Complex Neurological Disorder Research Articles

A review of migraine treatment methods: a comparative analysis of therapeutic approaches

Migraine, a complex neurological disorder, affects a significant portion of the population and presents both medical and societal challenges. The aim of this paper is to provide a detailed review and analysis of available therapeutic methods for patients suffering from migraines, considering both pharmacological and non-pharmacological therapies. The approaches presented include acute treatment with triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), as well as preventive therapies, such as beta-blockers and antiepileptic drugs. The section on non-pharmacological therapies focuses on cognitive-behavioral therapy (CBT), biofeedback, and lifestyle recommendations, including diet and sleep hygiene. A review of the literature indicates that integrating pharmacological and non-pharmacological approaches can significantly improve treatment effectiveness and the quality of life for patients with migraines.

"Brain Biopsy Revolution: Unveiling the Core Syringe Technique with Clinical Insights"

BackgroundObtaining a definitive pathological diagnosis from brain tissue sampling was challenging due to the small, non-representative sample. This study introduced a novel syringe technique for brain biopsy aimed at enhancing diagnostic accuracy by obtaining core tissue samples that better represent the targeted tissue. MethodsThe ten patients with atypical brain lesions underwent the syringe biopsy. After meticulous preoperative planning with neuronavigation, a minimally invasive approach was used: a 3 cm skin incision and a 14 mm burr hole were created. A modified 3-cc syringe was used to create negative pressure and cannulate the brain tissue. The desired sample size (24 cm³) was obtained by controlling the syringe depth and withdrawal. Medical records were reviewed to assess sample analysis results and any complications. ResultsThe syringe technique successfully yielded adequate tissue samples in 9 out of 10 patients. In one case, the desired tissue could not be retrieved and required a microsurgical approach for removal. In all ten cases, a correct diagnosis was made without significant complications. ConclusionThe preliminary findings suggest that the syringe technique is both safe and effective for obtaining substantial volumes of brain tissue, facilitating accurate pathological evaluation in cases of complex neurological disorders.

A Beginner's Guide to Genomics in Complex Neurological Disorders

In view of the recent progress in genomics and next-generation sequencing technologies, we consider here their contribution toward neurological disorders. We describe the revolutionary impact that whole-genome and whole-exome sequencing have had on diagnostics and the identification of important genetic loci associated with a range of disorders. Neurological disorders affecting the central and peripheral nervous systems are complex, both in diagnosis and treatment. Herein we show that by applying multiomic tools to assist researchers in identifying new biomarkers and therapeutic approaches, the diagnosis, treatment, and prognosis of these disorders can be significantly improved.

Deciphering the Symptom Spectrum: A Comprehensive Analysis of Migraine Patterns and Types

Complex neurological diseases like migraine migraine affect a large section of the global population, causing health, social, and economic issues. Migraine causes intense, painful headaches that are usually one-sided and pulsing. Auras, nausea, vomiting, and excessive light and sound sensitivity may precede these episodes. Migraine affect millions worldwide and can be intermittent or persistent, impairing function. Diet and stress may induce it, but the cause is unknown. Prevention and symptom treatment drugs and lifestyle changes are used. Debilitating migraines are hard to diagnose due to their varied presentation and subjective symptom reporting. Traditional migraine diagnosis, based on clinical evaluation, typically fails to classify migraine types, requiring more objective and rigorous instruments. This study proposes a machine learning-based migraine categorization method to address this issue. The dataset includes different patient demographics and clinical variables; thus, we use complex algorithms like Random for Forest, XGBoost, and Extra Trees. These algorithms are great for deciphering migraine patterns because they excel at evaluating complex datasets. The research seeks to close this gap to improve migraine classification accuracy, objectivity, and reliability, enabling tailored migraine management and treatment. This neurology study could im- prove migraine diagnosis and treatment with more effective and personalized plans.

Neuropsychiatric Manifestations of Degenerative Cerebellar Ataxia.

