Neurology International

21 pages, 2508 KiB

Open AccessReview

Artificial Intelligence in the Diagnosis of Neurological Diseases Using Biomechanical and Gait Analysis Data: A Scopus-Based Bibliometric Analysis

by Aikaterini A. Tsiara, Spyridon Plakias, Christos Kokkotis, Aikaterini Veneri, Minas A. Mina, Anna Tsiakiri, Sofia Kitmeridou, Foteini Christidi, Evangelos Gourgoulis, Triantafylos Doskas, Antonia Kaltsatou, Konstantinos Tsamakis, Dimitrios Kazis and Dimitrios Tsiptsios

Neurol. Int. 2025, 17(3), 45; https://doi.org/10.3390/neurolint17030045 - 20 Mar 2025

Viewed by 884

Abstract

Neurological diseases are increasingly diverse and prevalent, presenting significant challenges for their timely and accurate diagnosis. The aim of the present study is to conduct a bibliometric analysis and literature review in the field of neurology to explore advancements in the application of [...] Read more.

Neurological diseases are increasingly diverse and prevalent, presenting significant challenges for their timely and accurate diagnosis. The aim of the present study is to conduct a bibliometric analysis and literature review in the field of neurology to explore advancements in the application of artificial intelligence (AI) techniques, including machine learning (ML) and deep learning (DL). Using VOSviewer software (version 1.6.20.0) and documents retrieved from the Scopus database, the analysis included 113 articles published between 1 January 2018 and 31 December 2024. Key journals, authors, and research collaborations were identified, highlighting major contributions to the field. Science mapping investigated areas of research focus, such as biomechanical data and gait analysis including AI methodologies for neurological disease diagnosis. Co-occurrence analysis of author keywords allowed for the identification of four major themes: (a) machine learning and gait analysis; (b) sensors and wearable health technologies; (c) cognitive disorders; and (d) neurological disorders and motion recognition technologies. The bibliometric insights demonstrate a growing but relatively limited collaborative interest in this domain, with only a few highly cited authors, documents, and journals driving the research. Meanwhile, the literature review highlights the current methodologies and advancements in this field. This study offers a foundation for future research and provides researchers, clinicians, and occupational therapists with an in-depth understanding of AI’s potentially transformative role in neurology. Full article

► Show Figures

Figure 1

7 pages, 686 KiB

Open AccessCase Report

Successful Long-Term Treatment of Pediatric Relapsing Idiopathic Optic Neuritis with Mycophenolate Mofetil

by Shuhei Fujino, Keiji Akamine, Eiichiro Noda and Sahoko Miyama

Neurol. Int. 2025, 17(3), 44; https://doi.org/10.3390/neurolint17030044 - 18 Mar 2025

Cited by 1 | Viewed by 440

Abstract

Background: Pediatric optic neuritis (ON) is a rare but severe condition characterized by acute visual impairment, with 3–5% of relapsing cases lacking identifiable markers for associated conditions, such as neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS); these cases are thus classified [...] Read more.

Background: Pediatric optic neuritis (ON) is a rare but severe condition characterized by acute visual impairment, with 3–5% of relapsing cases lacking identifiable markers for associated conditions, such as neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS); these cases are thus classified as relapsing idiopathic optic neuritis (RION). Corticosteroids are typically used for acute management; however, their prolonged use in children poses significant risks, including central obesity, hypertension, and growth impairment, underscoring the need for nonsteroidal, long-term treatment options. Current strategies for preventing recurrence in pediatric RION are limited due to a lack of data on immunosuppressive efficacy and safety. Given its rarity and the challenges of long-term immunosuppression in children, identifying optimal therapeutic approaches remains critical. Case Presentation: We report a case of a six-year-old girl with RION, who was initially treated with intravenous methylprednisolone (IVMP) and prednisolone (PSL) tapering, and who experienced recurrence eight months post-treatment. Additional corticosteroids and intravenous immunoglobulin (IVIg) were administered during relapse, but, due to adverse effects, treatment was transitioned to mycophenolate mofetil (MMF), enabling early PSL tapering. Conclusions: With MMF, the patient maintained stable vision and achieved a five-year recurrence-free period without notable side effects. In conclusion, this case suggests MMF’s efficacy as a long-term management option for pediatric RION, potentially reducing corticosteroid-related risks. Full article

