Frontiers in Neurology最新文献

{"title":"Perioperative ASL-derived CBF changes are associated with complications after Moyamoya bypass surgery.","authors":"Jiachao Lu, Chao Li, Tiansheng Su, Yong Mo, Guangxiang Huang, Shuling Tang, Ligen Mo, Chaojue Huang, Jun Yan","doi":"10.3389/fneur.2026.1928443","DOIUrl":"https://doi.org/10.3389/fneur.2026.1928443","url":null,"abstract":"<p><strong>Background: </strong>Postoperative hyperperfusion and insufficient perfusion augmentation are important contributors to morbidity after revascularization surgery for Moyamoya disease (MMD). Arterial spin labeling (ASL) enables noninvasive assessment of cerebral blood flow (CBF), but the relationship between perioperative ASL-derived CBF changes and specific postoperative complications after direct bypass remains incompletely defined. This study evaluated whether perioperative ASL-derived CBF changes were associated with postoperative complications after direct bypass surgery in patients with MMD.</p><p><strong>Methods: </strong>We retrospectively reviewed 146 patients with MMD who underwent first-time direct bypass surgery between June 2020 and October 2024. Preoperative ASL and a standardized postoperative ASL examination on postoperative day 5 were performed, and CBF values were measured in the recipient vascular territory. Subsequent intracranial hemorrhage, cerebral infarction, and postoperative seizures occurring within 90 days after surgery were analyzed. Firth penalized logistic regression was used for the hemorrhage outcome, conventional logistic regression was used for cerebral infarction, and ROC analyses included bootstrap assessment of cutoff uncertainty and 0.632 + bootstrap correction of AUC optimism.</p><p><strong>Results: </strong>Postoperative intracranial hemorrhage occurred in 8 patients (5.5%), cerebral infarction in 14 patients (9.6%), and postoperative seizures in 9 patients (6.2%); all events occurred after the day-5 ASL examination and within 90 days after surgery. ASL-derived CBF change was associated with postoperative intracranial hemorrhage in Firth penalized logistic regression (OR, 1.219; 95% profile-likelihood CI, 1.102-1.580; <i>p</i> < 0.001). The exploratory cutoff was >43.48 mL/100 g/min, with an apparent AUC of 0.9891 and a 0.632 + corrected AUC of 0.9890. ASL-derived CBF change was inversely associated with postoperative cerebral infarction (OR, 0.885; 95% CI, 0.839-0.933; <i>p</i> < 0.001). The exploratory cutoff was ≤4.48 mL/100 g/min, with an apparent AUC of 0.9150 and a 0.632 + corrected AUC of 0.9150. No significant association was observed between ASL-derived CBF change and postoperative seizures.</p><p><strong>Conclusion: </strong>Perioperative ASL-derived CBF change was associated with hemorrhagic and ischemic complications after direct bypass surgery for MMD. Marked postoperative CBF elevation was observed in patients with intracranial hemorrhage, whereas insufficient perfusion augmentation was associated with cerebral infarction. The proposed thresholds are exploratory, cohort-specific estimates and require external validation before clinical application.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1928443"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223850","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":"Neurology and headache medicine in Malawi: territory, education, and the path to strengthening primary care in sub-Saharan Africa.","authors":"Daniele Martinelli, Massimo Leone, Cristina Tassorelli","doi":"10.3389/fneur.2026.1869988","DOIUrl":"10.3389/fneur.2026.1869988","url":null,"abstract":"<p><p>Sub-Saharan Africa (SSA) bears a disproportionate burden of neurological and pain-related diseases while facing a severe shortage of trained specialists. In this context, expanding neurology and, particularly, headache medicine, through education and integration within primary care represents both a necessity and an opportunity. This Perspective proposes a context-sensitive framework in which three interconnected domains-territory, culture, and capacity-shape the accessibility, acceptability, and sustainability of neurological care. Drawing on the experience of the International Headache Society (IHS)-DREAM healthcare network partnership in Malawi, we examine how locally adapted education, task-shifting and task-sharing can contribute to capacity building while highlighting the limitations of approaches that focus on training alone. We argue that closing the neurological treatment gap requires a shift from specialist-centred to system-centred neurology, integrating workforce development with primary care, culturally grounded community engagement, appropriate supervision and referral pathways, supportive national health policies, and equitable access to essential medicines. Task shifting and task sharing between physicians and non-physician clinicians may constitute a sustainable component of this model when appropriately regulated, supervised, remunerated, and integrated with specialist support and referral pathways. Rather than proposing a model for direct transfer across SSA, this Perspective advocates locally led, context-dependent implementation strategies capable of adapting to diverse health systems. Such an approach reframes global neurological capacity building from the episodic transfer of expertise towards the development of resilient and sustainable systems of care.