Current Neurology and Neuroscience Reports最新文献

{"title":"MeVO: To Treat or Not To Treat? Review of the Latest Evidence.","authors":"Ossama Yassin Mansour, Ahmed Ossama, Nada Nasr, Eman Hamdy, Faisal Alghamdi, Nadia Hammami","doi":"10.1007/s11910-026-01515-0","DOIUrl":"10.1007/s11910-026-01515-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>Endovascular thrombectomy (EVT) is standard care for large vessel occlusion, but its role in medium vessel occlusion (MeVO) is contested. We appraise randomized and real-world evidence and ask whether, and in whom, MeVO should be treated.</p><p><strong>Recent findings: </strong>DISTAL, ESCAPE-MeVO and DISCOUNT found no functional benefit from adding EVT to medical treatment, with more hemorrhage and serious adverse events; DISTAL's 12-month results were also neutral. ORIENTAL-MeVO, restricted to deficits of NIHSS ≥ 6 within 24 h, reported greater functional independence with EVT (58.6% versus 46.6%). The MEMENTO registry (164 patients, 15 Middle East and North Africa centres) reproduced trial-level outcomes - 69% recanalization, 54% independence, 3% symptomatic hemorrhage - while modelled cost-effectiveness ratios of $26,875-71,333/QALY exceeded regional thresholds. DISTALS achieved high reperfusion without symptomatic hemorrhage using a MeVO-dedicated stentretriever. Routine MeVO thrombectomy is unjustified. Benefit concentrates in moderate-to-severe deficits, eloquent territory, salvageable tissue and technically accessible primary occlusions.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Nanomedicine for Brain Tumors: Overcoming Biological Barriers, Targeting Strategies, and Future Directions.","authors":"Yajing Mi, Huan Liu, Yongling Liu, Xinyue Lei, Chengjie Fu, Hao Xu, Pengtao Jiang, Jing Luan, Lin Feng, Xingchun Gao","doi":"10.1007/s11910-026-01520-3","DOIUrl":"10.1007/s11910-026-01520-3","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review evaluates nanomedicine strategies for brain tumors through a translational lens. Rather than cataloguing nanoparticle formulations, it focuses on representative lipid-based, polymeric, inorganic, self-assembled, protein-based, biomimetic, and nanoconjugate platforms according to the delivery problem they are designed to solve: crossing or bypassing the blood-brain barrier (BBB) and blood-brain tumor barrier (BBTB), improving intratumoral penetration, controlling payload release, reducing toxicity, or enabling image-guided therapy.</p><p><strong>Recent findings: </strong>Preclinical studies show that nanomedicines can increase brain tumor exposure through receptor-mediated transport, physical BBB modulation, local delivery, stimuli-responsive release, biomimetic trafficking, and theranostic integration. However, the strength of evidence remains uneven. Many systems are supported mainly by isolated or model-specific preclinical studies, with limited pharmacokinetic, pharmacodynamic, toxicity, reproducibility, or manufacturing validation. Among clinically tested platforms, gadolinium-based AGuIX nanoparticles currently provide one of the clearest brain tumor-directed examples, supported by early-phase data showing tumor accumulation and acceptable tolerability when combined with radiotherapy. Conversely, the withdrawn SERIL trial of intratumoral JCXH-211 illustrates that mechanistic promise alone does not establish clinical feasibility in glioma. Nanomedicine may improve drug delivery, intratumoral exposure, immunomodulatory payload delivery, and image-guided radiotherapy for brain tumors. Its clinical impact will depend on reproducible central nervous system delivery, validated intratumoral pharmacodynamic readouts, disease-specific safety assessment, scalable good manufacturing practice (GMP)-compliant production, and prospective trials showing benefit over current standards of care.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Glymphatic System in Neurological Diseases: Mechanisms, Imaging Surrogates, and Translational Uncertainties.","authors":"Ahmed Sami Raihane, Mario Di Napoli, Denis Bragin, Eder Cáceres, Michael M Ortiz, Marina N Moore, Afshin A Divani","doi":"10.1007/s11910-026-01521-2","DOIUrl":"10.1007/s11910-026-01521-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>This narrative review critically synthesizes mechanistic, imaging, and clinical evidence on the glymphatic system in neurological disease. It distinguishes direct tracer-based observations from indirect imaging surrogates and identifies the principal uncertainties that currently limit clinical translation.