Frontiers in Neurology最新文献

Introduction: In hemiparesis, spastic cocontraction is typically quantified by normalizing electromyographic activity to the root mean square (RMS) values obtained during maximal voluntary contraction (MVC) of the cocontracting muscle when it acts as an agonist. However, the selection of the RMS time window and the use of filtering procedures vary widely across studies, limiting comparability. In this study, we evaluated the effects of window size and low-pass filter cutoff frequency (ƒc) on the RMS values obtained during MVC in chronic hemiparesis.

Methods: Participants with stroke-induced hemiparesis and gastrocnemius spasticity (X_V1-GAS-X_V3-GAS >5°) were tested in a seated position on an isokinetic ergometer, with the knee extended and the ankle positioned at 90°. Surface electromyography (EMG) was recorded from the medial and lateral gastrocnemius (MG and LG), soleus (SL), and tibialis anterior (TA) during standardized isometric plantar flexor and dorsiflexor MVCs. RMS values were computed using sliding windows ranging from 5 to 1,250 ms (in increments of 5 ms) and analyzed across low-pass filter cutoff frequencies between 6 and 100 Hz.

Results: A total of 20 participants with hemiparesis (age: 56.4 ± 7.0 years and time since lesion: 7.8 ± 5.7 years) were included. Regardless of muscle type, experimental RMS curves as a function of window size adhered to a first-order model, with high consistency across trials (R ² ≈ 0.90, RMSE ≈ 8%). RMS values stabilized beyond 168.3 ms (time constant τ = 33.6 ms; 5τ threshold). In contrast, low-pass filtering caused a marked loss of amplitude, with >40% reduction in RMS magnitude at cutoff frequencies below 10 Hz, despite preservation of signal shape.

Conclusion: These findings demonstrate that reliable EMG normalization in spastic hemiparesis requires a minimal RMS window of approximately 200 ms during MVC and that unsmoothed EMG should be used to preserve signal amplitude. Methodological standardization using these parameters can improve the validity, reproducibility, and comparability of cocontraction indices across studies and may facilitate their application in clinical assessments and rehabilitation research in spastic paresis.

Objectives: It is well established that calcified plaques are highly likely to lead to residual stenosis after stenting; however, the specific characteristics responsible for this effect remain unknown. This study aimed to identify both qualitative and quantitative imaging risk factors for residual stenosis using computed tomography angiography.

Methods: We retrospectively enrolled 233 patients with carotid artery stenosis. Patients were categorized into two groups based on the presence or absence of postoperative residual stenosis. Carotid computed tomography angiography evaluated plaque characteristics both qualitatively and quantitatively. Logistic regression analysis identified independent risk factors for residual stenosis. We evaluated the predictive model's discriminative ability by calculating the area under the receiver operating characteristic (ROC) curve.

Results: Univariate analysis indicated a statistical difference in age, creatinine, total plaque volume, percentage of total calcified plaque, percentage of total soft plaque, maximum slice attenuation value, maximum thickness, total length, and a circumferential calcification score ≥2 points (p < 0.05). Multivariable logistic regression identified creatinine (OR = 1. 020; 95%CI: 1.005-1.035; p = 0.010), maximum slice attenuation value(Z-score; OR = 1.627; 95%CI: 1.024-2.585; p = 0.039), percentage of calcified plaque volume(Z-score; OR = 1.872; 95%CI: 1.137-3.082; p = 0.014) and circumferential calcification score ≥2 (OR = 3.257; 95%CI: 1.620-6.548; p < 0.001) as independent factors associated with residual stenosis. Furthermore, receiver operating characteristic curve analysis revealed that the area under the curve for the combined model in diagnosing residual stenosis was 0.784.

Conclusion: In conclusion, preoperative CTA-based assessment of specific plaque characteristics, such as calcified plaque volume percentage, circumferential calcium score, and the maximum slice attenuation value of calcification are related to residual stenosis.

