BMC Neurology

IntroductionHeadache disorders are one of the most common health problems worldwide, they can be classified into primary and secondary disorders. In the primary group, migraine - the second most common type of headache - is the most disabling one and one of the most important reasons why its treatment is mandatory. Migraine treatment involves different steps and kinds of medical therapy and patient education, and in these past years studies have been exploring the effect music therapy can have in reducing the severity and duration of an acute migraine attack. It has been reported that adding music to the pharmacological treatment can help decrease the pain severity, thus, reducing the disability migraine can cause. ObjectiveEvaluate the effectiveness of music therapy as a treatment or coadjuvant of migraine attacks in people who suffer this condition. Methods and analysisThis protocol is consistent with the methodology recommended by the PRISMA-P and the Cochrane handbook for systematic reviews of interventions. This study will be carried out as a systematic review and meta-analysis. In order to do so, electronic searches will be performed in PubMed, Medline and Cochrane (through Ovid) and Embase. The data range parameters used in searching all databases are from the last 20 years. Randomized controlled trials (RCTs) published in English, Spanish, French and Portuguese; with the primary outcomes being reduction of headache intensity, resolution of the migraine and decreased frequency of migraine attacks. Three investigators will screen all retrieved studies titles and abstracts, making a first preliminary list. A second screen will be done by the same three investigators similarly to the first one, but reviewing the full texts and building the final list. Then, the evaluation of the risk of bias and extraction of all data will be performed. The risk of bias of the included RCTs will be evaluated by the Cochrane Collaborations tool. A qualitative synthesis will be provided in text and tables, to summarize the main results of the selected publications. The heterogeneity between studies will be assessed through the I2 statistic. If there is sufficient homogeneity across outcomes, a meta-analysis will be conducted. ConclusionsThis systematic review will provide evidence regarding the effectiveness of music therapy as a single or coadjuvant treatment in patients with migraine attacks. Based on this analysis, it will be feasible to know whether this intervention is effective in the reduction of the intensity of the migraine attack, if it can help resolve the migraine attack, or reduce the frequency of migraine attacks.

BackgroundMultiple sclerosis (MS) is a chronic neurodegenerative disease charac-terised by progressive neurological disability and heterogeneous symptom trajectories. Cur-rent clinical monitoring methods, including magnetic resonance imaging (MRI) and episodic neurological assessments, provide limited insight into subtle disease progression and real-world functional changes. Digital health technologies integrating multimodal biosignals and behavioural assessments may enable continuous monitoring and personalised rehabilitation for patients with MS. ObjectiveThis study aims to evaluate the clinical utility of the BodyMirror Clinical MS platform, a multimodal software-as-a-medical-device (SaMD) that combines wearable biosensors, neuroscience-based games, and machine learning algorithms to remotely monitor disease progression and deliver personalised neurorehabilitation for individuals with multiple sclerosis. MethodsThis study is a prospective, randomised, double-blind, controlled, multisite clinical trial enrolling 400 participants, including 300 individuals with multiple sclerosis and 100 healthy controls. MS participants will be randomly assigned (1:1) to either an adaptive neurorehabilitation intervention group or a control group receiving non-therapeutic digital activities matched for engagement and exposure. Participants will perform three 30-minute sessions per week over a 24-month period using the BodyMirror platform. The system integrates multiple biosignals, including electroencephalography (EEG), electromyography (EMG), inertial measurement unit (IMU) motion data, speech analysis, and behavioural performance metrics, to generate digital biomarkers of neurological function. The primary endpoint is change in Expanded Disability Status Scale (EDSS) score from baseline to 24 months. Secondary outcomes include changes in Multiple Sclerosis Functional Composite (MSFC), MRI brain volume, cognitive performance, patient-reported outcomes, adherence to digital rehabilitation, and health-economic outcomes. ConclusionsThis trial will provide the first large-scale clinical evaluation of a mul-timodal digital neurotechnology platform combining wearable biosensors and game-based neurorehabilitation for remote management of multiple sclerosis. If successful, BodyMirror Clinical MS may enable scalable remote monitoring, earlier detection of disease progres-sion, and personalised digital rehabilitation for individuals living with MS.

