Current Opinion in Neurology最新文献

Purpose of review: This review explores the use of brain age estimation from MRI scans as a biomarker of brain health. With disorders like Alzheimer's and Parkinson's increasing globally, there is an urgent need for early detection tools that can identify at-risk individuals before cognitive symptoms emerge. Brain age offers a noninvasive, quantitative measure of neurobiological ageing, with applications in early diagnosis, disease monitoring, and personalized medicine.

Recent findings: Studies show that individuals with Alzheimer's, mild cognitive impairment (MCI), and Parkinson's have older brain ages than their chronological age. Longitudinal research indicates that brain-predicted age difference (brain-PAD) rises with disease progression and often precedes cognitive decline. Advances in deep learning and multimodal imaging have improved the accuracy and interpretability of brain age predictions. Moreover, socioeconomic disparities and environmental factors significantly affect brain aging, highlighting the need for inclusive models.

Summary: Brain age estimation is a promising biomarker for identify future risk of neurodegenerative disease, monitoring progression, and helping prognosis. Challenges like implementation of standardization, demographic biases, and interpretability remain. Future research should integrate brain age with biomarkers and multimodal imaging to enhance early diagnosis and intervention strategies.

Purpose of review: Movement disorders (MD) represent a growing healthcare challenge in India, where a diverse population and limited resources complicate diagnosis and management. This review aims to identify and categorize the systemic, socio-economic, cultural, educational, and infrastructural barriers impeding timely and effective MD care, drawing on literature spanning rural and urban contexts.

Recent findings: Recent studies show low awareness of MD treatments - such as deep brain stimulation and botulinum toxin therapy - among both patients and clinicians. Socio-economic disparities, particularly in rural areas, combine with limited specialist availability and fragmented referral systems exacerbate care gaps. Meanwhile, gender biases, stigma, and reliance on alternative medicine further delay appropriate interventions. India's partial insurance coverage and insufficient policy frameworks constrain long-term management, although select government initiatives and community-level strategies offer promise. Technological approaches, including telemedicine, show potential for expanding care access.

Summary of findings: Multiple interwoven factors hinder optimal MD care in India, diminishing patient outcomes and quality of life. Targeted educational campaigns, enhanced specialist training, improved insurance coverage, and robust policy guidance are crucial. By addressing these issues in a coordinated manner, India can significantly improve the delivery and effectiveness of MD care across its diverse regions.

Purpose of review: This review highlights recent studies examining disparities in access to deep brain stimulation (DBS), an effective but resource-intensive therapy for neurological and neuropsychiatric disorders. As DBS indications expand, understanding barriers to equitable provision is increasingly urgent to ensure that all eligible patients can benefit.

Recent findings: Emerging literature confirms persistent disparities in DBS utilization based on geography, gender, race, and socioeconomic status. Geographic disparities reflect regional differences in healthcare infrastructure, with limited access in both rural areas of high-income countries and throughout low-income and middle-income nations. Women remain less likely than men to receive DBS for movement disorders, influenced by referral patterns, social support, and patient preference. Racial and ethnic minority patients - particularly Black and Hispanic individuals - consistently receive DBS at lower rates, in part due to reduced referrals. Socioeconomic factors, including insurance status and household income, strongly predict DBS access, favoring privately insured and wealthier patients.

Summary: These findings underscore the need for systemic changes in referral practices, institutional policies, and healthcare funding to reduce structural barriers to DBS. Future research should focus on intersectional factors driving disparities and evaluate targeted interventions to promote equitable access.

Purpose of review: Viral encephalitis is a potentially devastating condition of cerebral inflammation manifest as a combination of fever, altered mentation, and sometimes focal neurological signs and seizures. In this review we explore the new developments in understanding of the epidemiology, pathogenesis and treatment options.

Recent findings: The WHO technical brief is a landmark document which sets the stage for the advancement of the surveillance, prevention and management of viral encephalitis. Adjunctive dexamethasone given in herpes simplex virus encephalitis is not associated with a worse outcome or CSF viral persistence but may not significantly improve overall outcome. Simple interventions in resource limited settings can significantly increase the proportion of patients with a syndrome or aetiological diagnosis of viral encephalitis.

Summary of implications: This review highlights ongoing research further elucidating the underlying pathophysiological mechanisms of brain injury, paving the way for adjunctive targeted immunotherapy which can ameliorate those aspects of the inflammatory response contributing to brain injury. Nevertheless, large-scale networks are required to establish the prospective, adaptive platform trials necessary. Pending this, as laid out in the WHO Technical Brief on encephalitis, preventive measures have the potential to save lives, including surveillance, vector control, and uptake of established and emerging vaccines.

Purpose of review: Neurocysticercosis, the infestation of the human central nervous system by Taenia solium cysts, accounts for a significant burden of neurological disorders in endemic regions. It is a neglected tropical disease and, hence, often overlooked. However, its importance is underscored by the high burden of epilepsy in endemic regions and many imported cases in nonendemic areas. Given recent epidemiological shifts and advances in diagnosis and treatment, a new focus on neurocysticercosis is required.

Recent findings: While South & Central America remain endemic, sub-Saharan Africa has emerged as a newly recognized hotspot. Recent developments include the potential for antigen-based assays to facilitate 'point of care' diagnosis and treatment monitoring, the combination of antiparasitic regimens, and a newer antiparasitic agent, oxfendazole, currently in clinical trial.

