BACKGROUND: Sarcopenia is a common and often overlooked nonmotor symptom of Parkinson's disease (PD), significantly increasing the risk of falls and exacerbating the disease burden. Increasing evidence suggests that PD i...BACKGROUND: Sarcopenia is a common and often overlooked nonmotor symptom of Parkinson's disease (PD), significantly increasing the risk of falls and exacerbating the disease burden. Increasing evidence suggests that PD is not merely a neurodegenerative disease confined to the central nervous system (CNS) but also involves significant systemic metabolic disturbances and peripheral tissue dysfunction, indicating a systemic pathological character. In recent years, epigenetic modifications have gradually become an important perspective for understanding the inflammatory progression of PD. Lactate is no longer simply considered the end product of glycolysis, but can regulate gene transcription and protein function through protein lactylation. OBJECTIVE: This paper systematically proposes that lactylation is a key molecular bridge between neuroinflammation and sarcopenia in PD. METHODS: We searched literature from the PubMed database from 2010 to 2026, screened qualified English articles, and integrated the latest research advances in neuroimmunology, skeletal muscle biology, and metabolic epigenetics. RESULTS: In PD, microglia epigenetic modifications and metabolic reprogramming lead to lactate accumulation, which may drive a persistent neuroinflammatory response through lactate modification. Simultaneously, chronic inflammation and metabolic abnormalities can propagate along the brain-muscle axis, promoting skeletal muscle protein metabolic imbalance and accelerating the development of sarcopenia. Based on this, this paper systematically proposes that lactylation is a key molecular bridge between neuroinflammation and sarcopenia in PD. Combining the latest research advances in neuroimmunology, skeletal muscle biology, and metabolic epigenetics, this paper elucidates the potential mechanisms by which abnormal lactate metabolism and lactylation play a role in altered glial cell inflammatory phenotypes and skeletal muscle homeostasis imbalances. Furthermore, in conjunction with exercise intervention studies, this paper explores how lactylation, as a key regulatory molecule, can achieve bidirectional improvement in CNS inflammation and peripheral muscle function, providing a new theoretical basis for systemic intervention strategies for PD.
De Marco G, Bernabé G, Leta C
… +18 more, Menghi V, Faini C, Morri D, Ceccaroni F, Bitondo MM, Saporito D, Visconti E, Lolli F, Menetti F, Ottani F, Baiocchi M, Salcuni A, Ruggiero M, Lotti EM, Montomoli J, Grippo A, Callegarini C, Romoli M
BACKGROUND AND OBJECTIVES: Post-cardiac arrest (CA) prognostication primarily focuses on predicting poor outcome, whereas early markers of good prognosis remain less explored. We aimed to identify early predictors of fav...BACKGROUND AND OBJECTIVES: Post-cardiac arrest (CA) prognostication primarily focuses on predicting poor outcome, whereas early markers of good prognosis remain less explored. We aimed to identify early predictors of favorable outcome at 3 months in comatose CA survivors. METHODS: We prospectively enrolled adult patients with post-anoxic coma admitted to the Intensive Care Unit of a secondary-care hospital (2020-2025). Demographic, CA-related, clinical, electroencephalographic (EEG), neuron-specific enolase (NSE) and neuroimaging data were collected. Good outcome was defined as Cerebral Performance Category (CPC) 1-2 at 3 months. Logistic regression analyses identified independent predictors of good outcome. Model performance was internally validated with bootstrap resampling. RESULTS: Among 121 included patients (median age = 66; 72% male), outcome was available for 118, of whom 42.3% achieved good outcome. Patients with CPC 1-2 were younger, had predominant shockable initial rhythms and cardiac etiology of CA, higher Glasgow Coma Scale scores, lower NSE levels, and decreasing NSE trend. Peak NSE ≤ 36 ng/mL was the optimal cut-off for favorable prognosis. Early benign EEG (continuous/nearly continuous background with preserved reactivity ≤72 h) was associated with neurological recovery. In multivariable analysis, independent predictors of favorable outcome were younger age (OR 0.92, 95% CI 0.86-0.99), shockable initial rhythm (OR 28.0, 95% CI 3.87-202.1), early benign EEG (OR 10.76, 95% CI 1.95-59.4) and peak NSE ≤ 36 ng/mL (OR 43.17, 95% CI 6.01-309.9). The model showed excellent discrimination (apparent AUC 0.97, optimism-corrected AUC 0.96). CONCLUSIONS: In comatose post-CA patients, a model combining age, initial rhythm, early benign EEG and peak NSE independently predicted good outcome at 3 months.
