Neurological Sciences最新文献

Transcranial magnetic stimulation (TMS), a non-invasive neuromodulation technique, is widely employed in treating various neurological and psychiatric disorders due to its favorable safety and tolerability profile. While traditionally recognized for its role in motor control, accumulating evidence implicates the cerebellum in regulating non-motor functions, including cognition. Historically, TMS research predominantly targeted cortical brain regions. However, leveraging the functional and structural characteristics of the cerebellum, recent investigations have increasingly focused on the cerebellum as a stimulation target, exploring the effects of cerebellar transcranial magnetic stimulation (CRB-TMS) on cognitive function.This review presents an overview of the current understanding and status of the cerebellar-cognitive connection. It critically examines the effects of cerebellar CRB-TMS on different cognitive functions, such as memory, language, attention and executive function .And it discusses the effects of different stimulation modes and stimulation sites on cognitive functions. Furthermore, it explores the research progress and potential clinical applications of CRB-TMS for cognitive disorders. We summarize key findings, discuss underlying mechanisms, and outline future research directions to inform the optimization of CRB-TMS for modulating cognitive function.

Purpose: This study investigates the potential of preoperative MEG functional connectivity networks to predict the efficacy of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy (DRE).

Methods: A total of 18 DRE patients and 18 healthy controls were enrolled. Resting-state MEG data were collected preoperatively, and brain network connectivity was assessed across seven frequency bands (δ, θ, α, β, γ, ripple, and fast ripple) using corrected amplitude envelope correlation (AEC-c). Network-based statistics (NBS) were employed to identify differences in connectivity patterns.

Results: Compared to healthy controls, DRE patients, particularly non-responders (NR-VNS), exhibited widespread abnormal functional connectivity, including significant increases in low-frequency bands and mixed alterations in mid-to-high frequency bands. Responders (R-VNS) showed marked normalization of brain connectivity, with reductions in differences from controls, especially within alpha and beta bands. These connectivity patterns were significantly associated with treatment outcomes, indicating their potential as predictive biomarkers.

Conclusions: Preoperative brain network patterns derived from multi-frequency MEG, particularly in alpha and beta bands, hold promise for predicting VNS treatment response in DRE patients. The "health status" of the brain's network prior to implantation appears to be a crucial factor influencing therapeutic efficacy.

Introduction: Febrile infection-related epilepsy syndrome (FIRES) is a subtype of new onset refractory status epilepticus (NORSE) that has, in recent years, been recognized to not only affect pediatric but adult patients too. While inpatient mortality in adult-onset FIRES has been suggested to be higher than in pediatric patients, little is known about the factors associated with survival, hampering research into developing prognostic and stratification models and also posing a challenge for clinical communications and decision making.

Methods: We report a fatal case of FIRES in a 21-year-old lady and performed a review of literature involving adult-onset FIRES from 1 Aug 2022 to 17 Aug 2024, analyzing the data to identify factors associated with survival of the initial hospital stay.

Results: Including our case, 49 patients of adult-onset FIRES were identified. Of the 47 patients who had MRI brain scan findings described at any time during the illness, 35 patients (74.5%) had abnormal findings in at least one scan, and the most common site of abnormality was the temporal lobe (59.6%). A total of 41 patients survived the initial hospital stay (83.7%). The presence of MRI temporal lobe abnormalities was associated with survival at discharge (p = 0.013), and the association remained significant on multivariate analysis with corticosteroid usage.

Conclusion: In adult-onset FIRES, MRI temporal lobe abnormalities may be associated with survival beyond the acute phase. Our study findings suggest that the site of MRI abnormalities in FIRES may have value in the clinical stratification and prognostication of adult-onset FIRES.

Background: This study aimed at investigating whether high plasma homocysteine (Hcy) levels affect specific cognitive functions in individuals with Frontotemporal Dementia (FTD). While Hcy is a well-established risk factor for cerebrovascular disorders and Alzheimer's Disease, its role in other neurodegenerative dementias remains unclear. Furthermore, it is not known whether elevated Hcy levels contribute to a generalized cognitive decline or selectively impair specific cognitive domains. This uncertainty may stem from previous studies predominantly relying on global cognitive assessments rather than detailed domain-specific measures.

Methods: In a cross-sectional design, 173 patients with a diagnosis of FTD underwent a comprehensive neuropsychological evaluation assessing key cognitive domains, including memory, language, visuoperception, visuospatial abilities, executive functioning, constructional praxis, and ideomotor praxis. The influence of plasma Hcy levels and other potential risk factors (e.g., cholesterol levels, smoking habits, triglycerides, and the presence of the apolipoprotein E ε4 allele) was analysed.

Results: A Generalized Linear Model analysis revealed no significant association between elevated Hcy levels and cognitive performance across domains in the FTD cohort.

