Transient ischemic attack (TIA) often precedes ischemic stroke and, therefore, requires urgent treatment. In contrast, transient global amnesia (TGA) is a benign condition, though it often causes concern among patients and their relatives. The longitudinal prognoses of TIA and TGA in Finland have not been reported recently. Here, we studied the 5-year prognosis of TIA and TGA regarding stroke, recurrent TIA, and mortality. The original study population comprised 293 patients with TIA and 56 patients with TGA diagnosed at Kuopio University Hospital (KUH) in 2017. Baseline data were collected from the hospital records at KUH in 2017. The above-mentioned 5-year outcomes, as well as cardiovascular events were studied using national registers provided by Findata. The risk of recurrent stroke within 5 years of the index event was 29.4% (n=86) after TIA and 7.1% (n=4) after TGA. Among the patients with TIA as the index event, ABCD2 score ≥4 correlated with higher risk of stroke (p=0.04). Recurrent TIA occurred in 29.0% (n=85) of patients in the TIA group; none of the patients with TGA experienced TIA. Regarding mortality, 25.9% (n=76) of patients with TIA and 3.6% (n=2) with TGA died during the follow-up period. Vascular cause of death occurred in 10.2% of patients with TIA and in none with TGA. Patients with TIA had a significantly higher risk of stroke, recurrent TIA, and death than patients with TGA. Factors associated with cardiovascular outcomes require more research to prevent recurrent events after TIA.

Introduction Guillain-Barré Syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, with an annual worldwide incidence of 1-2 cases per 100,000 people. The incidence of GBS in Australia has not been studied in the past 38 years, and existing Australian literature presents a different severity profile compared to that observed in the Barwon South West Region (BSWR). The aim of this study was to describe and compare the prevalence of GBS in two proximate regional areas of Australia. Methods A retrospective file audit was conducted for patients residing in the BSWR or Grampians Region (GR, a region adjacent to BSWR), admitted with GBS between 2009 and 2019. Results We identified 120 GBS patients during the study period: 91 from the BSWR and 29 from the GR. The age-adjusted incidence of GBS in the BSWR was 3.0 cases per 100,000 people per year (95% CI: 2.4-3.7), compared to 0.9 cases per 100,000 in the GR (95% CI: 0.6-1.3, p=0). The risk of GBS was significantly higher for those living in the BSWR compared to the GR (IRR 3.26, 95% CI: 2.14-4.95, p<0.001). There were no significant differences between the two groups in terms of age, gender, preceding illness, season of onset, disability severity, need for mechanical ventilation, medical treatments, or rehabilitation outcomes. Discussion This study provides updated data on the incidence and severity of GBS in two regional areas in the state of Victoria (Australia), revealing substantial regional variation within geographically proximate areas. These findings are crucial for resource planning and staff training. Further research is needed to explore the underlying causes of these regional differences.

Existing studies have focused on neurological disorders' morbidity and mortality, yet their economic consequences remain unquantified. We estimated the macroeconomic impact of neurological disorders and subcategories at the global, super-regional, and national levels in 2019 and 2021, and described sex and age distribution. We obtained mortality and morbidity data, reflecting long-run and short-run disease burden respectively, from the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease 2021 study. Purchasing power parity (PPP)-adjusted gross domestic product (GDP) data were sourced from the World Bank. Economic burden was estimated using the value of lost welfare (VLW) framework, which rests on the value of a statistical life (VSL) and covers non-market losses. All monetary values are expressed in 2021 international dollars adjusted for PPP. In 2021, the global VLW of neurological disorders was $10,710.51 billion, equal to 7.23% of global gross domestic product (GDP), and the short-run economic burden predominates over the long-run component. By subcategories, headache disorders accounted for 44.7%, and Alzheimer's disease and other dementias for 35.7%. From 2019 to 2021, global VLW changed little, while VLW/GDP (%) declined slightly due to rising nominal GDP. Neurological disorders impose substantial economic burden globally, particularly in High-income super-region and older populations. Policy emphasis should reflect regional burden profiles. High-income settings prioritize earlier dementia detection, life-course risk-factor control, and caregiver support., while low- and middle-income settings scale primary-care chronic management and effective acute headache therapies.

This study evaluates the use of infarct growth rate (IGR) from CT perfusion (CTP) imaging to predict poor prognosis in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT). We analyzed data from a prospective clinical database of patients admitted with anterior circulation large vessel occlusive stroke from January 2022 to December 2024. IGR was defined as the ischemic core volume on CTP imaging divided by the time from stroke onset to imaging. O.662utcomes were assessed at 90 days using the modified Rankin scale (mRS). Multivariate logistic regression and restricted cubic spline (RCS) analyses were employed to assess the independent and combined effects of IGR and NIHSS score on the clinical prognosis of AIS patients after thrombectomy. Receiver operating characteristic (ROC) curve analysis was further utilized to evaluate the predictive performance of these associations. A total of 232 patients satisfied the inclusion criteria. Among them, 83 patients (35.8% of the study cohort) exhibited a poor prognosis. After adjustment for potential confounders, an increased IGR was independently associated with a higher risk of poor prognosis (adjusted odds ratio: 1.17; 95% CI: 1.10-1.24; P<0.001), a relationship which was further characterized as nonlinear (P for nonlinearity < 0.0001). The AUC for the combination of NIHSS score and IGR was 0.90 (95% CI: 0.86-0.94). An elevated IGR wasidentified asan independent predictor of poor prognosis in patients with AIS who underwent EVT.

