Objective: To investigate the clinical value of three vertigo scales in the diagnosis of benign paroxysmal positional vertigo (BPPV) in the community.

Methods: Patients with dizziness and (or) vertigo as the main complaint, who were referred from the Xinhua Sub-district Community Health Service Center of Changning District to Renhe Hospital of Baoshan District, Shanghai, between January 2023 and June 2024, were selected. Patients were grouped based on whether they were diagnosed with BPPV. Before diagnosis, screening was conducted using the Dizziness Handicap Inventory (DHI), Berg Balance Scale (BBS) and Vertigo Symptom Scale-Chinese (VSS-C), and the results of the scale evaluations were recorded. A multivariate logistic regression model was used to analyze the factors related to BPPV, and the clinical values of DHI, BBS, VSS-C and the combined application of the three scales in supporting diagnosis of BPPV were analyzed.

Results: A total of 80 patients were included, of whom 36 were diagnosed with BPPV. The DHI and VSS-C scores in the BPPV group were significantly higher than those in the non-BPPV group (P＜0.05), while the BBS score was lower than that in the non-BPPV group (P＜0.05). Multivariate logistic regression analysis showed that DHI score [odds ratio (OR)＝4.440, 95% confidence interval (CI): 1.820-10.831, P＝0.001], VSS-C score (OR＝1.036, 95% CI: 1.009-1.063, P＝0.008) and BBS score (OR＝0.539, 95% CI: 0.298-0.973, P＝0.040) were independent influencing factors for BPPV. ROC curves for DHI score, BBS score, VSS-C score, and the combined application of the three scales showed that the combined application of the three scales had the optimal diagnostic efficacy for BPPV, with a sensitivity of 0.834 and a specificity of 0.779.

Conclusion: The combined application of DHI, BBS and VSS-C scales is helpful for the initial screening of patients with acute vertigo, improves the efficiency of BPPV identification, and enables patients to receive timely diagnosis and treatment.

Movement disorders are one of common neurological complications following solid organ transplantation. They encompass various clinical manifestations, including tremor, myoclonus, and chorea, which significantly impact patients' quality of life. Neurological complications following solid organ transplantation are generally observed at a relatively high overall incidence, with variations across different types of organ transplants. Among these, neurological complications are relatively more common after liver transplantation, which is associated with multiple factors such as hepatic encephalopathy. Although the underlying mechanisms remain incompletely understood, these complications are thought to arise from neurotoxicity from immunosuppressive drugs, metabolic disturbances, and surgical factors. Post-transplant movement disorders often coexist with multiple symptoms, necessitating an active search for underlying causes, ruling out possibilities such as ischemic-hypoxic encephalopathy, infection, or stroke. If movement disorders occur in isolation, the neurotoxicity of medications, such as immunosuppressive agents, should be considered first. Treatment involves etiological management (optimizing the immunosuppressive regimen) and symptomatic therapy (such as antiepileptic drugs, clonazepam, or botulinum toxin injections). With timely intervention, most cases achieve favorable outcomes with a good prognosis. This review focuses on the epidemiology, clinical manifestations, associated symptoms, diagnosis and differential diagnosis, treatment, and prognosis of involuntary movements following liver, kidney, and heart transplantation, aiming to serve as a clinical reference.

Parkinson's disease (PD) is a common neurodegenerative disorder whose pathogenesis is complex and remains incompletely understood. Oligomers formed by the abnormal aggregation of α‍-synuclein (α‍-syn) are considered one of the central culprits of PD pathology. These oligomers accumulate not only within neurons but also propagate pathological changes by mediating neuron-glia crosstalk. Accumulating evidence indicates that α‍-syn oligomers exacerbate neuronal injury and accelerate neurodegeneration by triggering glial activation and inflammatory responses. Nevertheless, the precise molecular mechanisms through which α-syn oligomers transduce signals between neurons and glia are still largely unresolved. Here we systematically review the biogenesis and toxic mechanisms of α-syn oligomers, the activation states of glial cells and their associated inflammatory pathways, and the latest advances in intercellular signaling between the two compartments, with the goal of illuminating the pivotal roles of these processes in PD pathobiology. By integrating these molecular insights, we aim to provide new theoretical frameworks and research directions for the early diagnosis and treatment of Parkinson's disease, thereby fostering the development of innovative therapeutic strategies.

