Curr Neurol Neurosci Rep [JOURNAL]
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200 papers
Monogenic Epilepsies in Adult Epilepsy Clinics and Gene-Driven Approaches to Treatment.
Clayton LM, Vakrinou A, Balestrini S … +1 more , Sisodiya SM
Curr Neurol Neurosci Rep · 2025 May · PMID 40381056 · Full text
PURPOSE OF REVIEW: Genetic factors play an important contribution to the aetiology of epilepsy and may have implications for management. Whilst the study of monogenic epilepsies has predominantly centred around children,...
PURPOSE OF REVIEW: Genetic factors play an important contribution to the aetiology of epilepsy and may have implications for management. Whilst the study of monogenic epilepsies has predominantly centred around children, there is a critical need to understand the burden of monogenic epilepsies in adults. This understanding is essential to steer the application of genetic testing and to facilitate access to gene-driven therapies in adults with epilepsy. RECENT FINDINGS: The yield of diagnostic genetic testing in adults with epilepsy and neurodevelopmental disorders is similar to that in children (ranging from 23-50%). Distinct causal genes underlie the most common monogenic epilepsies identified in adulthood compared to childhood, although SCN1A is the most commonly implicated gene across both populations. Genetic diagnoses made in adults with epilepsy frequently have direct implications for clinical management. However, very few gene-driven therapies are supported by evidence from formal studies. Genetic testing should be considered in adults with unexplained epilepsy and may have important implications for management, including the potential for gene-driven therapies. However, further work is needed to understand the outcomes of gene-driven therapies in adults with epilepsy.
Artificial Intelligence in Vascular Neurology: Applications, Challenges, and a Review of AI Tools for Stroke Imaging, Clinical Decision Making, and Outcome Prediction Models.
Alqadi MM, Vidal SGM
Curr Neurol Neurosci Rep · 2025 May · PMID 40343612 · Publisher ↗
PURPOSE OF REVIEW: Artificial intelligence (AI) promises to compress stroke treatment timelines, yet its clinical return on investment remains uncertain. We interrogate state‑of‑the‑art AI platforms across imaging, workf...
PURPOSE OF REVIEW: Artificial intelligence (AI) promises to compress stroke treatment timelines, yet its clinical return on investment remains uncertain. We interrogate state‑of‑the‑art AI platforms across imaging, workflow orchestration, and outcome prediction to clarify value drivers and execution risks. RECENT FINDINGS: Convolutional, recurrent, and transformer architectures now trigger large‑vessel‑occlusion alerts, delineate ischemic core in seconds, and forecast 90‑day function. Commercial deployments-RapidAI, Viz.ai, Aidoc-report double‑digit reductions in door‑to‑needle metrics and expanded thrombectomy eligibility. However, dataset bias, opaque reasoning, and limited external validation constrain scalability. Hybrid image‑plus‑clinical models elevate predictive accuracy but intensify data‑governance demands. AI can operationalize precision stroke care, but enterprise‑grade adoption requires federated data pipelines, explainable‑AI dashboards, and fit‑for‑purpose regulation. Prospective multicenter trials and continuous lifecycle surveillance are mandatory to convert algorithmic promise into reproducible, equitable patient benefit.
Thrombectomy Selection in the Large Core Era: Implications for Regional Transfers.
Cirillo L, Abdalkader M, Klein P … +8 more , Yedavalli VS, Siegler JE, Kang M, Shu L, Al Mufti F, Yaghi S, Ranta A, Nguyen TN
Curr Neurol Neurosci Rep · 2025 May · PMID 40317401 · Publisher ↗
PURPOSE OF REVIEW: This review aims to evaluate recent advances in large core stroke management with a focus on diagnostic imaging protocols to select patients for endovascular therapy. RECENT FINDINGS: Recent randomized...
PURPOSE OF REVIEW: This review aims to evaluate recent advances in large core stroke management with a focus on diagnostic imaging protocols to select patients for endovascular therapy. RECENT FINDINGS: Recent randomized controlled trials have shown that thrombectomy can lead to favorable outcomes in patients with large infarcts, contradicting previous assumptions that thrombectomy was not indicated in such patients due to higher risks and very low benefits. Although mechanical thrombectomy remains the gold standard of medical treatment for large vessel occlusions with demonstrated salvageable brain tissue, analysis of the results of recent randomized trials in patients with large ischemic stroke should help us expand patient selection, optimize timing, and explore different management modalities to improve the outcomes of therapy in these patients.
Sport-Related Concussions in High School Athletes: A Comprehensive Update.
Shaffer A, Kemprecos HJ, Woolridge MG … +2 more , Soulakis ND, Arnold PM
Curr Neurol Neurosci Rep · 2025 Apr · PMID 40279054 · Publisher ↗
PURPOSE OF REVIEW: Sport-related concussions (SRC) in high school athletes are a growing public health concern, with recent advancements in epidemiology, pathophysiology, diagnosis, management, and prevention. We concise...
