Frontiers in Neurology最新文献

Purpose: This systematic review and meta-analysis evaluates the effectiveness and safety of stellate ganglion block (SGB) for tinnitus.

Methods: A comprehensive systematic literature search was performed across four Chinese databases include China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), and SinoMed. five English databases include PubMed, Cochrane Library, Embase, Ovid, and Web of Science to identify randomized controlled trials (RCTs) investigating the use of SGB for tinnitus treatment published before November 28, 2025. Searches were conducted in both Chinese and English. Following a rigorous screening process, meta-analyses were carried out using Stata 17.0 and RevMan 5.2.1 software. The study protocol was registered on PROSPERO (CRD420251242113).

Results: A total of 11 randomized controlled trials comprising 915 patients were included in this study. Meta-analysis demonstrated that SGB combined other therapy was significantly more effective than the control group in treating tinnitus, with an overall effective rate (OR = 4.53, 95% CI [3.15, 6.53], p < 0.00001). In terms of functional improvement, SGB significantly reduced the THI (MD = -5.73, 95% CI [-6.10, -5.36], p < 0.00001) and the SAS (MD = -11.37, 95% CI [-12.46, -10.29], p < 0.00001). Hemodynamic assessments revealed a notable increase in basilar artery blood flow velocity following SGB treatment (Vs: MD = 5.60 cm/s, 95% CI [4.40, 6.80], p < 0.00001; Vd: MD = 4.26 cm/s, 95% CI [3.70, 4.83], p < 0.00001). Similarly, carotid artery blood flow velocity showed significant improvement (PSV: MD = 4.73 cm/s, 95% CI [3.26, 6.18], p < 0.00001; EDV: MD = 10.85 cm/s, 95% CI [6.02, 15.68], p < 0.0001).

Conclusion: SGB combination therapy shows promise in managing tinnitus by improving effective rates, blood flow, THI and SAS scores. However, future large-scale, rigorous trials are essential to standardize treatment, address potential bias, and confirm long-term benefits.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420251242113.

Background: Early assessment of traumatic brain injury (TBI) severity and prognosis is critical for clinical diagnosis and treatment. However, existing biomarkers have limitations in terms of predictive accuracy and timeliness. This study aimed to investigate the dynamic changes of the novel biomarker milk fat globule-EGF factor 8 (MFGE8) following TBI and systematically evaluate its value in predicting TBI severity and clinical prognosis, in comparison to GFAP.

Methods: This was a prospective, single-center observational study involving 70 patients with acute TBI and 33 healthy controls. Serum levels of MFGE8 and GFAP were quantitatively determined by ELISA at admission (within 12 h of injury) and at 24, 48, and 72 h after injury. TBI severity was graded by the Glasgow Coma Scale (GCS) at admission, and the Rotterdam CT score was used to evaluate radiological injury severity. Outcome measures included 30-day mortality and the Glasgow Outcome Scale-Extended (GOSE) score at 3 months. Longitudinal biomarker trajectories and their associations with clinical severity, radiological severity, and outcomes were analyzed using linear mixed-effects models (LMMs), with Spearman's correlation and receiver operating characteristic (ROC) analyses performed as complementary assessments.

Results: The levels of serum MFGE8 and GFAP in TBI patients at all time points were significantly higher than those in the control group (p < 0.001) and peaked 24 h post-injury. In addition, significant correlations were shown between the two biomarkers, as well as between each biomarker and the clinical and radiographic severity scores (all p < 0.001). LMMs demonstrated significant differences in biomarker concentrations across clinical severity, radiological severity, and outcome groups, with significant main effects of time and group and significant group × time interactions. Pairwise comparisons indicated that GFAP provided earlier separation of clinical severity at admission, whereas MFGE8 exhibited its strongest severity separation at 24 h post-injury, with similar time-dependent patterns observed for radiological severity. Both biomarkers were consistently higher in patients with unfavorable outcomes and death compared with favorable survivors at admission and 24 h post-injury. MFGE8 showed superior prognostic performance for 30-day mortality at 24 h (AUC = 0.895), while GFAP demonstrated strong early discriminatory ability at admission. The GFAP/MFGE8 ratio exhibited moderate prognostic value.

Conclusion: Serum MFGE8 is a promising biomarker after TBI. It is closely related to the injury severity and clinical prognosis. Particularly, it demonstrates high prognostic predictive value within 24 h post-injury. Continuous monitoring of MFGE8 may aid in early risk stratification and prognostic assessment for TBI.

