Hyperkinetic movement disorders, including dystonia and choreiform syndromes, are pathophysiologically linked to dysregulated dopamine metabolism within the basal ganglia-thalamo-cortical (BGTC) circuitry. Mounting research highlights dopaminergic hyperactivity as a driver of aberrant signaling and motor symptoms. Vesicular monoamine transporters (VMATs) package monoamines into synaptic vesicles, yet they remain pharmacologically underexplored compared to plasma membrane transporters. Recent advances in VMAT2 inhibitors offer a promising therapeutic avenue for hyperkinetic movement disorders. As a selectivity VMAT2 inhibitor, deutetrabenazine demonstrates unique advantages in dopamine modulation due to deuterium isotope-mediated metabolic stabilization, which extends the dynamics of dopamine receptor occupancy and reduces fluctuations in plasma concentration. Clinically, deutetrabenazine has emerged as a significant therapeutic approach for hyperkinetic movement disorders, with substantial evidence supporting its efficacy in the treatment of chorea associated with Huntington’s disease (HD), tardive dyskinesia (TD), and Tourette syndrome. Future research should prioritize large-scale randomized trials incorporating rigorous subgroup analyses and extended safety monitoring to assess the distinct role of deutetrabenazine in other types of hyperkinetic movement disorders. This review unpacks the workings of VMAT2 inhibitors, paying particular attention to deutetrabenazine’s distinct metabolic profile, and assesses their clinical promise across the range of choreiform disorders to hyperkinetic dystonic syndromes.
Background Patients with multiple sclerosis (MS) report high prevalence of sleep fragmentation and poor sleep quality. However, the relationship between sleep and MS is poorly understood. Objectives To identify the prevalence of obstructive sleep apnea (OSA) among patients with MS, assess the difference between patients with MS and healthy controls in sleep metrics detected by polysomnography, and evaluate the impact of OSA metrics on disability indices. Design Systematic review and meta-analysis. Methods On September 29, 2025, we searched PubMed, Embase, Scopus, CINAHL and CENTRAL. The inclusion criteria were observational studies that included patients with MS who underwent polysomnography and reported the prevalence of OSA, the difference in polysomnography data such as total sleep time, sleep efficiency, and apnea hypopnea index (AHI) between patients with MS and healthy controls or the correlation between the aforementioned polysomnography variables and MS disability indicated by expanded disability status scale (EDSS) or symbol digit modality test (SDMT). Weighted mean difference (WMD) and rho (r) correlation coefficient and their associated 95% confidence intervals (95%CI) were used as the effect measures in the analysis. Results A total of 3,264 patients with MS and 679 healthy controls from 40 studies were included in the analysis. The prevalence of OSA among patients with MS was 44% (95%CI: 33%-56%). Patients with MS had lower total sleep time (WMD=-37.70; 95%CI: -62.27- -13.12) and sleep efficiency (WMD=-6.38; 95%CI: -9.71- -3.06) and higher AHI (WMD=1.76; 95%CI: 0.20-3.32) compared to healthy controls. Sleep efficiency (r=-0.16; 95%CI: -0.02- -0.29) and AHI (r=0.41; 95%CI: 0.26-0.54) were correlated with EDSS. Conclusions It is fundamental to screen patients with MS for OSA and offer management options such as continuous positive airway pressure (CPAP) when appropriate.
Pediatric stroke is a rare but serious cause of morbidity and mortality, with disproportionately high burden in low- and middle-income countries (LMICs). Asia and Africa report the highest global incidence and prevalence, driven by region-specific risk factors such as sickle cell disease (SCD), moyamoya disease (MMD), and infectious etiologies. Despite this substantial burden, data from these regions remain limited and fragmented, hindering effective clinical care and policy development. Incidence rates across Asia and Africa consistently exceed those in high-income countries. Western Sub-Saharan Africa, Southeast Asia, and Central Asia present some of the world’s highest age-standardized rates. The most common etiologies include infections, particularly tuberculous meningitis, hematologic disorders such as SCD, and vasculopathies including MMD. Clinical features resemble those in high-income settings; however, children in LMICs experience delays in diagnosis due to limited diagnostic modalities, shortages of pediatric stroke expertise, and lack of standardized protocols. Management practices vary widely, consistent with global challenges due to lack of clinical data. LMICs are further constrained by resource limitations. Pediatric stroke care disparities in Asia and Africa reflect both geographic inequities between LMICs and HICs and system-level inequities within LMICs, where tertiary urban centers may provide advanced care while rural and secondary facilities remain limited. Emerging initiatives, including resource-adapted diagnostic algorithms, community screening tools, educational programs, and multicenter prevention trials, highlight growing efforts to strengthen pediatric stroke care. Improving outcomes require strengthening epidemiological surveillance, expanding regional and national stroke registries, developing resource-adapted diagnostic and treatment guidelines, and increasing access to preventive and therapeutic interventions. This review synthesizes available literature on pediatric stroke across Asian and African regions using the Global Burden of Disease (GBD) regional framework. Countries within Sub-Saharan Africa, North Africa and the Middle East, East Asia, High-Income Asia Pacific, South Asia, and Southeast Asia were examined. Key themes include epidemiology, etiologies, clinical presentations, and management strategies within these regions.
