Current Opinion in Neurology最新文献

Purpose of review: Ischemic stroke remains a leading cause of death and disability worldwide, with carotid atherosclerosis as a major underlying mechanism. For decades, treatment decisions were based primarily on luminal stenosis, overlooking the biological complexity of plaque instability. This review summarizes recent progress in the imaging-based identification and risk stratification of unstable cerebrovascular plaque, emphasizing the transition from geometric to biological evaluation.

Recent findings: Advances in CT, MRI, and ultrasound have enabled in vivo visualization of key features associated with plaque vulnerability, including intraplaque hemorrhage, fibrous cap rupture, neovascularization, inflammation, and perivascular fat alterations. Dual-energy and photon-counting CT now provide spectral and spatial information capable of tissue differentiation at submillimeter scales. MRI offers superior soft-tissue characterization, while contrast-enhanced ultrasound reveals microvascular activity and flow dynamics. The recent introduction of standardized interpretative systems, such as Plaque-reporting and data system (RADS), allows integration of multimodal findings into a unified risk framework.

Summary: Contemporary imaging has transformed the assessment of carotid atherosclerosis from a static measurement of stenosis into a dynamic, biology-driven discipline. The combination of advanced imaging, quantitative analysis, and emerging molecular and genetic correlates promises to refine individualized risk prediction and guide targeted prevention strategies for cerebrovascular disease.

Purpose of review: This review highlights recent advances in neuro-vestibular rehabilitation, with emphasis on vestibular adaptation and emerging mobile technologies. It summarizes developments in promoting vestibular plasticity and discusses novel tools such as virtual reality, wearable sensors, and telehealth platforms that enhance access, engagement, and outcomes. The scope is broad, focusing on general principles rather than specific populations.

Recent findings: New methods to enhance vestibulo-ocular reflex (VOR) adaptation include incremental adaptation devices and gamified exercises. Inducing VOR gain-down adaptation temporarily increases postural sway, which normalizes via sensory reweighting, demonstrating central compensation. Portable tools like StableEyes show promise in boosting VOR gain with brief sessions. Concurrently, technology-driven approaches are gaining traction. Gamified mobile applications and wearable sensors allow home-based rehabilitation with remote supervision and monitoring, showing promising results in conditions like multiple sclerosis. Virtual reality interventions and telehealth models accelerated during the COVID-19 era, expanding therapy delivery to underserved populations. Adjunctive methods such as vibrotactile feedback and galvanic vestibular stimulation are emerging as complementary therapies.

Summary: Recent developments are advancing vestibular rehabilitation by refining adaptive training techniques and leveraging digital tools to overcome barriers in access and adherence. These innovations point to a more personalized, technology-enabled approach to optimizing neuro-vestibular recovery.

Purpose of review: Vestibular migraine (VM) is a prevalent yet underdiagnosed cause of vestibular symptoms, which overlaps with other vestibular and migraine-related conditions. This review focuses on detailed clinical phenomenology, alongside comorbidities, and the appraisal of emerging therapies.

Recent findings: Recent work shows that migraine-associated features such as allodynia, photophobia, and movement sensitivity sharpen clinical discrimination. Premonitory and cognitive symptoms, including brain fog and executive slowing, are increasingly recognized. Chronobiological factors such as menstrual cycle and menopause modulate susceptibility. Oculomotor assessment and neuroimaging point to disturbed integration across vestibular, sensorimotor, and visual networks rather than focal lesions. Comorbid persistent postural-perceptual dizziness, dysautonomia, and autoimmune tendencies complicate diagnosis and management. Early trials support calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxin-A, with lifestyle interventions, and nutraceuticals commonly being used, although clinical trial designs and endpoints remain heterogeneous.

Summary: VM reminds us that bedside examination remains the anchor: a detailed history, eye-movement examination, and context refine diagnosis. Objective markers and interdisciplinary strategies assist rather than replace clinical judgement. Further studies should integrate multimodal assessment and phenotype-guided treatment stratification.

Purpose of review: Patients with grade 2 and 3 meningioma have high recurrence rates and limited treatment options after failure of radiation and surgery. Recent advances in molecular profiling of these tumors have enabled the investigation of novel targeted therapeutic approaches.

Recent findings: Innovative treatment strategies under investigation for recurrent high-grade meningiomas include targeted therapies, immunotherapy, and radionuclide-based approaches. Inhibition of angiogenesis, histone deacetylases, FAK, mTOR, and CDK4/6 pathways has shown early signs of activity in small clinical trials of patients with recurrent meningiomas. Immunotherapy, such as immune checkpoint inhibition (ICI), has also demonstrated prolonged disease control in a subset of patients. Larger randomized studies are needed for further investigation of the efficacy and safety of these newer therapies in patients with high-grade and recurrent meningioma.

Summary: Emerging molecularly driven treatment strategies show promise for the treatment of patients with high-grade meningiomas. Larger trials that incorporate molecular testing are warranted to fully evaluate their therapeutic potential.

Purpose of review: Recovery after spinal cord injury (SCI) is variable, and the contribution of locomotor training to neurological and functional outcomes remains debated. This review summarizes post-SCI locomotor recovery patterns, compares training modalities, and presents recovery findings from the Kunming Locomotor Training (KLT) program, one of the largest reported series of patients with initial complete (AIS A) injuries.

Recent findings: Several months of intensive task-specific overground training yielded substantial gains in neurological, locomotor, and autonomic outcomes. In a retrospective cohort of 485 AIS A patients, 47% improved their AIS grade, while nearly all showed some locomotor recovery measured by the Kunming Locomotor Scale (KLS). A ≥4-point KLS gain strongly predicted AIS conversion (sensitivity 83%, specificity 82%). Recovery probability was highest with lower thoracic and lumbar injuries. Improvements, including ambulation with assistive devices, and significant bladder and bowel recovery occurred even without AIS change. These outcomes reinforce the importance of active, patient-driven training.