Atrial fibrillation (AF) is a critical risk factor for stroke. Despite secondary prevention with anticoagulant therapy, the annualized risk of stroke recurrence in patients with AF remains substantial, ranging from 3.2% to 6.5%. The traditional CHA2DS2-VASc scoring system, which is based on clinical factors for risk stratification, fails to adequately reflect dynamic cardiac structural remodeling or subclinical cerebrovascular injury. This paper reviews recent advances in neuroimaging (covert brain infarction, cerebral microbleeds and white matter hyperintensities) and echocardiography (left atrial structure, left atrial strain, left atrial appendage morphology, left atrial appendage spontaneous echo contrast and left atrial appendage emptying velocity) for risk assessment of stroke recurrence in patients with atrial fibrillation, which aims to optimize the traditional scoring system for more precise risk stratification.

Objective: To report the first real-world case of an Alzheimer's disease patient who achieved PET-defined amyloid clearance sufficient to meet the discontinuation criteria and successfully discontinue donanemab therapy, and to illustrate the feasibility of PET-guided individualized treatment duration in clinical practice.

Methods: A 78-year-old female patient with AD was systematically evaluated before and after donanemab therapy. Cognitive function, amyloid-β (Aβ) and Tau PET imaging, and MRI findings were longitudinally monitored, along with the assessment of treatment-related adverse events.

Results: After six infusions of donanemab, the patient's Aβ load decreased to 7.02 Centiloids (CL), meeting the predefined discontinuation criterion. Tau deposition showed a mild visual reduction compared with baseline. The MoCA score increased from 17 to 21, mainly in the orientation domain, while activities of daily living remained stable. Asymptomatic amyloid-related imaging abnormalities (ARIA) was detected and remained stable during follow-up

Conclusion: This case demonstrates that donanemab can achieve substantial Aβ clearance with favorable safety in real-world settings. PET-based quantitative guidance for individualized therapy duration appears feasible, though long-term follow-up is required to assess the durability of Aβ clearance and its downstream impact on Tau dynamics and clinical outcomes, providing insights for precision application of anti-Aβ therapies.

Objective: To observe the clinical efficacy of fire needle therapy in treating symptoms of bulbar paralysis such as dysphagia in patients with amyotrophic lateral sclerosis (ALS).

Method: The study included 56 ALS patients with bulbar palsy symptoms such as dysphagia from June 2020 to December 2024, who were randomly divided into a fire acupuncture group and conventional acupuncture group. Based on modern medical treatment, the fire acupuncture group received sublingual three-needle fire acupuncture therapy, while the conventional acupuncture group received conventional acupuncture therapy, with an 8-week treatment period. Fire acupuncture points selected were Lianquan (tongue I acupuncture) and bilateral points 0.8 cun lateral to Lianquan (tongue II and III acupuncture). Efficacy was evaluated using the Water Swallowing Test, Fujimura Swallowing Function Scoring Standard, Amyotrophic Lateral Sclerosis Symptom Score in Integrative Treatments (ALS-SSIT) oropharyngeal function score, modified Amyotrophic Lateral Sclerosis Symptom Functional Rating Scale (ALSFRS-R) and Drooling Severity and Frequency Scale (DSFS).

Results: Fifty-six patients were enrolled, 5 patients dropped out, and 51 patients were finally included in the statistical analysis (26 cases in the fire acupuncture group, 25 cases in the conventional acupuncture group). At the 8th week of treatment, the proportion of patients with mild symptoms according to the Water Swallowing Test in the fire acupuncture group increased compared to before treatment, and the difference was statistically significant (P<0.05). After 8 weeks of treatment, Fujimura Swallowing Function score, ALS-SSIT oropharynx function score and DSFS score in the fire acupuncture group were significantly better than those before treatment (P<0.05), and were significantly better than those after treatment in the conventional acupuncture group (P<0.05). The ALSFRS-R score of the fire acupuncture group after treatment was also significantly better than that of the conventional acupuncture group (P<0.05).

Conclusion: Compared with conventional acupuncture, fire acupuncture can significantly improve the dysphagia and salivation symptoms of ALS patients, and can delay the disease progress to a certain extent. Fire acupuncture may serve as an adjuvant treatment for ALS patients with symptoms of medullary paralysis such as swallowing difficulties and drooling.

