Therapeutic Advances in Neurological Disorders最新文献

{"title":"Implementing the 2024 revision of the McDonald diagnostic criteria for multiple sclerosis in Germany: Practical considerations and consensus recommendations.","authors":"Mike P Wattjes, Antonios Bayas, Stefan Bittner, Birte Elias-Hamp, Ralf Linker, Daniela Rau, Thomas Skripuletz, Ralf Gold","doi":"10.1177/17562864261481602","DOIUrl":"10.1177/17562864261481602","url":null,"abstract":"<p><p>Early and reliable diagnosis of multiple sclerosis (MS) is critical for initiating an appropriate disease-modifying therapy (DMT). The 2024 revisions of the McDonald diagnostic criteria incorporate novel fluid and imaging biomarkers aiming to facilitate an accurate and timely diagnosis. The aim of this point-of-view paper is to discuss the implementation of the 2024 McDonald criteria in the clinical routine setting in context of the German Health care system and provide consensus recommendations by an interdisciplinary expert panel. A multidisciplinary panel of nine experts in the field of diagnosis and treatment of MS convened to discuss the potential advances and challenges of the clinical implementation of the 2024 McDonald criteria and develop consensus recommendations. The panel identified implementation challenges regarding limited specialized resources for the suggested additional imaging markers such as the detection of optic nerve (ON) lesions, paramagnetic rim lesions (PRLs) and the demonstration of lesions with a central vein sign (CVS) as well as the implementation of kappa free light chains (kFLC) in Germany. We advocate a stratified diagnostic approach: cerebrospinal fluid (CSF) analysis remains essential. The consideration of ON lesions, PRLs and lesions with a CVS should be reserved for diagnostic situations in which the diagnosis cannot be established with conventional MRI protocols or other methods for examination of the optic nerve. To minimize misdiagnosis and to address the complexity of treating radiologically isolated syndrome, there is a necessity of continuous professional training and nuanced, patient-centered therapeutic strategies, especially for individuals with radiologically isolated syndrome but also for atypical presentations. In conclusion, the 2024 revisions of the McDonald criteria aim to facilitate an accurate and early diagnosis of MS potentially enabling earlier MS therapy initiation. However, the routine implementation, particularly regarding the new imaging markers, requires an expansion of resources and expertise limiting the general applicability in the German healthcare system.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261481602"},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840103","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":"OnabotulinumtoxinA for chronic migraine: A real-life multicenter study of 479 patients.","authors":"Marta Waliszewska-Prosół, Karol Marschollek, Małgorzata Paczkowska, Jarosław Sławek, Marta Bott-Karoń, Magdalena Hellmann, Bartosz Karaszewski, Krzysztof Wierzbicki, Monika Adamczyk-Sowa, Magdalena Konieczna-Brazis, Milena Świtońska, Sylwia Kujawa, Andrzej Fabian, Paulina Lange, Edyta Leśniewska-Furs, Joanna Bielewicz, Kinga Caban-Ułanek, Konrad Rejdak, Iwona Rościszewska-Żukowska, Ilona Malska, Anna Bieniasiewicz, Beata Łabuz-Roszak, Elżbieta Gradek-Kwinta, Małgorzata Smyczyńska, Małgorzata Boroń, Sławomir Budrewicz","doi":"10.1177/17562864261476132","DOIUrl":"10.1177/17562864261476132","url":null,"abstract":"<p><strong>Background: </strong>Chronic migraine (CM) is a neurological disorder that poses significant treatment challenges, particularly when complicated by medication-overuse headache (MOH).</p><p><strong>Objectives: </strong>This study aimed to evaluate the effectiveness of onabotulinumtoxin A (BoNT-A) in a large cohort of Polish patients within national reimbursement program and to identify clinical predictors of treatment response.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Methods: </strong>This was a retrospective multicenter observational study of 479 patients (88.9% female, mean age 43.6±11.6 years) treated with BoNT-A (195 U, PREEMPT protocol) across 12 tertiary headache centers. All patients had failed at least two prior oral preventive therapies. Effectiveness was assessed after three treatment cycles (9 months). Uni- and multivariable logistic regression analyses were performed to evaluate factors associated with treatment response, defined as a ≥50% reduction in monthly headache days (MHD).</p><p><strong>Results: </strong>At baseline, the mean MHD was 19.1±4.4. After 9 months, the mean reduction in MHD was 5.9±5.4 days, and the Migraine Disability Assessment Scale (MIDAS) score improved by an average of 52.7±48.3 points. At the 9-month follow-up, 27.3% of patients achieved a ≥50% reduction in MHD, and 23.2% were partial responders (25-49% reduction). Notably, 41.6% of patients with concomitant MOH at baseline no longer met the criteria for MOH after treatment. Multivariable analysis identified a positive family history of migraine (OR=0.55; 95% CI 0.36-0.84; p=0.005) and ≥4 prior preventive medication failures (OR=0.61; 95% CI 0.37-0.98; p=0.04) as independent predictors of a poorer response. However, the model demonstrated low discriminative ability (AUC=0.605; cross-validated AUC=0.54).