Summary: Recent developments offer significant hope. Wider access to neuroimaging, improved serological tests including antigen assays, and novel therapeutic strategies such as combination antiparasitic treatment have improved outcomes. Ultimately, however, a concerted prevention strategy incorporating diverse approaches will be crucial in reducing the global burden of neurological disorders associated with neurocysticercosis.

Purpose of review: Syphilis continues to be a major global health problem. In recent years epidemics of syphilis have also been reported in many high-income countries. In this review, we aim to highlight varied presentations, including recent guidelines on diagnosis and treatment, including in people with HIV (PWH).

Recent findings: Neurosyphilis is increasingly being diagnosed and presentations are varied in both the immunocompetent and immunocompromised host. An appropriate history, examination and diagnostic work-up is central to identification of neurosyphilis and to enable appropriate treatment. Clear criteria for indication and interpretation of results from lumbar punctures, neuroimaging and treatment protocols have been outlined by the British association for sexual health and HIV (BASHH) in 2024.

Summary: The increase in overall cases of syphilis has been accompanied by increases in the number of cases with neurological involvement. The presentation of neurosyphilis is variable and may occur early or late in the disease course. It is important to be aware of the varied presentations, diagnostic and treatment criteria to limit the late sequelae of disease and address the global health challenge it poses and measures being taken to help reduce this global burden.

Purpose of review: The outcome of central nervous system (CNS) tuberculosis has shown little improvement over several decades, with diagnosis remaining unconfirmed in nearly half of the cases. This review highlights current insights and advancements in the diagnosis and treatment of CNS tuberculosis.

Recent findings: Miliary pulmonary tuberculosis is often linked to CNS tuberculosis and is associated with a worse prognosis. Complications, such as, optochiasmatic arachnoiditis, strokes, and transverse myelitis severely affect prognosis and quality of life. Nearly half of tuberculous meningitis patients exhibited impaired cognition. Diagnosing CNS tuberculosis is challenging because of the low accuracy of standard tests. Advanced techniques like metagenomic and nanopore sequencing enhance detection but are hindered by high costs and limited access. Treatment outcomes remain suboptimal but approaches such as higher drug doses, novel medications, and host-directed therapies are being explored. Drug-resistant tuberculous meningitis is increasingly recognized, posing significant challenges to both diagnosis and treatment. Artificial intelligence (AI) enhances care by enabling early diagnosis, disease monitoring, and personalized treatments, improving outcomes.

Summary: CNS tuberculosis diagnosis faces challenges due to limited sensitivity and delayed results of available tests. Treatments remain suboptimal, with multidrug-resistant cases posing high mortality risks. AI aids in early diagnosis and personalized care.

Purpose of review: Gamma oscillations (30-80 Hz) play a crucial role in sensory processing and cognitive functions, with disruptions in these rhythms linked to neurological disorders such as schizophrenia and Alzheimer's disease. This review highlights the emerging role of astrocytes in regulating gamma oscillations, emphasizing their contribution to the inhibitory tone and extracellular ion homeostasis.

Recent findings: Recent studies suggest that astrocytes facilitate gamma synchrony, while dysfunction in astrocytic activity - such as impaired Ca 2+ signaling - is associated with deficits in gamma oscillations and increased network hyperexcitability. Thus, astrocytic dysfunction may contribute to the pathophysiology of gamma-related disorders.

Summary: By examining the role of astrocytes in maintaining neuronal network stability, this review highlights new aspects of neuroglia signaling.

Purpose of review: The number of known genetic movement disorders and potential treatments for these disorders have grown rapidly over the last few decades. Despite this, genetic testing for movement disorders remains relatively underutilized in clinical practice. In this review, we explore a number of barriers that prevent more routine and widespread use of genetic testing for movement disorders.

Recent findings: Cost and limited health insurance coverage as well as difficulty accessing genetic testing and counselling are major barriers to genetic testing and disproportionately affect low- and middle-income countries and specific sociodemographic groups. Clinician misperceptions and limited knowledge about genetic testing for movements disorders as well as patient and clinician concerns about the potential for genetic discrimination are further obstacles. Despite these barriers, several recent international collaborative studies have demonstrated the feasibility of delivering clinical genetic testing and genetic counselling for movement disorders on a large scale.

Summary: Concerted action at multiple organizational levels (government, specialty societies, health insurance organizations, etc.) is required in order to address the identified barriers and improve utilization of genetic testing in movement disorders on a global scale.

Purpose of review: On World Encephalitis Day 19th February 2025, Encephalitis International launched the World Health Organization technical brief on encephalitis, highlighting the growing public health challenge and need for improved diagnostics. This review summarizes the published literature over the last 18 months on novel methods of identifying the aetiology of neurological infections and existing research gaps.

Recent findings: There is an increased availability and sensitivity of multiplex polymerase chain reaction assays and untargeted metagenomic sequencing in clinical practice. This is contributing to increasing diagnostic yield in suspected neurological infections. Preliminary results suggest that novel serological methods such as phage immunoprecipitation sequencing (Phip-seq) may be useful where molecular approaches are negative.

Summary: Significant progress in improving diagnostics has been made in the last decade. Going forward, multicentre studies and meta-analyses are needed to achieve adequate power in ascertaining the role of novel diagnostic methods in neurological infections. Studies need to investigate the impact on patient management and cost-effectiveness. The role of other omics methods in identifying host biomarkers for utilization in diagnostic algorithms needs further work.