Background Variability in functional response to exercise interventions in Parkinson’s disease (PD) remains poorly understood. Sex-related differences in motor performance and rehabilitation outcomes have been described but are rarely examined within intervention studies. This study presents a secondary sex-stratified analysis of a previously published randomized controlled trial (RCT) to explore factors associated with differential improvements in physical performance. Objectives To analyze sex-specific factors associated with improvements in physical performance following a 12-week SSM Fisior® walking training program in individuals with PD. Design Secondary analysis of a RCT with a sex-stratified approach. Methods Fifty-two community-dwelling older adults (57.7% men; mean age 71.4 ± 8.0 years) participated in the study. Physical performance was assessed using the Short Physical Performance Battery (SPPB), FallSkip system, and Timed Up and Go (TUG) test. Changes in SPPB scores were analyzed using sex-stratified Spearman correlations and multivariable linear regression models adjusted for age, body mass index, baseline Barthel Index, sensory aids, polypharmacy, falls history, and prosthesis use. Results Women showed greater improvements in SPPB total score compared with men (0.73 ± 0.09 vs. 0.50 ± 0.09). In women, SPPB changes were significantly correlated with TUG performance, and TUG improvement remained independently associated with SPPB gains (β = 9.07; 95% CI: 1.34–19.49). In men, SPPB improvements were correlated with FallSkip gait, sit-to-stand performance, FallSkip total score, FallSkip time, and TUG performance. In adjusted models, SPPB gains were independently associated with age, TUG improvement, balance, and sit-to-stand performance. Conclusion Functional improvements following the intervention differed by sex. In women, mobility performance was the primary determinant of SPPB improvement, whereas in men, gains were associated with multiple domains including balance, strength, gait, and age. These findings support sex-specific considerations in exercise-based interventions for older adults.
Stem cell-based therapies for movement disorders show inconsistent translation due to variations in product characterisation, delivery, endpoints, safety, and follow-up. Regulatory guidance provides principles but lacks a unified trial framework. The objective was to create a practical framework that translates scientific, regulatory, manufacturing, ethical, and clinical expectations into an auditable pre-First Patient In (FPI) checklist for stem cell trials. A structured review of the literature, clinical trials, and guidance documents was conducted. Searches were performed in PubMed/MEDLINE, Embase, Google Scholar, and clinical trial registries, including ClinicalTrials.gov, Japan Registry, European Union Register, and Clinical Trials Registry-India, until January 2026. Key guidance documents from the FDA, EMA, ICH, ISSCR, and selected PMDA sources were reviewed. Recurring requirements related to nonclinical evidence, manufacturing quality, ethics, trial design, safety, and follow-up were identified and translated into auditable pre-FPI checklist items. A framework was developed, structured as a universal Core Gate plus three risk-proportionate modules: Module A for pluripotent-derived neural grafts, Module B for somatic neural grafts, and Module C for mesenchymal stromal cell/secretome approaches. The Core Gate outlines the minimum pre-FPI requirements across preclinical justification, GMP release documentation, regulatory and ethics readiness, patient selection, trial design, safety oversight, trial conduct, long-term follow-up, and transparency. The modules add platform-specific requirements according to biological and procedural risks, including tumourigenicity and genomic stability assessment, immunologic monitoring, and route-appropriate biodistribution and persistence expectations. Movement disorder-specific operational elements not defined in general guidance were also incorporated, including harmonised baseline phenotyping, disease-specific endpoint menus, practical imaging and biomarker options. This framework turns fragmented guidance into a practical, auditable pre-FPI roadmap for stem cell trials in movement disorders. By combining a universal Core Gate with risk-proportionate modules, it aims to reduce protocol heterogeneity, improve cross-trial comparability, strengthen regulatory planning, and support safer, interpretable clinical translation.
