Current Opinion in Neurology最新文献

{"title":"New approaches to lesion assessment in multiple sclerosis.","authors":"Paolo Preziosa, Massimo Filippi, Maria A Rocca","doi":"10.1097/WCO.0000000000001378","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001378","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize recent advancements in artificial intelligence-driven lesion segmentation and novel neuroimaging modalities that enhance the identification and characterization of multiple sclerosis (MS) lesions, emphasizing their implications for clinical use and research.</p><p><strong>Recent findings: </strong>Artificial intelligence, particularly deep learning approaches, are revolutionizing MS lesion assessment and segmentation, improving accuracy, reproducibility, and efficiency. Artificial intelligence-based tools now enable automated detection not only of T2-hyperintense white matter lesions, but also of specific lesion subtypes, including gadolinium-enhancing, central vein sign-positive, paramagnetic rim, cortical, and spinal cord lesions, which hold diagnostic and prognostic value. Novel neuroimaging techniques such as quantitative susceptibility mapping (QSM), χ-separation imaging, and soma and neurite density imaging (SANDI), together with PET, are providing deeper insights into lesion pathology, better disentangling their heterogeneities and clinical relevance.</p><p><strong>Summary: </strong>Artificial intelligence-powered lesion segmentation tools hold great potential for improving fast, accurate and reproducible lesional assessment in the clinical scenario, thus improving MS diagnosis, monitoring, and treatment response assessment. Emerging neuroimaging modalities may contribute to advance the understanding MS pathophysiology, provide more specific markers of disease progression, and novel potential therapeutic targets.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076599","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":"Update on the clinical and therapeutic aspects of myotonic dystrophy type 1.","authors":"Masanori P Takahashi","doi":"10.1097/WCO.0000000000001374","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001374","url":null,"abstract":"<p><strong>Purpose of review: </strong>Myotonic dystrophy type 1 (DM1) is a genetically mediated, multisystemic neuromuscular disorder with significant phenotypic heterogeneity. This review aimed to summarize recent advances in clinical understanding, natural history, and therapeutic development, with a focus on cardiac, respiratory, cognitive, and pediatric aspects of DM1.</p><p><strong>Recent findings: </strong>Longitudinal studies are refining the natural history of both adult and pediatric DM1. Advances in biomarker discovery, including composite ribosomal nucleic acid splicing metrics and imaging findings, are improving disease monitoring and treatment assessment. Cardiac risk stratification is evolving, although respiratory management remains challenging due to adherence issues. Increasing attention is being given to cognitive and behavioral impairments, particularly in congenital and childhood-onset DM1. Although disease-modifying therapies remain in development, real-world data on symptomatic treatments such as mexiletine and nonpharmacological interventions, including exercise and cognitive behavioral therapy, provide valuable clinical insights.</p><p><strong>Summary: </strong>Recent literature highlights substantial progress in understanding DM1 across different age groups and organ systems. Although no approved disease-modifying therapies exist, ongoing clinical trials and biomarker advancements offer hope. This review synthesizes these developments to inform clinical management and guide future research efforts.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076601","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 in studying disparities in neuropsychiatric hyperkinetic movement disorders.","authors":"Marisela E Dy-Hollins, Adys Mendizabal, Alexander C Tsai","doi":"10.1097/WCO.0000000000001379","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001379","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to highlight challenges in studying disparities in neuropsychiatric hyperkinetic movement disorders, specifically Tourette syndrome and Huntington's disease.</p><p><strong>Recent findings: </strong>We highlight racial and ethnic disparities in understudied movement disorders, particularly the neuropsychiatric hyperkinetic movement disorders, Tourette syndrome and Huntington's disease. These diagnoses are likely under-recognized and under-diagnosed in racial and ethnic minority groups, leading to disparities in access to subspecialty care and treatment. Factors contributing to disparities are complex and likely include patient mistrust of the medical community, stigma, and structural racism. Application of health disparities research frameworks used in other disciplines may have utility in the study of inequities in neurology.</p><p><strong>Summary: </strong>There are significant challenges in studying disparities in Tourette syndrome and Huntington's disease. We also highlight frameworks used in neurology as well as recommendations from the National Institute of Neurological Disorders and Stroke around training in health disparities and recommendations in reducing disparities in neurological disorders across the life span.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076580","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":"Barriers to providing movement disorders care in India.","authors":"Heli Shah, Prashanth Lingappa Kukkle","doi":"10.1097/WCO.0000000000001375","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001375","url":null,"abstract":"<p><strong>Purpose of review: </strong>Movement disorders (MD) represent a growing healthcare challenge in India, where a diverse population and limited resources complicate diagnosis and management. This review aims to identify and categorize the systemic, socio-economic, cultural, educational, and infrastructural barriers impeding timely and effective MD care, drawing on literature spanning rural and urban contexts.