Current Neurology and Neuroscience Reports最新文献

Purpose of review: Cardiovascular conditions and related risk factors are an important and common group of diseases. Stroke is a disease that requires rapid diagnosis and treatment, and there are significant inequalities in stroke diagnosis, treatment and follow-up between countries, regions, societies and economic levels. This inequality becomes even more evident in regions where war and turmoil continue. What is the goal of your paper? What questions did you seek to answer? This review aims to explore whether war and armed conflicts impact stroke and care and describe potential mechanisms and solutions.

Recent findings: There is some evidence for a relationship between war and stroke epidemiology, clinical presentations, and health system barriers in current and post-conflict settings. Summarize the latest research on your topic. There is increasing research focusing on this subject. War and conflict zones have impact on stroke related to decreased access to stroke care facilities and increassed harmful effects of environmental factors, such as infections and stress. What answers did you find? What are the major takeaways/conclusions of your examination? What's the impact on future research? War imposes a significant neurological burden through direct injury, psychological trauma, infections, and disrupted care. Addressing this requires integrated care models, research investment, and international cooperation to mitigate the long-term disability in post-conflict populations. New systems must be established to reduce war related stroke burden to develop rapid-response neurology and stroke care units in conflict zones, improve tele-stroke and neurology for remote care delivery, and long-term registries for war-related stroke and other neurological outcomes. There is urgent need for stroke surveillance, prevention, and care strategies tailored to war-affected populations.

Purpose of review: There is increasing interest in the study of exercise training as an approach to treat the cognitive consequences of multiple sclerosis (MS). The current paper reviews recent research on exercise training effects on cognition in MS, and provides several future directions for guiding, and perhaps optimizing, research in this area.

Recent findings: Overall, the newest evidence in this field is associated with substantial heterogeneity in study characteristics (i.e., sample sizes, demographic/clinical characteristics, exercise interventions, control/comparator conditions). The studies further focused on different primary outcomes, such that cognition is inconsistently included as a primary outcome. As a result, the study results were heterogeneous overall. Collectively, evidence on exercise training as an approach to improve cognition in persons with MS over the past two decades is mixed, and the efficacy or effectiveness of such an approach has not yet been established. Based on recently published studies, we believe that future research will involve stronger, better-designed RCTs that evaluate exercise, as a standalone and/or combinatory approach for improving cognition in MS, that are founded upon hypothesized mechanisms-of-action regarding adaptations in the central nervous system.

Purpose of review: This review examines the evolving field of neurocardiology, tracing its development from early homeostatic theories to modern understandings of the bidirectional neural networks that link the heart and brain. We propose an integrative framework to explain neuro-cardiac interactions in health and disease, with a focus on clinical applications and emerging therapies.

Recent findings: The neuro-cardiac axis comprises hierarchical neural networks, from the intrinsic cardiac nervous system to subcortical and cortical brain regions. This structure underlies a range of clinical syndromes. Acute brain injuries can induce cardiac dysfunction via autonomic dysregulation, as seen in neurogenic stunned myocardium (NSM), while cardiac disease contributes to cerebral small vessel disease (CSVD) and cognitive decline. Cardioception-the brain's processing of cardiac signals-is increasingly recognized as a key mediator of autonomic control and emotional experience. Clinical trials highlight the value of targeted interventions, including extended cardiac monitoring to detect occult atrial fibrillation, improved risk stratification for managing patent foramen ovale, and intensive vascular risk control for cerebrovascular protection. Growing awareness of neuro-cardiac pathways is reshaping clinical care. Understanding how brain insults provoke cardiac dysfunction via disrupted autonomic outflow is critical, particularly in NSM. Meanwhile, cardioception is gaining relevance as a therapeutic target in the regulation of emotions and the autonomic nervous system. Conversely, cardiac pathology promotes stroke, CSVD, and cognitive impairment not only through embolism but also through altered perfusion and autonomic imbalance. Comprehensive management of modifiable vascular risks confers dual protection for the heart and brain. Interdisciplinary collaboration is increasingly vital for managing disorders along the heart-brain continuum. Translating insights from neurocardiac mechanisms into precision therapies marks a new frontier. Advances in neuroimaging, artificial intelligence, and neuromodulation offer opportunities for personalized care. The ongoing development of cross-specialty training and integrated research platforms will be essential for translating scientific progress into improved outcomes in neurocardiac disorders.

