Frontiers in Neuroinformatics

One of the prominent methods in neuroimaging data processing is SSM-PCA, which is based on principal component analysis and allows for the identification of diagnostically significant patterns in the form of statistical maps. We developed software, PIE Toolbox, employs SSM-PCA and classification based on the obtained diagnostic patterns revealed from functional and structural tomographic brain imaging. The program supports the entire analysis pipeline including preprocessing of brain images, diagnostic patterns extraction, building classification models, and prediction based on them. The resulting diagnostic patterns are weighted principal components obtained through SSM-PCA, or their linear combinations. PIE Toolbox allows selection of relevant structural and functional brain patterns, computation of their expression values in regions of interest, classification using support vector machines, and evaluation of model performance via cross-validation. This approach enables the use of patterns as features of intergroup differences for individual diagnosis. The software has been validated on both simulated and ADNI datasets.

Despite growing understanding of the benefits of having Findable, Accessible, Interoperable, and Reusable (FAIR) data, many datasets still cannot be shared. Federated analysis methods can enable multisite studies that do not require the sharing of participant-level information. However, there are many practical hurdles that prevent the large-scale adoption of federated methods. We discuss challenges related to cross-site data preparation for federated learning, present solutions offered by recent neuroinformatics projects, and showcase an example of tool integration applied to neurodegenerative disease data.

Three-dimensional (3D) whole-organ imaging and analysis at cellular resolution (termed 3D histology) provide profound insights into the organization and interactions of cells throughout organs. However, the quantitative analysis of these massive datasets remains a significant bottleneck due to the lack of integrated, user-friendly tools. Here, we present 3DBrainOne, an end-to-end ImageJ plugin that streamlines the essential 3D histological analysis of the mouse brain--from raw image preprocessing to region-wise quantification--within a single platform. 3DBrainOne features a robust whole-brain cell-counting module that uses a Difference-of-Gaussians (DoG) blob detection algorithm followed by a ResNet18-based deep learning classifier, enabling high-fidelity automatic whole-brain cell counting with a graphical user interface (GUI) for visual inspection and manual curation of analysis results. 3DBrainOne also supports multi-channel colocalization analysis. Furthermore, this platform includes modules for atlas alignment and brain-region-wise volumetric quantification, enabling brain region-resolved cell counting and structural analyses. As an ImageJ plugin, 3DBrainOne is compatible with a range of operating systems and hardware. In summary, 3DBrainOne is an integrated, versatile, and easy-to-use platform that will facilitate 3D histological analyses in experimental neuroscience.

Currently, there is no consensus about how investigators should format their NIBS data for sharing. This presents a barrier to the advancement of big data analyses because it requires time-consuming operations to generate consistent formats across different shared datasets. Recently, we launched Big non-invasive brain stimulation data (Big NIBS data), an open-access platform and repository for NIBS data (https://www.bignibsdata.com/), providing a structured mechanism for researchers to share NIBS data. However, the reusability and interoperability of data uploaded to Big NIBS data is restricted by the absence of a common data structure. The current paper addresses this problem by creating the NIBS data analysis structure (NIBS-DAS), a template pipeline for the layout, management, and analysis of collated NIBS outcome data. While its primary purpose is to provide a template layout for uploading collated data to the Big NIBS data repository, NIBS-DAS also offers guidelines for the management and analysis of collated NIBS data, thereby forming a data analysis pipeline that can be freely used by the NIBS field in general. We anticipate that NIBS-DAS will serve to facilitate data sharing on the Big NIBS data platform and promote greater standardisation of data management and analytical practices in the NIBS field.

