Parkinson disease (PD) is a progressive neurodegenerative disorder marked by the loss of dopaminergic neurons in the substantia nigra. Clinically, PD presents with motor symptoms such as bradykinesia, tremor, and rigidity, which significantly compromise patients' daily function and quality of life. Deep brain stimulation (DBS) has become a cornerstone in the management of advanced PD, delivering high-frequency electrical stimulation to specific brain targets to alleviate motor deficits. However, conventional DBS operates with fixed parameters, lacking the ability to adapt in real-time to symptom fluctuations. This rigidity can lead to suboptimal outcomes including overstimulation or inadequate symptom control.Adaptive DBS (aDBS) represents an advanced therapeutic approach that continuously monitors neural activity, such as local field potentials (LFPs), and dynamically adjusts stimulation parameters through a closed-loop "sense-decode-stimulate" system. This facilitates personalized therapy that responds in real-time to the patient's clinical state. aDBS has been shown to not only enhance motor symptom control but also reduce stimulation-induced side effects such as dysarthria and dysphagia. Despite its promise, several clinical and technical challenges remain. These include the miniaturization of pulse generators, precision placement of flexible electrodes, reliable signal decoding and feedback, safety of compact high-energy batteries and wireless charging, and minimizing surgical invasiveness and related complications. Future developments in implantable brain-computer interface (BCI) technologies, such as integrated circuit-based implantable pulse generators, microelectrode array, high-performance computing, and secure high-bandwidth communication, hold disruptive potential that may benefit not only PD but also other neurological and psychiatric conditions including Alzheimer disease and depression. This article reviews the fundamental principles, clinical benefits, biomarker validation, trial design considerations, and technological advancements in aDBS systems, and discusses current limitations and future directions to guide further clinical translation.

To observe the effects of high-frequency and low-frequency repetitive transcranial magnetic stimulation (rTMS) treatment on the expression of brain-derived neurotrophic factor (BDNF)/tyrosine kinase receptor B (TrkB) signalling pathway and MBP content in rats with delayed encephalopathy in acute carbon monoxide poisoning (DEACMP) and to explore the therapeutic effects.

Cognitively qualified male 24 SD rats were screened by Morris water maze, 6 were randomly selected as the blank group (NC group), and 18 were randomly divided into the sham stimulation group (Sham group), the high frequency 5 Hz group (5 Hz group), and the low frequency 1 Hz group (1 Hz group), each with 6 rats in each group, after the establishment of the DEACMP model. The treatment group was given 5 Hz and 1 Hz rTMS treatment respectively, and the Sham group was given sham stimulation. Cognitive function was assessed by Morris water maze after treatment. Hematoxylin-eosin (HE) staining was used to observe the changes in the hippocampal region of rats; enzyme-linked immunosorbent assay (ELISA) was used to analyse the serum concentration of BDNF, TrkB and myelin basic protein (MBP); immunohistochemical staining (IHC) was used to detect the positive expression of BDNF, TrkB and MBP in each group.

(1) The results of Morris water maze showed that 21 d after CO poisoning, the mean avoidance latency was significantly longer in the Sham group, 1 Hz group and 5 Hz group compared with the NC group (P<0.05); the mean avoidance latency was significantly shorter in the 1 Hz and 5 Hz groups compared with that in the Sham group (P<0.05); and the mean avoidance latency was even shorter in the 5 Hz group compared with that in the 1 Hz group (P<0.05). (2) The results of HE staining showed that the cells in the hippocampus of the NC group were neatly arranged, with clear boundaries and normal cell number, while the cells in the hippocampus of the Sham group were disorganised, with a reduced cell number and some of them showed nuclear necrosis. The hippocampal area of the 1 Hz and 5 Hz groups was more neatly arranged, with occasional cell necrosis. (3) The ELISA results indicated that compared with the NC group, the expression content of BDNF and TrkB in the Sham group decreased, and the expression content of MBP increased (P<0.05); in the 1 Hz and 5 Hz groups, the expression content of BDNF and TrkB increased significantly compared with that of the Sham group, and the expression content of MBP increased significantly compared with that of the Sham group. MBP expression content was significantly lower than that in the Sham group (P<0.05). (4) IHC staining indicated that the mean optical density values of BDNF and TrkB in the Sham group were decreased compared with that in the NC group (P<0.05); the mean optical density values of BDNF and TrkB in both the 1 Hz group and the 5 Hz group were higher than that in the Sham group (P<0.05); the MBP mean optical density values of BDNF and TrkB in the Sham group and the 5 Hz group were higher than those in the Sham group (P<0.05); the mean optical density values of MBP in the Sham group were significantly higher than those in the NC group, and the mean optical density values of MBP in the 1 Hz and 5 Hz groups were lower than those in the Sham group (P<0.05).

