Current Opinion In Neurology[JOURNAL]
Sun
200 papers
Headache care around the world: a review of access, equity, and system-level solutions.
Özge A, Hassan A, Souza MNP
Curr Opin Neurol · 2026 Jun · PMID 41709688 · Publisher ↗
PURPOSE OF REVIEW: Headache disorders are the leading cause of neurological disability globally, yet their management remains marked by profound inequities in access to diagnosis, evidence-based treatment, specialist car...
PURPOSE OF REVIEW: Headache disorders are the leading cause of neurological disability globally, yet their management remains marked by profound inequities in access to diagnosis, evidence-based treatment, specialist care, and policy prioritization. This review examines current regional disparities in headache care delivery and highlights emerging system-level approaches aimed at reducing the global treatment gap. RECENT FINDINGS: High-income regions in Western and Northern Europe, East Asia, and North America have developed advanced care models but continue to face inequities related to socioeconomic gradients, insurance coverage, and fragmented care pathways. In contrast, Eastern Europe, South and Central Asia, Latin America, and much of Africa experience substantial limitations in workforce capacity, diagnostic infrastructure, and medication availability, with population-based surveys indicating high prevalence but minimal health-system readiness. Transitional health systems, including Türkiye and the MENA region, demonstrate increasing awareness and partial integration of structured headache pathways, though coverage remains insufficient. Across regions, telemedicine, digital health tools, community-based initiatives, and workplace programs have shown promise in expanding access, reducing stigma, and improving continuity of care, while reinforcing the central role of primary care. SUMMARY: Collectively, these developments signal a shift toward more coordinated and equity-oriented headache service models. Sustainable progress will require strengthened global collaboration, integration of AI-supported decision tools, expansion of cross-border registries and real-world data platforms, and the systematic inclusion of headache disorders within national noncommunicable disease frameworks to ensure high-quality care across diverse populations.
Decoding Alzheimer's disease through down syndrome: insights from a genetically defined population.
Russell JK, Schlachetzki Z, Rafii MS
Curr Opin Neurol · 2026 Apr · PMID 41709686 · Publisher ↗
PURPOSE OF REVIEW: This review explores Alzheimer's disease (AD) in individuals with Down syndrome (DS), a genetically defined population with near-universal development of AD neuropathology by age 40. We examine the gen...
PURPOSE OF REVIEW: This review explores Alzheimer's disease (AD) in individuals with Down syndrome (DS), a genetically defined population with near-universal development of AD neuropathology by age 40. We examine the genetic basis of DS-AD, epidemiology, biomarker trajectories, and clinical trial innovations, highlighting how insights from DS research inform broader AD pathogenesis, early detection, and therapeutic strategies. RECENT FINDINGS: Advances in biomarker research, including longitudinal studies such as ABC-DS, have mapped predictable trajectories of amyloid, tau, and neurodegeneration in DS-AD, aligning closely with clinical staging. Plasma and CSF biomarkers (Aβ42, p-tau, NfL, GFAP) and neuroimaging modalities (amyloid/tau PET, MRI) demonstrate early and sequential changes decades before dementia onset. Revised AD diagnostic criteria now classify DS individuals as Stage 0 from birth, acknowledging genetic determinism and enabling earlier intervention. Comparative analyses between DS-AD, autosomal-dominant AD, and sporadic AD reveal shared pathological features but distinct timing and distribution of amyloid and tau. Clinical trials targeting amyloid and APP pathways in DS are underway, leveraging predictable disease progression to accelerate therapeutic development. SUMMARY: Studying AD in DS provides a unique lens into the natural history of Alzheimer's disease, offering critical insights into genetic drivers, biomarker evolution, and therapeutic opportunities. The genetically defined and biologically concordant nature of DS-AD enables precise staging and early intervention strategies that can be translated to sporadic and familial AD. Continued investment in DS research will advance biomarker validation, refine clinical trial design, and inform personalized treatment approaches for the broader AD population.
Chronobiology and cluster headache: insights into a hypothalamic disorder.
