Acta neurologica Belgica最新文献

{"title":"Cutaneous allodynia across MIDAS disability grades in episodic migraine: a cross-sectional analysis.","authors":"Mehmet Mühürdaroğlu","doi":"10.1007/s13760-026-03217-3","DOIUrl":"https://doi.org/10.1007/s13760-026-03217-3","url":null,"abstract":"<p><strong>Background: </strong>Cutaneous allodynia is a clinical manifestation of central sensitization in migraine and is associated with poorer treatment response. Whether its relationship with migraine-related disability is uniform across levels of disability remains unclear. We examined whether allodynia burden differed non-uniformly across MIDAS disability grades.</p><p><strong>Methods: </strong>In this cross-sectional study, 152 consecutive patients with episodic migraine were assessed using the Migraine Disability Assessment Scale (MIDAS; Grades I-IV) and the 12-item Allodynia Symptom Checklist (ASC-12; score ≥ 3 indicating clinically significant allodynia). Allodynia prevalence and severity were compared across adjacent MIDAS grades, and the association between the MIDAS and ASC-12 scores was examined. Multivariable logistic regression identified factors independently associated with allodynia.</p><p><strong>Results: </strong>The mean age was 32.6 ± 9.9 years and 85.5% were women. Allodynia was present in 63.8%. The Grade I-II comparison showed the largest difference in allodynia prevalence (45.5% vs. 78.9%; +33.5% points; p < 0.001) and ASC-12 score (2.7 ± 1.5 vs. 4.2 ± 2.1; Cohen's d = 0.86). Differences between later adjacent grades were not significant, although the confidence intervals were wide. The MIDAS and ASC-12 scores were positively correlated (Spearman's ρ = 0.477, p < 0.001), and MIDAS score was independently associated with allodynia (odds ratio = 1.18 per point, 95% CI 1.08-1.28; p < 0.001).</p><p><strong>Conclusions: </strong>The contrast between MIDAS Grades I and II was associated with a marked increase in allodynia burden. Given the cross-sectional design and the small size of the higher-grade subgroups, this observation should be regarded as exploratory and requires prospective validation.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics of headache in the patients with Neuro-Behçet's disease.","authors":"Ayşegül Şeyma Sarıtaş, Yağmur İnalkaç Gemici, Melike Batum, Ayşın Kısabay Ak","doi":"10.1007/s13760-026-03204-8","DOIUrl":"https://doi.org/10.1007/s13760-026-03204-8","url":null,"abstract":"<p><strong>Background: </strong>Behçet's disease (BD) is a chronic vascular-inflammatory condition of unknown pathogenesis presenting with mucocutaneous lesions, attacks of uveitis that may lead to blindness, and involvement of many systems including vascular, musculo-skeletal system and the gastrointestinal tract.</p><p><strong>Objective: </strong>The objective of this study was to examine the frequency of various forms of headache in patients diagnosed with BD, the characteristics of headache in BD, the characteristics of attacks, and the relationship between the disease and headache attacks.</p><p><strong>Methods: </strong>A total of 35 patients with Neuro-Behçet's disease (NBD) aged ≥ 18 years, who were followed at the Department of Neurology of XX University between 2021 and 2026, were retrospectively analyzed. Patients were evaluated for demographic characteristics, headache characteristics and severity, imaging studies, cerebrospinal fluid findings, relationship to attacks, and acute and chronic treatment.</p><p><strong>Results: </strong>The most common complaint was headache. It was observed that headache could be of primary type as migraine or tension-type headache or secondary headache due to neurological involvement. Headache in NBD was frequently observed during BD attacks (aphthosis and/or uveitis) or in temporal proximity to these attacks, suggesting a possible association with disease activity.</p><p><strong>Conclusion: </strong>Headache in NBD is heterogeneous and cannot be fully explained by primary headache syndromes alone; a substantial proportion is associated with disease activity and neurological involvement. The temporal association observed between headache and disease attacks may indicate an association between headache and disease activity. Therefore, in patients presenting with headache, NBD involvement should also be considered.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological characteristics of MOG antibody-associated disease (MOGAD): a comparative study between pediatric and adult cohorts.","authors":"Ahmet Kasim Kilic, Hanife Senturk, Safiye Gunes Sager","doi":"10.1007/s13760-026-03216-4","DOIUrl":"https://doi.org/10.1007/s13760-026-03216-4","url":null,"abstract":"<p><strong>Objective: </strong>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct inflammatory demyelinating disorder As being first national study of pediatric and adult Turkish MOGAD patients so we aimed to report the clinical presentations, radiological findings, and relapse characteristics between pediatric and adult patients with MOGAD.