Degenerative cerebellar ataxias (DCA) present a group of complex neurological disorders primarily affecting the cerebellum and its pathways. Classic manifestations include motor symptoms of cerebellar ataxia. However, emerging evidence suggests that the cerebellum also plays a crucial role in various cognitive and emotional processes. The objective was to assess the psychiatric profile of a heterogeneous group of patients with degenerative cerebellar ataxia. Our sample comprised 107 participants diagnosed with cerebellar degenerative ataxia. All patients were clinically evaluated using SARA, INAS, and different neuropsychiatric scales (ACE-R, HAMA, HAMD, AS, and GAF). The majority of patients had autosomal dominant ataxia (38.3%) followed by sporadic ataxia (32.7%) with an average age at the moment of diagnosis of 35.3 ± 16.23 years, while the mean duration of disease at the study beginning was 12.1 ± 9.9 years. Psychiatric disorders were present in 40 patients (37.4%), with dysthymia (14.2%), major depressive disorder (9.4%), and MDD with melancholic features (7.6%). The presence of MDD with melancholic features was statistically significantly correlated with a lower ACE-R total score (r = -0.223; p = 0.022), while dysthymia was statistically significantly associated with a shorter duration of the disease (r = -0.226; p = 0.020) and older age (r = 0.197; p = 0.043). Statistically significant differences were observed between MSA-C patients and those with sporadic ataxia (HDRS p < 0.001, HARS p < 0.001, Apathy Scale p = 0.003, and GAF p = 0.004). Based on our findings, we can conclude that the degree of motor deficit has a significant impact on the development of psychiatric disorders, including depression, anxiety, and apathy. However, it is not the only factor, and the impact also depends on the type of DCA.

Brain imaging traits and epilepsy: Unraveling causal links via mendelian randomization.

Epilepsy, a complex neurological disorder, is closely linked with structural and functional irregularities in the brain. However, the causal relationship between brain imaging-derived phenotypes (IDPs) and epilepsy remains unclear. This study aimed to investigate this relationship by employing a two-sample bidirectional Mendelian randomization (MR) approach. The analysis involved 3935 cerebral IDPs from the UK Biobank and all documented cases of epilepsy (all epilepsies) cohorts from the International League Against Epilepsy, with further validation through replication and meta-analyses using epilepsy Genome-Wide Association Studies datasets from the FinnGen database. Additionally, a multivariate MR analysis framework was utilized to assess the direct impact of IDPs on all epilepsies. Furthermore, we performed a bidirectional MR analysis to investigate the relationship between the IDPs identified in all epilepsies and the 15 specific subtypes of epilepsy. The study identified significant causal links between four IDPs and epilepsy risk. Decreased fractional anisotropy in the left inferior longitudinal fasciculus was associated with a higher risk of epilepsy (odds ratio [OR]: 0.89, p=3.31×10-5). Conversely, increased mean L1 in the left posterior thalamic radiation (PTR) was independently associated with a heightened epilepsy risk (OR: 1.14, p=4.72×10-5). Elevated L3 in the left cingulate gyrus was also linked to an increased risk (OR: 1.09, p=.03), while decreased intracellular volume fraction in the corpus callosum was correlated with higher epilepsy risk (OR: 0.94, p=1.15×10-4). Subtype analysis revealed that three of these IDPs are primarily associated with focal epilepsy (FE). Notably, increased L1 in the left PTR was linked to an elevated risk of hippocampal sclerosis (HS) and lesion-negative FE, whereas elevated L3 in the left cingulate gyrus was associated with HS-related FE. Our research offers genetic evidence for a causal link between brain IDPs and epilepsy. These results enhance our understanding of the structural brain changes associated with the onset and progression of epilepsy.

