Innovative Opportunities in Neurological Diseases Diagnosis, Management and Therapy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 July 2024) | Viewed by 13856

Special Issue Editor


E-Mail Website
Guest Editor
Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
Interests: digital health; remote monitoring; digital therapeutics; telemedicine; e-health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

At present, neurological disorders are characterized by the need to find new solutions for their management—both from an epidemiological perspective, and for progress in the field of diagnostic, pharmacological, symptomatic and rehabilitative therapies. We have been diagnosing so-called millennials with neurological diseases for some years now. It is, therefore, the duty of science to explore new tools for diagnosis, management and future approaches, which is precisely the goal of this Special Issue on “Innovative opportunities in neurological diseases diagnosis, management and therapy”.

Dr. Luigi Lavorgna
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multiple sclerosis
  • Parkinson’s disease
  • amyotrophic lateral sclerosis
  • Alzheimer’s disease
  • migraine
  • epilepsy
  • myasthenia gravis
  • stroke
  • neurological genetic disorders
  • peripheral neuropathies
  • neuromuscular diseases
  • ataxia
  • Huntington’s disease
  • digital health
  • e-health
  • remote monitoring
  • digital therapeutics
  • machine learning
  • artificial intelligence

Published Papers (9 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Editorial

Jump to: Research, Review

10 pages, 437 KiB  
Editorial
The Peculiarity of Infection and Immunity Correlated with Guillain-Barré Syndrome in the HIV-Infected Population
by Yanli Wang, Jun Yang and Ying Wen
J. Clin. Med. 2023, 12(3), 907; https://doi.org/10.3390/jcm12030907 - 23 Jan 2023
Cited by 1 | Viewed by 2208
Abstract
Guillain-Barré syndrome (GBS) can occur at all stages of human immunodeficiency virus (HIV) infection. HIV, cytomegalovirus (CMV), and varicella zoster virus (VZV) are the main infectious agents in HIV-positive GBS cases. These cases include acute and chronic HIV infection, immune reconstitution inflammatory syndrome [...] Read more.
Guillain-Barré syndrome (GBS) can occur at all stages of human immunodeficiency virus (HIV) infection. HIV, cytomegalovirus (CMV), and varicella zoster virus (VZV) are the main infectious agents in HIV-positive GBS cases. These cases include acute and chronic HIV infection, immune reconstitution inflammatory syndrome (IRIS) shortly after anti-retroviral therapy (ART), those with ART interruption, or those with cerebrospinal fluids (CSF) HIV escape. The mechanisms are involved in both humoral and cellular immunities. Demyelinating and axonal neuropathies are the main pathological mechanisms in GBS. Presentation and prognosis are identical to those in patients without HIV infection. Typical or atypical clinical manifestations, CSF analysis, electrophysiological and pathological examination, and antiganglioside antibody detection can help diagnose GBS and classify its various subtypes. Intravenous immunoglobulin and plasma exchange have been used to treat GBS in HIV-positive patients with a necessary ART, while ganciclovir or foscarnet sodium should be used to treat ongoing CMV- or VZV-associated GBS. Steroids may be beneficial for patients with IRIS-related GBS. We reviewed HIV-positive cases with GBS published since 2000 and summarized their features to highlight the necessity of HIV testing among patients with GBS. Moreover, the establishment of a multidisciplinary team will guarantee diagnostic and therapeutic advantages. Full article
Show Figures