► Show Figures

Figure 1

12 pages, 2111 KiB

Open AccessArticle

Responsiveness and Minimal Important Change of the Mini- and Brief-Balance Evaluation Systems Tests in People with Incomplete Cervical Spinal Cord Injury: A Prospective Cohort Study

by Yusuke Morooka, Yosuke Kunisawa, Shigeru Obayashi and Yasuyuki Takakura

Neurol. Int. 2025, 17(3), 43; https://doi.org/10.3390/neurolint17030043 - 18 Mar 2025

Viewed by 234

Abstract

Background/Objectives: Responsiveness and minimal important change (MIC) are key metrics that vary across conditions and should be determined for specific populations. However, these metrics have not yet been established for the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest in people with subacute traumatic [...] Read more.

Background/Objectives: Responsiveness and minimal important change (MIC) are key metrics that vary across conditions and should be determined for specific populations. However, these metrics have not yet been established for the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest in people with subacute traumatic incomplete cervical spinal cord injury (iCSCI). In this study, we aimed to determine the responsiveness and MIC of the Mini-BESTest and Brief-BESTest in people with subacute iCSCI. Methods: This study included people with iCSCI who could maintain the standing position for 30 s without assistance within 7 days of injury at the university hospital’s advanced critical care center. Responsiveness was assessed by correlating Mini-BESTest and Brief-BESTest change scores with the Berg Balance Scale (BBS). MIC values were determined using the global rating of change scale as an anchor, employing receiver operating characteristic curve methods (MIC_ROC) and predictive modeling methods adjusted for the proportion of improved participants (MIC_adjusted). Results: Fifty people with iCSCI were included in the analysis. Changes in BBS scores were moderately positively correlated with changes in Mini-BESTest and Brief-BESTest scores. MIC_adjusted values were 3.7 for the Mini-BESTest and 2.2 for the Brief-BESTest. The MIC_ROC, based on an improvement rate of 64%, was deemed less appropriate for interpreting meaningful changes due to the high proportion of improved participants. Conclusions: MIC_adjusted benchmarks can help clinicians measure significant improvements in dynamic balance, design effective interventions, and evaluate rehabilitation outcomes in people with iCSCI. Full article

► Show Figures

Figure 1

13 pages, 1423 KiB

Open AccessArticle

Dysregulation of Retinal Melatonin Biosynthetic Pathway and Differential Expression of Retina-Specific Genes Following Blast-Induced Ocular Injury in Ferrets

by Chetan Pundkar, Rex Jeya Rajkumar Samdavid Thanapaul, Manoj Govindarajulu, Gaurav Phuyal, Joseph B. Long and Peethambaran Arun

Neurol. Int. 2025, 17(3), 42; https://doi.org/10.3390/neurolint17030042 - 17 Mar 2025

Cited by 1 | Viewed by 388

Abstract

Background/Objectives: Blast-induced traumatic ocular injuries (bTOI) pose a significant risk to military and civilian populations, often leading to visual impairment or blindness. Retina, the innermost layer of ocular tissue consisting of photoreceptor and glial cells, is highly susceptible to blast injuries. Despite its [...] Read more.