Background:Sarcopenia significantly impacts stroke prognosis. Temporal muscle thickness (TMT) is an emerging metric for sarcopenia. Objectives:To developed a TMT-incorporated model to predict 6-month adverse outcomes in acute ischemic stroke (AIS). Design:In this retrospective study, 479 AIS patients were divided into training (n=283), test (n=120), and external validation cohorts (n=76). Methods:A combined model was constructed to predict adverse outcomes in the training and test cohorts using LASSO regression analysis. Model performance was assessed via calculating accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and F1 score. Results:The proportion of patients with an adverse outcomes in the training and test sets was 18.02% vs 17.50%, respectively (P = 0.90). Ischemic stroke event, admission NIHSS score, BI score, TMT were used to construct the prediction model. The combined model presented good discriminatory potential in the training and test sets (AUC = 0.929 and 0.930, respectively), which was verified in the external validation cohort (AUC = 0.902). For the combined model, the P values of the Hosmer-Lemeshow test in the training set, the test set, and the external validation were < 0.001 (χ2 = 44.007), 0.472 (χ2 = 7.611), and <0.001 (χ2 = 4919.666), respectively. The combined model showed good calibration and discrimination. The clinical usefulness of the model was confirmed by decision curve analysis. Conclusion:This study developed a combined model incorporating ischemic stroke event, admission NIHSS score, BI score, TMT and infarct volume to predict 6-month adverse outcomes in AIS patients, providing clinicians with a practical tool for treatment decisions and prognosis assessment.
Background:Effective treatment monitoring and treatment decisions in relapsing-remitting multiple sclerosis (RRMS) require accurate and individualized prediction of future disease courses. Guidelines from the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) group and the Canadian Multiple Sclerosis Working Group (CMSWG) frequently cite MRI outcomes as predictive, but the methodological quality of this evidence is uncertain. Objectives:This study aims to critically assess the methodological standards underlying predictive claims about MRI outcomes in four major relevant MS guidelines. Design:We conducted a content review of citations in the MAGNIMS 2015 and 2021 and the CMSWG 2013 and 2020 guideline publications. Methods:Each source was evaluated for whether it reported quantitative predictive evidence: either predictive values with confidence intervals, Kaplan-Meier-based risk estimates, or externally validated models that provide accurate risk estimates (good calibration) and correctly separate high- from low-risk patients (good discrimination); We also checked if measures such as correlations, odds ratios, hazard ratios, Prentice criteria, or likelihood ratio tests were used. Results:Across all four guidelines, most predictive statements relied on secondary citations and association-based measures. Odds ratios, hazard ratios, correlations, or Prentice criteria were commonly reported. Some studies reported predictive values, but confidence intervals were frequently not provided. Only isolated examples of properly validated prediction models were cited, and only one had undergone full external validation. Advanced methods, such as the likelihood reduction factor, were absent. Conclusion:Current guideline statements on MRI prediction in RRMS often rely on associations rather than validated individualized predictions. They do not quantify individual risk or provide evidence for accuracy, calibration, discrimination, or robustness (reliability of predictions across different patients and settings). To ensure trustworthy and actionable evidence, future guidelines should require prospective risk estimates with confidence intervals, externally validated models with calibration and discrimination, predefined thresholds for predictive usefulness, and evaluation of clinical utility (e.g., decision curve analysis).
Acute ischaemic stroke care has long been guided by the maxim “time is brain,” yet outcome variability suggests that clock time alone is insufficient. We propose the Time, Tissue, and Systems (TTS) framework, a quantitative model integrating temporal progression, tissue vulnerability, and health-system performance. Biological injury is conceptualized as accelerated neuronal loss scaled by tissue phenotype and systems friction, and clinical decision-making is reframed as net utility optimization. Illustrative modeling across four archetypal stroke profiles demonstrates how identical clock times yield divergent biological and functional trajectories. The TTS framework provides a coherent structure for precision stroke care, aligning biological time with system time.
