Current Journal of Neurology

Changes in P2X4 receptor expression following AbobotulinumtoxinA treatment in patients with chronic migraine: A case series study

2026-05-30T11:52:50+00:00

Background: Chronic migraine (CM) is a debilitating neurological disorder often complicated by medication overuse (MO). While abobotulinumtoxinA (ABO-BoNT-A) is a well-established preventive treatment for CM, its molecular mechanisms are not fully understood. Emerging evidence suggests that neurotrophic tyrosine receptor kinase 2 (NTRK2), SRC kinase signaling inhibitor 1 (SRCIN1), and P2X4 purinergic receptor (P2X4R) are involved in migraine chronification and botulinum neurotoxin A (BoNT-A) function, but their roles in humans remain underexplored. This case series investigated changes in NTRK2, SRCIN1, and P2X4R gene expression in peripheral blood pre- and post-BoNT-A treatment and assessed associated clinical outcomes in patients.

Methods: The messenger ribonucleic acid (mRNA) levels of NTRK2, SRCIN1, and P2X4R genes were analyzed in a sample of eight patients with CM and MO following BoNT-A treatment using quantitative real-time polymerase chain reaction (qRT-PCR). Additionally, migraine characteristics were assessed using Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), and Patient Health Questionnaire-9 (PHQ-9).

Results: The intervention resulted in early measurable improvements in migraine symptoms and disability. Post-treatment, P2X4R expression significantly increased (P < 0.05), while NTRK2 and SRCIN1 showed no significant changes.

Conclusion: Findings indicate that P2X4R upregulation may be linked to the therapeutic effects of BoNT-A, while NTRK2 and SRCIN1 appear uninvolved. The trend in P2X4R expression suggests it may serve as a predictive biomarker and therapeutic target, but further validation in larger cohorts is necessary.

The effect of probiotic supplementation on constipation in patients with Parkinson’s disease: A randomized controlled trial

2026-05-30T11:52:48+00:00

Background: Constipation is a common non-motor symptom (NMS) in Parkinson’s disease (PD), affecting up to 70% of patients and reducing quality of life (QOL). Probiotics may improve bowel function via gut microbiota modulation and gut-brain axis regulation. This randomized, double-blind, placebo-controlled trial evaluated the efficacy of six-week multi-strain probiotic supplementation on constipation in Iranian patients with PD.

Methods: Seventy-two patients with PD (aged 50-80 years, functional constipation per Rome IV criteria) were randomized 1:1 to probiotics or placebo. The probiotic capsule contained Lactobacillus acidophilus (L. acidophilus), Lactobacillus casei (L. casei), Lactobacillus rhamnosus (L. rhamnosus), Bifidobacterium lactis (B. lactis), Bifidobacterium longum (B. longum), and Bifidobacterium breve (B. breve) [1 × 10⁹ colony-forming unit (CFU) each, total 12 × 10⁹ CFU/day]. Dietary intake and physical activity were assessed and included as covariates in analysis of covariance (ANCOVA) models. Primary outcome was weekly spontaneous bowel movements (SBMs); secondary outcomes included Patient Assessment of Constipation-Quality of Life (PAC-QOL) and Unified Parkinson's Disease Rating Scale (UPDRS) Part III. Baseline demographic, clinical, dietary, and physical activity characteristics were comparable between groups.

Results: The study involved patients with a mean age of 69.53 [standard deviation (SD) = 13.4] years, who were hospitalized for about 4.97 days. Gender distribution was with women at 51% and men at 49%. After discharge, a significant majority (66%) received care exclusively from private settings, while 34% utilized both private and governmental services. In contrast, governmental settings showed no significant differences in costs related to NIHSS scores (P = 0.120). Similarly, Barthel scores indicated notable cost disparities in private settings at all stages (P = 0.0001), while governmental settings exhibited no significant differences post-discharge (P = 0.777).

Conclusion: Our study reveals that patients primarily rely on private settings for post discharge services, with costs largely borne by themselves. The financial burden of hospitalization is mostly covered by basic insurance.

Hospitalization and post-discharge expenses of stroke in Iran: A retrospective cohort study

2026-05-30T11:52:47+00:00

Background: Stroke claims about 5.5 million lives annually, making it the second leading cause of death worldwide. In the United States (US), it is the fifth leading cause, trailing behind cardiovascular diseases (CVD) and cancer.

