Neurology International最新文献

{"title":"Route-Specific Meningo-Ophthalmic and Orbitomeningeal Communications Relevant to Middle Meningeal Artery Embolization: A Systematic Review and Meta-Analysis.","authors":"Alejandro Bruna-Mejias, Loreto Paez-Allendes, Valentina Perez-Lira, Diego Santander-Chavez, Mathis Miranda-Schoen, Juan José Valenzuela-Fuenzalida, María P Moya, Gustavo Oyanedel-Amaro, Gloria Cifuentes-Suazo, Mathias Orellana-Donoso, Juan J Cabezas-Salgado, Cristopher Blackwood-Espinoza, Juan Sanchis-Gimeno","doi":"10.3390/neurolint18070128","DOIUrl":"10.3390/neurolint18070128","url":null,"abstract":"<p><strong>Purpose: </strong>Meningo-ophthalmic and orbitomeningeal arterial communications comprise route-specific relationships between the middle meningeal artery (MMA) and the ophthalmic or orbital arterial system. Their recognition is relevant to middle meningeal artery embolization because orbital or ophthalmic collateral pathways may create routes for non-target embolization. This systematic review aimed to synthesize the prevalence and anatomical patterns of these communications, using quantitative pooling only where the anatomical definition and denominator were sufficiently coherent.</p><p><strong>Methods: </strong>This systematic review and meta-analysis were conducted according to PRISMA 2020 principles and registered in PROSPERO (CRD420261361050). Eligible studies were original human cadaveric anatomical, angiographic, or radiological investigations reporting MMA-ophthalmic or MMA-orbital arterial relationships. After the closure of the full-text retrieval audit, studies and extracted rows were audited by anatomical family, unit of analysis, numerator, denominator, and independence. No global pooled prevalence was calculated across anatomical families. When family-specific pooling was methodologically defensible, proportions were synthesized using logit transformation, restricted maximum likelihood random-effects models, and Hartung-Knapp confidence intervals.</p><p><strong>Results: </strong>Database searches identified 558 records. After removal of 228 duplicates, 330 records were screened, and 285 were excluded by title and abstract. Forty-five reports were sought for retrieval; 10 were not retrieved or were not available as assessable full-text reports after retrieval auditing. Thirty-five full-text reports were assessed; thirteen were excluded for reasons, and three were duplicate reports at the full-text stage. Nineteen studies were included in the qualitative synthesis, and 12 contributed independent data to the final R-ready matrix. MMA arising from the ophthalmic artery was uncommon, with a pooled prevalence of 0.03 (95% CI 0.01 to 0.13; I<sup>2</sup> = 75.9%). After excluding the clinically selected chronic subdural hematoma subgroup, the estimate was 0.02 (95% CI 0.01 to 0.06; I<sup>2</sup> = 7.7%). The meningolacrimal/lacrimal-MMA route yielded an exploratory pooled proportion of 0.45 (95% CI 0.09 to 0.86; I<sup>2</sup> = 95.9%), with substantial anatomical and methodological heterogeneity.</p><p><strong>Conclusions: </strong>The available evidence supports route-specific synthesis rather than a single global prevalence estimate. MMA arising from the ophthalmic artery appears uncommon but procedurally important; however, this estimate should be interpreted as a route-specific estimate across eligible angiographic/anatomical series rather than as a universal anatomical prevalence. Meningolacrimal and lacrimal-MMA routes are frequently described, but their prevalence remains difficult to generalize because detection methods,","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 7","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13414621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Transcutaneous Vagus Nerve Stimulation on Gastrointestinal Symptoms and Cardiovascular Autonomic Outcomes: A Systematic Review and Meta-Analysis.","authors":"María Pérez-Montalbán, Encarna García-Domínguez, Manuel Pabón-Carrasco, Ángel Oliva-Pascual-Vaca","doi":"10.3390/neurolint18070127","DOIUrl":"10.3390/neurolint18070127","url":null,"abstract":"<p><p><b>Background</b>: Autonomic dysfunction is increasingly recognized as a key mechanism in disorders involving the brain-gut axis and gastrointestinal symptom generation. Transcutaneous vagus nerve stimulation (tVNS) is a noninvasive neuromodulatory technique investigated for its potential