Neurology, distilled.

To evaluate the safety and effectiveness of middle meningeal artery embolization (MMAE) with the TRUFILL n-butyl cyanoacrylate (n-BCA) liquid embolic system plus standard of care versus standard of care alone in patients with symptomatic chronic subdural hematoma.

Primary effectiveness end point (residual/re-accumulation of hematoma >10 mm at 6 months or surgery on the cSDH within 6 months) occurred in 11.6% (17/146) with MMAE plus SOC vs 22.1% (29/131) with SOC alone — common OR 0.53 (90% CI, 0.31-0.91); P = .04, a 47% reduction in odds

To evaluate the safety, tolerability, and efficacy of alixorexton (ALKS 2680), an oral orexin 2 receptor (OX2R) agonist, in adults with narcolepsy type 1.

Alixorexton dramatically improved wakefulness at week 6: placebo-corrected LSM change in mean sleep latency on the MWT was +22.2 min (95% CI 17.2–27.2, adjusted p=0.0099) for 4 mg, +24.1 min (19.0–29.1, p<0.0001) for 6 mg, and +26.0 min (21.0–31.0, p<0.0001) for 8 mg; observed MSL reached the normative range (≥20 min) in all dose groups

To evaluate the long-term safety, tolerability, and immunological memory of ABvac40 active immunotherapy (anti-Aβ40 vaccine) in an 18-month extension (Part B) of a phase 2 trial in amnestic MCI and very mild Alzheimer's disease, including a delayed booster in previously vaccinated participants and first-time vaccination of prior placebo participants.

TEAEs occurred in 75.0% of the placebo + booster group and 81.1% of the ABvac40 group during Part B; serious TEAEs in 5.0% vs 16.2%, with no deaths and no TEAEs leading to discontinuation

To systematically identify factors associated with an increased likelihood of a multiple sclerosis (MS) diagnosis after a clinically isolated syndrome (CIS), via systematic review and meta-analysis of observational studies.

Younger age at CIS onset (OR 1.60, 95% CI 1.30–2.00, p=0.0001) and multifocal presentation (OR 1.55, 95% CI 1.10–2.19, p=0.022) predicted subsequent MS diagnosis

To determine whether plasma p-tau217 can reliably detect treatment-related amyloid clearance (TRAC, <24.1 Centiloids on amyloid PET) after donanemab treatment in early symptomatic Alzheimer's disease, using data from the phase 3 TRAILBLAZER-ALZ 2 trial.

Plasma p-tau217 (mass spectrometry) showed low diagnostic performance for detecting TRAC (<24.1 CL on PET): AUROC 0.61 at 52 weeks, 0.64 at 24 weeks, 0.63 at 76 weeks; immunoassay similar (AUROC 0.67 at 24 weeks, 0.64 at 52 and 76 weeks)

In patients with acute ischaemic stroke due to large vessel occlusion undergoing endovascular thrombectomy, does a single IV dose of nerinetide (2.6 mg/kg) improve 90-day functional outcomes compared with placebo.

Primary outcome (mRS 0–2 at 90 days) was not met: 337/549 (61.4%) nerinetide vs 329/556 (59.2%) placebo; adjusted RR 1.04 (95% CI 0.96–1.14), p=0.35.

Determine whether lying-flat vs sitting-up head positioning for 24 hours after acute stroke reduces 90-day disability.

No significant difference in 90-day disability distribution on modified Rankin scale: unadjusted OR 1.01 (95% CI 0.92–1.10), P=0.84.

Determine whether mechanical thrombectomy added to intravenous alteplase improves functional independence at 3 months in patients with acute ischaemic stroke and proximal anterior-circulation large-vessel occlusion.

Primary: mRS 0-2 at 3 months achieved by 106/200 (53%) with IVT+thrombectomy vs 85/202 (42%) with IVT alone (OR 1.55, 95% CI 1.05-2.30; p=0.028; NNT=9).