Frontiers in Neurology最新文献

{"title":"Effect of repetitive transcranial magnetic stimulation on upper limb motor function in stroke patients with right hemiplegia based on EEG microstates and EMG.","authors":"Xianxian Yu, Rong Xin, Siman Cheng, Jiale Xie, Gengqiang Ling, Xin Wei, Pu Wang","doi":"10.3389/fneur.2025.1587928","DOIUrl":"https://doi.org/10.3389/fneur.2025.1587928","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke severely impairs neural function and daily living, creating an urgent need for innovative rehabilitation strategies. This study aimed to investigate the effects of transcranial magnetic stimulation (TMS) on upper limb motor recovery in stroke patients, combining EEG microstate analysis and EMG to elucidate associated neuromuscular and cortical changes.</p><p><strong>Methods: </strong>Twenty patients with right-hemiplegic stroke and twenty healthy controls were enrolled. Patients underwent Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) before and after repetitive TMS (rTMS) intervention. Resting-state EEG and EMG recordings were acquired pre- and post-one week of rTMS treatment.</p><p><strong>Results: </strong>Following rTMS, patients exhibited significant improvements in FMA-UE and ARAT scores (<i>p</i> < 0.05). EEG microstate analysis indicated that stroke patients initially showed decreased time coverage and occurrence of Microstate B (associated with sensorimotor integration, <i>p</i> < 0.05). After rTMS, these parameters increased markedly, approaching levels observed in healthy controls (<i>p</i> < 0.05). In contrast, Microstate C (motor execution-related) and Microstate D (attention-related) displayed reduced duration and coverage post-intervention (<i>p</i> < 0.05). Critically, enhancement in Microstate B metrics correlated with improved motor coordination in specific muscles (flexor/extensor carpi ulnaris, <i>p</i> < 0.05), while changes in Microstate C were positively correlated with gains in upper limb strength.</p><p><strong>Discussion: </strong>These findings highlight two central mechanisms: (1) rTMS promotes motor recovery in hemiplegic patients by normalizing cortical dynamics, as reflected in microstate reorganization; (2) Microstate B and C represent promising neurophysiological biomarkers for tracking rehabilitation progress, with the former reflecting motor coordination and the latter indexing strength recovery. This study bridges microstate-level neurophysiological changes and functional improvements, supporting rTMS as a precision intervention in stroke neurorehabilitation. Further research should validate these biomarkers in larger cohorts and explore microstate-guided rTMS protocols.</p><p><strong>Clinical trial registration: </strong>chictr.org.cn, Identifier: ChiCTR2100049509.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1587928"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DMPS-induced neurological deterioration in neurological Wilson's disease patients: a retrospective case-control study on clinical characteristics and risk factors.","authors":"Yannan Gao, Jing Zhang, Lulu Tang, Shupei Jia, Guran Yu, Wenming Yang","doi":"10.3389/fneur.2025.1599209","DOIUrl":"https://doi.org/10.3389/fneur.2025.1599209","url":null,"abstract":"<p><strong>Background and aim: </strong>Wilson's disease (WD), an autosomal recessive copper metabolism defect, causes pathological copper deposition in hepatic and neurological systems, culminating in cirrhosis and neuropsychiatric manifestations. Our understanding of neurological deterioration in neurological WD patients following sodium dimercaptopropanesulfonate (DMPS) treatment is limited. Thus, this study aims to analyze the phenotypic spectrum and predictors of DMPS-induced neurological deterioration in neurological WD.</p><p><strong>Methods: </strong>Demographic (age, gender, weight), clinical (K-F ring, duration of illness), and biochemical parameters [alanine aminotransferase, aspartate aminotransferase, albumin, serum ceruloplasmin, blood urea nitrogen, serum creatinine, 24 h urinary copper, lactate, homocysteine (HCY)] were systematically evaluated alongside neuroimaging data, followed by receiver operating characteristic (ROC) curve analysis to identify predictive biomarkers for neurological deterioration in DMPS-induced neurological WD patients.