Ran C, Spulber S, Belin AC
Curr Opin Neurol · 2026 Jun · PMID 41709685 · Publisher ↗
PURPOSE OF REVIEW: Cluster headache is a disorder which has been shown to have both a circadian and a circannual pattern. This review gives an overview of the chronobiology of cluster headache summarizing recent findings...
PURPOSE OF REVIEW: Cluster headache is a disorder which has been shown to have both a circadian and a circannual pattern. This review gives an overview of the chronobiology of cluster headache summarizing recent findings on structural variations with a focus on the hypothalamus and the implication of the molecular clock and circadian and circannual variations in gene expression. RECENT FINDINGS: Recent imaging studies using high-resolution structural and functional MRI have highlighted subtle hypothalamic alterations in cluster headache, specifically at the microstructural and connectivity level rather than clear macrostructural changes. Diffusion-based measures reveal altered fractional anisotropy and diffusivity in the hypothalamus, suggesting modified neuronal connectivity that may relate to attack frequency. In parallel, experimental data suggest significant differences in pain perception between day and night, which correlate to circadian oscillations of gene expression, and several drugs used for cluster headache have been reported to alter the molecular clock. SUMMARY: The striking circadian and circannual phenotype of cluster headache opens for the possibility of clock-modulating therapy. The potential to pharmacologically target the molecular clock mechanism is supported by experimental data from mice demonstrating substantial effects of standard cluster headache treatments on the molecular clock.
Novel pharmacological therapies in development.
Perucca P, Perucca E
Curr Opin Neurol · 2026 Apr · PMID 41623087 · Publisher ↗
PURPOSE OF REVIEW: To review progress in developing new pharmacological treatments for epilepsy, focusing on agents in clinical development. RECENT FINDINGS: Over 30 different treatments are currently in clinical develop...
PURPOSE OF REVIEW: To review progress in developing new pharmacological treatments for epilepsy, focusing on agents in clinical development. RECENT FINDINGS: Over 30 different treatments are currently in clinical development, including novel small molecules, nucleic acid-based therapies, stem cells, microbiome-targeting bacteria, and repurposed drugs originally approved for other indications. Most of these treatments target rare epilepsies, particularly the developmental and epileptic encephalopathies, reflecting a development shift from common epilepsies to rare drug-resistant syndromes where unmet therapeutic needs are greatest. Most compounds are still in early development, and publicly accessible data consist mainly of conference reports and congress abstracts. For only two compounds (the K v 7 activator azetukalner and the inhaled emergency treatment Staccato alprazolam) has evidence of efficacy been obtained from relatively large, well designed randomized placebo-controlled trials. SUMMARY: New paradigms in drug discovery have brought to development innovative treatments with diverse targets and mechanisms of action. Many of these treatments are etiology-targeting and have the potential for disease-modifying effects. Although high-quality evidence is awaited, there is hope that over the next few years much needed life-changing therapies will be widely available for millions of people with disabling, drug-resistant epilepsies.
Peripheral alterations of mitochondrial function and mitophagy in Alzheimer's disease: from fundamental research to clinical perspectives.
Eysert F, Deportes G, Delaquaize E … +1 more , Chami M
Curr Opin Neurol · 2026 Apr · PMID 41623082 · Publisher ↗
PURPOSE OF REVIEW: Alzheimer's disease (AD) is commonly defined by its hallmark brain pathologies, yet mounting evidence shows that metabolic impairment particularly linked to mitochondrial dysfunction, is a central and...