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1869988"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223895","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":"Predictive roles of inflammatory indicators (NLR, PLR, LMR and SII) in poststroke depression rehabilitation: a systematic review.","authors":"Hao Dai, Ming Cheng","doi":"10.3389/fneur.2026.1890435","DOIUrl":"https://doi.org/10.3389/fneur.2026.1890435","url":null,"abstract":"<p><p>Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide. Almost all AIS survivors suffer physical disabilities and neuropsychiatric disturbances, among which poststroke depression (PSD) is a typical poststroke complication. The development of new tools to diagnose PSD at the early stage and predict its long-term outcome has attracted the attention of clinicians and researchers. Neuroinflammation has been increasingly considered a critical modulator of stroke evolution. Following an IS, an inflammatory response arises in the CNS, characterized by the activation of microglia; the recruitment of peripheral immune cells, including neutrophils, monocytes, and lymphocytes; and the release of proinflammatory cytokines. In this review, we present a comprehensive and critical examination of the diagnostic and predictive roles of inflammatory indicators, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII), in PSD. A systematic literature search on PubMed, Google Scholar, Web of Science, and CNKI was performed up to January 31, 2026. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS), and heterogeneity was evaluated using the <i>I</i> ² statistic. Nine original studies involving 2,626 patients were included. Compared with non-PSD (NPSD) patients, PSD patients had a significantly greater NLR (<i>MD</i> = 0.47, 95% <i>CI</i> [0.39, 0.56], <i>I</i> ² = 49%), PLR (<i>MD</i> = 20.79, 95% <i>CI</i> [12.25, 29.33], <i>I</i> ² = 90%), and SII (<i>MD</i> = 123.92, 95% <i>CI</i> [68.85, 178.98], <i>I</i> ² = 70%) and a significantly lower LMR (<i>MD</i> = -0.21, 95% <i>CI</i> [-0.34, -0.08], <i>I</i> ² = 64%). Most included studies were rated as moderate-to-high quality on the basis of their NOS scores. These findings suggest that the NLR, PLR, LMR, and SII may serve as accessible peripheral blood biomarkers for early risk assessment of PSD, although further research is needed to establish optimal cutoff values and validate their predictive utility across different stroke subtypes.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1890435"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223979","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":"Simple renal cysts are associated with ischemic stroke in young adults: a case-control study.","authors":"Fangyi Li, Qingxi Zhang, Guohua He, Yangping Tong, Kangping Song","doi":"10.3389/fneur.2026.1926737","DOIUrl":"https://doi.org/10.3389/fneur.2026.1926737","url":null,"abstract":"<p><strong>Background: </strong>The incidence of ischemic stroke among young patients is increasing, and ischemic stroke has become a major cause of death and disability in young adults. The key to alleviating this problem is to identify the risk factors and causes of stroke to optimize treatment. The current study aims to assess whether simple renal cysts are associated with the occurrence of ischemic stroke among young adults.</p><p><strong>Methods: </strong>Data from patients with acute ischemic stroke aged 18-50 years and age- and sex-matched controls who underwent medical examinations at the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, from October 2022 to September 2025 were retrospectively collected. Potential risk factors (including blood pressure, fasting blood glucose, dyslipidemia, homocysteine, and simple renal cysts) were compared between young patients with stroke and controls. Binary logistic regression analysis was conducted to identify risk factors for ischemic stroke among young patients.</p><p><strong>Results: </strong>A total of 219 young patients with acute ischemic stroke and 219 controls were enrolled for analysis. Patients with elevated blood pressure, elevated blood glucose, and concurrent simple renal cysts had a higher risk of ischemic stroke. Simple renal cysts were associated with a higher risk of ischemic stroke in young adults, but they did not correlate with greater stroke severity.</p><p><strong>Conclusion: </strong>Simple renal cysts are associated with ischemic stroke in young adults and thus merit clinical awareness. Prospective multicenter cohort studies are expected to confirm this association and clarify potential mechanisms.