Frontiers in Neurology最新文献

{"title":"Polysomnographic and nocturnal heart rate correlates of cognitive impairment in Parkinson's disease: a cross-sectional study.","authors":"Zhang Linwei, Lv Pu, Wang Lu, Zhang Xiangfei, Wang Kang, Jin Miao","doi":"10.3389/fneur.2026.1913495","DOIUrl":"10.3389/fneur.2026.1913495","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the correlations between cognitive impairment in Parkinson's disease (PD) and nocturnal video-polysomnography (vPSG) and electrocardiogram (ECG) parameters, evaluating their independent clinical value.</p><p><strong>Methods: </strong>We analyzed 84 PD patients divided into normal cognition (PD-NC, <i>n</i> = 27), mild cognitive impairment (PD-MCI, <i>n</i> = 27), and dementia (PDD, <i>n</i> = 30) groups. Clinical scales, overnight vPSG, and electrocardiogram parameters were recorded. Multivariable linear regression was used to evaluate independent factors associated with the Montreal Cognitive Assessment (MoCA) scores.</p><p><strong>Results: </strong>As cognitive impairment progressed, REM sleep latency significantly shortened (128.82 ± 117.32 min in PDD vs. 200.54 ± 90.26 min in PD-NC, <i>p</i> = 0.006). Concurrently, mean nocturnal heart rate (65.80 ± 10.80 bpm) and minimum heart rate (50.77 ± 12.51 bpm) were significantly higher in the PDD group than in the other two groups (<i>p</i> < 0.01). Multivariable linear regression revealed that, after adjusting for age, education, and UPDRS III score, mean nocturnal heart rate remained independently and negatively associated with MoCA scores (<i>B</i> = -0.158, <i>β</i> = -0.264, <i>t</i> = -3.018, <i>p</i> = 0.003), while REM sleep latency was independently and positively associated with MoCA scores (<i>B</i> = 0.010, <i>β</i> = 0.192, <i>t</i> = 2.224, <i>p</i> = 0.029). Collinearity diagnostics showed no significant multicollinearity (<i>VIF</i>: 1.029-1.261).</p><p><strong>Conclusion: </strong>Higher mean nocturnal heart rate and shorter REM sleep latency were independently associated with lower global cognitive performance in PD patients. Both measures can be obtained from routine overnight PSG, although their physiological significance remains uncertain. The cross-sectional design and the absence of direct autonomic or cholinergic measurements preclude causal or mechanistic conclusions.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1913495"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244224","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 robust adversarial learning framework for EEG emotion recognition.","authors":"Hao Yang, Li Chen, Jianyong Gao, Junqiang Zhang, Jianfeng Zhang","doi":"10.3389/fneur.2026.1951986","DOIUrl":"10.3389/fneur.2026.1951986","url":null,"abstract":"<p><strong>Introduction: </strong>Electroencephalography (EEG) provides an objective means of capturing neural patterns associated with emotion, but substantial inter-subject variability limits the ability of existing models to generalize to unseen subjects.</p><p><strong>Methods: </strong>We propose a robust adversarial domain generalization framework for cross-subject EEG emotion recognition. In the first stage, long short-term memory-based encoders are jointly trained to learn domain-invariant and domain-specific representations using reconstruction, emotion classification, and adversarial domain objectives. This process preserves emotion-relevant information while suppressing subject-specific distribution shifts. In the second stage, the invariant encoder and emotion classifier are further refined through distributionally robust optimization with gradient-guided feature augmentation. Theframework is evaluated on the AMIGOS and DREAMER datasets using leave-one-subject-out cross-validation.</p><p><strong>Results: </strong>The proposed method achieves mean accuracies of 69.94% and 68.97% and F1 scores of 0.59 and 0.65 on AMIGOS and DREAMER, respectively, outperforming the comparison methods on both datasets. Ablation results further show that adversarial learning provides the primary improvement in cross-subject generalization, while distributionally robust optimization offers complementary robustness.</p><p><strong>Discussion: </strong>These findings indicate that combining representation learning that is invariant across domains with distributionally robust optimization effectively reduces distribution shifts across subjects and improves EEG emotion recognition for unseen subjects.