This article revisits an original case of bulbar-onset amyotrophic lateral sclerosis (ALS) recorded by Jean-Martin Charcot in 1877–78, highlighting his clinical methodology and its enduring significance. The case of Eugénie Florentine P., a 62-year-old patient at the Salpêtrière, illustrates Charcot’s rigorous approach: precise observation of clinical signs, longitudinal documentation of disease progression, and anatomoclinical correlation confirmed by autopsy findings. Charcot identified the combined role of anterior horn and lateral column lesions, establishing ALS as a distinct nosological entity. While predecessors such as Aran, Cruveilhier, and Duchenne contributed key observations, Charcot synthesized clinical and pathological data to define the disease later known as “Charcot’s disease.” This historical perspective underscores the lasting value of bedside examination in an era dominated by neuroimaging and biomarkers. By comparing 19th-century clinical reasoning with current diagnostic and therapeutic challenges, the article demonstrates how Charcot’s work continues to inform the modern multidisciplinary management of ALS.

Introduction: This systematic review and meta-analysis was conducted to investigate the association between alcohol use pattern and ischemic stroke risk. Methods: We searched PubMed, Scopus, Web of Sciences, Embase, and CENTRAL till the 1st of June, 2024. Studies were included if they were articles that assessed the impact of alcohol drinking pattern on the risk of ischemic stroke. The random-effect model was utilized to combine the results. Data analysis was performed using Meta XL, version 5.3. Results: The total number of included participants was 21,293,471 from 125 studies. The model that investigated the association between light alcohol use and ischemic stroke risk showed no association (relative risk [RR] = 0.97, 95% confidence interval [CI]: 0.89–1.05). Moderate alcohol use was associated with significant decrease in ischemic stroke risk (RR = 0.87; 95% CI: 0.83–0.92), while heavy alcohol use was associated with significant increase in ischemic stroke risk (RR = 1.31; 95% CI: 1.19–1.44). Subgroup analysis among males showed results similar to the primary analysis while among females, and only moderate alcohol drinking was significantly associated with ischemic stroke (RR = 0.50; 95% CI: 0.33–0.75). Moderate and heavy wine use was associated with significant reduction in ischemic stroke risk (RR = 0.61; 95% CI: 0.45–0.84; RR = 0.77; 95% CI: 0.63–0.93). Conclusions: Our analysis provided a strong and robust evidence that there was a significant association between moderate and heavy alcohol use with ischemic stroke risk. However, this association varied by several variables including type of alcohol with the effect being more protective among people who use wine.