</p><p><strong>Conclusions: </strong>BoNT-A is an effective and safe treatment for CM in a real-world setting, significantly reducing headache burden and MOH rates. While high treatment resistance and genetic predisposition were statistically associated with a poorer response, the poor predictive ability of the clinical model suggests that standard clinical phenotypes alone are insufficient to predict BoNT-A outcomes. These findings highlight the challenges of managing highly refractory populations within strict programmatic frameworks.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261476132"},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840741","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":"Preserved neurovascular coupling in early multiple sclerosis is associated with reduced white matter lesion burden.","authors":"Cristina Duque, João Sargento-Freitas, Roumen Balabanov, Bruce Cohen, Farzaneh Sorond","doi":"10.1177/17562864261481753","DOIUrl":"10.1177/17562864261481753","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by inflammation, demyelination and axonal degeneration of the central nervous system. Whether these pathological changes impact neurovascular coupling (NVC), which can be compromised in various neurodegenerative disorders, remains unclear in MS.</p><p><strong>Objectives: </strong>To investigate the relationship between NVC, clinical characteristics and neuroimaging measures in patients with MS.</p><p><strong>Design: </strong>We conducted a cross-sectional study of patients with MS recruited from the Comprehensive Multiple Sclerosis Clinic at Northwestern Medicine, Chicago, USA.</p><p><strong>Methods: </strong>Seventy-six patients with MS underwent NVC assessment using transcranial Doppler (TCD) ultrasound in the middle cerebral artery (MCA) and posterior cerebral artery (PCA) territories. Clinical assessment included manual dexterity, cognitive function and gait. Brain magnetic resonance imaging (MRI) quantified white matter hyperintensity (WMH), gray matter (GM) and white matter (WM) volumes. Associations were examined using multivariate linear regression, adjusting for demographic and vascular risk factors, and stratified by disability and cognitive performance.</p><p><strong>Results: </strong>Higher NVC in the PCA territory correlated with lower WMH burden (r=-0.32, p=0.02), particularly in patients with lower disability (Expanded Disability Status Scale <2). This association remained significant after adjustment (β=-0.071, 95% CI [-0.135, -0.007], p=0.031). Higher NVC PCA was also associated with lower WMH in patients with better executive (β=-0.104, 95% CI [-0.176, -0.033], p=0.007) and global cognitive scores (β=-0.116, 95% CI [-0.222, -0.009], p=0.035). No association was found with GM volume.</p><p><strong>Conclusion: </strong>Preserved PCA neurovascular function is associated with lower WM lesion burden, measured using conventional MRI, in MS patients with lower disability and better cognition, a finding that may inform risk stratification and guide future therapeutic targets.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261481753"},"PeriodicalIF":4.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819542","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":"Real-world siponimod use in secondary progressive multiple sclerosis: the RESYZE study.","authors":"Celia Oreja-Guevara, Irene Gómez-Estévez, Laura Agüado García, Jesus Martín Martínez, Montserrat Gómez Gutiérrez, Francisco Gascón Giménez, Eduardo Agüera Morales, Virginia Meca-Lallana, Francisco Javier Barrero Hernández, Vicente González Quintanilla, Lucía Romero Pinel, Virginia Delgado Gil, Eduardo Durán Ferreras, Rosario Blasco Quílez, Jose Meca-Lallana, Lamberto Landete Pascual, Yolanda Aladro-Benito, Sabas Boyero Durán, Julia Gracia Gil, Ana Belén Caminero Rodríguez, Antonio Tomás Cano Orgaz, Sara Eichau Madueño, María Rosa Querol Pascual, María Otano Martínez, Ana María Alonso Torres, Carmen Calles Hernández, Ana López Real, Adrián Ares Luque, Jose Ramón Lorenzo González, Lidia Gómez Vicente, María Díaz Sánchez","doi":"10.1177/17562864261472650","DOIUrl":"https://doi.org/10.1177/17562864261472650","url":null,"abstract":"<p><strong>Background: </strong>Siponimod is approved in Europe for active secondary progressive multiple sclerosis (SPMS), but real-world data on its treatment patterns and outcomes in people with SPMS (pwSPMS) is limited.</p><p><strong>Objective: </strong>To assess the demographic and clinical characteristics, effectiveness, and safety of siponimod in pwSPMS in a real-world setting.</p><p><strong>Design: </strong>Non-interventional/observational, retrospective, multicenter study (28 centers).