PURPOSE OF REVIEW: Sport-related concussions (SRC) in high school athletes are a growing public health concern, with recent advancements in epidemiology, pathophysiology, diagnosis, management, and prevention. We concisely summarize SRC in high school athletes, emphasizing current research and clinical implications. RECENT FINDINGS: Athletes are at significant risk of SRCs, with incidence varying by sport, sex, and competitive setting. Advances in pathophysiology highlight the role of metabolic disruption, inflammation, and axonal injury. Updated diagnostic tools, such as SCAT6, aid clinical evaluation, while advanced neuroimaging and biomarkers remain investigational. Return-to-sport/learn protocols emphasize a gradual, stepwise return. Preventative measures, including policy changes, neuromuscular training, and protective equipment, have reduced SRC incidence. Comprehensive SRC management includes recognition and removal from play followed by a structured return to sport/learning. Future research directions include biomarker validation, optimized prevention strategies, and long-term outcome assessment to reduce the burden of SRC in adolescent athletes.
Current Understanding of the Pathophysiology of Idiopathic Intracranial Hypertension.
Lowe M, Berman G, Sumithran P … +1 more , Mollan SP
Curr Neurol Neurosci Rep · 2025 Apr · PMID 40237861 · Full text
PURPOSE OF REVIEW: Development of safe targeted therapies for idiopathic intracranial hypertension requires a thorough understanding of recent evidence discovering the pathophysiology of the condition. The aim is to prov...
PURPOSE OF REVIEW: Development of safe targeted therapies for idiopathic intracranial hypertension requires a thorough understanding of recent evidence discovering the pathophysiology of the condition. The aim is to provide a review of studies that inform on the underpinning mechanisms that have been associated with idiopathic intracranial hypertension. RECENT FINDINGS: People living with active idiopathic intracranial hypertension and obesity have been found to have with insulin resistance, hyperleptinaemia, and adverse cardiovascular outcomes. Clinically their adipose tissue is predominantly located in the truncal region and on detailed laboratory analysis the cells are primed for weight gain. There is evidence of androgen excess, altered glucocorticoid regulation and changes in pro-inflammatory cytokines. There are distinct alterations in metabolic pathways found in serum, urine and cerebrospinal fluid, that resolve following disease remission. These findings are associated with raised intracranial pressure and are likely secondary to cerebrospinal fluid hypersecretion. Idiopathic intracranial hypertension has a profile of systemic metabolic changes, endocrine dysfunction and cardiovascular risk profile distinct from that associated with obesity alone. These systemic metabolic changes are likely to contribute to dysregulation of cerebrospinal fluid dynamics, primarily hypersecretion but with a possible additional effect of reduced clearance resulting in the core feature of raised intracranial pressure.
The Use Of Fundus Photography In The Emergency Room-A Review.
Browning SD, Costello JM, Dunn HP … +1 more , Fraser CL
Curr Neurol Neurosci Rep · 2025 Apr · PMID 40214922 · Full text
PURPOSE OF REVIEW: The ocular fundus reveals a wealth of pathophysiological findings which should change patient management in the emergency room (ER). Traditional fundoscopy has been technically challenging and diagnost...
PURPOSE OF REVIEW: The ocular fundus reveals a wealth of pathophysiological findings which should change patient management in the emergency room (ER). Traditional fundoscopy has been technically challenging and diagnostically inaccurate, but technological advances in non-mydriatic fundus photography (NMFP) have facilitated clinically meaningful fundoscopy. This review presents an update on the literature regarding NMFP and its application to the ER, illustrating pivotal publications and recent advances within this field. RECENT FINDINGS: NMFP's application in the ER is demonstrably feasible and seamlessly integrates into emergency physicians' (EP) diagnostic workflows in a clinically meaningful and time efficient manner. The images of the ocular fundus (OF) generated by NMFP are consistently high quality, allowing a greater diagnostic accuracy to EP and ophthalmology interpreters alike. Digital NMFP images facilitate effective ophthalmology input via telemedicine to review the images in the ER. NMFP has been shown to change management decisions in the ER, improving patient and departmental outcomes. Interpretation of fundus images remains a medical education challenge, and early research highlights the potential for artificial intelligence (AI) image systems of NMFP to augment image interpretation in the ER. NMFP can change the ER approach to OF assessment, however the factors limiting its routine implementation need further consideration. There is potential for AI to contribute to NMFP image screening systems to augment EPs diagnostic accuracy.
Neurological Manifestations Associated with Exercise at Altitude.
