Introduction Narcolepsy type 1 (NT1) is a chronic neurological disorder characterised by excessive daytime sleepiness, cataplexy and disturbed nocturnal sleep. Current pharmacological treatments often have limited efficacy, significant side effects or potential for abuse. Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique that has shown promise in regulating sleep–wake cycles and neural network activity. Preliminary evidence from our prior study on Transcutaneous Auricular Vagus Nerve Stimulation in patients with NT1 (TARGET-NT1 study) suggests potential benefits of taVNS for NT1. The TARGET-2 trial aims to evaluate the efficacy and safety of bilateral taVNS compared with unilateral taVNS and sham stimulation in patients with NT1.Methods and analysis TARGET-2 is a randomised double-blind trial. A total of 153 participants with NT1 will be recruited from four centres in China. Participants will be randomly allocated (1:1:1) to receive either (1) bilateral taVNS (active stimulation on both ears), (2) unilateral taVNS (active stimulation on the left ear only) or (3) sham taVNS (minimal intensity stimulation on both ears). Participants and outcome assessors are blinded. The intervention will be administered twice daily for 30 min per session over 12 weeks. The primary outcome is the change in the Epworth Sleepiness Scale (ESS) score from baseline to the 12-week endpoint. Secondary outcomes are changes in the narcolepsy severity scale score, Pittsburgh Sleep Quality Index, fatigue severity scale score, 14-item Hamilton Anxiety Rating Scale score and 17-item Hamilton Depression Rating Scale score, as well as responder rates (proportion with ≥25% ESS reduction) from baseline to week 12. Safety will be assessed by monitoring adverse events.Ethics and dissemination Ethical approval has been granted by the Medical Ethical Committee of Xijing Hospital (Approval Number: XJLL-KY-20252403). Written informed consent will be obtained from all participants before initiating any study-specific procedures. The results will be submitted for publication in a peer-reviewed journal. The anticipated completion date for reporting of the study results is 31 March 2027.Trial registration Chinese Clinical Trial Registry, ChiCTR2500110531 (registered on 15 October 2025).

To assess exploratorily the safety and efficacy of transcutaneous auricular vagus nerve stimulation (tVNS) as an adjunctive therapy in improving symptoms in patients with narcolepsy type 1 (NT1). The TARGET-NT1 trial, a two-arm, double-blinded, sham-controlled trial was conducted from April 2022, to June 2024 ​at Xijing Hospital in Xi'an, China. Participants were randomised to receive tVNS treatment or sham tVNS (stVNS) treatment. Both interventions were performed for two 30-min periods per day with the same stimulation parameters but different stimulation points, for 12 weeks. The primary outcome was the change in mean sleep onset latency of maintenance of wakefulness test (MWT) from baseline to week 12. Secondary outcomes included changes in Narcolepsy Severity Scale (NSS), Epworth Sleepiness Scale (ESS), 14-item Hamilton Anxiety Rating Scale (HAMA-14), 17-item Hamilton Depression Rating Scale (HAMD-17). Among 60 randomised participants (32 men [53.3 ​%] and 28 [46.7 ​%]; mean [SD] age, 29.9 [9.9] years), 56 were included in the modified intention-to-treat (mITT) analysis. From baseline to week 12, the difference in mean change in mean sleep onset latency of MWT was 3.09 (95 ​% CI, 1.00, 5.88; P ​= ​0.0041) as compared with stVNS group. Significant improvements in NSS-EDS (−2.61 [95%CI, −4.07, −1.15; P ​= ​0.0006]), NSS-SP (−1.11 [95%CI, −1.83, −0.38; P ​= ​0.0030]), NSS-HH (−2.71 [95%CI, −3.36, −2.05; P ​< ​0.0001]), NSS- DNS (−0.52 [95%CI, −0.87, −0.17; P ​= ​0.0036]), ESS (−3.03 [95%CI, −4.30, −1.75; P ​< ​0.0001]) and HAMD-17 (−2.50 [95%CI, −4.30, −0.70; P ​= ​0.0069]) were observed in the tVNS group as compared with stVNS group. This exploratory study supported the efficacy and safety of tVNS in patients with NT1 and provided insights into the mechanisms underlying tVNS treatment for NT1. The findings highlight tVNS as a potential non-pharmacological adjunctive therapy for patients with NT1. This trial was registered with the Chinese Clinical Trial Registry, ChiCTR2400094550.

