Objectives： Parkinson’s disease (PD) is a neurodegenerative disorder affecting multiple systems. Previous studies have indicated that autonomic dysfunction in PD patients may manifest in the early stages of the disease. This study aims to investigate the correlation between autonomic dysfunction and the progression of motor symptoms in PD patients.
Methods： A total of 738 PD patients participated in this research. The status of autonomic dysfunction was examined by Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT). And the motor progression was monitored by using Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Besides, neuropsychological status was recorded using Hamilton Depression Scale and Hamilton Anxiety Scale. The participants were followed up for 2 years (±3 months) and the MDS-UPDRS was reassessed to examine the progress in motor function.
Results： The SCOPA-AUT score was significantly correlated with the total MDS-UPDRS score (P＜0.001) as well as the changes in Part Ⅰ (P＝0.005), Part Ⅱ (P＜ 0.001), and Part Ⅲ (P＜0.001) scores (absolute difference between baseline and 2-year follow-up). Among the sub-items of SCOPA-AUT, the scores for autonomic dysfunction related to digestive system, urinary system, cardiovascular symptoms, skin symptoms, and drug use showed significant correlations with the total MDS-UPDRS score and certain sub-scores. However, sexual dysfunction and changes in motor scores did not show significant correlations with the total MDS-UPDRS score or changes in any sub-scores.
Conclusions： Autonomic dysfunction could be considered as a potential predictor of motor progression in PD.
With the rapid advancement of cancer therapies, the survival of patients with malignancies has markedly improved, accompanied by an increasing incidence of cancer- and treatment-related neurological complications. These changes have driven the emergence of onco-neurology as a multidisciplinary subspecialty. This review focuses on the clinical value of imaging in onco-neurology. By integrating disease onset along the temporal course with treatment-related context, we systematically summarize major onco-neurological conditions, including paraneoplastic syndromes, diagnostic or procedure-related neurological injuries, and treatment-related neurological complications. The imaging features and key differential diagnostic considerations of these entities are discussed. In addition, the potential role of advanced multimodal neuroimaging in early injury detection, differential diagnosis, and longitudinal follow-up is explored, with the aim of providing imaging-based support for the evaluation and management of cancer-related neurological injury.
Objective: To report the clinical features of a sporadic amyotrophic lateral sclerosis (ALS) patient carrying a HARS1 variant with mildly elevated cerebrospinal fluid (CSF) protein, and to discuss the clinical significance of CSF protein changes in ALS as well as the co-occurrence of the HARS1 variant and CSF protein elevation.
Methods: The patient's clinical symptoms, electrophysiology, imaging, cerebrospinal fluid, and genetic test results were documented, alongside a literature review and analysis.
Results: The patient, a middle-aged female, presented with a progressively worsening disease course. The primary clinical manifestations included increasing limb weakness, dysarthria, atrophy of the tongue muscles, hyperactive tendon reflexes, and positive pathological signs. Cerebrospinal fluid analysis revealed elevated protein levels. Electromyography demonstrated extensive neurogenic damage, while imaging studies indicated involvement of the corticospinal tract. Genetic testing identified a heterozygous variant of HARS1 c.210G>A (p.Met70Ile).Based on these findings, a clinical diagnosis of ALS was established. Following treatment with riluzole, coenzyme Q10, and short-term corticosteroid therapy, the patient's condition stabilized.
Conclusion: This ALS patient with a rare HARS1 variant suggests a broader clinical spectrum for this gene than previously known. The slight increase in CSF protein indicates blood-brain barrier dysfunction rather than an immune response. The pathogenicity of the HARS1 variant needs further study and additional cases for confirmation. As mild CSF protein elevation is not uncommon in ALS, it should not be interpreted as specifically attributable to the HARS1 variant; the two findings may be independent or indirectly linked by shared neurodegenerative pathology.
Multiple system atrophy (MSA) is a rare disease with an extremely poor prognosis, for which no effective treatment currently exists. In recent years, non-invasive neuromodulation techniques have shown significant advantages in the field of neurodegenerative diseases. Transcranial magnetic stimulation (TMS), as a non-invasive neuromodulation technique, has demonstrated potential in the treatment of various neurological disorders. This article aims to review the latest research progress on TMS for MSA, with a particular focus on the evidence of its efficacy against core motor symptoms (such as parkinsonism and ataxia) and some non-motor symptoms in MSA patients. The feasibility of broadly implementing TMS in the clinical management of MSA is also discussed.
