Cutaneous electrophysiology is a fundamental non-invasive technique for assessing electrically active organs such as the brain, heart, and muscles. Standard approaches, however, are limited in spatial resolution, reducing sensitivity to certain pathological features. The development of body surface potential mapping using electrode arrays has helped overcome these limitations, enhancing the diagnostic power of cutaneous recordings, yet clinical adoption remains constrained by challenges in electrode performance, wiring complexity, wearability, data transmission, and interpretability. Here, we present a hybrid e-textile electrode array system that overcomes these barriers, enabling simultaneous mapping of electrical activity along the cortico-muscular axis. The system combines application-specific conducting polymer coatings to improve electrode performance, a flexible fabrication process for robust connectivity and wearability, and interpretable machine learning algorithms for data analysis. In controlled single-subject experiments, we demonstrate reliable muscle and brain recordings, enabling classification of grasped object shapes and somatosensory stimuli. Simultaneous multi-site recordings along the cortico-muscular axis provide spatial maps of reaction time distributions and allow prediction of muscle activation patterns from cortical activity. This platform establishes a framework for wearable, multi-modal electrophysiological mapping and non-invasive study of cortico-muscular dynamics, representing a step towards practical brain-body interfaces with applications in neurorehabilitation, prosthetics, and human-machine interaction.
To predict individual emergence from post-traumatic amnesia (PTA) in patients with moderate to severe traumatic brain injury (TBI). Prospective nationwide cohort study based on data from a national registry: Danish Head Trauma Database. Two highly specialized neurorehabilitation hospitals in Denmark. TBI patients admitted between 2004 and 2020 were included in the study. Not applicable. Duration of PTA, defined as the number of days from TBI onset until regaining anterograde memory function, is a proxy for the resolution of the confusional state. Using competing risk survival analyses, we estimated absolute risks (probabilities) of emerging from PTA according to the included covariates of interest: sex, age, severity of TBI and time since injury. 955 TBI patients (mean age 45.2 (SD=17.8), 21% female) were included in the study, of which 658 emerged from PTA within one year. In the fully adjusted model, male sex, older age, and greater TBI severity were associated with a lower probability of emerging from PTA. Among patients with severe TBI, 99 out of 100 in the youngest age group will emerge from PTA within one year, compared with 72 out of 100 in the oldest age group. Among patients with very severe TBI, the corresponding estimated probabilities are 62 and 24 out of 100 within one year, respectively. The prognostic model offers clinicians an evidence-based tool to individually predict TBI patient's probability of emerging from PTA, incorporating key prognostic factors while accounting for competing risks such as mortality and non-emergence.
Several studies have identified transcutaneous spinal cord stimulation (tSCS) as a noninvasive neuromodulation technique for improving motor function in individuals with neurological disorders, including stroke. Despite a plethora of preliminary findings, there remains no standardized protocol regarding the optimal tSCS parameters tailored to patients with stroke. The objective of this study was to employ a supervised machine learning (ML) approach to determine the optimal tSCS frequency and intensity parameters for patients with chronic stroke by leveraging data from single-day interventions that systematically varied in frequency and intensity across four stimulation conditions. Twenty adults with chronic hemiparetic stroke (mean age 53.3 ± 10.8 years; 13 males, 7 females) who were ≥6 months post-stroke was enrolled, excluding individuals with multiple strokes, severe spasticity, or implanted devices. Each participant participated in a baseline session followed by five intervention sessions, during which the frequency and intensity of stimulation were varied randomly. Multimodal sensors, including surface EMG, inertial measurement unit-based kinematics, and spatiotemporal gait parameters, were used to quantify acute changes in gait symmetry, and optimal stimulation frequency and intensity were defined as those yielding the greatest improvement in the combined gait asymmetry metric. A supervised machine-learning classifier was trained using nested leave-one-subject-out cross-validation to predict the optimal stimulation frequency and intensity to maximize differences from the baseline data alone. AUROC values were calculated for the frequency and intensity predictions. The ML models achieved AUROC values of 0.86 [0.75-0.94] for frequency prediction and 0.82 [0.69-0.94] for intensity prediction. The top ten predictive features for each model spanned with spinal motor evoked potentials, wearable sensors, and demographic domains, highlighting multimodal contributions to stimulation optimization. These findings demonstrate that supervised learning can predict individualized tSCS parameters from demographic data and baseline sensor features that yield the greatest improvement in gait symmetry after stroke, representing a promising step toward the data-driven personalization of neuromodulation therapy in neurorehabilitation.
