Brain

Post-stroke epilepsy (PSE) is a clinically relevant complication after ischemic stroke. While lesion location and established clinical risk factors contribute to PSE risk, the role of lesion-induced disruption of neurotransmitter-specific brain networks remains unclear. We retrospectively analyzed 251 patients with acute large-vessel occlusion ischemic stroke treated with mechanical thrombectomy. Binary lesion masks were embedded into normative neurotransmitter-informed structural connectomes derived from PET-based receptor and transporter density maps, yielding damage scores for 19 neurotransmitter systems and a global measure of structural disconnection. Partial least squares (PLS) regression was used for feature selection, followed by multivariable logistic regression adjusted for age, sex, and SeLECT. As a secondary internal resampling analysis, elastic-net logistic regression with repeated stratified cross-validation was used to assess whether the identified pattern remained informative under regularization. Twenty-six patients (10.4%) developed PSE. PLS identified a neurochemical signature dominated by serotonergic and {micro}-opioid-informed systems. In adjusted models, damage to 5-HT1a, 5-HT2a, and {micro}-opioid networks showed the strongest and most robust associations with PSE, independent of clinical predictors and global structural disconnection. Cholinergic network measures showed weaker and less consistent effects. In repeated internal cross-validation, the same networks were selected more consistently and were associated with higher discrimination than the clinical base model. Lesion-induced disruption of specific neurotransmitter-informed structural networks, most robustly serotonergic and {micro}-opioid systems, is associated with PSE and showed incremental signal in internal cross-validation beyond established clinical risk factors. These findings provide a mechanistically interpretable extension to existing PSE risk models.

There is substantial interest in understanding neurological impact and recovery over time, but there is a dearth of longitudinal assessment extending from minutes to months surrounding neural system impact. We compared rare intraoperative recordings in three patients, obtained immediately before and after anterior temporal lobe (ATL) resection during a semantic prediction task, with longitudinal source-localized electroencephalography (EEG) obtained 2-6 weeks before and 2 and 6-14 months after surgery. Relative to controls (n = 20), task performance showed sustained impairment in the two left-hemisphere patients and delayed impact in the right-hemisphere patient. Consistent with theory on ipsilateral and contralateral hemisphere compensation, all three patients exhibited bilateral EEG alterations in speech responses and effective connectivity that did not recover to pre-operative levels. Direct comparison of the datasets for intrinsic neurophysiological biomarkers associated with timescales of processing ({tau}INT) and excitatory-inhibitory balance (aperiodic slope, {chi}SPEC) showed a striking months-long reduction in rapid timescale processing and gradually increasing aperiodic slope (e.g., putatively increased cortical inhibition) in the ipsilateral hemisphere of all three patients. Amidst these neurophysiological alterations, task performance did not return to pre-operative levels. These rare longitudinal patient data advance a framework to broadly evaluate neurological impact over multiple timeframes.

Hyperpolarization-activated cyclic nucleotide-gated 1 channels (HCN1) mediate the Ih cationic current and play a central role in regulating neuronal excitability and synaptic integration. HCN1 is predominantly expressed in the neocortex and hippocampus. Pathogenic variants in HCN1 have been increasingly identified in individuals presenting with a broad spectrum of epileptic disorders, ranging from severe developmental and epileptic encephalopathy (DEE) to milder epilepsies. Here, we used patch-clamp electrophysiology in combination with confocal imaging in HEK293 cells to functionally characterize 43 HCN1 variants found in patients presenting with neurodevelopmental disorders, with or without epilepsy. Based on their biophysical properties, we defined four functional classes: (I) low or no current, (II) hyperpolarizing (i.e. left) shift in voltage dependence, (III) depolarizing (i.e. right) shift in voltage dependence, and (IV) generation of an instantaneous current. Integration of this functional classification with detailed clinical data from a cohort of 49 patients revealed a striking genotype-phenotype correlation. Loss-of-function variants were strongly enriched among individuals without epilepsy or with milder generalized phenotypes, whereas gain-of-function and mixed variants were predominantly associated with epilepsy, including all cases of DEE. Notably, non-epileptic cases clustered within a subgroup of loss-of-function variants affecting the selectivity filter. We further show that allosteric modulators, including the peptides NB6 and TRIP8bnano and the small molecule J&J12e, normalize the functional properties of mutant HCN1 channels in three classes. These findings establish a clinically relevant framework for interpreting HCN1 gain- and loss-of-function variants suggesting that the direction of channel dysfunction is a major determinant of epilepsy risk and severity.

