Orthostatic hypotension （OH） is the main symptom of cardiovascular autonomic dysfunction in the elderly population，which often manifests as orthostatic dizziness，syncope，and traumatic falls. OH often has a poor prognosis and is one of the causes of cognitive impairment in the elderly，and therefore，it is important to explore the pathogenesis of OH and related interventions. The vestibular system participates in orthostatic blood pressure regulation through vestibular sympathetic reflex，and dysfunction of the vestibular system can lead to the dysfunction of orthostatic blood pressure regulation，which further leads to OH. Previous studies have shown that galvanic vestibular stimulation （GVS） can regulate the function of the cardiovascular system，and different stimulation parameters have different target effects on blood pressure. This article summarizes the role of vestibular system and GVS in orthostatic blood pressure regulation，in order to provide a reference for the future research on the application of GVS in the treatment of OH.

This study reports a pair of sisters with generalized dystonia and 3-methylglutaconic aciduria，including clinical phenotype analysis and genetic testing. Through medical history collection，imaging and laboratory examinations，and genetic analysis，it was found that the two patients had a homozygous mutation，c.1687T>C，in the Serac1 gene on chromosome 6，which was located at exon 16. The Serac1 gene mutation with adolescent-onset generalized dystonia as the main clinical phenotype has not been reported in the literature before. This study finds for the first time that Serac1 mutation at this site can cause generalized dystonia，which can provide a reference for the diagnosis and treatment of similar cases in the future.

Objective To investigate the clinical and radiological features of patients with different phenotypes of multiple system atrophy （MSA）. Methods A total of 400 patients with MSA who attended the outpatient service or were hospitalized in Department of Neurology，Chinese PLA General Hospital，were enrolled，among whom there were 294 patients with MSA-cerebellar type （MSA-C） and 106 patients with MSA-Parkinsonian type （MSA-P）. The t-test and the chi-square test were used to analyze the clinical manifestations，radiological features，and blood biochemical indicators of the two groups. Results As for clinical manifestations，there were significant differences in cerebellar symptoms，constipation，and Babinski sign between MSA-C patients and MSA-P patients （P<0.05）. As for radiological features，positron emission tomography/computed tomography （PET/CT） showed that MSA-P patients had a typical reduction in DAT uptake in the putamen and the caudate nucleus，while magnetic resonance imaging showed that compared with the MSA-C group，the MSA-P group had a significantly higher proportion of patients with putamen fissure sign or white matter demyelination； for MSA-C patients，PET/CT showed cerebellar hypometabolism，and magnetic resonance imaging showed the cross sign and high signal intensity in the pontine arm，as well as a significantly higher proportion of patients cerebellar and pontine atrophy than MSA-P patients （P<0.05）. As for laboratory markers，MSA-P patients had a significantly lower level of uric acid than MSA-C patients （P=0.029）. Conclusion Patients with different subtypes of MSA have specific clinical features，radiological features，and uric acid level，which has a certain significance in the accurate diagnosis of MSA.

Objective To investigate the features of non-motor symptoms and transcranial substantia nigra ultrasound in essential tremor （ET）. Methods General data were collected from 50 patients with ET and 50 healthy controls，and non-motor symptom scales and transcranial nigra sonography （TCS） were used for assessment. The t-test，the non-parametric test，and the chi-square test were used for comparison of general data，scale assessment results，and TCS findings between the two groups. Results There were significant differences between the ET group and the healthy control group in the total scores of NMSS，MoCA，HAMA，HAMD，PSQI，ESS，and FSS and the incidence rates of cognitive impairment，moderate or severe anxiety，poor sleep，and daytime sleepiness，while there were no significant differences in the incidence rates of moderate or severe depression and fatigue between the two groups. There were no significant differences between the two groups in terms of “hyperechoic area of the left side” “hyperechoic area of the right side” “hyperechoic area of both sides” “S/M value” “the number of cases with a hyperechoic area of >0.2 cm² for at least one side” “the number of cases with an S/M ratio of >7%” and “the number of cases with positive TCS results”. Conclusion Compared with healthy controls，ET patients are more susceptible to cognitive impairment，anxiety，depression，poor sleep quality，daytime sleepiness，and fatigue，and the non-motor symptoms of ET should be taken seriously in clinical practice. TCS examination has a relatively low diagnostic value in ET patients and healthy individuals.

