BMC Neurology[JOURNAL]
Sun
200 papers
Interactive effects of vitamin D status and visit-to-visit systolic blood pressure variability on 12-month cognition and mild cognitive impairment in older adults with hypertension.
Zhao L, Wang P, Zhao H … +2 more , Xiao N, Tan L
BMC Neurol · 2026 May · PMID 42174475 · Full text
BACKGROUND: Visit-to-visit systolic blood pressure variability (BPV) has been linked to cognitive decline, but inter-individual susceptibility may depend on modifiable factors such as vitamin D status. We investigated wh...
BACKGROUND: Visit-to-visit systolic blood pressure variability (BPV) has been linked to cognitive decline, but inter-individual susceptibility may depend on modifiable factors such as vitamin D status. We investigated whether baseline serum 25-hydroxyvitamin D [25(OH)D] modifies the association between systolic BPV and 12-month cognition among older adults with hypertension. METHODS: In this single-center prospective cohort, participants were recruited from May 2023 to June 2024 and followed for 12 months, adults aged ≥ 65 years with hypertension underwent baseline 25(OH)D measurement and Montreal Cognitive Assessment (MoCA) at baseline and Month 12. BPV was calculated from clinic SBP values during Months 0-10 (≥ 6 visits required). Average real variability of SBP (ARV-SBP) was the primary BPV metric; standard deviation (SD-SBP), coefficient of variation (CV-SBP), variability independent of mean (VIM-SBP), and range-SBP were examined in sensitivity analyses. Average real variability of SBP (ARV-SBP) was the primary BPV metric. The primary analysis used ANCOVA-style multivariable linear regression for Month 12 MoCA including ARV-SBP (per 1 SD), 25(OH)D (per 10 ng/mL, centered), and their interaction, adjusting for baseline MoCA and prespecified covariates. A screening-based, algorithm-defined MCI status at Month 12 was analyzed using modified Poisson regression with robust standard errors. RESULTS: Among 176 participants (mean age 73.1 years), 73 (41.5%) had low vitamin D status [25(OH)D < 20 ng/mL] and 48 (27.3%) met algorithm-defined MCI status at Month 12. Higher ARV-SBP was associated with lower Month 12 MoCA (β=-0.22, 95% CI - 0.37 to - 0.07 β), and 25(OH)D significantly modified this association (interaction β = 0.18, 95% CI 0.05 to 0.32; p = 0.01 β), indicating attenuation of BPV-related cognitive disadvantage at higher vitamin D levels. The interaction remained directionally consistent across SD-SBP, CV-SBP, VIM-SBP, and range-SBP sensitivity models (all nominal p ≤ 0.04 ; FDR q ≤ 0.04 ). In joint-exposure analysis, low vitamin D status plus high BPV was associated with a higher probability of meeting algorithm-defined MCI status versus 25(OH)D ≥ 20 ng/mL with low BPV (adjusted RR = 4.14, 95% CI 1.93 to 8.90), while additive interaction was suggestive but imprecise (RERI = 1.94, 95% CI - 0.10 to 6.03). CONCLUSIONS: Baseline 25(OH)D was associated with heterogeneity in the observed association between clinic visit-to-visit systolic BPV and 12-month cognition in adults aged ≥ 65 years with hypertension. These findings support attention to BP stability and low vitamin D status as a potential marker of cognitive vulnerability in older hypertensive outpatients, while causal inference and supplementation effects require confirmation.
Red flags in asymmetric axonal neuropathy revealing MPO-ANCA-associated microscopic polyangiitis: a case report.
Wang Y, Liu N, Yang C … +1 more , Zhu J
BMC Neurol · 2026 May · PMID 42168891 · Full text
BACKGROUND: Mononeuritis multiplex is a recognized, though sometimes overlooked, clinical feature of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis. When renal or pulmonary involveme...
BACKGROUND: Mononeuritis multiplex is a recognized, though sometimes overlooked, clinical feature of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis. When renal or pulmonary involvement is initially mild, the condition may mimic common neurological disorders and diagnosis can be delayed. CASE PRESENTATION: A 51-year-old woman presented with a five-month history of progressive bilateral lower-limb pain and edema, followed by three weeks of rapidly progressive asymmetric weakness affecting all four limbs. Nerve conduction studies showed severe multifocal axonal neuropathy with marked side-to-side compound muscle action potential asymmetry, consistent with mononeuritis multiplex. Laboratory evaluation demonstrated anemia, hypoalbuminemia, proteinuria, microscopic hematuria, MPO-ANCA positivity, and a subsequent creatinine rise from 76 to 121 μmol/L, indicating early but clinically evident systemic involvement. Chest computed tomography showed right-sided nodular/parenchymal pulmonary lesions with bilateral chronic/interstitial changes. Treatment with glucocorticoid-based induction therapy together with a documented cyclophosphamide-containing discharge regimen was associated with marked early improvement in pain, strength, inflammatory markers, and renal indices. CONCLUSIONS: Three red flags should prompt early ANCA testing in patients with rapidly progressive asymmetric axonal neuropathy: multifocal asymmetric axonal loss with relatively preserved conduction velocities on nerve conduction studies; early renal abnormalities such as hematuria, proteinuria, or rising creatinine; and concordant systemic findings including hypoalbuminemia, elevated inflammatory markers, or pulmonary imaging changes. Early recognition may allow treatment before axonal injury becomes irreversible.
Optimising support for stroke caregiver burden: a systematic review and meta-analysis of randomised clinical trials on occupational therapy-related interventions.
