BMC Neurology[JOURNAL]
Sun
200 papers
Prognostic value of C-reactive protein to albumin ratio for in-hospital mortality in acute stroke patients.
Gül T, Kaya Y, Kaya A … +3 more , Kaygısız Ş, Akkaya F, Yüce Onur G
BMC Neurol · 2026 Jun · PMID 42251284 · Full text
BACKGROUND: This study aimed to evaluate the prognostic significance of the C-reactive protein to albumin ratio (CAR) in predicting in-hospital mortality among patients presenting with acute stroke. METHOD: A total of 48...
BACKGROUND: This study aimed to evaluate the prognostic significance of the C-reactive protein to albumin ratio (CAR) in predicting in-hospital mortality among patients presenting with acute stroke. METHOD: A total of 483 adult patients (≥ 18 years) consecutively hospitalized for stroke over a one-year period (July 2022 - July 2023) were analyzed retrospectively. Exclusion criteria include malignancy, autoimmune/rheumatological disorders, chronic infections, conditions affecting inflammation or protein status, including liver failure and nephrotic syndrome, cachexia (BMI < 18 kg/m²). Baseline demographics, comorbidities, and laboratory indices were recorded upon admission. The CAR was derived by dividing the C-reactive protein (CRP) level by the serum albumin level. Comparative analysis was conducted between the mortality and non-mortality groups. The independent prognostic value of CAR was determined via binary logistic regression model. RESULTS: Significant differences were observed between the mortality and non-mortality groups regarding baseline laboratory parameters. Patients in the in-hospital mortality group exhibited significantly higher levels of glucose (p = 0.001), AST (p = 0.001), white blood cell (p = 0.001), CRP (< 0.001) and CAR (< 0.001) levels were found to be significantly higher. Conversely, hemoglobin levels were significantly lower in the mortality group (p = 0.031). As a result of Binary logistic regression analysis to find independent predictors of in-hospital mortality CAR (Exp(B) 95% CI = 1.047 (1.026-1.068) p < 0.001) and glucose (Exp(B) 95% CI = 1.006 (1.000-1.011) p = 0.048) were found as independent predictors. ROC curve analysis demonstrated that a CAR cutoff value of 1.06 predicted in-hospital mortality with 74% sensitivity and 65% specificity [AUC: 0.774, 95% CI: 0.686-0.862]. CONCLUSION: The present study found a significant association between elevated CAR levels and early in-hospital mortality from all causes in patients with acute stroke. It also demonstrated that CAR may be an independent predictor of early in-hospital mortality from all causes in all patients hospitalized with acute stroke, both in the general ward and intensive care unit.
Expanding the genetic spectrum of autosomal recessive microcephaly in Pakistani families.
Ahmad B, Adams M, Javed I … +11 more , Tariq M, Muhammad A, Harrold L, Almond RJ, Ubeyratna N, Sarwar MT, Leslie JS, Crosby AH, Baple EL, Rawlins LE, Qasim M
BMC Neurol · 2026 Jun · PMID 42249392 · Full text
BACKGROUND: Autosomal recessive microcephaly encompasses a group of rare neurogenetic disorders in which microcephaly presents at birth or postnatally as part of a syndromic disorder. Autosomal recessive microcephaly is...
BACKGROUND: Autosomal recessive microcephaly encompasses a group of rare neurogenetic disorders in which microcephaly presents at birth or postnatally as part of a syndromic disorder. Autosomal recessive microcephaly is both clinically and genetically heterogeneous, with numerous genes associated. In the present study, we investigated the genetic basis of likely autosomal recessive microcephaly in a cohort of five unrelated consanguineous and non-consanguineous Pakistani families presenting with microcephaly, intellectual disability, and developmental delay. METHODS: Whole-exome sequencing was performed on one affected individual from each family. Candidate variants identified by WES were subsequently validated by Sanger sequencing, and segregation analysis was performed in all available affected and unaffected family members. RESULTS: We identified five homozygous pathogenic variants, including three novel variants: ASPM (NM_018136.5:c.1669_1670del p.(Ser557Leufs*2)), CDK5RAP2 (NM_018249.6:c.199del p.(Ile67Serfs*4)), and VPS13B (NM_152564.5:c.8230 C > T (p.Gln2744*)). Alongside, two previously reported homozygous variants in ASPM (NM_018136.5:c.9190 C > T p.(Arg3064*) & NM_018136.5:c.3978G > A p.(Trp1326*)). All variants matched a suspected autosomal recessive inheritance pattern, segregated within their respective families, and were absent or very rare in proxy population genetic databases. CONCLUSION: The results expand the genetic spectrum of autosomal recessive microcephaly within the Pakistani population and highlight the importance of whole exome sequencing in diagnosing rare neurodevelopmental disorders and understanding genetic diversity.
Bladder, bowel, and sexual dysfunction are overlooked in the management of neurological conditions: a qualitative interview study.
Webb K, Clunie G, Cossou G … +3 more , Roy H, Smith M, Drake M
BMC Neurol · 2026 Jun · PMID 42249384 · Full text
BACKGROUND: One in six people in the UK live with a neurological condition, of which many experience bladder, bowel and sexual dysfunction that are present during the time of neurological diagnosis. However, it not clear...
