This study explores motor cortex stimulation (MCS) as a treatment for Ramsay Hunt syndrome (RHS)-related neuralgia, which often persists despite traditional therapies. A 68-year-old patient with RHS experienced significant pain and sensory relief after MCS, after ineffective conventional treatments. MCS enhances neural plasticity, offering a promising alternative for managing intractable neuralgia and sensory disturbances in RHS patients. This case underscores MCS's potential efficacy, advocating for further research into its broader application and benefits for RHS-related pain management.

Postherpetic neuralgia (PHN) after herpes zoster is a debilitating complication that severely affects the quality of life of patients. Neuromodulation such as spinal cord stimulation (SCS) and trigeminal semilunar ganglion stimulation (TSGS) have become effective methods for treating postherpetic neuralgia. A retrospective analysis of clinical data from 30 patients with postherpetic neuralgia who underwent SCS or TSGS treatment from January 2022 to January 2024. Patients received conventional treatment before neuromodulation. Clinical data including patient age, gender, pain characteristics, treatment outcomes were collected. The efficacy was evaluated using the Visual Analog Scale (VAS) and the Modified Global Impression of Change scale. Optimal stimulation parameters were also analyzed. The results showed that postoperative pain was significantly reduced in both SCS and TSGS groups, with a higher satisfaction rate in the SCS group (89% vs. 77%). Patients with facial PHN treated with TSGS experienced shorter pain recurrence times. The optimal stimulation parameters for the two treatments were also different. Compared to SCS, TSGS required a higher frequency but lower pulse width and voltage. This study suggests that neuromodulation may be an effective treatment for PHN, but the subtle differences between SCS and TSGS support a more personalized treatment approach.

Uric acid (UA) is a naturally antioxidant that is strongly associated with the development and progression of Parkinson’s disease (PD). The purine diet is an important exogenous pathway that modulates blood UA levels. Deep brain stimulation (DBS) is an important tool for PD treatment. This study aimed to explore the effects of preoperative purine diet on the prognosis of patients with PD after DBS. Sixty-four patients with PD who underwent DBS were included in this study, and their clinical data, blood UA levels, and daily purine intake. Patients were followed up for improvement 1 year after surgery. We found that patient higher purine intake was strongly associated with the rate of improvement after DBS and was a protective factor for patient prognosis. Daily purine intake from meat and seafood was significantly higher in the responsive patients than in the less-responsive patients. Mediation analysis showed that UA mediated 78% of the effect of purine intake on motor symptom improvement after DBS. In summary, we observed that purine intake is strongly associated with the rate of improvement in motor symptoms after subthalamic nucleus-DBS in patients with PD. This study provides a reference for preoperative diet planning in patients with PD undergoing DBS.

INTRODUCTION: Parkinson's Disease (PD) is a growing burden with varied clinical manifestations and responses to Subthalamic Nucleus Deep Brain Stimulation (STN-DBS). At present, there is no effective and simple machine learning model based on comprehensive clinical scales to predict the improvement in motor symptoms of PD treated with DBS. METHODS: A total of 647 PD patients from the First Affiliated Hospital of University of Science and Technology of China were enrolled retrospectively. Modeling with 5 kinds of machine learning algorithms (SVM, LR, RF, LigtGBM and XGBoost ), and using the Qingdao municipal hospital, 123 cases of PD patients as the external data verify the validity of the model. RESULTS: The LightGBM model outperformed others, demonstrating an internal test set AUC of 0.874 (95%CI [0.822-0.927]) and an average AUC of 0.921±0.03 during crossvalidation. The external validation yielded an AUC of 0.769 (95% CI[0.685-0.853]). Key predictive variables identified include MMSE scores, HAMA scores, years of education, medication improvement rate, and preoperative UPDRS scores. On the basis of the selected variables and the machine-learning model, we developed a web calculator for clinical use. CONCLUSIONS: The results indicate that the LightGBM model based on the top seven influencing factors is a promising tool for predicting the improvement in motor symptoms of PD after 1 year of DBS.