Liu X, Zhang W, An Z … +7 more , Wan S, Jiang W, Yan Z, Yin Y, Li W, Yan Y, Lv P
BMC Neurol · 2026 May · PMID 42163206 · Full text
BACKGROUND: Stroke caregivers often experience significant physical and psychological burden during long-term caregiving, leading to reduced quality of life. Traditional unidimensional support models inadequately address...
BACKGROUND: Stroke caregivers often experience significant physical and psychological burden during long-term caregiving, leading to reduced quality of life. Traditional unidimensional support models inadequately address their complex needs. Occupational therapy interventions based on the International Classification of Functioning, Disability and Health (ICF), which integrate multidimensional support across body function, activity and participation, and environmental factors, may systematically alleviate caregiver burden. However, the efficacy and optimal intervention approaches lack comprehensive synthesis. METHODS: A systematic literature search was performed in the following seven databases from January 2010 until January 2025: PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, and WANFANG. The search aimed to identify all relevant randomized controlled trials (RCTs) where the participants were informal stroke caregivers, the intervention was occupational therapy, and the comparator was usual care. Subgroup analyses were performed to explore heterogeneity by categorising interventions according to the International Classification of Functioning, ICF framework: body functions, activities and participation, environmental factors, and personal factors. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Random-effects meta-analyses were employed to calculate mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). RESULTS: Twelve RCTs involving 1,636 participants were included in the analysis. The meta-analysis demonstrated that occupational therapy-related interventions significantly reduced caregiver burden (SMD = -0.32, 95% CI: -0.53 to -0.10; p = 0.004). For secondary outcomes, no significant effects were found for caregiver depression or survivor functional recovery. Subgroup analyses based on the ICF framework indicated that interventions combining activity participation, environmental factors, and personal factors resulted in a statistically significant reduction in caregiver burden (SMD = -0.50, 95% CI: -0.81 to -0.20; p = 0.001). Interventions targeting other dimensions did not show significant effects. CONCLUSION: Occupational therapy-related interventions demonstrate a small but statistically significant beneficial impact on alleviating the caregiving burden for stroke caregivers. Prioritizing multifaceted ICF-based interventions that address activities, participation, and contextual factors is crucial. Future research should evaluate long-term outcomes to advance the shift from patient-centered to family-centered rehabilitation, thereby enhancing wellbeing for stroke caregivers.
Prophylactic efficacy and safety of valproate versus topiramate for migraine: a systematic review.
Wasti SA, Wasti A, Abid MA … +6 more , Shahid MS, Kuo VFH, Cano-Reyes SE, Iqbal MU, Vasylyshyn A, Krymchantowski AV
BMC Neurol · 2026 May · PMID 42163197 · Full text
BACKGROUND: Migraine prophylaxis options commonly include valproate and topiramate. Although several randomised trials have directly compared these agents, their relative efficacy and safety remain underexplored. Existin...
BACKGROUND: Migraine prophylaxis options commonly include valproate and topiramate. Although several randomised trials have directly compared these agents, their relative efficacy and safety remain underexplored. Existing reviews have largely focused on placebo-controlled or indirect comparisons and have not comprehensively synthesised the available head-to-head evidence. This systematic review, therefore, evaluates the comparative efficacy and safety of valproate versus topiramate using a comprehensive, multilingual search METHODS: This review has been registered on the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/ZC3S6). Databases and registers were searched to 9 September 2025. We included randomised controlled trials (RCTs) comparing valproate with topiramate in adult migraineurs. Due to the high risk of bias, evaluated at the outcome level using the revised Cochrane Risk of Bias 2 tool, a descriptive approach was adopted. RESULTS: Eight trials were included (1659 participants; 72.2% female; mean ages 29.2-42.1 years). Two studies were in Chinese, one in Persian, and the rest were in English. Both drugs appeared to reduce migraine frequency meaningfully. Reductions in migraine duration, pain intensity, and disability measures (HIT-6, MIDAS) improved similarly with both drugs. The evidence base was insufficient to support a definitive efficacy advantage for either drug. Adverse events were common but mostly mild. Valproate use was often associated with increased appetite, drowsiness, and tremor, while topiramate use was commonly associated with paraesthesia and appetite loss. CONCLUSIONS: The head-to-head randomized evidence appears to suggest that both valproate and topiramate may be effective for migraine prophylaxis. However, the current evidence is insufficient to support definitive claims of superiority for either drug. Differences in adverse- event profiles may therefore play a key role in guiding individualised treatment decisions. High- quality, well-powered trials are needed.
Joint effects of dyslipidemia and the platelet count on stroke risk: Longitudinal analysis via dynamic lipid stratification in the CHARLS cohort.
Xu G, Gu H, Ding H … +2 more , Wang Y, Wu G
BMC Neurol · 2026 May · PMID 42163171 · Full text
BACKGROUND: Dyslipidemia and elevated platelet count are independent risk factors for stroke, but their joint effect remains unclear. This study aimed to investigate the combined influence of dynamic lipid trajectories a...