BACKGROUND: Myofascial Pain Syndrome (MPS) is a common musculoskeletal pain condition associated with myofascial trigger points that has been reported to occur in 30-93% of patients who present with musculoskeletal pain. The current pharmacologic treatments (such as nonsteroidal anti-inflammatory drugs [NSAIDs], muscle relaxants, and tricyclic antidepressants) are only partially effective and have side effects. Shilajit, a mineral-organic exudate from the Himalayas, has antioxidant, anti-inflammatory, mitochondrial bioenergetic, and central analgesic effects and has not previously been examined as an analgesic in any musculoskeletal pain condition. METHODS: This was an exploratory pilot clinical trial with open-label design in a single arm for an 18-month period at All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Patients aged 18 to 65 years with clinically diagnosed MPS (Simons et al. 1999 criteria) and a baseline visual analog scale (VAS) score >4 were enrolled. Native Himalayan Shilajit 250 mg daily was administered as add-on therapy for 49 days. The main outcome was the percentage of participants with more than or equal to 30% VAS reduction at Day 49. The intensity of pain, the dose of analgesics consumed, and the number of trigger points were evaluated at five time points (Day 0, 12, 24, 36, 49). Throughout, adverse events were monitored. RESULTS: Of 80 enrolled participants, 76 (95.0%) completed the per-protocol analysis. Mean age was 41.25 (SD 9.05) years; 52.6% were male. A total of 56 of 76 participants (73.7%; 95% CI: 62.1-82.8%) achieved the primary endpoint. Mean VAS score declined from 6.63 (SD 1.08) at baseline to 3.63 (SD 1.72) at Day 49 (mean reduction 45.3%; Friedman Chi-square= 278.5, p<0.001). The first signs of pain reduction were seen at Day 24. The number of analgesic doses consumed decreased by 75.5% during the study period (chi-square = 126.1, p<0.001). There was a significant reduction in trigger point count from baseline to Day 49 (p=0.031) of 23.4%. One Grade 2 adverse event (gastrointestinal irritation, Day 28, resolved within 24 hours, no drug discontinuation) occurred; no serious adverse events were reported. Trial registration: CTRI/2025/06/088636. The study was not funded by any external sources. CONCLUSIONS: Native Himalayan Shilajit 250 mg/day for 49 days was associated with clinically and statistically significant reductions in pain intensity, analgesic consumption, and trigger-point burden in patients with MPS, with a favorable safety profile. These findings warrant confirmation in a larger, randomized, placebo-controlled trial.

BackgroundMiddle meningeal artery embolization is an emerging neuroendovascular therapy for chronic subdural hematoma. Recently, a number of randomized control trials have been conducted to assess the efficacy of middle meningeal artery embolization to reduce the recurrence or progression of chronic subdural hematoma. MethodsA systematic review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The authors will systematically search MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov (National Library of Medicine) for randomized control trials evaluating middle meningeal artery embolization for chronic subdural hematoma. A meta-analysis will be undertaken to compare patients undergoing middle meningeal artery embolization and standard care compared to standard care alone; primary effectiveness endpoints will be symptomatic recurrence, radiographic re-accumulation, or reoperation; secondary safety endpoints will be new disabling stroke, myocardial infarction, or death within 30 days. DiscussionThis proposed systematic review and meta-analysis will synthesize and appraise available data regarding middle meningeal artery embolization, a novel neurointerventional therapy. Findings will help clinicians, patients, administrators, policy makers to determine the role of this new treatment and its potential benefits. Systematic review registrationPROSPERO #CRD42024512049

BackgroundTelemedicine is feasible and well-accepted by people with multiple sclerosis (MS). ObjectiveThe aim of this study is to validate a smartphone-based cognitive screening battery, icognition, to faster signal cognitive deterioration. Methodsicognition consists of three tests (Symbol Test, Dot Test and visual Backwards Digit Span (vBDS)) that are equivalents of validated paper-pencil tests. These are the Symbol Digit Modalities Test (SDMT), the 10/36 Spatial Recall Test (SPART) and the auditory Backwards Digit Span (aBDS), respectively. To establish the validity of icognition, 101 people with MS and 82 healthy subjects completed all tests. 21 healthy subjects repeated testing 2 to 3 weeks later. ResultsAll tests in icognition correlate well with their paper-pencil equivalent (Symbol Test: r=.63, p<.001; Dot Test: r=.31, p=0.002; vBDS: r=.71, p<.001), negatively correlate with the Expanded Disability Status Scale (EDSS: Symbol Test: rho=-.27, p=.01; Dot Test: rho=-.29, p=.006; vBDS: rho=- .23, p=.027) and show high test-retest reliability (Symbol Test: r=.81, p<.001; Dot Test: r=.75, p<.001; vBDS: r=.84, p<.001). Test performance was not significantly different between people with MS and healthy subjects for all cognitive tests, both in icognition and their paper-pencil equivalents. Conclusionicognition is a valid and reliable tool to remotely screen for cognitive functioning in persons with MS.

