Authors: Miriam Hiebeler, Simone Thiele and Maggie C. Walter
Abstract:
Background: Due to improved treatment options, more SMA patients reach childbearing age. Currently, limited data
on pregnant SMA patients is available, especially in relation to disease-modifying.....
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Authors: Miriam Hiebeler, Simone Thiele and Maggie C. Walter
Background: Due to improved treatment options, more SMA patients reach childbearing age. Currently, limited data
on pregnant SMA patients is available, especially in relation to disease-modifying therapies (DMT). This case report
helps to elucidate new approaches for future guidelines in the management of pregnancy and SMA.
Case Report: A 33-year-old wheelchair-bound patient with SMA type 3 (sitter) became pregnant following 36
months of Nusinersen treatment. The last dose was administered in the third gestational week. After pregnancy was
confirmed, therapy was stopped immediately. A healthy child was born in the 34th gestational week by caesarean
section. After a short nursing period, Nusinersen was restarted 6 weeks after the expected gestational date. At this
time, the patient reported deteriorated motor functions, which stabilized at a lower level compared to pre-pregnancy
in the 2-year follow-up, despite restarting Nusinersen treatment.
Discussion: So far, only few cases of successful pregnancies of SMA patients on DMT have been reported. In natural
history, the majority of patients experienced an increased deterioration of motor function while fetal outcome was
not impaired. Our case shows that although Nusinersen treatment was applied in the third gestational week prior
to proof of pregnancy, outcome was positive for mother and child. Future studies will have to determine whether
ongoing treatment with Nusinersen during pregnancy should be recommended.
How To Cite this Article
Hiebeler, M., Thiele, S. & Walter, M.C. Successful pregnancy of an SMA type 3 sitter on Nusinersen therapy - a case report. BMC Neurol 25, 8 (2025). https://doi.org/10.1186/s12883-024-04005-3
Authors: Nozomi Sasaki, Yukiko Enomoto, Takamitsu Hori, Hirofumi Matsubara, Yusuke Egashira and Tsuyoshi Izumo
Abstract:
Background: Tyrosine kinase inhibitors (TKIs) improve prognosis in chronic myeloid leukemia (CML). Nilotinib
and ponatinib, second- and third-generation TKIs, respectively, have been reported to cause adverse.....
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Authors: Nozomi Sasaki, Yukiko Enomoto, Takamitsu Hori, Hirofumi Matsubara, Yusuke Egashira and Tsuyoshi Izumo
Background: Tyrosine kinase inhibitors (TKIs) improve prognosis in chronic myeloid leukemia (CML). Nilotinib
and ponatinib, second- and third-generation TKIs, respectively, have been reported to cause adverse vascular occlu
sive events such as myocardial infarction and peripheral arterial disease. However, little is known about the risk of cer
ebral infarction associated with severe cerebrovascular stenosis, which is a late complication of TKIs. Herein, we report
two cases of cerebrovascular stenosis associated with TKIs for CML.
Case presentation: A 53-year-old man with CML experienced transient right-sided hemiparesis and dysarthria.
The patient had been treated with ponatinib for 5 years. Digital subtraction angiography revealed diffuse steno
sis with luminal narrowing from the terminal portion of the internal carotid artery (ICA) to the entire M1 length
of the middle cerebral artery (MCA). He was diagnosed with hemodynamic cerebral ischemia due to severe intrac
ranial ICA stenosis and underwent superficial temporal artery (STA)-MCA bypass surgery. He had no atherosclerotic
factors or immunological serum markers such as vasculitis. As a side effect of TKI therapy was suspected, ponatinib
therapy was discontinued.
A 74-year-old man treated with nilotinib for CML presented with gait disturbances. Diffusion-weighted magnetic
resonance imaging revealed multiple infarctions in the right cerebral hemisphere, and magnetic resonance angiogra
phy revealed severe bilateral intracranial ICA and MCA stenosis. The patient underwent a STA-MCA bypass surgery. We
discontinued nilotinib treatment. The postoperative course was uneventful.
Conclusions: CML prognosis has steadily improved with the advent of new TKIs. In the future, reports of cerebrovas cular stenosis caused by TKIs for CML may increase and systemic complications may become a problem. We should
be aware that some TKIs may cause cerebrovascular stenosis.
How To Cite this Article
Sasaki, N., Enomoto, Y., Hori, T. et al. Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases. BMC Neurol 25, 6 (2025). https://doi.org/10.1186/s12883-024-04006-2
Authors: Adam Viktorisson, Aref Haj Hashem, Katharina S Sunnerhagen and Tamar Abzhandadze
Abstract:
Background and objectives: Poststroke pain (PSP) is a prevalent and severe consequence of stroke, encompassing
central, neuropathic, and nonneuropathic pain. In this study, we aimed.....
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Authors: Adam Viktorisson, Aref Haj Hashem, Katharina S Sunnerhagen and Tamar Abzhandadze
Background and objectives: Poststroke pain (PSP) is a prevalent and severe consequence of stroke, encompassing
central, neuropathic, and nonneuropathic pain. In this study, we aimed to investigate clinical factors associated with
PSP three months after stroke and concurrently explore the association between PSP and one-year mortality.
Methods: This registry-based study comprised data from stroke patients admitted to three hospitals in Sweden
between November 2014 and June 2019. The outcome was PSP three months after stroke. Twelve (out of 28)
predictor variables were selected by three machine learning methods, and a multivariable binary logistic regression
model was fitted for predicting PSP. The association between PSP and one-year poststroke mortality was examined
using Cox proportional hazards models.
Results: Among 4,160 stroke patients participating in the three-month follow-up, 54.7% reported PSP. Antiplatelet
use, diabetes, hemiparesis, sensory deficits, and need for assistance before stroke were significant predictors of PSP.
Male sex, being born in Sweden, higher income, and regular prestroke physical activity predicted the absence of PSP.
After adjustment for age, sex, region of birth, and stroke severity, patients experiencing PSP had a significantly higher
one-year mortality rate than those without pain, and the most severe level of pain (constant pain) was associated with
the highest cumulative mortality.
Conclusion: The study findings indicate treatable factors associated with PSP, which highlight areas of improvement
in management strategies. Clinicians should recognize that PSP is associated with increased one-year mortality,
emphasizing the importance of pain prevention and treatment for enhanced poststroke outcomes.
How To Cite this Article
Viktorisson, A., Hashem, A.H., S Sunnerhagen, K. et al. Predicting pain and its association with mortality in patients with stroke. BMC Neurol25, 10 (2025). https://doi.org/10.1186/s12883-024-04011-5
Authors: Yinyin Xie, Wanwan Zhang, Aoya Han, Wenlin Sun, Xinru Zhou, Yi Xie, Yunqing Ma, Yajun Lian, Cui Wang and Nanchang Xie
Abstract:
Background: Awareness of the characteristics of glial fibrillary acidic protein autoantibody (GFAP-IgG) associated
myelitis facilitates early diagnosis and treatment. We explored features in GFAP-IgG myelitis.....
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Authors: Yinyin Xie, Wanwan Zhang, Aoya Han, Wenlin Sun, Xinru Zhou, Yi Xie, Yunqing Ma, Yajun Lian, Cui Wang and Nanchang Xie
Background: Awareness of the characteristics of glial fibrillary acidic protein autoantibody (GFAP-IgG) associated
myelitis facilitates early diagnosis and treatment. We explored features in GFAP-IgG myelitis and compared them
with those in myelitis associated with aquaporin-4 IgG (AQP4-IgG) and myelin oligodendrocyte glycoprotein IgG
(MOG-IgG).
Methods: We retrospectively reviewed data from patients with GFAP-IgG myelitis at the First Affiliated Hospital of
Zhengzhou University and Henan Children’s Hospital from May 2018 to May 2023. AQP4-IgG and MOG-IgG myelitis
patients served as controls.