Figure 1

Research

Jump to: Editorial, Review

7 pages, 705 KiB  
Article
Evaluating the Efficacy of Vagus Nerve Stimulation across ‘Minor’ and ‘Major’ Seizure Types: A Retrospective Analysis of Clinical Outcomes in Pharmacoresistant Epilepsy
by Flavius Iuliu Urian, Corneliu Toader, Razvan-Adrian Covache Busuioc, Luca-Andrei Glavan, Antonio Daniel Corlatescu, Gabriel Iacob and Alexandru Vlad Ciurea
J. Clin. Med. 2024, 13(14), 4114; https://doi.org/10.3390/jcm13144114 - 14 Jul 2024
Viewed by 412
Abstract
Background: Evaluating the differential impact of vagus nerve stimulation (VNS) therapy across various seizure types, our study explores its efficacy specifically in patients with categorized minor and major seizures. Methods: We conducted a retrospective cohort study involving 76 patients with pharmacoresistant epilepsy treated [...] Read more.
Background: Evaluating the differential impact of vagus nerve stimulation (VNS) therapy across various seizure types, our study explores its efficacy specifically in patients with categorized minor and major seizures. Methods: We conducted a retrospective cohort study involving 76 patients with pharmacoresistant epilepsy treated at the University Emergency Hospital of Bucharest between 2021 and 2024. Seizures were classified as ‘minor’ (including focal-aware and non-motor/absence seizures) and ‘major’ (including focal to bilateral tonic-clonic and generalized motor seizures), based on modified International League Against Epilepsy (ILAE) criteria. This classification allowed us to assess the response to VNS therapy, defined by a 50% or greater reduction in seizure frequency at the 12-month follow-up. Results: Our findings reveal that major seizures respond more favorably to VNS therapy, significantly reducing both frequency and intensity. In contrast, minor seizures showed a less pronounced response in frequency reduction but noted improvements in neurocognitive functions, suggesting a nuanced benefit of VNS in these cases. Conclusion: The study underscores the importance of seizure type in determining the efficacy of VNS therapy, advocating for personalized treatment approaches based on seizure classification. This approach could potentially enhance clinical outcomes by tailoring VNS settings to specific seizure types, improving overall management strategies in pharmacoresistant epilepsy. Full article
Show Figures

Figure 1

18 pages, 1899 KiB  
Article
Neuromuscular Electrical Stimulation Does Not Influence Spinal Excitability in Multiple Sclerosis Patients
by Martina Scalia, Riccardo Borzuola, Martina Parrella, Giovanna Borriello, Francesco Sica, Fabrizia Monteleone, Elisabetta Maida and Andrea Macaluso
J. Clin. Med. 2024, 13(3), 704; https://doi.org/10.3390/jcm13030704 - 25 Jan 2024
Viewed by 1351
Abstract
(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus [...] Read more.
(1) Background: Neuromuscular electrical stimulation (NMES) has beneficial effects on physical functions in Multiple sclerosis (MS) patients. However, the neurophysiological mechanisms underlying these functional improvements are still unclear. This study aims at comparing acute responses in spinal excitability, as measured by soleus Hoffmann reflex (H-reflex), between MS patients and healthy individuals, under three experimental conditions involving the ankle planta flexor muscles: (1) passive NMES (pNMES); (2) NMES superimposed onto isometric voluntary contraction (NMES+); and (3) isometric voluntary contraction (ISO). (2) Methods: In total, 20 MS patients (MS) and 20 healthy individuals as the control group (CG) took part in a single experimental session. Under each condition, participants performed 15 repetitions of 6 s at 20% of maximal voluntary isometric contraction, with 6 s of recovery between repetitions. Before and after each condition, H-reflex amplitudes were recorded. (3) Results: In MS, H-reflex amplitude did not change under any experimental condition (ISO: p = 0.506; pNMES: p = 0.068; NMES+: p = 0.126). In CG, H-reflex amplitude significantly increased under NMES+ (p = 0.01), decreased under pNMES (p < 0.000) and was unaltered under ISO (p = 0.829). (4) Conclusions: The different H-reflex responses between MS and CG might reflect a reduced ability of MS patients in modulating spinal excitability. Full article
Show Figures

