BMC Neurology[JOURNAL]
Sun
200 papers
Efficacy of transcranial direct current stimulation on motor and cognitive functions in patients with multiple sclerosis: a systematic review and meta-analysis.
Ahmed GU, Abbas H, Komal F … +8 more , Muskan F, Tharwani A, Khiani RK, Ramani S, Raza AA, Shaikh JG, Sanaullah O, Samadi A
BMC Neurol · 2026 May · PMID 42141416 · Full text
BACKGROUND: Multiple Sclerosis (MS) is a chronic neurological disorder affecting 2.8 million individuals worldwide, characterized by motor dysfunction and cognitive impairment that remain poorly addressed by pharmacologi...
BACKGROUND: Multiple Sclerosis (MS) is a chronic neurological disorder affecting 2.8 million individuals worldwide, characterized by motor dysfunction and cognitive impairment that remain poorly addressed by pharmacological interventions alone. Transcranial Direct Current Stimulation (tDCS) has emerged as a promising non-invasive neuromodulation technique for symptom management in MS patients. OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the efficacy of tDCS in improving motor and cognitive functions in patients with MS, and to assess its safety profile. METHODS: A comprehensive literature search was conducted across PubMed, Scopus, EMBASE, Wiley Online Library, and Google Scholar databases. Studies were selected based on PICOS criteria, including randomized controlled trials and quasi-experimental studies involving adults (≥ 18 years) with all types of MS receiving tDCS interventions. Methodological quality was assessed using RoB 2.0 and ROBINS-I. Meta-analyses were performed using RevMan 5.4.1 with random-effects models for outcomes with substantial heterogeneity and fixed-effects models where I = 0%. Additionally, the protocol was prospectively registered with the Open Science Framework. RESULTS: Twenty-two studies published between 2015 and 2025 were included in this review. Meta-analysis revealed that tDCS significantly improved information processing speed (SDMT: MD = 7.71, 95% CI: 1.60-13.82, p = 0.01) and functional mobility (TUG: MD = -1.03 s, 95% CI: -2.08-0.02, p = 0.05). While individual studies showed improvements in gait speed and balance, pooled analyses for these outcomes did not reach statistical significance (gait speed: MD = 0.16 m/s, 95% CI: -0.07-0.38, p = 0.18; Berg Balance Scale: MD = 1.18, 95% CI: -2.03-4.39, p = 0.47). Qualitative analysis revealed consistent improvements in manual dexterity, working memory, executive function, and complex attention. Additionally, no serious adverse events were reported across studies; mild and transient side effects (e.g., tingling, itching) were noted, and completion rates were high (98% in studies that reported them). CONCLUSION: This systematic review provides preliminary evidence supporting tDCS as a potentially beneficial adjunctive intervention for MS patients, particularly for cognitive processing speed enhancement based on two small studies. While individual studies reported motor improvements, pooled meta-analyses for gait speed and balance failed to demonstrate statistical significance, indicating insufficient evidence for definitive motor benefits despite positive signals in individual trials. The substantial limitation of small study numbers per meta-analysis (2-6 studies), combined with limited MS subtype-specific data in most studies, significantly constrains confidence in these findings and limits assessment of external validity across different MS populations. Larger, standardized, multi-center randomized controlled trials with adequate subgroup representation and extended follow-up periods are essential to establish clinical significance and treatment durability.
Myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions (FIP1L1::PDGFRA) complicated by Loeffler's endocarditis leading to stroke.
Luo R, Qi X
BMC Neurol · 2026 May · PMID 42135668 · Full text
Myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions (MLN-TK) represent a distinct category of hematologic malignancies characterized by eosinophil-rich proliferations driven by specific gene rea...
Myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase gene fusions (MLN-TK) represent a distinct category of hematologic malignancies characterized by eosinophil-rich proliferations driven by specific gene rearrangements. Among these, the FIP1L1::PDGFRA fusion is one of the most clinically relevant due to its exquisite sensitivity to imatinib. Loeffler's endocarditis, a complication of eosinophil-mediated endomyocardial damage, can lead to thromboembolic events including ischemic stroke. We report a case of a 56-year-old male who presented with acute onset of right homonymous hemianopia. Neurological evaluation revealed acute infarction in the left occipital lobe and thalamus. Subsequent workup demonstrated marked eosinophilia (absolute eosinophil count 3.05 × 10⁹/L, 43.4%), echocardiographic findings consistent with Loeffler's endocarditis with left ventricular thrombus, and bone marrow eosinophilia (27.5%). Molecular testing confirmed the presence of FIP1L1::PDGFRA fusion, leading to a diagnosis of MLN-TK with FIP1L1::PDGFRA. Treatment with low-dose imatinib (100 mg daily) and enoxaparin resulted in rapid normalization of eosinophil counts and reduction in thrombus size. This case highlights the importance of recognizing eosinophil-associated cardiac and neurologic complications and underscores the diagnostic and therapeutic value of molecular testing in patients with unexplained stroke and eosinophilia.
Diagnostic challenges and lessons learned of Guillain-Barré syndrome mimicking central nervous system infection - a case report.
Wang Z, Tang J, Yang K … +2 more , Cui Z, Li Z
BMC Neurol · 2026 May · PMID 42129710 · Full text
BACKGROUND: Guillain-Barré syndrome (GBS) is an immune-mediated disorder affecting the peripheral nervous system, often triggered by infections, vaccinations, trauma, or surgery. Typically, it presents as progressive, sy...