Results: Thirty-four patients with GFAP-IgG myelitis were included (15 women, 12 children; median age at onset,
28.5 years). Over half experienced prodromal symptoms and required intensive care support. The median Expanded
Disability Status Scale (EDSS) score was 4 at admission and 0 at final follow-up (median, 20 months). Cerebrospinal
fluid (CSF) analysis showed markedly elevated leukocyte counts in 23 patients, elevated total protein in 28 patients,
and decreased glucose levels in 9 patients. Longitudinally sagittal T2 and gadolinium-enhancing spinal cord lesions
were detected. Features favoring GFAP-IgG over the other types included presence of fever and neck stiffness,
requirement of intensive care and mechanical ventilation, higher monocyte-to-lymphocyte ratio (MLR), presence of
hyponatremia, markedly elevated CSF leukocyte counts, increased CSF total protein levels, and decreased CSF glucose
levels. Imaging findings more common in GFAP-IgG than in AQP4-IgG myelitis were longer diseased segments, central
canal enhancement, and gadolinium-enhancing brain lesions. Higher EDSS scores at discharge distinguished GFAP-IgG from MOG-IgG.
Conclusion: Clinical, laboratory, imaging, and outcome variables facilitate differential diagnosis of myelitis subtypes.
How To Cite this Article
Xie, Y., Zhang, W., Han, A. et al. Myelitis associated with glial fibrillary acidic protein IgG: characterization and comparison with aquaporin-4 IgG and myelin oligodendrocyte glycoprotein IgG myelitis. BMC Neurol 25, 4 (2025). https://doi.org/10.1186/s12883-024-04013-3
Authors: Yun-Ting Chen, Yan-Cheng Huang, Hsiu-Ling Chen, Hsin-Chih Lo, Pei-Chin Chen, Chiun-Chieh Yu, Yi-Chin Tu, Tyng-Luh Liu and Wei-Che Lin
Abstract:
Background and purpose: White matter hyperintensities in brain MRI are key indicators of various neurological
conditions, and their accurate segmentation is essential for assessing disease.....
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Authors: Yun-Ting Chen, Yan-Cheng Huang, Hsiu-Ling Chen, Hsin-Chih Lo, Pei-Chin Chen, Chiun-Chieh Yu, Yi-Chin Tu, Tyng-Luh Liu and Wei-Che Lin
Background and purpose: White matter hyperintensities in brain MRI are key indicators of various neurological
conditions, and their accurate segmentation is essential for assessing disease progression. This study aims to
evaluate the performance of a 3D convolutional neural network and a 3D Transformer-based model for white matter
hyperintensities segmentation, focusing on their efficacy with limited datasets and similar computational resources.
Materials and methods: We implemented a convolution-based model (3D ResNet-50 U-Net with spatial and
channel squeeze & excitation) and a Transformer-based model (3D Swin Transformer with a convolutional stem).
The models were evaluated on two clinical datasets from Kaohsiung Chang Gung Memorial Hospital and National
Center for High-Performance Computing. Four metrics were used for evaluation: Dice similarity coefficient, lesion
segmentation, lesion F1-Score, and lesion sensitivity.
Results: The Transformer-based model, with appropriate adjustments, outperformed the well-established
convolution-based model in foreground Dice similarity coefficient, lesion F1-Score, and sensitivity, demonstrating
robust segmentation accuracy. DRLoc enhanced the Transformer’s performance, achieving comparable results on
internal and benchmark datasets despite limited data availability.
Conclusion: With comparable computational overhead, a Transformer-based model can surpass a well-established
convolution-based model in white matter hyperintensities segmentation on small datasets by capturing global
context effectively, making them suitable for clinical applications where computational resources are constrained.
How To Cite this Article
Chen, YT., Huang, YC., Chen, HL. et al. Automatic segmentation of white matter lesions on multi-parametric MRI: convolutional neural network versus vision transformer. BMC Neurol25, 5 (2025). https://doi.org/10.1186/s12883-024-04010-6
Background: Acute intermittent porphyria (AIP) is a rare but treatable disease. COVID-19 has various possible
complications including posterior reversible encephalopathy syndrome (PRES). COVID-19 was reported to trigger an.....
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Background: Acute intermittent porphyria (AIP) is a rare but treatable disease. COVID-19 has various possible
complications including posterior reversible encephalopathy syndrome (PRES). COVID-19 was reported to trigger an
acute attack in patients with acute hepatic porphyria (AHP). The pathophysiology of AHP-associated PRES is not fully
elucidated.
Case presentation: A 31-year-old Vietnamese female initially presented with seizures, severe hyponatremia, and
hypertension after COVID-19. Despite the initial treatment, she had recurrent seizures and developed PRES as
confirmed by magnetic resonance imaging. Further investigations revealed a genetic mutation of c.517 C > T in
HMBS, leading to a diagnosis of AHP. Treatment with hemin significantly improved her symptoms and corrected her
electrolyte imbalance.
Conclusions: This case highlights the potential for COVID-19 to trigger acute attacks in patients with underlying
porphyria, potentially leading to complications such as PRES. Also, we observed elevated catecholamine levels
during an acute porphyria attack and PRES, suggesting their involvement in the pathogenesis of AIP-associated PRES.
Clinicians should consider the possibility of porphyria in patients with COVID-19-associated PRES, especially when
they present with gastrointestinal and neuropsychiatric symptoms
How To Cite this Article
Handa, H., Masuda, H., Hanayama, S. et al. Unmasked acute intermittent porphyria in a patient with COVID-19-associated posterior reversible encephalopathy syndrome. BMC Neurol25, 139 (2025). https://doi.org/10.1186/s12883-025-04159-8
Authors: Kosar Kohandel, Sara Ala, Banafshe Tamizifar, Maryam Karaminia and Mohammadali Sahraian
Abstract:
Background: Pyoderma Gangrenosum (PG) is often considered an immune-mediated disease. Up to 50% of PG
cases - a rare, non-infectious inflammatory skin disease characterized by painful.....
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Authors: Kosar Kohandel, Sara Ala, Banafshe Tamizifar, Maryam Karaminia and Mohammadali Sahraian
Background: Pyoderma Gangrenosum (PG) is often considered an immune-mediated disease. Up to 50% of PG
cases - a rare, non-infectious inflammatory skin disease characterized by painful necrotic ulcers -are associated with
underlying systemic diseases like Rheumatoid Arthritis (RA), and Inflammatory Bowel Disease (IBD), moreover with
monoclonal antibody therapy.
Case presentation: We described a 38-year-old female patient with multiple sclerosis (MS) who was treated for three
years with Natalizumab. Myalgia, fever, and erythematous plaques accompanied by painful lesions in both upper
extremities manifested with the fifteenth dosage of NTZ. After comprehensive testing and a Magnetic Resonance
Imaging (MRI) scan, we excluded other systemic diseases and a recurrence of multiple sclerosis, respectively. After
consulting a dermatologist, a skin biopsy was performed, and pathology report confirmed PG. Eventually, the lesions
began to heal after stopping NTZ injection without receiving any dermatological care.
Conclusion: Based on PG incidence, it was associated with some medications like Rituximab and Ocrelizumab, on
the other hand, after discontinuation of NTZ the lesions started to heal even without dermatological treatment. In our
situation, it is conceivable that NTZ injection, and PG incidence are connected.
How To Cite this Article
Kohandel, K., Ala, S., Tamizifar, B. et al. Pyoderma gangrenosum in a patient with multiple sclerosis under natalizumab treatment: a case report. BMC Neurol25, 137 (2025). https://doi.org/10.1186/s12883-025-04146-z
Background & Introduction: Meningiomas are tumors that originate from non-neuroepithelial progenitor cells,
meningothelial cells and the arachnoid cap cells, thus they usually appear with.....