BACKGROUND: One in six people in the UK live with a neurological condition, of which many experience bladder, bowel and sexual dysfunction that are present during the time of neurological diagnosis. However, it not clear whether their bladder, bowel or sexual symptoms are considered when formulating a neurological diagnosis. This study aimed to explore the patients experiences of being diagnosed with and managing neurological conditions and the considerations of their bladder, bowel and sexual symptoms. METHODS: Semi-structured qualitative interviews were conducted with patients with a diverse range of neurological conditions. Interviews were recorded and transcribed verbatim and analysed using reflexive thematic analysis. A patient and public involvement group supported the pilot testing of the topic guide and the data analysis. RESULTS: Twenty participants (12 female, 1 non-binary and 7 male) aged between 30 and 83 and 13/20 people from the global majority participated in the study. Four themes and ten subthemes were identified: (1) Challenges within healthcare - dismissive encounters with healthcare professionals and systemic pressures directly impacting care. (2) Understanding and Advocacy - insufficient communication, education and expectation management across contexts, "I am the ruler of my own self"- self advocacy is essential and peer support. (3) Emotional and Psychological Impact - Grief - "you go through the grieving cycle; you've lost a bit of yourself" and difficulty describing sensations. (4) Sex Matters - Gender differences and sex remains a low priority within healthcare. CONCLUSIONS: The findings demonstrate that during diagnosis of neurological conditions bladder bowel and sexual symptoms are overlooked in building the clinical picture, and the needs of managing these emotionally challenging and difficult symptoms are not being effectively met by the healthcare system at present.
Inflammatory CADASIL: the cross-link between CADASIL and multiple sclerosis: a report of two cases and systematic review of the literature.
Ahmed AM, Mistry N, Gehad AS … +1 more , Hassan AM
BMC Neurol · 2026 Jun · PMID 42249339 · Full text
BACKGROUND: Multiple Sclerosis (MS) is sometimes misdiagnosed in people with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aimed to discuss two CADASIL patients...
BACKGROUND: Multiple Sclerosis (MS) is sometimes misdiagnosed in people with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aimed to discuss two CADASIL patients who were misdiagnosed with MS and review the literature for similar cases. METHODS: In addition to reporting our two cases, we searched the literature and all available databases for CADASIL cases with clinical or radiological features suggestive of MS. RESULTS: We reported two CADASIL cases misdiagnosed as MS. The review identified 12 reports describing 19 cases with CADASIL and inflammatory or MS-like features. The most prevalent features were sensory manifestations (76.2%), followed by motor manifestations (71.4%), gait imbalance (66.7%) and migraine (61.9%). Majority of the patients (90.5%) had either small vessel disease, demyelinating lesions, or both. Our cases shared these predominant features. CONCLUSION: CADASIL may occasionally present with MS like inflammatory features, . The term "inflammatory CADASIL" can be considered when such red flags are present in atypical MS patients. Genetic testing is imperative for suspected CADASIL.
Clinical characteristics of pure menstrual migraine and menstrually-related migraine: a cross-sectional online questionnaire study.
Zhou Y, Zhang Q, Xia T … +2 more , Guo M, Zhao H
BMC Neurol · 2026 Jun · PMID 42249327 · Full text
BACKGROUND: Migraine is a highly prevalent neurological disorder which is more common in women. Clinically, there are two subtypes of menstrual migraine, including pure menstrual migraine (PMM) and menstrually-related mi...
BACKGROUND: Migraine is a highly prevalent neurological disorder which is more common in women. Clinically, there are two subtypes of menstrual migraine, including pure menstrual migraine (PMM) and menstrually-related migraine (MRM). The former experiences migraine attacks only during the perimenstrual period, while the latter experiences migraine attacks during the perimenstrual period and at other times of the menstrual cycle. MRM accounts for 20-25% of female cases and is associated with greater severity and disability. Although hormonal fluctuations are implicated, the pathophysiology of these subtypes remains poorly understood, and treatment options are limited. Whether PMM and MRM differ clinically or in treatment response has not been systematically compared. This study compared their clinical characteristics and acute treatment responses, which may offer insights into menstrual migraine pathophysiology and help with precise treatment. METHODS: A cross-sectional study was conducted among 430 female migraine patients recruited from the Headache Specialty Clinic of the First Affiliated Hospital of Soochow University using electronic questionnaires. According to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria, participants were divided into PMM (n = 43) and MRM (n = 322). Concurrently, individuals whose migraine attacks were unrelated to menstruation were classified as NMM (n = 65). This analysis focused on the clinical characteristics and acute medication treatment responses between the PMM and MRM groups. RESULTS: Compared to MRM cases, PMM patients had shorter disease duration (6.8 ± 5.7 vs. 11.1 ± 8.6 years, P < 0.001), fewer prodromal symptoms (58.1% vs. 75.5%, P = 0.016) and accompanying symptoms, including nausea, ocular pain, and osmophobia (all P < 0.05). The efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) for acute attacks in the PMM group was superior to that in the MRM group, whether perimenstrual period (96.4% vs. 72.8%, P = 0.010) or non-menstrual period (96.4% vs. 78.3%, P = 0.031). Subgroup analysis of patients with low attack frequency (< 4 per month) confirmed that differences in prodromal symptoms and accompanying symptoms remained between PMM and MRM patients, suggesting that attack frequency alone does not explain these differences. CONCLUSIONS: PMM was associated with fewer prodromal and accompanying symptoms, while MRM presented with a broader range of symptoms. In the overall analysis, PMM showed a more favorable response to NSAIDs than MRM; however, this difference did not persist after controlling for attack frequency, suggesting it may be partly attributable to differences in migraine burden. By contrast, differences in prodromal and accompanying symptoms remained significant after adjustment, supporting intrinsic phenotypic distinctions between the two subtypes.
Intrathecal antibody synthesis - Reiber method revisited.
Halperin JJ, Granger D
BMC Neurol · 2026 Jun · PMID 42243753 · Full text
BACKGROUND: CSF immunoglobulin (IgG) often informs diagnosis in CNS inflammatory disease- qualitatively (oligoclonal bands; OCBs), or quantitatively (CSF: serum IgG: albumin, e.g. IgG index). Most US laboratories estimat...