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1951986"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244219","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":"Polyclonal IgG therapy in neurologic and neuromuscular disease: mechanisms of action and insights from newer therapies.","authors":"Mel Berger","doi":"10.3389/fneur.2026.1819474","DOIUrl":"https://doi.org/10.3389/fneur.2026.1819474","url":null,"abstract":"<p><p>Plasma-derived polyclonal IgG (IVIG or SCIG) has become the mainstay of therapy for autoimmune peripheral neuropathies including Guillain-Barre Syndrome, Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP) and Multifocal Motor Neuropathy, as well as Myasthenia Gravis. Use in these diseases exceeds that for all immune deficiencies combined. Laboratory and animal studies suggest many diverse mechanisms of action of IgG on cellular and humoral immunity. However, the spectrum of immune-mediated diseases in which IgG is efficacious is largely limited to conditions mediated by autoantibodies and/or complement. Careful analysis of clinical results indicates that only a few mechanisms are physiologically relevant: anti-idiotype neutralization, accelerated catabolism of IgG autoantibodies, and blockade of complement activation and deposition. These MOAs likely operate simultaneously and may contribute synergistically to the overall efficacy of IgG. Importantly, IgG does not act as a disease modifying drug, and repeat dosing at regular intervals is necessary in chronic diseases. This review seeks to provide a firm basis for understanding the mechanisms of action <i>in vivo</i>, and to provide benchmarks for understanding the effects and uses of new agents that have been recently approved and/or are under development.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1819474"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265657","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":"Treatment of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): acute attacks, relapse prevention, and symptomatic care.","authors":"João Vitor Mahler, Marina Vilardo, Guilherme Diogo Silva, Anastasia Vishnevetsky, Philippe-Antoine Bilodeau, Michael Levy, Marcelo Matiello","doi":"10.3389/fneur.2026.1965135","DOIUrl":"https://doi.org/10.3389/fneur.2026.1965135","url":null,"abstract":"<p><p>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct inflammatory demyelinating disorder of the central nervous system, and its diagnosis is guided by the 2023 International MOGAD Panel criteria. Its clinical spectrum includes optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, and brainstem or cortical encephalitis, with a phenotype distribution that is strongly age-dependent. Although attacks are typically steroid-responsive and recovery is often good, roughly half of adults relapse, and it is the accumulation of incompletely recovered attacks, rather than a progressive phase, that drives long-term disability. Management therefore has three aims: to abort and reverse the acute attack, to prevent relapses in patients at risk, and to relieve residual symptomatic disability. This review synthesizes current evidence for acute treatment (high-dose corticosteroids, therapeutic plasma exchange, and intravenous immunoglobulin), the corticosteroid taper, and maintenance immunotherapy, with attention to when treatment should be started and when it may reasonably be stopped. We summarize comparative data favoring maintenance intravenous immunoglobulin, the emerging evidence for interleukin-6 receptor blockade, the more variable performance of B-cell depletion relative to AQP4-IgG-seropositive neuromyelitis optica spectrum disorder, and the first phase 3 trials in the field (satralizumab and rozanolixizumab). We give particular attention to children, in whom acute disseminated encephalomyelitis predominates and in whom cognitive, academic, growth and skeletal outcomes must shape treatment decisions, and to the real-world availability of antibody testing and therapy outside high-income settings. Finally, we address symptomatic care: visual rehabilitation, neuropathic and spasticity-related pain, fatigue, bladder dysfunction, cognition, and mood.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1965135"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265743","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":"Periprocedural body temperature and clinical outcomes after successful reperfusion in large vessel occlusion stroke.","authors":"Hong-Ting Yan, Qi Wang, Lu Zhang, Gao-Peng Xing, Jia-Qi Wang, Yue Wang, Hui-Sheng Chen","doi":"10.3389/fneur.2026.1910898","DOIUrl":"10.3389/fneur.2026.1910898","url":null,"abstract":"<p><strong>Background: </strong>Functional recovery remains heterogeneous among patients with large-vessel occlusion stroke, even after successful reperfusion. Body temperature may constitute a potentially modifiable physiological factor associated with functional outcome. In particular, whether clinical factors, including baseline stroke severity, modify this temperature-outcome association remains uncertain.