Objective To investigate the surface electromyography （sEMG） characteristics of drug-induced tremor， and to identify electrophysiological biomarkers for differentiating it from tremor caused by Parkinson disease （PD）. Methods A total of 50 patients with drug-induced tremor and 71 patients with PD were enrolled. The sEMG signals from bilateral radial wrist extensors and flexors，along with accelerometer signals， were recorded under resting and postural conditions.Tremor frequency，amplitude，contraction pattern，and harmonic resonance were analyzed. Results The patients in the drug-induced tremor group exhibited symmetrical bilateral tremor， with a higher proportion of patients with mandibular tremor compared with the PD group（70% vs 42.25%，χ2=9.09，P=0.003）.Compared with the PD group， the drug-induced tremor group had a significantly higher tremor frequency under both resting and postural conditions[（6.43±0.41）Hz/（6.57±0.33）Hz vs （4.68±0.27）Hz，F=620.64，P<0.001]， while there was no significant difference in tremor amplitude. Compared with the PD group， the drug-induced tremor group had a significantly lower proportion of patients with alternating contraction pattern under both resting （χ2=23.20，P<0.001） and postural（χ2=27.52，P<0.001） conditions， as well as a significantly lower proportion of patients with harmonic resonance under both resting（χ2=26.64，P<0.001） and postural（χ2=22.32，P<0.001） conditions. Conclusion Drug-induced tremor has the following electrophysiological features：bilateral symmetry，a higher prevalence rate of mandibular tremor， a higher tremor frequency，and a lower proportion of patients with alternating contraction pattern and harmonic resonance， which can provide objective evidence for differentiating drug-induced tremor from PD in clinical practice.
Objective To compare the differences in non-motor symptoms between the patients with Parkinson disease （PD） carrying LRRK2 G2385R mutation and those without such mutation， and to identify key clinical features. Methods The patients who were consecutively admitted to Xuanwu Hospital， Capital Medical University， from January to November 2025 and were diagnosed with PD were enrolled. According to the results of genetic testing， the patients were divided into carrier group and non-carrier group， and other known pathogenic mutations were excluded. Demographic data and the results of multiple clinical scales were collected， including UPDRS-Ⅲ，NMSS，MMSE，MoCA，HAMA，HAMD， RBDQ-HK， and olfactory questionnaire. Traditional statistical methods and Elastic Net regression were used for comparison between the two groups. Results A total of 292 PD patients were enrolled，among whom there were 27 carriers and 265 non-carriers， and there were no significant differences between the two groups in sex， age of onset， disease duration， and motor symptoms （all P>0.05）. The univariate analysis showed that the carrier group had a significantly lower RBDQ-HK score than the non-carrier group （P<0.05）. The Elastic Net analysis further revealed that RBD symptoms， olfactory function， and overall non-motor symptom burden were negatively correlated with the carrier status， while anxiety score was positively correlated with the carrier status，suggesting a relatively milder burden of non-motor symptoms in carriers. Conclusion There are no significant differences in motor symptoms between LRRK2 G2385R carriers and non-carriers， but LRRK2 G2385R carriers have a distinctive non-motor symptom phenotype， especially milder RBD symptoms.The multivariate analysis suggests that the carrier status may be associated with a lower burden of non-motor symptoms， which may help to deepen the understanding of clinical heterogeneity in genetic subtypes of PD and provide a reference for individualized assessment.
