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Abstract Background Chronic migraine (CM) is often complicated by medication-overuse headache (MOH), worsening disability. Although withdrawal of overused medications is recommended, adherence is poor and relapse is frequent. Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway may offer an effective preventive option without requiring discontinuation, but current evidence is limited by few and heterogeneous randomized controlled trials (RCTs). Objective To systematically assess the efficacy and safety of anti-CGRP mAbs in treating CM with MOH (CM + MOH) under a conservative approach. Methods The PubMed, Embase, and Cochrane Central databases were searched for RCTs comparing anti-CGRP mAbs with placebo in adults with CM + MOH. The primary outcome was the mean change in monthly migraine days (MMDs) at 3 months. The secondary outcomes included acute medication use, disability, drug overuse resolution, response rate, and adverse events (AEs). Random-effects models with Sidik-Jonkman estimator and Knapp-Hartung adjustments pooled effect sizes. Results We included seven RCTs, totalling 3,094 patients. Anti-CGRP mAbs significantly reduced MMDs (mean difference [MD] = −0.35; 95%CI: −0.43 to −0.26) and acute medication use (MD = −0.35; 95%CI: −0.51 to −0.19) compared with placebo. Higher rates, of ≥ 50%, of response (risk ratio [RR] = 1.94; 95%CI: 1.60-2.34) and drug overuse resolution (RR = 1.38; 95%CI: 1.04-1.83) were observed, with no significant increase in AEs (RR = 1.09; 95%CI: 0.85-1.40). Conclusion Anti-CGRP mAbs were effective and well tolerated in CM + MOH, representing a viable alternative, especially for patients unable to discontinue acute medications. Further research should assess long-term outcomes and subgroup effects.

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Abstract Background Cognitive impairment is common in multiple sclerosis (MS), and visual memory impairments are increasingly considered clinically important, yet still underappreciated. Objective To compare cognitive performance assessed by the Rey Complex Figure Test (RCFT) and Symbol Digit Modalities Test (SDMT) in MS patients and healthy controls, and to examine correlations between these measures and physical disability indices. Methods A total of 177 participants were assessed using RCFT subtests and SDMT, of whom 95 had relapsing-remitting MS (RRMS) and 82 were healthy controls. Group comparisons and correlation analyses were performed. Results The MS patients scored significantly lower on all RCFT subtests and SDMT. Moderate correlations were found between SDMT and RCFT 0 to 2, but not RCFT 3. Conclusion Both RCFT and SDMT may serve as potentially complementary measures of cognitive domains relevant to MS. Incorporating both recall and recognition-based measures, along with processing speed assessments, can provide a broader evaluation of cognitive strengths and weaknesses in MS, helping clinicians better characterize patients’ profiles.

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Abstract Background Chronic migraine is a prevalent and debilitating condition, frequently associated with sleep disorders, particularly insomnia. Objective To evaluate the impact of sleep psychoeducation measures on clinical aspects of chronic migraine patients with sleep quality complaints, under the hypothesis that such interventions would benefit both migraine symptoms and insomnia difficulties. Methods A total of 100 patients from our neurology service's headache outpatient clinic were screened using an author-developed questionnaire addressing sleep quality complaints. The intervention group included 68 patients with sleep disturbance complaints, who completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index (ISI), and subsequently received psychoeducation guidelines and individualized recommendations. The control group consisted of 32 patients without sleep disorder complaints, from whom clinical data on migraine were collected. After 2 to 3 months, the questionnaires were reapplied to the intervention group, and medical records from both groups were reviewed for comparison. Results In the control group, there was no statistically significant change in headache frequency or intensity. In the intervention group, a significant reduction was observed in both parameters. Regarding sleep disturbance, the intervention group showed a significant reduction in PSQI (from 13.7 to 11.7) and ISI (from 18.5 to 13.4), but no significant variation in ESS. Conclusion Sleep psychoeducation, supported by an informative booklet, produced positive outcomes not only in sleep parameters but also in reducing the frequency and intensity of headaches in chronic migraine sufferers.

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Abstract Background The diagnosis of predementia stages indicates an increased risk of progression to dementia. The Amyloid, Tau, and Neurodegeneration AT(N) classification considers measurements of altered proteins and the presence of neurodegeneration to classify the risk groups regarding the pathophysiology of Alzheimer's disease (AD). The cognitive and anatomical characteristics of the patients in the predementia stage according to the AT(N) classification are not fully understood. Objective To investigate whether there are differences in the clinical and anatomical profiles among older adults in the predementia stage according to the ATN classification, and to investigate the associations involving cognition and cortical thickness and subcortical volume in the AT(N) groups. Methods In total, 72 older adults with subjective cognitive decline and mild cognitive impairment were allocated to groups according to the AT(N) classification (AD continuum: n = 37; suspected non-AD pathophysiology: n = 8; normal biomarkers: n = 27). The participants were investigated through cognitive tests, magnetic resonance imaging scans, and cerebrospinal fluid analyses. We used multivariate and univariate analyses with post-hoc testing to verify differences among groups. In addition, linear regressions were performed to verify the interactions involving cognition and gray matter metrics. Results The suspected non-AD pathophysiology group showed worse performance in attention/executive function than the AD continuum and normal biomarkers groups (p = 0.04). However, the ATN classification groups did not differ in terms of cortical thickness (p > 0.05). In addition, in the AD continuum group, memory was associated with left fusiform gyrus thickness (p = 0.000 uncorrected; r = 0.238). Conclusion Cognition, but not gray matter metrics, differs among AT(N) classification groups. Memory is associated with cortical thickness in patients with positive amyloid Beta (AD continuum).

