This systematic review aimed to assess the impact of non-statin lipid-lowering therapies on imaging-defined features of carotid plaque vulnerability. Only studies assessing the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or ezetimibe met inclusion criteria for this review. Recent clinical trials and cohort studies suggest that PCSK9 inhibitors are associated with reductions in lipid-rich necrotic core volume, intraplaque neovascularization, and inflammatory activity. In contrast, ezetimibe has shown neutral or inconsistent effects, particularly when combined with low- or moderate-intensity statins. PCSK9 inhibitors appear to contribute to early and multidimensional stabilization of vulnerable carotid plaques, whereas the evidence supporting ezetimibe remains limited. However, given the heterogeneity of imaging methods, study designs, and outcome definitions, further well-designed clinical studies with standardized imaging protocols are needed to better understand the role of these therapies in carotid plaque remodeling and stroke prevention.

This review examines the expanding role of genetic factors in cerebral palsy (CP), with a focus on cryptogenic presentations and CP-masquerading conditions. It addresses how genomic insights refine diagnosis, guide management, and influence counseling. Emerging evidence demonstrates that de novo single-nucleotide variants, copy number variants, mitochondrial variants, and, rarely, repeat expansions contribute significantly to CP, particularly when neuroimaging is normal, progression is atypical, or additional neurodevelopmental features are present. Diagnostic yield is highest in these contexts. Trio-based whole-exome sequencing is recommended as first-line testing, supported by chromosomal microarray or whole-genome sequencing. Integration of genomic testing remains limited by inconsistent CP definitions, restricted test access, and under-recognition of genetic etiologies, especially in adults. Standardized CP classification frameworks, such as SCPE (Surveillance of Cerebral Palsy in Europe), combined with early genomic evaluation, can improve diagnostic accuracy, reveal treatable conditions, and enable precision care. This approach has potential to transform management and outcomes across the lifespan.

To summarise contemporary strategies to detect atrial fibrillation (AF) after stroke/transient ischemic attack (TIA) with emphasis on implantable loop recorders (ILRs), evaluate who should receive anticoagulation in device detected AF/atrial high-rate episodes, and evaluate biomarkers that increase the likelihood of detecting AF. ILRs substantially increase AF detection beyond 12-36 months of monitoring. General population screening with ILRs increases AF diagnosis without a definitive stroke reduction. For subclinical/device detected AF, anticoagulation may reduce stroke but comes at the expense of increased bleeding. The burden of AF, biomarkers and atrial cardiomyopathy markers show promise to stratify risk and guide extended monitoring. An individualized approach is needed to identify who benefits most from ILR and subsequent anticoagulation. Research priorities include outcome-powered trials after stroke/TIA, the role of AF burden in decision making and the role of wearables within clinical pathways.

The frontal cortex plays a key role in many functions considered to be relevant for consciousness. Furthermore, altered consciousness appears to exist in those with disorders that disrupt or damage frontal areas and/or networks. This article reviews recent research discussing the impact of frontal disorders on consciousness. Many theories of consciousness have been developed over the last century to help explain the neural correlates of consciousness. Some theories argue that the frontal cortex is necessary for consciousness, while others argue that posterior cortical regions are critical for consciousness. The Memory Theory of Consciousness argues that consciousness requires modality-specific localization throughout the brain. We argue that frontal disorders do not abolish consciousness but they may disrupt conscious abilities such as sustained attention, working memory, problem-solving, complex thought, executive function, response inhibition, decision-making, and goal-oriented behavior. Understanding the role of the frontal cortex in consciousness has significant scientific, clinical, and societal implications.