A Case Report on Anti-N-methyl-d-aspartate Receptor Encephalitis in a 52-year-old Female with Schizophrenia

Abstract Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a complex neurological and psychiatric disorder. It often presents with psychiatric symptoms, leading to misdiagnosis, but can progress to severe neurological manifestations. In this study, we presented a 52-year-old woman with a 30-year history of schizophrenia who suddenly developed mutism, agitation, and incontinence. Electroencephalography showed generalized slowing, and autoimmune testing revealed NMDAR antibody positivity. Treatment with intravenous methylprednisone led to rapid improvement, highlighting the importance of considering autoimmune causes in such cases. NMDAR encephalitis is a condition with both neurological and psychiatric symptoms. It is often initially mistaken for psychiatric issues. Physicians should carefully assess and be vigilant in psychiatric cases. If routine tests show no significant issues, but the neurological state worsens, considers NMDAR encephalitis, and acts promptly. Delayed treatment can be harmful.

EEG-based epileptic seizure detection using deep learning techniques: A survey

Epilepsy is a complex neurological disorder marked by recurrent seizures, often stemming from abnormal discharge of the brain. Electroencephalogram (EEG) captures temporal and spatial shifts in cerebral electrical activity, holding pivotal diagnostic and therapeutic value for epilepsy. Deep learning techniques have made remarkable progress in EEG-based seizure detection over recent years. This review is dedicated to exploring seizure detection approaches based on deep learning, focusing on three distinct avenues. Primarily, we delve into the application of canonical deep learning methods in epilepsy detection. Subsequently, a more in-depth study was conducted on the hybrid models of deep learning. Next, the third is the integration of deep learning and traditional machine learning strategies. Finally, the challenges and future prospects related to this topic are put forward. The uniqueness of this review lies in its novel and comprehensive perspective on the latest research on deep learning-based epilepsy detection by systematically classifying methods, visualizing research progress, and addressing challenges and gaps in current research. It can provide valuable guidance for researchers who want to delve into the field of epileptic seizure detection based on EEG signals.

Aducanumab in Alzheimer's Disease: A Critical Update.

Alzheimer's disease (AD) is a complex neurological disorder that results in cognitive decline. The incidence rates of AD have been increasing, particularly among individuals 60 years of age or older. In June 2021, the US FDA approved aducanumab, the first humanized monoclonal antibody, as a potential therapeutic option for AD. Clinical trials have shown this drug to effectively target the accumulation of Aβ (beta-amyloid) plaques in the brain, and its effectiveness is dependent on the dosage and duration of treatment. Additionally, aducanumab has been associated with improvements in cognitive function. Biogen, the pharmaceutical company responsible for developing and marketing aducanumab, has positioned it as a potential breakthrough for treating cerebral damage in AD. However, the drug has raised concerns due to its high cost, limitations, and potential side effects. AD is a progressive neurological condition that affects memory, cognitive function, and behaviour. It significantly impacts the quality of life of patients and caregivers and strains healthcare systems. Ongoing research focuses on developing disease-modifying therapies that can halt or slow down AD progression. The pathogenesis of AD involves various molecular cascades and signaling pathways. However, the formation of extracellular amyloid plaques is considered a critical mechanism driving the development and progression of the disease. Aducanumab, as a monoclonal antibody, has shown promising results in inhibiting amyloid plaque formation, which is the primary pathological feature of AD. This review explores the signaling pathways and molecular mechanisms through which aducanumab effectively prevents disease pathogenesis in AD.

A critical appraisal of geroprotective activities of flavonoids in terms of their bio-accessibility and polypharmacology

