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.

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.

Epilepsy is a chronic brain disease characterized by central nervous system dysfunction, and its frequent seizures have a serious impact on the quality of life for patients. At present, the primary treatment is based on Western anti-epileptic medications; however, long-term use of these drugs can lead to a series of adverse reactions. Chaihu Jia Longgu Muli Decoction, mentioned in Article 107 of the On Cold Damage (Shang Han Lun), has been commonly used by both ancient and modern physicians to treat mental and emotional diseases such as "chest fullness and agitation". In recent years, many studies have shown that this formula has a significant efficacy in treating epilepsy. Chaihu Jia Longgu Muli Decoction can exert its anti-epileptic effects by regulating neurotransmitters, enhancing the function of central nervous systems cells, and modulating inflammatory markers. This formula serves multiple functions, including harmonizing the Shaoyang, Tongyang Xiezhuo, and tranquilizing mind. Its effects are multi-targeted and systemic in nature. In the clinical treatment of patients with epilepsy, Chaihu Jia Longgu Muli Decoction has played an important role. This article offers a comprehensive overview of the recent developments regarding this formula's application in epilepsy treatment, focusing on the prescription compatibility, its underlying mechanisms of action, and relevant clinical observations.

Migraine, with its high prevalence, ranks as the second leading cause of disability among neurological disorders. Chronic migraine, in particular, imposes a greater disease burden, leads to poorer quality of life for patients, and results in higher healthcare resource consumption. Current conventional oral preventive medications often suffer from inadequate efficacy, poor tolerability, and potential drug-drug interactions, which can contribute to the persistence of headaches. This makes chronic migraine a significant clinical challenge and public health issue. Botulinum toxin type A injection has gained widespread attention as an effective preventive treatment for chronic migraine. This expert consensus is developed based on domestic and international advances in diagnosis and treatment, combined with the actual situation in China, with the aim of guiding neurologists and other relevant clinicians in the standardized use of botulinum toxin type A for the management of chronic migraine.

Autoimmune encephalitis (AE) is a group of inflammatory disorders caused by immune-mediated attacks on the central nervous system, with common clinical manifestations including psychiatric and behavioral abnormalities, cognitive and motor impairments and epileptic seizures. Conventional first-line therapies mainly rely on corticosteroids, intravenous immunoglobulin, and plasma exchange. However, a subset of patients exhibits suboptimal responses or high relapse rates, underscoring the urgent need for the development of novel therapeutic strategies. In recent years, targeted therapeutic approaches have advanced rapidly in the field of AE, primarily focusing on key immune components such as B cells, T cells, the complement cascade, and key inflammatory cytokines. Anti-CD20 monoclonal antibodies have demonstrated promising efficacy in refractory AE. Moreover, emerging agents such as ocrelizumab, epratuzumab, telitacicept, and daratumumab have provided refined strategies for the precise depletion of B cells and plasma cells. In parallel, cytokine-targeting biologics, Janus kinase inhibitors, and the proteasome inhibitor bortezomib have shown potential value for modulating aberrant immune responses. In addition, chimeric antigen receptor (CAR)-T cell immunotherapy is gradually emerging as an important frontier in exploratory research. Looking ahead, by integrating neurorestorative strategies with artificial intelligence-assisted diagnostic and therapeutic decision-making, targeted therapies are expected to drive AE management from traditional empirical immunosuppression toward a new era of precision intervention, thereby enabling more efficient and personalized disease management.

With the increasing clinical use of anti-amyloid-β (Aβ) monoclonal antibodies in Alzheimer's disease (AD) in China, some patients have completed or are approaching the predefined treatment period, leading to emerging clinical questions regarding post-treatment maintenance, discontinuation, monitoring, and retreatment. However, no consensus has yet been established on long-term management or sequential-like treatment strategies after anti-Aβ monoclonal antibody therapy. Based on current clinical evidence and the practical experience of the Cognitive Center of Renji Hospital, Shanghai Jiao Tong University School of Medicine, this article proposes an experience-based protocol for sequential-like management of anti-Aβ monoclonal antibody therapy. The protocol uses amyloid PET-derived Centiloid values as the core objective reference and recommends stratified management according to clinical clearance status and prior amyloid clearance rate. After treatment discontinuation, dynamic monitoring with plasma p-tau217 protein and amyloid PET is recommended, and an increase in the Centiloid value to >24.1 CL may serve as an important reference for restarting anti-Aβ monoclonal antibody therapy. This protocol is intended to provide a clinical reference and requires further validation and optimization through real-world studies and long-term follow-up.

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.

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.

