2026-04-02
Bin Han, Raynald, Muhammad Firdaus, Yaxin Wu, Ganghua Feng, Xuehan Liu, Peng Zhang, Pengyu Lu, Yi Liu, Wei Hu, Yaxuan Sun
PurposeThis study aimed to evaluate the safety and efficacy of endovascular treatment (EVT) performed under general anesthesia (GA) versus conscious sedation (CS) in patients with acute basilar artery occlusion (aBAO).MethodsPatients were stratified into GA and CS group. Propensity score matching (1:1) was performed to balanced baseline characteristics. The primary outcome was a favorable functional outcome, defined as a 90-day modified Rankin Scale (mRS) score of 0–2. Secondary outcomes included 90-day mRS 0–1 and 0–3, National Institutes of Health Stroke Scale (NIHSS) scores at 24 and 72 h, successful recanalization, puncture-to-recanalization time, and safety outcomes, including any intracerebral hemorrhage (ICH) and 90-day mortality.ResultsAfter propensity score matching, there was no significant between the GA and CS groups (adjusted odds ratio [aOR], 0.97, 95% CI, 0.52–1.84; p = 0.935). Rates of successful recanalization and puncture-to-recanalization time were also comparable between groups. Ninety-day mortality did not differ significantly between CS and GA (adjusted risk ratio: 1.16; 95% CI: 0.70 to 1.91; p = 0.565).ConclusionIn patients with aBAO undergoing EVT, CS was associated with clinical and safety outcomes comparable to those observed with GA. However, given the modest sample size and limited statistical power, these findings should be interpreted cautiously.
DOI: 10.3389/fneur.2026.17727542026-04-02
Chunmei Wang, Longlong Lin, Yuanfeng Zhang, Simei Wang, Xiaona Luo, Xuqin Chen
Leigh syndrome (LS) is a prevalent mitochondrial encephalomyopathy in childhood, triggered by mutations in mitochondrial DNA (mtDNA) or nuclear DNA (nDNA). The protein encoded by the SURF1 gene localizes to the inner mitochondrial membrane and is involved in the biosynthesis of the cytochrome c oxidase (COX) complex. We enrolled 5 children harboring SURF1 gene variants whose clinical manifestations were highly consistent with LS. The clinical characteristics and potential pathogenic mechanisms of the disease were elucidated by systematic analysis of their clinical data. Among the 5 patients, 4 were female and 1 was male, with ages ranging from 13 months to 2 years and 7 months. Next-generation sequencing (NGS) results revealed 6 variant sites in the SURF1 gene among the 5 patients, of which 2 were known variants and 4 were unreported novel variants, namely c.314-317delTGCC (p.L105Qfs*7), c.588+1_588+3delGTA (splicing), c.655G>T (p.Glu219), and c.515+3G>C. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was performed on the peripheral blood of 4 patients, and the results demonstrated that the messenger RNA (mRNA) expression level of the SURF1 gene was significantly lower than that in their parents. Using 10 healthy children as controls, we analyzed the ratios of mitochondria-related NADH–ubiquinone oxidoreductase core subunit 1 (ND1), Cytochrome c oxidase subunit I (COX1), Cytochrome c oxidase subunit II (COX2), NADH–ubiquinone oxidoreductase chain 4 (ND4), Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) was used as a nuclear reference gene. Mitochondrial DNA content was determined by measuring the ND1/GAPDH ratio using RT-qPCR, and further verified with COX1, COX2, and ND4. These ratios were all significantly decreased, indicating reduced mitochondrial DNA (mtDNA) copy number/mtDNA depletion. Iterative Threading ASSEmbly Refinement (I-TASSER)-based three-dimensional (3D) structural analysis indicated that all 6 variant sites induced alterations in the spatial structure of the SURF1 protein. The SURF1 protein is a hydrophilic protein, protein hydrophobicity and stability analyses showed that the 4 unreported novel variants could reduce the hydrophilicity, increase the hydrophobicity, and decrease the structural stability of the protein. The Saccharomyces cerevisiae Homolog of Yeast 1 (Shy1) domain serves as the key structural basis for SURF1 to exert its mitochondrial functions. We found that all 6 variant sites in the SURF1 gene were located within the Shy1 domain.
