The burden of neurological diseases in Europe: an analysis for the Global Burden of Disease Study 2017

Understanding the link between type 2 diabetes mellitus and Parkinson's disease: role of brain insulin resistance

Type 2 diabetes mellitus and Parkinson's disease are chronic diseases linked to a growing pandemic that affects older adults and causes significant socio-economic burden. Epidemiological data supporting a close relationship between these two aging-related diseases have resulted in the investigation of shared pathophysiological molecular mechanisms. Impaired insulin signaling in the brain has gained increasing attention during the last decade and has been suggested to contribute to the development of Parkinson's disease through the dysregulation of several pathological processes. The contribution of type 2 diabetes mellitus and insulin resistance in neurodegeneration in Parkinson's disease, with emphasis on brain insulin resistance, is extensively discussed in this article and new therapeutic strategies targeting this pathological link are presented and reviewed.

Liposomes as versatile agents for the management of traumatic and nontraumatic central nervous system disorders: drug stability, targeting efficiency, and safety

Various nanoparticle-based drug delivery systems for the treatment of neurological disorders have been widely studied. However, their inability to cross the blood-brain barrier hampers the clinical translation of these therapeutic strategies. Liposomes are nanoparticles composed of lipid bilayers, which can effectively encapsulate drugs and improve drug delivery across the blood-brain barrier and into brain tissue through their targeting and permeability. Therefore, they can potentially treat traumatic and nontraumatic central nervous system diseases. In this review, we outlined the common properties and preparation methods of liposomes, including thin-film hydration, reverse-phase evaporation, solvent injection techniques, detergent removal methods, and microfluidics techniques. Afterwards, we comprehensively discussed the current applications of liposomes in central nervous system diseases, such as Alzheimer's disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, traumatic brain injury, spinal cord injury, and brain tumors. Most studies related to liposomes are still in the laboratory stage and have not yet entered clinical trials. Additionally, their application as drug delivery systems in clinical practice faces challenges such as drug stability, targeting efficiency, and safety. Therefore, we proposed development strategies related to liposomes to further promote their development in neurological disease research.

Long-Term Consumption of Ultraprocessed Foods and Prodromal Features of Parkinson Disease

BACKGROUND AND OBJECTIVES

Consumption of ultraprocessed foods (UPFs) has been associated with a higher risk of various chronic diseases, but its relation to prodromal Parkinson disease (PD) remains unclear. We aimed to assess the association between long-term UPF consumption and nonmotor features suggestive of prodromal PD.

METHODS

This longitudinal analysis included participants without a history of PD from the Nurses' Health Study and Health Professionals Follow-Up Study. UPF consumption was assessed using repeated food frequency questionnaires (1984-2006) and grouped based on Nova classification. Participants provided data on probable REM sleep behavior disorder (pRBD) and constipation in 2012. Between 2014 and 2015, a subset of participants provided data on 5 additional nonmotor features, including hyposmia, impaired color vision, excessive daytime sleepiness, body pain, and depressive symptoms. The primary outcome was the combination of all 7 prodromal features and further categorized as 0 (reference), 1, 2, and ≥3 features. The secondary outcomes were all features except constipation, a combination of 3 commonly recognized features (constipation, pRBD, and hyposmia), and individual features. Multinomial logistic regression was used to estimate the association of UPF consumption with the combination of prodromal features. The association between UPF consumption and each individual feature was further examined using logistic regression.

RESULTS

The study analyzed 42,853 participants (25,095 women [58.6%]; mean [SD] age, 47.8 [5.2] years). Comparing extreme quintiles of UPF consumption, the multivariable-adjusted odds ratio (OR) for having ≥3 vs 0 prodromal features was 2.47 (95% CI 1.89-3.23, ptrend < 0.0001) for cumulative average intake and 1.50 (95% CI 1.18-1.89, ptrend = 0.0009) for baseline intake. Similar results were observed for combinations of all features except constipation (OR 2.00, 95% CI 1.29-3.11, ptrend < 0.0001) and combinations of 3 features (OR 2.47, 95% CI 1.41-4.34, ptrend = 0.008). In addition, higher UPF consumption was associated with increased odds of individual prodromal features, including pRBD, constipation, body pain, and depressive symptoms.

DISCUSSION

Long-term UPF consumption was positively associated with nonmotor prodromal PD features. More studies are warranted to confirm whether lowering UPF consumption may prevent the occurrence of nonmotor symptoms that often precede PD diagnosis.

Differential involvement of neurotransmitter pathways in AD, bvFTD and MCI: Whole-brain MRI analysis

BACKGROUND AND OBJECTIVES

Neurodegenerative diseases, including Alzheimer's disease (AD), mild cognitive impairment (MCI), and frontotemporal dementia (FTD), are a growing public health challenge, with dementia incidence projected to triple in the coming decades. AD is associated with memory impairment, bvFTD with behavioral dysfunction, and MCI as a transitional stage between normal cognition and dementia. While structural brain changes have been widely studied, the role of neurotransmitter pathways remains underexplored. This study aims to correlate gray matter atrophy in AD, bvFTD, and MCI with neurotransmitter pathways to identify distinctive neurochemical impairments.

METHODS

We included 214 participants (89 CE, 74 bvFTD, 51 MCI) from a single-center cohort. MRI from 3 T scanners was segmented via FreeSurfer. Neurotransmitter maps were sourced from JuSpace. We performed volumetric and whole-brain correlation analyses to evaluate relationships between brain regional volumes (BRVs) and neurotransmitter pathways. Group differences were assessed with Kruskal-Wallis tests followed by post-hoc analyses.

RESULTS

Volumetric analysis showed expected atrophy patterns in each group. Correlation analysis indicated distinct neurotransmitter involvement: AD showed significant atrophy correlations with dopamine D2 and GABA A receptor distribution; bvFTD had significant negative correlations with the mu-opioid receptor; MCI exhibited early serotonergic dysregulation.

CONCLUSIONS

We identified distinct atrophy patterns linked to specific neurotransmitter systems, each showing unique neurochemical profiles. In AD, precuneus and inferior parietal lobules atrophy aligns with dopaminergic and GABAergic receptors, potentially impacting memory and executive functions. In bvFTD, medial orbitofrontal and temporal atrophy, is linked to mu-opioid receptor impairment, possibly contributing to behavioral symptoms. In MCI, early serotonergic dysregulation involving SERT occurs before detectable atrophy.

Burden of neurological disorders in China and its provinces, 1990-2021: Findings from the global burden of disease study 2021

BACKGROUND

The burden of neurological disorders in China has not been systematically analyzed. We aim to provide a comprehensive estimation of the national and subnational neurological burden across China from the Global Burden of Disease Study (GBD) 2021.

METHODS

We assessed burden estimates for 16 neurological disorders by age, sex, and province from 1990 to 2021, with prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We performed decomposition analysis to determine contributing factors for DALYs and used the socio-demographic index (SDI) to assess relations with development level.

FINDINGS

In 2021, there were 468.29 million prevalent cases of neurological disorders in China, corresponding to 78.10 million DALYs. Intracerebral hemorrhage was the leading cause of DALYs, followed by ischemic stroke, dementias, and migraine. DALYs of neurological disorders were higher in males than females, peaking at 70-74 years. From 1990 to 2021, the number and age-standardized rate of DALYs significantly decreased for idiopathic epilepsy and subarachnoid hemorrhage, primarily attributed to the reduction in YLLs, while the number of DALYs disproportionately increased for dementias, Parkinson's disease, and ischemic stroke contributed by population aging. The age-standardized DALY rates of seven neurological disorders had more than 5-fold variation between western and eastern provinces, despite reduced burdens with rising SDI.

CONCLUSIONS

Neurological disorders pose a large and growing burden on public health, primarily driven by population aging. Our findings could inform priority setting and targeted strategies to optimize neurological service delivery.

FUNDING

The funding information is presented in the acknowledgments.

Exploring the Effectiveness of Adjunctive Cenobamate in Focal Epilepsy: A Time-Based Analysis

BACKGROUND

A growing body of evidence supports the effectiveness of cenobamate (CNB). This study aimed to assess the clinical response to add-on CNB through a time-to-event approach and explore the potential contribution of the concomitant classes of antiseizure medications (ASMs) to improve CNB clinical use.

PATIENTS AND METHODS

This study is a subgroup analysis of a larger retrospective, multicenter study on adults with focal-onset seizures participating in the Italian Expanded Access Program at five pre-established centers. The primary endpoint was the time-to-baseline seizure count; secondary endpoints included the rates of seizure response, seizure freedom (defined as no seizures' occurrence since at least the previous follow-up visit), treatment discontinuation, and adverse events (AEs).

RESULTS

Data on 92 participants were extracted, with a median age of 44 (first quartile (Q1)-third quartile (Q3): 29.25-50.75) years. The number of seizures recorded during the 90-day baseline was reached by 59/92 (64.1%) subjects during the 12-month follow-up. A higher, but not statistically significant probability of reaching the baseline seizures count was shown in the subgroups of subjects taking CNB with sodium channel blockers (SCBs) (hazard ratio [HR] 2.75; 95% confidence interval [CI] 0.79-9.61, p = 0.112) and both SCBs and GABAergics (HR 1.48; 95% CI 0.43-5.09, p = 0.536) compared with subjects taking GABAergics without SCBs. At 12 months, the rates of seizure response, seizure-freedom, and treatment discontinuation were 42.0%, 13.6%, and 23.9%, respectively. A total of 47/92 (51.1%) subjects experienced AEs (mainly somnolence, dizziness, and balance disorders) at a median time of 61 (Q1-Q3: 30-101) days. There was a higher, but not statistically significant risk of AEs occurrence in subjects treated with both SCBs and GABAergics and in those taking SCBs without GABAergics (HR 2.24; 95% CI 0.51-9.82, p = 0.286 and HR 1.40; 95% CI 0.31-6.39, p = 0.661, respectively) compared with those taking GABAergics without SCBs. The main limitations are the retrospective design and the small sample size.

CONCLUSIONS

This time-to-event analysis added new insights to the currently available evidence about the real-world effectiveness of add-on CNB. Explorative estimates suggested favorable trends for subjects treated with concomitant GABAergics and without SCBs, who seemed to reach baseline seizure count and experience AEs less frequently and later than subjects treated with other concomitant ASMs. Further studies are needed to identify the best combinations of CNB with other ASMs to maximize seizure control and tolerability.