PURPOSE OF REVIEW: Alzheimer's disease (AD) is commonly defined by its hallmark brain pathologies, yet mounting evidence shows that metabolic impairment particularly linked to mitochondrial dysfunction, is a central and systemic feature of the disease. This review highlights consistent abnormalities in mitochondrial function, and turnover (mitophagy) across multiple AD-derived peripheral cells, including skin fibroblasts, lymphocytes, platelets, and peripheral blood mononuclear cells. We also report on potential peripheral AD biomarkers linked to mitochondria dysfunction in AD. RECENT FINDINGS: Mitochondrial abnormalities in peripheral cells from individuals with AD robustly correlate with disease development. These mitochondrial dysfunctions mostly include reduced respiratory chain activity, increased accumulation of reactive oxygen species (ROS), altered mitochondrial membrane potential, and consequently decreased ATP production. Studies have also identified a complex pattern of mitochondrial hyperactivity and hypoactivity in peripheral cells of AD patients that appears to depend on the stage of AD and whether the disease is sporadic or familial. Furthermore, multiple steps of the mitophagy pathway are disrupted in peripheral cells as AD progresses. Finally, biochemical and proteomic analyses of peripheral fluids further support the loss of mitochondrial homeostasis in AD patients. SUMMARY: Collectively, the reviewed findings support mitochondrial homeostasis disruption as a core pathophysiological component of AD and a promising target for biomarker development and therapeutic intervention.
The monoaminergic systems as drivers of Alzheimer's disease pathophysiology and symptomatology.
Jacobs HIL
Curr Opin Neurol · 2026 Apr · PMID 41603464 · Full text
PURPOSE OF REVIEW: To summarize recent animal, postmortem and in vivo human studies examining the role of the noradrenergic and serotonergic system in the pathophysiology and symptomatology of Alzheimer's disease (AD). R...
PURPOSE OF REVIEW: To summarize recent animal, postmortem and in vivo human studies examining the role of the noradrenergic and serotonergic system in the pathophysiology and symptomatology of Alzheimer's disease (AD). RECENT FINDINGS: Early in adulthood, the locus coeruleus and raphe nucleus accumulate tau, undergo morphological changes, and exhibit hyperexcitability, which contributes to the development of neuropsychiatric symptoms. As cortical AD pathology increases, these nuclei become hypoactive, but elevated neurotransmitter levels persist in the cortex, presumably driving amyloid-related hyperexcitability and contributing to tau spreading and cognitive decline. SUMMARY: The pathologic changes occurring within these monoaminergic systems temporally align with the observation that neuropsychiatric symptoms precede cognitive changes in AD, indicating that these systems link the earliest pathobiology of the disease to the evolution of the symptoms. The proposed monoaminergic framework intends to guide researchers into investigating the temporal dynamics between monoaminergic changes, AD pathology, and symptoms, with the ultimate goal of evaluating and developing effective precision therapeutic approaches taking into account the disease stage and symptom profile.
Idiopathic generalised epilepsies in 2026.
Breuer E, Vorderwülbecke BJ, Holtkamp M
Curr Opin Neurol · 2026 Apr · PMID 41589711 · Publisher ↗
PURPOSE OF REVIEW: One in five patients with epilepsy has idiopathic generalized epilepsy (IGE). Novel definitions of seizure types, recent data on pharmacotherapy, and new studies on psychiatric and cognitive comorbidit...
PURPOSE OF REVIEW: One in five patients with epilepsy has idiopathic generalized epilepsy (IGE). Novel definitions of seizure types, recent data on pharmacotherapy, and new studies on psychiatric and cognitive comorbidities will be critically discussed. RECENT FINDINGS: Epileptic seizures have been re-classified by the International League Against Epilepsy (ILAE), acknowledging absence-to-tonic-clonic seizures and generalized negative myoclonic seizures. Differing from the classical ILAE definition of IGE subtypes, current evidence underlines that IGEs represent rather a neurobiological continuum than separate syndromes. Valproate is still the most efficacious compound to suppress myoclonic and tonic-clonic seizures, but novel data confirm the high risk for both anatomical and neurodevelopmental teratogenicity. However, switching from valproate to other antiseizure medications commonly results in seizure recurrence or worsening. As compared to the general population, persons with IGE have a two- to fourfold increased risk of psychiatric disorders, the lifetime risk is 30-50%. Bidirectional associations between IGE and psychiatric conditions suggest that the latter are integral components of a broader IGE endophenotype. SUMMARY: Valproate continues to be the most efficacious treatment for IGE but also the most teratogenic, leaving women who plan to become pregnant in a dilemma. Psychiatric comorbidities are frequent in IGE and thus require special attention and a holistic treatment approach.
