group agreed that when determining whether to start, change, add, or discontinue a treatment, essential considerations include patient and family/caregiver perspective, and treatment safety and side effects. When initiating treatment for patients newly diagnosed with SMA, important patient characteristics are age and <i>Survival Motor Neuron 2</i> gene <i>(SMN2)</i> copy number. Furthermore, when initiating, changing, or adding treatment, current clinical status and comorbidities drive decision-making. When considering a medication or treatment plan change, unless there is an urgent indication, a treatment and associated patient outcomes should be monitored for a minimum of 6-12 months. When determining a treatment plan with an adolescent or adult with SMA, consider factors such as quality of life, burden vs benefit of treatment, and reproductive issues. Access to care coordination and interdisciplinary/multidisciplinary care are essential to treatment success.</p><p><strong>Discussion: </strong>Sharing information about current knowledge of treatments and shared decision-making between health care providers and patients living with SMA and caregivers are essential to overcoming barriers to providing SMN-enhancing treatments.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200374"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-08DOI: 10.1212/CPJ.0000000000200380
Kathryn A Wyman-Chick, Tanis J Ferman, Daniel Weintraub, Melissa J Armstrong, Bradley F Boeve, Ece Bayram, Ella Chrenka, Matthew J Barrett
Background and objectives: It can be clinically challenging to differentiate dementia with Lewy bodies (DLB) and Alzheimer disease (AD). As potential therapies emerge with the goal of slowing or halting misfolded protein aggregation, it is imperative to be able to identify individuals before the disease becomes disabling. Differentiating between DLB and AD in the preclinical or prodromal phase of DLB and AD becomes more important. Studies are needed to validate the proposed criteria for prodromal DLB.
Methods: Longitudinal data were obtained from the Uniform Data Set of the National Alzheimer's Coordinating Center. Included participants had a baseline diagnosis of normal or mild cognitive impairment and a consecutive 2-year follow-up diagnosis of DLB or AD. We examined whether core DLB clinical features, supportive neuropsychiatric features, and neuropsychological data in the 2 years preceding the dementia diagnosis distinguished DLB from AD.
Results: We identified 143 participants with DLB and 429 age-matched/sex-matched participants with AD. The presence of 2 or more core DLB features in the year before dementia diagnosis yielded the greatest AUC (0.793; 95% CI 0.748-0.839) in distinguishing prodromal DLB from prodromal AD. Sleep disturbances, hallucinations, and a cognitive profile of worse processing speed, attention, and visuoconstruction performance were evident at least 2 years before the dementia diagnosis in DLB compared with AD.
Discussion: Data from this multisite, longitudinal, well-characterized research North American cohort support the validity of the recently published criteria for prodromal DLB. In the prodromal stage, patients who subsequently develop DLB are more likely to have core DLB clinical features and worse attention, processing speed, and visuospatial performance than those who go on to develop AD. Differentiation of DLB and AD before dementia emerges provides an opportunity for early, disease-specific intervention and overall management.
背景和目的:区分路易体痴呆(DLB)和阿尔茨海默病(AD)在临床上具有挑战性。随着以减缓或阻止错误折叠蛋白聚集为目标的潜在疗法的出现,必须能够在疾病致残之前识别出患者。在 DLB 和 AD 的临床前或前驱阶段区分 DLB 和 AD 变得更加重要。需要进行研究来验证所提出的DLB前驱期标准:纵向数据来自国家阿尔茨海默氏症协调中心的统一数据集。纳入的参与者基线诊断为正常或轻度认知障碍,并连续两年随访诊断为DLB或AD。我们研究了核心 DLB 临床特征、支持性神经精神特征以及痴呆诊断前 2 年的神经心理学数据是否将 DLB 与 AD 区分开来:我们发现了 143 名 DLB 患者和 429 名年龄/性别匹配的 AD 患者。在痴呆诊断前一年出现 2 个或 2 个以上 DLB 核心特征的 AUC(0.793;95% CI 0.748-0.839)最高,可将前驱 DLB 与前驱 AD 区分开来。与AD相比,DLB患者在确诊痴呆症至少2年前就出现了明显的睡眠障碍、幻觉以及处理速度、注意力和视觉建构能力下降等认知特征:这个多地点、纵向、特征明确的北美研究队列的数据支持了最近公布的前驱DLB标准的有效性。在前驱阶段,后来发展为DLB的患者更有可能具有DLB的核心临床特征,其注意力、处理速度和视觉空间表现也比后来发展为AD的患者差。在痴呆症出现之前区分 DLB 和 AD,为早期进行疾病特异性干预和整体管理提供了机会。