</p><p><strong>Results: </strong>A total of 277 neurological WD patients were enrolled, among whom 24.5% (68/277) developed neurological deterioration. Notably, 70.6% (48/68) of the patients experiencing neurological worsening were male. Among the patients, 91.2% (62/68) exhibited mild deterioration, while 8.8% (6/68) experienced severe deterioration. Multivariate logistic regression analysis indicated that sex [odds ratio (OR) = 0.41[95% confidence interval (CI) = 0.18-0.94], <i>p</i> = 0.035], brain Magnetic Resonance Imaging (MRI) score (OR = 2.89[95% CI = 1.99-4.21], <i>p</i> < 0.001), and HCY (OR = 1.45[95% CI = 1.27-1.65], <i>p</i> < 0.001) were associated with neurological deterioration. Subgroup analysis revealed statistically significant differences in male proportion (36/19 vs. 75/84, <i>p</i> = 0.019), brain MRI score (median: 5 vs. 4, <i>p</i> < 0.001), and HCY levels (mean: 20.75 vs. 17.77, <i>p</i> < 0.001) between the deterioration and non-deterioration groups within the under-35 cohort. ROC analysis of composite biomarkers demonstrated significant predictive capacity for neurological deterioration in DMPS-induced neurological WD (AUC = 0.862).</p><p><strong>Conclusion: </strong>Neurological deterioration in DMPS-induced neurological WD patients is not rare and predominantly occurs in males. We identified three independent risk factors for this deterioration: sex, brain MRI score, and HCY. A composite risk model incorporating these parameters achieved superior predictive accuracy compared to individual biomarker.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1599209"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroencephalogram prediction of propofol effects on neuromodulation in disorders of consciousness.","authors":"Xuewei Qin, Xuanling Chen, Xin Zhao, Lan Yao, Hongchuan Niu, Kai Li, Yuanli Zhao, Zhenhu Liang, Zhilei Lan, Yuqian Wang, Xiangyang Guo, Jiapeng Huang, Xiaoli Li","doi":"10.3389/fneur.2025.1637647","DOIUrl":"https://doi.org/10.3389/fneur.2025.1637647","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize electroencephalogram (EEG) responses to low-dose propofol anesthesia in patients with disorders of consciousness (DoC) of distinct etiologies-traumatic brain injury (TBI), anoxic ischemic encephalopathy (AIE), and cerebrovascular accident (CVA)-and explore their prognostic relevance for recovery after spinal cord stimulation (SCS).</p><p><strong>Methods: </strong>A retrospective cohort of 40 DoC patients (TBI: 15, CVA: 14, AIE: 11) undergoing SCS under propofol anesthesia was analyzed. Pre- and post-anesthesia 19-lead EEG recordings were evaluated for power spectral density (PSD) in δ (0.5-4 Hz), θ (4-8 Hz), α (8-13 Hz), β (13-30 Hz), and γ (30-45 Hz) bands, alongside permutation entropy (PE). Consciousness levels were quantified using the Coma Recovery Scale-Revised (CRS-R) preoperatively and 3 months post-SCS. Etiology-stratified analyses compared neurophysiological and clinical outcomes.</p><p><strong>Results: </strong>Propofol universally suppressed β- (<i>p</i> < 0.001-0.05) and γ-band (<i>p</i> < 0.001-0.05) power across all groups. Etiology-specific EEG patterns emerged: AIE patients displayed reduced frontal α-power (Δ = -0.23, <i>p</i> = 0.03), while TBI/CVA patients showed prefrontal-parietal β/γ suppression (Δβ = -0.41, Δγ = -0.38; <i>p</i> < 0.001). Significant PE reduction (ΔPE = -0.21, <i>p</i> < 0.001) correlated with CRS-R improvement (<i>r</i> = -0.67, <i>p</i> = 0.003) in TBI/CVA subgroups but not in AIE (ΔPE = -0.05, <i>p</i> = 0.12). Three-month outcomes varied by etiology: 20% of TBI patients achieved a minimally conscious state (CRS-R ≥ 10) with enhanced motor (Δ = +0.25, <i>p</i> < 0.01) and visual function (Δ = +0.19, <i>p</i> = 0.03). CVA patients exhibited partial motor (Δ = +0.20, <i>p</i> = 0.007) and arousal gains (Δ = +0.17, <i>p</i> = 0.01), whereas AIE patients showed negligible improvement (mean ΔCRS-R = 0.4 ± 0.3).</p><p><strong>Conclusion: </strong>Propofol-induced EEG modulation reflects etiology-dependent neural network vulnerabilities in DoC. TBI/CVA patients demonstrated entropy reduction linked to clinical recovery, suggesting transient network stabilization that may enhance SCS efficacy. In contrast, AIE-associated static dynamics imply irreversible structural damage. Integrated PSD/PE analysis holds prognostic potential for predicting SCS responsiveness, particularly in TBI/CVA cohorts. These findings advocate etiology-tailored neuromodulation strategies, though multicenter validation is imperative for clinical translation.