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Background & Introduction: Meningiomas are tumors that originate from non-neuroepithelial progenitor cells,
meningothelial cells and the arachnoid cap cells, thus they usually appear with attachment to the dura mater. But
sylvian fissure meningiomas are a rare type of meningioma that has no dural attachment.
Case presentation: A rare case of sylvian fissure meningioma is presented. The patient is a 34-year-old male with
headache, and preoperative images showed a massive lesion in his right frontotemporal lobe that had no contact
with the dura mater. Postoperative histopathological examination confirmed the diagnosis of a clear cell meningioma,
which is a WHO grade 2 atypical meningioma and a rare subtype of meningioma that only accounts for less than 1%
of all meningiomas.
Conclusion: Preoperative diagnosis of sylvian meningiomas can be challenging, leading to inappropriate operation
plan and postoperative treatment. Thus, we present this case and a brief review of past cases reported, hoping to
improve our understanding of the origin of meningiomas and accuracy in diagnosis of similar lesions.
Key message: A rare case of massive sylvian fissure meningioma is presented, which is a clear cell meningioma and WHO grade 2
atypical type. Based on previous reports, which confirm our case as the largest lesion so far, we analyzed the origin
of intraparenchymal meningiomas and difficulty in its differential diagnosis.
How To Cite this Article
He, T., Zhang, Z. & Wang, X. A huge cerebral parenchymal meningioma in sylvian fissure: case report and literature review. BMC Neurol 25, 140 (2025). https://doi.org/10.1186/s12883-025-04151-2
Authors: Rezvan Nemati, Ahmadreza Sohrabi-Ashlaghi, Parsa Saberian, Mohammad Sadeghi, Sajjad Mardani, Amir Sina Jafari Hossein Abadi, Ali Yaghoobpoor
Abstract:
Background: Growth-associated protein 43 (GAP-43) is a key protein involved in neuronal growth and synaptic
plasticity. Alterations in GAP-43 levels have been associated with Alzheimer’s Disease.....
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Authors: Rezvan Nemati, Ahmadreza Sohrabi-Ashlaghi, Parsa Saberian, Mohammad Sadeghi, Sajjad Mardani, Amir Sina Jafari Hossein Abadi, Ali Yaghoobpoor
Background: Growth-associated protein 43 (GAP-43) is a key protein involved in neuronal growth and synaptic
plasticity. Alterations in GAP-43 levels have been associated with Alzheimer’s Disease (AD), potentially reflecting
synaptic dysfunction. We evaluated the potential of GAP-43 as a biomarker for AD and explored its association with
amyloid-beta (Aβ) levels, as well as its correlation with Aβ plaque burden in the brain.
Methods: We screened 1,639 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. A
total of 226 individuals met the eligibility criteria and were enrolled. Participants were classified into three groups: 77
cognitively normal (CN) individuals, 111 with mild cognitive impairment (MCI), and 38 with a diagnosis of AD. The
associations between cerebrospinal fluid (CSF) GAP-43 levels with other biomarkers as well as [¹⁸F] AV-45 (Florbetapir)
PET Standardized Uptake Value Ratios (SUVR) were investigated.
Results: Our findings revealed significantly elevated CSF GAP-43 levels in individuals with AD compared to CN and
MCI groups. Furthermore, GAP-43 levels showed a significant positive correlation with tau pathology. Notably, we
observed a significant association between GAP-43 and [¹⁸F] Florbetapir PET SUVR in the MCI group, suggesting that
GAP-43 may serve as a reliable biomarker in the early stages of AD.
Conclusion: This study provides evidence supporting the role of GAP-43 as a potential biomarker for AD, particularly
in relation to predicting the amyloid pathology pattern in the brain in the MCI stage.
How To Cite this Article
Nemati, R., Sohrabi-Ashlaghi, A., Saberian, P. et al. Growth associated protein 43 (GAP-43) predicts brain amyloidosis in Alzheimer’s dementia continuum: an [18 F] AV-45 study. BMC Neurol25, 134 (2025). https://doi.org/10.1186/s12883-025-04140-5
Authors: Justine Itorralba, Koroboshka Brand-Arzamendi, Georges Saab, Alexandra Muccilli and Raphael Schneider
Abstract:
Background: MS is characterized by persistent central nervous system (CNS) inflammation. Investigating the CNS-compartmentalized inflammation associated with progressive MS could uncover new biomarkers and therapeutic
targets. Cerebrospinal fluid.....
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Authors: Justine Itorralba, Koroboshka Brand-Arzamendi, Georges Saab, Alexandra Muccilli and Raphael Schneider
Background: MS is characterized by persistent central nervous system (CNS) inflammation. Investigating the CNS-compartmentalized inflammation associated with progressive MS could uncover new biomarkers and therapeutic
targets. Cerebrospinal fluid (CSF) interleukin-6 (IL-6) can be markedly elevated in neuroinflammatory conditions, such
as neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. This
study investigated the association between CSF IL-6 levels, progressive disease, and disease severity in MS.
Methods: Advanced technologies, including single-molecule arrays and microfluidics, were used to analyse CSF
samples from individuals with MS at the time of diagnosis for IL-6. IL-6 levels were then correlated with clinical course,
disease severity, and other known biomarkers associated with inflammation and disease severity.
Results: Elevated IL-6 levels in the CSF were found in individuals with progressive MS, and CSF IL-6 showed positive
correlations with the Expanded Disability Status Scale, the Multiple Sclerosis Severity Score, and CSF glial fibrillary
acidic protein levels.
Conclusions: IL-6 in CSF indicates ongoing CNS inflammation and may contribute to the compartmentalized
inflammation associated with disease progression and overall disease severity.
How To Cite this Article
Itorralba, J., Brand-Arzamendi, K., Saab, G. et al. Intrathecal interleukin-6 levels are associated with progressive disease and clinical severity in multiple sclerosis. BMC Neurol 25, 136 (2025). https://doi.org/10.1186/s12883-025-04145-0
Background: Anti-kelch-like protein 11 (KLHL11) antibody-associated encephalitis is a rare autoimmune neurological
disorder, typically presenting with cerebellar syndrome and brainstem involvement. Diagnosis relies on the detection.....
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Background: Anti-kelch-like protein 11 (KLHL11) antibody-associated encephalitis is a rare autoimmune neurological
disorder, typically presenting with cerebellar syndrome and brainstem involvement. Diagnosis relies on the detection
of anti-KLHL11 antibodies in serum and/or cerebrospinal fluid (CSF). Immunotherapy remains the cornerstone of
treatment.
Case presentation: Patient 1 presented with an acute onset of dizziness, limb weakness, and slowed responses,
with rapid symptom progression. Despite receiving immunotherapy—including intravenous corticosteroids,
immunoglobulin, plasma exchange, and efgartigimod—which resulted in partial improvement, the patient
experienced a rapid relapse and further clinical deterioration. He ultimately succumbed to central circulatory failure.
Patient 2 exhibited a relatively slow disease course, primarily characterized by gait disturbances, slurred speech, and
memory decline. He received only symptomatic treatment without immunotherapy. Follow-up assessments indicated
slight symptomatic improvement. Brain magnetic resonance imaging (MRI) showed multiple hyperintense lesions on
T2-weighted fluid-attenuated inversion recovery (T2/FLAIR) in the bilateral subcortical cerebral hemispheres and pons
in patient 1. However, dominant pontine and cerebellar atrophy were noted in patient 2. Initial serum cell-based assay
(CBA) testing detected anti-KLHL11 antibody titers of 1:30 in patient 1 and 1:100 in patient 2.