Neuro-vestibular rehab: new developments.
Gimmon Y, Gordon CR
Curr Opin Neurol · 2026 Feb · PMID 41502328 · Publisher ↗
PURPOSE OF REVIEW: This review highlights recent advances in neuro-vestibular rehabilitation, with emphasis on vestibular adaptation and emerging mobile technologies. It summarizes developments in promoting vestibular pl...
PURPOSE OF REVIEW: This review highlights recent advances in neuro-vestibular rehabilitation, with emphasis on vestibular adaptation and emerging mobile technologies. It summarizes developments in promoting vestibular plasticity and discusses novel tools such as virtual reality, wearable sensors, and telehealth platforms that enhance access, engagement, and outcomes. The scope is broad, focusing on general principles rather than specific populations. RECENT FINDINGS: New methods to enhance vestibulo-ocular reflex (VOR) adaptation include incremental adaptation devices and gamified exercises. Inducing VOR gain-down adaptation temporarily increases postural sway, which normalizes via sensory reweighting, demonstrating central compensation. Portable tools like StableEyes show promise in boosting VOR gain with brief sessions. Concurrently, technology-driven approaches are gaining traction. Gamified mobile applications and wearable sensors allow home-based rehabilitation with remote supervision and monitoring, showing promising results in conditions like multiple sclerosis. Virtual reality interventions and telehealth models accelerated during the COVID-19 era, expanding therapy delivery to underserved populations. Adjunctive methods such as vibrotactile feedback and galvanic vestibular stimulation are emerging as complementary therapies. SUMMARY: Recent developments are advancing vestibular rehabilitation by refining adaptive training techniques and leveraging digital tools to overcome barriers in access and adherence. These innovations point to a more personalized, technology-enabled approach to optimizing neuro-vestibular recovery.
Multimodal biomarker landscape in vestibular schwannoma.
Vasilijic S, Moore LS, Stankovic KM
Curr Opin Neurol · 2026 Feb · PMID 41502327 · Publisher ↗
PURPOSE OF REVIEW: This review provides an update on recent advances in molecular and imaging biomarker discovery for the diagnosis and prognosis of vestibular schwannoma (VS), with the goal of accelerating their validat...
PURPOSE OF REVIEW: This review provides an update on recent advances in molecular and imaging biomarker discovery for the diagnosis and prognosis of vestibular schwannoma (VS), with the goal of accelerating their validation and clinical adoption. RECENT FINDINGS: A panel of nine circulating plasma biomarkers - TNF-R2/MIF/CD30/MCP-3/IL-2R/BLC/TWEAK/eotaxin/S100B - shows strong discriminatory power between patients with VS and healthy controls, with MCP-3 and S100B correlating with hearing loss and tumor size, respectively. A ~40-fold elevation of CFHR2 levels in the perilymph of patients with severe VS-induced hearing loss implicates complement activation in cochlear inflammation. Tumor-secreted TNF-α and TWEAK reach the inner ear and exhibit synergistic ototoxicity. Tissue profiling identified two distinct biomarker panels: one comprising ANGPTL1/IL17RC/LTBR/OLR1/TGFBR1, which associates with tumor cell proliferation and migration; and another including MMP-2/MMP-14/CD80/CD163/CD45, which accurately predicts peritumoral adhesion. Several tumor-derived miRNAs, including miR-431-5p, miR-7, miR-142-3p/5p, miR-155, and hypoxamiRs, are associated with hearing outcomes and tumor growth. MRI biomarkers from dynamic contrast-enhanced and diffusion-weighted imaging, as well as perilymph signal intensity ratio correlate with tumor growth, surgical outcomes, and auditory decline, respectively. SUMMARY: This review outlines emerging circulating, tissue-derived and imaging biomarker candidates in VS that may complement MRI and support more precise diagnosis, monitoring, and individualized management.