BACKGROUND: CSF immunoglobulin (IgG) often informs diagnosis in CNS inflammatory disease- qualitatively (oligoclonal bands; OCBs), or quantitatively (CSF: serum IgG: albumin, e.g. IgG index). Most US laboratories estimate excess CSF IgG using linear models, most in Europe, Reiber's hyperbolic model - the latter often also incorporated into CSF pathogen-specific immunoreactivity calculations. We compared Reiber hyperbolic and linear approaches. METHODS: Required data were available for 1,872 samples, Lyme-specific data for 1,365. We compared linear and Reiber's hyperbolic models to determine which better describes normal CSF: serum IgG/albumin, assessed correlations with OCBs using ROC analysis and compared Lyme-specific antibody indices (AI) by both methods. RESULTS: On linear regression (CSF: serum albumin vs. CSF: serum IgG) in 890 normals, r 0.98; 0.86 on polynomial. In 982 abnormals r was 0.95 by both linear and polynomial regression. Linear regression slope was 74% greater in abnormals than normals. We tested the linearity of the Reiber hyperbolic model and found it to be essentially linear in the clinically relevant range. Dichotomizing the full dataset by OCBs, IgG index ROC AUC was 0.81, Reiber 0.74 (p<0.001). Linear models consistently demonstrated stronger associations with OCBs than the Reiber method. IgG index and IgG synthesis cutoffs from ROC analyses differed substantially from, and were more robust than, customary ones. On Lyme AI analysis, Reiber modification was potentially applicable in just 14.7% of samples, possibly changing the diagnostic conclusion in just 0.1%. CONCLUSIONS: Linear models more accurately reflect intra-CNS inflammation, including a novel linear regression model. Notably, we found that, despite its equation's complexity, the Reiber hyperbolic model is also linear in the clinically relevant range. In CNS inflammation, local antibody production and altered BBB/BCB permeability both contribute to excess CSF IgG. ROC-derived cutoffs for IgG index and IgG synthesis more accurately reflect CSF immunoreactivity. Reiber Q substitution in the Lyme-specific AI denominator did not improve accuracy.
Blood-based biomarkers for early diagnosis of Alzheimer's disease: a current systematic review of diagnostic accuracy studies.
Efe JJ, Anibor E, Pandey P … +4 more , Sunday OG, Innocent DC, Anyakorah PE, Emmanuel OI
BMC Neurol · 2026 Jun · PMID 42243744 · Full text
BACKGROUND: Alzheimer disease (AD) is the most common cause of dementia in the world and its prevalence is increasing and it has important public health consequences. Early diagnosis remains challenging due to reliance o...
BACKGROUND: Alzheimer disease (AD) is the most common cause of dementia in the world and its prevalence is increasing and it has important public health consequences. Early diagnosis remains challenging due to reliance on costly and invasive methods such as positron emission tomography (PET) and cerebrospinal fluid (CSF) analysis. Blood-based biomarkers have emerged as a promising, less invasive alternatives to identify AD pathology, especially in the early and preclinical stages. This systematic review aim to evaluate the diagnostic accuracy of blood-based biomarkers for the early detection of Alzheimer's disease. METHODS: An extensive literature search was performed in PubMed/MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library on studies published since 2010 up to March 2026. The search strategies involved the use of Medical Subject Headings (MeSH), and free-text words associated with Alzheimer disease, blood-based biomarkers, and diagnostic accuracy. Peer-reviewed diagnostic accuracy studies focused on adult populations were included in line with PICO framework. The selection of studies was based on PRISMA guidelines and were critically appraised using QUADAS-2. Because of heterogeneity across the included studies, synthesis of findings was carried out using a narrative approach. RESULTS: Six studies were included in this review. Diagnostic performance of phosphorylated tau biomarkers (p-tau181 and p-tau217) was consistently high (AUC up to 0.93), and glial fibrillary acidic protein (GFAP) also showed strong performance (AUC up to 0.87). Amyloid-β ratios (Aβ42/Aβ40) showed moderate to high accuracy, especially in preclinical detection, but had varying performance across assays (AUC 0.69-0.94). Neurofilament light chain (NfL) demonstrated moderate diagnostic value (AUC of up to 0.79) and was more predictive of progression than an early diagnosis. Combinations of biomarkers, especially those that included genetic variables like APOE genotype, were consistently more effective than individual biomarkers (AUC up to 0.92). CONCLUSION: Biomarkers in blood, especially p-tau and GFAP, have a strong potential for early detection of Alzheimer disease, with their combination yielding better results. Although promising, assay variation and lack of standardisation hinder clinical translation. To facilitate their integration into standard diagnostic practice further large-scale validation and harmonisation effort is required.
Impact of non-motor symptoms on the quality of life of Parkinson's disease patients in a cohort of Senegalese patients.
Mondomobe A, Njohjam M, Ngoule M … +10 more , Kahwagi J, Diop A, Boukoulou M, Kane F, Ndeye K, Mouandza E, Guene A, Kwama C, Ndiaye M, Fall M
BMC Neurol · 2026 Jun · PMID 42237258 · Full text
BACKGROUND: Non-motor symptoms (NMS) are common in Parkinson's disease (PD). They contribute significantly to changes in patients' quality of life (QOL). OBJECTIVE: To assess the impact of NMS on the QOL of patients with...