Functional connectivity across multi-frequency bands in patients with tension-type headache: a resting-state fMRI retrospective study

OBJECTIVES

Tension-type headache (TTH) is the most common nervous system disorder worldwide. This study aimed to examine abnormal network-level brain functional connectivity (FC) alterations in patients with TTH across multi-frequency bands.

METHODS

The study enrolled 63 subjects, comprising 32 patients with TTH and 31 healthy controls (HC). According to our team's previous research, the brain regions with abnormal ReHo in the conventional frequency band (0.01-0.08 Hz) and the slow-5 band (0.01-0.027 Hz) were chosen as seed regions of interest (ROIs). Subsequently, the FC between ROIs and the entire brain analysis across various frequency bands was calculated to evaluate network-level alterations, and differences between the TTH and HC were analyzed. Pearson's correlation analysis was conducted to assess the relationship between significantly altered FC values in two frequency bands and visual analog score (VAS) in TTH patients.

RESULTS

In the slow-5 band (0.01-0.027 Hz), FC between right medial superior frontal gyrus and right medial temporal pole/right inferior temporal gyrus as well as right middle frontal gyrus and left supramarginal gyrus of TTH patients exhibited significantly higher, compared to the HC group, while FC between right middle frontal gyrus and right lateral occipital cortex reduced. For the correlation results, there was no correlation between abnormal brain regions of FC and VAS score.

CONCLUSIONS

Changes in FC within brain regions associated with TTH are linked to pain processing. And the altered FC in TTH patients were frequency dependent. These initial observations could enhance our understanding of TTH's pathophysiological mechanism and offer insights for its future diagnosis and treatment.

Molecular imaging-guided diagnosis and treatment integration for brain diseases

In practical clinical scenarios, improved diagnostic methods have been developed for the precise visualization of molecular targets using molecular imaging in brain diseases. Recently, the introduction of innovative molecular imaging modalities across both macroscopic and mesoscopic dimensions, with remarkable specificity and spatial resolution, has expanded the scope of applications beyond diagnostic testing, with the potential to guide therapeutic interventions, offering real-time feedback in the context of brain therapy. The molecular imaging-guided integration of diagnosis and treatment holds the potential to revolutionize disease management by enabling the real-time monitoring of treatment responses and therapy adjustments. Given the vibrant and ever-evolving nature of this field, this review provides an integrated picture on molecular image-guided diagnosis and treatment integration for brain diseases involving the basic concepts, significant breakthroughs, and recent trends. In addition, based on the current achievements, some critical challenges are also discussed.

G9a an Epigenetic Therapeutic Strategy for Neurodegenerative Conditions: From Target Discovery to Clinical Trials

This review provides a comprehensive overview of the role of G9a/EHMT2, focusing on its structure and exploring the impact of its pharmacological and/or gene inhibition in various neurological diseases. In addition, we delve into the advancements in the design and synthesis of G9a/EHMT2 inhibitors, which hold promise not only as a treatment for neurodegeneration diseases but also for other conditions, such as cancer and malaria. Besides, we presented the discovery of dual therapeutic approaches based on G9a inhibition and different epigenetic enzymes like histone deacetylases, DNA methyltransferases, and other lysine methyltransferases. Hence, findings offer valuable insights into developing novel and promising therapeutic strategies targeting G9a/EHMT2 for managing these neurological conditions.

The Regional Burden of Parkinson's Disease in Kazakhstan 2014-2021: Insights From National Health Data

Background: This study explores the burden of Parkinson's disease (PD) in Kazakhstan, the largest country in Central Asia, a region where data on neurological disorders are notably sparse. Methods: Utilizing data from Kazakhstan's Unified National Electronic Health System during 2014-2021, the study investigates the epidemiology, disability-adjusted life years (DALYs), and survival outcomes in a cohort of PD patients. The authors employed Cox proportional hazards regression models and Kaplan-Meier analysis, alongside sensitivity analyses, to assess the impact of demographic factors, hypertension, and the Charlson Comorbidity Index (CCI) on survival. Results: The study cohort included 10,125 patients, revealing a tenfold increase in PD prevalence during the study period. Mortality rates varied significantly, with the highest rates observed in the eldest age group (137.05 per 1000 person-years). PD contributed to a loss of 156.12 DALYs per 100,000 population, primarily driven by years of life lost. The analysis identified an increased risk of all-cause mortality among males (adjusted hazard ratio (aHR) 1.6; 1.5-1.8), older individuals (aHR 1.05; 1.04-1.06), those with higher CCIs, and individuals of Kazakh ethnicity. Interestingly, patients with comorbid hypertension had a higher probability of survival (aHR 0.67; 0.60-0.73). Conclusion: This study is the first of its kind in Central Asia to examine the burden of PD using a large-scale outpatient registry. The findings underscore the need for targeted interventions to address the growing burden of PD, particularly among males and ethnic Kazakhs. Additionally, further research is needed to explore the inverse association between hypertension and survival in the PD cohort.

Neuroimaging-based data-driven subtypes of spatiotemporal atrophy due to Parkinson's disease

Parkinson's disease is the second most common neurodegenerative disease. Despite this, there are no robust biomarkers to predict progression, and understanding of disease mechanisms is limited. We used the Subtype and Stage Inference algorithm to characterize Parkinson's disease heterogeneity in terms of spatiotemporal subtypes of macroscopic atrophy detectable on T1-weighted MRI-a successful approach used in other neurodegenerative diseases. We trained the model on covariate-adjusted cortical thicknesses and subcortical volumes from the largest known T1-weighted MRI dataset in Parkinson's disease, Enhancing Neuroimaging through Meta-Analysis consortium Parkinson's Disease dataset (n = 1100 cases). We tested the model by analyzing clinical progression over up to 9 years in openly-available data from people with Parkinson's disease from the Parkinson's Progression Markers Initiative (n = 584 cases). Under cross-validation, our analysis supported three spatiotemporal atrophy subtypes, named for the location of the earliest affected regions as: 'Subcortical' (n = 359, 33%), 'Limbic' (n = 237, 22%) and 'Cortical' (n = 187, 17%). A fourth subgroup having sub-threshold/no atrophy was named 'Sub-threshold atrophy' (n = 317, 29%). Statistical differences in clinical scores existed between the no-atrophy subgroup and the atrophy subtypes, but not among the atrophy subtypes. This suggests that the prime T1-weighted MRI delineator of clinical differences in Parkinson's disease is atrophy severity, rather than atrophy location. Future work on unravelling the biological and clinical heterogeneity of Parkinson's disease should leverage more sensitive neuroimaging modalities and multimodal data.

The burden of common neurological disorders in Asia: insights from the Global Burden of Disease Study (1990-2021)

BACKGROUND

Neurological disorders represent a significant global health issue, leading to severe cognitive impairments and being a major cause of premature mortality and disability. This study aims to utilize data from the Global Burden of Disease (GBD) research website to assess the burden of neurological disorders in the Asian region and its individual countries and territory from 1990 to 2021, with the goal of providing reference for global efforts and decision-making in the prevention, treatment, and management of neurological disorders.

METHODS

Based on the Global Burden of Disease data, this study assessed the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of 13 neurological disorders in the Asian region from 1990 to 2021. The epidemiological characteristics of neurological disorders across these Asian regions were analyzed. Joinpoint regression analysis was employed to assess the temporal patterns of the burden of neurological disorders, and the average annual percent change (AAPC) was calculated to determine the overall trend throughout the study period.

RESULTS

In 2021, stroke, migraine, and Alzheimer's disease and other dementias emerged as the primary contributors to neurological burden in Asia, with stroke accounting for 112.87 million disability-adjusted life years (DALYs), followed by migraine (25.4 million) and Alzheimer's disease and other dementias (20.0 million). Stroke was also the leading cause of neurological mortality (5.03 million deaths), trailed by Alzheimer's disease and other dementias (1.0 million). Stroke, migraine, and tension-type headache had the highest prevalence rates among neurological disorders, with 57.3 million, 683.5 million, and 1130.2 million. Temporal trends from 1990 to 2021 revealed a significant decline in age-standardized DALY rates for stroke (estimated annual percentage change [EAPC]: - 1.65%), though absolute DALYs increased (EAPC: 0.06%). In contrast, Alzheimer's disease and other dementias exhibited rising age-standardized (EAPC: 0.14%) and absolute DALYs (EAPC: 2.8%), while infectious neurological diseases (e.g., meningitis, tetanus) demonstrated marked reductions in burden. Sex-specific disparities were evident, with males experiencing a higher total DALY burden (84.8 million vs. 77.05 million), driven by stroke and Parkinson's disease, whereas Alzheimer's disease and other dementias and migraine disproportionately affected females. Geographically, stroke dominated Southeast Asia (67.6% of regional DALYs), while migraine contributed most substantially to West Asia (16%). Nationally, stroke ranked as the leading cause of neurological DALYs in most Asian countries, contrasting with migraine in Israel, Kuwait, Qatar, and the United Arab Emirates. Longitudinal analyses highlighted accelerated declines in stroke DALYs post- 2004 but escalating burdens for Alzheimer's disease and other dementias after 2019, reflecting divergent epidemiological trajectories.

CONCLUSIONS

In 2021, the burden of neurological disorders in Asia remained substantial, with stroke, migraine, and Alzheimer's disease and other dementias being the top three contributors to DALYs. The study also revealed significant differences in the burden of neurological disorders across various subregions and countries in Asia, highlighting the need for enhanced international collaboration, sharing of best practices, provision of technical support, and optimization of healthcare resource allocation.

Association of sarcopenia with Parkinson's disease and related functional degeneration among older adults: A prospective cohort study in Europe

BACKGROUND

Former evidence on the risk factors for Parkinson's disease (PD), especially the PD-related functional limitation and neurological outcomes was scarce. We aimed to explore the association between sarcopenia and PD along with the PD-related functional degeneration. Further, we testified the heterogeneity in the above relationships of multimorbidity severity and patterns.