effects on autonomic regulation. <b>Methods</b>: A systematic review and meta-analysis were conducted following PRISMA guidelines, with protocol registration in PROSPERO. Randomized controlled trials (RCTs) investigating auricular or cervical tVNS in patients with visceral disorders were included. Continuous outcomes were pooled using mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). When multiple publications originated from the same trial population, only independent datasets were considered for quantitative synthesis to avoid double-counting participants. Risk of bias was assessed using the PEDro scale and certainty of evidence with the GRADE approach. <b>Results</b>: Seven RCTs met the inclusion criteria. tVNS demonstrated a small but statistically significant improvement in gastrointestinal symptoms based on change-from-baseline GSRS scores (MD -0.19; 95% CI -0.29 to -0.09; <i>p</i> < 0.001; I² = 0%). Although statistically significant, the magnitude of this effect was modest, and its clinical relevance remains uncertain. No significant effects were observed on cardiac vagal tone (SMD 0.19; 95% CI -0.53 to 0.90; <i>p</i> = 0.61; I² = 73%) or systolic blood pressure (MD -1.24 mmHg; 95% CI -6.69 to 4.21; <i>p</i> = 0.66; I² = 0%). Evidence regarding cardiac autonomic neuropathy (CAN) was limited to a single independent randomized controlled trial, which found no significant differences between tVNS and sham stimulation. <b>Conclusions</b>: tVNS provides modest statistically significant improvements in gastrointestinal symptoms, supporting its role as a symptomatic neuromodulatory intervention. However, the available evidence for this outcome was based on only two studies, and the clinical relevance of the observed effect remains uncertain. No statistically significant pooled effects were observed for the cardiovascular autonomic markers assessed in this review. Evidence regarding CAN was limited to a single independent study. Therefore, the available evidence remains limited and heterogeneous, and further high-quality randomized controlled trials are warranted.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 7","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13414916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Morphological Classification of Intracranial Aneurysm Wall Irregularity Associates Specific Features with Increased Size and Rupture Risk: A Retrospective Single-Center Cross-Sectional Study.","authors":"Kamil Krystkiewicz, Aleksander Kowal, Magdalena Krystkiewicz-Orzechowska, Filip Arczewski, Karol Dziedzic, Marcin Tosik","doi":"10.3390/neurolint18070126","DOIUrl":"10.3390/neurolint18070126","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Wall irregularity is a known risk factor in the evaluation of intracranial aneurysms, but the prognostic value of its subtypes remains unclear.</p><p><strong>Materials and methods: </strong>In this retrospective single-center cross-sectional study (2023-2025), we reviewed consecutive adult patients with intracranial aneurysms. Morphology was classified as daughter sac, multilobulated, or complex irregularity. We compared rupture status and calculated PHASES, ELAPSS, and UIATS scores. Principal Component Analysis (PCA), and logistic and linear regression were applied.</p><p><strong>Results: </strong>A total of 180 patients with 180 index aneurysms were included; mean age was 67.2 ± 12.1 years, and 72.2% were women. Overall, 43.3% of aneurysms were irregular, specifically: daughter sac (25.0%), multilobulated (36.1%), and complex irregularity (11.1%). SAH occurred in 40 patients (22.2%). Ruptured aneurysms had larger maximum diameter, size ratio, and aspect ratio (all <i>p</i> < 0.0001), plus higher 5-year PHASES (<i>p</i> = 0.0091) and ELAPSS growth scores (<i>p</i> < 0.0001). PCA identified three clusters with differing 5-year rupture risks; Cluster 3 had the highest risk (5.71 ± 5.25%) and was characterized by a higher proportion of daughter sac and multilobulated morphology (<i>p</i> = 1.65 × 10^-7 and 8.80 × 10^-16). Linear models showed each irregular subtype was associated with significantly larger aneurysm size.</p><p><strong>Conclusions: </strong>Irregular wall patterns were common and associated with larger aneurysm dimensions and higher risk scores. These findings support further investigation of refined morphological descriptors in rupture risk stratification.