Introduction: Neonatal seizures affect 1–3 per 1,000 live term newborns and are most often acute provoked. Seizure verification with electroencephalogram (EEG) or amplitude-integrated EEG (aEEG) is of major importance for correct diagnosis. The aim of this study was to investigate the risks of developmental delay (DD), intellectual disability (ID), autism, attention-deficit hyperactivity disorder (ADHD), and cerebral palsy (CP) after EEG/aEEG-verified neonatal seizures of any cause in a Swedish population-based cohort. Methods: Data from five national health care registers were used. Infants with EEG/aEEG-verified seizures, born from January 1, 2009, to December 31, 2020, were matched with controls, negative for neonatal seizure diagnosis. Follow-up time was from January 1, 2009, to December 31, 2021. Cumulative incidences, unadjusted and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) from Cox regression analysis of each outcome, were explored. In infants with neonatal seizures, the occurrence of prespecified etiologies was investigated. Results: In total, 1,062 infants with neonatal seizures were matched with 5,310 controls. Overall, the cumulative incidences were greater in infants with neonatal seizures compared with controls, and CP presented with the highest incidence of 21.9% (95% CI: 19.4–24.6%) in children with neonatal seizures at 10 years of age and 0.42% (95% CI: 0.27–0.64%) in controls. The greatest aHR of 42.6 (95% CI: 26.3–69.1) was found for CP, followed by an aHR of 18.9 (95% CI: 11.8–30.4) for ID when children with neonatal seizures were compared with controls. In children with neonatal seizures, 57.1% (n = 606) were registered with any of the prespecified etiologies. Conclusion: Neonatal seizures were associated with overall increased risks of DD, ID, autism, ADHD, and CP. The findings emphasize the risks of adverse developmental trajectories in the exposed children and the importance of standardized follow-up programs to initiate clinical interventions when needed.

Introduction: The inclusion of spinal cord injury (SCI) in the Global Burden of Diseases (GBD) study in 2016 as a distinct entity represented a significant milestone in recognizing and quantifying its global health impact. The study’s purpose was to quantify the discrepancies between SCI incidence rates estimated by the GBD and those reported in published literature to assess the external validity of GBD outputs at the country level and propose methodological refinements to improve their utility for policymakers, clinicians, and global health stakeholders. Methods: We compared GBD 2016, 2019, and 2021 country-level SCI incidence estimates with data from 10 systematic reviews and a scoping search in Embase. Studies were eligible for inclusion if they explicitly reported both case counts and incidence rates of SCI at the country level. Two authors checked the data for accuracy and reliability purposes. We categorized studies into two periods – pre-2000 and 2000 to 2024 – to align with key GBD benchmark years: 1990 for pre-2000 data, and 2016, 2019, and 2021 for post-2000 data. A meta-analysis calculated SCI incidence rates for each country across two timeframes (pre-2000 and 2000–2024). We then computed a discrepancy ratio (DR) by dividing GBD estimates by literature-based rates, categorizing discrepancies as low (DR < 2), moderate (2 to <5), substantial (5 to <10), or significant (DR > 10). Further analysis explored countries with national registries, the impact of prehospital mortality, and GBD’s SCI definition and reporting methodology. Results: In our analysis of 30 countries, we identified a high proportion of significant (50%) and substantial (23.4%) discrepancies relative to GBD 2016 estimates. When compared against GBD 2021 data, significant discrepancies decreased to 6.6%, though substantial discrepancies rose to 50%; indicating an overall improvement but persistent overestimation. Japan, South Africa, Taiwan, and Tanzania showed low discrepancies, while Denmark, France, Italy, and Spain continued to have significant discrepancies in GBD 2021. We identified three key areas for GBD improvement: unclear inclusion of non-traumatic SCI, lack of incidence stratification by severity, and omission of sports-related SCI as a distinct etiology. Conclusion: Early GBD SCI estimates were often overestimates, but continuous methodological refinements are leading to better alignment with real-world data. Future GBD reports should further enhance interpretability by integrating injury severity data and a more granular breakdown of SCI etiologies.

