Search

In 2024, therapeutic and diagnostic advancements are shaping the field of neurology. Three new drugs show promise for treating myasthenia gravis and chronic inflammatory demyelinating polyneuropathy. A new classification for Parkinson's disease has been proposed, while a neuroprosthesis is improving gait in advanced stages. Revised criteria for inclusion body myositis and multiple sclerosis are refining diagnoses, and blood biomarkers are enabling early detection of Alzheimer's disease. The effectiveness of early thrombolysis in stroke has been confirmed, and new treatments are being explored for cerebral hemorrhages. In epilepsy, surgery reduces mortality by 30% in drug-resistant patients. Finally, new treatments targeting PACAP and CGRP are reducing refractory migraines with good tolerability., Competing Interests: le CHUV a reçu pour M. Théaudin : des honoraires de conférencière, des frais pour participation à des comités consultatifs et des subventions de voyage de la part d’Alexion, Argenx, Sanofi, Biogen, Roche, Novartis, CSL Behring, Merck, Alnylam et AstraZeneca. P. Ryvlin a perçu des honoraires des laboratoires Novartis, Lundbeck et Angelini Pharma dans le cadre de présentations orales et de comités consultatifs, ainsi qu’une subvention de recherche du laboratoire Novartis. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Study Objectives: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) may improve sleep dysfunction, a common non-motor symptom of Parkinson disease (PD). Improvement in motor symptoms correlates with DBS-suppressed local field potential (LFP) activity, particularly in the beta frequency (13 - 30 Hz). Although well-characterized in the short term, little is known about the innate progression of these oscillations across the sleep-wake cycle. We sought to characterize LFP fluctuations over several days and nights in the home setting in patients chronically treated with DBS., Methods: LFPs in the beta and alpha frequency range were recorded from the STN in 13 PD subjects (18 hemispheres) over 14.6 (interquartile range 4) days. Sleep and wake were determined by validated actigraphy. We calculated the mean difference between sleep and wakefulness in LFP power (µVp), probability density functions of normalized LFP, and the fraction of overlap between probability density histograms., Results: STN LFPs showed a consistent fluctuation based on behavioral state. LFP power was higher during wakefulness than during sleep, with little overlap in the magnitude of LFP power between these two states. Delineation of subject activity patterns revealed that LFP variance by time of day was more strongly correlated at night., Conclusions: STN LFP fluctuations represent a useful measure to distinguish between sleep and wakefulness in PD. These fluctuations can be detected in the home setting using commercially available devices, including in patients who have been treated with DBS for years. This technology may lead to opportunities for closed-loop DBS therapy., (© The Author(s) 2025. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

We report a patient with autonomic dysfunction following acute SARS-CoV-2 infection, presenting progressively worsening severe orthostatic hypotension to the point where she could no longer sit or stand. The patient experienced a delay in diagnosis after an initial misdiagnosis of a functional neurological disorder. Persistent orthostatic symptoms prompted us to re-examine the diagnosis and explore other diagnostic tools, which ultimately allowed us to identify and treat severe immune-mediated orthostatic hypotension (OH). We identified autoantibodies (AAB) targeting the autonomic nervous system. Intravascular immunoglobulin therapy, along with early, specific multi-disciplinary rehabilitation, completely resolved the symptoms. Hard-to-assess patients are often penalized by suboptimal care due to the lack of a comprehensive patient history and physical examination, resulting in unnecessary and costly ancillary examinations that lead to delays in diagnosis or misdiagnoses. Furthermore, a lack of awareness of rare complications with new diseases may also hamper proper patient care. In the present case, this includes the wide range of SARS-CoV-2 infection manifestations, including immune-mediated autonomic complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Theiler, Bronchain, Grouzmann, Duflon, Hirt, Du Pasquier, Waeber, Wuerzner, Diserens and Bally.)