Glucagon-like Peptide-1 Receptor Agonists and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy: Systematic Review and Meta-Analysis

胰高血糖素样肽 -1 受体激动剂与非动脉炎性前部缺血性视神经病变风险：系统评价与荟萃分析

Recent observational studies have reported conflicting evidence regarding an association between glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly semaglutide, and nonarteritic anterior ischemic optic neuropathy (NAION). We aimed to synthesize the pooled evidence assessing the association between GLP-1RA use and NAION risk. Low-to-moderate certainty evidence indicates that semaglutide significantly increases risk of NAION relative to non-GLP-1RAs, particularly among patients with diabetes. These findings warrant further investigation and should inform clinical risk-benefit discussions.

近期的观察性研究在胰高血糖素样肽 -1 受体激动剂（GLP - 1RA），尤其是司美格鲁肽与非动脉炎性前部缺血性视神经病变（NAION）之间的关联方面给出了相互矛盾的证据。我们旨在综合评估使用 GLP - 1RA 与 NAION 风险之间关联的汇总证据。低至中等确定性的证据表明，与非 GLP - 1RA 相比，司美格鲁肽显著增加了 NAION 的风险，尤其是在糖尿病患者中。这些发现值得进一步研究，并应为临床风险 - 获益讨论提供参考。

REF: Dhivagaran T, Butt F, Arunasalam L, et al. Glucagon-like Peptide-1 Receptor Agonists and Risk of Nonarteritic Anterior Ischemic Optic Neuropathy: Systematic Review and Meta-Analysis. Neurology. 2026;106(10):e214864. doi:10.1212/WNL.0000000000214864 PMID: 42060879

Association of 24-Hour Blood Pressure Variability With Cognition and Brain MRI Markers of Structural Change in Adults in Mid- to Late-Life

中老年人24小时血压变异性与认知及脑磁共振成像结构改变标志物的关联

Blood pressure (BP) fluctuates across the 24-hour period. High 24-hour BP variability (BPV) is associated with cardiovascular disease risk, yet its relevance for brain health is unclear. We aimed to examine associations between 24-hour BPV, cognition, and multimodal MRI markers of brain health, and whether these were modified by APOE ε4 status. Higher BPV was associated with poorer global cognition and executive functioning, and compromised blood-brain barrier integrity, with additional associations evident only among APOE ε4 carriers. Elevated BPV may be a risk factor for accelerated brain aging, particularly in APOE ε4 carriers.

血压（BP）在24小时内会波动。24小时血压变异性（BPV）高与心血管疾病风险相关，但它对大脑健康的相关性尚不清楚。我们旨在研究24小时BPV、认知功能和大脑健康的多模态磁共振成像（MRI）标志物之间的关联，以及这些关联是否会因载脂蛋白E（APOE）ε4状态而改变。较高的BPV与整体认知功能和执行功能较差相关，还与血脑屏障完整性受损相关，且仅在APOE ε4携带者中存在额外的关联。BPV升高可能是加速大脑衰老的一个危险因素，尤其是在APOE ε4携带者中。

REF: Gibson M, Snelson M, Rowsthorn E, et al. Association of 24-Hour Blood Pressure Variability With Cognition and Brain MRI Markers of Structural Change in Adults in Mid- to Late-Life. Neurology. 2026;106(10):e214935. doi:10.1212/WNL.0000000000214935 PMID: 42060877

Temporal Trends and Regional Variations in Mortality of Adults With Status Epilepticus in the United States: A Retrospective Study From 1999 to 2020

美国成人癫痫持续状态死亡率的时间趋势和区域差异：一项1999年至2020年的回顾性研究

With an incidence of 18.3-41 per 1,000 people in the United States, status epilepticus (SE) can frequently result in death. We aimed to investigate the mortality trends in SE in the United States stratified by age groups, sex, race/ethnicity, and geographic region. SE-related mortality in adults has been rising with notable disparities. Addressing racial disparities and tailoring management strategies for high-risk groups are critical to curb SE.

