Parkinson’s disease (PD) is characterized by motor and non-motor symptoms (NMS) due to alpha-synuclein aggregation in the central and peripheral nervous system. There is limited data on the temporal evolution of NMS in patients with long-standing PD.

To elucidate the chronology of the evolution of NMS in patients with long-standing PD.

This single-centre cross-sectional study was conducted at a tertiary care centre from May 2023 to December 2024. Patients with clinically diagnosed idiopathic PD of at least 10 years” duration were recruited, and the chronology of the evolution of NMS was characterized.

One hundred patients with PD (68% male) were recruited, with a mean age at assessment of 58.8 ± 9.7 years, an age at onset of 45.7 ± 10.1 years and a disease duration of 13.2 ± 3.3 years. Six percent of the patients did not develop any NMS despite the long duration of the illness. Rapid eye movement sleep behavioural disorder (RBD) (63%) was the most frequent NMS, followed by constipation (59%) and urinary dysfunction (55%). Pre-motor onset of NMS was present in 24% of the patients, with RBD (8%) and constipation (8%) being the most frequent. Post-motor onset was observed in 70% of cases. Based on the pre- or post-motor onset of RBD, patients were classified into two subtypes: body-first (8%) and brain-first (84%) PD subtypes.

This study highlights the distinct trajectories of NMS evolution in PD. While the majority developed at least one NMS, the occurrence of pre-motor NMS was present in about one-fourth. The body-first subtype, characterized by pre-motor RBD, was distinctly uncommon.

Involvement of non-ocular motor cranial nerves, such as the trigeminal, facial or hypoglossal nerves, has rarely been reported in recurrent painful ophthalmoplegic neuropathy (RPON). This study aimed to determine the incidence and clinical significance of multi-cranial nerve involvement in RPON.

Eight patients (females = 5; mean age = 53.3 ± 15.6 years) who met International Classification of Headache Disorders-3 diagnostic criteria for RPON were enrolled at a single tertiary hospital. Repeated evaluations were performed for differential diagnosis, including cranial nerve examination, brain MRI, CSF analysis and serologic testing for autoimmune and tumor markers. Clinical features, neuroimaging findings and laboratory results were reviewed.

Five patients (62.5%) had a present or past history of migraine. Among 25 ophthalmoplegic attacks, the abducens nerve was most frequently affected (60%), followed by the oculomotor nerve (32%). Most attacks were preceded by ipsilateral headache (4.0 ± 2.9 days; 88%). Facial nerve involvement was common (7/8, 87.5%); two patients had three recurrent facial neuropathies on the same side, and one showed simultaneous ipsilateral oculomotor and facial neuropathies. All facial neuropathies were peripheral. Of the three patients who underwent MRI for facial neuropathy, two demonstrated focal facial nerve enhancement. Postauricular pain usually preceded facial neuropathy and lacked migrainous features. Both facial neuropathy and ophthalmoplegia resolved within days to weeks.

Facial neuropathy may be more common in RPON than previously recognized. Despite similarities to Bell’s palsy, our findings support considering facial neuropathy within the RPON spectrum and suggest that recurrent, multifocal and alternating cranial neuropathy may underlie its pathophysiology.

Patients with inflammatory bowel disease (IBD) may be at increased risk of complications following lumbar spine surgery due to systemic inflammation, immunosuppressive therapy and nutritional deficiencies. This systematic review and meta-analysis evaluated the comparative outcomes of lumbar spinal surgery in patients with and without IBD.

We searched five databases through June 2025 for randomized and observational studies comparing postoperative outcomes of lumbar spine surgery of any type between adult patients with and without IBD. A random-effects meta-analysis was performed using the DerSimonian and Laird method.

