Faculty Bibliography

BACKGROUND:Epstein-Barr virus (EBV) is a key environmental risk factor for multiple sclerosis (MS), and tonsils and adenoids serve as a primary viral reservoir. This study investigates the potential role of adenotonsillectomy in pediatric-onset multiple sclerosis (POMS) risk and relapse rate. OBJECTIVES/OBJECTIVE:status, were collected. Multivariable logistic regression assessed the association between adenotonsillectomy and MS risk. In addition, negative binomial regression offset by follow-up time was used to assess the relationship between adenotonsillectomy and relapse rate in POMS participants with available follow-up data. RESULTS: = 0.013). CONCLUSIONS:Prior adenotonsillectomy was associated with increased risk of MS and greater relapse rate in pediatric patients, suggesting a potential interplay between EBV, immune regulation, and MS pathogenesis.

PURPOSE/UNASSIGNED:To investigate the short-T1 fraction as a potential biomarker of white matter myelin integrity, using myelin histology as ground truth. METHODS/UNASSIGNED:short-T1 fraction data were acquired from two elderly volunteers with WMHs to demonstrate translational feasibility. RESULTS/UNASSIGNED:significant reductions in short-T1 fractions were detected within WMHs. CONCLUSION/UNASSIGNED:The short-T1 fraction correlated with myelin content in postmortem brain white matter, supporting its potential as a clinically translatable biomarker of myelin integrity.

BACKGROUND:Public understanding about brain death/death by neurologic criteria (BD/DNC) is generally poor. With the rising popularity of utilization of large language model (LLM) chatbots to answer medical questions, we sought to determine the quality of information about BD/DNC provided by ChatGPT 4o-mini and Gemini 3 Flash (Fast). METHODS:With the assistance of a family advocate, we developed 45 open-ended questions about BD/DNC and submitted them to ChatGPT 4o-mini and Gemini 3 Flash (Fast) in January 2026. We recorded response word count, Flesch-Kincaid Readability Score and source reputability (non-reputable sources were defined as nonmedical, nongovernmental, nonlegal and not affiliated with an organ donation organization). Two authors of the 2023 BD/DNC guidelines independently assessed response accuracy relative to accepted medical standards and a third adjudicated discrepancies. RESULTS:Most responses were ≥ 10th grade level [ChatGPT 4o-mini: 44/45 (98%), Gemini 3 Flash (Fast): 39/45 (86%)]. After adjudication, 22/45 (49%) responses from Gemini 3 Flash (Fast) and 20/45 (44%) from ChatGPT 4o-mini were considered completely correct (p = 0.673). There was no relationship between accuracy and: word count; readability; or citation of at least one non-reputable source. CONCLUSION/CONCLUSIONS:ChatGPT 4o-mini and Gemini 3 Flash (Fast) responses to questions about BD/DNC may include inaccuracies. This could promote confusion and distrust. There is remarkable potential for integration of artificial intelligence in public education about healthcare, but there is a need for improvement to ensure responses are accurate and readable. The healthcare team should be prepared to address misconceptions about BD/DNC based on use of LLMs.

INTRODUCTION/BACKGROUND:Patient and arteriovenous malformation (AVM) characteristics that portend success after treatment for low-grade brain AVMs remain unknown. PATIENTS AND METHODS/METHODS:We utilised the MISTA multicentre registry to identify patients with Spetzler-Martin (SM) grade I or II AVMs treated with stand-alone curative-intent intervention (resection, stereotactic radiosurgery [SRS] or endovascular embolisation). Bivariate and multivariable analyses were performed to identify patient and AVM characteristics predictive of complete obliteration or favourable outcome (complete obliteration without new permanent deficit or post-treatment haemorrhage). RESULTS:A total of 522 patients were included (292 microsurgery, 152 SRS, 78 embolisation). Complete obliteration rates differed between microsurgery (95.9%), SRS (75.0%) and embolisation (71.8%) (P < .001); among patients classified as cured, digital subtraction angiography (DSA) confirmed obliteration in 96.1%, 75.9% and 52.4%, respectively. Favourable outcome was achieved in 89.4%, 64.5% and 67.9% (P < .001). In adjusted models for obliteration, elderly age (odds ratio [OR] 0.49, P = .022), larger nidus (OR 0.64, P = .005) and compacted morphology (OR 1.93, P = .019) were independent predictors overall; paediatric age predicted incomplete obliteration after microsurgery (OR 0.05, P = .045), and elderly age (OR 0.19, P = .001) and larger nidus (OR 0.59, P = .015) after SRS. For favourable outcome, SM grade II overall (adjusted OR [aOR] 0.58, P = .031) and elderly age after SRS (aOR 0.31, P = .019) were independent negative predictors. DISCUSSION/CONCLUSIONS:Low-grade AVMs showed high rates of complete obliteration, though DSA-confirmed rates were substantially lower after embolisation, underscoring the importance of angiographic confirmation. CONCLUSION/CONCLUSIONS:The predictors identified in this study may help guide management when 2 or 3 of the primary treatment options carry clinical equipoise.