</p><p><strong>Recent findings: </strong>Recent studies show low awareness of MD treatments - such as deep brain stimulation and botulinum toxin therapy - among both patients and clinicians. Socio-economic disparities, particularly in rural areas, combine with limited specialist availability and fragmented referral systems exacerbate care gaps. Meanwhile, gender biases, stigma, and reliance on alternative medicine further delay appropriate interventions. India's partial insurance coverage and insufficient policy frameworks constrain long-term management, although select government initiatives and community-level strategies offer promise. Technological approaches, including telemedicine, show potential for expanding care access.</p><p><strong>Summary of findings: </strong>Multiple interwoven factors hinder optimal MD care in India, diminishing patient outcomes and quality of life. Targeted educational campaigns, enhanced specialist training, improved insurance coverage, and robust policy guidance are crucial. By addressing these issues in a coordinated manner, India can significantly improve the delivery and effectiveness of MD care across its diverse regions.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076577","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":"Deep brain stimulation access in 2025: geographic, gender, racial, and socioeconomic disparities re-examined.","authors":"Jonathon Cavaleri, Kristen Stefanescu, Darrin Lee, Xenos Mason","doi":"10.1097/WCO.0000000000001377","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001377","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review highlights recent studies examining disparities in access to deep brain stimulation (DBS), an effective but resource-intensive therapy for neurological and neuropsychiatric disorders. As DBS indications expand, understanding barriers to equitable provision is increasingly urgent to ensure that all eligible patients can benefit.</p><p><strong>Recent findings: </strong>Emerging literature confirms persistent disparities in DBS utilization based on geography, gender, race, and socioeconomic status. Geographic disparities reflect regional differences in healthcare infrastructure, with limited access in both rural areas of high-income countries and throughout low-income and middle-income nations. Women remain less likely than men to receive DBS for movement disorders, influenced by referral patterns, social support, and patient preference. Racial and ethnic minority patients - particularly Black and Hispanic individuals - consistently receive DBS at lower rates, in part due to reduced referrals. Socioeconomic factors, including insurance status and household income, strongly predict DBS access, favoring privately insured and wealthier patients.</p><p><strong>Summary: </strong>These findings underscore the need for systemic changes in referral practices, institutional policies, and healthcare funding to reduce structural barriers to DBS. Future research should focus on intersectional factors driving disparities and evaluate targeted interventions to promote equitable access.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076581","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":"Neuromuscular sarcopenia: what do we know?","authors":"Michael Drey","doi":"10.1097/WCO.0000000000001373","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001373","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sarcopenia is a common and relevant health problem in the treatment of geriatric patients. After many years of dealing with the definition of this phenomenon, the focus in the future must be on underlying and treatable pathomechanisms.</p><p><strong>Recent findings: </strong>The article describes the initial state with regard to the definition of sarcopenia and derives from this the focus on subgroups of sarcopenia with treatable pathomechanisms. One subgroup of neuromuscular sarcopenia, which focuses on the degeneration of the neuromuscular junction, is discussed. In this context, the proteoglycan agrin with its ability to cluster acetylcholine receptors in the postsynaptic membrane of the muscle plays a role. Inactivation of agrin leads to destabilization of the neuromuscular junction and thus to sarcopenia. The resulting neuronal 22 kDa C-terminal agrin fragment should serve as a biomarker of neuromuscular sarcopenia.</p><p><strong>Summary: </strong>The neuronal C-terminal agrin fragment must be established as a biomarker for neuromuscular sarcopenia, taking renal function into account as the fragment accumulates in renal insufficient patients. On this basis, treatment with agrin could be a therapeutic option for this subgroup of sarcopenia.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076595","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":"SEEG in 2025: progress and pending challenges in stereotaxy methods, biomarkers and radiofrequency thermocoagulation.","authors":"Philippe Ryvlin","doi":"10.1097/WCO.0000000000001351","DOIUrl":"10.1097/WCO.0000000000001351","url":null,"abstract":"<p><strong>Purpose of review: </strong>Technological innovations and clinical research in SEEG have dramatically increased with its worldwide dissemination. In this review, we summarize the main advances in the field from the last 5 years.