Ischemic stroke (IS), a predominant cerebrovascular disorder contributing to global disability and mortality, characterizes by a complex, multi-tiered cascade of pathological processes. As the primary innate immune cells within the central nervous system (CNS), microglia exhibit dual functional characteristics following ischemic injury, switching dynamically between pro-inflammatory detrimental phenotypes and anti-inflammatory reparative phenotypes in response to temporal progression, cellular phenotypic transformation, and changes in the local microenvironment. Consequently, therapeutic strategies targeting microglia have garnered considerable research interest, challenging the traditional neuron-centric therapeutic approaches. Microglia display a wide range of phenotypes, and the traditional M1/M2 classification is overly simplistic, failing to capture the full spectrum of their functional diversity. In contrast, single-cell RNA sequencing (scRNA-seq) technology has surpassed the limitations of bulk sequencing, providing a robust tool for elucidating microglial heterogeneity. Recent studies utilizing animal models of stroke have identified several subsets distinct from the conventional M1/M2-like subsets, including but no limited to ischemic stroke-associated microglia (ISAM), Prdx1 + SAM, Spp1 + microglia and SAM-foamy. The mechanisms underlying microglial heterogeneity encompass innate programming influenced by genetic background, dynamic remodeling of epigenetic modifications, metabolic reprogramming in response to extrinsic microenvironmental stress, and intercellular interaction networks. This review systematically examines, from the perspective of scRNA-seq, the biological functions of MG, the heterogeneity observed throughout their CNS life cycle development and regional homeostasis, the characteristics and regulatory mechanisms of heterogeneous microglial subpopulations following ischemic stroke, and potential therapeutic strategies and associated challenges. The aim is to provide a reference for the development of precise therapeutic strategies for IS.
Early detection of Parkinson’s disease (PD) through speech analysis offers significant clinical advantages, yet no validated tools exist for Arabic-speaking populations, representing a critical gap in global healthcare. Previous studies have relied on limited machine learning (ML) classifiers and voice attributes, which may introduce bias and hinder effective technique discovery. To address this, we developed an optimal PD prediction pipeline by testing multiple ML classifiers and feature extraction methods. We created the first Arabic PD speech dataset, comprising 40 subjects (17 with PD and 23 controls), and validated our methodology on an independent Spanish cohort of 100 subjects. Feature extraction included traditional, audio-to-text, and deep voice features from a pre-trained Whisper model. We employed feature selection and dimensionality reduction techniques to refine the dataset dimensions. Final features were assessed using twelve classifiers with leave-one-out and k-fold cross-validation for robust performance evaluation. Shapley additive explanations (SHAP) were utilized to determine feature importance as vocal biomarkers. Linear Discriminant Analysis achieved optimal performance with 90% accuracy, precision, recall, and F1-score using leave-one-out cross-validation. Linear Support Vector Classification also performed well, achieving 87.7% precision and 87.5% recall. When tested on the independent Spanish dataset, our methodology attained 83% accuracy, confirming cross-linguistic generalizability. SHAP analysis indicated that audio-to-text features provide contextual insights on fluency and coherence, while traditional features effectively capture acoustic variations. This study establishes the first validated Arabic PD speech classification system and demonstrates its universal applicability, laying the groundwork for global speech-based PD screening.
Objectives Severe acquired brain injury (sABI) can impact the psychological health not only in patients, but also in their caregivers. The present study was aimed at examining depression, anxiety and stress symptoms in patients with sABI and in their caregivers, exploring differences and correlations between the two, and investigating the role of cognitive reserve as potential predictor of patients and caregiver’s psychological wellbeing. Methods Fifty-four individuals (27 patients-caregiver’s dyads) took part in the present study. All patients had a severe injury and data were collected approximately five years post-injury. During a telemedicine assessment, the Depression Anxiety Stress Scale (DASS-21), the Caregiver Burden Inventory (CBI) and the Cognitive Reserve Index questionnaire (CRIq) were administered. Results Results show higher levels of anxiety and perceived stress in caregivers, when compared with patients. Significant associations emerged between patients and caregivers’ symptoms of depression and anxiety. Furthermore, cognitive reserve emerged as a significant modulator of caregivers’ emotional burden and depressive symptoms. Conclusion Findings highlight the interconnection between patients’ and caregivers’ psychological wellbeing and suggest that cognitive reserve might be considered a predictor of caregivers’ mental health.