BACKGROUND:Diet may influence MS activity, but most studies use a single dietary measure. The stability of diet over time in pediatric-onset MS (POMS) is unclear. OBJECTIVES/OBJECTIVE:To evaluate the reproducibility and short-term temporal stability of dietary intake in youth with POMS using repeated food frequency questionnaires (FFQ). METHODS:This longitudinal study included participants with a baseline FFQ (the Block Kids Food Screener, 2014). Intraclass correlation coefficients (ICCs) were estimated using random-intercept mixed-effects models to quantify the relative contributions of between-person and within-person variability. Temporal trends in intake were assessed by modeling time since baseline as a fixed effect, using log-transformed dietary variables to estimate percent change over time. RESULTS:Of 419 FFQs from 195 participants, 140 (71.8%) completed ≥2 FFQs over a median of 6.5 months (range 2.8-18). ICCs ranged from 0.41 to 0.78 across dietary measures, with the highest reproducibility observed for vegetables and fiber (ICCs 0.78 and 0.72). Log-transformed models showed small declines in several nutrients over time, corresponding to <10% change over a six-month period. CONCLUSIONS:Dietary intake demonstrated moderate to good reproducibility over the 6 to 18 month follow-up period. Vegetable and fiber intake had the strongest reliability. These findings suggest that reported dietary intake assessed by a single or infrequent FFQ may remain reasonably stable over a 6- to 18-month period in longitudinal POMS studies. However, the moderate-to-good reproducibility observed indicates that within-person variability persists and may attenuate diet-disease associations when only a single dietary assessment is available.

IMPORTANCE:Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impact exposure. CTE can only be diagnosed post mortem, and the antemortem neuropsychological profile is poorly understood, hindering accurate diagnosis before death. OBJECTIVE:To characterize antemortem neuropsychological test performance of former National Football League (NFL) players with autopsy-confirmed CTE. DESIGN, SETTING, AND PARTICIPANTS:This retrospective case series included former NFL players who completed an antemortem neuropsychological evaluation and had autopsy-confirmed CTE. Data were collected between January 1, 2017, and April 30, 2025. Statistical analysis was performed from September 2025 to June 2026. EXPOSURE:CTE neuropathology, defined by the National Institute of Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering consensus panel. MAIN OUTCOMES AND MEASURES:Neuropsychological test performance, neuropathologic diagnoses, and semiquantitative phosphorylated tau (p-tau) pathology across 11 brain regions were examined. Raw scores were converted to z scores using age, sex, and/or education level-based normative data. Test results with z scores of -1.5 or less were categorized as impaired; domains with 2 or more impaired test results were considered impaired. RESULTS:The primary analytic sample included 33 men (mean [SD] age at death, 65.4 [13.3] years; mean [SD] time between testing and death, 2.4 [1.6] years), 25 with high- and 8 with low-stage CTE. Learning and memory was most impaired (17 of 27 [63.0%]), followed by executive function (15 of 29 [51.7%]) and language (12 of 29 [41.4%]). High-stage CTE participants generally had worse scores than low-stage CTE participants. Greater global p-tau burden was associated with worse learning and memory performance (B = -0.40; 95% CI, -0.70 to -0.09; P = .01). Findings were similar after excluding 9 participants with co-occurring Alzheimer disease or frontotemporal lobar degeneration tau. CONCLUSIONS AND RELEVANCE:In this retrospective case series of NFL players with autopsy-confirmed CTE, memory, executive function, and language impairments were common, and p-tau burden was associated with worse memory performance. Findings provide insight into the expected CTE neuropsychological profile and may help advance diagnosis before death.