METHODS

Data was from the Survey of Health, Ageing and Retirement in Europe (wave 4-8). PD was ascertained by self-reported doctor diagnosis. PD-related functional degeneration was defined as the coexistence of PD and functional limitation, mild cognitive impairment (MCI), and dementia. Sarcopenia status was determined by the criteria of European Working Group on Sarcopenia in Older People in 2019. Cox regression models were conducted to examine the association between sarcopenia and PD risk.

RESULTS

Among 40,041 participants, those with sarcopenia were significantly associated with onset of PD (HR = 2.16, 95 % CI: 1.41-3.31), along with related functional limitation (HR = 2.58, 95 % CI: 1.59-4.19), MCI (HR = 2.93, 95 % CI: 1.37-5.15), and dementia (HR = 6.05, 95 % CI: 3.17-11.56). Heterogeneity of multimorbidity severity and patterns was found in the relationship of sarcopenia with PD-related functional limitation and MCI and the observed associations only existed among those with highest level of multimorbidity severity and those with complicated pattern.

CONCLUSIONS

Sarcopenia status was correlated to PD and the related functional degeneration, and the difference in the above relationships of multimorbidity patterns and severity was observed. Early screening on sarcopenia-related indicators and more emphasis on the precaution of PD among those with severe and complicated multimorbidity patterns were recommended.

Time value of informal care of people with alzheimer's disease in Spain: a population-based analysis

The aims of this paper are to estimate the monetary value of informal care for people with Alzheimer's disease (AD) in Spain, to compare results with those obtained in 2008 and to analyse the main determinants of the time of the value of informal care. The Survey on Disabilities, Autonomy and Dependency carried out in Spain in 2020/21 was used to obtain information about disabled individuals with AD and their informal caregivers. Assessment of informal care time was carried out using two alternative approaches: the replacement method, and the contingent valuation method (willingness to pay & willingness to accept). The number of people with AD residing in Spanish households and receiving informal care rose to more than 200,000, representing an increase of 43% compared with 2008. The average number of hours of informal care per week ranged from 86 to 101 h, with an estimated value of between €31,584 - €37,019 per year per caregiver (willingness to accept) or €71,653 - €83,984 per year (replacement). The annual total number of caregiving hours ranged between 896 and 1,061 million hours, representing between 0.52 and 0.62 of GDP in 2021 (willingness to accept) or 1.19-1.40 of GDP (replacement). The level of care needs plays a central role in explaining heterogeneity in estimates. These results should be taken into account by decision-makers for long-term care planning in the coming years.

The serum proteomic profile in patients with migraine

Background

Migraine is a paroxysmal headache disorder, which seriously affects the patients' quality of life. However, the pathogenesis of migraine is not clear yet. Proteomics is an emerging technology for studying small molecules and protein components in biological systems. This study aimed to analyze the serum proteome of migraine patients and healthy controls and identify differentially expressed proteins, which could provide a reference for the study of biomarkers and pathophysiological mechanisms of migraine.

Methods

Fasting venous blood was collected, and serum was separated. Liquid chromatography-mass spectrometry was used to detect the proteome of the two groups, and MaxQuant was used to analyze the protein profile and identify the differentially expressed proteins.

Results

Twenty-seven migraine patients and 20 healthy people matching the age and sex ratio of the migraine group were collected. A total of 27 differentially expressed proteins were identified between migraine and control groups, which were mainly related to immune response, inflammation, glycolysis, lipid metabolism, neurotrophy and development, and so on. Subgroup analysis also identified several differentially expressed proteins between the migraine with aura and the migraine without aura groups and between the ictal and interictal migraine groups. Moreover, the signal pathways that may be related to migraine include the glycolysis/gluconeogenesis pathway and the hypoxia-inducible factor-1 signal pathway. Differentially expressed proteins are mainly distributed in the extracellular area. Related biological processes include complement activation, immunoglobulin receptor binding, and phagocytosis.

Discussion

The research screened out several differentially expressed proteins of migraine patients, which may be potential biomarkers, but it still needs verification in further studies with larger sample sizes. Various proteins related to inflammation, immune response, and energy metabolism are differentially expressed between the migraine group and the control group, suggesting that the pathogenesis of migraine may be related to inflammation, immunity, and energy metabolism disorders. In the future, we can further explore the therapeutic targets of migraine in terms of these biological processes.

Fluid-based biomarkers for neurodegenerative diseases

Neurodegenerative diseases, such as Alzheimer's Disease (AD), Multiple Sclerosis (MS), Parkinson's Disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are increasingly prevalent as global populations age. Fluid biomarkers, derived from cerebrospinal fluid (CSF), blood, saliva, urine, and exosomes, offer a promising solution for early diagnosis, prognosis, and disease monitoring. These biomarkers can reflect critical pathological processes like amyloid-beta (Aβ) deposition, tau protein hyperphosphorylation, α-syn misfolding, TDP-43 mislocalization and aggregation, and neuronal damage, enabling detection long before clinical symptoms emerge. Recent advances in blood-based biomarkers, particularly plasma Aβ, phosphorylated tau, and TDP-43, have shown diagnostic accuracy equivalent to CSF biomarkers, offering more accessible testing options. This review discusses the current challenges in fluid biomarker research, including variability, standardization, and sensitivity issues, and explores how combining multiple biomarkers with clinical symptoms improves diagnostic reliability. Ethical considerations, future directions involving extracellular vehicles (EVs), and the integration of artificial intelligence (AI) are also highlighted. Continued research efforts will be key to overcoming these obstacles, enabling fluid biomarkers to become crucial tools in personalized medicine for neurodegenerative diseases.

Micromagnetic stimulation (μMS) controls dopamine release: anin vivostudy using WINCSHarmoni

Research into the role of neurotransmitters in regulating normal and pathologic brain functions has made significant progress. Yet, clinical trials that aim to improve therapeutic interventions do not take advantage of thein vivochanges in the neurochemistry that occur in real time during disease progression, drug interactions or response to pharmacological, cognitive, behavioral, and neuromodulation therapies. In this work, we used the WINCSHarmonitool to study the real timein vivochanges in dopamine release in rodent brains for the micromagnetic neuromodulation therapy. Although still in its infancy, micromagnetic stimulation (μMS) using micro-meter sized coils or microcoils (μcoils) has shown incredible promise in spatially selective, galvanic contact free and highly focal neuromodulation. These μcoils are powered by a time-varying current which generates a magnetic field. As per Faraday's Laws of Electromagnetic Induction, this magnetic field induces an electric field in a conducting medium (here, the brain tissues). We used a solenoidal-shaped μcoil to stimulate the medial forebrain bundle (MFB) of the rodent brainin vivo. The evokedin vivodopamine releases in the striatum were tracked in real time by carbon fiber microelectrodes (CFM) using fast scan cyclic voltammetry (FSCV). Our experiments report that μcoils can successfully activate the MFB in rodent brains, triggering dopamine releasein vivo. We further show that the successful release of dopamine upon micromagnetic stimulation is dependent on the orientation of the μcoil. Furthermore, varied intensities of μMS can control the concentration of dopamine releases in the striatum. This work helps us better understand the brain and its conditions arising from a new therapeutic intervention, like μMS, at the level of neurotransmitter release. Despite its early stage, this study potentially paves the path for μMS to enter the clinical world as a precisely controlled and optimized neuromodulation therapy.

Evolving trends and burden of idiopathic epilepsy among children (0-14 years), 1990-2021: a systematic analysis for the Global Burden of Disease study 2021

Objective

This systematic analysis aims to elucidate the trends and burden of idiopathic epilepsy among children aged 0 to 14 from 1990 to 2021, utilizing Global Burden of Disease (GBD) 2021 data to explore demographic and geographical variations, highlight progress, and identify ongoing challenges.

Methods

Data were sourced from the GBD 2021 database, focusing on children aged 0-14. Annual absolute numbers and age-standardized rates for incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (ASDR) of idiopathic epilepsy were retrieved. Joinpoint regression analyses assessed changes over time, calculating average annual percentage change (AAPC) statistics. Data collation and visualizations were conducted using R software, with statistical significance established at a p-value threshold of 0.05.

Results

In 2021, there were 1,227,191 incident cases, 6,095,769 prevalent cases, 3,564,497 DALYs, and 18,171 deaths due to idiopathic epilepsy globally. The ASIR increased by 0.27% from 55.74 to 61.35 per 100,000 population from 1990 to 2021. In contrast, ASPR (AAPC = -0.03), ASMR (AAPC = -1.60), and ASDR (AAPC = -1.01) all decreased. Regionally, the low-middle SDI region had the highest burden, while the high SDI region had the highest ASIR and ASPR. The low SDI region experienced the highest ASMR and ASDR. Significant regional variations were noted, with the African Region exhibiting the highest ASIR and ASDR, while the Western Pacific Region had the lowest. Nationally, substantial variations were observed across 204 countries, with notable differences in ASIR, ASPR, ASMR, and ASDR.

Conclusion

Despite overall declines in ASPR, ASMR, and ASDR, the slight increase in ASIR and regional disparities highlight ongoing challenges. Low and low-middle SDI regions continue to bear a higher burden, underscoring the need for targeted interventions and improved healthcare access. Future efforts should focus on strengthening healthcare systems, enhancing diagnostic and treatment capabilities, and increasing awareness, particularly in resource-limited regions.

Interaction Between Traffic-Related Air Pollution and Parkinson Disease Polygenic Risk Score

Importance

Genetic and environmental factors are linked to Parkinson disease (PD), but the role of genetic susceptibility in the association between traffic-related air pollution (TRAP) and PD remains unclear.

Objective

To assess the gene-environment interaction between the polygenic risk score (PRS) for PD and long-term TRAP exposure and to estimate the joint effect with PD risk.

Design, Setting, and Participants

This population-based case-control study used a meta-analytical assessment of studies conducted in central California and Denmark. The Parkinson Environment and Genes (PEG) study in California (June 1, 2000, to July 31, 2017) included 634 patients with PD and 733 controls; the Parkinson Disease in Denmark (PASIDA) study (January 1, 2006, to December 31, 2017) included 966 patients with PD and 1045 controls. Data were analyzed from July 1 to October 31, 2024.

