Thrombolysis out to 24 hours works on imaging selection — and triples symptomatic bleeding

The edition in brief

Today's neurology edition opens with neurocysticercosis: a Bayesian meta-analysis of 35 well-defined studies estimates that 25.2% of people presenting with epileptic seizures in endemic regions have it, with the proportion apparently declining since 2008. A JAMA Neurology cohort study of the Parkinson Progression Markers Initiative and three US trial cohorts finds that MC1R loss-of-function variants, carried by more than 60% of people of European descent, mark 30% faster motor decline in sporadic Parkinson disease, replicated at 50% in a second cohort, with a more than fourfold phenoconversion risk in a small prodromal group. A meta-analysis of 50 studies in neurofibromatosis type 1 finds ADHD in 33%, seizures in 11%, epilepsy in 9%, and intellectual disability in 8% overall but 41% in those with microdeletions. An updated Cochrane review of 110 trials in 48,919 community-dwelling older people finds multifactorial fall prevention reduces falls rate against usual care but adds nothing over falls advice alone, and probably increases falls rate slightly against it. The edition closes on an updated meta-analysis of 14 trials and 4,944 patients showing intravenous thrombolysis given 4.5 to 24 hours after onset in imaging-selected patients raises excellent functional outcome at three months, at the cost of a 2.5-fold increase in symptomatic intracranial haemorrhage and no mortality difference.