Status epilepticus (SE) is a neurological emergency with a mortality of up to 39% in population-based studies. Animal studies suggest that, beyond a critical timepoint (t2), SE induces neuronal injury exceeding what can be expected from the underlying aetiology, but in vivo evidence in humans is scarce. Thirty-six prospectively recruited individuals with SE with a mean age of 59 years underwent serial high-resolution T1-weighted brain MRI over a mean follow-up period of 5 months and were compared with 34 individuals with drug-resistant focal epilepsy and 36 propensity-score matched healthy controls, which were retrospectively included. Cortical thickness and volume of subcortical structures were estimated and harmonised for scanner-related effects. Longitudinal change was assessed using linear mixed-effects models correcting for age at baseline and interscan interval and compared between groups. We further investigated the independent effects of SE duration, semiology and level of consciousness after mutual adjustment for each variable as well as aetiology and age at baseline, and investigated longitudinal structural change associated with key locations of peri-ictal MRI abnormalities (PMA). SE was associated with pronounced bilateral hippocampal atrophy in comparison to normal aging and drug-resistant epilepsy, alongside volume increase in several deep grey matter nuclei as well as a trend for cortical thinning of medial brain structures. SE duration was the strongest independent driver of brain change, producing widespread cortical thinning and bilateral hippocampal atrophy. A convulsive semiology was independently associated with accelerated medial temporal cortical thinning and bilateral hippocampal volume loss when compared with non-convulsive (NCSE) and other prominent-motor SE, while reduced consciousness predicted faster thinning of medial frontoparietal cortex. PMA was associated with distinct longitudinal trajectories of subcortical volume, with pulvinar and hippocampus involvement predicting thalamic and hippocampal atrophy patterns. According to our findings, a single episode of SE was associated with a measurable structural imprint in the brain that evolved over months beyond what would be expected for aetiology alone, with atrophy trajectories highlighting a vulnerability of the hippocampus and other limbic structures. A long SE duration, together with, to a lesser extent, convulsive semiology and impaired consciousness, independently amplified this damage. These findings corroborate the timepoint-based (t2) concept of SE and reinforce the clinical imperative of rapid seizure termination to contain long-term structural brain injury.

KCNT1-related disorders represent clinically heterogeneous severe epilepsies associated with profound neurodevelopmental impairment. The full phenotypic spectrum and longitudinal disease trajectory remain incompletely characterized, which is a critical gap limiting the establishment of quantifiable endpoints necessary for future clinical trials. Compounding this challenge, identical pathogenic variants result in phenotypically distinct syndromes, including early infantile developmental and epileptic encephalopathy (EIDEE) and autosomal dominant sleep-related hypermotor epilepsy (ADSHE), underscoring unresolved genotype-phenotype relationships. To address these gaps, we performed a comprehensive analysis of 159 individuals with KCNT1-related disorders, including a longitudinally characterized subgroup of 62 individuals across 390 patient years, systematically defining disease progression, seizure trajectories, developmental outcomes, and treatment response across the full spectrum of the disorder. Seizures were nearly universal, affecting 157 of 159 individuals, with 81% (n=126/156) having seizure onset within the first year of life. Stratification by clinical subgroup revealed divergent seizure onset patterns. Recurrent variants did not significantly differ in age of seizure onset yet exhibited variant-specific clinical fingerprints, such as the preponderance of focal clonic seizures (OR=5.03, 95% CI 1.60-15.7, f=0.47) in those with the p.Gly288Ser variant. Comparison with a broader cohort of 14,893 individuals with neurodevelopmental disorders revealed phenotypic features such as migrating focal seizures (OR=21716, 95% CI 2409-Inf, f=0.42) and hypertonia (OR=26.5, 95% CI 18.2-38.3, f=0.45) to be more common in EIDEE, and nocturnal seizures (OR=29787, 95% CI 3062-Inf, f=0.5) and hyperactivity (OR=13.7, 95% CI 4.70-35.9, f=0.32) to be more common in ADSHE. These findings corroborate and extend those reported in the existing literature. Developmental milestones revealed marked delays across all domains. Analysis of longitudinal medication prescription patterns exposed striking therapeutic variability, reflecting the absence of a consistent treatment framework. Several anti-seizure medications frequently cited as beneficial, quinidine and cannabidiol, were not associated with seizure improvement or sustained seizure freedom in our cohort. In contrast, clobazam (OR=1.39, 95% CI 1.12-1.72, f=0.85), ketogenic diet (OR=1.30, 95% CI 1.07-1.57, f=0.75), and lacosamide (OR=2.03, 95% CI 1.54-2.66, f=0.59) demonstrated positive comparative effectiveness. Quantitative EEG analysis distinguished individuals with KCNT1-related disorders from age-matched controls with high accuracy (AUC=0.906), with key discriminating spectral features, including alpha power in the central and parietal regions, demonstrating significant reduction across childhood and adolescence. Collectively, these findings expand the phenotypic and genotypic landscape of KCNT1-related disorders through large-scale real-world clinical data, establish quantifiable longitudinal clinical endpoints, and provide actionable insights into genotype-phenotype relationships and differential treatment response. Together, these findings will help identify outcome measures and biomarkers to inform future clinical trial design.