BACKGROUND: Non-motor symptoms (NMS) are common in Parkinson's disease (PD). They contribute significantly to changes in patients' quality of life (QOL). OBJECTIVE: To assess the impact of NMS on the QOL of patients with PD in Senegal. METHODS: We conducted a cross-sectional study from January to August 2024. All patients who met the diagnostic criteria for PD and were followed up in the neurology department at the Pikine National Hospital Center were included. NMS were assessed using the Movement Disorders Society-Non-motor Symptoms Scale (MDS-NMS), while QOL was assessed using the 39-item Parkinson's Disease Questionnaire (PDQ-39). The Hoehn and Yahr scale was used to determine the disease stage for each patient. The student's t-test was used to compare quantitative variables, and linear regression was used to identify predictive factors for poor QOL. RESULTS: A total of 52 patients with PD were enrolled. The mean age was 64.6 ± 10 years. The mean MDS-NMS score was 61.8 ± 30.48. The most prevalent NMS were sleep disturbance (98%), constipation (84.6%), and pain (84.6%). The mean PDQ-39 index was 23.45 ± 12.5%. The most affected domains for the QOL were mobility and activities of daily living. There was a significant correlation between the MDS-NMS score and the PDQ-39 index (β = 0.448; P = 0.001). In addition, depression (β = 0.398; P = 0.043) and cognitive impairment (β = 0.355; P = 0.046) were predictive of poor QOL. Patients presenting with depression (p = 0.000), fatigue (p = 0.018), urinary urgency (p = 0.03), and hypersalivation (p = 0.003) had a significantly worse QOL than those who did not. CONCLUSION: In our cohort, non-motor symptoms, particularly depression and cognitive impairment, were significantly associated with poorer quality of life. Although the confounding effect of motor symptoms was not fully assessed, motor severity, assessed by the Hoehn and Yahr stage, also contributed substantially.
Long-term effect of the German Parkinson's disease multimodal complex treatment: a clinical trial with randomized allocation.
Heimrich KG, Schönenberg A, Mendorf S … +5 more , Mühlhammer HM, Teschner U, Lehmann T, Brodoehl S, Prell T
BMC Neurol · 2026 Jun · PMID 42237254 · Full text
BACKGROUND: The German Parkinson´s disease multimodal complex treatment (PD-MCT) is a structured multidisciplinary inpatient treatment for people with Parkinson's disease (PwPD). However, data on its long-term effect are...
BACKGROUND: The German Parkinson´s disease multimodal complex treatment (PD-MCT) is a structured multidisciplinary inpatient treatment for people with Parkinson's disease (PwPD). However, data on its long-term effect are limited. METHODS: A monocentric, non-blinded, clinical trial with randomized allocation and six-month follow-up was conducted at the Department of Neurology of the Jena University Hospital. At total of 120 patients admitted for PD-MCT were allocated 1:1 to two predefined treatment durations (short: 7-13 days; long: 14-20 days) according to the German Operation and Procedure Classification System (OPS; code 8-97d). The primary outcome was change in the Movement Disorder Society sponsored revision of the unified Parkinson's disease rating scale (MDS-UPDRS) part II after six months. Secondary outcomes included change in quality of life assessed by the Parkinson's Disease Questionnaire 8 (PDQ-8) and the influence of treatment duration. Analyses were performed as-treated. RESULTS: In 93 PwPD, MDS-UPDRS II improved by 3 points (r = 0.435; p < 0.001), with 52.7% achieving a clinically relevant improvement. Improvement was associated with higher baseline MDS-UPDRS II (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07-1.27; p < 0.001), lower Hoehn and Yahr stage (OR 0.29, 95% CI 0.09-0.97; p = 0.045), and fewer nonmotor symptoms (OR 0.88, 95% CI 0.77-1.00; p = 0.042) (x(3) = 14.94; p = 0.002; R = 0.22). PDQ-8 improved by 8 points (r = 0.524; p < 0.001), with 58.1% showing clinically relevant improvement, which was associated with lower Hoehn and Yahr stage (OR 0.30, 95% CI 0.10-0.92; p = 0.035), and more depressive symptoms (OR 1.17, 95% CI 1.04-1.33; p = 0.012) (x(2) = 10.53; p = 0.005; R = 0.15). Treatment duration had no significant influence on MDS-UPDRS II (p = 0.611, Eta² = 0.001) or PDQ-8 (p = 0.809, Eta² = 0.001). CONCLUSIONS: PD-MCT is an effective multidisciplinary inpatient treatment with clinically relevant long-term effects up to six months. In clinical practice, the shorter treatment duration may be similarly effective in selected patients. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00025225, registered 30 June 2021, https://drks.de/search/de/trial/DRKS00025225 .
Patient-reported health utility in adults with myasthenia gravis: a systematic review and meta-analysis of EQ-5D outcomes.
Budumuri VSK, G AK, Murugadoss H … +2 more , Arun V, Basheer A
BMC Neurol · 2026 Jun · PMID 42231266 · Full text
BACKGROUND: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder associated with impaired health-related quality of life. EQ-5D utility and EQ-VAS scores are used in health economic evaluations, but repo...
BACKGROUND: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder associated with impaired health-related quality of life. EQ-5D utility and EQ-VAS scores are used in health economic evaluations, but reported estimates vary across MG populations, instruments, tariffs, and study designs. METHODS: We systematically searched PubMed, Embase, Scopus, and CENTRAL from inception to February 2026. Observational studies and randomized controlled trials reporting baseline or pre-intervention EQ-5D utility or EQ-VAS data in adults with MG were included. Random-effects meta-analyses used restricted maximum likelihood estimation. Subgroup, sensitivity, GRADE-informed certainty, and exploratory aggregate-level meta-regression analyses were performed. RESULTS: Ten studies were included. Eight studies (n = 1,514) contributed to EQ-5D utility synthesis, yielding a descriptive pooled mean of 0.74 (95% CI 0.68-0.80), with very high heterogeneity (I² = 95.4%; Cochran Q p < 0.001) and a wide prediction interval (0.52-0.96). Seven studies (n = 2,760) contributed to EQ-VAS synthesis, with a descriptive pooled mean of 66.49 (95% CI 60.99-71.99), very high heterogeneity (I² = 96.3%; Cochran Q p < 0.001), and a wide prediction interval (47.70-85.28). Sensitivity analysis excluding the RCT baseline dataset did not materially change the pooled EQ-5D estimate. In an exploratory analysis based on two studies, utility declined across Myasthenia Gravis Foundation of America (MGFA) classes I-IV. Exploratory meta-regression suggested a possible negative association between mean disease duration and utility, but certainty was very low. CONCLUSION: EQ-5D and EQ-VAS estimates indicate impaired patient-reported health status in MG, but pooled values should be interpreted as low-certainty descriptive summaries, not definitive utility inputs.
