Brain Sciences

23 pages, 1586 KB

Open AccessReview

The Endogenous Opioid System in Compulsive Eating

by Aneesha Janbandhu, Caden Leung, Evelyn Wu, Aidan Tom, Tobias D. Chang, Vinit Shah, Lauren Kim, Evan Robert Lauterborn and Kabirullah Lutfy

Brain Sci. 2026, 16(7), 741; https://doi.org/10.3390/brainsci16070741 - 13 Jul 2026

Abstract

Background/Objectives: The rates of obesity and binge-eating disorder (BED) have increased markedly over the last few decades. The onset of these conditions has been associated in part with the disruption of neural pathways that regulate food reward. Existing literature has implicated the endogenous [...] Read more.

Background/Objectives: The rates of obesity and binge-eating disorder (BED) have increased markedly over the last few decades. The onset of these conditions has been associated in part with the disruption of neural pathways that regulate food reward. Existing literature has implicated the endogenous opioid system as an important mediator of pleasure and reinforcing behaviors associated with food intake. While the relationship between opioids and food intake has been studied extensively, how dysregulated opioid signaling contributes to compulsive eating still remains unclear. Therefore, the aim of this review is to analyze the role of opioid peptides and receptors, and their interactions with dopamine in hedonic feeding. Methods: We conducted a narrative review of preclinical and clinical trials, incorporating studies that were relevant to opioid-mediated feeding and food reward. Results: β-endorphins appear to modulate the hedonic value of food, but their effects appear to be context-dependent. Enkephalins may influence motivational drive toward food, while nociceptin signaling has been linked to the preferential consumption of palatable foods under binge-like conditions. Consistent with these findings, NOP antagonism has been reported to reduce binge-like intake of a high-fat diet (HFD) without affecting homeostatic eating patterns. Lastly, chronic mu-opioid receptor (MOP) activation by palatable foods may induce neuroadaptive changes, including receptor desensitization, dopamine D2 receptor downregulation, and reward hypofunctionality, which overlap with mechanisms associated with substance use disorders. Conclusions: Altered MOP signaling may disrupt the hedonic and behavioral mechanisms that regulate feeding behavior. Pharmacological therapies targeting opioid and opioid-dopamine interactions may show promise for treating obesity and BED. However, additional research is still needed to clarify peptide-specific mechanisms, sex differences, and long-term neurobiological consequences associated with hedonic and compulsive eating. Full article

(This article belongs to the Special Issue Neural Substrates of Opioid Reward and Addiction: From Bench to Bedside)

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15 pages, 1102 KB

Open AccessArticle

Morphological and Biochemical Changes in Rat Hippocampal Tissue Following Exposure to Different Doses of Cisplatin

by Milorad Antić, Vladimir Antić and Dušan Sokolović

Brain Sci. 2026, 16(7), 740; https://doi.org/10.3390/brainsci16070740 - 13 Jul 2026

Abstract

Background/Objectives: Cisplatin (CP) is a platinum-based chemotherapeutic agent associated with neurotoxicity and cognitive impairment. Due to its high metabolic activity and sensitivity to oxidative stress, the hippocampus represents a particularly vulnerable brain structure. The present study evaluated dose-dependent hippocampal alterations [...] Read more.

Background/Objectives: Cisplatin (CP) is a platinum-based chemotherapeutic agent associated with neurotoxicity and cognitive impairment. Due to its high metabolic activity and sensitivity to oxidative stress, the hippocampus represents a particularly vulnerable brain structure. The present study evaluated dose-dependent hippocampal alterations following single-dose cisplatin administration in rats using biochemical, histopathological, and morphometric analyses. Methods: Male Wistar rats were divided into four groups (n = 8): control and cisplatin-treated groups receiving single intraperitoneal doses of 8, 9, or 10 mg/kg. Five days after treatment, hippocampal tissue was analyzed for oxidative stress and inflammatory, apoptotic, and morphological changes. Results: Cisplatin administration significantly increased TBARS and AOPP levels, indicating enhanced lipid and protein oxidation. Elevated hippocampal TNF-α, IL-6, and IL-1β levels demonstrated activation of inflammatory pathways, particularly in animals receiving 9 and 10 mg/kg cisplatin. Higher doses additionally increased Bax/Bcl-2 ratio, caspase-3 content, and DNase I/II activity, consistent with enhanced apoptotic signaling. Histopathological examination revealed neuronal degeneration, pyknotic nuclei, pericellular halo formation, and progressive disruption of hippocampal cytoarchitecture, while morphometric analysis demonstrated significant alterations in neuronal nuclear surface area, predominantly in the 10 mg/kg group. Conclusions: These findings demonstrate that acute cisplatin exposure induces oxidative, inflammatory, apoptotic, and structural progressive hippocampal injury with a threshold-like increase in several endpoints at higher cisplatin doses, with 10 mg/kg producing the most pronounced neurotoxic effects. Full article

(This article belongs to the Special Issue Chemotherapy-Associated Brain Damage—Translational Insights from Pre-Clinical and Clinical Research)

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13 pages, 817 KB

Open AccessArticle

Effects of Frequency-Labeled Narrowband Noise on Postural Stability and Cortical Activation: An fNIRS Study

by Sang Seok Yeo, Zi Han Sun and Dong Hyun Byun

Brain Sci. 2026, 16(7), 739; https://doi.org/10.3390/brainsci16070739 - 12 Jul 2026

Abstract

Background: Maintaining postural stability requires the integration of multisensory information, including visual, vestibular, and somatosensory inputs. This study aimed to investigate the effects of narrowband noise across different frequency bands on static postural balance and cortical activation in healthy adults. Methods: Twenty healthy [...] Read more.