Update on functional vestibular and gait disorders.
Staab JP
Curr Opin Neurol · 2026 Feb · PMID 41502326 · Publisher ↗
PURPOSE OF REVIEW: Three functional neurological disorders are encountered in neuro-otologic practice, persistent postural-perceptual dizziness (PPPD), which is the commonest cause of chronic vestibular and balance sympt...
PURPOSE OF REVIEW: Three functional neurological disorders are encountered in neuro-otologic practice, persistent postural-perceptual dizziness (PPPD), which is the commonest cause of chronic vestibular and balance symptoms, mal de debarquement (MdDS), a rarer but potentially debilitating disorder, and functional gait disorder, an often overlooked but treatable condition. RECENT FINDINGS: Recent investigations of PPPD suggested that there may be subtypes or subthreshold variants that merit further investigation. Studies of pathological mechanisms continue to offer new insights into the complex processes that initiate and sustain the disorder, which will require nuanced models to bring together disparate findings. Evidence continues to accumulate in support of vestibulo-ocular reflex readaptation therapy for MdDS, with pilot studies offering refinements and possible alternatives. Functional gait disorder is one of the commonest manifestations of functional neurological disorder, often presenting with other functional neurological symptoms including PPPD. Specialized methods of physical and occupational therapy continue to mature. Optimal outcomes may require short and focused periods of intensive treatment. SUMMARY: Evolving theories and continuing emergence of new data are beginning to make functional vestibular and gait disorders a manageable part of neuro-otologic practice.
Converging perspectives in vestibular neurology.
Bronstein AM
Curr Opin Neurol · 2026 Feb · PMID 41502325 · Publisher ↗
Abstract loading — click title to view on PubMed.
Endovascular treatment of distal medium vessel occlusions.
Ciacciarelli A, Pensato U, Ospel JM
Curr Opin Neurol · 2026 Feb · PMID 41502324 · Publisher ↗
PURPOSE OF REVIEW: Endovascular treatment (EVT) has dramatically improved outcomes of patients suffering from acute ischemic stroke due to large vessel occlusion (LVO), becoming the standard of care. However, up to one-t...
PURPOSE OF REVIEW: Endovascular treatment (EVT) has dramatically improved outcomes of patients suffering from acute ischemic stroke due to large vessel occlusion (LVO), becoming the standard of care. However, up to one-third of ischemic strokes are caused by distal medium vessel occlusions (DMVO), which are beyond the LVO territory. Medical management, including intravenous thrombolysis, leaves more than half of DMVO patients disabled at 3 months, with mortality exceeding 10%. In face of this grim prognosis, expanding EVT to DMVO has gained considerable interest. This review summarizes the clinical, anatomical, and imaging features of DMVO stroke, discusses recent EVT trial results and their interpretation, and outlines future directions for establishing safe and effective reperfusion strategies in this population. RECENT FINDINGS: Recent randomized trials investigating EVT for DMVO stroke yielded neutral results overall. However, they provided important insights about patient subgroups likely to benefit from intervention and set key challenges to improving the management of patients with DMVO. SUMMARY: While current evidence does not support routine EVT for DMVO stroke, the field is evolving rapidly. Ongoing advances in device technology, patient selection, and trial design hold promise for refining treatment and improving outcomes in carefully selected patients.
Progress in the identification of unstable carotid artery plaque.
Saba L
Curr Opin Neurol · 2026 Feb · PMID 41355355 · Publisher ↗
PURPOSE OF REVIEW: Ischemic stroke remains a leading cause of death and disability worldwide, with carotid atherosclerosis as a major underlying mechanism. For decades, treatment decisions were based primarily on luminal...
