Current Neurology and Neuroscience Reports最新文献

Purpose of review: The current review aims to address critical gaps in the field of stroke rehabilitation related to sensory impairment. Here, we examine the role and importance of sensation throughout recovery of neural injury, potential clinical and experimental approaches for improving sensory function, and mechanism-based theories that may facilitate the design of sensory-based approaches for the rehabilitation of somatosensation.

Recent findings: Recently, the field of neurorehabilitation has shifted to using more quantitative and sensitive measures to more accurately capture sensory function in stroke and other neurological populations. These approaches have laid the groundwork for understanding how sensory impairments impact overall function after stroke. However, there is less consensus on which interventions are effective for remediating sensory function, with approaches that vary from clinical re-training, robotics, and sensory stimulation interventions. Current evidence has found that sensory and motor systems are interdependent, but commonly have independent recovery trajectories after stroke. Therefore, it is imperative to assess somatosensory function in order to guide rehabilitation outcomes and trajectory. Overall, considerable work in the field still remains, as there is limited evidence for purported mechanisms of sensory recovery, promising early-stage work that focuses on sensory training, and a considerable evidence-practice gap related to clinical sensory rehabilitation.

Purpose of review: The benefits of acute stroke unit care, with nurses as central figures, are well-documented. As care bundles gain traction to enhance evidence-based nursing care, this review explores their development and adaptation in a setting where stroke care is integrated into general neurology. It also highlights key elements for reinforcing competence and interdisciplinary support.

Recent findings: Most evidenced based acute stroke unit recommendations focus on hyperacute medical management. In comparison, the literature on decision-making for selecting and evaluating key components of nursing surveillance to support specialized stroke care in geographically smaller settings is sparse although the benefits of nursing care bundles is emerging. Well-structured care bundles, grounded in robust evidence and supported by thorough documentation and effective implementation strategies, provide a clear framework for nursing care, facilitate continuous monitoring, and are useful for enhancing practices especially in smaller stroke units that lack the resources of more comprehensive state-of-the-art units. Tailoring stroke nursing care bundles to local contexts requires an adaptable approach.

Purpose of review: We provide an overview of the field of microbiome research, the current understanding of the microbiome-gut-brain axis, and the most recent updates on the interplay between migraine and the gut microbiome.

Recent findings: Pre-clinical studies suggest that gut microbiota is required for normal pain sensation. There is also evidence in rodent models that there is potential application of food, herbal medicines, probiotics, and short chain fatty acids (SCFAs) as novel therapies for migraine. Evidence from human cohorts suggests that there is altered gut microbiota in people with migraine, and that the microbiome dysbiosis is from both compositional and functional aspects. Recent metagenome-wide association studies (MWAS) that employ Mendelian Randomization support the causal association between gut microbiota and migraine. The connection between migraine and the gut microbiome remains underexplored, but recent preclinical and clinical studies support the association between gut microbiota and the development of migraine.

Purpose of review: This review investigates the use of machine learning (ML) in prognosticating outcomes for traumatic brain injury (TBI). It underscores the benefits of ML models in processing and integrating complex, multimodal data-including clinical, imaging, and physiological inputs-to identify intricate non-linear relationships that traditional methods might overlook.

Recent findings: ML algorithms of clinical features, neuroimaging, and metrics from the autonomic nervous system enhance the early detection of clinical deterioration and improve outcome prediction. Challenges persist, including issues of data variability, model interpretability, and overfitting. However, advancements in model standardization and validation are key to enhancing their clinical applicability. ML-based, multimodal approaches offer transformative potential for personalized treatment planning and patient management. Future directions include integrating digital twins and real-time continuous data analysis, reinforcing the idea that comprehensive data amalgamation is essential for precise, adaptive prognostication and decision-making in neurocritical care, ultimately leading to better patient outcomes.

Purpose of review: Epilepsy has long been considered a late-stage consequence of Alzheimer's Disease (AD), but recent studies highlight its role early in the disease process, even preceding cognitive symptoms. Population studies reveal a two- to fourfold increased epilepsy risk in AD, particularly in early-onset cases, with seizures clustering around diagnosis. Furthermore, individuals with late-onset unexplained epilepsy have an elevated risk of developing mild cognitive impairment and dementia, underscoring a bidirectional relationship between AD and epilepsy.

Recent findings: Experimental models support this connection, demonstrating amyloid and tau pathology-induced hyperexcitability at pre-symptomatic stages, implicating soluble Aβ oligomers and inhibitory interneuron dysfunction in excitatory/inhibitory imbalance. Subclinical or clinical epileptiform activity, detectable in 20-50% of AD patients, is associated with cognitive decline, possibly due to sleep-related memory consolidation disruption. Emerging biomarkers, such as TIRDA and high-frequency oscillations, show promise for early detection and intervention. Anti-seizure medications (ASMs), particularly low-dose levetiracetam, show potential not only for seizure control but also for mitigating amyloid deposition, tau hyperphosphorylation, and cognitive decline. However, treatment complexities remain due to variable ASM efficacy, age-related side effects, and limited clinical trials. The bidirectional nature of AD and epilepsy emphasizes the need for integrated diagnostics, including EEG and biomarker assessments, to guide early intervention and targeted therapies. Future research should focus on the mechanistic interplay between amyloid, tau, and hyperexcitability, alongside trials of ASM regimens, to refine therapeutic strategies and improve outcomes in this population.