BACKGROUND: Dyslipidemia and elevated platelet count are independent risk factors for stroke, but their joint effect remains unclear. This study aimed to investigate the combined influence of dynamic lipid trajectories and platelet count on new-onset stroke risk in middle-aged and older Chinese adults. METHODS: A total of 7,917 stroke-free participants from the CHARLS cohort were enrolled and stratified into four lipid trajectory groups. Multivariable logistic regression, restricted cubic splines, interaction analysis, Cox proportional hazards model, and Fine-Gray competing risk model were used for analyses. All models were adjusted for medication use and other confounders. Additive interaction was evaluated using the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI). RESULTS: During follow-up, 9.22% of participants developed stroke. Platelet count was linearly associated with new-onset stroke (per 10-SD increase: aOR = 1.019, p < 0.001), and this association was significant only in the new-onset and persistent dyslipidemia groups. Significant multiplicative interaction was observed (p < 0.001), but no significant additive interaction was found (all RERI 95% CI included 0). Results from Cox and Fine-Gray models were consistent with the main findings. Baseline balance between included and excluded participants was confirmed using standardized mean differences (SMD). CONCLUSIONS: Elevated platelet count amplifies stroke risk in individuals with deteriorating or persistent dyslipidemia, showing a linear dose-response relationship. Integrated assessment of lipid dynamics and platelet count may help identify high-risk populations for precision stroke prevention.
Unawareness of deficits in mild cognitive impairment: a systematic review of its role in progression to Alzheimer's disease.
Moore L, Lund AE, Russell C
BMC Neurol · 2026 May · PMID 42163170 · Full text
BACKGROUND: Reduced awareness or poor insight into cognitive abilities is a well-documented feature of Alzheimer's disease, yet its role in the earlier stages of cognitive decline-particularly in individuals with mild co...
BACKGROUND: Reduced awareness or poor insight into cognitive abilities is a well-documented feature of Alzheimer's disease, yet its role in the earlier stages of cognitive decline-particularly in individuals with mild cognitive impairment (MCI)-remains less clear. Understanding whether diminished awareness in MCI is a predictor of progression to dementia is crucial, as it may help identify individuals who are at greater risk and who could benefit from timely support and intervention. This systematic review evaluates the evidence linking reduced awareness in MCI with an increased likelihood of conversion to dementia. METHOD: Four electronic databases (CINAHL, Medline, Embase and PsychInfo) were systematically searched for all studies assessing awareness in individuals with MCI, which tracked their cognitive status over time. The protocol was registered with PROSPERO and PRISMA guidelines were followed. Inclusion criteria-studies must: Include participants with confirmed MCI diagnosis; Assess the relationship between awareness of cognitive and/or functional abilities and the development of dementia; Have longitudinal design; Be peer-reviewed. Exclusion criteria-studies must not: Be published in a different language to English; Include participants with comorbid neurological conditions; Include participants from the same cohort as another study; Use a case series design. Eleven studies were identified as fulfilling all criteria. Study quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for cohort studies. RESULTS: Six studies reported a statistically significant association between reduced awareness and conversion to dementia. Four studies found a trend toward significance, suggesting a possible link, but either did not test for significance or failed to reach it. Only one study found no association. Study quality was rated as high in five studies, moderate in two, and low in four. Notably, higher-quality studies were more likely to report significant associations. Due to substantial methodological variability across studies, a meta-analysis was not feasible. CONCLUSIONS: Reduced awareness of memory impairment appears predictive of increased risk of progression from MCI to dementia. Assessing awareness-through informant reports and/or comparisons between subjective and objective cognitive measures-could help identify individuals at elevated risk. These individuals may benefit from closer monitoring to facilitate timely diagnosis and intervention.
Methotrexate-induced myelopathy: a great imitator of relapsed malignant lymphoma.
Ishikawa M, Watanabe H, Nakashima H … +5 more , Ozawa T, Anan Y, Koide R, Tanaka R, Fujimoto S
BMC Neurol · 2026 May · PMID 42163128 · Full text
BACKGROUND: Methotrexate-induced myelopathy is a rare adverse effect of intrathecal methotrexate, characterized by acute or subacute myelopathy-like neurological manifestations and magnetic resonance imaging findings res...
BACKGROUND: Methotrexate-induced myelopathy is a rare adverse effect of intrathecal methotrexate, characterized by acute or subacute myelopathy-like neurological manifestations and magnetic resonance imaging findings resembling subacute combined degeneration. Because neurological symptoms often precede radiological abnormalities, accurate diagnosis can be challenging, particularly in patients with hematological malignancies, in whom central nervous system relapse must also be considered. CASE PRESENTATION: A 61-year-old man with extranodal natural killer/T-cell lymphoma, nasal type, developed progressive lower limb weakness and sensory disturbance four days after his 11th course of intrathecal methotrexate for central nervous system relapse. Initial spinal magnetic resonance imaging showed no abnormalities; however, subsequent imaging revealed longitudinally extensive, ascending T2-hyperintense lesions in the posterior and lateral columns of the thoracic spinal cord without gadolinium enhancement. Methotrexate-induced myelopathy was diagnosed based on clinical and radiological findings. Despite intravenous administration of vitamin B12 and folate, as well as oral supplementation with S-adenosylmethionine, spinal lesions extended rostrally without further neurological deterioration. One month later, the patient developed progressive unilateral axonal neuropathy of the left lower limb. Subsequent skin biopsy confirmed relapse of extranodal natural killer/T-cell lymphoma. CONCLUSIONS: This case illustrates that methotrexate-induced myelopathy may present with delayed radiological abnormalities and can closely mimic relapse of the underlying malignancy. Furthermore, the development of peripheral axonal neuropathy during the clinical course of methotrexate-induced myelopathy should prompt careful evaluation for disease recurrence in patients with hematological malignancies.
Reversibility of cognitive and psychiatric impairments following surgical resection of frontotemporal meningiomas: a predictive factor analysis.
Ko K, Park YJ, Hwang K … +6 more , Park YH, Ryoo N, Baek MJ, Han JH, Kim S, Kim CY
BMC Neurol · 2026 May · PMID 42157157 · Full text
BACKGROUND: Cognitive and psychiatric impairments are common in patients with frontotemporal meningiomas. While meningiomas are often histologically benign, they can cause significant morbidity through mass effect and pe...
