Acta neurologica Taiwanica最新文献

{"title":"Can One Predict Persistence beyond Adolescence in Childhood Absence Epilepsy?","authors":"Sirichai Chayasirisobhon, Suresh Gurbani, Noriko McCall, Pantea Zohrevand, Benjamin Spurgeon, Keira Chayasirisobhon, Jason Chau","doi":"10.4103/ant.ANT-D-24-00032","DOIUrl":"https://doi.org/10.4103/ant.ANT-D-24-00032","url":null,"abstract":"<p><strong>Background: </strong>Although typical childhood absence epilepsy is common and drug-resistance is not uncommon, predictors of drug resistance and its persistence beyond adolescence have not been well studied.</p><p><strong>Objectives: </strong>To predict recalcitrant childhood absence epilepsy (CAE).</p><p><strong>Materials and methods: </strong>Retrospective data analysis of 153 CAE patients was done. Controlled CAE group (cCAE) had seizure control within 2 years of starting antiseizure medication regimen (ASM) and electroencephalographic (EEG) normalization at <16 years of age. The remaining cohort was classified as drug-resistant CAE group (rCAE). The factors which may affect outcome were analyzed. Seizure freedom was defined as 10 years of clinical seizure-free period with at least 5 years off ASM.</p><p><strong>Results: </strong>Of 153 patients, 104 (67.97%) qualified for cCAE and 79 (75.96%) responded to the first ASM. All in cCAE also achieved seizure freedom. The comparison of initial EEG abnormalities to ASM efficacy proved divalproex sodium (VPA) superiority for patients with poly spike and wave discharges (PSW), Fisher's exact test, P = 0.021, but not ethosuximide (ESM), Fisher's exact test, P = 0.00058; both ASM were equally effective for single spike and wave discharges (SSW); and VPA equally effective for SSW and PSW. Of 49 patients in rCAE, 11 (22.45%) eventually achieved seizure freedom. None in cCAE but 17 (34.69%) in rCAE developed other seizure types which included 9 (18.37%) who developed juvenile myoclonic epilepsy (JME).</p><p><strong>Conclusions: </strong>The majority of CAE patients attained seizure control over 2 years with EEG normalization before the age of 16 years, and all of them went on to achieve seizure freedom. Almost 3/4th of the patients who are likely to attain seizure control and achieve seizure freedom will do so with the first-line ASM. In addition, ESM should be the first ASM for patients with CAE with SSW, but VPA may be used as the first ASM for patients with CAE with PSW. Furthermore, seizure control and freedom are still possible in some patients with rCAE. Persistent PSW and later development of additional seizure type may predict refractory status and, in some patients, evolving JME.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"35 3","pages":"137-142"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Managing Carotid Free-floating Thrombus in Marfan Syndrome: A Case Report and Therapeutic Considerations.","authors":"Yu-Han Wang, Chih-Hao Chen, Yen-Heng Lin, Sung-Chun Tang","doi":"10.4103/ant.ANT-D-24-00056","DOIUrl":"10.4103/ant.ANT-D-24-00056","url":null,"abstract":"<p><strong>Abstract: </strong>Carotid free-floating thrombus (CFFT) is an uncommon vascular condition involving an elongated thrombus that extends in the direction of distal blood flow, remaining only partially attached to the artery wall. Risk factors include atherosclerosis, hypercoagulable states, and vascular trauma. Symptoms of CFFT can include sudden unilateral weakness or numbness, slurred speech, visual disturbances, dizziness, and headaches, which may indicate a transient ischemic attack or stroke. However, due to its rarity, the optimal treatment strategies remain under investigation. Here, we present a unique case of a patient with Marfan syndrome who developed CFFT while on long-term warfarin therapy, effectively managed with enoxaparin. This case illustrates the role of arterial tortuosity and aneurysmal dilatation in thrombus formation as a manifestation of Marfan syndrome. It also emphasizes the complexities of managing CFFT, presenting a therapeutic dilemma due to the uncertainty surrounding optimal treatment strategies and shedding light on the need for further research to inform clinical decision-making.