This paper systematically explores the academic thought and characteristic formulas and medications of ancient physician ZOU Shu in Qing Dynasty for treating epilepsy. Integrating theories from the Huangdi Neijing and Shanghan Lun, Zou Shu innovatively proposed the "three reversals, three excesses and three escapes" pathogenesis model to elucidate the pathological mechanisms and dynamic evolution of mania, delirium and epilepsy. The "three reversals (Qi reversal, Jue reversal and Shen reversal)" represent the fundamental disease state, reflecting profound disturbances in Yin-Yang and Qi-blood. The "three excesses (Yang excess, fire excess and blood excess)" signify the intensified stage, characterized by hyperactive Yangqi and pathogenic fire. The "three scurries (wind scurry, phlegm scurry and fire scurry)" represent the manifest symptoms, reflecting the invasion of wind, phlegm and fire pathogens through the meridians and obstruction of the clear orifices. Based on this model, ZOU Shu distilled the core therapeutic principle of "regulating water and fire through earth, and guiding Yang back to Yin", emphasizing the fundamental importance of harmonizing Yin and Yang rather than merely suppressing spasms and convulsions. This paper provides an in-depth analysis of the properties, tastes and functions of medicinal herbs such as dragon bone, oyster shell, Stephania root and cicada slough, along with their corresponding relationships to the pathogenesis. Integrating modern pharmacological research, it reveals that these herbs exert antiepileptic effects through multiple pathways, including regulating calcium ion channels, inhibiting inflammatory responses, and preventing neuronal apoptosis. This paper highlights ZOU Shu's diagnostic philosophy, which prioritizes disease mechanism analysis and holistic regulation, providing classical foundations and clinical insights for modern traditional Chinese medicine treatment of epilepsy.

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder whose rehabilitation requires individualized strategies based on disease subtype and functional impairment. This review systematically summarizes recent advances in the assessment and rehabilitation of respiratory, motor and swallowing dysfunctions in patients with SMA. For respiratory dysfunction, the techniques such as pulmonary function tests, diaphragmatic ultrasound and sleep monitoring, along with interventions including non-invasive ventilation, were evaluated. For motor function, various assessment tools such as functional scales, muscle ultrasound and physical fitness tests were summarized. Additionally, rehabilitation strategies for patients with different motor abilities were analyzed, including strength training, robot-assisted training and neuromodulation techniques. For swallowing function, the assessment methods such as videofluoroscopic swallowing examination, fiberoptic endoscopic evaluation of swallowing and oral pressure measurement, as well as therapeutic approaches including functional training and compensatory strategies, were examined. This review aims to provide an evidence-based framework for rehabilitation and suggests that future research should focus on the clinical translation of multimodal biomarkers and home-based rehabilitation technology to optimize the outcomes and enhance the quality of life.

Alzheimer's Disease (AD) is often accompanied by various neuropsychiatric symptoms, among which depressive symptoms are particularly common and may even appear in the preclinical stage. This paper systematically reviews the complex relationship between depressive symptoms (including subsyndromal symptomatic depression) and AD-related cognitive impairment, with a focus on the potential role of AD-characteristic brain regions such as the hippocampus. Current evidences have suggested that depressive symptoms may accelerate the progression of cognitive decline through various pathways, such as promoting brain atrophy of key brain regions, affecting neuroplasticity, and exacerbating the deposition of amyloid β-protein (Aβ). Future research should further integrate multimodal neuroimaging techniques with non-invasive biomarkers, in order to provide new theoretical basis and clinical targets for early identification and precise intervention of AD in high-risk populations.

Standardized residency training is one of the most crucial stages in the continuing education of neurology physicians, closely tied to the professional conduct of physicians. Neurology, a clinical discipline based heavily on substantial theoretical knowledge and multidisciplinary integration, requires the teaching process to not only impart essential professional knowledge and skills but also to focus on developing physicians' professionalism, advanced medical skills, humanistic qualities, and strict adherence to medical ethics. Based on the basic requirements set by the Ministry of Education for the construction of ideological and political courses, we boldly propose a "disease-political education-scenario" three-dimensional case matrix and a "three-dimensional four-step" teaching model. This approach aims to treat clinical scenarios as the third dimension of ideological and political education within courses, thereby enriching and deepening the traditional two-dimensional teaching method, making it more impact and empathetic, and allowing ideological and political education to better integrate into all aspects of neurology teaching. By employing methods such as situational simulations, role-playing, and case discussions, we aim to seamlessly incorporate ideological and political education into the entire neurology teaching process. We hope this three-dimensional case matrix can genuinely enhance residents' ethical sensitivity, communication skills, and clinical decision-making abilities. Furthermore, by learning through cases, the educational function of ideological and political elements in medical professional courses is strengthened.