The recent introduction of High-Efficacy Therapies (HETs) in clinical practice has drastically reduced the frequency of acute inflammatory episodes and relapses, in patients with Multiple Sclerosis (MS), gradually shifting the interest of clinicians toward preventing disease progression and treating symptoms associated with the residual disease. This article summarizes the output of a recent meeting (June 2025, in Rome) among an Italian group of neurologists, who discussed about published evidence supporting the involvement of the endocannabinoid system (ECS) in MS spasticity and its associated symptoms. Sharing their clinical experiences about the silent progression of the disease, in patients with Relapse-Free Multiple Sclerosis (RFMS), treated with HETs, authors propose a new algorithm to treat residual disease in RFMS, by enhancing ECS with both cannabinoid agents and lifestyle interventions (diet and physical activity).

Introduction: Post-mortem human brain banks are a key resource for researching brain diseases. The New South Wales Brain Tissue Resource Center (BTRC) is a brain bank that focuses on neurodegenerative diseases, including alcohol use disorder and Alzheimer's disease. Most banks hemi-sect brains, freezing one half and fixing the other. Traditionally, formalin-fixed, paraffin-embedded tissue has been used for immunostaining, whereas frozen tissue has been used for complementary molecular studies. Immunofluorescent staining has been more difficult to employ than chromogen-based immunostaining in post-mortem brain tissue because of autofluorescence that is amplified further in archival tissue kept in formalin for long term storage. Multiplex immunofluorescence (mIF) is extremely useful for visualizing complex cell interactions in the brain but is limited by the availability of primary-secondary antibody combinations. Tyramide signal amplification (TSA) systems largely solved the latter issue but remains expensive to perform.

Methods and results: Given the increasing interest in human post-mortem brain tissue for mechanistic studies, we explored whether modifying stripping protocols for traditional mIF staining could improve performance to match newer TSA-based methods.

Conclusion: Employing β-mercaptoethanol (BME)-containing stripping buffer instead of heat-induced epitope retrieval gave similar results for both techniques in both short-term and long-term fixed tissue. However, iterative imaging sessions between cycles for traditional mIF still pose a greater risk for malalignment of target molecules in composite images.

Background: Post-traumatic disorders of consciousness (DoC) remain a major barrier to recovery after traumatic brain injury (TBI), yet therapeutic guidance is fragmented across modalities.

Objective: To synthesize the highest-level evidence on efficacy and safety of interventions for TBI-related DoC and derive practice-oriented recommendations.

Methods: Following PRISMA and a prospectively registered protocol (INPLASY202480015), we systematically screened PubMed, Embase, Web of Science, and CNKI through June 2024 for peer-reviewed systematic reviews and meta-analyses focused on TBI-induced DoC. Methodological quality was appraised using AMSTAR-2. Primary outcomes were CRS-R, GCS, GOS, and overall efficacy rate; random- or fixed-effects models were applied per heterogeneity.

Results: Seven high-quality evidence syntheses encompassing 121 trials and eight interventions were included. Neuromodulation showed consistent benefits: repetitive transcranial magnetic stimulation (rTMS) improved CRS-R (MD 3.00, 95% CI 2.47-3.52) and GCS (MD 2.92, 1.65-4.19); transcranial direct current stimulation (tDCS) improved CRS-R (MD 2.08, 0.63-3.25). Peripheral and sensory approaches were robust: acupuncture improved GCS (MD 2.03, 1.54-2.52), GOS (RR 1.22, 1.16-1.29), and Efficacy Rate (RR 1.48, 1.40-1.56); multisensory stimulation improved GCS (MD 2.28, 2.02-2.54) and GOS (MD 1.11, 0.77-1.45). Right median nerve stimulation (RMNS) and family-centered sensory-affective stimulation also yielded significant gains, while single-study Trigeminal nerve stimulation (TNS) effects were mixed.

Conclusions: tDCS, rTMS, median nerve stimulation, multisensory stimulation, and acupuncture emerge as leading strategies for TBI-related DoC. We highlight priorities for the field: adequately powered multicenter RCTs with standardized protocols, mechanistic studies to refine dosing and targets, and predictive tools for personalized therapy selection. This umbrella synthesis provides a pragmatic evidence map to accelerate recovery and improve long-term outcomes in this vulnerable population.

Objectives: To evaluate the effects of receptive music therapy (RMT) combined with usual nursing care on cognitive performance, quality of life (QoL), mood, and metabolic stability among elderly patients with type 2 diabetes mellitus (T2DM) and cognitive impairment.