Marengo A, Tejada M, Zirena IH … +1 more , Molina S
Curr Neurol Neurosci Rep · 2025 Apr · PMID 40202557 · Publisher ↗
PURPOSE OF REVIEW: The effects that exercise at altitude has on the neurological system are diverse and still not well studied, and range from metabolic adaptations to modification of cerebral blood flow and neurotransmi...
PURPOSE OF REVIEW: The effects that exercise at altitude has on the neurological system are diverse and still not well studied, and range from metabolic adaptations to modification of cerebral blood flow and neurotransmitters. In this review we summarise changes with exercise intensity, the implications of ascent, cognitive impairment, psychosis-like symptoms, the role of exercise in the development and prevention of AMS, and use of free radical scavengers to enhance sports performance and acclimatization. RECENT FINDINGS: We discuss the impact of oxidative stress in hypobaric hypoxia and reactive oxygen species (ROS) production and its consequences, with special focus on exercise at altitude. Finally we consider how moderate intensity exercise could help prevent AMS, and the necessity of research on high intensity exercise with elevated rate of ascent, the development of specific tools of cognitive assessment, and the role of free-radical scavengers in the prevention of AMS and neurological symptoms.
Hepatic Encephalopathy: Current Thoughts on Pathophysiology and Management.
Sen BK, Pan K, Chakravarty A
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40153081 · Publisher ↗
PURPOSE OF REVIEW: This review highlights the causes, types and clinical staging of hepatic encephalopathy (HE). Current concepts on the probable pathogenetic mechanisms and currently practiced therapeutic options are di...
PURPOSE OF REVIEW: This review highlights the causes, types and clinical staging of hepatic encephalopathy (HE). Current concepts on the probable pathogenetic mechanisms and currently practiced therapeutic options are discussed. RECENT FINDINGS: HE may be covert and overt. Also known as minimal HE. Covert HE, where there are behavioral abnormalities and impairment in activities of daily living with intact sensorium. The pathophysiology of HE remains poorly understood. There is disturbance of the urea cycle due to liver disease leading to increased production of ammonia. The ammonium ion enters the astrocytes along with glutamate (converted to glutamine by ammonia) and myo-inositol, thereby increasing the osmolality of the astrocytic cytoplasm. This osmotic gradient results in accumulation of water inside the astrocytes resulting in cerebral edema and increase in brain volume. Additionally, current research has noted the role of cerebral oxidative/nitrosative stress and the synergistic effects of increased cerebral ammonia and alteration in neurotransmitters, neurometabolites, and cortical excitability due to systemic inflammation. In advanced liver disease with systemic infection or inflammation, neuroinflammatory processes play significant role in the development of HE. Inflammatory cytokines like TNF-α, IL-6, IL-17 in presence of hyperammonemia have been found to induce neurotoxicity of ammonia by passing through the blood brain barrier and causing enlarged/swollen pale astrocytes, resulting in HE. Disrupted enterohepatic circulation in end stage liver disease also causes elevation of bile acids which induces neuroinflammation. Manganese and zinc play as co-factors of enzymatic reaction. These metal deposition causes multiple psychomotor symptoms observed in HE. The gut environment has a major impact on brain function in patients with HE. Toxins such as ammonia and inflammatory cytokines produced by this impaired intestinal flora access the circulation through porto-systemic anastomoses and exacerbate or precipitate HE. Finally, as a result of recurrent cerebral edema from astrocytic dysfunction and neuroinflammation, permanent neurodegeneration occurs with cognitive decline and motor disturbances, especially parkinsonian features and gait disturbances. This is the stage of chronic hepatic encephalopathy. Currently L-ornithine L-aspartate (LOLA) is being used to lower the ammonia level by stimulating the urea cycle. HE comprises a broad spectrum of neurological and/or psychiatric abnormalities caused by hepatic insufficiency and/or portal-systemic shunting in the absence of any other causes of brain dysfunction. HE may be caused or precipitated by several factors like infections, intoxications and drugs. The encephalopathic features may be covert or overt. The pathogenetic mechanisms for HE may be different. In the presence of liver disease, HE primarily results from disturbed urea cycle with hyperammonemia causing astrocytic swelling and cerebral edema. Porto-systemic anastomoses with intact liver function can cause HE by allowing ammonia and other toxins produced by the gut microbial flora and allowing these to bypass detoxification by the liver and exposing the brain to their harmful effects. Principles of therapy are twofold. First protecting the liver and the brain from gut generated ammonia and other toxins by ensuring smooth bowel function and avoiding stagnation with the use of osmotic laxatives like lactulose or lactitol and also reducing the gut microbial load with use of anti-bacterials/bacteriophages like neomycin and rifaximin along with metronidazole. Second, reducing the already generated cerebral edema by use of mannitol and appropriate ventilatory support. Currently L-ornithine L-aspartate (LOLA) is being used to reduce the ammonia load to the liver. LOLA is a stable compound formed from two amino acids. L-ornithine plays a crucial role in stimulating the urea cycle, leading to a reduction in ammonia levels. Both L-ornithine and L-aspartate serve as substrates for the enzyme glutamate transaminase, and their administration results in elevated glutamate concentrations. Ammonia is subsequently utilized in the conversion of glutamate to glutamine through the action of glutamine synthetase. Finally in resistant cases the use of liver transplant needs to be considered. Alternatively extracorporeal liver assist devices may be used like Molecular Adsorbent Recirculating System (MARS) or Single-Pass Albumin Dialysis (SPAD).
