Journal of Neurology最新文献

{"title":"Patients' experience with and perspectives on long-term use of continuous subcutaneous infusion of foslevodopa/foscarbidopa in Parkinson's disease.","authors":"Michael Soileau, Rajeev Kumar, Ashwini Parab, Triza Brion, Kailee White, Connie H Yan, Megha B Shah, Pavnit Kukreja, Maurizio F Facheris, Anand Shewale, Jason Aldred","doi":"10.1007/s00415-025-13123-y","DOIUrl":"10.1007/s00415-025-13123-y","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to assess ease of use, convenience, self-efficacy, and satisfaction with long-term use of foslevodopa/foscarbidopa (LDp/CDp), a 24-h continuous subcutaneous infusion therapy delivered via an external portable pump for managing motor fluctuations in people with Parkinson's disease (PwP).</p><p><strong>Methods: </strong>PwP using LDp/CDp for ≥ 6 months and enrolled in an open-label study participated in semi-structured interviews, which were qualitatively analyzed using a content and thematic approach.</p><p><strong>Results: </strong>Nineteen adults, with an average (standard deviation) age of 63.6 (10.8) years, disease duration of 9.2 (3.4) years, and duration of LDp/CDp use of 15.4 (3.4) months, were interviewed. Most found LDp/CDp to be user-friendly (89.5%) and reliable (100%), and developed strategies to integrate the pump into their daily lives. The pump was commonly worn crossbody or around the waist, with minimal impact on sleep, though participants emphasized being mindful of the infusion set tubing to prevent tangling. Participants established routines using reminders, alarms, or schedules, and 84.2% prepared the pump in ≤ 20 min. Most (81.3%) were confident using LDp/CDp independently and 92.3% were satisfied with LDp/CDp, citing improved, consistent symptom control that allowed more freedom to participate in daily and social activities. Participants suggested improvements for the pump, including making it smaller and lighter.</p><p><strong>Conclusion: </strong>PwP expressed high satisfaction and willingness to continue using LDp/CDp. PwP and their care partners developed innovative strategies to integrate the pump into daily routines, and the perceived symptom improvement drove successful persistence on this well-tolerated treatment.</p><p><strong>Trial registration: </strong>NCT04750226; started February 18, 2021.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"416"},"PeriodicalIF":4.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The gut-brain axis in early Parkinson's disease: from prodrome to prevention.","authors":"Patrick James Oliver, Livia Civitelli, Michele T Hu","doi":"10.1007/s00415-025-13138-5","DOIUrl":"10.1007/s00415-025-13138-5","url":null,"abstract":"<p><p>Parkinson's disease is the second most common neurodegenerative disorder and fastest growing neurological condition worldwide, yet its etiology and progression remain poorly understood. This disorder is characterized pathologically by the prion-like spread of misfolded neuronal alpha-synuclein proteins in specific brain regions leading to Lewy body formation, neurodegeneration, and progressive neurological impairment. It is unclear what triggers Parkinson's and where α-synuclein protein aggregation begins, although proposed induction sites include the olfactory bulb and dorsal motor nucleus of the vagus nerve. Within the last 20 years, there has been increasing evidence that Parkinson's could be triggered by early microbiome changes and α-synuclein accumulation in the gastrointestinal system. Gut microbiota dysbiosis that alters gastrointestinal motility, permeability, and inflammation could enable prion-like spread of α-synuclein from the gut-to-brain via the enteric nervous system. Individuals with isolated rapid eye movement sleep behavior disorder have a high likelihood of developing Parkinson's and might represent a prodromal 'gut-first' subtype of the condition. The gut-first model of Parkinson's offers novel gut-based therapeutic avenues, such as anti-, pre-, and pro-biotic preparations and fecal microbiota transplants. Crucially, gut-based interventions offer an avenue to treat Parkinson's at early prodromal stages with the aim of mitigating evolution to clinically recognizable Parkinson's disease characterized by motor impairment.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"413"},"PeriodicalIF":4.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of subcutaneous foslevodopa/foscarbidopa: a case report.","authors":"Samir Abu-Rumeileh, Markus Otto, Michael Bucher, Karl-Stefan Delank, Carmelo Carrubba, Georg Ebersbach, Jan Kassubek, Bettina-Maria Taute","doi":"10.1007/s00415-025-13149-2","DOIUrl":"10.1007/s00415-025-13149-2","url":null,"abstract":"","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"414"},"PeriodicalIF":4.