Exposures

PRS was computed by summing the effect estimates of well-known risk alleles from an existing genome-wide association study's summary statistics using participants' genetic arrays. TRAP exposure was estimated using dispersion models to calculate long-term exposure (10- or 15-year means with a 5-year lag) to traffic-related pollutants (represented by carbon monoxide [CO] levels) at participants' residences.

Main Outcomes and Measures

The main outcome was diagnosis of PD. Using multivariable logistic regression, PD risk was estimated from interactions between PRS (per SD) and TRAP exposure (per IQR), with joint effects based on low (quartiles 1-3) and high (quartile 4) exposure levels.

Results

A total of 1600 patients with PD (mean [SD] age, 65.1 [9.9] years; 990 [61.9%] male) and 1778 controls (mean [SD] age, 64.5 [10.3] years; 992 [55.8%] male) were included. Meta-analytical estimates suggest that both higher PRS and increased TRAP exposure increased PD risk, with an interaction effect estimate of 1.06 (95% CI, 1.00-1.12). Joint effect analysis indicated that individuals with both high PRS and high TRAP exposure were at greatest risk of PD (odds ratio, 3.05; 95% CI, 2.23-4.19) compared with the reference group with a low PRS and low TRAP exposure, suggesting a synergistic effect.

Conclusions and Relevance

In this gene-environment interaction study, a combination of long-term air pollution exposure and genetic susceptibility strongly contributed to the risk of developing PD. Widespread exposure to air pollution makes TRAP an important modifiable risk factor affecting large populations globally, particularly individuals with genetic vulnerability.

Practice in evaluating solid organ transplant candidates and recipients with neurological impairment: The European Academy of Neurology neurocritical care panel survey

BACKGROUND

Brain disorders can occur in the context of peripheral organ diseases as well as solid organ transplants. The aim of this study was to explore the involvement of neurologists in the evaluation and management of solid organ transplant candidates and recipients when a nervous system impairment co-exists.

METHODS

We invited all European Academy of Neurology members to answer a web-based survey. Descriptive statistics were used to summarize the results.

RESULTS

In total, 176 respondents completed the survey; neurologists are more involved in the evaluation of neurological complications after (31.8%) than before an organ transplant (21%), when they see a small volume of patients, and mainly for neurological comorbidities. A minority (9%) of neurologists received a specific training on the topic of neurological manifestations of extracranial conditions as well as only 6.2% of them are involved in research activities in the brain-body interactions field.

CONCLUSION

This survey highlights a mismatch between the impressive statistics on brain dysfunction in peripheral organ diseases as well as transplant and the small volume of solid organ transplant candidates/recipients seen by neurologists. According to recent recommendations every organ-eligible candidates should undergo a cognitive screening, however, it is not common that neurologists are involved in the multidisciplinary committee to determine the transplant eligibility. Delirium is the most frequent reason for a neurological consultation after a transplant, but also other critical brain conditions. Educational programs in the field of neurology of systemic diseases are worth being implemented as well as including neurologists in research programs on brain-body interactions.

The Current Situation of Neurological Health in Bangladesh: A Perspective

BACKGROUND AND AIMS

In Bangladesh, neurological disorders are becoming a bigger public health concern because they significantly increase disability, mortality, and medical costs. This review explores the current neurological health landscape in Bangladesh, with a focus on prevalent disorders such as stroke, epilepsy, Parkinson's disease, and meningitis.

METHODS

To complete this review, we retrieved pertinent information from published articles that we located in Google Scholar, PubMed, and Scopus. We looked up terms like meningitis, stroke, Parkinson's disease, epilepsy, and neurological disease.

RESULTS

Due to common risk factors like diabetes, high blood pressure, and lifestyle choices, the prevalence of these conditions is increasing. Inadequate healthcare infrastructure, especially in rural areas, and a lack of specialized medical care make diagnosis and treatment extremely difficult. Effective disease management is made more difficult by systemic flaws in the public health system and socioeconomic disparities.

CONCLUSION

Public education campaigns, preventive measures, better access to necessary medications, and improvements to the healthcare infrastructure are all vital to lessen this burden. To improve neurological health outcomes in Bangladesh, this review emphasizes the urgent need for focused interventions and strong policies. It also emphasizes the significance of ongoing research and medical advancements in managing and lowering the prevalence of major neurological disorders in Bangladesh.

Investigating the common genetic architecture and causality of metabolic disorders with neurodegenerative diseases

BACKGROUND

The co-occurrence of metabolic dysfunction and neurodegenerative diseases suggests a genetic link, yet the shared genetic architecture and causality remain unclear. We aimed to comprehensively characterise these genetic relationships.

METHODS

We investigated genetic correlations among four neurodegenerative diseases and seven metabolic dysfunctions, followed by bidirectional Mendelian randomisation (MR) to assess potential causal relationships. Pleiotropy analysis (PLACO) was used to detect the pleiotropic effects of genetic variants. Significant pleiotropic loci were refined and annotated using functional mapping and annotation (FUMA) and Bayesian colocalisation analysis. We further explored mapped genes with tissue-specific expression and gene set enrichment analyses.

RESULTS

We identified significant genetic correlations in nine out of 28 trait pairs. MR suggested causal relationships between specific trait pairs. Pleiotropy analysis revealed 25 931 significant single-nucleotide polymorphisms, with 246 pleiotropic loci identified via FUMA and 55 causal loci through Bayesian colocalisation. These loci are involved in neurotransmitter transport and immune response mechanisms, notably the missense variant rs41286192 in SLC18B1. The tissue-specific analysis highlighted the pancreas, left ventricle, amygdala, and liver as critical organs in disease progression. Drug target analysis linked 74 unique genes to existing therapeutic agents, while gene set enrichment identified 189 pathways related to lipid metabolism, cell differentiation and immune responses.

CONCLUSION

Our findings reveal a shared genetic basis, pleiotropic loci, and potential causal relationships between metabolic dysfunction and neurodegenerative diseases. These insights highlight the biological connections underlying their phenotypic association and offer implications for future research to reduce the risk of neurodegenerative diseases.

Sex disparities and trends in stroke incidence, prevalence, and mortality in the US and worldwide: Findings from the global burden of disease, 1990-2021

BACKGROUND

Stroke is a leading cause of death/disability, with notable differences in incidence, prevalence, and mortality observed. Despite advancement in stroke research, notable gaps persist in understanding the overall trend and sex-specific disparities in stroke burden over the past three decades, both in the United States of America (USA) and globally.

AIMS

This observational-study aims to investigate evolving trends and sex-specific disparities in the incidence, prevalence, and mortality of stroke in the USA and globally from 1990 to 2021.

METHODS

Leveraging data from the Global Burden of Disease database, we calculated age-standardized incidence (ASIR), prevalence (ASPR), and mortality (ASMR) rates per 100,000 individuals for stroke in the USA and globally, stratified by sex and type of stroke. Joinpoint regression analysis was employed to assess the annual percent changes (APCs) in ASIR, ASPR, and ASMR, with 95 % confidence interval. Average annual percentage changes (AAPCs) were subsequently computed as weighted averages of the APCs. Statistical significance was defined as a p-value < 0.05.

RESULTS

From 1990 to 2021, the ASIR of stroke in the USA exhibited a significant decline from 113.45 to 75.64 per 100,000, marking a 33.3% reduction. Globally, ASIR decreased from 180.97 to 141.55, reflecting a 21.8% reduction. Furthermore, The ASPR from 1990 to 2021 in the USA slightly decreased of 1.7%, while globally, it was 8.5%. Additionally, The ASMR from 1990 to 2021 in the USA declined by 31%, from 44.05 to 30.27, whereas globally, from 144.31 to 87.45, representing a 39% reduction. Similar patterns were observed across sexes for incidence, prevalence, and mortality of stroke. Males demonstrated marginally higher rates compared to females across all parameters, with a diminished sex disparity noted across the examined variables.

CONCLUSION

Despite a downward trend in stroke incidence, prevalence, and mortality rates observed both in the United States and globally, these rates continue to be notably elevated, with a male dominance but reduced sex gap. Targeted interventions and strengthened international collaboration are essential for effectively addressing these elevated rates and disparities, thereby mitigating the global and national stroke burden.

The burden of ischemic stroke in Eastern Europe from 1990 to 2021

BACKGROUND AND PURPOSE

Ischemic stroke is a significant public health concern, particularly in Eastern Europe, where the burden remains high. This study aims to evaluate the trends and burden of ischemic stroke in Eastern Europe from 1990 to 2021, providing insights into epidemiological changes and informing public health strategies.

METHODS

We used data from the Global Burden of Disease 2021 database to comprehensively assess regional and national ischemic stroke indicators in Eastern Europe. These indicators included the number of cases, incidence, number of deaths, mortality, disability-adjusted life years (DALYs), DALY rates, and estimated annual percentage change (EAPC). Joinpoint analysis was employed to examine sex-specific time trends in the burden of ischemic stroke across Eastern European countries. These estimates incorporated the Socio-Demographic Index (SDI).

RESULTS

In 2021, Eastern Europe reported 490,197 cases of ischemic stroke, with an age-standardized incidence rate (ASIR) of 142.57 (95% UI: 122.12 to 164.67), exceeding the global level. The region recorded 329,291 deaths, with an age-standardized mortality rate (ASMR) of 90.99 (95% UI: 82.79 to 98.48), significantly higher than the global rate. Disability-adjusted life years (DALYs) totaled 5,713,718, with an age-standardized DALYs rate (ASDR) of 1601.20 (95% UI: 1483.51 to 1723.12). Our joinpoint regression analysis indicates that the disease burden remains notably high in Eastern Europe, despite an overall declining trend from 1990 to 2021 in ASIR and ASMR across most countries, with estimated annual percentage changes (EAPC) of -1.13 (95% CI: -1.24 to -1.02) and - 2.78 (95% CI: -3.24 to -2.32), respectively. Lithuania reported the highest incidence rate, while the Russian Federation had the highest mortality and DALY rate. Conversely, Estonia showed significant improvements in stroke indicators. Key risk factors included low temperature and smoking, contributing notably to environmental and behavioral risks.

CONCLUSION

Ischemic stroke continues to be a significant global health issue. Our temporal trends study results indicate that the disease burden remains notably high in Eastern Europe, particularly in Lithuania and the Russian Federation.