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 7","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerated Brain Aging in Multiple Sclerosis: Microstructural and Metabolic Correlates of the Brain Age Gap.","authors":"Anas Z Nourelden, Fen Bao, Abigail Biddix, Nidhi Patel, Mawadda Abdelhai, Basil Memon, Vivian Truong, Zaima Liaquat, Carla Santiago-Martinez, Yongsheng Chen, Anza B Memon","doi":"10.3390/neurolint18070124","DOIUrl":"10.3390/neurolint18070124","url":null,"abstract":"<p><strong>Background/objectives: </strong>Multiple sclerosis (MS) can cause neurodegeneration leading to accelerated brain atrophy. Brain-predicted age (BA) is an emerging neuroimaging biomarker for neurodegeneration but remains underexplored in MS. This study examines the pathophysiological substrates associated with the brain age gap in MS compared with healthy controls (HCs) through a combination of volumetric, spectroscopic, and diffusion imaging.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included 33 HCs and 124 MS patients. Participants underwent 3T MRI including 3D-T1, MR spectroscopy, magnetization transfer, and diffusion imaging. BA and volumes were estimated from T1-weighted scans using brainageR. Metabolic integrity (total N-acetylaspartate to total creatine ratio, tNAA/tCr) and microstructural damage (magnetization transfer ratio [MTR], fractional anisotropy [FA]) were evaluated independently in normal-appearing tissues. Multivariate linear regression assessed MS diagnosis as an independent predictor of BA metrics, controlling for age, sex, and race.</p><p><strong>Results: </strong>MS patients showed significantly higher predicted brain age (53.3 vs. 31.8 years) and a markedly larger age gap (10.2 vs. -0.1 years) compared to HCs. Beyond macroscopic volume loss, accelerated aging paralleled profound subclinical degradation, including lower neuronal integrity (tNAA/tCr: 2.0 vs. 2.4) and widespread microstructural damage, evidenced by reduced MTR and FA across both normal-appearing gray and white matter. Linear regression confirmed MS diagnosis as an independent predictor of both BA and Age Gap (15.09 and 13.50 years) after adjusting for confounders.</p><p><strong>Conclusions: </strong>MS patients exhibit accelerated biological brain aging, characterized by a significant age gap and concurrent tissue volume loss. The brain age gap in MS extends beyond macroscopic atrophy, capturing underlying subclinical metabolic failure and widespread microstructural degradation in normal-appearing tissues. This positions BA as a robust, multi-dimensional proxy for neuroaxonal pathology.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 7","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Insights into the Role of Herpesviridae in Alzheimer's Disease: A Structured Narrative Review Based on a Systematic Literature Search.","authors":"Domenico Plantone, Carlo Manco, Delia Righi, Stefania Lago, Alessio Rocco Sangiorgio, Valentina Schino, Matteo Pardini, Angela Stufano, Guglielmo Lucchese","doi":"10.3390/neurolint18070125","DOIUrl":"10.3390/neurolint18070125","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Herpesviridae have been increasingly investigated as possible contributors to Alzheimer's disease (AD) because of their neurotropism, lifelong latency, and capacity to modulate inflammatory and amyloid-related pathways <b>Methods</b>: This structured narrative review, based on a systematic literature search, examined original studies published between December 2020 and December 2025 on the association between human herpesviridae and AD. Searches were conducted in PubMed, Web of Science, and Scopus using a PRISMA-informed screening framework. <b>Results</b>: The available evidence was heterogeneous across viruses and study designs. HSV-1 emerged as the most consistently implicated virus, supported by epidemiological, biomarker, neuroimaging, and experimental studies, although contradictory findings were also reported. VZV was mainly associated with AD through vascular, inflammatory, and vaccination-related evidence, with several studies suggesting lower dementia risk after zoster vaccination. CMV, EBV, and HHV-6 showed biologically plausible but less consistent associations, whereas HHV-7 and HHV-8 were supported only by limited or indirect evidence. Across studies, the proposed mechanisms included chronic neuroinflammation, vascular injury, amyloid and tau dysregulation, host immune responses, and cumulative infectious burden. <b>Conclusions</b>: Overall, the literature suggests that the relationship between herpesviridae and AD is not uniform and that HSV-1 appears to be the most relevant candidate. However, methodological heterogeneity, possible reverse causation, and unequal study intensity across viruses limit firm conclusions. More robust longitudinal and subtype-specific studies are needed to clarify causal relevance.