Objective To investigate the cause，pathogenesis，clinical manifestations，treatment，and prognosis of secondary hemichorea based on related clinical features and examinations by summarizing the medical records of 25 patients with secondary hemichorea-hemiballism. Methods An analysis was performed for 25 patients with hemichorea-hemiballism who were admitted and treated from July 2018 to April 2024，including general status，clinical features，laboratory examinations，MRI or CT examination，treatment methods，and prognosis. Results Of all 25 patients，11 （44.0%） had acute cerebrovascular diseases [including 7 cases （28.0%） of cerebral infarction，3 cases （12.0%） of cerebral hemorrhage，and 1 case （4.0%） of moyamoya disease]，13 （44.0%） had hyperglycemia，and 1 had unknown causes. Of all 25 patients with hemichorea-hemiballism after treatment of the primary disease and symptomatic treatment，18 patients had significant improvements in hemichorea symptoms，and 7 had disappearance of hemichorea symptoms. One patient experienced recurrence after half a year due to self-withdrawal of medication，and the other patients took medication regularly，with no recurrence at follow-up half a year later.Conclusion Hemichorea-hemiballism is more common in the elderly，and acute cerebrovascular disease is the most common cause of hemichorea-hemiballism，followed by hyperglycemia，with the basal ganglia as the main lesion site. In addition to the treatment of the primary disease，symptomatic treatment with haloperidol，clonazepam，or risperidone can significantly improve clinical symptoms and help to achieve a good prognosis.

Stiff-person syndrome （SPS） is a rare autoimmune neurological disorder with atypical symptoms and signs，which often leads to missed diagnosis or misdiagnosis，resulting in delayed treatment. This article reports a female patient，aged 72 years，who was diagnosed with SPS，and her symptoms were improved after symptomatic treatment including intravenous injection of human immunoglobulin，corticosteroids，clonazepam，and baclofen. It is suggested that early diagnosis and timely treatment can improve the quality of life and prognosis of SPS patients with positive anti-amphiphysin antibodies.

Objective Narcolepsy type 1 （NT1） is known to be associated with low levels of hypocretin-1 （Hcrt-1） in cerebrospinal fluid （CSF）. The standard method for Hcrt-1 measurement is radioimmunoassay （RIA） with imported reagents， but this antibody-dependent method is limited to radiation safety-certified lab， gradual radioactivity degradation， and slow turn-around time. The purpose of this study is to explore a non-radioactive， faster， and antibody independent domestic method in China for Hcrt-1 detection. Methods Repeated testing of cerebrospinal fluid from 14 clinically diagnosed NT1 patients and 10 non-narcolepsy patients was performed using liquid chromatography-tandem mass spectrometry （LC-MS/MS）technology，including the establishment and optimization of fundamental methodological procedures. The main steps involved the addition of non-radioactive isotope-labeled internal standards to the cerebrospinal fluid， followed by solid-phase extraction， mass spectrometry signal acquisition， and quantitative analysis. The results were then compared with the corresponding radioimmunoassay（RIA） findings. Results The LC-MS/MS method showed faster speed， and good linearity across a wider range of synthesized standard（5~2 500 pg/ml）， and good repeatability. Although this absolute-quantitation-based LC-MS/MS method and RIA method have different reading values in Hcrt-1 quantitation， they both can segregate NT1 group from non-NT1 group well. Conclusion Although larger cohorts are needed to set up a standard method in China，LC-MS/MS method is proved to be an easier， safer， faster， and possibly more accurate method for Hcrt-1 quantitation and detection for NT1 diagnosis.

Objective To investigate the effect of Baduanjin on mood and sleep quality in patients with mild to moderate Parkinson disease （PD） and related mechanisms. Methods A total of 110 patients with Hoehn-Yahr stage 1-3 stable PD were randomly divided into Baduanjin group and control group， with 55 patients in each group. The patients in the Baduanjin group received Baduanjin exercise for 30 minutes each time， 5 days a week for 12 weeks， and those in the control group did not do any exercise. Motor function， anxiety and depression mood， and sleep quality were assessed before exercise and after exercise for 12 weeks. Results Compared with the control group， the Baduanjin group had significant improvements in UPDRS-Ⅲ score and 6-minute walk test results. There was a significant difference in Berg Balance Scale in terms of the interaction between time and intervention. There were significant differences between the two groups in HAMA14，HAMD24，and PSQI scores. Conclusions Baduanjin can improve mood and sleep quality in patients with mild to moderate PD.