Trojan Horse Delivery Strategies of Natural Medicine Monomers: Challenges and Limitations in Improving Brain Targeting

Central nervous system (CNS) diseases, such as brain tumors, Alzheimer's disease, and Parkinson's disease, significantly impact patients' quality of life and impose substantial economic burdens on society. The blood-brain barrier (BBB) limits the effective delivery of most therapeutic drugs, especially natural products, despite their potential therapeutic effects. The Trojan Horse strategy, using nanotechnology to disguise drugs as "cargo", enables them to bypass the BBB, enhancing targeting and therapeutic efficacy. This review explores the applications of natural products in the treatment of CNS diseases, discusses the challenges posed by the BBB, and analyzes the advantages and limitations of the Trojan Horse strategy. Despite the existing technical challenges, future research is expected to enhance the application of natural drugs in CNS treatment by integrating nanotechnology, improving delivery mechanisms, and optimizing targeting characteristics.

Burden of neurological diseases in Asia, from 1990 to 2021 and its predicted level to 2045: a Global Burden of Disease study

INTRODUCTION

Neurological diseases are a significant contributor to premature mortality and temporary or long-term disability among survivors. Asia serves as an essential region for assessing the shifting burden of these disorders. This study aims to calculate and evaluate the changes in burden of neurological diseases across Asia.

METHODS

The Global Burden of Disease database provided data on deaths, disability-adjusted life-years (DALYs), incidence, and prevalence from 1990 to 2021 across Asian subregions and countries. Twelve common neurological diseases were analyzed. Estimated Annual Percent Change were calculated to reveal trends in all the metrics. The Nordpred age-period-cohort model was employed to project the neurological disease burden.

RESULTS

In 2021, the leading neurological disorders in DALYs were stroke (109,144.87, 95% uncertainty intervals (UI) 95,992.89-123,089.90), headache disorders (25,713.91, 95%UI 4,693.65-54,853.47), and Alzheimer's disease and other dementias (19,156.46, 95% UI 9,137.72-41,421.18). Stroke and degenerative neurological disorder presented the most severe burden in East Asia, while headache disorders were prominent in South Asia. Between 1990 and 2021, Asia's regions showed varying reductions in age-standardized DALYs and age-standardized death rates for neurological diseases, with the steepest decline observed in high-income Asia Pacific (DALYs -2.27, 95% confidence interval (CI) -2.4 to -2.13; ASDR -3.85, 95% CI -4.02 to -3.69). Neurological disease burden was higher in males, peaking at ages 65-74. Projections to 2045 indicate a decline in DALYs for stroke, infectious neurological diseases, Parkinson's disease, and idiopathic epilepsy across most regions of Asia. In contrast, trends for other neurological diseases will vary regionally.

CONCLUSION

Neurological diseases were the primary cause of DALYs in 2021, ranking second only to cardiovascular diseases as a leading cause of death. As the aging trend in Asia's population continues to intensify, it is crucial to focus more on the prevention and management of neurological disorders.

Can behavioural science be used to understand factors that influence the prescription choice for Parkinson's disease? A pan-European focus group study of clinicians' prescribing practice

OBJECTIVES

This study aimed to establish a consensus on key factors that influence medication choices for Parkinson's disease and to identify the behavioural determinants of these factors using behavioural change theory as a theoretical lens.

DESIGN

This qualitative study used the nominal group technique to conduct structured online focus group meetings. A facilitator guided participants to (1) individually generate a list of factors that influence their decision to prescribe, (2) collectively share these factors, (3) refine and clarify factors and (4) rank the most important factors. Subsequently, the most important factors identified were mapped to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation-Behaviour (COM-B) model to identify the behavioural determinants that influence medication choice.

PARTICIPANTS

Eighteen healthcare professionals, including neurologists, consultants and specialist nurses/practitioners who prescribe medication, were recruited across Europe and participated in one of seven focus groups.

RESULTS

There was good consensus among the participants about which factors influence their prescribing decisions. Overall, participants identified 60 unique factors that were broadly categorised into the following themes: medical or symptom concern, patient characteristics, side effects, access to treatment, clinical guidelines, social support and patient preference. Factors discussed and prioritised by the participants aligned with seven of the 14 TDF domains: knowledge; memory, attention and decision processes; beliefs about consequences; goals; social/professional role and identity; environment context and resources; and social influences. Together, these were subsequently mapped onto four of the six subdomains of the COM-B model: psychological capability, reflective motivation, physical opportunity and social opportunity.

CONCLUSIONS

These findings suggest that prescribing decisions for Parkinson's disease are determined by a complex range of factors linked to the COM-B components capability, motivation and opportunity. These can be further understood by specific behavioural domains, as identified by the TDF, which should be targeted to help optimise subsequent prescribing decisions.

German translation, transcultural adaptation and test-retest reliability of the headache screening questionnaire

INTRODUCTION

Tension-type headache (TTH) and migraines are frequent headache types. For appropriate treatment, physiotherapists need to be able to recognize these two headache types. The Dutch Headache Screening Questionnaire (HSQ-DV) is the only screening questionnaire designed specifically for migraines and TTH, based on the latest International Classification of Headache Disorders and supporting evidence. The aim of this study is to translate the HSQ-DV into German and evaluate its test-retest reliability.

METHODS

A cross-sectional and prospective cohort study was conducted to answer the research questions. The HSQ-DV was translated according to the COMSIN checklist for patient-reported outcome measurement instruments. Test-retest reliability was assessed with a retest after two weeks. Weighted kappa values, intraclass-correlation coefficients (ICCs) and standard error of the measurements (SEMs) were calculated separately for migraines and THH, based on point scale ranging from 0 to 8.

RESULTS

The HSQ-DV was translated and culturally adapted into German. An introductory clarification was added to guide participants with multiple headaches, which headache type to consider. Sixty-one subjects were included in the reliability study. For migraine, the weighted kappa was 0.70 (95% Confidence Interval (CI) 0.52 to 0.87), the ICC was 0.84 (95% CI: 0.71 to 0.91), and the SEM was 0.39 points. For TTH, the weighted kappa was 0.73 (95% CI: 0.57 to 0.90), the ICC was 0.85 (95% CI: 0.74 to 0.92), and the SEM was 0.29 points.

CONCLUSION

The HSQ-GV is a reliable screening questionnaire for migraines and TTH in physiotherapy settings, demonstrating substantial to nearly perfect reliability.

Unmet needs in the management of migraine in Greece from the perspective of medical experts: a Delphi consensus

Introduction

Migraine is a chronic, debilitating neurological disorder affecting billions worldwide. While not life-threatening, migraine patients experience significant unmet needs in diagnosis and management. Addressing these challenges could result in improvement of patient outcomes and reduction of the socioeconomic burden migraine imposes on individuals, healthcare system and the society.

Objective

This survey aimed to capture in Greece the perspective of medical experts (neurologists) specializing in migraine management regarding the socioeconomic burden of migraine and the unmet needs in diagnosis and treatment.

Methods

An online Delphi-based survey was conducted with 13 neurologists, experts in migraine. The survey consisted of 55 statements derived from literature research, regarding the burden of disease, diagnosis, treatment and unmet needs. Participants' level of agreement for each statement was measured through a 5-point Likert scale ("Strongly Agree," "Agree," "Neither Agree nor Disagree," "Disagree" and "Strongly Disagree"). Three rounds of voting were conducted to achieve consensus. The consensus threshold was set at 70% of responses, focusing on "Strongly Agree"/ "Agree" or "Disagree"/ "Strongly Disagree."

Results

Most experts agreed on statements emphasizing on financial and social impact of the disease and its epidemiology. However, consensus was not reached on statements concerning patient preferences for treatment administration, treatment adherence, opioid use, and frequency of visits to neurologists. Consensus was reached on the need for better healthcare professional training and the development of effective, safe treatments.

Conclusion

This survey highlighted the challenges of prompt diagnosis and effective management of migraine. Addressing these needs requires patient-centered approaches, enhanced healthcare-provider training, tailored therapeutic interventions, and advanced communication platforms.

Quantification and correlation of amyloid-β plaque load, glial activation, GABAergic interneuron numbers, and cognitive decline in the young TgF344-AD rat model of Alzheimer's disease

Background

Animal models of Alzheimer's disease (AD) are essential tools for investigating disease pathophysiology and conducting preclinical drug testing. In this study, we examined neuronal and glial alterations in the hippocampus and medial prefrontal cortex (mPFC) of young TgF344-AD rats and correlated these changes with cognitive decline and amyloid-β plaque load.

Methods

We compared TgF344-AD and non-transgenic littermate rats aged 7-8 months of age. We systematically quantified β-amyloid plaques, astrocytes, microglia, four different subtypes of GABAergic interneurons (calretinin-, cholecystokinin-, parvalbumin-, and somatostatin-positive neurons), and newly generated neurons in the hippocampus. Spatial learning and memory were assessed using the Barnes maze test.

Results

Young TgF344-AD rats had a large number of amyloid plaques in both the hippocampus and mPFC, together with a pronounced increase in microglial cell numbers. Astrocytic activation was significant in the mPFC. Cholecystokinin-positive cell numbers were decreased in the hippocampus of transgenic rats, but calretinin-, parvalbumin-, and somatostatin-positive cell numbers were not altered. Adult neurogenesis was not affected by genotype. TgF344-AD rats had spatial learning and memory impairments, but this cognitive deficit did not correlate with amyloid plaque number or cellular changes in the brain. In the hippocampus, amyloid plaque numbers were negatively correlated with cholecystokinin-positive neuron and microglial cell numbers. In the mPFC, amyloid plaque number was negatively correlated with the number of astrocytes.

Conclusion

Pronounced neuropathological changes were found in the hippocampus and mPFC of young TgF344-AD rats, including the loss of hippocampal cholecystokinin-positive interneurons. Some of these neuropathological changes were negatively correlated with amyloid-β plaque load, but not with cognitive impairment.

Effects of neck-exercise and health promotion on headache outcomes in office workers: secondary analysis of the NEXpro stepped wedge cluster randomised controlled trial

BACKGROUND

Headache conditions have a high prevalence worldwide. Office workers with high and demanding workload, but low physical activity levels are considered vulnerable for suffering from headache. This analysis examines whether exercise combined with health promotion at the workplace is effective for headache relief in office workers.