Migraine phases and treatment response: a post hoc analysis of participants with migraine with aura from the TEAM study.
Johnson MAL, Panza G, Kuruvilla DE
BMC Neurol · 2026 Jun · PMID 42231198 · Full text
BACKGROUND: Migraine is a phased neurological disorder progressing through prodrome, aura (in approximately one-third of patients), headache, and postdrome. Migraine with aura (MA) and migraine without aura (MO) are path...
BACKGROUND: Migraine is a phased neurological disorder progressing through prodrome, aura (in approximately one-third of patients), headache, and postdrome. Migraine with aura (MA) and migraine without aura (MO) are pathophysiologically distinct subtypes with potentially different treatment responses. Some acute therapies, including triptans, show reduced efficacy when administered during the aura phase. Whether this extends to neuromodulation remains unclear. This study examined whether the presence of migraine aura-a phase reflecting cortical spreading depolarization-modifies the therapeutic response to acute external trigeminal nerve stimulation (eTNS), using data from the TEAM (Trial of eTNS for the Acute Treatment of Migraine) study. METHODS: This was a post hoc, non-pre-specified analysis from a prospective, multicenter, randomized, double-blind, sham-controlled trial (N = 538). Participants were randomized 1:1 to verum (N = 259) or sham (N = 279) eTNS for 2 h during an active migraine. We compared treatment outcomes between MA (N = 224) and MO (N = 314) participants using logistic regression with interaction terms to test whether aura status modified treatment effect. Models were adjusted for age, sex, and baseline headache severity. RESULTS: The MA group had more male participants and higher rates of severe baseline headache pain compared to the MO group. No significant treatment-by-aura interactions were found for any endpoint, including 2-h pain freedom, most bothersome symptom resolution, 2-h pain relief, sustained outcomes at 24 h, or rescue medication use. Adjusted analyses confirmed these findings. The interaction for rescue medication use approached but did not reach significance (P = .054). CONCLUSIONS: No evidence of an interaction was found for the therapeutic effect of eTNS across MA and MO populations, suggesting that the aura phase does not diminish treatment efficacy. eTNS represents a viable non-pharmacological option for acute migraine management regardless of aura status. Future studies should investigate whether timing treatment to specific migraine phases-particularly the prodrome or early aura-can further optimize neuromodulation outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03465904. Registered 08 March 2018.
Idiopathic intracranial hypertension presenting with obsessive thoughts: a rare neuropsychiatric manifestation "case report".
Rehab MM, Zaki AS, Farwiez MG … +1 more , Moustafa RR
BMC Neurol · 2026 Jun · PMID 42226173 · Full text
BACKGROUND: Idiopathic intracranial hypertension (IIH) classically presents with headache, papilledema, and visual disturbances. Psychiatric manifestations are rare and may obscure a timely diagnosis. CASE PRESENTATION:...
BACKGROUND: Idiopathic intracranial hypertension (IIH) classically presents with headache, papilledema, and visual disturbances. Psychiatric manifestations are rare and may obscure a timely diagnosis. CASE PRESENTATION: A 23-year-old obese female with no prior psychiatric history presented with new-onset intrusive thoughts and compulsive finger-tapping rituals, leading to a diagnosis of obsessive-compulsive disorder (OCD). Despite treatment with high-dose SSRIs, antipsychotic augmentation, and cognitive-behavioural therapy for six months, she showed no improvement. She concurrently reported a refractory bitemporal headache, tinnitus, and transient visual obscurations. Examination revealed bilateral papilledema. MRI/MRV showed features of raised intracranial pressure (ICP) associated with right transverse sinus stenosis. Lumbar puncture (LP) confirmed an elevated opening pressure of 30 cm H₂O. Despite treatment with acetazolamide (2 g/day), she remained symptomatic. Venous sinus stenting was subsequently performed, restoing sinus caliber and reducing the pressure gradient. Within three months, her headache improved markedly, and her papilledema resolved. Remarkably, her obsessive thoughts and compulsive acts completely disappeared without psychiatric medication, with her Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score dropping from 20 to 5. CONCLUSION: This case illustrates IIH presenting with predominant psychiatric manifestations mimicking primary OCD. The dramatic resolution of compulsive symptoms following intracranial pressure normalization suggests a possible association between IIH and obsessive thoughts. Clinicians should maintain a high index of suspicion for IIH in atypical psychiatric presentations accompanied by headache, tinnitus, or visual symptoms; in such cases, routine fundoscopy is essential.
Presumed parasitic meningoencephalitis following fresh snail exposure: physiotherapy interventions and functional outcomes in two distinct families and one solo case.
Fafolahan A, Davis A, Sodipo O … +4 more , Ogunmola M, Bello U, Awofiranye P, Tajudeen Y
BMC Neurol · 2026 Jun · PMID 42226040 · Full text
BACKGROUND: Meningoencephalitis can arise from several infections, but those linked to the parasitic infection Angiostrongylus cantonensis are uncommon. This parasite, often transmitted through consuming raw or undercook...