BACKGROUND AND OBJECTIVE:Juvenile absence epilepsy is a common idiopathic generalized epilepsy syndrome that often requires long-term antiseizure medications (ASMs). However, it remains unclear whether and when such long-term medication is necessary. In this study, we aimed to explore the long-term seizure outcomes and the feasibility of ASMs withdrawal in patients with JAE. Additionally, we aimed to investigate the evolution of EEG patterns over time. METHODS:We conducted a retrospective study on patients diagnosed with JAE according to the 2022 ILAE at Xijing Hospital between March 2014 and Dec 2024. We performed a retrospective review of their 24-h video-EEG recordings for seizure semiology and EEG pattern. Patient demographics, baseline clinical characteristics, and treatment details were extracted from clinical charts and electronic health records. All further follow-up visits were either through telemedicine or in-person visits. RESULTS:This retrospective study included 58 patients diagnosed with JAE, with a mean age at epilepsy onset of 11.86 ± 3.87 years. The median follow-up duration was 9.57 years (range, 3-27 years). Among these patients, 38 (65.5 %) achieved seizure freedom for at least 2 years. Treatment with valproate was identified as an independent predictor of a favorable outcome in terms of seizure freedom. Conversely, the total number of generalized tonic-clonic seizures experienced, presence of absence seizures on follow-up EEG and the persistence of hyperventilation positivity on EEG were associated with an unfavorable outcome regarding seizure freedom. Among the 38 patients, 25 (65.8 %) did not experience seizure recurrence. ASMs withdrawal was attempted in 28 patients (48.3 %) and 18 of them did not experience seizure recurrence during the tapering process. Among these 18 patients, ASMs were discontinued in 9 patients at the last follow-up. The age of onset (p = 0.040) and age at last follow up (p = 0.044) were associated with seizure recurrence. After a median EEG follow-up period of 6 years, abnormal EEG improved in 34 of the 58 patients (58.6 %). Additionally, 14 of the 58 patients (24.1 %) had normal EEG in subsequent recordings. CONCLUSION:Seizures were effectively controlled with ASMs in most patients with JAE, and a significant proportion of patients were able to attempt ASMs withdrawal without experiencing seizure recurrence. Additionally, EEG patterns of GSWD improved on follow-up EEGs for the majority of patients.

Background The high burden of cerebral small vessel disease (CSVD) on neuroimaging is a significant risk factor for stroke, cognitive dysfunction, and emotional disorders. Currently, there is a lack of studies investigating the correlation between metabolic syndrome (MetS), complete blood count-derived inflammatory markers, and total CSVD burden. This study aims to evaluate the total CSVD imaging load using machine learning (ML) algorithms and to explore further the relationship between MetS, complete blood count-derived inflammatory markers, and CSVD load. Methods We included CSVD patients from Xijing Hospital (2012-2022). Univariate and lasso regression analyses identified variables linked to CSVD neuroimaging burden. Six ML models predicted CSVD burden based on MetS and inflammatory markers. Model performance was evaluated using ROCauc, PRauc, DCA, and calibration curves. The SHAP method validated model interpretability. The best-performing model was selected to develop a web-based calculator using the Shiny package. Results The Logistic regression model outperformed others in predicting CSVD burden. The model incorporated MetS, neutrophil-to-lymphocyte ratio (NLR), homocysteine (Hcy), age, smoking status, cystatin C (CysC), uric acid (UA), and prognostic nutritional index (PNI). Conclusion MetS, NLR, Hcy and CSVD high load were positively correlated, and the Logistic regression model could accurately predict the total CSVD load degree.