Objective To investigate the feasibility and efficacy of bilateral globus pallidus internus deep brain stimulation （GPi-DBS） as a rescue treatment strategy after failed subthalamic nucleus deep brain stimulation （STN-DBS） in the management of Parkinson disease （PD）. Methods A retrospective analysis was conducted on two patients who had undergone STN-DBS treatment at another hospital for Parkinson’s disease （PD） but showed poor therapeutic response. After evaluation at the Central Hospital affiliated with Shandong First Medical University confirmed that efficacy could not be restored through parameter optimization or medication adjustment， both patients underwent a procedure to retain their original STN-DBS system and implant bilateral GPi-DBS systems. Following the deactivation of the STN-DBS， surgical outcomes were assessed by comparing preoperative and postoperative Unified Parkinson's Disease Rating Scale Part Ⅲ（UPDRS-Ⅲ） scores under conditions of active GPi-DBS， as well as during "on" and "off" medication periods. Results Both patients successfully retained their original STN-DBS systems and underwent uneventful implantation of bilateral GPi-DBS systems， without complications such as bleeding or infection. Six months postoperatively， Patient 1 showed a UPDRS-Ⅲ improvement rate of 61.21% during the "on" medication phase and 68.92% during the "off" medication phase with GPi-DBS activated. Patient 2 demonstrated an improvement rate of 55.81% during the "on" medication phase and 59.34% during the "off" medication phase under GPi-DBS activation. Both patients exhibited significant improvements in dyskinesia， speech， and balance. Conclusion Retaining the original STN system with simultaneous bilateral GPi-DBS reimplantation may be a safe and effective rescue treatment strategy for PD patients who experience a decline in efficacy or severe complications following STN-DBS surgery that cannot be improved by optimizing medication or programming parameters.
Rigidity is a core motor symptom of Parkinson disease（PD），characterized by uniformly increased resistance during passive muscle stretching. It can be classified into two types：lead-pipe rigidity and cogwheel rigidity. This review systematically summarizes the pathophysiological mechanisms underlying rigidity in PD，including enhanced long-latency stretch reflexes， the combined effects of shortening reaction and stretch-induced inhibition，functional abnormalities in brainstem and cortico-basal ganglia-cerebellar circuit， and alterations in muscle biomechanical properties.This review also summarizes recent advances in objective assessment methods such as electromyography，ultrasound elastography， servo motors， and inertial sensors.Studies indicate that rigidity in PD results from the interaction between abnormal neural regulation and changes in muscle biomechanical properties，with assessment methods evolving from subjective clinical scoring toward multimodal objective quantification.A deeper understanding of the mechanisms and assessment methods of rigidity is crucial for the diagnosis and treatment of PD.
The pathological mechanism of neurogenic orthostatic hypotension （nOH） in Parkinson disease （PD） is shifting from peripheral sympathetic denervation to central network dysfunction. This article explores the core role of locus coeruleus （LC） degeneration and abnormalities in the central autonomic network （CAN） and the somato-cognitive action network （SCAN） in the pathogenesis of nOH. A current research challenge lies in determining whether network hyperconnectivity is physiological compensation or a pathological marker， with a lack of longitudinal multimodal imaging data. Based on the novel understanding of CAN/SCAN impairment， the treatment of PD with nOH is transitioning towards precise neuromodulation paradigms， including SCAN-targeted cortical stimulation， epidural spinal cord stimulation， and closed-loop neuromodulation， which provides new perspectives for individualized management in clinical practice.
Parkinson disease （PD） is a degenerative disease of the nervous system with the main pathological change of nigral-striatal dopaminergic pathway degeneration， mainly manifesting as motor dysfunction. However， in recent years， more and more studies have started to investigate the non-motor symptoms of PD， among which impulse control disorders （ICD）， as one of the most common non-motor symptoms of PD， seriously affects the quality of life of patients. ICD has complex pathogenesis and risk factors， which remain unclear at present. With the development of imaging technology， neuroimaging techniques can help to evaluate the brain structure and function of PD-ICD patients， thereby helping to explore the pathogenesis of ICD and assist in its diagnosis and treatment. Therefore， this article reviews the advances in neuroimaging studies of ICD in PD.
Parkinson disease is a degenerative disorder of the central nervous system characterized by progressive loss of dopaminergic neurons in the midbrain substantia nigra. Pain is one of the most common non-motor symptoms of Parkinson disease， and its pathogenesis remains unclear at present. Structural damage to the substantia nigra may contribute to the development and progression of pain symptoms in such patients. This article reviews the physiological significance of the substantia nigra and summarizes the research advances in its role in mediating the pathogenesis of pain in Parkinson disease.
