This episode reviews 5 publications on Idiopathic Normal Pressure Hydrocephalus (iNPH), specifically addressing diagnosis, patient selection for shunting, and long-term treatment outcomes. One article is a systematic review and consensus protocol from the International Parkinson and Movement Disorders Society, which addresses the lack of standardization in the large-volume lumbar puncture "tap test," reviewing extensive literature to propose a consistent protocol for volume removal, timing of reassessment, and clinical assessments for gait, cognition, and urination. The second source is a research article discussing long-term shunt responsiveness and the phenomenon of delayed shunt non-responders, presenting detailed clinical data on comorbidities and outcomes in patients categorized as early non-responders, late non-responders, and full responders to ventriculoperitoneal shunt surgery. All articles aim to refine clinical practice and future research efforts related to the diagnosis and management of iNPH. One article is a very recent clinical trial providing evidence for the benefit of shunting to improve gait in these patients.

This 2025 article titled "Progressive Encephalomyelitis With Rigidity and Myoclonus With Glycine Receptor Antibodies" by Guasp et al., published in Neurology Neuroimmunology Neuroinflammation aims to detail the clinical features and long-term prognosis of patients suffering from Glycine Receptor (GlyR) antibody–mediated Progressive Encephalomyelitis with Rigidity and Myoclonus (PERM). Through a retrospective analysis of cases from a laboratory database and a systematic literature review, the authors identified 41 patients to understand the disease's characteristics, which included rapid onset, a male predominance, and frequent brainstem involvement. The findings conclude that GlyR antibody–mediated PERM is a distinct, rapidly progressive, and severe clinical entity, separate from other related stiff-person spectrum disorders, with older age and Intensive Care Unit (ICU) admission being independent predictors of poor outcome.

The paper provides an extensive overview of the neurological complications stemming from drug misuse, encompassing both illicit substances and prescription medications. It addresses the global prevalence of drug-use disorders and the increasing complexity introduced by new psychoactive substances like synthetic cannabinoids and potent opioids such as fentanyl. The document details the acute and long-term neurological manifestations associated with various drug classes, including opiates, stimulants, hallucinogens, and inhalants, outlining specific syndromes of toxicity and withdrawal. Furthermore, it discusses complications such as trauma, infections, seizures, strokes, cognitive impairment, and movement disorders, emphasizing the disproportionate impact on young individuals. The text underscores the critical importance for neurologists to promptly identify acute toxicity and comprehend the lasting consequences of drug-use disorders for effective patient care.

This document outlines the protocol for a multicenter, randomized clinical study evaluating the effectiveness and safety of minimally invasive surgery (MIS) using the Artemis Neuro Evacuation Device for treating supratentorial intracerebral hemorrhage (ICH) compared to conventional medical management (MM). The study employs an adaptive design with potential interim analyses to assess efficacy and possibly stop early for success or futility. It details the responsibilities of the sponsor and investigators, emphasizing ethical considerations like informed consent and subject data protection. Various neurological exams and stroke scales are used for assessment, and the document also covers risk analysis, adverse event reporting, and statistical procedures for analyzing outcomes, including 30-day mortality as a primary safety endpoint and 180-day global disability as a primary efficacy endpoint.

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This research investigates alpha-synuclein (aSyn) strains in Lewy body diseases (LBDs), specifically Parkinson's disease (PD) and Dementia with Lewy bodies (DLB). The study utilized monoclonal antibodies to detect distinct aSyn species, termed strain A and strain B, in various human biological samples. Significantly, higher levels of both strain A and B aSyn were found in the plasma of individuals with PD compared to those with DLB. The authors also found that lower levels of plasma aSyn strain A correlated with a faster rate of cognitive decline in PD patients. Importantly, these plasma aSyn species demonstrated pathogenic potential, capable of inducing aSyn fibrillization in vitro and aggregate formation in cell models, suggesting their role in disease progression and as potential biomarkers.

This article investigates the features, outcomes, and treatment efficacy of postanoxic status epilepticus (SE) following cardiac arrest. The researchers conducted a multicenter pooled analysis of patient data, including the TELSTAR trial and two registries, to identify predictors of neurological recovery and determine when antiseizure medication is beneficial. The study highlights that definite or possible SE does not always lead to a poor outcome, with a significant percentage of patients achieving good recovery, especially when certain unfavorable prognostic factors are absent. Key findings suggest that SE cessation and higher doses of specific antiseizure medications are associated with better outcomes, particularly in cases of definite SE, emphasizing the importance of early EEG monitoring and tailored treatment strategies. The authors acknowledge that further randomized controlled trials are necessary to establish definitive treatment guidelines.

This systematic review and meta-analysis evaluates the efficacy and safety of various preventive treatments for episodic migraine, focusing on options available in Mexico. The research synthesizes findings from randomized controlled trials (RCTs), categorizing treatments into pharmacological (like anti-CGRP monoclonal antibodies, gepants, and traditional medications) and non-pharmacological approaches (such as neuromodulation and acupuncture). The primary objective was to assess the impact of these interventions on monthly migraine days (MMD), monthly headache days (MHD), and acute medication days (AMD), alongside adverse events (AE). While CGRP-targeted therapies and gepants showed the most consistent reduction in MMD with favorable tolerability, traditional agents had more modest effects and higher adverse event rates. Non-pharmacological methods demonstrated promise but often lacked standardized reporting, highlighting the need for individualized, multimodal treatment strategies.

This study explores the clinical significance of serum autoantibody titers and neurofilament light chain (NfL) levels in patients diagnosed with CASPR2/LGI1 autoimmune encephalitis. Researchers investigated these biomarkers longitudinally to understand their relationship with disease progression and patient outcomes. The findings indicate that NfL levels at the onset of the disease can predict long-term cognitive impairment, suggesting their utility in identifying patients requiring tailored management. While autoantibody titers correlate with disease stage and the occurrence of relapses, they do not appear to have prognostic value for long-term functional or cognitive outcomes. The research highlights the potential for a combined assessment of these biomarkers to enhance patient care and management strategies for this specific form of autoimmune encephalitis.

This paper explores Multiple Sclerosis (MS), an autoimmune disease affecting the central nervous system, and focuses on identifying biomarkers to predict disease activity. The researchers used high-dimensional flow cytometry to analyze peripheral blood mononuclear cells (PBMCs) from individuals with MS and healthy controls. Their findings highlight HLA-DRhiCD141+ classical monocytes (CMs) as a significant predictor of both impending relapses and disability worsening in patients with active relapsing-remitting MS. This novel biomarker offers a more precise prognostic tool for MS progression, potentially aiding in treatment decisions by complementing existing clinical assessments. The study also suggests that these monocytes could be detected using a simpler, more translational manual gating method, enhancing their practical application in clinical settings.