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic efficacy of transcranial Doppler combined with upright tilt test in vasovagal syncope.","authors":"Jingyi Wang, Hua Li, Liming Cao","doi":"10.1007/s00415-025-13154-5","DOIUrl":"10.1007/s00415-025-13154-5","url":null,"abstract":"<p><strong>Background: </strong>Vasovagal syncope (VVS) is the most common subtype of syncope, and it significantly impacts patients' quality of life and incurs substantial healthcare costs. Although the head-up tilt table test (HUTT) is the gold standard method for diagnosing VVS, its sensitivity and specificity are limited, which leads to diagnostic challenges. Combining HUTT with transcranial Doppler (TCD) can improve diagnostic accuracy by addressing limitations in monitoring cerebral blood flow during syncope evaluation. In this study, we aimed to analyze the diagnostic efficacy of combining the HUTT and TCD in patients with VVS.</p><p><strong>Methods: </strong>In this prospective study, we enrolled 102 patients with suspected VVS who underwent combined HUTT and TCD evaluation. The diagnostic performance of the combined approach was compared to that of the standalone HUTT, with a focus on sensitivity, specificity, and accuracy.</p><p><strong>Results: </strong>The multimodal testing group showed a 25.61% increase in sensitivity for diagnosing VVS compared to the standalone HUTT group, albeit with a 10.00% reduction in specificity. The false-negative rate decreased by 25.61%, while the false-positive rate increased by 10.00%. Furthermore, the positive likelihood ratio increased by 0.151, and the negative likelihood ratio decreased by 0.3701. The overall accuracy increased by 7.8%. Notably, the areas under the curve for systolic and mean cerebral blood flow velocities were 0.717 and 0.744, respectively.</p><p><strong>Conclusions: </strong>The combination of HUTT and TCD significantly enhanced the diagnostic efficacy in patients with VVS, improving the prediction of syncope and reducing the risks associated with testing.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"412"},"PeriodicalIF":4.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare case of spontaneous predominantly posterior infarction of the conus medullaris: MRI clears the dilemma.","authors":"Robert Forbrig, Kasturi Rangan, Andreas Schindler","doi":"10.1007/s00415-025-13165-2","DOIUrl":"10.1007/s00415-025-13165-2","url":null,"abstract":"","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"411"},"PeriodicalIF":4.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inconsistent primary motor cortex glucose hypometabolism in primary lateral sclerosis.","authors":"Annaliis Lehto, Julia Schumacher, Jens Kurth, Bernd J Krause, Elisabeth Kasper, Stefan Teipel, Johannes Prudlo","doi":"10.1007/s00415-025-13089-x","DOIUrl":"10.1007/s00415-025-13089-x","url":null,"abstract":"<p><strong>Objective: </strong>Primary lateral sclerosis (PLS) is a rare neurodegenerative disorder and a model for upper motor neuron degeneration, which is believed to begin in the primary motor cortex. However, clinical observation suggests that not all PLS cases show primary motor cortex glucose hypometabolism on 2-deoxy-2-[¹⁸F]fluoro-D-glucose positron emission tomography (FDG-PET). We aimed to assess the reliability of FDG-PET in identifying motor cortex hypometabolism over disease course in a sample of patients with PLS.</p><p><strong>Methods: </strong>Baseline FDG-PET data from nine consecutive PLS patients were analyzed. At least one follow up assessment was available for five patients. We extracted the average FDG-PET signal in the primary motor cortex and other motor regions and calculated the covariate-corrected z scores based on data of healthy controls from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort.</p><p><strong>Results: </strong>Among the nine patients evaluated, only four demonstrated glucose hypometabolism in the primary motor cortex across available baseline and follow up assessments. Glucose metabolism of motor regions declined over time in some patients, whereas others maintained stable levels despite a worsening in symptom severity.</p><p><strong>Interpretation: </strong>Primary motor cortex hypometabolism in PLS patients is less consistent than previously reported, and the absence of this hypometabolic sign should not be considered as irrefutable evidence against PLS in the diagnostic process. The findings of our study underline the heterogeneity of PLS, indicating that more precise diagnostic tools would be beneficial to confirm a PLS diagnosis at an earlier stage.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"410"},"PeriodicalIF":4.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tourette syndrome: effects of acetyl-leucine in two individuals.","authors":"Eva Maria Hofer, Richard Musil, Lennard Strupp, Peter Falkai, Michael Strupp, Katharina A Schindlbeck","doi":"10.1007/s00415-025-13136-7","DOIUrl":"10.1007/s00415-025-13136-7","url":null,"abstract":"","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"408"},"PeriodicalIF":4.