Parkinson disease （PD） is one of the most common neurodegenerative diseases all over the world， and its prevalence rate is constantly increasing， which brings a huge physical and psychological burden to patients， as well as a heavy care and economic burden to their families. Cognitive impairment， as one of the common non-motor symptoms in PD， has attracted more and more attention in recent years due to the difficulty in early identification， rapid clinical progression， unsatisfactory treatment efficacy， and poor prognosis. At present， the research on PD-associated cognitive impairment is gradually deepening， from pathophysiological mechanism to clinical manifestations and how to achieve early effective diagnosis and treatment， so as to minimize the pain of patients， especially elderly patients and their families. This article discusses the pathogenesis， clinical manifestations， and treatment methods of cognitive impairment in PD at present， in order to better review the current research advances and provide more ideas for future research directions.
Objective To investigate the characteristics of nystagmus during the attack of vestibular migraine， and to provide a basis for the precise diagnosis and pathogenesis clarification of vestibular migraine. Methods A total of 70 patients with vestibular migraine from the Department of Neurology， Xuanwu Hospital， Capital Medical University， from September 2022 to May 2025 were enrolled， among whom 37 patients had a confirmed diagnosis of vestibular migraine and 33 had probable vestibular migraine. The characteristics of spontaneous nystagmus and positional nystagmus during attack were collected and analyzed. Results Among the 70 patients with nystagmus during the attack of vestibular migraine， 37 presented with spontaneous nystagmus and 33 had positional nystagmus. Among the patients with spontaneous nystagmus， 51.35% had horizontal nystagmus， 29.73% had horizontal nystagmus with a torsional component， 13.51% had downbeat nystagmus， and 5.41% had horizontal nystagmus with downbeat nystagmus. Among the patients with positional nystagmus， 60.60% had unidirectional positional nystagmus， 15.15% had bidirectional positional nystagmus， and 8 patients （24.24%） showed multiple types of nystagmus at the same time during examinations at different head positions. Conclusion Different types of nystagmus during the attack of vestibular migraine may involve different pathophysiological mechanisms. Spontaneous horizontal nystagmus with or without a torsional component may be related to the interaction between the vestibular nucleus and the trigeminocervical complex and multisensory integration mechanisms； spontaneous downbeat nystagmus may be associated with the modulation of oculomotor pathways by the cerebellar flocculus； various types of positional nystagmus may be related to abnormal signal integration between the semicircular canals and the otolith organs. Nystagmus during the attack of vestibular migraine is characterized by diversity， complexity， and atypical manifestation， and mastering the characteristics of nystagmus during the attack of vestibular migraine is of great importance for the diagnosis of vestibular migraine.
Objective To investigate the characteristics of vulnerable plaques and related risk factors in male patients with moderate-to-severe atherosclerotic stenosis of the carotid artery. Methods A retrospective analysis was performed for 214 male patients who were consecutively admitted to Stroke Center of The First People’s Hospital of Changde City from January 2024 to March 2025 and was diagnosed with moderate-to-severe atherosclerotic stenosis of the carotid artery by color Doppler flow imaging. According to the nature of plaque， the patients were divided into vulnerable plaque group with 146 patients and non-vulnerable plaque group with 68 patients. A univariate analysis was used for comparison of baseline data and plaque characteristics between the two groups， and a multivariate Logistic regression analysis was used to identify the risk factors for vulnerable plaques in male patients with moderate-to-severe atherosclerotic stenosis of the carotid artery. Results The univariate analysis showed that compared with the non-vulnerable plaque group， the vulnerable plaque group had a significantly higher proportion of patients with overweight， ≥3 risk factors for stroke， stroke history， hyperlipidemia， low-echo dominance and ulcerative plaques ，along with greater BMI and plaque thickness （P<0.05），as well as significantly lower age and proportion of patients with regular plaque morphology or intact fibrous cap（P<0.05）. The multivariate Logistic regression showed that BMI （OR=1.224，95%CI 1.087‒1.390， P<0.01） and plaque thickness（OR=2.523， 95%CI 1.591‒4.188，P<0.01） were risk factors for vulnerable plaques. Conclusion There are multiple risk factors for plaque vulnerability in culprit vessel stenosis in male patients with moderate-to-severe atherosclerotic carotid stenosis， and specifically， BMI and plaque thickness are identified as risk factors for vulnerable plaques.