IntroductionRegenerative Peripheral Nerve Interface (RPNI) and Targeted Muscle Reinnervation (TMR) are two reinnervation techniques which have shown clear superiority over classical amputation. It is mainly due to a lower incidence of painful neuromas, residual limb pain and phantom limb pain associated with these new procedures. However, they have never been compared to each other. Neither has their effectiveness been evaluated based on patients demographics, age, sex, comorbidities (diabetes, coronary heart disease, peripheral arterial disease, chronic kidney disease, congestive heart failure), amputations cause, type of amputation, amputation level, previous surgeries and if there was or not previous nerve division into fascicles. Therefore, the objective of this systematic review and meta-analysis is to compile all the evidence to date and provide a comprehensive view of what each technique offers. Methods and designThe review will be conducted according to this protocol, following the recommendations of the Cochrane Handbook for Systematic Reviews. A comprehensive electronic search will be performed in: Cochrane Register of Controlled Trials (CENTRAL), Web of Science, Scopus, PubMed and MedRixb. This review will include randomized, quasi-randomized, and observational studies written in any language. We will use Covidence for assessing all titles and abstracts identified during the literature search. Two review authors will independently assess the trial eligibility, risk of bias and extract appropriate data points. Ethics and disseminationThe proposed systematic review will collect and analyse data from published studies; therefore, it raises no ethical issues. The results of the review will be disseminated by publication in a peer-review journal and submitted for presentations at conferences. PROSPERO registration numberCRD42024617299 STRENGTHS AND LIMITATIONS OF THIS STUDY- This will be the first systematic review to include a comparison between RPNI and TMR. - Through a comprehensive search and selection of high-quality articles, the best available evidence of RPNI and TMR against classical amputation will be gathered. - Gray literature and unpublished studies will be sourced from MedRixb aiming to reduce the impact of a possible publication bias. - Exclusion of non-English/Spanish papers may lead to language bias. PICO QUESTIONO_ST_ABSPopulationC_ST_ABSAny adults (aged over 18 years) and gender with a superior or inferior limb amputation. InterventionProphylactic Targeted Muscle Reinnervation (TMR) or Regenerative Peripheral Nerve Interface (RPNI). ComparatorsClassical amputation. TMR vs RPNI. Outcomes1) Incidence of neuroma, 2) Incidence of residual limb pain (RLP), 3) Severity of Pain 4) Incidence of phantom limb pain (PLP), and 5) Surgical complications (dehiscence, infection, haematoma and seroma).

BackgroundTrauma is one of the leading causes of death worldwide. Tranexamic acid (TXA) has shown effectiveness in reducing hemorrhage-related mortality in a hospital setting. However, its application in the prehospital setting still presents challenges. AimTo determine the efficacy and safety of TXA administered in the prehospital setting in trauma patients. MethodsA systematic review with meta-analysis was conducted. PRISMA guidelines were followed.Randomized clinical trials evaluating the administration of TXA in the prehospital setting in trauma patients aged 18 years or older were included. Studies were assessed by two reviewers independently. The GRADE approach was used to assess the quality of evidence and ROB2 to identify the risk of bias. Results were analyzed by meta-analysis, using fixed or random effects models, depending on the heterogeneity observed. ResultsA total of 979 records were identified; PubMed (149), Embase (565), Cochrane (29) and Scopus (236). Three studies were included. After analysis TXA reduced mortality in the first 24 hours (RR 0.74, 95% CI: 0.56-0.97; P = 0.03) and at 28 days (RR 0.82, 95% CI: 0.69-0.98; P = 0.03). No improvement in survival with favorable long-term functional outcome was observed (RR 1.11, 95% CI: 0.91-1.35; P = 0.29). No significant differences were found in adverse events such as deep vein thrombosis (RR 1.23, 95% CI: 0.96-1.58; P = 0.11), pulmonary embolism (RR 1.08, 95% CI: 0.76-1.53; P = 0.66) or myocardial infarction (RR 2.17, 95% CI: 0.75-6.31; P = 0.15). ConclusionsPrehospital TXA use in trauma patients reduces short-term mortality, mortality in the first 24 hours, and mortality at 28 days. In addition, it does not increase the risk of serious adverse events; deep vein thrombosis, pulmonary embolism, myocardial infarction, or ischemic stroke.