Flavonoids, a commonly consumed natural product, elicit health-benefits such as antioxidant, anti-inflammatory, antiviral, anti-allergic, hepatoprotective, anti-carcinogenic and neuroprotective activities. Several studies have reported the beneficial role of flavonoids in improving memory, learning, and cognition in clinical settings. Their mechanism of action is mediated through the modulation of multiple signalling cascades. This polypharmacology makes them an attractive natural scaffold for designing and developing new effective therapeutics for complex neurological disorders like Alzheimer's disease and Parkinson's disease. Flavonoids are shown to inhibit crucial targets related to neurodegenerative disorders (NDDs), including acetylcholinesterase, butyrylcholinesterase, β-secretase, γ-secretase, α-synuclein, Aβ protein aggregation and neurofibrillary tangles formation. Conserved neuro-signalling pathways related to neurotransmitter biogenesis and inactivation, ease of genetic manipulation and tractability, cost-effectiveness, and their short lifespan make Caenorhabditis elegans one of the most frequently used models in neuroscience research and high-throughput drug screening for neurodegenerative disorders. Here, we critically appraise the neuroprotective activities of different flavonoids based on clinical trials and epidemiological data. This review provides critical insights into the absorption, metabolism, and tissue distribution of various classes of flavonoids, as well as detailed mechanisms of the observed neuroprotective activities at the molecular level, to rationalize the clinical data. We further extend the review to critically evaluate the scope of flavonoids in the disease management of neurodegenerative disorders and review the suitability of C. elegans as a model organism to study the neuroprotective efficacy of flavonoids and natural products.

Genetic Architecture of Neurological Disorders and Their Endophenotypes: Insights from Genetic Association Studies.

Population-scale genetic association studies of complex neurologic diseases have identified the underlying genetic architecture as multifactorial. Despite the study sample sizes reaching the millions, the identified disease-related genes explain only a small fraction of the phenotypic variance. Notable advancements in statistical methods now enable researchers to gain insights even from genomic regions where genotype-phenotype associations do not reach statistical significance. Such studies confirm a highly interconnected molecular network comprising a core group of genes directly involved in the disease process, alongside an expanded peripheral network, each contributing a small but potentially important (modulatory) effect. Additionally, causal inference methods, utilizing genetic instruments, have shed light on putative causal links between risk factors and clinical endpoints. In light of the pervasive genetic overlap or pleiotropy, however, caution is warranted in interpreting causal relationships inferred from these analyses. In this chapter, I will introduce the genetic association model, provide insights into the current state of genetic association studies, and discuss potential future directions.

Preterm birth and risk of hospitalisation for complex chronic conditions during childhood and adolescence.

To examine the relationship between preterm birth and hospitalisation for paediatric complex chronic conditions. We conducted a cohort study of 1 269 745 children born between 2006 and 2022 in Quebec, Canada. We classified preterm birth as extreme (<28 weeks), very (28-31 weeks), and moderate (32-36 weeks). The outcome was hospitalisation for complex chronic conditions, including neurologic, neuromuscular, cardiovascular, respiratory, renal, gastrointestinal, haematologic, immunologic, endocrine, and neoplastic disorders up to 16 years of age. We computed adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between preterm birth and complex chronic conditions during 9 948 734 person-years of follow-up. Hospitalisation rates for complex chronic conditions were higher for children born preterm than at term (6.88 vs. 2.24 per 1000 person-years). Preterm birth was associated with all complex chronic conditions, especially respiratory (HR 4.64, 95% CI 4.01-5.37), cardiovascular (HR 3.68, 95% CI 3.47-3.90), and neurologic disorders (HR 3.48, 95% CI 3.21-3.77). Associations were present at all ages and for all degrees of prematurity, but were strongest with extreme prematurity. Preterm birth increases the risk of hospitalisation for complex chronic conditions up to age 16 years. Preterm children may benefit from enhanced care throughout childhood and adolescence.

Multi-omics Mendelian randomization integrating GWAS, eQTL and pQTL data revealed GSTM4 as a potential drug target for migraine

