Revista de neurologia最新文献

{"title":"Peripheral Neuropathy: A Phenotype-Driven Review for Diagnosis and Management.","authors":"Tomoo Yuba, Ali Dabbagh, A Sassan Sabouri","doi":"10.31083/RN48384","DOIUrl":"10.31083/RN48384","url":null,"abstract":"<p><p>The purpose of this narrative review is to provide a clinic-ready synthesis of contemporary concepts in peripheral neuropathy, spanning epidemiology, diagnosis, and treatment, with emphasis on high-yield advances applicable to daily practice. The authors integrate pragmatic tools-including a diagnostic algorithm, suggested initial laboratory panels, and commonly used outcome measures-to support clinical decision-making. However, this review is intended as a clinic-oriented synthesis rather than a formal practice guideline. Peripheral neuropathy can be systematically categorized into seven pathophysiologic phenotypes-(1) distal \"dying-back\" axonopathy, (2) neuronopathy (ganglionopathy), (3) demyelinating neuropathies, (4) small-fiber neuropathy, (5) autonomic neuropathy, (6) ischemic/infiltrative/inflammatory axonopathies, and (7) focal compressive/entrapment neuropathies. An organized evaluation and management around this phenotype-first structure, combined with a structured stepwise escalation algorithm (from bedside pattern recognition to targeted laboratory testing, electrodiagnostics, selective imaging, small-fiber assessment, and immune work-up when indicated), bridges fragmented evidence into a clinic-ready decision-support framework that improves diagnostic precision, rational test utilization, and therapeutic alignment. Beyond optimizing pharmacologic care, neuromodulation may expand options in carefully selected patients. For painful diabetic peripheral neuropathy (DPN), high‑frequency (10 kHz) spinal cord stimulation (SCS) has been evaluated in randomized comparative studies against optimized medical management and has been associated with sustained pain reduction and functional improvement through 24 months in follow‑up reports, supporting consideration in medication‑refractory cases where access and patient factors permit. Ultrasound ‑guided pulsed radiofrequency (PRF)-a nondestructive, field‑based neuromodulation that limits tip temperature to <42 °C-has been studied in small randomized trials and observational cohorts for focal entrapment‑type neuropathic pain after positive diagnostic blocks; reported benefits are generally short‑ to mid‑term with heterogeneous protocols, so certainty varies by indication. For hereditary transthyretin amyloid polyneuropathy (ATTRv), disease‑modifying approaches-including nucleic acid-based therapies-are increasingly integrated into contemporary care. Overall, these developments support earlier pattern recognition, more precise phenotyping, and rational escalation while using standardized outcome measures to track response.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 4","pages":"48384"},"PeriodicalIF":0.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Autism in Women: Invisibilised Profiles and Gender Bias.","authors":"Ana Muiño Tato","doi":"10.31083/RN49367","DOIUrl":"10.31083/RN49367","url":null,"abstract":"<p><strong>Introduction: </strong>Autism spectrum disorder (ASD) shows marked clinical heterogeneity and a pronounced sex disparity in diagnosis, with male-to-female ratios of up to 4.6:1 in the Spanish educational context, suggesting potential systematic under-identification in females. This systematic review critically examines gender bias in ASD diagnosis, focusing on females, and assesses whether current diagnostic criteria adequately capture Level 1 presentations.</p><p><strong>Method: </strong>A literature search was conducted in December 2025 across American Psychological Association's database (APA) PsycInfo, Dialnet, PsicoDoc and Education Resources Information Center (ERIC), using Population, Exposure, Comparator, Outcome (PECO) and Patient, Intervention, Comparison, Outcome (PICO) frameworks. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process, 26 studies (2015-2025) were included, encompassing observational, psychometric, technological, quasi-experimental and qualitative designs. Overall methodological quality was good to very good (mean CRF-QS = 15.7), and risk of bias was predominantly low.</p><p><strong>Results: </strong>Findings indicate consistent diagnostic inequities: delayed diagnosis in girls, reduced sensitivity of standard instruments to less externalizing phenotypes, the role of social camouflaging, and moderating effects of comorbidities and contextual factors.