Central Nervous System Manifestations of Cutaneous Lymphomas.
Chakravarty A
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40131611 · Publisher ↗
PURPOSE OF REVIEW: Primary cutaneous lymphomas (PCL) are an uncommon malignancy of the lymphocytes, primarily presenting with dermatologic lesions. Central nervous system(CNS) metastatic manifestations, are even rarer. T...
PURPOSE OF REVIEW: Primary cutaneous lymphomas (PCL) are an uncommon malignancy of the lymphocytes, primarily presenting with dermatologic lesions. Central nervous system(CNS) metastatic manifestations, are even rarer. This review focus mainly on three aspects namely early suspicion of CNS involvement, selection of cases for CNS chemo-prophylaxis and lastly, the rare occurrence from skin straight to brain without other organ involvement. RECENT FINDINGS: Primary extranodal large B-cell lymphomas are very heterogeneous. Recent molecular data have thrown some light on such divergent clinical behaviour. The peculiar, stage-independent risk of CNS spread in testicular, breast, uterine, and possibly Primary Cutaneous Diffuse Large B Cell Lymphoma Leg type (PCDBLCL-LT), may be related to prevalent MCD (MYD88/CD79B-mutated) genomic subtype in these lymphomas. It remains to be seen how this genotype might facilitate invasion of the CNS parenchyma, and whether therapies targeting the B-cell receptor or NF-κB signalling pathways could lower the risk. Some sites of extranodal involvement, almost always indicate disseminated disease with a high propensity to invade the bone marrow and leptomeningeal compartments, particularly in double-hit lymphoma. Conversely, unifocal bone, craniofacial, thyroid, or gastric DLBCL show a relatively favourable prognosis with standard immunochemotherapy. Their risk of CNS recurrence might be largely driven by potential local invasion due to anatomic proximity when epidural, orbital, or skull involvement is present, thus requiring a case-by-case approach to prophylaxis. Future studies can help clarify the relationship between extranodal DLBCLs and their indolent MALT counterparts, and whether the favorable behavior of some ABC-like lymphomas (Activated B-cell-like (ABC) diffuse large B-cell lymphomas (e.g. in the stomach or craniofacial sites) might be explained by less aggressive genotypes (e.g. BCL6/NOTCH2 subtype). MALT lymphoma is a type of non-Hodgkin lymphoma (NHL) that starts in the mucosa lining some body organs and cavities. It is a type of NHL called marginal zone lymphoma. PCL can be defined as non-Hodgkin lymphomas that initially present in the skin without any extra cutaneous manifestations at the time of diagnosis. The skin is the second most common site of occurrence of non-Hodgkin lymphomas, second only to the lymphatic system. PCL can be broadly divided into two types-T cell lymphomas and B cell lymphomas.Major subtypes of T cell lymphomas include mycosis fungoides (MF) and its variants, Sezary syndrome, CD30 + lymphoproliferative disorders, and other more rare entities like subcutaneous panniculitis- like T-cell lymphoma, extranodal NK/T cell lymphoma nasal type, primary cutaneous peripheral T-cell lymphoma not otherwise specified, and adult T-cell leukemia/lymphoma. Cutaneous B-cell lymphomas comprise approximately 25% of all cutaneous lymphomas. There are three main morphologic groups: primary cutaneous marginal zone lymphoma, cutaneous follicle-centre lymphoma, and diffuse large B-cell lymphoma, leg type(DLBCL). Other subtypes include - DLBCL other type (non-leg), and intravascular large B-cell lymphoma. Immunohistochemically cutaneous marginal zone lymphoma is classically bcl-2 positive and bcl-6 negative. This condition has an excellent prognosis, with five-year disease related survival noted to be > 95%. Primary cutaneous follicle-centre lymphoma is a lymphoma of cells of the follicle centre, usually including a combination of centrocytes and centroblasts. Immunohistochemically, the neoplastic follicle cells express bcl-6, and expression of bcl-2 is typically absent or faint. Prognosis is again excellent, with five-year disease related survival noted to be over 95%. Primary cutaneous diffuse large B-cell lymphoma, leg type is a neoplastic disorder of centroblasts and immunoblasts, which typically presents as a red to violaceous nodules or tumours on the lower extremities. Phenotypically, bcl-2 and bcl-6 are often expressed, as is MUM-1. Extracutaneous disease is common, with these tumours having a relatively high propensity to disseminate. Prognosis is variable with disease related 5-year survival being 40-50% in patients with multiple lesions at time of diagnosis, to 100% in those patients that present with a single lesion. Other, rare large B-cell lymphomas can also present in the skin. Intravascular large B-cell lymphoma is a subtype in which neoplastic B-cells have accumulated within blood vessels and often affect many organ systems (including brain), however rarely skin lesions only can occur. CNS involvement is uncommon in both types of cutaneous lymphomas and overall prognosis is not good. Brain masses and meningeal infiltration are the usual patterns though imaging may be negative with demonstration of lymphoma cells only in the CSF by flow cytometry. At times, no other organ involvement may be noted, albeit very rarely. Selection of patients who might benefit with CNS prophylactic agents is of utmost importance. On the whole, most cases of high grade cutaneous DLBCLs need to have CNS chemo-prophylaxis.