Refractory status epilepticus (RSE) is a neurological emergency with high mortality and multisystemic comorbidities. Rapid diagnosis and early detection of complications can decrease early mortality and decrease severe long-term effects. Status epilepticus (SE) has multisystemic complications involving essential organs, rapidly inducing neuronal death programming, severe cardiopulmonary insults, hemodynamic collapse and other systems failure. In this review, based on recent basic science research, observational studies and case series, we will go over the concepts of status and categories, common local and systemic physiopathological changes and clinical manifestations of these time sensitive medical complications. More research and updates are needed to establish how medical therapy, with old and new antiseizure medication and ICU interventions can prevent or minimize complications. There are many areas of ongoing investigation and can represent more recent developments or evolving understandings: Neuroinflammation: The role of neuroinflammation and inflammatory cytokines (IL-1β and TNF-α) in the induction and exacerbation of status epilepticus is an area of active research. Animal models and serological biomarkers have elucidated the central role of neuroinflammation in initiating and perpetrating the pathogenic process leading to SE. Autoimmune Encephalitis:The association between autoimmune conditions and refractory status epilepticus, particularly NMDA receptor encephalitis, paraneoplastic encephalitis, and lupus vasculitis, and the need for immunotherapy in these cases. Targeting inflammatory pathways and cytokines is essential when treating and mitigating injury induced by SE. Non-Convulsive Status Epilepticus (NCSE): The challenges in diagnosing NCSE, its increasing prevalence, especially in the elderly, and the association with poorer outcomes and specific comorbidities. The use of continuous video EEG and other EEG methods can help detecting NCSE sooner and may improve outcomes and decrease neurological and systemic sequelae of RSE. The Relationship between Seizure Duration and Complications:The duration of status epilepticus is a cardinal point in determining complications. Mortality rates increase significantly as status epilepticus (SE) progresses to super-refractory status epilepticus (SRSE). Status Epilepticus (SE) is a severe neurological emergency characterized by prolonged seizures that disrupt brain function and trigger a cascade of systemic complications. These complications span multiple organ systems, including neurological deficits, cardiac arrhythmias, respiratory failure, renal dysfunction, and gastrointestinal issues, often exacerbated by the metabolic demands of the seizures and the side effects of treatment. Prompt diagnosis and management of underlying causes, along with vigilance for potential complications, are crucial to improving outcomes and reducing the high mortality associated with SE, particularly in its refractory and non-convulsive forms.

To outline a practical and comprehensive approach to evaluating transient neurologic dysfunction (TND) in adults. TNDs are a common reason for neurologic consultation. Diagnosis relies largely on history, as neurologic examination is usually normal in the post-ictal stage. The differential of TNDs is extensive, and testing should be targeted to the more likely etiologies and ones that may portend permanent loss of neurologic function. In addition to the more common causes - transient ischemic attack (TIA), seizures, migraine auras, drug-induced adverse events, hypoglycemia, blood pressure fluctuations, hyperventilation, panic attacks, and paroxysmal vestibular disorders, there are some distinctive TND presentations and special circumstances that may point to the less common etiologies. The article outlines the key features of the common presentations and presents a comprehensive differential diagnosis that includes many rare causes of TNDs in adults and adolescents. The proposed approach relies on carefully elucidating the nature, timeline, and circumstances of the symptoms, gathering examination clues, and seeking to determine whether the event is likely due to neuro-vascular, non-vascular neurologic (paroxysmal or chronic), non-neurologic, or rare neurologic etiologies. Specific diagnoses are listed for each of these categories.

Neuromodulation provides additional treatment options for patients with drug-resistant epilepsy who are not candidates or unwilling to undergo resective or ablative surgery. However, our current knowledge on the safety and efficacy of different neuromodulating devices during pregnancy is limited. This article reviews recent research on pregnancy outcomes in epilepsy patients treated with vagus nerve stimulation (VNS), deep brain stimulation (DBS), or responsive neurostimulation (RNS). Currently available information about pregnancy outcomes in epilepsy patients with neuromodulating devices all comes from cases series or case reports. Randomized control trials or prospective observational studies are lacking in this patient population. The overall sample size is too small to draw conclusions on the safety of these neuromodulating devices in pregnancy and maternal outcomes including obstetric complications. There is no clear sign of device-related teratogenicity. Further research should be directed at establishing a pregnancy registry and conducting multi-center prospective studies to track pregnancy outcomes in epilepsy patients with various neuromodulating devices.

Purpose of ReviewTo evaluate the effectiveness of rehabilitation therapies for managing symptoms of sleep and autonomic dysfunction (cardiovascular, gastrointestinal, urinary and sexual) in Parkinson’s disease (PD). The narrative review focuses on recent data drawn from clinical trials, particularly randomized controlled trials, to assess these therapies and the overall quality of the evidence.Recent FindingsResistance training and aerobic exercises can improve sleep quality in PD. Resistance and aerobic exercises, along with abdominal binders, may help alleviate orthostatic hypotension, though the quality of evidence is not high. Interventions such as expiratory muscle strength training, sensorimotor training, and video-assisted swallowing therapy are beneficial for dysphagia. Pelvic floor muscle training combined with behavioral therapy can potentially mitigate urgency and urge incontinence.SummaryMany rehab-based strategies though promising lack sufficient evidence for implementation into clinical practice. The current evidence supports their role in addressing sleep disturbances, orthostatic hypotension and dysphagia. However, the evidence for their effectiveness in treating gastroparesis, constipation, and urinary and sexual dysfunction remains limited.