Frontiers in Neurology最新文献

Introduction: Most chronic stroke survivors develop learned helplessness regarding motor recovery prospects, accepting permanent disability despite evidence that neuroplasticity windows remain accessible years post-stroke. This review examines how intensive protocols targeting learned helplessness can achieve meaningful recovery across diverse healthcare settings.

Methods: Comprehensive literature review using PubMed, Scopus, and specialized databases (1990-2024). Analysis included constraint-induced movement therapy protocols, progressive muscle lengthening techniques, and neuroplasticity principles across European high-technology centers and African human-intensive programs. Search incorporated systematic analysis of therapeutic intensity parameters, cultural adaptation protocols, and cross-continental implementation strategies.

Results: Literature synthesis reveals meaningful functional recovery 2-5 years post-stroke when intensive protocols directly challenge learned helplessness through forced-use approaches, training intensities exceeding traditional therapy doses (3-6 h daily versus 30-45 min), and systematic addressing of secondary muscle adaptations. Cross-continental validation demonstrates equivalent outcomes between European technology-dependent and African human-intensive approaches when therapeutic intensity and neuroplasticity targeting remain consistent.

Conclusion: Neuroplasticity-driven intensive rehabilitation can overcome learned helplessness and achieve meaningful motor recovery years after stroke without requiring expensive technology. Success depends on abandoning traditional recovery timelines, implementing culturally-adapted intensive protocols, and recognizing human expertise as the most powerful rehabilitation tool when properly applied.

Background: Post-stroke cognitive impairment (PSCI) affects ~40% of survivors, hindering recovery. Dual-task training (combining cognitive and motor tasks) may help, but its superiority over single-task training or usual care remains unclear. This study examines whether dual-task training improves cognitive function more than (1) single-task training or (2) usual rehab/control, and whether effects vary by intervention duration.

Methods: Keywords were used to search Chinese and English databases. The search period was up to 15 October 2023. Randomized controlled trial (RCT) studies comparing the effects of dual-task training and single-task training or blank control on improving cognitive impairment in stroke patients were included and the quality of the included studies was evaluated using the Cochrane collaboration's risk assessment tool. The effect indicators were evaluated based on fixed-effects or random-effects models.

Results: A total of 15 RCT studies were included. The results of the studies showed that there was a significant difference in mini-mental state examination scores in the dual-task training group compared with the control group (p < 0.0001). At intervention time >6 weeks trail making test-A scores were lower compared with controls (p < 0.00001). After intervention time >4 weeks, there was a significant difference in digit span test-backward scores compared with controls (p = 0.0003). There was a significant difference in digit span test-forward scores compared with controls (p = 0.0001) after >4 weeks of intervention. There was a significant difference in Montreal Cognitive Assessment scores compared with controls in elderly patients with insignificant cognitive deficits post-stroke (p < 0.00001) and patients with significant cognitive impairment following a stroke (p < 0.00001).

Conclusion: Dual-task training is more effective than conventional rehabilitation in improving PSCI, but the aspects of improvement may be limited by the duration of the intervention, the number and quality of included studies and the differences in cognitive function, motor tasks and so on.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, CRD42023393550.

Background: Cognitive impairment is a common and disabling non-motor symptom of Parkinson's disease, markedly diminishing quality of life and elevating caregiver burden. Although considerable research has been conducted, the early prediction of cognitive impairment remains challenging owing to heterogeneous clinical presentations, variations in treatment adherence, and the inherent limitations in sensitivity of conventional biomarkers and cognitive assessment tools.

Methods and materials: A retrospective cohort study involving 514 Parkinson's disease patients who had complete baseline data and a minimum of 6 months of follow-up. Participants were randomly allocated into a training cohort (n = 359) and a test cohort (n = 155). Demographic, clinical, biochemical, and neuropsychological variables were obtained at baseline. Cognitive impairment was defined based on Mini-Mental State Examination scores falling below education-adjusted thresholds and further validated using the Montreal Cognitive Assessment. Multiple machine learning models-including Random Forest, Logistic Regression, Gradient Boosting, CatBoost, and Support Vector Machine-were developed and evaluated using the area under the receiver operating characteristic curve, accuracy, recall, F1-score, calibration, and decision curve analysis. Feature importance analysis was performed to identify key predictive variables.