BACKGROUND: Meningoencephalitis can arise from several infections, but those linked to the parasitic infection Angiostrongylus cantonensis are uncommon. This parasite, often transmitted through consuming raw or undercooked snails, can cause severe neurological complications. This case series highlights physiotherapy management of neurological sequelae in children with presumed parasitic exposure associated meningoencephalitis. CASE PRESENTATIONS: Five pediatric cases of presumed parasitic meningoencephalitis temporally associated with raw snail consumption are presented. All patients were Yoruba children from Southwest Nigeria. Two familial clusters were observed, involving a 9 year old boy and a 5 year old boy in one family, and a 5 year old boy and an 8 year old boy in a second family, alongside one isolated case involving a 9 year old girl. One patient died within 24 h of admission. All five cases received initial medical management, including anti-parasitic and supportive care. All surviving patients received medical and supportive care, while physiotherapy was initiated early to manage neurological impairments including muscle weakness, mobility limitations, and functional deficits. Interventions included range of motion exercises, strengthening, soft tissue techniques, transfer training, gait re-education, and desensitisation strategies for sensory disturbances. CONCLUSIONS: These cases highlight the importance of preventive public health education on zoonotic exposure risks associated with snail consumption. Physiotherapy may play a supportive role in improving functional outcomes in children with neurological deficits secondary to presumed parasitic meningoencephalitis, particularly in resource limited settings.
Comparative effectiveness of exercise interventions on postural balance and activity ability in stroke patients: a systematic review and network meta-analysis.
Shi Y, Lu Y, Zhao L … +2 more , Yu C, Zhang GZ
BMC Neurol · 2026 Jun · PMID 42219469 · Full text
OBJECTIVE: This systematic review and network meta-analysis aims to synthesize and compare the evidence on the effects of different exercise interventions on postural balance and activity ability in stroke survivors, and...
OBJECTIVE: This systematic review and network meta-analysis aims to synthesize and compare the evidence on the effects of different exercise interventions on postural balance and activity ability in stroke survivors, and to determine their relative effectiveness through probability ranking, to provide to offer preliminary evidence for clinical practice in post-stroke rehabilitation. METHODS: A systematic literature search was performed across the following electronic databases from inception until January 2026, China National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journal Database, Cochrane Library, Embase, PubMed, Web of Science, and MEDLINE. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the quality of included studies. The study protocol was registered a priori with PROSPERO CRD420251031404. RESULTS: This study included a total of 24 randomized controlled trials, which compared the effects of six types of exercise interventions on the postural balance and activity ability of stroke patients: robot-assisted training, treadmill training, core stability training, resistance training, aquatic therapy, and overground gait. The analysis demonstrated that exercise interventions significantly improved postural balance (SMD = 0.27, 95% CI: 0.03, 0.51) and activity ability (SMD = 0.96, 95% CI: 0.15, 1.76) of stroke patients. Probability ranking further indicated that, compared to other exercise interventions, core stability training showed a superior potential in enhancing both postural balance (SUCRA = 75.4%; SMD = 0.50, 95% CI: 0.04, 0.96) and activity ability (SUCRA = 96.0%; SMD = 2.68, 95% CI: 0.66, 4.70). CONCLUSIONS: This network meta-analysis indicates that core stability training shows the greatest potential in improving postural balance and activity ability in stroke patients. In clinical rehabilitation practice, it may be considered as a preferred option; however, given the limitations of evidence certainty, these findings should be interpreted cautiously and further validated by high-quality studies.
Associations between oral migraine preventive regimens and CGRP monoclonal antibody initiation: real-world evidence from a resource-limited setting.
Thanprasertsuk S, Hiransuthikul A, Roongrojwittayakul S … +3 more , Pongpitakmetha T, Rattanawong W, Anukoolwittaya P
BMC Neurol · 2026 Jun · PMID 42219465 · Full text
BACKGROUND: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective migraine-specific preventive therapies; however, access remains limited in many low- and middle-income countries (LMICs). In suc...
BACKGROUND: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective migraine-specific preventive therapies; however, access remains limited in many low- and middle-income countries (LMICs). In such settings, oral migraine preventive medications (OMPMs) continue to serve as the foundation of preventive care. The association between baseline preventive regimens and real-world escalation to CGRP mAbs has not been well characterized. METHODS: We conducted a single-center retrospective cohort study of adults with migraine attending a university-based headache clinic in Thailand between January 2021 and December 2023. Participants with at least one baseline OMPM, no prior CGRP mAb exposure, and at least 6 months of follow-up were included. Multivariable Cox proportional hazards models, adjusted for age, sex, and migraine subtype, were used to examine associations between baseline OMPM classes and CGRP mAb initiation. A secondary analysis evaluated factors associated with discontinuation of baseline OMPMs. RESULTS: Among 80 participants, 16 (20.0%) initiated CGRP mAbs over 11,554 person-days of follow-up, with a median time to initiation of 44.5 days. Baseline use of beta-blockers (BBs) or tricyclic antidepressants (TCAs) was independently associated with a lower likelihood of CGRP mAb initiation (BB: adjusted hazard ratio [aHR] 0.17, 95% CI 0.04-0.66; TCA: aHR 0.12, 95% CI 0.02-0.57). In secondary analyses, baseline BB use was also associated with greater persistence with preventive therapy (aHR for discontinuation 0.24, 95% CI 0.09-0.64). CONCLUSIONS: Baseline oral preventive regimens were associated with differing likelihoods of switching to CGRP mAbs in this LMIC setting. Optimizing oral preventive treatment strategies remains essential in settings where access to CGRP-targeted therapies is limited, either due to unavailability or lack of reimbursement.