BACKGROUND: Guillain-Barré syndrome (GBS) is an immune-mediated disorder affecting the peripheral nervous system, often triggered by infections, vaccinations, trauma, or surgery. Typically, it presents as progressive, symmetric limb weakness with hyporeflexia. However, some GBS subtypes can present atypically with symptoms like headache, facial palsy, and confusion. These symptoms overlap significantly with central nervous system (CNS) infections, often causing diagnostic delays. CASE PRESENTATION: A 57-year-old man was admitted with cough, sputum, and shortness of breath, having received a rabies vaccination a month earlier. He developed headache, dysphagia, progressive muscle weakness, and impaired consciousness, requiring Intensive Care Unit (ICU) transfer, endotracheal intubation, and mechanical ventilation. The initial cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) detected Pseudomonas aeruginosa (sequence count: 6094), combined with fever and a series of clinical symptoms before transfer to the ICU, CNS infection was considered. Treatment with piperacillin-tazobactam, meropenem, and ciprofloxacin yielded no improvement. Albumino-cytological dissociation in the CSF led to a neurology consultation for suspected GBS, and intravenous immunoglobulin (IVIg) therapy began. Negative CSF bacterial cultures and mNGS, along with positive anti-GT1a IgM ganglioside antibodies and electromyogram(EMG) result indicating nerve damage, confirmed the GBS diagnosis. After five days of IVIg, the patient was weaned from mechanical ventilation and showed significant neurological recovery. CONCLUSION: The significant clinical overlap between GBS and CNS infections poses a major diagnostic and therapeutic challenge. This case highlights the importance of thorough history-taking, comprehensive neurological assessment, careful interpretation of lab results, and early neurologist involvement to minimize diagnostic delays in GBS and prevent subsequent treatment delays.
Cerebral venous thrombosis revealed by psychiatric disorders: a diagnosis not to be missed.
Albakaye M, Guindo Y, Fofana AS … +3 more , Goita L, Maiga AB, Maiga Y
BMC Neurol · 2026 May · PMID 42129704 · Full text
BACKGROUND: Cerebral Venous Thrombosis (CVT) is a rare condition. Diagnosis must be made urgently despite highly varied neurological symptoms, initially dominated by headaches. In some cases, CVT may have an unusual pres...
BACKGROUND: Cerebral Venous Thrombosis (CVT) is a rare condition. Diagnosis must be made urgently despite highly varied neurological symptoms, initially dominated by headaches. In some cases, CVT may have an unusual presentation, making diagnosis difficult. A purely psychiatric manifestation is exceptional and can lead to diagnostic uncertainty and delay. Diagnosis is radiological and treatment is based on early anticoagulation. The prognosis for CVT is much better than that for cerebral infarcts of arterial origin. CASE PRESENTATION: We present a case of postpartum cerebral thrombophlebitis with late diagnosis revealed by psychotic disorders, which had a favorable outcome. CONCLUSION: Cerebral Venous Thrombosis (CVT) is a rare and urgent thrombotic vascular disease. Its clinical presentation is varied. The diagnosis must be considered in the presence of any acute psychiatric manifestation during the postpartum period.
Risk factors for post-traumatic hydrocephalus after decompressive craniectomy in patients with traumatic brain injury.
Chen K, Wang Y, Niu H … +1 more , Wang K
BMC Neurol · 2026 May · PMID 42129692 · Full text
BACKGROUND AND OBJECTIVES: Post-traumatic hydrocephalus (PTH) is a prominent complication that arises after decompressive craniectomy(DC) for traumatic brain injury, characterized by a multifaceted pathogenesis and subst...
BACKGROUND AND OBJECTIVES: Post-traumatic hydrocephalus (PTH) is a prominent complication that arises after decompressive craniectomy(DC) for traumatic brain injury, characterized by a multifaceted pathogenesis and substantial inter-individual variability. This study aims to identify potential risk factors to provide clinical support for the diagnosis and treatment of PTH. METHODS: This study retrospectively analyzed the clinical data of 457 patients who underwent decompressive craniectomy for traumatic brain injury at the Department of Neurosurgery, Sir Run Run Shaw Hospital, between January 2015 and December 2022. Univariate analysis and Multivariable binary logistic regression were conducted to identify risk factors. The resulting model was validated using three approaches: ROC curve analysis, decision curve analysis (DCA), and goodness-of-fit tests. RESULTS: PTH occurred in 123 patients (26.9%). Multivariable analysis identified postoperative intracranial infection (OR = 15.296), midline shift ≥ 10 mm (OR = 195.636), effacement of the ambient cistern (OR = 25.361), subarachnoid hemorrhage (OR = 5.324) and distance between the superior margin of the bone window and the midline < 2.5 cm (OR for ≥ 2.5 cm = 0.334) as independent risk factors. Firth regression confirmed midline shift as a robust predictor (OR = 95.63). Subgroup analysis based on the timing of PTH onset showed that distance between the superior margin of the bone window and the midline < 2.5 cm was associated with earlier PTH onset (< 3 months) (OR = 10.40). CONCLUSION: Several clinical and radiological factors are independently associated with PTH after DC, with midline shift being the most significant predictor. A short distance between the superior margin of the bone window and the midline is associated with earlier onset of PTH.
Endothelial Activation and Stress Index (EASIX) in migraine: association with disease subtypes and clinical characteristics.
Ucaroglu Can N, Can Y
BMC Neurol · 2026 May · PMID 42129672 · Full text
BACKGROUND: Migraine is a common neurovascular disorder associated with endothelial dysfunction and systemic microvascular stress. The Endothelial Activation and Stress Index (EASIX) is a novel composite biomarker that h...
