{"title":"Persistent post-concussion syndrome: pathophysiology, diagnosis, current and evolving treatment strategies.","authors":"Amir Hadanny, Shai Efrati","doi":"10.1080/14737175.2025.2515061","DOIUrl":"10.1080/14737175.2025.2515061","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent post-concussion syndrome (PCS) following mild traumatic brain injury (mTBI) represents a growing global health challenge that significantly impacts patients' quality of life. Despite advances in acute concussion management, there remains a critical need for effective, evidence-based treatments for chronic PCS, as current interventions show limited success in addressing both symptoms and underlying pathophysiology.</p><p><strong>Areas covered: </strong>In this review, the authors examine recent advances in PCS pathophysiology, diagnostic approaches, and therapeutic interventions. The authors evaluate epidemiological trends, advanced neuroimaging findings, validated biomarkers, and emerging treatment modalities such as hyperbaric oxygen therapy, neuromodulation techniques, and biomarker-guided therapeutic approaches.</p><p><strong>Expert opinion: </strong>Integration of recent evidence suggests a paradigm shift toward personalized, multimodal treatment approaches for PCS, combining targeted physiological interventions with symptom-specific therapies. Future management strategies should focus on early identification of at-risk patients and implementation of evidence-based treatment protocols that address both neurobiological and psychological aspects of recovery.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"1-13"},"PeriodicalIF":3.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247198","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}
Hannah M Carroll, Robyn P Thom, Christopher J McDougle
{"title":"The differential diagnosis of autism spectrum disorder in adults.","authors":"Hannah M Carroll, Robyn P Thom, Christopher J McDougle","doi":"10.1080/14737175.2025.2490533","DOIUrl":"10.1080/14737175.2025.2490533","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosing autism spectrum disorder (ASD) in adults is challenging due to its heterogeneity and symptom overlap with other conditions. Making an accurate diagnosis can be difficult and overwhelming but is vital for proper accommodations and interventions while avoiding unproductive or harmful treatments.</p><p><strong>Areas covered: </strong>The authors have based their review on a comprehensive literature search using PubMed, PsycINFO, and Google Scholar to identify relevant recommendations, diagnostic tools, and common differential diagnoses for adults with ASD. A clinical framework is provided based on the DSM-5 criteria, starting with an evaluation of childhood symptom onset and persistent manifestations of the core criteria - social and communication impairment, along with restricted, repetitive behaviors. Conditions with overlapping presentations, including personality disorders, anxiety, depression, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and schizophrenia, are discussed, as well as challenges in differentiating these from ASD.</p><p><strong>Expert opinion: </strong>Many factors complicate diagnosing ASD in adults - such as skewed public perception or misinformation spread on social media. Existing tools frequently miss subtle or atypical presentations, particularly in underdiagnosed groups like women and older adults. Promising advances in machine learning and artificial intelligence will hopefully improve diagnostic precision in the future. Up-to-date clinician training and large-scale research remain paramount for refining adult ASD diagnosis.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"635-648"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810875","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}
Michael Griffin, Chun Shing Kwok, Adnan I Qureshi, Gregory Y H Lip
{"title":"The latest therapeutic advances with spontaneous intracerebral hemorrhage.","authors":"Michael Griffin, Chun Shing Kwok, Adnan I Qureshi, Gregory Y H Lip","doi":"10.1080/14737175.2025.2502048","DOIUrl":"10.1080/14737175.2025.2502048","url":null,"abstract":"<p><strong>Introduction: </strong>Intracerebral hemorrhage (ICH) accounts for 10% of strokes; however, compared with ischemic stroke, progress leading to novel treatments and improved patient outcomes has been lacking. Recently, there have been several promising developments and renewed research interest within the field. Positive results from randomized controlled trials have now been reported in multiple domains of care for patients with ICH. Anticoagulation-associated ICH is increasingly frequent, and clinicians deciding on reversal and timing of re-initiation of oral anticoagulation now have more therapeutic agents available and evidence to guide them. Minimally invasive techniques are also added to the neurosurgical arsenal, leading to improvements in functional outcomes. Acute treatment at presentation is best served by bundled care approaches, which ensure goal-directed management of blood pressure, glucose and temperature.