Frontiers in Neurology最新文献

Background: Stroke is a significant cause of disability worldwide, often resulting in persistent upper-limb dysfunction. Robot-assisted therapy has emerged as an effective rehabilitation strategy by enabling intensive, repetitive, and task-specific training. In this study, we aimed to investigate the effects of resistance- versus assistance-based robotic interventions on brain activation and motor recovery in patients with stroke, as these effects remain insufficiently understood.

Methods: Twenty-five adults with hemiparetic stroke were randomized to a resistance-based robot training group (RTG, n = 13) or assistance-based robot training group (ATG, n = 12). Interventions were delivered using the InMotion 2.0 for 30 min per session, five sessions/week over 4 weeks. Brain activation was measured using functional near-infrared spectroscopy (fNIRS), motor function using the Fugl-Meyer Assessment for the Upper Limb (FM-UL) and kinematic indices from InMotion 2.0, and activities of daily living using the Motor Activity Log (MAL).

Results: Prefrontal activation decreased from pre- to post-intervention in both groups. In the ipsilesional hemispheres, differences between groups were significant (p < 0.05). In the resistance training group, additional improvements were found in mean velocity, circle size, and movement independence (p < 0.05). Both groups showed significant gains in FM-UL and ADL performance (p < 0.05), with no significant between-group differences in these measures.

Conclusion: Resistance-based robotic training was associated with greater motor improvements in kinematic smoothness, and larger reductions in prefrontal activation within ipsilesional hemispheres compared with assistance-based training. These findings suggest differences in prefrontal activation patterns accompanied by improvements in kinematic movement smoothness in stroke survivors.

Clinical trial registration: https://cris.nih.go.kr, (Registration Number: KCT0011076).

Objective: Restless legs syndrome (RLS) is a common sensorimotor disorder that disrupts sleep and quality of life. Sarcopenia-reduced skeletal muscle mass and function-has been linked to sleep disturbances, but its relationship with RLS remains unclear. We examined whether sarcopenia is associated with RLS, with a focus on sex-specific effects.

Methods: We conducted a cross-sectional analysis of 5,752 adults who underwent both type-I polysomnography (PSG) and bioelectrical impedance analysis (BIA) at a tertiary sleep center. RLS was diagnosed by IRLSSG criteria. Sarcopenia was defined using skeletal muscle index (SMI) and fat-free mass index (FFMI) thresholds. Multivariable models adjusted for age, physical activity, caffeine/alcohol intake, and apnea-hypopnea index (AHI).

Results: RLS prevalence was 6.6% in females and 2.9% in males. Sarcopenia was more frequent in the RLS group than in non-RLS (10.6 vs. 6.8%), particularly among males (8.7 vs. 3.2%). In males, lower SMI and FFMI were independently associated with higher odds of RLS; sex interaction for FFMI was significant.

Conclusions: Reduced muscle mass is independently associated with RLS in men, suggesting a male-specific muscle phenotype relevant to RLS pathophysiology. Incorporating BIA-based screening and muscle-preserving interventions may benefit the management of male patients with RLS.

Objective: After endovascular treatment (EVT) for ischemic stroke (IS), clinical observations have shown that some patients with small infarct volumes develop hemorrhagic transformation (HT), while some patients with large infarct volumes do not. This study aims to analyze the factors contributing to these differences and to assess the impact of HT on neurological outcomes.

Methods: A total of 732 patients were divided into small infarct volume (0-15 mL) and large infarct volume (≥70 mL) groups. The incidence of HT, risk factors, neurological outcomes (NIHSS changes), early neurological deterioration (END), and 7- and 90-day mortality rates were compared.

Results: In patients with small infarcts, higher systolic blood pressure, lower triglyceride levels, the number of EVTs, and other factors were related to an increased risk of HT. By contrast, in those with large infarcts, where HT occurred more frequently and was more severe, it was associated with more severe neurological deficits before treatment, elevated albumin levels, and the number of EVTs. PH2 hemorrhage was linked to more severe neurological deficits, higher END rates, and increased short- and long-term mortality, particularly in large infarcts.

Conclusion: Infarct volume is closely related to the occurrence and severity of HT. HT in small infarcts is influenced by hemodynamic and metabolic factors, while in large infarcts, it is linked to extensive brain tissue damage. PH2 hemorrhage is the most adverse prognostic subtype, highlighting the need for careful monitoring and intervention in patients with large infarcts.

Background: Drug-resistant epilepsy continues to be a major challenge, as treatment response to additional antiseizure medications is often limited, and early prediction remains crucial. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index has emerged as a noninvasive imaging method to assess glymphatic function, which plays a key role in brain waste clearance. We aimed to evaluate whether the DTI-ALPS index could serve as a valuable prognostic biomarker of treatment response in patients with drug-resistant focal epilepsy receiving lacosamide (LCM) add-on therapy.