Objective To investigate the association between obstructive sleep apnea hypopnea syndrome （OSAHS） and white matter lesions （WMLs）. Methods A total of 91 patients who attended Department of Neurology and Department of Epilepsy and Sleep Disorders in The Second Affiliated Hospital of Harbin Medical University from June 2019 to December 2020 and met the diagnostic criteria for WMLs were enrolled as WMLs group， and 61 patients without WMLs were enrolled as control group. All subjects underwent brain MRI and PSG examinations， and related data were collected， including demographic data， past history， personal history， laboratory examination， and imaging findings. Results The WMLs group had a prevalence rate of OSAHS of 92.3% and an AHI of （32.85±19.86） events/hour on PSG， which were significantly higher than those in the control group （P<0.05）. The Spearman rank correlation analysis showed a strong positive correlation between WMLs severity and OSAHS severity（r=0.602 52，P<0.0001）. Conclusion The WMLs group is more susceptible to OSAHS than the control group， and the severity of WMLs is positively correlated with the severity of OSAHS.

Rapid eye movement sleep behavior disorder（RBD）， as a sleep disorder with unique clinical manifestations， is currently widely regarded as a precursor marker for α-synucleinopathies （Parkinson disease， dementia with Lewy bodies， and multiple system atrophy）. In recent years， great achievements have been made in radiological studies on isolated RBD and RBD comorbid with various α-synucleinopathies. This article reviews the research findings in RBD in terms of magnetic resonance imaging and radionuclide imaging and discusses the significance of radiological features in the diagnosis and prognosis of RBD， so as to provide a reference for subsequent research and clinical practice.

Rapid eye movement sleep behavior disorder （RBD） is a type of parasomnia closely associated with neurodegenerative diseases related to α-synucleinopathies， such as Parkinson disease， dementia with Lewy bodies， and multiple system atrophy， and early diagnosis is of great importance for disease monitoring and intervention.At present， RBD is mainly diagnosed based on video polysomnography （v-PSG） and nocturnal abnormal behaviors， but the application of v-PSG is limited by its high technical demands.Various validated RBD-related scales have become essential tools for auxiliary diagnosis， which provides methods and tools for the diagnosis of RBD and the assessment of disease progression and outcomes.

Narcolepsy（NP） is a rare central sleep disorder， and it is categorized into narcolepsy type1 （NT1） and narcolepsy type2（NT2）.The main clinical symptoms of NP include daytime lethargy， cataplexy induced by emotions， and sleep paralysis， with a peak onset during adolescence （with an age of 8‒12 years）. At present， the pathogenesis of NP remains unclear and is associated with various factors such as human leucocyte antigen （HLA）， infection， and epigenetic silencing， and the selective loss of hypocretin neurons in the hypothalamus is the key pathophysiological mechanism of NP. Pharmacological intervention is currently the main treatment method， and diagnostic delay can be as long as more than 10 years， which not only affects the social activities， academic performance， and work of patients， but also leads to mental health issues such as anxiety and depression. This article reviews the latest research findings in the epidemiology， pathogenesis， and treatment of NT1 and clarifies the deficiencies and controversies in current research， so as to provide new ideas and directions for subsequent studies.

Restless legs syndrome （RLS） is a common neurological sensory-motor disorder， and the diagnosis of RLS mainly rely on the subjective clinical symptoms described by the patient， with a lack of specific auxiliary examinations or biomarkers. The diagnosis of this disease is still challenging for atypical cases. Various other diseases may have similar clinical symptoms as RLS， such as leg discomfort， leg pain and abnormal leg movement. This article summarizes the RLS mimics that might be confused with RLS symptoms， including the neurogenic， vascular， and musculoskeletal factors that might cause leg discomfort and pain， as well as the differential diagnosis of sleep-related movement disorders with symptoms overlapped with RLS， so as to help clinicians recognize RLS phenotype and provide a reference for the diagnosis of diseases that might be confused with RLS.

Cerebral small vessel disease （CSVD） is a spectrum of pathological conditions affecting intracranial small blood vessels and is associated with a variety of clinical manifestations， including cognitive impairment， gait abnormalities， and sleep disorders. In recent years， the association between CSVD and sleep disorders has attracted increasing attention. This article reviews the association of CSVD with various sleep disorders such as obstructive/central sleep apnea hypoventilation syndrome， restless legs syndrome， and insomnia， analyzes the mechanisms by which sleep disorders cause CSVD， and proposes potential directions for future research.