Conclusion: This study indicates that patients with KLHL11-IgG encephalitis may present not only with typical
cerebellar symptoms, such as ataxia, and brainstem signs, such as dysarthria, but also with rapidly progressive
impairment of consciousness accompanied by seizures. The differences in disease course and MRI findings observed
between the two patients further suggest that clinical and imaging heterogeneity may be related to disease
chronicity. Therefore, it is essential to recognize the diverse clinical presentations and varying stages when diagnosing
KLHL11-IgG encephalitis. For patients exhibiting such symptoms, after exclusion of other potential causes, timely
KLHL11-IgG antibody testing and tumor screening are recommended to facilitate early diagnosis and prompt
treatment, thereby improving prognosis.
How To Cite this Article
Chai, S., Liu, G. & Zhang, Y. Anti-kelch-like protein 11 antibody-associated encephalitis: two case reports and literature review. BMC Neurol25, 297 (2025). https://doi.org/10.1186/s12883-025-04308-z
Authors: Moritz Mahlberg, Johannes Dorst, Zeynep Elmas, Ulrike Haase, Michael Heming, Louisa Müller-Miny, Gerd Meyer zu Hörste, Mark Stettner, Florian Then Bergh, Petra Baum
Abstract:
Background and objectives: There is limited study data on both therapeutic plasma exchange (PE) and
immunoadsorption (IA) in chronic inflammatory demyelinating polyneuropathy (CIDP), mostly based on.....
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Authors: Moritz Mahlberg, Johannes Dorst, Zeynep Elmas, Ulrike Haase, Michael Heming, Louisa Müller-Miny, Gerd Meyer zu Hörste, Mark Stettner, Florian Then Bergh, Petra Baum
Background and objectives: There is limited study data on both therapeutic plasma exchange (PE) and
immunoadsorption (IA) in chronic inflammatory demyelinating polyneuropathy (CIDP), mostly based on case series in
patients in the early stages of the disease.
The aim of this retrospective study was to compare the efficacy and tolerability of the two therapy procedures in a
larger sample with a longer duration of disease and immunomodulatory pre-treatment.
Methods: In this retrospective study from 5 centers in Germany, register data on the efficacy, safety and tolerability
of therapy with IA or PE in patients with CIDP were examined. Treatment response was assessed using neurological
scores (INCAT and Hughes Score), duration of hospital stay, and subjective assessment by examiners and patients. In
addition, side effects were recorded.
Results: A total of 44 patients were analyzed, 23 treated with PE (mean age 61.3 years, 17 male, 6 female) and 21 with
IA (mean age 67, 14 male, 7 female).
The mean duration of disease before treatment was 8.48±3.82 years (PE group) and 7.24±3.15 years (IA group). IA
and PE showed a comparable treatment response. With IA, 11 out of 21 (52.4%) patients improved, whereas with
PE, 14 out of 23 (60.9%) patients improved. The differences between before- and after-treatment INCAT and Hughes
scores also showed an improvement with both PE and IA individually (INCAT 1.17±1.61 and 0.71±1.65, respectively,
Hughes score 0.48±0.73 and 0.33±0.66, respectively), while there were no significant differences between the two
groups. The patients in the IA group had a significantly shorter inpatient stay (p < 0.019). There was one adverse
event in each group, but no serious adverse events in either group.
Discussion: This retrospective study indicates that IA and PE show comparable efficacy in chronic autoimmune
neuropathies, including patients with longer disease duration and immunomodulatory pretreatment.
How To Cite this Article
Mahlberg, M., Dorst, J., Elmas, Z. et al. Extracorporeal therapy procedures (plasma exchange and immunoadsorption) in chronic inflammatory demyelinating polyneuropathies (CIDP)– a database analysis. BMC Neurol 25, 293 (2025). https://doi.org/10.1186/s12883-025-04294-2
Authors: Moritz Mahlberg, Johannes Dorst, Zeynep Elmas, Ulrike Haase, Michael Heming, Louisa Müller-Miny, Gerd Meyer zu Hörste, Mark Stettner, Florian Then Bergh, Petra Baum
Account Details mentioned below: For Electronic Fund Transfer: (NEFT/RTGS)
Background: Atrial fibrillation is the most common arrhythmia that causes an increased risk of thromboembolism.
We aimed to evaluate stroke and major bleeding risk in patients with atrial.....
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Background: Atrial fibrillation is the most common arrhythmia that causes an increased risk of thromboembolism.
We aimed to evaluate stroke and major bleeding risk in patients with atrial fibrillation using rivaroxaban, apixaban,
dabigatran and the effects of using antiplatelet, atorvastatin and proton pump inhibitor (PPI) on development of
stroke.
Methods: Patients who were administered rivaroxaban, dabigatran or apixaban for atrial fibrillation between June
2014 and December 2020 were retrospectively analysed. Demographic data, CHADS2 and CHA2DS2-VASc scores, HAS-BLED scores, antiplatelet, proton pump inhibitor, atorvastatin medications were evaluated. Furthermore, we evaluated
the risk of major bleeding and stroke during treatment.
Results: We investigated 162 patients using dabigatran, 255 patients using rivaroxaban and 104 patients using
apixaban. No significant difference was observed between the groups in terms of CHA2DS2-VASc scores and the use
of atorvastatin, proton pump inhibitor and antiplatelet. HAS-BLED scores before DOACs treatment were statistically
significantly higher in the apixaban group compared to rivaroxaban and dabigatran groups (p = 0.038); we found
no difference between the study groups in terms of major bleeding (p = 0.528) and stroke risk (p = 0.498). The use of
antiplatelet, proton pump inhibitor and atorvastatin did not have a significant effect on stroke risk (p = 0.533, p = 0.169
and p = 0.949).
Conclusion: Rivaroxaban, dabigatran and apixaban have similar safety and efficacy for stroke prophylaxis. The use of
antiplatelet, proton pump inhibitor and atorvastatin did not have a significant effect on stroke risk.
How To Cite this Article
Tanoğlu, C., Ersoy, A. Safety and effectiveness of Rivaroxaban, Dabigatran and Apixaban in patients with non-valvular atrial fibrillation for stroke prophylaxis. BMC Neurol 25, 294 (2025). https://doi.org/10.1186/s12883-025-04306-1
Authors: Yehia Nabil, Mohamed Mohsen Helal, Israa Ahmed Qutob, Ali I. Abbas Dawoud, Salma Allam, Roaa Haddad, Ghaida Majid Manasrah, Esraa M. AlEdani, Wadi Sleibi, Ayhan faris
Abstract:
Background: Parkinson’s disease (PD) involves progressive neurodegeneration with motor and non-motor symp
toms. Gut microbiota alterations are implicated in PD pathogenesis, leading to interest in fecal microbiota.....
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Authors: Yehia Nabil, Mohamed Mohsen Helal, Israa Ahmed Qutob, Ali I. Abbas Dawoud, Salma Allam, Roaa Haddad, Ghaida Majid Manasrah, Esraa M. AlEdani, Wadi Sleibi, Ayhan faris
Background: Parkinson’s disease (PD) involves progressive neurodegeneration with motor and non-motor symp
toms. Gut microbiota alterations are implicated in PD pathogenesis, leading to interest in fecal microbiota transplan
tation (FMT) as a therapeutic option. This systematic review assesses the efficacy and safety of FMT in managing PD
symptoms.
Methods: We conducted a comprehensive search across PubMed, Scopus, Web of Science, and Cochrane Central
Controlled trials databases. Studies were screened based on predetermined inclusion criteria, focusing on randomized
controlled trials (RCTs) involving FMT in PD patients. Two reviewers independently performed the data extraction
and quality assessment. Key outcomes included improvements in motor and non-motor symptoms, quality of life,
and adverse effects.