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Abstract Background Stroke remains the second leading cause of death worldwide and the leading cause in Brazil. The implementation of a stroke center (SC) has played a crucial role in improving outcomes, increasing both survival rates and functional recovery. Objective To examine the experience of Hospital Universitário de Brasília of Universidade de Brasília's (HUB-UnB) SC, focusing on its performance indicators. Methods The present observational, retrospective, and analytical study evaluated 19 patients diagnosed with acute ischemic stroke (AIS) who received intravenous thrombolysis with alteplase at the HUB-UnB SC between July 2021 and December 2024. Performance indicators were compared with national and international data. Results The door-to-CT time was less than 25 minutes in 16 patients (84%), and the door-to-needle time was less than 60 minutes in 12 patients (63%). The mean National Institutes of Health Stroke Scale score significantly decreased from 12.4 at admission to 1.6 at discharge. Consequently, 76% of patients achieved a modified Rankin Scale score of 0 to 2. Complication rates were low, including 5.3% hemorrhagic transformation and 10.5% in-hospital mortality. No statistically significant differences were observed when comparing performance indicators with national and international benchmarks. Conclusion The implementation of the HUB-UnB's SC proved feasible and effective in providing specialized care for AIS within a university hospital of the Unified Health System (Sistema Único de Saúde, SUS, in Portuguese). Despite operating only during weekday business hours, outcomes were comparable to those of high-income countries. Expansion to 24-hour operation, infrastructure improvements, recruitment of additional healthcare professionals, and greater integration with the SUS remain key challenges.

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Abstract Background Stroke remains one of the leading causes of morbidity and mortality worldwide, requiring rapid and accurate recognition, especially in the context of prehospital care. Objective To construct, validate, and produce simulated scenarios for teaching and learning about the care of stroke victims in prehospital settings. Methods The present is a methodological, descriptive, and quantitative study involving the development of two simulated scenario scripts based on best simulation practices and Bloom's taxonomy. Validation was conducted by 11 expert judges selected according to Fehring's criteria, using an adapted instrument and the Content Validity Index (CVI), with a value of 0.90 or higher considered valid. Results All evaluated items of the scripts achieved full agreement among the judges, with a mean CVI of 1.0. The scenarios incorporate both typical and atypical signs and symptoms of stroke and are applicable for training prehospital care teams. Conclusion The validated simulated scenarios have the potential to enhance the training of prehospital care professionals, promoting the early recognition of stroke across different regional contexts in Brazil.

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Abstract Background Amyotrophic lateral sclerosis (ALS) is a rare degenerative disease of motor neurons, predominantly sporadic, with approximately 10% of the cases showing familial inheritance. Objective To characterize the clinical and sociodemographic profile of patients with familial ALS type 8 (fALS8) and compare it with sporadic ALS (sALS). Methods We reviewed the medical records (1997–2022) from a specialized Brazilian center. Patients with a confirmed diagnosis of ALSs were included, and sociodemographic and clinical data were collected. Results The sample was composed of 89 ALS patients, with a slight female predominance (53%) and a high frequency of fALS8 cases (45%). The fALS8 patients were diagnosed at a younger age, at approximately 50 years, compared to 53 years among the sALS patients (p = 0.043). Lower limb onset predominated in the fALS8 group (87%), while the sALS group showed more heterogeneous presentations, including bulbar onset (14%). The time until the diagnosis was significantly longer in the fALS8 group compared to the sALS group, both from symptom onset (approximately 51 versus 30 months respectively; p < 0.001) and after admission to a specialized center (7 versus 4 months respectively; p = 0.002). Dysphagia and gastrostomy were more frequent in the sALS group compared to the fALS8 group (p = 0.02 and p < 0.01 respectively), and older age at diagnosis was associated with worse functional scores. Conclusion The fALS8 group presented with distinct clinical and demographic features compared to the sALS group, including younger age at diagnosis, more homogeneous symptom onset, and lower frequency of dysphagia and need for gastrostomy. The diagnosis was more delayed in the fALS8 group, and older age at diagnosis was associated with worse functional status. The current study contributes to the scarce data on fALS8 in South America.

