BMC Neurology[JOURNAL]
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200 papers
The HLA paradox across populations in multiple sclerosis progression: a systematic review.
Maghbooli Z, Nasir E, Mahdavinasab F … +2 more , Sahraian MA, Shirvani A
BMC Neurol · 2026 Jun · PMID 42343278 · Full text
BACKGROUND: Multiple sclerosis (MS) exhibits heterogeneity in disease courses. Although HLA DRB1*15:01 represents the strongest genetic risk factor for MS susceptibility, conferring approximately threefold increased risk...
BACKGROUND: Multiple sclerosis (MS) exhibits heterogeneity in disease courses. Although HLA DRB1*15:01 represents the strongest genetic risk factor for MS susceptibility, conferring approximately threefold increased risk, whether this allele similarly influences disease progression remains contentious. METHODS: This systematic review was conducted to clarify the relationship between HLA polymorphisms and the course of multiple sclerosis from inception through November 2025. A three-level random effects meta-analysis was used to account for statistical non-independence. Study quality was evaluated using Q GENIE criteria. RESULTS: In total, 56 eligible studies were selected, comprising 22,145 participants; 35 studies contributed 276 effect sizes to quantitative synthesis. The pooled estimate indicated a modest overall association between HLA variants and MS progression (Odds Ratio (OR) 1.30, 95% CI 1.09 to 1.55, p = 0.003). HLA DRB1*15 showed no significant association with disease progression (OR 1.10, 95% CI 0.79 to 1.51, p = 0.57). Exploratory subgroup analysis revealed significant regional heterogeneity (QM = 10.48, p = 0.033): Asian (OR 1.70, p < 0.001) and North American (OR 1.95, p < 0.001) studies suggested significant effects, whereas European studies showed no effect (OR 1.02, p = 0.92). Three alleles demonstrated significant adverse associations: HLA DRB1*04 (OR 1.79, 95% CI 1.33 to 2.42), HLA DRB1*09 (OR 4.21, 95% CI 1.93 to 9.18), and HLA DRB1*03 (OR 1.44, 95% CI 1.01 to 2.05). CONCLUSION: This systematic review suggests that multiple sclerosis susceptibility and progression appear governed by distinct genetic architectures.
Prevalence and associated factors of sarcopenia in stroke inpatients: a cross-sectional study with SarQoL-assessed quality of life.
Tang H, Li J, Chen J … +5 more , Zhu X, Hao M, Chen L, Yang J, Xue C
BMC Neurol · 2026 Jun · PMID 42343261 · Full text
BACKGROUND: Stroke is associated with a high burden of sarcopenia, which may be related to poorer functional outcomes and quality of life (QoL). AIM: To estimate the prevalence of sarcopenia among stroke inpatients, iden...
BACKGROUND: Stroke is associated with a high burden of sarcopenia, which may be related to poorer functional outcomes and quality of life (QoL). AIM: To estimate the prevalence of sarcopenia among stroke inpatients, identify factors associated with stroke-related sarcopenia, and examine the association between stroke-related sarcopenia and sarcopenia-specific QoL. METHODS: Sarcopenia was evaluated according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Demographic and clinical data were collected. Nutritional status, dysphagia, activities of daily living (ADLs), and stroke severity were assessed using the Nutritional Risk Screening 2002 (NRS-2002), Water Swallow Test (WST), Barthel Index (BI), and National Institutes of Health Stroke Scale (NIHSS), respectively. QoL was assessed using the Sarcopenia and Quality of Life questionnaire (SarQoL). RESULTS: The prevalence of sarcopenia among stroke inpatients was 50.8%. Binary logistic regression analysis showed that age, limb dysfunction, dysphagia status, BI score, and NRS-2002 score were independently associated with sarcopenia, whereas regular exercise was associated with lower odds of sarcopenia. The total SarQoL score was 57.06 ± 17.583 in patients with sarcopenia and 66.72 ± 19.201 in patients without sarcopenia. Significant differences were observed between patients with and without sarcopenia in physical and mental health, locomotion, body composition, functionality, ADLs, fears, and the total SarQoL score. CONCLUSION: This study demonstrated a high prevalence of sarcopenia among stroke inpatients and identified several factors independently associated with sarcopenia. Sarcopenia was also associated with poorer sarcopenia-specific QoL.
Correlation between SHR and 28-day all-cause mortality risk in patients with spontaneous intracerebral hemorrhage.
Wang J, Tang C, Xie Z
BMC Neurol · 2026 Jun · PMID 42337711 · Full text
BACKGROUND: The stress hyperglycemia ratio (SHR) has recently been suggested as a dependable indication for predicting adverse outcomes in critically ill ICU patients. Previous studies have primarily focused on cardiovas...