Results: Five RCTs involving 157 patients met the inclusion criteria. Some studies reported improvements in motor
and non-motor symptoms, particularly with colonic FMT, while others found no significant benefit. One trial observed
motor function worsening. FMT was generally well-tolerated, with mild and transient gastrointestinal side effects.
Conclusion: FMT may relieve PD symptoms, but findings are inconsistent. Larger trials with standardized protocols
are needed to determine its long-term efficacy and safety.
How To Cite this Article
Nabil, Y., Helal, M.M., Qutob, I.A. et al. Efficacy and safety of fecal microbiota transplantation in the management of parkinson’s disease: a systematic review. BMC Neurol25, 291 (2025). https://doi.org/10.1186/s12883-025-04105-8
Authors: Yehia Nabil, Mohamed Mohsen Helal, Israa Ahmed Qutob, Ali I. Abbas Dawoud, Salma Allam, Roaa Haddad, Ghaida Majid Manasrah, Esraa M. AlEdani, Wadi Sleibi, Ayhan faris
Account Details mentioned below: For Electronic Fund Transfer: (NEFT/RTGS)
Background: The clinical application of dual-task training based on movement and cognition in stroke population is
still controversial. This study used a systematic review and.....
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Background: The clinical application of dual-task training based on movement and cognition in stroke population is
still controversial. This study used a systematic review and meta-analysis to compare the effects of dual-task exercise
versus single-task training including cognitive-only, exercise-only, and usual rehabilitation for motor function and
cognitive function in stroke patients.
Methods: Extensive electronic database search (from inception to November 27, 2024) was conducted in 8 databases
to identify randomized controlled trials that investigated the effects of dual task-based training on motor and
cognitive function in stroke patients.
Results: 30 RCTs involving 1,588 people were included in the analysis. The study found that compared with
the control group, dual-task cognitive motor training can improve the walking performance of stroke patients
(WMD = 3.19, 95%CI: 2.26, 4.12), the recovery of lower limb motor function (WMD = 2.78, 95% CI: 1.38, 4.18), cognitive
function (WMD = 2.93, 95% CI: 0.95, 4.91) and mental state (WMD = 3.39, 95% CI: 0.06, 6.72), and the functional state of
activities of daily living (WMD = 7.47, 95% CI: 3.97, 10.96). Subgroup analyses showed that cognitive-motor dual-task
training was more likely to have a clinical effect after at least 3 weeks of intervention.
Conclusions: Dual-task training significantly improves walking ability, lower limb motor function, cognitive function,
mental status, and activities of daily living in stroke patients. No significant effects were found for basic mobility
and gait speed. These findings support its clinical application, with personalized programs recommended based on
patient needs.
How To Cite this Article
Mou, C., Jiang, Y. Effect of dual task-based training on motor and cognitive function in stroke patients: a systematic review and meta-analysis of randomized controlled trails. BMC Neurol25, 290 (2025). https://doi.org/10.1186/s12883-025-04305-2
Authors: Emre Şenocak, Seda Karaca and Adem Aktürk
Abstract:
Objective: Humans use their motor and cognitive functions simultaneously while voluntarily performing real-time
selective motor movements in daily life. This study aimed to investigate the effects.....
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Authors: Emre Şenocak, Seda Karaca and Adem Aktürk
Objective: Humans use their motor and cognitive functions simultaneously while voluntarily performing real-time
selective motor movements in daily life. This study aimed to investigate the effects of dual-task training on upper
extremity motor skills and daily living activities in patients with Parkinson’s disease.
Methods: The patients were randomized into two groups. One of the groups (Control) received a conventional
physiotherapy program, while the other group (Dual-Task) also performed a cognitive-based dual-task intervention
in addition to traditional rehabilitation. All rehabilitation programs were continued for 60 × 5 × 6 min/day/week. The
assessments were performed twice: The two subsections of the MDS-Unified Parkinson’s Rating Scale (MDS-UPDRS II
and III), Box Block Test (BBT), and Parkinson’s Disease Questionnaire-39 (PDQ-39).
Results: There was no difference in any parameter between the groups, neither baseline nor after treatment
(p > 0.05 for all). In the within-group assessments, the amount of change was higher in the MDS-UPDRS II and III
sub-dimensions scores of the Dual-Task group. An increase was observed in the BBT results of both groups compared
to pre-treatment (p < 0.05 for all). While the PDQ-39 score of the Dual-Task group improved by approximately 18%
(p = 0.003), no change was detected in the control group (p = 0.413).
Conclusion: Dual-task interference maintained throughout rehabilitation may enable the development of motor-cognitive functions required by individuals with Parkinson’s disease to perform daily living activities. For this reason,
including dual-task training in rehabilitation to manage upper extremity impairment due to Parkinson’s disease may
be helpful to maximize gains.
Trial registration This study was registered to clinicaltrials.gov with NCT06803212 ID (01.30.2025).
How To Cite this Article
Şenocak, E., Karaca, S. & Aktürk, A. Effect of dual-task interference on upper extremity motor experience with Parkinson’s disease motor effect of dual-task in Parkinson’s disease. BMC Neurol25, 436 (2025). https://doi.org/10.1186/s12883-025-04462-4
Authors: Chenchen Li, Chongbo Zhao, Chao Quan, Jingzi ZhangBao, Yue Zhang, Juncang Wu, Chi Zhang and Xiang Li
Abstract:
Background: Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disorder
characterized by eosinophilic intranuclear inclusions in neurons and multiple visceral organs, leading to
heterogeneous.....
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Authors: Chenchen Li, Chongbo Zhao, Chao Quan, Jingzi ZhangBao, Yue Zhang, Juncang Wu, Chi Zhang and Xiang Li
Background: Neuronal intranuclear inclusion disease (NIID) is a progressive neurodegenerative disorder
characterized by eosinophilic intranuclear inclusions in neurons and multiple visceral organs, leading to
heterogeneous clinical manifestations. This case report presents two rare NIID patients with recurrent encephalitis-like
episodes, periodic prolonged hospitalizations, mimicking mitochondrial encephalomyopathies.
Case presentation: The first patient was a 63-year-old man with a history of migraines, who experienced two
episodes of acute fever, headache, motor aphasia, behavioral abnormalities, seizures, and stroke-like symptoms
over a period of four years. Brain MRI revealed swelling in the temporo-occipital lobe. Cerebrospinal fluid analysis
demonstrated elevated protein levels, while tests for autoimmune encephalitis antibodies and mitochondrial gene
mutations were negative. The second patient was a 38-year-old man with a family history of consanguinity, who
presented with recurrent episodes of fever, limb weakness, aphasia, and psychiatric disturbances, occurring numerous
times over five years. A recent MRI showed swelling in the left temporo-occipital lobe, dot-like high signals in the right
frontal-parietal-temporal lobe, and filamentous high signals at the corticomedullary junction. Genetic testing revealed
93 and 101 GGC repeats, respectively, in the 5' untranslated region (5' UTR) of the NOTCH2NLC gene, indicating
abnormal expansion and confirming the diagnosis of NIID.
Conclusions: This report underscores the importance of recognizing NIID in patients with recurrent encephalitis
like presentations and highlights the diagnostic utility of genetic testing in distinguishing it from conditions like
mitochondrial encephalopathies.
How To Cite this Article
Li, C., Zhao, C., Quan, C. et al. Neuronal intranuclear inclusion disease with recurrent encephalitis. BMC Neurol 25, 442 (2025). https://doi.org/10.1186/s12883-025-04453-5
Authors: Mitku Tessafa, Winta Tesfaye, Yibeltal Yismaw Gela, Baye Ashenef, Amanuel Baye and Mohammed Jemal
Abstract:
Introduction: Cognitive impairment is characterized by compromised cognitive function in one or more domains.
Nonetheless, it has devastating health and socioeconomic burdens on diabetic patients.....
