The hung-up reflex (HUR) is a tonic reflex response characterized by delayed muscular relaxation following the elicitation of a tendon reflex. First described by Woltman in patients with myxedema and hypothyroidism, it is best demonstrated in the Achilles tendon. Currently, two primary techniques are used for its measurement: photomotography and the anemometer. The pathogenic mechanism underlying this phenomenon is closely linked to the physiological process of cellular membrane recovery, particularly the reabsorption of calcium by the sarcoplasmic reticulum. This sign has been documented in various pathologies, including Huntington's disease, stiff-person syndrome, stiff-limb syndrome, hypothyroidism, myxedema, and Sydenham's chorea. Over time, it has played a significant role in the clinical examination of movement disorders. The objective of this review is to analyze the historical description, pathophysiological mechanisms, and clinical significance of HUR, aiming to enhance the understanding of its presence in different pathological entities and facilitate differential diagnoses.

This study aimed to explore the relationships between diabetes mellitus and Guillain-Barré syndrome (GBS) progression and short-term prognosis. This retrospective cohort analysis included 330 patients with GBS. The study was performed at the Department of Neurology, Kasturba Medical College, Manipal, from January 2016 to December 2023. Diabetes mellitus was present in 31.8% of the 330 GBS patients. The degree of disability was assessed according to the GBS Disability Scale (GDS). Compared with patients with normal glycosylated hemoglobin A1c (HbA1c) and cerebrospinal fluid (CSF) glucose levels, patients in the high HbA1c and high CSF glucose groups were characterized by severe disability (GDS ≥ 3) at admission (52.4 vs. 75.2, P = 0.001; 80 vs. 53.4, P = 0.001), at nadir (63.1 vs. 83.8, P = 0.02; 84.5 vs. 60.6, P = 0.03), and at discharge (52.4 vs. 31.1, P = 0.04; 57.8 vs. 27.8, P = 0.03). Older age, gastrointestinal tract infection, and axonal subtype were significantly associated with severe disability at admission, at nadir, and at discharge. Elevated blood levels of HbA1c were significantly correlated with worse disability at admission (OR = 0.64) and at nadir (OR = 0.74) but not at discharge. Elevated CSF glucose levels were significantly correlated with severe disability at admission (OR = 0.68), at nadir (OR = 0.62), and at discharge (OR = 0.72). The present study revealed that elevated glucose levels in the blood and CSF were correlated with disease severity at admission, nadir and discharge and might predict the short-term prognosis of GBS patients.

This study investigated EEG microstate dynamics in trigeminal neuralgia (TN) patients to understand the central nervous system's contribution to this neuropathic pain condition. Despite TN's traditional classification as a peripheral neuropathy, altered brain network organization may play a critical role in pain chronification and treatment resistance, making EEG microstates a valuable tool for capturing these dynamic neural signatures. We analyzed resting-state EEG recordings from 14 healthy individuals and 36 TN patients through a systematic analytical pipeline. After preprocessing with a fifth-order Butterworth band-pass filter (10-40Hz), we employed k-means clustering to identify four distinct microstate configurations (4-7 states). From these configurations, we extracted temporal parameters (duration, occurrence, coverage, and mean global field power) and constructed transition probability matrices to characterize brain state dynamics. These features were then evaluated using ANOVA and utilized in machine learning classification models to assess their discriminative potential. TN patients demonstrated distinct microstate abnormalities, including dramatically increased durations in specific microstates (5-6 times longer than controls) and consistently reduced global field power (0.03 vs. 0.35). Transition probability analyses revealed striking differences between groups: healthy subjects exhibited balanced bidirectional transitions (particularly B↔C at ~ 31-33%), whereas TN patients showed highly asymmetric patterns with strong directional flows (B→A: 33.5%, C→A: 35.2%, D→A: 34.4% in 4-state model). Most notably, state E functioned as a distinctive "sink" in TN patients, receiving significant transitions while exhibiting minimal outward flow (only 2.8-3.6% in 7-state model), suggesting trapped neural processing. Machine learning classification achieved exceptional discrimination between groups (91.9% accuracy with SVM), with optimal performance using four features in simpler 4-state models. Our findings establish EEG microstate analysis as a promising neurophysiological framework for understanding TN pathophysiology, revealing objective biomarkers that reflect altered brain network dynamics rather than simply peripheral nerve dysfunction. These distinctive microstate patterns align with contemporary pain processing theories and offer potential applications in diagnosis, treatment monitoring, and development of novel therapeutic approaches targeting the central mechanisms of TN.

Spasticity is a common complication of stroke limiting patient's daily activities. Transcranial magnetic stimulation is a painless and non-invasive method that can potentially reduce post-stroke spasticity (PSS). Motor evoked potentials (MEP) parameters have been shown to be related with prognosis of stroke patients. In this study we analysed the changes in MEP parameters after 3 sessions of low Hz rTMS therapy among PSS patients. Patients with upper limb spasticity after stroke of 3 months duration were randomised into active and sham groups. In the active group three sessions of 1000 pulses, 1 Hz rTMS at an intensity of 90% of resting motor threshold were applied to the primary motor area of the contra-lesional hemisphere over three consecutive days. Sham rTMS intensity was 0% with coil placed over scalp for same duration. MEP was measured pre and post therapy in each group. 106 patients were screened of which 50 patients were selected. 25 patients were allotted to active group and 25 to sham group. Mean amplitude of MEP on stimulation of normal side was 1.98±1.70 mV before versus 1.53±1.16 mV after therapy showing significant reduction p=0.001 (95% CI-.135 - -.630). Similarly, there was significant increase in latency after therapy [22.92±2.25 ms vs 24.26±2.62 ms, p=0.001 (95% CI-2.0 - -.96)]. There was no significant change in amplitude (1.05±.69 mV vs 1.17±1.01 mV) or latency (23.66±2.45 ms vs 24.05±2.58 ms) after therapy in sham group. MEP parameters revealed even three sessions of therapy can be helpful in supressing normal hemisphere. We found reduction in amplitude and increase in latency of MEP after low Hz rTMS therapy in contra-lesional hemisphere suggesting its suppression after therapy.

Mirror movements (MM) are involuntary, symmetrical motor actions that accompany voluntary movements of the opposite limb, arising from disruptions in corticospinal tract function and interhemispheric communication. While physiological MM occur transiently in early childhood, persistent MM are pathological and may be congenital, linked to genetic mutations affecting axon guidance, or acquired due to neurological injury. This review explores the epidemiology, classification, clinical presentation, and underlying neurophysiological mechanisms of MM, emphasizing impaired interhemispheric inhibition and abnormal corticospinal projections. Advances in electrophysiology, neuroimaging, and genetics have improved diagnostic precision, yet standardized assessment protocols remain a challenge. Current treatment strategies include motor rehabilitation, neuromodulation, and assistive interventions, with emerging approaches such as genetic therapies showing promise. A multidisciplinary framework integrating clinical, genetic, and technological advancements is essential for optimizing management and improving quality of life for individuals with MM. Further research is needed to refine diagnostic tools and explore novel therapeutic targets.