Results: During follow-up, patients who developed cognitive impairment were significantly older and had longer disease duration, lower levels of albumin, hematocrit, and blood lipids, as well as a higher prevalence of hypertension. Feature selection identified: Age, Platelet count, Time from diagnosis to baseline visit, Apolipoprotein B, and Hematocrit as the predictors. The Random Forest model demonstrated the best overall performance, with the area under the receiver operating characteristic curve = 0.846, accuracy = 0.75, and an F1-score = 0.775, followed by CatBoost and Logistic Regression. Calibration and decision curve analyses confirmed stable probability estimation and superior clinical utility of Random Forest compared with "treat all" or "treat none" strategies. Further use the Montreal Cognitive Assessment score to verify the stability of the model.

Conclusion: Machine learning models integrating multimodal clinical and neuropsychological data demonstrate high accuracy in predicting cognitive impairment in Parkinson's disease, with Random Forest emerging as the most reliable approach. This framework provides a practical tool for early risk stratification, potentially enabling timely interventions and individualized management to reduce the burden of cognitive decline in Parkinson's disease.

Background: Sudden sensorineural hearing loss (SSNHL) is a medical emergency that can significantly impact quality of life. The study aimed to compare the efficacy and safety of intratympanic methylprednisolone therapy (IMT) with standard treatment (ST) in adult patients suffering from unilateral SSNHL.

Methods: A retrospective analysis was conducted on 300 adult patients diagnosed with unilateral SSNHL, treated at our hospital from June 2022 to November 2024. Patients were divided into two groups based on their treatment protocols: IMT group (142 patients) and ST group (158 patients). All patients completed 1 year of follow-up. Outcomes were assessed via pure tone average (PTA), word recognition score (WRS), tinnitus/dizziness resolution, and quality of life (SF-36).

Results: The IMT group showed significantly greater improvement in PTA and WRS at both follow-up points compared to the ST group (p < 0.05). Tinnitus reduction was also significantly better in the IMT group at 10 days and 8 weeks (p < 0.01). Overall treatment efficacy (cured + markedly effective + effective) was significantly higher with IMT (p = 0.031), especially in severe cases (p = 0.034). ST caused more systemic side effects like gastrointestinal issues and blood sugar problems (p < 0.05). IMT caused more local ear discomfort (p < 0.001). Quality of life (SF-36) scores for physical functioning, role-physical, and social functioning were significantly better in the IMT group (p < 0.05). Logistic regression confirmed IMT significantly reduced the risk of ineffective treatment.

Conclusion: IMT demonstrated superior efficacy and an acceptable safety profile compared to ST for adult patients with unilateral SSNHL, suggesting it as a preferable therapeutic option.

Background: Stroke is the leading cause of disability worldwide. Upper extremity paresis is the most common functional consequence, affecting more than half of all stroke survivors. Research has shown that an adequate therapy should begin in the sub-acute stage, but also that an enhanced intensity and frequency of therapy can positively affect patients' recovery curve. Therefore, here we assessed whether an additional VR-based training can be beneficial for recovery of stroke patients, with particular emphasis on upper extremity functions.

Methods: The study was organized as prospective and single-blinded (analysis). Two groups of pairwise-matched subacute stroke patients with arm paresis were recruited at our rehabilitation clinic while controlling for gender, age, sidedness and modified Rankin scale (mRS). Both groups - conventional therapy (CT) and conventional therapy plus virtual reality (CT + VR) - received 30-45 min of conventional therapy on 3 to 4 days/week over 4 weeks; in addition to that, the CT + VR group received 3 times per week a specially designed VR-based training for upper extremity. Data acquisition was performed within 24 h before the baseline and after the training has ended. Main outcomes were patients' performance on Fugl-Meyer test for upper extremity (FME), Box-and-Block test, hand dynamometry and Functional independence test (FIM).

Results: Twenty-two subjects aged 57-85 were pairwise-matched and assigned to the conventional therapy (CT) group (n = 11, 67.82 ± 8.69 years; three females) and the conventional therapy plus virtual reality (CT + VR) group (n = 11, 70.45 ± 6.79 years; three females). No difference in gender, age, sidedness, mRS and mini-mental status examination (MMSE) existed between the two groups. The CT + VR group showed significantly better improvements over time on FME (44.3 ± 7.8 to 58.7 ± 11.2 vs. 42.1 ± 6.2 to 49.5 ± 10.9; p = 0.009) and FIM (90.1 ± 18.0 to 118.1 ± 6.9 vs. 105.0 ± 12.4 to 110.6 ± 12.6; p < 0.001), compared to the CT group. Other tests revealed no significant differences.