Hepatolenticular degeneration (also known as Wilson's disease), as a rare inherited disorder of copper metabolism, presents complexities and multidisciplinary challenges in clinical diagnosis and treatment, requiring long-term patient management that addresses both physiological and psychological needs. With the advancement of the multi-site practice policy, the flow of medical resources has introduced new opportunities and challenges for the clinical education of hepatolenticular degeneration. Based on the author's personal experience with multi-site practice, this paper analyzes the innovation of multi-site practice on the clinical teaching of hepatolenticular degeneration, reviews the current status and difficulties of the integration of clinical teaching and humanistic care, and proposes optimization strategies such as establishing a cross-institutional "teaching-care" integration platform and developing standardized teaching modules. It further explores how to integrate existing resources through multi-site practice to achieve synergistic development in improving clinical teaching quality and enhancing humanistic care for patients, aiming to provide a reference for the clinical teaching and patient management of rare diseases.
Sleep disorders are among the most common and prominent neuropsychiatric symptoms in patients with Alzheimer’s disease (AD), which mutually exacerbates the progression of AD. Currently, western medicine treatment relies primarily on symptomatic management using sedative-hypnotics agents and melatonin receptor agonists; however, their efficacy is limited, and they are associated with adverse effects and potential drug dependence. In traditional Chinese medicine (TCM), sleep disorders in AD fall into the category of “Bu Mei” (insomnia), with treatment emphasizing syndrome differentiation and individualized therapies including herbal medicine, acupuncture, and moxibustion. In recent years, the integrated traditional Chinese and western medicine has demonstrated unique advantages in managing sleep disorders in AD. Through complementary strengths, it has achieved practical progress in improving sleep quality, delaying cognitive decline, and reducing the adverse effects of western drugs. This review systematically outlines the pathophysiological mechanisms underlying sleep disorders in AD from both TCM and western medical perspectives, reviews integrated treatment strategies, and discusses current challenges,with the aim of providing evidence-based guidance for clinical practice and future research.
The incidence of upper limb and hand dysfunction after stroke is as high as 85%, severely impacting patients' quality of life. Traditional rehabilitation therapies have limited efficacy in some patients, making the exploration of novel rehabilitation techniques a research hotspot. Brain-computer interface (BCI), by decoding motor intention and providing real-time feedback, offers a new approach to inducing neuroplasticity and promoting motor function reconstruction. This article systematically reviews the clinical application progress, mechanisms of action, main paradigms, efficacy assessment, influencing factors, and future directions of BCI in upper limb motor rehabilitation after stroke. With the evolution of technology towards intelligence, the accumulation of high-level evidence, and the construction of a multimodal neural rehabilitation ecosystem, BCI is expected to grow from a cutting-edge technology into a reliable and transformative tool in neural rehabilitation therapy.
Objective: Sleep deprivation can lead to cognitive impairment, and acupuncture has been shown to symptoms associated with insufficient sleep; however, effects on cognitive impairment and the underlying mechanisms remain unclear. Following a "clinical observation–basic validation" approach, this study aimed to investigate the impact of acupuncture on cognitive function in both sleep-deprived patients and rats.
Methods: A total of 22 middle-aged and elderly patients with chronic insomnia were enrolled and randomly assigned to either an acupuncture group (receiving bilateral needling at Shenmen, Sanyinjiao, and Taichong acupoints) or a placebo group. Sleep quality and cognitive function were assessed before and after treatment using the Athens Insomnia Scale-5 (AIS-5) and Verbal Fluency Test (VFT). In the animal experiment, 24 rats were randomly divided into four groups: a blank control group, a sleep deprivation (SD) group, a SD＋acupoint electroacupuncture (SDA) group, and an SD＋sham acupuncture (SDS) group. Emotional state and learning and memory performance were recorded in all rats. Serum levels of hypothalamic-pituitary-adrenal (HPA) axis hormones, including adrenocorticotrophic hormone (ACTH), corticotropin releasing hormone (CRH), and corticosteroid (CORT)], as well as oxidative stress enzymes [superoxide dismutase (SOD) and malonaldehyde (MDA)], and proinflammatory cytokines [interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α)] were measured. The morphology and density of neurons and glial cells in the cornu ammonis1 (CA1) of the hippocampus were also examined.