</p><p><strong>Methods: </strong>Patients (⩾18 years) with active SPMS treated with siponimod in routine care were included. Retrospective clinical, radiological, and laboratory data were collected for patients up to 24 months before and 12 months after siponimod treatment.</p><p><strong>Results: </strong>In total, 210 participants were included (mean age: 52.5 ± 8.6 years; females: 71.0%). At treatment initiation, the mean Expanded Disability Status Scale (EDSS) score was 5.7 ± 1.2. The mean time since multiple sclerosis diagnosis and the median time since active SPMS diagnosis were 16.7 ± 8.9 years and 1.3 (0.3; 4.4) years, respectively. Common comorbidities included psychiatric disorders and dyslipidemia (20.6%, each). Regarding working status, 55.9% with available information showed incapacity for work. Prior to siponimod, 44.3% received highly effective therapies: fingolimod (20.5%), rituximab (9.5%), ocrelizumab (5.2%), natalizumab (4.8%), and alemtuzumab (2.4%). After 1 year, 82.8% of the patients remained stable in terms of disability progression, 94.3% were free of relapses, and 85.7% did not present radiological disease activity; 46.2% experienced adverse events, 8.6% experienced serious adverse events, and 26 (12.4%) patients discontinued permanently.</p><p><strong>Conclusion: </strong>In the study cohort, pwSPMS had high disability scores and comorbidities; more than half were unable to work, and over 40% had previously received high-efficacy therapies. After 1 year of siponimod treatment, most pwSPMS showed no signs of disease activity, with stabilized EDSS scores and relapses and new T2 or gadolinium-T1 lesions, as well as a favorable safety profile.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261472650"},"PeriodicalIF":4.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766448","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":"Current practices in delirium prevention and treatment after acute stroke: results of a multicentre survey.","authors":"Markus Kneihsl, Annerose Mengel, Stefan Sumerauer, Natalie Berger, Margherita Cavalieri, Thomas Gattringer, Christian Enzinger, Wilfried Lang, Michael Knoflach, Mira Katan, Else Sandset, Robert Fleischmann, Julia Ferrari","doi":"10.1177/17562864261464310","DOIUrl":"10.1177/17562864261464310","url":null,"abstract":"<p><strong>Background: </strong>Delirium affects 10-30% of acute stroke patients, is associated with poor outcomes and places a substantial burden on healthcare staff. Evidence-based prevention and treatment strategies are limited, resulting in heterogeneous and poorly standardised delirium management in acute stroke care.</p><p><strong>Objectives: </strong>We aimed to describe real-world delirium management in German and Austrian stroke units (SUs) and to delineate the extent of practice variation in prevention and treatment.</p><p><strong>Design: </strong>We conducted a cross-sectional, web-based survey of stroke neurologists working at SUs in Austria and Germany.</p><p><strong>Methods: </strong>The 30-item questionnaire assessed professional background, delirium prevention and pharmacological treatment approaches. Descriptive statistics and exploratory subgroup analyses were performed.</p><p><strong>Results: </strong>Seventy responses from 63 SUs were analysed (median physician SU experience, 14.5 years). Delirium was estimated to affect 20% of patients and was perceived as highly burdensome for both physicians and nurses (median score, 9/10 each). Delirium prevention measures were established in 42 (67%) SUs but routinely applied to all patients in only 12 (19%), mainly due to staffing shortages (nurses, 48%; physicians, 25%). Pharmacological delirium treatment was reported by all respondents. Benzodiazepines were preferred for alcohol withdrawal delirium (60%) and antipsychotics for hyperactive or mixed delirium (59%). α2-Agonists were the most common escalation therapy across these subtypes (46%-67%).</p><p><strong>Conclusion: </strong>Delirium management in German and Austrian SUs is highly heterogeneous, limited by staffing constraints and strongly relies on non-evidence-based pharmacological strategies. These findings highlight critical gaps in care and call for enhanced staffing and stroke-specific trials to inform evidence-based delirium management.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261464310"},"PeriodicalIF":4.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723715","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":"Relapse risk and functional outcomes in anti-LGI1 encephalitis: A multicenter retrospective analysis.","authors":"Chun-Hong Shen, Bo Jin, Ye Du, Wen-Jing Shen, Rui Li, Yin-Xi Zhang, Qi-Lun Lai, Hao Song, Shan Wang, Mei-Ping Ding, Shuang Wang, Yi Guo, Meng-Ting Cai","doi":"10.1177/17562864261477197","DOIUrl":"10.1177/17562864261477197","url":null,"abstract":"<p><strong>Background: </strong>Anti-leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis presents relapse risk and potential functional impairment, with no established maintenance treatment guidelines.