Frontiers in Neurology最新文献

Background/objectives: Primary progressive aphasia (PPA) is managed with speech-language therapy (SLT) to slow language decline. Pairing transcranial direct current stimulation (tDCS) with SLT can enhance its effects. However, further research is needed to confirm these findings and guide its clinical use. We evaluated the feasibility of providing an intervention combining tDCS with SLT as a home-based and remotely supervised intervention.

Methods: Participants with confirmed PPA who had word-finding difficulties were recruited for an open-label observational study. The intervention consisted of 20 daily sessions over 1 month, each with 45-min of personalized word retrieval training. During the first 30-min, participants received tDCS over the left inferior frontal gyrus (anode F7, cathode O1) at 2.0 mA. Language measures were remotely administered at baseline and intervention end.

Results: We enrolled 10 patients (age: 70 ± 7 years; 60% male) with confirmed logopenic variant (n = 2), semantic variant (n = 2), or unspecified (n = 6) PPA. The intervention was well-tolerated with no treatment-limiting adverse events. All participants completed all sessions, confirming the feasibility of the home-based treatment. There were no declines in language functioning measures, with improved naming for trained vs. untrained items (p = 0.003) and a significant improvement in confrontation naming (p = 0.016) from baseline to intervention end.

Conclusions: Our case series demonstrates that home-based tDCS added to SLT is feasible for patients with PPA. However, larger controlled studies are required to confirm its effectiveness in slowing language decline and to fully determine the benefits of this approach. This approach not only facilitates broader access to participation but also enables the extended treatment necessary to evaluate its clinical benefits, moving this treatment closer to clinical availability as a telehealth treatment.

Background: Cytokines are powerful immune response factors that operate at inflammation sites and are also found in the blood. Nevertheless, research on encephalitis and these circulating inflammatory proteins is quite limited.

Methods: This study investigated the potential causal effects of 91 circulating inflammatory proteins on three different types of encephalitis using a two-sample Mendelian randomisation analysis. The data source for encephalitis was the latest Finngen_R12 dataset, released in 2024. The study investigated causal effects mainly using Steiger, MR-Egger, weighted median and inverse variance weighting (IVW) methods. In addition, sensitivity analyses were performed, including heterogeneity assessment, horizontal pleiotropy and leave-one-out techniques.

Results: In this study, 91 circulating inflammatory proteins were subjected to MR analysis of causality with each of the three types of encephalitis. The results suggest that the inflammatory factors with a potential causal relationship with viral encephalitis are artemin, C-C motif chemokine 28, C-X-C motif chemokine 1, interleukin-10 and neurotrophin-3. Inflammatory factors potentially causally associated with acute disseminated encephalomyelitis are monocyte chemoattractant protein 2, interleukin-10 receptor subunit beta and matrix metalloproteinase-1. Inflammatory factors potentially causally associated with autoimmune encephalitis are C-C motif chemokine 28 levels and Macrophage inflammatory protein 1a levels.

Conclusion: This study identifies potential causal effects of certain circulating inflammatory factors on susceptibility to three types of encephalitis. Although the exact mechanisms by which inflammatory proteins contribute to the pathogenesis of different encephalitis subtypes remain unclear, our findings provide new perspectives on these potential causal relationships.

Background: Peak width of skeletonized mean diffusivity (PSMD) is a novel marker of small vessel disease. This study aimed to investigate the presence of small vessel disease in patients with occipital lobe epilepsy (OLE) using PSMD.

Methods: We enrolled 27 patients newly diagnosed with OLE and included 29 healthy controls. The age and sex of the patients and controls were comparable. Diffusion tensor imaging (DTI) was performed using a 3 T MRI scanner. We measured the PSMD based on DTI in several steps, including preprocessing, skeletonization, application of a custom mask, and histogram analysis, using the FSL program. We compared PSMD between patients with OLE and healthy controls. Additionally, we performed a correlation analysis between PSMD and clinical factors in patients with OLE.