Objective To investigate the impact of serum interleukin-6 （IL-6） and high-sensitivity C-reactive protein （hs-CRP） on the prognosis of elderly patients with acute ischemic stroke （AIS） and severe pneumonia （SP）. Methods A total of 172 elderly patients with AIS and SP who were admitted to our hospital from January 2022 to March 2025 were enrolled， and according to their 90-day follow-up results， they were divided into death group and survival group. The two groups were compared in terms of the serum levels of IL-6 and hs-CRP and general information； a multivariate logistic regression analysis was used to identify independent influencing factors for the prognosis of elderly patients with AIS and SP； the receiver operating characteristic （ROC） curve analysis was used to evaluate the value of IL-6 and hs-CRP used alone or in combination， as well as age and National Institutes of Health Stroke Scale （NIHSS） score， in predicting the prognosis of patients with AIS and SP. Results Among the 172 patients after follow-up for 90 days， 10 were lost to follow-up， and the remaining 162 patients had a 90-day mortality rate of 38.89%. The death group had significantly higher serum levels of IL-6 and hs-CRP than the survival group （P<0.05）. The multivariate logistic regression analysis showed that an older age （OR=2.105，95%CI 1.142‒3.880， P<0.05）， an increase in NIHSS score （OR=3.259， 95%CI 1.469-7.229， P<0.05）， the presence of dysphagia （OR=2.317，95%CI 1.344‒3.995，P<0.05）， and an increase in IL-6 （OR=2.862，95%CI 1.435‒5.707， P<0.05）， and an increase in hs-CRP （OR=3.834，95%CI 1.656‒8.874，P<0.05） were risk factors for poor prognosis in elderly patients with AIS and SP.The ROC curve analysis showed that IL-6 and hs-CRP had a larger area under the ROC curve （AUC） than age and NIHSS score in predicting poor prognosis in elderly patients with AIS and SP， and pairwise comparisons showed that combined measurement of IL-6 and hs-CRP had a larger AUC than IL-6 or hs-CRP alone in predicting poor prognosis in elderly patients with AIS and SP （Z=2.663， P=0.0077； Z=2.197，P=0.028）. Conclusion Age， NIHSS score， comorbidity with dysphagia， IL-6， and hs-CRP are independent risk factors for the prognosis of elderly patients with AIS and SP， and the combination of IL-6 and hs-CRP has a relatively high value in predicting poor prognosis in elderly patients with AIS and SP.
Objective To investigate the dynamic changes in cerebral perfusion pressure （CPP） and plasma biomarkers in patients with severe ischemic stroke （IS）， as well as their association with neurological function. Methods A retrospective analysis was performed for the clinical data of 121 patients with severe IS who attended our hospital from July 2022 to July 2023， and according to the prognosis， the patients were divided into good prognosis group with 89 patients and poor prognosis group with 32 patients. Clinical data were compared between the two groups， and the dynamic changes in CPP were monitored within 14 days after admission， as well as the changes in plasma biomarkers. A hierarchical regression analysis was used to investigate the association between the influencing factors for severe IS and the level of CPP； the LOWESS method was used to analyze the linear relationship between CPP parameters and plasma biomarkers in the poor prognosis group；a joint model was established to evaluate the association between the rate of increase in CPP and poor prognosis. The restricted cubic spline model and the decision curve analysis were used to investigate the association between CPP and prognosis. Results There were significant differences between the good prognosis group and the poor prognosis group in infarct area，National Institutes of Health Stroke Scale score， microtubule-associated protein （Tau）， neuron-specific enolase （NSE），neurofilament light chain（NFL），and β-amyloid（Aβ）（P<0.05）.Both groups had gradual increases in CPP within 2 weeks after admission，and the good prognosis group had significantly higher values than the poor prognosis group； both groups had gradual reductions in the levels of Tau， NSE， Aβ and NfL，and the poor prognosis group had significantly higher values than the good prognosis group. The hierarchical regression analysis showed that the increases in Tau， NSE， Aβ， NfL and the reduction in CPP were risk factors for severe IS（P<0.05）. The LOWESS analysis showed a nonlinear negative correlation between CPP and Tau/NSE/NFL/Aβ.The joint model showed that the risk of poor prognosis was increased by 1.17 times for every unit decrease in CPP.The decision curve analysis showed that CPP had a certain practical value in clinical decision-making. Conclusion This study shows that there is a linear relationship between CPP and plasma biomarkers in patients with severe IS， and a low rate of increase in CPP is associated with an increase in the risk of poor neurological function， which provides an important reference for early identification of high-risk patients in clinical practice.