IntroductionMigraine, as a complex neurological disease, brings heavy burden to patients and society. Despite the availability of established therapies, existing medications have limited efficacy. Thus, we aimed to find the drug targets that improve the prognosis of migraine.MethodWe used Mendelian Randomization (MR) and Summary-data-based MR (SMR) analyses to study possible drug targets of migraine by summary statistics from FinnGen cohorts (nCase = 44,616, nControl = 367,565), with further replication in UK Biobank (nCase = 26,052, nControl = 487,214). Genetic instruments were obtained from eQTLGen and UKB-PPP to verify the drug targets at the gene expression and protein levels. The additional analyses including Bayesian co-localization, the heterogeneity in dependent instruments(HEIDI), Linkage Disequilibrium Score(LDSC), bidirectional MR, multivariate MR(MVMR), heterogeneity test, horizontal pleiotropy test, and Steiger filtering were implemented to consolidate the findings further. Lastly, drug prediction analysis and phenome-wide association study(PheWAS) were employed to imply the possibility of drug targets for future clinical applications.ResultThe MR analysis of eQTL data showed that four drug targets (PROCR, GSTM4, SLC4A1, and TNFRSF10A) were significantly associated with migraine risk in both the FinnGen and UK Biobank cohorts. However, only GSTM4 exhibited consistent effect directions across the two outcomes(Discovery cohort: OR(95%CI) = 0.94(0.93–0.96); p = 2.70e − 10; Replication cohort: OR(95%CI) = 0.93(0.91–0.94); p = 4.21e − 17). Furthermore, GSTM4 passed the SMR at p < 0.05 and HEIDI test at p > 0.05 at both the gene expression and protein levels. The protein-level MR analysis revealed a strong correlation between genetically predicted GSTM4 with a lower incidence of migraine and its subtypes(Overall migraine: OR(95%CI) = 0.91(0.87–0.95); p = 6.98e-05; Migraine with aura(MA): OR(95%CI) = 0.90(0.85–0.96); p = 2.54e-03; Migraine without aura(MO): OR(95%CI) = 0.90(0.83–0.96); p = 2.87e-03), indicating a strong co-localization relationship (PPH4 = 0.86). Further analyses provided additional validation for the possibility of GSTM4 as a migraine treatment target.ConclusionThis study identifies GSTM4 as a potential druggable gene and promising therapeutic target for migraine.

Interneuron diversity in the human dorsal striatum

Deciphering the striatal interneuron diversity is key to understanding the basal ganglia circuit and to untangling the complex neurological and psychiatric diseases affecting this brain structure. We performed snRNA-seq and spatial transcriptomics of postmortem human caudate nucleus and putamen samples to elucidate the diversity and abundance of interneuron populations and their inherent transcriptional structure in the human dorsal striatum. We propose a comprehensive taxonomy of striatal interneurons with eight main classes and fourteen subclasses, providing their full transcriptomic identity and spatial expression profile as well as additional quantitative FISH validation for specific populations. We have also delineated the correspondence of our taxonomy with previous standardized classifications and shown the main transcriptomic and class abundance differences between caudate nucleus and putamen. Notably, based on key functional genes such as ion channels and synaptic receptors, we found matching known mouse interneuron populations for the most abundant populations, the recently described PTHLH and TAC3 interneurons. Finally, we were able to integrate other published datasets with ours, supporting the generalizability of this harmonized taxonomy.

Comparison of patients with chronic and episodic migraine with healthy individuals by brain volume and cognitive functions

Objectives: Migraine is a complex neurological disease. In addition to headache, individuals with migraine may develop structural changes inside the brain and cognitive impairment. There is increased evidence associated with impairments in brain volume and cognitive functions in patients with migraine. The present study aimed to investigate the impairment in memory function in individuals with migraine using brain magnetic resonance imaging, volume measurement, and neuropsychological tests. Methods: The study included 20 patients with episodic migraine, 20 patients with chronic migraine, and 20 healthy controls. Subcortical volumes of all participants were measured by FreeSurfer, an automatic segmentation method. The Wechsler Memory Scale-Revised Form (WMS-R), Stroop test, Raven’s Standard Progressive Matrices, Verbal Fluency Test, and Lines Orientation Test were applied in all the study participants. Results: Putamen volume decreased as migraine duration increased, and subcortical gray matter, left cerebellar cortex, and bilateral thalamus volumes were lower in the chronic and episodic group compared to the control group, bilateral putamen and right cerebellar cortex volumes were lower in patients with chronic migraine compared to patients in episodic migraine and control groups. Upon neuropsychological examination, delayed memory was affected as the duration of migraine increased, and there was impairment in patients with chronic migraine upon fluency tests and mental control tests. Conclusions: Changes in subcortical volume and cognitive effects in patients with migraine raise questions about whether migraine qualifies as a benign disease. Structural changes and cognitive impairment may contribute to migraine-associated disability, and therefore, these causalities should be investigated by future studies. Silent infarcts, white matter damage, and cortical spreading depression, which occur in migraine cases, may be associated with subcortical volume changes and thus, cognitive effects. In the context, studies with larger samples to achieve a better understanding are needed.