Both high-frequency (5 Hz) and low-frequency (1 Hz) rTMS can improve the cognitive function of DEACMP mice, and the possible mechanism is to improve demyelinating lesions by up-regulating the expression of BDNF/TrkB pathway, so as to reduce the expression content of MBP, thus improving cognitive ability.

To explore the effectiveness of early rehabilitation physical therapy in patients with critical cerebrovascular disease based on propensity score matching.

A retrospective analysis was performed on clinical data from patients with critical cerebrovascular disease admitted to the Rehabilitation Medicine Department of West China Hospital of Sichuan University from 2011 to 2019. According to whether early rehabilitation physical therapy was administered during the intensive care unit (ICU) stay, patients were divided into an early rehabilitation physical therapy group and a non-early rehabilitation physical therapy group. Propensity score matching (1∶1, caliper 0.02) was used to balance baseline differences. Linear regression or quantile regression was used to compare ICU length of stay and final GCS scores between the groups, while binary logistic regression was used to analyze differences in discharge outcomes. Multivariate Logistic regression was performed to assess the independent impact on discharge outcomes.

A total of 1211 patients were included, of which 474 (39.1%) received early rehabilitation physical treatment and the remaining 737 did not receive early rehabilitation physical therapy. After propensity score matching, there were 390 cases in each of the two groups, and the baseline characteristics between the two groups were balanced and comparable. There were no statistically significant differences in ICU length of stay or GCS scores between the matched groups (P>0.05). The incidence of favorable outcomes in the early rehabilitation physical therapy group was 67.4%, which was significantly higher than that in the non-early rehabilitation group (49.5%) (P<0.05). Multivariate Logistic analysis showed that not receiving rehabilitation therapy, cerebral infarction with hemorrhage, and infection were independent risk factors for unfavorable outcomes, while cranial surgery was identified as an independent protective factor.

Early rehabilitation physical therapy significantly increased the likelihood of achieving a favorable outcome at discharge in patients with critical cerebrovascular disease and has important clinical value in improving patient outcomes.

To evaluate the therapeutic efficacy of transcutaneous auricular vagus nerve stimulation (ta-VNS) in post-stroke dysphagia rehabilitation.

Patients with post-stroke dysphagia admitted to the Rehabilitation Medicine Department of Shanghai General Hospital from January to June 2024 were selected as study subjects,and were divided into an experimental group and a control group using a random number table method. Two groups of patients received conventional swallowing rehabilitation therapy, while the experimental group underwent ta-VNS targeting the concha region, and the control group received sham ta-VNS stimulation at the earlobe. The intervention was administered at a frequency of 20 min/d, 5 d/week, for a total duration of 4 weeks. The swallowing function of subjects in both the experimental and control groups was assessed before and after treatment using the water swallow test, SSA score, soft palate movement, mandibular movement, lip movement, tongue movement, pharyngeal reflex, gag reflex, and cough reflex.

A total of 52 patients were included, including 26 in the experimental group and 26 in the control group. After treatment, the scores of water swallowing test, SSA, palatal movement, mandibular movement, labial movement, lingual movement, pharyngeal reflex, gag reflex, and cough reflex in two groups of patients were better than before treatment, and the differences were statistically significant (P<0.05). The scores of water swallowing test, SSA, palatal movement, mandibular movement, labial movement, lingual movement, pharyngeal reflex, and gag reflex in the experimental group after treatment were better than those in the control group, and the differences were statistically significant (P<0.05), while there was no statistically significant difference in cough reflex scores (P>0.05).

ta-VNS is a safe and effective intervention for improving post-stroke dysphagia.

To investigate the effect of apolipoprotein E (APOE) gene polymorphisms on post-stroke depression (PSD) after acute ischemic stroke.

A total of 180 patients with acute ischemic stroke admitted to the Department of Neurology of Luoyang Central Hospital from January 1 to December 1, 2024 were continuously included. Routine hematological examinations were conducted within 24 h of admission, and the National Institutes of Health stroke scale (NIHSS) score was used to assess the degree of neurological deficits in stroke patients, while the modified Rankin scale (mRS) score was used to assess the degree of disability in stroke patients. The Hamilton depression scale (HAMD) was used to assess the depression status of patients at 2, 3 weeks, and 1 month after the onset of stroke. Patients were divided into PSD group and non PSD (NPSD) group based on whether PSD was present. Real-time fluorescence quantitative PCR was used to detect APOE gene polymorphisms in the 2 groups, and baseline clinical data, laboratory tests, APOE genotype distribution, and allele frequency were compared between the 2 groups. Multiple Logistic regression was used to analyze the influencing factors of PSD.

