Neurology, distilled.

To determine whether the PASCAL (PFO-Associated Stroke Causal Likelihood) classification system identifies patients who will experience net benefit vs net harm from PFO closure

Individual participant-level meta-analysis of all 6 RCTs of PFO closure (SCOPE consortium), 3,740 patients aged 18-60 with PFO and cryptogenic stroke (2000-2017)

To determine whether training of the less impaired ipsilesional arm improves motor performance in chronic stroke patients with severe contralesional arm paresis

Ipsilesional arm training (5 weeks, 15 sessions of VR + manipulation) produced significant improvement in Jebsen-Taylor Hand Function Test: −5.87 seconds (95% CI −8.89 to −2.85, p=0.003), a 12% reduction in completion time

To evaluate whether catheter-based left atrial appendage closure is noninferior to physician-directed best medical care (predominantly DOACs) for preventing stroke, systemic embolism, major bleeding, or cardiovascular death in AF patients at high risk for both stroke and bleeding.

LAA closure FAILED noninferiority vs best medical care (85% DOACs): primary composite (stroke, systemic embolism, major bleeding, CV/unexplained death) 16.8 vs 13.3 per 100 patient-years (RMST difference -0.36 years; 95% CI -0.70 to -0.01; P=0.44 for noninferiority).

Is CGRP inhibitor use associated with an increased risk of cardiovascular events in patients with migraine?

In a large Medicare cohort of 900,370 beneficiaries, CGRP inhibitor initiation was associated with a modest 26% increase in composite cardiovascular events (aHR 1.26), driven primarily by ischemic stroke. The absolute risk increase remains small (8.77 vs 6.76 per 1,000 person-years), and results are hypothesis-generating rather than practice-changing.

Can eslicarbazepine acetate prevent the development of post-stroke epilepsy in patients at high risk after acute stroke?

Eslicarbazepine acetate did not significantly reduce the composite endpoint of first unprovoked seizure, death, or treatment discontinuation compared to placebo in post-stroke patients (28% vs 37%, OR 0.66, p=0.37). The trial was underpowered due to slow recruitment and COVID-19 disruptions but demonstrates the feasibility of conducting antiepileptogenesis trials.

Is intrathecal zorevunersen, an antisense oligonucleotide that upregulates NaV1.1 sodium channels, safe and effective in reducing seizures in children and adolescents with Dravet syndrome?

Zorevunersen at 70 mg doses reduced convulsive-seizure frequency by 59-91% over 20 months in children with Dravet syndrome, with improvements in clinical status, quality of life, and adaptive behavior sustained over 36 months. This represents the first disease-modifying therapy targeting the underlying SCN1A haploinsufficiency in Dravet syndrome.

What are the effectiveness and tolerability outcomes of opicapone as add-on treatment to levodopa/DDCI in patients with Parkinson's disease and motor fluctuations in real-world clinical practice in Spain?

In real-world clinical practice, opicapone added to levodopa significantly improves motor function and reduces motor fluctuations without significantly enhancing dyskinesia intensity, with a tolerable safety profile across different PD phenotypes.

Does a single IV dose of delandistrogene moxeparvovec slow disease progression over 2 years in ambulatory boys with DMD?

Primary endpoint (NSAA at 52 weeks vs placebo) not met, but 2-year data showed significant stabilization vs external control with maintained micro-dystrophin expression and manageable safety.