Methods: We retrospectively enrolled 155 patients with drug-resistant focal epilepsy who underwent diffusion tensor imaging (DTI) prior to initiating LCM add-on therapy and had at least 12 months of clinical follow-up. Patients were classified into LCM responders and non-responders based on seizure reduction. The DTI-ALPS index was calculated from preprocessed DTI data acquired on a 3 T magnetic resonance imaging scanner and compared between the groups.

Results: Among 155 patients with drug-resistant focal epilepsy, 33 were classified into LCM responders and 122 into LCM non-responders. Non-responders had a higher number of prior antiseizure medication (ASM) burden (3 vs. 2, p < 0.001) and more frequent epileptiform discharges on electroencephalography (78.5% vs. 57.6%, p = 0.015). Additionally, the DTI-ALPS index was significantly greater in responders (1.4022 vs. 1.1936, p = 0.024) than in non-responders, and receiver operating characteristic curve analysis showed its predictive value for LCM response (area under the curve = 0.620, p = 0.015).

Conclusion: DTI-ALPS index was significantly lower in non-responders to LCM add-on therapy among patients with drug-resistant focal epilepsy, suggesting that glymphatic dysfunction may contribute to reduced ASM responsiveness and serve as a potential noninvasive biomarker to aid in treatment prediction.

Objective: Peripheral nerve injury (PNI) remains a significant clinical challenge due to its limited recovery outcomes. Understanding the underlying molecular mechanisms is crucial for improving therapeutic efficacy. This study aims to explore the current status, research hotspots, and development trends of molecular mechanism studies in PNI through bibliometric analysis, providing valuable insights for the development of more effective treatment strategies.

Methods: Relevant literature on PNI and its molecular mechanisms published from January 1, 2005, to November 22, 2025, was retrieved from the Web of Science, PubMed, and Scopus databases. CiteSpace and VOSviewer software were utilized to analyze research hotspots and trends, generating visual maps of countries, institutions, authors, journals, keywords, and references.

Results: A total of 1,799 publications were analyzed, revealing a steady annual increase in PNI-related research, with a significant surge after 2016. China emerged as the leading contributor, followed by the United States and Japan. Nantong University and Sun Yat-sen University were identified as the major contributing institutions, with Gu Xiaosong being one of the most influential authors. Key journals in the field include Neural Regeneration Research and Molecular Pain. Research hotspots include Schwann cells, neuropathic pain, inflammatory responses, non-coding RNAs, and molecular signaling pathways. Notably, advances in bioinformatics technologies, such as high-throughput genomics, proteomics, transcriptomics, and single-cell sequencing, have significantly propelled the research on PNI molecular mechanisms. Future research is likely to focus on the application of precision medicine and gene editing technologies to enhance PNI treatment outcomes.

Conclusion: This bibliometric analysis provides a comprehensive overview of the current status and trends in PNI molecular mechanism research, revealing key research areas and future directions. The advancement of bioinformatics technologies is expected to drive the development of future therapeutic strategies, offering new avenues for nerve regeneration and functional recovery.

Objective: This study aims to systematically compare the relative efficacy of six non-invasive rehabilitation interventions-Standardized Rehabilitation (SR), Aerobic Rehabilitation (AR), Resistance Training Rehabilitation (RTR), Intelligent Rehabilitation (IR), Traditional Chinese Rehabilitation (TCR), and Neuromodulation Rehabilitation (NR)-in improving lower limb function and gait function in stroke patients using a network meta-analysis approach. It also ranks the efficacy of each intervention.

Methods: We systematically searched five databases-PubMed, Embase, EBSCO, Web of Science, and Scopus-for randomized controlled trials (RCTs) published from January 2003 to November 2025. Two researchers independently screened studies, extracted data, and assessed risk of bias. Stata 18.0 software was used for statistical analysis. Standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were calculated. Probabilistic ranking of intervention efficacy was performed using the cumulative ordered ranking curve area (SUCRA) value.

Results: A total of 33 RCTs were included. Network meta-analysis revealed: (1) For lower limb function improvement (using the Fugl-Meyer lower limb score as the core indicator), the efficacy ranking was IR (SUCRA = 75.7) > AR (60.7) > RTR (53.1) > SR (10.5). Smart rehabilitation had the highest probability (46.7%) of being the optimal approach. (2) For gait function improvement (core measures: walking speed, 6-min walk test), the efficacy ranking was NR (SUCRA = 82.2) > IR (71.6) > AR (50.8) > RTR (38.8) > TCR (35.7) > SR (20.9). Neuromodulation rehabilitation had the highest probability of being the optimal solution (36.5%). Direct and indirect comparison results were largely consistent, with funnel plots showing no significant publication bias.

Conclusion: Based on existing evidence, intelligent rehabilitation may offer relative advantages in improving lower limb function in stroke patients, while neuromodulation rehabilitation demonstrates greater potential for enhancing gait function. Standardized rehabilitation, as a conventional baseline approach, demonstrated relatively weaker effects. The ranking results from this study provide evidence-based guidance for clinicians selecting individualized rehabilitation programs targeting different functional goals. Future high-quality research is needed to validate and refine intervention recommendations for different disease stages.