Background Myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) is a rare central nervous system demyelinating disease with a variable course, including both monophasic and relapsing phenotypes. Effective treatment options, particularly for relapsing disease, remain limited. Ofatumumab (OFA), a subcutaneous anti-CD20 monoclonal antibody approved for multiple sclerosis, has not been studied in pediatric MOGAD. This study aims to assess its safety and efficacy in this population. Objective To describe the safety and efficacy of off-label OFA use in pediatric MOGAD patients. Patients and Methods We conducted a retrospective case series of consecutive pediatric patients with relapsing MOGAD who received OFA. Clinical data, including relapse history, annualized relapse rate (ARR), laboratory findings, and adverse events, were collected and analyzed. Results Three pediatric (1 female, 2 males) were included. Age at onset was 2.3, 6.1, and 2.5 years; disease duration before OFA was 6.3, 2.2, and 9.1 years; and age at OFA initiation was 8.6, 8.3, and 11.6 years. Two patients started OFA due to breakthrough relapses on mycophenolate mofetil (MMF); one switched from maintenance intravenous immunoglobulin (IVIG) for administrative convenience. Treatment durations were 12, 9, and 9 months. All patients achieved rapid B-cell depletion (CD19+ < 10 cells/μL), which was sustained in two. Serum MOG-IgG titers increased in two patients and became negative in one. Two patients remained relapse-free during OFA treatment; one experienced a single relapse at 3 months. ARR decreased in all three patients post-OFA initiation. OFA was well tolerated. Only one patient developed transient fever after the first injection, which resolved with symptomatic treatment and did not recur. Conclusion In this small case series, OFA was generally well-tolerated and associated with a reduction in ARR, suggesting a potential role in combination therapy for relapsing pediatric MOGAD. Given the use of combination treatments in some cases, including OFA+MMF and IVIG, the role of OFA alone remains unclear. Its subcutaneous route provides practical advantages in terms of convenience. Owing to the small sample size and relapse observed in one patient, these findings remain preliminary and warrant validation in larger, prospective studies.
Background Epilepsy surgery improves seizure outcomes in Sturge-Weber syndrome (SWS), yet the electrophysiological patterns of postoperative recovery remain poorly characterized. Previous studies suggest that early intervention may yield distinct clinical trajectories, but the associated changes in EEG background activity have not been systematically investigated. Objective To investigate whether age of surgery influences the postoperative modulation of EEG background rhythms in children with unilateral SWS, and to evaluate the utility of preoperative EEG asymmetry for lateralizing the epileptogenic hemisphere. Design Retrospective cohort study. Methods We analyzed children with unilateral SWS who underwent epilepsy surgery, stratified by age at intervention (<2 vs. ≥2 years). Pre- and postoperative scalp EEGs were visually assessed to quantify posterior dominant alpha frequency and slow-wave (delta and theta bands) activity separately in the affected and unaffected hemispheres (AH, UH). Preoperative lateralization accuracy was also evaluated for both frequency bands. Results A total of 99 patients were included. Seizure freedom rates were comparable between age groups. However, younger patients exhibited a significantly greater postoperative increase in alpha frequency, particularly in the UH (20 ± 20% vs. 4 ± 10%, P < 0.001). This effect was consistent across both focal resection (17±12% vs. 1 ± 8%, P < 0.001) and hemispheric surgery (22 ± 22% vs. 7 ± 11%, P = 0.006). In contrast, slow-wave modulation did not differ by age. Preoperative alpha asymmetry correctly lateralized the surgical hemisphere in 86.9% of cases (sensitivity 85.7%, specificity 88.0%, κ = 0.74), outperforming slow-wave asymmetry (accuracy 66.7%, κ = 0.33). Conclusion Early epilepsy surgery in SWS is associated with enhanced postoperative modulation of alpha frequency in the UH, possibly reflecting greater neuroplastic capacity during early development. Preoperative alpha asymmetry offers robust lateralizing value. These findings support the clinical utility of background EEG analysis in surgical planning and postoperative monitoring.