BACKGROUND: The stress hyperglycemia ratio (SHR) has recently been suggested as a dependable indication for predicting adverse outcomes in critically ill ICU patients. Previous studies have primarily focused on cardiovascular disorders include myocardial infarction and coronary artery disease, but the connection between SHR and prognosis in severely ill individuals with cerebrovascular disorders, particularly those with spontaneous intracerebral hemorrhage, remains unclear. This investigation aims to investigate the relationship between SHR and adverse outcomes in critically ill individuals experiencing spontaneous intracerebral hemorrhage. METHODS: This study analyzed information collected from critically ill patients in the MIMIC database, grouped by tertiles of SHR, to demonstrate the clinical characteristics of the different groups of patients. The primary outcome was 28-day all-cause mortality. Cox regression and Kaplan-Meier curves, with restricted cubic spline, were used to investigate the connection between SHR and risk of death in individuals with spontaneous cerebral hemorrhage. Additionally, subgroup analyses were conducted to investigate the effect of different baseline characteristics on the correlation between SHR and risk of death. Lastly, predictive models were constructed using machine learning algorithms to illustrate the predictive efficacy of SHR. RESULTS: The study analyzed the data of 815 patients who met the inclusion criteria. The average age of all patients was 69.46 ± 15.05, and 432 patients were male (53.0%). Cox regression analysis demonstrated the connection of SHR with the risk of death as a continuous variable and a categorical variable. Subsequently, Kaplan-Meier curves were generated to illustrate the survival characteristics for the three cohorts of patients(P<0.001). Further restricted cubic splines showed a nonlinear connection between SHR and the risk of death; Higher SHR was significantly correlated with an elevated mortality risk in individuals diagnosed with cerebral hemorrhage (HR>1, p<0.05). In the subgroup analysis, higher SHR was consistently correlated with the mortality risk in the vast majority of subgroups. Finally, five machine learning models were built and ROC were plotted to demonstrate the predictive efficacy of SHR for poor prognosis. CONCLUSION: SHR can be used as an noteworthy predictor of adverse outcome in patients with spontaneous cerebral hemorrhage. Higher SHR is strongly correlated with an elevated risk of unfavorable prognosis, particularly in non-diabetic patients. Additionally, it may help to risk stratify this specific population.
Prevalence and factors associated with chemotherapy induced peripheral neuropathy among adult patients with cancer at Mbarara Regional Cancer Centre: a cross-sectional study.
Avaga S, Ngbape SN, Damale A … +7 more , Kato IK, Bacia L, Nakate C, Kyomya J, Isiiko J, Tamukong R, Yadesa TM
BMC Neurol · 2026 Jun · PMID 42337703 · Full text
BACKGROUND: Chemotherapy is a common modality used for management of cancers but some agents are known to cause peripheral neuropathy. Chemotherapy induced peripheral neuropathy (CIPN) refers to a disorder in structure a...
BACKGROUND: Chemotherapy is a common modality used for management of cancers but some agents are known to cause peripheral neuropathy. Chemotherapy induced peripheral neuropathy (CIPN) refers to a disorder in structure and functionality of peripheral sensory, motor, and autonomic neurons triggered by the toxic effects of these drugs. CIPN is a common adverse drug reaction (ADR) caused by mainly platinum analogs, vinca alkaloids and taxanes. Severe CIPN can cause paresis, complete immobilization and disability. The objectives of this study were to determine the prevalence, factors associated with and evaluate treatment of CIPN among adult patients with cancer at Mbarara Regional Cancer Centre. METHODS: A cross-sectional study was conducted for a period of 2 months among adult patients with cancer receiving chemotherapy at Mbarara Regional Cancer Centre. Consecutive sampling technique was used to enroll 235 participants into the study. Data collection was done through patient interviews and file reviews. Assessment of the clinical features of CIPN was done using EORTC-QLQ-CIPN20 tool. SPSS version 27 was used for data entry and analysis. RESULTS: The prevalence of CIPN was 31.1%. The factors associated with occurrence of CIPN include age greater or equal to 60 years (aOR = 2.04, 95% CI: 1.07-3.91, p-value = 0.031), concurrent administration of non-chemotherapeutic neurotoxic drugs (aOR = 6.50, 95% CI: 1.64-9.36), past resolved neuropathy prior to initiation of chemotherapy (aOR = 6.99, 95% CI: 2.28-9.21). 30.1% of patients with CIPN received treatment and were managed with agents such as pregabalin, gabapentin, cachnerve, Nat B, neuroton, amitriptyline and vitamin B complex. The American Society of Clinical Oncology guideline recommends use of duloxetine for treatment of CIPN. CONCLUSION: Nearly one-third of patients at Mbarara Regional Cancer Centre had CIPN. Patient age 60 years and above, past resolved neuropathy and concurrent administration of non-chemotherapeutic neurotoxic drugs are factors associated with occurrence of CIPN. Therefore, such patients require close monitoring for the symptoms of peripheral neuropathy so that appropriate treatment can be initiated promptly.
Characteristics, treatment patterns, healthcare resource use, and costs among adult patients diagnosed with neurofibromatosis type 1 and plexiform neurofibromas in the United States.
Yang X, Obeng-Kusi M, Dettling T … +7 more , Adeyemi A, Cunnington M, Liu Q, Lejeune D, Chen G, Duh MS, Jordan JT
BMC Neurol · 2026 Jun · PMID 42337518 · Full text
BACKGROUND: Neurofibromatosis type 1 (NF1) is a progressive rare genetic disorder that frequently involves the development of plexiform neurofibromas (PN). Until recently, there was no approved pharmacological treatment...
BACKGROUND: Neurofibromatosis type 1 (NF1) is a progressive rare genetic disorder that frequently involves the development of plexiform neurofibromas (PN). Until recently, there was no approved pharmacological treatment for adults with NF1-PN, and the disease burden is not well understood. This real-world retrospective study aimed to describe treatment patterns, healthcare resource utilization (HRU), and costs among adults with NF1-PN in the US. METHODS: Data were obtained from the Merative™ MarketScan Commercial and Medicare Databases (01/01/2016-12/31/2022). Adults diagnosed with NF1 and PN were matched to controls without NF1-PN on sociodemographic characteristics (1:5 ratio). Continuous enrollment for ≥ 12 months before and ≥ 3 months after the index diagnosis (defined as the latter of NF1 or PN diagnosis by ICD-10-CM codes) was required for all patients. Treatment patterns, all-cause, and NF1/PN-specific HRU and costs were characterized during the follow-up period. A generalized linear model with Poisson or Tweedie distribution was used to compare all-cause HRU and costs, respectively, between patients and controls. RESULTS: This study included 944 patients with NF1-PN and 4,720 controls. The mean age was 39.6 (standard deviation: 15.6) years and 59.6% were female. Over a mean follow-up of 25.8 months, the most common treatment among patients with NF1-PN was prescription pain medication (69.5%), followed by debulking surgeries (22.9%), cytotoxic chemotherapy (7.0%), radiotherapy (4.8%), and targeted therapies (e.g., MEK inhibitors) (4.7%). All-cause HRU was significantly higher among patients than controls across all settings (1.6 vs. 0.27 inpatient days per patient per year [PPPY], 18.8 vs. 9.1 outpatient visits PPPY, 0.80 vs. 0.53 emergency department visits PPPY), with adjusted incidence rate ratios of 1.4 to 4.2 (all p < 0.001). Among patients with NF1-PN, 53% and 18% of all-cause inpatient days and outpatient visits, respectively, were attributable to an NF1 or PN diagnosis. The adjusted mean total healthcare costs were $23,516 PPPY higher among the NF1-PN ($34,398 PPPY) versus matched control ($6,149 PPPY) cohort, with a cost ratio of 4.3 (p < 0.001). CONCLUSIONS: This real-world study identified a substantially higher HRU and economic burden among adult patients with versus without NF1-PN across all settings, highlighting the need for new treatments to manage NF1-PN among this population.