Background: Maintaining postural stability requires the integration of multisensory information, including visual, vestibular, and somatosensory inputs. This study aimed to investigate the effects of narrowband noise across different frequency bands on static postural balance and cortical activation in healthy adults. Methods: Twenty healthy adults participated in a repeated-measures experiment in which they maintained a tandem stance with eyes closed under four conditions: no sound, low-frequency narrowband noise (500 Hz), mid-frequency narrowband noise (2000 Hz), and high-frequency narrowband noise (5000 Hz). Static balance was assessed using center of pressure parameters, including sway length, ellipse surface, delta X, and delta Y, recorded via a pressure measurement platform. Cortical activation in the premotor cortex (PMC), frontal eye fields (FEF), superior temporal gyrus (STG), and middle temporal gyrus (MTG) was measured simultaneously using functional near-infrared spectroscopy. Results: Mid-frequency narrowband noise significantly improved postural stability, as evidenced by reductions in sway length, ellipse surface, and delta Y compared to the high-frequency and no-sound conditions (p < 0.05). In contrast, high-frequency narrowband noise consistently produced the greatest postural instability, with significantly larger ellipse surface and delta Y values (p < 0.05). Regarding cortical activation, high-frequency stimulation induced significantly greater bilateral activation in the PMC compared to low-frequency stimulation, while all auditory conditions elicited widespread activation across PMC, STG, and MTG. Conclusions: These findings suggest that the frequency characteristics of auditory stimulation exert differential neurophysiological effects on balance control. Mid-frequency narrowband noise may enhance static balance by facilitating sensorimotor integration, whereas high-frequency narrowband noise may induce PMC hyperactivation, potentially contributing to postural instability. Full article

(This article belongs to the Section Sensory and Motor Neuroscience)

19 pages, 1529 KB

Open AccessArticle

Whole-Brain Structural Connectivity Alterations in Chronic Subjective Tinnitus: An Exploratory Diffusion Tensor Imaging Study

by Pınar Elpen Karyemez, Sıla Ulus, Eren Yılmaz and Düzgün Yıldırım

Brain Sci. 2026, 16(7), 738; https://doi.org/10.3390/brainsci16070738 - 12 Jul 2026

Abstract

Background/Objectives: Subjective tinnitus, the underlying mechanism of which remains largely unknown, accounts for the majority of cases. Although conventional MRI and audiometric assessments demonstrate limited effectiveness in identifying organic causes, advanced microstructural techniques—such as diffusion tensor imaging (DTI) and fiber tractography—facilitate the evaluation [...] Read more.

Background/Objectives: Subjective tinnitus, the underlying mechanism of which remains largely unknown, accounts for the majority of cases. Although conventional MRI and audiometric assessments demonstrate limited effectiveness in identifying organic causes, advanced microstructural techniques—such as diffusion tensor imaging (DTI) and fiber tractography—facilitate the evaluation of microanatomical connectivity related to auditory processing. This study employed DTI to examine alterations in microanatomical brain connectivity in patients with chronic subjective tinnitus, in comparison to a healthy control group. Methods: This study performed a comparative analysis of whole-brain connectivity maps, derived from Diffusion Tensor Imaging, between 47 patients with chronic subjective tinnitus (symptom duration ≥ 2 years) and 42 healthy controls. To ensure a robust assessment of micro-anatomical neural connectivity, DTI datasets were processed using the DSI Studio platform, with anatomical regions systematically mapped using automatic anatomical labeling atlases. Specifically, these metrics were evaluated across nodes in the central auditory pathway and limbic system to identify potential disruptions in structural integrity. Results: The comparative analysis revealed significant micro-anatomical connectivity alterations in patients with chronic subjective tinnitus. Changes in structural integrity were observed predominantly across key nodes within the central auditory pathway and limbic system, specifically involving the frontal, submarginal, cingular, insular, parietal, precuneus, cuneus, amygdala, thalamus, supplementary motor area, and precentral regions. Conclusions: Chronic subjective tinnitus was associated with a distinct, largely asymmetrical pattern of whole-brain structural connectivity, predominantly involving nodes of the salience, default-mode, and central-executive networks. Because behavioral, audiometric, and cognitive measures were not acquired, these findings are exploratory and hypothesis-generating; their cognitive and occupational relevance will require confirmation in studies that combine connectivity mapping with direct behavioral and audiological testing. Full article

(This article belongs to the Special Issue Predictive Processing in Brain and Behavior)

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24 pages, 3253 KB

Open AccessArticle

Soy Sauce Odor Improves Upper Limb Motor Performance with Preliminary Evidence of Increased Alpha-Band Intermuscular Coherence Between Postural Muscles: An Exploratory Within-Subjects Crossover Study

by Yutaka Yano, Junichi Inatomi, Hajime Yamakage, Tsuyoshi Miyata, Yoshihiro Murata, Mutsuo Taniguchi, Fumino Okutani, Hideto Kaba and Masahiro Yamaguchi

Brain Sci. 2026, 16(7), 737; https://doi.org/10.3390/brainsci16070737 - 12 Jul 2026

Abstract

Background/Objectives: While odor stimuli can modify motor function, the underlying mechanisms remain unclear. This study examined the impact of olfactory stimuli on muscle activities involved in upper limb motor performance and balance in nine healthy young Japanese males. Methods: In [...] Read more.