Dual-tasking is commonly used to assess functional capacity in neurologically intact and poststroke populations. Stroke survivors often experience significant dual-task deficits due to cognitive-motor interference and neurological impairments that limit mobility and daily participation. Emerging evidence suggests non-invasive brain stimulation (NIBS) may enhance neuroplasticity and improve dual-task performance; however, findings remain limited and inconsistent. This systematic review aims to evaluate the effects of NIBS as a central nervous system priming technique on dual-task performance in individuals poststroke. This protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with PROSPERO (CRD420250644455). A comprehensive search will be conducted in PubMed (MEDLINE), Embase, Web of Science and Scopus using keywords related to stroke, dual-tasking and NIBS. Reference lists of included studies will also be manually screened. Eligible studies must be randomised controlled trials or crossover designs involving adults poststroke that use NIBS while explicitly evaluating dual-task performance. Two independent reviewers will assess study quality using the Cochrane Risk of Bias tool, with disagreements resolved by a third reviewer. Meta-analysis will be conducted when feasible; otherwise, a narrative synthesis will be provided.This review will clarify current evidence supporting NIBS for improving dual-task motor-cognitive outcomes in stroke rehabilitation and may guide clinical decision-making and future neurorehabilitation research. Ethical approval is not required because no human participants are involved. Findings will be disseminated through peer-reviewed publications and conference presentations. CRD420250644455.
Heterozygous variants in FBXW7 have recently been recognized as a cause of a rare neurodevelopmental disorder with variable developmental delay, neurological manifestations, and multisystem involvement. The breadth of clinical variability and penetrance remains incompletely defined. We report a retrospective multicenter case series of seven previously unreported individuals (five males, two females) with heterozygous FBXW7 variants identified through clinical genetic testing, aged 5-9 years at last evaluation (median 6 years). Six variants occurred de novo and one was inherited. Neurodevelopmental involvement was present in six individuals and was characterized by global developmental delay and language impairment; hypotonia was observed in all seven. Formal intellectual disability was documented in four cases, while one individual showed preserved cognitive functioning with predominant behavioral difficulties. Epileptic seizures occurred in four individuals, whereas three had no history of epilepsy. Brain MRI was available for six individuals and was normal in four, whereas two showed structural anomalies involving the corpus callosum. Extracerebral features were variably reported, most commonly constipation and recurrent respiratory/otolaryngological infections. Comparison with previously reported individuals confirmed the core neurodevelopmental phenotype and further refined the spectrum. This case series expands the phenotypic spectrum associated with FBXW7-related neurodevelopmental disorder and highlights variable expressivity and incomplete penetrance, including clinically relevant variants presenting with mild or atypical phenotypes. These findings support considering FBXW7 across a broad range of neurodevelopmental presentations and inform genetic counseling.
Exercise is a well-established protective factor which may support healthy aging, yet questions remain regarding its direct benefit on cognition, especially in older adult populations with extensive prior athletic participation. Data were drawn from 636 participants (Mage = 61.0, SD = 7.4) that completed a study of brain health in former college athletes. Participants completed self-report measures of depression (PHQ-8), anxiety (GAD-7), and cognition (CFI), in addition to an objective cognitive screening instrument (TICS-40). Weekly exercise was reported across aerobic, resistance, and wellness activities, and modeled as a latent factor. Structural equation modeling (SEM) was used to examine associations between exercise, emotional symptoms, and cognitive functioning while adjusting for age and education. Latent models demonstrated good to excellent fit to the data. In separate models, greater weekly exercise engagement was significantly associated with better objective cognitive functioning (β = .12, p =.019), but not with subjective cognition (β = -.05, p =.274). Instead, depression (β = .32, p  < .001) and anxiety (β = .22, p  < .001) symptoms were stronger predictors of greater subjective cognitive difficulties than exercise engagement. Among former college athletes, exercise engagement was positively associated with objective cognitive functioning but not subjective cognition, which instead was weakly to moderately related to emotional symptom endorsement. These findings highlight the importance of considering both psychological and physical health when evaluating cognition in former athletes and suggest that ongoing exercise may support healthy cognitive aging even in those with extensive athletic histories.