Background: Age-related changes in vestibular function may play a role in decreased postural control and increased fall risk. Past research suggests that age-related changes in vestibular perception begin at ~40 years of age; however, this pattern may vary depending on motion trajectory, reflecting contributions of peripheral end-organ structures. Further, motion specific relationships to sway variability have been previously identified. However, relationships between age-related vestibular perceptual changes to multiple sway metrics in multiple planes, reflecting unique aspects of postural control, have yet to be quantified.

Methods: 100 healthy adults (21-84 years) completed a vestibular threshold test battery and quiet stance balance assessments. All participants completed motion conditions with predominant contributions from the horizontal canals (2 Hz yaw rotation), vertical canals (2 Hz RALP/LARP tilt), utricles (1 Hz y-translation), saccules (1 Hz z-translation), and integration of canal-otolith cues (0.5 Hz roll tilt). For balance testing, participants completed an instrumented Modified Romberg Balance Test. Regression analyses assessed relationships between age-adjusted measures of vestibular perception to root mean square distance (RMS), mean velocity (MV), and mean frequency (MF) of center of pressure (CoP) in the mediolateral (ML) and anterior-posterior (AP) planes.

Results: Thresholds for most motions - except 0.5 Hz roll tilt - were matched by a two-segment model with stable values below ~40-50 years and linear increases thereafter. For balance conditions with predominant vestibular contributions (i.e., eyes-closed foam-surface), associations between ML RMS to thresholds with predominant contributions from the utricle (y-translation) and canal-otolith integration (roll tilt) were identified. No consistent associations between vestibular thresholds to MV and MF were identified.

Conclusion: Across a population, we were able to confirm that vestibular perceptual thresholds are stable until around middle age after which linear increases in perceptual sensitivity are seen. Our findings linking ML RMS to vestibular perceptual metrics support past hypotheses that sensory noise, as quantified by vestibular thresholds, may contribute to sway variability.

Background: Contrast agent extravasation detected on immediate post-thrombectomy flat-panel detector computed tomography (Dyna-CT) may reflect blood-brain barrier disruption and microcirculatory dysfunction following mechanical thrombectomy (MT) for acute anterior circulation large vessel occlusion (AC-LVO). This study aimed to determine whether contrast extravasation on Dyna-CT after successful MT is associated with the subsequent development of malignant brain edema (MBE).

Methods: A retrospective study was conducted in AC-LVO patients who underwent MT with successful recanalization between January 2020 and December 2023. Dyna-CT was performed immediately after MT, followed by serial head CT scans. MBE was defined as acute cerebral swelling with a midline shift ≥5 mm accompanied by radiological signs of brain herniation. Patients were divided into MBE and non-MBE groups. Multivariable logistic regression analyses were performed to identify independent predictors of MBE and construct a predictive model.

Results: A total of 174 patients (median age, 71 years) were included, with an MBE incidence of 23.6% (41/174). Core infarct volume, baseline NIHSS score, collateral circulation, number of thrombectomy passes, and contrast extravasation were independent predictors of MBE (all P < 0.05). The combined predictive model showed excellent discrimination (AUC = 0.90, 95% CI: 0.85-0.96).

Conclusion: Immediate Dyna-CT detection of contrast extravasation serves as a valuable imaging biomarker for predicting MBE in AC-LVO patients after successful MT, offering timely guidance for early risk identification and individualized management.

Background: This study investigates the clinical characteristics and approximately two-year treatment outcomes of patients with new-onset epileptic seizures during the acute phase of COVID-19 infection.

Methods: A retrospective, single-center cohort study was conducted from December 2022 to June 2023. The patients were categorized into two groups: those with acute encephalopathy (Group 1) and those without (Group 2).

Results: This study enrolled a total of 34 patients (15 male and 19 female), with 18 assigned to Group 1 and 16 to Group 2. Patients in Group 2 (median: 32.5 years) were significantly younger than those in Group 1 (median: 60 years; p < 0.05). Status epilepticus was more frequent in Group 1 (66.7%, 12/18) compared to Group 2 (6.3%, 1/16; p < 0.001). Seizure latency was significantly shorter in Group 1 (median: 2 days) than in Group 2 (median: 9 days; p < 0.001). Abnormal posterior background activity on EEG was observed in 57.1% of Group 1 patients (4/7, p < 0.05), but in none of the Group 2 patients. However, a higher proportion of Group 2 patients showed interictal epileptiform discharges (72.7%, 8/11) compared to Group 1 (28.6%, 2/7). Epilepsy-related MRI abnormalities appeared in 22.2% (4/18) of Group 1 and 31.3% (5/16) of Group 2 patients. The proportion diagnosed with epilepsy was significantly higher in Group 2 compared to Group 1 (87.5% vs. 22.2%, p < 0.05). After 25 months of follow-up, one patient from each group developed drug-resistant epilepsy.

Conclusion: New-onset epileptic seizures associated with COVID-19 generally have a favorable prognosis. A lower proportion of patients developed drug-resistant epilepsy.