Alzheimer's Disease and Epilepsy: Exploring Shared Pathways and Promising Biomarkers for Future Treatments.

Background: Alzheimer's disease (AD) and epilepsy represent two complex neurological disorders with distinct clinical manifestations, yet recent research has highlighted their intricate interplay. This review examines the association between AD and epilepsy, with particular emphasis on late-onset epilepsy of unknown etiology, increasingly acknowledged as a prodrome of AD. It delves into epidemiology, pathogenic mechanisms, clinical features, diagnostic characteristics, treatment strategies, and emerging biomarkers to provide a comprehensive understanding of this relationship. Methods: A comprehensive literature search was conducted, identifying 128 relevant articles published between 2018 and 2024. Results: Findings underscore a bidirectional relationship between AD and epilepsy, indicating shared pathogenic pathways that extend beyond traditional amyloid-beta and Tau protein pathology. These pathways encompass neuroinflammation, synaptic dysfunction, structural and network alterations, as well as molecular mechanisms. Notably, epileptic activity in AD patients may exacerbate cognitive decline, necessitating prompt detection and treatment. Novel biomarkers, such as subclinical epileptiform activity detected via advanced electroencephalographic techniques, offer promise for early diagnosis and targeted interventions. Furthermore, emerging therapeutic approaches targeting shared pathogenic mechanisms hold potential for disease modification in both AD and epilepsy. Conclusions: This review highlights the importance of understanding the relationship between AD and epilepsy, providing insights into future research directions. Clinical data and diagnostic methods are also reviewed, enabling clinicians to implement more effective treatment strategies.

Expanding the Understanding of Stiff-Person Syndrome: Insights from 17 Cases in India.

Stiff-person syndrome (SPS) is a rare and complex neurologic disorder characterized by progressive muscle stiffness, painful spasms, and gait difficulties. In this report, we describe a case of SPS who presented with a relapse while on maintenance immunosuppressive treatment. In addition, we review the literature of 16 previously reported cases of SPS from India, highlighting the diverse clinical features, comorbidities, treatment response, and relapse. The occurrence of paraneoplastic SPS emphasizes the need for early recognition and diagnosis.

"Behavioral rescue: Naringenin's neuroprotective effects against PTZ-induced seizures by mitigating oxidative stress and neuroinflammation in zebrafish larvae"