Epileptic seizures exhibit marked phenotypic heterogeneity that reflects distinct underlying network mechanisms, yet these differences are incompletely captured by current clinical classifications. Computational models offer a principled approach to infer latent excitation-inhibition dynamics from intracranial EEG, enabling mechanism-informed seizure characterization. We analyzed 205 seizures from 15 patients with drug-resistant epilepsy from the European Epilepsy Database, covering seven clinically annotated seizure onset patterns. Using the Wendling neural mass model, we fitted five-second iEEG segments by optimizing synaptic excitation and inhibition parameters across four temporal windows spanning 60 s before to 25 s after seizure onset. Model-derived excitation-inhibition changes distinguished seizure types significantly above chance. Classification performance was strongest when combining excitation and inhibition parameters, with peridendritic inhibition being the single most discriminative parameter. Seizure-type-specific signatures were detectable not only during seizure onset and within seizure onset zones, but already during interictal periods and in non-onset channels, indicating that seizure mechanisms are preconfigured tens of seconds before clinical onset and extend beyond focal onset regions. Although all seizure types showed increases in both excitation and inhibition during seizure transition, their timing and magnitude differed systematically. In particular, our study supports and extends prior evidence that high-amplitude slow (HAS) seizures are driven by localized hyperexcitation within the seizure onset zone, whereas low-amplitude fast (LAF) seizures arise from inhibition-driven network mechanisms. Excitation-inhibition signatures were further linked to individual patient characteristics and surgical outcomes, highlighting their potential clinical relevance.

Hippocampal sclerosis is a frequent finding in pediatric epilepsy surgery and has traditionally been regarded as an acquired lesion. It commonly co-occurs with focal cortical dysplasia (FCD IIIa), yet whether hippocampal injury is secondary to seizures or reflects a shared underlying etiology remains unresolved. Here we identified somatic variants activating the RAS-MAPK pathway in 40% of patients with hippocampal sclerosis, but in none with non-sclerotic hippocampus. Gain-of-function variants in PTPN11 were the most common finding, with mutations present in both cortex and hippocampus and enriched in hippocampal neurons, consistent with a shared developmental origin. In mice, Ptpn11D61Y mutants developed profound hippocampal degeneration and gliosis following subthreshold kainic acid exposure, whereas wild-type controls were unaffected. p38-dependent stress pathways were upregulated in patients and mice, suggesting a mechanism through which ERK-p38 crosstalk lowers the threshold for seizure-induced injury. These results provide a genetic explanation for FCD IIIa, elucidate the role of somatic mutations within the RAS-MAPK pathway in driving hippocampal sclerosis, and provide a target for pathway-specific interventions for intractable seizures.

Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an established thermoablative treatment for tremor. Although outcomes in Essential Tremor approach those of deep brain stimulation, efficacy in tremor-dominant Parkinsons disease (TDPD) is often less durable, with tremor relapse reported in 30-50% of cases. Previous associations with lesion size or age remain descriptive and do not explain why anatomically similar lesions yield divergent long-term outcomes. We retrospectively analyzed 20 patients with TDPD who underwent unilateral MRgFUS. Lesions were used as seeds for normative structural and functional connectivity analyses. Durable tremor control was associated with lesion showing stronger functional connectivity to primary motor (M1), primary somatosensory (S1), and supplementary motor areas, as well as inferior frontal and occipital cortices. In contrast, relapse was linked to greater connectivity with cerebellar motor and associative regions. Structurally, optimal lesions converged at the triangular interface of the nuclei ventralis intermedius, ventralis oralis, and ventro caudalis. Streamlines associated with better outcomes projected posteriorly towards S1, with M1 delineating an anterior functional boundary beyond which outcomes declined. Structural fingerprints emphasized posterior sensorimotor areas as critical therapeutic outputs. Findings define a connectivity-based substrate of durable tremor suppression and support the development of individualized, network-guided targeting strategies for MRgFUS in TDPD