Chronic Neurological Complications of Brain Tumors and Brain Tumor Treatments.
Thakkar JP, Luy DD, Pickles A … +2 more , Refaat T, Prabhu VC
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40116979 · Publisher ↗
PURPOSE OF REVIEW: Chronic complications of brain tumors and brain tumor treatments can lead to impairment of health-related quality of life and decreased functionality. These largely include cognitive decline, fatigue,...
PURPOSE OF REVIEW: Chronic complications of brain tumors and brain tumor treatments can lead to impairment of health-related quality of life and decreased functionality. These largely include cognitive decline, fatigue, headache, seizures, and secondary malignancies. Outpatient neurologists are an integral part of the multidisciplinary neuro-oncology team who help diagnose and manage chronic complications in this complex patient population. Timely diagnosis and treatment of these complications in outpatient neurology and neuro-oncology clinics helps improve quality of life and survival of brain tumor patients. RECENT FINDINGS: We discuss updated information and management regarding various chronic neurologic complications among neuro-oncology patients. Understanding of chronic neurologic complications associated with central nervous system tumors and with common contemporary cancer treatments will facilitate neurologists management of these patient populations. While there are aspects analogous to the diagnosis and management in the non-oncologic population, a number of unique features discussed in this review should be considered.
Leptomeningeal Disease: Current Approaches and Future Directions.
Sener U, Wilcox JA, Boire AA
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40100294 · Full text
PURPOSE OF REVIEW: Leptomeningeal disease (LMD), or spread of cancer cells into the pia and arachnoid membranes encasing the brain and spinal cord, is associated with high symptom burden and poor survival at 2 to 5 month...
PURPOSE OF REVIEW: Leptomeningeal disease (LMD), or spread of cancer cells into the pia and arachnoid membranes encasing the brain and spinal cord, is associated with high symptom burden and poor survival at 2 to 5 months. Conventional treatments including photon-based radiation therapy, systemic chemotherapy, and intrathecal chemotherapy demonstrate limited efficacy. Despite significant successes for a range of solid tumors, immunotherapy has not yet demonstrated significant efficacy in management of LMD. Advances in understanding of LMD pathophysiology, improved diagnostics, and novel therapeutics are shifting this paradigm. In this article, we review diagnostic and treatment challenges associated with LMD. RECENT FINDINGS: We discuss the use of novel cerebrospinal fluid (CSF) analysis techniques such as circulating tumor cell and CSF cell-free DNA assessment to overcome limitations of conventional diagnostic modalities. We then review advances in treatment including clinical trial data demonstrating efficacy of proton craniospinal radiation to treat the entire neuroaxis. We discuss emerging data regarding targeted therapeutics conferring durable survival benefit. Novel therapeutics and combinatorial treatment approaches will likely further improve outcomes for patients with LMD.
Insights on the Shared Genetic Landscape of Neurodevelopmental and Movement Disorders.
Indelicato E, Zech M, Eberl A … +1 more , Boesch S
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40095113 · Full text
PURPOSE OF REVIEW: Large-scale studies using hypothesis-free exome sequencing have revealed the strong heritability of neurodevelopmental disorders (NDDs) and their molecular overlap with later-onset, progressive, moveme...
PURPOSE OF REVIEW: Large-scale studies using hypothesis-free exome sequencing have revealed the strong heritability of neurodevelopmental disorders (NDDs) and their molecular overlap with later-onset, progressive, movement disorders phenotypes. In this review, we focus on the shared genetic landscape of NDDs and movement disorders. RECENT FINDINGS: Cumulative research has shown that up to 30% of cases labelled as "cerebral palsy" have a monogenic etiology. Causal pathogenic variants are particularly enriched in genes previously associated with adult-onset progressive movement disorders, such as spastic paraplegias, dystonias, and cerebellar ataxias. Biological pathways that have emerged as common culprits are transcriptional regulation, neuritogenesis, and synaptic function. Defects in the same genes can cause neurological dysfunction both during early development and later in life. We highlight the implications of the increasing number of NDD gene etiologies for genetic testing in movement disorders. Finally, we discuss gaps and opportunities in the translation of this knowledge to the bedside.