</p><p><strong>Conclusion: </strong>Diagnostic bias appears multifactorial and calls for gender-sensitive, multi-method and intersectional approaches to ensure equitable access to diagnosis and support.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 4","pages":"49367"},"PeriodicalIF":0.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Program to Enhance Cognitive Reserve in Patients With Multiple Sclerosis (EM Reserva Program).","authors":"Miriam Ben-Yelun Insenser, Rocío Lopez Ruiz, Mónica Borges Guerra, Elvira Vázquez Domínguez, Eloisa Rubio Perez, Sara Madueño Eichau","doi":"10.31083/RN48330","DOIUrl":"10.31083/RN48330","url":null,"abstract":"<p><strong>Background: </strong>Cognitive reserve (CR) may help mitigate cognitive decline in people with multiple sclerosis (PwMS); however, few interventions have targeted CR enhancement, and none have focused on individuals without baseline cognitive impairment. The EM Reserva program is a multimodal intervention that combines cognitive leisure activities, aerobic exercise, and structured social engagement and is designed to strengthen CR in individuals with relapsing-remitting MS (RRMS).</p><p><strong>Methods: </strong>This pragmatic, single-center, observer-blinded randomized controlled trial included PwMS aged 18-55 years with RRMS and no cognitive impairment. Participants were randomized in a 1:1 ratio to either the EM Reserva program or usual cognitive care. Outcomes were assessed at baseline and at 6-month and 12-month time points. The primary endpoint was the change in Symbol Digit Modalities Test (SDMT) scores at 6 months. Secondary outcomes included additional neuropsychological measures, Modified Fatigue Impact Scale-5 (MFIS-5), Perceived Deficits Questionnaire-5 (PDQ-5), and Multiple Sclerosis Quality of Life‑54 (MSQOL-54). Analyses followed a modified intention-to-treat approach.</p><p><strong>Results: </strong>Forty-five participants completed follow-up. At 6 months, the EM Reserva group showed a significant improvement in SDMT scores compared with controls (mean difference -4.23, <i>p</i> < 0.022) and higher Controlled Oral Word Association Test (COWAT) scores. These cognitive gains were not sustained at 12 months. Fatigue improved in both groups at 6 months but remained significantly lower only in the EM Reserva group at 12 months. No between-group differences were observed in PDQ-5, MSQOL-54, or other neuropsychological measures.</p><p><strong>Conclusion: </strong>The EM Reserva program produced short-term improvements in processing speed and verbal fluency in cognitively preserved PwMS, along with sustained reductions in fatigue. However, cognitive benefits were not maintained at 12 months, and subjective cognitive functioning remained unchanged. These findings suggest that multimodal CR-oriented interventions may offer temporary cognitive advantages, but long-term maintenance strategies are likely required to sustain gains.</p><p><strong>Clinical trial registration: </strong>No: NCT05546424. https://clinicaltrials.gov/study/NCT05546424.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 4","pages":"48330"},"PeriodicalIF":0.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comunicaciones LXI Reunión Anual de la SENFC Granada, 29 a 31 de Octubre de 2025].","authors":"","doi":"10.31083/RN50865","DOIUrl":"10.31083/RN50865","url":null,"abstract":"","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 4","pages":"50865"},"PeriodicalIF":0.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Neurophysiological Mechanisms of 10 Hz Repetitive Transcranial Magnetic Stimulation for Post-Stroke Dysphagia: A Randomized Controlled Trial.","authors":"Bangqiang Hou, Ke Pan, Rong Zhang, Xiaojuan Chen, Yizheng Li, Yinxu Wang, Yulei Xie","doi":"10.31083/RN49912","DOIUrl":"10.31083/RN49912","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke dysphagia (PSD) is a common and serious complication, yet conventional rehabilitation therapies have limited efficacy. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment, but its optimal intervention strategy remains undetermined.</p><p><strong>Methods: </strong>Seventy-five PSD patients were randomly assigned in a 1:1:1 ratio to the sham rTMS group, affected rTMS group and bilateral rTMS group. All groups received the corresponding rTMS intervention and conventional rehabilitation therapy. Swallowing function was assessed at baseline (T0) and after treatment (T1) using the standardized swallowing assessment (SSA), penetration-aspiration scale (PAS), yale pharyngeal residue severity rating scale (YPR-SRS), and suprahyoid motor evoked potentials (MEP). Adverse reactions and dropouts were recorded.