Replication analysis of the PRKN V380L (rs1801582) variant in a Japanese cohort of spinocerebellar ataxia type 3.
Nadbitova E, Takei N, Hirokawa S … +4 more , Hatano Y, Ishihara T, Onodera O, Koike YM
BMC Neurol · 2026 Jun · PMID 42337487 · Full text
BACKGROUND: Spinocerebellar ataxia type 3 (SCA3) is caused by CAG repeat expansion in ATXN3, which inversely correlates with age at onset but does not fully account for interindividual variability. A recent study in a mi...
BACKGROUND: Spinocerebellar ataxia type 3 (SCA3) is caused by CAG repeat expansion in ATXN3, which inversely correlates with age at onset but does not fully account for interindividual variability. A recent study in a mixed European/South and North American cohort suggested that the PRKN V380L variant (rs1801582), particularly in C/C homozygotes, was associated with earlier disease onset. We therefore performed a replication analysis to evaluate the frequency and potential clinical relevance of rs1801582 in a Japanese SCA3 cohort. METHODS: rs1801582 genotypes were determined by Sanger sequencing in 228 genetically confirmed SCA3 patients and 260 SCA6 patients as convenience disease controls. Genotype frequencies were additionally compared with East Asian reference populations from the 1000 Genomes Project Phase 3 dataset. Associations with age at onset were evaluated using multivariable linear regression adjusted for expanded ATXN3 CAG repeat length, normal ATXN3 CAG repeat length, and sex. RESULTS: Genotype frequencies in SCA3 (G/G: 86.0%, G/C: 13.2%, C/C: 0.9%) were similar to those in controls (G/G: 85.8%, G/C: 13.5%, C/C: 0.8%) and closely resembled those reported in East Asian reference populations. Because of the extremely small number of C/C carriers (n = 2), subsequent analyses focused on G/G and G/C carriers. In SCA3, median age at onset was comparable between genotypes (42 vs. 41 years), and median expanded ATXN3 CAG repeat lengths did not differ between groups (71 vs. 71 repeats). Multivariable regression analysis adjusting for expanded ATXN3 CAG repeat length, normal ATXN3 CAG repeat length, and sex demonstrated that rs1801582 was not independently associated with age at onset (β = - 0.42 years, p = 0.84), whereas expanded CAG repeat length remained a strong predictor (β = - 1.68 years per repeat, p < 0.0001). CONCLUSIONS: The rs1801582 C/C genotype is extremely rare in Japan; therefore, the present cohort had limited statistical power to directly evaluate the previously proposed recessive modifier effect. No detectable association between rs1801582 genotype and age at onset was identified among G/G and G/C carriers in this Japanese cohort. These findings highlight the importance of population-specific validation and adequately powered replication studies when evaluating candidate genetic modifiers in SCA3.
Pediatric Migraine Disability Assessment (PedMIDAS): translation into Turkish and cross-cultural adaptation.
Ayhanci NN, Parlak Özer Z, Can F … +3 more , Sönmez Şahin Ş, Yüksel Karatoprak E, Apak H
BMC Neurol · 2026 Jun · PMID 42332656 · Full text
BACKGROUND: The Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire is widely used to evaluate migraine-related disability in children and adolescents. The aim of this study was to assess the validity and t...
BACKGROUND: The Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire is widely used to evaluate migraine-related disability in children and adolescents. The aim of this study was to assess the validity and test-retest reliability of the Turkish version of the PedMIDAS. METHODS: The PedMIDAS was translated into Turkish using a forward-backward translation procedure. A total of 60 children and adolescents diagnosed with migraine participated in this cross-sectional study. Data collection was conducted in two sessions separated by 15 days. During the first session, sociodemographic information and migraine characteristics, including attack frequency, duration, and pain severity assessed by the visual analogue scale (VAS), were recorded. Participants also completed the Turkish PedMIDAS and the Child Self-Report form of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™) to evaluate convergent validity. Fifteen days later, the participants completed the Turkish PedMIDAS again to assess test-retest reliability. RESULTS: The Turkish version of the PedMIDAS demonstrated acceptable internal consistency (α = 0.74) and strong test-retest reliability (r = 0.92). PedMIDAS scores were significantly associated with migraine clinical characteristics and quality-of-life measures. CONCLUSION: The Turkish version of the PedMIDAS is a valid and reliable instrument for assessing migraine-related disability in children and adolescents.
Short-term outcomes of intracranial angioplasty with the Neuroform EZ stent in patients with hypoperfusion-related symptomatic intracranial atherosclerotic stenosis.