</p><p><strong>, materials and methods: </strong>In this retrospective study, 26 patients (10 pediatric [≤ 17 years] and 16 adult [> 17 years]) who tested positive for MOG antibodies were included. Demographic data, precipitating factors, Expanded Disability Status Scale (EDSS) scores, cerebrospinal fluid (CSF) findings, and magnetic resonance imaging (MRI) features were analyzed.</p><p><strong>Results: </strong>The mean age was 10.8 years for children and 32.5 years for adults. Precipitating factors, primarily upper respiratory infections, were more frequent in children (70% vs. 12.5%). Pediatric patients predominantly presented with polysymptomatic onset, including pyramidal signs (60%) and encephalopathy (30%), whereas adults most commonly presented with optic neuritis (62.5%). Although adults had higher mean EDSS scores during relapse compared to children (4.31 vs. 3.55), final follow-up EDSS scores were low for both groups (0.78 vs. 0.5). Relapses were recorded only in the adult group (mean rate 1.93). Radiologically, children showed significantly higher rates of brainstem (34.6% vs. 7.6%) and cortical involvement. Spinal MRI revealed the \"H-sign\" in both groups, but conus involvement was more prevalent in children (75% vs. 7.6%).</p><p><strong>Conclusion: </strong>MOGAD exhibits age-dependent clinical and radiological phenotypes. While pediatric cases often follow a post-infectious, polysymptomatic, and monophasic course, adult cases frequently present as optic neuritis with a higher tendency for relapse. Despite significant acute disability, functional recovery at the last visit was favorable in both populations over a mean follow-up of 24.1 ± 8.2 months in children and 33.6 ± 36.7 months in adults.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olfactory dysfunction and limbic volumetric changes in relapsing-remitting and secondary progressive multiple sclerosis.","authors":"Esra Tekmen, Berkan Kozan, Semra Mungan, Hatice Gül Hatipoğlu, İpek Yıldırım, Ilgın Baysan, Efil Aydoğan, Kadir Kaan Akgül, İdil Irmak Erdil, Caner İncekaş, Can Pelin","doi":"10.1007/s13760-026-03219-1","DOIUrl":"https://doi.org/10.1007/s13760-026-03219-1","url":null,"abstract":"<p><strong>Objective: </strong>To compare olfactory performance and olfactory-related brain region volumes between patients with relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) and to examine the relationship between olfactory performance and regional brain volumes.</p><p><strong>Materials and methods: </strong>This prospective cross-sectional study included 65 patients with MS (43 RRMS and 22 SPMS). Olfactory function was assessed using the Sniffin' Sticks-12 Odor Identification Test. Bilateral volumes of the hippocampus, amygdala, entorhinal cortex, and insular cortex were obtained from three-dimensional T1-weighted MRI using the vol2Brain automated analysis pipeline available through the volBrain platform. Both raw and total intracranial volume (TIV)-normalized regional volumes were analyzed. For volumetric outcomes, multivariable analyses were adjusted for age, sex, and TIV, whereas analyses of olfactory performance were adjusted for age and sex. Additional sensitivity analyses incorporated disease duration and EDSS.</p><p><strong>Results: </strong>In unadjusted comparisons, patients with SPMS had significantly lower Sniffin' Sticks-12 scores than those with RRMS (p = 0.004), and raw hippocampal volume was significantly lower in the SPMS group (p = 0.028). However, after adjustment for age, sex, and TIV, clinical subtype was not independently associated with hippocampal, amygdala, entorhinal cortex, or insular cortex volume (all p > 0.05). These findings remained non-significant in sensitivity analyses additionally accounting for disease duration and EDSS. The between-group difference in Sniffin' Sticks-12 scores was also attenuated after adjustment for age and sex (B = - 1.06; 95% CI, - 2.15 to 0.04; p = 0.058) and remained non-significant in further sensitivity analyses. No significant correlations were observed between Sniffin' Sticks-12 scores and regional volumetric measures.