Spinal Cord Stimulation (SCS) has become a key method in treating chronic pain, despite inherent challenges related to patient variability and optimal parameter settings. We consecutively enrolled 33 chronic pain patients undergoing SCS treatment. Among them, 18 cases had post-herpetic neuralgia (PHN), 5 cases had post-spinal cord injury pain, 4 cases had post-brachial plexus injury pain, 4 cases had diabetic foot pain, and 2 cases had postoperative pain. Patients underwent clinical assessment, baseline characteristic evaluation, and outcome assessment. Simultaneously, we systematically evaluated stimulation parameters, particularly focusing on adjustments for different body positions. All patients experienced pain relief following treatment and short-term follow-up. Among them, 16 patients required parameter adjustments due to changes in body position, showing distinct trends in stimulation frequency, pulse width, and voltage settings. Notably, patients stimulated below the 8th thoracic (T8) segment required adjustments to specific-position parameters for optimal comfort and efficacy. The SCS stimulated segments of the spinal cord were located below the 8th thoracic segment (T8) in 16 patients who required adjustment of the parameters due to postural changes. When the patient changes from the upright position to the sitting position and to the supine position, the stimulation parameters need to decrease accordingly. This study reaffirms the effectiveness of SCS in chronic pain management and underscores the impact of body position on parameter adjustments and treatment outcomes.

Parkinson’s Disease (PD) is a growing burden with varied clinical manifestations and responses to Subthalamic Nucleus Deep Brain Stimulation (STN-DBS). At present, there is no effective and simple machine learning model based on comprehensive clinical scales to predict the improvement in motor symptoms of PD treated with DBS. A total of 647 PD patients from the First Affiliated Hospital of University of Science and Technology of China were enrolled retrospectively. LightGBM machine learning algorithm was used for modeling, and 123 PD patients from Qingdao Municipal Hospital were used as external data to verify the effectiveness of the model. The study was registered in the Chinese Clinical Trial Registry with the registration number of ChiCTR2300073955. The LightGBM model outperformed others, demonstrating an internal test set AUC of 0.874 (95

Background: Percutaneous balloon compression (PBC) is an important treatment for trigeminal neuralgia (TN). Establishing the duration of balloon compression involves a tradeoff between outcome and postoperative complications. We aimed to explore the effect of the duration of balloon compression on the numbness response in areas innervated by the branches of the trigeminal nerve. Methods: Thirty-three patients with TN were included as an exploratory cohort, and the response area and compression time to the onset of facial numbness were recorded intraoperatively. Seventy-six patients with TN were then randomly divided into experimental (EG) and control groups (CG) for validation. The EG was treated with balloon compression times adjusted to reflect the compression-time effect observed in the initial investigation, whereas the CG was treated with a standardized compression time of 180 s. Patients were followed up postoperatively for pain relief and facials to verify the reliability of the effect. Results: We found that the mean compression time to numbness in the region innervated by the ophthalmic meridian (V1) was 89.09 ± 8.99 s; by V1 and the maxillary nerve (V2), 123.52 ± 7.97 s; and by V1, V2, and the mandibular nerve (V3), 181.33 ± 10.29 s. All 76 patients used to verify the effect had complete relief of pain, and the EG had significantly less numbness than the CG. Conclusion: In PBC, with the extension of balloon compression time, the numbness response of each branch of the trigeminal nerve appears in a certain order. This effect can guide PBC in mitigating complications while ensuring efficacy.