</p><p><strong>Recent findings: </strong>The glymphatic framework describes glia-associated perivascular routes that support exchange between cerebrospinal fluid (CSF) and interstitial fluid and contribute to solute transport in experimental models. Rodent studies show that aquaporin-4 polarization, vascular pulsatility, and sleep state modulate tracer movement, but the relative contribution of convection, diffusion, and alternative clearance pathways remains debated. Sleep-wake state alters interstitial or CSF concentrations of amyloid-beta and tau; however, these changes reflect both clearance and activity-dependent production or release. Meningeal lymphatic vessels interact anatomically and functionally with CSF drainage pathways in preclinical models, whereas direct evidence for an integrated glymphatic-meningeal circuit in humans remains limited. Most human disease studies use cross-sectional or longitudinal associations derived from indirect imaging markers rather than direct measurements of glymphatic flow. Intrathecal contrast-enhanced magnetic resonance imaging provides a tracer-based assessment of CSF influx, distribution, and clearance to cervical lymph nodes. Diffusion tensor imaging along the perivascular space assesses water movement in the perivascular spaces, and phase-contrast MRI quantifies pulsatile CSF velocity and volume; both are noninvasive sequences. MRI-visible perivascular spaces, dynamic contrast-enhanced MRI, and CSF-hemodynamic coupling are indirect or partially overlapping measures of perivascular fluid biology. No noninvasive biomarker has yet been validated as a direct measure of human glymphatic flow. Candidate interventions including sleep-directed strategies, photobiomodulation, respiratory entrainment, gamma-frequency sensory stimulation, neuromodulation, and pharmacological approaches, remain preclinical or early mechanistic, and none has improved patient-important neurological outcomes through a validated glymphatic mechanism.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of the Nervous System in Lung Disease.","authors":"Connar M A Mawer, Archie Patel, Nadja Zeltner, Marilyn K Glassberg Csete, Erica L Herzog","doi":"10.1007/s11910-026-01511-4","DOIUrl":"10.1007/s11910-026-01511-4","url":null,"abstract":"<p><strong>Purpose of review: </strong>Peripheral nerves regulate pulmonary physiology in a nerve-type- and compartment-specific manner through neurotransmitters, neurotrophins and axon-guidance cues. This review examines how sensory and autonomic pathways influence pulmonary homeostasis and disease, and evaluates the experimental models available to investigate these interactions.</p><p><strong>Recent findings: </strong>Dysregulated pulmonary innervation has been implicated in acute lung injury, airway hyperresponsiveness, pulmonary fibrosis and lung cancer, where neural signals may modulate immune activation, stromal remodelling and tumour progression. However, pulmonary neurobiology remains comparatively underexplored, in part because neuronal cell bodies are located outside the lung and pulmonary axons and nerve terminals are sparse, fragile and difficult to resolve using conventional methods. Rodent models remain essential for establishing causal mechanisms within intact neural circuits, although species-specific differences limit direct translation. Human pluripotent stem cell-derived sensory and autonomic neurons offer a platform for dissecting human nerve-immune and nerve-stromal interactions. Integration of mechanistic animal studies with human stem cell-derived neuronal models may overcome current experimental limitations and provide a more physiologically relevant framework for defining the contribution of pulmonary nerves to respiratory disease.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Multimodality Monitoring in Traumatic Brain Injury.","authors":"Dick Moberg, Ethan Jacob Moyer, Farah Kamar, Craig Maddux","doi":"10.1007/s11910-026-01518-x","DOIUrl":"10.1007/s11910-026-01518-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Multimodal monitoring (MMM) has the potential to transform the management of secondary brain injury following traumatic brain injury (TBI) to enable more personalized care. Despite its promise, the optimal combination of monitoring modalities and the interpretation of complex data streams remain insufficiently mature for MMM to be considered standard of care. This review evaluates the current state of MMM technologies, their clinical applications, and their emerging role in improving TBI management and guiding the path toward broader clinical adoption. This review focuses on real-time physiological data streams that can provide management guidance in a time frame commensurate with the onset of sudden events such as seizures, brain hypoxic events, and excursions of cerebral hypertension. Thus, we do not cover more static modalities such as imaging and biomarkers.