METHODS

This study reports the results of secondary outcomes of a stepped wedge cluster randomized controlled trial. Office workers (n = 120) were randomly assigned to a twelve-week supervised intervention period, consisting of neck and shoulder girdle exercises with health promotion interventions performed at the workplace. Secondary outcomes were analysed and modelled for headache occurrence, frequency, and the Headache Impact Test-6 (HIT-6), accounting for possible effects for the intervention, the period it had been introduced, and interactional and nested effects.

RESULTS

At baseline, 88 of the 120 participants reported ≥ one headache episode in the past four weeks, with a mean headache frequency of 3.58 days for that period. The mean HIT-6 score for the entire cohort amounted to 53.6 points. For headache occurrence and HIT-6, the simplest model with the intervention only, showed the best statistical fit with an odds ratio for headache occurrence of 0.46 (95% confidence interval: 0.25 to 0.84), and - 2.23 (95% confidence interval: -3.35 to -1.12) points on the HIT-6 questionnaire. For headache frequency, the model accounting for interaction effects (intervention x period) had the best statistical fit and showed an incidence rate ratio of 0.57 (95% confidence interval: 0.44 to 0.74) for the first period, but not for later ones.

CONCLUSIONS

Neck exercises and health promotion had a positive impact on headache occurrence, headache frequency and HIT-6, with the latter not reaching clinical importance. Although only statistically significant for headache frequency, larger effects were found during earlier periods or shorter interventional exposure for all outcomes, necessitating refresher sessions at later periods.

TRIAL REGISTRATION

NCT04169646.

Drug utilization study of antiparkinsonian medication in Romania during 25 years

Background

Antiparkinsonian medication has significantly evolved over the last 2 decades, offering various pharmacologic approaches. The aim of this study was to explore the trends and to determine the statistical significance of the observed changes in the antiparkinsonian medication utilization in Romania during 1998-2022.

Methods

This antiparkinsonian drug utilization study used data provided by CEGEDIM Romania, originating from the Pharma and Hospital Report. Quantitative data for each ATC N04 antiparkinsonian medication were converted to total defined daily doses (DDDs) and to DDD/1000inhabitants/day (DDD/TID). The autoregressive integrated moving average (ARIMA) model was employed to determine the statistical significance of the observed changes in the trends of antiparkinsonian drug use.

Results

The utilization of antiparkinsonian medication increased considerably (6-folds) in Romania during the 25 years, from 1.03 DDD/TID in 1998 to 6.22 DDD/TID in 2022. Starting 2005, dopamine precursor (levodopa) became the most used antiparkinsonian drug and remained on this position until the end of the study (13-fold increase from 0.17 in 1998 to 2.30 DDD/TID in 2022). MAO-B inhibitors represented the second most used antiparkinsonian drug class for the majority of the years. Selegiline was the most used until 2017 (0.82 DDD/TID), when a decrease in use was observed and continued until 2022 (0.49 DDD/TID). Utilization of dopamine agonists started in 1999, with less than 0.01 DDD/TID, and increased to 1.47 DDD/TID in 2022. Ropinirole was the most used dopamine agonist (0.56 DDD/TID in 2022). Anticholinergic agents represented the most used antiparkinsonian drugs until 2005. Trihexyphenidyl was the main anticholinergic prescribed with a maximum utilization of 0.82 DDD/TID in 2000 followed by a slight decrease until 2022 (0.56 DDD/TID). Amantadine utilization was mainly constant throughout the 25 years, with 0.32 DDD/TID prescribed in 2022. ARIMA analysis showed that the changes in antiparkinsonian drugs consumption were not statistically significant and overall, the trend for antiparkinsonian drug use demonstrates an upward trajectory.

Conclusion

Antiparkinsonian medication showed an increasing utilization trend in Romania during 1998-2022. Levodopa was the most used antiparkinsonian medicine after 2005, replacing anticholinergic agents. MAO-inhibitors utilization came in second and was followed by dopamine agonists. Observing the trend in antiparkinsonian medication utilization over time is essential for providing insights into their real-world use and uptake in a large population.

"It's knowing that there are other people and they've accepted it": Patients' experiences of an acceptance and commitment therapy group intervention for people with neurological conditions

Individuals living with neurological conditions often face chronic issues including motor and sensory impairments and cognitive deficits. These challenges can lead to significant psychological difficulties, including anxiety, depression, and post-traumatic stress. Acceptance and Commitment Therapy (ACT) is a psychotherapeutic approach which aims to enhance psychological flexibility and acceptance while promoting behavioural change. Although ACT groups have shown promise in supporting individuals with neurological conditions, the evidence on patients' experiences of attending them is sparse. This project explored the experiences of individuals with a range of neurological conditions who had attended ACT group sessions as part of routine clinical practice, with the aim to refine future iterations of the intervention and enhancing patient care. Ten individual qualitative semi-structured interviews were carried out and the data were analysed thematically. Three overarching themes emerged from the analysis: (1) Initial Barriers to Group Attendance and Engagement; (2) Building an Environment of Acceptance; (3) Developing an ACT toolkit. Overall, the results showed that the ACT group intervention led participants to develop stronger emotional connectedness, better knowledge of their difficulties, more effective psychological skills, and different mindsets regarding their condition. Implications for the refinement of future ACT groups, neuropsychological service development, and clinical practice are discussed.

Dementia and epilepsy without traumatic brain injury among subjects middle-aged females: a population-based case-control study

Background: Although the association between dementia such as Alzheimer's disease and traumatic brain injury (TBI) is well established, there are significant knowledge gaps with respect to the perspective of dementia and epilepsy without TBI. Objective: We aimed to investigate the relationship between dementia and epilepsy in a population-based study of patients without history of TBI. Methods: This study included a random sample of 30,715 patients with no history of TBI, including 6143 with epilepsy as the study cohort and 24,572 without epilepsy as the comparison cohort. Stratified Cox proportional hazard regression was used to calculate the adjusted hazard ratio (HR), with 95% confidence interval, for the risk of developing dementia in the two cohorts. Results: Patients with epilepsy but no history of TBI had increased risk of dementia (adjusted HR = 1.84). For patients aged 55-64 years, the adjusted HR for dementia was 4.5-fold higher among females in the study cohort than among males. Additionally, this study revealed that risk of dementia among above 75-year population lowest than other age subgroups (adjusted HR = 1.45). Conclusions: The study demonstrated an association between dementia and epilepsy in the patients who had no history of TBI. The effect was pronounced in patients aged 55-64 years, especially in the female population, suggesting that epilepsy needs to be more intensively prevented and controlled in this age group.

Altered brain functional connectivity in patients with tension-type headache

OBJECTIVE

To evaluate whether patients with tension-type headache (TTH) exhibit abnormal brain functional connectivity compared to healthy controls.

BACKGROUND

TTH is one of the most prevalent headache disorders throughout the world. The present study delves into brain functional connectivity in patients with TTH to enhance the understanding of its underlying pathophysiology.

METHODS

A cross-sectional study was conducted, enrolling patients with TTH diagnosed in line with the International Classification of Headache Disorders, 3rd edition beta criteria and a cohort of healthy controls (HCs). We used four metrics-global brain functional connectivity, functional connectivity, Granger causality analysis, and dynamic functional connectivity-to evaluate alterations of functional connectivity patterns in patients with TTH from both static and dynamic perspectives. Furthermore, correlational analyses were performed to explore the relationships between abnormal brain activities and clinical characteristics.

RESULTS

A total of 33 patients with TTH (mean age = 42.3; 13 males/20 females) and 30 HCs (mean age = 37.1; 13 males/17 females) were included in the current study. Compared to HCs, patients with TTH showed altered global brain functional connectivity in the right dorsolateral superior frontal gyrus (SFGdor, t = 4.60). Abnormal functional connectivity was also detected between the right SFGdor and the right superior temporal gyrus (t = 4.56). Furthermore, the right SFGdor exhibited altered information flow with several brain regions, including the left precuneus (t = 5.16), right middle temporal gyrus (MTG, t = 4.72/-4.41), right inferior temporal gyrus (t = 4.64), right caudate nucleus (t = 4.09), and right thalamus (THA, t = -4.04). In terms of dynamic functional connectivity, disconnection was observed between the right SFGdor and the right MTG (t = -3.10), right Rolandic operculum (ROL, t = 3.60), left opercular inferior frontal gyrus (t = -3.48), and left medial superior frontal gyrus (t = -3.00). In addition, the correlation analyses revealed that activities in the MTG (r = 0.48), THA (r = -0.38), and ROL (r = 0.36) were significantly correlated with disease duration, while THA activity was associated with Visual Analogue Scale scores (r = 0.50).

CONCLUSIONS

This study revealed alterations in both static and dynamic brain functional connectivity in patients with TTH within regions implicated in sensory perception, emotional processing, cognition, and pain regulation. These results may promote the understanding of the neural networks involved in TTH and potentially inform future therapeutic approaches for the condition.

Renin-angiotensin system inhibitor use and risk of Parkinson's disease: a meta-analysis

BACKGROUND

Hypertension is a recognized risk factor for Parkinson's disease (PD). The renin-angiotensin system (RAS) inhibitors are widely used to treat hypertension. However, the association of RAS inhibitor use with PD has still been an area of controversy.

METHODS

Thus, we conducted a meta-analysis to investigate the relationship between RAS inhibitor use and PD. PUBMED and EMBASE databases were searched for articles published up to Oct 2023. All studies that examined the relationship between RAS inhibitor use and the incidence of PD were included.

RESULTS

Seven studies with total 3,495,218 individuals met our inclusion criteria for this meta-analysis. Overall, RAS inhibitor use was associated with a reduction in PD risk (OR = 0.88, 95%CI = 0.79-0.98) compared with the controls. When restricted the analysis to individuals with RAS inhibitor use indication, RAS inhibitor exposure was also associated with a decreased risk of PD (OR = 0.76, 95%CI = 0.62-0.92). Pooled results of cohort studies also did support a protective role of angiotensin converting enzyme inhibitors (ACEIs) (OR = 0.97, 95%CI = 0.89-1.07) users and angiotensin II receptor blockers (ARBs) (OR = 0.8, 95%CI = 0.63-1.02) in PD.