Figure 1

12 pages, 1009 KiB  
Article
PEALut in the Dietary Management of Patients with Acute Ischemic Stroke: A Prospective Randomized Controlled Clinical Trial
by Massimo Bonzanino, Marianna Riolo, Iacopo Battaglini, Marilisa Perna and Marco De Mattei
J. Clin. Med. 2024, 13(2), 509; https://doi.org/10.3390/jcm13020509 - 16 Jan 2024
Viewed by 1021
Abstract
Acute ischemic stroke (AIS), which represents 87% of all strokes, is caused by reduced blood supply to the brain associated with a prolonged inflammatory process that exacerbates brain damage. The composite containing co-ultramicronized Palmitoylethanolamide and luteolin (PEALut) is known to promote the resolution [...] Read more.
Acute ischemic stroke (AIS), which represents 87% of all strokes, is caused by reduced blood supply to the brain associated with a prolonged inflammatory process that exacerbates brain damage. The composite containing co-ultramicronized Palmitoylethanolamide and luteolin (PEALut) is known to promote the resolution of neuroinflammation, being a promising nutritional approach to contrast inflammatory processes occurring in AIS. This study included 60 patients affected by acute ischemic stroke and undergoing thrombolysis. PEALut 770 mg was administered to 30 patients, twice daily for 90 days, in addition to the standard therapy. Neurological deficit, independence in activities of daily living, disability and cognitive impairment were investigated. In all patients, the severity of AIS defined by the NIHSS score evolved from moderate to minor (p < 0.0001). Patients’ independence in daily living activities and disability evaluated using BI and mRS showed a significant improvement over time, with a statistically significant difference in favor of PEALut-treated patients (p < 0.002 for BI, p < 0.0001 for mRS), who achieved also a marked improvement of cognitive function evaluated using MMSE and MoCA tests. PEALut proved to be a safe and effective treatment in addition to thrombolysis in the management of patients with acute ischemic stroke. Full article
Show Figures

Figure 1

10 pages, 627 KiB  
Article
Beliefs about Medicines and the Level of Intentional Non-Adherence to Treatment among Patients with Multiple Sclerosis Treated with First-Line Drugs
by Aleksandra Kołtuniuk and Justyna Chojdak-Łukasiewicz
J. Clin. Med. 2024, 13(1), 182; https://doi.org/10.3390/jcm13010182 - 28 Dec 2023
Viewed by 796
Abstract
Introduction: Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system. MS has no curable disease but drug modifying therapy (DMT) can delay the long-term disability progression of the disease. The effectiveness of MS treatment depends on [...] Read more.
Introduction: Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system. MS has no curable disease but drug modifying therapy (DMT) can delay the long-term disability progression of the disease. The effectiveness of MS treatment depends on the patient’s adherence to therapy. Aim: This study evaluated the level of intentional non-adherence and the relationship between beliefs about medication and the level of intentional non-adherence to treatment of patients with multiple sclerosis. Material and methods: A group of 146 patients with relapsing–remitting MS were included. To assess different aspect of adherence, the Intentional Non-Adherence Scale (INAS) was used. For evaluating patients’ beliefs and opinions regarding medication, the Beliefs about Medicines Questionnaire (BMQ) was used. Results: The mean total INAS score was 51.41 ± 27.83 points. Patients were most concerned about the necessity to take medication and least concerned about the harm caused by medication. The overuse and harm domains of the BMQ were significantly correlated with INAS scores (p < 0.05). Conclusions: Independent determinant of intentional non-adherence was overuse. Full article
Show Figures