Yao Y, Fan W, Lv J … +6 more , Liu X, Wu Y, Li D, Zhang O, Li Q, Chen F
BMC Neurol · 2026 Jun · PMID 42332626 · Full text
BACKGROUND: This study aimed to evaluate the safety profile and limitations of Neuroform EZ stenting in patients with hypoperfusion-related symptomatic intracranial atherosclerotic stenosis (ICAS), focusing on lesion mor...
BACKGROUND: This study aimed to evaluate the safety profile and limitations of Neuroform EZ stenting in patients with hypoperfusion-related symptomatic intracranial atherosclerotic stenosis (ICAS), focusing on lesion morphology and risk stratification to identify patient subgroups that require stricter preoperative selection criteria. METHODS: We conducted a retrospective analysis of consecutive patients with hypoperfusion-related symptomatic ICAS who underwent Neuroform EZ stent placement at our institution between January 2020 and October 2023. The primary endpoint was the occurrence of any stroke or death within 30 days post-procedure. Secondary endpoints included technical success rate, incidence of ischemic stroke in the target artery territory from 30 days to 6 months post-procedure, and in-stent restenosis (ISR) rate during follow-up. RESULTS: A total of 64 patients (64 lesions) were included, all treated with Neuroform EZ stents. The technical success rate was 98.4%. The 30-day stroke or death rate was 6.2% (4/64). The incidence of ischemic stroke in the target artery territory from 30 days to 6 months post-procedure was 1.6% (1/64). During a mean follow-up of 10.4 ± 6.5 months, the ISR rate was 13.7% (7/51). Subgroup analysis revealed that the 30-day perioperative complication rate was significantly higher in patients with Mori type C lesions (25.0%, 4/16) than in those with Mori type A (0%, 0/16) or type B lesions (0%, 0/32) (Fisher's exact test, P = 0.002). Additionally, the ISR rate was significantly higher in Mori type C lesions (46.2%, 6/13) compared with Mori type A (0%, 0/14) or type B lesions (4.2%, 1/42) (Fisher's exact test, P < 0.001). CONCLUSION: Neuroform EZ stenting may be a reasonable option for carefully selected patients with hypoperfusion-related ICAS and Mori type A/B lesions. However, its use in Mori type C lesions carries substantial periprocedural and restenosis risks and must be approached with extreme caution. These findings provide safety-focused risk stratification but require external validation, and do not prove that Neuroform EZ stenting is superior to standard medical therapy or other stent devices. Further controlled studies are required to validate these observations.
Therapeutic drug monitoring of antiepileptic drugs in the West Bank, Palestine: a 25-year retrospective cohort study from a multi-branch laboratory network.
Salhi I, Karmi B
BMC Neurol · 2026 Jun · PMID 42332619 · Full text
BACKGROUND: Therapeutic drug monitoring (TDM) of antiepileptic drugs (AEDs) is essential for optimizing seizure control while minimizing toxicity, particularly in resource-constrained settings. Palestine's West Bank heal...
BACKGROUND: Therapeutic drug monitoring (TDM) of antiepileptic drugs (AEDs) is essential for optimizing seizure control while minimizing toxicity, particularly in resource-constrained settings. Palestine's West Bank healthcare system operates under profound geopolitical and infrastructural constraints. This study presents the first large-scale, multi-decade retrospective analysis of AED TDM patterns from a Palestinian multi-branch laboratory network. METHODS: A retrospective cohort study was conducted using 9,232 individual AED serum level measurements from 5,197 unique patients recorded in the Laboratory Information System of Medicare Laboratories (33 branches, West Bank) from 2001 to 2026. Six AEDs were evaluated: carbamazepine, levetiracetam, lamotrigine, phenobarbital, phenytoin, and valproic acid. Results were classified as sub-therapeutic, therapeutic, or toxic against established reference ranges. RESULTS: Of 9,232 measurements, 53.4% were therapeutic, 40.4% sub-therapeutic, and 6.1% toxic. Phenytoin showed the worst therapeutic control (31.0% therapeutic; median 8.4 mcg/mL). Valproic acid exhibited a 47.8% sub-therapeutic rate despite the highest test volume (n = 4,021). Lamotrigine had the highest toxic proportion (25.9%). Levetiracetam demonstrated the best control (88.6% therapeutic). Testing volume increased approximately 5.7-fold over the 25-year period. CONCLUSIONS: Frequent out-of-range AED levels, particularly for phenytoin and valproic acid, reflect complex pharmacokinetic and systemic challenges in the West Bank. The overall sub-therapeutic rate (40.4%) highlights the urgent need for enhanced TDM programs, improved patient adherence strategies, and strengthened pharmaceutical care infrastructure in this conflict-affected region.
A systematic review of brain stimulation in functional seizures.
Baerz MM, Zafarabadi S, Rajabi AH … +3 more , Aghdam ZT, Naderi M, Zali A
BMC Neurol · 2026 Jun · PMID 42332599 · Full text
BACKGROUND: Functional (dissociative) seizures (FDS) are disabling neurological disorders characterized by significant diagnostic and therapeutic challenges. Brain stimulation (BS) techniques are being investigated as po...
