Frontiers in Neurology最新文献

Background: Meige syndrome (MS) is a craniocervical dystonia characterized by blepharospasm and oromandibular dystonia. Its etiology remains unclear, and clinical diagnosis is often delayed. Currently, there is a lack of effective risk prediction tools, making early intervention challenging.

Objective: To systematically analyze the risk factors for MS and develop and validate a clinical prediction nomogram model based on clinical indicators to facilitate early risk assessment.

Methods: A retrospective case-control study was conducted, enrolling 450 confirmed MS patients and 450 controls from the Third People's Hospital of Henan Province between January 2021 and December 2023. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, and a nomogram prediction model was constructed based on regression coefficients. The model's discriminative ability, calibration, and clinical utility were evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA).

Results: Multivariate analysis revealed that a history of thyroid disease (OR = 12.797), psychiatric disorders (OR = 6.892), and head/face surgery (OR = 3.466) were independent risk factors for MS, while female sex (OR = 1.87) and cerebrovascular disease (OR = 1.999) were moderate-risk factors. Notably, smoking (OR = 0.411), alcohol consumption (OR = 0.396), and diabetes (OR = 0.534) showed protective associations. The constructed nomogram model demonstrated strong predictive performance in both the training and validation sets (AUC = 0.789 and 0.800, respectively). Calibration curves indicated high consistency between predicted and observed probabilities, and DCA confirmed its clinical applicability.

Conclusion: We developed and validated a clinical prediction nomogram for MS incorporating eight independent predictors: history of thyroid disorders, psychiatric disorders, head/face surgery, female sex, cerebrovascular disease, as well as protective factors including smoking, alcohol consumption, and diabetes. The model provides a quantifiable tool for early risk stratification and targeted intervention in clinical practice. However, further optimization and validation through multicenter prospective studies are warranted.

Introduction: Laughter among physicians when observing clinical manifestations of functional seizures (FS) or other functional disorders is frequently noted. This reflexive response can occur both in clinical practice and during video presentations at medical conferences. We examine the underlying factors contributing to physicians' laughter in response to the diagnosis of FS.

Methods: The research, spanning 5 years and diverse geographical locations, surveyed 221 participants, including physicians and non-physicians, to understand the reasons behind laughter during FS diagnoses.

Results: A total of 221 respondents (estimated 20-25% of attendees) completed the survey, with 56% identifying as physicians and 44% as non-physicians. Observational data showed laughter responses to FS videos varied widely across settings: approximately 57% at U. S. medical grand rounds, compared to 5-17% at international conferences, and 0% among non-medical audiences. Survey analysis revealed 10 thematic categories for reasons behind laughter, with significant differences between physicians and non-physicians. Non-physicians more frequently cited defense mechanisms, negative opinions, and ignorance, whereas physicians more often attributed laughter to superiority, diagnostic skepticism, or perceived patient deception. U. S. physicians were significantly more likely than non-U. S. physicians to report discomfort, negative opinions, and ignorance. No significant differences were found between neurologists and internists.

Significance: Laughter may serve multifaceted adaptive functions in response to the complexities of diagnosing and managing patients with FS. By highlighting misperceptions surrounding functional disorders, the study underscores the importance of fostering a deeper understanding among clinicians to ensure equitable care for patients experiencing FS.

Background: Cognitive performance such as rapidly reacting to a target or making correct decisions can directly impact task effectiveness in military, emergency, or athletic settings. Saccades are rapid changes in gaze that support recognition and analysis of objects of potential interest in human vision whose acuity rapidly degrades away from the center. The saccade behavior is highly selective and controlled and thus is an expression of attention. We implemented a two-dimensional reactive saccade task to quantify attention performance.

Methods: We studied a sample of 169 healthy individuals aged 8-82 years old (39% male), 37 of whom were retested 1-3 months later. Subjects viewed a target presented in a randomized spatiotemporal sequence, and associated timings of saccade initiation and gaze arrival were registered. Individuals' performance was characterized with the mean and standard deviation of the reciprocals of these measures (1/time, postulated to represent the cortical decision speed).