</p><p><strong>Conclusion: </strong>Although patients with SPMS showed poorer olfactory performance and lower raw hippocampal volume in unadjusted comparisons, clinical subtype was not independently associated with regional brain volumes after adjustment for age, sex, and TIV, and the olfactory difference did not reach statistical significance after adjustment for age and sex. Furthermore, olfactory performance was not directly associated with regional volumetric measures, suggesting that olfactory dysfunction in MS may reflect mechanisms beyond regional structural volume alone.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness and safety of rituximab versus ocrelizumab in relapsing-remitting multiple sclerosis: a real-world experience from Iran.","authors":"Fatemeh Meshkini, Nahid Beladi Moghaddam, Mehran Ghaffari, Elham Asl Fallah, Sepideh Paybast","doi":"10.1007/s13760-026-03207-5","DOIUrl":"https://doi.org/10.1007/s13760-026-03207-5","url":null,"abstract":"<p><strong>Introduction: </strong>Anti-CD20 monoclonal antibodies are regarded as high-efficacy disease-modifying therapy (DMT) for relapse-remitting multiple sclerosis (RRMS). Herein, we aimed to compare the effectiveness and safety of OCR and RTX in patients with RRMS.</p><p><strong>Methods and materials: </strong>Between 2020 and 2025, RRMS patients prescribed OCR or RTX at the Imam Hossein MS Center in Tehran, Iran, were identified. Clinician-reported data were retrospectively extracted from medical records using a standardized data-collection checklist. Treatment allocation was non-random and was influenced by insurance coverage and drug availability. Rituximab was commonly administered using an extended-interval dosing protocol. Comparative analyses used survival methods and regression analyses. A two-sided P value < 0.05 indicated statistical significance.</p><p><strong>Results: </strong>150 patients (OCR = 90, RTX = 60) were followed for a mean of 42.1 ± 15.1 months (RTX: 46.2 ± 19.1 months; OCR: 39.5 ± 11.0 months; P = 0.12). Baseline demographic and MS-related characteristics were comparable. The annualized relapse rate (ARR) decreased from a pre-treatment mean of 1.23 to 0.70 in the OCR group and 0.76 in the RTX group (mean difference, - 0.06; P = 0.34), with corresponding absolute relapse counts of one in the OCR group and two in the RTX group. Confirmed disability worsening occurred in five patients (1 OCR, 4 RTX; P = 0.16). Among patients with follow-up MRI data (n = 115), new asymptomatic MRI activity was observed in 4.4% of OCR-treated and 5.0% RTX-treated (P = 0.99) patients. Secondary hypogammaglobulinemia (SHG) occurred in 17/90 (18.9%) of OCR-treated and 10/60 (16.7%) of RTX-treated patients, (P = 0.60), which was mainly asymptomatic. Treatment persistence was high in both groups (OCR 98.9%, RTX 93.3%).</p><p><strong>Conclusion: </strong>Over a mean follow-up exceeding three years, no statistically significant differences in relapse, MRI, or disability outcomes were detected between OCR and RTX. Because treatment allocation was non-random and RTX was commonly administered using extended-interval dosing, these findings represent a comparison of real-world treatment strategies, not a causal comparison of the intrinsic effects of RTX versus OCR.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalized primary headache in children after emergency department evaluation: a retrospective cohort study.","authors":"Miguel Ángel Molina Gutiérrez, Natalia Alfaro León, Miguel Ángel Fernández-García, Begoña de Miguel Lavisier, María de Ceano-Vivas La Calle","doi":"10.1007/s13760-026-03205-7","DOIUrl":"https://doi.org/10.1007/s13760-026-03205-7","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the clinical features, diagnostic evaluation, management, and final diagnoses of children hospitalized for headache following emergency department (ED) evaluation, and to explore factors associated with treatment refractoriness.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of children aged 4-17 years presenting to a tertiary pediatric ED with headache as the primary complaint who required hospitalization between January 2019 and June 2024. Patients whose headache was clearly attributed to trauma, fever, or a previously identified systemic or neurological disorder were excluded. Final headache diagnoses were established during hospitalization by the pediatric neurology team, using ICHD-3 criteria when applicable. Data included demographics, clinical presentation, diagnostic testing, treatments, and discharge diagnoses. Descriptive analyses were performed, with exploratory comparisons between patients requiring ≤ 2 versus > 2 sequential pharmacologic interventions.