Sharing new innovations from the frontiers of neurology #neurotwitter 🧠
Joined May 2008
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Thrombectomy for smaller artery strokes: no benefit, more brain bleeds.
In DISCOUNT (244 people), good outcomes at 3 months were 62% with thrombectomy versus 68% with standard care. Symptomatic brain bleeds: 11% versus 3%.
pubmed.ncbi.nlm.nih.gov/4248…
🩸 MS progression, tracked in a blood test
In 2,329 people with MS, elevated GFAP meant ~40% higher risk of near-term progression. When treatment lowered GFAP, progression risk fell by up to 67%.
pubmed.ncbi.nlm.nih.gov/4254…
A vitamin B3 supplement failed to slow early Parkinson's — symptoms worsened slightly more on it.
In NOPARK (410 people, 52 weeks), motor scores rose 2.45 points on nicotinamide riboside versus a 0.27-point fall on placebo.
pubmed.ncbi.nlm.nih.gov/4284…
🦴 The spinal cord tells MS's story before age does
In 1,295 people with MS, upper cervical cord shrinkage ran beyond normal aging — visible from age 30, steepest in the 50s. Cord measures could sharpen disability prediction beyond brain scans.
pubmed.ncbi.nlm.nih.gov/4281…
Could a daily aspirin prevent dementia — but only for some?
In ASPREE (n=13,541), those with top platelet-count genetic scores had 3.5x lower dementia risk on aspirin, with more bleeding. Hypothesis-generating — but personalized prevention is the dream.
pubmed.ncbi.nlm.nih.gov/4278…
🌍 MS now affects 3.1 million people worldwide
The MS Atlas update — 133 countries covering 93% of the population — puts prevalence up 54% in a decade, including 40,000+ children and adolescents. Better diagnosis and longer survival explain much of it.
pubmed.ncbi.nlm.nih.gov/4269…
Frequent cannabis use looked worse, not better, in drug-resistant epilepsy.
Frequent users had more than twice as many convulsive seizures per year as nonusers (3.00 vs 1.32). Small and retrospective — but worth an honest conversation.
pubmed.ncbi.nlm.nih.gov/4280…
📈 Strokes in young adults nearly doubled in 30 years.
From 1993 to 2020, stroke rates in adults 20–54 rose from 34 to 62 per 100,000 — while falling in older adults. Ischemic stroke drove the rise.
Vascular risk doesn't wait until 65.
pubmed.ncbi.nlm.nih.gov/4277…
Hearing aids didn't stop dementia — but they helped more people get better.
In the CHOICE trial (703 adults with MCI and hearing loss), hearing aids didn't cut 24-month dementia conversion — but 15% improved cognitively vs 2% with education alone.
pubmed.ncbi.nlm.nih.gov/4280…
🧬 The “red hair” gene and faster Parkinson’s
MC1R variants in 60%+ of Europeans meant 30% faster Parkinson’s motor decline over 12 years.
The twist: MC1R is druggable. A gene test could one day guide prognosis and drug development.
pubmed.ncbi.nlm.nih.gov/4270…
Your blood tells a different story than your memory test.
In 1,967 patients on lecanemab, the plasma proteins tracking amyloid clearance behaved differently from the ones tracking cognitive decline — two separate biological stories in one treatment.
pubmed.ncbi.nlm.nih.gov/4278…
🧠 A spinal-fluid test that separates Parkinson's carriers who have disease from those who don't
In 76 LRRK2 G2019S carriers, an α-synuclein seeding assay flagged disease with 97% accuracy — positive in 80% of those with Parkinson's, negative in nearly all carriers without it.
For a gene variant where carriers often wonder "will I get it?", that's a meaningful step toward an answer — and a tool for smarter trial enrollment.
pubmed.ncbi.nlm.nih.gov/4280…
A new lead in C9orf72 ALS — and it starts with DNA repair.
A gene called PAICS protects cerebellar neurons by fixing DNA damage; restoring it rescued neurons in zebrafish. Very early days, but it opens a fresh therapeutic door in ALS.
pubmed.ncbi.nlm.nih.gov/4181…
🤖 AI found a biological footprint for migraine. A model identified who has migraine from non-headache health and genetic data alone — and found four distinct biological subtypes. Not a clinical tool yet, but migraine is more legible than we thought. neurology.org/doi/10.1212/WN…
Most atypical Alzheimer's patients would be locked out of the new anti-amyloid drugs.
70–85% ineligible — mostly because memory-based test cutoffs don't fit non-memory presentations. The drugs exist. The eligibility criteria need to catch up.
neurology.org/doi/10.1212/WN…
🧬 For adults with Down syndrome, Alzheimer's arrival changes everything.
Once Alzheimer's symptoms begin, epilepsy risk climbs relentlessly — 57% within 9 years — doubling mortality. Not a footnote: a call for seizure surveillance in this population.
thelancet.com/journals/lance…
Incisionless brain surgery — mostly good news, with a catch.
One-sided focused ultrasound safely eased motor complications — but treating both sides left 1 in 4 with lasting speech, gait, or balance problems. Minimally invasive isn't risk-free.
thelancet.com/journals/laneu…
💊 MS treatment timing: the old playbook is losing.
Starting strong with B-cell therapies meant fewer relapses and less lesion growth than oral drugs. No disability difference at 2 years — but the "hit hard early" camp just got ammunition.
neurology.org/doi/10.1212/WN…