Background/Objectives: Blast-induced traumatic ocular injuries (bTOI) pose a significant risk to military and civilian populations, often leading to visual impairment or blindness. Retina, the innermost layer of ocular tissue consisting of photoreceptor and glial cells, is highly susceptible to blast injuries. Despite its prevalence, the molecular mechanisms underlying retinal damage following bTOI remain poorly understood, hindering the development of targeted therapies. Melatonin, a neuroprotective indoleamine with antioxidant, anti-inflammatory, and circadian regulatory properties, is synthesized in the retina and plays a crucial role in retinal health. Similarly, retina-specific genes, such as Rhodopsin, Melanopsin, and RPE65, are essential for photoreceptor function, visual signaling, and the visual cycle. However, their responses to blast exposure have not been thoroughly investigated. Methods: In this study, we utilized a ferret model of bTOI to evaluate the temporal expression of melatonin-synthesizing enzymes, such as tryptophan hydroxylase 1 and 2 (TPH1 and TPH2), Aralkylamine N-acetyltransferase (AANAT), and Acetylserotonin-O-methyltransferase (ASMT), and retina-specific genes (Rhodopsin, Melanopsin) and retinal pigment epithelium-specific 65 kDa protein (RPE65) at 4 h, 24 h, 7 days, and 28 days post-blast. Ferrets were exposed to tightly coupled blast overpressure waves using an advanced blast simulator, and retinal tissues were collected for quantitative polymerase chain reaction (qPCR) analysis. Results: The results revealed dynamic and multiphasic transcriptional responses. TPH1 and TPH2 exhibited significant upregulation at 24 h, followed by downregulation at 28 days, indicating blast-induced dysregulation of tryptophan metabolism, including melatonin synthesis. Similarly, AANAT and ASMT showed acute downregulation post-blast, with late-phase disruptions. Rhodopsin expression increased at 24 h but declined at 28 days, while Melanopsin and RPE65 demonstrated early upregulation followed by downregulation, reflecting potential disruptions in circadian regulation and the visual cycle. Conclusions: These findings highlight the complex regulatory mechanisms underlying retinal responses to bTOI, involving neuroinflammation, oxidative stress, and disruptions in melatonin synthesis and photoreceptor cell functions. The results emphasize the therapeutic potential of melatonin in mitigating retinal damage and preserving visual function. Full article

► Show Figures

Figure 1

41 pages, 614 KiB

Open AccessReview

Glial Cells in Spinal Muscular Atrophy: Speculations on Non-Cell-Autonomous Mechanisms and Therapeutic Implications

by Andrej Belančić, Tamara Janković, Elvira Meni Maria Gkrinia, Iva Kristić, Jelena Rajič Bumber, Valentino Rački, Kristina Pilipović, Dinko Vitezić and Jasenka Mršić-Pelčić

Neurol. Int. 2025, 17(3), 41; https://doi.org/10.3390/neurolint17030041 - 13 Mar 2025

Viewed by 966

Abstract

Spinal muscular atrophy (SMA) is a neuromuscular disorder caused by homozygous deletions or mutations in the SMN1 gene, leading to progressive motor neuron degeneration. While SMA has been classically viewed as a motor neuron-autonomous disease, increasing evidence indicates a significant role of glial [...] Read more.

Spinal muscular atrophy (SMA) is a neuromuscular disorder caused by homozygous deletions or mutations in the SMN1 gene, leading to progressive motor neuron degeneration. While SMA has been classically viewed as a motor neuron-autonomous disease, increasing evidence indicates a significant role of glial cells—astrocytes, microglia, oligodendrocytes, and Schwann cells—in the disease pathophysiology. Astrocytic dysfunction contributes to motor neuron vulnerability through impaired calcium homeostasis, disrupted synaptic integrity, and neurotrophic factor deficits. Microglia, through reactive gliosis and complement-mediated synaptic stripping, exacerbate neurodegeneration and neuroinflammation. Oligodendrocytes exhibit impaired differentiation and metabolic support, while Schwann cells display abnormalities in myelination, extracellular matrix composition, and neuromuscular junction maintenance, further compromising motor function. Dysregulation of pathways such as NF-κB, Notch, and JAK/STAT, alongside the upregulation of complement proteins and microRNAs, reinforces the non-cell-autonomous nature of SMA. Despite the advances in SMN-restorative therapies, they do not fully mitigate glial dysfunction. Targeting glial pathology, including modulation of reactive astrogliosis, microglial polarization, and myelination deficits, represents a critical avenue for therapeutic intervention. This review comprehensively examines the multifaceted roles of glial cells in SMA and highlights emerging glia-targeted strategies to enhance treatment efficacy and improve patient outcomes. Full article

(This article belongs to the Special Issue Molecular Research of CNS Diseases and Neurological Disorders)

13 pages, 4471 KiB

Open AccessArticle

The Impact of Biseasonal Time Changes on Migraine

by Carl H. Göbel, Katja Heinze-Kuhn, Axel Heinze, Anna Cirkel and Hartmut Göbel

Neurol. Int. 2025, 17(3), 40; https://doi.org/10.3390/neurolint17030040 - 5 Mar 2025

Viewed by 1050

Abstract

Background: Changes in the daily rhythm can trigger migraine attacks. The sensitivity for triggering attacks is closely linked to the regulation of biological rhythms controlled by the hypothalamus. In over 70 countries around the world, the time is changed between daylight savings [...] Read more.