Purpose of review: Rehabilitation is the mainstay of recovery after stroke, but key recommendations focused on delivering 'as much therapy as possible' and stroke survivor outcome measures have remained relatively unchanged for decades. Traditional therapy approaches focus on maximum improvement of physical impairments while a stroke survivor is in hospital to ensure that community discharge can be deemed 'safe'. This narrow approach sidelines the outcomes that are meaningful to the stroke survivor in the long term and the challenges they may face within their social context. In this article, we highlight the importance of the whole-person approach and review recent research introducing novel considerations to optimise outcomes after stroke.

Recent findings: Psychosocial well-being is a major component of health but is poorly acknowledged and managed for stroke survivors. Evidence supports the use of self-management interventions, peer befriending, and culturally - responsive methods, including deep engagement with Indigenous and cultural knowledge. Cultural safety and involvement of a stroke survivor's important personal connections are also vital for achieving truly person-centred care and equity in rehabilitation outcomes. Outcomes in rehabilitation will be optimised if we shift our mindsets from a sole focus on improving physical impairments to a broader scope of delivering whole-person care.

Purpose of review: Autosomal dominant cerebellar ataxias, also known as spinocerebellar ataxias (SCAs), are genetically and clinically diverse neurodegenerative disorders characterized by progressive cerebellar dysfunction. Despite advances in sequencing technologies, a large proportion of patients with SCA still lack a definitive genetic diagnosis. The advent of advanced bioinformatic tools and emerging genomics technologies, such as long-read sequencing, offers an unparalleled opportunity to close the diagnostic gap for hereditary ataxias. This article reviews the recently identified repeat expansion SCAs and describes their molecular basis, epidemiology, and clinical features.

Recent findings: Leveraging advanced bioinformatic tools and long-read sequencing, recent studies have identified novel pathogenic short tandem repeat expansions in FGF14, ZFHX3, and THAP11, associated with SCA27B, SCA4, and SCA51, respectively. SCA27B, caused by an intronic (GAA)•(TTC) repeat expansion, has emerged as one of the most common forms of adult-onset hereditary ataxias, especially in European populations. The coding GGC repeat expansion in ZFHX3 causing SCA4 was identified more than 25 years after the disorder's initial clinical description and appears to be a rare cause of ataxia outside northern Europe. SCA51, caused by a coding CAG repeat expansion, is overall rare and has been described in a small number of patients. The recent identification of three novel pathogenic repeat expansions underscores the importance of this class of genomic variation in the pathogenesis of SCAs. Progress in sequencing technologies holds promise for closing the diagnostic gap in SCAs and guiding the development of therapeutic strategies for ataxia.

Purpose of review: In low-grade glioma (LGG), besides the patient's neurological status and tumor characteristics on neuroimaging, current treatment guidelines mainly rely on the glioma's genetics at diagnosis to define therapeutic strategy, usually starting with surgical resection. However, this snapshot in time does not take into account the antecedent period of tumor progression and its interactions with the brain before presentation. This article reviews new concepts that pertain to reconstruct the history of previous interplay between the LGG's course and adaptive changes in the connectome within which the glioma is embedded over the years preceding the diagnosis.

Recent findings: Microscale and macroscale parameters helpful for extrapolating backward in time are considered, both for the glioma (kinetics, migration vs. proliferation profile, metabolism with possible intratumoral heterogeneity, relationships with surrounding cerebral pathways) and for patterns of reconfiguration within and across neural networks in reaction to the LGG leading to considerable interindividual cerebral variability. Modelling these continuous variations at the time of LGG diagnosis is a prerequisite to predict recovery from treatment(s). It is important to go beyond the biology of the LGG at a given moment of its history, and instead construct a more comprehensive picture of the past and present dynamics of glioma-brain interactions, and their ongoing evolution, as a necessary stage to optimize a personalized management plan by thinking several steps ahead.

Purpose of review: Mobilization in the Neurological Intensive Care Unit (NICU) significantly improves outcomes and functional recovery while preventing immobility-related complications. The heterogeneity of neurologic conditions necessitates tailored, interdisciplinary mobilization strategies. This article reviews recent research on enhancing the feasibility and effectiveness of mobilization interventions in NICU settings.

Recent findings: Early mobilization improves functional outcomes, reduces complications like muscle atrophy and pressure ulcers, and can shorten ICU stays. Safe implementation involves individualized protocols and a multidisciplinary team, emphasizing that early mobilization benefits critically ill neurological patients. Development of evidenced-based protocols for interdisciplinary NICU patient mobilization enhances patient outcomes and quality of life. Use of outcome measures can facilitate mobility while preventing complications from immobility. Future research in embracing emerging technologies such as mobilization equipment and virtual/augmented reality will help determine optimal timing as well as dosage of mobility to improve long-term functional outcomes in the unique NICU population.

Purpose of review: Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (SAH) is the most influential clinical determinant of outcomes. Despite significant advances in understanding of the pathophysiology of EBI, currently no treatments to target EBI have been developed. This review summarizes recent advances in EBI research over the past five years with a focus on potential therapeutic targets.

Recent findings: Mechanism-specific translational studies are converging on several pathophysiologic pathways: improved antioxidant delivery and the Sirt1/Nrf2 pathway for reactive oxygen species; NLRP3 inflammasome and microglial polarization for inflammation; and the PI3K/Akt pathway for apoptosis. Recently identified mechanistic components, such as microcirculatory failure and ferroptosis, need particular attention. Clinical studies developing radiographic markers and mechanism-specific, biofluid markers are attempting to bridge the translational therapeutic gap. There has been an exponential growth in EBI research. Further clinical studies which address specific pathophysiology mechanisms need to be performed to identify novel therapeutic approaches.