Handgrip strength (HGS) is a significant biomarker for overall health, offering a simple, cost-effective method for assessing muscle function. Lower HGS is linked to higher mortality, functional decline, cognitive impairments, and chronic diseases. Considering the influence of anthropometrics and demographics on HGS, this study aims to develop a corrected HGS score using machine learning (ML) models to enhance its utility in understanding brain health and disease. Using UK Biobank data, sex-specific ML models were developed to predict HGS based on three anthropometric variables and age. A novel biomarker, ∆HGS, was introduced as the difference between true HGS (i.e., directly measured HGS) and bias-free predicted HGS. The neural basis of true HGS and ∆HGS was investigated by correlating them with regional gray matter volume (GMV). Statistical analyses were performed to test their sensitivity to longitudinal changes in stroke and major depressive disorder (MDD) patients compared to matched healthy controls (HC). HGS could be accurately predicted using anthropometric and demographic features with high accuracy using linear support vector machine (SVM). Compared to true HGS, ∆HGS showed high reassessment reliability and stronger, widespread associations with GMV, especially in motor-related regions. Longitudinal analysis revealed that neither HGS nor ∆HGS effectively differentiated patients from matched HC at post time-point. The proposed ∆HGS score exhibited stronger correlations with GMV compared to true HGS, suggesting it better represents the relationship between muscle strength and brain structure. While not effective in differentiating patients from HC at post time-point, the increase in ∆HGS from pre to post time-point in patient cohorts may indicate improved utility for monitoring disease progression, treatment efficacy, or rehabilitation effects, warranting further longitudinal validation.
Fasting-related headache has traditionally been attributed to dehydration, caffeine withdrawal, and sleep disruption, but pre-existing primary headache disorders may also play an important role in determining susceptibility. To determine the prevalence, clinical characteristics, and predictors of headache during Ramadan fasting and to explore the relative contribution of pre-existing primary headache disorders and the lifestyle-related factors assessed in this study to headache occurrence during fasting. In this multinational cross-sectional survey across 14 countries, adults (18-65 years) observing Ramadan fasting completed a 17-item questionnaire. Headache during Ramadan was the primary outcome. Classification and regression tree (CRT) modelling were used to identify predictors and characterize fasting related headache. Headache attacks occurred mainly in the afternoon/pre-iftar period and improved after iftar in 54.6% of cases. Pre-existing primary headache disorders, particularly migraine, were more strongly associated with headache occurrence within the exploratory CRT model than the lifestyle variables assessed in this study. Fasting-related headache is highly prevalent and is influenced by both lifestyle-related factors and underlying headache susceptibility. A history of primary headache disorders was strongly associated with headache occurrence during Ramadan fasting, highlighting the importance of considering individual headache history alongside fasting- related exposures when assessing vulnerability.
Rehabilitation pathways for patients with brain tumors are often heterogeneous and poorly standardized, limiting clinicians' ability to implement evidence-based interventions. Aim of this scoping review is to systematically map and synthesize the available evidence on rehabilitation strategies for adults with brain tumors, with a focus on clinical pathways, timing, and implementation practices. A scoping review was conducted according to PRISMA-ScR guidelines. Searches were performed in PubMed/MEDLINE, Google Scholar, and selected organizational websites up to December 2025. Eligible sources included clinical guidelines, consensus statements, and position papers addressing rehabilitation in adults with primary brain tumors. Systematic reviews, observational studies, and one randomized controlled trial were additionally included as contextual evidence to support interpretation of rehabilitation needs and implementation practices. Seventeen documents met inclusion criteria, including five guidelines or consensus documents and twelve contextual evidence sources. Across documents, multidisciplinary rehabilitation was consistently recommended, particularly for patients with motor, cognitive, or language impairments. Early and longitudinal rehabilitation approaches were advocated, although referral pathways and implementation practices remained inconsistent. Major gaps included limited tumor-specific protocols, under-referral, and uncertainty regarding optimal rehabilitation settings. Rehabilitation should be integrated early and longitudinally across the PBT care continuum. Standardized, tumor-specific pathways and further high-quality research are urgently needed.