Background/Objectives: While odor stimuli can modify motor function, the underlying mechanisms remain unclear. This study examined the impact of olfactory stimuli on muscle activities involved in upper limb motor performance and balance in nine healthy young Japanese males. Methods: In this exploratory, within-subject crossover study, odors of soy sauce, β-phenylethyl alcohol (PEA, a component of rose odor), and water were used to assess their effects on motor function through the modified functional reach test (mFRT), which measures sitting balance during upper limb extension. Surface electromyography from four muscles (upper trapezius, anterior deltoid, serratus anterior, and lumbar multifidus) was recorded to analyze intermuscular coherence (IMC) before and after odor exposure. Results: Only soy sauce odor increased mFRT reach distance. Within-condition analysis revealed that soy sauce odor was associated with increased α-band IMC in the serratus anterior–lumbar multifidus pair at the overall reach and second half of reach (both Benjamini–Hochberg-corrected p < 0.05; Cohen’s d > 1.0), while no significant between-condition difference (Group × Time interaction) was observed. No significant within-condition changes were observed for PEA or water. Conclusions: These preliminary findings suggest that soy sauce odor improved mFRT performance. While an exploratory within-condition analysis showed a concomitant increase in α-band IMC in a postural muscle pair (serratus anterior–lumbar multifidus), the absence of a significant Group × Time interaction prevents attributing the behavioral improvement to this specific neuromuscular change. Given the small, homogeneous sample (nine healthy young Japanese males) and the exploratory design, these results are hypothesis-generating and require replication in larger, adequately powered studies before any conclusions about underlying mechanisms or clinical application can be drawn. Full article

(This article belongs to the Section Sensory and Motor Neuroscience)

20 pages, 974 KB

Open AccessArticle

Effects of Gahvora Cradling on Learning, Motor Behavior, and Expression of Affect in 3-Month-Olds in Tajikistan

by Lana B. Karasik, Scott R. Robinson and Rano Dodojonova

Brain Sci. 2026, 16(7), 736; https://doi.org/10.3390/brainsci16070736 - 12 Jul 2026

Abstract

Background/Objectives: We examined spontaneous movement in 26 3-month-olds in Tajikistan, all reared in a “gahvora” cradle from birth for most of each day. The gahvora swaddles and binds infants’ limbs and torso, restricting movement. Methods: Infants participated in a conjugate reinforcement mobile paradigm [...] Read more.

Background/Objectives: We examined spontaneous movement in 26 3-month-olds in Tajikistan, all reared in a “gahvora” cradle from birth for most of each day. The gahvora swaddles and binds infants’ limbs and torso, restricting movement. Methods: Infants participated in a conjugate reinforcement mobile paradigm immediately after release from the gahvora or after several minutes of unrestricted activity. Infants completed the task at home across five 3 min blocks: baseline, three acquisition blocks, and extinction. Coders scored tethered and untethered leg kicks from video in every block and also scored facial expressions and vocalizations to track affect. Mothers reported typical gahvora use. Results: All infants learned: kicks of the tethered leg exceeded kicks of the untethered leg, and kicking remained elevated at extinction relative to baseline. Learning rates diverged most between infants tested immediately after release from the gahvora and infants who had several minutes of unrestricted activity beforehand. Conclusions: A within-culture comparison of infants’ exposure to body and limb restriction reveals how cultural childrearing practices shape opportunities for perceptual–motor development. Full article

(This article belongs to the Section Sensory and Motor Neuroscience)

18 pages, 1577 KB

Open AccessReview

Beyond Relapses: A Multimodal Biomarker Framework for Progression Independent of Relapse Activity and Smouldering Multiple Sclerosis

by Nayeli Alejandra Sánchez-Rosales, Edgar Ricardo Valdivia-Tangarife, Blanca Miriam Torres-Mendoza, Antonio Kobayashi-Gutiérrez, Francisco Javier Frías-Márquez, Betsabe Contreras-Haro, Martha Rocío Hernández-Preciado, Ana Miriam Saldaña-Cruz, Enrique Gomez-Figueroa, José De Jesús García-Rivera, Teresita J. Villaseñor-Cabrera, Miriam E. Jiménez-Maldonado, Fabiola González-Ponce and Jazmin Marquez-Pedroza

Brain Sci. 2026, 16(7), 735; https://doi.org/10.3390/brainsci16070735 - 12 Jul 2026

Abstract

Progression independent of relapse activity (PIRA) and smouldering multiple sclerosis (MS) represent major unmet challenges in contemporary MS care. Disability may accumulate independently of clinical relapses, driven in part by chronic compartmentalised inflammation behind a relatively intact blood–brain barrier and incompletely captured by [...] Read more.

Progression independent of relapse activity (PIRA) and smouldering multiple sclerosis (MS) represent major unmet challenges in contemporary MS care. Disability may accumulate independently of clinical relapses, driven in part by chronic compartmentalised inflammation behind a relatively intact blood–brain barrier and incompletely captured by conventional monitoring tools. This narrative review synthesises evidence across four complementary biomarker domains for detecting smouldering MS and PIRA: advanced MRI (paramagnetic rim lesions [PRLs], slowly expanding lesions, deep grey matter atrophy, quantitative susceptibility mapping); fluid biomarkers (serum glial fibrillary acidic protein [sGFAP], serum neurofilament light chain [sNfL]); retinal optical coherence tomography (ganglion cell–inner plexiform layer thinning); and digital health metrics (wearable accelerometry, digital Symbol Digit Modalities Test). In a single prospective cohort, combined elevation of sGFAP and sNfL conferred a 4.71-fold increased hazard for PIRA (HR 4.71; 95% CI 2.05–9.77); independent data suggest sGFAP may carry selectivity for progression beyond sNfL, although this remains to be confirmed. No single domain sufficiently characterises smouldering pathology. We therefore propose a hypothesis-generating Multimodal PIRA Score (MPS) as a conceptual validation scaffold intended to structure—rather than inform—prospective multicentre evaluation against a long-horizon disability endpoint. Harmonisation of acquisition protocols, reference ranges, and digital phenotyping algorithms remains a prerequisite. Full article

(This article belongs to the Special Issue Neuroprotection for Neurodegenerative Diseases: Current Status and Future Perspectives)

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23 pages, 3357 KB

Open AccessArticle

A Brain Imaging Study on the Association Between Chess Expertise and Visual Spatial Working Memory in School-Aged Children

by Xingjie Hao, Zongchao Chang and Youfa Li

Brain Sci. 2026, 16(7), 734; https://doi.org/10.3390/brainsci16070734 - 11 Jul 2026

Abstract

Objectives: To explore the brain imaging correlates of the association between chess skill level and visual spatial working memory (VSWM) in school-aged children. Methods: This study analyzed a final sample of 20 school-aged children (aged 10–15 years, mean age of 13.48 ± 1.23 [...] Read more.

