Beyond 4.5 hours, thrombectomy carries the evidence; bridging tenecteplase remains unproven

The edition in brief

A Bayesian network meta-analysis of 15 randomised trials (8 in confirmed large-vessel or basilar occlusion) found that endovascular thrombectomy 4.5 to 24 hours after onset improved functional independence (OR 2.93, 95% CrI 1.40–6.53) and lowered 90-day mortality (OR 0.71) against medical care, with more symptomatic haemorrhage. Adding tenecteplase to thrombectomy gave imprecise, inconclusive estimates (OR 1.10, 0.34–3.52). Nationwide data from France and Sweden linked epilepsy to young-onset dementia: in a French cohort, ten-year incidence was 2.2% after new epilepsy in midlife against 0.21% without (adjusted HR 6.02). This is observational. A meta-analysis of eight paediatric trials found no difference in seizure freedom between levetiracetam and valproate (RR 0.95, 0.83–1.09; low certainty), with fewer adverse events and less weight gain on levetiracetam. In 294 people with Parkinson's disease, higher physical activity was associated with slower cognitive and motor decline over up to seven years.