Late-onset unexplained epilepsy is a potential harbinger of dementia, likely driven by network hyperexcitability that facilitates amyloid-{beta} release and tau propagation. Dampening this activity with antiseizure medications offers a potential disease modifying strategy, yet whether specific agents differentially alter this neurodegenerative trajectory remains unknown. Here, we emulated a target trial using global real-world federated data on patients with late-onset unexplained epilepsy to compare dementia risk across antiseizure monotherapies. Using data from over 75 million adults aged 55 years or older, we found that sodium channel blockers were associated with a 27% lower hazard of incident all-cause dementia (hazard ratio = 0.73, 95% confidence interval 0.61- 0.88) and 34% lower hazard of Alzheimer's disease (hazard ratio = 0.66, 0.49 -0.88), compared with levetiracetam/brivaracetam. While the class effect was protective, individual agents such as phenytoin, carbamazepine, and lamotrigine showed divergent safety and efficacy profiles. We replicated these findings in both a Down syndrome cohort and the external National Alzheimer's Coordinating Center dataset. Our results suggest that targeting neuronal excitability with sodium channel blockers is associated with lower risk of dementia, prioritizing the repurposing of these agents for dementia prevention trials.

Cognitive difficulties are increasingly recognized in juvenile myoclonic epilepsy (JME), but scalable biomarkers linking resting-state brain dynamics to general mental ability remain limited. Here, we combined topological data analysis, graph signal processing, machine learning, inverse Langevin modeling, and biophysical simulations to test whether EEG-derived network dynamics capture individual differences in general mental ability in JME. We studied 54 patients with JME and 45 healthy controls using resting-state high-density EEG and the raw estimated full-scale score derived from the Wechsler Abbreviated Scale of Intelligence (WASI), used here as an index of general mental ability. Subject-specific low-alpha activity was reconstructed with generalized eigendecomposition, and graph-derived features were extracted from the projection of topological and alpha-power signals onto the functional connectome, providing a graph-harmonic description of large-scale brain-state dynamics. In controls, dynamic EEG-derived features significantly predicted general mental ability, whereas the same framework failed in JME. Because prediction in controls was driven mainly by dynamic measures of smoothness (Dirichlet energy), we next examined the temporal organization of alpha-power smoothness using an inverse Langevin framework. Within the patient group, greater thermodynamic rigidity--that is, stronger confinement of fluctuations around preferred network states--was associated with lower general mental ability. Relative to controls, patients also showed lower thermodynamic noise, indicating a reduced tendency to explore alternative network regimes. Biophysical simulations suggested that reduced dendritic arborization can generate rigidity directly, whereas pharmacological stabilization of hyperexcitable circuits can shift the system toward a more rigid, lower-noise regime. Together, these findings suggest that cognition in JME is linked not only to altered resting-state network dynamics but also to stronger confinement of network-state fluctuations, with both intrinsic circuit abnormalities and treatment-related stabilization representing plausible routes to this rigid phenotype.

Adapting ongoing gait patterns to environmental challenges is essential for safe navigation through the environment. Impairment of gait adaptation is common in many neurodegenerative disorders, such as Parkinson's disease (PD), where it hampers mobility and limits quality of life. The neural control of gait adaptation remains largely unclear, thereby limiting the development of targeted treatments, such as deep brain stimulation of the subthalamic nucleus (STN-DBS). We integrated clinical, kinematic, brain metabolic imaging, and electrophysiological data, obtained during a fully immersive virtual reality overground walking task, to characterize the neural underpinnings of gait adaptation performance during dynamic obstacle avoidance and its improvement with STN-DBS. Movement kinematics, brain oscillatory activity, and metabolic activation were simultaneously acquired in 12 patients with PD during rest and gait adaptation, under active or paused STN-DBS, using inertial measurement units, electroencephalography, and three separate [18F]fluorodeoxyglucose positron emission tomography scans. Eight age-matched healthy subjects completed the same task for comparative kinematic analyses. All patients showed significant clinical improvement with STN-DBS. During the gait adaptation task with paused stimulation, patients exhibited increased metabolic activity in the cerebellum and sensorimotor cortex. Active STN-DBS selectively enhanced thalamic and superior frontal gyrus (SFG) metabolism, while concomitantly reducing cerebellar uptake. Right-lateralized SFG metabolism correlated with gait adaptation performance, with DBS-driven shifts toward greater right SFG activity predicting the magnitude of gait adaptation improvement. This correlation was independent of baseline asymmetry in clinical impairment, electrode placement, or structural connectivity to the SFG. Of note, STN-DBS amplitude asymmetry emerged as an independent predictor of right-lateralization of SFG metabolism. EEG recordings confirmed this lateralized network modulation, with theta-band asymmetry paralleling PET findings. Our findings identify a lateralized thalamo-cortical network supporting gait adaptation in PD and highlight a distinctive role for the SFG. We further show that effective STN-DBS acts as a lateralized regulator, dynamically rebalancing cortico-thalamic circuits to support context-appropriate gait control. The observed right-hemispheric lateralization may foster novel image-guided programming strategies to enhance the consistency and effectiveness of gait control in PD.