BACKGROUND: Functional (dissociative) seizures (FDS) are disabling neurological disorders characterized by significant diagnostic and therapeutic challenges. Brain stimulation (BS) techniques are being investigated as potential, neurobiologically-grounded interventions. This systematic review aims to synthesize and evaluate the existing evidence on the therapeutic and diagnostic applications of various BS modalities in patients with FDS. METHODS: Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Scopus, and Web of Science databases from their inception. We included all original research studies, regardless of design, that investigated invasive or non-invasive brain stimulation for therapeutic or diagnostic purposes in patients with a confirmed diagnosis of FDS. Due to substantial clinical and methodological heterogeneity across studies, a narrative synthesis was performed instead of a quantitative meta-analysis. RESULTS: The search yielded 4963 records, from which 19 studies (11 therapeutic, 8 diagnostic) met the inclusion criteria after screening. Therapeutic studies, predominantly case reports and small series, indicated that non-invasive techniques such as repetitive transcranial magnetic stimulation (rTMS), intermittent theta-burst stimulation (iTBS), and transcranial direct current stimulation (tDCS) have been associated with reductions in seizure frequency and comorbid psychiatric symptoms in preliminary reports. The right temporoparietal junction (rTPJ) emerged as a commonly targeted region, with preliminary reports suggesting potential benefit. Reported modulation of other regions, including the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), lends support to a network-based pathophysiology for FDS. Diagnostic studies confirmed the utility of provocative techniques like photic stimulation in inducing events during video-EEG monitoring. Adverse effects were generally mild and transient, with headache being the most common. CONCLUSION: Brain stimulation, particularly non-invasive modalities targeting key nodes within fronto-limbic-motor circuits, represents a field of significant research interest and a potential future therapeutic avenue for FDS. The evidence supports a shift towards conceptualizing FDS as a heterogeneous network disorder, necessitating phenotype-guided treatment strategies. Future research must prioritize large-scale, sham-controlled randomized clinical trials with standardized protocols and long-term follow-up to definitively establish efficacy and optimize treatment parameters.
Acute ischemic stroke caused by Percheron artery occlusion after vertebral artery stent placement: a case report.
He Y, Diao S, Li T … +2 more , Hou S, Zhang J
BMC Neurol · 2026 Jun · PMID 42332579 · Full text
BACKGROUND: The paramedian thalamic artery has four types of anatomical variants, among which type IIb is commonly referred to as the artery of Percheron (AOP). Occlusion of this artery typically results in bilateral par...
BACKGROUND: The paramedian thalamic artery has four types of anatomical variants, among which type IIb is commonly referred to as the artery of Percheron (AOP). Occlusion of this artery typically results in bilateral paramedian thalamic infarction, with variable involvement of the rostral midbrain. We report a case of acute ischemic stroke caused by AOP occlusion, which is a rare complication of a neurointerventional procedure. CASE PRESENTATION: A 51-year-old male underwent stent placement due to severe stenosis with dissection of the V4 segment of the left vertebral artery. After the procedure, he presented with classic symptoms of AOP infarction, including acute altered consciousness and memory impairment. Magnetic resonance imaging (MRI) revealed bilateral paramedian thalamic and rostral midbrain infarction. He was diagnosed with an acute ischemic stroke caused by AOP occlusion and achieved a favorable outcome with symptomatic therapy, supportive care, and rehabilitation. CONCLUSIONS: This case underscores that in patients who have stenosis with dissection undergoing neurointerventional procedures, heightened vigilance is required for the complication of distal embolization, and distal blood flow should be repeatedly assessed. When neurological deficits, such as altered consciousness, arise after the procedure, the possibility of AOP infarction should be considered, especially in patients with an anatomical variant of this artery. Timely MRI and treatments such as intravenous thrombolysis and endovascular therapy should be performed.
Gait in childhood and adulthood in persons with myelomeningocele - a retrospective analysis.
Eriksson M, Gutierrez-Farewik EM, Bartonek Å
BMC Neurol · 2026 Jun · PMID 42332577 · Full text
BACKGROUND: Gait patterns in children with myelomeningocele (MMC) at various neurological levels have been described, both with and without orthotic support. Although the neurological level of the lesion serves as an imp...
BACKGROUND: Gait patterns in children with myelomeningocele (MMC) at various neurological levels have been described, both with and without orthotic support. Although the neurological level of the lesion serves as an important predictor of ambulatory potential, the expected walking ability is not always achieved, as additional factors such as spasticity may influence gait negatively. The aim of this study was to retrospectively compare gait patterns as assessed in childhood with those observed in adulthood. METHODS: Of 59 individuals with MMC aged 18 years or older, 29 had undergone three-dimensional gait analysis in childhood (Ch-GA). These data were retrospectively analysed and compared with findings from a subsequent adult gait analysis (Ad-GA). The mean (standard deviation) age at the time of Ch-GA was 11.6 (4.1) years and at Ad-GA 25.9 (3.9) years. The median (range) interval between assessments was 15.0 years (5.1-17.2). RESULTS: Twenty-two participants maintained independent, non-assisted walking (Group A), 5 had transitioned from independent walking to using a walking aid (Group B), and 2 used a walking aid at both Ch-GA and Ad-GA (Group C), with individualized orthotic prescriptions provided at both time points. In Group A, two of eleven kinematic variables and six of eleven kinetic variables in the hip, knee, and ankle showed deterioration, and walking speed had decreased. Functional ambulation declined from 18 community ambulators and 4 household ambulators (Ha) in childhood to 8 and 14, respectively, in adulthood. In Group B, analysed with only Gait Deviation Index (GDI), values were unchanged, but all temporospatial gait parameters had deteriorated. Functional ambulation decreased from five individuals classified as Ha to two Ha and three non-functional ambulators. The two individuals in Group C, who used a walker at both assessments, largely maintained the same GDI values and temporospatial parameters as in childhood. CONCLUSION: Largely consistent with our original expectations, the findings indicate that gait patterns remain relatively stable from childhood to adulthood in individuals with MMC when supported by appropriate rehabilitation interventions, though some deterioration of gait and ambulation occurred. The results reflect gait-related changes that can be expected during growth in this population.
Efficacy of remote rehabilitation therapy for upper limb dysfunction following stroke: a systematic review and meta-analysis of randomised controlled clinical trials.
Shen Y, Gao T, Dai T … +2 more , Gao J, Feng X
BMC Neurol · 2026 Jun · PMID 42323531 · Full text
BACKGROUND: Stroke is a leading cause of disability in adults, with approximately 80% of patients experiencing residual upper limb motor impairment that significantly impacts quality of life. Traditional rehabilitation m...