IntroductionMultiple sclerosis (MS) is a chronic progressive neurological disease. There is ample evidence that exercise can be beneficial. The advancement of modern technology led to improvements in the way therapy can be offered and can make it more motivating, thereby increasing adherence. The primary objective of this two site single blinded randomized control trial (RCT) is to explore the feasibility of conducting a multicentre definite RCT trial with a neuroanimation intervention of high-dose practice in people with mild-to-moderate MS. The secondary objective is to collect data on the variability of outcome measures to inform sample size calculations for a RCT. The tertiary outcome is to assess if this intervention changes exercise behaviour. Methods and analysisThis study is in preparation for a future definitive randomised control trial (RCT) where the efficacy compared to a dose matched control therapy will be assessed. The setting for this study is a research laboratory at Edith Cowan University (ECU) and a neurological service provider, Multiple Sclerosis Society of Western Australia (MSWA). This feasibility study will recruit people with MS who have mild to moderate disability. Subjects will participate in 24 session, 2 times a week, of 60 minutes time-on-task intense arm training, using an exergaming system. Participants will undergo a follow up within 3 days and at 6 months after the final study visit. Ethics and disseminationThis study was approved by the local Ethics Committee of Edith Cowan University. Subjects will be included after signing informed consent. Study outcomes will be disseminated through presentations at scientific conferences and through peer-reviewed journals. Trial registrationACTRN12622000281796 Strengths and limitations of this studyO_LIThe study intervention is a newly developed exercise intervention protocol designed to be engaging and motivating C_LIO_LINext to investigating primary efficacy in order to determine sample size for a larger trial, the study also uses implementation science to assess future obstacles in a follow up randomized control trial C_LIO_LIThe feasibility of conducting a larger trial will be based on standardised criteria regarding process, resource, and management metrics C_LIO_LIThis study without a control group demonstrates feasibility rather than efficacy C_LI

IntroductionIn clinical practice, headache presentations may fit more than one ICHD3 diagnoses. This project seeks to exhaustively list all these logically consistent "codiagnoses" according to ICHD3 criteria. We limit our project to cases where only two diagnoses are involved. MethodsWe included the ICHD3 criterias for "Migraine" (1.1, 1.2, 1.3), "Tension-type headache" (2.1, 2.2, 2.3, 2.4), "Trigeminal autonomic cephalalgias" (3.1, 3.2, 3.3, 3.4, 3.5), as well as all "Other primary headache disorders". We excluded "Complications of migraine"(1.5) and "Episodic syndrome that may be associated with migraine" (1.6) since these diagnoses require codiagnoses of migraine as first assumption. We also excluded "probable" diagnosis criteria. Each phenotype in the above criteria is assigned an unique prime number. We then encoded each ICHD3 criteria into integers, call "criteria representations", through multiplication in a list format. "Codiagnoses representations" are generated by multiplying all possible pairings of criteria representations. To eliminate logical inconsistent codiagnses, we manually encode a list of logically inconsistent phenotypes through multiplication: For example, headache lasting "seconds" would be logically inconsistent with "headache lasting hours"; the prime representation for both are multiplied together. We called this list the "inconsistency representations". All codiagnoses representation divisible by any inconsistency representations are filtered out, generating a list of codiagnoses represenation that are logically consistent. This list is then translated back into ICHD3 diagnoses. ResultsA total of 103 prime numbers were used to encode phenotypes from the included ICHD3 criteria diagnosis with 578 encodings generated. We generated 99 pairs of illogical phenotypes. Once illogical phenotypes were excluded, a total of 253,842 composite numbers representing unique dual-diagnosis clinical profiles were obtained. The number of profiles, although unique, yields duplicate dual diagnoses; once these duplicates are removed, we obtained 145 possible logical dual diagnoses. Of the dual diagnoses, 2 contains with intersecting phenotypes due to subset relationships, 14 dual diagnoses with intersecting phenotype without subset relationships, 129 contains dual diagnoses as a result of non-intersecting phenotypes. ConclusionPrime number representations of primary headache disorders not only offer clinicians with an automated way of diagnosing headaches but also provides a powerful method of investigating co-diagnosis in headache classifications. Applications of this method to the investigations of dual diagnosis and headaches may offer insight into "loopholes" in the ICHD3 as well as potential explanation for sources of a number of controversies in headache disorders. Futures applications of the method includes extending the methodology to all of ICHD3.

ObjectiveThe ENRICH Trial was the first to demonstrate superiority of surgical intervention over medical management when performed within 24 hours of symptom onset for supratentorial lobar hemorrhages. We aimed to determine whether the implementation of an intracranial hemorrhage detection algorithm that provides immediate active notification to provider cell phones would expediate the screening of hemorrhagic stroke patients for the trial at our institution. MethodsA retrospective review of our prospectively collected ENRICH Trial patient screening log was performed at our Comprehensive Stroke Center. The log encompassed patients screened for the ENRICH Trial who presented between January 2018 and March 2022. Trial screening data was compared pre- and post-implementation of the VizAI (Viz.ai, San Francisco, California, USA) smartphone application. Results188 adult patients were identified during the study period. Time between CT Head and notification of the neurosurgical team for trial screening was reduced by 50 minutes after the implementation of VizAI (p<0.002). The number increases to 57 minutes when hemorrhages not identified by the ICH algorithm were excluded. ConclusionsActive notification of the neurosurgical team by an artificial intelligence application significantly reduces the time from hemorrhage identification to trial screening. Further studies are needed to evaluate whether this results in a clinical benefit.