Post-stroke depression (PSD) is one of the most common neuropsychiatric complications following stroke, with a high incidence rate. Depressive states inhibit the secretion of brain-derived neurotrophic factors and hinder neural repair. Early identification and intervention of PSD are crucial for patients' functional recovery, quality of life, and prognosis. Antidepressants can significantly improve depressive symptoms, and early use of antidepressants can also improve patients' motor and cognitive functions. Combining pharmacotherapy with exercise therapy and occupational therapy can enhance the effectiveness of drug treatment. Early intervention for PSD can correct patients' negative cognition towards post-stroke dysfunction, reduce the risk of depressive relapse, and avoid long-term psychosocial impairment.

Epilepsy is a common chronic brain disorder, with approximately 30% of patients being resistant to conventional anti-epileptic drugs, necessitating precision medicine strategies for individualized treatment. This article systematically reviews the key advances and future directions in the precision treatment of epilepsy, , with its core framework built on three main pillars. First, targeted therapies based on genetic etiology serves as the cornerstone of precision medicine. By using genetic diagnostics to identify pathogenic mutations (such as in SCN1A and KCNQ2), treatment strategies can be tailored with channel modulators, receptor antagonists, or ketogenic diets that address the underlying causes. Second, pharmacogenomics aids in the personalized selection of conventional anti-epileptic drugs by analyzing key genes such as CYP2C9 and HLA-B*15:02, effectively predicting therapeutic efficacy and preventing severe adverse reactions. Third, for drug-resistant epilepsy, precision surgical techniques and neuromodulation methods accurately localize the epileptogenic focus, providing effective intervention options for patients. In the future, integrating multi-omics data, developing of novel targeted therapies, and overcoming clinical translation bottlenecks will be crucial in making precision treatments accessible to a broader patient population.

Hereditary epilepsy refers to a type of epilepsy in which seizures are directly triggered by genetic defects and constitute the core clinical manifestation of the disease. In recent years, with the rapid advancement of gene detection technologies, the genetic mechanisms associated with epilepsy have been progressively elucidated, thereby driving progress in the precision diagnosis and treatment of the condition. Genetic testing has become a crucial tool for the clinical diagnosis and management of hereditary epilepsy. Based on in-depth analysis of specific gene mutations and pathogenic mechanisms, more targeted individualized treatment plans can be developed for patients. This article aims to focus on the etiological classification of hereditary epilepsy and the latest research advances in its precision diagnosis and treatment. Overall, the prospects for precision medicine in hereditary epilepsy are promising. Moving forward, continued multidisciplinary collaboration and sustained efforts are needed to further integrate genetics into clinical practice for epilepsy.

Vascular dementia (VaD), as the second most prevalent type of dementia after Alzheimer's disease, seriously affects the quality of life of patients. Although VaD is theoretically reversible, there is currently no definitive treatment available. Traditional Chinese Medicine (TCM) has been widely employed in VaD management due to its distinct advantages of proven efficacy, minimal adverse effects, cost-effectiveness, and multi-target intervention. The integration of TCM with modern medical approaches can better serve clinical practices. This article systematically reviews the main research advances in VaD over the past decade from both clinical treatment and basic research perspectives. It covers the current mainstream clinical interventions for VaD, along with exploratory findings regarding the mechanisms and potential targets of TCM in VaD treatment. Furthermore, considering the current trends in scientific and technological advancements, we provide insights and prospects on future research avenues and therapeutic development for VaD.

Multiple system atrophy (MSA) is a rare neurodegenerative disorder with very low incidence and prevalence worldwide. Clinically, it presents as a heterogeneous combination of autonomic failure, Parkinsonism and cerebellar ataxia. This review synthesizes current evidence on the epidemiology, subtype distribution, natural history and prognostic modifiers of MSA, with particular emphasis on the prodromal phase (e.g., rapid eye movement sleep behavior disorder and pure autonomic failure), hallmark clinical milestones after diagnosis (e.g., recurrent falls, wheelchair dependence, dysphagia, and inspiratory stridor), and key determinants of disease progression (including age at onset, severity of autonomic involvement, motor subtype and levodopa responsiveness). The clinical features and prognostic contrasts between young-onset and late-onset MSA are examined, and the future priorities focusing on biomarker development, early diagnosis and prodromal detection, and optimization of multidisciplinary care strategies are highlighted, aiming to inform clinical practice and interventional research.