</p><p><strong>Methods: </strong>We retrospectively analyzed 219 patients with large-vessel occlusion acute ischemic stroke (LVO-AIS) who underwent EVT and achieved successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction score of 2b-3. Pre and post-EVT body temperatures were recorded. The primary outcome was favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days. Logistic regression analyses and exploratory subgroup analyses were performed to evaluate the association between body temperature and clinical outcomes.</p><p><strong>Results: </strong>Among the 219 included patients, 104 (47.5%) achieved favorable functional outcome at 90 days. Pre-EVT temperature was not significantly associated with functional outcome. In unadjusted analysis, each 1 °C increase in post-EVT temperature was associated with lower odds of favorable functional outcome (OR, 0.40; 95% CI, 0.20-0.79; <i>P</i> = 0.01) and higher odds of mortality (OR, 2.02; 95% CI, 1.11-3.66; <i>P</i> = 0.02). However, these associations were attenuated after multivariable adjustment (adjusted OR, 0.47; 95% CI, 0.19-1.15; <i>P</i> = 0.10; adjusted OR, 1.22; 95% CI, 0.49-3.02; <i>P</i> = 0.67). In exploratory subgroup analyses, a potential association between higher post-EVT temperature and lower odds of favorable outcome was observed in patients with baseline NIHSS ≤ 15 (adjusted OR, 0.29; 95% CI, 0.08-0.98; <i>P</i> = 0.047), although the interaction was not statistically significant (<i>P</i> for interaction = 0.64).</p><p><strong>Conclusion: </strong>In this exploratory study, body temperature was not independently associated with functional outcome in the overall cohort. Although a potential association between higher post-EVT temperature and unfavorable outcome was observed in patients with baseline NIHSS ≤ 15, the interaction was not significant. This finding is hypothesis-generating and warrants prospective validation with pre-specified subgroup analyses.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1910898"},"PeriodicalIF":3.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244166","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":"Dibucaine induces autophagic flux and reduces Ser129-phosphorylated <i>α</i>-synuclein in induced pluripotent stem cell-derived neurons with <i>SNCA</i> duplication.","authors":"Mitsuhiro Kitagawa, Kengo Miyamoto, Kozo Yoshida, Kei-Ichi Ishikawa, Yukiko Sasazawa, Wado Akamatsu, Shinji Saiki, Taku Hatano, Masaya Imoto, Hidetaka Nagata, Nobutaka Hattori","doi":"10.3389/fneur.2026.1891393","DOIUrl":"https://doi.org/10.3389/fneur.2026.1891393","url":null,"abstract":"<p><p>The accumulation of α-synuclein (α-syn) in the form of Lewy bodies and Lewy neurites is a neuropathological hallmark of Parkinson's disease (PD) and is closely associated with disease progression. Targeting the autophagy pathway to enhance the clearance of α-syn aggregates therefore represents a promising therapeutic strategy. In the present study, we conducted high-throughput screening using rat embryonic primary neurons, followed by validation of the identified compounds in human induced pluripotent stem cell (iPSC)-derived neurons. We identified dibucaine, a local anesthetic, as a compound that induced autophagic flux in neuronal models. In human iPSC-derived dopaminergic neurons from a patient with PD carrying an <i>SNCA</i> duplication, dibucaine reduced cellular levels of Ser129-phosphorylated α-synuclein (pS129 α-syn). In SH-SY5Y cells, dibucaine increased 5'-AMP-activated protein kinase (AMPK) Thr172 phosphorylation. LY364947 partially attenuated dibucaine-induced LC3-II accumulation in the iPSC-derived neurons through an unidentified mechanism. Although the requirement for AMPK and the mechanism underlying the reduction in pS129 α-syn remain unresolved, our findings show that dibucaine induces autophagic flux and reduces pS129 α-syn levels in disease-relevant human neurons.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1891393"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265722","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":"Association of leucine pathway metabolites with moyamoya disease and its clinical phenotypes.","authors":"Miaoran Fu, Jixuan Xu, Tianjiao Zhang, Yueming Luo, Lijun Wang, Lulu Qi, Min Zhang, Chuming Tao","doi":"10.3389/fneur.2026.1875390","DOIUrl":"https://doi.org/10.3389/fneur.2026.1875390","url":null,"abstract":"<p><strong>Background: </strong>Leucine and its metabolic derivatives have emerged as promising candidates for biomarker discovery in cardio-cerebrovascular diseases. Despite this, their involvement in the pathophysiology and phenotypic expression of moyamoya disease (MMD) remains largely unexplored. This investigation therefore sought to delineate the potential links between perturbations in the leucine metabolic pathway and susceptibility to MMD.