BACKGROUND: Migraine is a common neurovascular disorder associated with endothelial dysfunction and systemic microvascular stress. The Endothelial Activation and Stress Index (EASIX) is a novel composite biomarker that has been proposed to reflect endothelial stress and thrombo-inflammatory activity. This study aimed to investigate the association between EASIX levels and migraine subtypes and to explore its potential clinical relevance in patients with migraine with aura. METHODS: This retrospective cross-sectional study included 66 patients with migraine with aura, 99 patients with migraine without aura, and 81 age- and sex-matched healthy controls. EASIX was calculated using the formula: (lactate dehydrogenase × creatinine) / platelet count. EASIX values were compared among the study groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminative ability of EASIX in distinguishing patients with migraine with aura and overall migraine patients from healthy controls. Univariate logistic regression analysis was conducted to evaluate the association between EASIX levels and migraine with aura. RESULTS: Mean EASIX values were higher in patients with migraine with aura compared to healthy controls (p = 0.048). ROC analysis demonstrated that EASIX had a modest discriminative ability to differentiate patients with migraine with aura from healthy controls (AUC = 0.58). An optimal cut-off value of 0.37 yielded a sensitivity of 66.6% and specificity of 51.8%. Logistic regression analysis revealed that higher EASIX levels were significantly associated with migraine with aura (OR: 3.35, 95% CI: 1.45-7.74, p = 0.004). CONCLUSIONS: EASIX levels were higher in patients with migraine with aura compared to healthy controls, suggesting a potential association between endothelial stress and this migraine subtype. However, its discriminative performance was limited, and EASIX should be considered as an exploratory biomarker rather than a diagnostic tool. Further prospective studies are warranted to clarify its clinical relevance.
Drug-coated balloon versus bare-metal stent for the treatment of symptomatic vertebral artery origin stenosis: a systematic review and meta-analysis.
Liu T, Chen K, Zhong C … +2 more , Lan Y, Pang L
BMC Neurol · 2026 May · PMID 42121079 · Full text
BACKGROUND: Symptomatic vertebral artery origin stenosis (VAOS) is associated with high recurrent stroke risk despite medical therapy. While bare-metal stents (BMS) are established for endovascular treatment, in-stent re...
BACKGROUND: Symptomatic vertebral artery origin stenosis (VAOS) is associated with high recurrent stroke risk despite medical therapy. While bare-metal stents (BMS) are established for endovascular treatment, in-stent restenosis remains common. Drug-coated balloons (DCB) offer a stent-free alternative, but comparative effectiveness is uncertain. METHODS: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus for comparative studies of DCB vs. BMS in symptomatic VAOS. The primary outcome was imaging-confirmed restenosis; secondary outcomes included symptomatic restenosis, technical success, periprocedural complications, and follow-up cerebrovascular events. Subgroup (study type, VAOS severity, imaging modality: digital subtraction angiography [DSA]-based vs. non-DSA-based) and sensitivity analyses were performed. RESULTS: Four studies (2 randomized controlled trials [RCTs], 2 cohort studies) involving 329 patients (165 DCB, 164 BMS) were included. DCB significantly reduced imaging-confirmed restenosis (risk ratio [RR] = 0.45; 95% confidence interval [CI]: 0.27-0.73), with benefits in RCTs (RR = 0.44, 95% CI: 0.25-0.77), severe VAOS (≥ 70%; RR = 0.39, 95% CI: 0.22-0.70), and DSA-based follow-up (RR = 0.36, 95% CI: 0.19-0.68). No between-group differences were observed in secondary outcomes. Sensitivity analysis indicated that the primary result was highly influenced by the largest RCT, with limited robustness. CONCLUSIONS: In this hypothesis-generating meta-analysis, DCB is associated with lower rates of imaging-confirmed restenosis than BMS in symptomatic VAOS, with comparable safety. These are preliminary findings limited to four small-sample studies from a single country and should not be used to guide routine clinical selection. Large, multicenter, long-term follow-up RCTs are required to confirm these results.
Gut microbiota profiles associated with temporal lobe epilepsy and psychiatric comorbidities: a family-matched case-control 16S rRNA study.
Song C, Li Y, Deng Y … +2 more , He D, Fan X
BMC Neurol · 2026 May · PMID 42121077 · Full text
We investigated alterations in the intestinal microbiota of patients with temporal lobe epilepsy (TLE) and their associations with drug resistance and psychiatric comorbidities. Thirty TLE patients and 30 family-matched...
We investigated alterations in the intestinal microbiota of patients with temporal lobe epilepsy (TLE) and their associations with drug resistance and psychiatric comorbidities. Thirty TLE patients and 30 family-matched healthy controls sharing the same household diet were recruited, and fecal samples were analyzed by high-throughput 16S rDNA sequencing on the Illumina MiSeq [Formula: see text] bp platform. Differential abundance was assessed using Metastats and LEfSe with Benjamini-Hochberg false-discovery-rate correction, and independently validated using ANCOM-BC to account for the compositional nature of microbiome data. Community α- and β-diversity indices showed no significant differences between groups; however, ANCOM-BC identified species-level signatures in drug-resistant epilepsy, including significant depletion of Bacteroides plebeius and Coprococcus comes. Among psychiatric subgroups, Ruminococcus was significantly reduced in patients with comorbid depression, while Bilophila was enriched in those with comorbid anxiety and depression. Bacteroides stercoris distinguished the anxiety-plus-depression subgroup from the depression-only subgroup with robust support from both ANCOM and ANCOM-BC. Given the modest overall sample size ([Formula: see text] per arm) and small psychiatric and drug-resistance subgroups, these findings should be regarded as exploratory and hypothesis-generating associations rather than definitive biomarkers. They identify candidate microbial taxa warranting validation in larger, longitudinal cohorts combined with metagenomic and metabolomic approaches.
Clinical factors associated with cognitive impairment in cerebral small vessel disease: a retrospective study.