BackgroundThe DNAjB2 gene encodes a co-chaperone protein that interacts with the heat shock protein (HSP) family to maintain protein quality control and preserve neuronal integrity. Variants in this gene have been associated with the axonal form of Charcot-Marie-Tooth Disease (CMT2). Recent literature has also suggested an association between DNAjB2 variants and neurodegenerative disorders such as Parkinson's disease (PD).Design/MethodsCase Report.Case DescriptionWe present a 36-year-old female patient initially diagnosed with CMT2 at the age of 28, who later developed symptoms of PD in her fourth decade. Genetic test revealed compound heterozygous pathogenic variants in DNAjB2 (c.352+1 G>A and c.175+2T>A).ConclusionTo our knowledge, this is the first case report describing the dual phenotype of CMT2 and young-onset PD linked to compound heterozygosity in DNAjB2. The dual dysfunction of axonal degeneration and dopaminergic neuron loss suggests that DNAjB2 plays a pivotal role in maintaining proteostasis in both the peripheral and central nervous systems.
Central nervous system (CNS) demyelination is an uncommon observation in patients with Charcot-Marie-Tooth disease (CMT). Where it does occur, it is usually associated with X-linked CMT. We present a case of CMT type 1A with a likely de novo mutation who experienced initial symptoms, and subsequent exacerbation, of multiple sclerosis following respiratory infection. A review of the literature reveals that reports of CMT1A with CNS demyelination are rare. We propose that the mutations in the PMP22 gene result in an over-expression of PMP22 mRNA, which overcomes the normal suppression by miRNA species that occurs in the CNS. This abnormal expression of PMP22 protein may, in certain circumstances, exacerbate autoimmune responses to result eventually in CNS demyelination.
Objective To investigate the association between the Dietary Inflammatory Index (DII) and stroke risk among hypertensive adults, as well as all-cause mortality post-stroke, utilizing data from the National Health and Nutrition Examination Survey (NHANES). Methods This cross-sectional analysis included 7,590 hypertensive participants (stroke group: N=609; non-stroke group: N=6,981). DII was derived from 28 dietary components. Participants were stratified into DII tertiles: Q1 (lowest), Q2 (moderate), and Q3 (highest). Weighted multivariable logistic regression assessed associations between DII (continuous and categorical) and stroke prevalence. Restricted cubic splines (RCS) evaluated non-linearity. Subgroup analyses identified effect modifiers. Cox proportional hazards regression modeled associations of DII and its components with all-cause mortality in the stroke cohort. Results Stroke patients exhibited significantly higher DII scores than non-stroke controls ( P <0.05). Each 1-unit increase in DII was associated with a 13% elevated stroke risk (Odds Ratio (OR)=1.13, 95%CI: 1.04–1.22, P =0.006). Compared to Q1, Q3 had a 68% higher stroke risk (OR=1.68, 95%CI: 1.22–2.32, P =0.002). RCS confirmed significant non-linearity ( P <0.001). Antihypertensive medication modified this association ( P -interaction =0.042). Among stroke patients, DII demonstrated a U-shaped association with mortality ( P -trend =0.048): Q2 had the lowest mortality, while Q1 and Q3 showed poorer survival. Component analysis revealed higher β-carotene scores associated with increased mortality risk (Hazard Ratio (HR)=1.44, 95%CI: 1.01–2.04), whereas higher vitamin A scores correlated with reduced risk (HR=0.68, 95%CI: 0.47–0.99). Conclusion This cross-sectional study identifies a significant, dose-response association between elevated DII and increased stroke risk in hypertensive adults, suggesting that reducing dietary inflammatory load holds preventive potential. Moreover, β-carotene and vitamin A show opposing associations with post-stroke mortality, reflecting the complexity of nutritional inflammation and informing precision nutrition strategies for stroke.
Background:Posterior circulation ischemic stroke (PCS) accounts for up to 25% of all ischemic strokes but remains frequently under-recognized due to atypical symptoms and poor representation in conventional stroke scales. Early diagnosis is critical yet challenging. This study aimed to derive a pragmatic clinical scoring tool, the PCS-SCORE, to identify patients at high risk of PCS based solely on bedside features. Methods:We retrospectively analyzed 5163 patients from a prospective stroke registry, including 1571 with -confirmed PCS. Key predictors were identified through multivariable logistic regression and lasso modeling. Variables were weighted according to regression coefficients and clinical relevance. The final PCS-SCORE (0-9 points) included: diabetes (1 point), hypertension (1), male sex (1), double/blurred vision (2), vertigo with vomiting (2), and incoordination (2). Results:At a score threshold >3, the PCS-SCORE achieved an area under the curve (AUC) of 0.76, with 87.9% specificity and 43.4% sensitivity. Raising the threshold to >4 increased specificity to 94.4% (sensitivity 27.9%). Higher scores corresponded with progressively increased likelihood of PCS, enabling confident identification of high-risk patients. Conclusion:The PCS-SCORE is a simple, highly specific bedside tool for early detection of posterior circulation strokes. Its rule-in strength makes it especially useful in prehospital settings, resource-limited environments, and crowded emergency departments. Prospective validation is ongoing.