{"title":"Distinguishing Prodromal Dementia With Lewy Bodies From Prodromal Alzheimer Disease: A Longitudinal Study.","authors":"Kathryn A Wyman-Chick, Tanis J Ferman, Daniel Weintraub, Melissa J Armstrong, Bradley F Boeve, Ece Bayram, Ella Chrenka, Matthew J Barrett","doi":"10.1212/CPJ.0000000000200380","DOIUrl":"10.1212/CPJ.0000000000200380","url":null,"abstract":"<p><strong>Background and objectives: </strong>It can be clinically challenging to differentiate dementia with Lewy bodies (DLB) and Alzheimer disease (AD). As potential therapies emerge with the goal of slowing or halting misfolded protein aggregation, it is imperative to be able to identify individuals before the disease becomes disabling. Differentiating between DLB and AD in the preclinical or prodromal phase of DLB and AD becomes more important. Studies are needed to validate the proposed criteria for prodromal DLB.</p><p><strong>Methods: </strong>Longitudinal data were obtained from the Uniform Data Set of the National Alzheimer's Coordinating Center. Included participants had a baseline diagnosis of normal or mild cognitive impairment and a consecutive 2-year follow-up diagnosis of DLB or AD. We examined whether core DLB clinical features, supportive neuropsychiatric features, and neuropsychological data in the 2 years preceding the dementia diagnosis distinguished DLB from AD.</p><p><strong>Results: </strong>We identified 143 participants with DLB and 429 age-matched/sex-matched participants with AD. The presence of 2 or more core DLB features in the year before dementia diagnosis yielded the greatest AUC (0.793; 95% CI 0.748-0.839) in distinguishing prodromal DLB from prodromal AD. Sleep disturbances, hallucinations, and a cognitive profile of worse processing speed, attention, and visuoconstruction performance were evident at least 2 years before the dementia diagnosis in DLB compared with AD.</p><p><strong>Discussion: </strong>Data from this multisite, longitudinal, well-characterized research North American cohort support the validity of the recently published criteria for prodromal DLB. In the prodromal stage, patients who subsequently develop DLB are more likely to have core DLB clinical features and worse attention, processing speed, and visuospatial performance than those who go on to develop AD. Differentiation of DLB and AD before dementia emerges provides an opportunity for early, disease-specific intervention and overall management.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200380"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11464229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-06DOI: 10.1212/CPJ.0000000000200418
Jamison Seabury, Jennifer Weinstein, Anika Varma, Spencer James Rosero, Charlotte Engebrecht, Abigail Arky, Christine Zizzi, Nuran Dilek, Abigail Mathewson, Susan Salem-Spencer, Elizabeth J Santos, Chad Rydel Heatwole
Background and objectives: In preparation for future clinical trials involving individuals with Alzheimer disease (AD), mild cognitive impairment (MCI), and dementia, it is important to ascertain the widespread impact of symptoms from the direct perspectives of patients and caregivers. In this study, we performed cross-sectional surveys using large-scale patient and caregiver data to identify the prevalence and average impact of symptoms and symptomatic themes experienced by adults with AD, MCI, and dementia. Subsequent analyses were used to determine which demographic and disease-specific factors are associated with more severe disease.
Methods: Fifteen adults with AD (6), MCI (8), and dementia (1) and 15 caregivers of adults with AD (7), MCI (6), and dementia (2) participated in qualitative interviews providing 1,166 and 1,097 unique quotes pertaining to symptom burden. Using open-ended questions from a comprehensive interview guide, participants were asked to identify the symptoms of AD that have the greatest effect on their lives or the lives of the individual for whom they provide care. A cross-sectional survey was then implemented inquiring about the potential symptoms of importance identified during preliminary qualitative interviews. Four-hundred thirty-three individuals (patients and caregivers) participated in the cross-sectional survey, providing more than 35,000 symptom rating responses. Subsequent analyses were conducted to determine how demographic and disease-specific characteristics correlate with symptomatic theme prevalence.
Results: The most frequent symptomatic themes reported by individuals with AD, MCI, and dementia in the cross-sectional survey were memory problems (99.0%), problems thinking (90.3%), and communication difficulties (80.4%). Patients identified decreased satisfaction in social situations (1.45), fatigue (1.45), and memory problems (1.41) as the most impactful symptomatic themes (range 0-4). Patient-reported symptomatic theme prevalence was strongly associated with the Modified Rankin Scale (mRS) for neurologic disability.
Discussion: Individuals with AD, MCI, and dementia experience a variety of symptoms that significantly affect their daily lives. These symptoms, many underrecognized, are of variable importance to individuals with these diseases and may inform potential targets for future therapeutic intervention as well as facilitate the development and validation of disease-specific outcome measures.