CONCLUSION

Overall, RAS inhibitor use as a class is associated with a reduction in PD risk. However, the findings of ACEIs and ARBs may be limited by small sample size. Future well-designed studies considering the classification by inhibitor type, duration, dose, or property of BBB penetration of RAS inhibitors are needed to clarify the contribution of these exposure parameters on the risk of PD.

ROS Regulation in CNS Disorder Therapy: Unveiling the Dual Roles of Nanomedicine

The treatment of brain diseases has always been the focus of attention. Due to the presence of the blood-brain barrier (BBB), most small molecule drugs are difficult to reach the brain, leading to undesirable therapeutic outcomes. Recently, nanomedicines that can cross the BBB and precisely target lesion sites have emerged as thrilling tools to enhance the early diagnosis and treat various intractable brain disorders. Extensive research has shown that reactive oxygen species (ROS) play a crucial role in the occurrence and progression of brain diseases, including brain tumors and neurodegenerative diseases (NDDs) such as Alzheimer's disease, Parkinson's disease, stroke, or traumatic brain injury, making ROS a potential therapeutic target. In this review, on the structure and function of BBB as well as the mechanisms are first elaborated through which nanomedicine traverses it. Then, recent studies on ROS production are summarized through photodynamic therapy (PDT), chemodynamic therapy (CDT), and sonodynamic therapy (SDT) for treating brain tumors, and ROS depletion for treating NDDs. This provides valuable guidance for the future design of ROS-targeted nanomedicines for brain disease treatment. The ongoing challenges and future perspectives in developing nanomedicine-based ROS management for brain diseases are also discussed and outlined.

Italian version of the Headache Disability Inventory: Cross-cultural adaptation, validity, and reliability

OBJECTIVE

To translate and cross-culturally adapt the Headache Disability Inventory (HDI) into Italian and study its reliability and validity.

METHODS

A total of 132 participants with primary and secondary headaches were included. The translation was performed following international guidelines with forward and back translation procedures. Structural validity, internal consistency, test-retest reliability, measurement error, and construct validity were studied. Test-retest reliability and measurement error were tested on a subsample of 32 participants.

RESULTS

The cross-cultural adaptation into Italian was performed without issues. Confirmatory factor analysis supports the structural validity partially (comparative fit index = 0.963; Tucker-Lewis index = 0.959; root mean square error of approximation = 0.051; standardized root mean square residual = 0.084), showing a two-factor structure (i.e., emotional and functional). Each subscale presented high internal consistency (α = 0.87 and 0.87 for the emotional and functional subscales, respectively), excellent and good test-retest reliability (intraclass correlation coefficient = 0.93 and 0.88 for the emotional and functional subscales, respectively), and acceptable measurement error (standard error of the measurement [SEM] = 3.6 points, minimal detectable change [MDC] = 10.0 points for the emotional subscale; SEM = 3.8 points, MDC = 10.7 points for the functional subscale). Construct validity was satisfactory for the emotional subscale and moderate for the functional subscale, as 85.7% (6/7) and 57.1% (4/7) of a priori hypotheses were met, respectively.

CONCLUSION

The HDI was successfully translated into Italian and has acceptable psychometric properties. The Italian version of the HDI can be used in daily clinical practice and research to assess the functional and emotional impact of primary and secondary headaches. Further research should study other psychometric properties (i.e., content validity, responsiveness, and reliability in a larger sample).

A novel feature extraction method based on dynamic handwriting for Parkinson's disease detection

Parkinson's disease (PD) is a common disease of the elderly. Given the easy accessibility of handwriting samples, many researchers have proposed handwriting-based detection methods for Parkinson's disease. Extracting more discriminative features from handwriting is an important step. Although many features have been proposed in previous researches, the insight analysis of the combination of handwriting's kinematic, pressure, and angle dynamic features is lacking. Moreover, most existing feature is incompletely represented, with feature information lost. Therefore, to solve the above problems, a new feature extraction approach for PD detection is proposed using handwriting. First, built on the kinematic, pressure, and angle dynamic features, we propose a moment feature by composed these three types of features, an overall representation of these three types of features information. Then, we proposed a feature extraction method to extract time-frequency-based statistical (TF-ST) features from dynamic handwriting features in terms of their temporal and frequency characteristics. Finally, we proposed an escape Coati Optimization Algorithm (eCOA) for global optimization to enhance classification performance. Self-constructed and public datasets are used to verify the proposed method's effectiveness respectively. The experimental results showed an accuracy of 97.95% and 98.67%, a sensitivity of 98.15% (average) and 97.78%, a specificity of 99.17% (average) and 100%, and an AUC of 98.66% (average) and 98.89%. The code is available at https://github.com/dreamhcy/MLforPD.

The health and economic burden of brain disorders: Consequences for investment in diagnosis, treatment, prevention and R&D

Brain disorders are prevalent across all age groups but particularly in the elderly, highlighting the importance of preserving brain health in ageing populations. There have been few previous studies to address the complete scope of burden of brain disorders, including direct and indirect costs as well as intangible costs from morbidity and mortality. We seek to illustrate the full health and economic impact of brain disorders by leveraging data from previous large-scale epidemiological and health economic studies to estimate the total direct, indirect and intangible cost of brain disorders in 2019. Two alternative methods were used to estimate indirect costs: the human capital (HC) method (data from the CBDE2010 study), and the willingness-to-pay (WTP) per DALY method (data from GBD2019). Less than 10% of the costs of Alzheimer's disease (AD) and other dementias are incurred by the health care system, while Alzheimer's disease and other dementias is the costliest condition using the HC approach and stroke is the costliest condition due to the large number of life-years lost, followed by AD using the WTP approach. Using per-capita GDP as a proxy for WTP, the indirect costs were nearly four times higher compared to the conventional HC approach. We found that Indirect costs of brain disorders outweigh the direct costs for diagnosis, treatment and care even in high-income countries with advanced, universally accessible systems in Europe. There is likely underinvestment in R&D for brain disorders, and health care systems may lack sufficient incentives to invest in their treatment and prevention.

A roadmap toward promoting and improving brain health in Europe and closing the awareness and funding gap

BACKGROUND AND PURPOSE

The global burden of neurological diseases exceeds 43.1%, imposing a significant burden on patients, caregivers and society. This paper presents a roadmap to reduce this burden and improve brain health (BH) in Europe.

METHODS

The roadmap is based on the European Academy of Neurology's (EAN) five-pillar BH strategy: advancing a global BH approach (P1), supporting policymaking (P2), fostering research (P3), promoting education (P4), and raising awareness of prevention and treatment (P5). It reviews current efforts, collaborations and future directions aligned with the WHO Intersectoral Global Action Plan (iGAP) for Neurological Disorders and suggests future initiatives and call for action.

RESULTS

P1: Support WHO-iGAP through defined action points, international collaborations, in particular, the WHO BH Unit, and the EAN Brain Health Mission. P2: Collaborate with 48 national neurological societies to promote National Brain Plans (NBPs), addressing local needs, and improving access to care. P3: Advocate for more research funding; identify determinants of BH; develop preventive measures. P4: Provide educational opportunities for neurologists, public education programs, and advocacy training, including tools to educate the public. P5: Spearhead global awareness campaigns, organize public educational activities, and train BH advocates to contribute toward sustainable and long-term public health campaigns and policy engagement.

CONCLUSIONS

The paper highlights the importance of a unified approach, integrating international collaborations and local initiatives, to improve BH outcomes based on the WHO-iGAP, and support sustainable development goals, in particular SDG 3: Good Health and Well-being and SDG 4: Quality Education.

Integrated network pharmacology and transcriptomics to explore the mechanism of compound Dihuang granule (CDG) protects dopaminergic neurons by regulating the Nrf2/HMOX1 pathway in the 6-OHDA/MPP+-induced model of Parkinson's disease

BACKGROUND

Parkinson's disease (PD) is a degenerative neurological disease that worsens over time. Ferroptosis has been proven to contribute to PD pathogenesis. CDG exhibits neuroprotective effects. However, CDG's potential mechanism in PD therapy remains uncertain.

PURPOSE

The purpose of this investigation is to ascertain the specific molecular mechanisms of CDG against neuronal ferroptosis and present an alternative option for PD management.

METHODS

Network pharmacology along with LC-MS were used to identify possible targets and candidate pathways. Then RNA-sequencing combined in the in vitro and in vivo experiments were utilized to validate these findings.

RESULTS

According to network pharmacology prediction, NFE2L2, HMOX1 and PTGS2 may be the key genes for ferroptosis in PD. In the in vivo experiments, CDG ultimately improved the neurobehavior of PD rats by alleviating the damage of dopamine neurons, decreasing the levels of MDA, ROS and Fe2+, increasing the GSH level, inhibiting ferroptosis by decreasing ACSL4, TF, and PTGS2 expression levels, and increasing the GPX4, FTH, Nrf2, and HMOX1 levels. RNA-seq analysis showed the differential genes in Model and CDG group were all enriched in Nrf2 and HMOX1, and the enrichment analysis of these differential genes showed they were closely related to the ferroptosis. Subsequently, in vitro experiments, the CDG, OE-Nrf2 and OE-HMOX1 group showed more active cell vitality, with decreasing levels of MDA, ROS, Fe2+, ACSL4, TF and PTGS2, and increasing level GSH, GPX4, FTH, Nrf2 and HMOX1.

CONCLUSION

CDG has a neuroprotective involvement in alleviating ferroptosis by regulating the Nrf2/HMOX1 pathway. Moreover, this research offers pharmacological evidence supporting the applications of CDG for treating PD.

Exploration of Novel Biomarkers for Neurodegenerative Diseases Using Proteomic Analysis and Ligand-Binding Assays

BACKGROUND/OBJECTIVES

Neurodegenerative diseases are a major cause of morbidity and mortality worldwide, and their public health burden continues to increase. There is an urgent need to develop reliable and sensitive biomarkers to aid the timely diagnosis, disease progression monitoring, and therapeutic development for neurodegenerative disorders. Proteomic screening strategies, including antibody microarrays, are a powerful tool for biomarker discovery, but their findings should be confirmed using quantitative assays. The current study explored the feasibility of combining an exploratory proteomic strategy and confirmatory ligand-binding assays to screen for and validate biomarker candidates for neurodegenerative disorders.