The rupture and demyelination of nerve fibers after spinal cord injury (SCI) are primary contributors to neurological dysfunction. The axon attraction signal pathway mediated by netrin-1 is crucial for promoting the effective regeneration and repair of nerve axons. Previous studies have proved that electroacupuncture (EA) can improve nerve function and promote nerve repair and regeneration in rats with SCI, yet its underlying mechanism remains to be elucidated. This study aims to evaluate the effects of EA on neural repair and to investigate its regulatory role in the axon guidance signaling pathway, thereby clarifying the mechanisms by which EA promotes nerve repair following SCI. Male Sprague Dawley rats were randomly assigned to the Normal group, Sham group, SCI group, and EA group, with each group further divided into subgroups based on intervention duration: 7, 14, and 28 days. Allen's method was employed to establish the SCI model. Dazhui (GV14) and Mingmen (GV4) acupoints were selected for EA intervention. Basso-Beattie-Bresnahan (BBB) score and the inclined plate test were used to evaluate the motor function of rats in each group. Morphological and structural changes in the injured spinal cord were assessed through magnetic resonance imaging (MRI). The fractional anisotropy (FA), radial diffusivity (RD), and mean diffusivity (MD) values in the injured area were measured via diffusion tensor imaging (DTI), and the morphological changes of nerve fiber bundles were analyzed via diffusion tensor tractography (DTT). The expressions of netrin-1, deleted in colorectal cancer (DCC), ras-related C3 botulinum toxin substrate 1 (Rac1) and F-actin were quantified using immunofluorescence (IF) staining, Western blot (WB) and real-time quantitative polymerase chain reaction (RT-PCR). Compared with the Sham group, the SCI group exhibited significant deficits in motor function (P<0.01), disorganized spinal cord tissue structure, a markedly increased lesion area (P<0.01), impaired integrity of nerve fiber bundles, a significant decrease in FA value (P<0.01), and significantly elevated MD and RD values (P<0.01). Moreover, the expression levels of netrin-1, DCC, Rac1, and F-actin were significantly reduced (P<0.01). EA improved the behavioral performance of rats with SCI (P<0.01). Following EA intervention, the extent of spinal cord structural damage was alleviated, with increased FA values, decreased MD and RD values (P<0.01), alongside evident repair and reconstruction of damaged fiber bundles. Additionally, EA upregulated the expression levels of netrin-1, DCC, Rac1, and F-actin (P<0.01). EA can significantly improve the motor function of rats with SCI, regulate the nerve guidance factor netrin-1 and its receptor DCC, as well as the molecular switch Rac1, thereby promoting axonal cytoskeletal remodeling and facilitating neural repair. The nerve repair effect of EA may be achieved by regulating the axon attraction signal pathway mediated by netrin-1.
Exertion testing helps inform exercise prescription during concussion recovery. The Calgary Adapted aRm Ergometer (CARE) test, developed as the first upper-body specific exertion test, aims to improve accessibility and inclusivity in concussion care. While initial development was conducted in adults, its applicability in adolescents remains unknown. This study compared physiological responses between the CARE test and the Calgary Concussion Cycle Test (CCCT) in non-disabled adolescent male and female athletes. Fifteen females and fifteen males (aged 14-17) performed CARE and CCCT to volitional fatigue. Response differences, Bland-Altman plots, effect sizes, intraclass correlation and moderation by sex for heart rate (HR), middle cerebral artery velocity (MCAv), volume of oxygen consumption ( V ̇ O 2 ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}}}$ ), minute ventilation ( V ̇ E ${{\dot{V}}_{\mathrm{E}}}$ ) and end-tidal carbon dioxide ( P ETC O 2 ${{P}_{{\mathrm{ETC}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ ) were analysed at 25%, 50%, 75% and 100% of peak exertion levels. CARE elicited lower absolute values for HR, MCAv, P ETC O 2 ${{P}_{{\mathrm{ETC}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ , V ̇ O 2 ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}}}$ and V ̇ E ${{\dot{V}}_{\mathrm{E}}}$ compared to CCCT, with differences and 95% limits-of-agreement becoming more pronounced at higher intensities. For mild-to-moderate exercise (25-50% exertion), the range typically used in clinical concussion testing, HR and MCAv differences were small for both sexes. Near maximal intensity, the HR gap widened, but MCAv was comparable. Sex did not modify the relationship between tests for HR and MCAv. While CARE predominantly employs smaller muscle mass than CCCT, results showed robust and relatively comparable physiological responses between tests and between male and female adolescents. These findings further support CARE as an accessible and inclusive post-concussion exertion test for those not able to perform lower-body protocols.