We present a free and open-source, semi-automated, topologically robust pipeline for fitting cable models to 3D surface mesh morphology data of neuronal membranes, particularly suited to structures with complex shapes and topological holes. The motivation for this work is the discovery of morphologically complex neural spines on the auditory space-specific neurons of the barn owl (Tyto alba, Tyto furcata), dubbed "toric spines", notable for their high curvature, branching density, and holes/loops. Multicompartmental simulation software requires morphology to be represented as cable models (e.g., SWC format), yet existing software tools for fitting cable models to complex 3D surface meshes have not produced satisfactory results for toric spines, and loops are generally unsupported. We present the Mesh and Skeleton Cable Fitting (MASCAF) pipeline and software, which fits a cable model (e.g., SWC format) to a surface mesh using mean-curvature flow skeletonization. In this paper, we demonstrate how MASCAF is applied to fit cable models, how loops can be reconstructed in simulations with the Arbor and NEURON simulation software, and how the results can be validated using geometry and simulator-based methods. While non-tree morphologies such as toric spines are neuroanatomically special, our software pipeline provides a cable-model fitting approach for surface mesh data that is topologically robust, deterministic, open-source, and applicable to general morphologies, thereby closing a crucial gap between neuronal imaging and high-resolution simulation.

BackgroundThe relevance of spontaneous activity has been unlocked thanks to recent large scale recordings that revealed, via Shared Variance Component Analysis (SVCA), the high-dimensional nature of the ongoing activity. A fundamental problem is how the dimension modifies when more neurons are included in the analysis. Contradictory results have been reported on this subject based on SVCA and Principal Component Analysis (PCA). New MethodWe investigate pro et contra of SVCA and PCA for the identification of reliable responses encoding underlying state variables. We focus on common features of the spectra of the reliable variances (RVs) and on their dimensionality. The analysis is demonstrated on previously published Ca2+ data from the visual and the dorsal cortex in head fixed mice during spontaneous behavior. ResultsRVs grow proportionally to the number N of neurons and show a power-law decay k- with the k-th SVC dimension over a range bounded by a maximal dimension kc, initially diverging as N 1/ and then saturating at sufficiently large N. The reliable dimensionality, estimated with different methodologies, also shows a clear saturation to an asymptotic value for large N. Furthermore, its value decreases when becomes larger, as demonstrated by employing experimental data as well as theoretical predictions. ConclusionWe have shown that SVCA is an extremely effective tool to extract reliable features from the neural signals, and that the exponent represents a biomarker able to reveal the level of correlation of the neurons as well as the dimensionality of the reliable space. HighlightsO_LIAdvantages and drawbacks of Shared Variance Component Analysis to extract reliable signals from neural data C_LIO_LIComparison of different methods to estimate reliable neural dimensionality associated to spontaneous activity C_LIO_LIAnalytical expressions of embedding dimensionality for power-law decaying reliable variances C_LIO_LIBounded growth of the dimensionality with the number of neurons C_LI

PurposeTo present the design and validation of a lowcost, microcontrollerbased gas delivery system that automates fixed inspired respiratory stimuli for MRI experiments. MethodsThe system uses three solenoid valves controlled by an Arduinobased circuit to switch between premixed medical gas cylinders according to predefined timing protocols. By using the MRI scanner external timing signal, gas delivery can be synchronised with image acquisition. Both a permanently installed configuration and a portable enclosure were constructed using commercially available components, with a total material cost of approximately {pound}650. The system was integrated with a singleuse breathing circuit and evaluated using hypercapnic and hyperoxic stimulus paradigms. Endtidal oxygen and carbon dioxide were measured using a respiratory gas analyser and physiological responses were assessed using BOLD MRI at 3 T. ResultsThe system delivered reliable, repeatable gas transitions during MRItriggered protocols. During hypercapnia (n{square}={square}15), the mean increase in endtidal carbon dioxide was 8.7{square}{+/-}{square}1.8{square}mmHg from a baseline of 32.2{square}{+/-}{square}3.1{square}mmHg, producing a mean grey matter BOLD signal increase of 3.2{+/-}1.7%. During hyperoxia (n{square}={square}15), the mean increase in endtidal oxygen was 292.3{square}{+/-}{square}59.0{square}mmHg from a baseline of 114.5{square}{+/-}{square}10.7{square}mmHg, with an associated BOLD signal change of 1.2{+/-}1.7%. Across both protocols respiratory and BOLD responses were consistent across participants. ConclusionThis microcontrollerbased system provides an inexpensive and reliable method for administering fixed inspired respiratory stimuli with automated MRI synchronisation. It offers an intermediate option between simple manual systems and higher cost commercial gas blenders, making it well suited for technical and methodological studies in cerebrovascular reactivity, hyperoxiaBOLD and related applications.