Parkinson's Disease (PD) is a progressive neurodegenerative disorder with substantial impact on patients' quality of life. Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced PD, but patient responses vary, necessitating predictive models for personalized care. Recent advancements in medical imaging and machine learning offer opportunities to enhance predictive accuracy, particularly through deep learning and multi-instance learning (MIL) techniques. This retrospective study included 127 PD patients undergoing STN-DBS. Medical records and imaging data were collected, and patients were categorized based on treatment outcomes. Advanced segmentation models were trained for automated region of interest (ROI) delineation. A novel 2.5D deep learning approach incorporating multi-slice representation was developed to extract detailed ROI features. Multi-instance learning fusion techniques integrated predictions across multiple slices, combining radiomics and deep learning features to enhance model performance. Various machine learning algorithms were evaluated, and model robustness was assessed using cross-validation and hyperparameter optimization. The MIL model achieved an area under the curve (AUC) of 0.846 for predicting STN-DBS outcomes, surpassing the radiomics model's AUC of 0.825. Integration of MIL and radiomics features in the DLRad model further improved discriminative ability to an AUC of 0.871. Calibration tests showed good model reliability, and decision curve analysis demonstrated clinical utility, affirming the model's predictive advantage. This study demonstrates the efficacy of integrating MIL, radiomics, and deep learning techniques to predict STN-DBS outcomes in PD patients. The multimodal fusion approach enhances predictive accuracy, supporting personalized treatment planning and advancing patient care.

Background Postherpetic neuralgia (PHN) after herpes zoster is a debilitating complication that severely affects the quality of life of patients. Neuromodulation such as spinal cord stimulation (SCS) and trigeminal semilunar ganglion stimulation (TSGS) have become effective methods for treating postherpetic neuralgia. Methods A retrospective analysis of clinical data from 30 patients with postherpetic neuralgia who underwent SCS or TSGS treatment from January 2022 to January 2024. Patients received conventional treatment before neuromodulation. Clinical data including patient age, gender, pain characteristics, treatment outcomes were collected. The efficacy was evaluated using the Visual Analog Scale (VAS) and the Modified Global Impression of Change scale. Optimal stimulation parameters were also analyzed. Results The results showed that postoperative pain was significantly reduced in both SCS and TSGS groups, with a higher satisfaction rate in the SCS group (89 % vs. 77 %). The optimal stimulation parameters for the two treatments were also different. Compared to SCS, TSGS required a higher frequency but lower pulse width and voltage. Conclusion This study suggests that neuromodulation may be an effective treatment for PHN, but the subtle differences between SCS and TSGS support a more personalized treatment approach.

Background: Parkinson’s disease (PD) is a common neurodegenerative disorder that is predominantly known for its motor symptoms but is also accompanied by non-motor symptoms, including anxiety. Objective: The underlying neurobiological substrates and brain network changes associated with comorbid anxiety in PD require further exploration. Methods: An analysis of oscillation-specific nodal properties in patients with and without anxiety was conducted using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory. We used a band-pass filtering approach to differentiate oscillatory frequency bands for subsequent functional connectivity (FC) and graph analyses. Results: The study included 68 non-anxiety PD (naPD) patients, 62 anxiety PD (aPD) patients, and 64 healthy controls (NC). Analyses of nodal betweenness centrality (BC), degree centrality (DC), and efficiency were conducted across multiple frequency bands. The findings indicated no significant differences in BC among naPD, aPD, and NC within the 0.01–0.08 Hz frequency range. However, we observed a specific reduction in BC at narrower frequency ranges in aPD patients, as well as differing patterns of change in DC and efficiency, which are believed to reflect the neurophysiological bases of anxiety symptoms in PD. Conclusions: Differential oscillation-specific nodal characteristics have been identified in PD patients with anxiety, suggesting potential dysregulations in brain network dynamics. These findings emphasize the complexity of brain network alterations in anxiety-associated PD and identify oscillatory frequencies as potential biomarkers. The study highlights the importance of considering oscillatory frequency bands in the analysis of brain network changes.