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that may result in dehydration, malnutrition, and electrolyte imbalance. Wernicke's encephalopathy (WE), caused by thiamine deficiency, and refeeding syndrome (RFS), a metabolic complication of nutritional rehabilitation, are rare but serious sequelae of prolonged starvation in HG. We present the case of a multiparous woman in her 30s with severe HG and missed miscarriage at approximately 16 weeks, who developed refractory hypokalaemia, hypomagnesaemia, and evolving neurological symptoms following medical management of miscarriage. Magnetic resonance imaging demonstrated symmetrical medial thalamic and mammillary body changes suspicious for WE. She improved following intravenous thiamine and vitamin B complex replacement, potassium and magnesium correction, and multidisciplinary care. This case underscores the importance of early thiamine prophylaxis in severe HG and highlights persistent refractory electrolyte abnormalities as a potential early indicator of RFS and evolving WE.
BackgroundIn post-acute stroke rehabilitation, cognitive assessment is clinically important but frequently incomplete. Complete-case analysis excludes much of the sample, reducing representativeness.ObjectivesTo determine whether incomplete routine post-stroke cognitive assessments can still yield clinically interpretable relationships among cognitive, clinical, and contextual variables, and support group-level stratification using a reduced feasible cognitive set.MethodsRetrospective cohort study of adults admitted to post-acute stroke neuro-rehabilitation between 2007 and 2026 with at least one neuropsychological assessment. The baseline cohort included 2654 patients, with 5417 assessments within 6 months available for confirmatory analysis. The 24-subtest baseline battery showed 37.5% to 88.4% missingness. Five representative cognitive measures were selected based on data availability, domain coverage, and within-domain Spearman correlations. Bayesian networks were fitted in the baseline cohort, their stability was assessed by bootstrapping, key dependencies were examined across all available assessments.ResultsStable, bootstrap-supported dependency patterns were recovered and broadly replicated in the confirmatory analysis. Replicated associations linked age and time since injury to verbal learning and naming; stroke subtype to verbal learning, timed orientation/performance, and phonemic fluency. Verbal learning occupied a central position, with additional replicated links to naming, timed orientation/performance, and attentional span. Among the contextual variables, economic status was the only one showing a direct link to a cognitive measure (attentional span). Group-level stratification of verbal learning showed moderate performance (R2 = 0.42).ConclusionsIncomplete routine cognitive assessments need not rely on complete-case restriction or score imputation; they can still support clinically meaningful interpretation and group-level stratification in post-acute stroke rehabilitation.
Current cardiopulmonary exercise testing (CPET) guidelines for lung cancer surgery rely on expert consensus and scientific statements, lacking robust, graded evidence. This study aimed to provide an evidence-based evaluation of CPET variables for assessing perioperative morbidity and long-term mortality risks. Electronic databases were searched through December 20, 2025, for cohort studies on CPET variables and lung cancer surgery. Quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the Q-test and I2 statistic, with fixed or random effects models. Publication bias was assessed via funnel plots and Egger's test, with adjustment using the trim-and-fill method when necessary. Effect sizes were pooled, and evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Of 3080 studies, 47 studies involving 11,356 surgeries and 13 CPET variables were included. Meta-analysis and GRADE assessment showed lower peak oxygen uptake (peak V˙O₂) increased the risk of perioperative complications by 2.04-3.02 times (P < 0.001), using a cutoff point of 15 mL/kg/min or peak V˙O2 expressed as %pred. A higher minute ventilation to carbon dioxide production (V˙E/V˙CO₂) slope was associated with a 2.44-fold increased risk (95% CI [1.82-3.27], P < 0.001), with a cutoff point of 35 (high-level). Limited studies suggest peak V˙O₂ (L/min) and V˙E/V˙CO₂ slope relate to cancer-specific and all-cause mortality. Evidence for variables such as V˙O₂ at anaerobic threshold and peak ventilation remains low. Among 13 CPET variables, only peak V˙O₂ (15 mL/kg/min or %pred values) and V˙E/V˙CO₂ slope (35) are supported by high-certainty evidence for perioperative risk. Further studies are needed to establish CPET's role in predicting cancer-specific mortality in lung cancer surgery. PROSPERO CRD42023405083.