在美国，癫痫持续状态（SE）的发病率为每1000人中有18.3 - 41例，该病症常可导致死亡。我们旨在研究美国按年龄组、性别、种族/族裔和地理区域划分的癫痫持续状态死亡率趋势。成人癫痫持续状态相关死亡率一直在上升，且存在显著差异。解决种族差异并为高风险群体量身定制管理策略对于控制癫痫持续状态至关重要。

REF: Nadeem ZA, Kashif MAB, Nadeem A, et al. Temporal Trends and Regional Variations in Mortality of Adults With Status Epilepticus in the United States: A Retrospective Study From 1999 to 2020. Neurology. 2026;106(10):e214939. doi:10.1212/WNL.0000000000214939 PMID: 42060883

Phosphorylated TDP-43 Pathology in Skin and Muscle Tissue of Patients With Amyotrophic Lateral Sclerosis

肌萎缩侧索硬化患者皮肤和肌肉组织中的磷酸化TAR DNA结合蛋白43（TDP - 43）病理改变

Phosphorylated TAR DNA-binding protein 43 (pTDP-43) is the pathologic hallmark of amyotrophic lateral sclerosis (ALS), yet no peripheral premortem biomarker is available. We evaluated pTDP-43 distribution in skin and tongue tissues and its association with ALS and clinical stage. Peripheral pTDP-43 deposition distinguishes ALS from controls and reflects disease stage, supporting its potential role as a biomarker of ALS and disease severity. Larger and longitudinal studies are required for validation.

磷酸化TAR DNA结合蛋白43（pTDP - 43）是肌萎缩侧索硬化症（ALS）的病理特征，但目前尚无用于生前诊断的外周生物标志物。我们评估了pTDP - 43在皮肤和舌组织中的分布情况及其与ALS和临床分期的关联。周围神经pTDP - 43沉积可将ALS患者与对照者区分开来，并能反映疾病阶段，表明其有潜力作为ALS及疾病严重程度的生物标志物。需要开展更大规模的纵向研究来验证这一结论。

REF: Nolano M, Provitera V, Caporaso G, et al. Phosphorylated TDP-43 Pathology in Skin and Muscle Tissue of Patients With Amyotrophic Lateral Sclerosis. Neurology. 2026;106(10):e214940. doi:10.1212/WNL.0000000000214940 PMID: 42060881

Safeguarding Neural Data

保护神经数据

A growing suite of neurotechnologies that capture brain activity, ranging from wearables to implanted devices, is rapidly transforming practice and research in the clinical neurosciences. States such as Colorado and California have incorporated "neural data" into their privacy laws. In addition, in September 2025, two senators introduced federal legislation, the Management of Individuals' Neural Data (MIND) Act of 2025, which defined "neural data," addressed ethical concerns about its collection and use, and directed the Federal Trade Commission to study how to regulate it. Legislative actions such as these recognize that neural data can potentially reveal unusually sensitive details about identity, cognition, and capacities that ordinary health information does not. In practice, however, neural data are heterogeneous, requiring careful consideration of their varying forms, degrees of sensitivity, and the clinical or nonclinical contexts in which they are generated. We describe the difficulties of using common tools, including data privacy and intellectual property, to regulate neural data and examine how clinicians can complement these efforts through deliberate, ethically informed safeguards in clinical practice even before regulatory frameworks are finalized.

从可穿戴设备到植入式设备，一系列不断发展的用于捕捉大脑活动的神经技术正在迅速改变临床神经科学的实践与研究。科罗拉多州和加利福尼亚州等已将“神经数据”纳入其隐私法。此外，2025年9月，两名参议员提出了联邦立法——《2025年个人神经数据管理（MIND）法案》，该法案对“神经数据”进行了定义，解决了有关其收集和使用的伦理问题，并指示联邦贸易委员会研究如何对其进行监管。诸如此类的立法行动认识到，神经数据有可能揭示关于身份、认知和能力的异常敏感细节，而这些是普通健康信息所无法体现的。然而在实践中，神经数据具有异质性，需要仔细考虑其不同形式、敏感程度以及生成的临床或非临床背景。我们阐述了使用常见工具（包括数据隐私和知识产权）来监管神经数据所面临的困难，并探讨了在监管框架最终确定之前，临床医生如何通过在临床实践中采取深思熟虑、符合伦理的保障措施来辅助这些工作。

REF: Young MJ, Simon D, Evans BJ. Safeguarding Neural Data. Neurology. 2026;106(10):e214942. doi:10.1212/WNL.0000000000214942 PMID: 42060878

Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019–2023

2019 - 2023年美国商业保险人群在初级保健或急诊科就诊后等待神经科诊疗的时间

Despite the importance of timely access to ambulatory specialty care, data regarding wait times to neurologists are largely lacking. This study examines wait times, and drivers of wait times, for new neurology office visits among commercially insured persons in the United States. Wait times for new neurology appointments vary by sex, neurologic condition, insurance type, and geographic level variables.