DOI: 10.3389/fneur.2026.17930542026-04-02
Xiuen Chen, Chenchen Zhang, Wenhui Shi, Zhichao Ning, Jiejiao Zheng, Yongjun Zheng, Yunyun Zhang
ObjectiveDysphagia frequently co-occurs with cognitive impairment, suggesting that swallowing may involve cognitive processes. However, the relationship between cognitive load and swallowing performance remains unclear. This study aimed to examine the effects of different levels of cognitive load on swallowing performance under dual-task conditions in healthy adults.MethodsForty-three graduate students (mean age: 24.49 ± 1.63 years, male/female: 22/21) were recruited and performed five tasks: swallowing single task (SST), low-load cognitive single task (STlow), high-load cognitive single task (SThigh), low-load cognitive-swallowing dual task (DTlow), and high-load cognitive-swallowing dual task (DThigh). Here, a dual-task refers to the concurrent execution of a swallowing task and a cognitive task, designed to evaluate the competition for attentional resources and performance trade-offs. The low-load cognitive task consisted of a digit forward-span task, while the high-load cognitive task involved a digit backward-span task, which demands greater cognitive processing complexity and working memory load. Swallowing measures (e.g., swallowing volume) and cognitive task accuracy were recorded, and dual-task cost (DTC) was calculated to evaluate performance changes under dual-task conditions.ResultsSwallowing volume differed significantly among SST, DTlow, and DThigh (p < 0.05), with lower volume in DThigh compared to SST (p < 0.05). Cognitive accuracy was significantly lower in DThigh than in DTlow (p < 0.05), indicating greater interference under high cognitive load.ConclusionThe findings confirm that swallowing engages executive function and attentional resources, and suggest that participants prioritize swallowing performance during dual-task conditions by adjusting prefrontal activation patterns rather than increasing overall cortical activation to manage interference. This study provides preliminary evidence for the cognitive involvement in swallowing and highlights the need to consider cognitive load in dysphagia assessment and rehabilitation.
DOI: 10.3389/fneur.2026.17430032026-04-01
Ruiying Ding, Zhonghong Guo, Rongming Ding
ObjectiveTo explore the effectiveness of comfort nursing intervention in the care of elderly patients with acute cerebral infarction to improve patient comfort and quality of life.MethodIn this study, 120 elderly patients with acute cerebral infarction were randomly divided into an experimental group and a control group. The experimental group was given individualized nursing intervention based on comfort nursing intervention, including physical, psychological, social and environmental nursing. The control group received routine nursing measures. The National Institutes of Health Stroke Scale, Fugl-Meyer Assessment of Motor Function Scale, Activities of Daily Living Assessment Scale, Newcastle Nursing Satisfaction Scale and Hamilton Anxiety Scale were used to evaluate the degree of neurological deficits, motor function recovery, self-care ability of daily life, satisfaction with nursing services and anxiety level of the two groups of patients. The data were analyzed using SPSS software.ResultThe effective implementation of comfort nursing intervention significantly improved the neurological function, motor ability, activities of daily living and nursing satisfaction of elderly patients with acute cerebral infarction, and reduced the level of anxiety (p < 0.01), and the overall satisfaction was significantly improved.ConclusionThe effective implementation of comfort nursing intervention significantly improved the comfort and quality of life of elderly patients with acute cerebral infarction, indicating that the application of this theory in clinical nursing is of great value.