Objective: To analyze the complications related to deep brain stimulation(DBS) surgery in Parkinson's disease(PD) patients and to determine whether there is a learning curve effect in terms of complications. Methods: Retrospective analysis of the DBS surgical data of 822 PD patients performed by the same surgeon at the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from December 2012 to December 2022. The complications related to DBS were evaluated and analyzed the complications of every 100 DBS surgery were further analyzed. Results: A total of 822 PD patients, 453 males and 369 females, aged 31-80 years old, were included. The minimum follow-up period after DBS surgery is 6 months. Surgical related complications occurred in 55 patients (6.69%), including 5 patients (0.61%) with slight bleeding around the electrode, 1 patient (0.12%) with cerebral infarction, 4 patients (0.49%) with postoperative epilepsy, 42 patients (5.11%) with postoperative delirium, 2 patients (0.24%) with respiratory distress, and 1 patient (0.12%) with acute cardiac insufficiency. There were 16 cases (1.94%) of hardware related complications in DBS, of which 4 cases (0.48%) had infection, 1 case (0.12%) had a broken angle at the connection between the pulse generator and the extension wire, 8 cases (0.97%) had an excessively tight extension wire, and 3 cases (0.36%) had an IPG bag hematoma. In the infected cases, 2 patients removed IPG and extension wires. There were 7 cases (0.85%) of stimulus related complications, including 4 cases (0.61%) with programmed sensory abnormalities, 1 case (0.12%) with postoperative abnormal movements and dance like movements, and 2 cases (0.24%) with psychiatric symptoms. A comprehensive analysis was conducted on the above complications, among which 8 cases (0.97%) were relatively serious complications. After active treatment, satisfactory results were achieved, and none of them affected the patient's DBS treatment effect and no patients died. For every 100 cases of DBS surgery complications were analyzed, the percentage of complications decreased significantly from 14.50% (58 cases) in the first 400 cases to 4.73% (20 cases) in the last 400 cases (P<0.001). Conclusion: DBS surgery is safe and has an acceptable low incidence of complications. The incidence of complications also decreases with the accumulation of experience, showing a learning curve effect.

Objective The aim of this study was to investigate the differences in clinical response and imaging data before and after surgery in patients with Parkinson’s disease and to attempt to predict clinical response using connectivity differences.Methods Connectivity analysis was performed on resting-state functional magnetic resonance imaging（rs-MRI） of 41 patients with Parkinson’s disease who underwent deep brain stimulation, and the subcortical connectivity network was calculated, evaluated before and one year after surgery on the UPDRSIII scale, correlated with the above-mentioned brain connectivity network, and predicted clinical motor symptoms, and predictive performance was discussed based on actual clinical improvement.Results Functional connectivity（FC） between the subcortical nuclei of interest and the DBS response showed that FC from bilateral red nuclei to the shell nuclei correlated with overall changes in UPDRS-III（left: r=-0.44P=0.0056,right r=-0.46p=0.0029,P＜0.05 after FDR correction）.In addition, FC predicted the change in UPDRSIII 1 year after DBS（r=0.5P=0.0011 error rate=0.175）.Conclusion The functional connectivity between the putamen and the red nucleus can serve as an important predictor of treatment outcomes in PD patients undergoing DBS surgery.

Objective To investigate the efficacy and safety of multimodal neuroelectrophysiological monitoring in the treatment of pain after spinal cord injury by incision of the dorsal root of the spinal cord into the medullary region.Methods Four patients with pain after spinal cord injury were treated with Dorsal Root Entry Zone（DREZ） incision under multimodal neuroelectrophysiological monitoring, including 2 cases of brachial plexus avulsion, 1 case of thoracic spine injury, and 1 case of lumbar spine injury.All patients were monitored for lower limb movement and sensation through sensory evoked potentials（SEP） and motor evoked potentials（MEP）.When the latency of SEP and MEP decreases by 10% on the healthy side or the amplitude decreases by 30% on the baseline, a warning is given to guide the incision angle and deep range of DREZ.All patients were analyzed for preoperative and postoperative pain visual analysis scale（VAS）,muscle strength and deep sensory function of healthy limbs on the surgical side, and second bowel function.At the same time, the quality of life of patients before and after surgery was evaluated using the SF-36 quality of life scale.Results After a follow-up of 9 months to 3 years, the pain relief rate in 3 patients was 100%,and the pain relief rate in 1 patient was greater than 50%.None of the patients had muscle decline and deep sensory decline in the healthy limb on the surgical side, and there was no decline in the second bowel function in all patients.The total score of SF-36 increased from 80.6±10.2 before surgery to 108.9±12.4（P＜0.05）.Conclusion Multimodal neuroelectrophysiological monitoring of spinal dorsal root incision can not only effectively alleviate pain, improve quality of life, but also effectively protect spinal cord function.

Background: Anxiety is one of the most common and disturbing non-motor symptoms of Parkinson's disease (PD). However, few studies have explored the relationship between functional connectivity (FC) and the rate of anxiety improvement after subthalamic nucleus deep brain stimulation (STN-DBS). Therefore, in this study, we aimed to explore the correlation between FC and the rate of anxiety improvement in patients with PD who underwent STN-DBS. Methods: The resting-state functional magnetic resonance imaging (rs-fMRI) data of 62 patients with anxious PD (aPD), 68 patients with PD without anxiety (naPD), and 64 healthy controls (HCs) were analyzed according to FC. Intergroup comparison and correlation analyses of anxiety improvement rates were performed. Results: The HC, aPD and naPD groups of zFCs were then used for the ANOVA test, and the results were FDR-corrected. There were 24 significant differences in FCs between the three groups. Post tests were conducted between groups found that 15 significantly different FCs were observed between the naPD and aPD groups. In addition, the two FCs in patients with aPD were significantly correlated with the rate of improvement in anxiety. Conclusion: We found that the two FCs in patients with aPD (olfactory cortex and inferior frontal gyrus [IFG] pars orbitalis; inferior temporal gyrus and posterior orbital gyrus) were significantly correlated with the rate of improvement in anxiety. Our study may help us understand the underlying mechanisms by which STN-DBS improves anxiety in PD patients and identify more effective treatment strategies.

Introduction Parkinson’s disease (PD) is a neurodegenerative disorder characterized by dyskinesia and is closely related to oxidative stress. Uric acid (UA) is a natural antioxidant found in the body. Previous studies have shown that UA has played an important role in the development and development of PD and is an important biomarker. Subthalamic nucleus deep brain stimulation (STN-DBS) is a common treatment for PD. Methods Based on resting state function MRI (rs-fMRI), the relationship between UA-related brain function connectivity (FC) and STN-DBS outcomes in PD patients was studied. We use UA and DC values from different brain regions to build the FC characteristics and then use the SVR model to predict the outcome of the operation. Results The results show that PD patients with UA-related FCs are closely related to STN-DBS efficacy and can be used to predict prognosis. A machine learning model based on UA-related FC was successfully developed for PD patients. Discussion The two biomarkers, UA and rs-fMRI, were combined to predict the prognosis of STN-DBS in treating PD. Neurosurgeons are provided with effective tools to screen the best candidate and predict the prognosis of the patient.

Background: Parkinson's disease (PD) represents one of the most frequently seen neurodegenerative disorders, while anxiety accounts for its non-motor symptom (NMS), and it has greatly affected the life quality of PD cases. Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) can effectively treat PD. This study aimed to develop a clinical prediction model for the anxiety improvement rate achieved in PD patients receiving STN-DBS. Methods: The present work retrospectively enrolled 103 PD cases undergoing STN-DBS. Patients were followed up for 1 year after surgery to analyze the improvement in HAMA scores. Univariate and multivariate logistic regression were conducted to select factors affecting the Hamilton Anxiety Scale (HAMA) improvement. A nomogram was established to predict the likelihood of achieving anxiety improvement. Receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), and calibration curve analysis were conducted to verify nomogram performance. Results: The mean improvement in HAMA score was 23.9% in 103 patients; among them, 68.9% had improved anxiety, 25.2% had worsened (Preop) anxiety, and 5.8% had no significant change in anxiety. Education years, UPDRS-III preoperative score, and HAMA preoperative score were independent risk factors for anxiety improvement. The nomogram-predicted values were consistent with real probabilities. Conclusions: Collectively, a nomogram is built in the present work for predicting anxiety improvement probability in PD patients 1 year after STN-DBS. The model is valuable for determining expected anxiety improvement in PD patients undergoing STN-DBS.