Several neuroimaging studies demonstrated that spiritual/religious beliefs and practices rely on the same brain regions as secular cognition. Several reviews shaped the framework within which religious and secular cognition interacts, emphasizing the need for a precise definition of religiousness and spirituality. Christian faith presents a well-defined theological context, characterized by belief in its tenets; trust and commitment; and allegiance expressed as confession of faith or associated practices. Anthropological studies indicate that spiritual certainties develop with practice over longer periods of time. Only a few neuroimaging studies explored the neural correlates of Christian faith. Three investigated propositional belief, five prayer, and two spiritual practice. This sparse evidence leaves several key issues open. Christian commitment and practice may yield, over time, dedicated sets of neuronal structures and/or networks and foster interplay with secular cognition. To explore these aspects, we formulate five hypotheses and propose methodological approaches to test them. We also outline options to investigate the inner disposition of trust and commitment, which has not yet been studied in the context of Christian faith. Pursuing investigations into the neural underpinning of faith may not only reveal how the faith is represented in our brains, but also how faith possibly modifies it.
Traumatic brain injury (TBI) triggers a cascade of neurological impairment, cerebrovascular dysfunction, and gut microbiota dysbiosis, perpetuating a cycle of neuroinflammation. Exercise is known to promote recovery, however, its impact on the integrated gut-brain axis following TBI remains unexplored. In this study, we investigated the capacity of voluntary exercise to reverse TBI-induced cerebral hypoperfusion and gut dysbiosis. Male Kunming mice were randomly assigned to sham or TBI groups, with or without access to voluntary exercise for 7 days, starting 48 h post-injury. We assessed neurological deficits, cerebral blood flow (CBF), and gut microbiota composition. Results showed that voluntary exercise facilitated neurological recovery, restoring motor coordination and balance by day 7. It reversed 90.1% of the acute cerebral perfusion deficit and fully restored interhemispheric symmetry. TBI-induced gut dysbiosis was counteracted, as evidenced by rescued alpha diversity, normalized beta diversity, and profound taxonomic shifts that suppressed pro-inflammatory pathobionts and enriched immunomodulatory commensals. These findings suggest that voluntary exercise serves as a multisystem therapy for TBI by facilitating neurological recovery, normalizing cerebrovascular perfusion, and restoring gut microbiota homeostasis.
Despite recent advances, the pathophysiology of functional neurological disorder (FND) remains incompletely understood. Structural neuroimaging studies have identified grey matter alterations in somatomotor, salience, limbic, and default mode network associated areas, although findings are inconsistent. Mega-analyses, which combine individual-level data across studies, can help clarify structural alterations. We conducted a mega-analysis of brain structural morphometrics derived from T1-weighed MRI scans from fifteen international research groups. After across-site harmonisation with ComBat, we compared 493 functional motor and seizure patients with 564 healthy controls. Euler numbers were included to account for head motion. The FND cohort showed reduced cortical thickness in the bilateral superior frontal gyri (left d = 0.22, right d = 0.21) and sulci (d = 0.22 & 0.23), bilateral superior precentral sulcus (d = 0.22 & 0.26), right precentral gyrus (d = 0.25), right paracentral gyrus and sulcus (d = 0.23), right cuneus (d = 0.23), and right inferior opercular gyrus (d = 0.21); reduced left postcentral gyrus surface area (d = 0.25) and right hippocampal volume (d = 0.22). No regions were different in relative surface area. There were no associations between morphometrics and illness duration, or lifetime history of depression or anxiety. Differences between motor and seizure variants were not identified. This large mega-analysis suggests subtle morphometric differences, particularly in prefrontal and motor regions. This may represent predisposing vulnerabilities, compensatory mechanisms, or FND-specific alterations. Improved neuropsychiatric characterisation of FND research cohorts will help further contextualise the biological relevance of structural alterations.