Summary: KLT experience indicates that prolonged, intensive overground locomotor training can promote neurological and functional recovery in individuals with initially complete injuries. KLS provides a sensitive measure of functional progress. These findings underscore the clinical value of task-specific stepping and provide a new benchmark for evaluating sustained rehabilitation strategies and research into post-SCI recovery.

Purpose of review: Accurate and reliable determination of tumor response and progression on neuroimaging is critical to identify effective therapies for glioma in clinical trials. In this article, we review response assessment criteria for adult glioma including their evolution over time, current recommendations, limitations, and future directions.

Recent findings: Response Assessment in Neuro-Oncology (RANO) 2.0 delineates unified magnetic resonance imaging (MRI)-based criteria informed by patient data to evaluate endpoints of tumor response and tumor progression. The positron emission tomography (PET) RANO 1.0 criteria propose endpoints for tumor progression and response on amino acid PET imaging.

Summary: The RANO 2.0 criteria provide standardized recommendations to assess tumor response and progression across adult glioma clinical trials regardless of tumor grade, contrast enhancement, molecular profile or treatment modality. Additional validation and exploratory studies can facilitate future refinements to the criteria and possible incorporation of novel neuroimaging endpoints. Advanced imaging modalities such as perfusion MRI and amino acid PET may help overcome some limitations of MRI-based response assessment.

Purpose of review: Chimeric antigen receptor (CAR) T-cell therapies are increasingly used in hematologic malignancies and are now being investigated in autoimmune disorders. This review aims to summarize the spectrum of neurological complications associated with CAR-T.

Recent findings: While early-onset neurotoxicity is well characterized, other neurological syndromes are increasingly reported. Neurological complications can be provisionally classified into three categories: early-onset immune effector cell-associated neurotoxicity syndrome (ICANS); delayed-onset neurological syndromes specific to single CAR T-cell types; and tumour inflammation-associated neurotoxicity (TIAN). Other postinfusion neurological syndromes have also been observed but with uncertain links to CAR T-cells. Management must be tailored to preserve both neurological function and CAR T-cell efficacy. Ongoing efforts target biomarker development, and risk-adapted strategies, especially in steroid-refractory cases.

Summary: As CAR T-cell indications broaden, clinicians must recognize diverse neurological toxicities and implement individualized, evidence-based interventions to improve neurological outcomes.

Purpose of review: Spinal cord injury (SCI) causes profound gait impairment and autonomic dysfunction. Deep brain stimulation (DBS) of supraspinal locomotor centers may strengthen spared descending motor and autonomic pathways to improve walking. Preclinical and clinical studies have targeted the cuneiform nucleus (CnF) and pedunculopontine nucleus (PPN) of the mesencephalic locomotor region (MLR) and the lateral hypothalamus. To summarize recent progress in DBS as a strategy to facilitate locomotion with a particular focus on SCI.

Recent findings: DBS of the CnF, PPN, and lateral hypothalamus enhances gait and cardiorespiratory function in animal models and early human trials. Directional electrodes and individualized programming appear to reduce risks and optimize efficacy. Evidence suggests DBS can amplify supraspinal command circuits, supporting locomotor facilitation after injury.

Summary: DBS of MLR and lateral hypothalamus circuits represent a promising therapeutic approach for gait recovery in SCI. Key priorities for future clinical trials include stratification by injury severity, monitoring of autonomic outcomes, and assessment of long-term effects on mobility and quality of life. Integration with physiotherapy may further augment recovery. Collectively, current findings support DBS as an emerging intervention to restore locomotor function following SCI. The use of DBS for motor recovery after SCI is investigational.

Purpose of review: In this review, we discuss electrical and optogenetic technologies for stimulating the spinal cord to improve movement after spinal cord injury (SCI).

Recent findings: Paralysis or paresis following SCI severely impairs control and movement of the extremities. Restoring movement in the upper and lower extremities is a top priority for this population. Invasive and noninvasive electrical stimulation of the spinal cord can modulate the activity of spinal circuits, resulting in improvements in motor and sensory function. More recently, optogenetic stimulation has emerged as another technique capable of modulating spinal circuity to facilitate movement recovery in animal models. Recent studies are offering new insights into the effects of parameter selection, multisite stimulation, and the combined effects of stimulation and wearable robotic exoskeletons, all with the goal of restoring movement after SCI.

Summary: Modulating the activity of the spinal cord via electrical and optogenetic stimulation is a promising intervention for improving movement after SCI. Future studies should determine optimal stimulation parameters, synergistic effects when combined with wearable robotics, and the safety of optogenetics in the human spinal cord. Such work will best position these emerging technologies for clinical translation.

Purpose of review: Spinal cord stimulation (SCS) for pain control and movement recovery have developed under parallel conceptual frameworks. SCS for pain has traditionally targeted the dorsal columns, while SCS for movement recovery has targeted the large-diameter afferent fibers near the dorsal root entry zone. We review the evidence to support these parallel mechanistic frameworks and explore potential mechanistic overlap between the two fields.

Recent findings: Recent advances in closed-loop stimulation for pain and dorsal root (DR) stimulation for movement recovery speak to the value of these parallel mechanistic models in each field. However, review of the devices, electrode placement, and stimulation parameters used in both fields reveals overlap in the doses of SCS considered effective in each. Furthermore, evidence from finite element modeling suggests overlapping recruitment of dorsal column and dorsal root fibers from both midline and lateral stimulation.

Summary: There is evidence to support overlapping mechanisms of SCS for pain and movement recovery. The implications of potential mechanistic overlap warrant further investigation.