PURPOSE OF REVIEW: Ischemic stroke remains a leading cause of death and disability worldwide, with carotid atherosclerosis as a major underlying mechanism. For decades, treatment decisions were based primarily on luminal stenosis, overlooking the biological complexity of plaque instability. This review summarizes recent progress in the imaging-based identification and risk stratification of unstable cerebrovascular plaque, emphasizing the transition from geometric to biological evaluation. RECENT FINDINGS: Advances in CT, MRI, and ultrasound have enabled in vivo visualization of key features associated with plaque vulnerability, including intraplaque hemorrhage, fibrous cap rupture, neovascularization, inflammation, and perivascular fat alterations. Dual-energy and photon-counting CT now provide spectral and spatial information capable of tissue differentiation at submillimeter scales. MRI offers superior soft-tissue characterization, while contrast-enhanced ultrasound reveals microvascular activity and flow dynamics. The recent introduction of standardized interpretative systems, such as Plaque-reporting and data system (RADS), allows integration of multimodal findings into a unified risk framework. SUMMARY: Contemporary imaging has transformed the assessment of carotid atherosclerosis from a static measurement of stenosis into a dynamic, biology-driven discipline. The combination of advanced imaging, quantitative analysis, and emerging molecular and genetic correlates promises to refine individualized risk prediction and guide targeted prevention strategies for cerebrovascular disease.
Precision medicine in Moyamoya vasculopathy.
Patel R, Memon M, Mendoza JA … +3 more , Qadeer YK, Tangsrivimol JA, Krittanawong C
Curr Opin Neurol · 2026 Feb · PMID 41355354 · Publisher ↗
PURPOSE OF REVIEW: Moyamoya vasculopathy is a progressive cerebrovascular steno-occlusive disease with variable presentation. As revascularization techniques, antiplatelet therapies, and imaging-based artificial intellig...
PURPOSE OF REVIEW: Moyamoya vasculopathy is a progressive cerebrovascular steno-occlusive disease with variable presentation. As revascularization techniques, antiplatelet therapies, and imaging-based artificial intelligence (AI) diagnostics continue to advance, there is an emerging opportunity to refine patient stratification by integrating genetic profiling, neuroimaging phenotypes, and circulating biomarkers. RECENT FINDINGS: The RNF213 locus (particularly p.R4810K) represents the primary susceptibility allele in East Asian cohorts, with secondary contributors including ACTA2 and GUCY1A3 showing incomplete penetrance. Emerging. data reveal dysregulated lipid metabolism, impaired arginine-arginine-nitric oxide (NO) and methionine signaling, heightened oxidative stress, and ferroptotic pathways. Proteomic studies identify disrupted angiogenic and cytoskeletal programs with potential biomarker utility in cerebrospinal fluid and serum. Current diagnostic standards employ MRI/MRA and digital subtraction angiography. Observational data support antiplatelet agents, including cilostazol, in reducing stroke recurrence and mortality. Direct and combined bypass approaches demonstrate superior outcomes in adult hemorrhagic disease, whereas indirect revascularization predominates in pediatric populations. Emerging AI-integrated diagnostic algorithms incorporating imaging and multiomic data exhibit promising diagnostic accuracy. SUMMARY: Systematic integration of genotypic and multiomic profiling with hemodynamic assessment could enhance prognostic precision, optimize surgical timing, and guide antiplatelet selection in Moyamoya. Next step priorities include studying ethnically diverse multicenter registries and rigorous trials evaluating targeted and regenerative therapeutic strategies. Digital subtraction angiography (DSA)-guided diagnosis and individualized revascularization strategies remain the clinical standard.
Vestibular migraine. Clinical and diagnostic challenges, and emerging therapeutic approaches.
Villar-Martinez MD, Abdalla A, Goadsby PJ
Curr Opin Neurol · 2026 Feb · PMID 41324222 · Full text
PURPOSE OF REVIEW: Vestibular migraine (VM) is a prevalent yet underdiagnosed cause of vestibular symptoms, which overlaps with other vestibular and migraine-related conditions. This review focuses on detailed clinical p...