BACKGROUND: Telemedicine has expanded rapidly in neurological care and is increasingly applied to headache management to improve access and continuity of follow-up. However, patient experience and healthcare system impac...BACKGROUND: Telemedicine has expanded rapidly in neurological care and is increasingly applied to headache management to improve access and continuity of follow-up. However, patient experience and healthcare system impact in real-world practice remain insufficiently explored. OBJECTIVE: The objective of this narrative review is to evaluate clinical effectiveness, patient experience, and healthcare system impact in the management of headache disorders. METHODS: A narrative review of the literature was conducted, including randomized controlled trials, observational studies, real-world evidence contributions, and reviews addressing telemedicine in headache care. Evidence was synthesized thematically, focusing on clinical outcomes, patient acceptance, and implementation aspects. RESULTS: Available evidence supports the clinical effectiveness and safety of telemedicine in selected headache patients, particularly in non-acute settings and structured follow-up pathways. Outcomes assessed using validated instruments (HIT-6, MIDAS, VAS) are generally comparable to in-person visits. High patient satisfaction and willingness to continue telemedicine are consistently reported, mainly due to convenience and time and cost savings. Real-world studies suggest telemedicine may improve access to specialist care and optimize healthcare resource utilization, although challenges related to digital literacy, organizational requirements, and equity remain. CONCLUSIONS: Telemedicine is a valuable component of contemporary headache management when integrated into structured clinical pathways. Beyond clinical effectiveness, patient experience and organizational context are critical for successful implementation. Future research should focus on standardized care models, larger populations, and long-term real-world outcomes.
BACKGROUND: Cardiac surgery is a major therapeutic advancement but remains associated with neurological complications, including ischemic stroke and postoperative cognitive decline. Compared with stroke of other etiologi...BACKGROUND: Cardiac surgery is a major therapeutic advancement but remains associated with neurological complications, including ischemic stroke and postoperative cognitive decline. Compared with stroke of other etiologies, ischemic brain injury following cardiac surgery may involve distinct vascular territories and functional networks, potentially influencing its characteristic cognitive profile. METHODS: We performed a systematic review of case reports describing ischemic brain lesions occurring after cardiac surgery in adults with available neuroimaging data. Lesions were manually traced onto a standard brain atlas and compared with ischemic stroke lesions from the ATLAS database, matched for hemispheric involvement. Lesion topography was analyzed at the arterial territory and voxel levels. Lesion network mapping was conducted using normative resting-state functional connectivity data to identify patterns of functional disconnection. Permutation-based statistical analyses were applied, with correction for multiple comparisons and lesion volume included as a covariate. RESULTS: Nineteen articles met the inclusion criteria, yielding 20 cases of post-cardiac surgery ischemic lesions. Compared with stroke controls, these lesions more frequently involved posterior arterial territories, particularly the occipital branches of the posterior cerebral arteries and posterior thalamic regions. Lesion network mapping revealed a distinct pattern of functional disconnection in the occipital lobes, posterior thalamus (including the pulvinar), and medial frontal cortex. CONCLUSIONS: Our results suggest that ischemia associated with cardiac surgery may preferentially involve posterior arterial territories and be associated with distinct patterns of functional disconnection involving the occipital lobe, the pulvinar, and the medial frontal cortex.
BACKGROUND: Evidence regarding the clinical manifestations, disease-specific profiles and diagnostic significance of limb apraxia in Parkinson's disease and Atypical Parkinsonian Syndromes (APS) is limited. OBJECTIVES: T...BACKGROUND: Evidence regarding the clinical manifestations, disease-specific profiles and diagnostic significance of limb apraxia in Parkinson's disease and Atypical Parkinsonian Syndromes (APS) is limited. OBJECTIVES: The present systematic review aims to consolidate current knowledge on limb apraxia across neurodegenerative disorders, including Parkinson's disease (PD), corticobasal syndrome (CBS), Progressive Supranuclear Palsy (PSP) and Multiple System Atrophy (MSA). METHODS: A systematic literature review was conducted in accordance with PRISMA guidelines. Studies were included if they enrolled ≥ 10 patients in at least one of the patient groups and ≥ 10 control subjects with quantitative data on apraxic deficits. Risk of bias assessment was assessed. RESULTS: Twenty-two studies met inclusion criteria (PD n = 11; CBS n = 10; PSP n = 7; MSA n = 3). Across PD and APS, praxis assessment primarily involved gesture imitation, pantomime, action sequencing, actual tool use and measures of fine motor coordination. CBS demonstrated the most severe/widespread apraxic impairment, affecting both meaningless and meaningful (transitive and intransitive) gestures, as well as action sequencing and fine motor control. In PD, apraxic deficits were generally milder but shared overlapping features with CBS. Direct comparative studies between PD and CBS remain scarce. PSP was characterized by less frequent and predominantly sequence-related impairments, whereas findings in MSA were heterogeneous and less pronounced. CONCLUSIONS: Limb apraxia phenotypes differ across PD, CBS, PSP and MSA and may contribute to their differential diagnosis. Future research should adopt standardized, multimodal praxis assessment protocols in larger cohorts including all major neurodegenerative parkinsonian disorders, to facilitate the direct comparison of limb apraxia across these diseases.
