Revista de neurologia最新文献

{"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":0.6,"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":0.6,"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":0.6,"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}

{"title":"Pediatric Migraine Aura Status and Cortical Laminar Necrosis: A Clinical Case and a Narrative Review.","authors":"Federica Cernigliaro, Cristina Gallo, Giuseppina Alessi, Luca Maria Messina, Carola Meo, Edvige Correnti, Giuseppe Craparo, Vincenzo Raieli","doi":"10.31083/RN47684","DOIUrl":"10.31083/RN47684","url":null,"abstract":"<p><strong>Introduction: </strong>Migraine aura status is a complication of migraine. It is characterised by the presence of at least 3 episodes of migraine aura within a 3-day period. The pain and/or associated symptoms are often debilitating. Cortical laminar necrosis (CLN) is a gyriform brain lesion caused by insufficient oxygen and glucose supply, resulting in the loss of cortical neurons, often due to cardiac arrest, global hypoxia, and hypoglycaemia. Metabolic disorders, hypoglycaemia, renal and hepatic dysfunction, and immunosuppressive chemotherapy. In children, cortical laminar necrosis has been linked to the subacute or chronic phase of brain damage due to hypoxic-ischaemic encephalopathy. Metabolic disorders, hypoglycaemia, renal and hepatic dysfunction, and immunosuppressive chemotherapy are included as other possible aetiologies. CLN has also been reported in patients with encephalitis, but it is extremely rare in migraine with or without aura.</p><p><strong>Clinical case: </strong>We describe a 14-year-old boy with no previous neurological problems who was admitted to our unit due to the onset of acute and persistent symptoms characterised by headache, confusion, dysarthria, aphasia and visual disturbances. An initial emergency brain neuroimaging scan revealed edema localised in the supramarginal gyrus of the left cerebral hemisphere, with possible vascular etiology. A control magnetic resonance imaging revealed laminar necrosis of the cortico-pial area located in the same region.</p><p><strong>Conclusions: </strong>This clinical case is interesting due to the uncommon correlation between cortical laminar necrosis and migraine with aura (MA), the pediatric presentation, the location of hypoperfusion and the atypical progression of the migraine aura. We have reported a narrative review of the two disorders.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 3","pages":"47684"},"PeriodicalIF":0.6,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582373","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":"Optimizing Chronic Migraine Care: The Impact of Advanced Practice Nurse Involvement in OnabotulinumtoxinA Administration.","authors":"Eulalia Gine-Cipres, Marta Torres-Ferrus, Víctor J Gallardo, Alicia Alpuente Ruiz, Edoardo Caronna, Laura Gomez-Dabo, Patricia Pozo-Rosich","doi":"10.31083/RN45618","DOIUrl":"10.31083/RN45618","url":null,"abstract":"<p><strong>Background: </strong>Chronic migraine is a disabling and prevalent neurological disease that significantly impacts patients' quality of life. OnabotulinumtoxinA (OnabotA) is a safe and effective chronic migraine preventive treatment. The objective was to evaluate adherence to the recommended time interval between consecutive OnabotA injections according to the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol, and to analyze changes in the interval adherence before and after the introduction of an Advanced Practice Nurse (APN) in a specialized Headache Unit of a tertiary hospital.</p><p><strong>Methods: </strong>This was a retrospective study performed in a Spanish specialized Headache Clinic. Patients diagnosed with chronic migraine and treated with OnabotA following the PREEMPT protocol were included, before and after the introduction of APNs. Treatment was considered interval-compliant if the injection interval ranged from 75 to 105 days. The data collected included three 18-month periods. Statistical analyses examined differences across periods using R-Studio.</p><p><strong>Results: </strong>A total of 2991 participants were included, of whom 83.8% (2507/2991) were women, with a median age [interquartile range (IQR)] of 48.0 [40.0-57.0] years old. A statistically significant association between the introduction of the APN and improved adherence to the PREEMPT protocol was observed over time (Z = -19.60, <i>p</i> < 0.001). Adherence rates increased from 52.1% in P1 to 76.1% in both P2 and P3. The median time between visits decreased from 105 days in P1 to 96 days in P2, with a slight increase to 98 days in P3.</p><p><strong>Conclusion: </strong>The involvement of advanced practice nurses in OnabotA administration decreased the time interval between infiltrations and improved adherence to the PREEMPT protocol. These findings highlight the APN's role in optimizing patient care.