Background: This study aimed to systematically evaluate the clinical efficacy of oblique pulling manipulation and its combination with massage, acupuncture, Chinese herbal medicine, and injection therapy in lumbar disc herniation (LDH).

Methods: The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO (CRD420251107984). A comprehensive search was conducted in databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, EMBASE, Web of Science, and the Cochrane Library until June 2025. All statistical analyses were conducted using Review Manager 5.4.1. Dichotomous outcomes were summarized as odds ratios (ORs) with 95% confidence intervals (CIs), and continuous outcomes were summarized as standardized mean differences (SMDs) with 95% CIs.

Results: A total of 26 studies comprising 2,766 patients with lumbar disc herniation were included. The results of the meta-analysis revealed that oblique pulling manipulation and its combination with massage, acupuncture, Chinese herbal medicine, and injection therapy in LDH significantly improved the effective rate and cure rate in patients with LDH. In addition, oblique pulling manipulation significantly improved the Japanese Orthopedic Association (JOA) score, and oblique pulling manipulation combined with massage or acupuncture decreased the Oswestry Disability Index (ODI).

Discussion: Oblique pulling manipulation and its combination with massage, acupuncture, Chinese herbal medicine, and injection therapy improved efficacy and cure rates in patients with lumbar disc herniation. Future research should focus on standardizing treatment protocols and extending follow-up periods to confirm long-term safety and effectiveness, thereby ensuring broader applicability and better patient outcomes.

Systematic review registration: https://www.crd.york.ac.uk/prospero/CRD420251107984, identifier: CRD420251107984.

Background: Accurate early prognostication in acute ischemic stroke (AIS) is essential for optimizing post-thrombectomy management strategies. However, the predictive utility of baseline clinical characteristics remains underexplored in real-world emergency settings.

Objective: To identify independent clinical predictors of in-hospital neurological improvement following mechanical thrombectomy in AIS patients, with particular focus on admission NIHSS score and comorbid diabetes mellitus.

Methods: In this retrospective single-center cohort study, 250 AIS patients who underwent emergency mechanical thrombectomy between January 2020 and December 2022 were analyzed. Patients were dichotomized according to an in-hospital early neurological improvement endpoint defined a priori as ENI-4 (decrease ≥4 points in NIHSS from admission to discharge). All analyses were repeated in sensitivity analyses using two alternative definitions: a clinician-adjudicated composite of in-hospital neurological improvement and discharge NIHSS ≤1/0. Logistic regression analyses were employed to determine independent predictors. Model performance was evaluated using ROC curve analysis, calibration plots, and nomogram construction.

Results: Among the 250 patients, 196 (78.4%) showed neurological improvement during hospitalization. Multivariate logistic regression revealed that a lower admission NIHSS score (OR = 0.867, 95% CI: 0.810-0.927; p < 0.001) and absence of diabetes mellitus (OR = 0.357, 95% CI: 0.129-0.988; p = 0.047) were independently associated with favorable short-term outcomes. The final model demonstrated moderate discriminative ability (AUC = 0.711) and good calibration. Spline analysis demonstrated a non-linear NIHSS-outcome relationship, and decision-curve analysis showed positive net benefit across 10-30% thresholds. A nomogram based on the model was developed for bedside application. Using ENI-4 as the primary outcome, lower admission NIHSS and absence of diabetes remained independently associated with in-hospital neurological improvement in the multivariable model (NIHSS OR 0.867; diabetes OR 0.357).

Conclusion: Lower NIHSS scores at presentation and non-diabetic status are independent predictors of early neurological improvement following thrombectomy. The internally validated model provides a clinically accessible tool for early risk stratification in AIS patients and may inform post-procedural monitoring and care planning in settings lacking long-term functional follow-up.

Objective: The benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion is now well established. EVT is highly effective for treating embolic occlusions; however, there remains ongoing debate regarding the optimal management of underlying intracranial atherosclerotic disease (ICAD). Current approaches often involve a combination of best medical therapy and mechanical rescue strategies, such as intracranial angioplasty or stenting. In this study, we aimed to compare EVT outcomes between patients with ICAD-related strokes and those with cardioembolic strokes.

Materials and methods: The study was designed retrospectively. Data of patients admitted to the stroke center were analyzed. The results of the ICAD group were compared with the cardioembolic stroke group. Demographic characteristics, comorbidities, medications, IV rtPA use before EVT, contraindications, radiologic imaging results, and mechanical thrombectomy results were evaluated. Modified Rankin Score (mRS) results at discharge and 3 months were analyzed. At the end of 3 months, those with mRS 0-2 were included in the good outcome group, and those with mRS 3-6 were included in the poor outcome group. In this study, propensity score matching (PSM) was implemented. The logistic regression model was used.