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Authors: Mitku Tessafa, Winta Tesfaye, Yibeltal Yismaw Gela, Baye Ashenef, Amanuel Baye and Mohammed Jemal
Introduction: Cognitive impairment is characterized by compromised cognitive function in one or more domains.
Nonetheless, it has devastating health and socioeconomic burdens on diabetic patients worldwide, and studies
conducted, especially in Ethiopia, are not large enough. This study aimed to assess the prevalence of cognitive
impairment and its associated factors among adult diabetes mellitus patients in Amhara National Regional State
Referral Hospitals, Ethiopia.
Methods: A multicenter institution-based cross-sectional study was conducted with 415 study participants at referral
Hospitals in Amhara National Regional State between May 1 and June 10, 2022. The sample was selected using a
simple and systematic random sampling technique. Data were collected using a pretested structured interviewer-administered questionnaire. Cognitive impairment was assessed using standardized Mini-Mental State Examination
(MMSE) tool. Epi data 4.6 and STATA (14.0) were used for data entry and analysis, respectively. Bivariable and
multivariable logistic regression, odds ratios, and with 95% confidence interval (CI) at a p-value of ≤ 0.05 was used to
declare significantly associated variables.
Results: The magnitude of cognitive impairment among adult diabetes mellitus patients was 46.27%, with 95% CI
(41.5%, 51.1%). No formal education (AOR = 4.81, 95% CI:1.54, 15); older age > 60 years (AOR = 3.91, 95% CI:1.6, 7.9),
current alcohol drinking (AOR = 2.64, 95% CI: 1.13, 6.18), physical activity (AOR = 0.44, 95% CI:0.22, 0.89), fasting blood
sugar (FBS) > 130 mg/dl (AOR = 4.69, 95% CI: 2.61, 8.41), hypoglycemia episode (AOR = 2.87, 95% CI: 1.62, 5.06), insulin
treatment (AOR = 3.76, 95% CI: 1.94, 7.27), body mass index (BMI) ≥ 30 kg/m2 (AOR = 3.3, 95% CI:1.03, 10.56) were
variables significantly associated with cognitive impairment.
Conclusion: and recommendation Nearly, half of the study participants had cognitive impairment. No formal
education, older age > 60 years, current alcohol drinking, physical activity, FBS > 130 mg/dl, hypoglycemia episode, insulin treatment, and BMI ≥ 30 kg/m2 were significantly associated with cognitive impairment. Healthcare providers
are recommended to routinely screen diabetic patients during follow-up and, frequently follow cognitively impaired
and high-risk groups.
How To Cite this Article
Tessafa, M., Tesfaye, W., Gela, Y. et al. Cognitive impairment and associated factors among adult diabetes mellitus patients in Amhara National Regional State referral hospitals, Ethiopia: a multicenter institution-based cross-sectional study. BMC Neurol25, 435 (2025). https://doi.org/10.1186/s12883-025-04415-x
Authors: Hamidreza Ashayeri, Moloud Balafar, Amir Ebrahimi, Hassan Soleimanpour, Nasim Hajipoor-Kashgsaray, Kavous Shahsavarinia, and Hanieh Salehi-Pourmehr
Abstract:
Background: Therapeutic hypothermia (TH) is an intervention conducted to reduce brain damage in neonatal
asphyxia and postcardiac arrest patients. Traumatic brain injury (TBI) dysregulates cerebral.....
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Authors: Hamidreza Ashayeri, Moloud Balafar, Amir Ebrahimi, Hassan Soleimanpour, Nasim Hajipoor-Kashgsaray, Kavous Shahsavarinia, and Hanieh Salehi-Pourmehr
Background: Therapeutic hypothermia (TH) is an intervention conducted to reduce brain damage in neonatal
asphyxia and postcardiac arrest patients. Traumatic brain injury (TBI) dysregulates cerebral blood flow and causes
ischemic brain damage. TH could lower brain damage by reducing the metabolism rate and need for oxygen. In this
umbrella review, we aim to investigate different aspects of TH intervention in TBI patients.
Methods: We searched MEDLINE, Scopus, Embase, Cinahl, Epistemonikos, Cochrane Library, Web of Science, and
Google Scholar for relevant systematic reviews until August 03, 2025. Then, studies entered the screening process,
and systematic reviews of TH`s effect on TBI patients were included. We excluded studies without any quality
assessments. Data for mortality, favorable and unfavorable neurologic outcomes, and possible complications of TH
were extracted from the included studies. We avoided meta-analysis due to the vast heterogeneity between the
studies’ methodologies.
Results: Of the 1466 studies identified from the primary search, 30 met our inclusion criteria. According to the JBI
critical appraisal tool for systematic reviews, 29 studies were of high quality, and 1 was of medium quality. Studies
had different methodologies, such as different induction methods and durations, different age groups, target
temperatures, and rewarming rates. Mortality was the most common outcome assessed by the studies. Morbidity was
assessed as either favorable or unfavorable neurological outcomes at a follow-up of 1,3,6,12,24 months. Pneumonia
was the most investigated side-effect of TH, and most studies reported a greater chance of pneumonia in the TH
group. Other investigated complications of TH were electrolyte abnormalities, coagulopathy, and arrhythmia.
Conclusion: Studies have shown controversial results regarding the effect of TH on mortality and morbidity.
Differences in the target population, hypothermia protocol, and quality of included studies may be responsible for
part of this controversy. Some of the important parameters that may affect the results are the age of TBI patients,
the use of barbiturates, target TH temperature, rewarming rates, and method of cooling. Additionally, the subgroup analysis of high-quality studies differed from the pooled analysis provided by each study. More high-quality studies
with specific protocols are needed to better understand TH’s role in TBI patients.
How To Cite this Article
Ashayeri, H., Balafar, M., Ebrahimi, A. et al. Therapeutic hypothermia in patients with traumatic brain injury: an umbrella review. BMC Neurol 25, 440 (2025). https://doi.org/10.1186/s12883-025-04463-3
Parkinson’s disease (PD) is a neurodegenerative disorder linked to alpha-synuclein pathology and dopaminergic
neuron loss. Exosomes play dual roles in PD progression, facilitating pathological protein spread or exerting.....
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Parkinson’s disease (PD) is a neurodegenerative disorder linked to alpha-synuclein pathology and dopaminergic
neuron loss. Exosomes play dual roles in PD progression, facilitating pathological protein spread or exerting
neuroprotective effects. This study aimed to identify exosome-related gene biomarkers for PD diagnosis and
therapy. Using multi-dataset analysis (Series: GSE42966, Platforms: GPL4133, Series: GSE99039, Platforms: GPL570,
Series: GSE156926, Platforms: GPL19920) from the Gene Expression Omnibus (GEO), we integrated principal
component analysis (PCA), differential gene screening (|logFC|>0.5, p < 0.05), and machine learning to identify PD-associated exosome-related genes. Functional enrichment revealed associations with oxidative phosphorylation,
Huntington’s disease pathways, and immune responses. A predictive model comprising five genes—GNAS, TUBB2A,
RPL22, RPL5, and WNT5A—was established and validated using ROC curves (Receiver Operating Characteristic
Curve) and nomograms. Immune profiling linked these genes to B cells, MDSCs, and CD4+/CD8 + T cells. Drug-gene network analysis highlighted interactions with compounds like NSC94017 and phosphine, while molecular
docking identified key binding residues (e.g., GLN294, ASP295). These genes may serve as early diagnostic
biomarkers and therapeutic targets. Despite promising results, further validation in larger cohorts and mechanistic
studies are needed to confirm their roles in PD pathogenesis and treatment. This study provides a foundation for
developing precision gene therapies and non-invasive diagnostic strategies for PD.