Objective To explore the correlations between lipoprotein（a） [LP（a）] levels and the characteristics of cerebral microbleeds （CMBs） in patients with acute cerebral infarction （ACI）， and to provide a basis for clinical evaluation of the risk of cerebral small vessel injury. Methods A retrospective study was conducted on 258 ACI patients admitted to the Department of Neurology， Anting Hospital of Jiading District， Shanghai between March 2023 and May 2024. According to the results of cranial magnetic resonance susceptibility-weighted imaging， the patients were divided into the CMB group （90 cases） and the non-CMB group （168 cases）. Demographic data， underlying disease history， lifestyle， and blood lipid-related laboratory indicators of the two groups were collected， and the differences in indicators between the groups were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for CMB in ACI patients. The correlations between blood lipid indicators such as LP（a） and the number and location of CMB were further analyzed. Results Age， the proportions of patients with hypertension， diabetes， and smoking history， and LP（a） level in the CMB group were significantly higher than those in the non-CMB group， while the level of high-density lipoprotein cholesterol （HDL-C） was significantly lower （P<0.05）. There were no significant differences in total cholesterol， triglycerides， and low-density lipoprotein cholesterol between the two groups （P>0.05）. Multivariate logistic regression analysis showed that advanced age， history of hypertension， hypo-HDL-cholesterolemia， and hyperlipoproteinemia（a） were independent risk factors for CMB in ACI patients. Correlation analysis suggested that the number of CMB was positively correlated with LP（a） and negatively correlated with HDL-C. LP（a） levels were higher and HDL-C levels were lower in patients with deep/infratentorial CMB than in patients with lobar CMB （P<0.05）. Conclusion Hyperlipoproteinemia（a） and hypo-HDL-cholesterolemia are closely related to the occurrence of CMB in ACI patients， and may be related to the number and location of CMB. Clinically， it is necessary to focus on monitoring the levels of LP（a） and HDL-C in ACI patients for early prevention and control of cerebral small vessel disease and the risk of microbleeds.
Objective To investigate the expression levels of inflammatory factors and the mTOR signaling pathway in a mouse model of Alzheimer disease and their association with the course of the disease， as well as the therapeutic effect of donepezil in mice with severe Alzheimer disease. Methods C57BL6 mice， aged 8 weeks， were given intraperitoneal injection of different doses （60， 120， and 180 mg/kg） of D-galactose to induce mild， moderate， and severe Alzheimer disease， and the mice in the 180 mg/kg D-galactose group were given Aricept by gavage at a dose of 5 mg/kg as the treatment group. Behavioral experiments （water maze， Y maze， and novel object recognition test） were used to observe the change in cognitive ability； Western blotting was used to measure the expression levels of proteins associated with the mTOR signaling pathway； ELISA was used to measure the expression levels of the peripheral blood inflammatory factors interleukin-6 （IL-6）， interleukin-1β （IL-1β）， and tumor necrosis factor-α （TNF-α）； the Pearson test was used to investigate the correlation between inflammatory factors and the course of the disease in each group. Results The behavioral experiments showed that compared with the control group， the mice in each model group had different degrees of cognitive impairment （P<0.05）， and donepezil treatment could reverse such changes （P<0.05）. Western blotting showed varying degrees of abnormal activation of the mTOR signaling pathway in each model group （P<0.05）， and the degree of activation increased with the increase in the dose of D-galactose （P>0.05）； donepezil treatment could reverse such changes （P<0.05）. ELISA showed that there were abnormal increases in the expression levels of the peripheral blood inflammatory factors IL-6， IL-1β， and TNF-α in each model group （P<0.05）， and the increases in these factors increased with the dose of D-galactose； the expression levels of IL-6 and TNF-α were positively correlated with the dose of D-galactose. Conclusion The mTOR signaling pathway is abnormally activated in mice with Alzheimer disease， with abnormal increases in the levels of inflammatory factors， and the increases in inflammatory factors are associated with the course of the disease. Aricept has a therapeutic effect in mice with severe Alzheimer disease.