</p><p><strong>Methods: </strong>This was a cross-sectional case-control study with prospective participant enrollment (337 MMD patients; 84 age- and sex-comparable healthy controls). Serum leucine, glycine, and N-isovalerylglycine (N-IVA) were quantified via LC-MS/MS. Multivariable logistic regression and ROC analysis (including NRI and IDI) were used to assess independent associations and incremental predictive value.</p><p><strong>Results: </strong>Relative to healthy controls, patients with MMD exhibited higher serum leucine concentrations [median (IQR): 217.91 (186.70-245.32) vs. 188.05 (166.09-217.76) μmol/L, <i>p</i> < 0.001], accompanied by lower N-isovalerylglycine (N-IVA) levels (<i>p</i> = 0.004). After adjustment for clinical and laboratory variables, higher leucine levels remained independently linked to an increased probability of MMD (OR = 1.01, 95% CI: 1.00-1.02, <i>p</i> = 0.010), whereas higher N-isovalerylglycine (N-IVA) levels were associated with lower odds of MMD (per 1-SD increase, OR = 0.74, 95% CI: 0.55-1.00, <i>p</i> = 0.049). Incorporation of leucine into the baseline clinical model resulted in improved risk stratification (categorical NRI = 0.140, <i>p</i> = 0.007). In addition, the basic clinical model achieved an AUC of 0.880, which increased to 0.892 after incorporating leucine, glycine, and N-IVA, reflecting a modest but consistent increase in discrimination, and further enhanced reclassification performance (NRI: 0.193, <i>p</i> < 0.001; IDI: 0.032, <i>p</i> = 0.011). Serum leucine concentrations also showed positive correlations with inflammatory and lipid-related indicators.</p><p><strong>Conclusion: </strong>Alterations in leucine metabolism, reflected by elevated leucine and reduced N-isovalerylglycine levels, are associated with MMD and contribute additional predictive value beyond conventional clinical factors. These results indicate that alterations in leucine pathway metabolism are associated with MMD and may reflect broader systemic metabolic disturbances relevant to its pathophysiology, warranting further mechanistic investigation.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1875390"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265726","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":"\"I feel like I'm in a dream\": a qualitative investigation of the lived experience of Visual Snow Syndrome.","authors":"Amy Claire Thompson, Georgia F Caruana, Jacob M Paul, Olivia Carter, Jason D Forte","doi":"10.3389/fneur.2026.1973126","DOIUrl":"https://doi.org/10.3389/fneur.2026.1973126","url":null,"abstract":"<p><strong>Background: </strong>Visual Snow Syndrome (VSS) is neurological condition typified by persistent visual snow, or static, throughout the visual field, alongside additional phenomena that impact night vision, visual perception, and visual processing. Only formally characterized in the 2010s, little consideration has been given to the broader impacts of this condition on the lives of those who experience it. This study presents the first qualitative investigation of the lived experience of Visual Snow Syndrome, to further inform clinical, research, and consumer communities alike.</p><p><strong>Methods: </strong>Forty-nine adults who self-identified as having VSS completed an online survey that queried the good and bad aspects of VSS, and its general impact on their daily life. Their qualitative data were analyzed iteratively, to determine the key themes represented across and between individual responses.</p><p><strong>Results: </strong>The lived experience of VSS varied both inter and intra-individually across this sample. Responses endorsed several themes: mental health and psychosocial wellbeing, functional vision, the dynamic course of visual snow syndrome, clinical challenges, and medical system limitations. The majority of participants described their VSS as a negative component of their daily life, with specific descriptions outlining how living with VSS worsened their mental health, cognition, sleep, daily routines, visual quality, and comfort in both natural and artificial light. However, one third of participants were able to identify some positive aspects of their visual snow experience, highlighting that it can bring unique meaning and fascination to their lives.</p><p><strong>Conclusion: </strong>VSS has broad and varied impacts on the day-to-day lives of those who experience it. It can introduce substantial mental health and psychosocial wellbeing challenges and functional vision impairments, but also a unique, and sometimes beautiful perspective. These experiences, paired with its variability between and within persons, indicates a need for more holistic and individualized approaches to the long-term treatments and supports.