BACKGROUND: Stroke is a leading cause of disability in adults, with approximately 80% of patients experiencing residual upper limb motor impairment that significantly impacts quality of life. Traditional rehabilitation models face constraints of time and space, alongside uneven distribution of resources. Telerehabilitation (TR) delivers rehabilitation services via the internet and smart technologies, yet its precise efficacy for upper limb function remains lacking in systematic evaluation.This study has been registered with the PROSPERO platform (ID: CRD420261279487). OBJECTIVE: Systematically evaluate the efficacy of remote rehabilitation on the recovery of upper limb motor function in stroke patients. METHODS: This study has been registered on the PROSPERO platform. Randomised controlled trials published in Chinese and English databases up to 6 January 2026 were systematically retrieved and screened according to the PICOS principle. Two researchers independently conducted literature screening, data extraction, and risk of bias assessment. Meta-analysis was conducted using RevMan 5.4 software. Continuous variables were expressed as mean differences or standardised mean differences. Fixed-effect or random-effects models were selected based on heterogeneity assessment results. Where significant heterogeneity was present (I²>50%, P < 0.10), subgroup analyses and sensitivity analyses were performed. RESULTS: A total of nine randomised controlled trials involving 600 patients were included. Meta‑analysis revealed that the TR group showed higher Fugl‑Meyer upper limb motor function scores compared with the conventional rehabilitation group, but the difference did not reach statistical significance(MD = 6.12, 95%CI[-3.66,15.90], P = 0.21). No statistically significant differences were observed between groups for the Modified Ashworth Scale, MAL-14 usage score, or Motion Study Arm Test (P > 0.05). Subgroup analysis suggested a positive trend towards improved motor function in studies with intervention cycles ≤ 4 weeks. Risk of bias assessment indicated that one study had low risk of bias across all domains (Grade A), while the remaining eight studies were rated as Grade B, mainly due to lack of blinding of participants and personnel. CONCLUSIONS: TR holds potential for improving upper limb motor function in stroke patients. However, the precise effect size remains uncertain, and its potential benefit in alleviating spasticity, promoting daily use, and facilitating task completion remains unclear. Nevertheless, given limitations in the number and quality of included studies, further large-scale, high-quality randomised controlled trials with extended follow-up periods are required to validate its therapeutic benefits. However, these findings should be interpreted with caution due to high heterogeneity and the limited number and quality of included studies.
Neurofilament light chain and glial fibrillary acidic protein as biomarkers of peripheral nervous system involvement in multiple sclerosis: diagnostic and prognostic evaluation.
Flintere-Flinte A, Krutovs V, Pantelejeva E … +4 more , Blennow K, Zetterberg H, Zolovs M, Kenina V
BMC Neurol · 2026 Jun · PMID 42321679 · Full text
BACKGROUND: Multiple sclerosis is a chronic demyelinating disease of the central nervous system caused by an immune-mediated inflammatory process. Its aetiology remains unclear, and numerous pathogenetic theories have be...
BACKGROUND: Multiple sclerosis is a chronic demyelinating disease of the central nervous system caused by an immune-mediated inflammatory process. Its aetiology remains unclear, and numerous pathogenetic theories have been proposed. The diversity of clinical manifestations and the lack of reliable biomarkers make diagnosis challenging. Serum neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) have been investigated as potential biomarkers for disease progression and response to disease-modifying therapies; however, their specificity and sensitivity remain variable, particularly in the presence of other conditions associated with neuronal damage and neurodegeneration. METHODS: This retrospective study analysed serum NfL and GFAP levels in 149 patients with multiple sclerosis and 40 healthy controls. Additionally, the association between the two biomarkers was evaluated in patients with and without polyneuropathy to assess their reliability and prognostic value for disease severity and progression. RESULTS: Serum NfL was found to be a reliable marker of disease activity and progression. In contrast, GFAP demonstrated limited specificity and was not suitable as a single, independent biomarker. The presence of co-existing polyneuropathy influenced biomarker levels and complicated their interpretation. CONCLUSION: Serum NfL shows promise as a reliable biomarker for monitoring disease activity and progression in multiple sclerosis. However, GFAP should not be used independently due to its limited specificity. Co-existing polyneuropathy may further reduce the reliability of these biomarkers, highlighting potential diagnostic challenges in clinical practice.
Post-stroke epilepsy in Saudi Arabia - frequency, management and outcomes at a comprehensive stroke center in Riyadh, Kingdom of Saudi Arabia.
AlSudayri MS, AlMosa MS, AlShehri S … +4 more , AlGhweinem Z, Ali NH, Vishwakarma R, Khatri IA
BMC Neurol · 2026 Jun · PMID 42321665 · Full text
BACKGROUND: Approximately 5% to 7% of patients with stroke develop post-stroke epilepsy (PSE). There is limited published literature about frequency, characteristics and outcomes of post-stroke epilepsy in Saudi populati...