Discussion: As hypothesized, an additional immersive VR-based training can be beneficial for stroke patients suffering from upper extremity deficiency. Nevertheless, the principle of specificity could be observed, with only trained functions being associated with improvements on FME and FIM. Future studies with larger sample of participants are required to confirm these findings.

Introduction: This study aims to compare the effectiveness and safety of methylprednisolone pulse versus docetaxel in treating recurrent thymoma with myasthenia gravis (MG).

Methods: We conducted a single-center, open-label, retrospective study that included 90 patients with thymoma recurrence accompanied by MG, who were treated with either methylprednisolone pulse or docetaxel. Compared the improvement rate of the Myasthenia Gravis Foundation of America Post-intervention Status (MGFA-PIS) and Quantitative Myasthenia Gravis Score (QMGS), changes in acetylcholine receptor antibodies (AchR-AB), and alterations in thymoma after treatment. Adverse events were also recorded.

Results: Both treatments significantly reduced QMGS and AchR-AB levels (p < 0.05). For MG, the overall effective rate (ORR1) was similar between groups (p > 0.05). However, the methylprednisolone group showed a higher objective response rate (ORR2) and disease control rate (DCR) for thymoma (p < 0.05). The incidence of adverse reaction incidence was 66.7% for the methylprednisolone group and 44.4% for the docetaxel group (p < 0.05).

Discussion: Methylprednisolone is more effective against thymoma than docetaxel for recurrent thymoma with MG, but has greater side effects. Docetaxel has similar MG efficacy compared to methylprednisolone, and with fewer side effects. The choice of treatment should be based on the patient's specific clinical situation.

Lumbar disc herniation (LDH) remains a leading cause of low back pain and sciatica, imposing a considerable global health and socioeconomic burden. Over the past decades, substantial progress has been made in both conservative and surgical interventions, yet controversies persist regarding optimal treatment strategies, long-term efficacy, and recurrence prevention. This review provides a comprehensive overview of current therapeutic approaches, including pharmacological management, physical therapy, minimally invasive and open surgical techniques, as well as emerging biological therapies. Special attention is given to platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and chemonucleolysis, which demonstrate potential in delaying disc degeneration and enhancing tissue repair. Moreover, we highlight the growing role of artificial intelligence (AI) in diagnosis, surgical planning, prognosis prediction, and rehabilitation monitoring, along with the increasing emphasis on multidisciplinary team (MDT) management. Finally, we discuss ongoing challenges, such as the need for standardized long-term outcome evaluation, individualized treatment pathways, and the clinical translation of regenerative medicine. By integrating traditional strategies with novel technologies, this review underscores the evolving paradigm of LDH management toward more minimally invasive, personalized, and multidisciplinary approaches.

Background: Stroke frequently causes upper limb dysfunction, impairing daily activities and quality of life. This study evaluates seven repetitive transcranial magnetic stimulation and transcranial direct current stimulation protocols for improving upper limb motor function, muscle tone, and daily living in stroke patients, providing evidence for optimizing non-invasive brain stimulation therapy.

Methods: Computerized searches were conducted in the VIP database (VIP), Wan-fang database, China National Knowledge Infrastructure (CNKI), PubMed, SinoMed Database (CBM), Cochrane Library, and Web of Science databases to identify publicly published randomized controlled trials on different non-invasive brain stimulation techniques for upper limb motor dysfunction after stroke. The search period was up to November 2024. The Cochrane Risk of Bias tool (version 5.4.0) was used to assess the quality of the included studies. R software (version 4.1.1) was used to perform Bayesian network meta-analysis for data comparison and ranking.

Results: A total of 28 studies were included, with a total sample size of 1,340 patients, encompassing 7 non-invasive brain stimulation techniques. Probability ranking results indicated the following: for Fugl-Meyer Assessment for Upper Extremity (FMA-UE), the top three rankings were high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) (29%), continuous theta burst stimulation (cTBS) (27%), and anodal transcranial direct current stimulation (aDCS) (17.5%); for Barthel Index (BI), the top three were aDCS (71.5%), low-frequency repetitive transcranial magnetic stimulation(LF-rTMS) (20.9%), and HF-rTMS (4.4%); for Wolf Motor Function Test (WMFT), the top three were aDCS (63.6%), cTBS (13%), and HF-rTMS (9.1%); for Modified Ashworth Scale (MAS), the top three were intermittent theta burst stimulation (iTBS) (42%), LF-rTMS (24%), and cTBS (16%); for Action Research Arm Test (ARAT), the top three were iTBS (72.6%), aDCS (22.3%), and LF-rTMS (2.8%).