BACKGROUND:Public awareness of concussion has grown significantly over the past 2 decades, driven largely by media coverage of sports-related injuries. This has paralleled a rise in traumatic brain injury (TBI)-related emergency department visits, underscoring the need for specialized concussion care centers. Despite this, most existing programs focus on sports or pediatric populations, leaving critical care gaps. RECENT FINDINGS/RESULTS:The NYU Langone Concussion Center was established in 2013 to address these gaps by providing interdisciplinary care for both sports-related and non-sports-related concussions. Approximately 60% of cases seen at the center are not sports related. This article outlines the center's inception, operational model, patient demographics, and evolution over the past decade. IMPLICATIONS FOR PRACTICE/CONCLUSIONS:Lessons learned from the NYU Langone model offer valuable guidance for developing comprehensive concussion programs that can serve diverse urban populations. Key strategies include cross-specialty collaboration, flexible infrastructure, and systems-level integration to address heterogeneous mechanisms of injury and outcomes.

This practice guideline provides updated evidence-based recommendations regarding the use of pharmacologic migraine prevention in adults. A multidisciplinary panel conducted a systematic review and developed practice recommendations following the process outlined in the 2017 edition of the American Academy of Neurology Clinical Practice Guideline Process Manual. The systematic review includes studies published through June 6, 2024, and is available in a companion publication. Recommendations are supported by structured rationales that integrate evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Recommendations are provided on how to decide when it is appropriate to start a pharmacologic migraine preventive medication and how to decide which migraine preventive medication to start. Recommendations address decision making on appropriate choices of migraine preventive medications in specific situations and populations, including patients with fibromyalgia, obesity, or hypertension; considerations for older adults; treatment during pregnancy and lactation; sex-related factors in choosing medications; and treatment for patients with medication overuse. Recommendations on assessment of treatment efficacy, adverse effects, and discontinuing migraine preventive medications are provided.

Subjective cognitive decline (SCD) refers to cognitive concerns that may occur with or without objective impairment on standardized testing. Studies suggest that SCD may be an early clinical marker of Alzheimer's disease and related dementias, and that it can predict future objective cognitive decline and progression to dementia. However, the research that supports these conclusions is primarily based on samples with homogeneous socioeconomic and cultural backgrounds. The limited studies in samples with more diverse representations of racial, ethnic, gender, and sexual orientation characteristics show varying SCD prevalence, correlates, and outcomes. Here, we review this literature, focusing on how to apply the findings to advance our understanding of SCD. We further evaluate how our findings inform a roadmap for future research. Overall, we conclude that broader investigations across more diverse populations enhance our understanding of the factors that may differentially contribute to SCD and shape its utility as a clinical metric.

OBJECTIVE:Novel proof-of-concept designs utilizing biomarkers associated with an established clinically meaningful outcome are needed for antiseizure medication (ASM) efficacy assessment in patients with epilepsy, including drug-resistant focal epilepsy. Changes in long episode (LE) frequency, recorded by the responsive neurostimulator (RNS® System), are associated with changes in clinical seizure (CS) frequency following ASM initiation, suggesting that LEs may serve as a valid biomarker. Here, we aimed to establish the LE reduction magnitude associated with a clinically meaningful CS reduction. METHODS:Post hoc retrospective analyses of CS and LE frequencies, responder rate, and receiver operating characteristics from a long-term RNS open-label treatment study in patients who met predefined criteria were performed to evaluate the association between changes in LE and CS frequency and the LE reduction cutpoint associated with a ≥ 50% CS reduction. RESULTS:Patients (N=45) initiated clobazam (n=15), levetiracetam (n=4), or lacosamide (n=26). Patients achieved a median 30% LE and 50% CS reduction. Patients with <50% and ≥50% CS reductions had a median 5.9% LE increase and 52.4% LE reduction, respectively. A positive association between LE and CS frequency reduction across the entire range of responses (0-100%) was observed. A ≥30% LE reduction was associated with a ≥50% CS reduction; AUC=0.765, N=45. SIGNIFICANCE/CONCLUSIONS:If LE reductions may serve as a potential biomarker, a threshold associated with meaningful improvement in CSs is paramount. Results from this hypothesis-generating analysis support the use of a ≥ 30% LE reduction as a biomarker associated with clinically meaningful improvement in focal epilepsy.