Adults with restless sleep disorder (RSD) have never been studied clinically and polysomnographically. This study aimed to describe the clinical manifestation, duration, and distribution of sleep-related movements in adult patients with restless sleep disorder. Patients who had performed VPSG from Jan 2021 to Jan 2022 and met the diagnosis criteria of RSD were enrolled in the study. Patients’ bed partners were also interviewed or telephoned in identifying this disorder. Scoring of movements during sleep was according to the diagnosis criteria of RSD and scoring of large muscle group movements during sleep proposed by the International RLS Study Group in 2020 and 2021, respectively. The clinical manifestation, the distribution of sleep stage as well as the types and duration of the movements were carefully recorded and analyzed. We included ten patients in the study with a mean age of 27.6 years (range 22–38). There was a male prevalence in adults with RSD. The study highlighted the findings from video-polysomnography, which indicated frequent sleep-related movements occurring throughout the Night. These movements were most prominent during N1 and N2 sleep stage, followed by REM sleep, while fewer movements were observed during N3 sleep. Adults with RSD experienced significant daytime functioning impairments, including non-refreshing sleep, daytime fatigue/sleepiness, and mood disturbance. Two of the patients in the study were diagnosed with anxiety and depression, further underscoring the impact of RSD on mental health. Adult patients also suffer from severe RSD, and the RSD that originates in childhood tends to persist into adulthood. In these cases, longer duration of the disease and poor sleep quality may be associated with an increased risk of developing psychiatric comorbidities. Our cases represent an objectively documented type of RSD in younger adult patients.

Background:Sleep-related facial mandibular myoclonus (SRFMM) remains rare in clinical practice. The aim of this study was to provide a comprehensive understanding of the electroclinical manner, therapeutic regimen, and prognosis of SRFMM.Methods:Twenty-three patients who were diagnosed with SRFMM by clinical manifestation, video-electroencephalography (EEG) and electromyography over bilateral masseter and temporalis muscles were enrolled. Clinical and electrophysiological evaluation as well as follow-up information were recorded and analyzed.Results:The cohort involved 4 infants and 19 adults with a mean onset age of 43.5 years for SRFMM, among whom 19 were male. Twenty-one patients complained of tongue injuries and disturbed night-time sleep. SRFMM in 4 patients were ascribed to oral aripiprazole, brainstem ischemia and brain trauma. In 62 SRFMM episodes, 93.5% occurred in NREM sleep and 6.5% in REM sleep, and all events were associated with EEG arousals. In 13 patients with or without clonazepam, the motor events gradually disappeared, and the rest turned to be sporadic.Conclusion:SRFMM is a characteristic parasomnia manifested by tongue biting and accompanying facial mandibular myoclonus, leading to disrupted sleep. Besides adults, infants can also experience SRFMM with spontaneous remission. Most patients respond well to clonazepam, eventually with favorable prognosis.

Background: Excessive daytime sleepiness (EDS) forms a prevalent symptom of obstructive sleep apnea (OSA) and narcolepsy type 1 (NT1), while the latter might always be overlooked. Machine learning (ML) models can enable the early detection of these conditions, which has never been applied for diagnosis of NT1. Objective: The study aimed to develop ML prediction models to help non-sleep specialist clinicians identify high probability of comorbid NT1 in patients with OSA early. Methods: Totally, clinical features of 246 patients with OSA in three sleep centers were collected and analyzed for the development of nine ML models. LASSO regression was used for feature selection. Various metrics such as the area under the receiver operating curve (AUC), calibration curve, and decision curve analysis (DCA) were employed to evaluate and compare the performance of these ML models. Model interpretability was demonstrated by Shapley Additive explanations (SHAP). Results: Based on the analysis of AUC, DCA, and calibration curves, the Gradient Boosting Machine (GBM) model demonstrated superior performance compared to other machine learning (ML) models. The top five features used in the GBM model, ranked by feature importance, were age of onset, total limb movements index, sleep latency, non-REM (Rapid Eye Movement) sleep stage 2 and severity of OSA. Conclusion: The study yielded a simple and feasible screening ML-based model for the early identification of NT1 in patients with OSA, which warrants further verification in more extensive clinical practices.