尽管及时获得门诊专科护理非常重要，但关于看神经科医生的候诊时间的数据却十分匮乏。本研究调查了美国商业保险人群首次神经科门诊就诊的候诊时间及其影响因素。首次神经科预约的候诊时间因性别、神经疾病状况、保险类型和地理区域变量而异。

REF: Laffargue EK, Van Der Goes DN, Wilson AM, Parziale SD, Sico JJ, Ney J. Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023. Neurology. 2026;106(10):e218008. doi:10.1212/WNL.0000000000218008 PMID: 42054604

What Is the Potential Relevance of Hippocampal Area CA2 in Neurologic Disorders?

海马CA2区在神经系统疾病中有哪些潜在关联？

The hippocampus has a critical role in the online processing of information; encoding, storage, and retrieval of episodic memory; and novelty detection. These functions have been classically associated with a trisynaptic circuit connecting the entorhinal cortex, the dentate gyrus, area CA3, and area CA1. Until recently, the role of area CA2, located between CA3 and CA1, has been underappreciated. However, increased evidence indicates that, despite its small size, area CA2 has a critical role in in regulating activity throughout the hippocampal circuit and has a unique importance in social recognition memory. Area CA2 has widespread connectivity with other hippocampal regions2 and has unique structural features, electrophysiologic responses, pattens of receptor expression, and subcortical inputs. Pyramidal CA2 neurons are more resistant to excitotoxicity than those in other hippocampal subfields. However, area CA2 is susceptible to accumulation of alpha-synuclein and tau. Experimental studies show loss or impaired function of a critical subpopulation of local inhibitory CA2 interneurons in several disorders, including temporal lobe epilepsy, Alzheimer disease (AD), multiple sclerosis, schizophrenia, and autism spectrum disorder.

海马体在信息的在线处理、情景记忆的编码、存储和提取以及新奇性检测中起着关键作用。这些功能传统上与连接内嗅皮质、齿状回、CA3区和CA1区的三突触回路有关。直到最近，位于CA3区和CA1区之间的CA2区的作用一直未得到充分重视。然而，越来越多的证据表明，尽管CA2区体积小，但它在调节整个海马回路的活动中起着关键作用，并且在社会识别记忆方面具有独特的重要性。CA2区与其他海马区域有广泛的连接，具有独特的结构特征、电生理反应、受体表达模式和皮质下输入。CA2区的锥体神经元比其他海马亚区的神经元更能抵抗兴奋性毒性。然而，CA2区易发生α - 突触核蛋白和tau蛋白的积累。实验研究表明，在包括颞叶癫痫、阿尔茨海默病（AD）、多发性硬化症、精神分裂症和自闭症谱系障碍等多种疾病中，CA2区局部抑制性中间神经元的一个关键亚群会出现缺失或功能受损的情况。

REF: Benarroch E. What Is the Potential Relevance of Hippocampal Area CA2 in Neurologic Disorders?. Neurology. 2026;106(10):e218096. doi:10.1212/WNL.0000000000218096 PMID: 42048628

Association of MRI-Visible Perivascular Spaces With Longitudinal Cognitive Decline Over a Decade

MRI可见血管周围间隙与十年间纵向认知衰退的关联

Cerebral small vessel disease (SVD) is the most common vascular contributor to dementia. SVD markers often coexist, contributing to difficulty assessing their independent contributions to cognitive domains. MRI-visible perivascular spaces (PVSs) are an emerging SVD marker visualized by MRI. We previously showed that basal ganglia PVSs cross-sectionally contribute to worse cognition, independent of other SVD markers. To further characterize the clinical relevance of PVS, we studied its role as a unique SVD marker of longitudinal cognitive decline. Basal ganglia PVS burden independently contributes to worse longitudinal executive function and visuospatial skills independent of other SVD markers, highlighting PVS as an emerging marker of domain-specific cognitive decline in aging. Although causation cannot be established, findings further support PVS as a vascular contributor to deep brain structure damage underlying cognitive decline over time.