DOI: 10.3389/fneur.2026.16679312026-04-01
Minoru Fujiki, Kaito Arimatsu, Hiroyuki Matsuta, Hirotaka Fudaba, Kouhei Onishi, Yukari Kawasaki, Nobuhiro Hata, Mitsuhiro Anan
Intraoperative monitoring of motor-evoked potentials (MEPs) is important for preventing serious ischemic complications during aneurysm surgery following subarachnoid hemorrhage (SAH). Reduced intraoperative MEP amplitude indicates corticospinal tract neuronal damage, which should be avoided during surgical maneuvers. We aimed to investigate whether the MEP amplitude immediately before surgery can serve as both a control value for intraoperative MEP and an indicator of the pathophysiology of cortical excitability and inhibitory–facilitatory circuits immediately after SAH and neurological functional disturbance during the perioperative period. The present study focused on the MEP amplitude prior to intraoperative clipping and coil embolization and found that the MEP amplitude in the hemisphere with more significant SAH was significantly higher than that in the contralateral hemisphere. We also demonstrated that the MEP amplitude facilitation ratio significantly and linearly correlated with the initial computed tomography (CT) hematoma density [Hounsfield units (HU)] (p < 0.0001). The MEP facilitation ratio linearly correlated with abnormalities in short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) values. Significant correlations were observed in the SICI and ICF groups with delayed cerebral ischemia (p < 0.0001), whereas the ICF group showed a similar trend but weaker correlation (p = 0.0732). A high MEP amplitude just before surgery correlates well with Sylvian fissure HU values on initial CT and may reflect dysfunction in the cortical electrophysiological intracortical inhibitory–facilitatory neuronal circuits of SAH.
DOI: 10.3389/fneur.2026.16902412026-04-01
Xiuxiu Lu, Liqiong Cao, Li Zeng, Liangbing Zhang
BackgroundThe optimal antiplatelet approach for branch atheromatous disease (BAD) remains uncertain. We evaluated whether early administration of tirofiban plus aspirin (T + A) improves outcomes compared with dual antiplatelet therapy (DAPT) and assessed its potential as rescue therapy for early neurological deterioration (END).MethodsThis single-center retrospective cohort study included patients with acute BAD treated between November 2022 and August 2025. Patients received either T + A or DAPT. Propensity score matching (caliper 0.02) was performed to balance baseline characteristics. Primary outcomes were END within 7 days and excellent functional outcome (mRS 0–1) at 90 days; secondary outcomes included favorable outcome (mRS 0–2) and early neurological improvement.ResultsAfter matching, END occurred less frequently in the T + A group than in the DAPT group (10.1% vs. 55.1%; adjusted OR 0.08; 95% CI 0.03–0.20; p < 0.001). Excellent functional outcome at 90 days was more common with T + A (88.4% vs. 58.0%; adjusted OR 5.17; 95% CI 2.12–12.61; p < 0.001). T + A also improved early neurological recovery and favorable functional outcomes. Among patients who deteriorated on DAPT, exploratory rescue T + A was associated with improved recovery. No major bleeding increase was observed. These results are specific to this single-center cohort of Chinese patients with acute, mild-to-moderate BAD (NIHSS <15).ConclusionIn this single-center cohort of Chinese patients with acute, mild-to-moderate BAD (NIHSS <15), tirofiban plus aspirin reduced END and improved 90-day functional outcomes. Exploratory evidence suggests it may also serve as a rescue therapy for patients deteriorating under DAPT. However, its efficacy and safety require validation in prospective, randomized studies.
DOI: 10.3389/fneur.2026.18029902026-03-31
Dan Tong Jia
Progressive multifocal leukoencephalopathy (PML) is a rare, often fatal demyelinating disease of the central nervous system caused by reactivation of latent JC virus in immunocompromised individuals. Despite advances in understanding its pathogenesis, PML remains a diagnostic challenge due to its diverse clinical manifestations, radiographic overlap with other disorders, low incidence and subsequent lack of clinical familiarity. Diagnostic delays, often extending months after symptom onset, are common and contribute to poor outcomes. This review outlines the key clinical features, risk factors, diagnostic and neuroradiographic findings of PML to aid practicing neurologists in timely recognition and expedited diagnosis. We review emerging biomarkers and advanced diagnostic tools to identify PML. We also compare PML with its common mimics to underscore diagnostic pitfalls and how to overcome them. Novel and experimental therapies are beyond the scope of this article; instead, we focus on equipping neurologists with a framework grounded in patient data and clinical experience to establish timely diagnoses of PML.