I was 39 years old when Professor Heinz Kaeser, then chair of neurology in Basel and about to retire, called me to ask if I would take over the editorship of European Neurology after him. Interestingly enough, it had been one of my favorite neurological journals since 1978, when I started my training with 1 year of clinical psychiatry in Geneva. At the time, the journal had already been around for nearly 100 years, being the third oldest active neurological journal, founded as Monatsschrift für Neurologie und Psychiatrie by Carl Wernicke and Theodor Ziehen in 1897. To me, Wernicke has always been one of the most fascinating historical figures in the field, even with some form of genius (which allowed him, for example, to predict the existence of conduction aphasia and its lesion localization without having seen a single case!). Thus, the appointment as editor-in-chief was for me both prestigious and committing. Here, I am very grateful to the late Professor Henry J.M. Barnett, from London, Canada, who was at the time the world leader of clinical cerebrovascular research, and with whom I had the privilege to spend 1 year. Indeed, as chief editor of Stroke, he taught me much on the editorship work. “The war against biases” was his line, along with scientific rigor and attention to details.I am also grateful to the late Dr. Thomas Karger and his collaborators, who have been unwaveringly supportive, sometimes in uneasy situations. In fact, my first contact with the Karger company was earlier, in 1989–1990, when, along with my friend Professor Michael Hennerici, from Düsseldorf and then Mannheim, we founded the journal Cerebrovascular Diseases, in parallel with launching the European Stroke Conference.Over 3 decades later, I am particularly happy to be succeeded by Professor Laurent Tatu, a major leader in neuromuscular disease from the University of Franche-Comté, and Professor Cristina Granziera, from the University of Basel, now a rising star in neuro-immunology and imaging. Both spent significant time working with me, so that I am totally aware and confident of their competence and thrive to handle the editorship of the journal in a very balanced and complementary way.Under my guidance, European Neurology has remained a very clinical journal. In an increasingly technical medical world, where patient care – in fact the only real goal of medicine – is too often overlooked, maintaining a clinical focus is more vital than ever. Our focus has been general neurology from neuromuscular disease to cognitive dysfunction. The help of my associate editors (most recently, M. Paciaroni, H.P. Hartung, A. Bernasconi, and F. Assal), each an expert in a specific field, was here critical. We published two special issues, one for the century of the journal and one for its 125th anniversary, which were mainly devoted to progress in neurological therapies. In this field, the advances in therapy have indeed been gigantic during these years, with acute stroke management, the revolution of immunological treatment of multiple sclerosis, the introduction of new molecules for migraine, or transcranial pulse-ultrasound therapy for certain tremors and parkinsonian symptoms, to quote only a few. In 1984, with the help of Professor Franco Regli, my chief at the time, I authored a book on therapy of neurological diseases, encompassing all conditions and known treatments at the time… Nowadays, such a task would require a team of dozens of specialists.Proper assessment and subsequent help to patients with targeted management has always been my motto, including in my research activity. My academic years are over, but my commitment to patient care remains undiminished in my ongoing activity as head of the Swiss Medical Network Neurocenter. I heartedly wish that European Neurology, under its new guidance and along with its own evolution and changes, will nevertheless continue in that direction.Julien Bogousslavsky, MD, DM, PhD, FANA, FAHAEditor-in-Chief, European Neurology, 1994–2025The author has no conflicts of interest to declare.This study had no funding.

Introduction: Strokes rank among the most common acute conditions in neurology, leading to substantial increases in morbidity and mortality rates. It is essential to preserve patients’ autonomy in decision-making regarding resuscitation measures to prevent unnecessary interventions and safeguard their right to self-determination. This study aimed to identify the factors associated with an active decision against post-stroke patient resuscitation. Methods: We conducted a retrospective analysis of 139 patients from 2014 to 2021 at the University Hospital Zurich, Switzerland. All patients died within 3 months after stroke, with a documented active decision against resuscitation within this timespan. We examined sociodemographic and clinical factors, including outcome scores associated with the decision to change of code status. Results: Our cohort had a median age of 76.8 years, with 58% men. The median duration from stroke until do-not-resuscitate (DNR) decision was 4 days (range = 0–69), and 3 days (range = 0–59) from DNR decision until death. In total, 5 (range = 0–23) documented discussions were held with each patient’s family during the disease trajectory. Existing pre-stroke illnesses did not significantly influence these decisions. A total of 22.3% (n = 31) of patients received a consultation from palliative care specialists and/or palliative treatment, and 9.4% (n = 13) were referred to the PC ward. Conclusions: Our findings suggest that decisions against resuscitation primarily result from collaboration between healthcare professionals and families, respecting patients’ wishes, and were neither associated with comorbidities nor the severity of stroke. Every fifth patient was seen by a palliative care specialist, supporting the complex decision-making in this non-cancer population.

Introduction: Tuberous sclerosis (TSC) is an autosomal dominant genetic disorder with a wide range of clinical manifestations. This study aimed to retrospectively analyze the clinical records of TSC patients, focusing on the first onset times and age ranges for various symptoms. Methods: The clinical data of TSC patients were analyzed retrospectively, including general information, clinical manifestations, and treatment plans, with particular attention to the first onset times and age ranges for different symptoms. Results: The study found that 15 patients presented with different types of skin lesions, 13 patients, including 6 with intellectual disabilities, experienced epileptic seizures. Additionally, 14 patients had kidney damage, 6 showed varying degrees of cardiac involvement, and 8 exhibited lung lesions. Conclusion: By integrating the clinical features and imaging characteristics of TSC, multiple manifestations of the disease were identified, providing further clinical evidence for its recognition. This is beneficial for early monitoring and effective disease prevention and improvement.