Parkinsons disease is defined clinically by motor dysfunction, but its pathology is not confined to nigral dopaminergic neurons. Prominent non-motor features including cognitive impairment, autonomic failure and sleep disturbance indicate widespread neurodegeneration that remains incompletely characterised. We pre-registered and conducted a multilevel meta-analysis of 166 case-control post-mortem studies published between 1963 and 2025, mapping neuronal loss across 85 brain regions, 38 cell types and 145 region-cell populations. The evidence base behind this map is thin. Only 4 of 145 populations are adequately powered, and 82% of Allen Brain Atlas regions have never been quantified in Parkinsons disease. A further 18 populations would reach adequate power with five or fewer additional studies, identifying an efficient route to closing current gaps. Noradrenergic neurons of the locus coeruleus degenerate to a similar extent as substantia nigra dopaminergic neurons, with both populations losing more than 60% of neurons. Cholinergic neurons of the basal nucleus and pedunculopontine tegmental nucleus and dopaminergic neurons of the ventral tegmental area show significant but less severe loss. These findings establish Parkinsons disease as a multi-system neurodegenerative disorder and expose key gaps and biases in the existing literature.

Gain-of-function variants (GOF) in SCN8A, which encodes the NaV1.6 sodium channel, lead to epilepsy syndromes ranging from drug-responsive self-limited (SeLIE) and intermediate epilepsy to drug-resistant developmental and epileptic encephalopathy (DEE). It is currently unclear why individuals with SCN8A GOF variants show variable responses to sodium channel blockers (SCBs). Here, we compared the clinical characteristics of 173 individuals with 25 different SCN8A GOF variants following the hypothesis that carriers of variants affecting activation gating respond less well to SCBs than those with variants affecting fast inactivation gating, given that use-dependent SCBs preferentially target inactivated channel states. We found that individuals with variants altering channel activation gating were more severely affected than those with variants altering inactivation properties: They had an earlier age at onset (3 vs. 5 months, P < 0.0001), higher prevalence of DEE (75% vs. 39%; P < 0.0001), and poorer response to SCBs (20% vs. 69% seizure free; P < 0.0001). We performed pharmacological studies on representative and recurrent variants from each group: two variants (F846S and M1760I) causing hyperpolarizing shifts of the voltage-dependent activation curves, and two variants (G1475R and N1877S) causing depolarizing shifts of the voltage-dependent fast inactivation curves. Phenytoin failed to suppress neuronal firing in neurons expressing activation-related variants, but showed good suppressing effects in neurons expressing inactivation-related variants. In contrast, PRAX-330, a new SCB, which showed much faster binding rates than phenytoin, was effective for both groups of variants by markedly reducing neuronal firing through rapidly and persistently stabilizing NaV1.6 in the inactivated state. Our findings provide new insights into the mechanism of drug-resistance in SCN8A-DEE and support PRAX-330 and compounds with similar pharmacological properties as a promising preclinical candidate for targeted therapies.

Synapse loss is an early feature of neurodegeneration and may provide sensitive biomarkers for experimental medicine. Positron emission tomography (PET) with the synaptic vesicle glycoprotein 2A radioligand [11C]UCB-J shows widespread signal reduction across dementias. However, it remains unclear which aspects of synaptic integrity [11C]UCB-J PET measures. We developed a histological-imaging pipeline to quantify structurally intact synapses in post-mortem brain tissue. We applied it to six donors with the tauopathy progressive supranuclear palsy (PSP) who had ante-mortem [11C]UCB-J-PET, alongside six controls across 11 brain regions. Synapse loss in PSP was widespread but region-specific across cortical, subcortical, and brainstem regions. Greater synapse loss was associated with higher tau burden and pathology, and cortical synaptic density correlated with ante-mortem cognition. Post-mortem synaptic density correlated with in vivo [11C]UCB-J-PET signal. This study provides validation of SV2A PET as a biomarker of synaptic density and supports integration of imaging with histopathology in neurodegenerative disease research.

