by Viktoria Papp
Each month the eanNews editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for March 2025.
Cognitive Decline After First-Time Transient Ischemic Attack | JAMA Neurology
This longitudinal cohort study evaluated the first transient ischaemic attack (TIA) as a possible independent risk factor for cognitive impairment. Patients were included from a population-based cohort of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, where participants were followed up for cerebrovascular events and periodically performed a telephone-based cognitive test battery. The cognitive domains tested were verbal learning, verbal recall memory, processing speed, and executive function. Data from three subgroups of patients with “first TIA” (n=356), “first stroke” (n=965) and the asymptomatic community control group (n=14882) were analysed. By using adjusted segmented regression models, they determined the pre-event and post-event cognition and annual cognitive change. Here, they found that the cognitive function of the stroke group was lower than in the TIA and control groups even before the event. Significant post-event decline was registered in the cognitive composite of the stroke group compared to the TIA group and control group, while the post-event annual decline was faster in the TIA group compared to the control group and no different from the stroke group. These findings suggest that TIA is a risk factor for cognitive impairment, independent of vascular and demographic risk factors, with an estimated annual decline similar to a single ischaemic stroke.
Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache | JAMA Neurology
In this Danish nationwide population-based cohort study, the association between primary headaches and attempted or completed suicide was investigated. Prospectively collected data on 119,486 persons with headache diagnoses and 597,430 matched controls between the period of 1995 and 2020 showed an elevated absolute risk of both attempted and completed suicide among headache patients compared to the matched control group. The hazards of attempted suicide (HR, 2.04; 95% CI, 1.84-2.27) and completed suicide (HR, 1.40; 95% CI, 1.17-1.68) were higher compared to the control group. Trigeminal autonomic cephalalgias and posttraumatic headache had the strongest association. There was no difference in sex or age at diagnosis. The results revealed solid data on the association of headaches and suicide, emphasising the need for behavioural health evaluation and treatment in these patients.
Discontinuation of First-Line Disease-Modifying Therapy in Patients With Stable Multiple Sclerosis The DOT-MS Randomized Clinical Trial | JAMA Neurology
This Dutch multicentre, rater-blinded, noninferiority 1:1 randomised clinical trial aimed to evaluate whether the discontinuation of first-line disease modifying therapy (DMT) in patients with long-term stable (minimum 5 years) relapsing-remitting multiple sclerosis (MS) could be safe. The primary endpoint was defined as a sign of significant disease activity; either clinical MS relapse, or three or more new T2 lesions, or two or more contrast enhancing lesions on the follow-up MRI. Among the 89 included patients with a median age of 54.0 (IQR: 49.0-59.0) years, 44 were assigned to continue DMT and 45 participants were assigned to discontinue. The study was terminated after a median follow-up time of 15.3 (IQR: 11.4-23.9) months, shorter than the planned 3.5-year study period, due to significant disease activity in the discontinue group (continue: 0/44 [0] vs. discontinue: 8/45 [17.8%]; p<.001). These findings reveal the risk of recurrence of disease activity after terminating first-line DMT even in long-term stable patients.
Normobaric hyperoxia combined with endovascular treatment for acute ischaemic stroke in China (OPENS-2 trial): a multicentre, randomised, single-blind, sham-controlled trial | Lancet
OPENS-2 was a multicentre, randomised, single-blind, sham-controlled trial investigating whether normobaric hyperoxia as an add-on treatment can improve the functional outcome after endovascular treatment in patients with large-vessel occlusion. Patients eligible for endovascular treatment due to large-vessel occlusion in the anterior circulation were included. The 1:1 randomisation divided participants to receive either normobaric hyperoxia (100% oxygen at a flow rate of 10 L/min) combined with endovascular treatment or sham normobaric hyperoxia (100% oxygen delivered at a flow rate of 1 L/min) combined with endovascular treatment. The primary endpoint was a modified Rankin Scale (mRS) score at 90 days. They found that the patient group receiving normobaric hyperoxia add-on treatment had a significantly favourable distribution of mRS scores compared with the sham normobaric hyperoxia group. The occurrence of side effects and death were similar in the two groups. These results indicate the potential benefit of normobaric hyperoxia in combination with endovascular treatment without raising safety concerns.