Epilepsy is a chronic neurological disorder often complicated by drug resistance and comorbidities, with limited benefits from conventional therapies. This review explores the role of neuro-immune interactions in epilepsy, detailing a core mechanism where seizures disrupt the blood-brain barrier, enabling immune cell infiltration and activating glial cells to release pro-inflammatory factors, thus perpetuating a vicious cycle. Key signaling pathways are also discussed. The article surveys diagnostic advances, including neuro-immune biomarkers and technologies like multimodal imaging and single-cell sequencing. For treatment, immunomodulatory strategies—such as targeting inflammation, modulating glial cells or gut microbiota, and cell therapies—as well as the development of novel anti-seizure medications​ are summarized. Current challenges involve controversies over immune cell functions and inflammatory causality, as well as limitations in animal models and clinical translation. Future directions like multi-omics integration, artificial intelligence, and novel delivery systems are highlighted, offering a new paradigm for precise, etiology-targeted therapy in drug-resistant epilepsy.

Cervical dystonia (CD) is the most common type of adult-onset focal dystonia, which can significantly impair patients' self-care ability and quality of life. Current mainstream therapeutic approaches include botulinum toxin therapy, pharmacotherapy, surgical treatment, physical therapy, psychological therapy, and characteristic therapies of traditional Chinese medicine (TCM). This paper conducts a literature review on the existing therapeutic modalities for CD and summarizes the efficacy, safety and limitations of different interventional measures. It is found that the existing therapies exert definite effects in managing the motor symptoms of CD, whereas obvious deficiencies remain in the efficacy evaluation and clinical attention to non-motor symptoms such as depression and anxiety. Future research should focus on exploring multimodal individualized treatment regimens integrating pharmacotherapy, surgery, rehabilitation and psychological intervention, so as to achieve precise matching of patients' treatment needs and comprehensive improvement of their quality of life.

Vascular cognitive impairment (VCI) is the second most common type of cognitive disorder in the elderly population, ranking only after Alzheimer's disease, with its clinical spectrum encompassing the entire progression from mild cognitive impairment to vascular dementia. Inflammaging, a prevalent low-grade chronic inflammatory state during aging, is closely associated with various age-related diseases, and has been confirmed to play a pivotal role in the occurrence and progression of VCI. The neurovascular unit (NVU), a core structure for maintaining normal brain function, consists of neurons, glial cells, vascular endothelial cells, pericytes, and the basement membrane. Through a complex intercellular signaling network, the NVU collaboratively regulates cerebral blood flow, maintains blood-brain barrier integrity, and provides the metabolic support for neuronal activity. This review focuses on the NVU to systematically elucidate the mechanisms by which inflammaging contributes to the development of VCI, aiming to reveal the intrinsic relationship between inflammaging and VCI from an inflammatory perspective and provide a theoretical basis for a deeper understanding of the pathophysiological processes of VCI.

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.

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.

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.

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.

Vascular dementia (VaD) is the second most common type of dementia after Alzheimer's disease, and its pathogenesis is closely related to chronic cerebral ischemia, neuroinflammation, and neuronal apoptosis. Recent studies have indicated that endoplasmic reticulum stress (ERS) plays a critical role in the pathological process of VaD. Cerebral ischemia and hypoxia can lead to the accumulation of unfolded/misfolded proteins in the endoplasmic reticulum lumen, triggering the unfolded protein response (UPR). Persistent ERS excessively activates core signaling pathways such as protein kinase RNA-like endoplasmic reticulum kinase (PERK)-eukaryotic translation initiation factor 2A (eIF2α)-activating transcription factor (ATF)4-C/EBP homologous protein (CHOP), inositol-requiring enzyme 1 (IRE1)α-X-box binding protein 1 (XBP1), and ATF6, ultimately inducing neuronal apoptosis. This article reviews the mechanism of ERS in VaD and focuses on the potential strategies of traditional Chinese medicine (TCM) for preventing and treating VaD. Research has shown that various TCM compound formulations (e.g., Taohong Siwu Decoction, and Buyang Huanwu Decoction) and TCM extracts (e.g., crocin, and tetrahydroxystilbene glucoside) can effectively inhibit ERS through multi-target and multi-pathway synergistic effects, alleviate oxidative stress and neuroinflammation, reduce neuronal apoptosis, and thereby improve cognitive function. Targeting the regulation of ERS provides a new direction for VaD treatment. In-depth research into the specific molecular mechanisms of TCM in preventing and treating VaD via the ERS pathway holds significant theoretical value and clinical translation prospects.

Objective: To evaluate the effectiveness of integrating the evidence-based medicine (EBM) PICOS framework with case-based learning (CBL) in the teaching of neurorehabilitation.