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1973126"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265632","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":"Embolization of jugular bulb diverticula in the management of pulsatile tinnitus.","authors":"Timothy White, Cassidy Werner, Brianna Donnelly, Varun Sridhar, Kadir Ozler, Justin Turpin, Kelly Hannsgen, Shyle Mehta, Athos Patsalides","doi":"10.3389/fneur.2026.1951324","DOIUrl":"https://doi.org/10.3389/fneur.2026.1951324","url":null,"abstract":"<p><strong>Introduction: </strong>Pulsatile tinnitus (PT) caused by a high riding jugular bulb or prominent diverticulum can negatively impact quality of life. This study evaluates the effectiveness of endovascular treatments, including stenting, coiling, and Woven EndoBridge (WEB; Terumo Neuro, Aliso Viejo, CA) devices, for managing jugular bulb diverticula (JBD)-induced PT.</p><p><strong>Methods: </strong>A retrospective review was conducted from September 1, 2020 to April 30, 2026, identifying twelve patients diagnosed with JBD. Data extracted included demographics, PT characteristics, treatment details, and outcomes. Endovascular interventions were pursued after in depth work-up, often including balloon test occlusion. The outcomes and techniques of various interventions are described.</p><p><strong>Results: </strong>Twelve patients (eight females and four males) underwent endovascular treatment for JBD, with a median age of 40.5 years and a median BMI of 25.8 kg/m². Balloon-test occlusion (BTO) showed at least moderate improvement in 7/8 patients (87.5%). Stent-assisted coiling for the JBD was performed in eleven cases (91.7%), and placement of a WEB was successful in one patient. There were two unsuccessful attempts in placing a WEB device, and treatment was converted to stent-assisted coiling. At an average last follow-up of 7.25 months, nine patients (75%) had complete resolution and three (25%) had significant improvement (25%) of their symptoms.</p><p><strong>Conclusion: </strong>Endovascular interventions are safe and effective for treating JBD-related PT. BTO is an important intraprocedural tool that may help predict treatment success. Further investigation into optimal patient selection and the role of specific devices in treating JBD is warranted.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1951324"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265720","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":"Precision medicine for futile recanalization after mechanical thrombectomy in acute ischemic stroke: mechanisms, diagnostics, and tailored therapies.","authors":"Yihua Zhu, Jie Wen, Xingqi Zhao, Haoxuan Li, Gelin Xu","doi":"10.3389/fneur.2026.1962902","DOIUrl":"https://doi.org/10.3389/fneur.2026.1962902","url":null,"abstract":"<p><p>Mechanical thrombectomy has substantially improved outcomes in appropriately selected patients with acute ischemic stroke, yet futile recanalization remains a major clinical challenge. Futile recanalization describes poor functional recovery despite technically successful macrovascular reperfusion, underscoring the incomplete relationship between angiographic reperfusion and tissue-level or microvascular perfusion. This narrative review summarizes current clinical, mechanistic, and translational evidence on the determinants of futile recanalization and evaluates emerging precision-medicine approaches to its prevention and management. Precision imaging has established a role in tissue-based patient selection, and recent randomized trials have expanded thrombectomy evidence to selected patients with large-core infarction. In contrast, current randomized evidence does not support routine endovascular treatment for unselected medium-vessel occlusion populations. We further examine bridging therapy versus direct mechanical thrombectomy, individualized periprocedural management, biomarkers, and decision support based on artificial intelligence. Clinical and imaging phenotypes may provide prognostic or mechanistic information, but no phenotype-based strategy has been prospectively validated to select bridging therapy or direct thrombectomy. Biomarkers currently remain primarily prognostic or exploratory. Artificial intelligence applications are largely focused on diagnostic and prognostic support. treatment-benefit prediction, by contrast, requires evidence of treatment-effect modification and prospective validation. Experimental studies of microvascular no-reflow and thrombo-inflammation provide biological rationale for targeted interventions but do not establish clinical efficacy. Future research should integrate multimodal imaging, biological profiling, and validated decision-support tools to move beyond angiographic success toward individualized strategies focused on tissue integrity and meaningful functional recovery.</p>","PeriodicalId":12575,"journal":{"name":"Frontiers in Neurology","volume":"17 ","pages":"1962902"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265635","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}