Methods: This retrospective cohort study conducted at Valiasr Hospital in Arak City, Iran, focused on patients with stroke registered in Arak University of Medical Sciences. 153 patients were examined. Data on demographics, stroke types, financial items, and National Institutes of Health Stroke Scale (NIHSS), Barthel, and modified Rankin Scale (mRS) scores were collected. NIHSS, mRS, and Barthel scales were used to assess economical findings of hospitalization and the first trimester after discharge in private and governmental health settings. Data were analyzed through SPSS software for statistical analysis.

Results: The study involved patients with a mean age of 69.53 [standard deviation (SD) = 13.4] years, who were hospitalized for about 4.97 days. Gender distribution was with women at 51% and men at
49%. After discharge, a significant majority (66%) received care exclusively from private settings, while 34% utilized both private and governmental services. In contrast, governmental settings showed no significant differences in costs related to NIHSS scores (P = 0.120). Similarly, Barthel scores indicated notable cost disparities in private settings at all stages
(P = 0.0001), while governmental settings exhibited no significant differences post-discharge (P = 0.777).

Conclusion: Our study reveals that patients primarily rely on private settings for post-discharge services, with costs largely borne by themselves. The financial burden of hospitalization is mostly covered by basic insurance.

Diagnostic challenges and clinico-genetic features in ARSACS: A case series

2026-05-30T11:52:46+00:00

Background: Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare neurodegenerative disorder characterized by early-onset cerebellar ataxia, spasticity, and distal amyotrophy.
This descriptive retrospective case series focuses on patients with ARSACS from the Indian subcontinent, with disease durations exceeding 10 years.

Methods: This case series included patients with typical clinical features of ARSACS who were evaluated in a single neurology unit between 2016 and 2022. Data on age at onset, illness duration at the last follow-up, and clinical manifestations were recorded. Electrophysiology reports, neuroimaging findings, and genetic testing results were reviewed. Functional disability documented at the last available clinical evaluation was recorded.

Results: The study comprised eight Indian patients with ARSACS [male/female (M:F) = 5:3] from unrelated families. The age at onset was between 2-5 years of age, with walking difficulties being the initial symptom in all cases. The correct diagnosis was established after the first decade of life, with a mean age at diagnosis of 23 years (range: 17-30 years) and a mean time to diagnosis of 20 years (range: 14-27 years). Electrophysiological studies showed demyelinating sensorimotor neuropathy. Imaging revealed characteristic linear
T2-hypointensities in the pons and cerebellar atrophy. Genetic testing identified novel homozygous sacsin molecular chaperone (SACS) gene variants.

Conclusion: This study provides valuable insights into the clinical and genetic features of ARSACS in the Indian subcontinent. The time taken to establish the diagnosis ranged from 14 to 27 years in this series. Recognizing characteristic clinical and imaging findings may facilitate earlier diagnosis. The identification of novel genetic variants further expands our understanding of ARSACS.

Combating cognitive decline in a rat model of Alzheimer’s disease: The role of high-intensity interval training and cannabidiol administration in modulating microRNA-124, BACE1, and nestin

2026-05-30T11:52:45+00:00

Background: The global prevalence of Alzheimer’s disease (AD) has emerged as a paramount concern due to the aging population. The current research examines the effects of six-week high-intensity interval training (HIIT), with and without cannabidiol (CBD) supplementation, on cognitive decline, micro ribonucleic acid (miRNA)-124 expression levels, and the protein expression of beta-site amyloid precursor protein cleaving enzyme 1 (BACE1) and nestin in the hippocampus of rats with amyloid beta (Aβ)-induced AD.

Methods: 30 male Wistar rats were randomly divided into six groups: control (CNT), sham, Alzheimer (AD), Alzheimer + HIIT (H-AD), Alzheimer + CBD (C-AD), and Alzheimer + HIIT + CBD (CH-AD). Following the hippocampal injection of Aβ1-42, the HIIT protocol and CBD supplementation [20 mg/kg/day, per os (P.O.)] were initiated and conducted over six weeks. After the last intervention, the hippocampus tissues were collected to assess miRNA-124 expression levels and the protein expression of BACE1 and nestin.