Background: Changes in the daily rhythm can trigger migraine attacks. The sensitivity for triggering attacks is closely linked to the regulation of biological rhythms controlled by the hypothalamus. In over 70 countries around the world, the time is changed between daylight savings time and standard time twice a year due to legal regulations. The aim of this study was to investigate whether the time change has an influence on migraine. Methods: In this retrospective study, the headache frequency of patients with episodic or chronic migraine at a tertiary headache center in the years 2020, 2021, and 2022 was evaluated. The primary outcome measure was the frequency of migraine occurrence on either Sunday or Monday of the time change weekend compared to Sunday or Monday before or Sunday or Monday after the time change. Results: Data from 258 patients were analyzed (86.8% women; average age: 51.5 years; average headache frequency: 7.7 days/month; 83.3% episodic migraine). Our results showed a significant increase of 6.4% in migraine frequency on the Sunday and/or Monday in the week after the time change in spring compared to the week before the change. In autumn, conversely, there was a significant reduction of 5.5% in migraine frequency on the Sunday and/or Monday one week after the time change compared to the week before the change. The factor responsible for the significant changes was the increase in migraines on Monday one week after the time change in spring and the decrease in migraines on Sunday one week after the time change in autumn. Conclusions: When switching from standard time to daylight savings time in the spring, the frequency of migraines increases significantly one week after the time change. In autumn, in comparison, there is an inverse trend with a reduction in migraine frequency. These data suggest that synchronization is disturbed when switching to daylight savings time. Conversely, synchronization normalizes in autumn. In view of the high prevalence of migraines, this can have extensive individual and social consequences. Full article

(This article belongs to the Special Issue Migraines and Beyond: Advances in the Pathogenesis and Treatment of Chronic Headache Disorders, Second Edition)

► Show Figures

Figure 1

12 pages, 263 KiB

Open AccessArticle

The Impact of Age on Outcomes in Seizure Hospitalizations—Analysis of a National Sample

by Anudeep Surendranath, Saurabh Singhal, Rahul Khanna, Subhendu Rath and Temenuzhka Mihaylova

Neurol. Int. 2025, 17(3), 39; https://doi.org/10.3390/neurolint17030039 - 4 Mar 2025

Viewed by 544

Abstract

Objective: Seizures are a critical public health issue, with incidence rising significantly after age 50. Using this inflection point, we divided patients into two age groups to examine the impact of age on patient characteristics and hospitalization outcomes for seizures. Methods: Using the [...] Read more.

Objective: Seizures are a critical public health issue, with incidence rising significantly after age 50. Using this inflection point, we divided patients into two age groups to examine the impact of age on patient characteristics and hospitalization outcomes for seizures. Methods: Using the 2021 National Inpatient Sample (NIS), a nationally representative database, we conducted a retrospective cohort analysis of adult patients aged ≥18 years admitted with a principal diagnosis of seizures. Patients were divided into two age groups: 18–49 and ≥50 years. Outcomes included in-hospital mortality, length of stay, and hospital charges. Multivariate logistic and linear regression models adjusted for confounders were employed to assess the association between age and outcomes. Results: The cohort included 211,055 patients, with 59% aged ≥50 years. Older patients were more likely to have Medicare coverage (66% vs. 16%, p < 0.01), to reside in the south (41% vs. 38%, p < 0.01), and to have a higher proportion of White individuals (62% vs. 54%, p < 0.01). Younger patients were more likely to be Hispanic (15% vs. 9%, p < 0.01), admitted to urban hospitals (96% vs. 94%, p < 0.01), and treated at teaching hospitals (84% vs. 79%, p < 0.01). After adjusting for confounders, older adults had over twice the odds of in-hospital mortality compared with younger patients (adjusted OR 2.17; 95% CI, 1.61–2.92; p < 0.01). They also experienced longer hospital stays (mean difference 0.7 days; 95% CI, 0.54–0.92; p < 0.01) and higher hospital charges (mean increase USD 4322; 95% CI, USD 1914–6731; p < 0.01). Significance: Age is an independent predictor of in-hospital mortality, longer hospitalizations, and higher costs in seizure-related admissions. These findings underscore the need for age-specific management strategies to improve outcomes and optimize healthcare resource utilization for older adults with seizures. Full article