</p><p><strong>Recent findings: </strong>Recent studies highlight the potential of MMM to reduce variability in TBI outcomes associated with secondary insults. Integration of physiological variables-such as intracranial pressure, brain tissue oxygenation, arterial blood pressure, and electroencephalography-combined with artificial intelligence (AI) and advanced analytics, may enable earlier detection and prediction of adverse events. However, key challenges remain, including the need for larger harmonized datasets, standardized acquisition and interpretation methods, and prospective validation of multimodal-guided interventions. MMM is emerging as a cornerstone technology to enhance patient phenotyping in TBI, enabling more individualized and timely therapeutic interventions. Continued advances in data integration, analytics, and standardization will be essential to translate MMM from a promising research tool into a validated component of precision neurocritical care.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic Diagnosis in Epilepsy: Implications for Clinical Management.","authors":"Krista S Schatz, Dawn B Lammert, Christa W Habela","doi":"10.1007/s11910-026-01514-1","DOIUrl":"10.1007/s11910-026-01514-1","url":null,"abstract":"<p><strong>Purpose of review: </strong>To describe the clinical implications of genetic diagnoses in epilepsy and the recent advancements in this field.</p><p><strong>Recent findings: </strong>A genetic diagnosis in epilepsy has been shown to impact clinical management in almost half of individuals, often within three months of diagnosis, with anti-seizure medication recommendations being the most common change. More recently, data from somatic genetic testing in brain tissue has shown the potential to impact prognostic information and medication recommendations. Genetic testing is becoming routine clinical care in epilepsy and is recommended for all individuals with unexplained epilepsy, regardless of age. A monogenic epilepsy diagnosis impacts clinical seizure management and provides additional non-seizure management benefits. The clinical utility of genetic testing will only continue to increase as gene therapies and other precision medicine treatments are approved.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-cost Rehabilitation Solutions: Lessons From LMIC Settings.","authors":"Ayush Agarwal, M V Padma Srivastava","doi":"10.1007/s11910-026-01516-z","DOIUrl":"10.1007/s11910-026-01516-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Rehabilitation in LMICs is more important than in HICs due to the lack of access to acute stroke interventions (thrombolysis, endovascular thrombectomy, and stroke unit care) in most treated patients which leads to worse long-term outcomes, and thereby greater disability and functional impairment, therefore requiring specialized rehabilitation.</p><p><strong>Recent findings: </strong>The are barriers to rehabilitation in LMICs. These can be considered under healthcare- and patient-related factors. Healthcare factors include limited skilled rehabilitation specialists, negligible stroke unit care, lack of government policies, insurance for rehabilitation and adequate infrastructure for rehabilitation. Patient-related factors include lack of awareness about the benefits of rehabilitation, financial constraints and belief in alternate systems of care. The barriers to rehabilitation in LMICs can be overcome with LMIC specific solutions like community-based rehabilitation, task shifting, stroke unit care, telerehabilitation, offering integrated models of care and increased recruitment and training of rehabilitation professionals.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Brain Injury in Austere Environments: a Review of Recent Advances.","authors":"Laura M Loaiza-Cardona, Diego Felipe Batz Casia, Andres M Rubiano","doi":"10.1007/s11910-026-01508-z","DOIUrl":"https://doi.org/10.1007/s11910-026-01508-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Traumatic brain injury (TBI) is still a leading cause of death and disability worldwide, with a disproportionate burden in low- and middle-income countries (LMICs) where access to imaging, invasive intracranial pressure (ICP) monitoring, and neurosurgical care is limited. This review examines recent advances in TBI management in austere environments, where standard high-resource paradigms are frequently impractical, and analyzes the quality of evidence supporting context-adapted approaches.