Results: In the 22 middle-aged and elderly patients with chronic insomnia, acupuncture treatment significantly reduced both the total AIS-5 score and individual subscale scores compared to baseline (all P < 0.05), and VFT scores showed meaningful improvement (P = 0.022). The effects of acupuncture on SD rats were observed across five main dimensions. (1) Behavioral outcomes: compared with the SD group, both the SDA and SDS groups exhibited prolonged sleep duration (P < 0.001 and P = 0.001, respectively); the SDA group showed an increased number of entries into the central area of the open field(P = 0.027), and both the SDA and SDS groups demonstrated a significant greater number of platform crossings in the Morris water maze(P = 0.002 and P = 0.012, respectively). (2) HPA axis hormone levels: compared with the SD group, the SDA group showed elevated CRH levels and reduced CORT levels, while ACTH levels remained unchanged (P = 0.014, 0.020, and 0.436, respectively); the SDS group exhibited increased ACTH levels, with no significant difference in CRH or CORT (P = 0.017, 0.371, and 0.944, respectively). (3) Oxidative stress response: compared with the SD group, SOD levels were significantly lower in the SDA group (P = 0.018). (4) Inflammatory response: compared with the SD group, the SDA group showed markedly reduced levels of TNF-α,IL-1β and IL-6 (P = 0.017, 0.006, and 0.007, respectively). (5) Histopathological findings: compared to the SD group, the SDA group demonstrated greater preservation of neurons and a reduction in glial cells in the hippocampal CA1 region.
Conclusion: Acupuncture can ameliorates cognitive impairment induced by acute SD, potentially through pathways involving HPA axis-mediated oxidative stress and inflammatory responses.
The intertwined somatic damage and psychological distress induced by malignant tumors severely compromise patient prognosis. Currently, the construction of psychological intervention models in oncology that both meet modern evidence-based requirements and align with local cultural contexts has become an important endeavor in integrative oncology. The Huangdi Neijing states: "When the body and the spirit are united, they will live to the end of their allotted life span." This passage offers a profound articulation of the fundamental unity between the body and the mind—a conception that resonates closely with modern psychosomatic medicine and the neurobiological mechanisms underlying brain-body interactions. Centering on the concept of "integrated treatment of body and mind," this paper systematically reviews the pathological evolution of cancer-related emotional dysregulation from both Chinese and western medical perspectives, as well as the syndrome differentiation framework of "Five Zang-organs Storing Spirit". Drawing on an integrative medicine outlook, it further explores the organic interface between traditional Chinese medicine clinical pathways and the modern stepped-care model. Through a systematic exposition of non-pharmacological interventions—including Chinese psychological therapies, five-element music therapy, acupuncture, and auricular vagus nerve stimulation—alongside contemporary psychotherapeutic techniques, this paper constructs an integrated Chinese-western intervention strategy spanning the full disease continuum of cancer: from diagnosis and active treatment through rehabilitation and palliative care. The aim is to offer a new integrative therapeutic paradigm with distinctive Chinese characteristics for the advancement of modern psycho-oncology.
Objective: To summarize the diagnosis and treatment process of a patient with dementia with Lewy bodies accompanied by psychotic symptoms, and to explore the clinical value of integrated traditional Chinese and western medicine in the management of complex neuropsychiatric symptoms.
Methods: A retrospective analysis was conducted on the clinical data, treatment course, and follow-up outcomes of a 74-year-old woman with dementia with Lewy bodies accompanied by psychotic symptoms. The patient initially presented with Parkinsonian motor symptoms and subsequently developed cognitive decline, visual hallucinations, nocturnal dream-enactment behaviors, and autonomic dysfunction. During hospitalization, traditional Chinese medicine based on syndrome differentiation was added on the basis of adjustment of western medications. The syndrome pattern was identified as "marrow sea insufficiency with phlegm and blood stasis obstructing the collaterals."
Results: After dynamic adjustment of neurological and psychiatric medications combined with syndrome-differentiated traditional Chinese medicine treatment based on tonifying the kidney and replenishing essence, resolving phlegm, and removing blood stasis, the patient showed improvement in visual hallucinations, nocturnal dream-enactment behaviors, and daytime somnolence. Constipation was relieved, mental status, medication adherence, and activity safety improved, caregiver burden was reduced, and no further falls or other adverse events occurred during follow-up.
Conclusion: Patients with dementia with Lewy bodies accompanied by psychotic symptoms often have complex clinical conditions and high sensitivity to medications. Western medicine alone frequently faces difficulty in balancing symptom control and adverse effects. On the basis of careful assessment and dynamic adjustment, integrated traditional Chinese and western medicine may serve as a supplementary strategy for individualized comprehensive management; however, its independent efficacy still requires further validation in more rigorous studies.
The pathogenesis of stress-induced hypertension is complex, involving interactions among multiple systems such as the nervous, endocrine, and inflammatory systems. Western medicine has limitations in individualized treatment and may have potential side effects associated with drugs. Traditional Chinese Medicine (TCM) offers a distinct diagnostic and therapeutic perspective, explaining the relationship between hypertension and emotional factors from the theory of "Body-mind unity", proposing the concept of "heart-liver co-treatment". It associates common clinical syndromes with emotional influences and employs non-drug therapies such as acupuncture, bloodletting, and acupoint stimulation to achieve holistic regulation. This study aims to explore the TCM approach to diagnosing and treating stress-related hypertension and its advantages.