16 pages, 1141 KiB

Open AccessArticle

Using Immunoliposomes as Carriers to Enhance the Therapeutic Effectiveness of Macamide N-3-Methoxybenzyl-Linoleamide

by Karin J. Vera-López, María Aranzamendi-Zenteno, Gonzalo Davila-Del-Carpio and Rita Nieto-Montesinos

Neurol. Int. 2025, 17(3), 38; https://doi.org/10.3390/neurolint17030038 - 3 Mar 2025

Viewed by 669

Abstract

Background/Objectives: Epilepsy is one of the most common chronic neurological disorders, characterized by alterations in neuronal electrical activity that result in recurrent seizures and involuntary body movements. Anticonvulsants are the primary treatment for this condition, helping patients improve their quality of life. However, [...] Read more.

Background/Objectives: Epilepsy is one of the most common chronic neurological disorders, characterized by alterations in neuronal electrical activity that result in recurrent seizures and involuntary body movements. Anticonvulsants are the primary treatment for this condition, helping patients improve their quality of life. However, the development of new drugs with fewer side effects and greater economic accessibility remains a key focus in nanomedicine. Macamides, secondary metabolites derived from Maca (Lepidium meyenii), represent a promising class of novel drugs with diverse therapeutic applications, particularly in the treatment of neurological disorders. Methods: In this study, we optimized the potential of the macamide N-3-methoxybenzyl-linoleamide (3-MBL) as an anticonvulsant agent through its encapsulation in PEGylated liposomes conjugated with OX26 F(ab′)₂ fragments. Results: These immunoliposomes exhibited a size of 120.52 ± 9.46 nm and a zeta potential of −8.57 ± 0.80 mV. Furthermore, in vivo tests using a pilocarpine-induced status epilepticus model revealed that the immunoliposomes provided greater efficacy against epileptic seizures compared to the free form of N-3-methoxybenzyl-linoleamide at the same dose. Notably, the observed anticonvulsant effect was comparable to that of carbamazepine, a traditional FDA-approved antiepileptic drug. Conclusions: This pioneering work employs liposomal nanocarriers to deliver macamides to the brain, aiming to set a new standard for the use of modified liposomes in anticonvulsant epilepsy treatment. Full article

► Show Figures

Figure 1

10 pages, 7275 KiB

Open AccessCase Report

Confusing Onset of MOGAD in the Form of Focal Seizures

by Małgorzata Jączak-Goździak and Barbara Steinborn

Neurol. Int. 2025, 17(3), 37; https://doi.org/10.3390/neurolint17030037 - 27 Feb 2025

Viewed by 529

Abstract

MOGAD is a demyelinating syndrome with the presence of antibodies against myelin oligodendrocyte glycoprotein, which is, next to multiple sclerosis and the neuromyelitis optica spectrum, one of the manifestations of the demyelinating process, more common in the pediatric population. MOGAD can take a [...] Read more.

MOGAD is a demyelinating syndrome with the presence of antibodies against myelin oligodendrocyte glycoprotein, which is, next to multiple sclerosis and the neuromyelitis optica spectrum, one of the manifestations of the demyelinating process, more common in the pediatric population. MOGAD can take a variety of clinical forms: acute disseminated encephalomyelitis (ADEM), retrobulbar optic neuritis, often binocular (ON), transverse myelitis (TM), or NMOSD-like course (neuromyelitis optica spectrum disorders), less often encephalopathy. The course may be monophasic (40–50%) or polyphasic (50–60%), especially with persistently positive anti-MOG antibodies. Very rarely, the first manifestation of the disease, preceding the typical symptoms of MOGAD by 8 to 48 months, is focal seizures with secondary generalization, without typical demyelinating changes on MRI of the head. The paper presents a case of a 17-year-old patient whose first symptoms of MOGAD were focal epileptic seizures in the form of turning the head to the right with the elevation of the left upper limb and salivation. Seizures occurred after surgical excision of a tumor of the right adrenal gland (ganglioneuroblastoma). Then, despite a normal MRI of the head and the exclusion of onconeural antibodies in the serum and cerebrospinal fluid after intravenous treatment, a paraneoplastic syndrome was suspected. After intravenous steroid treatment and immunoglobulins, eight plasmapheresis treatments, and the initiation of antiepileptic treatment, the seizures disappeared, and no other neurological symptoms occurred for nine months. Only subsequent relapses of the disease with typical radiological and clinical picture (ADEM, MDEM, recurrent ON) allowed for proper diagnosis and treatment of the patient both during relapses and by initiating supportive treatment. The patient’s case allows us to analyze the multi-phase, clinically diverse course of MOGAD and, above all, indicates the need to expand the diagnosis of epilepsy towards demyelinating diseases: determination of anti-MOG and anti-AQP4 antibodies. Full article

