Revue neurologique最新文献

{"title":"Disease modifying treatment of radiologically isolated syndrome: A systematic review of the use, efficacy, effectiveness, and safety","authors":"D. Ripsman ,&nbsp;H. Tremlett ,&nbsp;A. Alzahrani ,&nbsp;N Makhani","doi":"10.1016/j.neurol.2025.09.005","DOIUrl":"10.1016/j.neurol.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Radiologically isolated syndrome (RIS) is characterized by incidental brain lesions suggestive of demyelination without symptoms of multiple sclerosis (MS). We systematically assessed the use, benefits, and adverse effects of DMTs for RIS.</div></div><div><h3>Methods</h3><div>MEDLINE, EMBASE, and Web of Science were searched to identify English language studies including individuals with RIS treated with a DMT. Extracted data included patient characteristics, clinical progression, and adverse events. We conducted a meta-analysis using inverse probability weighting. Risk of bias (RoB) assessments used Cochrane's RoB-2 tool and Newcastle-Ottawa cohort study scale.</div></div><div><h3>Results</h3><div>A total of 1012 abstracts were screened: 20 studies were included consisting of 2 RCTs, 12 observational cohort studies, and 6 case reports. A total of 1401 individuals with RIS were included; 291 (21%) received a DMT. The two RCTs randomized people with RIS to teriflunomide or dimethyl fumarate versus placebo and followed patients for at least 96<!--> <!-->weeks. In all other studies, follow-up ranged from 2<!--> <!-->months to 18<!--> <!-->years; only 3 studies exceeded 5<!--> <!-->years. DMT treatment was associated with a lower risk of a clinical demyelinating event (4 studies with different DMTs, adjusted hazard ratio<!--> <!-->=<!--> <!-->0.37 95% confidence interval [CI]: 0.15–0.95, high certainty). There was a higher rate of adverse events in DMT treated patients with RIS versus placebo (risk ratio<!--> <!-->=<!--> <!-->1.44, 95% CI: 1.09–1.90, moderate certainty). RoB was low for both RCTs, but high for 83% (10/12) of cohort studies.</div></div><div><h3>Conclusions</h3><div>DMTs reduced the risk of a clinical demyelinating event in individuals with RIS, albeit with more adverse events compared to placebo. However, no literature addressed longer-term benefits/adverse effects.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 10","pages":"Pages 955-969"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neural correlates of foreign accent syndrome: Is white matter the key to the mystery?","authors":"G. Costentin ,&nbsp;L. Deheinzelin ,&nbsp;L. Zourdani ,&nbsp;O. Ozkul ,&nbsp;A. Triquenot ,&nbsp;E. Massardier ,&nbsp;D. Maltete ,&nbsp;D. Wallon ,&nbsp;A. Morin","doi":"10.1016/j.neurol.2025.08.003","DOIUrl":"10.1016/j.neurol.2025.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Foreign accent syndrome is a rare entity with neural underpinnings that are not yet fully understood. Cases of neurogenic foreign accent syndrome due to right hemisphere lesion are very uncommon. We investigated the cortical and white matter lesions in a patient to better understand this syndrome.</div></div><div><h3>Case report</h3><div>A 39-year-old French woman had a right middle cerebral artery stroke. This French native speaker was now perceived as speaking with an English accent, without signs of dysarthria or aphasia. Lesions involved right insula, pre-central gyrus and surrounding white matter tracts. After transformation in MNI-152 coordinate system, we compared the lesions in our patient with Tractotron software, a white matter tract tool providing a probability of fiber disconnection.</div></div><div><h3>Discussion</h3><div>Speech evaluation suggested a disruption in the speech output motor system. We found lesions within this system, in anterior frontal and insular cortices, in accordance with previous descriptions. Besides structural grey matter damage, white matter also exhibited damage related to the stroke, particularly the frontal aslant tract. Very few studies have focused on the specific role of this tract in speech motor programming, but a role in speech production and stuttering have been described. Some cases of foreign accent syndrome appeared consecutively to right hemisphere lesions. There is growing evidence suggesting that right hemisphere lesions might lead to subclinical alteration of prosody contributing to the emergence of foreign accent syndrome.</div></div><div><h3>Conclusion</h3><div>This study emphasizes the importance of analyzing subcortical areas and their associated tracts, which could play a crucial role in better understanding symptoms and anatomical correlation.