A man aged 61 years presented with chronic progressive weakness and gait dysfunction over a 4-year period. He had Ashkenazi Jewish ancestry and a history of memory loss, inappropriate laughter, dysarthria, and hypertension. Examination revealed impaired recall, extremity spasticity, distal sensory loss, and normal cerebellar function, and imaging showed hyperintensities in the periventricular white matter of the corticospinal tracts of the pons and medulla. What is your diagnosis?

The association of encephalitogenic antiself antibodies with inflammatory brain disease has grown markedly with the identification of new species of autoantibodies at an ever-increasing pace over the last 25 years. The initial classification of a scattered selection of such syndromes—mostly considered to be paraneoplastic disorders—has evolved to an era with scores of identified autoantibodies with a wide spectrum of phenotypes. Despite improved characterization of the variety of antibodies associated with central nervous system (CNS) autoimmune disease and a better understanding of the range of clinical manifestations of these conditions, a unified understanding of the relationship of these antibodies to actual pathogenicity remains elusive. This impacts both our biological understanding of these disorders and hampers efforts to optimize treatment of these disorders.

This case report describes a 75-year-old man who presented with sudden-onset right hemiplegia.

This cohort study analyzes electroencephalography data from healthy participants to analyze and validate a cortical biomarker signature for pain, which comprised the measures sensorimotor peak alpha frequency and corticomotor excitability.

This open-label extension of a randomized clinical trial evaluates 5-year safety and efficacy of patisiran for the treatment of hereditary transthyretin amyloidosis with polyneuropathy.

This Viewpoint discusses protecting neural data privacy.

Identifying objective biomarkers that track individual pain severity has been dubbed “the holy grail” of pain neuroscience. While pain is among the most fundamental, ubiquitous, and adaptive experiences that can befall an organism, there is still a murky understanding of how pain is generated in the nervous system. Modern consensus on brain mechanisms underlying maladaptive chronic pain (pain that persists for greater than 3 months) is even less clear. Chronic pain affects up to one-fifth of US adults, and its complexity is attributed to a confluence of physical, emotional, and cognitive factors that contribute to suffering and disability. The epidemic of chronic pain initially contributed to the rise of the opioid epidemic and continues to plague nearly all fields of clinical medicine. Identifying and validating biomarkers to predict individual risk for chronic pain facilitate a precision medicine approach to pain medicine. A new human study using an experimental prolonged pain model by Chowdhury et al may bring us one step closer to the objective prediction of individual pain sensitivity.

In the Original Investigation titled “Antiseizure Medications and Cardiovascular Events in Older People With Epilepsy,” published online September 30, 2024, the title and short title were missing the study name. In addition, the project identification number in the Additional Contributions section was incorrect. The title and short title were updated to include Canadian Longitudinal Study on Aging (CLSA), and the project number was corrected from 21044036 to 2104036. The supplements were also updated with the new title. This article was corrected online.

This cohort study investigates the association between headache and risk of attempted and completed suicide.

This review assesses current research gaps and priorities in neuropalliative care.

This study attempts to determine whether the addition of neurostimulation to upper-extremity therapy enhances motor function in children with perinatal stroke and unilateral cerebral palsy.

In Reply We appreciate Ondo for their thoughtful letter on our recent article in JAMA Neurology. We appreciate the insights, particularly regarding the distinction between subjective reports of itching and observable scratching behaviors, which may reflect stereotypic movements rather than itch-driven actions. This distinction highlights an important nuance that could enhance the understanding and interpretation of our findings.

To the Editor I read with great interest the article by Hadad et al in this issue of JAMA Neurology. However, I do have concerns categorizing the symptom as itching based on the methodology of searching for the word itching and related words in the clinic record. I suspect that many of these patients diagnosed with itching actually did not have any subjective sensation of itching, but rather, only had the behavior of scratching. The entire section “Qualitative Descriptions of Itching” only describes the act of rubbing or scratching and seems to assume this results from itching. The specific statement “…itching was repetitive, stereotyped, and compulsive in nature” is intrinsically inaccurate, as the report of itching is entirely subjective and cannot be observed, only the movement can be observed, and this likely represents an assumption that the scratching resulted from symptomatic itching.