Fan X, Wu X, Hao J … +4 more , Luo L, Zhao Y, Wang R, Feng L
BMC Neurol · 2026 May · PMID 42121072 · Full text
BACKGROUND: Cerebral small vascular disease (CSVD) has an insidious onset and progresses slowly, leading to cognitive impairment. Understanding the clinical characteristics of cognitive impairment is crucial for early id...
BACKGROUND: Cerebral small vascular disease (CSVD) has an insidious onset and progresses slowly, leading to cognitive impairment. Understanding the clinical characteristics of cognitive impairment is crucial for early identification, prevention, and treatment. This study aimed to analyze risk factors associated with cognitive impairment related to CSVD. METHODS: This retrospective study included 270 patients with CSVD and independent living abilities. Laboratory tests included measurements, such as fasting blood glucose (FBG), glycosylated hemoglobin, and blood creatinine. All patients underwent neuropsychological evaluation, and the main factors influencing cognitive impairment were analyzed using multivariate logistic regression. RESULTS: Among the patients, 80% (n = 216) had symptomatic cerebral infarction. Factors such as history of symptomatic cerebral infarction, FBG level, blood fibrinogen level, and CSVD total burden score were significantly different between the normal cognition and cognitive impairment groups (p < 0.001, p = 0.049, p = 0.009, p = 0.001, respectively). Logistic regression analysis revealed that age, FBG level, and number of lacunar cerebral infarctions were the main factors influencing cognitive impairment. Age, education level, fibrinogen and d-dimer levels, and CSVD total burden score significantly correlated with the level of cognitive impairment. Impaired daytime function affected the cognitive levels of patients with CSVD (p = 0.043). CONCLUSIONS: This study has highlighted the main risk factors for cognitive impairment in patients with CSVD, such as age, FBG levels, and number of lacunar cerebral infarctions. Additionally, education played a significant role in cognitive outcomes. These findings suggest that managing these risk factors and enhancing cognitive reserve can mitigate the cognitive decline associated with CSVD.
Alterations in resting-state neural networks in subacute non-fluent aphasia after stroke: a fNIRS study.
Li Q, Chen M, Zhang Y
BMC Neurol · 2026 May · PMID 42116001 · Full text
BACKGROUND: Post-stroke aphasia is a prevalent and often disabling language impairment. Despite its high incidence, the neuropathological mechanisms underlying post-stroke aphasia and the neural substrates of functional...
BACKGROUND: Post-stroke aphasia is a prevalent and often disabling language impairment. Despite its high incidence, the neuropathological mechanisms underlying post-stroke aphasia and the neural substrates of functional recovery remain poorly understood. Understanding these mechanisms is essential for developing targeted rehabilitation strategies. METHODS: In this study, we used fNIRS to collect resting-state data from three participant groups. Pearson correlation was applied to compute whole-brain functional connectivity, followed by graph theory analysis to compare global and regional network characteristics across groups. RESULTS: Compared with the healthy control (HC) group, the aphasia group exhibited significantly reduced whole-brain functional connectivity and a lower global clustering coefficient. Further nodal analysis revealed alterations in both node degree and nodal efficiency within the aphasia group. Notably, the local efficiency of the right-hemisphere homologue of Broca's area and the right dorsolateral prefrontal cortex (DLPFC) was significantly higher than that in the HC group. Furthermore, network hub analysis identified the right supplementary motor area (SMA) as a prominent global hub, demonstrating its elevated centrality within the overall network of the aphasia group. CONCLUSIONS: While global network topological metrics did not differ significantly after correction for multiple comparisons, exploratory analyses revealed trends toward reduced clustering and increased global efficiency. Regional nodal analysis identified specific alterations in right-hemisphere homologues, providing potential targets for neuroregulation in aphasia rehabilitation.
Dissociated neurovascular dynamics in ATP1A2-related familial hemiplegic migraine mimicking acute ischemic stroke.
Lee GH, Kim J, Cho JW
BMC Neurol · 2026 May · PMID 42115975 · Full text
BACKGROUND: Hemiplegic migraine (HM) is a rare migraine subtype with motor aura. Familial hemiplegic migraine type 2 (FHM2), caused by ATP1A2 mutations, often mimics acute stroke, making early neuroimaging differentiatio...
BACKGROUND: Hemiplegic migraine (HM) is a rare migraine subtype with motor aura. Familial hemiplegic migraine type 2 (FHM2), caused by ATP1A2 mutations, often mimics acute stroke, making early neuroimaging differentiation critical. While dynamic perfusion changes are documented during attacks, the dissociated neurovascular dynamics with reduced macrovascular flow signal and presumed microvascular hyperemia has not been well characterized. CASE PRESENTATION: A 37-year-old man presented with acute severe headache and global aphasia. Initial diffusion-weighted MRI was unremarkable, but time-of-flight magnetic resonance angiography (TOF-MRA) demonstrated attenuated vascular signal in the left middle and posterior cerebral arteries without fixed stenosis. Concurrently, susceptibility-weighted imaging (SWI) revealed prominent cortical veins in the same territories, indicating a dissociated perfusion pattern. Electroencephalography showed left hemispheric slowing. Symptoms resolved completely within 72 h. Genetic testing confirmed a heterozygous pathogenic mutation (c.1816G > A, p.Ala606Thr) in ATP1A2, consistent with FHM2. CONCLUSIONS: This case highlights a unique neurovascular dissociation in FHM2, where macrovascular signal attenuation and presumed microvascular hyperemia coexist during the acute phase. These findings suggest that ATP1A2-related astrocytic dysfunction and cortical spreading depression lead to layered, asynchronous vascular dysregulation. Recognizing this reversible pattern is essential to distinguish FHM2 from stroke mimics and prevent inappropriate thrombolytic interventions.