</p><p><strong>Areas covered: </strong>This narrative review summarizes the recent developments in this area, as well as the current recommendations of key international guidelines. Literature search was carried out using PubMed database with priority given to publications since 2020.</p><p><strong>Expert opinion: </strong>There is renewed optimism for innovation in ICH. The standard of care for this condition now leads to improvements in mortality and long-term functional ability. Efforts to improve the patient selection and surgical techniques for operative management are ongoing.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"661-673"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004622","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}
Madia Lozupone, Vittorio Dibello, Emanuela Resta, Rodolfo Sardone, Fabio Castellana, Roberta Zupo, Luisa Lampignano, Ilaria Bortone, Anita Mollica, Giuseppe Berardino, Mario Altamura, Antonello Bellomo, Antonio Daniele, Vincenzo Solfrizzi, Francesco Panza
{"title":"Uncertainties in anti-amyloid monoclonal antibody therapy for Alzheimer's disease: the challenges ahead.","authors":"Madia Lozupone, Vittorio Dibello, Emanuela Resta, Rodolfo Sardone, Fabio Castellana, Roberta Zupo, Luisa Lampignano, Ilaria Bortone, Anita Mollica, Giuseppe Berardino, Mario Altamura, Antonello Bellomo, Antonio Daniele, Vincenzo Solfrizzi, Francesco Panza","doi":"10.1080/14737175.2025.2500752","DOIUrl":"10.1080/14737175.2025.2500752","url":null,"abstract":"<p><strong>Introduction: </strong>Alzheimer's disease (AD), the leading cause of dementia, poses a significant burden on patients, caregivers, and healthcare systems worldwide. After two decades of extensive efforts, we are still without significantly effective disease-modifying drugs for AD. Although brain amyloid-β (Aβ) accumulation may predict cognitive decline, several drug candidates, including anti-Aβ monoclonal antibodies, have been developed and tested to reduce Aβ plaque burden effective, but without significant clinical success.</p><p><strong>Areas covered: </strong>The following review presents and discusses anti-Aβ monoclonal antibody therapeutics used to treat AD. The article considers both current approaches and alternatives. This article is multiple database searches (MEDLINE, EMBASE, Scopus, Ovid and Google Scholar) on all the available literature up to 1 February 2025.</p><p><strong>Expert opinion: </strong>Randomized clinical trials (RCTs) of anti-Aβ drugs in AD have not fully validated the Aβ cascade hypothesis. Nevertheless, eight anti-Aβ monoclonal antibodies have, thus far, made it to Phase III RCTs. Moving forward, the use of the Apolipoprotein E genotype and tau protein as alternative biomarkers can assist clinicians in providing patients with even more individualized and efficacious anti-Aβ monoclonal antibodies dosing regimens and reduce the risk of serious amyloid-related imaging abnormalities.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"649-659"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963902","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}
Xiaofeng Zhu, Xiu Yang, Ming Wei, Huayan Wang, Jun Shen, Qiu Han
{"title":"Efficacy of botulinum neurotoxin-A in the treatment of neuropsychiatric symptoms in patients with Parkinson's disease: an open-label randomized controlled study.","authors":"Xiaofeng Zhu, Xiu Yang, Ming Wei, Huayan Wang, Jun Shen, Qiu Han","doi":"10.1080/14737175.2025.2500753","DOIUrl":"10.1080/14737175.2025.2500753","url":null,"abstract":"<p><strong>Objectives: </strong>Parkinson's disease (PD) often presents with neuropsychiatric symptoms that worsen quality of life. The aim of this study was to evaluate the effectiveness of Botulinum neurotoxin-A (BTX-A) in managing neuropsychiatric manifestations in PD patients.</p><p><strong>Methods: </strong>Neuropsychiatric status was assessed in 185 PD patients using the Cornell Medical Index (CMI). Ninety-four patients exhibiting neuropsychiatric symptoms were randomly assigned to two groups: BTX-A (n=47, local injections) and citalopram (n=47, 10-40 mg/day). Outcomes were compared at baseline and 8 weeks post-treatment.