Purpose of review: Psychedelics are often queried as a potential therapeutic option in a multitude of conditions, including pain and mental health disorders, with a growing body of patient reports and scientific publications describing potential benefit. This article reviews recent research on psychedelic compounds for treatment of headache disorders.

Recent findings: Observational data, case reports, and a few recent small, controlled trials suggest symptom benefit at sub-hallucinogenic doses for both migraine and cluster headache. There have not been new completed studies of psychedelics in other headache disorders. Safety signals also tend to be favorable, although there are continuing concerns for systemic and psychiatric effects in varying doses, preparations and clinical contexts. While available studies on psychedelics suggest potential benefit in cluster headache and migraine, access remains complex due to legal considerations, and additional studies are needed to confirm their effectiveness and to ensure safety before they can be recommended for use.

Purpose of review: Dizziness is a frequent neurologic symptom in patients with headache, which overlaps with many etiologies beyond vestibular migraine. This review aims to help neurologists distinguish when dizziness is due to vestibular migraine (VM) versus other vestibular syndromes.

Recent findings: VM is now recognized as the most common cause of spontaneous episodic vertigo, with expanding diagnostic criteria, new pathophysiological insights involving CGRP, and emerging treatment strategies including anti-CGRP therapies. It overlaps with benign paroxysmal positional vertigo (BPPV), Meniere's disease, persistent postural-perceptual dizziness (PPPD), and cerebrovascular events. Novel tools such as the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) and frameworks like Timing, Triggers And Targeted Examination (TiTrATE) enhance diagnostic accuracy and patient outcomes. Differentiating VM from other causes of dizziness relies on a detailed clinical history, neurological examination, and increasingly, awareness of VM's protean features and comorbidities. Recognition is essential as treatments can differ significantly across etiologies. Future research should target biomarkers, subtypes and comparative treatment trials for VM and its mimics.

Purpose of review: Mitochondrial myopathies (MM) are a genetically and clinically heterogeneous group of disorders that remain underrecognized in adult and pediatric neurology. This review aims to provide a clinically useful tool for guiding diagnosis and management of MM. We also highlight the rapidly evolving diagnostic and therapeutic landscape, including novel diagnostic approaches and disease-modifying interventions.

Recent findings: Large cohort data highlight key clinical subtypes - fixed myopathies, syndromic forms, and metabolic myopathies- with distinct diagnostic implications. Novel tools such as GDF-15, long-read mtDNA sequencing, and multi-omic approaches are enhancing diagnostic sensitivity. Emerging therapies for TK2 deficiency and precision mitochondrial gene editing are progressing rapidly, with several nearing regulatory decisions. Numerous preclinical therapeutic strategies are currently under development, offering promise for improving outcomes in these otherwise devastating disorders. Recognizing MM in clinical settings is essential for timely diagnosis, to guide prognosis and family planning as well as provide access to emerging treatment. A tiered diagnostic approach and integration of new genomic technologies can improve outcomes.

Human and animal rights: This article does not contain any studies with human or animal subjects performed by any of the authors.

Purpose of review: To describe the different options available to collect clinical data for headache care via intake forms, questionnaires, diary, and electronic health record (EHR) and practical ways to optimize clinic flow and data integration in this era of information overload.

Recent findings: Digital technologies can be leveraged to help with data integration and processing of information. New technologies and progress with data integration have the potential to help streamline flow and improve healthcare outcomes. The benefits of new technologies must be weighed against potential ethical risks such as widening of healthcare disparities especially for those without English proficiency, technology proficiency, and those without access to internet. Concerns regarding data privacy and the potential commercialization of patient data must be addressed. The optimization of tracking tools, EHR-patient interfaces, and data integration across software is an area of ongoing work.

Purpose of review: In this narrative review, we discuss the current literature on status migrainosus (SM) in the context of the definition, epidemiology, management and prognosis.

Recent findings: SM is associated with a substantial cost burden driven by health care utilization. Individuals with SM have higher rates of ED visits, hospitalizations and progression to chronic migraine. Early treatment and preventative strategies are key aspects of the management of SM. There are a wide variety of medications utilized for the acute treatment of SM. "Bridge strategies" are often employed in an attempt to alleviate refractory pain and prevent a trip to the Emergency Department. It is important that physicians identify patients with SM and prepare them for future attacks, due to the debilitating nature of these episodes and the disease burden. Recent studies highlight the numerous approaches to managing SM. Clinicians should educate their patients about SM as a significant complication of migraine attacks, as well as develop a plan for preventative measures and early treatment of SM.