Background: Amyloid-beta PET provides critical biomarker data for Alzheimer's disease diagnosis and anti-amyloid therapy evaluation, yet low spatial resolution and partial volume effects result in decreased interpretability, particularly in cases with low or borderline cortical amyloid burden. While quantitative metrics (SUVr, Centiloid) aid in interpretation of amyloid burden, disagreement between visual reads and quantitative burden does occur, further blurring the line between positive or negative scans. We evaluated whether a vendor-neutral MR-guided PET denoising and resolution enhancement method (MRG) that uses Bowsher regularization improves image interpretability and reader performance while preserving established quantitative biomarkers across multiple amyloid tracers, leading to increased concordance among visual reads and quantitative metrics. Methods: Standard (STN) and MRG PET images were compared for four tracers ([18F]AV-45 ([18F]florbetapir, FBP), [18F]florbetaben (FBB), [18F]flutemetamol (FMM), and [11C]Pittsburgh compound-B (PiB) collectively from 24 MRI and 33 PET scanners. Quantitative equivalence was assessed by comparing Standardized Uptake Value ratio (SUVr) and Centiloid scores. In three of the four tracers (FBP, FBB, FMM), visual-quantitative concordance (AUC) and reader performance were evaluated in a blinded multi-reader study by four highly experienced brain PET readers who assessed image quality, artifact severity, reader confidence, and binary amyloid positivity. Results: Across all tracers, MRG preserved quantitative SUVr and Centiloid metrics relative to STN (R2 >0.90 for all tracers) without introducing bias to the SUVr metric. Concordance between visual reads and quantitative burden measures significantly improved with MRG. In the multi-reader study, MRG resulted in significantly higher image quality, lower artifact burden, and greater reader confidence compared to STN (p < 0.0001). Reader accuracy increased from 0.89 to 0.94, and the false-negative rate decreased from 0.08 to 0.04. Crucially, improvements in reader confidence, accuracy, and the reduction in false negative reads were most pronounced in cases with low amyloid burden near the threshold of visual positivity. Conclusions: MRG denoising and resolution enhancement improved perceived image quality, reader confidence, and accuracy for amyloid PET while preserving standard quantitative behavior across tracers. By improving cortical definition in visually challenging low-burden cases without disrupting established SUVr/Centiloid behavior, MRG may reduce visual-quantitative discordance and support more confident amyloid PET interpretation near the threshold of positivity.

Neuroimaging data management and processing are tedious and error-prone, prompting reproducibility concerns. Globally, studies with heterogeneous infrastructure and governance policies lead to eclectic data processing and sharing, necessitating standardization of data workflows to ensure reusability and comparability of multi-centric datasets. The Nipoppy neuroinformatics framework facilitates such standardization by combining specification, protocol, and software to manage study-level data workflows. With its adoption, researchers can share standardized, derived datasets enabling efficient, reproducible, and inclusive research.