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 7","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental Neurotoxicity of Alcohol from Neuronal Basis to Behavioural Outcomes: A Comprehensive Review.","authors":"Kamal Smimih, Chaima Azzouhri, Bilal El-Mansoury, Ahmed Draoui, Hasna Lahouaoui, Abdelali Bitar, Mohamed Merzouki, Omar El Hiba","doi":"10.3390/neurolint18070123","DOIUrl":"10.3390/neurolint18070123","url":null,"abstract":"<p><p>Prenatal alcohol exposure (PAE) is recognized as a major public health concern due to its profound and lasting effects on the central nervous system (CNS) and its ability to induce fetal alcohol spectrum disorders (FASD), which encompass a wide range of cognitive, behavioural, and neuropsychiatric disorders that persist throughout life. Experimental and clinical studies have identified several mechanisms underlying ethanol impairing brain development, including apoptosis, oxidative stress, disruption of morphogen and growth factor signalling pathways, impaired neuronal proliferation and migration, neurotransmitter systems' dysfunction, glial cells damage associated with deficient myelination, vascular and blood-brain barrier (BBB) alterations, and lasting epigenetic reprogramming. However, to date no widely accepted integrative framework explaining how these impairments underline the heterogeneous phenotype observed in FASD is available. The present brings together developmental neurobiology and computational neuroscience to conceptualize PAE as a disorder of emerging neural and functional architecture. Here, we summarize the pharmacokinetics of ethanol in pregnancy, critical windows of vulnerability, and the classical pathways of alcohol teratogenesis affecting neuronal survival, migration, synaptogenesis, myelination, and gene regulation. We have also reviewed MRI, diffusion imaging, and EEG/MEG evidence showing altered brain volumes, white matter microstructure, functional connectivity, and network organization in individuals with PAE. Finally, we propose a systems-level model that conceptualizes PAE as a disorder of emerging neuro-computational architecture, in which ethanol-induced cellular and molecular perturbations collectively alter the building blocks and self-organization rules of brain network assembly.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 7","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare EEG Finding of Eye Closure Sensitivity in a Child with Genetic Generalized Epilepsy: A Case Report.","authors":"Rayya Ali S Almarwani, Anas Muslih B Alkalbi, Juan Toro Perez","doi":"10.3390/neurolint18070122","DOIUrl":"10.3390/neurolint18070122","url":null,"abstract":"<p><p><b>Background</b>: Eye-closure sensitivity (ECS) is a rare reflex epilepsy phenomenon characterized by epileptiform discharges on electroencephalogram (EEG), triggered by eye closure. It has been reported in all genetic generalized epilepsies (GGEs), particularly in adolescents and adults. However, pediatric cases remain uncommon in the literature. <b>Case Presentation</b>: We report a 10-year-old previously healthy girl who presented with recurrent generalized tonic-clonic seizures beginning at age nine. Seizures occurred every few months without identifiable triggers, lasting 1-2 min with complete loss of consciousness, limb stiffening, rhythmic jerking, and upward eye deviation. Her developmental history was unremarkable, with no family history of epilepsy or febrile seizures. Neurological examination was normal. Initial EEG revealed intermittent generalized spike-and-wave and polyspike-and-wave discharges at 3 Hz (range 2-4 Hz), triggered by eye closure, consistent with ECS. These discharges occurred immediately following both spontaneous and instructed eye closure, were more prominent during drowsiness, and resolved upon eye opening. The patient remained alert during these subclinical events. No photosensitivity or hyperventilation response was observed. Brain magnetic resonance imaging was normal. The patient's electroclinical findings were most consistent with a GGE phenotype with prominent ECS. She was treated with levetiracetam and has remained seizure-free for approximately 1.5 years to date. <b>Conclusions</b>: This case demonstrates that ECS can present in pediatric patients with GGE primarily manifested as generalized tonic-clonic seizures. EEG evaluation should include repeated eye-open/close maneuvers to unmask ECS, particularly in children with suspected generalized seizures.