BACKGROUND:Studies assessing the effectiveness of selective tibial neurotomy (STN) assume that the procedure, combined with a rehabilitation program, reduces foot spasticity and allows the achievement of personal goals. However, few studies have reported failures in goal attainment or recurrence of spasticity, and no predictive factors have been established. OBJECTIVES:To identify predictors associated with the failure to achieve personal goals after STN and rehabilitation programs. METHODS:Eighty-eight adult participants with spastic foot, irrespective of the etiology, who underwent STN followed by a rehabilitation program were included. Personal goals were assessed using the Goal Attainment Scaling methodology, with T-scores calculated through a 5-year follow-up. Spasticity recurrence was defined as worsening of spasticity on the modified Ashworth scale compared with the clinical status 1 year after STN. Clinical characteristics were analyzed to identify independent predictors, which were subsequently confirmed using logistic regression. RESULTS:At the 5-year follow-up, 10 participants (10/88, 11 %) had a T-score <50. Logistic regression identified the degree of preoperative disability (modified Rankin Scale ≥3, P = 0.003) as the only significant predictor of failure to achieve personal goals. Spasticity-free survival was significantly higher among participants who had achieved their goals at least as expected (P < 0.0005), suggesting a strong relationship between long-term functional gains and sustained spasticity reduction. CONCLUSION:Failure to achieve personal goals after STN and a rehabilitation program is rare. However, greater preoperative disability was identified as a predictor of goal attainment failure over time.

BACKGROUND:Although prism adaptation (PA) has been applied in spatial neglect (SN) for 27 years, its efficacy remains controversial and lacks consistency. OBJECTIVE:The first aim was to assess the immediate and long-term effects of PA on SN via meta-analysis of randomized controlled trials (RCTs). The second aim was to identify potential effect modifiers of PA efficacy. METHODS:We searched four databases up to March 2025 for RCTs comparing PA, or PA+conventional vs. shamPA, or shamPA+conventional, or only conventional in participants with SN, and assessing behavioral or neuropsychological tests (such as Catherine Bergego scale (CBS) and behavioral inattention test (BIT)). Cochrane risk-of-bias assessment tool and random-effects meta-analysis were used, and effect size was reported as Weighted Mean Difference (WMD) with 95 % CI. RESULTS:Only 10 RCTs (356 participants) could be included, eight of them reporting CBS data and six for BIT. Immediate PA effects on SN showed a significant improvement for CBS between the PA group (PA/PA+conventional) and control group (shamPA/ shamPA+conventional/only conventional), all studies with prism shift ≥10°, (WMD = -2.13, 95% CI -3.93 to 0.33; P = 0.020), but non-significance for conventional BIT (BIT-C). Long-term benefit was not significant for CBS, while it was significant for BIT-C when the prism shift was ≥10° (n = 2; WMD = 12.37, 95% CI 0.53 to 24.21; P = 0.041). Linear regressions showed non-significant effect modifiers among the participant characteristics or PA intervention parameters. Subgroup analyses for CBS showed a significant immediate improvement in the larger total quantity of prism exposure (number of total trials × prism shift) subgroup (WMD = -2.73, 95% CI -5.01 to -0.44; P = 0.019), whereas the subgroup with smaller total exposure showed no significant difference. CONCLUSION:Even with stringent inclusion criteria, significant effects of PA on SN were observed in the short-term CBS (all studies with prism shift ≥10°), mainly derived from studies with total exposure ≥11250°·trials. The total quantity of prism exposure (°·trials) may be an applicable effect modifier of PA efficacy. TRIAL REGISTRATION:PROSPERO database (registration number: CRD420250650402).