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSBackgroundC_ST_ABSWe aimed to assess the impact of pain catastrophizing, measured using the Italian version of the Pain Catastrophizing Scale (PCS), on the clinical response of patients with chronic migraine to anti-CGRP monoclonal antibodies combined with a multidisciplinary approach, including psychological treatment. Methods25 Outpatients from SS. Antonio e Biagio e Cesare Arrigo headache clinic randomly assigned to receive Galcanezumab, Erenumab, or Fremanezumab. Their clinical response was evaluated over six months using various measures, including reducing the number of days with migraine per month, and quality of life using Headache Impact Test (HIT 6), MIgraine Disability Assessment Score questionnaire (MIDAS), and Becks Inventory Scale (BDI II) scales to assess comorbid depression. ResultsWe established a strong correlation between HIT 6 and PCS, with coefficients of 0.81 and 0.88 at T1 and T2, respectively. Furthermore, we found no significant correlation between PCS and the other scales, such as MIDAS, as with any pharmacological therapies. ConclusionThis study aims to clearly define the impact of a multidisciplinary approach including a psychological follow-up on a particular clinical phenotype of chronic migraines and their tendency to catastrophize, but more extended data are needed.

BackgroundTraumatic brain injury (TBI) is a critical problem which portends an intensive burden with increased mortality and disability affecting more the young population worldwide. The primary goal of TBI treatment is to control intracranial pressure (ICP) and to prevent he devastating effect of secondary brain insult. For over a hundred years decompressive craniectomy has been a standard surgical intervention for treatment of TBI, however it is not without harm since it causes serious complications including meningitis, subdural hygroma, hydrocephalous and increased reoperation rate. Cisternostomy is the most recently introduced intervention for management of cerebral edema Cisternostomy has proven its efficiency a standalone treatment as an adjunctive to decompressive craniectomy in treatment of severe traumatic brain injury. This review aims at investigating the therapeutic effects of cisternostomy when used independently or as an adjunctive to decompressive craniectomy (DC) across the available randomized clinical trials (RCTs) and non randomized studies of effect intervention (NRSI) sectional studies to optimize the strength of evidence for underpinning the strategy for treatment of traumatic brain injury. Methods and AnalysisWe will conduct the systematic review and meta-analysis by employing the provisions of Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guideline and the review protocol has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) for registration before commencement of the study. We will construct the search strategy using the all field terms, medical subheading terms [MeSH Terms] with all permutations combined with Boolean operators such as AND and OR. PubMed, EMBASE, Scopus, COCHRAINE, Web Of Science, Global Index Medicus, Semantic Scholar and Google Scholar electronic databases will be searched. Ethical Consideration and DisseminationThis review will not include any human participant such that the ethical clearance approval is not applicable. The protocol of this review has been registered at PROSPERO ID CRD42023400894. We will disseminate the final report of this review to local and international scientific conferences and The results of this review will be submitted for publication in the Journal of Neurotrauma.

Structured AbstractO_ST_ABSObjectiveC_ST_ABSDifferential diagnosis is fundamental to medicine. Using DiffNet, a differential diagnosis generator, as a model we studied the structure and organization of how collections of diagnose (i.e. sets of diagnoses) are related in the ICHD3. Specifically, we asked: Which sets of differential diagnoses are subsets of each other? What is the minimum number of sets of differential diagnoses that encompass all ICHD3 codes? Furthermore, we explored the clinical and theoretical implication of these answers. MethodsDiffNet is a freely distributed differential diagnosis generator for headaches using graph theoretical properties of ICHD3. For each ICHD3 diagnosis, we generated a set of differential diagnoses using DiffNet. We then determined algorithmically the set/subset relationship between these sets. We also determined the smallest list of ICHD3 diagnosis whose differential diagnoses would encompass the totality of ICHD3 diagnoses. ResultsAll ICHD3 diagnoses can be represented by a minimum of 92 differential diagnosis sets. Differential diagnosis sets for 10 of the 14 first digit subcategories of ICHD3 are represented by more than one differential diagnosis sets. Fifty-one of the 93 differential diagnosis sets contain multiple subset relationships; the remaining 42 do not enter into any set/subset relationship with other differential diagnosis sets. Finally, we included a hierarchical presentation of differential diagnosis sets in ICHD3 according to DiffNet. ConclusionWe propose a way of interpreting headache differential diagnoses as partial ordered sets (i.e. poset). For clinicians, fluency with the 93 diagnoses and their differential put forth here implies a complete description of ICHD3. On a theoretical level, interpreting ICHD3 differential diagnosis as poset, allows researchers to translate differential diagnoses sets topologically, algebraically, and categorically.