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 7","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing, Composition, and Clinical Correlates of Immunotherapy Response in GAD65 Antibody-Associated Epilepsy: A Literature-Derived Patient-Level Analysis of 375 Published Cases.","authors":"József Janszky, József Janszky, Réka Horváth","doi":"10.3390/neurolint18060121","DOIUrl":"10.3390/neurolint18060121","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Glutamic acid decarboxylase 65 (GAD65) antibody-associated epilepsy often presents as chronic focal epilepsy, usually with temporal lobe predominance, marked drug resistance, and inconsistent response to first-line immunotherapy. We assembled a large, harmonized, and literature-derived patient-level cohort to examine whether immunotherapy timing and regimen composition were associated with seizure outcome and to identify clinically meaningful prognostic signals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a literature-derived patient-level analysis of 375 unique published cases linked to 132 contributory source publications from an audited full-text register of 166 reviewed studies. Descriptive analyses used the whole cohort. Treatment-response analyses assessed seizure outcome at the first evaluable post-immunotherapy assessment and at the last follow-up. Good seizure outcome was defined as seizure freedom and/or ≥50% seizure reduction. The primary timing comparison contrasted early treatment, defined as immunotherapy within 6 months of symptom onset, with late treatment, defined as immunotherapy after more than 12 months; four cases treated in the intermediate &gt;6 to ≤12 month window were retained for descriptive timing summaries but excluded from the primary comparison. Statistical testing used the Fisher exact, Chi-square, Mann-Whitney U, and prespecified clustered logistic sensitivity analyses where appropriate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The pooled phenotype was predominantly female, usually temporal-lobe-based, and frequently drug-resistant, with common autoimmune comorbidity and heterogeneous MRI abnormalities. Among timing-evaluable treated cases, earlier immunotherapy showed a class-specific, exploratory signal rather than a uniform regimen-independent effect. In rituximab/CD20-directed regimens, early treatment was associated with a higher rate of good seizure outcome than late treatment at both the first post-immunotherapy assessment and last follow-up (93.8% vs. 50.0%; risk difference [RD]: 43.8 percentage points; 95% CI: 7.7 to 72.7). A similar pattern was observed in the broader escalation group (94.4% vs. 55.6%; RD: 38.9 percentage points; 95% CI: 6.3 to 68.1). By contrast, steroid-containing regimens showed no clear early-versus-late advantage (84.6% vs. 88.2%; RD: -3.6 percentage points; 95% CI: -18.4 to 20.1). Shorter epilepsy duration before immunotherapy and absence of established drug resistance were the most clinically meaningful favorable baseline features.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Significance: &lt;/strong&gt;In GAD65 antibody-associated epilepsy, the therapeutic window may be most relevant for escalation strategies rather than for steroid-containing first-line regimens. However, these class-specific findings are exploratory and hypothesis-generating. They derive from non-randomized, literature-derived data and may reflect treatment intensity, center practice, publication era, and confounding by indicat","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Serum Glial Fibrillary Acidic Protein and Low Serum Vitamin D Levels as Risk Factors for Cognitive Impairment in Ischemic Stroke Patients.","authors":"Patricia Patricia, Anak Agung Ayu Putri Laksmidewi, Kumara Tini, Anak Agung Ayu Meidiary, Ni Made Susilawathi, Ida Ayu Sri Wijayanti","doi":"10.3390/neurolint18060120","DOIUrl":"10.3390/neurolint18060120","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is a common complication after ischemic stroke and affects patients' quality of life. Elevated glial fibrillary acidic protein (GFAP) and low vitamin D levels may contribute to neuroinflammation and impaired neuroplasticity, but their association with post-stroke cognitive impairment remains unclear. This study aimed to determine whether high serum GFAP and low vitamin D levels are risk factors for cognitive impairment in ischemic stroke patients.