Sleep-related hypermotor epilepsy （SHE） is a rare type of epilepsy with a prevalence rate of approximately 1.8/100 000. This disease mainly manifests as complex motor behaviors during non-rapid eye movement sleep， such as leg kicking， arm waving， and sitting up. Since such symptoms are similar to non-epileptic disorders such as night terrors and sleepwalking and abnormal discharges may not be observed on electroencephalography， the diagnosis of SHE is quite challenging. Currently， there is still a lack of evidence from large-scale randomized controlled studies to support pharmacological treatment strategies for SHE， and related data in China remain scarce. This article reports a case of SHE， in order to provide a clinical reference for the diagnosis and medication treatment of this disease.

Objective To investigate the characteristics of tremor in Parkinson disease （PD）， essential tremor （ET）， and neuronal intranuclear inclusion disease （NIID）. Methods The surface electromyography （sEMG） data of both upper limbs were collected from 73 patients with tremor （30 patients in PD group， 23 in ET group， and 20 in NIID group）， and the a power spectral analysis was used to investigate frequency characteristics. A one-way analysis of variance and the chi-square test were used for comparison of electrophysiological parameters on sEMG between the three groups. Results The ET group had a higher tremor frequency than the PD group （F=41.86， P<0.01）， while the PD group had a higher tremor frequency than the NIID group in resting state （F=41.86， P=0.002） and in postural state （F=41.86， P=0.011）. The PD group had a higher proportion of patients with alternating contractions than the NIID group in resting state （χ²=5.70， P=0.017） and in postural state （χ²=7.24， P=0.007）， as well as a higher proportion of such patients than the ET group （χ²=9.67， P=0.002）. The PD group also had a higher proportion of patients with harmonic resonances than the NIID group in resting state （χ²=4.64， P=0.031） and in postural state （χ²=7.73， P=0.005）， as well as a higher proportion of such patients than the ET group （χ²=6.52， P=0.011）. Conclusion The highest tremor frequency is observed in ET， while the lowest tremor frequency is observed in NIID； patients with PD have a higher proportion of individuals with alternating contractions or harmonic resonances than patients with NIID and ET.

Objective To investigate the state of anxiety and depression in patients with Parkinson disease due to high-altitude exposure in Tibet， China and its impact on quality of life. Methods A total of 93 patients with Parkinson disease who attended Tibet Autonomous Region People’s Hospital from February 2023 to November 2024 were enrolled， and basic information and assessment scales were collected. The Unified Parkinson’s Disease Rating Scale Part Ⅲ （UPDRS-Ⅲ） and Hoehn-Yahr （H-Y） stage were used to evaluate disease severity； Parkinson’s Disease Quality of Life Questionnaire （PDQ-39） was used to evaluate the quality of life of patients； the diagnostic criteria for depression and anxiety in Parkinson disease were used for the diagnosis of depression and anxiety in patients with Parkinson disease； Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used to assess the severity of depression and anxiety. Results Among the 93 patients with Parkinson disease， the prevalence rates of depression and anxiety were 59.1% and 44.1%， respectively. There were significant differences between the depression group and the non-depression group in the somatization， despair， cognitive impairment， block factor， and day-night changes of anxiety， but there were no significant differences in sleep disorders and body weight between the two groups. The depression group had significantly higher PDQ-39 scores than the non-depression group， and the anxiety group had significantly higher PDQ-39 scores than the non-anxiety group. Depressive state was negatively correlated with folate and was positively correlated with blood homocysteine. Anxiety state was positively correlated with H-Y stage and UPDRS Ⅲ score. Conclusion There are relatively high prevalence rates of depression and anxiety in patients with Parkinson disease in Tibetan plateau area， which significantly affects the quality of life of patients.