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1637647"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of a novel patient reported outcome measure for visual snow syndrome: the Colorado visual snow survey 2.0.","authors":"Samuel M Maione, Victoria S Pelak, Peter Gerhardstein","doi":"10.3389/fneur.2025.1664310","DOIUrl":"https://doi.org/10.3389/fneur.2025.1664310","url":null,"abstract":"<p><strong>Introduction: </strong>Visual snow syndrome (VSS) is a condition in which people experience a continuous overlay of small dots atop their entire visual field. As a newly recognized condition, there is a gap in patient reported outcome measures (PROMs) that target VSS symptom impact.</p><p><strong>Methods: </strong>We sought to assess the Colorado Visual Snow Survey 2.0 (CVSS) as a possible PROM for VSS using a convenience sample of undergraduate students and people with VSS recruited through the Visual Snow Initiative (N = 144).</p><p><strong>Results: </strong>We found the CVSS (1) strongly differentiated people with VSS from healthy controls, (2) demonstrated high internal consistency, and (3) aside from visual static, the degree of night vision impairment, blue field entoptic phenomenon, and afterimages, and tinnitus (in that order) best predicted group membership. We also find evidence to suggest people with VSS may be more sensitive to entoptic phenomenon and depersonalization/derealization than control participants.</p><p><strong>Conclusion: </strong>Overall, CVSS is a promising PROM that warrants further validation.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1664310"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Assessment and treatment interventions for traumatic brain injury.","authors":"Andrew P Lavender, Ryusuke Takechi, Sarah C Hellewell, Keisuke Kawata","doi":"10.3389/fneur.2025.1696541","DOIUrl":"https://doi.org/10.3389/fneur.2025.1696541","url":null,"abstract":"","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1696541"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postictal punctate hippocampal diffusion restriction: the chicken or the egg?","authors":"Jan Heckelmann, Yvonne Weber, Manuel Dafotakis, Stefan Wolking","doi":"10.3389/fneur.2025.1659610","DOIUrl":"https://doi.org/10.3389/fneur.2025.1659610","url":null,"abstract":"<p><strong>Introduction: </strong>Magnet resonance imaging (MRI) is the imaging gold standard for the evaluation of suspected epileptic seizures but also indispensable for detecting cerebral ischemia, using diffusion-weighted imaging (DWI) sequences. DWI restrictions can also occur following an epileptic seizure, thus mimicking cerebral ischemia. Postictal DWI lesions typically cross vascular territories and are confined to the cortex. Here, we present four illustrative cases with the unusual finding of reversible punctate postictal hippocampal DWI lesions, reminiscent of transient global amnesia (TGA).</p><p><strong>Methods: </strong>Case 1 was identified during video-EEG examination. We consecutively screened our database for similar cases, identifying three additional cases (3 male/1 female, age range 53-78 years). The initial MRI was performed within 5 days, a follow-up MRI within 4.5 months. All patients received video-EEG-monitoring.</p><p><strong>Results: </strong>All cases were initially referred for a first epileptic seizure. The occurrence of punctate hippocampal DWI lesions prompted the diagnosis of ischemic stroke with acute-symptomatic seizures. None of the patients featured classical symptoms of stroke or TGA. Follow-up MRIs were normal, ruling out ischemic stroke. During subsequent video-EEG workup one patient was diagnosed with epilepsy, the other patients with a first unprovoked seizure.</p><p><strong>Conclusion: </strong>We postulate that punctate hippocampal DWI lesions can be postictal phenomenon. Recognizing this imaging finding is relevant for the therapeutic management, we encourage referring patients for video-EEG monitoring in case of unconclusive findings. Besides vasogenic oedema related to neuronal hyperactivity, venous compression could be a potential pathomechanism. Prospective postictal imaging studies could help to better understand and quantify punctate hippocampal DWI lesions.