Figure 1

14 pages, 1566 KiB  
Article
Psychometric Calibration of a Tool Based on 360 Degree Videos for the Assessment of Executive Functions
by Francesca Borgnis, Francesca Borghesi, Federica Rossetto, Elisa Pedroli, Luigi Lavorgna, Giuseppe Riva, Francesca Baglio and Pietro Cipresso
J. Clin. Med. 2023, 12(4), 1645; https://doi.org/10.3390/jcm12041645 - 18 Feb 2023
Cited by 2 | Viewed by 1592
Abstract
Introduction: Over the last decades, interactive technologies appeared a promising solution in the ecological evaluation of executive functioning. We have developed the EXecutive-functions Innovative Tool 360° (EXIT 360°), a new instrument that exploits 360° technologies to provide an ecologically valid assessment of executive [...] Read more.
Introduction: Over the last decades, interactive technologies appeared a promising solution in the ecological evaluation of executive functioning. We have developed the EXecutive-functions Innovative Tool 360° (EXIT 360°), a new instrument that exploits 360° technologies to provide an ecologically valid assessment of executive functioning. Aim: This work wanted to evaluate the convergent validity of the EXIT 360°, comparing it with traditional neuropsychological tests (NPS) for executive functioning. Methods: Seventy-seven healthy subjects underwent an evaluation that involved: (1) a paper-and-pencil neuropsychological assessment, (2) an EXIT 360° session, involving seven subtasks delivered by VR headset, and (3) a usability assessment. To evaluate convergent validity, statistical correlation analyses were performed between NPS and EXIT 360° scores. Results: The data showed that participants had completed the whole task in about 8 min, with 88.3% obtaining a high total score (≥12). Regarding convergent validity, the data revealed a significant correlation between the EXIT 360° total score and all NPS. Furthermore, data showed a correlation between the EXIT 360° total reaction time and timed neuropsychological tests. Finally, the usability assessment showed a good score. Conclusion: This work appears as a first validation step towards considering the EXIT 360° as a standardized instrument that uses 360° technologies to conduct an ecologically valid assessment of executive functioning. Further studies will be necessary to evaluate the effectiveness of the EXIT 360° in discriminating between healthy control subjects and patients with executive dysfunctions. Full article
Show Figures

Figure 1

11 pages, 264 KiB  
Article
Assessment of Changes in Serum C-Reactive Protein Levels in Patients after Ischemic Stroke Undergoing Rehabilitation—A Retrospective Observational Study
by Wojciech Borowicz, Kuba Ptaszkowski, Lucyna Ptaszkowska, Eugenia Murawska-Ciałowicz and Joanna Rosińczuk
J. Clin. Med. 2023, 12(3), 1029; https://doi.org/10.3390/jcm12031029 - 29 Jan 2023
Viewed by 1354
Abstract
Inflammation plays a key role in the pathogenesis and prognosis of ischemic stroke. C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect the progression of vascular disease. Using a biomarker such as CRP to predict recovery rather than mortality may [...] Read more.
Inflammation plays a key role in the pathogenesis and prognosis of ischemic stroke. C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect the progression of vascular disease. Using a biomarker such as CRP to predict recovery rather than mortality may present clinical value in providing rehabilitation. The primary aim of the study was to analyze changes in serum CRP levels in patients after ischemic stroke during the regenerative-compensatory period and to assess the usefulness of CRP as a potential biomarker during the rehabilitation period. The project was carried out as a retrospective analysis of prospectively collected data from post-stroke patients from the Department of Neurological Rehabilitation of the Regional Specialist Hospital in Wrocław. A group of 52 patients, after their first-ever ischemic stroke with subsequent hemiplegia, was finally qualified to participate in the study. Serum CRP levels were determined during blood laboratory tests. The Modified Rankin Scale (mRS) and Barthel Index (BI) were used to assess functional outcomes. Rehabilitation using neurophysiological methods was applied five days a week (each session lasted 60 min, and the entire period was 42 days). At the first test, serum CRP levels were found to be above 5 mg/L in 19 patients, the second test in 12 patients, the third test in five patients, and the fourth test in 9 patients. Only three patients had values higher than 5 mg/L in all consecutive assessments (p > 0.05). There was a statistically significant increase in BI scores after therapy (p < 0.001) as well as a decrease in the mRS score by 2.2 points (p < 0.001), in CRP values by 5.02 mg/L (p = 0.019), and in cortisol levels by 2.5 nmol/L (p = 0.002). Statistically significant relationships were observed between the CRP levels after rehabilitation and the corresponding mRS scores (rs = 0.29, p = 0.038). Furthermore, the effect of BMI on CRP levels was demonstrated (B = 0.20, p = 0.038). In conclusion, despite demonstrating a significant relationship between CRP levels and corresponding mRS scores, CRP levels alone may not serve as an independent predictor of long-term functional outcomes in ischemic stroke patients undergoing rehabilitation. Full article
22 pages, 395 KiB  
Article
Resilience, Stress, Well-Being, and Sleep Quality in Multiple Sclerosis
by Anne Marie Novak and Shahar Lev-Ari
J. Clin. Med. 2023, 12(2), 716; https://doi.org/10.3390/jcm12020716 - 16 Jan 2023
Cited by 10 | Viewed by 3109
Abstract
(1) Background: Multiple Sclerosis (MS) is a chronic, progressive, immune-mediated disorder that affects the Central Nervous System and is the most common cause of non-traumatic neurological disability in young adults. The study aimed to assess the levels of stress, resilience, well-being, sleep quality, [...] Read more.
(1) Background: Multiple Sclerosis (MS) is a chronic, progressive, immune-mediated disorder that affects the Central Nervous System and is the most common cause of non-traumatic neurological disability in young adults. The study aimed to assess the levels of stress, resilience, well-being, sleep quality, and fatigue in Israeli people with MS (PwMS), and to examine the associations between these factors and the sociodemographic and clinical characteristics. These factors had never before been studied in conjunction in PwMS, nor had they been systematically addressed in Israel, the unique geopolitical situation of which may pose unique challenges. (2) Methods: This was a survey-based, cross-sectional study conducted through an Internet platform. (3) Results: Israeli PwMS who participated in the study were experiencing relatively high levels of stress and low resilience, poor sleep quality, and severe fatigue. The analysis revealed significant associations between resilience and stress, well-being, and anxiety, as well as stress and well-being, resilience, sleep quality, fatigue, and Clinically Isolated Syndrome (CIS). (4) Conclusions: the Israeli PwMS who participated in the study were experiencing higher levels of stress, lower resilience and worse sleep quality than PwMS in other countries, as compared to results previously reported in literature. The findings of this study ought to serve as a call to action for the MS care providers in Israel and warrant further research into the possible causes of the phenomenon and strategies to address it. Full article