Objectives: To explore the brain imaging correlates of the association between chess skill level and visual spatial working memory (VSWM) in school-aged children. Methods: This study analyzed a final sample of 20 school-aged children (aged 10–15 years, mean age of 13.48 ± 1.23 years; including 9 experts and 11 novices) selected from an initial pool of 40 recruited participants from primary and secondary schools and chess clubs in Beijing. They were divided into an experimental group (expert-level school-aged children from a Beijing chess club) and a control group (novice-level children from a Beijing primary and secondary school who had not systematically participated in chess courses but understood basic chess knowledge). The N-back task was used to assess behavioral differences in VSWM. Voxel-based morphometry (VBM) and surface-based morphometry (SBM) techniques were employed to analyze differences in gray matter volume and cortical thickness in the brain structure of expert- and novice-level children. Differences in resting-state functional imaging were also analyzed. Results: The results showed the following: (1) The expert-level children demonstrated significantly higher accuracy and shorter reaction times in VSWM tasks compared to novices. (2) Differences in gray matter volume and cortical thickness were observed between the expert and novice groups. (3) Expert-level children showed significantly higher resting-state ALFF/fALFF values in the dorsolateral superior frontal gyrus, cingulate gyrus, and orbitofrontal cortex compared to novices. Conclusions: In conclusion, expert-level school-aged children exhibit distinctive regional structural and intrinsic functional profiles. These non-causal neural variations co-vary with selective cognitive baselines characterizing specialized low-load visual spatial processing rather than a generalized working memory expansion, reflecting brain signatures associated with varying tiers of chess expertise. Full article

(This article belongs to the Section Cognitive, Social and Affective Neuroscience)

19 pages, 1150 KB

Open AccessArticle

Clinical, Laboratory, and CT Morphological Factors Associated with 3-Month Functional Outcomes in Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study

by Mustafa Harun Şahin, Özhan Özcan and Oğuzhan Kurşun

Brain Sci. 2026, 16(7), 733; https://doi.org/10.3390/brainsci16070733 - 11 Jul 2026

Abstract

Background/Objectives: Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and disability. We aimed to identify clinical, laboratory, and imaging factors independently associated with 3-month functional outcome across non-contrast computed tomography (NCCT) morphological markers, laboratory biomarkers, and established clinical scoring systems. Methods: This [...] Read more.

Background/Objectives: Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and disability. We aimed to identify clinical, laboratory, and imaging factors independently associated with 3-month functional outcome across non-contrast computed tomography (NCCT) morphological markers, laboratory biomarkers, and established clinical scoring systems. Methods: This retrospective cohort study included 337 consecutive patients with spontaneous ICH admitted between 2019 and 2022. Admission clinical findings, laboratory parameters, NCCT morphological markers (swirl, blend, black hole, island, hypodensities, and satellite signs), volumetrically segmented hematoma volumes, and prognostic scores (ICH and FUNC scores) were recorded. Poor functional outcome was defined as modified Rankin Scale (mRS) 3–6 at 3 months. Independent predictors were identified using a primary Firth penalized multivariable logistic regression model; discrimination (area under the ROC curve, AUC), calibration, and optimism-corrected performance (1000-resample bootstrap) were assessed, and incremental value over the ICH and FUNC scores was tested with the DeLong method. Results: Poor functional outcome occurred in 60.2% of patients, and 3-month mortality was 36.8%. In the primary penalized model, independent predictors of poor outcome were lower admission Glasgow Coma Scale, larger hematoma volume, NCCT hypodensities, history of hypertension, and lower low-density lipoprotein (LDL) cholesterol. The model showed good discrimination (apparent AUC 0.881; optimism-corrected 0.872) and calibration (slope 0.92) and significantly outperformed the ICH and FUNC scores (DeLong p = 0.009 and p < 0.001, respectively). Several laboratory and treatment variables reached significance only in an unpenalized model and were statistically unstable; these were treated as exploratory. Although swirl, blend, black hole, and island signs were associated with poor outcomes in univariable analysis, they did not remain independent predictors in the final model. The ICH and FUNC scores were significantly associated with poor functional outcome in univariable analysis. Conclusions: Poor 3-month functional outcome after spontaneous ICH is independently associated with neurological severity, hematoma volume, NCCT hypodensities, and selected clinical and laboratory factors. Integrating clinical, volumetric, and CT morphological parameters improved discrimination over established prognostic scores; however, these findings are associative and require prospective, multicenter validation before clinical implementation. Full article

(This article belongs to the Section Neurosurgery and Neuroanatomy)

32 pages, 1942 KB

Open AccessReview

Robotic Rehabilitation in Spinal Cord Injury: Neurophysiological Basis and Severity-Based Clinical Framework

by Rocco Salvatore Calabrò, Andrea Calderone, Tiziana Di Gregorio, Maria Pia Onesta and Angelo Quartarone

Brain Sci. 2026, 16(7), 732; https://doi.org/10.3390/brainsci16070732 - 11 Jul 2026

Abstract

Background/Objectives: Spinal cord injury (SCI) causes heterogeneous motor, sensory, autonomic, and participation limitations; recovery priorities vary by injury level, completeness, time since injury and residual function. Robotic rehabilitation has expanded from assistive technology to restorative, compensatory and health-promoting interventions, but patient-tailored prescription frameworks [...] Read more.

