The aim of this study was to investigate the effects of central vestibular dysfunction on physical functionality and cognitive function in individuals with multiple sclerosis (MS).

Fifty-two fully ambulatory individuals with MS (Expanded Disability Status Scale [EDSS] ≤ 4) were included and divided into two groups: those with central vestibular involvement (Group 1; n = 25) and those without (Group 2; n = 27). Central vestibular involvement was assessed using videonystagmography. Physical and cognitive functions were evaluated in all participants using the Glittre Activities of Daily Living (ADL) test, Godin Leisure-Time Exercise Questionnaire (GLTEQ), and the physical dimension of the MSQoL-54 for physical functionality, and the BICAMS, Trail Making Test (TMT), Word List Generation test and the cognitive dimension of the MSQoL-54 for cognitive function.

According to the physical functionality assessment results, the time required to complete the Glittre ADL test was longer in group 1 than in group 2 (p = 0.01). The score for the physical dimension of the MSQoL-54 was lower in group 1 (p = 0.045). In the BICAMS Symbol Digit Modalities Test, Group 1 scored lower than Group 2 (p = 0.013). A significant difference between the groups was also observed in the time taken to complete the TMT (p = 0.017). Additionally, Group 1 exhibited lower scores on the cognitive dimension of the MSQoL-54 (p = 0.012).

Physical functionality and specific cognitive domains differed between MS participants with and without central vestibular involvement. It should be considered that vestibular dysfunction may adversely impact cognitive and physical functionality, even in low-moderate disability level.

Stroke remains a major public health issue globally. Tele-rehabilitation, incorporating internet-based interventions and wearable devices, offers an accessible strategy for post-discharge rehabilitation. This study evaluates their effectiveness in stroke patients.

A total of 160 subacute stroke patients hospitalized between November 2022 and September 2023 were enrolled and randomly allocated to four groups at discharge (n = 40 per group): a control group receiving conventional rehabilitation, an internet-based tele-rehabilitation (ITR) group, a wearable-device-assisted (WDA) group and a combined intervention (IWT) group, which received both ITR and WDA training. The primary outcome was assessed by the Modified Barthel Index (MBI) at discharge, 4 weeks and 12 weeks post-discharge, with the 12-week score prespecified as the primary endpoint. Secondary outcomes included Berg Balance Scale (BBS), simplified Fugl-Meyer Assessment (sFMA), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Mini-Mental State Examination (MMSE) and Zarit Burden Interview (ZBI), all assessed at discharge, 4 weeks and 12 weeks post-discharge.

At baseline, no significant differences were observed among groups (P > 0.05). Over 12 weeks, all intervention groups demonstrated significant improvements in MBI, BBS and sFMA compared to the control group (P < 0.05), with the IWT group achieving the greatest gains (P < 0.01). Anxiety, depression and caregiver burden significantly decreased across intervention groups, with the IWT group showing the most pronounced reductions (P < 0.01). Cognitive function also improved significantly, particularly in the IWT group (P < 0.01).

ITR and WDA training enhances functional and psychological recovery in stroke patients, highlighting its potential clinical significance in managing stroke recovery.

Parkinson’s disease (PD) is a neurodegenerative disorder whose diagnostic motor symptoms appear only after significant progression of neurodegeneration. Identification of preclinical markers is essential. Idiopathic rapid eye movement sleep behavior disorder (iRBD) has a high risk of conversion to PD. Olfactory impairment (hyposmia) is present in both PD and iRBD; hyposmia in iRBD may be an additional clue indicating the development of PD. The processes underlying hyposmia in iRBD are unknown. Using resting-state functional connectivity (rsFC), a “sensory olfactory subnetwork” (SOS) has been identified that is thought to represent the processing of basic sensory olfactory information. We investigated whether changes in the SOS are seen in both PD and iRBD and whether changes are associated with hyposmia in both conditions.

The University of Pennsylvania Smell Identification Test (UPSIT) and a seed-based approach to analyze SOS region rsFC in early PD, iRBD and healthy controls (HC) were employed. Our SOS regions included (right hemisphere) anterior piriform cortex, dorsal insula (INSd), ventral insula (INSv), posterior insula (INSp) and ventral posterior thalamus (THLvp).

Compared to HC, idiopathic iRBD and PD participants performed significantly worse on UPSIT and exhibited lower FC between INSd and INSv and higher FC between INSd and THLvp and INSv and THLvp. UPSIT scores were negatively correlated with FC between INSv and THLvp and INSp and THLvp.

Idiopathic iRBD may be associated with similar functional and perceptual olfactory alterations and potential compensatory changes as early PD, which may show promise as additional preclinical biomarkers of PD.

In-hospital strokes comprise a small but high-risk subgroup of patients and are associated with worse outcomes compared to community-onset strokes. We compared clinical characteristics, workflow metrics and clinical outcomes of adult patients with in-hospital strokes and those with community-onset strokes in Alberta.

We conducted a retrospective cohort study (INPATIENTS: IN-hosPitAl sTrokes InAlbErta iNcidence and ouTcomeS) from Jan 1, 2018–Dec 31, 2022 using provincial administrative data and chart review to compare in-hospital and community-onset acute ischemic and hemorrhagic strokes. We performed multivariable logistic regression to determine the association of stroke onset location (in-hospital vs community-onset) with the following outcomes: in-hospital mortality, prolonged hospital stay and in-hospital complications. Negative binomial regression was conducted to compare workflow metrics between cohorts. All models were adjusted for age, sex, comorbidities, facility type and admission year.