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 3","pages":"45618"},"PeriodicalIF":0.6,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582356","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":"Progress in the Treatment of Refractory Myasthenia Gravis.","authors":"Dan Liu, Jialing Mao, Jing Song, Manxia Wang","doi":"10.31083/RN47260","DOIUrl":"10.31083/RN47260","url":null,"abstract":"<p><p>Myasthenia gravis (MG) is an autoantibody-mediated, cellular immune-dependent and complement system-involved autoimmune disorder characterized by acquired neuromuscular junction transmission dysfunction driven by genetic and environmental factors. Approximately 10% therapies such as cholinesterase inhibitors, glucocorticoids, and immunosuppressants, resulting in the development of refractory MG (RMG). The current emergence of new therapeutic strategies such as targeted biologics (e.g., complement inhibitors, Fc receptor (FcRn) antagonists, etc.), B-cell depletion therapy, and Chimeric Antigen Receptor (CAR)-T cell therapy contribute to the significant improvement in the clinical management of RMG. Accordingly, the present study systematically reviewed the treatment progress of RMG, aiming to provide evidence-based individualized treatment decision-making clinically, alleviate patients' pain, and explore future research directions.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 2","pages":"47260"},"PeriodicalIF":0.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318166","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":"Cognitive, Behavioral, and Emotional Manifestations in Nodding Syndrome: A Neuropsychological Narrative Review.","authors":"Ana Cristina de Castro, María J García-Rubio","doi":"10.31083/RN47379","DOIUrl":"10.31083/RN47379","url":null,"abstract":"<p><strong>Background: </strong>Nodding syndrome is a childhood-onset epileptic encephalopathy described in onchocerciasis-endemic regions of sub-Saharan Africa. Although characterized by recurrent atonic seizures with repetitive head-nodding movements, increasing evidence suggests that the condition extends beyond a purely motor epilepsy and involves progressive cognitive, behavioral, and emotional impairment.</p><p><strong>Methods: </strong>This study was designed as a narrative review with a specific neuropsychological focus. A literature search was conducted in PubMed, Scopus, and Google Scholar for publications between 2013 and 2025. Studies describing cognitive, behavioral, emotional, psychiatric, neuroimaging, or neuropathological findings in patients with nodding syndrome were included. Due to heterogeneity in study design and assessment methods, findings were synthesized narratively.</p><p><strong>Results: </strong>Across studies, nodding syndrome is consistently associated with progressive cognitive decline affecting attention, processing speed, executive functions, memory, and global intellectual functioning. Behavioral disturbances such as irritability, aggression, and emotional lability are frequently reported, alongside depressive symptoms and social withdrawal. Neuroimaging findings commonly demonstrate cortical and cerebellar atrophy, while neuropathological studies report tau-protein deposition and neuronal loss, supporting diffuse cerebral involvement with possible neurodegenerative features.</p><p><strong>Conclusions: </strong>Nodding syndrome represents a complex epileptic encephalopathy characterized not only by seizures but also by significant cognitive, behavioral, and emotional impairment. A clearer neuropsychological characterization may inform clinical assessment and guide future research aimed at improving supportive and rehabilitative interventions.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 2","pages":"47379"},"PeriodicalIF":0.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318136","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":"[Continuous Subcutaneous Apomorphine Infusion Therapy: Economic Impact in Spain].","authors":"Lina Micolta-Córdoba, Juan Pablo Castro-Ramirez, Carlos Reyes-Ortiz","doi":"10.31083/RN38994","DOIUrl":"10.31083/RN38994","url":null,"abstract":"","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 2","pages":"38994"},"PeriodicalIF":0.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318184","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":"[CefaleApp: A Mobile Application for Migraine Diagnosis in Primary Health Care].","authors":"Daniel Apolinar García-Estévez, Baltasar García Pérez-Schofield, Nabil Alberto Sabbagh Casado","doi":"10.31083/RN46506","DOIUrl":"10.31083/RN46506","url":null,"abstract":"<p><strong>Introduction: </strong>Headaches are the main reason for visits to Neurology clinics, and migraine is the most common primary headache. with migraine being the most frequent. Our objective was to develop a computer application (app) that could empower Primary Health Care (PHC) physicians in decision-making regarding migraine.