Current Neurology and Neuroscience Reports最新文献

Purpose of review: This systematic review aimed to assess the impact of non-statin lipid-lowering therapies on imaging-defined features of carotid plaque vulnerability.

Recent findings: Only studies assessing the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or ezetimibe met inclusion criteria for this review. Recent clinical trials and cohort studies suggest that PCSK9 inhibitors are associated with reductions in lipid-rich necrotic core volume, intraplaque neovascularization, and inflammatory activity. In contrast, ezetimibe has shown neutral or inconsistent effects, particularly when combined with low- or moderate-intensity statins. PCSK9 inhibitors appear to contribute to early and multidimensional stabilization of vulnerable carotid plaques, whereas the evidence supporting ezetimibe remains limited. However, given the heterogeneity of imaging methods, study designs, and outcome definitions, further well-designed clinical studies with standardized imaging protocols are needed to better understand the role of these therapies in carotid plaque remodeling and stroke prevention.

Purpose of review: Exercise is a recommended non-pharmacological approach to treat multiple sclerosis (MS) symptoms. Mind-body movement interventions (MBMIs) offer a multi-component exercise option that integrates movement, breathwork, and mindfulness. Using an umbrella review, we assessed the current best evidence on MBMIs (ai chi, dance, Pilates, qigong, tai chi, and yoga) for managing MS symptoms.

Recent findings: MBMIs significantly improved balance, equal to or superior to active controls (AC) or usual care (UC). Ai chi/tai chi/qigong significantly improved depression. Analyzed with other mind-body therapies, yoga reduced pain compared to AC/UC. Mixed results were found for fatigue. Physical function and quality of life were comparable to AC/UC. The certainty of evidence was low to very low for most MBMIs. Most reviews were "critically low" quality. MBMIs are commonly included in MS exercise reviews and may improve balance, pain, and depression. However, larger trials with active comparators and comprehensive reporting are needed to improve quality and certainty.

Purpose of review: Dystonia is a highly heterogeneous movement disorder with complex molecular underpinnings. This review aims to synthesize insights into pathophysiological mechanisms driving dystonia with emphasis on latest advances.

Recent findings: In recent years, key molecular pathways in dystonia have been elucidated, among them: aberrant transcriptional regulation, altered protein turnover, nuclear envelope dysfunction, and mitochondrial impairment. Emerging data reveal the interplay and convergence of some of these disease-related processes, highlighting overarching molecular vulnerabilities critical to pathogenesis. Deciphering molecular mechanisms underlying dystonia facilitates the stratification of affected individuals into biologically defined subgroups, which will be essential for the development of targeted therapies. Patient assessment based on individual molecular profiles represents a promising avenue for future therapeutic and preventive strategies in dystonia.

Purpose of review: To discuss the landscape of immunotherapy trials for central nervous system (CNS) tumors including immune checkpoint inhibitors, vaccine therapies, oncolytic viruses, and chimeric antigen receptor T-cell therapy as well as explore the corresponding spectrum of neurologic toxicities.

Recent findings: As more clinical trials are underway in CNS tumors, we are starting to appreciate both the promise of immunotherapy and current limitations. While a subset of patients demonstrate benefit, immunotherapy trials have not transformed CNS tumor outcomes, which prompts the field to consider next generation therapies and combinatorial approaches. In addition, novel toxicities of CNS immunotherapy are being described such as tumor-inflammation associated neurotoxicity. Immunotherapy in CNS tumor is still in its nascent stages and shows early signs of promise. However, immunotherapeutic approaches in CNS tumors need to account for the unique physiology of the CNS and the corresponding neurologic toxicities that are associated with therapies targeting the CNS. Elucidating both will set the stage for advancement of safe and effective immunotherapy for CNS tumors.

Purpose of review: This review examines the expanding role of genetic factors in cerebral palsy (CP), with a focus on cryptogenic presentations and CP-masquerading conditions. It addresses how genomic insights refine diagnosis, guide management, and influence counseling.