BackgroundMajor depression disorder (MDD) forms a common psychiatric comorbidity among patients with narcolepsy type 1 (NT1), yet its impact on patients with NT1 is often overlooked by neurologists. Currently, there is a lack of effective methods for accurately predicting MDD in patients with NT1.ObjectiveThis study utilized machine learning (ML) algorithms to identify critical variables and developed the prediction model for predicting MDD in patients with NT1.MethodsThe study included 267 NT1 patients from four sleep centers. The diagnosis of comorbid MDD was based on Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). ML models, including six full models and six compact models, were developed using a training set. The performance of these models was compared in the testing set, and the optimal model was evaluated in the testing set. Various evaluation metrics, such as Area under the receiver operating curve (AUC), precision-recall (PR) curve and calibration curve were employed to assess and compare the performance of the ML models. Model interpretability was demonstrated using SHAP.ResultIn the testing set, the logistic regression (LG) model demonstrated superior performance compared to other ML models based on evaluation metrics such as AUC, PR curve, and calibration curve. The top eight features used in the LG model, ranked by feature importance, included social impact scale (SIS) score, narcolepsy severity scale (NSS) score, total sleep time, body mass index (BMI), education years, age of onset, sleep efficiency, sleep latency.ConclusionThe study yielded a straightforward and practical ML model for the early identification of MDD in patients with NT1. A web-based tool for clinical applications was developed, which deserves further verification in diverse clinical settings.

癫痫性猝死( sudden unexpected death in epilepsy, SUDEP)是癫痫患者整体死亡风险较普通人群显著增高的重要原因,由SUDEP所致的癫痫性死亡已成为重大公共卫生问题.

目的 评估拉考沙胺(lacosamide,LCM)治疗发作性运动诱发性运动障碍(paroxysmal kinesigenic dyski?nesia,PKD)的有效性和安全性.方法 以"发作性运动诱发性运动障碍"、"PKD"为关键词在西京医院神经内科脑电监测中心进行检索,检索时间为2018年11月至2022年9月,共计25例患者符合PKD诊断标准,排除20例使用其他治疗方案的患者,最终纳入使用LCM治疗的5例患者,对5例患者的临床资料、基因检测结果、治疗及随访情况进行回顾性分析.结果 5例患者来自4个家系,男3例,女2例,起病年龄4～17岁,发作均出现于突然运动或有运动想法之后,其中4例患者为双侧症状,1例为单侧肢体症状及面部症状,发作频率5～15次/d,每次持续3～20 s.4例PRRT2基因(+),LCM初始剂量为25～50 mg/d,3 d加量至维持剂量为100～200 mg/d(2.5～3.1 mg/kg);1例PRRT2基因(-),LCM初始剂量为100 mg/d,当天服药即控制症状,目前维持剂量为100 mg/d(1.2 mg/kg).4例(4/5)患者服药后无发作,1例(1/5)患者(PRRT2基因突变阳性)偶有"发作预感"(每2～3个月1次),所有患者服用LCM期间未出现不良反应.结论 LCM治疗PKD可以快速加量,1～3 d可控制症状,未见不良反应.PRRT2基因(-)的PKD患者可能需要小剂量LCM即可控制症状.

