Pub Date : 2026-01-01DOI: 10.1016/j.neurol.2025.10.004
E. Oprea
Sexual difficulties are common but under-recognized in Parkinson's disease (PD), significantly affecting quality of life. They include both sexual dysfunction (SD) — a non-motor symptom — and hypersexuality (HS) — an impulse control disorder (ICD). SD often presents as reduced libido, arousal issues, or orgasmic problems, while HS involves compulsive sexual thoughts or behaviors, often linked to dopamine agonists. These opposing symptoms may coexist, adding to diagnostic complexity. Sexual health in PD is influenced by neurological, vascular, endocrine, psychological, and medication-related factors. Despite its impact, sexual difficulties are rarely discussed in clinical settings due to limited time and patient reluctance. A proactive, nonjudgmental approach is essential. This review aims to equip neurologists with practical, time-efficient strategies to identify and manage sexual difficulties in both men and women with PD.
{"title":"Addressing sexual difficulties in Parkinson's disease","authors":"E. Oprea","doi":"10.1016/j.neurol.2025.10.004","DOIUrl":"10.1016/j.neurol.2025.10.004","url":null,"abstract":"<div><div>Sexual difficulties are common but under-recognized in Parkinson's disease (PD), significantly affecting quality of life. They include both sexual dysfunction (SD) — a non-motor symptom — and hypersexuality (HS) — an impulse control disorder (ICD). SD often presents as reduced libido, arousal issues, or orgasmic problems, while HS involves compulsive sexual thoughts or behaviors, often linked to dopamine agonists. These opposing symptoms may coexist, adding to diagnostic complexity. Sexual health in PD is influenced by neurological, vascular, endocrine, psychological, and medication-related factors. Despite its impact, sexual difficulties are rarely discussed in clinical settings due to limited time and patient reluctance. A proactive, nonjudgmental approach is essential. This review aims to equip neurologists with practical, time-efficient strategies to identify and manage sexual difficulties in both men and women with PD.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"182 1","pages":"Pages 1-9"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426794","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 : 2026-01-01DOI: 10.1016/j.neurol.2025.10.007
E. Hologne , Y. Chen , S. Moulin , L. Tyvaert
Late-onset epilepsy of unknown origin (LOEU) is a prevalent and disabling condition. Emerging evidence suggests a potential link between LOEU and new-onset dementia. Cerebral small vessel disease (cSVD) is a common pathology and a major risk factor for both stroke and dementia. cSVD has been hypothesized to contribute to the development of LOEU and cognitive decline through blood-brain barrier dysfunction. This review summarizes current data exploring the association between LOEU and cSVD, highlighting conflicting results, probably due to major methodological limitations. Furthermore, in individuals over 60 years of age conditions such as obstructive sleep apnea (OSA), amyloidopathy, and tauopathy are frequently observed and independently associated with both LOEU and cSVD. To date, no robust evidence has established cSVD as a causal factor of LOEU. The complex interplay of these conditions necessitates further investigation to quantify the contribution of each pathology to the development of LOEU. Future studies using rigorous methodologies are required to determine whether cSVD acts as a primary trigger or merely represents a bystander in LOEU.