BACKGROUND: Cognitive and psychiatric impairments are common in patients with frontotemporal meningiomas. While meningiomas are often histologically benign, they can cause significant morbidity through mass effect and peritumoral edema. Compared to gliomas, the reversibility of these impairments following surgical resection is relatively under-investigated. This study aimed to evaluate postoperative neuropsychological changes and identify tumor-related factors associated with recovery in patients with frontotemporal meningiomas. METHODS: We retrospectively reviewed 29 patients who underwent surgical resection for frontotemporal meningiomas and completed both pre- and postoperative neuropsychological assessments (Neurooncologic Psychological Test [NOPT], Seoul Neuropsychological Screening Battery-II [SNSB-II], or Bundang Neuropsychological Testing Protocol-M1 [BNTP-M1]). Exploratory multivariable linear regression analysis was performed using Δ scores (postoperative minus preoperative) to identify radiologic factors associated with recovery in each domain. RESULTS: Postoperatively, patients demonstrated significant improvements across all tested domains: attention (P = 0.002), language (P = 0.041), memory (P < 0.001), visuospatial function (P = 0.024), executive function (P < 0.001), and psychiatric symptoms (P = 0.043). In exploratory multivariable analysis, mass effect was associated with greater improvement in attention (B = 1.33, 95% CI, 0.36 to 2.30; P = 0.009), whereas frontal lobe involvement was associated with less improvement in language function (B = -3.00, 95% CI, -5.06 to -0.94; P = 0.006). Convexity origin was associated with less improvement in Stroop test performance (B = -29.79, 95% CI, -59.48 to -0.11; P = 0.049), and frontal base origin was associated with less improvement in psychiatric symptoms (B = -14.91, 95% CI, -24.83 to -4.98; P = 0.005). Edema index was not significantly associated with executive function recovery in the final exploratory model. CONCLUSIONS: Neuropsychological impairments in patients with frontotemporal meningiomas demonstrated statistically significant postoperative improvements following surgical resection. Recovery trajectories may be associated with tumor-related factors such as mass effect and anatomical origin. These findings should be interpreted cautiously given the limited sample size and the exploratory nature of the analyses, and support further investigation of tailored rehabilitation strategies based on preoperative radiologic characteristics.
Predictors of functional outcome after endovascular thrombectomy in patients with large ischemic core based on DWI-ASPECTS.
He J, Ren K, Xu Y … +8 more , Zhao B, Yue L, Wang Y, Tang T, Xie X, Wang W, Zhao Y, Liu Z
BMC Neurol · 2026 May · PMID 42151928 · Full text
BACKGROUND: Several clinical trials have shown the benefit of endovascular thrombectomy (EVT) in patients with large ischemic core infarction. However, the imaging selection modalities used for patient selection have dif...
BACKGROUND: Several clinical trials have shown the benefit of endovascular thrombectomy (EVT) in patients with large ischemic core infarction. However, the imaging selection modalities used for patient selection have differed across studies. This study aimed to assess the efficacy, safety, and prognostic factors of EVT in patients with large ischemic core selected only on the basis of Diffusion-Weighted Imaging Alberta Stroke Program Early CT Score (DWI-ASPECTS). METHOD: This single-center study, conducted from 2019 to 2024, included patients with anterior circulation acute large vessel occlusion and stratified them into three groups according to DWI-ASPECTS: non-large ischemic core (≥ 6) treated with EVT (n = 77), large ischemic core (3-5) treated with EVT (n = 91), and large ischemic core (3-5) treated with medical management alone (n = 70). The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale (mRS) score of 0-2. Secondary endpoints included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality within 90 days. Multivariate binary logistic regression was performed to identify factors associated with functional independence in the large-ischemic-core EVT group. RESULTS: Patients with large ischemic core treated with EVT had a significantly higher rate of 90-day functional independence than those who received medical management (53.8% vs 28.6%, P = 0.001). No significant differences in sICH or mortality were observed between the large-ischemic-core EVT and medical management groups. However, compared with patients with non-large ischemic core treated with EVT, those with large ischemic core treated with EVT had a lower rate of functional independence (53.8% vs 70.1%, P = 0.039). In the large ischemic core EVT group, intravenous thrombolysis (OR 0.164, P = 0.018) and parenchymal hematoma type 2 (PH2) hemorrhage (OR 25.641, P = 0.012) were independent predictors of 90-day outcomes. CONCLUSION: In this cohort, EVT was associated with improved 90-day functional outcomes in patients with large ischemic core (DWI-ASPECTS 3-5) compared with medical management alone, without a statistically significant increase in sICH or mortality. Intravenous thrombolysis and PH2 hemorrhage were identified as independent predictors of outcome. These results require further confirmation in larger and adequately powered studies.
Anti-GLDN antibody-associated CIDP (nodopathy): transient IVIg response and B-cell depletion remission.
Wu Y, Gu L, Liu J … +4 more , Yang W, Zhu D, Wei J, Chen X
BMC Neurol · 2026 May · PMID 42151911 · Full text
BACKGROUND: The classification of chronic inflammatory demyelinating polyneuropathy (CIDP) is evolving with the discovery of autoantibodies against nodal and paranodal proteins, leading to the recognition of "autoimmune...