Background Gait impairment is a central sign of cervical spondylotic myelopathy (CSM) that is typically evaluated through subjective patient-reported questionnaires or objective in-clinic measures. These systems require substantial resources to administer and are poorly suited for longitudinal monitoring, however, emerging smartphone applications present an efficient alternative. We developed and assessed the validity of a data processing framework based on the SynapTrack smartphone application to assess gait function in individuals with CSM. Methods Participants completed walking tasks which were recorded on both the SynapTrack app and a gold standard gait mat. Acceleration data extracted from the smartphone by the app were filtered and processed to produce gait cycle features including velocity, step time, waveform features and frequency domain features. Standard gait features were compared across the two methods by correlation and Bland-Altman plots to assess validity. App-based gait features were then compared to the standard modified Japanese Orthopedic Assessment (mJOA) assessment to determine construct validity through correlation and ability to discriminate between individuals with CSM and healthy controls. Finally, intraclass correlation coefficients and coefficients of variation were used to measure test-retest reliability and standard variation across app features. Results A total of 110 participants were included in this study, of which 55 (50%) had CSM, 24 (22%) had peripheral neuropathy, and 31 (28%) were healthy controls. SynapTrack gait measures including velocity, step time, and double support showed strong validity as indicated through Bland-Altman plots and high correlation (>0.8) with mat features. In addition to the gait features, acceleration root mean square, acceleration crest, spectral entropy, and dominant frequency showed strong construct validity compared to the mJOA across correlation (0.2-0.54), trend test (p < 0.001), and AUROC (0.62-0.79) analyses. ICCs showed moderate test-retest reliability (0.52-0.67). Discussion The proposed framework for processing gait data showed strong validity compared to the gold standard mat and high construct validity compared to the mJOA suggesting the utility of the SynapTrack app as an efficient alternative to existing methods. The confirmation of gait metrics related to CSM severity and identification of relevant waveform and frequency domain features present opportunities to use smartphone apps to develop ecologically valid data driven markers of CSM severity.

Structured AbstractO_ST_ABSObjectiveC_ST_ABSWe represent primary headaches of the ICHD3 in matrix form and show that this representation allows for automated diagnosis as well as additional insights into headache classification. MethodsEach diagnosis in the ICHD3 is defined by a list of characteristics; combinations of characteristics form phenotypes. Multiple phenotypes may fit a given diagnosis. We first translated all characteristics for primary headache diagnoses in the ICHD3 into true/false statements. We generated a matrix of valid ICHD3 diagnosis as follows: O_LIEach row of the matrix represents a phenotype. C_LIO_LIEach column of the matrix represents a characteristic. C_LIO_LIIf any phenotype contains a characteristic, then that element is encoded as 1. Otherwise, it is encoded as 0. C_LI From this matrix, we calculated its bipartite projection and Markov cluster. We also row reduced to derive the basis vectors that span the space of all headache phenotypes. ResultsChronic migraine diagnoses as well as the characteristics "greater than 15 days per month" and "more than 3 months" have the strongest associations based on bipartite projection. Markov clustering yields 64 clusters. These clusters can be organized by ICHD3 diagnoses and demonstrates the level of fragmentation of individual diagnosis in the classification: Migraine is composed of 1 cluster, for example, whereas paroxysmal hemicrania can be broken down into 9 clusters. Finally, row reduction of our matrix yields 63 basis vectors, implying that all headache diagnoses in the ICHD3 can be represented as linear combinations of 63 characteristics. These 63 characteristics corresponds to the following: duration, frequency, aura characteristics, size/location, laterality, clearly remembered onset, TAC features, total number of episodes, severity, nausea/vomiting, photophobia, pulsating, alleviation by triptans, and association with awakening, sexual activity, physical activity, temperature, compression or traction, coughing. ConclusionOur result demonstrates that ICHD3 is a mathematical entity and that headache diagnoses exist in a 63-dimensional vector space. This mathematical embodiment of classification allows us to conduct 1) large scale systematic investigations of relationships between headache and phenotypes, 2) generate a graphical representation of characteristics and phenotypes and 3) improves diagnostic accuracy and efficiency.

