Acta neurologica Belgica最新文献

{"title":"The sneezing reflex: neurophysiology, neuroimmune pathways and clinical disorders.","authors":"Nuray Bayar Muluk","doi":"10.1007/s13760-026-03164-z","DOIUrl":"https://doi.org/10.1007/s13760-026-03164-z","url":null,"abstract":"<p><strong>Objective: </strong>To review the physiological mechanisms, neural and molecular mediators, and clinical pathologies associated with the sneezing reflex.</p><p><strong>Methods: </strong>A comprehensive narrative review was conducted utilizing established databases (PubMed/Medline, Scopus, Web of Science, Embase), covering articles published up to 2025. A structured search strategy applied keywords such as \"sneezing reflex,\" \"neuromedin B (NMB),\" \"trigeminal nucleus,\" \"allergic rhinitis,\" \"chronic rhinosinusitis,\" and \"neuromodulation.\"</p><p><strong>Results: </strong>The sneeze reflex is a complex protective mechanism divided into an initial sensory phase and an efferent respiratory phase, orchestrated by the ventromedial spinal trigeminal nucleus in the brainstem. Signal transmission strictly relies on small-diameter Trpv1 + nasal sensory neurons releasing Neuromedin B (NMB). Triggers range from chemical irritants to allergens. Pathological hyperactive sneezing is prominent in allergic rhinitis and Type 2 chronic rhinosinusitis (CRSwNP), driven by profound neuroimmune cross-talk. Conversely, Lateral Medullary Syndrome can abolish the ability to sneeze despite a preserved urge. Additionally, the photic sneeze reflex represents a visual-somatosensory cross-activation, while psychogenic intractable sneezing roots in psychological distress. For recalcitrant hyperactive sneezing, specific neuromodulation treatments, such as capsaicin desensitization and posterior nasal nerve (PNN) cryoablation or neurectomy, effectively disrupt the local neuro-secretory circuitry.</p><p><strong>Conclusion: </strong>Sneezing transcends a simple automatic response, functioning as a highly coordinated neuroimmune reflex. Elucidating its precise neural circuitry provides critical insights for developing targeted pharmacological and procedural neuromodulation treatments for sneezing disorders, ultimately enhancing patient care.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676670","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":"The wooden tongue depressor: a multi-purpose tool for bedside neurology.","authors":"Dimitri Renard, Gert Cypers","doi":"10.1007/s13760-026-03138-1","DOIUrl":"https://doi.org/10.1007/s13760-026-03138-1","url":null,"abstract":"<p><p>The wooden tongue depressor (WTD), popular due to its biodegradability, strength, and odourless and tasteless nature, is primarily used during medical examination to depress the tongue in order to provide a clearer view of the throat and mouth. WTD are designed for single use in order to prevent cross-contamination. Beyond its classical use, the WTD is a surprisingly useful multi-purpose tool for bedside neurology. In this practical bedside neurology guide, we will discuss these multiple functions of the WTD.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676647","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":"Brain morphometric alterations along the visual pathway in nonarteritic anterior ischemic optic neuropathy: a voxel-based morphometry study.","authors":"Selda Celik Dülger, Mehtap Oktay, Nihal Gürlek Celik","doi":"10.1007/s13760-026-03160-3","DOIUrl":"https://doi.org/10.1007/s13760-026-03160-3","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate brain morphometric changes in patients with non-arteritic anterior ischemic optic neuropathy (NAION) using voxel-based morphometry (VBM) and to explore their associations with structural and functional ophthalmic parameters.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study included 15 patients with NAION and 15 healthy controls. All participants underwent high-resolution 3.0-Tesla brain magnetic resonance imaging. Whole-brain VBM was performed using the Computational Anatomy Toolbox (CAT12) implemented in Statistical Parametric Mapping (SPM12) to assess gray and white matter volume differences between groups. Ophthalmic evaluation included best-corrected visual acuity, visual field mean deviation, retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness measured by optical coherence tomography. Correlation analyses were performed to evaluate the relationships between brain morphometric measures and ophthalmic parameters.</p><p><strong>Results: </strong>Compared with controls, patients with NAION exhibited reduced gray matter volumes in the limbic lobe, cuneus, occipital lobe, temporal lobe, middle temporal gyrus, parietal lobe, and frontal lobe at an exploratory voxel-level threshold (p < 0.001, uncorrected). Increased gray matter volumes were observed in the bilateral cerebellum, while increased white matter volumes were identified in the right cerebellum and posterior cerebellar lobe. No significant correlations were identified between brain morphometric measures and ophthalmic parameters, time since onset, or visual function (all p > 0.05). None of the observed gray or white matter clusters remained statistically significant after family-wise error (FWE) correction for multiple comparisons.