PURPOSE OF REVIEW: Vestibular migraine (VM) is a prevalent yet underdiagnosed cause of vestibular symptoms, which overlaps with other vestibular and migraine-related conditions. This review focuses on detailed clinical phenomenology, alongside comorbidities, and the appraisal of emerging therapies. RECENT FINDINGS: Recent work shows that migraine-associated features such as allodynia, photophobia, and movement sensitivity sharpen clinical discrimination. Premonitory and cognitive symptoms, including brain fog and executive slowing, are increasingly recognized. Chronobiological factors such as menstrual cycle and menopause modulate susceptibility. Oculomotor assessment and neuroimaging point to disturbed integration across vestibular, sensorimotor, and visual networks rather than focal lesions. Comorbid persistent postural-perceptual dizziness, dysautonomia, and autoimmune tendencies complicate diagnosis and management. Early trials support calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxin-A, with lifestyle interventions, and nutraceuticals commonly being used, although clinical trial designs and endpoints remain heterogeneous. SUMMARY: VM reminds us that bedside examination remains the anchor: a detailed history, eye-movement examination, and context refine diagnosis. Objective markers and interdisciplinary strategies assist rather than replace clinical judgement. Further studies should integrate multimodal assessment and phenotype-guided treatment stratification.
The cortical vestibular system: insights from electroencephalography.
Bronstein AM, Mirdamadi JL, Ellmers TJ
Curr Opin Neurol · 2026 Feb · PMID 41311190 · Full text
PURPOSE OF REVIEW: Although electroencephalography (EEG) is central to epilepsy diagnosis, its role in patients presenting with dizziness or balance disorders has historically been negligible. This review provides a time...
PURPOSE OF REVIEW: Although electroencephalography (EEG) is central to epilepsy diagnosis, its role in patients presenting with dizziness or balance disorders has historically been negligible. This review provides a timely synthesis of recent methodological and conceptual advances demonstrating how modern EEG analyses can probe cortical contributions to vestibular and balance function. RECENT FINDINGS: While vestibular epilepsy remains rare, EEG is increasingly being applied to investigate cortical dynamics during vestibular stimulation, postural control, and balance perturbations. Contemporary analytic techniques have revealed that alpha-band and beta-band EEG activity reflect key aspects of vestibular perception, adaptation, and postural control. Findings in patients with higher order vestibular dysfunction link symptoms to abnormal oscillatory patterns corresponding to disrupted sensory integration and maladaptive attentional engagement. Advances in mobile EEG approaches now permit reliable signal acquisition during movement and direct vestibular stimulation, allowing quantification of ecologically relevant cortical responses such as the perturbation-evoked potential. SUMMARY: EEG provides a powerful, accessible, and scalable tool to characterize cortical contributions to vestibular processing and balance. These developments highlight its emerging value for identifying neurophysiological biomarkers of vestibular dysfunction, improving diagnostic precision, and informing targeted rehabilitation strategies.
Recent advances in stroke biomarkers - implications for prognosis and treatment.
Seetge J, Frenger J, Katan M … +1 more , Grosse GM
Curr Opin Neurol · 2026 Feb · PMID 41311168 · Full text
PURPOSE OF REVIEW: To summarize recent advances in blood-based biomarkers for acute ischemic stroke relevant to diagnosis, etiological assessment, risk prediction, and outcome prognostication, and to outline future direc...
PURPOSE OF REVIEW: To summarize recent advances in blood-based biomarkers for acute ischemic stroke relevant to diagnosis, etiological assessment, risk prediction, and outcome prognostication, and to outline future directions for clinical implementation. RECENT FINDINGS: Novel biomarkers enhance differentiation of ischemic from hemorrhagic stroke and large vessel occlusion detection, optimizing triage via point-of-care testing. Specific biomarkers improve etiological classification and identification of mechanisms like cardioembolic sources and atrial cardiopathy, enabling targeted secondary prevention. Circulating markers stratify risks of vascular recurrence and infections, linking inflammatory, thrombotic, and endothelial pathways. Prognostic biomarkers refine predictions of functional outcomes, mortality, and reperfusion responses. SUMMARY: To translate these promising findings into clinical care and to identify novel molecular targets, standardized sample collection, rigorous external validation, and multiomics/panel integration will be required. In this sense, blood-based-biomarkers have the potential to sustainably improve diagnostics, prognosis and treatment in stroke care.