Results: Our findings revealed that the patients with OLE exhibited higher PSMD compared to healthy controls (2.459 vs. 2.079 × 10^-4 mm²/s, p < 0.001). In addition, PSMD positively correlated with age (r = 0.412, p = 0.032). However, the PSMD of the patients with OLE was not associated with other clinical factors such as age at seizure onset and duration of epilepsy.

Conclusion: We demonstrated that patients with OLE had a higher PSMD than healthy controls, indicating evidence of small vessel disease in patients with OLE. This finding also highlights the potential of PSMD as a marker for detecting small vessel diseases in epileptic disorders.

Purpose: This study aims to develop hippocampal texture model for predicting cognitive impairment in middle-aged patients with cerebral small vessel disease (CSVD).

Methods: The dataset included 145 CSVD patients (Age, 52.662 ± 5.151) and 99 control subjects (Age, 52.576±4.885). An Unet-based deep learning neural network model was developed to automate the segmentation of the hippocampus. Features were extracted for each subject, and the least absolute shrinkage and selection operator (LASSO) method was used to select radiomic features. This study also included the extraction of total intracranial volume, gray matter, white matter, cerebrospinal fluid, white matter hypertensit, and hippocampus volume. The performance of the models was assessed using the areas under the receiver operating characteristic curves (AUCs). Additionally, decision curve analysis (DCA) was conducted to justify the clinical relevance of the study, and the DeLong test was utilized to compare the areas under two correlated receiver operating characteristic (ROC) curves.

Results: Nine texture features of the hippocampus were selected to construct radiomics model. The AUC values of the brain volume, radiomics, and combined models in the test set were 0.593, 0.843, and 0.817, respectively. The combination model of imaging markers and hippocampal texture did not yield improved a better diagnosis compared to the individual model (p > 0.05).

Conclusion: The hippocampal texture model is a surrogate imaging marker for predicting cognitive impairment in middle-aged CSVD patients.

Background: The effects of the menstrual cycle on neuropsychiatric and physical symptoms have been examined in multiple psychiatric illnesses, but research on Tourette syndrome (TS) and menstruation is limited and inconclusive. One study published in 1992 reported that 34% of female respondents experienced tic fluctuations with their menstrual cycles; however, a subsequent 2001 study found no significant relationship between menstrual cycle-related hormonal changes and tic symptoms across participants. There has been no further published exploration of this topic in the intervening 20+ years, and thus these discrepant results have not been reconciled. The current study aimed to assess tic changes across the menstrual cycle and to explore clinical predictors of tic fluctuations in adult females with TS.

Methods: An online survey was completed by 112 of 315 eligible female adults with TS. Respondents were asked to share their age of TS symptom onset, history of OCD and ADHD diagnoses, and current tic symptoms and severity. Participants also retrospectively reported their experiences with fluctuations in tics and other physical and psychiatric symptoms over the course of the menstrual cycle.

Results: 26% of the 112 respondents endorsed tic changes in relation to their menstrual cycles. Univariable and multivariable logistic regression demonstrated that higher current tic severity and impairment as well as co-occurring cycle-related mood and anxiety changes significantly predicted the presence of self-reported tic fluctuations during the menstrual cycle.

Discussion: Results suggest that some females with TS experience changes in tic symptoms during their menstrual cycles, although future research is required to clarify the complex relationships between the menstrual cycle, tics, and other psychiatric symptoms. The low response rate, retrospective recall of symptoms, and lack of information about hormonal influences such as contraceptives and menopause are notable study limitations.

Background: In recent years, we have witnessed a continuous, evidence-based expansion of indications for endovascular therapy (EVT) in the treatment of ischaemic stroke, driven by advancements in extended time windows and target vessel occlusion. Our study aimed to evaluate the temporal changes in patients' characteristics, treatment, and outcomes in clinical practice.

Methods: We used data from the German Stroke Registry, a large national multicentre prospective registry, which includes all patients receiving EVT for ischaemic stroke at its participating centers. We analysed baseline factors, treatment details, and clinical outcomes [Modified Rankin Scale (mRS) at 3 months] over a 5-year period (2017-2021).