Prism adaptation (PA) is a well-established method for sensorimotor recalibration and influencing visuospatial processing. It is also one of the rehabilitation approaches for neglect patients. Recent studies have shown effective adaptation in virtual reality (VR) settings simulating the classic PA procedure. However, no research has explored prism adaptation in augmented reality (AR), which combines the advantages of VR with greater ecological validity, allowing individuals to perform a virtual PA procedure in a real environment with natural visual feedback from their own hand. The present study introduces Augmented Reality Prism Adaptation (ARPA), a novel procedure that incorporates the benefits of AR with the classic PA technique. Forty-eight healthy participants underwent either leftward or rightward ARPA, and their sensorimotor and visuospatial aftereffects were evaluated immediately post-ARPA and over a 40-minute period. Results revealed significant and long-lasting sensorimotor aftereffects following both leftward and rightward ARPA, while only leftward ARPA induced an immediate rightward visuospatial aftereffect. Importantly, we investigated the generalization of these changes to the real environment, finding that ARPA-induced sensorimotor aftereffects extended beyond the virtual setting. While these findings show that ARPA produces both sensorimotor and visuospatial aftereffects, further research is essential to evaluate its applicability and effectiveness in neglect rehabilitation.

OBJECTIVE:To develop a multidisciplinary French framework addressing neurosurgical management in the initial phase of traumatic brain injury (TBI) in adults and children. DESIGN:A panel of 29 experts was formed at the request of the French Society of Neurosurgery (SFNC), with the participation of the French Society of Pediatric Neurosurgery (SFNCP), French Society of Private-Practice Neurosurgeons (SFNCL), French-Speaking Neurocritical Care and Neuro-Anesthesiology Society (ANARLF), French Society of Anesthesia, Critical Care and Perioperative Medicine (SFAR), French-Speaking Pediatric Emergency and Intensive Care Group (GFRUP), French Society of Neuroradiology (SFNR), French-Speaking Infectious Diseases Society (SPILF), and the French Society of Physical Medicine and Rehabilitation (SOFMER). METHODS:Questions were formulated using the PICO (Patients, Intervention, Comparison, Outcome) format, grouped into 7 categories: 1. Factors of poor prognosis, 2. Extradural hematoma, 3. Acute subdural hematoma, 4. Skull-base fracture and dural tear, 5. Penetrating traumatic brain injury, 6. Post-traumatic cerebrospinal fluid disorder, and 7. Pediatric specificities. RESULTS:Synthesis by the experts and application of the GRADE® method resulted in the formulation of 45 recommendations. Strong consensus was reached for all recommendations at the first round of rating, CONCLUSION: There was a strong consensus among the experts on important interdisciplinary recommendations to improve the neurosurgical management of patients with TBI.

Objective To evaluate heart rate deceleration on affective auditory stimulations as an objective marker of purposeful affective behaviour, as used in the diagnosis of minimally conscious state (MCS) in brain-injured individuals with disorders of consciousness (DoC), awake but unable to communicate. Methods We recorded the heart rate of participants (14 healthy controls and 10 brain injured individuals, conscious or with DoC) on repeated exposure to a random sequence of three emotional sounds of neutral, positive, and negative valence, in an unconditioned manner (experiment 1) or in a trace-conditioning procedure (experiment 2), with successful trace-conditioning assumed to indicate consciousness. Results In experiment 1, heart rate deceleration after aversive acoustic stimulus was significantly higher in healthy subjects at the group level from the second to the seventh inter-beat interval, with limited sensitivity at the individual level. In experiment 2, there was no evidence of trace-conditioned learning in healthy subjects, precluding any extrapolation to brain-injured individuals. Conclusions Heart rate deceleration after aversive acoustic stimulus was significant in passive hearing but not in a trace-conditioning paradigm and was of limited sensitivity at the individual level. Significance Heart rate deceleration may constitute an objective marker of purposeful affective behaviour triggered by emotional sounds. The question of whether this response is a reflex or a marker of conscious access needs further study.

With age, walking can be impaired, with a high risk of falls. This risk is even greater with Parkinson's disease. This research highlights the fact that, during walking, the need for cognitive resources increases with age and with Parkinson's disease. It also demonstrates that after an intensive exercise program, the demand for resources is reduced. These results are promising for improving the mobility and quality of life of these people.