Acute vertigo: stroke or not?
Kaski D
Curr Opin Neurol · 2026 Feb · PMID 41263134 · Full text
PURPOSE OF REVIEW: Acute vertigo accounts for about 4% of emergency department visits in both the United States and Europe. Despite this frequency, the management of dizziness, vertigo, and balance disorders remains frag...
PURPOSE OF REVIEW: Acute vertigo accounts for about 4% of emergency department visits in both the United States and Europe. Despite this frequency, the management of dizziness, vertigo, and balance disorders remains fragmented, with no established international care pathway. The acute vestibular syndrome (AVS) is particularly challenging, and timely recognition is essential to avoid potentially devastating outcomes. This review is timely, because misdiagnosis rates remain unacceptably high, especially for posterior circulation strokes presenting with dizziness. RECENT FINDINGS: The literature highlights a wide differential diagnosis for AVS, ranging from benign peripheral vestibular disorders to life-threatening central causes. Distinguishing stroke from peripheral disorder remains a key clinical dilemma, compounded by the limitations of early neuroimaging - MRI can yield false negatives within 48 h. Up to 35% of posterior circulation strokes with dizziness are initially missed, often by nonspecialists unfamiliar with targeted bedside tests. SUMMARY: A structured bedside approach, focusing on key clinical features and targeted examination, can improve diagnostic accuracy and reduce delays in appropriate treatment. Incorporating such strategies into standard practice could address a major gap in acute neurology care and improve patient outcomes.
Imaging of vestibular function and disorders and its clinical relevance.
Dieterich M, Brandt T
Curr Opin Neurol · 2026 Feb · PMID 41262047 · Full text
PURPOSE OF REVIEW: To discuss recent advances in imaging of the structural organization and functional connectivity of central vestibular disorders with various MRI techniques. Vestibular paroxysmia, in particular the ch...
PURPOSE OF REVIEW: To discuss recent advances in imaging of the structural organization and functional connectivity of central vestibular disorders with various MRI techniques. Vestibular paroxysmia, in particular the characteristics of neurovascular cross-compression of the eighth nerve, serves as an example of the peripheral vestibular disorders. MAIN FINDINGS: The bilateral vestibular system is intricately connected with other sensory systems and is hierarchically organized within sensory, motor, cognitive, emotional, and memory networks. This has been demonstrated by fMRI using galvanic vestibular stimulation and fear-conditioning paradigms. Another study using transcranial electrical stimulation of the prefrontal cortex alongside galvanic vestibular stimulation showed that vestibular sensations and BOLD signals in the vestibular cortex were reduced, indicating a top-down control of vestibular input. Acute vascular cerebellar lesions around the midline and brainstem lesions affecting the vestibular nuclei can clinically mimic acute unilateral vestibulopathy; an MRI becomes clinically relevant after a few days. In unilateral thalamic infarcts, ipsilateral or contralateral tilts of perceived verticality can be differentiated by functional connectivity MRI. Rare cases of cortical rotational vertigo are due to a disconnection of interhemispheric pathways via the corpus callosum. About 30% of patients with vestibular migraine have a mild bilateral endolymphatic hydrops of the inner ear, especially in the vestibulum rather than the cochlea. Classical vestibular paroxysmia is caused by neurovascular cross-compression, which is most reliably detected by vestibular nerve angulation in DTI-MRI. SUMMARY: The general message of this selected review is that peripheral and central vestibular disorders do not present solely with purely vestibular signs and symptoms; they involve various levels of subcortical and cortical structures organized into neural networks.
Neuro-oncology is moving quickly toward new horizons of diagnosis and treatment.
Soffietti R
Curr Opin Neurol · 2025 Dec · PMID 41189510 · Publisher ↗
Abstract loading — click title to view on PubMed.
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