Background and objectiveSudden unexpected death in epilepsy (SUDEP) has been regarded as a leading cause of premature death in patients with epilepsy (PWE). Although patients, relatives and caregivers have the right to be informed of SUDEP, neurologists prefer not to release the facts for fear of associated anxiety. In the study, a Chinese questionnaire survey was carried out to elucidate effect of SUDEP disclosure on anxiety in PWE and variables determining the anxiety of patients and provided suggestions for SUDEP disclosure.MethodsA survey study in China was conducted. We recruited 305 PWE from 3 tertiary epilepsy centers who attended outpatient clinic from December 2021 to February 2022. Two hundred and thirty-two PWE completed the screening evaluation, survey and Hamilton anxiety rating scale (HAMA) twice with 171 PWE completing third HAMA at follow-up. HAMA scores at baseline, T1, T2 were compared using analysis of variance and dependent samples t-test. The variables related to anxiety were screened out by univariate analysis and used for multivariate logistic regression.ResultWe found 127 (54.7%) among the 232 participants experienced anxiety after SUDEP disclosure. HAMA scores at T1 were significantly higher than at baseline and T2, while there was no statistical difference between baseline and T2. Medical insurance, seizure severity, and whether the PWE supported SUDEP being disclosed to their relatives and caregivers only were associated with the occurrence of anxiety.ConclusionSUDEP disclosures may cause short-term acute anxiety, but have no long-term effects in PWE. Acute anxiety caused by SUDEP disclosure may be more common in PWE with NCMI and severe seizures. Meanwhile, compared with indirect SUDEP disclosure to their relatives and caregivers, direct SUDEP disclosure to PWE reduces the risk of anxiety. Recommendations are provided to avoid anxiety caused by SUDEP disclosure.

Objective:To explore the electro-clinical characteristics of sleep-related hypermotor epilepsy (SHE) in rapid eye movement (REM) stage.Methods:Five patients of SHE in REM stage were studied and followed up in the Electroencephalogram Monitoring Center, Department of Neurology, Xijing Hospital, the Air Force Military Medical University, from January 2016 to August 2021.Results:Among the 5 patients, there are 3 male patients, aged 21 to 46 years. A total of 23 seizures were monitored in 5 patients, of which 22 occurred in REM sleep and 1 occurred in non-REM Ⅲ sleep. Each attack lasted from 30 seconds to 1 minute, and was manifested as "hyperkinetic attack" during sleep, with or without disturbance of consciousness. There were no obvious abnormalities in electroencephalography during 13 attacks, with the focal sharp slow waves or slow waves during 9 attacks, and the focal slow waves occurrence at the end of the 10 attacks.Conclusion:Most of the hypermotor epileptic seizures in REM stage started from awakening reaction, and the interictal discharges occured in waking and non-REM sleep stage, which is necessary to distinguish from the REM sleep behavior disorder.

Study Objectives: To evaluate clinical and electrophysiological features of sleep-related head jerk (SRHJ) and electromyographic activity of superficial neck muscles during head jerk. Methods: Totally, 850 cases with video-polysomnography recording were collected, among which 50 presented with SRHJ. In these 50 patients, 15 underwent electromyography (EMG) check on bilateral sternocleidomastoid (SCM) and trapezius muscles as well as chin, while 35 had only chin EMG check. Further, the sensitivity and specificity of the both EMGs were calculated and compared. Results: Six among the 50 SRHJ patients had a primary complaint of involuntary head jerks associated with impaired sleep. Approximately 76.1% of head jerks occurred during REM sleep with the median head jerk index of 5.9/h, 64.5% of which were associated with electroencephalogram arousals and 66.4% with body movements. One patient showed SRHJ predominantly in NREM sleep but also in wakefulness. Surface EMG of SCM/ trapezius muscles showed a sensitivity of 92% and a specificity of 97.8%, whereas chin EMG had a sensitivity of 14.5% and a specificity of 98.8%. Conclusion: SRHJ was associated with electroencephalogram arousals and might interfere with sleep. Surface EMG of SCM/trapezius muscles exhibited a good accuracy in the revelation of SRHJ.

*These authors contributed equally to this work Study Objectives: To evaluate clinical and electrophysiological features of sleep-related head jerk (SRHJ) and electromyographic activity of superficial neck muscles during head jerk. Methods: Totally, 850 cases with video-polysomnography recording were collected, among which 50 presented with SRHJ. In these 50 patients, 15 underwent electromyography (EMG) check on bilateral sternocleidomastoid (SCM) and trapezius muscles as well as chin, while 35 had only chin EMG check. Further, the sensitivity and specificity of the both EMGs were calculated and compared. Results: Six among the 50 SRHJ patients had a primary complaint of involuntary head jerks associated with impaired sleep. Approximately 76.1% of head jerks occurred during REM sleep with the median head jerk index of 5.9/h, 64.5% of which were associated with electroencephalogram arousals and 66.4% with body movements. One patient showed SRHJ predominantly in NREM sleep but also in wakefulness. Surface EMG of SCM/ trapezius muscles showed a sensitivity of 92% and a specificity of 97.8%, whereas chin EMG had a sensitivity of 14.5% and a specificity of 98.8%. Conclusion: SRHJ was associated with electroencephalogram arousals and might interfere with sleep. Surface EMG of SCM/trapezius muscles exhibited a good accuracy in the revelation of SRHJ.