Results: We included 6,251 patients from eight centres. Over time, the characteristics of patients undergoing EVT changed in several aspects (2017 vs. 2021). Patients became older (median age from 76 [IQR: 65-82] to 77 [65-84 years]; p_trend = 0.02), and less severely affected (NIHSS from 15 [11-19] to 13 [8-18]; p_trend <0.001). There was an increase in patients treated more than 6 h after last seen well (22.0% to 28.3%; p_trend<0.001), and more patients were treated for medium vessel occlusion (16.1% to 28.1%; p_trend<0.001). The use of intravenous thrombolysis decreased (52.4% to 40.4%; p_trend<0.01). Good functional outcome declined (percentage of patients with mRS ≤ 2 from 36.0 to 34.9%; aOR 0.94 per year [0.89-0.99]), while mortality at 3 months increased from 25.3% in 2017 to 34.7% in 2021; aOR 1.13 per year [1.07-1.19].

Conclusion: Between 2017 and 2021, there were significant shifts in the demographic and clinical profiles of patients undergoing EVT, along with an expansion in EVT indications. Despite these patients presenting with less severe stroke symptoms, improvements in functional outcomes were not observed, and mortality rates increased. These trends may reflect willingness to treat patients with more severe underlying health conditions.

Introduction: The brain's spontaneous neural activity can be recorded during rest using resting state functional magnetic resonance imaging (rs-fMRI), and intricate brain functional networks and interaction patterns can be discovered through correlation analysis. As a crucial component of rs-fMRI analysis, effective connectivity analysis (EC) may provide a detailed description of the causal relationship and information flow between different brain areas. It has been very helpful in identifying anomalies in the brain activity of depressed teenagers.

Methods: This study explored connectivity abnormalities in brain networks and their impact on clinical symptoms in patients with depression through resting state functional magnetic resonance imaging (rs-fMRI) and effective connectivity (EC) analysis. We first introduce some common EC analysis methods, discuss their application background and specific characteristics.

Results: EC analysis reveals information flow problems between different brain regions, such as the default mode network, the central executive network, and the salience network, which are closely related to symptoms of depression, such as low mood and cognitive impairment. This review discusses the limitations of existing studies while summarizing the current applications of EC analysis methods. Most of the early studies focused on the static connection mode, ignoring the causal relationship between brain regions. However, effective connection can reflect the upper and lower relationship of brain region interaction, and provide help for us to explore the mechanism of neurological diseases. Existing studies focus on the analysis of a single brain network, but rarely explore the interaction between multiple key networks.

Discussion: To do so, we can address these issues by integrating multiple technologies. The discussion of these issues is reflected in the text. Through reviewing various methods and applications of EC analysis, this paper aims to explore the abnormal connectivity patterns of brain networks in patients with depression, and further analyze the relationship between these abnormalities and clinical symptoms, so as to provide more accurate theoretical support for early diagnosis and personalized treatment of depression.

Introduction: Benign paroxysmal positional vertigo is the most frequent peripheral vestibular disorder, characterized by brief but intense vertigo crises related to changes in position. The Liberatory maneuver is considered the gold-standard treatment, with a short-term resolution of the vertigo in over 70% of cases, and achieving a 90% success rate after four maneuvers. An immediate reaction to the subsequent repositioning maneuver is often an orthotropic nystagmus (Ny) occurring in the same direction as the Ny observed after returning to the primary position. This reaction, occurring seconds to minutes after reaching the second position, is considered a positive predictor of the maneuver's effectiveness. To improve the success rate after the maneuver, many authors have suggested postural restrictions.

Methods: To determine the best predictors of outcome between the immediate behavior after the Semont maneuver and postural restriction, we analyzed 102 patients with posterior semicircular canalithiasis who underwent the Semont maneuver. In each case, we assessed the immediate reaction to the maneuver. Postural restrictions were recommended to 55 participants, while the remaining 40 were instructed to engage in normal head movements, even immediately following the maneuver.

Results: The resolution rate was almost the same (69% versus 62%), regardless of postural behavior, while a significantly high success rate was obtained in the presence of Ny in position 2 of the Semont maneuver.

Conclusion: Our results support the hypothesis that postural restriction is not necessary after the Semont maneuver and that the occurrence of Ny during position 2 is the main outcome indicator.