After intracerebral haemorrhage, blood pressure control is the treatment

The edition in brief

RECAP-ICH pooled individual data from four trials and 2,944 patients with previous spontaneous intracerebral haemorrhage. An 11.2 mm Hg mean systolic difference reduced first recurrent stroke of any type from 10.4% to 6.5% (adjusted HR 0.62, 95% CI 0.48 to 0.80), driven almost entirely by fewer recurrent haemorrhages (2.2% versus 5.6%, HR 0.39). Serious adverse events were no higher. Benefit appeared within about six months and held across every prespecified subgroup, including time since the index event. Three-quarters of participants were Asian. TEMPLE compared atogepant 60 mg with topiramate head-to-head in 540 adults over 24 weeks. Discontinuation for adverse events was 12% versus 30% (RR 0.4), and 64% versus 39% achieved at least a 50% reduction in monthly migraine days. Atogepant won on both tolerability and efficacy — in an AbbVie-funded trial of its own drug. The AAN and American Headache Society have published updated migraine prevention guidance covering when to start, what to choose, pregnancy and lactation, older adults, and how to stop. EURAP followed 15,893 antiseizure-medication-exposed pregnancies. Against lamotrigine, birthweight centile was lower with topiramate by 11.93, phenobarbital by 8.08 and oxcarbazepine by 5.10; polytherapy raised small-for-gestational-age risk by about 50%. A meta-analysis of 25 studies and 18,073 participants found plasma p-tau217 detects amyloid pathology with sensitivity and specificity near 0.87 to 0.93 depending on platform, and the p-tau217/amyloid-beta-42 ratio roughly doubles the diagnostic odds ratio. Today's pearl: do not withhold cholinesterase inhibitors from Lewy body dementia because of bradycardia.