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vestibular self-motion perception in a patient with bilateral thalamic infarction.","authors":"Heiko M Rust, J Lieb, F Honegger, M A Gresty","doi":"10.1007/s00415-025-13162-5","DOIUrl":"https://doi.org/10.1007/s00415-025-13162-5","url":null,"abstract":"","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"409"},"PeriodicalIF":4.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094070","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":"Beyond EDSS: multidomain impairments are detectable and associated with walking disorders in low-disabled people with multiple sclerosis.","authors":"Elisa Gervasoni, Alessandro Torchio, Rita Bertoni, Raffaella Chieffo, Maria Assunta Rocca, Massimiliano Pau, Eleonora Cocco, Tetsu Morozumi, Massimo Filippi, Davide Cattaneo, Marco Rovaris","doi":"10.1007/s00415-025-13128-7","DOIUrl":"10.1007/s00415-025-13128-7","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple sclerosis is characterized by a spectrum of motor, sensory, and cognitive impairments often overlooked in low-disabled people with multiple sclerosis (PwMS). The assessment of subtle functional deficits in this population is crucial to track the evolution of impairments and treatments effects. This study aims to explore the prevalence of multidomain impairments and their association with walking disorders in minimally disabled PwMS.</p><p><strong>Methods: </strong>In this cross-sectional study, 80 PwMS with EDSS scores < 2.5 underwent a comprehensive assessment that included both EDSS Functional Scores (EDSS FS) and clinical scales measuring lower limb strength (Squat Jump test), tactile sensitivity (Monofilament Test), balance (instrumented test), fatigue (Fatigue Severity Scale) and cognitive function (Symbol Digit Modalities Test). Walking performances in PwMS were objectively measured with the Six-Minute Walking Test (6MWT) and subjectively by the MS Walking Scale-12 (MSWS-12).</p><p><strong>Results: </strong>Abnormalities in EDSS FS were common, with over 50% (95% CI 43-65%) of PwMS exhibiting impaired Pyramidal FS and more than 20% (95% CI 13-32%) showing deficit in sensory FS. Compared with normative values, 30% of PwMS demonstrated reduced lower limb strength (95% CI 21-41%), impaired tactile sensation (95% CI 20-40%), and increased fatigue (95% CI 9-26%). Multivariate analyses indicated that while EDSS FS moderately predicted subjective (MSWS-12) and objective (6MWT) walking impairments, strength (β = 8.62, p < 0.001) and fatigue (β = 0.10, p < 0.001) emerged as stronger predictors.</p><p><strong>Conclusion: </strong>Low-disabled PwMS exhibit multidomain impairments and incorporating sensitive clinical assessments may facilitate early identification of subtle deficits, thereby enabling targeted interventions to improve mobility.</p><p><strong>Trial registration: </strong>NCT06219291 (09/11/2023).</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"404"},"PeriodicalIF":4.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094063","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":"Effects of exercise on balance function in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.","authors":"Yifan Zhang, Gen Li, Hao Su, Yin Liang, Yuanyuan Lv, Laikang Yu","doi":"10.1007/s00415-025-13129-6","DOIUrl":"10.1007/s00415-025-13129-6","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the effect of exercise on balance function in multiple sclerosis (MS) patients and identify the optimal exercise prescription for this population.</p><p><strong>Methods: </strong>A comprehensive search was conducted across PubMed, Web of Science, EBSCO, Cochrane, and Scopus up to February 21, 2025. The data were pooled using weighted mean differences (WMD) and 95% confidence interval.</p><p><strong>Results: </strong>Fifty-two studies fulfilled the inclusion criteria. Exercise significantly improved Berg balance scale (BBS; WMD, 4.03; p < 0.00001) and timed up and go test (TUG; WMD, -1.01; p < 0.00001) in MS patients. The subgroup analyses revealed that resistance exercise (WMD, 6.07; p = 0.004), interventions lasting ≥ 8 weeks (WMD, 4.24; p < 0.00001), ≥ 3 times per week (WMD, 4.57; p < 0.00001), ≥ 60 min per session (WMD, 4.36; p < 0.00001), ≥ 180 min per week (WMD, 4.41; p < 0.00001) were most effective in improving BBS. Greater improvements were observed in patients aged < 45 years (WMD, 4.57; p < 0.00001) and those with baseline EDSS > 3.5 (WMD, 3.97; p < 0.00001).</p><p><strong>Conclusions: </strong>Exercise was found to improve balance in MS patients. Our results suggest that MS patients may benefit from engaging in exercise sessions at least three times per week, with each session lasting 60 min or more, for a minimum duration of 8 weeks. Achieving a weekly exercise goal of 180 min or more may further enhance balance function.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 6","pages":"405"},"PeriodicalIF":4.8,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094064","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}