This randomized clinical trial investigates if intravenous prourokinase vs standard care is beneficial for patients with ischemic stroke who present with minor neurologic deficits.

Embolic stroke of undetermined source (ESUS) accounts for an estimated one-fifth of ischemic strokes. As a result, there is a clear need for effective therapeutic strategies for secondary prevention in these patients. Atrial fibrillation is a potentially important underlying cause of ESUS, and prior research suggests that brief episodes of previously unrecognized atrial fibrillation can be detected in up to 20% of these patients if cardiac monitoring is extended beyond 24 hours. The current standard of care is to monitor patients with ESUS for atrial fibrillation for at least a month, and more recent data suggest rates of detection are even more impressive when implantable loop recorders are used to monitor patients with stroke for up to 3 years, although the duration of heart rhythm monitoring in patients with ESUS is controversial.

This case series evaluates patients in China who presented with an unknown meningoencephalomyelitis syndrome associated with an astrocytic autoantibody.

To the Editor We read with interest the article by Kaplitt et al in JAMA Neurology about bilateral thalamotomy using magnetic resonance (MR)–guided focused ultrasound (MRgFUS) and appreciate the authors’ contribution to this emerging field. Although the study presents promising results, we would like to offer a constructive critique and advocate for a more comprehensive neuropsychological assessment in future research involving lesion procedures.

This economic evaluation analyzes retrospective and prospective data in 9 quality measures to determine their value in improving care for patients who have had a stroke.

In Reply We appreciate Aubignat and Godefroy’s interest in our article. In their letter, they propose that we may have underestimated cognitive changes following magnetic resonance–guided focused ultrasound (MRgFUS) ablation of the ventral intermediate nucleus of the thalamus, as cognition was evaluated by a screening assessment, the Montreal Cognitive Assessment, rather than a more robust measure, a neuropsychological battery. There is no question that if we had emphasized the possibility of cognitive complications, a comprehensive battery would be preferred. However, the most commonly reported, although generally mild and transient, complications after staged, bilateral MRgFUS are sensory, gait, and speech disturbances, not cognition. Still, in this trial to evaluate speech, we included comprehensive evaluations by speech pathologists at each center. Detailed evaluation for the less likely adverse events would have added considerable effort and burden to an already complex multicenter trial.

This case-control study assesses imaging and autopsy data from patients with dementia with Lewy bodies and probable dementia with Lewy bodies to investigate longitudinal change in 18F-fluorodeoxyglucose positron emission tomography.

This secondary analysis of a parallel-design double-blind secondary stroke prevention trial in patients with cryptogenic stroke and atrial cardiopathy evaluates the association between apixaban and the incidence of covert infarcts.

This Viewpoint advocates for inclusive artificial intelligence (AI) training and iterative testing and cautions against the uncritical adoption of AI engines that are trained on median patient groups and exclude the outlier groups that neurology regularly treats.

Mission Statement: The mission of JAMA Neurology is to publish and disseminate scientific information primarily important for physicians caring for people with neurologic disorders and for those interested in the structure and function of the normal and diseased human nervous system. The specific aims are to (1) publish timely original research, including clinical trials that will directly improve clinical neurologic care and that will inform efforts to improve neurological health and promote health care equity; (2) report translational research that is pertinent to the understanding of neurologic disease; (3) address topics of practice, ethics, education, and public health that are a key part of modern medicine; and (4) provide a forum for discussion and publication of important topics including bias, racism, and diversity. This information will be published only after extensive review by scientific peers and journal editors so that clarity, rigor, originality, and precision are ensured.