Results: A total of 349 patients were included, with 12% classified in the ICAD group and 88% in the cardioembolic group. Through PSM, 40 matched patients were successfully identified in the cardioembolism group, corresponding to 42 patients in the ICAD group. During EVT, dissection (OR: 1.105, 95% CI: 1.002-1.219) and reocclusion after EVT (p = 0.002) rates were statistically significant in the ICAD group. No significant difference in the rate of symptomatic intracerebral hemorrhage (sICH) was observed between the groups (p = 0.892). The ICAD group showed higher rates of failed recanalization (mTICI 0-2b) and worse 3-month mRS scores (mRS 3-6) compared to the cardioembolic group.

Conclusion: In this comparative study of EVT outcomes in ICAD-related and cardioembolic strokes, no significant difference was seen in the rate of post-procedural hemorrhagic complications. It was observed that 3-month poor outcome rates were higher in acute stroke patients with ICAD compared to cardioembolic strokes. We revealed that patients with ICAD presenting with acute ischemic stroke demonstrated higher rates of complications (dissection) and lower recanalization rates following EVT. These results highlight the need for tailored therapeutic strategies and careful procedural planning in patients with ICAD to improve clinical outcomes.

Objective: To assess the prevalence of post-stroke poor sleep quality using the Pittsburgh Sleep Quality Index (PSQI).

Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following the PICO framework, a systematic search was conducted in PubMed, CINAHL, Cochrane Library, and Web of Science for relevant cohort, case-control, and cross-sectional studies published up to October 2024. The retrieved literature was then meta-analyzed using Stata 13.0 software.

Results: Eighteen studies were reviewed, showing a total poor sleep quality prevalence of 55% (95%CI = 0.47 to 0.62) and a PSQI score is 8.12 (95%CI = 6.71 to 9.53). Compared to normal people, stroke patients sleep onset latency (SL) was prolonged by 1.36 min (95%CI = 0.82 to 1.90), sleep efficiency (SE) decreased by 1.48% (95%CI = -0.20 to -0.92), and periodic leg movements per hour of sleep (PLMI) increased by 1.07 per hour (95%CI = 0.56 to 1.59). Subgroup analysis showed that, compared with hemorrhagic stroke patients, ischemic stroke patients had higher incidence of poor sleep quality at 52% (95%CI = 0.24 to 0.86); the incidence of poor sleep quality was 59% (95%CI = 0.49 to 0.70) higher in chronic stroke patients compared to acute and subacute stroke patients; the incidence of poor sleep quality was 61% (95%CI = 0.51 to 0.71) higher in community stroke patients than in hospitalized stroke patients; and the incidence of poor sleep quality was 59% (95%CI = 0.58 to 0.61) higher in stroke patients in developing countries than those in developed countries.

Conclusion: Current evidence suggests that quality of sleep worsens after a stroke, with symptoms being widespread. Factors such as stroke type, stroke phase, clinical setting, and research region can all impact sleep quality after stroke. These findings underscore the importance of monitoring sleep quality in these populations and implementing appropriate preventive and interventional strategies.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420251161167.

Background: Slow-release 4-aminopyridine (fampridine) has been shown to improve walking function in people with multiple sclerosis (MS). Its effect on other MS symptoms, such as fatigue, remains controversial. We performed this systematic review to summarize the evidence of the effect of fampridine on fatigue in patients with MS.

Methods: PubMed, Scopus, EMBASE, Web of Science, google scholar, and ProQuest were searched for randomized trials or observational studies reporting fatigue scores before and after the treatment with fampridine. We summarized the findings of all relevant reports.

Results: A literature search revealed 2,675 records; after removing duplicates, we had 1,504 records. Ninety-seven full texts were evaluated, and finally, 33 studies remained for systematic review. Most studies were done in USA, France, Germany, and Italy. The participants' age and the duration of studies ranged between 39 and 54 years and 2 and 48 weeks, respectively. Out of 20 non-randomized or observational studies, 19 reported a benefit of fampridine in improving MS fatigue; however, only three out of 13 randomized, placebo-controlled studies showed that fampridine improved fatigue better than a placebo.