{"title":"Small vessel disease: Trigger or bystander of late-onset epilepsy of unknown origin?","authors":"E. Hologne , Y. Chen , S. Moulin , L. Tyvaert","doi":"10.1016/j.neurol.2025.10.007","DOIUrl":"10.1016/j.neurol.2025.10.007","url":null,"abstract":"<div><div>Late-onset epilepsy of unknown origin (LOEU) is a prevalent and disabling condition. Emerging evidence suggests a potential link between LOEU and new-onset dementia. Cerebral small vessel disease (cSVD) is a common pathology and a major risk factor for both stroke and dementia. cSVD has been hypothesized to contribute to the development of LOEU and cognitive decline through blood-brain barrier dysfunction. This review summarizes current data exploring the association between LOEU and cSVD, highlighting conflicting results, probably due to major methodological limitations. Furthermore, in individuals over 60 years of age conditions such as obstructive sleep apnea (OSA), amyloidopathy, and tauopathy are frequently observed and independently associated with both LOEU and cSVD. To date, no robust evidence has established cSVD as a causal factor of LOEU. The complex interplay of these conditions necessitates further investigation to quantify the contribution of each pathology to the development of LOEU. Future studies using rigorous methodologies are required to determine whether cSVD acts as a primary trigger or merely represents a bystander in LOEU.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"182 1","pages":"Pages 26-35"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820513","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 : 2026-01-01DOI: 10.1016/j.neurol.2025.11.007
M. Sýkora , S. Baranová , E. Parobková , T. Moško , J. Keller , K. Holada , R. Rusina , R. Matěj
Gerstmann–Sträussler–Scheinker syndrome is an extremely rare hereditary human prion disease caused by distinct mutations in the prion protein-encoding gene and is frequently associated with a positive family history. The disease typically presents with progressive cerebellar symptoms such as gaze apraxia with limb ataxia and axial ataxia; thus, the diagnostic process is often challenging due to nonspecific clinical presentation. We present a case of a 73-year-old patient with no family history of dementia and cerebellar symptomatology during the course of rapidly progressing dementia. Owing to the clinical suspicion of prion disease, antemortem analysis of cerebrospinal fluid using a real-time quaking-induced conversion (RT-QuIC) assay was performed, with positive results. Postmortem histopathological examination confirmed a familiar form of human prion disease with concomitant asymptomatic tauopathy. An additional finding was a novel 6 octapeptide repeat insertion mutation in the prion gene. Familiar cases with an increasing number of repeated insertions seem to be associated with a longer overall disease course, milder clinical deterioration and often false-negative RT-QuIC results. The performance of RT-QuIC in inherited prion diseases may vary. Our case, involving a 6 octapeptide repeat insertion mutation, is particularly noteworthy due to the rapidly progressive clinical course and positive RT-QuIC results in both antemortem and postmortem tissue analyses.
{"title":"Gerstmann–Sträussler–Scheinker syndrome neuropathology in a Creutzfeldt–Jakob disease-like phenotype patient caused by a novel 6-OPRI sequence in the PRNP gene","authors":"M. Sýkora , S. Baranová , E. Parobková , T. Moško , J. Keller , K. Holada , R. Rusina , R. Matěj","doi":"10.1016/j.neurol.2025.11.007","DOIUrl":"10.1016/j.neurol.2025.11.007","url":null,"abstract":"<div><div>Gerstmann–Sträussler–Scheinker syndrome is an extremely rare hereditary human prion disease caused by distinct mutations in the prion protein<em>-encoding g</em>ene and is frequently associated with a positive family history. The disease typically presents with progressive cerebellar symptoms such as gaze apraxia with limb ataxia and axial ataxia; thus, the diagnostic process is often challenging due to nonspecific clinical presentation. We present a case of a 73-year-old patient with no family history of dementia and cerebellar symptomatology during the course of rapidly progressing dementia. Owing to the clinical suspicion of prion disease, <em>antemortem</em> analysis of cerebrospinal fluid using a real-time quaking-induced conversion (RT-QuIC) assay was performed, with positive results<em>. Postmortem</em> histopathological examination confirmed a familiar form of human prion disease with concomitant asymptomatic tauopathy. An additional finding was a novel 6 octapeptide repeat insertion mutation in the prion gene. Familiar cases with an increasing number of repeated insertions seem to be associated with a longer overall disease course, milder clinical deterioration and often false-negative RT-QuIC results. The performance of RT-QuIC in inherited prion diseases may vary. Our case, involving a 6 octapeptide repeat insertion mutation, is particularly noteworthy due to the rapidly progressive clinical course and positive RT-QuIC results in both <em>antemortem</em> and <em>postmortem</em> tissue analyses.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"182 1","pages":"Pages 97-105"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846223","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 : 2026-01-01DOI: 10.1016/j.neurol.2025.11.004
E.K. Van Obberghen , R. Fabre , L. Bailly , M. Lanteri-Minet
The burden of cluster headache (CH) requires better knowledge of management to improve it.