► Show Figures

Figure 1

17 pages, 8202 KiB

Open AccessReview

Current Management of Aneurysmal Subarachnoid Hemorrhage

by Jay Max Findlay

Neurol. Int. 2025, 17(3), 36; https://doi.org/10.3390/neurolint17030036 - 26 Feb 2025

Viewed by 691

Abstract

The diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) is most difficult in patients who are in good clinical condition with a small hemorrhage, especially when a ruptured aneurysm might not be considered, or if a computed tomographic (CT) scan is not obtained, or if [...] Read more.

The diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) is most difficult in patients who are in good clinical condition with a small hemorrhage, especially when a ruptured aneurysm might not be considered, or if a computed tomographic (CT) scan is not obtained, or if when a CT is obtained, the findings are subtle and missed by an inexperienced reviewer. All acute onset (thunderclap) headaches should be considered ruptured aneurysms until proven otherwise. Treatment begins with immediate control of pain and blood pressure, placement of an external ventricular drain (EVD) in poor-grade patients and those with acute hydrocephalus on CT scanning, administration of antifibrinolytic tranexamic acid, and then repair of the aneurysm with either surgical clipping or endovascular techniques as soon as the appropriate treatment team can be assembled. After securing the aneurysm, aSAH patient treatment is focused on maintaining euvolemia and a favorable systemic metabolic state for brain repair. A significant and aneurysm-specific threat after aSAH is delayed arterial vasospasm and resulting cerebral ischemia, which is detected by vigilant bedside examinations for new-onset focal deficits or neurological decline, assisted with daily transcranial Doppler examinations and the judicious use of vascular imaging and cerebral perfusion studies with CT. The management of diagnosed symptomatic vasospasm is the prompt induction of hypertension with vasopressors, but if this fails to reverse deficits quickly after reaching a target systolic blood pressure of 200 mmHg, endovascular angioplasty is indicated, providing CT scanning rules out an established cerebral infarction. Balloon angioplasty should be considered early for all patients found to have severe angiographic vasospasm, with or without detectable signs of ischemic neurological deterioration due to either sedation or a pre-existing deficit. Full article

► Show Figures

Figure 1

16 pages, 1717 KiB

Open AccessArticle

Shifting Outcomes: Superior Functional Recovery in Embolic Stroke of Undetermined Source Compared to Cardioembolic Stroke

by Jessica Seetge, Balázs Cséke, Zsófia Nozomi Karádi, Edit Bosnyák and László Szapáry

Neurol. Int. 2025, 17(3), 35; https://doi.org/10.3390/neurolint17030035 - 25 Feb 2025

Viewed by 377

Abstract

Background/Objectives: An embolic stroke of undetermined source (ESUS) is a subtype of ischemic stroke characterized by a non-lacunar infarct in the absence of a clearly identifiable embolic source, despite comprehensive diagnostic evaluation. While ESUS patients are typically younger, have fewer cardiovascular comorbidities, and [...] Read more.