{"title":"Patient- and Caregiver-Reported Impact of Symptoms in Alzheimer Disease, Mild Cognitive Impairment, and Dementia.","authors":"Jamison Seabury, Jennifer Weinstein, Anika Varma, Spencer James Rosero, Charlotte Engebrecht, Abigail Arky, Christine Zizzi, Nuran Dilek, Abigail Mathewson, Susan Salem-Spencer, Elizabeth J Santos, Chad Rydel Heatwole","doi":"10.1212/CPJ.0000000000200418","DOIUrl":"10.1212/CPJ.0000000000200418","url":null,"abstract":"<p><strong>Background and objectives: </strong>In preparation for future clinical trials involving individuals with Alzheimer disease (AD), mild cognitive impairment (MCI), and dementia, it is important to ascertain the widespread impact of symptoms from the direct perspectives of patients and caregivers. In this study, we performed cross-sectional surveys using large-scale patient and caregiver data to identify the prevalence and average impact of symptoms and symptomatic themes experienced by adults with AD, MCI, and dementia. Subsequent analyses were used to determine which demographic and disease-specific factors are associated with more severe disease.</p><p><strong>Methods: </strong>Fifteen adults with AD (6), MCI (8), and dementia (1) and 15 caregivers of adults with AD (7), MCI (6), and dementia (2) participated in qualitative interviews providing 1,166 and 1,097 unique quotes pertaining to symptom burden. Using open-ended questions from a comprehensive interview guide, participants were asked to identify the symptoms of AD that have the greatest effect on their lives or the lives of the individual for whom they provide care. A cross-sectional survey was then implemented inquiring about the potential symptoms of importance identified during preliminary qualitative interviews. Four-hundred thirty-three individuals (patients and caregivers) participated in the cross-sectional survey, providing more than 35,000 symptom rating responses. Subsequent analyses were conducted to determine how demographic and disease-specific characteristics correlate with symptomatic theme prevalence.</p><p><strong>Results: </strong>The most frequent symptomatic themes reported by individuals with AD, MCI, and dementia in the cross-sectional survey were memory problems (99.0%), problems thinking (90.3%), and communication difficulties (80.4%). Patients identified decreased satisfaction in social situations (1.45), fatigue (1.45), and memory problems (1.41) as the most impactful symptomatic themes (range 0-4). Patient-reported symptomatic theme prevalence was strongly associated with the Modified Rankin Scale (mRS) for neurologic disability.</p><p><strong>Discussion: </strong>Individuals with AD, MCI, and dementia experience a variety of symptoms that significantly affect their daily lives. These symptoms, many underrecognized, are of variable importance to individuals with these diseases and may inform potential targets for future therapeutic intervention as well as facilitate the development and validation of disease-specific outcome measures.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200418"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-17DOI: 10.1212/CPJ.0000000000200433
Susanna B Mierau
Attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder that causes difficulties with sustained attention, executive functioning, impulsivity, hyperactivity, and/or emotional regulation. Although many people are diagnosed with ADHD in childhood, others seek diagnosis in adulthood. Many adults have already reviewed available clinical scales or screening tools for ADHD and are referred for evaluation of attention problems by their primary care providers. Key features of the history and examination in a clinic visit can differentiate ADHD from other causes of attention problems in adults. Treatment with stimulant or nonstimulant medications for ADHD can be life-changing for adults with ADHD, increasing productivity at home and work, reducing anxiety and impulsive behaviors, and improving interpersonal and community relationships. This article aids neurologists in differentiating ADHD from other causes of attention and executive functioning problems in adults and in initiating treatment.
{"title":"Do I Have ADHD? Diagnosis of ADHD in Adulthood and Its Mimics in the Neurology Clinic.","authors":"Susanna B Mierau","doi":"10.1212/CPJ.0000000000200433","DOIUrl":"10.1212/CPJ.0000000000200433","url":null,"abstract":"<p><p>Attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder that causes difficulties with sustained attention, executive functioning, impulsivity, hyperactivity, and/or emotional regulation. Although many people are diagnosed with ADHD in childhood, others seek diagnosis in adulthood. Many adults have already reviewed available clinical scales or screening tools for ADHD and are referred for evaluation of attention problems by their primary care providers. Key features of the history and examination in a clinic visit can differentiate ADHD from other causes of attention problems in adults. Treatment with stimulant or nonstimulant medications for ADHD can be life-changing for adults with ADHD, increasing productivity at home and work, reducing anxiety and impulsive behaviors, and improving interpersonal and community relationships. This article aids neurologists in differentiating ADHD from other causes of attention and executive functioning problems in adults and in initiating treatment.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 1","pages":"e200433"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}