Results: HIIT alone and in combination with CBD treatment significantly improved cognitive impairment induced by AD. Moreover, both treatments significantly reduced BACE1 protein expression and increased nestin protein expression in AD rats. However, despite decreased miRNA-124 expression levels in the AD group in comparison with the CNT group, HIIT and CBD administration did not alter miRNA-124 expression levels in other groups.

Conclusion: The findings can contribute to a higher understanding of the beneficial effects of HIIT combined with CBD administration in mitigating AD-induced cognitive impairment by reducing BACE1 protein expression and increasing nestin protein expression.

Crocin as a multimodal therapy for multiple sclerosis: Recent breakthroughs in immunomodulation and neuroprotection

2026-05-30T11:52:44+00:00

Background: Multiple sclerosis (MS) is a disabling neurological disorder characterized by the existence of demyelinating lesions and affects more than 2.5 million people globally. The current approaches for patients with MS are mainly based on ameliorating symptoms and decreasing acute attacks, and so far, they have not been successful in providing effective neurological regeneration. Recently, natural-based therapies, like crocin, in light of their pharmacological and biological benefits, have acquired much attention in the treatment of neurological diseases like MS. Hence, this study attempts to answer the question of whether crocin therapy can be a suitable approach for MS with a mechanistic insight.

Methods: In this narrative literature review, all related articles (in press and published) in English were searched and assessed using electronic databases, including Web of Science, PubMed, and Google Scholar, up to April 1, 2025. The search keywords in the title and/or abstract of articles were: "Crocin" or "Crocus Sativus" and "Multiple Sclerosis" or "MS".

Results: Experimental evidence has revealed the ability of crocin to alleviate reflexive motor behavior-related tests, cognitive indices, depressive-like behavior, tail flick latency, the conduction velocity of the motor and sensory nerve, antioxidant factors, and to attenuate inflammatory factors. Besides improving some mental factors, such as anxiety, clinical outcomes indicated that crocin could modulate oxidative stress and inflammation-associated markers.

Conclusion: The current preclinical and clinical studies have provided convincing evidence showing that crocin therapy can be a suitable candidate for MS cases; however, larger and more in-depth clinical trials are warranted to support these results.

High odds of multiple sclerosis following major life stressors: Evidence from a population-based case-control study in Northern Iran

2026-05-30T11:52:43+00:00

as a trigger of multiple sclerosis (MS) onset, yet population-based evidence remains inconsistent across cultures. This study examined the association between major stressful life events and MS susceptibility in Northern Iran.

Methods: In a case-control study conducted between 2023 and 2025 in Mazandaran Province, Iran, 300 patients with definite MS and 300 age- and sex-matched healthy controls were enrolled. Exposure to major stressful life events during the five years preceding disease onset (for cases) or interview (for controls) was assessed using the validated Persian version of the Environmental Risk Factor Questionnaire (EnvIMS-Q). Logistic regression was used to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Exposure to at least one major stressful life event was reported by 92.7% of MS cases and 62.7% of controls (P < 0.001). After adjustment for demographic variables, six independent stressors were significantly associated with MS: marital separation (OR = 8.95, 95% CI: 1.92-41.6), financial debt (OR = 4.72, 95% CI: 2.73-8.16), death of a close relative (OR = 3.57, 95% CI: 2.25-5.66), unemployment or financial dependency (OR = 4.19, 95% CI: 1.64-10.7), serious personal illness or injury (OR = 2.66, 95% CI: 1.64-4.32), and marriage (OR = 3.99, 95% CI: 2.15-7.40). The identification of marriage as a stressor is contextually novel and may reflect region-specific psychosocial pressures.

Conclusion: Major life stressors appear to contribute to MS susceptibility, with certain stressors such as marriage showing culture-dependent associations. These findings provide new insight into sociocultural factors influencing MS risk in Iranian populations. These findings should be interpreted with caution and confirmed in longitudinal studies.

Delayed diagnosis of dopa-responsive dystonia initially attributed to syringomyelia: A case report

2026-05-30T11:52:42+00:00

The Article Abstract is not available.

Reconsidering milrinone: Time to revive the oral form for drug repurposing?

2026-05-30T11:52:41+00:00

The Article Abstract is not available.

Posterior inferior cerebellar artery originating from the cavernous internal carotid artery: A rare embryological variant identified during aneurysm evaluation

2026-05-30T11:52:39+00:00

The Article Abstract is not available.