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Abstract Background The Naples Prognostic Score (NPS) is widely used, especially in cancer patients. Although it has been emphasized that this scoring system has a strong prognostic power for cardiovascular diseases, studies on cerebrovascular patients are quite limited. Objective To investigate whether there is a relationship between the level of carotid artery stenosis and the NPS. Methods Measurements were taken and recorded using venous blood samples taken from the patients at the time of their first hospital admission. Patients with NPS of 0, 1, and 2 were classified as the low Naples group. Patients with NPS of 3 and 4 were classified as the high Naples group. When analyzing the patients, comparisons were made according to these two separate groups. Results According to the cut-off values of the neutrophil-to-lymphocyte ratio (NLR; > 2.96), the lymphocyte-to-monocyte ratio (LMR; < 4.44), total cholesterol (TC; < 180), and albumin (< 4), the NLR was high in 261 (40%) patients, the LMR was low in 113 (17.3%) subjects, the TG level was low in 215 (32.9%) participants, and the albumin level was low in 247 (48.4%) individuals. The NPS was calculated according to the sum of the NLR (> 2.96), LMR (< 4.44), TG (< 180) and albumin (< 4) cut-off values, and it was 0 in 17 (2.6%) patients, 1 in 87 (13.3%), 2 in 212 (32.5%), 3 in 214 (32.8%), and 4 in 123 (18.8%) subjects. Conclusion The current study revealed a significant correlation between the degree of carotid stenosis and the NPS, which can be used as a tool to predict the severity of carotid stenosis.

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Abstract Background Mechanical thrombectomy is the standard treatment for acute ischemic stroke due to large-vessel occlusion, but the impact of multiple retrieval attempts on angiographic success and procedural safety remains uncertain. Objective To evaluate the association between the number of thrombectomy passes and the likelihood of unsuccessful reperfusion and procedural complications. Methods We analyzed a prospective registry of 291 consecutive patients who underwent mechanical thrombectomy at a tertiary center between 2020 and 2025. The variables collected included clinical, radiological, and procedural data. Unfavorable angiographic outcome was defined as a modified Treatment in Cerebral Ischemia (mTICI) score ≤ 2a. Logistic regressions were used to evaluate the predictors of unfavorable reperfusion and complications. Results The mean number of retrieval attempts was of 2.6 ± 1.9. Each additional attempt was associated with a 37% increase in the odds of an unfavorable angiographic outcome (odds ratio [OR] =1.37; 95%CI: 1.18–1.60). Patients requiring ≥ 3 passes presented significantly higher odds of angiographic failure (OR = 2.85; 95%CI: 1.55–5.42) and significantly higher complication rates (OR = 1.98; 95%CI: 1.01–4.03). Complications occurred in 15.2% of the cases, including dissections (5.2%), distal embolization (6.3%), and arterial rupture (2.2%). The rate of favorable mTICI score (≥2b) progressively declined from 76.7% in the first pass to 17.6% for patients with ≥ 6 passes. Conclusion Thrombectomy cases requiring passes are strongly associated with a higher risk of angiographic failure and procedural complications. Further studies are necessary to explore the mechanisms behind this association.

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Abstract The recent approval of monoclonal antibodies for the treatment of Alzheimer's disease represents a significant advancement in neurology. This accomplishment coincides with a worrisome trend: the increasing hegemony of large corporate healthcare organizations and commercial laboratory corporations in the supply of these new medications. This editorial examines how corporate influence undermines the traditional physician-patient relationship, diminishes neurologist autonomy, and signals a broader incursion into neurological practice by nonspecialists. The current situation in Brazil, compared with the United States and Europe, including the United Kingdom, is discussed, and strategies are proposed to maintain the integrity of neurological therapy amid growing corporate influence in the medical field.

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Abstract A 25-year-old man presented with subacute progressive anxiety, cognitive deficits, hypernatremia, and left hemiparesis. Magnetic resonance imaging demonstrated multifocal lesions in bilateral basal ganglia (globus pallidus and putamen), fornices, pineal region, along with Wallerian degeneration of the right corticospinal tract with right brainstem atrophy. Serum B-hCG, alpha-fetoprotein, alkaline phosphatase, and placental alkaline phosphatase were normal. Cerebrospinal fluid studies were unremarkable. Brain biopsy revealed intracranial germinoma. The case herein presented highlights a rare presentation of an uncommon neuro-oncological condition that often demonstrates excellent treatment response but is often diagnosed late due to its non-specific presenting symptoms.

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Abstract Epilepsy, described for millennia, has historically been interpreted through supernatural perspectives, leading to the search for religious intercession. Among the saints associated with the disease, Saint Valentine stood out in medieval Europe, especially in German-speaking regions, where his image was depicted curing people with seizures. Pilgrimages to sites with relics and popular names such as "Saint Valentine's Disease" highlight this devotion. In the 21st century, this symbolic heritage was reinterpreted in the context of advocacy, influencing the creation of International Epilepsy Day, celebrated on the second Monday of February, close to the saint's liturgical date on February 14th. This article revisits the historical trajectory of this association and discusses how cultural elements can be used to reduce stigma and promote scientific awareness about epilepsy.