Methods: A total of 100 third-year undergraduates majoring in rehabilitation therapy at Changsha Medical University (Class of 2021) were randomly assigned into two groups through stratified randomization: a reform group and a control group, with 50 students in each. In the neurorehabilitation course, the control group received traditional teaching methods (lecture-based learning), while the reform group was taught using the EBM-PICOS framework combined with CBL. After course completion, teaching effectiveness was compared between the two groups across three dimensions: academic performance, learning outcomes, and clinical internship adaptability.

Results: Compared with the control group, the reform group demonstrated statistically significant improvements in academic performance and clinical internship adaptation scores (P<0.05). The reform group also showed superior learning outcomes in seven aspects: learning engagement, self-directed learning competency, evidence-based practice proficiency, literature retrieval skills, clinical reasoning ability, applied knowledge integration, and professional identity (all P<0.05). However, no statistically significant difference was observed in medical ethics and professionalism between the two groups (P>0.05).

Conclusion: The integration of the EBM-PICOS framework with CBL enhances teaching effectiveness in neurorehabilitation and effectively cultivates rehabilitation competency among rehabilitation therapy students.

This article reports a case of an elderly female who presented with instability in standing and walking. She had a long-term vegetarian diet and experienced nutritional deficiency in the three months preceding onset. Cervical spinal MRI revealed an "inverted V sign" in the posterior columns. Based on the patient's symptoms, signs, auxiliary examinations, and treatment follow-up results, a final diagnosis of subacute combined degeneration was made. By reviewing the pathophysiological mechanism of the "inverted V sign" as a distinctive imaging manifestation, this article explores the differential diagnostic considerations for this radiological finding.

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.

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.

Objective： To evaluate the effects of botulinum toxin type A (BTX-A) injection combined with serial plaster casting on fine motor function and upper limb spasticity in children with spastic cerebral palsy (CP).

Methods： A total of 119 children with CP were stratified according to clinical subtype and Manual Ability Classification System (MACS) level, and then randomly divided into an experimental group (n=61) and a control group (n=58) using a random number table. The control group received a single BTX-A injection combined with conventional upper limb rehabilitation training and guidance. The experimental group received additional serial plaster casting. Therapeutic effects were assessed using the Fine Motor Function Measure (FMFM) and the Modified Tardieu Scale (MTS), which assessed spasticity using parameter X, before BTX-A injection, at 1 month, and at 3 months after injection.

Results： At 1 month after treatment, FMFM scores and MTS parameter X scores significantly improved in both groups (P < 0.05), with the experimental group showing superior outcomes compared to the control group (P < 0.05). At 3 months, all scores in the experimental group remained improved despite a slight decrease, while in the control group, all indicators except for elbow extension showed no statistically significant difference compared to those at 1 month post-treatment.

Conclusion： BTX-A combined with conventional upper limb rehabilitation training can significantly improve upper limb muscle spasticity and large-joint motor function in children with CP. The addition of serial plaster casting helps to further enhance hand function and prolong the therapeutic effect.

Objective To enhance the efficiency of medical visits for patients with cognitive and emotional issues and the productivity of physicians, Longhua Hospital, Shanghai University of Traditional Chinese Medicine and Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine have jointly established an outpatient clinic for the integrated traditional Chinese and western medicine diagnosis and treatment of amnesia and emotional management disorders. This article aims to explore the clinical value of this outpatient clinic, providing important clinical practice templates and preliminary data support for future in-depth mechanistic research and efficacy verification. Methods A retrospective descriptive analysis was conducted on the outpatient settings and visits to the outpatient clinic for amnesia and emotional management disorders treated with integrated traditional Chinese and western medicine from August 16, 2023, to October 29, 2025. Results The outpatient clinic for amnesia and emotional management disorders treated with both traditional Chinese and western medicine received a total of 540 patients, including 236 males (43.70%) and 304 females (56.30%); 368 adults (68.15%) and 172 minors (31.85%). The patient return visit rate was 20.00%, and the overall patient satisfaction rate was 89.45%. The most common disease treated was Alzheimer's disease (31.11%), followed by depression (23.15%), anxiety disorders (20.93%), and insomnia disorders (11.48%). Bipolar affective disorder (2.78%) and schizophrenia (3.15%) were less common. The most common treatment approach was the combination of traditional Chinese and western medicine (57.59%), followed by pure western medicine treatment (13.07%) and the combination of western medicine with traditional Chinese medicine and psychological therapy (11.67%). Conclusion The outpatient clinic for amnesia and emotional management disorders treated with integrated traditional Chinese and western medicine features a wide age distribution of patients (6-89 years old), a variety of diseases, high patient satisfaction, and a steady increase in outpatient volume. This study provides a reproducible operational blueprint for peers by integrating the application of traditional Chinese medicine's syndrome differentiation and Western psychiatry within the bio-psycho-social medical model, offering valuable reference for optimizing clinical services.