</p><p><strong>Results: </strong>Among 3,646 ED visits for headache, 162 (4.4%) resulted in hospitalization; 30 children (18.5% of admissions) had a final diagnosis of primary headache and constituted the study cohort. Mean age was 12.7 years, and 70.0% were female. Although frontal location and pressure-type pain were the most common presentation features, 76.7% of patients were ultimately diagnosed with migraine or probable migraine. Acute neurological abnormalities were documented in 10.0% of patients. Cranial CT was performed in 63.3% and brain MRI in 23.3%, with no acute intracranial abnormality or secondary cause explaining the headache identified. Intravenous metamizole (dipyrone) was the most frequently used first-line acute therapy, and 70.0% of patients required a second sequential pharmacologic intervention. Among patients diagnosed with migraine or probable migraine, 21.7% met criteria for status migrainosus. No clinical variables were significantly associated with treatment refractoriness.</p><p><strong>Conclusions: </strong>Hospitalization for primary headache after pediatric ED evaluation was uncommon but identified a clinically severe subgroup, predominantly with migraine-spectrum disorders and frequently requiring escalation of acute treatment. Despite frequent neuroimaging, no acute intracranial abnormality or secondary cause explaining the headache was identified. These findings suggest that more selective imaging strategies may be appropriate in children with a reassuring clinical presentation, although prospective studies are needed to better define predictors of hospitalization, treatment refractoriness, and optimal acute management.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presumed sensory-onset focal aware seizures with transient speech arrest in a child with pathogenic DEPDC5-related epilepsy.","authors":"Arzu Eroğlu","doi":"10.1007/s13760-026-03218-2","DOIUrl":"https://doi.org/10.1007/s13760-026-03218-2","url":null,"abstract":"","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral multi-condition surface electromyographic characterization of tremor in Parkinson's disease and essential tremor.","authors":"Ayşen Süzen Ekinci, Sevgin Gündoğan, Zeynep Tanrıverdi, Şehnaz Arıcı, Yaprak Seçil","doi":"10.1007/s13760-026-03209-3","DOIUrl":"https://doi.org/10.1007/s13760-026-03209-3","url":null,"abstract":"<p><strong>Objectives: </strong>Clinical differentiation between Parkinson's disease (PD) and essential tremor (ET) remains challenging, particularly in early or overlapping cases. This study aimed to characterize bilateral tremor features using multi-condition surface electromyography (sEMG) and to evaluate task-dependent modulation patterns relevant to differential diagnosis.</p><p><strong>Methods: </strong>Thirty patients with PD and forty-one with ET underwent bilateral sEMG recordings from agonist-antagonist muscle pairs. Tremor frequency, burst duration, amplitude, and activation patterns were systematically analyzed under four functional conditions: rest, posture, object holding, and weight loading. Between-group and within-group comparisons were performed.</p><p><strong>Results: </strong>Across all task conditions, tremor frequency was significantly higher in ET than in PD. Tremor frequency was lowest at rest; within-group modulation differed between disorders, with ET showing a significant rest-posture difference and PD showing lower resting frequency than active conditions. ET predominantly showed synchronous agonist-antagonist activation and more homogeneous burst duration distribution, whereas PD was characterized by asynchronous activation and greater heterogeneity in burst duration. Bilateral recordings revealed no significant inter-lateral electrophysiological differences in either disorder, compatible with a predominantly central contribution to tremor generation.</p><p><strong>Discussion: </strong>Bilateral multi-condition sEMG analysis demonstrated task-dependent tremor modulation and differences in agonist-antagonist activation patterns between PD and ET. This electrophysiological approach may complement clinical assessment, particularly in cases with overlapping tremor phenomenology.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Description of a visuospatial mislocation symptom in dementia with Lewy Bodies.","authors":"João Grancho, Alexandre Montalvo, Ana Verdelho","doi":"10.1007/s13760-026-03213-7","DOIUrl":"https://doi.org/10.1007/s13760-026-03213-7","url":null,"abstract":"","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the hand opposes intention: peri-ictal alien hand phenomenon in post-traumatic frontal epilepsy.","authors":"Ritwik Ghosh, Manoj Soren, Abhirup Nag, Prasenjit Sengupta, Julián Benito-León","doi":"10.1007/s13760-026-03210-w","DOIUrl":"https://doi.org/10.1007/s13760-026-03210-w","url":null,"abstract":"","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}