Results: The intraclass correlation between the test and retest measures varied from 0.60 to 0.74. The reaction speed showed a tendency to become faster and less variable during development in childhood through young adulthood and thereafter become slower and more variable, with best performance tending to be seen in the 20s.

Conclusion: We verified inter-individual variability, within-individual stability, and across-age differences in the performance on a reactive saccade task. A quick assessment of attentional traits or states with saccade reaction metrics, aided by rapidly developing technology, may provide utility in a cognitive readiness test that can inform task assignment or return-to-duty/play decisions.

Objective: To investigate the association between peripheral blood inflammatory biomarkers and the clinical phenotypes, severity, and prognosis of myasthenia gravis (MG).

Methods: This retrospective study analyzed 134 MG patients (including 23 with myasthenic crisis [MC]) and 58 age- and sex-matched healthy controls hospitalized at the Second Affiliated Hospital of Soochow University (August 2016-March 2024). Peripheral blood inflammatory markers were compared across subgroups. Infection was strictly excluded based on clinical and laboratory criteria. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify risk factors and diagnostic value.

Results: Compared to controls, MG patients exhibited significantly elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) (all p < 0.05). Patients with MC were characterized by a higher prevalence of generalized MG (GMG) and thymoma, as well as elevated leukocyte counts, NLR, and SIRI compared to non-MC patients. Multivariate analysis identified elevated PLR [OR: 1.01, 95% CI: 1.00-1.02] as independent risk factors associated with MG onset, while elevated NLR [OR: 1.20, 95% CI: 1.05-1.41] and the presence of thymoma [OR: 13.44, 95% CI: 4.42-48.54] were independently associated with MC. Furthermore, inflammatory indices (NLR, PLR, and SII) were significantly higher in GMG and moderate-to-severe cases (MGFA III-V) compared to ocular and mild cases.

Conclusion: Systemic inflammatory biomarkers, particularly PLR and NLR, are significantly elevated in MG and correlate with disease severity and clinical subtypes. While PLR is associated with MG onset, NLR and thymoma are potential indicators for myasthenic crisis. These readily available markers may facilitate risk stratification in clinical practice.

Post-traumatic benign paroxysmal positional vertigo (BPPV) is a common but frequently underrecognized cause of dizziness following trauma. Unlike idiopathic BPPV, trauma-related BPPV arises from diverse injury mechanisms and is often characterized by heterogeneous canal involvement, greater need for repeated treatment, and frequent coexistence with broader vestibular dysfunction. These features contribute to diagnostic delays and variable clinical outcomes, particularly in the trauma and emergency care settings. We conducted a structured literature search and synthesized clinical, epidemiological, mechanistic, and implementation-focused evidence across diverse trauma contexts. This review aimed to synthesize current evidence on the mechanisms, epidemiology, and clinical characteristics of post-traumatic BPPV, contrast it with idiopathic BPPV, and propose a pragmatic clinical pathway to improve early recognition and management. We reviewed the clinical, epidemiological, mechanistic, and implementation-focused literature on post-traumatic BPPV across trauma contexts, including head injury, concussion, whiplash, sports-related injury, and traumatic brain injury. Evidence from cohort studies, comparative analyses, meta-analyses, and qualitative and feasibility studies was integrated to inform a clinically oriented framework. Accumulating evidence suggests that post-traumatic BPPV should not be regarded solely as a mechanical disorder of displaced otoconia. Trauma may disrupt the otolithic membrane, promote otoconial detachment, and induce utricular dysfunction, leading to canalithiasis or cupulolithiasis and potential interaction with central vestibular injury. Compared with idiopathic BPPV, post-traumatic cases more frequently involve horizontal or multiple canals, often require repeated canalith repositioning maneuvers, and demonstrate variable recurrence patterns. System-level barriers, including limited screening, insufficient training, and fragmented care pathways, further contribute to underdiagnosis and suboptimal management. Post-traumatic BPPV represents a distinct clinical phenotype within the spectrum of trauma-related vestibular disorders. Early identification through systematic screening, comprehensive positional testing, and timely canal-specific interventions provides practical opportunities to improve outcomes. We propose a structured clinical pathway emphasizing early recognition, planned reassessment, and escalation to integrated vestibular care when symptoms persist. Future research should clarify the relationships between trauma biomechanics and BPPV phenotypes, identify predictors of recurrence, and evaluate the real-world effectiveness of pathway-based care models across diverse trauma populations.