BACKGROUND: The classification of chronic inflammatory demyelinating polyneuropathy (CIDP) is evolving with the discovery of autoantibodies against nodal and paranodal proteins, leading to the recognition of "autoimmune nodopathies." While anti-neurofascin-155 (NF155) and anti-contactin-1 (CNTN1) antibodies are well-characterized, the phenotype of anti-gliomedin (GLDN) antibodies remains poorly defined. We present a comprehensive case to delineate its clinical and serological profile. CASE PRESENTATION: We report a detailed longitudinal case of a patient with anti-GLDN antibody-positive CIDP, including clinical presentation, electrophysiological and imaging studies, serological testing, treatment response, and follow-up. RESULTS: A 48-year-old woman presented with an 11-month history of relapsing-remitting, symmetric sensorimotor polyneuropathy, triggered by immune-activating events. Electrodiagnostic studies confirmed a demyelinating polyneuropathy meeting definitive European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) criteria. Cerebrospinal fluid (CSF) analysis showed marked albuminocytological dissociation (protein 1631 mg/L). Serology was positive for anti-GLDN IgG (cell-based assay titer 1:32). The patient exhibited an excellent but transient response to intravenous immunoglobulin (IVIg), leading to multiple relapses. Subsequent B-cell targeted therapy with rituximab resulted in sustained clinical stabilization, effective B-cell depletion, and negative conversion of anti-GLDN IgG antibody. CONCLUSIONS: This case suggests that anti-GLDN antibody-associated CIDP may be associated with a recognizable phenotype within the autoimmune nodopathy spectrum. Potential key features include a relapsing course following immune stimulation, markedly elevated cerebrospinal fluid protein, a unique pattern of robust but unsustained response to intravenous immunoglobulin (IVIg), and a favorable response to B-cell depletion therapy as evidenced by clinical remission and seroconversion.
Comparative analysis of blood flow velocity in middle cerebral artery stenosis by transcranial doppler ultrasonography and contrast-enhanced high-resolution magnetic resonance imaging.
Shi X, Huang J, Liu F … +2 more , Qi L, Yang G
BMC Neurol · 2026 May · PMID 42151891 · Full text
BACKGROUND: This study aimed to investigate the optimal cutoff value of transcranial Doppler (TCD) ultrasonography for detecting middle cerebral artery (MCA) stenosis and differences in MCA blood flow velocities between...
BACKGROUND: This study aimed to investigate the optimal cutoff value of transcranial Doppler (TCD) ultrasonography for detecting middle cerebral artery (MCA) stenosis and differences in MCA blood flow velocities between plaques with different characteristics using contrast-enhanced high-resolution magnetic resonance imaging (CE-HR-MRI). METHODS: A total of 122 patients with MCA stenosis detected using TCD underwent CE-HR-MRI. Peak systolic velocity (PSV), mean flow velocity (MFV), and end-diastolic velocity (EDV) of the stenotic and distal segments were recorded. The stenotic/distal MFV ratio (SDR) was then calculated. Plaque characteristics were analyzed using CE-HR-MRI to compare differences in blood flow velocity between the plaques with different characteristics. RESULTS: The optimal cutoff values for detecting mild, moderate, and severe stenosis were PSV = 140 cm/s, EDV = 60 cm/s, and MFV = 90 cm/s; PSV = 200 cm/s, EDV = 90 cm/s, MFV = 120 cm/s, and SDR = 1.7; and PSV = 270 cm/s, EDV = 150 cm/s, MFV = 180 cm/s, and SDR = 3.0, respectively. The agreement between TCD and CE-HR-MRI was highest when using PSV (weighted kappa = 0.839). PSV, MFV, EDV, and SDR were significantly elevated in concentric plaques compared with those in eccentric plaques. Plaque enhancement grade 2 was significantly higher in PSV, MFV, and EDV than plaque enhancement grades 0 and 1. However, after stratification by stenosis severity, these differences were no longer significant. CONCLUSIONS: TCD, particularly PSV, provides reliable grading of MCA stenosis when referenced against CE-HR-MRI. Although higher flow velocities are observed in concentric plaques and those with grade 2 enhancement, these differences are not independent of stenosis severity. Nevertheless, the established velocity cutoffs for stenosis grading may facilitate non-invasive risk stratification in patients with MCA stenosis.
Neuropathic pain in superficial radial neuropathy: neurophysiological correlations in a retrospective series of 20 patients.
Alaydın HC, Fidancı H, Yakıcı İ … +4 more , Cöddü C, Baştin SM, Ertürk AY, Mazman S
BMC Neurol · 2026 May · PMID 42151864 · Full text
BACKGROUND: Superficial radial neuropathy (SRN) is an uncommon sensory mononeuropathy, and data on neuropathic pain in SRN are limited. This study aimed to determine the frequency of neuropathic pain in patients with SRN...
BACKGROUND: Superficial radial neuropathy (SRN) is an uncommon sensory mononeuropathy, and data on neuropathic pain in SRN are limited. This study aimed to determine the frequency of neuropathic pain in patients with SRN and to evaluate its associations with neurophysiological severity. METHODS: We retrospectively reviewed adult patients diagnosed with SRN. Neuropathic pain was evaluated using the Douleur Neuropathique 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). Neurophysiological severity was categorized as mild, moderate, or severe according to the superficial radial sensory nerve action potential (SNAP) amplitude. Associations between neuropathic pain and SRN severity, etiology, and coexisting upper-limb neuropathies were examined. RESULTS: Twenty patients were included (mean age 36.2 ± 11.9 years; 75% male). SRN was trauma-related in 18 patients and entrapment-related in 2. Ten patients (50%) met screening criteria for neuropathic pain according to DN4 and 9 (45%) according to LANSS. Screening positivity tended to be more frequent in severe SRN than in mild-moderate SRN (DN4: 6/7 vs. 4/13, p = 0.057) and was significantly higher according to LANSS (6/7 vs. 3/13, p = 0.012). Screening positivity was also observed in 3/4 patients with coexisting median or ulnar neuropathies. CONCLUSION: Approximately half of patients with SRN met screening criteria for neuropathic pain. Higher screening positivity was observed in electrophysiologically severe SRN and in patients with coexisting median or ulnar neuropathies; these findings warrant confirmation in larger prospective cohorts.