Background/Objectives: Spinal cord injury (SCI) causes heterogeneous motor, sensory, autonomic, and participation limitations; recovery priorities vary by injury level, completeness, time since injury and residual function. Robotic rehabilitation has expanded from assistive technology to restorative, compensatory and health-promoting interventions, but patient-tailored prescription frameworks remain underdeveloped. Methods: PubMed/MEDLINE was searched from database inception to May 2026 using predefined domain-specific strategies, and findings were synthesized narratively to integrate mechanistic, clinical, safety and implementation evidence. Results: Robotic systems can increase task-specific repetition, sensorimotor feedback, active engagement and quantitative monitoring. Upper-limb robotics are feasible in cervical SCI and may support reach, grasp and activities of daily living, although SCI-specific controlled evidence remains limited. Lower-limb exoskeletons and locomotor robots can support gait practice, upright mobility, exercise exposure and selected secondary health outcomes, but walking speed, energy expenditure, cost, supervision needs and community translation remain important barriers. Sensory and non-motor effects, including proprioceptive input, spasticity, pain, bowel routine, cardiometabolic conditioning, participation and psychological well-being, are clinically relevant but should be interpreted according to evidence strength. Robotics combined with functional electrical stimulation, virtual reality, brain–computer interfaces, non-invasive brain stimulation and artificial intelligence-driven adaptation is promising but not yet routine. Conclusions: Robotic rehabilitation in SCI should be prescribed through a severity-based process that considers lesion level, American Spinal Injury Association Impairment Scale grade, residual voluntary and sensory function, safety, patient priorities and measurable goals. The proposed framework supports transparent selection and prospective validation of individualized robotic rehabilitation and shifts decisions beyond device availability toward clinically meaningful and equitable implementation. Full article

(This article belongs to the Special Issue Neurorehabilitation Insight 2026: AI, Robots and Digital Technologies)

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20 pages, 2010 KB

Open AccessSystematic Review

Clinical and Functional Outcomes of Delta Large-Channel Endoscopic Lumbar Decompression: A Systematic Review and Meta-Analysis

by Rishi Jain, Nikhil Sriram, Mehul Mittal, David Zhang, Noah B. Drewes, Dillan Prasad, James M. Mossner, Nader S. Dahdaleh, Najib El Tecle and Christopher S. Ahuja

Brain Sci. 2026, 16(7), 731; https://doi.org/10.3390/brainsci16070731 - 11 Jul 2026

Abstract

Background: Delta large-channel endoscopic decompression is an emerging, minimally invasive approach for lumbar degenerative disease, but its comparative effectiveness and perioperative performance have not been comprehensively synthesized. We performed a systematic review and meta-analysis to evaluate clinical, functional, and safety outcomes of Delta [...] Read more.

Background: Delta large-channel endoscopic decompression is an emerging, minimally invasive approach for lumbar degenerative disease, but its comparative effectiveness and perioperative performance have not been comprehensively synthesized. We performed a systematic review and meta-analysis to evaluate clinical, functional, and safety outcomes of Delta large-channel endoscopy relative to established decompression techniques. Methods: PubMed, Embase, and Scopus were searched from database inception through July 2025 (PROSPERO #CRD420251107750). Peer-reviewed English-language studies reporting extractable outcomes after Delta large-channel endoscopic surgery in adults were included. Random-effects meta-analyses were used for pooled comparisons. Results: Nine studies met the inclusion criteria, comprising 737 patients overall, including 379 treated with Delta large-channel endoscopy and 358 treated with comparator procedures. Reported outcome assessment generally ranged from 1 week to 12 months postoperatively, or variable latest follow-up timepoints, and mean follow-up was inconsistently reported. All studies originated in China and included five retrospective cohorts, two randomized controlled trials, one prospective cohort, and one case series. The pooled mean operative time for Delta procedures was 88.28 min (95% CI, 79.24–97.31), pooled mean intraoperative blood loss was 24.58 mL (95% CI, 11.14–38.02), and pooled mean hospital stay was 4.59 days (95% CI, 2.87–6.31). Compared with microscopic, endoscopic, and open techniques, Delta large-channel endoscopy showed no statistically significant differences in operative time (MD = 6.95 min, 95% CI: −11.51–25.40 min; p = 0.4037), intraoperative blood loss (MD, −40.62 mL; 95% CI, −83.68–2.44; p = 0.0598), 3-month ODI change from baseline (MD, 1.26; 95% CI, −2.17–4.69; p = 0.3661), or complication rates (OR, 0.67; 95% CI, 0.40–1.12; p = 0.1094). Delta procedures were associated with shorter hospital stay (MD, −1.69 days; 95% CI, −2.83 to −0.56; p = 0.0122) and marginally greater improvement in six-month VAS low back pain change from baseline (MD, 0.28; 95% CI, 0.26–0.29; p = 0.0002), though clinically insignificant. The pooled complication rate for Delta procedures was 6.0% (95% CI, 4–10%) and reported rates of excellent or good MacNab outcomes ranged from 80 to 93% across Delta cohorts. Conclusions: Delta large-channel endoscopy may provide clinical and functional outcomes comparable to established decompression techniques, with similar safety and potential perioperative benefits, including shorter hospitalization. However, these findings are based on limited, low-certainty evidence with high heterogeneity and should be interpreted as exploratory rather than definitive. Additional multicenter studies with longer follow-up, broader geographic representation, and higher methodological quality are necessary before definitive conclusions regarding comparative effectiveness can be established. Full article

(This article belongs to the Special Issue Neurosurgery: Minimally Invasive Surgery in Brain and Spine—2nd Edition)

17 pages, 369 KB

Open AccessArticle

Attitudes of Patients with Non-Psychotic Mental Disorders Towards Cannabis After Its Legalization—Comparison with Patients Before Legalization

by Michael Specka, Josef Rabl, Udo Bonnet, Marah Rosner, Anna Schmitt and Norbert Scherbaum

Brain Sci. 2026, 16(7), 730; https://doi.org/10.3390/brainsci16070730 - 11 Jul 2026

Abstract

Background: The illegal status of recreational cannabis (RC) is often considered a barrier to its use. RC was partially legalized in Germany in 2024. This study investigated whether attitudes towards cannabis were different in patients surveyed after recreational cannabis legalization (RCL), compared with [...] Read more.