Recent findings: Emerging evidence demonstrates that de novo single-nucleotide variants, copy number variants, mitochondrial variants, and, rarely, repeat expansions contribute significantly to CP, particularly when neuroimaging is normal, progression is atypical, or additional neurodevelopmental features are present. Diagnostic yield is highest in these contexts. Trio-based whole-exome sequencing is recommended as first-line testing, supported by chromosomal microarray or whole-genome sequencing. Integration of genomic testing remains limited by inconsistent CP definitions, restricted test access, and under-recognition of genetic etiologies, especially in adults. Standardized CP classification frameworks, such as SCPE (Surveillance of Cerebral Palsy in Europe), combined with early genomic evaluation, can improve diagnostic accuracy, reveal treatable conditions, and enable precision care. This approach has potential to transform management and outcomes across the lifespan.

Purpose of review: To gather (almost) all (reasonable) theories of phenomenal consciousness, describe them neutrally (largely in the words of their authors), and organize them in a comprehensive, cross-disciplinary taxonomy of categories-"Landscape of Consciousness." Perhaps the process can encourage novel ways of thinking among medical (psychiatry/neurology) practitioners and neuroscientists.

Recent findings: Landscape organizes more than 350 explanations of phenomenal consciousness across physicalist and non-physicalist traditions. There are 10 primary categories: Materialism. Non-Reductive Physicalism. Quantum & Dimensions. Information. Panpsychisms. Monisms. Dualisms. Idealisms. Anomalous & Altered States.

Challenge: Materialism, with the largest number of theories by far, has 12 subcategories: Philosophical. Eliminative/Illusionism. Neurobiological. Electromagnetic Field. Computational & Functionalism. Homeostatic & Affective. Embodied & Enactive. Relational. First-order. Higher-order. Language. Phylogenetic/Evolutionary. Representative theories are here summarized as (non-exhaustive) examples. The Landscape of Consciousness is a work-in-process-permanently. Two central theses: (i) understanding phenomenal consciousness at this point should not be restricted to selected ways of thinking or constrained by approved modes of knowing, but should rather seek expansive yet rational diversity, and (ii) issues of sentience, such as AI consciousness, virtual immortality, meaning/purpose, free will, life after death, etc., cannot be understood except in the light of particular theories of consciousness. Implications for psychiatry/neurology and neuroscience may be considered.

Purpose of review: To summarise contemporary strategies to detect atrial fibrillation (AF) after stroke/transient ischemic attack (TIA) with emphasis on implantable loop recorders (ILRs), evaluate who should receive anticoagulation in device detected AF/atrial high-rate episodes, and evaluate biomarkers that increase the likelihood of detecting AF.

Recent findings: ILRs substantially increase AF detection beyond 12-36 months of monitoring. General population screening with ILRs increases AF diagnosis without a definitive stroke reduction. For subclinical/device detected AF, anticoagulation may reduce stroke but comes at the expense of increased bleeding. The burden of AF, biomarkers and atrial cardiomyopathy markers show promise to stratify risk and guide extended monitoring. An individualized approach is needed to identify who benefits most from ILR and subsequent anticoagulation. Research priorities include outcome-powered trials after stroke/TIA, the role of AF burden in decision making and the role of wearables within clinical pathways.

Purpose of review: To highlight the unique clinical features, risk factors, and management strategies associated with early-onset Parkinson's disease (EOPD), and contrast these with late-onset Parkinson's disease (LOPD). We outline how these differences influence diagnostic and therapeutic approaches and identify key knowledge gaps critical to improving clinical care.

Recent findings: Compared to LOPD, EOPD (onset age 21-50) has a higher prevalence of monogenic risk factors, focal dystonia, depression, anxiety; slower motor progression; lower rates of cognitive decline; higher risk for delayed diagnosis. Treatment is complicated by earlier and more frequent dyskinesias, motor fluctuations, and unique considerations such as pregnancy and career impact. Risk factors, clinical presentation, progression, and management needs of EOPD can differ from LOPD. Despite advances in characterizing and diagnosing EOPD, most research remains focused on LOPD. There is a critical need to tailor research and clinical trials to address the distinct needs of people with EOPD.