Regression of central sensitization after bilateral focused ultrasound medial thalamotomies in atypical orofacial pain? - a case report.
Buecheler MV, Kolakowski L, Kleinsorge MT … +3 more , Pohl H, Stieglitz L, Wegener S
BMC Neurol · 2026 May · PMID 42151860 · Full text
Orofacial pain syndromes are a heterogenous group of pain disorders resulting in substantial morbidity. They are often refractory to medical treatment and can have an enormous impact on quality of life. Central sensitiza...
Orofacial pain syndromes are a heterogenous group of pain disorders resulting in substantial morbidity. They are often refractory to medical treatment and can have an enormous impact on quality of life. Central sensitization plays a major role in chronic pain disorders and poses a diagnostic and therapeutic challenge. Transcranial magnetic resonance-guided focused ultrasound bilateral medial thalamotomy is an emerging treatment in chronic pain syndromes with central sensitization. We here describe a 76-year-old female patient with a long history of atypical orofacial pain and central sensitization with a significant, but temporary regression of the latter after medial thalamotomy using bilateral focused ultrasound.
The impact of caffeine consumption on migraine: a systematic review.
Makhlouf HA, Khelifa H, Batarseh SF … +7 more , Alfahmi FK, Mansour A, Awadalla YF, Abdelmohsen N, El Arabawy MY, Shaheen O, Kassar O
BMC Neurol · 2026 May · PMID 42151857 · Full text
BACKGROUND: Migraine is a common, disabling neurological disorder affecting over one billion people worldwide, characterized by recurrent unilateral, pulsating headaches lasting 4-72 h. Caffeine, a widely consumed psycho...
BACKGROUND: Migraine is a common, disabling neurological disorder affecting over one billion people worldwide, characterized by recurrent unilateral, pulsating headaches lasting 4-72 h. Caffeine, a widely consumed psychoactive alkaloid found in coffee, tea, and other beverages, is frequently implicated as both a trigger and a treatment for attacks. OBJECTIVES: We aim to comprehensively evaluate the association between caffeine exposure and migraine by integrating observational evidence with Mendelian Randomization (MR) studies. METHODS: A comprehensive search was conducted through PubMed, Scopus, Web of Science, and the Cochrane Library till August 2025. We included primary studies assessing the impact of caffeine exposure on migraine risk. RESULTS: 19 studies (nine cross-sectional, seven MR, and three cohort) were included in our review. MR studies included over one million participants, while cross-sectional studies involved over 43,000 participants, and the cohort studies included 421 migraine cases. MR reflected lifelong genetic liability (population-level, chronic exposure) and associated with a reduced risk with overall odds ratio (OR) ranging from 0.53 to 0.71, with stronger associations reported in migraine with aura (ORs as low as 0.37-0.39). Observational studies captured short-term, acute effects and showed that abrupt withdrawal or acute excessive intake (≥ 3 drinks/day) can trigger attacks in some people (P = 0.024). While habitual moderate use was generally not linked to higher average migraine burden. CONCLUSIONS: Lifelong genetic liability to higher coffee/caffeine intake is associated with a reduced risk of migraine especially for migraines with aura. However, acute excessive intake or sudden changes in caffeine habits can trigger attacks in some people. More future large, well prospective cohorts and carefully designed MR studies are needed to confirm our results and clarify the precise impact of caffeine on migraine risk.
Early neurodevelopmental outcomes in a child with tuberous sclerosis complex treated with everolimus and vigabatrin.
Wilson SM, Samuels M, Pimentel L … +6 more , Varnado S, Sartwell C, Mansour R, Pearson D, Northrup H, Koenig MK
BMC Neurol · 2026 May · PMID 42151856 · Full text
OBJECTIVES: To report early neurodevelopmental outcomes in a child with Tuberous Sclerosis Complex (TSC) treated with everolimus and vigabatrin. METHODS: The authors report a five-year-old girl with Tuberous Sclerosis Co...
OBJECTIVES: To report early neurodevelopmental outcomes in a child with Tuberous Sclerosis Complex (TSC) treated with everolimus and vigabatrin. METHODS: The authors report a five-year-old girl with Tuberous Sclerosis Complex who was initiated on vigabatrin at seven weeks old to treat infantile spasms and on everolimus at two months of age to treat a subependymal giant cell astrocytoma. Neuropsychological assessments were conducted in this patient at 12, 24, and 36 months using the Bayley-III and Vineland-II. RESULTS: On the Bayley-III, the patient had a high average cognitive composite score at 12 months and a high average language composite score at 36 months. Bayley-III assessments at 12, 24, and 36 months, yielded average cognitive, language, and motor composite scores. On the Vineland-II at 12 months, her standard score fell in the moderately low range on daily living skills and overall adaptive behavior. Vineland-II assessments at 12, 24, and 36 months yielded average range standard scores in the areas of communication, socialization, daily living skills, overall adaptive behavior, and motor skills. DISCUSSION: This case highlights early neurodevelopmental outcomes in one TSC child treated with everolimus and vigabatrin in infancy. Continued assessment and longitudinal follow-up is required to understand the broader implications of early treatment with mTOR inhibitors and vigabatrin in TSC patients in childhood.