Conclusions: Hcy levels were not significantly associated with cognitive performance in a large sample of individuals with FTD. If replicated, these findings could challenge the hypothesis that Hcy constitutes a risk factor for FTD.

Background: Distinguishing dangerous from benign vertigo remains a diagnostic challenge. Our study aimed to develop and evaluate a machine learning model to differentiate between dangerous and benign vertigo in the outpatient setting across two medical institutions that used different equipment, testing methods, and protocols.

Methods: Patients in the dizziness clinics of Shuang Ho Hospital (SHH) and Taichung Tzu Chi Hospital (TTCH) were classified into "benign vertigo" and "dangerous vertigo" groups. The data of video-oculography (VOG) and video head impulse test were combined and preprocessed by applying the min-max scaler and the synthetic minority oversampling technique. The optimized Random Forest (RF)-Adaptive Boosting (AdaBoost) model was employed for classification. The SHapley Additive exPlanations method provided feature importance. Model performance was evaluated using a random 70/30 stratified split across sites, and 95% confidence intervals (CIs) were computed using stratified bootstrapping.

Results: A total of 294 patients were enrolled, including 184 (171 with benign vertigo and 13 with dangerous vertigo) in SHH and 110 (63 with benign vertigo and 47 with dangerous vertigo) in TTCH. The optimized RF-AdaBoost model was used to identify dangerous vertigo. The accuracy was 97% (95% CI: 92 - 100%), the sensitivity was 92% (95% CI: 75 - 100%), the specificity was 97% (95% CI: 93 - 100%), and the AUC was 0.95 (95% CI: 0.86 - 1.00).

Conclusion: Our VOG-based machine learning model for differentiating dangerous from benign vertigo demonstrated good accuracy and showed potential for use across different equipment, testing methods, and institutional protocols.

Background: Currently, the cognitive impact of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) remains unclear in non-diabetic patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI), despite their widespread use for type 2 diabetes. This meta-analysis summarized cognitive outcomes from randomized controlled trials (RCTs) of GLP-1 RAs in non-diabetic patients with AD or MCI.

Methods: PubMed, Cochrane Library, and Embase were searched for studies through October 27, 2024. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using random-effects models. Sensitivity analyses addressed variations in cognitive assessment methodologies. Between-study heterogeneity was evaluated using the I² index.

Results: Four RCTs comprising 112 patients (61 placebo, 51 treatment) were included. For cognitive tests where higher scores indicate better outcomes, no significant difference was observed between GLP-1 RA and placebo groups (pooled SMD: -0.10, 95% CI: -0.53, 0.34; I² = 23.9%). Sensitivity analyses yielded consistent results. Analysis of the Alzheimer's Disease Assessment Scale-Cognitive subscale from two studies, where lower scores indicate better outcomes, similarly showed no significant treatment effect (SMD: 0.07, 95% CI: -0.47, 0.62; I² = 0%).

Conclusion: There was no evidence that GLP-1 RAs improved cognitive outcomes compared to placebo in non-diabetic patients with AD or MCI. Further research is needed to clarify their neuroprotective potential and explore alternative therapeutic strategies for cognitive decline.

Background: Headache at the onset of acute ischemic stroke may point to specific vascular etiologies, yet the features and risk factors of headache attributed to ischemic stroke remain under-characterized. This study aimed to determine the prevalence, clinical phenotype, and independent predictors of acute headache attributed to ischemic stroke.

Methods: In this cross-sectional study, consecutive adults with acute ischemic stroke admitted to a Thai university hospital (July 2021 - December 2022) underwent a structured headache interview based on the International Classification of Headache Disorders, 3rd edition. Infarct topography was mapped with the Alberta Stroke Program Early CT Score. Multivariable logistic regression identified factors independently associated with acute headache attributed to ischemic stroke.

Results: Among 153 patients, 35 experienced acute headache attributed to ischemic stroke (prevalence 23%). Headache was usually mild (54%); pressing or tightening in character (46%); bilateral (51%) or ipsilateral to the infarct (31%); centered on the temporal region (66%); intermittent (54%); and typically lacked accompanying symptoms (66%). Female sex (adjusted odds ratio [aOR] 2.54, 95% confidence interval [CI] 1.10-5.85), large-artery atherosclerosis (aOR 2.56, 95% CI 1.09-6.01), and lentiform nucleus infarction (aOR 3.78, 95% CI 1.25-11.44) independently increased the odds of acute headache attributed to ischemic stroke.

Conclusions: Nearly one in four patients with acute ischemic stroke experienced acute headache attributed to ischemic stroke, characteristically a mild, tension-type pain that was bilateral or lateralized to the ischemic hemisphere, centered on the temporal region. Female sex, large-artery atherosclerosis, and lentiform nucleus involvement were independent risk factors.