Background: Insomnia is a common sleep disorder that substantially impairs quality of life. Drug-induced insomnia (DII), an important cause of secondary insomnia, is often underrecognized, and many potential signals are not yet documented in drug labels. Evidence regarding sex-specific differences in DII remains limited, hindering the development of tailored safety strategies.

Objective: To identify drug-insomnia associations, assess sex-specific differences, validate signals in an independent database, and characterize the time-to-onset (TTO) of high-risk drugs using large-scale real-world pharmacovigilance data.

Methods: We conducted a retrospective observational pharmacovigilance study using insomnia-related reports from FAERS (2004Q1-2025Q2). Disproportionality analyses (ROR, PRR, BCPNN, MGPS) were performed, and sex-stratified associations were compared using Wald chi-square tests. Signals were externally validated in the Canadian Vigilance Adverse Reaction Database (CVARDD). Weibull models were applied to evaluate TTO for the drugs with the highest insomnia report counts.

Results: A total of 266,429 insomnia-related reports were identified, with more reports from females (60.1%) than males (32.0%). A total of 237 drugs demonstrated significant disproportionality signals, including several without labeled insomnia risk. Among the 20 most frequently implicated drugs, 15 showed significant sex-drug interactions. Duloxetine exhibited a stronger association in males, whereas niraparib and levothyroxine showed higher risks in females. External validation confirmed 124 overlapping drugs with consistent signals. TTO analyses revealed an early-failure pattern (Weibull β < 1) for all five high-reporting drugs, with median onset ranging from 3 to 211.5 days.

Conclusion: This study identified multiple drug-insomnia signals, quantified sex-specific differences, and validated findings in an independent database. These results underscore the importance of recognizing DII and monitoring sex-related variability in clinical practice.

Objective: To investigate the effect of pre-ICU aspirin use on neuroinflammation and prognosis in sepsis-associated encephalopathy (SAE) patients.

Methods: Clinical data of SAE patients admitted to our ICU (Mar 2022-Feb 2025) were retrospectively analyzed. Patients were grouped based on pre-admission aspirin use: exposed (n = 45) and non-exposed (n = 68). After 1:1 propensity score matching (age, infection source; caliper = 0.2), 42 matched pairs were compared. Cerebral hemodynamics (Vm, Vd, and Vs), coagulation function (PLT, TT, PT, and APTT), neuroinflammation markers (IL-6, TNF-α, and S100β), Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores (admission, days 1, 3, and 5), ICU length of stay, adverse events, 28- and 60-day mortality were analyzed using appropriate statistical tests (t-test, χ² test; P < 0.05 significant).

Results: The exposed group had higher Vm, Vd, and Vs at all time points (P < 0.05). IL-6, TNF-α, and S100β levels were lower in the exposed group (P < 0.05). GCS scores were higher in the exposed group on days 3 and 5 (P < 0.05). Adverse event incidence, ICU stay, and 28-day mortality did not differ significantly (P < 0.05). The 60-day mortality was lower in the exposed group (P < 0.05).

Conclusions: Pre-ICU aspirin use can improve cerebral hemodynamics, reduce neuroinflammation, and improve 60-day survival in SAE patients without increasing adverse reactions.

Background: Art therapy is emerging as a promising adjunct to neurorehabilitation, giving creative engagement to improve motor, cognitive, and emotional outcomes. Digital technologies such as virtual reality (VR), augmented reality (AR), exergames, and sensor-based systems enable immersive and interactive therapeutic experiences, potentially enhancing rehabilitation effectiveness. This scoping review systematically evaluates the impact of technology-assisted art therapy on neurological rehabilitation and to identify effective intervention types.

Methods: A systematic search was conducted in PubMed, Cochrane, Web of Science, and Embase following PRISMA-ScR and JBI guidelines. Studies were included if they involved adults with neurological conditions receiving technology-supported art therapy and reported motor, cognitive, or emotional outcomes.

