This Week in Neurology: Stroke Thrombolysis Risks and Depression Treatments

This week's research highlights significant considerations regarding thrombolysis in acute ischemic stroke. A substudy of the AcT trial evaluated radiological markers in 482 thrombolyzed patients, finding that cortical superficial siderosis burden was consistently associated with higher risks of symptomatic intracerebral hemorrhage and worse functional outcomes ^[3].

Meanwhile, a post hoc analysis of a randomized controlled trial examined tenecteplase versus standard care in 884 patients with minor ischemic stroke. The authors describe that while younger patients achieved similar recovery, those over 80 years had worse outcomes and higher hemorrhage rates with tenecteplase, suggesting caution in using thrombolysis for minor strokes in the elderly ^[4].

Elsewhere this week, attention turned to Alzheimer disease pathology in cognitively unimpaired adults. A cross-sectional analysis examined 621 physically inactive, community-dwelling adults across three US universities to assess how brain reserve modifies the relationship between AD pathology and cognition. Results indicate that negative associations between AD pathology and cognitive function were weakest in individuals with younger appearing brains, suggesting a protective role for brain reserve, though longitudinal studies are required to confirm these findings before clinical application ^[2].

We also saw research in the Journal of clinical neuroscience regarding multiple sclerosis treatment. A 12-month, multicenter, phase 4 observational study of 645 Iranian patients initiating dimethyl fumarate found significant improvements in treatment satisfaction, quality of life, sleep, and work productivity when using a slow-dose titration regimen. These patient-reported benefits in a real-world setting warrant consideration alongside established efficacy and safety data, although the study notes limitations and a lack of comprehensive safety data ^[1].

Finally, in Zhongguo zhen jiu, researchers described a randomized trial involving 126 patients with post-stroke depression. In 90 patients analyzed after propensity score matching, abdominal acupuncture added to transcranial direct current stimulation over four weeks produced greater improvements in depression and functional scores than tDCS alone, with a higher total effective rate of 91.1% versus 73.3%. The authors suggest considering abdominal acupuncture as a possible adjunct to tDCS, while recognizing the short follow-up period and absent safety data ^[5].