INTRODUCTION: Primary Sjögren's syndrome (pSS) is a chronic autoimmune disorder primarily affecting exocrine glands but frequently associated with extra glandular manifestations, including neurological involvement. Centr...INTRODUCTION: Primary Sjögren's syndrome (pSS) is a chronic autoimmune disorder primarily affecting exocrine glands but frequently associated with extra glandular manifestations, including neurological involvement. Central nervous system (CNS) involvement is a rare and potentially severe manifestation of pSS, often leading to diagnostic uncertainty. We describe a case of pSS presenting with systemic manifestations and suspected CNS inflammatory involvement. METHODS: We report the clinical, laboratory, and imaging findings of a 43-year-old woman presenting with progressive focal neurological deficits and systemic symptoms. Diagnostic workup included brain MRI with magnetic resonance angiography (MRA) and vessel wall imaging (VWI), cerebrospinal fluid (CSF) analysis, autoimmune and infectious screening, and renal biopsy. RESULTS: Brain MRI revealed cerebral severe small vessel disease (cSVD), while MRA showed diffuse intracranial arterial irregularities, predominantly involving the vertebrobasilar circulation. VWI demonstrated vascular enhancement. Laboratory findings included high-titer antinuclear antibodies and anti-SSA/SSB positivity. Renal biopsy revealed tubulointerstitial nephritis with microangiopathic vascular changes. The overall clinical, laboratory, histopathological and imaging findings confirmed the diagnosis of pSS and suggested suggested a possible inflammatory vascular mechanism underlying the CNS involvement. The patient was treated with high-dose corticosteroids followed by rituximab. CONCLUSIONS: CNS inflammatory involvement may represent a rare manifestation of pSS and should be considered in patients with unexplained neurological symptoms and systemic autoimmune features. Advanced imaging techniques such as VWI may provide complementary informations. Early recognition and a multidisciplinary approach are essential to guide treatment and improve outcomes.
OBJECTIVE: This study aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for improving spasticity, motor function, and activities of daily living (ADL) in patients with post-stroke s...OBJECTIVE: This study aimed to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for improving spasticity, motor function, and activities of daily living (ADL) in patients with post-stroke spasticity (PSS), and to perform a comprehensive analysis of key factors related to its therapeutic effect. METHODS: Relevant randomized controlled trials (RCTs) were retrieved from four databases. Meta-analysis was conducted using RevMan, and the quality of evidence was assessed with the GRADEpro tool. RESULTS: Overall, 13 studies (encompassing 18 RCTs) were included. The results demonstrated that rTMS alleviated PSS (MD = - 0.23, 95% CI: -0.43 to - 0.02, P = 0.03) and improved motor (MD = 2.46, 95% CI: 1.54 to 3.38, P < 0.00001), whereas it showed no significant effect on ADL (SMD = 0.31, 95% CI: -0.06 to 0.67, P = 0.10). For spasticity, stimulating the unaffected hemisphere achieved significantly better efficacy (SMD = -0.19, 95% CI: -0.37 to -0.00, P = 0.05), and combined high and low frequency rTMS showed promising effects (SMD = -0.65, 95% CI: -0.94 to -0.36, P < 0.00001). For motor function, rTMS yielded greater improvement in upper limb PSS patients (SMD = 3.58, 95% CI: 2.18 to 4.98, P < 0.00001). Within a certain range, pulse number was positively correlated with motor improvement (β = 2.46, 95% CI: 0.097 to 4.81, P = 0.043). CONCLUSION: Moderate to high quality evidence demonstrates that rTMS can potentially alleviate PSS and improve motor function in patients, whereas its efficacy in improving ADL remains unclear, with very low quality of evidence. In addition, stimulation frequency, stimulation site, pulse number, and affected site are key moderators of rTMS efficacy. These findings guide the clinical optimization of rTMS regimens, and future research is required to identify specific parameter thresholds.