</p><p><strong>Recent findings: </strong>Several large series and meta-analyses have provided consistent data regarding a lower risk of serious complications with SEEG as compared to sub-dural grids, while some studies also suggest a greater diagnostic value. The safety and precision of SEEG partly depends on the type of vascular imaging and method of implantation, with some series suggesting that MR angiography might not provide an optimal delineation of electrode-vessel conflicts and that frameless stereotaxy lacks precision. Noninvasive frame coupled with robot-guided implantation might offer the best precision/invasiveness tradeoff. Small series suggest that SEEG can be safely performed from the age of 16 months, and that adding electrodes during SEEG often prove beneficial. Transhemispheric electrodes targeting the mesial frontal structures, bilaterally, proved safe and informative. Several interictal and ictal biomarkers of the epileptogenic zone have been investigated. Although high-frequency oscillations (HFOs) remain a biomarker of interest, a randomized controlled trial failed to demonstrate its diagnostic value against spikes. Furthermore, other interictal biomarkers proved to better correlate with the epileptogenic zone than HFOs rate, including spike-gamma and spike-ripples. Ictal biomarkers of interest include the so-called chirp and epileptogenic zone fingerprint. Overall, recent data suggest that high-frequency activities are not a mandatory feature of interictal and ictal biomarkers of the epileptogenic zone. Radiofrequency thermocoagulation (RFTC) performed during SEEG investigation have also progressed, with some authors reporting spectacular rates of seizure freedom in patients with localized epileptogenic lesion but also mesial temporal sclerosis. However, a systematic assessment of memory and mental health demonstrated the presence of altered memory and psychiatric complications in a significant proportion of mesial temporal lobe RFTC.</p><p><strong>Summary: </strong>Progress has been made in the technology and methods used to perform SEEG and RFTC, with the view to increase safety and effectiveness. Several interictal and ictal biomarkers appear promising but still face challenges in their validation and implementation in clinical practice. Future research requires harmonization in the concepts of the seizure onset and epileptogenic zones, and prospective pathology-specific studies.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"111-120"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381645","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":"Editorial introductions.","authors":"","doi":"10.1097/WCO.0000000000001354","DOIUrl":"https://doi.org/10.1097/WCO.0000000000001354","url":null,"abstract":"","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":"38 2","pages":"v"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566248","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":"Can brain network analyses guide epilepsy surgery?","authors":"Ghassan S Makhoul, Derek J Doss, Dario J Englot","doi":"10.1097/WCO.0000000000001346","DOIUrl":"10.1097/WCO.0000000000001346","url":null,"abstract":"<p><strong>Purpose of review: </strong>Epilepsy surgery is a potentially curative intervention for medically refractory epilepsy. In the last several decades, epilepsy has been studied as a network disorder. How has this disease model influenced surgical interventions?</p><p><strong>Recent findings: </strong>Surgical outcomes for resection are increasingly being tied to network features, such as node hubness score. These findings imply that measuring network features may augment epileptologist seizure onset zone designation for surgical planning. Network models are also leveraged for neuromodulation, specifically in studies with thalamic targets. Recent findings suggest that the thalamus may function as a reasonable target for neuromodulation because of its role in the seizure propagation networks.</p><p><strong>Summary: </strong>In this review, we discuss the degree these models of epilepsy are influencing surgery today and barriers for the widespread adoption of network models when planning epilepsy surgery.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"105-110"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064073","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":"Neuroinflammation and immunometabolism in neurodegenerative diseases.","authors":"Neha Lonkar, Eicke Latz, Róisín M McManus","doi":"10.1097/WCO.0000000000001356","DOIUrl":"10.1097/WCO.0000000000001356","url":null,"abstract":"<p><strong>Purpose of review: </strong>Immunometabolism is an emerging field of research investigating the ability of immune cells to modulate their metabolic activity for optimal function. While this has been extensively examined in peripheral immune cells like macrophages, only recently have these studies been extended to assess the immunometabolic activity of microglia, the innate immune cells of the brain.</p><p><strong>Recent findings: </strong>Microglia are highly metabolically flexible and can utilize different nutrients for their diverse functions. Like other immune cells, they undergo metabolic reprogramming on immune stimulation and in inflammatory, neurodegenerative conditions such as Alzheimer's disease (AD). In recent years, researchers have looked at the intricate mechanisms that modulate microglial activity and have uncovered key links between altered metabolism, neuroinflammation, and the involvement of disease-associated risk genes.</p><p><strong>Summary: </strong>This review highlights the recent studies that have significantly contributed to our understanding of the metabolic dysregulation observed in activated microglia in conditions such as AD, unveiling novel targets for therapeutic intervention.</p>","PeriodicalId":11059,"journal":{"name":"Current Opinion in Neurology","volume":" ","pages":"163-171"},"PeriodicalIF":4.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398571","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}