Evaluation of long-term quality of life in traumatic brain injury patients early treated with biperiden - a randomized controlled trial.
Romariz SAA, Marinelli BPT, Bergo MFC … +2 more , Foresti ML, Mello LE
BMC Neurol · 2026 Jun · PMID 42219462 · Full text
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of disability, with post-traumatic epilepsy (PTE) being a major complication. Biperiden has shown experimental potential in preventing epileptogenesis, however...
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of disability, with post-traumatic epilepsy (PTE) being a major complication. Biperiden has shown experimental potential in preventing epileptogenesis, however its impact on outcomes, such as quality of life (QoL), remains unknown. This study evaluated long-term QoL in TBI survivors treated with biperiden and identified clinical and socioeconomic predictors of their QoL. METHODS: We analyzed QoL data from a randomized, double-blind, placebo-controlled trial involving 48 adults with moderate to severe TBI, assessed on average 32 months post-injury. QoL was measured using the EQ-5D-3 L questionnaire. A cross-sectional analysis identified predictors of QoL using Generalized Linear Models (GLMs), and a longitudinal analysis of a 14-participant subgroup assessed changes over time using a paired t-test. RESULTS: Early treatment with biperiden did not significantly alter QoL compared to placebo. However, the study identified significant negative predictors for QoL: the presence of PTE (β = -0.23, p = 0.02), temporal lobe lesion (β = -0.22, p = 0.006), and being a beneficiary (p = 0.002). QoL scores significantly improved between 11.6 months (0.457) and 27.1 months (0.678) post-TBI (p = 0.004). Descriptively, while mobility and self-care were well-preserved, the anxiety/depression dimension was the most affected dimension, with 22.5% of participants reporting extreme problems. CONCLUSIONS: Biperiden did not impact QoL in TBI survivors. However, improvements were observed in the approximately 2 years following injury. Predictors like PTE, temporal lesions and receiving benefits as income were associated with lower Qol score. These preliminary findings guide future interventions for TBI patients and are particularly important as they fill a data gap for the Brazilian population. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov, a database managed by the U.S. National Library of Medicine (NLM) and National Institutes of Health (NIH), under the identifier NCT01048138 on January 13, 2010.
Diagnostic and therapeutic gaps in recurrent stroke management: real-world insights from a Ghanaian hospital-based registry.
Opare-Addo PA, Sarfo FS, Aikins M … +5 more , Asante E, Nyanaah M, Derkyi NOA, Holu JM, Amponsah GM
BMC Neurol · 2026 May · PMID 42218409 · Full text
BACKGROUND: Recurrent strokes account for up to 1 out of 4 strokes in Low-and-Middle-Income-Countries (LMICs), culminating in worsening of outcomes. International guidelines recommend subtype-specific etiological workup...
BACKGROUND: Recurrent strokes account for up to 1 out of 4 strokes in Low-and-Middle-Income-Countries (LMICs), culminating in worsening of outcomes. International guidelines recommend subtype-specific etiological workup to help tailor strategies for prevention of recurrence after an index stroke. However, huge gaps in secondary stroke prevention persist in LMICs. OBJECTIVES: We aimed to assess the extent of diagnostic evaluation (for risk-factor and underlying etiological identification) and treatment approaches among recurrent stroke patients in a Ghanaian tertiary hospital. METHODS: This was a cross-sectional study among recurrent stroke cases admitted to Komfo Anokye Teaching Hospital between 2023 and 2025. The data was analyzed using SPSS Version 28. RESULTS: Recurrent strokes accounted for 17.8% of all stroke admissions over 2 years, with ischemic strokes comprising 76.2% of these recurrent events. Hypertension was the most dominant modifiable risk factor among both ischemic and hemorrhagic subtypes, 97.0% and 92.1% respectively, (p = 0.297). Only a minority of ischemic stroke patients (12.6%) had sufficient diagnostic evaluation to allow definitive etiological classification according to the TOAST framework. Only 7.9% of hemorrhagic strokes underwent Computed tomography angiography (CTA)/ Magnetic resonance angiography (MRA) to evaluate for structural causes. Most ischemic stroke patients were prescribed a statin (93.7%) and an antiplatelet, while anticoagulant therapy was used only in a minority of patients (3.91%). Carotid endarterectomy or carotid stenting was not performed for any of the ischemic stroke patients. CONCLUSION: Our findings highlight significant gaps in recurrent stroke evaluation and management in the Ghanaian setting. Standardized algorithms for secondary stroke prevention and treatment are urgently needed to mitigate recurrence.
Association between body composition and disease progression in adults with amyotrophic lateral sclerosis: a cross-sectional study.
Abbasi H, Shafaatdoost M, Mohajerani A … +4 more , Asadollahi M, Rashidi M, Malekahmadi M, Sarraf P
BMC Neurol · 2026 May · PMID 42218400 · Full text
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by motor neuron degeneration, muscle wasting, and respiratory failure, with a median survival of 30 months. Due to the strong...
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by motor neuron degeneration, muscle wasting, and respiratory failure, with a median survival of 30 months. Due to the strong link between dysphagia, weight loss, and disease progression, this study investigates the relationship between body composition and clinical outcomes in ALS adults. This cross-sectional study involved 93 ALS adults (29 females, 64 males) from Imam Khomeini Hospital in Tehran, selected based on EI Escorial criteria. Researchers assessed body composition, functional abilities, and disease progression using ALSFRS-R, MRC scores, and DPR, analyzing associations through linear regression models with RStudio in conjunction with R software. In this study, significant differences were found between the third and first tertiles for various measures. Significant associations were observed between body composition and ALSFRS-R for MAC (β: 3.0; P = 0.006), with underweight and moderately active adults exhibiting notable differences. The MRC score was positively associated with FFM (β: 5.8; P = 0.002), SLM (β: 5.6; P = 0.002), SMM (β: 3.8; P = 0.001), MAC (β: 3.2; P = 0.002), ICW (β: 2.7; P = 0.002), and ECW (β: 1.5; P = 0.003), while underweight and low-to-moderate physical activity adults indicated inverse associations. For DPR, significant relationships were noted for weight (β: 4.5; 95% CI: 0.02, 9.3; P = 0.002) and FFM (β: 11; P < 0.001), influenced by gender and physical activity. The findings highlight the role of gender, weight, and activity in ALS management, suggesting that maintaining a healthy weight along and muscle mass along with regular activity is associated with better outcomes. This can inform personalized treatment strategies for better patient care.