BACKGROUND: Age-standardised rates of motor neuron disease (MND) have declined in many settings, yet the absolute burden continues to rise in ageing populations. Whether this divergence is driven by demographic change or...BACKGROUND: Age-standardised rates of motor neuron disease (MND) have declined in many settings, yet the absolute burden continues to rise in ageing populations. Whether this divergence is driven by demographic change or epidemiological shifts remains unclear, particularly in China. METHODS: Using data from the Global Burden of Disease Study 2021, we analysed trends in MND burden in China from 1990 to 2021. Decomposition analysis was applied to quantify the contributions of population ageing, population growth, and changes in age-specific rates. Age-specific incidence patterns were compared with global estimates, and key findings were validated against recent Chinese epidemiological studies. RESULTS: Despite declining age-standardised prevalence and DALY rates, the absolute number of cases and DALYs increased substantially. Population ageing accounted for 46.0% of the increase in DALYs, followed by population growth (35.0%) and changes in age-specific rates (19.0%). Age-specific incidence rates in China were consistently lower than global estimates. External validation demonstrated high consistency with national epidemiological studies. CONCLUSIONS: The increasing burden of MND in China is primarily driven by demographic ageing rather than increasing disease risk. Declining age-standardised rates may mask growing healthcare demands in rapidly ageing populations.
BACKGROUND: Natalizumab is effective for relapsing-remitting multiple sclerosis (RRMS) but increases the risk of progressive multifocal leukoencephalopathy (PML). Extended-interval dosing (EID) may lessen this risk by re...BACKGROUND: Natalizumab is effective for relapsing-remitting multiple sclerosis (RRMS) but increases the risk of progressive multifocal leukoencephalopathy (PML). Extended-interval dosing (EID) may lessen this risk by reducing drug exposure, though its efficacy and safety compared with standard-interval dosing (SID) remain unclear. This review and meta-analysis evaluates both regimens across clinical and MRI outcomes. METHODS: Following PRISMA guidelines, we systematically searched PubMed, Scopus, Web of Science, Cochrane Library, and ScienceDirect from inception to July 2025. Eligible studies compared extended- (5-12 weeks) and standard-interval (4 weeks) natalizumab dosing in MS. Meta-analyses used random- or fixed-effects models with results as RR or MD based on heterogeneity (I²). RESULTS: Twenty-five studies were included. Analysis showed no significant differences between EID and SID in disability progression (MD -0.09, 95% CI: -0.46 to 0.29), or the risk of new T2 lesions (RR 1.24, 95% CI: 0.96 to 1.61). For PML incidence (RR 1.03, 95% CI: 0.29-3.60), the analysis was severely underpowered due to rare events; the wide confidence interval precludes any firm conclusion about comparative safety. However, EID was associated with a significantly higher risk of gadolinium-enhancing lesions (RR 1.35, 95% CI: 1.03-1.77). EID was associated with a borderline reduction in the risk of clinical relapse (RR 0.91, 95% CI: 0.83 to 1.00), but this finding is likely influenced by selection bias and should be considered hypothesis-generating rather than confirmatory. Subgroup analysis suggested a possible difference between intervals (P = 0.0323 for T2 lesions), but this finding is based on very sparse data, with only one subgroup (Q5-8 W) containing multiple studies and all other subgroups relying on single studies. Therefore, no definitive conclusion about optimal interval length can be drawn; the result is hypothesis-generating only. CONCLUSION: Extended-interval dosing of natalizumab shows efficacy and safety comparable to standard dosing. Although relapse reduction was noted, this may reflect selection bias. Shorter EID intervals (5-8 weeks) appear to maintain better radiologic control, supporting EID up to 6-8 weeks as a viable option pending long-term and biomarker-guided validation.
OBJECTIVE: This study aimed to evaluate spontaneous swallowing frequency (SS-FR) and type of swallowing during awake and sleep states in patients with Parkinson's Disease (PD), using polygraphic recordings to identify po...OBJECTIVE: This study aimed to evaluate spontaneous swallowing frequency (SS-FR) and type of swallowing during awake and sleep states in patients with Parkinson's Disease (PD), using polygraphic recordings to identify possible associations with disease severity. METHODS: A total of 27 PD patients (19 male, 8 female) and 22 age-matched healthy controls were included. All participants underwent whole-night one-hour polygraphic monitoring, and SS-FR and type of swallowing were analyzed during both wakefulness and sleep stages. Clinical characteristics, disease severity (Hoehn and Yahr staging), and motor symptoms (Unified Parkinson's Disease Rating Scale) were assessed. RESULTS: SS-FR was significantly lower in PD patients compared to controls, both during wakefulness and especially during sleep. In PD patients, SS-FR during wakefulness was positively correlated with Hoehn and Yahr stage and motor symptom scores. The presence of dysphagia was more common in patients with markedly reduced SS-FR, indicating its potential role as a non-invasive marker for swallowing impairment. Salvo swallowing was observed in 4.5% (n = 1) of controls and 40.7% (n = 11) of patients with PD (p = 0.003). CONCLUSION: SS-FR is significantly altered in PD, with reductions during both awake and sleep states reflecting disease severity. SS-FR measurement through polygraphic recordings may have potential as a non-invasive marker for early detection of swallowing disorders and progression in PD.