</p><p><strong>Results: </strong>After treatment, the SSA scores of all three groups were significantly improved. Bilateral rTMS showed significantly greater improvement in SSA and a higher treatment response rate (77.27%) compared to both the sham group and the affected rTMS group (<i>p</i> < 0.001). Mixed-effects model and intention-to-treat analyses both supported the optimal efficacy of bilateral rTMS (interaction effect <i>p</i> < 0.01). Regarding swallowing safety (PAS), the bilateral rTMS group's score was significantly lower than that of the sham group (<i>p</i> = 0.017). In terms of pharyngeal residue clearance (YPR-SRS), the bilateral rTMS group showed significantly greater improvement in the piriform sinuses compared to the other two groups, and superior improvement in the vallecula compared to the sham group (<i>p</i> < 0.05). After treatment, MEP amplitudes increased in all groups. Notably, only the bilateral rTMS group not only significantly increased MEP amplitudes on both sides (<i>p</i> < 0.01) but also significantly shortened the latency on the contralesional side (<i>p</i> = 0.046). The bilateral rTMS group achieved a \"large effect size\" in improving SSA scores, increasing MEP amplitudes, and shortening latency on the contralesional side, with the SSA effect size (D = 2.339) far exceeding that of the other groups. All treatment regimens were well-tolerated, with only 5 cases of transient scalp discomfort reported and no serious adverse events.</p><p><strong>Conclusions: </strong>Conventional rehabilitation combined with 10 Hz rTMS targeting the swallowing cortex can effectively improve swallowing function in PSD patients. Bilateral rTMS is a superior strategy. Its therapeutic advantage may stem from the synergistic modulation of bilateral cortical excitability and neural conduction efficiency, providing a better multi-target neuromodulation option for clinical practice.</p><p><strong>Clinical trial registration: </strong>No: ChiCTR2300068730. https://www.chictr.org.cn/showproj.html?proj=182568.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 4","pages":"49912"},"PeriodicalIF":0.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 MOCA Cognitive Domains and Serum Biomarkers With Anxiety Disorders in Elderly Men With Cognitive Impairment: A Cross-Sectional Analysis.","authors":"Xiao Chen, Tong Li, Jiawei Zhang, Wei Zhou, Jiayun Dai","doi":"10.31083/RN48908","DOIUrl":"10.31083/RN48908","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anxiety symptoms in elderly patients with cognitive impairment (CI) often reflect shared neurobiological processes rather than distinct psychiatric disorders. Current diagnostic approaches lack objective biomarkers for early identification. This study investigated the association between serum biomarkers and anxiety disorder status in elderly men with CI and to evaluate the exploratory discriminative ability of cognitive domains and biomarker profiles in differentiating CI patients with and without comorbid anxiety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional retrospective study analyzed 86 elderly male CI patients (Group A: CI alone, n = 41; Group B: CI with anxiety, n = 45) at Jiangsu Rongjun Hospital (June-December, 2024). Anxiety disorder diagnosis was established through structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria conducted by two independent psychiatrists, with the Hamilton Anxiety Scale (HAMA) serving as an initial severity screening instrument. The Montreal Cognitive Assessment (MOCA) was used to evaluate cognitive function. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum Tau protein (Tau), β-amyloid (Aβ), visinin-like protein 1 (VILIP-1), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6); reverse transcription-polymerase chain reaction (RT-PCR) quantified microRNA-34c (&lt;i&gt;MiR-34c&lt;/i&gt;). Patients with acute inflammation (C-reactive protein [CRP] &gt;10 mg/L) were excluded. Bonferroni correction was used to address multiple comparisons across 25 simultaneous tests, and multivariate regression analysis was controlled for demographic and clinical confounders. Receiver operating characteristic (ROC) analysis was used to determine the discriminative ability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Group B showed worse cognitive performance across the MOCA domains, with attention (area under the curve [AUC] = 0.738) and delayed recall (AUC = 0.742) demonstrating the strongest discriminative ability. Biomarker analysis revealed elevated Tau (AUC = 0.957), MDA (AUC = 0.941), and VILIP-1 (AUC = 0.914) in anxiety patients. Within-group analyses showed that anxiety severity correlated negatively with MiR-34c and positively with Tau, Aβ, MDA, IL-6, and VILIP-1. Under the Bonferroni-adjusted threshold (&lt;i&gt;p&lt;/i&gt; &lt; 0.002), only MDA in Group B (r = 0.478, &lt;i&gt;p&lt;/i&gt; = 0.001) and MiR-34c in Group B (r = -0.523, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) remained significant. Multivariate analysis identified these factors as independently associated with the outcome after controlling for demographics and comorbidities. However, given the substantial baseline imbalances between the groups, these associations should be interpreted with caution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Combined cognitive assessment (attention, delayed recall) and serum biomarkers (Tau, MDA, VILIP-1, MiR-34c) demonstrate promising discriminative ","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 4","pages":"48908"},"PeriodicalIF":0.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Acute Flacid Paralysis and Encephalitis: A Deadly Combination. Report of the Latest Case of Human Rabies in Colombia: A Reminder of a Preventable Enemy].","authors":"Francisco Aureliano García Jimenez, Paula Andrea Valencia-Rey, Kevin Tutalchá Oviedo, Santiago Mejía López, Juan Carlos Arango Viana, Juan David Cuartas Ramírez","doi":"10.31083/RN49292","DOIUrl":"10.31083/RN49292","url":null,"abstract":"<p><strong>Introduction: </strong>In countries with a low incidence of human rabies, this lethal virus is rarely considered in the differential diagnosis of acute flaccid paralysis.</p><p><strong>Clinical case: </strong>A young woman presented with fever and progressive weakness that evolved into flaccid quadriparesis, associated with neuropsychiatric symptoms, multiple cranial neuropathy, and dysautonomia. The complementary tests and the unusual reflexes that accompanied the diagnosis of brain death are described. The diagnosis was confirmed postmortem by compatible histopathological findings.</p><p><strong>Conclusions: </strong>Human rabies should be considered in cases of flaccid paralysis with encephalitis due to its implications for preventing further deaths through public health measures.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 3","pages":"49292"},"PeriodicalIF":0.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serotonin Associated Mechanisms in Sudden Unexpected Death in Epilepsy: A Review.","authors":"Beixu Li, Wenrui Zhao, Junyi Lin, Yue Chen, Ru Zhou, Kaijun Ma, Youxin Fang","doi":"10.31083/RN45871","DOIUrl":"10.31083/RN45871","url":null,"abstract":"<p><p>Sudden Unexpected Death in Epilepsy (SUDEP) is the leading cause of death in patients with epilepsy (PWE), although the mechanisms are unclear. Early studies have shown that abnormal cardiopulmonary function plays a key role in SUDEP. Cardiopulmonary activity is regulated by the autonomic nervous system. Serotonin (5-hydroxytryptamine or 5-HT) neurons significantly influence respiration and are also closely related to epilepsy. Therefore, serotonin is hypothesized to be involved in SUDEP, and a substantial amount of research has focused on it. Notably, serotonin signals through at least 14 known receptor subtypes, with preclinical data suggesting a particular involvement of the 5-HT₂, 5-HT₃, and 5-HT₄ receptors in SUDEP. Dilute Brown Non-Agouti (DBA)/1 and DBA/2 mice, which often die of seizure-induced respiratory arrest (S-IRA) following audiogenic seizures (AGS), are the most commonly used animal models for studying SUDEP. Increased serotonin reduces S-IRA, activating serotonin neurons prevents SUDEP, abnormalities in serotonin receptors are associated with SUDEP, and selective serotonin reuptake inhibitors (SSRIs) affect electroencephalogram (EEG) activity. Other studies have found that serotonin protects against S-IRA in PWE. Pathological studies in patients with SUDEP have also revealed that, in comparison with controls, the axonal length (AL) of serotonin transporter (SERT)-positive axons is longer and the level of tryptophan hydroxylase (TPH), the rate-limiting enzyme in serotonin synthesis, is lower. Consequently, serotonin is possibly a potential target for preventing SUDEP. However, most of the results are from animal studies, while the experimental data in PWE are limited. More human studies are needed in the future.