</p><p><strong>Results: </strong>The authors findings revealed a significant reduction in somatization, tension, anxiety, depression, sensitivity, and overall scores in the BTX-A group at the eight-week follow-up (<i>p</i> < 0.05 for all). Notably, patients in the BTX-A group exhibited similar levels of somatization, depression, anxiety, maladjustment, sensitivity, anger, and overall scores compared to the citalopram group (<i>p</i> > 0.05 for all). Both groups reported comparable percentages of improvement in neuropsychiatric symptoms (75.6% vs. 82.6%, <i>p</i> = 0.57).</p><p><strong>Conclusions: </strong>This study demonstrates the potential of BTX-A in alleviating tension, anxiety, depression, sensitivity, and other neuropsychiatric symptoms in PD patients. Importantly, BTX-A's efficacy was comparable to that of citalopram, suggesting its potential as a viable therapeutic option for managing neuropsychiatric manifestations in PD.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"717-725"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987981","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":"Pharmacological therapies for early and long-term recovery in disorders of consciousness: current knowledge and promising avenues.","authors":"Rosalie Girard Pepin, Fatemeh Seyfzadeh, David Williamson, Olivia Gosseries, Catherine Duclos","doi":"10.1080/14737175.2025.2500757","DOIUrl":"10.1080/14737175.2025.2500757","url":null,"abstract":"<p><strong>Introduction: </strong>Disorders of consciousness (DoC) are characterized by impaired arousal and/or awareness, ranging from coma to unresponsive wakefulness syndrome, minimally conscious state, and cognitive motor dissociation. Pharmacological treatment options remain limited, complicated by the heterogeneity of etiologies, such as traumatic brain injury, stroke, and infections. The lack of rigorous clinical trials has led to off-label use of treatments, often without clear mechanistic understanding, posing challenges for effective patient care.</p><p><strong>Areas covered: </strong>In this perspective, the authors report on key studies concerning the effectiveness of pharmacological interventions, including dopaminergic and GABAergic agents, antidepressants, statins, and anticonvulsants, in promoting recovery of consciousness in DoC.</p><p><strong>Expert opinion: </strong>Robust longitudinal clinical trials are needed, with priority given to early subacute phase intervention. Outcomes should be better defined, considering immediate responses to medication while also increasing the emphasis on long-term quality of life. Unified functional and mechanistic frameworks are needed to guide research and foster collaboration. Furthermore, a shift toward personalized medicine would benefit this heterogeneous population. Moving forward, assessing the efficacy of more unconventional or 'paradoxical' pharmacological options in treatment plans will be essential. The authors also expect an increased use of AI tools to identify factors that best predict treatment responses.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"613-633"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988777","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":"Unlocking the potential of virtual reality for post-stroke sensorimotor rehabilitation - are we any closer?","authors":"Mindy F Levin, Jeroen B J Smeets","doi":"10.1080/14737175.2025.2490535","DOIUrl":"10.1080/14737175.2025.2490535","url":null,"abstract":"","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"609-611"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802897","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}
David Lauer, Jakub Sulženko, Hana Malíková, Ivana Štětkářová, Petr Widimský
{"title":"Advances in endovascular thrombectomy for the treatment of acute ischemic stroke.","authors":"David Lauer, Jakub Sulženko, Hana Malíková, Ivana Štětkářová, Petr Widimský","doi":"10.1080/14737175.2025.2490538","DOIUrl":"10.1080/14737175.2025.2490538","url":null,"abstract":"<p><strong>Introduction: </strong>Acute ischemic stroke (AIS) is the second leading cause of death and one of the leading causes of long-term disability globally. Endovascular thrombectomy (EVT) has revolutionized treatment for large vessel occlusion (LVO), providing 20% increase in post-stroke functional independence compared to intravenous thrombolysis (IVT) alone. Despite its proven efficacy, EVT is underutilized. While it is suitable for at least 15-20% of AIS patients, its mean adoption ranges from less than 1% to 7% in different areas.</p><p><strong>Areas covered: </strong>This review highlights key findings from pivotal randomized controlled trials and real-world data, focusing on patient selection criteria, advancements in thrombectomy devices, and procedural innovations. A comprehensive literature search was performed using PubMed, Scopus, EMBASE and the Cochrane Library for relevant randomized controlled trials and observational studies.