Background: The illegal status of recreational cannabis (RC) is often considered a barrier to its use. RC was partially legalized in Germany in 2024. This study investigated whether attitudes towards cannabis were different in patients surveyed after recreational cannabis legalization (RCL), compared with patients surveyed before RCL. Method: In 2022 (pre-RCL) and 2024/2025 (post-RCL), patients without psychosis and without substance use disorders from in-patient and day clinic wards of a psychiatric university hospital were interviewed using a standardized questionnaire. Results: Included were n = 143 patients pre-RCL and n = 117 post-RCL, with 84% presenting with affective disorders. Only 11.2% in the pre-RCL group, and 1.7% in the post-RCL group indicated the illegal status of RC as the main reason for cannabis abstinence. Attitudes towards cannabis with regard to health concerns, social distance, general rejection of (illicit) drugs, effects of drug education, or observation of negative consequences in others were not statistically significantly different between groups. There was a marked and statistically significant reduction in fear of being investigated by the police because of RC consumption. The suggestion to buy cannabis for personal use in specialized shops was completely rejected by 58.7% of the pre-RCL and by 71.8% of the post-RCL group. Conclusions: Compared with pre-RCL data, concerns about negative legal consequences of RC use were lower during the first year post-RCL, but readiness to legally obtain recreational cannabis was not increased. There were no indications that other attitudes about cannabis were affected in the short term. Full article

(This article belongs to the Section Behavioral Neuroscience)

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12 pages, 708 KB

Open AccessArticle

Epilepsy Surgery in a Resource-Limited Latin-American Center: Presurgical Evaluation Findings and Early ILAE Outcomes in a Mixed Adult-Pediatric Cohort

by Fabrizio A. Mortola, Ilse M. Mora-Rodríguez, Juan C. Barrera de Leon, Tania P. Sánchez-Murguía, Brenda Vega-Ruiz, Jonathan A. Cisneros-Orozco, Marco A. Román-Delgadillo, Andrea Enríquez-Zaragoza, Karla López-Jiménez, Mario A. Alonso-Vanegas, Fridha V. Villalpando-Vargas and Alioth Guerrero-Aranda

Brain Sci. 2026, 16(7), 729; https://doi.org/10.3390/brainsci16070729 - 9 Jul 2026

Abstract

Background: Resource-constrained programs perform epilepsy surgery under limited access to advanced imaging and neuromodulation. We describe presurgical evaluation findings, early seizure outcomes, and safety from a mixed adult-pediatric cohort. Methods: Retrospective single-center series of 22 consecutive patients meeting surgical candidacy. We captured demographics, [...] Read more.

Background: Resource-constrained programs perform epilepsy surgery under limited access to advanced imaging and neuromodulation. We describe presurgical evaluation findings, early seizure outcomes, and safety from a mixed adult-pediatric cohort. Methods: Retrospective single-center series of 22 consecutive patients meeting surgical candidacy. We captured demographics, epilepsy classification/etiology, presurgical investigations (long-term Video-EEG, MRI, selective FDG-PET), procedure type, histopathology when available, and postoperative seizure outcome (ILAE). Complications were recorded using the ILAE adverse-event taxonomy. Results: Mean age at surgery was 21.2 ± 11.2 years; 15 (68%) were male. Epilepsy was focal in 15 (68%); structural etiologies predominated in 15 (68%). MRI was concordant with the presumed epileptogenic zone in 13 (59%). FDG-PET was obtained in 10 (45.5%) and was concordant in 7 (70%). Long-term Video-EEG (≥2 habitual seizures) was completed in 21. Mean delay to surgery was 10 years (IQR [8–15]); presurgical work-up averaged 10 months (IQR [6–15]). Procedures were resective 14 (64%), disconnective 6 (27%), and neuromodulatory 2 (9%). Histopathology was available in 16 cases, most commonly showing hippocampal sclerosis (n = 5) and focal cortical dysplasia (n = 5). At 14 months median follow-up (range 12–34), ILAE outcomes were: I 41% (9), II 14% (3), III 23% (5), IV 23% (5). Outcomes significantly differed by procedure: curative-intent (resection/disconnection) achieved ILAE I 60% (9) versus ILAE III/IV 7 after palliative-intent (corpus callosotomy/neuromodulation). No deaths or permanent deficits occurred; one corpus callosotomy case developed transient aseptic meningitis. Conclusions: In a resource-limited program, structured presurgical evaluation and careful selection yield resection/disconnection outcomes comparable to high-resource benchmarks, while corpus callosotomy/neuromodulation remain largely palliative. Practical, reproducible pathways may help shorten delays and improve access in similar settings. Full article

(This article belongs to the Special Issue Electrophysiological Approaches to Cognitive Neuroscience)

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26 pages, 6252 KB

Open AccessSystematic Review

Global Prevalence of Internet Gaming Disorder: An Umbrella Review of Meta-Analytic Evidence and Implications for Child and Adolescent Psychiatry

by Elisabeth C. S. Poon, Xun Ci Soh, Trina J. H. Poh, Andre C. S. Tan and Andree Hartanto

Brain Sci. 2026, 16(7), 728; https://doi.org/10.3390/brainsci16070728 - 9 Jul 2026

Abstract

Background/Objectives: Internet gaming has become a widespread global activity, raising concerns about the prevalence of Internet Gaming Disorder (IGD). However, existing meta-analyses report highly variable prevalence estimates. This umbrella review aims to clarify the prevalence and variability of IGD by synthesizing evidence from [...] Read more.