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 10","pages":"Pages 970-974"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Hippocampal encephalopathy in heavy cannabis user: An emerging syndrome?","authors":"L. Lebrun ,&nbsp;V. Binkiewicz ,&nbsp;M. Reiff ,&nbsp;P. Kerschen","doi":"10.1016/j.neurol.2025.10.003","DOIUrl":"10.1016/j.neurol.2025.10.003","url":null,"abstract":"","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 10","pages":"Pages 1031-1033"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term follow-up of anti-MAG neuropathy patients given bendamustine plus rituximab combination therapy","authors":"N. Bezou ,&nbsp;P. Morel ,&nbsp;B. Hivert ,&nbsp;E. Diab ,&nbsp;P. Merle ,&nbsp;C. Tard","doi":"10.1016/j.neurol.2025.09.009","DOIUrl":"10.1016/j.neurol.2025.09.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Anti-myelin-associated glycoprotein (anti-MAG) IgM antibodies provoke demyelinating neuropathies, which can be particularly disabling. Conventionally, patients with anti-MAG neuropathies were treated with rituximab alone. This study aimed to evaluate the clinical and electrophysiological efficacy of bendamustine-rituximab (BR) combination therapy for anti-MAG neuropathy patients.</div></div><div><h3>Methods</h3><div>We retrospectively consulted the medical records of 11 patients whose diagnosis of anti-MAG neuropathy was retained and who were given BR combination therapy at university and community hospitals in northern France between 2017 and 2022. We collected clinical scores and electrophysiological data before BR therapy and at six to eleven months after treatment end (mean<!--> <!-->=<!--> <!-->8.40<!--> <!-->months).</div></div><div><h3>Results</h3><div>After BR therapy, six of eleven patients (54%) showed an improvement in their overall neuropathy limitations scale (ONLS) score as did five of eleven (45%) in their peripheral neuropathy disability (PND) score, but these results did not reach statistical significance. For the six patients who had a more complete clinical revaluation based on the neuropathy impairment score (NIS), five improved (<em>P</em> <!-->=<!--> <!-->0.021). An improvement in the sensory NIS was observed in three of six patients (50%), while the motor NIS remained stable. Patients improving their PND score seemed to start from a higher baseline value. Five of eight (62%) patients with electrodiagnostic control data met <em>Lunn and Nobile-Orazio's</em> electrophysiological improvement criteria. The higher the baseline PND score, the less likely was improvement of electrodiagnostic parameters. No link between duration of disease progression before treatment and clinical response was found.</div></div><div><h3>Conclusion</h3><div>This multicenter cohort of anti-MAG patients given BR combination therapy is, to our knowledge, the largest published to date. Although BR therapy seems to improve the clinical and electrophysiological outcome of anti-MAG patients, precise evaluation scales are nevertheless needed to highlight improvement. Sensitive scales such as the NIS should be used routinely for monitoring anti-MAG patients. Prospective studies with a larger number of patients would be useful to confirm the efficacy of BR therapy in these patients.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 10","pages":"Pages 1008-1014"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors of epilepsy in a cohort of brain arteriovenous malformation patients with a 5-year follow-up","authors":"B.O. Pirlog ,&nbsp;M. Porché ,&nbsp;M. Kyheng ,&nbsp;J. Labreuche ,&nbsp;A. Taleb ,&nbsp;E. Dubus ,&nbsp;E. Houdart ,&nbsp;M. Mazighi","doi":"10.1016/j.neurol.2025.09.007","DOIUrl":"10.1016/j.neurol.2025.09.007","url":null,"abstract":"<div><h3>Background and aims</h3><div>Data on factors associated with new-onset epilepsy in the follow-up of patients with brain arteriovenous malformations (BAVM) are scarce. We aimed to characterize the baseline patient and BAVM characteristics related to epilepsy and the predictive factors of new-onset epilepsy in BAVM patients during their follow-up.</div></div><div><h3>Patients and methods</h3><div>We retrospectively analyzed 200 BAVM patients treated between 2000 and 2023. We used univariate and multivariate analyses to assess the association between baseline characteristics and seizures. The risk of developing seizures during follow-up was estimated using nonparametric survival analysis for interval-censored data.