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 3","pages":"45871"},"PeriodicalIF":0.8,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Gait Training Using Robotic Devices in Subjects With Stroke: An Overview of Systematic Reviews and Meta-analysis].","authors":"Juan Antonio Chamorro-Hinojosa, Francisco Molina-Rueda, María Carratalá-Tejada","doi":"10.31083/RN46880","DOIUrl":"10.31083/RN46880","url":null,"abstract":"<p><strong>Introduction: </strong>Gait training using robotic devices in stroke patients is a widely researched treatment modality. Therefore, there is a lot of heterogeneous information that needs to be synthesized, sorted, and classified. The aim of this work was to synthesize and analyze the scientific evidence on the application of robotic devices for gait training in people with stroke.</p><p><strong>Methods: </strong>This overview of systematic reviews and meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Searches were performed in four electronic databases: PubMed, Scopus, Web of Science, and Cochrane Library Plus. Systematic reviews and meta-analyses that included randomized controlled trials (RCTs) that investigated the effects of robotic devices in combination or not with another physiotherapy treatment on gait recovery in stroke patients were included.</p><p><strong>Results: </strong>Thirteen studies with a total of 101 RCTs were included. Data regarding the participants, outcome measures, training protocols and main results were extracted. The A Messurement Tool to Assess Systematic Review (AMSTAR-2) scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of certainty of evidence were applied. Only one study had a high certainty of evidence; while four had a moderate certainty, six were classified as having a low certainty and two had a critically low quality.</p><p><strong>Conclusions: </strong>Robotic gait training combined with physiotherapy improves walking speed after stroke, especially with end-effector devices. However, benefits do not reach clinically meaningful functional thresholds, and applicability is limited due to insufficient evidence, high costs, and limited accessibility. The PROSPERO Registration: CRD42021237915, https://www.crd.york.ac.uk/PROSPERO/view/CRD42021237915.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 3","pages":"46880"},"PeriodicalIF":0.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ophthalmoplegia Caused by Non-Aneurysm Neurovascular Conflict: Clinical Cases of Eight Patients.","authors":"Xiuyun Kong, Shilei Cui, Jiawei Wang, Hanqiu Jiang","doi":"10.31083/RN47615","DOIUrl":"10.31083/RN47615","url":null,"abstract":"<p><strong>Background: </strong>Neurovascular conflict (NVC) is a rare but often overlooked cause of oculomotor cranial nerve (OCN) palsy. In this study, we aimed to enhance understanding of NVC as a potential cause of cranial nerve palsies by summarizing the characteristics of eight OCN palsy cases associated with NVC and reviewing previously reported cases.</p><p><strong>Methods: </strong>A retrospective case series of eight patients with OCN palsy due to NVC was analyzed. Diagnosis was made using 3.0 Tesla magnetic resonance imaging (MRI) with 3D-fast imaging with steady-state acquisition (3D-FIESTA) sequences. Differential diagnoses like myasthenia gravis, inflammatory diseases, and aneurysms were excluded.</p><p><strong>Results: </strong>The study involved eight patients (six males, two females), aged 34-78 years (average 58.4 years). Six had abducens nerve palsy, and two had partial oculomotor nerve palsy, all exhibiting painless partial ophthalmoplegia. Imaging revealed OCN compression by various arteries: abducens nerve palsy was due to the basilar artery (three patients), vertebral artery (one patient), and anterior inferior cerebellar artery (two patients); two cases of partial oculomotor nerve palsy were caused by compression of the superior cerebellar artery and the posterior cerebral artery, respectively.</p><p><strong>Conclusion: </strong>NVC should be considered in patients with abducens nerve palsy, particularly those with intermittent symptoms and painless ophthalmoplegia, especially if they have atherosclerotic risk factors; in this descriptive single-center cohort, diagnosis was supported by high-resolution MRI, including 3D-FIESTA and magnetic resonance angiography.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 3","pages":"47615"},"PeriodicalIF":0.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}