Background/Objectives: Internet gaming has become a widespread global activity, raising concerns about the prevalence of Internet Gaming Disorder (IGD). However, existing meta-analyses report highly variable prevalence estimates. This umbrella review aims to clarify the prevalence and variability of IGD by synthesizing evidence from meta-analyses to provide a comprehensive overview of IGD prevalence across populations, age groups, and regions. Methods: Following PRISMA guidelines, systematic searches were carried out across five published literature databases and two supplementary search sources. Title and abstract screening, followed by full-text eligibility assessment, were conducted independently by three authors. The same three authors then performed data extraction and quality assessment for the nine included meta-analyses. Results: After screening, nine eligible meta-analyses were included. The overall median prevalence of IGD was 6.20%, with an interquartile range of 4.25% to 8.30%. Subgroup analyses indicated a higher prevalence among males compared to females. Evidence for age differences between adolescents and adults was limited and should be interpreted cautiously because age groups were inconsistently defined across meta-analyses. Regional comparisons suggested higher prevalence estimates in Asia than in Europe, and gamer profile comparisons suggested higher prevalence estimates in gamers than in the general population, although evidence for these differences was limited and not consistent across meta-analyses. Conclusions: Overall, the findings indicate that IGD affects a sizeable proportion of the population, but prevalence estimates vary depending on demographic and regional characteristics. Greater consistency in diagnostic criteria, assessment tools, and reporting standards is needed to improve the comparability and interpretability of IGD prevalence research. Full article

(This article belongs to the Special Issue Advances in Child and Adolescent Psychiatry: Developmental Perspectives, Psychopathology, and Clinical Care)

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29 pages, 3972 KB

Open AccessArticle

The Impact of Anodal tDCS on Verbal and Nonverbal Functional Communication in Subacute Aphasia—An Observational Study

by Ilona Rubi-Fessen, Kathrin Gerbershagen, Prisca Stenneken and Klaus Willmes

Brain Sci. 2026, 16(7), 727; https://doi.org/10.3390/brainsci16070727 - 9 Jul 2026

Abstract

Background/Objectives: While a growing number of studies have demonstrated positive effects of adjuvant anodal transcranial direct current stimulation (tDCS) on linguistic performance in aphasia, evidence for corresponding effects on verbal and—in particular—nonverbal functional communication remains absent. This is a critical gap, given [...] Read more.

Background/Objectives: While a growing number of studies have demonstrated positive effects of adjuvant anodal transcranial direct current stimulation (tDCS) on linguistic performance in aphasia, evidence for corresponding effects on verbal and—in particular—nonverbal functional communication remains absent. This is a critical gap, given that restoring everyday communicative competence is the ultimate goal of speech and language therapy (SLT). In the present observational study, we investigated the add-on effect of anodal tDCS over language-relevant left-hemispheric areas on verbal and nonverbal functional communication in n = 34 individuals with subacute aphasia and examined the relationship between communicative and linguistic change. Methods: Participants underwent two consecutive two-week therapy phases (P1, P2), each consisting of 10 SLT sessions. Severity-specific linguistic and communicative assessments were administered before, between, and after both phases: the Aachen Aphasia Test (AAT; n = 26) combined with the Amsterdam–Nijmegen Everyday Language Test (ANELT, A-scale), and the Bielefeld Aphasia Screening Rehabilitation (BIAS-R; n = 8) combined with the Scenario Test. During P2, SLT was supplemented by online anodal tDCS. Results: Overall test performance improved significantly more in tDCS-supported P2 compared to P1 (AAT profile level, p < 0.001; BIAS-R mean percentage value (MPW), p = 0.027; ANELT A-scale raw score Version 1, p = 0.081, and version 2, p = 0.038; and Scenario Test total score, p = 0.003). Significant correlations between AAT profile level and ANELT total scores were found across all time points. Between the MPV and subtests of the BIAS-R and the Scenario total score, there was a tendency toward decreasing correlation levels from T1 to T3. Conclusions: To our knowledge, this is the first study demonstrating that adjuvant tDCS in subacute aphasia enhances not only linguistic performance but also verbal and nonverbal functional communication beyond SLT alone—assessed with standardized, performance-based, ecologically valid instruments. Full article

(This article belongs to the Special Issue Non-Invasive Brain Stimulation in Neurological Diseases and Neurorehabilitation)

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6 pages, 157 KB

Open AccessEditorial

Brain Stimulation for Psychiatric Disorders: Emerging Evidence and New Perspectives—2nd Edition

by Jacopo Lisoni and Stefano Barlati

Brain Sci. 2026, 16(7), 726; https://doi.org/10.3390/brainsci16070726 - 9 Jul 2026

Abstract

The application of Brain Stimulation to psychiatric disorders has undergone a substantial transformation over the past decades [...] Full article

(This article belongs to the Special Issue Brain Stimulation for Psychiatric Disorders: Emerging Evidence and New Perspectives—2nd Edition)

19 pages, 1041 KB

Open AccessArticle

Emotional Modulation of Working Memory in Older Adults: Dissociable Contributions of Cognitive Reserve and Emotional Intelligence

by Stefania Lucia, Bianca Monachesi, Elisabetta Pisanu, Silvia Fornaro and Raffaella Ida Rumiati

Brain Sci. 2026, 16(7), 725; https://doi.org/10.3390/brainsci16070725 - 8 Jul 2026

Abstract

Background/Objectives: Working memory declines with age, particularly under conditions of high cognitive load. Emotional information can modulate performance depending on its task relevance and on individual cognitive and emotional resources. This study investigated the dissociable contributions of cognitive reserve (CR) and emotional intelligence [...] Read more.