Objective: The first aim was to assess the immediate and long-term effects of prism adaptation (PA) on spatial neglect (SN) via meta-analysis of randomized controlled trials (RCTs). The second aim was to identify potential predictive factors of PA efficacy. Methods: We searched 4 databases up to March 2025 for RCTs comparing PA or PA+conventional vs. shamPA or shamPA+conventional or only conventional in participants with SN, and assessing behavioral or neuropsychological tests (such as Catherine Bergego Scale (CBS) and Behavioral Inattention Test (BIT)). Cochrane risk-of-bias assessment tool and random-effects meta-analysis were used, and effect size was reported as Weighted Mean Difference (WMD) with 95%CI. Results: Only 10 RCTs (356 participants) could be included, 8 of them reporting CBS data and 6 for BIT. Immediate PA effects on SN showed a significant improvement for CBS between the PA group and control group (all studies with prism shift ≥10°, WMD= -2.13, 95%CI: [-3.93, -0.33], P<0.05), while non-significance for BIT-C. Long-term benefit was not significant for CBS, while significant for BIT-C when the prism shift was ≥10° (WMD= 12.37, 95%CI: [0.53, 24.21], P<0.05). Linear regressions showed non-significant predictive factors among the participant characteristics or PA intervention parameters. Subgroup analyses for CBS showed a significant immediate improvement in the larger total quantity of prism exposure (number of total trials × prism shift) subgroup (WMD= -2.73, 95%CI: [-5.01, -0.44], P<0.05), whereas subgroup with smaller total exposure showed non-significance. Conclusion: Even with stringent inclusion criteria, robust effects of PA on SN were observed in the short-term CBS (all studies with prism shift ≥10°), mainly derived from studies with total exposure ≥11250°·trials. A significant improvement for long-term BIT-C was observed when the prism shift was ≥10° (n=2, with 4000°·trials and 21600°·trials). The total quantity of prism exposure (°·trials) may be a useful predictive efficacy factor of efficacy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the China Scholarship Council, the Agence Nationale de la Recherche (ANR) [grant numbers ANR-23-JSTD-0001, 2023], Inserm, CNRS, Hospices Civils de Lyon, and University Lyon 1. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This systematic review and meta-analysis used ONLY data from previously published studies that were openly available in peer-reviewed journals before the initiation of this study. All source data were extracted from publicly accessible publications indexed in four databases:PubMed, Cochrane, Embase, and Web of Science. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

OBJECTIVE The objective of this study was to evaluate the long-term effectiveness of selective tibial neurotomy (STN) for the treatment of the spastic foot using a goal-centered approach. METHODS Between 2011 and 2018, adult patients with a spastic foot (regardless of etiology) who received STN followed by a rehabilitation program were included. The primary outcome was the achievement of individual goals defined preoperatively (T0) and compared at 1-year (T1) and 5-year (T5) follow-up by using the Goal Attainment Scaling methodology (T-score). The secondary outcomes were the presence of spastic deformities (equinus, varus, and claw toes), modified Ashworth scale (MAS) score for the targeted muscles, and modified Rankin Scale (mRS) score at T0, T1, and T5. RESULTS Eighty-eight patients were included. At T5, 88.7% of patients had achieved their goals at least "as expected." The mean T-score was significantly higher at T1 (62.5 ± 9.5) and T5 (60.6 ± 11.3) than at T0 (37.9 ± 2.8) (p < 0.0001), and the difference between T1 and T5 was not significant (p = 0.2). Compared to T0, deformities (equinus, varus, and claw toes; all p < 0.0001), MAS score (p < 0.0001), and mRS score (p < 0.0001) were significantly improved at T1 and T5. Compared to T1, MAS score increased slightly only at T5 (p = 0.05) but remained largely below the preoperative value. There was no difference between T1 and T5 regarding other clinical parameters (e.g., deformities, walking abilities, mRS score). CONCLUSIONS This study found that STN associated with a postoperative rehabilitation program can enable patients to successfully achieve personal goals that are sustained within a 5-year follow-up period.

