Neurology

Psychiatric exclusions are common in neuropathic pain RCTs

Secondary analysis of 312 neuropathic pain RCTs found 60% reported definite psychiatric exclusion criteria and 55% probable criteria. Overall 80% of trials excluded participants by either definite or probable psychiatric criteria, most often for substance disorders and depression. Only 19% of trials with definite psychiatric exclusions described how eligibility was assessed. These exclusions likely limit applicability of RCT findings to patients with common psychiatric comorbidities. 1

Blood NfL rises after ischemic stroke and predicts 3‑month outcomes

Individual‑patient meta‑analysis of 2872 participants showed NfL Z‑scores rose from D1 to D6–7, with medians from 2.0 to 3.5. NfL discriminated ischemic stroke from controls (AUC 0.79–0.97) and had fair discrimination versus TIA. Higher early NfL was independently associated with symptomatic intracranial hemorrhage, larger infarct volume, worse 3‑month mRS (aOR 1.31), and mortality (aOR 1.67). Timing, age, and BMI adjustment are essential when using NfL for diagnosis or prognosis. 2

In NCSE, adequate ASM dosing predicts better outcomes than treatment sequence

Registry study of 189 adults with non‑anoxic NCSE found ASM underdosing in 38.6% of episodes. Under‑dosing was independently associated with failure to stop NCSE (OR 6.56) and higher in‑hospital mortality (OR 4.38). Absence of first‑line benzodiazepine and escalation to CIVADs were not independently linked to outcomes. Ensure weight‑ and indication‑appropriate ASM dosing in NCSE; treatment sequence alone is less predictive. 3