Background/Objectives: An embolic stroke of undetermined source (ESUS) is a subtype of ischemic stroke characterized by a non-lacunar infarct in the absence of a clearly identifiable embolic source, despite comprehensive diagnostic evaluation. While ESUS patients are typically younger, have fewer cardiovascular comorbidities, and experience milder strokes than those with cardioembolic strokes (CEs), their functional recovery remains underexplored. Methods: We retrospectively analyzed data from 374 ischemic stroke patients (n = 94 ESUS, n = 280 CE) admitted to the Department of Neurology, University of Pécs, between February 2023 and September 2024. Functional recovery was assessed using the modified Rankin Scale (mRS). Propensity score matching (PSM) was performed to balance the baseline characteristics, and the mRS-shift was compared between groups. Independent predictors of mRS-shift were identified using Huber regression and extreme gradient boosting (XGBoost). Results: The ESUS patients were significantly younger (60.7 ± 13.8 years vs. 75.1 ± 11.3 years, p < 0.001), had lower pre-morbid modified Rankin Scale (pre-mRS) scores (0.34 ± 0.91 vs. 0.81 ± 1.23, p < 0.001), were less likely to have hypertension (75.5% vs. 86.1%, p = 0.027) and diabetes (23.4% vs. 36.8%, p = 0.024), and presented with milder strokes (National Institutes of Health Stroke Scale [NIHSS] score at admission: 5.4 ± 4.5 vs. 8.1 ± 6.3, p < 0.001, and 72 h post-stroke: 3.0 ± 4.4 vs. 6.5 ± 6.3, p < 0.001) compared to the CE patients. After adjusting for baseline differences, the ESUS patients demonstrated significantly greater functional recovery than the CE patients (adjusted mRS-shift: 1.84 ± 1.14 vs. 2.53 ± 1.69, p = 0.022). Age, pre-mRS score, and NIHSS score at 72 h post-stroke were the strongest predictors of mRS-shift, with an older age, a higher pre-mRS score, and a greater stroke severity significantly decreasing the odds of recovery. Conclusions: The ESUS patients showed superior functional recovery compared to the CE patients, even after accounting for baseline differences. These findings highlight the need for further research into the pathomechanisms underlying ESUSs and the development of optimal treatment strategies to improve patient outcomes. Full article

► Show Figures

Figure 1

14 pages, 7603 KiB

Open AccessArticle

Ultrasound-Guided Percutaneous Nerve Stimulation in Post-Stroke Spasticity: A Case Report

by Francesco Sartori, Albert Puig-Diví and Javier Picañol

Neurol. Int. 2025, 17(3), 34; https://doi.org/10.3390/neurolint17030034 - 24 Feb 2025

Viewed by 630

Abstract

Introduction: Post-stroke spasticity (PSS) significantly impacts the quality of life for stroke survivors. While various treatments exist, options for refractory cases are limited. Ultrasound-guided percutaneous peripheral nerve stimulation (pPNS), commonly used in pain management, has not been studied for its potential use in [...] Read more.

Introduction: Post-stroke spasticity (PSS) significantly impacts the quality of life for stroke survivors. While various treatments exist, options for refractory cases are limited. Ultrasound-guided percutaneous peripheral nerve stimulation (pPNS), commonly used in pain management, has not been studied for its potential use in spasticity management. This case report aims to evaluate the sensorimotor effects of pPNS in a patient with severe PSS. Case description: A 38-year-old male with severe PSS and functional limitations post-ischemic stroke in the middle cerebral artery underwent a six-week pPNS protocol (12 sessions). Low-frequency (2 Hz) stimulation targeted the median, musculocutaneous, and anterior interosseous nerves, while medium-frequency (10 Hz) stimulation targeted the posterior interosseous and radial nerves. Spasticity was assessed using the Modified Ashworth Scale (MAS) and Tardieu Scale (TS). Somatosensory assessments included tactile thresholds, pressure pain thresholds, and conditioned pain modulation (CPM). Outcomes: Spasticity decreased significantly, with reductions of 60.4% and 67.0% in elbow and wrist MAS scores, respectively, and a 49.5% reduction in TS scores. However, spasticity levels returned to baseline between sessions. Somatosensory assessments revealed increased tactile thresholds, decreased pressure pain thresholds, and an 81.3% reduction in CPM. The intervention was well tolerated, with minor transient effects, and the patient preferred pPNS over botulinum toxin injections. Conclusions: pPNS may effectively reduce spasticity and modulate somatosensory thresholds in PSS. These preliminary findings highlight its potential as an alternative treatment for refractory PSS, warranting further research with larger sample sizes and control groups to assess its broader clinical applicability. Full article

(This article belongs to the Topic Neurorehabilitation in Movement Disorders and Neurodegenerative Diseases)