This study aims to analyze the clinical and imaging features of myelin oligodendrocyte glycoprotein （MOG） antibody-associated disorders through a retrospective analysis of the clinical data of a patient with anti-MOG antibody-associated brainstem encephalitis， including medical history， clinical manifestations， and cranial magnetic resonance imaging （MRI） findings. The patient had the main clinical manifestations of headache， dizziness， and ataxia， and cranial MRI revealed symmetric lesions in the bilateral pons， midbrain， and thalamus.In summary，anti-MOG antibody-associated brainstem encephalitis may have the imaging features of symmetric involvement of the intracranial midline structures.
Primary hypereosinophilic syndrome manifests as clonal proliferation of eosinophils （>1.50×109/L） in peripheral circulation， accompanied by damage to other tissues and organs， and at present， there are relatively few case reports on cerebral infarction caused by this disease in China. This article reports a case of multiple acute cerebral infarctions caused by this disease， in which the patient had abdominal pain as the initial presentation， accompanied by an increase in troponin. Then the patient developed multiple acute cerebral infarctions in the anterior and posterior circulation regions at both sides， and clinical symptoms were significantly improved after treatment with hormones and imatinib. This case report aims to improve the awareness of hypereosinophilic syndrome among clinicians. A confirmed diagnosis should be made as early as possible and treatment should be performed actively to improve prognosis.
Ischemic stroke （IS） is the nervous system disease with the highest mortality and disability rates worldwide， and current treatment strategies still have limitations in early identification， reperfusion risk assessment， and long-term management. The emergence of artificial intelligence （AI） provides new opportunities for full-cycle interventions in IS. Radiomics and deep learning models based on CT/MRI can enhance the accuracy of lesion detection and therapeutic decision-making， while electronic health record-driven models have shown a certain value in predicting mortality， complications， and healthcare resource utilization， and models integrating physiological signals and molecular markers are further applied in the monitoring of cognitive impairment and recurrence risk. Recent studies increasingly emphasize explainability， calibration， and clinical accessibility， while they are often constrained by sample heterogeneity， insufficient external validation， and privacy compliance challenges. This article summarizes the research advances in AI in IS over the past three years， focuses in multimodal modeling and clinical applications， and discusses its potential and limitations in precise diagnosis and treatment， in order to provide a reference for the development of intelligent stroke management.
Vestibular migraine （VM） is a neurological disorder characterized by headache and a series of vestibular symptoms. The symptoms of VM include vertigo， headache， nausea， vomiting， and hyperesthesia （photophobia and phonophobia）， and acute attacks typically last for a period of time ranging from 5 minutes to 72 hours， with varying degrees of impact on the quality of life of patients. The Bárány Society and the International Headache Society have established the diagnostic criteria for VM based on clinical symptoms；however，there is still a lack of consensus on the pathogenesis of VM， without pathophysiological criteria for diagnosis.The treatment methods for VM mainly include pharmacotherapy， behavioral therapy. The research on VM is ongoing， and this article reviews the pathogenesis of VM， in order to explore more effective diagnostic and therapeutic strategies.
Medical Publishing Centre of The First Hospital of Jilin University