Striatal dopamine release defects are an early pathological feature observed in diverse models of Parkinsons disease. However, the underlying molecular mechanisms responsible, and potential links to disease aetiology in humans, have been elusive. Here, we tested the hypothesis that dopamine release deficits are a characteristic feature of disease-relevant human neurons, using human Parkinsons patient iPSC-derived dopamine neurons carrying the SNCA-triplication mutation. We reveal deficits in dopamine release from SNCA-triplication patient-derived neurons, and identify that this is due to reduced dopamine content arising from a lower capacity to store dopamine through reduced expression and function of vesicular monoamine transporter 2 (VMAT2) compared to healthy controls. In turn, by imaging VMAT substrate FFN206, and reporters for synaptic vesicular dynamics, SynaptopHluorin and CypHer5E, we reveal corresponding deficits in the size of either VMAT-containing, presynaptic releasing or recycling vesicle pools. Consistent with diminished synaptic vesicle loading and recycling, the cytosolic turnover of dopamine indicated by the ratio of concentrations of dopamine metabolite DOPAC to dopamine was elevated. By contrast, glutamate release events and VGLUT2 levels in neurons in the same preparations were not disturbed, demonstrating that vesicular dysfunction is limited to vesicles for dopamine. These findings therefore reveal dopamine loading into vesicles as a locus of dysfunction in human Parkinsons-derived neurons. These disturbances will not only drive deficits in dopamine release but could potentially also be detrimental to dopamine neuron viability through an increased burden of oxidative stress associated with elevated cytosolic dopamine, thus contributing to both symptoms and aetiology of Parkinsons pathology and offering a strategic target for improved therapies.

YWHAG Syndrome (Developmental and Epileptic Encephalopathy 56, DEE56) is an ultra- rare childhood epilepsy associated with neurodevelopmental delays, with no therapeutic intervention available. Multiple de novo mutations in the YWHAG gene, encoding for the 14-3-3{gamma} protein, have been identified as causative for YWHAG Syndrome. 14-3-3{gamma} interacts with various targets, including major neurodevelopmental signaling proteins such as components of the ROCK pathway. Despite substantial evidence of the essential role of 14-3-3{gamma} in neurite outgrowth, cytoskeletal rearrangements, and neuronal migration during cortical development, little is known regarding the molecular consequences of YWHAG mutations and their effect on neuronal function and survival. Here, we characterized an isogenic, pluripotent stem cell (iPSC) model of YWHAGR132C/+ cortical neurons. The YWHAGR132C/+iPSC-derived neurons exhibited early cytoskeletal phenotypes, coupled with an elevated calcium baseline, lower frequency of calcium spikes, and reduced network activity. The widespread alterations in the transcriptome of mutant neurons revealed a biphasic dysregulation in the core genes and modulators associated with the ROCK pathway that resulted in maturation-dependent changes to cytoskeletal protein stability and calcium phenotypes. Direct inhibition of ROCK with Y27632 further increased the calcium baseline compared to the isogenic control. Exposure of YWHAGR132C/+ neurons to Trypsin-EDTA revealed underlying cytoskeletal instability, which was partially reversed by lovastatin treatment. Further, lovastatin partially rescued the elevated calcium baseline, but not the frequency or amplitude of calcium spikes. Together, these results suggest decoupling of calcium homeostasis and calcium signaling associated with cytoskeletal instability in YWHAGR132C/+ neurons. These findings lay the groundwork for future mechanistic studies of YWHAG function and molecular therapeutic targets for YWHAG Syndrome and YWHAG-associated conditions.