Review

Jump to: Editorial, Research

23 pages, 694 KiB  
Review
A Review on the Feasibility and Efficacy of Home-Based Cognitive Remediation in People with Multiple Sclerosis
by Angela Boschetti, Elisabetta Maida, Michelangelo Dini, Marta Tacchini, Giulia Gamberini, Giancarlo Comi and Letizia Leocani
J. Clin. Med. 2024, 13(7), 1916; https://doi.org/10.3390/jcm13071916 - 26 Mar 2024
Viewed by 728
Abstract
Cognitive impairment affects 34–65% of People with Multiple Sclerosis (PwMS), significantly impacting their quality of life. Clinicians routinely address cognitive deficits with in-clinic neuro-behavioural interventions, but accessibility issues exist. Given these challenges, coupled with the lifelong need for continuous assistance in PwMS, researchers [...] Read more.
Cognitive impairment affects 34–65% of People with Multiple Sclerosis (PwMS), significantly impacting their quality of life. Clinicians routinely address cognitive deficits with in-clinic neuro-behavioural interventions, but accessibility issues exist. Given these challenges, coupled with the lifelong need for continuous assistance in PwMS, researchers have underscored the advantageous role of telerehabilitation in addressing these requirements. Nonetheless, the feasibility and efficacy of home-based cognitive remediation remain to be firmly established. In this narrative review, we aimed to investigate the feasibility and efficacy of digital telerehabilitation for cognition in PwMS. Thirteen relevant studies were identified and carefully assessed. Regarding the feasibility of cognitive telerehabilitation, evidence shows adherence rates are generally good, although, surprisingly, not all studies reported measures of compliance with the cognitive training explored. Considering the efficacy of rehabilitative techniques on cognitive performance in PwMS, findings are generally inconsistent, with only one study reporting uniformly positive results. A range of methodological limitations are reported as potential factors contributing to the variable results. Future research must address these challenges, as more rigorous studies are required to draw definitive conclusions regarding the efficacy of home-based cognitive remediation in PwMS. Researchers must prioritise identifying optimal intervention approaches and exploring the long-term effects of telerehabilitation. Full article
Show Figures

Figure 1

Back to TopTop