Day: July 14, 2025

GLP-1 Receptor Agonists in Idiopathic Intracranial Hypertension

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In a retrospective cohort study Sioutas et al. from the Virginia Commonwealth University Health System, Richmond published in JAMA Neurology to evaluate whether GLP-1 receptor agonist (GLP-1 RA) therapy is associated with improved outcomes in patients with idiopathic intracranial hypertension (IIH), compared to conventional therapies.

Conclusions: In a large matched cohort drawn from a nationwide EHR database (TriNetX), GLP-1 RA therapy was significantly associated with lower medication burden, reduced symptoms (headache, papilledema, visual disturbances), fewer surgical interventions, and lower 1-year mortality. These benefits were not paralleled by significant differences in BMI, suggesting mechanisms beyond weight loss. Bariatric surgery yielded more weight loss but inferior clinical outcomes compared to GLP-1 RA use. The study suggests a promising role for GLP-1 RAs in IIH management, though causality remains unproven 1).

Summary of Findings

GLP-1 RAs were associated with:

↓ Medication burden

↓ Symptoms: headache, papilledema, visual disturbance

↓ Surgical interventions

↓ 1-year mortality

No significant difference in BMI change

Bariatric surgery achieved greater weight loss but inferior clinical outcomes

Authors’ Conclusion: GLP-1 RAs may provide benefit in IIH independent of weight loss, warranting further study.

Critical Review

1. Design Strengths:

Large nationwide dataset (TriNetX), increasing statistical power

Matching for baseline characteristics reduces—but does not eliminate—confounding

Clinically relevant composite endpoints

2. Methodological Caveats:

Retrospective EHR-based design is inherently limited by:

Confounding by indication

Missing or imprecise clinical detail (e.g. visual field data, CSF pressure)

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Chronic Glymphatic Dysfunction Modulates Domain-Specific Cognitive Recovery After Stroke: A DTI-ALPS Lesion Stratification Study

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In a retrospective cohort study, Qingwen Chen et al. (Qingyuan People’s Hospital; Guangdong Pharmaceutical University; South China Normal University, Guangzhou) published in CNS Neuroscience & Therapeutics, investigated the presence and temporal dynamics of glymphatic dysfunction in chronic-phase stroke using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. The study further aimed to correlate this dysfunction with domain-specific cognitive outcomes stratified by lesion topography.

The authors observed that glymphatic impairment — as measured by reduced ALPS indices — persisted up to one year after stroke, with asymmetry favoring more impairment in the lesioned hemisphere at 3 months, followed by partial recovery at 12 months. However, cognitive correlations (primarily in motor and memory domains) were weak, inconsistently significant, and vanished by one year. Neither lesion volume nor cortical vs subcortical location predicted ALPS values.

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Critical Review

This study introduces a compelling premise — glymphatic dysfunction as a chronic, measurable consequence of ischemic stroke — but its translational value remains limited. The authors apply the DTI-ALPS metric longitudinally, which is methodologically novel, yet still lacks validation against gold-standard glymphatic tracers. As a surrogate marker, ALPS remains indirect, anatomically constrained, and highly sensitive to white matter tract orientation and noise.

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Analysis of predictive factors for the efficacy of reinforced radiculoplasty in symptomatic sacral Tarlov cysts

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In a single-center retrospective cohort study (n=41) Jin Zhu et al. from the Beijing Jishuitan Hospital, published in Neurosurgical Review to assess clinical predictors of symptom improvement following reinforced radiculoplasty in patients with symptomatic sacral Tarlov cysts (TCs). Reinforced radiculoplasty significantly improves pain and numbness in sacral TC patients. Greater likelihood of pain-free status is associated with older age and lower preoperative VAS scores. No variables significantly predicted numbness relief 1).

Critical Review:

The study targets an underexplored treatment avenue—reinforced radiculoplasty—for symptomatic Tarlov cysts, an entity often managed conservatively due to unclear pathophysiology and outcome data. The authors utilize a small retrospective sample, limiting statistical power and generalizability. While binary logistic regression is appropriately applied, the absence of a control group and the reliance on telephone follow-ups raise concerns regarding recall bias and subjective assessment of outcomes. Furthermore, the study fails to delineate surgical technique variability or operator-dependence, critical factors in neurosurgical outcome studies. The lack of correlation with imaging changes and omission of bowel/bladder symptom stratification are notable limitations.

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