Central neuropathic pain resulting from spinal cord injury is notoriously debilitating and difficult to treat with few currently available treatments. A novel molecule with intrathecal administration: Ziconotide has been approved for treatment of refractory neuropathic pain in general. It acts as a presynaptic calcium channel blocker. A pilot study has shown its potential in SCI neuropathic pain patients. The aim of this study is to determine the long-term (6 months) efficacy of chronic intrathecal ziconotide for the treatment of neuropathic SCI pain. Multicenter, Randomized, Comparative, Placebo controlled, Double blind clinical trial, with a crossover of random alternated periods of 6 months (placebo or ITZ) for a total of 15 months including a total of 44 patients. • Patients with SCI of various etiologies exhibiting neuropathic pain refractory to non-invasive treatments. • > 18 years. Intrathecal administration of ziconotide via an implanted pump. Primary study outcome Difference in pain intensity for all patients between effective treatment and placebo periods. Secondary study outcomes 1. Continuous evaluation of pain intensity. 2. Percentage of patients with at least 30

Objective: Stroke is the leading cause of acquired disability in adults, and can induce different sequelae which impact on abilities such as driving. This study investigated how post-stroke patients perceived their driving practice and behavior. The aim of this study was to determine different profiles of post-stroke drivers according to their driving perception. Methods: Among 86 post-stroke patients who had undergone an official fitness-to-drive assessment in 2019 in the Kerpape Center or the Henry Gabrielle Hospital (France), 69 returned to drive. These 69 participants completed a questionnaire about their socio-demographic and clinical characteristics, and driving perception, approximately three years after resuming driving. Questions about driving perception were statistically analyzed using hierarchical clustering analysis. Socio-demographic, driving, and clinical characteristics from the clusters obtained were then compared. Results: Clustering analysis revealed two profiles of post-stroke drivers. One group consisting of 2/ 3 of the participants reported modified driving behavior, while the other group perceived no driving changes. A higher proportion of participants from the modified driving group reported driving significantly less, experiencing less pleasure, increased tiredness and more fear when driving post-stroke than those from the unmodified driving group. They also stated that they experienced more difficulties, avoided more situations, and implemented more driving strategies than participants in the unmodified driving group. Participants in the modified driving group were also younger (p = 0.014), lived in more rural areas (p = 0.028), and had more sequelae, including fatigue (p = 0.002), motor sequelae (p = 0.035), and cognitive sequelae (p = 0.013) than participants who did not modify their driving. Conclusions: Two profiles of post-stroke drivers were identified: those who had perceived the need to modify their driving behavior, and those who had perceived no driving changes. Differences in socio-demographic characteristics may partly explained the divergencies between the two groups. Other factors such as self-awareness of driving abilities may influence their driving perception. Two lines of action could be investigated to enable post-stroke drivers to better appreciate their driving abilities. The first would be to develop targeted support programs to help drivers become more aware of their own abilities, for example using video support during on-road training to replay critical situations and improve awareness of their own abilities. A second approach would be to deploy technological driving assistance systems. A monitoring system enabling the driver to adjust his driving in real time could be very useful and relevant to develop.

Botulinum neurotoxin serotype A (BoNT-A) has several therapeutic indications such as spasticity and dystonia. Although its use is generally considered safe, a systemic diffusion can lead to systemic complications, and a botulism-like syndrome can occur after intramuscular injections. Herein, two adult cases who developed general muscle weakness after a BoNT-A intramuscular injection are reported. Both presented with a progressive decrement on low-frequency (LF) repetitive nerve stimulation (RNS). It is suggested that a progressive decrement on LF-RNS in muscles distant from the injection site strongly supports the diagnosis of iatrogenic botulism.