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1926737"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223991","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":"Longitudinal dynamics of serum neurofilament light chain and prognostic value for functional outcome after acute stroke: a prospective cohort study.","authors":"Guangyong Chen, Yuxin Zhu, Feng Chen, Changhao Zhang, Jin Huang, Weijie Wu, Lei Chen, Lingling Lin, Yueping Chen, Anqi Lin, Qinqin Liu, Peipei Wang, Lidong Zhu, Xuerong Huang","doi":"10.3389/fneur.2026.1932102","DOIUrl":"https://doi.org/10.3389/fneur.2026.1932102","url":null,"abstract":"<p><strong>Background: </strong>Serum neurofilament light chain (sNfL) is a blood biomarker of neuroaxonal injury, but its early longitudinal dynamics and prognostic value in clinically heterogeneous acute stroke populations remain insufficiently defined. This study characterized early sNfL changes and examined their association with functional outcome after acute stroke.</p><p><strong>Methods: </strong>This prospective cohort study consecutively enrolled 104 patients with acute stroke and 86 healthy controls (HCs) between January 2023 and December 2024. Patients were grouped as intracerebral hemorrhage (ICH, <i>n</i> = 28), ischemic stroke treated with intravenous thrombolysis (IS+IVT, <i>n</i> = 33), and ischemic stroke without intravenous thrombolysis (IS-IVT, <i>n</i> = 43). sNfL was measured within 24 h after onset (D1) and on day 7 (D7). Functional outcome was assessed by modified Rankin Scale (mRS) at 3 and 6 months. Linear mixed-effects models assessed longitudinal sNfL trajectories. Multivariable logistic regression assessed prognostic associations, with the 3-month outcome as the primary endpoint and the 6-month outcome as the secondary endpoint. Restricted cubic spline (RCS) and interaction analyses were exploratory.</p><p><strong>Results: </strong>sNfL increased significantly from D1 to D7 (<i>p</i> < 0.001) and was higher in patients with stroke than in HCs at D1 (<i>p</i> < 0.001). In the linear mixed-effects model adjusted for age and admission National Institutes of Health Stroke Scale (NIHSS) score, longitudinal sNfL trajectories did not differ significantly among the clinical stroke groups (time × group interaction, <i>p</i> = 0.225). The predominantly mild-to-moderate severity profile may have limited the detection of trajectory differences. In multivariable logistic regression, each 10-pg/mL increase in D1 sNfL was associated with 5% higher odds of poor functional outcome at 3 months (OR = 1.05; 95% CI, 1.00-1.12; <i>p</i> = 0.047) and 7% higher odds at 6 months (OR = 1.07; 95% CI, 1.01-1.14; <i>p</i> = 0.025). D7 sNfL was not independently associated with poor functional outcome after adjustment. Exploratory RCS analyses found no statistical evidence of nonlinearity for D1 sNfL and suggested a nonlinear association between D7 sNfL and 3-month poor functional outcome.</p><p><strong>Conclusion: </strong>sNfL levels increased during the first week after acute stroke. Higher D1 sNfL was associated with poor functional outcome at 3 and 6 months, suggesting potential value for early prognostic assessment.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1932102"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223892","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":"The value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury.","authors":"Zhen-Hai Fei, Xing-Ming Zhong, Yong Cai, Li-Ying Dong","doi":"10.3389/fneur.2026.1838871","DOIUrl":"https://doi.org/10.3389/fneur.2026.1838871","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to explore the value of brainstem auditory evoked potentials in the diagnostic assessment of dysphagia after craniocerebral injury.</p><p><strong>Methods: </strong>To investigate the role of brainstem auditory evoked potentials (BAEPs) in dysphagia diagnosis, we prospectively analyzed BAEP findings and gold-standard diagnoses in 106 patients with head injury. Inclusion criteria: ① Age 18-70 years old; ② Diagnosed by Chinese Expert Consensus on Evaluation and Treatment of Dysphagia. Exclusion criteria: ① Patients with a Glasgow coma scale score ≤8 and patients who cannot be managed with intervention; ② Previous comorbidities that may affect swallowing function.</p><p><strong>Results: </strong>A total of 65 males and 41 females patients were enrolled. The positive rate of BAEP in moderate to severe dysphagia was 86.96%, which was significantly higher than that in the mild dysphagia group (45.95%; <i>p</i> < 0.01). 60 patients were BAEP-positive and moderate-to-severe dysphagia patients, and considered neurogenic dysphagia, 46 patients were BAEP-negative, and considered non-neurophagia. The AUC of BAEP diagnosis of moderate to severe dysphagia was 0.705.</p><p><strong>Conclusion: </strong>BAEP can be used as an accurate diagnostic method for nerve injury, it is helpful to identify whether it is a neurological dysphagia.