Background/Objectives: Working memory declines with age, particularly under conditions of high cognitive load. Emotional information can modulate performance depending on its task relevance and on individual cognitive and emotional resources. This study investigated the dissociable contributions of cognitive reserve (CR) and emotional intelligence (EI) to accuracy and response dynamics in an emotional n-back task in older adults. Methods: Forty-five healthy older adults completed an emotional n-back task under low (1-back) and high (2-back) cognitive load. Task relevance was manipulated by requiring judgments either on facial expressions (Emo task) or on age-related features (Age task). Accuracy and reaction times were analyzed using mixed-effects models, with CR and EI entered as continuous covariates. Results: Higher cognitive load was associated with reduced accuracy and slower reaction times. Emotional modulation of performance emerged primarily when emotional information was task-relevant. Happy facial expressions were associated with faster reaction times and higher accuracy than angry expressions, particularly under high cognitive load. CR was positively associated with overall accuracy across conditions, without interacting with task demands or emotional content. In contrast, EI did not predict accuracy but selectively modulated reaction times as a function of task relevance and emotional valence, with opposite effects observed across tasks for positive stimuli. Conclusions: These findings indicate that emotional modulation of working memory in older adults is strongly context-dependent. CR supported accuracy in a domain-general manner, whereas EI selectively modulated response speed in emotionally salient contexts without conferring a direct accuracy advantage. Cognitive and emotional resources thus contributed to distinct yet interacting components of working memory performance in ageing, suggesting that successful functioning in later life depends not only on preserved processing capacity but also on the flexible regulation of emotionally salient information. Full article

(This article belongs to the Special Issue New Insights on Emotion Regulation)

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16 pages, 377 KB

Open AccessArticle

Loneliness and Problematic Social Media Use Among Adolescents: The Mediating Role of Fear of Missing Out

by Marianna Chmiel, Marek Cieśluk and Jan Znajdek

Brain Sci. 2026, 16(7), 724; https://doi.org/10.3390/brainsci16070724 - 8 Jul 2026

Abstract

Background/Objectives: Social media use is central to adolescent functioning, yet problematic engagement is linked to adverse psychosocial outcomes. This study examined the relationship between loneliness and problematic social media use (PSMU), investigating the role of fear of missing out (FoMO) as an [...] Read more.

Background/Objectives: Social media use is central to adolescent functioning, yet problematic engagement is linked to adverse psychosocial outcomes. This study examined the relationship between loneliness and problematic social media use (PSMU), investigating the role of fear of missing out (FoMO) as an underlying mechanism. Methods: The study included 206 Polish adolescents (M = 17.21, SD = 1.16). Participants completed the Bergen Social Media Addiction Scale, the Fear of Missing Out Scale, and the de Jong Gierveld Loneliness Scale. Correlation, multiple regression, and bootstrapping analyses were performed to test these associations. Results: Loneliness was positively associated with PSMU and specific FoMO dimensions. PSMU correlated with all FoMO dimensions, although the association with fear of social exclusion was weaker. Social comparison anxiety and online monitoring were identified as key factors associated with the indirect path from loneliness to PSMU (β = 0.09, 95% CI [0.03, 0.23] and β = 0.05, 95% CI [0.01, 0.15], respectively). Fear of social exclusion did not show a significant association with loneliness. Conclusions: These findings align with a compensatory framework, suggesting that loneliness is related to PSMU through specific cognitive and behavioral processes related to FoMO. Given the cross-sectional design, these results are exploratory; future longitudinal research is required to establish the directionality and temporal stability of these associations. Full article

(This article belongs to the Special Issue Focus on Mental Health and Mental Illness in Adolescents (2nd Edition))

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27 pages, 4226 KB

Open AccessArticle

Align and Fuse: A Transformer-Based Framework for EEG-Augmented Visual Recognition

by Chao Zhang, Youpeng Ma, Mengting Li, Xiangping Gao and Xiaopei Wu

Brain Sci. 2026, 16(7), 723; https://doi.org/10.3390/brainsci16070723 - 7 Jul 2026

Abstract

Background: Integrating human neural signals with computational vision systems offers a promising route toward more robust visual recognition, yet supporting mixed-granularity recognition, where both coarse- and fine-grained categories must be distinguished within a unified system, remains challenging due to the heterogeneous feature [...] Read more.

Background: Integrating human neural signals with computational vision systems offers a promising route toward more robust visual recognition, yet supporting mixed-granularity recognition, where both coarse- and fine-grained categories must be distinguished within a unified system, remains challenging due to the heterogeneous feature spaces of electroencephalography (EEG) and visual data. Methods: We propose “Align and Fuse,” a two-stage Transformer-based framework. Stage 1 constructs a shared semantic space using a hardness-aware multimodal supervised contrastive loss with Hard Negative Weighting to explicitly target confusable class pairs. Stage 2 employs a multimodal Transformer with co-attention to fuse the aligned features for classification. Results: On the 80-class EEG-ImageNet benchmark, our framework achieved 91.12% Top-1 accuracy under a temporally separated control protocol, improving over the corresponding vision-only (89.08%) and Standard Transformer (89.95%) baselines. Under the original stratified random split, it achieved 92.56% Top-1 accuracy; on the 40-class EEGCVPR dataset, accuracy reaches 95.82%. Cross-subject experiments yield 90.92% average Top-1 accuracy on four unseen subjects, and Grad-CAM analysis suggests that aligned EEG signals shift the model’s attention toward semantically relevant regions. Conclusions: Coupling hardness-aware alignment with decoupled multimodal fusion supports EEG-augmented recognition by leveraging complementary stimulus-related information under the evaluated protocols. Because EEG features are required at inference time, the framework is positioned as a human-in-the-loop EEG-augmented recognition system rather than a standalone vision model. Full article

(This article belongs to the Section Computational Neuroscience, Neuroinformatics, and Neurocomputing)

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