How To Cite this Article
Chen, S., Feng, N. & Liu, Y. Identification of exosome-related gene biomarkers for parkinson’s disease: a multi-omics approach for early diagnosis and therapeutic targeting. BMC Neurol 25, 437 (2025). https://doi.org/10.1186/s12883-025-04477-x
Authors: Simón Cárdenas‑Robledo, Laura Estefanía Arenas‑Vargas, Rubén Darío Arenas, Jorge Mario Gaspar‑Toro, Ángela María Muñoz‑Rosero, Aranza Helena Tafur‑Borrero, Daniel Stiven Marín‑Medina
Abstract:
Background: Effective interventions for Multiple Sclerosis require timely treatment optimization which usually
involves switching disease modifying therapies. The patterns of prescription and the reasons for changing.....
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Authors: Simón Cárdenas‑Robledo, Laura Estefanía Arenas‑Vargas, Rubén Darío Arenas, Jorge Mario Gaspar‑Toro, Ángela María Muñoz‑Rosero, Aranza Helena Tafur‑Borrero, Daniel Stiven Marín‑Medina
Background: Effective interventions for Multiple Sclerosis require timely treatment optimization which usually
involves switching disease modifying therapies. The patterns of prescription and the reasons for changing treatment
in people with MS, especially in low prevalence populations, are unknown.
Objectives: To describe the persistence, reasons of DMT switches and prescription patterns in a cohort of Colombian
people with MS.
Methods: We conducted a retrospective observational study including patients with confirmed MS with at least
one visit at ourcentre. We estimated the overall incidence rate of medication changes and assessed the persistence
on medication with Kaplan–Meier survival estimates for individual medications and according to efficacy and mode
of administration. The factors associated with changing medications were assessed using adjusted Cox proportional-hazards models. The reasons for switching medication changes were described, and the prescription patterns were
assessed using network analysis, with measures of centrality.
Results: Seven hundred one patients with MS were included. Mean age was 44.3 years, and 67.9% were female. Mean
disease duration was 11.3 years and 84.5% had relapsing MS at onset, with median EDSS of 1.0. Treatment was started
in 659 (94%) of the patients after a mean of 3 years after MS symptom onset. Among them, 39.5% maintained their
initial DMT, 29.9% experienced a single DMT change, while 18.7% went through two, and 11.9% had three or more
DMT changes until the final follow‑up. The total number of treatment modifications reached 720, resulting in an incidence rate of 1.09 (95% confidence interval: 1.01–1.17) per patient per year The median time to change after the first
DMT was 3.75 years, and was not different according to the mode of administration or efficacy classification. The
main reasons for changing DMT were MS activity (relapses, 56.7%; MRI activity, 18.6%), followed by non‑serious
adverse events (15.3%) and disability (11.1%). Younger age at MS onset, care under our centre and insurer status were
the main determinants of treatment change. Network analysis showed that interferons and fingolimod were the most
influential DMTs.
Conclusions: A majority of patients switch medications, mostly due to disease activity, and in association with age
and insurer status.
How To Cite this Article
Cárdenas-Robledo, S., Arenas-Vargas, L. E., Arenas, R. D., Gaspar-Toro, J. M., Muñoz-Rosero, Á. M., Tafur-Borrero, A. H., ... & López-Reyes, L. (2024). Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors. BMC neurology, 24(1), 108.
Authors: Simón Cárdenas‑Robledo, Laura Estefanía Arenas‑Vargas, Rubén Darío Arenas, Jorge Mario Gaspar‑Toro, Ángela María Muñoz‑Rosero, Aranza Helena Tafur‑Borrero, Daniel Stiven Marín‑Medina
Account Details mentioned below: For Electronic Fund Transfer: (NEFT/RTGS)
Authors: Jenny Sedhed, Hanna Johansson, Nina Andersson, Elisabet Åkesson, Elke Kalbe, Erika Franzén and Breiffni Leavy
Abstract:
Background: Parkinson’s disease (PD) drastically affects motor and cognitive function, but evidence shows that
motor-cognitive training improves disease symptoms. Motor-cognitive training in the home is scarcely.....
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Authors: Jenny Sedhed, Hanna Johansson, Nina Andersson, Elisabet Åkesson, Elke Kalbe, Erika Franzén and Breiffni Leavy
Background: Parkinson’s disease (PD) drastically affects motor and cognitive function, but evidence shows that
motor-cognitive training improves disease symptoms. Motor-cognitive training in the home is scarcely investigated
and eHealth methods can provide continual support for PD self-management. Feasibility testing is however required.
Objective: To assess the feasibility (i) Recruitment capability (ii) Acceptability and Suitability (iii) Demand and Safety of
a home-based motor-cognitive eHealth exercise intervention in PD.
Methods: The 10-week intervention was delivered using the ExorLive® application and exercises were individually
adapted and systematically progressed and targeted functional strength, cardiovascular fitness, flexibility, and motor-cognitive function. People with mild-to moderate PD were assessed before and after the intervention regarding; gait
performance in single and dual-task conditions; functional mobility; dual-task performance; balance performance;
physical activity level; health related quality of life and perceived balance confidence and walking ability; global
cognition and executive function. Feasibility outcomes were continuously measured using a home-exercise diary and
contact with a physiotherapist. Changes from pre- and post-intervention are reported descriptively.
Results: Fifteen participants (mean age 68.5 years) commenced and 14 completed the 10-week intervention. In
relation to intervention Acceptability, 64% of the motor sessions and 52% of motor-cognitive sessions were rated as
“enjoyable”. Concerning Suitability, the average level of exertion (Borg RPE scale) was light (11–12). Adherence was
high, with 86% of all (420) sessions reported as completed. No falls or other adverse events occurred in conjunction
with the intervention.
Conclusions: This motor-cognitive eHealth home exercise intervention for PD was safe and feasible in terms of
Recruitment capability, Acceptability, Safety and Demand. The intensity of physical challenge needs to be increased
before testing in an efficacy trial.
Trial registration This trial is registered at Clinicaltrials.gov (NCT05027620).
How To Cite this Article
Sedhed, J., Johansson, H., Andersson, N. et al. Feasibility of a novel eHealth intervention for Parkinson’s disease targeting motor-cognitive function in the home. BMC Neurol 24, 114 (2024). https://doi.org/10.1186/s12883-024-03614-2
Authors: Patricia Pozo-Rosich, Mafalda Carmo, Alejandro Muñiz, Beatriz Armada, Carlota Moya-Alarcón and Julio Pascual
Abstract:
Background: Migraine is a leading cause of disability, estimated to affect one-in-ten people in Spain. This study
aimed to describe the management of migraine in Spain.....
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Authors: Patricia Pozo-Rosich, Mafalda Carmo, Alejandro Muñiz, Beatriz Armada, Carlota Moya-Alarcón and Julio Pascual
Background: Migraine is a leading cause of disability, estimated to affect one-in-ten people in Spain. This study
aimed to describe the management of migraine in Spain and identify improvement areas.
Methods: Non-interventional, retrospective, cross-sectional cohort study conducted using an electronic medical
records database covering visits to public healthcare providers for 3% of the Spanish population. Patients with a
migraine diagnosis (ICD-9 346) between 01/2015 and 04/2022 were included, as well as their demographic and
clinical characteristics, prescribed migraine treatments and the specialty of the prescribing physicians.