Results: Of 584 records screened, 19 studies were included. Interventions comprised dance therapy, music therapy, and visual art therapy supported by VR platforms, tablet-based applications, serious games, and motion-tracking systems. Reported benefits included improvements in motor function, attention and executive function, emotional well-being, and therapy engagement. However, most studies were small-scale, with heterogeneous methodologies and limited follow-up periods.

Conclusion: Technology-enhanced art therapy appears to be a promising approach in neurorehabilitation, offering personalized, engaging, and potentially effective interventions. Further high-quality randomized controlled trials with standardized outcome measures are needed to confirm these findings and guide clinical application.

Background: Executive function deficits are common among patients with Parkinson's disease (PD) and progressive supranuclear palsy (PSP). Executive function refers to higher-order cognitive processes thought to involve fronto-striatal circuits. Some patients with executive deficits may be unable to recognize or report them, a condition we refer to as executive anosognosia.

Objective: To conduct a comparative analysis of executive anosognosia in patients diagnosed with PSP and PD.

Methods: We compared an objective neuropsychological assessment (ONA) of composite executive function (ONA-CEF), which includes semantic and phonemic verbal fluency, as well as two sub-scores from the Wisconsin Card Sorting Test, with patient- and informant-reported rating scales. We used the Dysexecutive Questionnaire Revised (DEX-R) to evaluate near-transfer executive complaints and the Aachen Activity and Participation Index: Cognition and Participation (AAPI-CP) composite to evaluate far-transfer cognitive and social difficulties. Discrepancy indices were calculated for patients and informants (ONA-CEF minus DEX-R and ONA-CEF minus AAPI-CP).

Results: PSP patients had significantly larger negative discrepancies than PD patients, indicating stronger executive anosognosia. Although informant reports reduced these discrepancies, significant underreporting persisted in PSP informants. Correlational analyses revealed that patient-reported DEX-R difficulties were strongly correlated with depressive symptoms (r ≈ 0.65) but not with objective executive performance (r ≈ 0.00).

Conclusion: Executive anosognosia is a marker of PSP, highlighting the need for objective neuropsychological assessments in clinical trials. PSP patients' reports of executive dysfunction are more associated with mood than actual impairment, which challenges the validity of patient-reported outcomes in PSP and related neurological diseases.

Background: Total deafness-type sudden sensorineural hearing loss (SSNHL) represents one of the most challenging subtypes of SSNHL due to its poor response to initial therapy and uncertain prognosis. Secondary inpatient treatment has been proposed as a potential salvage strategy; however, its efficacy and predictors of favorable outcomes remain poorly defined.

Methods: This study included 120 patients with unilateral total deafness-type SSNHL, divided into secondary treatment and control groups. Hearing thresholds at low, middle, high, and full frequencies, pure-tone average (PTA) at speech frequencies, and speech recognition rate were evaluated across six time points (T1-T6). Tinnitus Handicap Inventory (THI) scores and improvement rates were also analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of marked hearing recovery. A nomogram was constructed to predict the hearing prognosis of patients with SSNHL.

Results: Compared with the control group, the secondary treatment group exhibited significantly earlier onset and greater magnitude of improvements in hearing thresholds and speech recognition rate (all p < 0.05), with distinct frequency-specific patterns. Recovery initiated at 4-8 weeks and stabilized after 12 weeks, while the control group showed delayed improvement. Tinnitus relief occurred earlier in the secondary treatment group. Multivariate analysis identified age ≤50 years, disease duration ≤3 days, absence of vertigo, and normal vestibular function (vHIT and caloric test) as independent predictors of marked recovery (all p < 0.05). The area under the receiver operating characteristic (ROC) curve was 0.876 (95% confidence interval [CI]: 0.762-0.989). The calibration curve showed good agreement with the standard curve. The decision curve analysis demonstrated that the prediction model yielded positive net benefits across nearly all threshold probability ranges.

Conclusion: Secondary inpatient treatment offers a significant auditory benefit for patients with total deafness-type SSNHL by accelerating and amplifying recovery. Young age, early intervention, and well-preserved vestibular function are key determinants of a favorable prognosis. The predictive model constructed hereby can effectively predict the prognosis of patients.