Serum ferritin, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio are associated with levodopa-induced dyskinesia severity in Parkinson's disease.
Saidvaliyev F, Pulatova D, Kilichev I … +8 more , Yusupov A, Shamuratova G, Turdibekov X, Pulatov M, Saidov J, Mirhayotova N, Axmedova Y, Abdullayeva D
BMC Neurol · 2026 May · PMID 42115954 · Full text
BACKGROUND: Levodopa-induced dyskinesia (LID) is a common motor complication of Parkinson's disease (PD), yet peripheral biological factors associated with dyskinesia severity remain insufficiently characterized. Systemi...
BACKGROUND: Levodopa-induced dyskinesia (LID) is a common motor complication of Parkinson's disease (PD), yet peripheral biological factors associated with dyskinesia severity remain insufficiently characterized. Systemic inflammation and iron dysregulation have been implicated in PD, but their relationship with LID expression is unclear. We investigated the association between serum ferritin, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and the presence and severity of LID. METHODS: In this study, 302 patients with idiopathic PD receiving stable levodopa therapy for at least 24 months were evaluated. Dyskinesia severity was assessed in the medication "ON" state using the Unified Dyskinesia Rating Scale (UDysRS). Serum ferritin and complete blood counts were obtained from fasting samples, and NLR and LMR were calculated. Multivariable regression analyses were performed adjusting for age, sex, weight, disease duration, levodopa equivalent daily dose, Hoehn and Yahr stage, motor severity, C-reactive protein, and amantadine use. RESULTS: LID was present in 158 patients (52.3%). Patients with dyskinesia had higher median ferritin levels (152 vs. 104 ng/mL, p < 0.001) and NLR (2.8 vs. 2.0, p < 0.001), and lower LMR (3.5 vs. 4.3, p < 0.001) compared with those without dyskinesia. In adjusted analyses, the highest ferritin quartile was associated with greater UDysRS scores (β = 5.9, p < 0.001), as were the highest NLR quartile (β = 4.2, p = 0.002). Conversely, higher LMR was independently associated with lower dyskinesia severity (β=-3.4, p = 0.017). CONCLUSIONS: Elevated serum ferritin and altered leukocyte-derived ratios (NLR, LMR) were independently associated with increased levodopa-induced dyskinesia severity in Parkinson's disease. These biomarkers may reflect systemic systemic processes linked to dyskinesia burden and warrant further evaluation in longitudinal studies.
Development of a simple clinical score to predict early neurological improvement after mechanical thrombectomy: a single-centre cohort study.
Zhao C, Li X, Han Y … +3 more , Zhou T, Ren X, Sun Y
BMC Neurol · 2026 May · PMID 42106686 · Full text
BACKGROUND: Early neurological improvement (ENI) after endovascular thrombectomy (EVT) is a clinically relevant early outcome and has been associated with subsequent functional recovery. However, simple bedside approache...
BACKGROUND: Early neurological improvement (ENI) after endovascular thrombectomy (EVT) is a clinically relevant early outcome and has been associated with subsequent functional recovery. However, simple bedside approaches for estimating the likelihood of ENI using routinely available clinical variables remain limited. We therefore sought to develop and internally evaluate a pragmatic prediction model for ENI after EVT in a real-world stroke cohort. METHODS: We performed a single-centre retrospective cohort study at Shanxi Provincial People's Hospital. A total of 314 EVT-treated patients were initially screened from hospital records. After preliminary data verification and assembly of the research database, 253 patients remained in the final study database available for variable-level assessment, of whom 185 with complete data on the primary outcome and prespecified key model variables were included in the primary complete-case analysis. ENI was defined as either a reduction in NIHSS score of at least 8 points from baseline to 1 week or an absolute 1-week NIHSS score of 1 or less. Candidate predictors included age, sex, baseline NIHSS, diabetes, cardioembolic aetiology, prior cerebrovascular disease, and door-to-puncture time (DPT). A multivariable logistic regression model was developed and translated into a simplified bedside score based on baseline NIHSS category and cardioembolic aetiology. Model performance was assessed using discrimination, calibration, Brier score, decision curve analysis, and bootstrap internal validation. Sensitivity analyses included an alternative ENI-4 definition, 48-hour neurological improvement as an alternative early outcome, alternative DPT thresholds, and multiple imputation for incomplete baseline covariates only. RESULTS: Among the 185 patients in the primary analytical cohort, 53 (28.6%) achieved ENI. Baseline NIHSS was the dominant predictor of ENI in both univariable and multivariable analyses, whereas the additional contribution of other candidate predictors was modest. In the full model (Model 2), each 1-point increase in baseline NIHSS was associated with a 13% increase in the odds of ENI (adjusted OR 1.13, 95% CI 1.05-1.21; p < 0.001). The full model showed an apparent AUC of 0.706 and an optimism-corrected AUC of 0.657 after 1,000 bootstrap resamples; the corresponding Brier scores were 0.181 and 0.197. Bootstrap-corrected calibration suggested some overfitting (intercept - 0.335, slope 0.591). The simplified bedside score yielded an apparent and optimism-corrected AUC of 0.677, while the NIHSS-only model showed an apparent AUC of 0.673 and an optimism-corrected AUC of 0.674. Missing 1-week NIHSS was associated with higher baseline NIHSS, shorter length of stay, lower availability of 48-hour NIHSS, and worse discharge outcomes, suggesting that missing outcome data were unlikely to be completely random. Sensitivity analyses using alternative outcome definitions, alternative DPT thresholds, and multiple imputation for incomplete baseline covariates were broadly supportive of the primary findings, although some smaller-effect covariates were unstable in restricted subsets. CONCLUSIONS: In this single-centre real-world EVT cohort, baseline NIHSS emerged as the main predictor of early neurological improvement. A parsimonious model based on routinely available clinical variables showed only moderate discrimination, and the derived simplified bedside score may be useful for exploratory early risk stratification rather than as a stand-alone clinical decision tool. Given the substantial missingness in 1-week NIHSS, the possibility of selection bias, evidence of overfitting, and the absence of external validation, the model should be considered exploratory and requires independent validation before routine clinical use.