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.

Objective: To investigate the neurological clinical manifestations, diagnosis, and key treatment strategies of acute intermittent porphyria (AIP), with the aim of improving early recognition and standardized management of the disease.

Methods: The clinical data of a patient who presented with abdominal pain and seizures at disease onset was reported, and a literature review regarding the clinical features, pathogenesis, diagnosis, differential diagnosis, and treatment of AIP was conducted.

Results: The patient successively developed acute abdominal pain, epileptic seizures, and predominantly proximal motor axonal neuropathy. Urinary porphobilinogen (PBG) levels were significantly elevated, and genetic testing revealed a heterozygous mutation in the hydroxymethylbilane synthase (HMBS) gene.

Conclusion: The neurological manifestations of AIP exhibited a characteristic temporal pattern of evolution, and urinary PBG screening is crucial for early diagnosis. Early initiation of hemin therapy is essential to halt disease progression and improve clinical outcomes.

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.

Social cognition is a core ability that enables individuals to recognize others' emotions and intentions and relies on a highly coordinated social brain network (SBN), which includes key brain regions such as the fusiform gyrus, amygdala, and medial prefrontal cortex. As a network disorder, epilepsy not only causes seizure manifestations but also disrupts the structure and function of the SBN through direct involvement of epileptogenic foci or the remote propagation of abnormal discharges, leading to social cognitive impairments such as difficulties in emotion recognition, deficits in theory of mind, impaired empathy, and abnormalities in social decision-making. Children and adolescents with epilepsy are particularly vulnerable to deviations in social cognitive development because their brain networks are still undergoing maturation. This review systematically elaborates on the neural underpinnings and clinical manifestations of the SBN in epilepsy, as well as its developmental characteristics in children and adolescents, and proposes a clinically translatable pathway from assessment to intervention. Furthermore, it emphasizes the integration of neuroimaging, neuropsychological assessment, and multimodal rehabilitation strategies to promote a paradigm shift in epilepsy management from seizure control to the improvement of social functioning.

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.

Vascular cognitive impairment (VCI) refers to a clinical syndrome primarily characterized by cognitive dysfunction caused by damage to brain tissue due to cerebrovascular disease. Its etiology is complex and diverse, encompassing underlying diseases, genetics, immunology, environmental factors, and other aspects. Most cases of VCI exhibit a chronic, insidious, and progressive onset, involving multiple clinical stages. Currently, modern medicine primarily focuses on treating individual etiologies, with considerable research on stroke prevention and treatment. Clinically, it is advisable to follow modern medical methods, control controllable risk factors, and intervene and treat early to achieve better primary or secondary prevention effects and delay disease progression. Regarding the cognitive impairment associated with VCI, modern medicine has not yet discovered effective therapeutic drugs. However, ancient Chinese medical texts contain treatment plans for corresponding conditions. Therefore, combining basic western medical treatment with traditional Chinese medicine (TCM) for the prevention and treatment of this disease has become a current research hotspot. This paper aims to explore the advancements in the prevention of VCI by collating preventive measures for VCI in ancient Chinese medical literature and combining them with modern medical methods, providing a reference for clinical practice.

Through a case report of Creutzfeldt-Jakob disease (CJD) featuring the cortical ribbon sign on cranial MRI, this article reviews the pathophysiological mechanism of this specific neuroimaging sign. It proceeds to explore the sign's association with a range of neurological diseases and its significance in diagnosis and differential diagnosis.

目的：提高临床上对幽门螺杆菌（Helicobacter pylori，Hp）与吉兰-巴雷综合征（Guillain-Barre syndrome，GBS）相关性的认识。

方法：报告1例Hp感染治疗后出现GBS患者的临床诊治经过，结合文献复习，重点探讨Hp感染与GBS的相关性。

结果：患者急性起病，前驱有Hp感染史。以消化道症状为首发表现，症状逐渐加重，进而出现双下肢对称性无力，腱反射减弱。脑脊液检查发现蛋白-细胞分离现象。电生理检查提示周围神经脱髓鞘改变，表现为远端运动神经传导潜伏期延长、传导速度减慢、F波异常、传导阻滞及波形离散。患者最终诊断为GBS，予以标准免疫治疗后，患者预后良好。

结论：对于接受Hp治疗的患者，若出现急性消化道及周围神经系统相关症状，临床上应早期识别是否为Hp感染诱发的GBS，以期做到早诊断和早治疗，改善患者预后。

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.

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.

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.