BackgroundMagnetic resonance imaging (MRI) is critical for acute stroke triage, but time-consuming, and often requires contrast injection for perfusion imaging. This study aimed to synthesize T-map perfusion maps from routinely available, non-contrast DWI and FLAIR using deep generative models. We hypothesized that relevant perfusion information could be inferred from these modalities to streamline imaging and reduce reliance on dynamic susceptibility contrast perfusion. MethodsAcute MRI data from 355 patients with anterior circulation stroke, including dynamic susceptibility contrast perfusion, were retrospectively collected from two European centers (Heidelberg: 2010-2018; Bordeaux: 2021-2022). Six versions of a denoising diffusion probabilistic model (DDPM) and a GAN architecture were trained to generate synthetic T-max perfusion maps from DWI, FLAIR, and infarct core mask as inputs. Performance was assessed by comparing synthetic and ground truth T-max maps using image similarity metrics. Regions with T-max >6s were compared using Dice coefficients, and mismatch volume distributions were analyzed. An ablation study quantified the contribution of each input. ResultsThe best performance was achieved by a DDPM with a 2.5D architecture using DWI, FLAIR, infarct core mask, and a perfusion-weighted loss function. It produced synthetic perfusion T-max maps with high similarity to ground truth under 110 seconds. The model showed strong spatial overlap for T-max >6s regions in internal validation (average Dice = 0.82, SD = 0.08), and external validation average (Dice 0.59, SD = 0.13), respectively. Synthetic maps closely matched ground-truth mismatch distributions, capturing key perfusion patterns. The infarct core mask played a critical role in model performance, alongside DWI and FLAIR inputs. ConclusionsWe propose a non-invasive, scalable framework to generate synthetic T-max perfusion maps from non-contrast MRI. This approach could expand access to perfusion data in acute stroke, shorten imaging protocols, and accelerate treatment decisions by eliminating the need for contrast-enhanced acquisition. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/684079v2_ufig1.gif" ALT="Figure 1"> View larger version (94K): org.highwire.dtl.DTLVardef@164235forg.highwire.dtl.DTLVardef@14e5489org.highwire.dtl.DTLVardef@190214eorg.highwire.dtl.DTLVardef@17a9e3a_HPS_FORMAT_FIGEXP M_FIG C_FIG

Electroencephalography (EEG) interpretation in clinical practice relies on the analysis of energy distribution across standard frequency bands. The Weed Plot framework encodes band-wise spectral energy, computed using Fourier-based methods, into a symbolic representation that preserves the interpretability of traditional EEG analysis. In this study, we propose a wavelet-based extension of this framework, where the energy of predefined clinical EEG bands is estimated using the Discrete Wavelet Transform instead of Power Spectral Density. Unlike Fourier-based approaches, wavelets provide a time-frequency representation that captures transient and non-stationary dynamics while remaining consistent with clinically defined bands. From these estimates, symbolic patterns are constructed based on the relative ordering of frequency bands within short temporal windows. Their empirical distribution is used to extract entropy-based features for epilepsy detection using multiple machine learning classifiers. From an Artificial Intelligence perspective, the main contribution is a structured symbolic encoding that enhances feature discriminability. From an engineering perspective, the contribution lies in an automated framework for EEG-based epilepsy detection. Experimental results show that wavelet-based representations improve classification performance compared to raw entropy and Fourier-based features. This improvement arises from the interaction between time-frequency localization and symbolic encoding, producing more discriminative feature distributions. These findings support wavelet-based symbolic representations as a robust and interpretable framework for EEG analysis, bridging clinical interpretation and data-driven methods.

BackgroundThis study examines a competition-based model (C-model) designed to capture the temporal dynamics of successive brain microstates derived from electroencephalography (EEG) recordings during eyes-open conditions. The analyzed data were obtained from a public repository comprising microstate sequences from 60 sessions of a single subject [1]. When applied to microstate dynamics, the C-model posits a stochastic competition among neural circuits underlying the expression of individual microstates. MethodsThe model is formulated at a conceptual level (computational level in Marrs framework) and employs a geometric distribution to account for the long right tail of microstate duration distributions, interpreted as the probability of "failure" of the currently active microstate to persist. To account for the short-lived left tail, the model incorporates a transient increase in the stability of the currently active network, or equivalently, a temporary decrease in the activation probability of competing microstates (refractory period). ResultsThe model provides a good fit to the microstate duration distributions across all 60 sessions. One third of sessions showed microstate identity sequential dependency with respect to the previous microstates. DiscussionThese results suggest that the C-model captures key aspects of microstate temporal structure. Moreover, because microstate probabilities can be modulated by psychophysiological conditions--including the influence of previously active networks--the model may serve as a building block for more comprehensive neurobiological frameworks of neural and behavioral dynamics. In such frameworks, microstate sequences could emerge from structured competition and flow among neural networks supporting microstate expression.