Traumatic Brain Injury and Gut Microbiome: The Role of the Gut-Brain Axis in Neurodegenerative Processes.
Lin D, Howard A, Raihane AS … +6 more , Di Napoli M, Cáceres E, Ortiz M, Davis J, Abdelrahman AN, Divani AA
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40087204 · Publisher ↗
PURPOSE OF REVIEW: A deeper understanding of the communication network between the gut microbiome and the central nervous system, termed the gut-brain axis (GBA), has revealed new potential targets for intervention to pr...
PURPOSE OF REVIEW: A deeper understanding of the communication network between the gut microbiome and the central nervous system, termed the gut-brain axis (GBA), has revealed new potential targets for intervention to prevent the development of neurodegenerative disease associated with tramatic brain injury (TBI). This review aims to comprehensively examine the role of GBA post-traumatic brain injury (TBI). RECENT FINDINGS: The GBA functions through neural, metabolic, immune, and endocrine systems, creating bidirectional signaling pathways that modulate brain and gastrointestinal (GI) tract physiology. TBI perturbs these signaling pathways, producing pathophysiological feedback loops in the GBA leading to dysbiosis (i.e., a perturbed gut microbiome, impaired brain-blood barrier, impaired intestinal epithelial barrier (i.e., "leaky gut"), and a maladaptive, systemic inflammatory response. Damage to the CNS associated with TBI leads to GI dysmotility, which promotes small intestinal bacterial overgrowth (SIBO). SIBO has been associated with the early stages of neurodegenerative conditions such as Parkinson's and Alzheimer's disease. Many of the bacteria associated with this overgrowth promote inflammation and, in rodent models, have been shown to compromise the structural integrity of the intestinal mucosal barrier, causing malabsorption of essential nutrients and further exacerbating dysbiosis. TBI-induced pathophysiology is strongly associated with an increased risk of neurodegenerative diseases, including Parkinson's and Alzheimer's diseases, which represents a significant public health burden and challenge for patients and their families. A healthy gut microbiome has been shown to promote improved recovery from TBI and prevent the development of neurodegenerative disease, as well as other chronic complications. The role of the gut microbiome in brain health post-TBI demonstrates the potential for microbiome-targeted interventions to mitigate TBI-associated comorbidities. Promising new evidence on prebiotics, probiotics, diet, and fecal microbiota transplantation may lead to new therapeutic options for improving the quality of life for patients with TBI. Still, many of these preliminary findings must be explored further in clinical settings. This review covers the current understanding of the GBA in the setting of TBI and how the gut microbiome may provide a novel therapeutic target for treatment in this patient population.
The Role of Sensory Impairments on Recovery and Rehabilitation After Stroke.
Hoh JE, Semrau JA
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40047982 · Full text
PURPOSE OF REVIEW: The current review aims to address critical gaps in the field of stroke rehabilitation related to sensory impairment. Here, we examine the role and importance of sensation throughout recovery of neural...
PURPOSE OF REVIEW: The current review aims to address critical gaps in the field of stroke rehabilitation related to sensory impairment. Here, we examine the role and importance of sensation throughout recovery of neural injury, potential clinical and experimental approaches for improving sensory function, and mechanism-based theories that may facilitate the design of sensory-based approaches for the rehabilitation of somatosensation. RECENT FINDINGS: Recently, the field of neurorehabilitation has shifted to using more quantitative and sensitive measures to more accurately capture sensory function in stroke and other neurological populations. These approaches have laid the groundwork for understanding how sensory impairments impact overall function after stroke. However, there is less consensus on which interventions are effective for remediating sensory function, with approaches that vary from clinical re-training, robotics, and sensory stimulation interventions. Current evidence has found that sensory and motor systems are interdependent, but commonly have independent recovery trajectories after stroke. Therefore, it is imperative to assess somatosensory function in order to guide rehabilitation outcomes and trajectory. Overall, considerable work in the field still remains, as there is limited evidence for purported mechanisms of sensory recovery, promising early-stage work that focuses on sensory training, and a considerable evidence-practice gap related to clinical sensory rehabilitation.
Acute Stroke Units Nested within Broader Neurology: Care Bundles for Nursing to Enhance Competence and Interdisciplinary Coordination.
Klinke ME, Thorarinsson BL, Sveinsson ÓÁ
Curr Neurol Neurosci Rep · 2025 Mar · PMID 40047971 · Full text
PURPOSE OF REVIEW: The benefits of acute stroke unit care, with nurses as central figures, are well-documented. As care bundles gain traction to enhance evidence-based nursing care, this review explores their development...