</p><p><strong>Conclusions: </strong>Preliminary evidence suggests that patients with NAION may exhibit brain morphometric alterations involving visual pathway-related cortical regions and the cerebellum. These exploratory findings raise the possibility that central nervous system changes in NAION may extend beyond isolated optic nerve pathology. However, because none of the observed clusters survived family-wise error (FWE) correction for multiple comparisons, these findings should be considered exploratory and require confirmation in larger studies.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148667970","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":"MRI mimics of primary empty sella: a retrospective educational case series highlighting clinical and uncommon magnetic resonance imaging presentations.","authors":"Mustafa Kemal Demir, Ural Verimli, Deniz Kılıc, Rovshan Rustamov, Yulet Alara Gurcanli, Emre Unal, Akın Akakın, Turker Kılıc","doi":"10.1007/s13760-026-03158-x","DOIUrl":"https://doi.org/10.1007/s13760-026-03158-x","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to describe a few rare differential diagnoses of primary empty sella by reporting clinical and magnetic resonance imaging (MRI) findings that can potentially mislead the diagnosis.</p><p><strong>Materials and methods: </strong>The study included patients with intrasellar arachnoid cyst, pituitary stalk interruption syndrome, spontaneous transsellar meningoceles extending to the sphenoid sinus, intrasellar Rathke cleft cyst, and pituitary adenoma with cystic degeneration.</p><p><strong>Results: </strong>Differentiation from primary empty sella was possible based on the pituitary morphology and location, pituitary stalk configuration, sellar floor integrity, extension to the sphenoid sinus, and MRI signal characteristics. Cerebrospinal fluid-equivalent signal intensity without enhancement was observed in the intrasellar arachnoid cyst. Pituitary stalk interruption syndrome was characterized by absent or interrupted stalk with an ectopic posterior pituitary. Spontaneous transsellar meningoceles extending to the sphenoid sinus demonstrated herniation of cerebrospinal fluid-containing meninges through sellar defects. Rathke's cleft cyst may simulate partial empty sella, however, the presence of a midline cyst and occasionally an intracystic nodule helps establish the diagnosis. Cystic degeneration in pituitary adenomas may mimic empty sella appearance, but asymmetric elevation of the diaphragma sellae, deviation of the pituitary stalk, and subtle peripheral enhancement of residual tumor tissue can provide important diagnostic clues.</p><p><strong>Conclusion: </strong>A structured MRI evaluation focusing on pituitary anatomy, stalk configuration, sellar floor integrity, sphenoid sinus pathology, and subtle cystic lesions characteristics can reliably differentiate true primary empty sella from its rare mimics.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663380","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":"Dysregulation of ferroptosis-related plasma biomarkers in treatment-free patients with relapsing-remitting multiple sclerosis in clinical remission: a case-control study.","authors":"Mahdieh Nazari-Robati, Beydolah Shahouzehi, Mahdis Rahimi Naiini","doi":"10.1007/s13760-026-03150-5","DOIUrl":"https://doi.org/10.1007/s13760-026-03150-5","url":null,"abstract":"<p><strong>Background: </strong>Ferroptosis, an iron-dependent form of programmed cell death characterized by lipid peroxidation, has emerged as a key mechanism associated with neuroinflammation. This process is particularly relevant in relapsing-remitting multiple sclerosis (RRMS), where neuroinflammatory pathways contribute significantly to disease pathology.</p><p><strong>Methods: </strong>This study included 38 patients with RRMS and 38 healthy controls. Plasma levels of key ferroptosis-related biomarkers, including malondialdehyde (MDA), glutathione (GSH), and glutathione peroxidase 4 (GPX4), as well as iron and ferritin, were analyzed.</p><p><strong>Results: </strong>The analysis demonstrated significantly elevated levels of MDA, iron, and ferritin in the RRMS group compared to the control group with p-values of 0.004, 0.042, and 0.038, respectively. Conversely, GSH and GPX4 levels were significantly reduced in the RRMS group with p-values of 0.028, and 0.014, respectively. A significant correlation was observed between MDA and iron levels in the control group (r = 0.346, p = 0.045).</p><p><strong>Conclusion: </strong>The significant differences in plasma levels of ferroptosis-related biomarkers between RRMS patients and healthy controls suggest a potential role for ferroptosis in the pathogenesis of multiple sclerosis.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663351","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":"Are perivascular spaces truly incidental? Evidence of structural-diffusion coupling in healthy young adults.","authors":"Abdulkadir Ermiş, Tehran Aliyeva, Ali Behram Salar, Melih Akan, Uğur Çekmez, Sena Ekinci Ermiş, Gülhan Ertan Akan, Erkingül Birday","doi":"10.1007/s13760-026-03155-0","DOIUrl":"https://doi.org/10.1007/s13760-026-03155-0","url":null,"abstract":"<p><strong>Objective: </strong>The glymphatic system is vital for metabolic waste clearance, and its impairment has been implicated in various neurological disorders. We investigated the relationship between structural perivascular space (PVS) burden and the DTI-ALPS index (A non-invasive proxy reflecting perivascular diffusion characteristics) in healthy young adults, to evaluate their utility as complementary markers of subclinical perivascular alterations.</p><p><strong>Methods: </strong>Twenty-four healthy volunteers (mean age: 32.3 ± 6.2 years) underwent 3T MRI including 64-direction diffusion tensor imaging. The DTI-ALPS index was calculated via an automated ROI method with visual quality control. Participants with Pittsburgh Sleep Quality Index (PSQI) > 5 were excluded. PVS burden (count and score) was assessed in the basal ganglia and centrum semiovale according to STRIVE criteria. Inter-rater agreement between two blinded neuroradiologists was assessed using Cohen's weighted kappa (κw). Group differences based on enlarged PVS (EPVS > 3 mm) were analyzed using Mann-Whitney U tests with effect size calculations.</p><p><strong>Results: </strong>Strong negative correlations were found between the DTI-ALPS index and total PVS score (ρ = -0.869) and total PVS count (ρ = -0.888) (p < 0.001). Participants with EPVS (n = 11) exhibited significantly lower DTI-ALPS indices (p < 0.001; rank-biserial correlation = 0.972). Regression analysis revealed PVS load independently explained 76.3% of DTI-ALPS variance (R² = 0.763) after controlling for age. Post-hoc power analysis confirmed adequate statistical power for all primary analyses (1 - β > 0.99) despite the modest sample size, owing to the large observed effect sizes.</p><p><strong>Conclusion: </strong>In healthy young adults, increased PVS burden and the presence of EPVS are strongly associated with reduced DTI-ALPS index values. This robust structure-diffusion coupling may hypothetically reflect subclinical alterations in glymphatic clearance capacity, though causal functional interpretation requires direct validation. PVS analysis may serve as a complementary, non-invasive radiological marker for monitoring perivascular integrity at its subclinical stages.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663359","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":"Functional outcome prediction after traumatic cervical spinal cord injury using ensemble machine learning: a three‑center validation study.","authors":"Zhenzhen Guan, Bo Wang, Tingting Wang, Yongqiu Zhang, Haiyun Zhu, Yijin Wang, Lina Geng","doi":"10.1007/s13760-026-03157-y","DOIUrl":"https://doi.org/10.1007/s13760-026-03157-y","url":null,"abstract":"<p><strong>Background: </strong>Traumatic cervical spinal cord injury (TCSCI) often causes severe neurological dysfunction. Accurate prediction of functional recovery is essential for clinical decision‑making and rehabilitation planning.</p><p><strong>Objective: </strong>To develop an ensemble learning model integrating baseline clinical data, neurological assessments, and cervical MRI features to predict neurological recovery and functional outcomes at one year post‑injury in TCSCI patients.</p><p><strong>Methods: </strong>We retrospectively collected data from 410 TCSCI patients across three medical institutions (2017-2025). A prediction model was constructed using a two‑layer Stacking ensemble strategy. Baseline characteristics included demographic, clinical, and radiologic features. Primary outcome was one‑year ASIA Impairment Scale (AIS) grade; secondary outcomes were Upper Extremity Motor Score (UEMS), Lower Extremity Motor Score (LEMS), Total Motor Score (TMS), and Spinal Cord Independence Measure III (SCIM III). SHapley Additive exPlanations (SHAP) analysis was performed to evaluate model interpretability and quantify the contribution of each predictor to the model output. Performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC), R², mean absolute error (MAE), and root mean square error (RMSE).</p><p><strong>Results: </strong>Of 340 patients analyzed (mean age 54.1 ± 14.9 years; 229 males), 242 formed the training set and 98 the external test set. The model achieved AUC ≥ 0.85 for all AIS grades. For continuous outcomes, R² values for UEMS, LEMS, TMS, and SCIM III were 0.9867, 0.9880, 0.9872, and 0.9863, respectively, with corresponding MAEs of 2.0667, 7.2751, 7.9496, 3.5956. SHAP analysis identified baseline UEMS and AIS grade as the most influential predictors, followed by maximum spinal cord compression (MSCC).</p><p><strong>Conclusion: </strong>This externally validated model accurately predicts 1‑year functional recovery in TCSCI patients and may support early prognosis assessment and individualized rehabilitation planning.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663419","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":"First presentation of congenital bilateral perisylvian syndrome as status epilepticus in an adolescent.","authors":"Mohnish Darshan, Sakshi Kapoor, Amber Kumar, Girish Chandra Bhatt, Shikha Malik","doi":"10.1007/s13760-026-03152-3","DOIUrl":"https://doi.org/10.1007/s13760-026-03152-3","url":null,"abstract":"","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663354","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":"Directional GPi deep brain stimulation for refractory status dystonicus in a child with PANK2-related PKAN.","authors":"Michał Sobstyl, Marta Skowrońska, Anna Stęplowska, Piotr Glinka, Beniamin Oskar Grabarek","doi":"10.1007/s13760-026-03148-z","DOIUrl":"https://doi.org/10.1007/s13760-026-03148-z","url":null,"abstract":"","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617874","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":"Long-term neuropsychiatric outcomes after neuromodulation in epilepsy patients: a systematic review and meta-analysis.","authors":"Margil Ranpariya, Gurleen Kaur, Hussain Shallwani, Alexus Ludwig, Imtiaz Nazam, Osman Farooq, Robert L Glover, Ping Li","doi":"10.1007/s13760-026-03113-w","DOIUrl":"https://doi.org/10.1007/s13760-026-03113-w","url":null,"abstract":"<p><strong>Background: </strong>Neuromodulation therapies, including vagus nerve stimulation (VNS), anterior nucleus of the thalamus deep brain stimulation (ANT-DBS), and responsive neurostimulation (RNS), have become established treatments for drug-resistant epilepsy. While seizure outcomes have been well-characterized, the long-term neuropsychiatric consequences of these interventions remain incompletely understood. This review aimed to compile available evidence on depression, anxiety, cognitive function, and quality of life following chronic neuromodulation therapy in adults and children with epilepsy.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, EMBASE, the Cochrane Library, and PsycINFO from inception through September 2025. Studies reporting neuropsychiatric outcomes after at least six months of VNS, ANT-DBS, or RNS therapy in patients with epilepsy were eligible. Random-effects meta-analysis was performed using standardized mean differences (SMDs). Heterogeneity was assessed via Cochran Q and I-squared statistics. Publication bias was evaluated with funnel plots and Egger regression.</p><p><strong>Results: </strong>From 2,847 records screened, 35 studies met inclusion criteria and 24 contributed to quantitative synthesis, encompassing 2,418 patients. The pooled effect on depression was a small but statistically significant improvement (SMD = -0.25; 95% CI: -0.43 to -0.07; p = 0.007). Subgroup analysis showed VNS had the largest antidepressant effect (SMD = -0.40; 95% CI: -0.69 to -0.10), while ANT-DBS (SMD = -0.18; 95% CI: -0.50 to 0.15) and RNS (SMD = -0.14; 95% CI: -0.47 to 0.19) showed non-significant trends toward improvement. Cognitive outcomes remained largely stable across all modalities, with no significant decline in overall cognitive performance (VNS: SMD = 0.07; DBS: SMD = 0.05; RNS: SMD = 0.02). Quality of life improved progressively, with clinically meaningful gains observed by the second year of treatment across modalities. Neuropsychiatric adverse events were most frequent in the ANT-DBS group, where 14.8% reported depressive symptoms during the blinded phase of the SANTE trial, though these diminished substantially over long-term follow-up.</p><p><strong>Conclusions: </strong>Neuromodulation for drug-resistant epilepsy is associated with modest improvements in depression and quality of life without meaningful cognitive deterioration over follow-up durations of 6 months to 14 years. VNS demonstrated the most robust antidepressant signal, likely reflecting its established effects on monoaminergic brainstem circuits. Clinicians should monitor neuropsychiatric status, particularly during the early postimplantation period for ANT-DBS. Earlier intervention may optimize mood and quality of life benefits.</p>","PeriodicalId":7042,"journal":{"name":"Acta neurologica Belgica","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617960","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}