DOI: 10.3389/fneur.2026.16925222026-03-31
Yijia Li, Mingyang Song, Xuan Zhou, Lanshu Zhou
BackgroundTraumatic brain injury (TBI) rehabilitation involves a complex, multi-stage journey across various healthcare settings. However, current research still lacks a comprehensive understanding of this process from the patient’s perspective. A detailed mapping of the patient journey is crucial for designing targeted and effective rehabilitation strategies.DesignA qualitative interpretative research design was performed and the standards for reporting qualitative research (SRQR) has been used.ObjectiveTo construct a patient journey map visualizing the rehabilitation care experiences of adult TBI patients, identify key pain points and service gaps, and provide recommendations for service optimization.MethodsA qualitative interpretative research design was employed, guided by the Patient-Centered Healthcare Accessibility Framework. Using purposive sampling, 26 TBI patients were recruited from five healthcare settings in a major Chinese city between February and July 2024. Data were collected through 78 semi-structured interviews and 156 h of non-participant observation across acute care, rehabilitation, and community settings. Thematic analysis was conducted using Braun and Clarke’s six-phase framework, followed by process mapping and journey visualization.ResultsThe TBI rehabilitation journey comprised three distinct phases: Acute Treatment Phase (2–8 weeks), Continuous Rehabilitation Phase (3–18 months), and Rehabilitation Community Integration Phase (ongoing). Nine emotional states were identified throughout the journey, ranging from fear and helplessness in the acute phase to acceptance and hope in the community integration phase. Thirteen core rehabilitation needs were prioritized across phases. Nineteen significant pain points were categorized into system-level (n = 6), provider-level (n = 7), and patient/family-level barriers (n = 6), with service discontinuity affecting 84% of participants.ConclusionThe TBI rehabilitation journey is characterized by complexity, non-linearity, and significant service fragmentation. Findings highlight the urgent need for integrated, patient-centered care models with enhanced care coordination, standardized pathways, and comprehensive family support systems. The patient journey map provides a framework for systematic service improvement and policy development.
DOI: 10.3389/fneur.2026.17682072026-03-31
Luisa Fofi, Claudia Altamura, Marilena Marcosano, Alberto Doretti, Francesca Pistoia, Antonio Granato, Simona Guerzoni, Michele Trimboli, Licia Grazzi, Danilo Antonio Montisano, Gianluca Avino, Gabriele Sebastianelli, Carla Fasano, Elisa Maria Piella, Pierangelo Geppetti, Nicoletta Brunelli, Luigi Francesco Iannone, Fabrizio Vernieri
IntroductionEptinezumab is an intravenous anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) approved for the prevention of episodic and chronic migraine. We aimed to explore the earliest changes in migraine pain intensity and associated symptoms during the first 30 min of eptinezumab infusion in a real-world setting, particularly when an acute migraine attack was ongoing.MethodsThe BE-FREE study is an ongoing Italian observational, multicenter, independent, real-world, and prospective study. We enrolled patients affected with episodic migraine (EM) and chronic migraine (CM) who were experiencing an ongoing migraine attack. Eptinezumab was administered within 1–12 h of the onset of the qualifying migraine attack. Data collected included monthly migraine days (MMDs), headache pain intensity, the number of monthly acute medications, and the use of concomitant or past standard preventive treatments (SPTs). The Numerical Rating Scale (NRS), associated symptoms, and pain freedom (PF) were recorded before infusion (T0) and at intervals of 10 (T10), 20 (T20), and 30 (T30) min during infusion.ResultsWe enrolled 31 patients (87% female), with a mean age of 43.1 years (SD 2.7); of these, 68% had CM. NRS scores significantly reduced at T10 (p = 0.011) and T20 (p = 0.004). Photophobia was less frequent at T10 (p = 0.045), phonophobia at T20 (p = 0.014), and osmophobia at T30 (p = 0.046) compared with T0. PF was reported by 6.5% of patients at T10, 19.4% at T20, 29.0% at T30, and 19.4% at T60, T90, and T120.DiscussionThe BE-FREE study results, representing the first real-world evidence, demonstrate the rapid effect of eptinezumab during the first 30 min of infusion in patients experiencing an ongoing migraine attack.