Computed tomography is the largest contributor to population radiation dose from medical imaging, yet no diagnostic reference levels (DRLs) have been published from Kosovo or the Western Balkans. This retrospective audit analyzed all CT examinations performed on a 128- slice scanner at the University Clinical Centre of Kosovo between January and March 2026. After exclusions, 1,535 acquisitions from 1,092 patients across nine examination categories were analyzed. Local DRLs were defined as the 75th percentile and compared against German (BfS 2022) and Turkish (Kahraman et al., 2024) reference values. Head CT (n = 590) demonstrated CTDIvol 4.7% below the BfS DRL yet scan length 98.5% above the orientation value (median 25.8 vs 13 cm). Abdomen-pelvis CTDIvol matched the BfS reference while scan length exceeded it by 28%. Coronary CTA showed CTDIvol +377%, consistent with retrospective ECG gating. Excess scan length, not CTDIvol, is the major driver of elevated dose at this institution. The identified excesses are correctable through technologist landmarking training, protocol review, and enabling iterative reconstruction.

Molecular neuroimaging with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) enables quantification of specific molecular targets in the living brain. Despite its scientific impact, molecular neuroimaging research has historically faced challenges due to high costs, small sample sizes, laboratory-specific analysis pipelines, and limited large-scale data sharing. These factors have hindered reproducibility and the broader reuse of valuable PET datasets. The OpenNeuroPET initiative was established to address these barriers by developing standards, infrastructure, and open-source tools for organizing, sharing, and analyzing molecular neuroimaging data. Through collaborations across Europe and North America, OpenNeuroPET has supported the PET extension of the Brain Imaging Data Structure (PET-BIDS), providing a standardized framework for PET datasets and metadata. Building on PET-BIDS, tools such as PET2BIDS, ezBIDS, and BIDSCoin facilitate data conversion and curation. In parallel, OpenNeuro now hosts PET-BIDS datasets for open sharing, while complementary platforms such as PublicnEUro enable GDPR-compliant controlled access. Emerging open-source workflows and BIDS applications further support automated, reproducible PET preprocessing and quantitative analysis, promoting harmonized processing across centers. Together, these developments mark an important step toward an open molecular neuroimaging ecosystem in which datasets, software, and workflows can be transparently shared, reused, and scaled for collaborative research.

The human cerebellum plays a central role in motor, emotional, and cognitive functions, and is implicated in many brain disorders. To improve the analysis of functional and anatomical imaging from the cerebellum, we introduce SUITPy, an improved and fully revised Python implementation of the widely used SUIT toolbox. For this new version, we developed a U-Net based model to automatically isolate the cerebellum from adjacent cortical tissue, which achieves higher fidelity than existing algorithms. The isolation works robustly without manual corrections for imaging data across the lifespan. We show that isolation and subsequent normalization to a cerebellum-only template lead to a more precise alignment of cerebellar structures across participants compared to normalization using a whole-brain template. We also show the utility of the cerebellar mask to prevent contamination of cerebellar functional data from surrounding cortical structures. The toolbox also provides functionality for visualizing cerebellar data on a flatmap, along with a range of anatomical and functional cerebellar atlases, thereby offering an essential tool that enables accurate cerebellar analysis across the lifespan.