Clinical characteristics and prognosis of focal cortical dysplasia with epilepsy in children.
Wu J, Tang L, Deng Y … +3 more , Chen J, Hong S, Jiang L
BMC Neurol · 2026 May · PMID 42106671 · Full text
OBJECTIVE: To characterize the clinical features of epilepsy related to focal cortical dysplasia ( FCD) in children and to identify factors associated with favorable postoperative outcomes. METHODS: Clinical data from 97...
OBJECTIVE: To characterize the clinical features of epilepsy related to focal cortical dysplasia ( FCD) in children and to identify factors associated with favorable postoperative outcomes. METHODS: Clinical data from 97 pediatric patients with FCD-related epilepsy who underwent surgical treatment were retrospectively collected and analyzed. Patients were categorized into good outcome and poor outcome groups according to Engel grading. Univariate and multivariate analyses were performed to identify factors associated with favorable prognosis. RESULTS: A total of 97 patients were included. Focal seizures were the most common seizure type, occurring in 72 patients. Magnetic resonance imaging (MRI) revealed positive findings in 82 patients. Ictal video-EEG (VEEG) demonstrated low-voltage fast activity in 46 patients, while interictal VEEG showed predominantly focal epileptiform discharges in 70 patients. Pathological examination revealed FCD type I in 17 patients, type II in 56, and type III in 24. At the most recent follow-up, 77 patients achieved Engel class I, 10 achieved class II, 5 achieved class III, and 5 achieved class IV. Univariate analysis identified focal interictal discharges on VEEG, epileptogenic focus resection, FCD type II, and temporal lobe lesion location as significant factors associated with good outcomes (P < 0.05). Multivariate analysis confirmed that epileptogenic focus resection, FCD type II, and temporal lobe location were independent predictors of favorable postoperative outcomes (P < 0.05). CONCLUSION: Most children with FCD-related epilepsy in this cohort achieved favorable postoperative outcomes. Epileptogenic focus resection, FCD type II pathology, and temporal lobe lesion location were identified as independent factors associated with good prognosis.
Serum calcium levels are independently associated with severe coronary artery stenosis combined with severe cerebral artery stenosis.
Wang Y, Qiu X, Wang Y … +6 more , Gu Y, Zhao L, Liang X, Dong Y, Shi Y, Wang L
BMC Neurol · 2026 May · PMID 42106666 · Full text
INTRODUCTION: Cardiovascular and cerebrovascular illnesses typically coexist clinically, resulting in increased rates of disability and fatality. Current clinical research on the link between albumin-corrected calcium (C...
INTRODUCTION: Cardiovascular and cerebrovascular illnesses typically coexist clinically, resulting in increased rates of disability and fatality. Current clinical research on the link between albumin-corrected calcium (Ca) and the risk of cardiovascular and cerebrovascular disorders is contentious. To address a void in this study field, we intend to investigate the relationship between Ca and severe coronary artery stenosis (Degree of vascular stenosis ≥ 70%) coexisting with severe cerebral artery stenosis (Degree of vascular stenosis ≥ 70%) (SCSC). METHODS: This single-center retrospective study enrolled 197 symptomatic patients with ischemic Cardio-CerebroVascular comorbidities. After preprocessing the data, we employed elastic net regression to automatically select the most informative variables from the large dataset. Stable variables were incorporated into a multivariate logistic regression model to determine their statistical significance and effect size. Variables demonstrating statistical significance were chosen as core variables for incremental value analysis based on traditional risk factor models. Finally, to assess potential nonlinear relationships, generalized correlation models were applied to all continuous variables, and dose-response curves were fitted for statistically significant variables. RESULTS: SCSC is commonly observed in patients with symptomatic ischemic cardiovascular and cerebrovascular complications (36.04%). Significant associations exist between Ca, international normalized ratio, monocytes, and high-density lipoprotein cholesterol with SCSC. Among these, Ca exhibits the strongest and most stable association with SCSC (selection frequency = 99.51%; OR = 2.21; 95% CI: 1.34-3.64; p = 0.002). Ca also contributes the greatest incremental value to the baseline model (∆AUC = -0.040, ∆Birer = -0.017). After controlling for traditional risk factors and serum phosphorus, renal function, and lipid profile indicators that may influence Ca levels, the relationship between Ca and SCSC remained statistically significant (OR = 2.12; 95% CI: 1.27-3.56; p = 0.005). CONCLUSION: There may be a close relationship between Ca and SCSC, but further research is needed to confirm whether a causal association exists.
Cinnarizine vs. topiramate for migraine prophylaxis in children: a randomized, double-blind, parallel-group clinical trial.
Abdi A, Abbasi E, Abazarlou A
BMC Neurol · 2026 May · PMID 42106656 · Full text
OBJECTIVES: Migraine is a common and disabling neurological disorder in children, often requiring preventive treatment. This study aimed to compare the efficacy and tolerability of cinnarizine and topiramate in the proph...