Effects of lower limb exoskeleton robot-assisted rehabilitation on motor function, activities of daily living, and electromyography in hemiplegic stroke: a randomized controlled trial.
Tang C, Zhang Y, Zhou T … +10 more , Yin R, Zhang L, Ren C, Gong Z, Wu Y, Chen Y, Zhu Y, Song P, Chen W, Wang H
BMC Neurol · 2026 May · PMID 42144590 · Full text
BACKGROUND: Post-stroke lower limb dysfunction affects the quality of life. Previous studies have confirmed that lower limb exoskeleton robots can improve the walking ability of stroke patients. This study aims to explor...
BACKGROUND: Post-stroke lower limb dysfunction affects the quality of life. Previous studies have confirmed that lower limb exoskeleton robots can improve the walking ability of stroke patients. This study aims to explore the impact of the UGO220 exoskeleton rehabilitation robot on the motor function and daily living ability of chronic stroke patients and to observe changes in lower limb muscle activity by surface electromyography before and after treatment. METHODS: Sixty stroke patients with hemiplegia were randomly divided into a conventional (CT, n = 30) group or a robot (RT, n = 30) group. Patients in both groups received 60 min of routine physical therapy and occupational therapy. The robot group received 30 min of lower limb exoskeleton robot-assisted gait training per day, whereas the conventional group received 30 min of physical therapist-assisted gait training per day, six days a week, for three consecutive weeks. The primary outcome was evaluated by Fugl-Meyer assessment-lower extremities (FMA-LE), and the secondary outcomes included the modified Barthel index (MBI) score, Berg balance scale (BBS), and lower extremity muscle surface electromyography (sEMG) of the rectus femoris, biceps femoris, anterior tibialis and medial gastrocnemius muscles, including the integrated EMG (iEMG) and root-mean-square (RMS) values. RESULTS: The robot group had significantly greater improvements in FMA-LE and MBI compared to the conventional group. The electromyography results indicated that in terms of the activation of the anterior tibial muscle, the robot group performed better than the traditional group. CONCLUSIONS: The UGO220 exoskeleton robot training is superior to conventional training in improving Activities of daily living and lower limb motor function. Moreover, it can better promote the improvement of the ankle dorsiflexion function. TRIAL REGISTRATION: ClinicalTrials.gov (ChiCTR2500096316)(2025-01-21).
BRAF-amplified glioblastoma patients have a worse prognosis than those with BRAF mutation and are associated with amplification of MET, RHEB and CUL1.
Da R, Wang M, Jiang H … +1 more , Wang W
BMC Neurol · 2026 May · PMID 42144589 · Full text
BACKGROUND: Glioblastoma (GBM) is a treatment-challenging disease with a poor prognosis and few treatment options available. Patients with GBM with BRAF gene mutations are expected to benefit from targeted therapy with B...
BACKGROUND: Glioblastoma (GBM) is a treatment-challenging disease with a poor prognosis and few treatment options available. Patients with GBM with BRAF gene mutations are expected to benefit from targeted therapy with BRAF inhibitors. METHODS: Genomic profiles, clinical and sample data, and tumor pathways were retrieved in a cohort of GBM patients with BRAF gene alterations. Statistical analysis was performed according to BRAF AMP, BRAF V600E, and BRAF non-V600E to study clinical features, survival curve analysis, tumor site, tumor signaling pathway and molecules. RESULTS: BRAF AMP and BRAF MUT include BRAF V600E and BRAF non-V600E in GBM patients account for the majority of BRAF-altered GBM. The prognosis of GBM patients with BRAF AMP is worse than that of patients with BRAF MUT, as well as BRAF V600E and BRAF non-V600E. The temporal lobe was primarily affected in GBM patients who carry BRAF gene alterations. CDKN2A DeepDel is a mutation associated with the BRAF variant GBM. In addition, BRAF AMP is often accompanied by amplified oncogenes, including MET, RHEB, and CUL1, as well as multiple types of mutations result in tumor suppressor genes in patients with BRAF non-V600E GBM including NF1 and TP53. CONCLUSIONS: Different BRAF gene alterations affect the prognosis of GBM and are associated with molecular alterations in classical tumor signaling pathways, and BRAF AMP is often accompanied by amplification of MET, RHEB, and CUL1.
Association between red cell index and stroke-associated pneumonia.
Nam KW, Kwon HM, Lee YS
BMC Neurol · 2026 May · PMID 42144582 · Full text
BACKGROUND: Stroke-associated pneumonia (SAP) is a common infectious complication of acute ischemic stroke (AIS). Although numerous predictive models for SAP have been proposed, a more objective and easily applicable mar...
BACKGROUND: Stroke-associated pneumonia (SAP) is a common infectious complication of acute ischemic stroke (AIS). Although numerous predictive models for SAP have been proposed, a more objective and easily applicable marker is required. This study evaluated the association between the red cell index (RCI) and SAP in patients with AIS. METHODS: We analyzed 500 consecutive patients with AIS. SAP was defined based on modified Centers for Disease Control and Prevention criteria. The RCI was calculated using blood sample results according to the following formula: RCI = (red blood cell count [⋅10/L] ⋅ hemoglobin [g/L]) / (lymphocyte count [⋅10/ L] ⋅ platelet count [⋅10/ L]) RESULTS: Among all patients, 62 (12.4%) developed SAP. In multivariable logistic regression analysis, RCI (adjusted odds ratio = 1.46; 95% confidence interval, 1.08-1.97) remained a significant predictor even after adjusting for confounders. Age, dysphagia, impaired consciousness, white blood cell count, and high-sensitivity C-reactive protein levels were also associated with SAP, independent of RCI. Patients with SAP exhibited worse outcomes during hospitalization and at discharge. Among patients with SAP, those with higher RCI values were more frequently admitted to the intensive care unit (P = 0.037) and required intubation (P = 0.009). CONCLUSION: We demonstrated that a higher RCI was associated with SAP in patients with AIS. Furthermore, elevated RCI was associated with worse outcomes in patients who developed SAP.