Guillain-Barre syndrome is an acute immune-mediated polyradiculoneuropathy with heterogeneous outcomes and limited molecular biomarkers for diagnosis, disease monitoring, and prognosis. To elucidate the circulating proteomic profile of this disorder and identify candidate biomarkers associated with disease activity and recovery, we measured over 6,500 proteins using an aptamer-based proteomic platform. We analysed paired, longitudinal sera from 20 patients at disease onset and one-year follow-up, alongside 15 healthy controls. Unbiased differential protein abundance and gene-set enrichment analyses were performed. Candidate proteins were validated using conventional immunoassays in a cohort including healthy and disease controls. We identified 39 differentially abundant proteins between the acute and recovery phases and 248 proteins altered in acute Guillain-Barre syndrome compared to controls. The acute phase was characterised by a marked enrichment in systemic immune cascades and muscle sarcomere proteins, alongside a significant depletion of axonal adhesion molecules. Serum amyloid A1 (SAA1) emerged as the most strongly increased protein in the acute phase. Validation through independent immunoassays confirmed robust serum amyloid A elevations at disease onset relative to the one-year recovery phase, healthy controls, and relevant post-infectious and neuromuscular disease controls (acute disseminated encephalomyelitis and myasthenia gravis), underscoring a peripheral nerve-specific inflammatory response. Furthermore, unexpected elevations of cardiac troponin T (cTnT) were observed at disease onset. Clinical validation using high-sensitivity assays demonstrated that cTnT exceeded the diagnostic 99th percentile upper reference limit in 25.5% of acute Guillain-Barre syndrome patients. A similarly high frequency of elevation in the myasthenia gravis disease control group (42.1%) suggests these increases predominantly reflect neuromuscular damage rather than myocardial injury. Finally, Mendelian randomisation provided causal genetic evidence linking specific systemic proteins to disease susceptibility, identifying robust roles for SERPING1 (plasma protease C1 inhibitor), CNDP1 (an antioxidant protein), and CRISPLD2 (a lipopolysaccharide-binding protein that regulates endotoxin function). Together, this comprehensive proteomic characterisation reveals distinct, stage-specific molecular signatures in Guillain-Barre syndrome. Importantly, it suggests SAA1 as a robust marker of acute peripheral nerve inflammation and challenges the conventional interpretation of elevated cTnT in severe neuropathies and neuromuscular disorders. Furthermore, this work provides a novel dataset to explore future targeted therapeutic development in Guillain-Barre syndrome.

Channelopathies are a class of neurodevelopmental disorders with often devastating consequences, and effective therapies depend on understanding how patient variants alter channel function. These effects are typically assessed by biophysical characterization in heterologous expression systems. Mutations in CACNA1A, which encodes the P/Q-type calcium channel CaV2.1, underlie a spectrum of neurological disorders in which symptoms are generally classified as loss-of-function (LoF) or gain-of-function (GoF). However, some patients present with overlapping phenotypes that defy this binary framework. Here we describe a CACNA1A variant for which heterologous assays fail to capture a key in vivo functional effect. We characterize a de novo variant of a highly conserved residue, D1634N, identified in a patient with a mixed clinical presentation that includes both LoF- and GoF-associated symptoms. Biophysical characterization in HEK293T cells supports a classic and severe LoF effect, including reduced current density and a right-shifted current-voltage relationship. In contrast, in vivo analysis of the corresponding endogenous variant in the C. elegans homolog reveals a paradoxical increase in spontaneous synaptic vesicle release, despite reduced channel expression. Molecular dynamics simulations predict that the mutation prolongs dwell time in a partially open state, potentially increasing calcium influx at rest. This model is supported by biophysical recordings of the human channel showing increased current at hyperpolarized potentials and by rescue of the C. elegans phenotype through genetic elevation of resting membrane potential. Together, these findings reconcile the patients clinical presentation by describing a complex, mixed-function variant, highlight the importance of cellular context in variant interpretation and therapeutic development, and establish C. elegans as a powerful in vivo platform for evaluating the functional consequences of pathogenic ion channel variants.