There were 62 patients in the PSD group and 118 patients in the NPSD group. There was no statistically significant difference in the general clinical data between the two groups (P>0.05). The serum total cholesterol (CHOL) and homocysteine (HCY) levels of patients in PSD group were higher than those in NPSD group, and the folic acid levels were lower than those in NPSD group, and the differences were statistically significant (P<0.05). The distribution frequency of the ε3ε4 and ε4ε4 genotypes in PSD group patients was higher than that in NPSD group, the frequency of the ε2 allele was lower than that in NPSD group, and the frequency of the ε4 allele was higher than that in NPSD group, the differences were statistically significant (P<0.05). The HAMD scores of patients carrying the ε4 allele were higher than those of patients without the ε4 allele in the PSD group, and the difference was statistically significant (P<0.05). All patients carrying the ε4 allele had higher NIHSS and mRS scores than those without the allele, and the differences were statistically significant (P<0.05). Multiple Logistic regression analysis showed that serum CHOL and HCY levels, and the ε4 allele, were independent risk factors for the development of PSD (P<0.05).

The polymorphism of APOE gene is closely related to PSD, and the ε4 allele is an independent risk factor influencing the development of PSD. Elevated serum CHOL and HCY levels may increase the risk of developing PSD.

To evaluate the therapeutic effectiveness of high-frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) for managing central post-stroke pain (CPSP).

Forty-six patients with CPSP admitted to the Neurorehabilitation Department of Shengli Oilfield Central Hospital between January 2021 and December 2022 were enrolled and randomly assigned to a control group and an experimental group, with 23 patients in each group. Both groups of patients received basic rehabilitation treatment, with the control group receiving sham stimulation and the experimental group receiving 10 Hz rTMS for 4 weeks of treatment; One patient in the experimental group and three patients in the control group withdrew from the study due to inability to tolerate rTMS. The visual analogue scale for pain (VAS), Barthel index, Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD) were employed to conduct a quantitative assessment of the patients' pain experience, daily living activity (ADL) capabilities, as well as their anxiety and depression states before and after treatment. Meanwhile, all adverse events that transpired throughout the treatment were carefully recorded.

Compared with before treatment, the VAS, HAMA, and HAMD scores between two groups decreased after treatment, and the experimental group showed a more significant decrease, with statistically significant differences (P<0.05). Compared with before treatment, the Barthel index of both groups of patients increased significantly (P<0.05), but the difference in Barthel index between the experimental group and the control group before and after treatment was not statistically significant (P>0.05). Two patients had headache, and the symptoms improved after reducing the intensity of rTMS, while other patients did not have study related adverse events.

The application of 10 Hz rTMS in the M1 area on the lesion side can effectively improve the pain, anxiety and depression states of patients with CPSP.

To explore the characteristic electrophysiological markers of patients with prolonged disorders of consciousness (pDOC) by analyzing the resting-state electroencephalogram (EEG) microstate features of patients with pDOC.

Twenty three patients with pDOC admitted to the Neurosurgery Department of Lu'an People's Hospital Affiliated to Anhui Medical University from January 2021 to March 2024 were selected as the pDOC group, and 17 healthy subjects who underwent physical examination in our hospital were collected as the healthy group at the same time. Video EEG data of resting-state were collected. Microstate clustering was performed using the EEGLAB toolkit based on the Matlab mathematical calculation platform, and statistical analysis was conducted on micro-state indicators (average duration, occurrence frequency, time coverage) between two groups.

The microstate topographic maps A, C and D of the two groups were similar, while the topographic maps of microstate B were significantly different. The time coverage rate of microstate B in the pDOC group (0.37±0.14) was higher than that in the healthy group (0.29±0.10), and the frequency of microstate D (2.96±0.75) and time coverage rate [0.27 (0.23, 0.42)] were lower than those in the healthy group [3.36±0.42, 0.35 (0.30, 0.39)], with statistically significant differences (P<0.05).

The microstate B of pDOC patients has a marked left-right distribution, which may serve as an electrophysiological marker for future assessment of pDOC and degree of consciousness impairment.

Epilepsy is a serious, recurrent, multifactorial neurological disorder, with approximately one-third of patients developing refractory epilepsy (RE). Recently, neuroregulatory therapy has emerged as an alternative treatment option to reduce the onset of RE, including invasive neuromodulation techniques such as vagus nerve stimulation, deep brain stimulation, and reactive nerve stimulation, as well as non-invasive neuroregulatory techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, and transcranial ultrasound stimulation. This paper reviews the basic introduction, key elements and clinical research of neuroregulation technology in RE, aiming to evaluate the scientific basis for the application of neural regulation technology in RE patients and provide ideas for developing appropriate RE treatment plans.

Neuroglobin (Ngb) is mainly present in neural tissue and is an endogenous neuroprotective molecule that can counteract hypoxic-ischemia and oxidative stress-induced injury in cultured neurons and animals. Its gene and protein expression under hypoxic conditions and has protective effect on cell survival, significantly protecting the heart and brain from hypoxia, ischaemia and oxidative stress-induced injury, whereas reduced levels of Ngb lead to increased tissue damage. Therefore, the strategy of upregulating endogenous Ngb expression has potential therapeutic prospects. This review focuses on the structure, physiological functions and protective mechanisms of Ngb, aiming to provide new ideas for the treatment of various clinical diseases.