</div></div><div><h3>Results</h3><div>In the present cohort, 90/200 patients (45%) had epilepsy at baseline. Patients with epilepsy were predominantly men (71.1%), and alcohol users (18.8%), and presented with BAVM located more often in the frontal lobe (55.6%) as compared to patients without epilepsy (40%, 7.4%, 23.6% respectively). Male gender was associated with higher prevalence of seizures at inclusion (OR 3.81 [95%CI, 1.77; 8.24]), while headaches (OR 0.19 [95% CI, 0.09; 0.41]), focal deficit (OR 0.22 [0.09; 0.49]) and BAVM occipital localization (OR 0.16 [95% CI, 0.05; 0.47]) remained associated with lower prevalence of epilepsy at inclusion. Among patients without epilepsy at baseline, 20.6% had new-onset epilepsy after five years. Baseline predictors of seizure occurrence included ruptured BAVM (HR 3.77 [95%CI 1.50; 9.44]) and surgery (HR 7.75, 95%CI, [2.04; 29.45]).</div></div><div><h3>Conclusions</h3><div>For patients with newly diagnosed BAVM, male gender, and frontal topography were baseline characteristics associated with a higher risk of epilepsy. Among patients without epilepsy, ruptured BAVM and surgery at baseline were predictors of epilepsy at five years follow-up.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 10","pages":"Pages 991-997"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lecanemab in France: The Times They Are a-Changin’?","authors":"N. Villain ,&nbsp;V. Planche ,&nbsp;A. Garnier-Crussard ,&nbsp;D. Wallon","doi":"10.1016/j.neurol.2025.10.002","DOIUrl":"10.1016/j.neurol.2025.10.002","url":null,"abstract":"","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 10","pages":"Pages 951-954"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic meningoencephalitis due to enterovirus A71 complicating rituximab therapy","authors":"A. David ,&nbsp;M. Claudé ,&nbsp;G. Martin de Frémont ,&nbsp;G. Trédez ,&nbsp;C. Henry","doi":"10.1016/j.neurol.2025.09.003","DOIUrl":"10.1016/j.neurol.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Rituximab and other anti-CD20 therapies are increasingly used in the treatment of autoimmune and hematologic disorders. These treatments are associated with persistent immune impairment, potentially leading to severe infections. We describe a resolutive case of proven chronic enterovirus A71 (EV A71) meningoencephalitis complicating rituximab maintenance therapy for non-Hodgkin lymphoma.</div></div><div><h3>Methods</h3><div>This article combines an original case report and a literature review of cases of enteroviral meningoencephalitis complicating rituximab treatment.</div></div><div><h3>Results</h3><div>A 38-year-old man was treated with rituximab and chemotherapy for a mantle cell lymphoma. During maintenance treatment with rituximab, he developed a “hand-foot-mouth disease”, and one month later severe neurological deterioration including quadriparesis and major neurocognitive disorder leading to a diagnosis of chronic enteroviral meningoencephalitis. A treatment associating monthly intravenous immunoglobulins (IVIg) and fluoxetine was initiated two months after neurological symptoms onset, resulting in dramatic clinical improvement within six months. A brief literature review shows that a treatment with high-dose IVIg often results in clinical improvement. Fluoxetine was added in recent reports based on in vitro evidence of anti-viral activity against enteroviruses.</div></div><div><h3>Discussion</h3><div>Enteroviral infection should be evoked in patients treated with rituximab presenting with an encephalitic symptomatology, and restoring humoral immunity with high-dose IVIg might improve their condition.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 10","pages":"Pages 975-980"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-onset epilepsy as a prodromal symptom","authors":"S. Dupont","doi":"10.1016/j.neurol.2025.07.007","DOIUrl":"10.1016/j.neurol.2025.07.007","url":null,"abstract":"<div><div>Late-onset epilepsy (LOE) of unknown etiology accounts for 15–30% of all LOE cases. A critical question is whether these unexplained seizures represent a prodromal manifestation of an underlying neurological disorder — most notably, stroke or Alzheimer's disease (AD). Growing evidence suggests that seizures may be an early sign of subclinical cerebrovascular disease, serving as a warning signal for future stroke, or an early symptom of a neurodegenerative disorder, particularly AD, reflecting initial pathological changes such as amyloid-β and tau deposition. An alternative hypothesis proposes that shared risk factors — especially cardiovascular ones — underlie all three conditions: LOE, stroke, and AD. As a result, it is recommended that patients with LOE of unknown etiology undergo comprehensive cardiovascular evaluation and receive appropriate management of any identified risk factors. However, it remains unclear whether this approach is sufficient to prevent future strokes. Cognitive assessment is also essential in these patients. In this context, prodromal seizures may provide an opportunity to identify individuals suitable for early, targeted interventions aimed at slowing neurodegeneration.