Conclusion: Based on the network meta-analysis results and probability ranking evidence, HF-rTMS is most likely to be the most effective intervention for restoring motor function (FMA-UE); aDCS may rank first for both activities of daily living (BI) and motor task performance (WMFT); iTBS appears beneficial for improving muscle tone regulation (MAS) and fine motor ability (ARAT). However, the results for ARAT (6 studies) and MAS (9 studies), based on a smaller number of studies, should be interpreted with caution due to limited evidence.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251019764.

Introduction: Healthcare disruptions imposed by the coronavirus disease (COVID-19) pandemic and possible biological links between SARS-CoV-2 and prion misfolding might influence the prevalence or characteristics of Creutzfeldt-Jakob Disease (CJD). This report investigates the potential impact of the COVID-19 pandemic on Canadian CJD diagnostics and surveillance from 2016-2025.

Methods: Canada-wide CJD diagnostic findings from end-point quaking induced conversion (EP-QuIC) cerebrospinal fluid (CSF) assays were compared across three periods: pre- (2016-01-29 - 2020-02-28), during (2020-03-01 - 2022-09-30), and post-COVID-19 (2022-10-01 - 2025-09-29). Presented are incidence rates and distributions of biomarker abundances, case demographics, CJD molecular subtypes, and disease durations.

Results: While EP-QuIC test submissions increased during the pandemic, CJD incidence was unaltered and not associated with SARS-CoV-2 incidence. Demographics, disease durations, and molecular subtypes of sporadic CJD (sCJD) were largely consistent across periods, although a higher proportion of females were tested during COVID and the prevalence of sCJD MV1 declined post-COVID.

Conclusion: CJD prevalence and characteristics remained stable during COVID-19 despite increased EP-QuIC test submissions. These findings verify that CJD surveillance in Canada remained vigilant during the pandemic and highlight the value of EP-QuIC CSF testing for comprehensive CJD monitoring.

Objective: This study investigated the prevalence and association of magnetic resonance imaging (MRI) imaging markers indicative of idiopathic intracranial hypertension (IIH) in patients diagnosed with endolymphatic hydrops (EH). The objective was to elucidate potential pathophysiological links between inner ear fluid dysregulation and alterations in intracranial pressure.

Methods: A total of 108 adult patients with dedicated MRI and delayed post-contrast (hydrops) sequences obtained for assessment of auditory/vestibular symptoms between 01/2020 and 06/2025 were retrospectively reviewed. EH grading, nerve volumes of the cochlear nerve, common vestibular trunk and facial nerve, IIH imaging features (e.g., Meckel's cave dilatation, optic nerve findings, venous sinus stenosis), and clinical symptoms were recorded. The prevalence and co-occurrence of EH and IIH features were statistically analyzed.

Results: Vestibular EH (grade 2) was noted in 71.3% (right) and 60.2% (left) of patients and cochlear EH (grade 2) in 42.6% (left) and 34.3% (right) of patients. IIH-related imaging markers were common: bilateral Meckel's cave dilatation (60.2%), partially empty sella turcica (50.9%), bilateral optic nerve sheath dilation (57.4%), optic nerve head enhancement on delayed FLAIR sequences (67.6%), and intrinsic bilateral transverse sinus stenosis (26.9%). Statistically significant associations were identified between vestibular EH severity and optic nerve sheath dilation (p = 0.0368), optic nerve tortuosity (p = 0.0309), slit-like lateral ventricles (p = 0.0023), and increased subcutaneous fat thickness in the scalp and neck (p = 0.003). Conversely, intrinsic bilateral transverse sinus stenosis was negatively correlated with EH severity (ρ = -0.228, p = 0.017). Overlap analyses demonstrated that many patients with moderate to severe EH exhibited multiple IIH imaging features concomitantly.

Conclusion: MRI findings demonstrate a frequent coexistence of EH and radiological biomarkers of IIH. This observation supports a potential pathophysiological association between inner ear fluid dysregulation and elevated intracranial pressure, underscoring the need for prospective studies integrating clinical outcomes with advanced MRI-based assessments of fluid dynamics.