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"35 3","pages":"166-170"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing Artificial Intelligence and ChatGPT in Early Detection of Neurodegenerative Disorders: A Transformative Opportunity for Neurology.","authors":"Roberto Tedeschi","doi":"10.4103/ant.ANT-D-25-00019","DOIUrl":"10.4103/ant.ANT-D-25-00019","url":null,"abstract":"","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":" ","pages":"171-172"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Psychosis Conceals a Motor Crisis: A Misleading Case of Catatonia Unveiling Parkinson's Disease off Phenomenon.","authors":"Wen-Wen Tsai, Pei-Hsin Kao, Kuan-Hsien Lu, Sheng-Hsiang Yang","doi":"10.4103/ant.ANT-D-25-00052","DOIUrl":"10.4103/ant.ANT-D-25-00052","url":null,"abstract":"<p><strong>Abstract: </strong>Psychosis is a frequent comorbidity in Parkinson's disease (PD) and often complicates the evaluation of motor and behavioral fluctuations. Distinguishing between psychosis-related catatonia and a PD off phenomenon presents a significant diagnostic challenge. We describe the case of a 48-year-old male with PD and depression who was admitted to a psychiatric ward following an episode of aggressive behavior and persecutory delusions. During hospitalization, he developed mutism, rigidity, and immobility - initially interpreted as catatonia. A Bush-Francis Catatonia Rating Scale score of 16 was documented, but a lorazepam challenge failed to elicit improvement. These symptoms coincided with the tapering of dopaminergic therapy, particularly pramipexole. Neurological consultation on hospital day 11 identified the presentation as a severe PD off state. Restoration of dopaminergic therapy, focusing on extended-release formulations and optimized timing, resulted in marked clinical improvement within 1 week. Dopamine agonists were avoided due to concern for exacerbating psychosis. This case highlights the importance of distinguishing catatonia from PD off states in patients with overlapping motor and psychiatric symptoms. Careful medication history, response to benzodiazepines, and interdisciplinary collaboration are critical to diagnostic accuracy and treatment success.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":" ","pages":"162-165"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we Rely on Smartphone to Evaluate Acute İschemic Strokes? A Diagnostic Accuracy Study.","authors":"İbrahim Feyyaz Naldemir, Ahmet Kürşat Karaman Kursat, Alper Aziz Ayaslı, Hasan Baki Altınsoy, Mehmet Karadağ, Mustafa Boğan","doi":"10.4103/ant.ANT-D-25-00018","DOIUrl":"https://doi.org/10.4103/ant.ANT-D-25-00018","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke requires rapid diagnosis and treatment for better clinical outcomes. In the emergency department, consultation via smartphone can be used to quickly confirm the radiological diagnosis.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate the diagnostic reliablity of diffusion-weighted magnetic resonance imaging (DWI) images evaluated via smartphone in detecting acute ischemic lesions.</p><p><strong>Materials and methods: </strong>One hundred and ten patients who underwent diffusion DWI examination with a preliminary diagnosis of ischemic stroke in the emergency department were included. Patients' images were sent by the neurologist via WhatsApp to the two radiologists and evaluated blindly. These images were also evaluated by two radiologists using the web-based mobile software of a DICOM imaging application. Evaluated areas were classified into five sections as large vessel territory, lacunar infarct, hemorrhage, chronic sequelae changes, and normal.</p><p><strong>Results: </strong>Excellent and good concordance was observed between observers for four abnormal classified sections. In the normal classified group, moderate and low level of concordance was found between the participants (Kappa = 0.353, P < 0.001). In the evaluation of lacunar infarcts, the sensitivity of smartphones was found to be low. In addition, it was observed that the specificity of the cases evaluated as normal on smartphones was low, being more evident in the videos sent from WhatsApp.</p><p><strong>Conclusions: </strong>In order to shorten the diagnosis time of ischemic stroke, clinicians may be requested to evaluate it with smartphones. However, to our findings, we suggest that mobile imaging techniques cannot take the role of medical monitors and that cases assessed using a mobile device should be verified using a monitor.