Background: Improvements in health technology offer opportunities for remote disease screening, diagnosis and monitoring. The Withings Sleep Analyzer (WSA), an under mattress ballistocardiograph sensor able to detect body movement, breathing, and cardiac ejection is a promising technology for the non-invasive detection and monitoring of neurodegenerative diseases. InSleep46 aims to evaluate whether the WSA is able to detect preclinical Alzheimer's disease in members of the 1946 British Birth cohort, now in their late 70s. Objectives: To assess feasibility of deployment of a remote sleep, circadian and physiological monitoring device in a population of older adults. Participants: 356 participants from the Insight 46 neuroimaging sub-study (1946 British Birth Cohort), all born in one week in March 1946. Methods: We describe remote recruitment, device installation, and troubleshooting protocols. Feasibility analysis examined participant characteristics associated with recruitment and successful device set-up using logistic regression. Troubleshooting events for device installation and maintenance were recorded over a mean 14-month follow-up period. Results: During the feasibility analysis period, 263 (74%) participants, mean (SD) age 77 years (0.47) agreed to take part, of whom 245 (93%) successfully set up the WSA. Recruitment and successful set up of the WSA were not dependent on cognitive ability, socioeconomic position, or educational attainment. 162 (62%) of recruited individuals required [&ge;]1 troubleshooting call (mean 2.3 per participant, range 0-16). 603 calls were required in total. Conclusion: Deployment of a remote sleep and physiological monitoring device in an older adult population is feasible. Most participants required individualised assistance to set up the device. For the technology to be widely implemented, the set up must be accessible, with dedicated support available.

ObjectivesStage-sensitive markers can aid in early diagnosis of Alzheimers disease (AD) and can improve sensitivity, performance and interpretability. In this study, causal markers from longitudinal imaging data were extracted and integrated with risk factors to improve diagnostic models. Data DescriptionOASIS-3, a longitudinal dataset consisting of 613 controls and 214 cases with very mild to moderate Alzheimers disease is used for this study. A meta model was built using a predisposition model built from risk factors, a stage-sensitization model built from MRI markers at various stages of atrophy and a confirmatory model built using PET markers. The meta model achieved good diagnostic performance (accuracy = 93%, sensitivity = 80%, specificity = 95%). Exclusion of PET data achieved comparable performance (accuracy = 91%, sensitivity = 85%, specificity = 92%). The results demonstrate that integrating causal pathological markers with risk factors improves diagnosis and aids in elucidating stage-specific patterns of AD.

BackgroundPrevious studies evaluated large language model (LLM) performance on the American Society of Nuclear Cardiology (ASNC) Board Preparation Exam. Without domain-specific context, the best model (GPT-4o) achieved 63.1%, below the estimated 65% passing threshold and the 78% mean score of human fellows-in-training (FITs). Providing textbook context improved GPT-4o to 73.8% on text-only questions, but still fell short of human trainees. Whether next-generation LLMs with retrieval-augmented generation (RAG) can exceed this gap is unknown. MethodsClaude Opus 4.7 and GPT-5.5 were administered all 168 questions (141 text-only, 27 image-based) from the 2023 ASNC Board Preparation Exam across 5 iterations each, using RAG with a nuclear cardiology textbook, companion atlas, and ASNC clinical guidelines. Claude used local FAISS-based semantic retrieval; GPT-5.5 used Azures cloud-hosted vector store. Performance was compared to prior LLM results and 13 human FITs. ResultsAcross 5 iterations, Claude Opus 4.7 achieved a mean accuracy of 86.3% {+/-} 1.4% (text 88.8%, image 73.3%). GPT-5.5 achieved 86.7% {+/-} 2.2% (text 88.5%, image 77.0%) but refused a mean of 12.2 questions (7.3%) per iteration due to safety filters. Both models surpassed the human FIT mean (78.0%) and the estimated passing threshold. Compared to GPT-4o without context (63.1%), this represents a 23-percentage-point improvement in 18 months. ConclusionNext-generation LLMs with RAG now surpass average human trainee performance on nuclear cardiology board preparation questions, suggesting significant potential as educational tools and knowledge-reference aids in cardiovascular imaging. Condensed AbstractAcross 5 iterations each, Claude Opus 4.7 and GPT-5.5 with retrieval-augmented generation achieved mean accuracies of 86.3% and 86.7% on the 2023 ASNC Board Preparation Exam (168 questions), both surpassing the mean human fellow-in-training score of 78%. GPT-5.5 refused a mean of 12.2 questions (7.3%) per iteration due to safety filters. These results represent a 23-percentage-point improvement over the best prior LLM without context (63.1%), demonstrating that RAG-enhanced LLMs have reached human-level proficiency in nuclear cardiology knowledge. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=111 SRC="FIGDIR/small/26352768v2_ufig1.gif" ALT="Figure 1"> View larger version (49K): org.highwire.dtl.DTLVardef@5f2465org.highwire.dtl.DTLVardef@4e80d3org.highwire.dtl.DTLVardef@1ebbb93org.highwire.dtl.DTLVardef@167d3c1_HPS_FORMAT_FIGEXP M_FIG C_FIG Overview of the three-study research arc evaluating LLM performance on the 2023 ASNC Board Preparation Exam. Study 1 (2024) tested four LLMs without context (best: GPT-4o, 63.1%). Study 2 (2025) added textbook context to GPT-4o (73.8%). Study 3 (2026, current) evaluated Claude Opus 4.7 and GPT-5.5 with retrieval-augmented generation across 5 iterations each (mean 86.3% and 86.7%, respectively), both surpassing the human fellow-in-training mean of 78%. Right panel shows the performance scale with key thresholds.