The concept of 'muscle health' is increasingly recognized as a central determinant of physical function, metabolic regulation, and disease resilience, yet its clinical integration remains fragmented by inconsistent definitions and measurement approaches. This Perspective synthesizes insights from the Research Topic 'Advancing Muscle Health: From Technical and Clinical Research to Practice', which brings together nine contributions spanning assessment technologies, biomarkers, clinical populations, and interventions. Collectively, these works illustrate a field transitioning from isolated advances toward more integrated, clinically meaningful frameworks. Emerging ultrasound-based methods demonstrate how improved reliability and automation may enable scalable muscle assessment, while biomarker studies highlight both the promise and limitations of metabolomic, functional, and surrogate metrics in capturing the systemic nature of muscle health. Evidence from neurological, vascular, and oncological contexts reinforces that muscle is not only an outcome of disease, but a key modifier of disease progression and risk. Across these domains, exercise, particularly resistance-based and multimodal approaches, continues to emerge as a key, yet under-implemented, strategy. Despite this progress, critical gaps remain. The field lacks longitudinal, diverse-cohort data, standardized measurement frameworks, and robust integration of emerging technologies such as multi-omics and artificial intelligence. Moving forward, advancing muscle health will require interdisciplinary, translational approaches that align mechanistic insight with clinical application, enabling precise phenotyping and scalable interventions. Bridging these gaps is essential to move muscle health from a research construct to a core component of routine clinical care and public health strategy.
Multiple sclerosis (MS) is a progressive neurological disease that affects not only individuals diagnosed but also their partners and relationships. However, couple-based counseling services and couples' preferences regarding such interventions remain insufficiently studied. The PAART study addressed this gap by exploring the counseling needs of couples living with MS and identifying suitable approaches for outpatient counseling services. This study applied a participatory health research (PHR) approach involving researchers, practitioners, and people living with MS as co-researchers throughout the project. A sequential qualitative design was conducted in two stages: first, expert interviews (EIs) with counselors from German MS Society service centers; second, virtual focus group discussions (FGDs) with couples living with MS. Findings from the interviews informed the focus of the FGDs. Data were analyzed using qualitative deductive-inductive content analysis based on the participatory DEPICT method. Ten counselors participated in the EIs, and four FGDs were conducted with 16 couples recruited nationwide. Both groups emphasized the importance of couple-oriented counseling, particularly around the time of diagnosis, with relationship-related concerns often outweighing disease-specific topics. Communication difficulties and balancing individual and shared needs emerged as central challenges. Counselors additionally highlighted caregiver burden, personal boundaries, and shame. Across both groups, uncertainty about the future was identified as a key theme. Findings from the EIs and FGDs were highly consistent, underscoring the importance of relationship-focused support in addressing present- and future-oriented challenges associated with MS. The results suggest that healthcare professionals should be prepared to address couple dynamics sensitively and effectively. Integrating couple-oriented counseling into outpatient psychosocial and rehabilitation services may strengthen relationship resilience, improve shared coping strategies, and support the long-term well-being of both partners. https://www.drks.de/DRKS00031739, Identifier DRKS00031739.
The rise of large language models (LLMs) such as GPT-4 and DeepSeek has transformed healthcare information processing by enabling natural language-based clinical reasoning. However, the integration of LLMs with privacy-sensitive biomedical signals, particularly electroencephalogram (EEG) data used in brain-computer interface (BCI) systems, remains underexplored. EEG signals, especially during motor imagery (MI) tasks, are critical for assistive neurotechnologies but pose significant privacy risks due to their capacity to reveal cognitive and medical information. Traditional encryption techniques often distort signal structure or require decryption with additional noise, compromising classification performance and real-time usability. To address this gap, we propose a deep denoising structure-preserving neural encoding network (DSNet) that enables accurate classification of privacy-preserving encoded EEG representations without requiring decryption. EEG features were extracted using common spatial pattern (CSP) and transformed into privacy-preserving encoded representations while preserving their statistical structure. Here, encoding refers to a non-reversible neural transformation designed for privacy preservation rather than a formal cryptographic guarantee. Two deep learning architectures, a feedforward neural network (NN) and a recurrent neural network (RNN), were evaluated for classification in the encoded feature space. Furthermore, we integrated an LLM (GPT-4) to generate clinical-style summaries based on model outputs, enhancing interpretability for clinician review and potential clinical support use. Using publicly available datasets, DSNet-NN achieved over 87% accuracy for every subject, outperforming both the RNN variant and baseline models. It also demonstrated resilience to simulated privacy attacks. LLM-generated reports provided clinician-friendly interpretations of MI predictions, supporting potential real-world applicability. This study introduces an AI framework that bridges privacy-preserving EEG decoding with LLM-based clinical reasoning, offering a practical solution for privacy-preserving neurorehabilitation and digital health systems.