The editors and Karger Publishers would like to thank the following reviewers for the ongoing support in reviewing manuscripts for European Neurology:Chifaou Abdallah, Montréal, QC, CanadaAlijan Ahmadi, Babol, IranSamar Farouk Ahmed, Kuwait, KuwaitTae-Beom Ahn, Seoul, Republic of KoreaDurdane Aksoy, Tokat, TurkeyEncarnita Ampil, Manila, PhilippinesAnita Arsovska, Skopje, MacedoniaMohammad Reza Asadi, Tabriz, IranV.C.S. Srinivasarao Bandaru, Hyderabad, IndiaDarina Bassil, Boston, MA, USAHale Zeynep Batur Caglayan, Ankara, TurkeyCan Ebru Bekircan-Kurt, Ankara, TurkeyFelix Benninger, Tel Aviv, IsraelFrancesco Brigo, Verona, ItalyKolbjørn Bronnick, Stavanger, NorwayFederico Cacciapuoti, Naples, ItalyVirginia Cancelloni, Perugia, ItalySalvatore Caratozzolo, Brescia, ItalyCristine Rosales Casingal, Manila, PhilippinesHsin-Yi Chi, Taichung, TaiwanElisabeth Chroni, Patras, GreeceVedat Cilingir, Van, TurkeySami Curtze, Helsinki, FinlandPhilippe Damier, Nantes, FranceMamede de Carvalho, Lisbon, PortugalGian Marco De Marchis, Basel, SwitzerlandVincenzo Di Lazzaro, Rome, ItalyVittorio Di Piero, Rome, ItalyRuth Djaldetti, Petach Tiqva, IsraelMervyn John Eadie, Herston, QLD, AustraliaPaul Eling, Nijmegen, The NetherlandsJose Manuel Morão Cabral Ferro, Lisbon, PortugalStanley Finger, St. Louis, MO, USAMalgorzata Florczak-Rzepka, Warsaw, PolandGéraud Forestier, Limoges, FranceNancy Futrell, Salt Lake City, UT, USASeana Gall, Hobart, TAS, AustraliaZuzana Gdovinova, Kosice, SlovakiaAura Virginia Gonzalez Ramirez, Piedecuesta, ColombiaNikolaos Grigoriadis, Thessaloniki, GreeceDaniel F. Hanley, Baltimore, MD, USAMasahiro Hatakeyama, Niigata, JapanMirjam R. Heldner, Bern, SwitzerlandMichael Hennerici, Mannheim, GermanyYuishin Izumi, Tokushima, JapanFélix Javier Jiménez-Jiménez, Arganda del Rey, SpainElias Johansson, Gothenburg, SwedenTheodoros Karapanayiotides, Thessaloniki, GreeceMehmet Karatas, Adana, TurkeyHee-Jin Kim, Seoul, Republic of KoreaPeter J. Koehler, Maastricht, The NetherlandsRajeev Kumar, Canberra, ACT, AustraliaKaren G. Langer, New York, NY, USAWei Li, Birmingham, AL, USARichard B. Mailman, University Park, PA, USAAvril Mansfield, Toronto, ON, CanadaGiuseppe Mariniello, Napoli, ItalyAlessandro Martorana, Rome, ItalyThomas Mattingly, Rochester, NY, USAAlex Medina, Calgary, AB, CanadaMaria Giulia Mosconi, Perugia, ItalyToshiho Otsuki, Osaka-Sayama, JapanNaoki Oyama, Kurashiki, JapanSerefnur Özturk, Konya, TurkeyFrancesca Pescini, Florence, ItalyAthanasios Petridis, Düsseldorf, GermanyAurel Popa-Wagner, Rostock, GermanyJukka Putaala, Helsinki, FinlandMohammad Dawood Rahimi, Shindand, IranDeepak Rawal, Udaipur, IndiaMichele Augusto Riva, Monza, ItalyRodrigo Rivas, Araucanía, ChileEgle Sakalauskaite-Juodeikiene, Vilnius, LithuaniaCorina Satler, Brasilia, BrazilGianluca Serafini, Genova, ItalyJijun Shi, Jiangsu, ChinaHash Brown Taha, Los Angeles, CA, USAYvonne Teuschl, Krems, AustriaAlexander Tsiskaridze, Tbilisi, GeorgiaWen-Jun Tu, Beijing, ChinaOlivier Walusinski, Brou, FranceTianhao Wang, Chicago, IL, USAKaishou Xu, Guangzhou, ChinaHaruko Yamamoto, Osaka, JapanQi Yang, Chaoyang, ChinaMehmet Ilker Yon, Ankara, TurkeyBin Zhou, London, UKWendy C. Ziai, Baltimore, MD, USA