OBJECTIVES: Migraine is a common and disabling neurological disorder in children, often requiring preventive treatment. This study aimed to compare the efficacy and tolerability of cinnarizine and topiramate in the prophylaxis of migraine in children and adolescents. MATERIALS AND METHODS: In this randomized, double-blind, parallel-group clinical trial, 96 children aged 6-15 years with a diagnosis of migraine according to the International Classification of Headache Disorders (ICHD-3) [1], including both migraine with and without aura, without restriction to specific subtypes were enrolled. Participants were randomly assigned to receive either cinnarizine (25 mg once daily) or topiramate (25 mg once daily) for 12 weeks. Migraine attack frequency and severity were recorded using headache diaries at baseline, one month, and three months after treatment initiation. The primary outcome was the change in monthly migraine attack frequency. Secondary outcomes included changes in headache severity and the occurrence of adverse events. Between-group comparisons were performed using the Mann-Whitney U test, and within-group changes over time were analyzed using the Friedman test. RESULTS: Both cinnarizine and topiramate significantly reduced monthly migraine attack frequency and headache severity over the 12-week treatment period (P < 0.001 for within-group comparisons). At three months, the median number of migraine attacks decreased to two attacks per month in both groups, with no statistically significant difference observed between the two treatments (P = 0.81). Headache severity scores also improved significantly in both groups, and no between-group differences were observed at follow-up (P = 0.74). Both medications were generally well tolerated, with no statistically significant differences in the incidence of adverse events between groups. Appetite reduction was reported in 4.2% of the cinnarizine group versus 14.6% of the topiramate group. While a numerically lower incidence of appetite reduction was observed in the cinnarizine group (4.2% vs. 14.6%), this difference was not statistically significant (P = 0.159, Fisher's exact test; OR = 0.255, 95% CI: 0.05-1.27). CONCLUSION: Both cinnarizine and topiramate significantly reduced the frequency and severity of migraine attacks in children. No statistically significant difference in efficacy was detected between the two treatments. A numerically lower incidence of appetite reduction was observed with cinnarizine, although this difference was not statistically significant. Larger studies are needed to evaluate potential differences in tolerability. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) IRCT20221108056444N1. Registered 12 February 2023 Retrospectively registered, https://www.en.irct.ir/trial/66774 .
Relationship between blood pressure level with prognosis of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis.
Li Y, Huang G, Li S … +4 more , Liu H, Li S, Bai X, Cai J
BMC Neurol · 2026 May · PMID 42106636 · Full text
BACKGROUND: Blood pressure (BP) management after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) remains challenging, and evidence on how BP levels relate to prognosis is inconsistent. We performed a syste...
BACKGROUND: Blood pressure (BP) management after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) remains challenging, and evidence on how BP levels relate to prognosis is inconsistent. We performed a systematic review and meta-analysis to evaluate associations between pre-/post-treatment BP levels and clinical outcomes after IVT. METHODS: We conducted this systematic review and meta-analysis in accordance with PRISMA. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 8, 2026, restricted to English-language published clinical studies. Adults with AIS treated with intravenous alteplase were eligible. Pre-treatment BP was defined as the measurement closest to IVT initiation; post-treatment BP preferentially referred to the mean BP within 2-4 h after completion of alteplase infusion (or 24-72 h when unavailable). Outcomes included 3-month functional outcome (favorable modified Rankin Scale (mRS) 0-2 vs. unfavorable mRS 3-6), symptomatic intracranial hemorrhage (sICH; study-specific definitions), and 3-month mortality. Mean differences (MDs) and odds ratios (ORs) were pooled using fixed- or random-effects models based on heterogeneity. RESULTS: Thirty-four studies were included. For functional outcome, 5,582 patients had favorable outcome and 5,179 had unfavorable outcome; the weighted mean pre-treatment SBP was 150.0 vs. 151.5 mmHg, respectively, and the pooled MD indicated lower pre-treatment SBP in the favorable group (MD = - 5.58 mmHg, 95% CI - 9.04 to - 2.12; I²=79%). For post-treatment SBP, 4,963 vs. 4,467 patients were included; the weighted mean SBP was 144.9 vs. 149.0 mmHg, and the pooled MD was - 4.09 mmHg (95% CI - 4.98 to - 3.20; I²=0%). For sICH, 279/12,362 (2.26%) patients developed sICH; the weighted mean pre-treatment SBP was 151.6 vs. 157.9 mmHg (no sICH vs. sICH), and the pooled MD was - 5.89 mmHg (95% CI - 8.26 to - 3.51; I²=0%). For post-treatment SBP, 182/10,541 (1.73%) patients developed sICH; the weighted mean SBP was 147.2 vs. 159.7 mmHg, and the pooled MD was - 11.71 mmHg (95% CI - 15.05 to - 8.37; I²=45%). Evidence for mortality and BP variability was limited. CONCLUSIONS: Higher SBP before and after IVT was associated with poorer 3-month functional outcome and with sICH. Further prospective studies with standardized BP ascertainment and outcome definitions are needed.
Association between Guillain-Barré syndrome and 7 autoimmune diseases: a mendelian randomization study.
Zhou J, Wang T, Chen G … +3 more , Yang S, Wang T, Li X
BMC Neurol · 2026 May · PMID 42106630 · Full text
BACKGROUND: The genetic and environmental factors influencing an individual's susceptibility to develop Guillain-Barré syndrome (GBS) remain largely unidentified. This study aims to evaluate the genetically predicted ass...