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1838871"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224024","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":"Microatherosclerosis is a common but often overlooked cause of ischemic stroke.","authors":"Sucheta Waghmare, Rafael Leal-Hidalgo, Jeffrey L Saver","doi":"10.3389/fneur.2026.1920003","DOIUrl":"https://doi.org/10.3389/fneur.2026.1920003","url":null,"abstract":"<p><strong>Background: </strong>Fisher described several distinct vascular pathologies underlying lacunar infarction. However, subsequent literature and clinical practice have often misattributed symptomatic lacunar stroke primarily to lipohyalinosis and intracranial branch ostial atherosclerosis. Classic neuropathologic studies indicate that many lacunar strokes are instead caused by microatherosclerosis - small atheromatous plaque within penetrating arteries. This study aims to quantify the proportion of symptomatic lacunar infarcts in clinical practice attributable to microatherosclerosis.</p><p><strong>Methods: </strong>Three systematic meta-analyses, per PRISMA guidelines were performed of large clinical series to delineate: (1) the proportion of ischemic strokes due to lacunar infarcts; (2) among lacunar events, the relative frequencies of pure motor hemiparesis (PMH), pure sensory stroke (PSS), dysarthria-clumsy hand (DCH), ataxic hemiparesis (AH); and (3) proportional contribution of microatherosclerosis, lipohyalinosis, intracranial branch-origin atherosclerosis and embolism to symptomatic lacunar stroke.</p><p><strong>Results: </strong>The neuropathology systematic review showed: PMH caused by microatherosclerosis-64%, lipohyalinosis-14%, embolism-14% and intracranial branch-artery atherosclerosis-7%; PSS caused by lipohyalinosis-100%: and DCH and AH each caused by microatherosclerosis-33%, intracranial branch-artery atherosclerosis-33%, and embolism-33%. The first clinical series meta-analysis showed, among 24 large ischemic stroke series enrolling 32,169 patients, lacunar infarct frequency was 17.8%. The second showed, among 7 large series enrolling 1,646 lacunar infarct patients, subtype frequencies were: PMH-47%, PSS-10.6%, DCH-7.7% and AH-11.2% (with the remainder sensorimotor stroke and less common lacunar syndromes). Quantitative synthesis indicated that: microatherosclerosis is estimated to be the most common cause of lacunar strokes, accounting for 43%, followed by lipohyalinosis-20%, embolism-20%, and intracranial branch-origin atherosclerosis-17%; and that microatherosclerosis is the estimated cause of 7.7% of all ischemic strokes.</p><p><strong>Conclusion: </strong>Microatherosclerotic plaque within a penetrating artery is a common cause of cerebral ischemia, accounting for an estimated 1 in 13 of all ischemic strokes. This substantial burden of microatherosclerosis may be an important pathophysiologic basis for the benefits of thrombolytic and statin therapy in select patients with lacunar ischemic strokes.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1920003"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223938","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":"A simplified Fazekas scale for efficient assessment of white matter hyperintensities.","authors":"Peng Liu, Songguo Liu, Chuanna Xu, Ming Zhu, Xue Liu, Xin Zhao, Bentao Wei, Qiang Li, Guang Han","doi":"10.3389/fneur.2026.1855460","DOIUrl":"https://doi.org/10.3389/fneur.2026.1855460","url":null,"abstract":"<p><strong>Background: </strong>White matter hyperintensities (WMH) are key neuroimaging markers of cerebral small vessel disease (CSVD) and are associated with neuropsychiatric symptoms in older adults. Although the Fazekas visual rating scale is widely used in research, its clinical adoption remains limited. Therefore, we developed a simplified Fazekas visual rating scale (sFazekas) for overall WMH assessment to facilitate clinical application.</p><p><strong>Methods: </strong>We randomly selected 900 participants from three MRI scanners and evaluated the reliability and scoring efficiency of sFazekas versus the Fazekas scale. Then, all participants were grouped according to the sFazekas scores, and intergroup differences among the different scores were analyzed. Next, we examined correlations among the sFazekas, the Fazekas, and WMH volume. Finally, we explored associations between the sFazekas and vascular risk factors related to CSVD.</p><p><strong>Results: </strong>The sFazekas demonstrated excellent inter-rater reliability (<i>κ</i> = 0.851) and required significantly less time to complete than the conventional Fazekas (<i>p</i> < 0.01). Significant differences in age, WMH volume, and vascular risk factors were observed across sFazekas score groups (<i>p</i> < 0.01). The sFazekas scores were strongly correlated with Fazekas scores for both deep and periventricular white matter, as well as with WMH volume (<i>p</i> < 0.001). Ordinal logistic regression indicated that age, hypertension, diabetes mellitus, and a history of stroke were independent predictors of higher sFazekas scores (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>The simplified Fazekas visual rating scale (sFazekas) demonstrates reliability comparable to the conventional Fazekas scale, with the practical advantage of shorter scoring time, suggesting its potential utility in the clinical assessment of overall white matter hyperintensity burden in patients with cerebral small vessel disease.