Current Neurology and Neuroscience Reports最新文献

Purpose of review: Headache in the context of stroke is common and represents significant morbidity in the acute and outpatient settings. This article reviews recent research on the incidence, pathophysiology and management of headache secondary to ischemic and hemorrhagic stroke.

Recent findings: Multiple studies have attempted to characterize the incidence and risk factors of post-stroke headache. Some studies regarding proposed pathophysiology exist but no clear consensus has been reached. Management strategies are limited and are typically guided by harm reduction rather than efficacy. There are some studies indicating that procedural based therapies can be both safe and effective with multiple ongoing trials focusing on ganglion blocks. The use of calcitonin-gene related peptide based therapies are limited in this setting with no robust evidence to its safety or efficacy. Headache following ischemic stroke and hemorrhagic stroke is prevalent and likely impedes recovery and quality of life. Management options are limited, though studies show promising initial results and trials are ongoing.

Purpose of review: Antithrombotic-associated intracerebral hemorrhage (ICH) is associated with high rates of morbidity and mortality. Rapid and effective antithrombotic reversal is critical for mitigating risk of hemorrhage expansion and neurological deterioration. This review provides an overview of the most recent advances in emergency antithrombotic reversal in ICH.

Recent findings: Rapid coagulopathy reversal within the first 60-90 min of hospital presentation may limit massive ICH expansion and improve outcomes. Current data suggests reversal of vitamin K antagonists with intravenous vitamin K and 4-factor prothrombin complex concentrates (4f-PCC), reversal of dabigatran with idarucizumab, and reversal or direct oral factor Xa inhibitors with either 4f-PCC or andexanet-alfa. While platelet transfusion is not suggested for antiplatelet-associated ICH, DDAVP may be reasonable, and a new reversal agent is under development for ticagrelor. Rapid reversal of antithrombotic-associated coagulopathy in the context of ICH may prevent ICH expansion and improve neurological outcomes.

Purpose of review: To review the pathophysiology, clinical presentation, evaluation methods, and current treatment strategies of nocturnal hypokinesia and early morning OFF in Parkinson's disease. A comprehensive literature search was conducted using PubMed, ScienceDirect, and the Cochrane Library for relevant treatment strategies.

Recent findings: We identified 31 clinical trials. Pharmacologic treatments include standard and sustained-release levodopa, dopamine agonists (rotigotine, ropinirol, pramipexole, and apomorphine), MAO-B inhibitors (rasagiline, safinamide), COMT inhibitors (opicapone), and rescue therapies like inhaled or dispersible levodopa or apomorphine injection. We propose a tiered treatment algorithm based on disease stage and symptom severity. Non-pharmacological treatment is recommended in all stages. For mild, disturbing symptoms in early PD, inhaled or dispersible levodopa or apomorphine injection are advised. In moderate to advanced stages, treatment options include long-acting dopamine agonists, MAO-B inhibitors, sustained-release levodopa, or COMT inhibitors selected based on factors such as daytime motor symptoms, and non-motor symptoms.

Purpose of review: This article aims to summarize the key evidence supporting the use of non-invasive neuromodulation devices in the treatment of various headache disorders in adults and children.

Recent findings: Over the last decade, different modalities have emerged for the non-invasive management of various headache disorders, with increasing evidence in recent years demonstrating their safety and efficacy in the treatment of migraine and trigeminal autonomic cephalgias, as well as other headache disorders. These devices include external trigeminal nerve stimulation (eTNS), transcutaneous electrical nerve stimulator (TENS), single-pulse transcranial magnetic stimulation (sTMS), non-invasive vagus nerve stimulation (nVNS), remote electrical neuromodulation (REN), and external concurrent trigeminal and occipital nerve neurostimulation (eCOT-NS). These non-pharmacologic options for the management of headache are safe, have evidence to support their use, and they are a particularly appealing option for patients vulnerable to the side effects of pharmacologic treatments or those who are looking to avoid them.

Purpose of review: Despite decades of research, intraventricular hemorrhage (IVH) remains a devastating condition with high morbidity and mortality. Traditional external ventricular drains (EVDs) have long served as the cornerstone of surgical management but are limited by various complications. This review evaluates recent literature on continuous ventricular irrigation as an alternative approach to treating IVH.

Recent findings: Early data surrounding continuous ventricular irrigation systems, including retrospective comparative studies and case series are encouraging. However, existing randomized data are limited by small sample size and methodological flaws. Larger, ongoing studies such as ACTIVE and ARCH aim to provide more definitive evidence. Continuous ventricular irrigation offers theoretical and practical advantages over static drainage in IVH patients, including enhanced clot clearance and improved catheter patency, particularly when combined with continuous thrombolytic therapy. Optimized protocols for irrigation rates, medication dosing, and timing are still being investigated. Robust clinical trials are necessary to validate the approach and establish best practices.