Risdiplam treatment in adults with spinal muscular atrophy: a single-center, real-world study.
Leonardis L, Pukšič Šimek P, Kadenšek S … +1 more , Koritnik B
BMC Neurol · 2026 May · PMID 42218378 · Full text
BACKGROUND: Spinal muscular atrophy (SMA) is a progressive, degenerative neuromuscular disease caused by mutations in the survival motor neuron 1 (SMN1) gene leading to muscle weakness and respiratory impairments. Risdip...
BACKGROUND: Spinal muscular atrophy (SMA) is a progressive, degenerative neuromuscular disease caused by mutations in the survival motor neuron 1 (SMN1) gene leading to muscle weakness and respiratory impairments. Risdiplam is an oral disease-modifying therapy approved for the treatment of SMA in both pediatric and adult patient populations; however, real-world data on the treatment of adults with SMA are limited. METHODS: This real-world, retrospective study analyzed data from 11 patients with Types 2, 3, and 4 SMA who had been treated with risdiplam at a single center in Slovenia and had up to 30 months of follow-up. Disease progression was assessed using motor and respiratory outcome measures. RESULTS: At baseline, patients had a mean (SD) age of 51 (20) years; range, 27-82 years. Baseline motor and respiratory function varied across the patient group. From baseline to month 30, stable motor function was observed for most patients over the treatment period, with no significant overall effect of time for Revised Upper Limb Module (F = 1.44, p = 0.23) or Revised Hammersmith Scale (F = 0.54, p = 0.74). Respiratory function was generally stable over 30 months of treatment with risdiplam: from baseline to month 30, no significant overall effect of time was observed for vital capacity (F = 1.20, p = 0.32), forced vital capacity (F = 0.93, p = 0.47), peak expiratory flow (F = 0.94, p = 0.46), maximal inspiratory pressure (F = 0.65, p = 0.66), maximal expiratory pressure (F = 1.25, p = 0.31), and sniff nasal inspiratory pressure (F = 1.10, p = 0.38). CONCLUSIONS: This real-world study suggests that risdiplam treatment for adults with Types 2, 3, and 4 SMA generally stabilizes motor and respiratory function over 30 months. These results add to the limited database of risdiplam treatment outcomes in adults with SMA, support the continued use of risdiplam for adults with SMA, and may help patients and clinicians to understand and assess treatment options.
Is faciobrachial dystonic seizure a misnomer? A case report of atypical leg-predominant tonic-dystonic attacks in LGI1-associated encephalitis.
Faouzi M, Galati A, Kaza S … +1 more , Bruno MK
BMC Neurol · 2026 May · PMID 42216157 · Full text
BACKGROUND: Antibody‑mediated encephalitis due to leucine‑rich glioma‑inactivated 1 (LGI1) is a frequent cause of immune‑responsive paroxysmal motor phenomena in older adults. The disorder is commonly associated with bri...
BACKGROUND: Antibody‑mediated encephalitis due to leucine‑rich glioma‑inactivated 1 (LGI1) is a frequent cause of immune‑responsive paroxysmal motor phenomena in older adults. The disorder is commonly associated with brief, stereotyped involuntary movements traditionally labeled faciobrachial dystonic seizures (FBDS). However, the "faciobrachial" descriptor may underrepresent the true phenotypic spectrum. We report a case of LGI1‑associated autoimmune encephalitis presenting with leg‑predominant tonic-dystonic attacks, expanding the recognized clinical presentation and highlighting variability in semiology. CASE PRESENTATION: A 62‑year‑old man presented following multiple falls caused by sudden, repetitive involuntary movements primarily affecting the left lower extremity. Episodes were short‑lived, painless, and occurred dozens of times daily, often provoked by initiation of voluntary movement and preceded by a brief sensory warning. Consciousness was consistently retained, although some attacks spread to involve the ipsilateral arm and face. Neurological examination, cognitive assessment, brain MRI, and EEG were unremarkable. Cerebrospinal fluid analysis demonstrated mildly elevated protein without pleocytosis. Antiseizure therapy provided no benefit. High‑dose intravenous corticosteroids resulted in minimal improvement, whereas plasma exchange led to complete symptom resolution. Serum autoimmune testing was positive for LGI1-IgG antibody and a low-titer P/Q-type calcium channel antibody, suggesting an autoimmune encephalitis- most likely LGI1 encephalitis. FDG-PET/CT showed no malignancies or hypermetabolic abnormalities. CONCLUSIONS: This case highlights that LGI1‑associated paroxysmal events may present as leg‑predominant tonic-dystonic attacks, rather than the more typical faciobrachial distribution. Clinicians should maintain a high index of suspicion for autoimmune causes in late‑onset paroxysmal movement disorders, as prompt immunotherapy can prevent falls, reduce morbidity, and significantly alter disease course. Recognition of serum‑positive, imaging‑negative LGI1 autoimmunity is particularly important, as such presentations may lack common cognitive or limbic features and risk diagnostic delay.
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