Haneen Sabet

Objective: To evaluate the effectiveness and safety of proximal and distal ultrasound‐guided greater occipital nerve block (US‐GONB) in patients with migraine. Methods: PubMed, Scopus, Web of Science, and the Cochrane Library were searched up to July 2025. Studies assessing US‐GONB in migraine were included. Data were pooled using a random‐effects model and expressed as mean difference (MD) with 95% confidence intervals (CI). Subgroup analyses were conducted based on the injection site. Results: Twelve studies (658 patients) were included. US‐GONB significantly reduced pain intensity (MD = −3.48 points, 95% CI [−3.84, −3.11]), monthly headache frequency (MD = −9.12 days, 95% CI [−11.65, −6.58]), headache duration (MD = −18.98 h, 95% CI [−26.86, −11.11]), and monthly analgesic use (MD = −10.01, 95% CI [−12.91, −7.11]). No significant subgroup difference was observed in pain intensity between injection sites. For monthly headache frequency, a significant subgroup difference was observed, with the proximal subgroup demonstrating numerically larger reductions than the distal subgroup (−10.83 vs. −6.36 days; p = 0.006). Adverse events were generally mild and transient: loss of pinprick sensation occurred in 80% of proximal vs. 100% of distal injections, dizziness in 22.7% vs. 3.9%, moderate‐to‐severe migraine attacks in 20.1% vs. 12.9%, and cerebellar‐like symptoms in 12.5% vs. 0%, respectively. Vasovagal syncope (9.1%) and local pain (8.1%) were reported only in proximal injections. Conclusions: US‐GONB appears to be a safe and effective intervention for migraine, significantly improving pain and headache burden. Proximal injections may be associated with greater reductions in headache frequency; however, these findings were based on indirect comparisons. Further comparative trials are warranted to optimize anatomical targeting.

Super large-bore aspiration catheters have emerged as promising tools for endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). The Route 92 Reperfusion System utilizes super large-bore catheters with specialized delivery mechanisms to maximize first-pass effect (FPE) and reperfusion rates. To evaluate the efficacy and safety of the Route 92 super large bore reperfusion System in treating AIS-LVO. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched five databases from inception through December 2025. Studies evaluating Route 92 Reperfusion System outcomes in AIS-LVO patients were included. Primary outcomes were FPE and functional independence (modified Rankin Scale (mRS) 0–2). Secondary outcomes included successful reperfusion (modified thrombolysis in cerebral infarction (mTICI) scores), symptomatic intracranial hemorrhage (sICH), mortality, and adverse events. Random-effects models were used for all analyses. Seven studies comprising 490 patients were included. In comparative analyses, Route 92 (0.088”) demonstrated significantly higher FPE rates (risk difference (RD): 0.18, number needed to treat (NNT) = 6, p = 0.001) and near-complete reperfusion (RD: 0.23, NNT = 4, p = 0.0005) compared to other techniques. Single-arm analyses showed 56% achieved FPE, 94% achieved near-complete to complete reperfusion, and 43% achieved functional independence at follow-up. The system demonstrated favorable safety with 3% sICH rate and 20% mortality. National Institutes of Health Stroke Scale (NIHSS) scores improved significantly (mean difference (MD): -9.55, p < 0.00001). The Route 92 Reperfusion System achieves high rates of FPE and successful reperfusion with acceptable safety profiles. Future RCTs is warranted to support these findings.

Objective: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with anorexia nervosa (AN) and bulimia nervosa (BN), focusing on its impact on psychological, psychopathological, neurocognitive, and behavioral outcomes. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to May 2025. Eligible studies included clinical trials involving adult patients with AN or BN treated with rTMS. Data were pooled using fixed or random-effects models depending on heterogeneity. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Risk of bias was assessed using Cochrane RoB 2.0 and NIH tools. Results: Thirteen studies were included, yielding a total of n = 195 active rTMS treatments and n = 132 sham treatments. Compared to sham, rTMS did not significantly improve BMI in AN patients (MD: 0.19; 95% CI: -0.50, 0.88; P = 0.59). A significant moderate reduction in eating disorder severity was found in single-arm analysis (31 patients, SMD: -0.50, 95% CI [-0.90, -0.10], p = 0.01). Depression improved with rTMS over sham (105 patients, SMD: -0.41, 95% CI [-0.81, -0.02], p = 0.04), while anxiety, binge frequency, and vomiting frequency did not. Urge to eat increased in AN (30 patients, MD: 1.20, 95% CI [0.20, 2.21], p = 0.02) and decreased in BN (25 patients, MD: -10.25, 95% CI [-15.88, -4.62], p = 0.0004). No serious adverse events were reported. Conclusions: rTMS shows potential in improving eating disorder severity and depressive symptoms in AN, with disorder-specific modulation of food-related urges. Its effects on BMI and behavioral symptoms remain inconclusive. rTMS was well tolerated.

To compare the efficacy and safety of different doses of intravenous thrombolytic agents in patients with acute ischemic stroke (AIS) and guide optimal dose selection. We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL until March 2025 to identify randomized controlled trials (RCTs) evaluating alteplase (tPA), tenecteplase (TNK), reteplase, and recombinant human prourokinase (rhPro-UK) at any dose in patients with AIS. Analysis was performed using R software, and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled. Primary outcomes included symptomatic intracranial hemorrhage (sICH), 90-day mortality, excellent functional outcome (defined as modified Rankin Scale [mRS] score 0-1), and functional independence (defined as mRS 0-2). We included 21 RCTs (16,643 patients). Compared to tPA (0.9 mg/kg), tPA (0.6 mg/kg) was associated with a significantly lower risk of sICH (RR = 0.48, 95% CI: 0.27-0.86), while TNK (0.4 mg/kg) showed a higher risk (RR = 1.88, 95% CI: 1.06-3.35). No significant differences were observed in 90-day mortality, functional independence, or serious adverse events across interventions. Reteplase (18 + 18 mg) (RR = 1.13, 95% CI: 1.05-1.21) and TNK (0.25 mg/kg) (RR = 1.05, 95% CI: 1.01-1.10) significantly improved 90-day excellent functional recovery compared to tPA (0.9 mg/kg). TNK (0.32 mg/kg) showed the lowest risk probability for any ICH and parenchymal hemorrhage. Some safety outcomes showed dose-dependent effects: lower-dose tPA and intermediate-dose TNK reduced ICH risk compared to higher doses, while mortality and functional independence remained comparable across doses.