Purpose of review: Neurogenetic disorders associated with hearing loss represent a rapidly expanding field, with recent gene discoveries revealing convergent mechanistic themes affecting both the nervous and auditory systems. Collectively, these findings highlight shared vulnerabilities of neural and auditory tissues. We summarize gene discoveries from 2021 to 2025, moving beyond classic syndromes to highlight newly implicated genes within mechanistic categories and discuss their implications for diagnosis, counseling, and therapeutic development.

Recent findings: We describe 38 genes with combined neurodevelopmental and auditory phenotypes, providing an updated view of the field. We explore common developmental pathways and, when possible, propose explanations for the variable expression of hearing impairment observed across disorders. A deeper understanding of the mechanisms linking the nervous and auditory systems is essential for clarifying the pathogenesis of auditory syndromes. The emerging picture underscores that hearing loss can serve as an early marker of systemic neurogenetic disease that may offer a window of opportunity for timely intervention.

Purpose of review: Biosensors and digital tools may enhance monitoring of people with multiple sclerosis (MS) and support timely, data-driven clinical decisions. We review current and emerging applications of biosensors to monitor function in MS.

Recent rindings: Biosensors track diverse physiological and kinetic metrics, allowing assessment of function across several key domains in MS, including physical activity, circadian rhythmicity, gait, balance, fine motor function, and bladder control. A consistent cross-study finding is that novel technologies reliably capture subtle abnormalities that are often missed by traditional assessment methods. Digital health technologies hold significant promise for transforming MS care by enabling precise, continuous monitoring of functional status and disease progression. They may facilitate personalized management, allowing clinicians to tailor interventions based on each person's unique disease trajectory. Further studies are essential to validate the predictive value and responsiveness of these tools and ensure their effective integration into clinical practice and trials.

Purpose of review: This article reviews recent literature on the association between migraine and trauma, particularly adverse childhood experiences (ACEs). It makes recommendations for research and clinical practice.

Recent findings: ACEs are prevalent and associated with lifetime morbidity and mortality. Observational studies have elucidated the association between migraine and ACEs. Emerging literature highlights a dose-dependent relationship between incident migraine and ACEs. ACEs have been linked with migraine-related outcomes in both children and adolescents as well as adults. However, the mechanisms linking ACEs to migraine remain poorly understood. Principles of, and approaches to, trauma-informed care in other populations can be drawn from, expanded, and extended to the context of migraine. We highlight the need for trauma-informed clinical care. We provide specific suggestions for how clinicians can integrate trauma-informed approaches in their clinical practice to improve patient outcomes. Finally, we make recommendations on how the field can advance research.

Purpose of review: Infections as a risk factor for stroke remain an underrecognized issue within the medical community although this link was identified for more than 60 years. Preceding infections acting as triggers or even causal factors for ischemic and hemorrhagic stroke were assessed notably for tropical infections.

Recent findings: Since the COVID 19 pandemic, the interest for all kind of infectious agents (bacteria, viruses, fungi, parasitosis) is becoming an emerging concern worldwide. Surprisingly, this risk is addressed only in classification of causes concerning young adults and children. In addition, the seasonality of meteorological conditions (temperature, humidity, rain patterns) probably obscured the underlying causes such as epidemic infections and air pollution peaks (which can act in synergy, notably for respiratory infections). Greater recognition of infection-related stroke risk is essential, especially given the potential for increased incidence driven by global warming, the availability of biomarkers for risk assessment, and the opportunities improving preventive and therapeutic strategies.

Purpose of review: Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia notable for its association with the later development of diseases with pathological α-synuclein deposition, including Parkinson's Disease (PD), Dementia with Lewy Bodies (DLB), and Multiple System Atrophy (MSA). The goal of this review is to summarize the recent advances in characterizing the clinical deficits, neuroimaging characteristics, and biomarker assay development of individuals with RBD.

Recent findings: Clinical research indicates that many people with RBD are presenting to clinical attention for reasons other than dream enactment behavior. They experience deficits in neuropsychiatric, autonomic, and motor domains and co-presentation of these features with RBD predict a faster rate of phenoconversion to PD, DLB, or MSA. RBD is considered a prodromal synucleinopathy with early abnormalities in α-synuclein protein pathways, together with inflammation and mitochondrial dysfunction being recognized as key pathophysiological mechanisms. Seed amplification assays for α-synuclein in various tissue types hold tremendous promise for antemortem diagnosis. RBD is clearly an at-risk population for neurodegenerative disease with well-defined measures that can refine enrollment and better target prodromal populations for interventional clinical trials. The first neuroprotective trials are underway.