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1659610"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From demyelination to neurodegeneration in multiple sclerosis: reassessing the role of visual evoked potential P100-N145 amplitudes: a missing piece of the puzzle?","authors":"Nurhan Kaya Tutar, Nilufer Kale","doi":"10.3389/fneur.2025.1649998","DOIUrl":"https://doi.org/10.3389/fneur.2025.1649998","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is a chronic demyelinating disease with a heterogeneous clinical course, making long-term disability prediction challenging. Visual evoked potentials (VEPs), particularly amplitude-based parameters, may serve as sensitive biomarkers of neurodegeneration and functional decline undetected by conventional clinical measures.</p><p><strong>Objective: </strong>To assess the relationship between longitudinal changes in P100-N145 amplitude and concurrent Expanded Disability Status Scale (EDSS) changes in relapsing-remitting MS (RRMS) and the relative utility of baseline and longitudinal VEP parameters in representing disability status.</p><p><strong>Methods: </strong>In this retrospective cohort study, 45 MS patients (90 eyes) with available VEP and EDSS data were followed for a median period of 48 months. The primary endpoints were (1) change in EDSS score over time and (2) EDSS progression, defined as any increase in EDSS score from baseline to follow-up. Generalized estimating equations (GEE) and logistic regression were used to investigate the relationships between the VEP parameters at baseline and follow-up and EDSS progression, accounting for inter-eye correlation; partial correlation analysis assessed amplitude-EDSS change associations, controlling for age.</p><p><strong>Results: </strong>EDSS progression was observed in 17.8% of patients. A longitudinal decrease in P100-N145 amplitude from baseline to follow-up was significantly associated with EDSS progression (OR: 1.511, 95% CI, <i>p</i> < 0.001). In addition, partial correlation analysis adjusting for age revealed a significant negative association between the difference in P100-N145 amplitude and EDSS difference (defined as baseline minus follow-up) in both eyes (right eye: <i>r</i> = -0.339, <i>p</i> = 0.024; left eye: <i>r</i> = -0.406, <i>p</i> = 0.006). In contrast, the changes in P100 latency and N75-P100 amplitude did not correlate significantly with EDSS worsening. Baseline VEP parameters, including P100 latency, N75-P100, and P100-N145 amplitudes, did not predict EDSS progression or change over time (all <i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>Our results demonstrate that a reduction in P100-N145 amplitude over time is associated with worsening disability in RRMS. This suggests that the P100-N145 may be an underestimated marker of progressive functional deterioration in RRMS.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1649998"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SHAP-based interpretable machine learning for Parkinson's disease severity prediction: integrated analysis of clinical and environmental features.","authors":"Yuting Jin, Xiang Li, Xinsheng Han, Yang Qiu, Hongyang Zhang, Jianke Xu, Miao Han","doi":"10.3389/fneur.2025.1678463","DOIUrl":"https://doi.org/10.3389/fneur.2025.1678463","url":null,"abstract":"<p><strong>Introduction: </strong>Parkinson's Disease (PD) represents the second most prevalent neurodegenerative disorder globally, with traditional assessment methods suffering from limitations including substantial inter-rater variability and inability to capture multifactorial complexity underlying disease progression.</p><p><strong>Methods: </strong>Based on data from 500 Parkinson's disease patients, we integrated 7 standardized clinical phenotypes (excluding UPDRS to prevent data leakage) and 8 environmental exposure factors, compared 10 machine learning algorithms using 5-fold cross-validation, and applied SHAP interpretability analysis for transparent feature importance assessment.</p><p><strong>Results: </strong>XGBoost with SMOTE sampling achieved clinically meaningful discriminative performance (AUC = 0.781, precision = 0.548, recall = 0.750) appropriate for screening applications. SHAP analysis revealed non-motor symptoms as the primary predictor (SHAP value = 2.76), followed by serum dopamine concentration (2.39) and age (2.16), while environmental factors demonstrated modest but statistically significant contributions.