Polyhydramnios, Megalencephaly, and Symptomatic Epilepsy syndrome (PMSE/STRADA-related disorder) is a rare neurodevelopmental disorder characterized by megalencephaly (ME), early-onset drug-resistant epilepsy, neurocognitive impairment, and high early mortality, often due to status epilepticus. PMSE is caused by a multi-exon deletion in STRADA, encoding STRADA, which regulates the mechanistic target of rapamycin (mTOR) pathway. GABAergic inhibitory interneurons (INs) critically modulate the excitatory:inhibitory balance in cortical and hippocampal networks, and IN deficits contribute to epileptogenesis in several epileptic encephalopathies. However, no studies have investigated INs in PMSE. We used a multimodal approach to study INs in a Strada-/- mouse model engineered with the same causative 5-exon deletion identified in human PMSE. We demonstrate that Strada/STRADA loss causes a reduction of INs in the somatosensory cortex and a corresponding increase in the striatum, representative of remnant ganglionic eminence progenitor origin, in Strada-/- mice and a single PMSE brain tissue specimen. RNA sequencing comparing wildtype to Strada-/- cortex and striatum corroborated these findings, revealing increased IN-related gene expression (e.g., Dlx2) in the striatum and decreased IN-related gene expression (e.g., Pvalb) in the developing cortex. Cytoskeletal (e.g., Tpp3, Kank4, Map1a) and mTOR-associated genes (e.g., Rictor, Cryab) are differentially expressed in the developing cortex, mature striatum, and mature cortex of Strada-/- mice. Functional validation confirmed enlarged INs in mouse and human Strada/STRADA-deficient brain and enhanced S6 phosphorylation in Strada-/- striatum. Together, these findings suggest STRADA/Strada loss contributes to failed IN migration -- the first such report in a developmental, mTOR-associated megalencephaly syndrome -- highlighting INs as a therapeutic target for seizure prevention in PMSE. Key PointsO_LI- Reduced numbers of cortical inhibitory interneurons were observed in the cerebral cortex of Strada-/- mice, with striatal interneuron aggregation C_LIO_LI- Reduced numbers of cortical inhibitory interneurons, with an aggregation in striatum, were observed in human PMSE brain, supporting the observations in Strada-/- mouse C_LIO_LI- Transcriptomic analysis in Strada-/- mice reveals evidence of early developmental interneuron and cytoskeletal dysfunction C_LIO_LI- We introduce a loss of cortical interneurons as a salient feature of PMSE developmental pathogenesis, potentially contributing to a loss of inhibitory modulation C_LIO_LI- This is the first study proposing interneuron migration impairment in the developmental pathogenesis of an mTOR-associated megalencephaly syndrome C_LI

BackgroundGangliogliomas (GGs) are low-grade glioneuronal tumors that frequently present with drug-resistant epilepsy. Although their indolent course contrasts with their high epileptogenic potential, the oncogenic mechanisms sustaining neuronal precursor-like populations within the tumor microenvironment remain poorly defined. MethodsWe performed spatial transcriptomic profiling on eight histologically confirmed GGs and matched healthy cortex to map the cellular and molecular architecture of the tumor microenvironment. Integrated analysis with weighted gene correlation network analysis (WGCNA) defined recurrent oncogenic programs and spatially resolved tumor-stroma interactions. ResultsEight conserved gene modules emerged, encompassing physiological cortical, reactive glial, and oncopathological programs. The latter captured extracellular matrix (ECM) remodeling, vascular-immune signaling, and persistence of immature, proliferative neuronal-like states. Spatial modeling revealed that these oncopathological programs form structured niches at the tumor-brain interface, where radial glia-derived neuronal-like tumor cells coexist with immune and stromal elements engaged in ECM turnover and cytokine signaling. ConclusionsGanglioglioma represents a hybrid glioneuronal neoplasm in which developmental neuronal programs are co-opted by tumor-associated stromal and immune cues. This convergence establishes a permissive oncogenic niche that sustains precursor-like tumor cells and provides a mechanistic basis for both the tumors benign growth and its intrinsic epileptogenicity. Key PointsO_LISpatial transcriptomics identifies reproducible transcriptional programs that define the ganglioglioma microenvironment. C_LIO_LITumor-associated regions show transcriptional programs consistent with immature neuronal states together with ECM remodelling and immune activity. C_LIO_LISingle-cell reference data indicate that immature neuronal programs in ganglioglioma resemble radial glia-derived developmental states. C_LI Importance of the StudyGanglioglioma is a low-grade glioneuronal tumor that combines benign growth with pronounced epileptogenicity, yet the molecular basis of this dual behavior remains poorly understood. Through spatial transcriptomics integrated with single-cell analysis, we reveal that ganglioglioma architecture is defined by two interacting transcriptional axes: a residual glioneuronal network and a tumoral niche enriched for extracellular-matrix, vascular, and immune programs. Within these niches, immature neuronal-like tumor cells persist in a developmentally arrested state maintained by ECM-immune signaling. This spatially organized interplay between physiological and pathological programs explains both the low oncologic aggressiveness and high excitability of these lesions. Our findings provide molecular signatures that may refine diagnostic classification within the LEAT spectrum, delineate epileptogenic zones, and identify candidate pathways for therapeutic modulation of the ganglioglioma microenvironment.