► Show Figures

Figure 1

19 pages, 2860 KiB

Open AccessArticle

Tracking Migraine Symptoms: A Longitudinal Comparison of Smartphone-Based Headache Diaries and Clinical Interviews

by Nicolas Vandenbussche, Jonas Van Der Donckt, Mathias De Brouwer, Bram Steenwinckel, Marija Stojchevska, Femke Ongenae, Sofie Van Hoecke and Koen Paemeleire

Neurol. Int. 2025, 17(3), 33; https://doi.org/10.3390/neurolint17030033 - 24 Feb 2025

Viewed by 486

Abstract

Background/Objectives: By leveraging the capabilities of a smartphone-based headache diary, the objective of this study was to determine the amount of agreement between migraine-associated symptomatology during headache events and the symptoms documented during clinician-led intake interviews. Methods: This was a 90-day longitudinal, [...] Read more.

Background/Objectives: By leveraging the capabilities of a smartphone-based headache diary, the objective of this study was to determine the amount of agreement between migraine-associated symptomatology during headache events and the symptoms documented during clinician-led intake interviews. Methods: This was a 90-day longitudinal, smartphone-based headache calendar study for participants diagnosed with migraine. Registered headache events were labeled as “definite migraine”, “probable migraine”, and “not migraine” in accordance with the International Classification of Headache Disorders, Third Edition (ICHD-3) criteria. Symptoms’ agreement with clinician-led intake interviews (agreement percentages and kappa coefficients), symptoms’ similarity between headache events within users (percentage), and amount of newly registered ICHD-3 symptoms per participant were calculated. Results: Twenty-seven participants provided 505 headache events eligible for analysis. The median agreement between recorded headache event symptomatology and clinician-led intake interview phenotyping ranged between 40% (for events fulfilling “not migraine” criteria) and 55.5% (“definite migraine”) (p < 0.001). Higher intraparticipant headache event pair similarity was observed for “definite migraine” pairs (p < 0.01), along with a decreasing trend in similarity as the attack-pair headache distance increases. Over half of the participants registered at least one new ICHD-3 symptom during the study. Conclusions: Electronic diary registrations show substantial longitudinal variability in intrapersonal headache symptomatology, with the similarity of headache events declining over time. The registration of a new ICHD-3 symptom was the rule rather than the exception. Full article

(This article belongs to the Special Issue Migraines and Beyond: Advances in the Pathogenesis and Treatment of Chronic Headache Disorders, Second Edition)

► Show Figures

Figure 1

20 pages, 3290 KiB

Open AccessReview

Evidence-Based Approach to Cerebral Vasospasm and Delayed Cerebral Ischemia: Milrinone as a Therapeutic Option—A Narrative Literature Review and Algorithm Treatment Proposition

by Pedro Batarda Sena, Marta Gonçalves, Bruno Maia, Margarida Fernandes and Luís Bento

Neurol. Int. 2025, 17(3), 32; https://doi.org/10.3390/neurolint17030032 - 21 Feb 2025

Viewed by 1811

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurocritical condition often complicated by cerebral vasospasm (CVS), leading to delayed cerebral ischemia (DCI) and significant morbidity and mortality. Despite advancements in management, therapeutic options with robust evidence remain limited. Milrinone, a phosphodiesterase type 3 (PDE3) [...] Read more.

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurocritical condition often complicated by cerebral vasospasm (CVS), leading to delayed cerebral ischemia (DCI) and significant morbidity and mortality. Despite advancements in management, therapeutic options with robust evidence remain limited. Milrinone, a phosphodiesterase type 3 (PDE3) inhibitor, has emerged as a potential therapeutic option. Intravenous milrinone demonstrated clinical and angiographic improvement in 67% of patients, reducing the need for mechanical angioplasty and the risk of functional disability at 6 months (mRS ≤ 2). Side effects, including hypotension, tachycardia, and electrolyte disturbances, were observed in 33% of patients, occasionally leading to early drug discontinuation. Based on the evidence, we propose a treatment algorithm for using milrinone to optimize outcomes and standardize its application in neurocritical care settings. Full article

► Show Figures

Figure 1

Journal Menu

Journal Browser

Neurol. Int., Volume 17, Issue 3 (March 2025) – 14 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI