Brain Sciences最新文献

{"title":"Clinical Management of Synthetic-Cannabinoid-Induced Psychosis: A Systematic Review of Treatment Strategies and Outcomes.","authors":"Alessio Mosca, Stefania Chiappini, Andrea Miuli, Clara Cavallotto, Mauro Pettorruso, Giovanni Martinotti, Fabrizio Schifano","doi":"10.3390/brainsci15091006","DOIUrl":"10.3390/brainsci15091006","url":null,"abstract":"<p><strong>Background: </strong>Synthetic cannabinoid receptor agonists (SCRAs, commercially known as \"Spice\") have become a leading cause of substance-induced psychosis worldwide. These compounds show strong associations not only with acute psychotic episodes but also, in a subset of patients, with persistent or relapsing psychotic disorders, patterns that raise concern about progression to schizophrenia. Yet clinicians still lack clear, evidence-based guidance, and the optimal management of SCRA-induced psychosis remains inadequately defined.</p><p><strong>Methods: </strong>We carried out a systematic search of PubMed, Scopus, and Web of Science on 2 April 2025, identifying 35 primary studies that together describe roughly 4600 clinical presentations (≈77% male; mean age: 24.7 years).</p><p><strong>Results: </strong>Across diverse settings a convergent three-step pharmacological strategy emerged. First, rapid tranquillization with parenteral benzodiazepines consistently controlled severe agitation and autonomic instability. Second, when florid psychosis persisted beyond 30-60 min, clinicians introduced a second-generation antipsychotic-most commonly olanzapine, risperidone, or aripiprazole-often at doses exceeding those used for primary psychoses. Third, for the minority of refractory or relapse-prone cases, escalation to long-acting injectable formulations or low-dose clozapine achieved symptom control, even at plasma levels below those required in treatment-resistant schizophrenia. Although the evidence base consists largely of uncontrolled clinical descriptions, across studies, a recurrent clinical pattern was observed: initial benzodiazepines for agitation, followed by antipsychotics when psychosis persisted and escalation to clozapine or long-acting injectables in refractory cases. This approach appears to be associated with symptom improvement, although the certainty of the evidence is low to very low.</p><p><strong>Conclusions: </strong>Prospective, comparative studies are urgently needed to refine dosing, directly compare antipsychotic classes, and evaluate emerging cannabinoid-modulating interventions.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Boosting Working Memory in ADHD: Adaptive Dual N-Back Training Enhances WAIS-IV Performance, but Yields Mixed Corsi Outcomes.","authors":"Alessandra Lintas, Michel Bader, Alessandro E P Villa","doi":"10.3390/brainsci15090998","DOIUrl":"10.3390/brainsci15090998","url":null,"abstract":"<p><p><b>Background/Objectives:</b> This study investigates the efficacy of working memory training (WMT) using the dual N-back (DNB) task on cognitive performance in young adults with Attention-Deficit/Hyperactivity Disorder (ADHD). <b>Methods:</b> Over the course of at least 18 daily sessions conducted within one month, 106 participants (33 non-medicated ADHD, 42 medicated ADHD, and 45 controls) were randomly assigned to either a fixed dual 1-back (FD1B) training condition or an adaptive DNB condition, wherein the N-back level increased following successful completion of each trial block. Cognitive performance was assessed pre- and post-intervention using the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Working Memory Index (WMI) and the Corsi Block-Tapping Task. <b>Results:</b> A mixed-design ANOVA revealed significant improvements in DNB performance across all groups, with the adaptive training condition producing larger gains (e.g., a 204.6% improvement in controls, Cohen's d=1.85). WAIS-IV WMI scores-particularly the Digit Span Backward subtest-also improved significantly post-training, with greater effect sizes in the adaptive condition (d=0.46) than in FD1B (d=0.27). Corsi performance showed very modest gains, showing a surprising tendency to be more associated with the FD1B condition than the adaptive condition. Control participants outperformed the medicated ADHD group on WAIS-IV subtests, although no significant differences emerged between medicated and non-medicated ADHD participants. Correlational analyses indicated task-specific training effects, with adaptive training enhancing associations between DNB and Corsi performance in both controls (r=0.60) and medicated ADHD participants (r=0.51). <b>Conclusions:</b> This study demonstrates that dual N-back training improves verbal working memory in young adults with ADHD, specifically in a sample without psychiatric comorbidities. Transfer benefit to visuospatial domains appears limited and may not generalize to adolescents, older adults, or individuals with complex clinical profiles. The results underscore the importance of tailoring training protocols to maximize cognitive outcomes across different domains.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Hot Flashes: The Role of Estrogen Receptors in Menopausal Mental Health and Cognitive Decline.","authors":"Jung Min Cho, Jihye Lee, Eun-Mi Ahn, Jaehoon Bae","doi":"10.3390/brainsci15091003","DOIUrl":"10.3390/brainsci15091003","url":null,"abstract":"<p><p>Menopause is a natural phase in a woman's life marked by the cessation of menstruation, typically accompanied by hormonal fluctuations that have significant impacts on physical and mental health. While much attention has been given to the physical symptoms of menopause, such as hot flashes and osteoporosis, the neurocognitive consequences of hormonal fluctuations during the menopausal transition and the subsequent sustained estrogen loss after menopause have received less focus. Estrogen receptors (ERs), specifically ERα and ERβ, play a critical role in maintaining brain health, influencing mood, memory, and cognition. This review explores the connection between estrogen receptor signaling and mental health during menopause, focusing on mood disorders such as depression and anxiety, as well as cognitive decline and dementia. We discuss the molecular mechanisms by which ERs modulate brain function, including their effects on neuroplasticity, neurotransmitter systems, and gene expression. The review also examines current clinical approaches to managing menopausal cognitive and mental health issues, including hormone replacement therapy and selective ER modulators, while emphasizing the need for further research into alternative therapies and individualized treatments. The importance of estrogen receptors in the menopausal brain and their potential as therapeutic targets is critically evaluated, aiming to shed light on this often-overlooked aspect of menopause and aging.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and Self-Expansion Behaviors Correlate with Spatial Navigation in Healthy Adults.","authors":"Melissa Ansara, MaKayla Duggan, Alana Schafer, Karina Villalobos, Alexis N Chargo, Ana M Daugherty, Taylor N Takla, Nora E Fritz","doi":"10.3390/brainsci15091002","DOIUrl":"10.3390/brainsci15091002","url":null,"abstract":"<p><p><b>Background:</b> Spatial navigation is one's ability to travel through their environment to reach a goal location. Self-expansion is the motivation to increase one's self-perception through engaging in novel activities. Our objective was to examine the relations among self-expansion, age, and navigation ability and investigate how one's internal motivation may influence navigation performance across paradigms. <b>Methods:</b> In total, 33 younger adults (YAs; 19F, 14M, mean age = 25.0 ± 1.6) and 74 older adults (OAs; 52F, 22M, mean age = 69.5 ± 8.0) completed the following: Self-Expansion Preference Scale (SEPS), Wayfinding Questionnaire (WQ), Virtual Supermarket Task, Virtual Morris Water Maze (vMWM), and a Floor Maze Task (FMT). Mann-Whitney U tests and Spearman ρ correlations were used to examine differences in navigation performance between YAs vs. OAs and self-expanders vs. self-conservers, and relations among the measures, respectively. <b>Results:</b> YAs had lower vMWM completion times compared to OAs (<i>p</i> < 0.001). Self-expanders had better recall of the vMWM environment compared to self-conservers (<i>p</i> = 0.049), independent of age. Greater self-expansion in YAs was correlated with lower spatial anxiety (<i>ρ</i> = -0.356, <i>p</i> = 0.042) and faster completion of the FMT (<i>ρ</i> = -0.36, <i>p</i> = 0.042). <b>Discussion:</b> Our results build on established age-related deficits in navigation abilities to identify correlations of self-expansion and better performance in various navigation tasks. Independent of age, individuals with greater inclination towards self-expansion exhibit superior navigation abilities. Future research should explore underlying mechanisms driving these associations and investigate intervention strategies aimed at improving navigation skills in aging populations through increasing self-expansion.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Music Experience Impact the Vascular Endothelial Response to Singing?","authors":"Mehri Bagherimohamadipour, Muhammad Hammad, Alexis Visotcky, Rodney Sparapani, Jacquelyn Kulinski","doi":"10.3390/brainsci15090996","DOIUrl":"10.3390/brainsci15090996","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Vascular endothelial function is closely related to brain health, especially in individuals with cardiovascular risk factors. In a randomized, crossover clinical trial (NCT04121741), we have previously shown that 30 min of singing improves microvascular endothelial function in older adults with coronary artery disease. Here, we report on secondary and exploratory analyses, including (1) changes in cortisol and cytokine levels and their impact on vascular endothelial function, and (2) the impact of personal music experience on vascular function. &lt;b&gt;Methods:&lt;/b&gt; Participants had three study visits separated by 2-7 days, according to a randomized, researcher-blinded, crossover, controlled design: (1) a 30-min period of live singing with an in-person music therapist, (2) a 30-min period of singing along to an instructional video and (3) a 30-min rest (control). Primary outcomes included macrovascular endothelial function assessed by brachial artery flow-mediated dilation (BA FMD%) and microvascular function assessed by peripheral arterial tonometry [Framingham reactive hyperemia index (fRHI) and reactive hyperemia index (RHI)]. Exploratory outcomes included (log) changes in salivary cortisol and cytokine (IL-6, TNF-α, IL-1β, IL-8) levels. Participants were asked to complete the Brief Music Experience Questionnaire (BMEQ), a 53-item validated self-report questionnaire designed to measure an individual's overall experience with music. The BMEQ assesses how people perceive, react to, and engage with music in various aspects of their lives. &lt;b&gt;Results:&lt;/b&gt; Sixty-five subjects (mean age 67.7 ± 6.6 years, 40% female) completed the study. Compared to those subjects completing the BMEQ (n = 31), there were no significant differences in age, sex, race, or presence of diabetes mellitus, hypertension, high cholesterol, heart failure, chronic kidney disease, or chronic respiratory disease in subjects who did not complete the BMEQ (n = 34). Total BMEQ score did not impact changes in BA FMD% (-3.49 ± 2.00, &lt;i&gt;p&lt;/i&gt; = 0.086), changes in fRHI (0.58 ± 0.93, &lt;i&gt;p&lt;/i&gt; = 0.535), or changes in RHI (0.73 ± 0.65, &lt;i&gt;p&lt;/i&gt; = 0.262). When we decompose the sum of squares based on intervention, sex, race, and age, the BMEQ score does not predict changes in vascular function measures. In cross-over analyses, there were no acute changes in salivary cortisol or cytokine levels with 30 min of singing compared to control. Changes in IL-8 were directly related to changes in microvascular endothelial function (0.470 ± 0.184, &lt;i&gt;p&lt;/i&gt; = 0.012 for RHI and 0.780 ± 0.248, &lt;i&gt;p&lt;/i&gt; = 0.002 for fRHI). Changes in TNF-α were inversely related to changes in fRHI (-0.547 ± 0.263, &lt;i&gt;p&lt;/i&gt; = 0.040). Changes in cortisol concentrations were not related to measures of vascular function. &lt;b&gt;Conclusions:&lt;/b&gt; The beneficial changes in microvascular endothelial function are not modified by personal music experience in older subjects with known coronary artery disease. There we","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Linguistic Influences on L2 Prosody Perception: Evidence from English Interrogative Focus Perception by Mandarin Listeners.","authors":"Xing Liu, Xiaoxiang Chen, Chen Kuang, Fei Chen","doi":"10.3390/brainsci15091000","DOIUrl":"10.3390/brainsci15091000","url":null,"abstract":"<p><strong>Background/objectives: </strong>This study sets out to explore how L1 Mandarin speakers with varying lengths of L2 experience perceived English focus interrogative tune, L*H-H%, within the framework of the autosegmental-metrical model.</p><p><strong>Methods: </strong>Eighteen Mandarin speakers with varying lengths of residence in the United States and eighteen English native speakers were invited to perceive prosodic prominence and judge the naturalness of focus prosody tunes.</p><p><strong>Results: </strong>For the perception of on-focus pitch accent L*, Mandarin speakers performed well in the prominence detection task but not in the focus identification task. For post-focus edge tones, we found that phrase accents were more susceptible to L1 influences than boundary tones due to the varying degrees of cross-linguistic similarity between these intonational categories. The results also show that even listeners with extended L2 experience were not proficient in their perception of L2 interrogative focus tunes.</p><p><strong>Conclusions: </strong>This study reveals the advantage of considering the degree of L1-L2 similarity and the necessity to examine cross-linguistic influences on L2 perception of prosody separately in phonological and phonetic dimensions.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive Clinical Signs in Functional Neurological Disorders: A Narrative Review and Development of a Clinical Decision Tool.","authors":"Ioannis Mavroudis, Katerina Franekova, Foivos Petridis, Alin Ciobica, Sotirios Papagiannopoulos, Dimitrios Kazis","doi":"10.3390/brainsci15090997","DOIUrl":"10.3390/brainsci15090997","url":null,"abstract":"<p><p><b>Background</b>: Functional Neurological Disorders (FNDs) encompass a spectrum of disabling conditions, including functional limb weakness, tremor, gait disorders, seizures, and cognitive impairments. While previously diagnosed by exclusion, a growing consensus now supports the use of positive clinical signs as a basis for diagnosis. Despite this paradigm shift, frontline clinicians lack an integrated, accessible clinical tool for guiding diagnostic reasoning across FND subtypes. <b>Objectives</b>: This study aims to (1) synthesize the contemporary evidence on positive clinical signs across major FND subtypes and (2) develop a structured Clinical Decision Tool to support early and confident diagnosis in routine clinical settings. <b>Methods</b>: A focused narrative review was conducted using peer-reviewed publications and neurology reference texts, identifying reproducible positive clinical signs relevant to FND diagnosis. Signs were extracted, tabulated by subtype, and integrated into a modular decision-making framework designed for usability across outpatient, emergency, and specialist contexts. <b>Results</b>: The review identified 60+ positive signs across seven FND subtypes. These include Hoover's sign for limb weakness, entrainment for tremor, variable responsiveness in NESs, and paradoxical memory performance in Functional Cognitive Disorder. A Clinical Decision Tool was developed, featuring subtype-specific checklists, diagnostic confidence indicators, and red flag alerts, and it is currently available in printable format. <b>Conclusions</b>: This study offers a novel, evidence-based decision tool to facilitate the positive diagnosis of FND. By consolidating observable signs into a practical format, it aims to reduce diagnostic delays, avoid unnecessary investigations, and enhance patient-clinician communication. Future efforts will focus on clinical validation and digital implementation.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical Parametric Mapping and Voxel-Based Specific Regional Analysis System for Alzheimer's Disease (VSRAD): Principles and Clinical Applications.","authors":"Shinji Yamamoto, Nobukiyo Yoshida, Noriko Sakurai, Yukinori Okada, Norikazu Ohno, Masayuki Satoh, Koji Takeshita, Masanori Ishida, Kazuhiro Saito","doi":"10.3390/brainsci15090999","DOIUrl":"10.3390/brainsci15090999","url":null,"abstract":"<p><p><b>Background</b>: The voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) allows quantitative evaluation of the degree of an individual's brain atrophy through statistical comparison of brain magnetic resonance imaging (MRI) of their brain to a normative database of healthy Japanese individuals. Currently, the VSRAD is used in routine clinical practice in the diagnosis of Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Recent studies using VSRAD have explored its utility in the assessment of brain atrophy associated with various conditions, including diabetes, oral health status, and olfactory dysfunction. This review summarizes the principles of the VSRAD and its foundational method, voxel-based morphometry (VBM), and their clinical and research applications. <b>Methods</b>: This narrative review was conducted by performing a literature search of PubMed to identify articles regarding VBM and the VSRAD that were published between 2005 and 2025. <b>Results</b>: VSRAD yields four indices for quantifying the severity and extent of gray matter atrophy, especially in the medial temporal lobe. Studies have demonstrated its high diagnostic accuracy in distinguishing among AD, mild cognitive impairment (MCI), and DLB. Furthermore, it is correlated with neuropsychological test scores and has been applied to evaluate brain changes associated with diabetes, olfactory dysfunction, and physical inactivity. Motion-corrected MR images, which utilize AI techniques, have also been validated using VSRAD-derived metrics. <b>Conclusions</b>: Quantifying brain atrophy using the VSRAD allows objective evaluation and facilitates the investigation of its association with various diseases. Specifically, VSRAD can be considered a useful adjunctive tool for diagnosing AD and DLB.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Neurophysiological Correlates of Mental Fatigue in Both Monotonous and Demanding Driving Conditions.","authors":"Francesca Dello Iacono, Luca Guinti, Marianna Cecchetti, Andrea Giorgi, Dario Rossi, Vincenzo Ronca, Alessia Vozzi, Rossella Capotorto, Fabio Babiloni, Pietro Aricò, Gianluca Borghini, Marteyn Van Gasteren, Javier Melus, Manuel Picardi, Gianluca Di Flumeri","doi":"10.3390/brainsci15091001","DOIUrl":"10.3390/brainsci15091001","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Mental fatigue during driving, whether passive (arising from monotony) or active (caused by cognitive overload), is a critical factor for road safety. Despite the growing interest in monitoring techniques based on neurophysiological signals, current biomarkers are primarily validated only for detecting passive mental fatigue under monotonous conditions. The objective of this study is to evaluate the sensitivity of the MDrow index, which is based on EEG Alpha band activity, previously validated for detecting passive mental fatigue, with respect to active mental fatigue, i.e., the mental fatigue occurring in cognitively demanding driving scenarios. <b>Methods</b>: A simulated experimental protocol was developed featuring three driving scenarios with increasing complexity: monotonous, urban, and urban with dual tasks. Nineteen participants took part in the experiment, during which electroencephalogram (EEG), photoplethysmogram (PPG), and electrodermal activity (EDA) data were collected in addition to subjective assessments, namely the Karolinska Sleepiness Scale (KSS) and the Driving Activity Load Index (DALI) questionnaires. <b>Results</b>:The findings indicate that MDrow shows sensitivity to both passive and active mental fatigue (<i>p</i> < 0.001), thereby demonstrating stability even in the presence of additional cognitive demands. Furthermore, Heart Rate (HR) and Heart Rate Variability (HRV) increased significantly during the execution of more complex tasks, thereby suggesting a heightened response to mental workload in comparison to mental fatigue alone. Conversely, electrodermal measures evidenced no sensitivity to mental fatigue-related changes. <b>Conclusions</b>: These findings confirm the MDrow index's validity as an objective and continuous marker of mental fatigue, even under cognitively demanding conditions.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the Management of Cavernoma-Related Epilepsy: Seizure Outcomes, Antiseizure Medication Practices, and Access to Intraoperative Technologies in Kazakhstan.","authors":"Karashash Menlibayeva, Chingiz Nurimanov, Iroda Mammadinova, Ainur Turzhanova, Serik Akshulakov, Yerbol Makhambetov","doi":"10.3390/brainsci15090992","DOIUrl":"10.3390/brainsci15090992","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to analyze the diagnostic patterns of cavernoma-related epilepsy, the management of antiseizure medications, and clinical outcomes following microsurgical treatment in patients with late-diagnosed epilepsy secondary to cavernous malformations in the Central Asian region.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted on 60 patients who underwent microsurgical resection for brain cavernous malformations over a 12-year period (2010-2022) at the National Centre for Neurosurgery, Astana, Kazakhstan. All participants were 18 years or older and presented with seizures. Follow-up evaluations were conducted by neurologists, and seizure outcomes were assessed using the 2017 classification criteria of the International League Against Epilepsy.</p><p><strong>Results: </strong>The mean follow-up period was 83.77 ± 39.81 months. In total, 51.67% of participants demonstrated positive ILAE outcomes, 33.33% had moderate ILAE outcomes, and the remaining 15.00% experienced negative ILAE outcomes. Approximately 47% of patients received antiseizure medication before surgery, primarily as monotherapy with carbamazepine (33%), and administered at a low dose (40%). Early microsurgical resection showed a positive post-surgery seizure outcome. Approximately 67% of patients who experienced seizures within one year prior to surgery showed positive ILAE outcomes, whereas those with a seizure history extending beyond five years were roughly 32% seizure-free (<i>p</i> = 0.01).</p><p><strong>Conclusions: </strong>Cavernoma-related epilepsy in Central Asia remains a significant clinical challenge, particularly with respect to diagnostic accuracy and antiseizure medication management. In our cohort, only approximately half of patients achieved favorable seizure control following microsurgical resection. Notably, early surgical intervention within one year of seizure onset was associated with improved outcomes, whereas delayed surgery, restricted availability of intraoperative technologies, and suboptimal antiseizure medication practices were linked to less favorable outcomes. Strengthening diagnostic pathways, antiseizure medication management, and expanding access to advanced surgical technologies are critical steps to improving treatment outcomes in a studied patient population.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}