</p><p><strong>Methods: </strong>A prospective cohort study was conducted in patients with acute ischemic stroke. Serum GFAP and vitamin D levels were measured on the third day after stroke onset using an enzyme-linked immunosorbent assay (ELISA). Cognitive function was assessed two weeks after stroke onset using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina). Data were analyzed using the chi-square test and multivariate logistic regression.</p><p><strong>Results: </strong>Seventy-six subjects were included in this study, of which 55 (72.4%) developed cognitive impairment. High serum GFAP (≥1.885 ng/mL) (RR = 1.755; 95% CI: 1.252-2.459; <i>p</i> = 0.001) and low vitamin D levels (<16.185 ng/mL) (RR = 1.773; 95% CI: 1.234-2.547; <i>p</i> = 0.001) were both associated with cognitive impairment. Multivariate analysis showed that high GFAP (AOR = 10.039; 95% CI: 2.484-40.569; <i>p</i> = 0.001) and low vitamin D levels (AOR = 6.640; 95% CI: 1.798-24.518; <i>p</i> = 0.005) were independent risk factors.</p><p><strong>Conclusions: </strong>Elevated serum GFAP and low vitamin D levels were independently associated with cognitive impairment after ischemic stroke and may serve as potential biomarkers for early risk stratification.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13304778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Hemoglobin Transfusion Thresholds in Moderate-to-Severe Blunt Traumatic Brain Injury on 6-Month Neurologic Outcomes: A Systematic Review and Meta-Analysis.","authors":"Faraz Behzadi, Thomas C Varkey, Shan Rizvi, Zana Alattar, Chase Seiter, Sydni Martinez, Allison J Tompeck, Khalid Alsherbini","doi":"10.3390/neurolint18060119","DOIUrl":"10.3390/neurolint18060119","url":null,"abstract":"<p><strong>Introduction: </strong>Moderate-to-severe TBI (msTBI) disproportionately affects younger populations with high mortality and severe morbidity amongst survivors. A higher hemoglobin level has been suggested to improve oxygen delivery to the injured brain, and recent randomized trials revealed that more liberal hemoglobin (Hgb) transfusion thresholds may improve 6-month neurologic functional outcomes measured by Glasgow Outcome Scale Extended (GOS-E). This article aims to perform a comprehensive meta-analysis of functional neurologic outcomes and early mortality in msTBI patients with liberal (8 g/dL) versus restrictive (7 g/dL) hemoglobin (Hgb) transfusion thresholds.</p><p><strong>Methods: </strong>The Medline, Embase, and Cochrane databases were searched for primary literature concerned with msTBI and early Hgb transfusion thresholds, from inception to October 2025. Risk of bias was assessed for all selected articles. With a common-effect model, we estimated the pooled odds ratio of the primary outcome (6-month unfavorable outcome defined as GOS-E ≤ 4 or 5) and the secondary outcome (30-day mortality) for liberal versus restrictive Hgb transfusion thresholds.</p><p><strong>Results: </strong>After reviewing 484 articles, 12 met the inclusion criteria with 8 reporting 6-month functional neurological outcomes and 10 that reported 30-day mortality. After a direct comparison of 5208 cumulative patients, those with more liberal transfusion thresholds had a statistically significant reduction in unfavorable outcomes at 6 months (OR = 0.67; 95% CI [0.58-0.77]; <i>p</i> < 0.0001) compared to those with restrictive thresholds. Liberal transfusion thresholds showed no significant effect on 30-day mortality with the direct comparison of 4589 cumulative patients (OR = 0.93, 95% CI [0.78-1.11]).</p><p><strong>Conclusions: </strong>Higher Hgb transfusion thresholds in patients presenting with msTBI can improve functional outcomes at 6 months with a lack of significant effects on 30-day mortality.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"18 6","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}