Among 24,039 stroke admissions, 2,545 (10.6%) were in-hospital strokes and 20,895 (86.9%) were ischemic. In-hospital strokes had higher rates of comorbidities and were associated with higher in-hospital mortality (adjusted OR [aOR] 3.09; 95% CI 2.80–3.41), prolonged hospital stays (aOR 5.47; 95% CI 4.89–6.112) and increased in-hospital complications. In-hospital ischemic stroke patients receiving thrombectomy showed lower odds of in-hospital mortality (aOR 0.46; 95% CI, 0.28–0.75) and pneumonia (aOR 0.38; 95% CI, 0.20–0.71) compared to non-treated patients. Workflow times were significantly longer in in-hospital ischemic strokes compared to community-onset strokes.

Patients with in-hospital stroke experience higher rates of mortality, poorer clinical outcomes and significant delays in management. Targeted quality improvement efforts are needed to address care gaps and improve outcomes in this population.

Optic neuritis (ON) represents the most common optic neuropathy in young adults; however, longitudinal data on visual recovery, particularly in autoimmune ON subtypes, remain limited. This study aimed to assess long-term visual outcomes in patients with severe ON without multiple sclerosis stratified by autoantibody status: aquaporin-4 (AQP4)-IgG positive, myelin oligodendrocyte glycoprotein (MOG)-IgG positive and double seronegative (DN).

A retrospective cohort analysis was conducted at a tertiary neurology center in southern India, including severe ON patients (best-corrected visual acuity [BCVA] ≤1.0 logMAR) between January 2016 and April 2024. Serological testing for AQP4 and MOG antibodies was performed via cell-based assays. Visual outcomes were categorized as “good recovery” (≥66.77% improvement in BCVA) and “complete recovery” (return to baseline BCVA).

Among 42 patients, 17 were AQP4-IgG positive, 10 MOG-IgG positive and 15 DN. The median BCVA at nadir was 1.7 logMAR. Compared with that in the MOG-IgG group, the likelihood of complete visual recovery was lower in both the AQP4-IgG (hazard ratio [HR]: 0.18; p = 0.16) and DN (HR: 0.56; p = 0.34) groups. For good recovery, the AQP4-IgG (HR: 0.16; p = 0.001) and DN (HR: 0.24; p = 0.001) groups had significantly lower HR. All MOG-IgG–positive patients achieved good recovery, compared with fewer than half in the other groups.

Antibody status predicted long-term visual outcomes in patients with isolated ON, with MOG-IgG conferring the best recovery, AQP4-IgG the worst and DN intermediate, underscoring the importance of early, antibody-guided management.

Due to the high prevalence of depression and anxiety in people with epilepsy, the International League Against Epilepsy Commission on the Neuropsychiatric Aspects of Epilepsy recommends implementing routine screening for depression and anxiety symptoms. Our epilepsy group began administering three screening questionnaires to all clinic patients in 2016: the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Beck Anxiety Inventory (BAI) and the Generalized Anxiety Disorder-7 (GAD-7).

We aim to review our experience with this screening approach.

We reviewed 2253 sets of questionnaires completed from January 2018 to March 2020 and studied the actions taken by epileptologists in response to a positive screening.

Thirty-six percent of all assessed patients screened positive on at least one questionnaire: 13.6% screened positive for depression symptoms (NDDI-E ≥ 16), 12.3% for anxiety symptoms (BAI ≥ 22) and 30.3% for GAD symptoms (GAD-7 > 7). Among patients with a positive screening, 36% received a care intervention, 59% did not and 5% declined the neurologist’s recommendation. Among patients for whom an intervention was implemented, 58% were referred to a mental health professional (generally a neuropsychiatrist), 29% had their antiseizure medication adjusted to alleviate their symptoms and 13% received another intervention.

In our clinic, an important proportion of patients screened positive for depression and/or anxiety symptoms. Fewer than half received a management option to alleviate their symptoms. We conclude that while routine screening increases the detection of depression and anxiety among epilepsy patients, it must be accompanied by effective interventions and access to mental-health professionals.

Levodopa-induced dyskinesia (LID) is a disabling symptom of Parkinson’s disease (PD). There have been prior attempts to find risk factors contributing to this symptom, but risk factors for the severity of LID have not been comprehensively studied. We aimed to evaluate factors that correlate with LID severity in patients with PD based on the Unified Dyskinesia Rating Scale (UDysRS).

A cross-sectional study was designed on 52 idiopathic PD patients who were referred for LID between 2023 and 2024. Their demographic and clinical records were studied. Furthermore, cognitive decline (MoCA), PD severity (Hoehn and Yahr) and the severity of dyskinesia (UDysRS) were examined. The association between factors and LID severity was evaluated by carrying out univariate regression and multivariate regression backward elimination analysis.

The mean age of patients with LID was 59.9 ± 11.4 years. Results of univariate regression analysis indicated that male sex (β = −0.24, P = 0.04), BMI (β = −0.3, P = 0.005), H&Y (β = 0.4, P = 0.002), diabetes mellitus (β = 0.3, P = 0.018) and levodopa dosage per kilogram (β = 0.37, P = 0.01) were significant factors involved in the severity of dyskinesia. The univariate regression model results showed that lack of constipation (P = 0.04), hyperlipidemia (P = 0.04) and total daily levodopa dosage per kilogram (P = 0.01) were associated with the severity of end-dose dystonia.

This study revealed that female sex, more advanced PD, diabetes mellitus, daily levodopa dosage per kilogram body weight and BMI are associated with the severity of LID. Also, it suggests that hyperlipidemia and lack of constipation are associated with the severity of end-dose dystonia.