脑小血管病（SVD）是导致痴呆最常见的血管因素。SVD标志物常常同时存在，这给评估它们对认知领域的独立影响带来了困难。磁共振成像（MRI）可见的血管周围间隙（PVS）是一种新兴的可通过MRI显示的SVD标志物。我们之前的研究表明，基底节区PVS在横断面研究中与较差的认知功能相关，且独立于其他SVD标志物。为了进一步明确PVS的临床相关性，我们研究了其作为纵向认知衰退独特SVD标志物的作用。基底节区PVS负荷独立于其他SVD标志物，对纵向执行功能和视空间技能的恶化有影响，这凸显了PVS作为衰老过程中特定领域认知衰退的新兴标志物。尽管无法确定因果关系，但研究结果进一步支持PVS是随着时间推移导致认知衰退的深部脑结构损伤的血管因素。

REF: Kohno K, Sun Y, LeFevre JD, et al. Association of MRI-Visible Perivascular Spaces With Longitudinal Cognitive Decline Over a Decade. Neurology. 2026;106(9):e214803. doi:10.1212/WNL.0000000000214803 PMID: 42030516 PMCID: PMC13112411

Postapproval Study for Brain-Responsive Neurostimulation for Drug-Resistant Focal Epilepsy: Three-Year Efficacy and Interim Safety Results

药物难治性局灶性癫痫脑应答神经刺激疗法的上市后研究：三年疗效和中期安全性结果

Neuromodulation therapies are approved for the treatment of focal epilepsy based on data from randomized controlled trials (RCTs). After approval of a responsive direct brain stimulation device (The RNS System for focal epilepsy), the Food and Drug Administration required a prospective study to evaluate whether real-world safety and effectiveness differed from outcomes in the RCT. This prospective real-world study contributes to the body of evidence that adjunctive direct brain-responsive neurostimulation provides significant and sustained reductions in the frequency of focal seizures. Seizure reductions were greater and were achieved faster than in the RCT and long-term treatment trials but were similar to a more recent retrospective multicenter real-world study. As in the preapproval studies, treatment was well-tolerated and safe, and the SUDEP rate was low. The RNS System showed similar safety and improved seizure outcomes in real-world use compared with the RCT. Improvements in efficacy may reflect changes in programming practices. Future research efforts will focus on using the brain data obtained by the device to optimize detection and stimulation paradigms for each patient.

基于随机对照试验（RCT）的数据，神经调节疗法已被批准用于治疗局灶性癫痫。在一种响应式直接脑刺激设备（用于局灶性癫痫的RNS系统）获批后，美国食品药品监督管理局要求开展一项前瞻性研究，以评估现实世界中的安全性和有效性是否与随机对照试验的结果不同。这项前瞻性的现实世界研究为辅助性直接脑响应神经刺激能显著且持续降低局灶性癫痫发作频率这一证据体系做出了贡献。与随机对照试验和长期治疗试验相比，癫痫发作频率降低幅度更大且速度更快，但与近期一项回顾性多中心现实世界研究结果相似。与获批前的研究一样，该治疗耐受性良好且安全，猝死率较低。与随机对照试验相比，RNS系统在现实世界应用中显示出相似的安全性和更好的癫痫发作控制效果。疗效的改善可能反映了编程操作的变化。未来的研究工作将聚焦于利用该设备获取的大脑数据，为每位患者优化检测和刺激方案。

REF: Eliashiv D, Rao VR, Jobst BC, et al. Postapproval Study for Brain-Responsive Neurostimulation for Drug-Resistant Focal Epilepsy: Three-Year Efficacy and Interim Safety Results. Neurology. 2026;106(9):e214875. doi:10.1212/WNL.0000000000214875 PMID: 42030518 PMCID: PMC13112409