DOI: 10.3389/fneur.2026.17842422026-03-31
Zhe Li, Ran Hui, Xiaoyun Guo, Qinmao Fang, Heping Deng
ObjectiveEarly etiologic discrimination between large-artery atherosclerosis (LAA) and small-vessel occlusion (SVO) is clinically relevant when advanced imaging is unavailable or delayed. We examined whether combining carotid pulse wave velocity (PWV) with the triglyceride–glucose (TyG) index improves early in - hospital discrimination of LAA vs. SVO, and developed a predictive model integrating PWV, TyG, and clinical indicators.MethodsWe performed a single-centre retrospective study including consecutive acute ischaemic stroke patients from September 2021 to November 2023. Carotid PWV (Wv, m/s) was measured bilaterally and averaged; TyG was calculated from fasting triglycerides and glucose. Restricted cubic splines (RCS) tested non-linearity. Multivariable logistic regression was applied to (i) estimate the adjusted association of PWV and TyG with LAA versus SVO, and (ii) identify independent predictors via backward stepwise selection and establish predictive model. Discrimination was assessed by ROC AUC with DeLong tests; calibration used bootstrap-corrected curves; internal validation used 1,000-bootstrap optimism correction; decision-curve analysis appraised clinical utility.ResultsOf 892 admissions screened, 298 were analysed (SVO 179; LAA 119). LAA showed higher PWV (median 17.72 vs. 15.02 m/s; p < 0.001) and higher TyG (8.85 vs. 8.64; p = 0.005) than SVO. RCS supported overall associations of PWV and TyG with LAA versus SVO without evidence of non-linearity. Compared with single markers (AUC: PWV = 0.627; TyG = 0.596), a two-marker model (PWV + TyG) achieved AUC 0.654, while a parsimonious four-variable model (PWV, TyG, sex, eGFR) reached AUC 0.685 and significantly outperformed either single marker (paired DeLong vs. PWV: ΔAUC 0.058, p = 0.043; vs. TyG: ΔAUC 0.089, p = 0.011). Calibration was acceptable after bootstrap correction.ConclusionPWV and TyG provide complementary, early in - hospital signals for moderate discrimination of LAA vs. SVO, with incremental value when combined. The predictive model constructed by combining PWV, TyG, and clinical indicators also performed well. These bedside markers provide adjunctive, early in-hospital risk stratification for suspected LAA versus SVO.
DOI: 10.3389/fneur.2026.17753022026-03-30
Yibing Sun, Qingguo Zhang
Cervical spondylotic myelopathy (CSM) is a severe degenerative spinal disorder caused by cervical spinal stenosis due to cervical degeneration, which compresses the spinal cord. Patients in the mid-to late-stages of the disease frequently undergo surgical treatment; however, some may still suffer from persistent sensorimotor dysfunction, inadequate pain relief, and surgery-related complications. Although substantial progress has been achieved in comprehending the pathology of CSM in recent years, the postoperative pathological mechanisms remain poorly understood, particularly the specific molecular mechanisms influencing the development of complications. Traditional research has focused on mechanical compression caused by herniated material, neglecting the potential adverse effects of postoperative immune microenvironment imbalance in the spinal cord. Current studies suggest that the glial scar–inflammation axis, which is triggered by abnormal activation of neural immune cells (glia) and peripheral immune cells (e.g., Th17 cells and neutrophils) and their interactions—may serve as a key factor contributing to poor postoperative outcomes and disease recurrence. This review summarizes the recent advances in the biology and pathology of the glial scar–inflammation axis following conventional surgical treatment for CSM, as well as innovative therapeutic strategies, such as stem cell transplantation. It aims to provide new insights and directions for future research on postoperative complications and their treatment in CSM.
DOI: 10.3389/fneur.2026.1774739