BACKGROUND: Approximately 5% to 7% of patients with stroke develop post-stroke epilepsy (PSE). There is limited published literature about frequency, characteristics and outcomes of post-stroke epilepsy in Saudi population. OBJECTIVES: We determined the frequency, management and outcomes of post-stroke epilepsy in a Saudi cohort. METHODS: After IRB approval, a retrospective chart-review was performed on patients admitted with stroke at King Abdulaziz Medical City, MNGHA, Riyadh between January 2016 and December 2020. PSE was defined as one or more seizures after the 7th day of incident stroke. The diagnosis was clinical, EEG was not required to make the diagnosis of PSE. Data was collected about demographic features, stroke characteristics, epilepsy management and outcomes. Data was analyzed using RStudio (R version 4.3.1.). Consecutive, nonrandom sampling technique was used and all patients were included from the study period. RESULTS: A total of 2985 patients were included, of whom 2596 (87.0%) had ischemic stroke, 389 (13.0%) had hemorrhagic stroke. PSE occurred in 164 (5.49%) patients. The median age was 66.0 years (IQR:55.5-76.5), 102 (62.2%) were men, and 157 (95.7%) were Saudis. In ischemic group, 129 (4.97%) had PSE, whereas 35 (8.99%) in hemorrhagic group (p = 0.001). The commonest type of seizures was generalized in 96 (58.5%), focal in 45 (27.4%), unclassified in 23 (14.0%). Twenty-six (16%) patients had status epilepticus. Epileptiform abnormalities were seen in 16 (9.8%) on electroencephalogram. Treatment was started in 151 (93.8%) after first seizure, levetiracetam was commonest 1st antiseizure medication (ASM) used in 133 (82.6%). Side effects were reported in 11 (6.9%) patients; behavioral changes in 9 (5.5%), irritability in 6 (3.7%) patients. Nineteen (11.8%) patients needed 2nd ASM, 10 (6.1%) needed 3rd ASM. Median (IQR) follow-up was 26.0 (13.0-48.0) months. At last follow up, 120 (87%) were seizure free. CONCLUSIONS: Post-stroke epilepsy was common in our cohort. The patients with hemorrhagic stroke were more likely to have post-stroke epilepsy compared to ischemic stroke. Generalized seizures were the commonest type of seizure. Most patients had good control at last follow up requiring only monotherapy.
Sex difference in Parkinson's disease hospitalization rates in Brazil (2010-2024).
da Silva RO, de Sousa Fontenele LG, Meira OT … +4 more , Nunes JPA, da Cruz HC, Uwishema O, Cal H
BMC Neurol · 2026 Jun · PMID 42321660 · Full text
BACKGROUND AND AIM: Sex-related differences in the epidemiology and outcomes of Parkinson's disease (PD) have been consistently reported. However, population-level evidence on disparities in hospitalization burden remain...
BACKGROUND AND AIM: Sex-related differences in the epidemiology and outcomes of Parkinson's disease (PD) have been consistently reported. However, population-level evidence on disparities in hospitalization burden remains limited, particularly in low- and middle-income countries. This study aimed to assess sex-specific differences in hospitalization rates for PD in Brazil over a 15-year period. METHODS/DESIGN: Nationwide hospital admission data for Parkinson's disease were obtained from the Brazilian national hospital information system for the period 2010-2024. Resident population estimates were used to calculate hospitalization rates per 1,000,000 inhabitants for males and females. Descriptive analyses included mean rates and graphical distribution assessment. Both crude and age-standardized rates were calculated. Sex-specific differences were assessed using Wilcoxon signed-rank tests. Effect size was estimated using mean rate ratios (RR) with 95% confidence intervals. Durbin-Watson test was applied and Newey-West standard errors were used to obtain robust estimates. All analyses were conducted using Python 3.10.12. RESULTS: A total of 17,108 hospitalizations for Parkinson's disease were analyzed, with an overall mean crude hospitalization rate of 5.58 per 1,000,000 inhabitants. Males consistently exhibited higher crude hospitalization rates than females (6.67 vs. 4.53 per 1,000,000 inhabitants). This difference was statistically significant (p < 0.001) and associated with a very large effect size (RR = 1.496; 95% CI: 1.387-1.605). The findings remained robust after correction for serial autocorrelation. CONCLUSIONS: Hospitalization rates for Parkinson's disease are significantly higher among males than females in Brazil. The observed disparity was substantial and statistically robust across multiple analytical approaches. These findings highlight the importance of sex-sensitive healthcare strategies and targeted interventions to reduce preventable hospitalizations and optimize Parkinson's disease management.
A case report of nitrous oxide-induced subacute combined degeneration complicated with neurosyphilis in a 23-year-old female.
Li W, Wu L, Chen J … +1 more , Tang J
BMC Neurol · 2026 Jun · PMID 42321648 · Full text
BACKGROUND: Recreational nitrous oxide (N₂O) abuse has become a common health issue in young adults, which can induce subacute combined degeneration (SCD) of the spinal cord. Neurosyphilis has highly similar clinical and...
BACKGROUND: Recreational nitrous oxide (N₂O) abuse has become a common health issue in young adults, which can induce subacute combined degeneration (SCD) of the spinal cord. Neurosyphilis has highly similar clinical and imaging manifestations with SCD. The coexistence of N₂O-induced SCD and asymptomatic neurosyphilis is extremely rare and easily overlooked. We herein report such a case to improve clinical diagnosis. CASE PRESENTATION: A 23-year-old female presented with 3-month progressive limb numbness and gait instability, with a 6-month history of N₂O inhalation. Spinal MRI showed typical "inverted V-sign" of SCD. Further examinations confirmed asymptomatic neurosyphilis, severe vitamin B12 deficiency and hyperhomocysteinemia. After standard combined treatment, her neurological function was significantly improved with no recurrence during follow-up. CONCLUSION: For young patients with spinal cord lesions, screening for N₂O abuse, vitamin B12 and syphilis should be performed simultaneously. Early diagnosis and combined intervention can effectively avoid permanent neurological damage.
Predictors of functional outcome of spontaneous intracerebral hemorrhage in elderly patients from a comprehensive stroke care unit, prospective cohort hospital based study.
El-Malky I, Abdelmageed HA, Abdelhafiz M … +1 more , El-Deen HB
BMC Neurol · 2026 Jun · PMID 42316090 · Full text
INTRODUCTION: Few studies have been reported on intracerebral Hemorrhage (ICH) in elderly patients at Middle East and North Africa region (MENA). It is thought that epidemiological, radiological characteristics, and neur...