Methods: A randomized controlled trial enrolled 80 participants (aged 65-80 years) with T2DM and mild cognitive impairment. They were randomly assigned (1:1) to an intervention group (RMT + usual nursing care, n = 40) or control group (usual nursing care only, n = 40) for 8 weeks. Primary outcomes were changes in Montreal Cognitive Assessment (MoCA), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Geriatric Depression Scale-15 (GDS-15) scores. Secondary outcomes included glycated hemoglobin (HbA1c) and fasting glucose. Paired and independent t-tests with ANCOVA adjustment for baseline values were used.

Results: Seventy-five participants completed the study (retention = 93.7%). Compared with the control group, the intervention group showed a significant improvement in MoCA scores (Cohen's d = 0.78; 22.5 ± 2.0 → 26.1 ± 1.8, F = 9.84, p = 0.003). Total WHOQOL-BREF scores increased from 52.5 ± 5.6 to 61.4 ± 5.1 (F = 8.73, p = 0.005), with notable gains in the psychological (+16.5%) and social (+14.2%) domains. GDS-15 scores declined markedly from 6.9 ± 1.5 to 4.1 ± 1.3 (F = 10.46, p = 0.002), indicating a ≈ 40% reduction in depressive symptoms and a positive correlation with cognitive improvement (r = 0.42, p < 0.05). Glycemic parameters remained stable (HbA1c 7.8 ± 0.9 → 7.5 ± 0.8%; p = 0.11; fasting glucose 8.4 ± 1.2 → 8.1 ± 1.0 mmol/L; p = 0.14), with no adverse events. Adherence exceeded 95%, and satisfaction was > 90%.

Conclusion: RMT integrated with standard nursing care significantly improved cognition, mood, and QoL in elderly patients with T2DM and cognitive impairment without affecting metabolic stability. These results support RMT as a safe, inexpensive, and feasible adjunct to conventional geriatric diabetes management, offering a holistic nursing approach to enhance mental and emotional well-being.

Objective: Given the clinical heterogeneity of Parkinson's disease (PD), identification of early -stage subgroups with shared non-motor symptom (NMS) profiles may clarify its pathophysiology. This study used latent-profile analyses (LPA) to define subgroups based on sleep disturbances, cognitive performance and neuropsychiatric symptoms, and examined dopaminergic function and brain volume differences between them.

Methods: We analyzed data from 51 cognitively normal non-PD older adults and 105 early-stage PD participants from the iPARK trial, including 19 who underwent [¹¹C]-raclopride PET/MR. Participants completed the Hospital Anxiety and Depression Scale, the short version of the Karolinska Sleep Questionnaire and a battery of neuropsychological tests. LPA were used in PD to identify subgroups based on NMS profiles, which were then characterized and examined in relation to dopaminergic integrity and brain morphology.

Results: LPA identified a two-cluster solution as the best fit. Group 1 (N = 49) showed poorer working memory, executive function and processing speed along with greater daytime sleepiness, depression and anxiety. Group 2 (N = 56) exhibited less affected cognitive function and minimal NMS. Groups were similar in demographics, disease duration, motor symptom severity and medication, but differed on UPDRS-1 NMS. Group 1 demonstrated significantly reduced [¹¹C]-raclopride binding potential compared to Group 2 in the left putamen at both ROI- and voxel-wise analysis.

Conclusion: These findings indicate clinically distinct subgroups in early-stage PD. Greater NMS burden is linked to impaired dopaminergic integrity, suggesting a potential neurobiological signature. Early identification of such subgroups may improve understanding of disease heterogeneity and support personalized management and interventions.

Clinical trial registration: https://clinicaltrials.gov/study/NCT03680170?id=NCT03680170&rank=1, identifier (NCT03680170).

Introduction: Seizure semiology reflects dynamic interactions among ictal activity, internal state, and environmental context, and often involves distributed neural networks beyond the epileptogenic focus.

Methods: We report a 27-year-old right-handed, blind, bilingual man with focal epilepsy whose seizures were characterized by intense fear of imminent death, loud and coherent vocalizations, context-dependent bilingual language use, accurate autobiographical references, preserved responsiveness, and complete postictal amnesia.