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"35 3","pages":"143-148"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Coherence Tomography in Understanding Neurodegeneration in Epilepsy - A Cross-sectional Study.","authors":"Archana Verma, Shrinkhal, Pooja Pathak, Ashutosh Mishra, Sachin","doi":"10.4103/ant.ANT-D-25-00054","DOIUrl":"https://doi.org/10.4103/ant.ANT-D-25-00054","url":null,"abstract":"<p><strong>Background: </strong>Even with improvements in epilepsy diagnosis and treatment, it is still difficult to comprehend the underlying structural alterations in the brain linked to epilepsy. A noninvasive imaging method that produces high-resolution pictures of tissue microstructure is optical coherence tomography (OCT).</p><p><strong>Objectives: </strong>The study's objective was to evaluate OCT changes in people with epilepsy (PWE) compared to healthy control patients and examine how these changes relate to the type of epilepsy, duration, abnormal imaging, and anti-seizure medication use.</p><p><strong>Materials and methods: </strong>A cross-sectional study was done. A cohort of adults PWE (from 18 to 40 years) with known epilepsy and healthy controls (n = 40) matched for age and gender were recruited. OCT was used to analyze the thickness of the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL).</p><p><strong>Results: </strong>A total of 40 PWE were recruited. Thirty-three people had epilepsy for 10-12 years, while 7 had it for more than 12 years. PWE showed significantly reduced temporal quadrant RNFL thickness compared with control in both right (62.6 ± 10.9 vs. 70.4 ± 6.9 µm; P < 0.001) and left eyes (61.9 ± 11.4 vs. 68.0 ± 6.0 µm; P < 0.004). RNFL thickness was significantly reduced in PWE with abnormal magnetic resonance imaging findings (left eye average: P =0.04; left superior: P =0.03; right eye average: P =0.03). No significant relationship was found between RNFL or GCC thickness and epilepsy type or duration (P > 0.05).</p><p><strong>Conclusion: </strong>Our study revealed that there is reduced temporal quadrant RNFL thickness in PWE and average RNFL thickness in those having abnormal imaging. OCT may serve as a noninvasive complementary tool to detect subtle structural changes in epilepsy.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"35 3","pages":"149-153"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myelin Oligodendrocyte Glycoprotein Antibody Associated with Lumbar Radiculitis: A Case Report.","authors":"Cheng-Yu Wang, Fu-Chi Yang, Yueh-Feng Sung, Chung-Hsing Chou, Yi-Chih Hsu, Chia-Kuang Tsai","doi":"10.4103/ant.ANT-D-25-00021","DOIUrl":"10.4103/ant.ANT-D-25-00021","url":null,"abstract":"<p><strong>Abstract: </strong>Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies have gained recognition in recent years for their role in a variety of demyelinating diseases affecting the central and peripheral nervous systems. This case report details a rare presentation of anti-MOG-positive acute inflammatory demyelinating polyradiculitis in a 32-year-old male, where urogenital dysfunction was the initial presenting symptom. His subsequent diagnosis, treatment, and recovery are discussed, contributing to the understanding of the varied manifestations of MOG antibody-related diseases.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":" ","pages":"154-157"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Intertwined Threat: How Diabetes Impacts Neurological Disorders - A Review Article.","authors":"Prajjwal Rajput, Manju Jakhar, Ashish Kashyap, Nidhi Rani, Thakur Gurjeet Singh","doi":"10.4103/ant.ANT-D-24-00046","DOIUrl":"https://doi.org/10.4103/ant.ANT-D-24-00046","url":null,"abstract":"<p><strong>Abstract: </strong>The chronic illness known as diabetes mellitus (DM) is typified by persistently high blood glucose levels or hyperglycemia. Both type 1 and type 2 diabetes, the latter of which is frequently referred to as \"adult-onset diabetes\" or \"insulin-dependent diabetes,\" are progressing conditions with complex and poorly understood etiologies. Often, patients show positive pancreatic beta-cell antibodies, signifying an autoimmune factor. The long-term complications of uncontrolled diabetes are numerous, not just physically based and encompassing everything from kidney failure to foot ulcers and damage to the cardiovascular system, but also with serious neurological disorders, including stroke, amyotrophic lateral sclerosis, Parkinson's disease, Alzheimer's disease (AD), and epilepsy. The interplay between neurological disorders and diabetes is complex, and the association of these pathological states in their general description proposes common events, namely oxidative stress, mitochondrial damage, amyloid protein aggregation, glucagon-like peptide-1 secretion skewing, and inflammation. Learning about these interconnections will help us to develop effective strategies for managing both diabetes and its neurological complications.