by Isabella Colonna and Raphael Wurm
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 May 2026.
For our Paper of the Month, go here: Research Paper of the Month: Timing of Initiation and Efficacy of Dual Antiplatelet Therapy in Minor Stroke or High-Risk TIA
LAA Closure Fails Noninferiority to Medical Care in High-Risk Atrial Fibrillation
The multicentre CLOSURE-AF trial investigated whether catheter-based left atrial appendage (LAA) closure is a suitable alternative to physician-directed medical therapy for stroke prevention. This study randomised 912 patients with atrial fibrillation at high risk for both stroke (mean CHA2DS2-VASc 5.2 ± 1.5) and bleeding (mean HAS-BLED 3.0 ± 0.9). Participants were assigned to either LAA closure or best medical care—including direct oral anticoagulants if eligible—to evaluate a primary composite endpoint of stroke, systemic embolism, major bleeding, or cardiovascular death.
After a median follow-up of three years, the primary endpoint occurred at a rate of 16.8 per 100 patient-years in the device group compared to 13.3 in the medical-therapy group. The trial concluded that LAA closure was not noninferior to medical therapy (p = 0.44 for noninferiority), with a restricted mean survival time difference of -0.36 years (95% CI, -0.70 to -0.01). Furthermore, serious adverse events were more frequent in the device group (82.5%) than in the medical group (77.4%), suggesting that best medical care remains the superior strategy for high-risk individuals.
Read the paper here: Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation | New England Journal of Medicine
Acute Brain Injury in New-Onset Refractory Status Epilepticus and Etiology-Defined Status Epilepticus
New-onset Refractory Status Epilepticus (NORSE) is a form of refractory status epilepticus occurring in both children and adults without a prior history of active epilepsy and in the absence of an identifiable structural, toxic, or metabolic cause within the first 72 hours. It represents a paradigmatic model of seizure-induced brain injury; therefore, identifying biomarkers of ongoing neuronal damage may help optimise therapeutic timing and improve outcomes.
A total of 78 patients with cryptogenic NORSE (cNORSE) and two independent cohorts of patients with etiology-defined status epilepticus (eSE; n=211 and n=73) were included in the study and compared with control individuals without status epilepticus, including patients with chronic epilepsy and healthy participants. Neurofilament light chain (NfL) levels were markedly increased in cNORSE compared with eSE, chronic epilepsy, and healthy controls, in both cerebrospinal fluid (CSF) and serum. Serum and CSF NfL concentrations were strongly correlated and progressively increased during the first three weeks after onset. Moreover, NfL effectively distinguished cNORSE from the other cohorts, and higher serum levels independently predicted poor functional outcome at discharge.
The results of this cross-sectional study indicate that cNORSE is associated with more severe and rapidly progressive neuronal injury than other forms of status epilepticus, highlighting the potential of NfL as a diagnostic and prognostic biomarker and the need for early, aggressive therapeutic interventions.
Read the paper here: Acute Brain Injury in New-Onset Refractory Status Epilepticus and Etiology-Defined Status Epilepticus | Epilepsy and Seizures | JAMA Neurology | JAMA Network
Risk of Cancer in Patients With First-Time Seizure
Seizures are a well-recognised complication of cancer; however, the significance of a first-time seizure as a potential marker of neurological or non-neurological malignancies remains unclear.
In this population-based study using nationwide Danish medical registries (January 1996–December 2022), 49,894 adults with a first-time seizure were identified. Within the first year of follow-up, 1.172 neurological and 850 non-neurological cancers were diagnosed; between 1 and <5 years, 87 neurological and 1.226 non-neurological cancers were observed; and between 5 and 20 years, 112 neurological and 2.120 non-neurological cancers were recorded. Across follow-up intervals of <1 year, 1 to <5 years, and 5 to 20 years, the absolute risks (ARs) of any cancer were 4.1%, 3.5%, and 13.4%, respectively. For neurological cancers, the corresponding ARs were 2.4%, 0.2%, and 0.7%, whereas for non-neurological cancers they were 1.7%, 3.3%, and 12.8%. Incidence rates for both neurological and non-neurological cancers peaked within the first month after a first-time seizure (191.4 and 95.3 per 1,000 person-years, respectively) and declined progressively thereafter. The greatest relative increase in cancer risk within the first year was observed for brain cancers. Among non-neurological cancers, the strongest associations were found for lung, bronchial, and tracheal cancers, as well as for metastatic and unspecified lymph node cancers.
Overall, first-time seizures were associated with an increased short-term relative risk and a modest long-term elevation in risk for both neurological and non-neurological cancers. These findings suggest that first-time seizures may represent an early clinical indicator of underlying occult malignancies, supporting broader diagnostic evaluation in affected patients.
Read the paper here: Risk of Cancer in Patients With First-Time Seizure | Neurology | JAMA Neurology | JAMA Network