Background:Stroke onset demonstrates a circadian pattern, but the relationship between onset time and stroke severity at admission remains insufficiently understood. Objectives:This study aimed to examine the association between time of stroke onset and admission severity in patients with acute ischemic stroke (AIS), and to determine whether this association varies across clinical subgroups. Design:A retrospective observational study. Methods:We conducted a multicenter retrospective cohort study including 14,048 patients diagnosed with AIS and admitted to 36 hospitals in Shenzhen, China, between January 1, 2022, and May 31, 2024. Stroke onset time was classified into 4 periods: Morning (05:00-10:59), Afternoon (11:00-16:59), Evening (17:00-22:59), and Night (23:00-04:59). The primary outcome was neurological severity at admission, measured by the NIHSS score. Associations between onset time and outcomes were evaluated using multivariable ordinal logistic and linear regression models, adjusted for demographic and clinical covariates. Subgroup analyses and sensitivity analyses using multiple imputation were also conducted. Results:Stroke onset in the Morning was associated with lower NIHSS scores (adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI]: 0.82-0.94; P < .001) and lower mRS scores (aOR = 0.81; 95% CI: 0.76-0.86; P < .001). In contrast, Night onset was associated with higher NIHSS scores (aOR = 1.20; 95% CI: 1.09-1.32; P < .001) and mRS scores (aOR = 1.25; 95% CI: 1.15-1.37; P < .001). These associations were consistent across strata defined by age and sex, and among patients with hypertension or diabetes. However, the circadian pattern was attenuated in patients with coronary artery disease, dyslipidemia, or atrial fibrillation. Conclusion:Admission stroke severity follows a circadian pattern, with milder presentations in the Morning and more severe impairments during Night hours. These findings highlight the potential role of circadian biology in stroke pathophysiology and support incorporating time-of-onset considerations into clinical risk stratification and acute management strategies.
Consumer-grade wearables offer promising opportunities for remote patient monitoring (RPM) in neurological disorders, yet their clinical application remains uncertain. In this exploratory analysis, we draw on prospective observational trials using smartwatches in patients with multiple sclerosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, and migraine, who were monitored for 6 to 24 months. Through detailed clinical case narratives, we illustrate both the potential and the limitations of RPM in neurology. Wearable-generated data successfully captured early, clinically meaningful changes, such as the onset of a myasthenic exacerbation, and supported patient engagement in identifying individual triggers, including for migraine. However, external influences such as holidays, infections, or mobility aid use confounded activity signals, underscoring the importance of contextual interpretation. While wearables can enhance neurological care, their integration into clinical workflows is challenged by limited validation and interpretability. Realising their potential requires robust validation in clinical settings and the development of interoperable RPM platforms supported by close collaboration between clinicians, engineers, and patients.
Objectives:Over the past decade, low-intensity transcranial ultrasound stimulation (LITUS) has emerged as a promising non-invasive neuromodulation technique for central nervous system (CNS) disorders. This study aims to chart the current research landscape, uncover key trends and challenges, and offer a reference for future investigations. Methods:Following PRISMA guidelines, we sourced data from 3 databases and included 454 literature. We conducted bibliometric analyses using R, VOSviewer, and CiteSpace to explore publication trends, journal/region contributions, keyword co-occurrence networks, research clusters, and emerging frontiers. Results:The United States, China, and South Korea were the most influential countries in the field, while Brain Stimulation was the leading journal. Keyword analysis revealed 7 research clusters, and burst-detection highlighted frontiers such as safety, thalamic stimulation, and frequency. The literature review shows that LITUS is an emerging field with therapeutic promise, but faces challenges in areas like safety and ultrasound parameter standardization. Conclusion:As the first comprehensive bibliometric and systematic review of LITUS in CNS disorders treatment, this work presents a global picture of publication trends, hotspots, and obstacles-providing valuable guidance for future research and clinical translation of LITUS.