Objectives
To describe changes in the real-world management of CH treated with subcutaneous sumatriptan and/or oxygen in France over the period 2014–2024.
Methods
This is an analysis of two open data databases from the French Social Health Insurance (‘Open Medic’ and ‘Open LPP’), providing an annual estimate from 2014 to 2024 of the delivery of subcutaneous sumatriptan and/or oxygen, the number of beneficiaries of these treatments and their socio-demographic profile.
Results
Annual deliveries of subcutaneous sumatriptan increased from 286,999 boxes in 2014 to 454,275 boxes in 2024 (58.2% increase). Beneficiaries of subcutaneous sumatriptan increased from 13,638 individuals in 2014 to 19,109 individuals in 2024 (40.1% increase). Annual deliveries of package for the weekly use of oxygen therapy equipment increased from 224,143 in 2014 to 790,768 in 2024 (2.5 times more). Beneficiaries of oxygen for CH increased from 7493 individuals in 2014 to 22,346 individuals in 2024 (2 times more). Over the period 2014–2024, the male to female ratio decreased from 2.3/1 to 1.5/1 and from 1.5/1 to 0.8/1 for individuals receiving subcutaneous sumatriptan and individuals receiving oxygen respectively.
Conclusions
The delivery of subcutaneous sumatriptan and oxygen increased from 2014 to 2024, reflecting an improvement in the management of cluster headache in France. Nevertheless, given the one year-prevalence of this disease and the number of people expected to suffer from it, the number of people benefiting from these two treatments in 2024 indicates that there are still unmet needs. This study confirms the increase in the number of women treated for cluster headache observed over the last twenty years.
{"title":"Trends in the real-world management of cluster headache patients treated by subcutaneous sumatriptan and/or oxygen in France – An analysis of the French National Social Security System Open Data over eleven years (2014–2024)","authors":"E.K. Van Obberghen , R. Fabre , L. Bailly , M. Lanteri-Minet","doi":"10.1016/j.neurol.2025.11.004","DOIUrl":"10.1016/j.neurol.2025.11.004","url":null,"abstract":"<div><div>The burden of cluster headache (CH) requires better knowledge of management to improve it.</div></div><div><h3>Objectives</h3><div>To describe changes in the real-world management of CH treated with subcutaneous sumatriptan and/or oxygen in France over the period 2014–2024.</div></div><div><h3>Methods</h3><div>This is an analysis of two open data databases from the French Social Health Insurance (‘Open Medic’ and ‘Open LPP’), providing an annual estimate from 2014 to 2024 of the delivery of subcutaneous sumatriptan and/or oxygen, the number of beneficiaries of these treatments and their socio-demographic profile.</div></div><div><h3>Results</h3><div>Annual deliveries of subcutaneous sumatriptan increased from 286,999 boxes in 2014 to 454,275 boxes in 2024 (58.2% increase). Beneficiaries of subcutaneous sumatriptan increased from 13,638 individuals in 2014 to 19,109 individuals in 2024 (40.1% increase). Annual deliveries of package for the weekly use of oxygen therapy equipment increased from 224,143 in 2014 to 790,768 in 2024 (2.5 times more). Beneficiaries of oxygen for CH increased from 7493 individuals in 2014 to 22,346 individuals in 2024 (2 times more). Over the period 2014–2024, the male to female ratio decreased from 2.3/1 to 1.5/1 and from 1.5/1 to 0.8/1 for individuals receiving subcutaneous sumatriptan and individuals receiving oxygen respectively.</div></div><div><h3>Conclusions</h3><div>The delivery of subcutaneous sumatriptan and oxygen increased from 2014 to 2024, reflecting an improvement in the management of cluster headache in France. Nevertheless, given the one year-prevalence of this disease and the number of people expected to suffer from it, the number of people benefiting from these two treatments in 2024 indicates that there are still unmet needs. This study confirms the increase in the number of women treated for cluster headache observed over the last twenty years.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"182 1","pages":"Pages 75-81"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775593","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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