Objectives: The aim of this study was to investigate the causal effects of body mass index (BMI) at different life stages (childhood and adulthood) on migraine and its subtypes. Background: While previous studies suggest BMI is a risk factor for migraine, it is unclear whether BMI influences migraine differently throughout the life course. The causal effect of childhood BMI may have obscured the association between adult BMI and migraine, making it difficult to determine the independent role of adult adiposity. Methods: We conducted a life-course Mendelian randomization (MR) study. Two-sample and conventional multivariable MR analyses were performed initially. Subsequently, Framework for Life-Course Pathway Analysis Using Mendelian Randomization – a newly developed three-sample multivariable MR method – was applied to estimate the direct, indirect, and total effects of BMI at childhood or adulthood on migraine. All estimates were scaled per 1-SD increase in BMI (SDs: 1.35 kg/m2 at age 1; 1.78 kg/m2 at age 8; 4.76 kg/m2 in adulthood). Results: The causal effect of BMI on migraine is strictly dependent on the timing of exposure. First, we found no evidence that adult BMI influences the risk of either migraine subtype. Second, higher BMI at age 8 exerted a direct protective effect against migraine with aura (OR = 0.522). Third, BMI at age 1 exhibited a dual role: its direct risk-increasing effect (OR = 1.983) was offset by an indirect protective effect mediated through 8-year-old BMI (OR = 0.511), resulting in a null total effect on migraine with aura. Migraine without aura was unaffected by BMI at any life stage. Conclusion: The causal effect of BMI on migraine is dependent on developmental timing, challenging the conventional view of BMI as a uniform risk factor. We emphasize that the observed protective role of childhood BMI is a model-estimated association from genetic data, which does not constitute a recommendation to increase body weight in children.

Background: Understanding the global burden of neuroblastoma and related tumors requires further research. This study aimed to provide global, regional, and national estimates of the incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) associated with neuroblastoma and other peripheral nervous cell tumors from 1990 to 2021. Methods: Data on the absolute counts and age-standardized rates (ASRs) of incidence, prevalence, deaths, and DALYs for neuroblastoma and other peripheral nervous cell tumors were extracted from the Global Burden of Disease (GBD) database covering 204 countries and territories. Decomposition analysis was employed to identify key contributors to changes in disease burden. Bayesian Age-Period-Cohort (BAPC) modeling was utilized to project disease trends over the next 25 years. Results: In 2021, the highest number of incidence, prevalence, deaths, and DALYs were observed in children under 5 years of age, followed by a sharp decline with increasing age. ASRs for incidence, prevalence, deaths, and DALYs were highest in countries within the high socio-demographic index (SDI) quintile, whereas the middle SDI quintile exhibited the highest absolute case counts for incidence, deaths, and DALYs. Between 1990 and 2021, the global burden of neuroblastoma and other peripheral nervous cell tumors increased substantially. Incident cases rose from 5,854 (95% uncertainty interval [UI]: 4,517–7,643) in 1990 to 10,867 (95% UI: 8,279–13,557) in 2021. Deaths increased from 2,675 (95% UI: 2,298–3,138) to 5,194 (95% UI: 4,295–5,932), while DALYs surged from 185,391 (95% UI: 158,570–219,544) to 285,479 (95% UI: 227,709–341,110). BAPC modeling projected a continued increase in both absolute numbers and ASRs for incidence, prevalence, deaths, and DALYs across both sexes from 2022 to 2046. Conclusions: Over the past 3 decades, the global incidence, prevalence, deaths, and DALYs associated with neuroblastoma and other peripheral nervous cell tumors have increased substantially. These findings underscore the urgent need for effective healthcare policies and targeted cancer control strategies to mitigate the growing disease burden.

Introduction: Early-onset dementia (EOD) and late-onset dementia (LOD) differ in etiology, clinical presentation, and societal impact. Characterizing their global burden and associated risk factors is essential for guiding targeted interventions and resource allocation. Methods: We analyzed data from the Global Burden of Disease (GBD) 2021 study (1990–2021) to estimate incidence, mortality, and disability-adjusted life years (DALYs) for EOD (ages 40–64) and LOD (≥65 years) across 204 countries and territories. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated. Risk factors examined included smoking, high fasting plasma glucose (FPG), and high body mass index. Associations with the sociodemographic index (SDI) were assessed, and Bayesian age-period-cohort model was used to project trends to 2050. Results: In 2021, global age-standardized incidence rates (ASIRs) were 63.58 per 100,000 for EOD and 1,173.19 per 100,000 for LOD. Corresponding age-standardized mortality rates (ASMRs) and age-standardized DALY (AS-DALY) rates were substantially higher for LOD. Point estimates for ASRs were consistently higher for females than for males across all metrics. From 1990 to 2021, the burden of EOD increased (ASIR EAPC = 0.13; ASMR EAPC = 0.08; AS-DALY EAPC = 0.08), while LOD trends remained largely stable. Regional variation was observed, with EOD burden highest in China, Canada, Brazil, and the USA and LOD in China, Germany, Italy, and Lebanon. Metabolic risks, particularly high FPG, were major contributors to LOD. SDI was positively correlated with LOD burden (r = 0.176; p < 0.001), indicating a weak but statistically significant association. Projections indicate that EOD cases will increase by 160% and LOD cases by 479% by 2050. Conclusions: The global dementia burden is rising, with distinct epidemiological patterns for EOD and LOD. Age- and region-specific risk factor profiles highlight the need for tailored prevention strategies, informed healthcare planning, and differentiated clinical management.