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1855460"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223849","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":"Restlessness in cluster headache: unveiling the role of its key associations and clinical implications from a cohort study.","authors":"Edis Hacılar, Pınar Yalınay Dikmen, Esme Ekizoğlu, Elif Ilgaz Aydınlar, Elif Kocasoy Orhan, Ferda Selçuk, Aynur Özge, Ayşenur Şahin, Tuba Erdogan Soyukibar, Bahar Taşdelen, Mustafa Ertaş, Betül Baykan","doi":"10.3389/fneur.2026.1946721","DOIUrl":"https://doi.org/10.3389/fneur.2026.1946721","url":null,"abstract":"<p><strong>Background: </strong>ICHD-3 recognizes restlessness/agitation as an accompanying feature of cluster headache (CH). However, its phenotypic significance within CH remains uncertain. We compared patients with CH with (CHwR) and without restlessness (CHwoR) to characterize the clinical features and symptom burden associated with restlessness.</p><p><strong>Methods: </strong>We conducted a cross-sectional cohort study of Turkish patients with CH (<i>n</i> = 318) across tertiary neurology clinics, using a standardized clinician-administered questionnaire. We compared patients with CHwR versus CHwoR across clinical domains, applied multivariable logistic regression to identify independent correlates, and used Partitioning Around Medoids clustering (six pre-specified variables) to explore data-driven profiles.</p><p><strong>Results: </strong>There were no patients diagnosed with restlessness alone, without any autonomic symptoms. Restlessness co-occurred with cranial autonomic symptoms-particularly eyelid ptosis and sweating-and also with photophobia, nausea and vomiting. Independent correlates were photophobia (OR 2.91; 95% CI 1.65-5.14), sweating (1.96; 1.04-3.71), and eyelid ptosis (1.75, 1.01-3.03). Workplace burden tended to be greater in CHwR (work-day loss median 10 vs. 5 days; work-life impact 84.1% vs. 73.4%), with higher work-life impact and a borderline difference in work-day loss. Exploratory clustering showed a graded pattern of restlessness, highest in the earlier-onset/high-burden profile.</p><p><strong>Conclusion: </strong>In this tertiary-care cohort, restlessness was associated with a broader, symptom-rich CH phenotype characterized by both cranial autonomic and migrainous features and greater clinical burden. As no migraine comparison group was included, its diagnostic discriminatory value cannot be directly assessed. These findings suggest that restlessness may be better interpreted in the context of the overall CH phenotype rather than as an isolated diagnostic feature.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1946721"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224005","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":"The cerebellum in migraine: a narrative review of anatomical, imaging, and clinical evidence.","authors":"Ruonan Zhang, Jiali Huang, Xiaoping Fan, Wanqun Hu, Liang Dong, Jiying Zhou","doi":"10.3389/fneur.2026.1877070","DOIUrl":"https://doi.org/10.3389/fneur.2026.1877070","url":null,"abstract":"<p><p>Migraine is usually framed through trigeminovascular pathways and interactions among the brainstem, hypothalamus, and cortex. The cerebellum has received less attention, although human studies place it within circuits that process trigeminal nociception and vestibular signals. This narrative review examines anatomical and experimental work together with imaging, genetic, and clinical studies, giving greatest weight to direct human migraine evidence. Repeated-measures imaging suggests that cerebellar connectivity changes across the migraine cycle, but the cohorts are small. Structural findings vary with analytic method, and population based testing does not show a general cerebellar deficit in common migraine. Evidence is more coherent in defined contexts: trigeminal stimulation recruits lobules VI/VIIIa and Crus I, vestibular migraine involves posterior cerebellar and wider vestibular-sensory networks, and treatment imaging shows cerebellar changes without localizing the site of CGRP-directed action. Findings in medication-overuse headache and familial hemiplegic migraine provide additional state-related and mechanistic clues. Taken together, the cerebellum is best viewed as a modulatory component of distributed migraine networks, with possible roles in sensory gain and vestibular integration. It is neither a demonstrated attack generator nor a validated treatment target. The next step is to test whether within-person cerebellar measures reproduce across attacks and whether intervention changes a prespecified circuit-level endpoint.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1877070"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223954","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}