</p><p><strong>Recent findings: </strong>Recent literature highlights the growing role of protocolized care pathways, noninvasive neuromonitoring adjuncts such as optic nerve sheath diameter ultrasonography, quantitative pupillometry, transcranial Doppler, and selected serum biomarkers, as well as alternative surgical strategies including hinge craniectomy. Emerging physiological frameworks, including stage-based models of intracranial decompensation, offer structured decision-making support when numeric ICP thresholds are unavailable. However, most supporting evidence remains observational, heterogeneous, and frequently extrapolated from high-income settings, with major limitations in external validation and implementation science. Enhancing outcomes in austere TBI care will depend less on technological development than on rigorous implementation science, context-specific validation, and sustainable health system strengthening to bridge the gap between evidence and clinical delivery.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep in Children with Neurodevelopmental Disorders: From Diagnostic Labels to Phenotype-directed Care.","authors":"Oliviero Bruni, Maria Breda, Valeria Mammarella, Daniela Polese, Maria Paola Mogavero, Giuseppe Lanza, Raffaele Ferri","doi":"10.1007/s11910-026-01513-2","DOIUrl":"10.1007/s11910-026-01513-2","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sleep disorders are highly prevalent in children with neurodevelopmental disorders (NDDs), but diagnostic labels alone provide limited guidance for assessment or treatment. This review summarizes recent advances and proposes a diagnosis-informed, phenotype-directed clinical framework.</p><p><strong>Recent findings: </strong>Recent studies reinforce the heterogeneity of sleep disturbance within and across autism, attention-deficit/hyperactivity disorder, intellectual disability, and genetic syndromes. Clinically relevant phenotypes include insomnia and circadian dysregulation, sleep-disordered breathing, sleep-related movement disorders, hypersomnolence, and parasomnias. Emerging research points to convergence among circadian, arousal, synaptic, sensory, and dopamine-iron pathways. Evidence for adapted behavioral interventions is growing. Melatonin has the strongest pharmacological evidence, particularly for insomnia in ASD and selected neurogenetic conditions, whereas evidence for other sedating agents and for many other NDD populations remains limited. Management should integrate diagnosis-informed risk recognition with phenotype-directed assessment. The neurodevelopmental diagnosis can identify syndrome-specific risks and surveillance needs, whereas the dominant sleep phenotype, contributing medical and environmental factors, and functional consequences should guide investigation and treatment. Better trials must include children with severe disability and rare NDDs and use developmentally appropriate, objective, and family-centered outcomes.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Adjunctive Use of CT Perfusion (CTP) in Acute Stroke: Pitfalls, False Negatives, and Diagnostic Clues for Stroke Mimics.","authors":"Hiroyuki Kawano, Teruyuki Hirano","doi":"10.1007/s11910-026-01510-5","DOIUrl":"10.1007/s11910-026-01510-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Computed tomography perfusion (CTP) has become an important tool for tissue-based assessment in acute ischemic stroke, particularly in patients considered for reperfusion therapy beyond conventional time windows. This review summarizes common pitfalls, diagnostic blind spots, and adjunctive uses of CTP.</p><p><strong>Recent findings: </strong>Although CTP supports patient selection for endovascular thrombectomy in the extended window, automated core-penumbra estimates are vulnerable to technical and interpretive error. Major pitfalls include overestimation of ischemic core (ghost infarct core) and underestimation of core (perfusion scotoma). Negative automated maps do not exclude small deep infarcts or posterior circulation stroke, and perfusion abnormalities may also occur in stroke mimics. CTP should not be interpreted in isolation. Its greatest clinical value lies in integration with non-contrast CT, CT angiography, perfusion parameter maps, and clinical assessment.</p>","PeriodicalId":10831,"journal":{"name":"Current Neurology and Neuroscience Reports","volume":"26 1","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}