Introduction: The objective of this study was to evaluate the effects and safety of monoamine oxidase-B inhibitors (MAO-B inhibitors) for early Parkinson’s disease (PD). Methods: All studies that assessed the efficacy of MAO-B inhibitors in patients with early PD were searched. Publications were screened, and data were extracted according to predefined criteria. Rev Man 5.4 and Stata 14.0 software were used for statistical analysis. Outcomes assessed included change of Unified Parkinson’s Disease Rating Scale (UPDRS) total score, UPDRS part II score, UPDRS part III score, and the incidence of adverse events. Results: Thirty trials were identified and included in this meta-analysis. Compared with placebo, rasagiline, selegiline, safinamide, and zonisamide were significantly more effective, with a standardized mean difference (SMD) of −0.41 (95% confidence interval (CI) = −0.64 to −0.18), SMD = −0.38 (95% CI = −0.51 to −0.24), SMD = −0.37 (95% CI = −0.54 to −0.21), and SMD = −0.31 (95% CI = −0.57 to −0.05) on the UPDRS III score change, respectively. The surface under the cumulative ranking results showed that rasagiline ranked first in improving UPDRS II and UPDRS III, respectively. For safety outcomes, safinamide combination with dopaminergic treatment had lower risk of incurring any adverse events (risk ratio = 0.1, 95% CI = 0.01–0.2), and no statistical difference in incidence of adverse events was observed among other MAO-B inhibitor regimes and placebo. Conclusion: Rasagiline, selegiline, safinamide, and zonisamide were effective compared to placebo in the treatment of early PD, but rasagiline was the most effective drug. As for safety, safinamide combination with dopaminergic treatment had lower risk of incurring any adverse events.

Background: In this paper, we argue that recent unprecedented social changes arising from social media and the internet represent powerful behavioral and environmental forces that are driving human evolutionary adaptive responses in a way that might reshape our brain and the way it perceives reality and interacts with it. These forces include decreases in physical activity, decreases in exposure to light, and face-to-face social interactions, as well as diminished predictability in biological rhythms (i.e., the sleep cycle is no longer dictated by natural light exposure and season). Summary: We discuss the roles of stress and of creativity and adaptability in Homo sapiens evolution and propose mechanisms for human adaptation to the new forces including epigenetic mechanisms, gene-culture coevolution, and novel mechanisms of evolution of the nervous system. Key Messages: We present the provocative idea that evolution under the strong selective pressures of today’s society could ultimately enable H. sapiens to thrive despite social, physical, circadian, and cultural deprivation and possible neurological disease, and thus withstand the loss of factors that contribute to H. sapiens survival of today. The new H. sapiens would flourish under a lifestyle in which the current form would feel undervalued and replaceable.