Conclusion: Overwhelmingly positive results of fampridine on fatigue reported in non-randomized and observational studies are compatible with the placebo-responsiveness of fatigue in MS. Randomized, placebo-controlled studies have provided inconsistent results on the effects of fampridine on MS fatigue. Although it is possible that fatigue, at least in a subgroup of people with MS, might respond to fampridine, high-quality, placebo-controlled, blinded, randomized trials are needed to show the efficacy of this medication in improving MS fatigue.

Objective: Spinal cord injury (SCI) is a highly disabling neurological condition that remains a worldwide challenge in healthcare. Our previous studies found that repetitive trans-spinal magnetic stimulation (rTSMS) applied at the L2 spinal segment yielded the most significant improvement in motor function in rats with SCI; however, the underlying mechanism remains unclear. Recent research indicates that disruption of the EphA4 signaling pathway in glutamatergic interneurons within the spinal cord leads to a loss of motor rhythm and a hopping gait in rats. Conversely, activating the locomotor central pattern generator (CPG) located in the L1-2 spinal segments promotes the recovery of motor function. Thus, by examining the effects of rTSMS on proteins associated with the EphA4 signaling pathway, this study provides novel insights for future investigations into its potential mechanisms of action.

Methods: A multidimensional approach, including behavioral assessments, immunofluorescence, RT-PCR, and Western blotting, was employed to evaluate the effects of rTSMS on motor function in rats with acute SCI. We also assessed its impact on EphA4 mRNA expression levels and the synthesis of related proteins, including VGluT2, EphA4, EphrinB3, and downstream effector molecules Chn1 and Nck1.

Results: The results showed that rTSMS improved the Basso, Beattie, and Bresnahan (BBB) locomotor scores in rats with acute spinal cord injury. It also exerted positive effects on upregulating the expression level of EphA4 mRNA and promoting the synthesis of proteins, including VGluT2, EphA4, EphrinB3, and the downstream effector molecules Chn1 and Nck1.

Conclusion: This study suggests that repetitive trans-spinal magnetic stimulation effectively improves motor function after acute spinal cord injury, concomitant with an upregulation of EphA4 pathway-related proteins, thereby providing a new direction for future mechanistic research.

Introduction: Spike-wave discharges (SWDs) are pathological brain oscillations caused by abnormal thalamocortical synchronization and are a hallmark of several epileptic syndromes. While several experimental models are characterized by SWDs during wakefulness and mimic several key features of absence epilepsy, the spontaneous occurrence of SWDs during sleep has been reported in a limited number of studies. Here, we report a comprehensive characterization of the electrophysiological profile and sleep-wake cycle of a mouse strain previously shown to present sleep-associated SWDs.

Methods: Inbred AJ mice from Jackson Laboratory (JAX) and matched control mice were instrumented for chronic video-EEG/EMG recordings. Data obtained during two 24-hour recording sessions were analyzed to characterize both the sleep-wake cycle and abnormal electrical activity.

Results: Unlike control animals, JAX mice consistently displayed numerous SWDs. The vast majority of episodes occurred during slow-wave sleep (SWS) without overt convulsive manifestations. JAX mice exhibited a reduction in SWS, spent more time in paradoxical sleep, and showed more transitions between vigilance states than controls. Interestingly, SWD events were distributed in a circadian fashion, peaking around the end of the rest period.

Discussion: Alongside previously characterized models, the consistent and spontaneous occurrence of SWDs during SWS makes the JAX mouse a viable experimental model to understand the mechanisms behind sleep-related SWDs. The results, including the peculiar circadian distribution of SWDs, pave the way for further studies addressing a fundamental pathogenetic conundrum, i.e., why is epileptiform activity specifically concentrated in SWS.

Chronic pain is a major global health issue, affecting approximately 25% of the population. Managing this condition remains challenging due to the limited efficacy of current therapeutic options. Spinal cord stimulation (SCS), a form of neuromodulation, has been utilized to treat intractable visceral pain. This review summarizes recent advancements in understanding the effects and mechanisms of SCS in refractory chronic pain. Key mechanisms include neurotransmitter modulation, descending inhibition, and cortical changes. SCS operates through various modes, such as high-frequency, burst, closed-loop, dorsal horn inhibition, and descending control. Clinical indications for SCS encompass Failed Back Surgery Syndrome (FBSS), Complex Regional Pain Syndrome (CRPS), Painful Diabetic Peripheral Neuropathy (PDPN), ischemic pain, and cancer pain. This article aims to explore the clinical potential of SCS and the mechanisms underlying its therapeutic efficacy.