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 9","pages":"Pages 929-936"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145486256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo molecular imaging of brain tissue pathology in presymptomatic multiple sclerosis","authors":"V.A.G. Ricigliano ,&nbsp;B. Stankoff","doi":"10.1016/j.neurol.2025.07.015","DOIUrl":"10.1016/j.neurol.2025.07.015","url":null,"abstract":"<div><div>The presence of focal lesions suggestive of multiple sclerosis (MS) seen with magnetic resonance imaging (MRI) in asymptomatic individuals defines the radiologically isolated syndrome (RIS). Pathologically, tissue changes in RIS subjects recapitulate, although being less extensive and pronounced, those observed in definite MS, with an amount of innate immune cell activation, myelin loss, gliosis, metabolic modifications, and structural damage affecting the neuro-axonal compartment. Conventional MRI, however, is not able to capture these biological abnormalities at the cellular and molecular level. Positron emission tomography (PET) with specific radiolabeled compounds could fill this gap, identifying in vivo and with higher granularity the processes underling the abnormal MRI signals. This review presents data obtained with PET in RIS individuals and discusses the potential application of this technique in exploring the different pathophysiologic changes going on in the RIS brain, with technical considerations on radiotracers already tested in MS or newly developed. By breaking up the study of complex tissular changes into single biological phenomena, the use of PET in RIS could encourage early interventions to selectively target each one of them, with potential consequences on the clinical conversion to MS.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 9","pages":"Pages 847-851"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145486262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presymptomatic multiple sclerosis: Insights from the Radiologically Isolated Syndrome","authors":"C. Lebrun-Frenay ,&nbsp;M. Cohen ,&nbsp;D.T. Okuda","doi":"10.1016/j.neurol.2025.06.013","DOIUrl":"10.1016/j.neurol.2025.06.013","url":null,"abstract":"<div><div>Radiologically isolated syndrome (RIS) represents the initial phase of multiple sclerosis (MS) and is identified incidentally in asymptomatic individuals who display typical brain or spinal cord lesions indicative of autoimmune inflammatory demyelination. The 2023 RIS criteria enhance diagnostic precision against imaging mimics by requiring one T2-weighted hyperintense lesion in two of four specified locations (periventricular, juxtacortical/cortical, infratentorial, spinal cord) alongside at least two of the following: a spinal cord lesion, CSF-restricted oligoclonal bands (OCB), or a new T2/gadolinium-enhancing lesion on MRI at any point, defining dissemination in time (DIT). After confirming the diagnosis, established risk factors for transition to clinical MS need to be assessed. Key factors include a younger age, male sex, the presence of infratentorial, spinal cord, or gadolinium-enhancing lesions, and CSF-restricted OCBs or increased kappa-free light chains. Two randomized trials showed the efficacy of two oral disease-modifying therapies in delaying the first clinical event in RIS. However, as some individuals remain asymptomatic, it's crucial to identify suitable candidates to balance treatment benefits with potential risks. Reviewing each RIS case with an MS expert team is advisable for better care and monitoring. The updated 2024 McDonald criteria classify RIS patients with additional features, such as positive CSF and susceptibility MRI biomarkers, as having preclinical MS.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 9","pages":"Pages 839-846"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804573","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}