Proper neuron-glia ratio is essential for normal brain development and function. Olig1 is a basic helix-loop-helix (bHLH) transcription factor generally used as a lineage tool for oligodendrocyte research in spinal cord. Recent studies have revealed a property of Olig1-positive cells as the common progenitors of GABAergic neurons and oligodendrocytes in the forebrain during embryogenesis, and a stage-dependent regulatory role of Wnt/β-catenin signaling in the differentiation of oligodendrocytes in spinal cord. Given the neurogenic role of Wnt/β-catenin signaling in neural progenitor cells, it is unclear how β-catenin affects the differentiation of Olig1-positive progenitors in brain. In the present study, we investigated the effects of β-catenin over-expression on the differentiation of Olig1-positive progenitors in the forebrain cortex, by using Olig1-Cre:β-cateninEX3 (loxp/+):ROSA-YFP (β-cateninEX3 CKO) mice as compared to Olig1-Cre:ROSA-YFP control. The results showed that in the cortex of Olig1-Cre:ROSA-YFP mice, approximately 28.6% of YFP labeled cells are GFAP-positive, 43.7% are NG2-positive, 23.4% are CC1-positive and 3.2% are NeuN-positive, showing that Olig1-positive cells are multi-potential and mainly gliogenic. However, in the cortex of β-cateninEX3 CKO mice, the percentage of astrocytes generated from Olig1-positive cells decreased dramatically to approximately 2%, NG2-positive cells to 0.4%, and CC1-positive cells to 0.5%. In contrast, the percentage of NeuN-positive cells increased to approximately 96% of YFP-labeled cells. Taken together, our data showed that the gliogenic property of Olig1-positive progenitors in forebrain can be efficiently switched to neurogenic by over-expressing β-catenin, revealing a neurogenic effect of β-catenin in the forebrain Olig1-positive progenitors.

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Ischemia not only leads to tissue damage, but also induces seizures, which in turn worsens the outcome of ischemia. Recent studies have revealed the impaired homeostatic functions of reactive astrocytes, which were thought to facilitate the development of seizures. However, how this phenotype of reactive astrocytes is regulated remains unclear. Here, using pentylenetetrazole (PTZ)‐kindling model, we investigated the roles of reactive astrocytes and their intracellular Wnt/β‐catenin signaling in the ischemia‐increased seizure susceptibility. Our data showed that somatosensory cortical ischemia significantly increased the susceptibility to PTZ‐induced seizure. Genetic ablation of Nestin‐positive reactive astrocytes significantly decreased the incidence and severity of seizures. By using a Wnt signaling reporter mice line Topgal mice, we found that Wnt/β‐catenin signaling was upregulated in reactive astrocytes after ischemia. Depletion of β‐catenin in reactive astrocytes significantly decreased the susceptibility of seizures and the expression of c‐Fos induced by PTZ in the ischemic cortex. Overexpression of β‐catenin in reactive astrocytes, in contrast, significantly increased seizure susceptibility and the expression of c‐Fos. Furthermore, the expression of aquaporin‐4 (AQP‐4) and inwardly rectifying K+ channel 4.1 (Kir4.1), two molecules reportedly associated with seizure development, was oppositely affected in reactive astrocytes with β‐catenin depletion or overexpression. Taken together, these data indicated that astrocytic Wnt/β‐catenin signaling accounts, at least partially, for the ischemia‐increased seizure susceptibility. Inhibiting Wnt/β‐catenin signaling may be utilized in the future for preventing postischemic seizures. GLIA 2016;64:1083–1091