PURPOSE OF REVIEW: The benefits of acute stroke unit care, with nurses as central figures, are well-documented. As care bundles gain traction to enhance evidence-based nursing care, this review explores their development and adaptation in a setting where stroke care is integrated into general neurology. It also highlights key elements for reinforcing competence and interdisciplinary support. RECENT FINDINGS: Most evidenced based acute stroke unit recommendations focus on hyperacute medical management. In comparison, the literature on decision-making for selecting and evaluating key components of nursing surveillance to support specialized stroke care in geographically smaller settings is sparse although the benefits of nursing care bundles is emerging. Well-structured care bundles, grounded in robust evidence and supported by thorough documentation and effective implementation strategies, provide a clear framework for nursing care, facilitate continuous monitoring, and are useful for enhancing practices especially in smaller stroke units that lack the resources of more comprehensive state-of-the-art units. Tailoring stroke nursing care bundles to local contexts requires an adaptable approach.
The Gut Microbiome and Migraine: Updates in Understanding.
Zhang N, Tran S, Moskatel LS
Curr Neurol Neurosci Rep · 2025 Feb · PMID 39985639 · Publisher ↗
PURPOSE OF REVIEW: We provide an overview of the field of microbiome research, the current understanding of the microbiome-gut-brain axis, and the most recent updates on the interplay between migraine and the gut microbi...
PURPOSE OF REVIEW: We provide an overview of the field of microbiome research, the current understanding of the microbiome-gut-brain axis, and the most recent updates on the interplay between migraine and the gut microbiome. RECENT FINDINGS: Pre-clinical studies suggest that gut microbiota is required for normal pain sensation. There is also evidence in rodent models that there is potential application of food, herbal medicines, probiotics, and short chain fatty acids (SCFAs) as novel therapies for migraine. Evidence from human cohorts suggests that there is altered gut microbiota in people with migraine, and that the microbiome dysbiosis is from both compositional and functional aspects. Recent metagenome-wide association studies (MWAS) that employ Mendelian Randomization support the causal association between gut microbiota and migraine. The connection between migraine and the gut microbiome remains underexplored, but recent preclinical and clinical studies support the association between gut microbiota and the development of migraine.
Machine Learning Approaches to Prognostication in Traumatic Brain Injury.
Badjatia N, Podell J, Felix RB … +5 more , Chen LK, Dalton K, Wang TI, Yang S, Hu P
Curr Neurol Neurosci Rep · 2025 Feb · PMID 39969697 · Publisher ↗
PURPOSE OF REVIEW: This review investigates the use of machine learning (ML) in prognosticating outcomes for traumatic brain injury (TBI). It underscores the benefits of ML models in processing and integrating complex, m...
PURPOSE OF REVIEW: This review investigates the use of machine learning (ML) in prognosticating outcomes for traumatic brain injury (TBI). It underscores the benefits of ML models in processing and integrating complex, multimodal data-including clinical, imaging, and physiological inputs-to identify intricate non-linear relationships that traditional methods might overlook. RECENT FINDINGS: ML algorithms of clinical features, neuroimaging, and metrics from the autonomic nervous system enhance the early detection of clinical deterioration and improve outcome prediction. Challenges persist, including issues of data variability, model interpretability, and overfitting. However, advancements in model standardization and validation are key to enhancing their clinical applicability. ML-based, multimodal approaches offer transformative potential for personalized treatment planning and patient management. Future directions include integrating digital twins and real-time continuous data analysis, reinforcing the idea that comprehensive data amalgamation is essential for precise, adaptive prognostication and decision-making in neurocritical care, ultimately leading to better patient outcomes.
The Bidirectional Relationship Between Epilepsy and Alzheimer's Disease.
Stewart D, Johnson EL
Curr Neurol Neurosci Rep · 2025 Feb · PMID 39921833 · Publisher ↗
PURPOSE OF REVIEW: Epilepsy has long been considered a late-stage consequence of Alzheimer's Disease (AD), but recent studies highlight its role early in the disease process, even preceding cognitive symptoms. Population...
