JAMA Editors' Summary Levodopa for Stroke Rehabilitation, Pediatric Insurance Coverage, Payments From AI Device Manufacturers, and more
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Sep 26, 2025 A new trial reveals that levodopa combined with rehabilitation shows no significant motor improvement for stroke survivors. The discussion includes the alarming churn in U.S. child insurance coverage, highlighting the impacts of Medicaid expansion. There's a look at rising payments to AI device manufacturers and concerns about prior authorizations and costs for GLP-1 medications in Medicare. The episode also focuses on teaching critical thinking in medical training, challenges with J-1 visa limits, and tips for effectively communicating risks to patients.
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Levodopa Shows No Motor Benefit Post-Stroke
- The ESTROL randomized trial found no significant motor benefit from levodopa-carbidopa plus standard rehab after stroke at 3 months using the Fugl-Meyer assessment.
- This neutral result undermines routine levodopa use to enhance post-stroke motor recovery.
Clinician Use Of Levodopa Exists Today
- Chris Muth described that some clinicians currently use levodopa aiming to enhance motor recovery after stroke.
- He noted the ESTROL trial provides important neutral evidence that may change that clinical practice.
High Insurance Churn Among U.S. Children
- Microsimulation estimated 61% of U.S. children were ever enrolled in Medicaid/CHIP and 42% were ever uninsured by age 18.
- Nonexpansion states showed much higher churn: 59% ever uninsured versus 36% in expansion states.