Background Uric acid is a natural antioxidant and it has been shown that low levels of uric acid may be a risk factor for the development of Parkinson’s disease. We aimed to investigate the relationship between uric acid and improvement of motor symptoms in patients with Parkinson’s disease after subthalamic nucleus deep brain stimulation. Methods We analyzed the correlation between serum uric acid levels in 64 patients with Parkinson’s disease and the rate of improvement of motor symptoms 2 years after subthalamic nucleus deep brain stimulation. Results A non-linear correlation was observed between uric acid levels and the rate of motor symptom improvement after subthalamic nucleus deep brain stimulation, during both the drug-off and drug-on periods. Conclusions Uric acid is positively associated with the rate of motor symptom improvement in subthalamic nucleus deep brain stimulation within a certain range.

The unique thermodynamic and kinetic coordination chemistry of ruthenium allows it to modulate key adverse aggregation and membrane interactions of α-synuclein (α-syn) associated with Parkinson's disease. We show that the low-toxic RuIII complex trans-[ImH][RuCl4 (Me2 SO)(Im)] (NAMI-A) has dual inhibitory effects on both aggregation and membrane interactions of α-syn with submicromolar affinity, and disassembles pre-formed fibrils. NAMI-A abolishes the cytotoxicity of α-syn towards neuronal cells and mitigates neurodegeneration and motor impairments in a rat model of Parkinson's. Multinuclear NMR and MS analyses show that NAMI-A binds to residues involved in protein aggregation and membrane binding. NMR studies reveal the key steps in pro-drug activation and the effect of activated NAMI-A species on protein folding. Our findings provide a new basis for designing ruthenium complexes which could mitigate α-syn-induced Parkinson's pathology differently from organic agents.

Abstract Background:While deep brain stimulation (DBS) of subthalamic nucleus (STN) is proved effective in managing motor symptoms of Parkinson's disease, it has substantial individulized variability of clinlcal responses. Prediction of treatment outcomes is therefore beneficial for surgical planning. This study aims to examine the capability of preoperative resting state brain connectivity as a potential tool to predict the clinlcal response of STN-DBS. Method: We collected the preoperative resting state functional Magnetic Resonance Imaging (MRI) of 41 participants who received DBS in the STN. The subcortical connectivity networks were estimated and correlated with postoperative exercise results. Linear regression was further used to predict the surgical improvements. Results: Functional Connectivity (FC) between subcortical nuclei of interest and DBS response showed that FC from bilateral red nuclei to putamen was related to the overall changes of UPDRS-III (left: r = -0.44 p = 0.0056, right r = -0.46 p = 0.0029, p < 0.05 after FDR correction). Additionally, FC can predict the changes of UPDRS III at 1 year after DBS (r = 0.5 p = 0.0011 error rate = 0.175 ). Cloclusions: The increased connectivity of the red nuclei in patients with Parkinson's disease may be a compensatory response to central nervous system damage. Functional MRI studies support the long-standing view that relatively intact cerebellar circuits can compensate for impaired basal ganglia function. Neuroplasticity is an adaptive mechanism that compensates for loss of function or maximizes residual function, leading to changes in brain function and morphology. This compensatory brain plasticity may be the reason why DBS improves the motor symptoms of Parkinson's disease.