</p><p><strong>Objectives: </strong>The study aimed to uncover prognostic signatures, and identify predictors of relapse and poor outcome using real-world evidence.</p><p><strong>Design: </strong>This multicenter retrospective study included anti-LGI1 encephalitis patients from five tertiary hospitals in Eastern China between January 2015 and January 2024, with ≥ 24-month follow-up.</p><p><strong>Methods: </strong>Relapse was defined as the presence of new or worsening clinical features after at least 3 months of stability or improvement. Poor outcome was defined as a modified Rankin Scale score > 2 at last follow-up.</p><p><strong>Results: </strong>A total of 104 patients were included (median age 56.5 years, 60.6% male). Following the acute phase, the majority (66.3%) received prolonged corticosteroid treatment (≥6 months) without steroid-sparing maintenance immunotherapy (SSMI), whereas 16.3% received SSMI. Twelve patients (11.5%) experienced relapse. Hyponatremia at diagnosis was more common in relapsing patients (<i>p</i> = 0.017), and was significantly associated with an increased risk of relapse in Cox regression (hazard ratio = 4.67, 95% confidence interval [CI] = 1.41-15.53, <i>p</i> = 0.012). Poor outcome was observed in 17 patients (16.3%), with male sex (odds ratio [OR] = 5.12, 95% CI = 1.27-34.48, <i>p</i> = 0.041) and hyponatremia (OR = 4.69, 95% CI = 1.54-15.47, <i>p</i> = 0.008) as potential risk factors.</p><p><strong>Conclusion: </strong>This study suggests that hyponatremia is associated with an increased risk of relapse and poor outcome in anti-LGI1 encephalitis. These findings may facilitate individualized risk stratification, but further validation in larger prospective cohorts is needed.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261477197"},"PeriodicalIF":4.0,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702295","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":"Evaluating the cognitive efficacy of marine-derived drugs in Alzheimer's disease: A systematic review and Bayesian network meta-analysis.","authors":"Zhaoming Song, Yun Xie, Hanmo Zhu, Jian Li, Chen Yang, Yanao Guo, Xun Nong, Zhanchi Zhu, Zhouqing Chen, Zhong Wang","doi":"10.1177/17562864261476868","DOIUrl":"10.1177/17562864261476868","url":null,"abstract":"<p><strong>Background: </strong>In recent years, marine-derived drugs for Alzheimer's disease (AD) have attracted growing attention, but their comparative cognitive efficacy and safety remain uncertain because of inconsistent findings across studies.</p><p><strong>Objectives: </strong>To compare the efficacy and safety of marine-derived interventions for Alzheimer's disease.</p><p><strong>Design: </strong>Systematic review and Bayesian network meta-analysis of randomized controlled trials conducted in accordance with PRISMA 2020.</p><p><strong>Data sources and methods: </strong>We systematically searched PubMed and the Cochrane Library for randomized controlled trials (RCT) of marine-derived drugs in patients with AD. Continuous outcomes were synthesized as mean differences (MD) in change-from-baseline, and dichotomous outcomes were synthesized as odds ratios (OR), each with 95% credible intervals (CI).</p><p><strong>Results: </strong>A total of 16 eligible RCTs involving 4,158 patients were included. For the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), GV-971 (vs placebo; MD -1.85, 95% CI -2.89 to -0.82) and tramiprosate (vs placebo; MD -0.83, 95% CI -1.63 to -0.02) significantly improved cognitive function. For the Mini-Mental State Examination (MMSE), rifampicin (vs placebo; MD 1.90, 95% CI 0.25 to 3.56) was associated with greater improvement in MMSE scores, whereas tramiprosate (vs placebo; MD -2.40, 95% CI -4.67 to -0.09) was associated with poorer cognitive performance. No statistically significant differences among drugs were observed for the Clinical Dementia Rating-Sum of Boxes (CDR-SB) or for the incidence of adverse events. Overall, treatment effects were outcome-dependent, with significant benefits observed mainly in ADAS-Cog and MMSE, whereas no intervention demonstrated consistent superiority across all cognitive outcomes.</p><p><strong>Conclusion: </strong>Marine-derived drugs showed generally acceptable safety and potential cognitive benefits in selected outcomes. GV-971 and tramiprosate improved ADAS-Cog scores, while rifampicin therapy showed a possible MMSE benefit. However, no intervention was consistently superior across cognitive outcomes, and the antibiotic finding was based on a single small trial. Current evidence is therefore insufficient to identify the optimal marine-derived therapy for AD, highlighting the need for larger, adequately powered RCTs.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261476868"},"PeriodicalIF":4.0,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702203","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":"Evolving MS criteria and the interpretation of research.","authors":"Afsaneh Shirani, Benjamin M Segal, Olaf Stuve","doi":"10.1177/17562864261471995","DOIUrl":"10.1177/17562864261471995","url":null,"abstract":"","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261471995"},"PeriodicalIF":4.