Results: The database included 61,204 patients diagnosed with migraine. A migraine treatment had been prescribed
to 50.6% of patients over the last 24 months (only acute to 69.5%, both acute and preventive to 24.2%, and only
preventive to 6.3%). The most frequently prescribed treatments were NSAIDs (56.3%), triptans (44.1%) and analgesics
(28.9%). Antidepressants were the most common preventive treatment (prescribed to 17.9% of all treated patients
and 58.7% of those treated with a preventive medication), and anti-CGRP monoclonal antibodies the least prescribed
(1.7%; 5.7%). In 13.4% of cases, preventive medications were the first treatment: alone in 5.8% of cases and together
with an acute medication in 7.6%. A fifth of patients who were initially prescribed with only acute treatment were
later prescribed a preventive medication (20.7%). On average, it took 29.4 months for this change to occur. Two-thirds of patients started their preventive treatment in primary care (64.2%). The percentage of patients treated by
a neurologist increased with the number of received preventive medications. However, 28.8% of patients who had
already been prescribed five or more distinct preventive treatments were not treated by a neurologist. Migraine
patients had between 1.2- and 2.2-times higher prevalence of comorbidities than the general population, age-gender
adjusted.
Conclusions: Our study emphasizes the need for improved management of migraine in Spain to reduce the risk
of chronification and improve patient outcomes. More training and coordination across healthcare professionals is
necessary to recognize and address risk factors for migraine progression, including multiple associated comorbidities
and several lines of treatment, and to provide personalized treatment plans that address the complex nature of the
condition.
How To Cite this Article
Pozo-Rosich, P., Carmo, M., Muñiz, A. et al. Migraine treatment: quo vadis? Real-world data study (2015–2022) in Spain. BMC Neurol24, 107 (2024). https://doi.org/10.1186/s12883-024-03600-8
Authors: Roger M. Lane, Taher Darreh‑Shori, Candice Junge, Dan Li, Qingqing Yang, Amanda L. Edwards, Danielle L. Graham, Katrina Moore and Catherine J. Mummery
Abstract:
Background: The authors sought to examine the impact of the K‑variant of butyrylcholinesterase (BCHE-K) carrier
status on age‑at‑diagnosis of Alzheimer disease (AD) in
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Authors: Roger M. Lane, Taher Darreh‑Shori, Candice Junge, Dan Li, Qingqing Yang, Amanda L. Edwards, Danielle L. Graham, Katrina Moore and Catherine J. Mummery
Background: The authors sought to examine the impact of the K‑variant of butyrylcholinesterase (BCHE-K) carrier
status on age‑at‑diagnosis of Alzheimer disease (AD) in APOE4 carriers.
Methods: Patients aged 50–74 years with cerebrospinal fluid (CSF) biomarker‑confirmed AD, were recruited to clinical
trial (NCT03186989 since June 14, 2017). Baseline demographics, disease characteristics, and biomarkers were evaluated in 45 patients according to BCHE-K and APOE4 allelic status in this post‑hoc study.
Results: In APOE4 carriers (N = 33), the mean age‑at‑diagnosis of AD in BCHE-K carriers (n = 11) was 6.4 years earlier
than in BCHE-K noncarriers (n = 22, P < .001, ANOVA). In APOE4 noncarriers (N = 12) there was no observed influence of BCHE-K. APOE4 carriers with BCHE-K also exhibited slightly higher amyloid and tau accumulations compared
to BCHE-K noncarriers. A predominantly amyloid, limited tau, and limbic‑amnestic phenotype was exemplified
by APOE4 homozygotes with BCHE-K. In the overall population, multiple regression analyses demonstrated an association of amyloid accumulation with APOE4 carrier status (P < .029), larger total brain ventricle volume (P < .021),
less synaptic injury (Ng, P < .001), and less tau pathophysiology (p‑tau181, P < .005). In contrast, tau pathophysiology
was associated with more neuroaxonal damage (NfL, P = .002), more synaptic injury (Ng, P < .001), and higher levels
of glial activation (YKL‑40, P = .01).
Conclusion: These findings have implications for the genetic architecture of prognosis in early AD, not the genetics
of susceptibility to AD. In patients with early AD aged less than 75 years, the mean age‑at‑diagnosis of AD in APOE4
carriers was reduced by over 6 years in BCHE-K carriers versus noncarriers. The functional status of glia may explain
many of the effects of APOE4 and BCHE-K on the early AD phenotype.
Trial registration: NCT03186989 since June 14, 2017
How To Cite this Article
Lane, R.M., Darreh-Shori, T., Junge, C. et al. Onset of Alzheimer disease in apolipoprotein ɛ4 carriers is earlier in butyrylcholinesterase K variant carriers. BMC Neurol 24, 116 (2024). https://doi.org/10.1186/s12883-024-03611-5
Authors: Roger M. Lane, Taher Darreh‑Shori, Candice Junge, Dan Li, Qingqing Yang, Amanda L. Edwards, Danielle L. Graham, Katrina Moore and Catherine J. Mummery
Account Details mentioned below: For Electronic Fund Transfer: (NEFT/RTGS)
Authors: Alexander H. Choi, Melanie Delgado, Kong Y. Chen, Stephanie T. Chung, Amber Courville, Sara A. Turner, Shanna Yang, Kayla Airaghi, Irene Dustin, Patrick McGurrin, Tianxia Wu
Abstract:
Background: A ketogenic diet (KD) may benefit people with neurodegenerative disorders marked by mitochondrial
depolarization/insufficiency, including Parkinson’s disease (PD).
Authors: Alexander H. Choi, Melanie Delgado, Kong Y. Chen, Stephanie T. Chung, Amber Courville, Sara A. Turner, Shanna Yang, Kayla Airaghi, Irene Dustin, Patrick McGurrin, Tianxia Wu
Background: A ketogenic diet (KD) may benefit people with neurodegenerative disorders marked by mitochondrial
depolarization/insufficiency, including Parkinson’s disease (PD).
Objective: Evaluate whether a KD supplemented by medium chain triglyceride (MCT-KD) oil is feasible and acceptable for PD patients. Furthermore, we explored the effects of MCT-KD on blood ketone levels, metabolic parameters,
levodopa absorption, mobility, nonmotor symptoms, simple motor and cognitive tests, autonomic function, and resting-state electroencephalography (rsEEG).
Methods: A one-week in-hospital, double-blind, randomized, placebo-controlled diet (MCT-KD vs. standard diet
(SD)), followed by an at-home two-week open-label extension. The primary outcome was KD feasibility and acceptability. The secondary outcome was the change in Timed Up & Go (TUG) on day 7 of the diet intervention. Additional
exploratory outcomes included the N-Back task, Unified Parkinson’s Disease Rating Scale, Non-Motor Symptom Scale,
and rsEEG connectivity.
Results: A total of 15/16 subjects completed the study. The mean acceptability was 2.3/3, indicating willingness
to continue the KD. Day 7 TUG time was not significantly different between the SD and KD groups. The nonmotor
symptom severity score was reduced at the week 3 visit and to a greater extent in the KD group. UPDRS, 3-back,
and rsEEG measures were not significantly different between groups. Blood ketosis was attained by day 4 in the KD
group and to a greater extent at week 3 than in the SD group. The plasma levodopa metabolites DOPAC and dopamine both showed nonsignificant increasing trends over 3 days in the KD vs. SD groups.
Conclusions: An MCT-supplemented KD is feasible and acceptable to PD patients but requires further study
to understand its effects on symptoms and disease.
Trial Registration Trial Registration Number NCT04584346, registration dates were Oct 14, 2020 – Sept 13, 2022.
How To Cite this Article
Choi, A.H., Delgado, M., Chen, K.Y. et al. A randomized feasibility trial of medium chain triglyceride-supplemented ketogenic diet in people with Parkinson's disease. BMC Neurol24, 106 (2024). https://doi.org/10.1186/s12883-024-03603-5
Authors: Alexander H. Choi, Melanie Delgado, Kong Y. Chen, Stephanie T. Chung, Amber Courville, Sara A. Turner, Shanna Yang, Kayla Airaghi, Irene Dustin, Patrick McGurrin, Tianxia Wu
Account Details mentioned below: For Electronic Fund Transfer: (NEFT/RTGS)
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