</p><p><strong>Expert opinion: </strong>Disparity in access to EVT requires strategic investments in healthcare systems and international multidisciplinary collaboration. Enhancing geographic coverage with thrombectomy-capable centers and optimizing prehospital triage systems are essential. Bridging the gap between treatment capability and real-world implementation is critical to improving global AIS outcomes.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"675-687"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810873","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":"Correlation between systemic bleeding during thrombolysis and intracranial hemorrhage after thrombolysis in acute ischemic stroke.","authors":"Xin-Lei Mao, Si-Si He, Ya-Xi Zhang, Cai-Dan Lin, Xin-Xin Chen, Shi-Zheng Zhang, Li-Na Ge, Qing-Qing Zhuang","doi":"10.1080/14737175.2025.2491674","DOIUrl":"10.1080/14737175.2025.2491674","url":null,"abstract":"<p><strong>Background: </strong>Current models primarily predict outcomes before thrombolytic therapy. This study explored if systemic bleeding during thrombolysis predicts hemorrhagic transformation (HT) within 36 hours post-thrombolysis.</p><p><strong>Research design and methods: </strong>Data from 591 acute ischemic stroke patients treated with rt-PA at Wenzhou Central Hospital (2016-2023) were prospectively collected and analyzed. The incidence of systemic bleeding was compared with the Stroke Prognostication using Age and the National Institutes of Health Stroke Scale (Span100) index, as well as the Hemorrhage After Thrombolysis (HAT) scale.</p><p><strong>Results: </strong>Systemic bleeding occurred in 285 patients, including 92 with HT. The HT rate was significantly higher in patients with late-onset oral bleeding (35.90%) or other systemic bleeding (38.89%) than in those without (<i>p</i> < 0.01). Late-onset oral and systemic bleeding during thrombolysis predicted HT in anterior circulation infarction (<i>p</i> < 0.001) but not in posterior circulation infarction (<i>p</i> = 0.70). The AUC for predicting HT was 0.578 for these bleeding types, versus 0.568 for Span-100 and 0.61 for HAT. Incorporating bleeding types increased Span-100 sensitivity to 0.623 and HAT to 0.648.</p><p><strong>Conclusions: </strong>Late-onset oral and other systemic bleeding during thrombolysis effectively predict HT in anterior circulation infarction, enhancing the sensitivity of Span100 and HAT scales when combined.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"727-735"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980510","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":"An overview of the challenges with the differential diagnosis of schizotypal personality disorder.","authors":"Katherine V Raffensperger, Philip D Harvey","doi":"10.1080/14737175.2025.2492379","DOIUrl":"10.1080/14737175.2025.2492379","url":null,"abstract":"<p><strong>Introduction: </strong>Schizotypal personality disorder (SPD) has a long history, and there is still considerable ongoing research. Although there are overlapping features of SPD and other personality disorders, the full constellation of schizotypal features is broader. The longitudinal course of SPD is variable, with differences in trajectory manifesting lifelong clinical significance. Particularly important is the relationship between SPD and prodromal states that may result in an eventual diagnosis of psychosis.</p><p><strong>Areas covered: </strong>This review covers the history and differential diagnosis of SPD, including the older conceptualization of 'borderline schizophrenia.' Clinical, cognitive, functional, brain imaging, and genetic features of SPD, and the implications of age at onset and method of ascertainment of the condition are reviewed. Differences between psychometrically identified schizotypy, clinically diagnosed SPD, and other psychiatric conditions are described. A comprehensive literature search using MEDLINE (via PubMed) did not specify a date range, to capture the full scope of research.</p><p><strong>Expert opinion: </strong>SPD is unique in that the age at ascertainment is critical for the persistence of the diagnosis. When diagnosed with SPD in late adolescence, some individuals develop psychosis, some remit, and others have persistent, lifelong symptoms. Predictors of conversion to psychosis have been identified but are no proven treatments.</p>","PeriodicalId":12190,"journal":{"name":"Expert Review of Neurotherapeutics","volume":" ","pages":"689-698"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063140","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}