METHODS

It analyzed cerebrospinal fluid (CSF) and plasma samples from patients with Alzheimer's disease, Parkinson's disease, and multiple sclerosis and healthy controls using an exploratory antibody microarray and validatory ligand-binding assays.

RESULTS

The screening antibody microarray identified differentially expressed proteins between patients with neurodegenerative diseases and healthy controls, including cluster of differentiation 14 (CD14), osteopontin, and vascular endothelial growth factor 165b. Quantitative ligand-binding assays confirmed that CD14 levels were elevated in CSF of patients with Alzheimer's disease (p = 0.0177), whereas osteopontin levels were increased in CSF of patients with Parkinson's disease (p = 0.0346).

CONCLUSIONS

The current study demonstrated the potential utility of combining an exploratory proteomic approach and quantitative ligand-binding assays to identify biomarker candidates for neurodegenerative disorders. To further validate and expand these findings, large-scale analyses using well-characterized samples should be conducted.

Efficacy of different acupuncture-related therapies for tension-type headache: a systematic review and network meta-analysis

Background

Tension-type headache (TTH) is among the most common primary headache disorders, characterized by recurrent episodes that are difficult to manage, thus posing a significant public health challenge. Acupuncture, a well-recognized non-pharmacological treatment, is frequently employed for pain management, including TTH. However, the variety of acupuncture techniques and inconsistent treatment outcomes underscore the need for a thorough evaluation. This study aims to update the current evidence on acupuncture and related therapies for TTH, evaluate the efficacy and safety of various acupuncture therapies, and identify the most effective therapeutic strategies, providing valuable guidance for clinical practice.

Methods

We systematically searched randomized controlled trials (RCTs) from four English databases (PubMed, Embase, Cochrane Library, and Web of Science) and four Chinese databases (Wanfang, VIP, CNKI, and SinoMed), including gray literature, up to April 19, 2024. The outcome measures included headache frequency, duration, pain intensity, and responder rate. A Bayesian network meta-analysis was conducted using Stata 17.0 to assess the relative effectiveness and safety of the different acupuncture therapies. This study was registered with the Prospective Register of Systematic Reviews (CRD42024537187).

Results

A total of 42 RCTs, encompassing 4,103 participants and 21 distinct treatment therapies, were included in the analysis. The network meta-analysis yielded the following findings: (1) regarding responder rate, several acupuncture or combined acupuncture and medication approaches, such as electro-acupuncture (EA) + cupping therapy (CT) [odds ratio (OR) = 28.66, 95% CI: 1.68 to 487.35], manual acupuncture (MA) + bloodletting therapy (BT) (OR = 6.07, 95% CI: 1.81 to 20.29), plum blossom needle tapping (PBNT) (OR = 3.76, 95% CI: 1.04 to 13.65), and scalp acupuncture (SPA) (OR = 3.65, 95% CI: 2.29 to 5.83), were significantly more effective than western medicine (WM) alone, with EA + CT (92.1%) being the most effective. (2) In terms of reducing headache frequency, EA (85.9%) was the most effective, followed by MA + PBNT (80.9%) and MA + WM (78.4%). Compared to WM, both MA + PBNT (SMD = -1.76, 95% CI: -3.31 to -0.22) and EA (SMD = -1.75, 95% CI: -3.30 to -0.20) significantly reduced headache frequency. (3) For shortening headache duration, EA (83.9%) emerged as the most effective treatment, followed by MA + WM (73.5%) and laser acupuncture (LA) (68.5%). (4) In terms of pain intensity reduction, the MA + WM combination (89.4%) was superior to other treatments, with SPA + WM (77.7%) being the next most effective. Compared to herbal medicine (HM), both MA + WM (SMD = -2.37, 95% CI: -4.20 to -0.55) and MA alone (SMD = -1.00, 95% CI: -1.75 to -0.24) significantly alleviated pain intensity.

Conclusion

This comprehensive analysis of 21 acupuncture and related therapies demonstrates that EA is the most effective in reducing headache frequency and shortening headache duration, while EA + CT and MA + WM are the optimal therapies for enhancing responder rate and reducing pain intensity, respectively. However, clinical decisions should be individualized based on the specific needs of each patient.

Systematic review registration

The study protocol was registered on the PROSPERO database under registration number CRD42024537187 (https://www.crd.york.ac.uk/prospero/#recordDetails).

Efficacy and safety of simple analgesics for acute treatment of episodic tension-type headache in adults: a network meta-analysis

OBJECTIVE

Tension-type headache is the most common type of primary headache and results in a huge socioeconomic burden. This network meta-analysis (NMA) aimed to compare the efficacy and safety of simple analgesics for the treatment of episodic tension-type headache (ETTH) in adults.

METHODS

We searched the Cochrane Library, PubMed, Web of Science, Embase, Chinese BioMedical Literature database and International Clinical Trials Registry Platform databases for eligible randomized clinical trials reporting the efficacy and/or safety of simple analgesics. A Bayesian NMA was performed to compare relative efficacy and safety. The surface under the cumulative ranking curve (SUCRA) was calculated to rank interventions. PROSPERO registration number: CRD42018090554.

RESULTS

We highlighted six studies including 3507 patients. For the 2 h pain-free rate, the SUCRA ranking was ibuprofen > diclofenac-K > ketoprofen > acetaminophen > naproxen > placebo. All drugs except naproxen reported a higher 2 h pain-free rate than placebo, with a risk ratio (RR) of 2.86 (95% credible interval, CrI: 1.62-5.42) for ibuprofen and 2.61 (1.53-4.88) for diclofenac-K. For adverse events rate, the SUCRA ranking was: metamizol > diclofenac-K > ibuprofen > lumiracoxib > placebo > aspirin > acetaminophen > naproxen > ketoprofen. The adverse event rates of all analgesics were no higher than those of placebo, except for ketoprofen. Moreover, all drugs were superior to placebo in the global assessment of efficacy. In particular, the RR of lumiracoxib was 2.47 (1.57-4.57). Global heterogeneity I2 between the studies was low.

CONCLUSIONS

Simple analgesics are considered more effective and safe as a placebo for ETTH in adults. Our results suggest that ibuprofen and diclofenac-K may be the two best treatment options for patients with ETTH from a comprehensive point of view (both high-quality evidence).

Exploring amyotrophic lateral sclerosis through the visual system: A systematic review

BACKGROUND AND PURPOSE

The human visual system relies on neural networks throughout the brain that are easily accessible for tests exploring eye structures and movements. Over the past two decades, investigations have been carried out on both afferent and efferent components of the visual system in people with amyotrophic lateral sclerosis (ALS). This approach might represent an innovative biomarker research strategy to better characterise the phenotypic variability of ALS. The purpose of this review was to determine whether exploring the visual system of patients with ALS (pwALS) is an effective strategy.

METHODS

The Medline and Web of science databases were searched for studies with terms relating to ALS and vision. Of 1146 references identified, 43 articles were included.

RESULTS

In this review article, both afferent and efferent components of the visual system were found to be impaired in pwALS in the absence of visual complaint, thereby contributing to the hypothesis that ALS is a multisystem disease with sensory involvement. Of note, some areas of the eye remain unexplored (i.e., tears, and retinal function using electroretinography).

CONCLUSIONS

According to the findings available in the literature, investigating the oculomotor system and exploring the ocular surface could represent two key promising strategies to identify new diagnostic biomarkers in pwALS. Further longitudinal studies are needed to identify relevant indicators of disease progression and response to therapeutic intervention.

Exploring the causal relationships between type 2 diabetes and neurological disorders using a Mendelian randomization strategy

While there is ample evidence indicating an increased occurrence of general neurological conditions among individuals with diabetes, there has been limited exploration into the cause-and-effect connection between type 2 diabetes (T2D) and specific neurological disorders, including conditions like carpal tunnel syndrome and Bell's palsy. We used Mendelian randomization (MR) approach to investigate the causal effects of T2D on 67 neurological diseases. We primarily utilized the inverse-variance weighted method for the analysis, and also employed the weighted median and MR-Egger methods in our study. To detect and correct potential outliers, MR-PRESSO analysis was used. Heterogeneity was assessed using Cochrane Q-values. The MR analyses found a possible relationship between T2D and a risk increase of 8 diseases at suggestive level of evidence (P < .05). Notably, among the positive findings that met the false discovery rate threshold, nerve, nerve root, and plexus disorders (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.08-1.15); neurological diseases (OR = 1.05; 95% CI = 1.03-1.07) and carpal tunnel syndrome (OR = 1.10; 95% CI = 1.05-1.16) were identified. Our findings affirm a cause-and-effect association between T2D and certain neurological disorders.

What is known about the challenges people with Parkinson's disease experience with their medicines and what solutions have been explored to overcome them? A scoping review

BACKGROUND

The symptomatic management of Parkinson's disease (PD) relies heavily on medications, which increase in complexity as the disease progresses.

OBJECTIVES

To describe (i) the extent, range, and nature of research describing the experience and challenges people with PD and their carers have with their medicines for symptomatic treatment, and (ii) any interventions that have been reported in a community setting that address medicine-related challenges experienced by people with PD.

METHODS

The scoping review searched electronic databases (EMBASE, PubMed, and CINAHL). The studies included were full-text articles in English only, including conference abstracts that focussed on patients with PD or their carers and discussed medicines in the primary care setting, even where this was not the primary focus.

RESULTS

Thirty-nine papers were taken forward for data extraction. Twenty described patient experience and challenges. Although none were explicitly focussed on medications, they did highlight challenges including the work of taking multiple medications and a desire for non-oral formulations. Nineteen described or tested interventions to support people with PD with their medication including community pharmacist-led reviews, medication compliance aids, and the use of text message reminders. These were all small-scale feasibility and pilot studies, and none were grounded in a methodological framework. Positive outcomes were reported against various scales, but no evidence of scaling up any of the interventions was found.

CONCLUSION

There is very little published research surrounding the challenges people with PD have with their medicines. The published research that does exist alludes to challenges with medicines taking in people with PD but identifies a gap in the detail and understanding. Further work is required to improve our understanding and allow the development of sustainable interventions that support people with PD and their carers.