PURPOSE OF REVIEW: Epilepsy has long been considered a late-stage consequence of Alzheimer's Disease (AD), but recent studies highlight its role early in the disease process, even preceding cognitive symptoms. Population studies reveal a two- to fourfold increased epilepsy risk in AD, particularly in early-onset cases, with seizures clustering around diagnosis. Furthermore, individuals with late-onset unexplained epilepsy have an elevated risk of developing mild cognitive impairment and dementia, underscoring a bidirectional relationship between AD and epilepsy. RECENT FINDINGS: Experimental models support this connection, demonstrating amyloid and tau pathology-induced hyperexcitability at pre-symptomatic stages, implicating soluble Aβ oligomers and inhibitory interneuron dysfunction in excitatory/inhibitory imbalance. Subclinical or clinical epileptiform activity, detectable in 20-50% of AD patients, is associated with cognitive decline, possibly due to sleep-related memory consolidation disruption. Emerging biomarkers, such as TIRDA and high-frequency oscillations, show promise for early detection and intervention. Anti-seizure medications (ASMs), particularly low-dose levetiracetam, show potential not only for seizure control but also for mitigating amyloid deposition, tau hyperphosphorylation, and cognitive decline. However, treatment complexities remain due to variable ASM efficacy, age-related side effects, and limited clinical trials. The bidirectional nature of AD and epilepsy emphasizes the need for integrated diagnostics, including EEG and biomarker assessments, to guide early intervention and targeted therapies. Future research should focus on the mechanistic interplay between amyloid, tau, and hyperexcitability, alongside trials of ASM regimens, to refine therapeutic strategies and improve outcomes in this population.
Supporting Long-Term Meaningful Outcomes in Stroke Rehabilitation.
Fu V, Thompson S, Kayes N … +1 more , Bright F
Curr Neurol Neurosci Rep · 2025 Feb · PMID 39899076 · Publisher ↗
PURPOSE OF REVIEW: Rehabilitation is the mainstay of recovery after stroke, but key recommendations focused on delivering 'as much therapy as possible' and stroke survivor outcome measures have remained relatively unchan...
PURPOSE OF REVIEW: Rehabilitation is the mainstay of recovery after stroke, but key recommendations focused on delivering 'as much therapy as possible' and stroke survivor outcome measures have remained relatively unchanged for decades. Traditional therapy approaches focus on maximum improvement of physical impairments while a stroke survivor is in hospital to ensure that community discharge can be deemed 'safe'. This narrow approach sidelines the outcomes that are meaningful to the stroke survivor in the long term and the challenges they may face within their social context. In this article, we highlight the importance of the whole-person approach and review recent research introducing novel considerations to optimise outcomes after stroke. RECENT FINDINGS: Psychosocial well-being is a major component of health but is poorly acknowledged and managed for stroke survivors. Evidence supports the use of self-management interventions, peer befriending, and culturally - responsive methods, including deep engagement with Indigenous and cultural knowledge. Cultural safety and involvement of a stroke survivor's important personal connections are also vital for achieving truly person-centred care and equity in rehabilitation outcomes. Outcomes in rehabilitation will be optimised if we shift our mindsets from a sole focus on improving physical impairments to a broader scope of delivering whole-person care.
Recent Advances in the Genetics of Ataxias: An Update on Novel Autosomal Dominant Repeat Expansions.
Pellerin D, Iruzubieta P, Xu IRL … +6 more , Danzi MC, Cortese A, Synofzik M, Houlden H, Zuchner S, Brais B
Curr Neurol Neurosci Rep · 2025 Jan · PMID 39820740 · Publisher ↗
PURPOSE OF REVIEW: Autosomal dominant cerebellar ataxias, also known as spinocerebellar ataxias (SCAs), are genetically and clinically diverse neurodegenerative disorders characterized by progressive cerebellar dysfuncti...
PURPOSE OF REVIEW: Autosomal dominant cerebellar ataxias, also known as spinocerebellar ataxias (SCAs), are genetically and clinically diverse neurodegenerative disorders characterized by progressive cerebellar dysfunction. Despite advances in sequencing technologies, a large proportion of patients with SCA still lack a definitive genetic diagnosis. The advent of advanced bioinformatic tools and emerging genomics technologies, such as long-read sequencing, offers an unparalleled opportunity to close the diagnostic gap for hereditary ataxias. This article reviews the recently identified repeat expansion SCAs and describes their molecular basis, epidemiology, and clinical features. RECENT FINDINGS: Leveraging advanced bioinformatic tools and long-read sequencing, recent studies have identified novel pathogenic short tandem repeat expansions in FGF14, ZFHX3, and THAP11, associated with SCA27B, SCA4, and SCA51, respectively. SCA27B, caused by an intronic (GAA)•(TTC) repeat expansion, has emerged as one of the most common forms of adult-onset hereditary ataxias, especially in European populations. The coding GGC repeat expansion in ZFHX3 causing SCA4 was identified more than 25 years after the disorder's initial clinical description and appears to be a rare cause of ataxia outside northern Europe. SCA51, caused by a coding CAG repeat expansion, is overall rare and has been described in a small number of patients. The recent identification of three novel pathogenic repeat expansions underscores the importance of this class of genomic variation in the pathogenesis of SCAs. Progress in sequencing technologies holds promise for closing the diagnostic gap in SCAs and guiding the development of therapeutic strategies for ataxia.
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