Four retrospective cohort studies encompassing 878,116 patients (15,763 with IBD and 564,733 controls) were included. IBD patients had significantly higher odds of multiple adverse outcomes, including any complication (OR = 1.63, 95% CI: 1.08–2.47), serious adverse events (OR = 1.68, 95% CI: 1.39–2.02), minor adverse events (OR = 2.04, 95% CI: 1.63–2.55), wound infections (OR = 1.21, 95% CI: 1.08–1.35), venous thromboembolic events (OR = 1.86, 95% CI: 1.49–2.32), pneumonia (OR = 2.31, 95% CI: 1.93–2.77), urinary tract infections (OR = 2.29, 95% CI: 1.35–3.87), acute kidney injury (OR = 1.91, 95% CI: 1.68–2.17) and blood transfusions (OR = 1.64, 95% CI: 1.29–2.08). Myocardial infarction (OR = 1.76, 95% CI: 1.40–2.23) was also more common in IBD patients. No significant difference was observed in 90-day hospital readmissions.

Patients with IBD may experience significantly increased risks of postoperative complications after lumbar spine surgery. However, substantial heterogeneity among retrospective studies limits the strength of causal inferences. These findings highlight the importance of tailored perioperative management and risk counseling in this population.

Depression and psychosocial sequelae are common after aneurysmal subarachnoid hemorrhage (aSAH), yet the extent to which aSAH survivors are at increased risk of suicide remains unclear. This systematic review and meta-analysis evaluated whether aSAH is associated with death by suicide and sought to identify potential patient-level risk factors.

Following PRISMA guidelines, MEDLINE, Embase and PsycINFO were searched from inception until April 1, 2025, for studies reporting suicide rates in adults with aSAH. Pooled relative risks (RRs) were calculated using a simple model adjusted for age, sex, year of event and a comprehensively adjusted model for age, sex, year of event, living status, region, socioeconomic status, physical comorbidity and psychiatric hospitalization.

Of 294 unique studies identified, 2 met the inclusion criteria, yielding 20,661 aSAH survivors. Median age was 55 years (IQR: 44–64) years, and 47.4% were male. Ninety deaths by suicide were reported. Pooled analysis demonstrated increased risk of suicide among aSAH survivors compared with non-aSAH controls in both the simple model (RR 1.79, 95% CI 1.46–2.19) and comprehensively adjusted model (RR 1.42, 95% CI 1.09–1.86). Insufficient data prevented the identification of independent patient-level risk factors for suicide.

Survivors of aSAH have a small but significantly increased risk of death by suicide compared to the general population, although suicide remains a rare cause of death following aSAH. Clinicians involved in the subacute and long-term care of aSAH survivors should maintain awareness of this increased risk and routinely screen for depression and suicidal ideation in aSAH survivors.

Vestibular dysfunction is common in people with multiple sclerosis (PwMS), but responses to optokinetic stimulation (OKS) across different vestibular conditions remain unclear. This study examined the immediate effects of VR-based OKS on balance and motion sickness in PwMS.

Forty-one PwMS and 23 matched healthy controls were included. Participants were classified by videonystagmography into MS with central vestibular involvement (n = 20, Group 1), MS without vestibular involvement (n = 21, Group 2) and healthy controls (n = 23, Group 3). Postural control was assessed with the FreeMED forceplate and VR sickness with the VR Sickness Questionnaire. Individually tailored OKS was delivered using Oculus Quest 2, with assessments immediately before and after stimulation.

Significant group × time interactions were found for sway length (open eyes [OE] monopodal left p = 0.024, closed eyes [CE] monopodal left p = 0.012, CE monopodal right p = 0.009), average speed (OE bipodal p = 0.004, OE monopodal left p = 0.017, CE monopodal right p = 0.026), mediolateral sway (CE bipodal p = 0.014, OE monopodal right p = 0.038) and anteroposterior sway (OE monopodal left p = 0.013). Post hoc analyses showed reduced sway length in G2 (p = 0.047), reduced average speed in G1 (p = 0.002), increased mediolateral sway in G1, G3 and G2 (p = 0.031, p = 0.026, p = 0.010) and opposite anteroposterior responses, decreasing in G1/G2 but increasing in G3, with differences between G1–G2 and G2–G3 (p = 0.007, p = 0.004). VR sickness scores did not differ between groups (p > 0.05).

VR-based OKS induced immediate, well-tolerated balance changes in PwMS, with group-specific responses across conditions. Greater destabilization was seen in those with central vestibular involvement. Individualized OKS may promote vestibular adaptation and improve postural control in MS rehabilitation.