To assess the effectiveness and safety of intravenous efgartigimod in patients with myasthenia gravis (MG) and to compare treatment responses between anti-acetylcholine receptor antibody (AChR-Ab)-positive and -negative subtypes. A comprehensive search was conducted in the PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases up to 15 October 2025. Clinical trials and cohort studies evaluating the effectiveness and safety of efgartigimod in patients with MG were included. A random-effects model was used to pool mean differences (MDs) for continuous outcomes and proportions for categorical outcomes, with corresponding 95% confidence intervals (CIs). Subgroup analyses were performed based on study design and MG subtype. Twenty-nine studies (1594 patients) were included. Overall, 83% of patients achieved clinically meaningful improvement (CMI; ≥ 2-point reduction in MG Activities of Daily Living [MG-ADL] score), and 36% achieved minimal symptom expression (MSE; MG-ADL score of 0 or 1) with no significant difference between AChR-Ab-positive and AChR-Ab-negative subtypes. MG-ADL score significantly decreased from baseline (MD: -4.3 points, 95% CI: -4.99 to -3.61), with no difference between the MG subtypes. Quantitative MG score (QMG; MD: -3.6 points, 95% CI: -4.28 to -2.91), MG Quality of Life 15-item revised scale (MG-QoL15r), IgG levels, and corticosteroid use showed significant reductions in the AChR-Ab-positive subtype; however, these outcomes were not reported in the AChR-Ab-negative subtype. Serious adverse events were reported in 4.42% of patients. Efgartigimod significantly improved clinical symptoms and quality of life in patients with MG and may offer a steroid-sparing effect, with no significant differences observed between subtypes.

Parkinson’s disease is a progressive neurodegenerative disorder. We assessed whether proton pump inhibitor (PPI) use is associated with PD risk through a systematic review and meta-analysis of observational studies, exploring heterogeneity and confounding. We searched PubMed, Web of Science, Scopus, and the Cochrane Library to September 2025 for cohort and case–control studies. Study quality was evaluated using the Newcastle–Ottawa Scale, and certainty was assessed using GRADE. Random-effects models pooled ORs; prespecified subgroup analyses examined study design, geography, and adjustment for Helicobacter pylori and H₂-blocker use. Six studies from four countries, including 344,580 participants, met the inclusion criteria. Main analysis showed that PPI use was associated with an increased risk of PD (OR = 1.14; 95% CI, 1.07–1.22; P < 0.001). Sensitivity analysis excluding one heterogeneous study reduced I2 to 0% with a slightly lower estimate (OR = 1.09; 95% CI, 1.06–1.13). Subgroup analyses confirmed increased PD risk across both case–control and cohort studies, with stronger effects in cohorts. Geographically, the association was significant in studies from Asia and Europe but not observed in the U.S. Elevated risks persisted when adjusting for H. pylori infection, eradication therapy, and H₂-blocker use. Overall GRADE certainty was low, affected by heterogeneity, missing confounder adjustment, and imprecision. Current evidence suggests a modest association between PPI use and PD, consistent across several analyses but with regional differences. Given their widespread use, further large-scale prospective studies with longer follow-up and careful adjustment for confounders are needed to clarify causality and strengthen the certainty of evidence.

Background: Neuromodulation therapy is gaining importance in managing chronic neuropathic pain. This network meta-analysis aims to compare the efficacy and safety of spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), pulsed radiofrequency (PRF), and their combinations in the management of herpes zoster (HZ)-related pain. Methods: We searched Scopus, Cochrane CENTRAL, PubMed, and Web of Science from inception until August 27, 2025. Clinical trials and observational studies evaluating the efficacy and safety of SCS, PNS, PRF, or their combinations in HZ-related pain were included. Mean difference (MD) and risk ratio (RR) with corresponding 95% confidence intervals (CIs) were pooled. Results: Eleven studies (1035 patients) were included. When compared to the reference group (PRF), SCS+PRF achieved the greatest reduction in pain intensity (MD: −3.58 points, 95% CI: −5.05 to −2.12) and the highest treatment success rate (RR: 2.54, 95% CI;: 1.45 to 4.45). PNS+PRF demonstrated the most significant improvement in Pittsburgh Sleep Quality Index (PSQI) score (MD: −1.75 points, 95% CI: −3.24 to −0.27), while SCS alone showed the greatest reduction in pregabalin dose (MD: −36.58 mg, 95% CI: −68.93 to −4.24), physical role (MD: 9.70 points, 95% CI: 6.21 to 13.19), and bodily pain (MD: 8.42 points, 95% CI: 2.10 to 14.73) domains of the Short Form-36 (SF-36) score, while no significant differences were observed among the interventions regarding the physical function domain. Conclusion: Combination neuromodulation therapies, particularly SCS+PRF, may provide superior pain relief. PNS+PRF and PNS also showed marked improvements in sleep quality, whereas SCS was most effective in reducing pregabalin use and enhancing SF-36 scores.