</p><p><strong>Discussion: </strong>This proof-of-concept study developed an interpretable framework with methodological safeguards against data leakage, demonstrating promising screening potential with realistic performance expectations. However, the cross-sectional, single-center design limits generalizability, requiring external validation and longitudinal studies before clinical deployment.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1678463"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glial fibrillary acidic protein autoimmunity in reversible splenial lesion syndrome: diagnostic and therapeutic implications.","authors":"Lingling Lin, Xiang Li, Chao Quan, Jingzi Zhangbao, Hongmei Tan, Yi Wang, Siyuan Xu, Zhihao Dai","doi":"10.3389/fneur.2025.1650256","DOIUrl":"https://doi.org/10.3389/fneur.2025.1650256","url":null,"abstract":"<p><p>Autoimmune GFAP astrocytopathy (GFAP-A) is a neuroinflammatory condition that often involves the brain, meninges, and spinal cord. Its characteristic MRI finding consists of linear or radial perivascular enhancement adjacent to the ventricles. While corpus callosum splenium lesions occur in only 5% of cases, association with reversible splenial lesion syndrome (RESLES) is very rare. In such instances, GFAP-A can clinically resemble viral encephalitis, making diagnosis difficult. This article discusses how to distinguish GFAP-A from viral encephalitis using clinical and auxiliary examinations when RESLES is present.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1650256"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-discharge \"continuum of care\" clinical pathway for persons with severe neurodisabilities-qualitative research to assess its concept and practicality after implementation.","authors":"Stephanie Reichl, Romy Pletz, Aukje Bartsch-de Jong, Nuria Vallejo, Tatjana Groß, Andreas Bender, Thomas Platz","doi":"10.3389/fneur.2025.1552692","DOIUrl":"https://doi.org/10.3389/fneur.2025.1552692","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to reflect the appropriateness and practicality of an evidence- and guideline-based clinical pathway (CP) for the intersectoral support of community-based neurorehabilitation of severely affected neurological patients requiring home-based intensive care nursing, early after its regional implementation in the Federal State of Bavaria, Germany. The CP is designed to support ongoing functional progress, with specialists from three regional neurological early rehabilitation centers (NER) providing rehabilitation expertise shared with healthcare professionals in the community across Bavaria, using a person-centered, individualized approach.</p><p><strong>Methods: </strong>Qualitative exploratory study design: Semi-structured interviews with three NER-based regional outreach teams (ROFTs), followed by a multi-stage qualitative analysis and interpretation of their responses.</p><p><strong>Results: </strong>Three group interviews were conducted with a total of 10 ROFT members. A total of 304 unique responses (i) were documented. Based on their experience, the teams reported numerous healthcare-related barrier observations (<i>i</i> = 69) and consequently, negative expectation reflections regarding the care situation in the community (<i>i</i> = 10). Regarding their outreach activities, the team's observations predominantly indicated that their interventions were successful (<i>i</i> = 12). Nevertheless, negative expectation reflections regarding the CP's implementation prevailed for both medical aspects (<i>i</i> = 27) and networking (<i>i</i> = 41).</p><p><strong>Conclusion: </strong>Although the CP was not challenged conceptually by the field experience, the teams implementing the intersectoral collaboration faced major challenges with the continuum of care approach. Most importantly, a lack of, and variability in, qualified therapeutic resources, as well as the fact that multiprofessional team approaches were not established as a healthcare standard in the community, were noted. While the research findings support the need for a situation analysis and targeted implementation efforts, they also indicate the potential for such a hybrid collaborative center- and community-based healthcare approach for a clientele with highly specialized healthcare needs.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"16 ","pages":"1552692"},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}