Objective To investigate the clinical features of dyskinesia and related risk factors in female patients with Parkinson disease （PD）. Methods A cross-sectional study was conducted among the female patients who met the diagnostic criteria for PD at the outpatient service of PD in Aerospace Center Hospital， and demographic data and clinical data were collected and compared between groups， including levodopa equivalent daily dose （LEDD）， Unified Parkinson’s Disease Rating Scale-Ⅲ（UPDRS-Ⅲ）， UPDRS-Ⅳ， scores of non-motor symptoms （cognition and depression）， presence or absence of dyskinesia， and single levodopa dose （LD） during the onset of dyskinesia. A binary logistic regression analysis was used to investigate the influencing factors for dyskinesia in female patients with PD. Results A total of 146 female PD patients were enrolled， among whom 30 patients had dyskinesia， with an incidence rate of 20.5%. Compared with the non-dyskinesia group in terms of clinical features， the dyskinesia group had a significantly younger age of onset [（54.3±12.5） years vs （62.7±10.0） years， P<0.001]， a significantly longer disease duration [（9.9±3.7） years vs （4.5±3.7） years， P<0.001]， a significantly higher severity of disease [H-Y stage： （2.65±0.58） vs （2.35±0.83）， P=0.03]， a significantly longer duration of LD administration [（7.5±3.2） years vs （3.2±2.6） years， P<0.001]， a significantly higher LEDD [（703.2±203.9） mg vs （442.1±226.3） mg， P<0.001]， and significantly lower body weight [（54.1±8.2） kg vs （60.0±8.7） kg， P=0.001] and BMI [（20.9±3.1） kg/m² vs （23.4±3.1） kg/m²， P<0.001]. The multivariate logistic regression analysis showed that high BMI （OR=0.770， P=0.005） was a protective factor against dyskinesia in female PD patients， while long disease duration （OR=1.304， P=0.001） and high LEDD （OR=1.003， P=0.012） were risk factors for dyskinesia. Conclusion There is a relatively high incidence rate of dyskinesia in female PD patients， which should be taken seriously in clinical practice， and high BMI is a protective factor， while long disease duration and high LEDD are risk factors for dyskinesia in female PD patients.

Objective To investigate the association between depression and autonomic nervous function in Parkinson disease （PD）， and to provide a basis for clinical treatment. Methods Clinical and neurocirculation data were collected from 168 PD patients who attended Department of Neurology， The Second Affiliated Hospital of Hainan Medical College， from July 2022 to July 2023， and according to the score of Beck Depression Inventory， the patients were divided into depression in PD （dPD） group with 57 patients and non-dPD （nPD） group with 111 patients. General clinical data were collected from all patients. The supine-to-standing TCD test was performed for all patients to record systolic blood pressure （SBP）， diastolic blood pressure （DBP）， heart rate （HR）， and the mean velocity （Vm）， pulsatility index （PI）， and resistance index （RI） of the middle cerebral artery （MCA） at 1， 3， and 5 minutes in both the supine and standing positions. A network was constructed for depression symptoms in PD. Results In the network of non-motor symptoms in PD， depression showed the highest centrality and the strongest predictability and was strongly correlated with sleep/fatigue and mood/cognition， with a strength centrality stability coefficient （CS strength） of 0.440. Compared with the nPD group， the dPD group had significantly lower supine HR， ∆HR， Vm in the standing position， and ∆Vm%， a significantly greater ∆DBP， and a significantly higher proportion of patients with dizziness with orthostatic hypotension or orthostatic cerebral hypoperfusion （P<0.05）. Depression was positively correlated with ∆SBP， ∆DBP， Vm in the supine position， and RI in the standing position， and it was negatively correlated with ∆HR， DBP in the supine position， HR in the supine position， and ∆PI （CS strength=0.375 and 0.222）. Conclusion Impairment of cardiovascular and cerebral autonomic nervous function might be involved in the pathogenesis of depression in PD， and intervention of depression can help improve the overall non-motor symptoms of PD， with sleep， fatigue， and cognition as the effective targets for improving depression in PD.

Parkinson disease (PD) is a complex neurodegenerative disorder characterized by a variety of motor and non-motor symptoms. Many studies have shown that the transmembrane protein 175 (TMEM175) gene may be a potential target for the treatment of PD and other neurodegenerative disorders, but the specific pathogenic mechanism remains unclear. TMEM175 is a lysosomal protein-coding gene that encodes a lysosomal proton channel protein. This article reviews the research advances in the characterization of the TMEM175 gene and its encoded proteins, the clinical features of mutant PD, and related pathogenic mechanism. It is shown that the TMEM175 gene has an impact on the pathogenesis of PD, and patients with different mutation sites tend to have different ages of onset and clinical features. Compared with the patients without TMEM175 mutations, the patients with TMEM175 mutations tend to have an earlier age of onset, more severe motor symptoms, and more susceptibility to cognitive impairment and non-motor symptoms. This article systematically reviews the TMEM175 gene, in order to assist in the early diagnosis of PD and the discovery of new disease-modifying therapies and treatment strategies.