We report a case of muscular polyarteritis nodosa in a 23-year-old man with no past medical history presenting with diffuse myalgias, weight loss, fatigue, hypertension, and elevated C-reactive protein. Normal creatine k...We report a case of muscular polyarteritis nodosa in a 23-year-old man with no past medical history presenting with diffuse myalgias, weight loss, fatigue, hypertension, and elevated C-reactive protein. Normal creatine kinase and electromyography contributed to a delayed diagnosis. MRI-guided muscular biopsy confirmed necrotizing vasculitis. Corticosteroid therapy led to rapid improvement.
To provide a practical framework for neuropsychological assessment in adult epilepsy, specifying what each measure evaluates and how results can support clinical decisions regarding epileptic patients. This work is a cli...To provide a practical framework for neuropsychological assessment in adult epilepsy, specifying what each measure evaluates and how results can support clinical decisions regarding epileptic patients. This work is a clinically oriented narrative review and expert proposal for non-surgical adult epilepsy care in Italian settings. Test selection was guided by domains repeatedly emphasized in epilepsy neuropsychology, by their practical relevance to routine clinical decision-making, by compatibility with major international recommendations, and by the availability of Italian adaptations or normative data. For each test, we describe the primary construct assessed and the specific epilepsy-related clinical question it may help address. Structured cognitive exams can be sensitive to lateralization and localization, medication-related cognitive effects, and comorbid mood and anxiety symptoms. When integrated with electroencephalography and structural imaging, these profiles support clinical interpretation and guide counseling. Serial assessment can also inform medical management, rehabilitation planning, and quality-of-life interventions. The expanded framework clarifies which patients should be referred for assessment, why epilepsy must be conceptualized as a heterogeneous group of syndromes and network disorders, where neuropsychological data may support but not replace differential diagnosis, and how current ILAE recommendations contextualize the proposed battery. Neuropsychological assessment is a core component of comprehensive epilepsy care, but its clinical value is greatest when the battery is tailored to the referral question, syndrome, disease stage, treatment context, and patient priorities. The proposed battery should be read as a structured, adaptable framework for routine adult non-surgical practice, rather than as a rigid battery to be applied uniformly across patients.
BACKGROUND: This study assessed the early implementation of transradial access (TRA) for mechanical thrombectomy (MT) in a primary stroke center (PSC) using a retrospective sequential cohort design with propensity score...BACKGROUND: This study assessed the early implementation of transradial access (TRA) for mechanical thrombectomy (MT) in a primary stroke center (PSC) using a retrospective sequential cohort design with propensity score matching. METHODS: We retrospectively analyzed patients with acute large vessel occlusion who underwent MT between January 2022 and December 2024. Patients were assigned to a transfemoral access (TFA) period (January 2022-June 2023) or a TRA period (July 2023-December 2024) based on the timing of formal TRA adoption. Propensity score matching (1:1) was used to reduce baseline imbalance. Primary outcomes were successful recanalization and favorable 90-day functional outcome (modified Rankin Scale 0-2). Secondary outcomes included access-site complications, hospital length of stay, and symptomatic intracranial hemorrhage (sICH). RESULTS: Of 74 eligible patients, 56 were included after matching (28 pairs). Successful recanalization (89.3% vs. 85.7%, P = 1.000) and favorable 90-day outcomes (53.6% vs. 46.4%, P = 0.796) were similar between the TRA and TFA groups. Major vascular complications were rare (0% vs. 3.6%, P = 1.000). Total access-site events were less frequent with TRA, although not statistically significant (3.6% vs. 25.0%, P = 0.052). Hospital stay was shorter during the TRA period (median, 7.0 vs. 10.0 days; P = 0.008). No significant differences were observed in sICH or 90-day mortality. CONCLUSIONS: Early TRA implementation in a PSC appeared feasible, with similar reperfusion and functional outcomes and a favorable safety profile. These findings should be considered exploratory given the small sample size and potential temporal improvements in stroke care.