Results: During seizures, the patient consistently addressed his mother in Urdu or English while speaking exclusively in English to medical staff, demonstrating preserved pragmatic awareness; nevertheless, he had no recollection of events afterward and expressed surprise when he heard his ictal vocalizations on the recorded video. Brain MRI revealed a left middle cranial fossa arachnoid cyst abutting the medial temporal lobe and ictal onset was in the right anterior temporal region.

Discussion: This case expands the spectrum of ictal fear and ictal speech by illustrating the convergence of multilingual communication, autobiographical integration, and pure postictal amnesia, highlighting the engagement of distributed limbic, interoceptive, and medial frontal networks.

Objective: Task-oriented circuit class training (CCT) is increasingly used in the rehabilitation of post-stroke gait dysfunction; however, current research findings remain inconsistent. This study aimed to further investigate its therapeutic efficacy.

Methods: Randomized controlled trials (RCTs) evaluating task-oriented CCT in stroke patients were identified through a systematic search of PubMed, the Cochrane Library, and EMBASE, covering the period from database inception to February 25, 2025. Studies were included if they assessed lower limb functional outcomes. Only publications in English were considered. Two independent reviewers conducted literature screening, data extraction, and risk-of-bias assessment. Meta-analysis was performed using Review Manager 5.4 and Stata 18.0 software.

Results: Twelve RCTs comprising 652 patients were included. Meta-analysis demonstrated significant, homogeneous effect sizes in favor of task-oriented CCT for the 6-min walk test (mean difference (MD) = 57.88, 95% CI 33.43 to 82.32, p < 0.00001), the Timed Up-and-Go test (MD = -1.74, 95% CI: -2.92 to -0.57, p = 0.004), and gait speed (MD = 0.13, 95% CI: 0.06 to 0.20, p = 0.0002). Subgroup analysis indicated that in patients within 3 months post-stroke, implementing task-oriented CCT with increased training frequency (≥3 times/week) was associated with improvements in 6-min walk distance and gait speed. In patients more than 3 months post-stroke, higher training frequency (≥3 times/week) or longer session duration (≥1 h) was linked to greater gains in 6-min walk distance and Timed Up-and-Go test (TUG) performance.

Conclusion: These findings support the beneficial effects of task-oriented CCT in improving walking ability after stroke. Future large-scale, multicenter RCTs are warranted to compare the effects of varying training components, including content, intensity, single-session duration, and intervention timing, on post-stroke walking function.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/home, identifier CRD420250652683.

Objective: Dry needling (DN) has been shown to exert beneficial effects in pain management. However, a comprehensive bibliometric analysis specifically examining the relationship between DN and pain has not yet been conducted. This study aims to systematically evaluate the global research landscape and emerging trends in the field of "dry needling and pain" from 2006 to 2025 using bibliometric methods, thereby providing a quantitative foundation and forward-looking guidance for future basic and clinical research.

Methods: A bibliometric analysis was conducted using literature published between 2006 and 2025, retrieved from the Web of Science Core Collection (WoSCC) and Scopus databases. Data were analyzed with Bibliometrix (R package), VOSviewer, and CiteSpace software.

Results: A total of 936 and 1,149 articles were retrieved from the WoSCC and Scopus databases, respectively. Over the past two decades, publication output in this field has steadily increased. The United States and Spain were the leading contributing countries, with Universidad Rey Juan Carlos in Spain serving as a central hub within the international collaboration network. Fernández-De-Las-Peñas C. was identified as the most prolific author. Journal analysis showed that the Journal of Bodywork and Movement Therapies published the most articles, whereas the Archives of Physical Medicine and Rehabilitation received the highest number of citations and acted as a key node in scholarly cooperation. Keyword co-occurrence and clustering analyses revealed four core research themes: evidence-based pain management, pathophysiological mechanisms of myofascial trigger points (MTrPs), clinical efficacy of DN for myofascial pain, and clinical trial design with outcome assessment. Current research hotspots focus on clinical effectiveness, mechanistic studies, refinement of trial methodologies, standardization of outcomes, and risk management in clinical practice.

Conclusion: The application of DN in pain management has garnered increasing global attention and is poised to become a major focus within the field. This study provides a comprehensive overview of the current research status and emerging themes, offering valuable insights for future investigations.