ObjectivesTo summarize the baseline methods for the Headache Assessment Via Digital Platform in United States (Head-US) study and report accuracy of self- reported diagnosis of migraine on the platform, and patterns of acute and preventive treatment use among participants with migraine. BackgroundThe HeAD-US is a new, ongoing cohort study of patients with migraine in the US, centered around comprehensive data collection via the Migraine Buddy platform, a smartphone app. Data from such platforms can be used to provide real-world insights, capturing patients voices directly. MethodsParticipants from the Migraine Buddy app completed baseline surveys assessing demographics, headache characteristics, and treatment use. Migraine diagnosis was determined using the AMS/AMPP diagnostic module, and treatment effectiveness was evaluated using the migraine Treatment Optimization Questionnaire (mTOQ-6, defined as scores [&ge;] 6 indicating moderate-to-maximum efficacy). ResultsOf 6810 participants who completed the baseline questionnaire, 6267 (92.0%) met migraine criteria and were included in the rest of the study. Participants had an average age of 41.5 years (SD=13.1, range 18-88), 5692 (90.8%) were female, 3924 (62.6%) met criteria for episodic migraine and 2343 (37.4%) met criteria for chronic migraine. Of the participants, 52.6% were using acute over-the-counter (OTC) medications, 73.2% were using acute prescription medications, 2.4% were using medical devices, and 60.1% were on preventive treatments. There was no significant difference in treatment effectiveness between participants on polytherapy (37.6%) and those on monotherapy (39.5%, p = 0.168). Among the 2621 patients on monotherapy with acute medications, the most common categories were triptans (39.0%), OTCs (28.2%), and gepants (20.8%). For patients on prescription monotherapy, individuals using gepants reported the highest rate of effective treatment (53.3%) in head-to-head comparison with triptans (47.28%, p=0.036), and opioid/barbiturates (27.1%, p<0.001). ConclusionsHeAD-US participants have higher rates of chronic migraine and headache-related disability in comparison with large-scale epidemiologic studies. The HeAD-US study offers a valuable opportunity to leverage real-world data for understanding migraine patients, their treatment patterns, and outcomes.

BackgroundPrevious clinical studies have demonstrated the effects of brain-computer interface (BCI) on the motor recovery of stroke patients. The aim of this study was to evaluate the therapeutic effects of BCI on improving motor functions of stroke patients. MethodsWe conducted a meta-analysis on randomized controlled trials (RCTs) on BCI training for post-stroke motor rehabilitation. Relevant publications were identified from the databases of PubMed, Embase, ScienceDirect, and Cochrane Library. The standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated as the pooled effect size of the motor outcome. ResultsThirty-five of the 43 candidate articles involving 749 participants were included in this meta-analysis. Overall, both the significant immediate effect size of 0.53 and long-lasting effect size of 0.26 were found for motor outcome measured by Fugl-Meyer Assessment. A further subgroup-analysis observed larger therapeutic effects on lower-limb than upper-limb. A subgroup-analysis also indicated that stroke patients may gain better functional outcome in the subacute phase than in the chronic phase. Superior effect of BCI training was also detected for distal function of upper-limb over proximal function. BCI training combined with functional electrical stimulation (FES) was more effective than BCI combined with robot. No significant effect was found in other combined interventional methods, especially the use of transcranial direct current stimulation, which cannot potentiate the effects of BCI training. In addition, subgroup-analysis also indicated a greater effect for longer durations of intervention. And the dosage between 15 min and 180 min was found to be optimal. ConclusionsBCI has significant immediate and long-lasting effects on improving motor function of both upper-limb and lower-limb of stroke patients. Superior therapeutic could be delivered to patients in the subacute phase and clearer benefits are evident in distal functions of upper extremity. When combined with FES, BCI seems to be more effective than when combined with robot and other external devices. Longer durations of intervention could provide better effects. But bigger is not always better for weekly dosage.

IntroductionTreatment burden is the workload of healthcare for people with long-term conditions and the impact on wellbeing. A validated measure of treatment burden for use as an outcome measure in stroke trials is needed. We adapted a patient-reported measure (PRM) of treatment burden in multimorbidity, PETS (Patient Experience with Treatment and Self-Management version 2.0), to create a stroke-specific measure, PETS-stroke, and examined its psychometric properties. Patients and MethodsWe recruited stroke and transient ischaemic attack (TIA) survivors between Feb 2022-June 2023 from 10 hospitals in the UK and through the Scottish Health Research Register (SHARE). Participants completed the PETS-stroke questionnaire along with 3 other PRMs (Stroke Southampton Self-Management Questionnaire, The Satisfaction with Stroke Care Measure, The Shortened Stroke Impact Scale). We performed confirmatory factor analysis to test the factor structure of the PETS-stroke. We assessed Spearmans rank correlations between PETS-stroke and other PRMs to determine convergent validity. Intra-class coefficient was performed to assess test-retest reliability. Proportions of missing data along with feedback from qualitative interviews were used to determine feasibility. T-tests were conducted to examine variations in PETS-stroke scores based on multimorbidity and socioeconomic factors. ResultsThree-hundred-eighty-one participants were included. The best fit was achieved with a 9-factor structure and internal consistency was good (Omega values 0.729 to 0.921). The factor loadings for the individual indicator items across eight of the nine domains were moderate to strong. All domains of PETS-stroke showed moderate to strong correlations with at least one other PRM. Test-retest reliability was good for all domains (ICC>0.7). Qualitative feedback on feasibility was positive and missing data was within acceptable limits for 7 domains. PETS-stroke scores significantly differed based on multimorbidity in 3 domains and in 8 domains based on socioeconomic status. DiscussionPsychometric performance suggests PETS-stroke is a highly promising measure of treatment burden after stroke.