</p><p><strong>Material and methods: </strong>A rule-based artificial intelligence system was designed to process patients' responses to the ID-Migraine screener and subsequently determine whether they met the diagnostic criteria for migraine or tension-type headache, according to the International Headache Society. The application, known as <i>CefaleApp</i>, is designed to generate a diagnosis of migraine, tension-type headache, or mixed headache.</p><p><strong>Results: </strong><i>CefaleApp</i> was validated in 152 patients referred from PHC clinics with a suspected diagnosis of migraine or tension-type headache. Patients were evaluated in the Neurology Department of a secondary-level hospital and in two regional hospitals. Agreement between the diagnosis generated by <i>CefaleApp</i> and that issued by an expert headache neurologist (gold standard) was estimated using Cohen's Kappa index and the Matthews correlation coefficient (MCC). Overall diagnostic accuracy was 90.8% (95% CI: 85.1-94.6%), Cohen's Kappa index was 0.73 (95% CI: 0.59-0.87), and the MCC value was 0.73.</p><p><strong>Conclusions: </strong>The migraine diagnosis generated by <i>CefaleApp</i> shows substantial-high agreement with that provided by the expert headache neurologist.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 2","pages":"46506"},"PeriodicalIF":0.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318211","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":"Unilateral Microelectrode Recording-Guided Pallidotomy in Advanced Parkinson's Disease: Clinical and Neuropsychological Outcomes in a Guatemalan Cohort.","authors":"Juan Carlos Lara-Girón, Diego Sánchez-Díaz, Abel Alejandro Sanabria-Sanchinel, Edwin Stanly Escobar-Pineda, Manuel Hernández-Salazar, Marco Díaz, Víctor Pineda, Williams González, Raúl Cardona, Zoe María Gómez","doi":"10.31083/RN44171","DOIUrl":"10.31083/RN44171","url":null,"abstract":"<p><strong>Background: </strong>Unilateral microelectrode-guided pallidotomy has re-emerged as a therapeutic option for advanced Parkinson's disease (PD), particularly in resource-limited settings. This study evaluated motor and neuropsychological outcomes following radiofrequency ablation of the internal globus pallidus (GPi) using image fusion and intraoperative microelectrode recording. To assess the motor efficacy, cognitive impact, and safety profile of unilateral GPi pallidotomy guided by neurophysiological monitoring in patients with advanced idiopathic PD of the rigid-akinetic subtype.</p><p><strong>Methods: </strong>This retrospective, single-center, observational case series included 12 patients with advanced PD who underwent unilateral radiofrequency pallidotomy targeting the internal segment of the GPi. Movement Disorder Society-Unified PD Rating Scale Part III (MDS-UPDRS-III), including both contralateral and ipsilateral domain sub scores. Levodopa-induced dyskinesias (UPDRS-IV) and cognitive performance (NEUROPSI Attention and Memory battery) were also assessed before and 12 months after surgery. Statistical analyses were conducted using paired <i>t</i>-tests or Wilcoxon signed-rank tests depending on data distribution, with significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>At 12-month follow-up, motor outcomes improved significantly. Mean MDS-UPDRS-III scores decreased from 64.1 ± 27.1 preoperatively (OFF medication) to 37.8 ± 24.4 postoperatively, and from 23.5 ± 17.0 to 10.6 ± 8.5 in the ON state. The overall OFF-state improvement was 44.4% ± 21.2%. Paired <i>t</i>-tests confirmed a highly significant reduction in motor scores (<i>t</i> = 6.19, <i>p</i> < 0.0001; mean change -26.3 points, 95% confidence intervals (CI) -34.7 to -18.0). Domain-specific analysis showed significant contralateral improvements in rigidity (-48%, <i>p</i> = 0.0006), bradykinesia (-49.5%, <i>p</i> < 0.0001), resting tremor (-81%, <i>p</i> = 0.004), gait (-27.8%, <i>p</i> = 0.013), postural stability (-39%, <i>p</i> = 0.021), and dyskinesias (-56%, <i>p</i> = 0.017). Ipsilateral changes were mild and not statistically significant for rigidity (-14.6%, <i>p</i> = 0.519), bradykinesia (-25.0%, <i>p</i> = 0.084), or rest tremor (-50.0%, <i>p</i> = 0.121). No major surgical complications occurred. Neuropsychological assessment revealed modest postoperative gains in executive functioning and working memory, with preservation of global cognition.</p><p><strong>Conclusion: </strong>Unilateral GPi pallidotomy guided by imaging and microelectrode recording is a safe and effective procedure that significantly improves motor symptoms while preserving cognitive function in appropriately selected patients with advanced PD, as demonstrated in our Guatemalan cohort.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 2","pages":"44171"},"PeriodicalIF":0.6,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318169","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}