BACKGROUND: The genetic and environmental factors influencing an individual's susceptibility to develop Guillain-Barré syndrome (GBS) remain largely unidentified. This study aims to evaluate the genetically predicted associations between GBS and candidate autoimmune diseases using a Mendelian randomization (MR) framework. METHODS: Genetic instruments for autoimmune diseases were extracted from large-scale genome-wide association study (GWAS) datasets. Following stringent quality control, seven autoimmune diseases were ultimately retained for the primary analysis. Summary statistics for GBS were obtained from the FinnGen consortium. We employed the inverse variance weighted (IVW) method as the primary approach, supplemented by sensitivity analyses to ensure robustness. Furthermore, a high-throughput two-step MR screening of 731 immune traits was integrated to explore potential biological mediators. RESULTS: Genetic liability to type 1 diabetes was suggestively associated with an increased risk of GBS [OR (95% CI) = 1.26 (1.04-1.52), p = 0.0176]. Conversely, genetic predisposition to psoriasis vulgaris showed a suggestive protective association [OR (95% CI) = 0.784 (0.623-0.986), p = 0.0375]. No significant or suggestive associations were observed for rheumatoid arthritis (p = 0.990), sarcoidosis (p = 0.993), systemic lupus erythematosus (p = 0.240), asthma (p = 0.906), or Graves' disease (p = 0.926). No circulating immune trait emerged as a significant mediator between these conditions. CONCLUSION: This study identifies suggestive genetically predicted associations between specific autoimmune diseases and GBS susceptibility, specifically a potential risk-increasing effect of type 1 diabetes and a protective effect of psoriasis vulgaris. The absence of significant peripheral immune mediators suggests that these neuro-immune interactions may be driven by more localized or complex tissue-resident mechanisms.
The relationship between homocysteine and post-stroke depression in patients with spontaneous intracerebral hemorrhage.
Zhang C, Chen G, Ding P … +2 more , Xiang L, Yue W
BMC Neurol · 2026 May · PMID 42104297 · Full text
INTRODUCTION: Depression after a stroke is the most frequent and burdensome neuropsychiatric post-stroke complication. This study aimed to determine the relationship between post-stroke depression (PSD) and the levels of...
INTRODUCTION: Depression after a stroke is the most frequent and burdensome neuropsychiatric post-stroke complication. This study aimed to determine the relationship between post-stroke depression (PSD) and the levels of homocysteine (HCY) in patients with spontaneous intracerebral hemorrhage (SICH). METHOD: We collected data from patients with hemorrhagic stroke (HS) admitted to the hospital and recorded their demographic and clinical characteristics. We also searched for information regarding HAM-D (Hamilton Depression) scores and HCY levels at 3 m, the use of antidepressant medications and folic acid during the follow-up period in the group of patients diagnosed with PSD and hyperhomocysteinemia (HHcy) in the acute phase. RESULT: A total of 1,852 patients were included. 642 (34.7%) patients with PSD and 598 (32.3%) patients with HHcy, 364 (19.7%) patients with both conditions. A link between depression and low HCY level has similarly been found in patients with HS (OR, 1.549; 95% CI, 1.358-1.768). Additionally, left-sided stroke, anterior circulatory stroke, intraventricular hemorrhage, symptoms of paralysis or dysarthria, and higher NIHSS scores occurred more often in the PSD group. Compared to the antidepressant medications (ADM) group, HAM-D scores decreased significantly in the ADM plus folic acid group at the end of 3 m (P = 0.036). CONCLUSION: On the basis of our data, PSD was significantly more frequent in patients with HHcy in patients with SICH at the acute phase. The location of hemorrhage and the severity of the disease are significantly correlated with the incidence of PSD. Oral doses of folic acid and ADM showed significant improvements in the HAM-D scores for the patients with comorbid PSD and HHcy.
Efficacy and safety of low-dose trazodone hydrochloride for insomnia in patients with myasthenia gravis.
Peng JT, Kong XY, Li R … +4 more , Cao YY, Jiang HQ, Wang JW, Cui SL
BMC Neurol · 2026 May · PMID 42104265 · Full text
BACKGROUND: The management of insomnia in patients with myasthenia gravis (MG) poses a clinical challenge, as MG is a well-recognized contraindication to sedative-hypnotic agents. This retrospective study aimed to assess...
BACKGROUND: The management of insomnia in patients with myasthenia gravis (MG) poses a clinical challenge, as MG is a well-recognized contraindication to sedative-hypnotic agents. This retrospective study aimed to assess the efficacy and safety of low-dose trazodone hydrochloride for the management of insomnia in MG patients. METHODS: Clinical data were collected from MG patients with comorbid insomnia who received low-dose trazodone hydrochloride (25-100 mg, once nightly, for ≥ 4 weeks). Enrolled patients were stratified into three groups based on Self-Rating Depression Scale (SDS) scores: pure insomnia group (SDS: 0-52), mild depression group (SDS: 53-62), and moderate-to-severe depression group (SDS ≥ 63). Changes in Pittsburgh Sleep Quality Index (PSQI) scores, SDS scores, and Myasthenia Gravis Activities of Daily Living (MG-ADL) scores before and after trazodone hydrochloride administration were analyzed. RESULTS: Total 68 MG patients were enrolled, including 17 cases of ocular MG and 51 cases of mild generalized MG. Of these patients, 18 (26.5%) were assigned to the pure insomnia group, 30 (44.1%) to the mild depression group, and 20 (29.4%) to the moderate-to-severe depression group. Post-treatment PSQI scores were significantly reduced compared to baseline across all groups (all p < 0.01). The mild depression group exhibited a significant decrease in SDS scores after treatment (p < 0.01), whereas no significant reduction in SDS scores was observed in the moderate-to-severe depression group. No patients experienced an increase in MG-ADL scores. Mild adverse events were reported in 4 patients (5.9%), including hypotension (n = 2), dizziness (n = 1), and nausea (n = 1). CONCLUSIONS: Low-dose trazodone hydrochloride demonstrates favorable efficacy and safety in improving insomnia in patients with stable and mild MG.
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