Acta neurologica Belgica最新文献

Objective: To provide an overview of alterations in anticipatory postural adjustments (APAs) during gait initiation (GI) and its possible clinical applicability in people with Parkinson's disease (pwPD).

Methods: A systematic search was conducted in PubMed and Web of Science using the terms: "Parkinson's disease" AND "postural adjustment" AND ("gait initiation" OR "step initiation"). Variables commonly used to assess APAs, including center of pressure (CoP) displacement and electromyography (EMG), were extracted. Study quality was assessed with the Newcastle-Ottawa Scale.

Results: Fourteen studies including 453 pwPD and 287 healthy subjects (HS) were reviewed. People with Parkinson's disease (PD) consistently exhibited smaller and slower CoP displacements in both anteroposterior and mediolateral directions, together with prolonged APAs durations. EMG findings indicated delayed onset and reduced amplitude, particularly in tibialis anterior and hip abductors, muscles pivotal for safe GI. Alterations were linked to disease severity and postural instability, with more pronounced changes in pwPD with freezing of gait (FoG). APAs-derived metrics showed sensitivity to subtle motor deficits even in early disease stages.

Conclusions: The reviewed literature demonstrates bradykinetic and hypokinetic APAs during GI in pwPD. GI-based measures may complement functional assessment for postural stability, gait, and fall risk, and have potential value for rehabilitation strategies such as external cueing. Levodopa improves but does not normalize APAs. Standardized, clinically feasible GI protocols are required to define meaningful thresholds and responsiveness so that APA-derived measures can be translated into routine clinical practice.

Background: The role of microvascular decompression (MVD) in patients with multiple sclerosis-related trigeminal neuralgia (MS-TN) remains unclear. Central demyelination is the primary underlying cause of MS-TN, and the absence of vascular compression raises questions about the role of MVD in MS-TN patients. We aimed to evaluate the efficacy and safety of MVD in MS-TN patients.

Methods: On April 9, 2025, a thorough search was performed, including studies that reported outcomes of MVD in MS-TN patients.

Results: Fifteen studies involving 230 patients were included. The meta-analysis revealed a pooled pain-free rate of 61% (95% CI: 10%-100%) and an adequate pain relief rate of 99% (95% CI: 93%-100%) at the initial follow-up. Our findings suggested that at the last follow-up, MVD resulted in a pooled pain-free rate of 29% (95% CI: 19%-41%) and an adequate pain relief rate of 76% (95% CI: 61%-89%), with a pooled complication rate of 16% (95% CI: 6%-29%).

Conclusion: MVD is associated with favorable initial pain-free and adequate pain-relief outcomes, acceptable long-term pain-related outcomes, and a relatively low complication rate. In MS-TN individuals with apparent NVC and no sign of brainstem lesions in the MRI studies, MVD can be associated with more favorable outcomes.

The build-up of beta-amyloid plaques in the brain leads to Alzheimer's disease (AD), a neurodegenerative condition. AD affects more than 30 million individuals globally every year. No cure for AD has been discovered yet. The available therapeutic options are administered to slow down the progress of the disease. The currently available treatment plans are used to relieve symptoms and improve cognitive abilities, thus slowing progression. Nanotechnology is highly effective and has demonstrated significant benefits across various medical applications. Nanoparticles have been explored as promising drug delivery systems for the targeted delivery of anti-AD therapeutics and for the precise diagnosis of the condition. Nanoparticles, such as dendrimers, lipid-based nanoparticles, polymer-based nanoparticles, and metal-based nanoparticles, have been designed and reported to inhibit Aβ aggregation, fibril formation, and disaggregating mature fibrils, prevent neuroinflammation and Aβ1-42-induced cell damage, treat oxidative stress and lower hallmark of Aβ, and display excellent capability to bypass blood-brain barrier (BBB). This review is focused on the preclinical therapeutic outcomes of nanoparticles and the challenges encountered in the treatment of AD. This review highlights the significant advancements of nanoparticles that are currently undergoing clinical trials for management of AD.

Background: The hypothalamus is involved in cluster headache (CH) pathophysiology and is a hub for autonomic control. While cranial autonomic symptoms are prominent during attacks, other autonomic manifestations may be present in CH. This study aims to explore the autonomic nervous system (ANS) in patients with CH during remission period.

Methods: Cross-sectional study including 30 CH and 30 age- and sex-matched controls. We analysed time- and frequency-domain parameters of heart rate variability (HRV) and active orthostatic tests. To investigate the sympathetic nervous system, plasma norepinephrine (NE) levels were determined. All assessments were performed during remission period.

Results: All HRV parameters were lower in CH; the percentage of adjacent R-R intervals that differ by more than 50 milliseconds (pNN50) and standard deviation of normal-to-normal R-R intervals in 24 h (SDNN) were significantly lower in CH (pNN50, 31.0 [5.3-44.3] vs. 44.5 [25.8-58.5], p = 0.043; SDNN, 79.6 ± 42.6 vs. 99.6 ± 42.6, p = 0.004). All other time-domain parameters, including the root mean square of successive R-R differences (RMSSD) were lower in CH than in controls (RMSSD 59.5 ± 36.9 vs. 77.3 ± 39.4, p = 0.077). Compared to controls, mean HR was significantly higher in CH (64.2 [59.6-75.8] vs. 60.4 [57.3-62.7], p = 0.038). Supine and upright NE levels were significantly higher in CH, (supine 228.9 [161.6-324.1] vs. 209.9 [151.2-314.1], p = 0.015; standing 376.1 [264.6-527.8 vs. 327.4 [256.4-400.9], p = 0.019).

Conclusions: The present study indicates a significant decrease in HRV and an upward trend of plasmatic NE levels in CH during remission periods, suggesting an imbalance of the ANS in this state.