ObjectiveSimultaneous recording of brain activity, behaviour, and virtual environments is essential for understanding large-scale neural dynamics during behaviour. However, existing systems often rely on software-based synchronization or post hoc alignment, introducing latency, jitter, and drift that obscure fast brain-behavior interactions. ApproachHere, we present a deterministically synchronized widefield calcium imaging platform that unifies neural imaging, high-speed behavioural monitoring, and closed-loop virtual reality (VR) under a shared hardware-defined clock. This system enables millisecond-precision temporal alignment across modalities, including dual-wavelength hemodynamic correction, pupil and orofacial tracking, locomotion sensing, and VR rendering. Main resultsThe platform achieves stable hardware-level synchronization across neural imaging, behavioural recordings, and VR rendering without reliance on software timestamps. It supports widefield imaging rates up to 100 Hz and integrates seamlessly with both ViRMEn and Blender VR engines, exhibiting a mean locomotion-to-VR update latency of [~]1.5 ms. Multimodal recordings during VR navigation demonstrate robust temporal alignment between cortical activity, facial dynamics, pupil signals, and locomotion. SignificanceThis system provides a deterministic multimodal framework for studying brain-behaviour relationships during active behaviour. By enabling millisecond-precision synchronization across neural imaging, behaviour, and virtual environments, this platform enables causal investigation of brain-behaviour interactions at millisecond precision and provides a foundation for next-generation closed-loop neuroengineering experiments.

Parkinsons disease patients may experience a different therapeutic effect after replacement of the Medtronic Activa(R) deep brain stimulation neurostimulator with the newer Percept model, which features multiple independent current sources and constant-current control. We analyzed patient-reported therapeutic effect changes after Activa(R)-to-Percept replacements (AP, n=52) across six Dutch DBS-centers, comparing appropriate (AP+, n=36) and inappropriate/no (AP-, n=16) use of the manufacturers replacement workflow. Previous Activa(R)-to-Activa(R) replacements (AA, n=69) were used as reference. Worsened therapeutic effect was reported in 75.0% of AP-, 44.4% of AP+, and 21.7% of AA replacements (p<0.001). In the AP group, most patients with worsened effect were previously programmed with constant-voltage. Concluding, the risk of worsened therapeutic effect following AP replacements is higher compared to AA replacements, in particular when the replacement workflow is not properly used or in complex electrode configurations. We advise to use the workflow, inform the patient and plan closer follow-up appointments.