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698000","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":"Bilateral transcutaneous auricular nerve stimulation promotes motor function recovery after stroke: A randomized controlled trial.","authors":"Jia Wang, Qiuyan Liu, Yifan Zhou, Chao Peng, Xiaoyang Dong","doi":"10.1177/17562864261476124","DOIUrl":"10.1177/17562864261476124","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Vagus nerve stimulation (VNS) has emerged as a promising adjunctive approach for stroke rehabilitation. However, current clinical applications are predominantly limited to invasive VNS implantation or unilateral transcutaneous auricular nerve stimulation (taNS), often characterized by small sample sizes and a primary focus on upper limb motor recovery. Although emerging evidence suggests that bilateral taNS (BtaNS) may confer superior neuromodulatory effects compared with conventional left-sided unilateral taNS (LtaNS), its efficacy and safety profile for comprehensive post-stroke limb motor rehabilitation remain largely unexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the efficacy and safety of BtaNS combined with routine rehabilitation in promoting motor recovery in post-stroke patients with hemiplegia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A prospective, double-blinded, three-arm randomized controlled trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with subacute or chronic stroke were recruited from the Department of Rehabilitation Medicine at the First Affiliated Hospital of Nanchang University between January 2025 and December 2025. Participants were randomly assigned to one of three groups: BtaNS, LtaNS, or a control group. All patients received routine rehabilitation therapy targeting both upper and lower limb motor function. Additionally, patients in the taNS groups received either LtaNS or BtaNS (stimulation parameters: 20 Hz frequency, 300 µs pulse width, intensity individually adjusted within a range of 0.5-1.0 mA) for 30 minutes twice daily, six days per week, over a four-week period. The primary outcome measures included the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Fugl-Meyer Assessment for Lower Extremities (FMA-LE) and the Wolf Motor Function Test (WMFT). Secondary outcomes encompassed the Berg Balance Scale (BBS), the Modified Barthel Index (MBI), and low-frequency oscillations measured via functional near-infrared spectroscopy (fNIRS). Adverse events were monitored to assess safety throughout the treatment period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 111 patients were enrolled in this study, of whom 5 withdrew and 4 were lost to follow-up, resulting in 102 participants completing the trial (34 per group). Compared with the control group, both the LtaNS and BtaNS groups exhibited significantly greater improvements in the FMA-UE, FMA-LE, and WMFT scores at all post-intervention assessment time points. Moreover, the BtaNS group demonstrated superior motor recovery relative to the LtaNS group. In addition, BtaNS was associated with significantly greater improvements in BBS and MBI scores at 4 weeks post-intervention and at follow-up compared with both the LtaNS and control groups. Subgroup analyses indicated that patients with a shorter time since stroke onset and those diagnosed with hemorrhagic stroke exhibited more pronounced improvements. No serious adverse events occurred; only","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261476124"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685848","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":"Lamotrigine-induced Stevens-Johnson syndrome in the setting of mitochondrial encephalomyopathy: A case report.","authors":"Ye Tian, Teng Chen, Jingwen Liu, Juan Wang, Lihong Zhang","doi":"10.1177/17562864261474798","DOIUrl":"10.1177/17562864261474798","url":null,"abstract":"<p><p>A 67-year-old male with Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-Like Episodes (MELAS) who developed life-threatening Stevens-Johnson Syndrome (SJS) more than one month after initiating lamotrigine (LTG) for epilepsy management. Despite prompt LTG discontinuation and aggressive immunomodulatory therapy, the patient succumbed to severe infection and multiple organ failure. LTG-induced SJS is associated with multiple risk factors. The immune-activating microenvironment resulting from mitochondrial dysfunction may potentiate the risk of LTG-induced SJS. Lamotrigine should be used cautiously for epilepsy in high-risk patients, particularly those with mitochondrial encephalomyopathy (ME), and comprehensive evaluation is required to minimize severe hypersensitivity reactions.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"19 ","pages":"17562864261474798"},"PeriodicalIF":4.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680019","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}