IntroductionDespite limited scientific evidence, trigeminal nerve blocks are alternative therapies for refractory trigeminal neuralgia (RTN). The duration of analgesia far exceeds the length of the conduction block. This study evaluated the quality of life 15 days after performing this block to treat RTN. MethodsThis retrospective study included all patients who, after informed consent, received iterative trigeminal blocks to treat a RTN between 2014 and 2018 in a university hospital. Patients received 0.5% levobupivacaine in combination with clonidine and a corticosteroid (cortivazol or betamethasone according their availability). Data were obtained from patients medical data files and a telephone questionnaire for the SF-12 score. The main criteria of evaluation was the change in quality of life according SF-12 performed at day 15. ResultsTwenty-one patients aged 62 {+/-}14 years were included. All patients exhibited RTN after many different clinical treatments according ICHD-3 criteria. Seventy-one per cent of RTN occurred after trauma or surgery. Before receiving blocks, SF-12 physical (SF12-PS) and mental (SF-12 MS) scores reached respectively 35 {+/-} 14 and 29 {+/-} 11. A mean time of 4 {+/-} 5 years elapsed between the occurrence of RTN and nerve blockade. At day 15, SF-12 PS increased by a 3 point mean value and SF-12 MS by 5 points. Approximately half of the patients (55%) were considered as non-responders with a cut-off value of less than 10% variation of their initial SF-12 score. When excluding these patients, SF-12 PS and SF-12 MS were increased by 17 and 9 points respectively. The mean duration of blocks lasted 15 {+/-} 59 days and no severe adverse effects were observed. Patient satisfaction was correlated with increased SF-12 PS (r2 = 0.3 p = 0.01) and with the length of analgesia (r2 = 0.51 p = 0.001) but not to SF-12 MS variation (p = 0.12). ConclusionTrigeminal nerve blocks are temporarily effective on pain that may increase the quality of life in responder patients. The reason why some patients are unresponsive to this treatment and why durations in efficacy are so variable remain unsolved. However, in responders, trigeminal nerve blocks seem simple, harmless, not excessively cumbersome and without severe adverse effects.

BackgroundThe Neuropathic Pain Symptom Inventory (NPSI) is a commonly used assessment in neuropathic pain (NP) trials, yet a Minimal Clinically Important Difference (MCID) has not been established. An MCID would enhance the interpretability of NPSI scores, guiding clinicians and researchers in assessing clinically important improvements in NP symptoms. The aim of this study was to calculate an MCID from the available scientific research that used the NPSI. MethodsWe conducted a systematic review and meta-analysis of NP trials reporting the NPSI. Four distributional approaches were applied to estimate the MCID: 1) meta-regression on the set of standard deviation (SD) of change scores, 2) meta-regression on the set of baseline SD scores, 3) simple aggregation on the set of SD of change scores, and 4) simple aggregation on the set of baseline SD scores. Only treatment arms within Randomized Controlled Trials (RCTs) were examined for MCID estimation. Control arms were examined separately in a sensitivity analysis using the simple aggregation method for both SD of change and baseline SD sets. Bias for each included study was assessed using the Cochrane tool for quality assessment of randomized controlled trials. Results323 trials were examined, 12 were selected for inclusion with a total of 17 treatment arms. The calculated MCID estimates for the NPSI total score (range 1-100) were 6.21 for the SD of change meta-regression and 7.1 for baseline SD meta regression. The MCID values aggregated using simple aggregation methods were 7.95 using pooled SD of change scores, 7.8 using pooled baseline SD. Control arms had a MCID of 8.04 for SD of Change and 8.71 for Baseline SD. ConclusionThis study provides preliminary MCID estimates for the NPSI. Limitations include limited data for NP subtypes, highlighting the need for additional anchor-based and etiology-specific MCID research to refine these estimates. These findings can aid in future NP trial design and the interpretation of results.