INTRODUCTION: Few studies have been reported on intracerebral Hemorrhage (ICH) in elderly patients at Middle East and North Africa region (MENA). It is thought that epidemiological, radiological characteristics, and neurological outcomes differ in elderly patients from younger age group. Our study's aim is detection of the difference between them as regard clinical and radiological characters, functional outcome, and its predictors. METHODS: All patients with spontaneous ICH were divided into two groups, elderly group (≥ 70 years old) and younger age group. All clinical and-radiological data were collected. The patients were classified into four categories (probable Cerebral Amyloid Angiopathy, Hypertensive, Vascular and Undetermined). One-month mortality and three months' functional outcome, using modified Rankin Scale (mRS). were determined. Multivariate logistic regression was performed to determine the predictors of favorable functional outcome. RESULTS: Prospective cohort study was conducted on 71 old age patients from 238 patients (30.3%). Hypertension, higher NIHSS (National Institutes of Health Stroke Scale) lower GCS (Glasgow Coma Scale) and previous medications of antiplatelet or anticoagulant were more common in elderly group with statistically significant difference (P value: < 0.017, 0.002, 0.002, and 0.003, respectively). Probability of CAA (Cerebral Amyloid Angiopathy) was common in elderly patients. Younger age group had better outcome as regard three months' functional outcome and one-month mortality (44.3% versus 19.7% with p value: < 0.001, 21.6% versus 39.4% with p value: 0.006, respectively). GCS and NIHSS are predictors of favorable functional outcome. CONCLUSION: Spontaneous ICH in elderly has different demographic, clinical and radiological findings with worse One-month mortality and functional outcome. Higher GCS and lower NIHSS are predictors of favorable functional outcome.
Exacerbation of myasthenia gravis after zoledronic acid and denosumab: a novel clinical observation with therapeutic implications.
Canneva S, De Giovanni A, Pagella F … +3 more , Trompetto C, Grandis M, Mori L
BMC Neurol · 2026 Jun · PMID 42316086 · Full text
BACKGROUND: Patients affected by myasthenia gravis undergoing long-term corticosteroid therapy have an increased risk of osteoporosis and fragility fractures, frequently requiring antiresorptive treatment. Although bisph...
BACKGROUND: Patients affected by myasthenia gravis undergoing long-term corticosteroid therapy have an increased risk of osteoporosis and fragility fractures, frequently requiring antiresorptive treatment. Although bisphosphonates and denosumab are generally well tolerated, rare cases of onset or worsening of myasthenic symptoms following bisphosphonate therapy have been reported, while no cases associated with denosumab have been described to date. CASE PRESENTATION: We report the case of a 78-year-old woman with long-standing, stable myasthenia gravis who developed a significant exacerbation of myasthenic symptoms following intravenous infusion of zoledronic acid and, subsequently, after a single administration of denosumab. In both instances, a temporary increase in corticosteroid therapy was required. Following these events, antiresorptive agents were discontinued, and supplementation with cholecalciferol was maintained. CONCLUSION: To our knowledge, this represents the first reported case of exacerbation of myasthenic symptoms following denosumab administration.
Artificial intelligence (AI)-powered diagnostic support for stroke via Telegram bot: preliminary findings.
Ogunmiloro B
BMC Neurol · 2026 Jun · PMID 42316077 · Full text
BACKGROUND: Annually, stroke affects over 15 million people globally. Early intervention is critical in the management of stroke. However, the "golden hour" opportunity for timely intervention is often missed in underser...
BACKGROUND: Annually, stroke affects over 15 million people globally. Early intervention is critical in the management of stroke. However, the "golden hour" opportunity for timely intervention is often missed in underserved regions where experts in neuroimaging are scarce, with some countries having 1 per million inhabitants in comparison to high-income countries with 10 per million inhabitants. This study explores the feasibility of a lightweight AI-powered diagnostic support system for stroke deployed via a widely accessible platform (Telegram) to help clinicians in underserved settings. METHODS: This study utilized a comparative analysis of two transfer learning models (EfficientNetB0 and MobileNetV2) which were employed for training, using 6,650 publicly available, anonymized but radiologist annotated brain CT images from three classes: normal (n = 4,427), hemorrhagic stroke (n = 1,093), and ischemic stroke (n = 1,130). An 80/20 split was executed at slice-level as a result of lack of patient identifiers which this study acknowledges as a limitation. A separately sourced Kaggle dataset with labels but no metadata on annotator provenance was used for quasi-external validation with further evaluation using standard performance metrics. The selected model was integrated into a Telegram bot (@BrainfloBot) with real-time inference capabilities, and automatic data deletion to ensure privacy compliance. RESULTS: EfficientNetB0 demonstrated superior performance over MobileNetV2, achieving 99% accuracy (95% Cl: 98.2-99.5%) with excellent inter-rater reliability (κ = 0.985) during training and internal validation with precision and recall values exceeding 96% across all classes. While quasi-external validation using the balanced set, the selected model achieved a robust performance with 95% accuracy level (95% CI: 90.3%-97.9%, n = 150) with excellent agreement (κ = 0.925). For the unbalanced set, 97% accuracy level (95% Cl: 95.77%-98.03%) with excellent agreement(κ = 0.948) The model showed particularly strong performance in hemorrhagic stroke detection (98% precision, 96% recall), critical for preventing inappropriate thrombolytic therapy. CONCLUSIONS: These preliminary findings demonstrates a successful integration of a novel AI-powered stroke diagnostics with a widely accessible messaging platform. This system can potentially close neuroimaging gaps in underserved regions where neuroimaging specialists are scarce. However, the study limitations include lack of patient-level separation, annotation provenance for external validation dataset, possible selection bias and lack of real world testing. Future work can integrate real world validation, out of distribution handling and robust testing with clinical images.
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