A novel limited-dose C5 inhibitor add-on as rescue therapy for refractory NMOSD attacks: a practical alternative to conventional multi-dose regimens.
Gao D, Cui L, Yu M … +5 more , Sun Q, Jiao J, Wang Y, Peng D, Zhang W
BMC Neurol · 2026 May · PMID 42143294 · Full text
BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) patients with refractory attacks, despite standard therapy with high-dose intravenous methylprednisolone (IVMP) and plasma exchange (PLEX), often experience sign...
BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) patients with refractory attacks, despite standard therapy with high-dose intravenous methylprednisolone (IVMP) and plasma exchange (PLEX), often experience significant disability. While complement C5 inhibition has established efficacy in relapse prevention, its role in acute-phase management remains unclear. METHODS: In this single-center, retrospective case series, eight patients (6 AQP4-IgG seropositive, 2 seronegative) with acute NMOSD and suboptimal responses to IVMP ± PLEX were treated with 1-4 weekly doses of ECU (900 mg per dose). The primary outcome was the change in functional scores (EDSS for myelitis and logMAR visual acuity (VA) of the worse eye for optic neuritis) from pre-ECU baseline to 1 and 3 months post-ECU. The secondary outcomes included the proportion of patients achieving good improvement, and safety. RESULTS: Six patients presented with severe, refractory attacks (median nadir EDSS/VA: 9.0/2.5) showing minimal response to conventional therapy (median post-IVMP/PLEX EDSS/VA: 8.75/2.5). The remaining two patients, while not meeting the criteria for a severe attack, also had an unsatisfactory response to first-line treatment. Add-on limited-dose ECU enhanced neurological function. In myelitis patients, the median EDSS score improved from 8.5 at baseline to 3.5 at 3 months. In optic neuritis patients, the median VA score improved from 1.9 to 0.5. The proportion of patients achieving good response increased from 42.9% at 1 month to 100% at 3 months. Both seronegative patients also responded favorably. The treatment regimen was well-tolerated, with no serious adverse events other than anti-HBc seroconversion in one patient, highlighting the importance of infectious monitoring during complement inhibition. CONCLUSIONS: Limited-dose ECU appears to be an effective rescue therapy for accelerating recovery in refractory NMOSD attacks, including in seronegative patients, with a generally favorable safety profile. It represents a promising bridging strategy to long-term immunosuppression, addressing a critical unmet need in acute-phase NMOSD management.
Experiences and challenges of caregivers of children with cerebral palsy in Magba subdivision, Cameroon: a qualitative analysis.
Lonn H, Ndep AO, Ekpenyong BN … +6 more , Cockburn L, Chirac AJ, Tchiaze ATG, Jingkuo GHM, Abua EE, Isho MC
BMC Neurol · 2026 May · PMID 42143268 · Full text
BACKGROUND: Cerebral palsy (CP) is one of the most common childhood neurodisability globally and disproportionately affects children in low- and middle-income countries. In Cameroon, limited epidemiological data, weak re...
BACKGROUND: Cerebral palsy (CP) is one of the most common childhood neurodisability globally and disproportionately affects children in low- and middle-income countries. In Cameroon, limited epidemiological data, weak rehabilitation infrastructure, and entrenched sociocultural beliefs shape how CP is understood and managed. Children with CP often require lifelong support, placing substantial physical, emotional, and economic demands on family-caregivers, most commonly mothers. Understanding caregivers' lived experiences within specific cultural and resource-limited contexts is critical for informing inclusive and effective interventions. This study explored the lived experiences and challenges of family-caregivers of children with CP in Magba Subdivision, West Region of Cameroon. METHOD: This study employed a qualitative exploratory design using in-depth interviews and inductive content analysis. Participants were family caregivers of children with CP, purposively recruited through community-based rehabilitation (CBR) services. In-depth, face-to-face interviews were conducted in English or local languages, audio-recorded, transcribed, and translated. Data were analysed using inductive content analysis following Elo and Kyngäs' approach. Findings were interpreted using Raina et al.'s multidimensional caregiving model. RESULTS: All participants, aged 15-49 years, were family caregivers of children with CP, aged 4-15 years. Six interrelated themes emerged: (1) sociocultural challenges, including stigma, discrimination, and harmful spiritual beliefs framing CP as witchcraft, ancestral punishment, 'snake', or 'marine spirit'; (2) economic constraints arising from inability to engage in paid work and the absence of social protections; (3) physical caregiving burden characterised by exhaustion, chronic pain, and musculoskeletal strain; (4) inadequate specialized services and health information; (5) limited social/family support; and (6) limited access rehabilitation services. These challenges intensified caregiver isolation and emotional distress. CONCLUSION: Caregiving for children with CP in Magba is shaped by intersecting sociocultural, economic, and systemic factors that extend beyond individual coping capacity. Strengthening culturally sensitive community-based rehabilitation, improving access to early diagnosis and rehabilitation, and implementing disability- and gender-responsive social protection policies are essential to reduce caregiver burden and promote inclusive child and family wellbeing in Cameroon.
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