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"35 3","pages":"119-127"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbleeds as a Causative Factor in Diffusion-weighted Imaging-Negative Acute Brainstem Stroke Syndrome: A Report of Three Cases.","authors":"Chi-Ju Lin, Chun-Jen Lin, Chih-Ping Chung","doi":"10.4103/ant.ANT-D-25-00024","DOIUrl":"10.4103/ant.ANT-D-25-00024","url":null,"abstract":"<p><strong>Abstract: </strong>A significant number of patients with acute stroke syndrome present with negative diffusion-weighted imaging (DWI) findings on brain magnetic resonance imaging (MRI). Cerebral microbleeds (CMBs), a marker of small vessel disease, are rarely considered a cause of acute neurological deficits and are often excluded from the differential diagnosis of stroke syndrome. Three cases of acute-onset brainstem syndrome were identified, each presenting with diplopia; two cases had abducens palsy, and one had oculomotor palsy upon assessment. Two patients also experienced dizziness and ataxia, while one presented with peripheral facial palsy. All cases showed negative DWI findings. CMBs were found in regions corresponding to the patients' neurological deficits. All patients recovered from their major symptoms within 7 days. These cases highlight the potential role of CMBs in DWI-negative acute brainstem syndrome, emphasizing the need to consider CMBs in the differential diagnosis of posterior circulation stroke syndromes. Future research is needed to better understand long-term outcomes and inform targeted management strategies for CMB-related acute neurological deficits. Microbleeds need to be considered as the causal lesion in patients presenting with acute stroke syndrome but DWI negative on brain MRI, particularly in those with brainstem syndrome.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":" ","pages":"158-161"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Cortical Ribboning and Corticomedullary Lesions in a Rare Case of Coexisting Anti-N-methyl-D-aspartate Receptor Encephalitis and Neuronal Intranuclear Inclusion Disease.","authors":"Chen-Chang Shih, Kuo-Hsuan Chang","doi":"10.4103/ant.ANT-D-25-00037","DOIUrl":"10.4103/ant.ANT-D-25-00037","url":null,"abstract":"<p><p>Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder characterized by psychiatric manifestations, seizures, and dyskinesias. Neuronal intranuclear inclusion disease (NIID) presents heterogeneously with dementia, neuropathy, and episodic encephalitis-like events, typically showing bilateral corticomedullary hyperintensities on diffusion-weighted imaging (DWI). The simultaneous occurrence of these conditions is extremely uncommon, complicating diagnosis due to overlapping clinical and radiological features. We report the case of a 68-year-old female with a history of atrial fibrillation and hyperthyroidism who presented with urinary tract infection, followed by acute consciousness disturbance, left arm paresis, and pyrexia. Initial antibiotic therapy resolved symptoms, but recurrent neurological deficits ensued. Diagnostic evaluation confirmed the presence of both anti-NMDAR encephalitis, evidenced by positive serum antibodies, and NIID, supported by abnormal GGC repeat expansions in the NOTCH2NLC gene and intranuclear inclusions on skin biopsy. Brain magnetic resonance imaging demonstrated unusual unilateral cortical ribboning and corticomedullary lesions on DWI. Therapy with corticosteroids and intravenous immunoglobulin resulted in significant improvement; however, subsequent workup revealed colorectal adenocarcinoma. This case highlights the diagnostic complexity and management challenges by the rare concurrence of anti-NMDAR encephalitis and NIID.</p>","PeriodicalId":93852,"journal":{"name":"Acta neurologica Taiwanica","volume":"35 2","pages":"108-111"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}