Abstract Objective Central pontine myelinolysis (CPM) is a rare demyelinating disease that affects the pons and which can cause extreme disabilities such as locked‐in syndrome (LIS) in the initial phase. The aim of the study was to describe the evolution over a 12‐month period of two patients with CPM causing an initial LIS. Method We retrospectively report the unexpected clinical outcome of these two patients in relation with the anatomical damages documented by brain MRI, associated with diffusion tensor imaging and reconstruction of corticospinal tracts in tractography. The following clinical parameters systematically assessed at 3, 6, 9, and 12 months: muscle testing on 12 key muscles (Medical Research Council), prehension metrics (box and block test and purdue pegboard), and independence for acts of daily living (functional independence measure). Results Both patients showed a progressive recovery beginning between 2 and 3 months after the onset of symptoms, leading to almost complete autonomy at 12 months (FIM > 110), with motor strength greater than 4/5 in all joint segments (MRC > 50/60). On brain MRI with tractography, CST appeared partially preserved at pons level. Interpretation The possibility of a near‐complete functional recovery at 12 months is important to consider given the ethical issues at stake and the discussions about limiting care that may take place initially. It seems to be the consequence of reversible myelin damage combined with partially preserved neurons. Development of collateral pathways or resolution of conduction block may explain this recovery. MRI comprising DTI and tractography could play a key role in the prognosis of motor recovery.

Background The locked-in syndrome (LIS), due to a lesion in the pons, impedes communication. This situation can also be met after some severe brain injury or in advanced Amyotrophic Lateral Sclerosis (ALS). In the most severe condition, the persons cannot communicate at all because of a complete oculomotor paralysis (Complete LIS or CLIS). This even prevents the detection of consciousness. Some studies suggest that auditory brain–computer interface (BCI) could restore a communication through a « yes–no» code. Methods We developed an auditory EEG-based interface which makes use of voluntary modulations of attention, to restore a yes–no communication code in non-responding persons. This binary BCI uses repeated speech sounds (alternating “yes” on the right ear and “no” on the left ear) corresponding to either frequent (short) or rare (long) stimuli. Users are instructed to pay attention to the relevant stimuli only. We tested this BCI with 18 healthy subjects, and 7 people with severe motor disability (3 “classical” persons with locked-in syndrome and 4 persons with ALS). Results We report online BCI performance and offline event-related potential analysis. On average in healthy subjects, online BCI accuracy reached 86% based on 50 questions. Only one out of 18 subjects could not perform above chance level. Ten subjects had an accuracy above 90%. However, most patients could not produce online performance above chance level, except for two people with ALS who obtained 100% accuracy. We report individual event-related potentials and their modulation by attention. In addition to the classical P3b, we observed a signature of sustained attention on responses to frequent sounds, but in healthy subjects and patients with good BCI control only. Conclusions Auditory BCI can be very well controlled by healthy subjects, but it is not a guarantee that it can be readily used by the target population of persons in LIS or CLIS. A conclusion that is supported by a few previous findings in BCI and should now trigger research to assess the reasons of such a gap in order to propose new and efficient solutions. Clinical trial registrations : No. NCT02567201 (2015) and NCT03233282 (2013).

Objective: Early functional evaluation and prognosis of patients with disorders of consciousness is a major challenge that clinical assessments alone cannot solve. Objective measures of brain activity could help resolve this uncertainty. We used electroencephalogram at bedside to detect voluntary attention with a paradigm previously validated in healthy subjects. Methods: Using auditory-oddball sequences, our approach rests on detecting known attentional modulations of Event Related Potentials that reflect compliance with verbal instructions. Sixty-eight unresponsive patients were tested in their first year after coma onset (37 coma and 31 first year post-coma patients). Their evolution 6 months after the test was considered. Results: Fourteen of the 68 patients, showed a positive response. Nine were in a coma and 5 in a minimally conscious state (MCS). Except for one who died early, all responders evolved to exit-MCS within 6 months (93%), while 35 (65%) among non-responders only. Conclusions: Among those patients for whom the outcome is highly uncertain, 21% responded positively to this simple but cognitively demanding test. Strikingly, some coma patients were among responders. Significance: The proposed paradigm revealed cognitive-motor dissociation in some coma patients. This ability to sustain attention on demand predicted awakening within 6 months and represents an immediately useful information for relatives and caregivers. (c) 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.