IntroductionEpilepsy is a complex neurological disorder affecting approximately 70 million people worldwide, accounting for about 1 % of the global population. Despite significant advancements in pharmaceutical therapies, the molecular mechanisms underlying epileptogenesis remain poorly understood, leading to symptomatic treatment being ineffective for about 30 % of patients. Recent evidence implicates oxidative stress and neuroinflammation in the pathophysiology of epilepsy. Traditional Chinese Medicine (TCM) has been used for millennia across Asia and beyond to treat conditions such as cancer, cardiovascular disorders, and neurological diseases, owing to its proven effectiveness. Naringenin is a traditional Chinese component commonly found in citrus fruits and is a naturally occurring flavonoid. MethodsThe present investigation aimed to examine the neuroprotective properties of Naringenin in mitigating PTZ-induced seizures in zebrafish larvae. Zebrafish were administered Naringenin (50 µM) for 24 h at 6 days post-fertilization (dpf), followed by exposure to 15 mM PTZ for 30 min. The study assessed c-fos expression and synaptic activity, oxidative damage, antioxidant defence mechanisms, apoptosis, and levels of nrf2, ho-1, and nqo-1 in the head regions of zebrafish larvae. Additionally, the expression of inflammatory cytokines (cox-2, tnfα, il-1β, and il-6) was evaluated. ResultsNaringenin pretreatment restored c-fos expression and synaptic activity in epileptic zebrafish larvae. The study observed high levels of oxidative damage, reduced antioxidant defences, and increased apoptosis in the larvae with epilepsy. Specifically, levels of nrf2, ho-1, and nqo-1 were decreased in the head regions of the epileptic zebrafish larvae. Naringenin administration mitigated oxidative stress, reduced neuronal apoptosis, and increased the expression of nrf2, ho-1, and nqo-1. Additionally, during seizures, inflammatory cytokines such as cox-2, tnfα, il-1β, and il-6 were upregulated, but naringenin pretreatment was shown to mitigate this effect. DiscussionThe findings collectively underscore the potential neuroprotective effects of Naringenin against PTZ-induced seizures. Naringenin modulates behavioural patterns, reduces oxidative stress, and dampens neuroinflammation, highlighting its promise as a therapeutic agent in epilepsy management. The comprehensive findings of this study serve as a foundation for further research into the mechanisms through which Naringenin confers its protective effects. Furthermore, it paves the way for exploring the potential clinical applications of Naringenin in treating epilepsy.

Advances in pharmacogenomics: optimizing antiepileptic drug therapy for drug-resistant epilepsy

Epilepsy, a complex neurological disorder, is influenced by intricate interactions within cortical, hippocampal, or thalamocortical neuronal networks, presenting a genetically complex condition with non-Mendelian inheritance patterns. This complexity is underscored by the involvement of numerous “susceptibilities” or “modifier” genes, complicating the assessment of risk and therapy outcomes. A critical inquiry in epilepsy treatment involves understanding how genetic diversity impacts treatment strategies and efficacy. Pharmacogenomic advancements have elaborated the connection between genetic variants and antiseizure medication (ASM) safety and response, marking a shift towards precision medicine in epilepsy care. Notably, genetic screening for variants such as HLA-B*1502 and HLA-A*3101 has demonstrated significant efficacy in preventing severe hypersensitivity reactions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), particularly among specific ethnic populations. However, putting pharmacogenomic discoveries into clinical practice faces numerous challenges, including educational, legal, and economic barriers, emphasizing the need for broader acceptance and integration of pharmacogenomic data. This review synthesizes recent studies on pharmacogenomics in epilepsy, highlighting the current advances and prospects for personalizing epilepsy treatment through genetic insights, aiming to enhance ASM safety, reduce adverse effects, and improve treatment outcomes. Through a comprehensive examination of the genetic basis of epilepsy and its influence on pharmacotherapy, this review endeavors to contribute to the evolving landscape of precision medicine in epilepsy care, advocating for a more individualized and effective treatment approach.

In Vitro and In Vivo Investigations of Chromone Derivatives as Potential Multitarget-Directed Ligands: Cognitive Amelioration Utilizing a Scopolamine-Induced Zebrafish Model.

Alzheimer's disease is a complex neurological disorder linked with multiple pathological hallmarks. The interrelation of therapeutic targets assists in the enhancement of cognitive decline through interference with overall neuronal transmission. We have synthesized and screened various chromone derivatives as potential multitarget-directed ligands for the effective treatment of Alzheimer's disease. The synthesized compounds exhibited multipotent activity against AChE, BuChE, MAO-B, and amyloid β aggregation. Three potent compounds, i.e., VN-3, VN-14, and VN-19 were identified that displayed remarkable activities against different targets. These compounds displayed IC50 values of 80 nM, 2.52 μM, and 140 nM against the AChE enzyme, respectively, and IC50 values of 2.07 μM, 70 nM, and 450 nM against the MAO-B isoform, respectively. VN-3 displayed potent activity against self-induced Aβ1-42 aggregation with inhibition of 58.3%. In the ROS inhibition studies, the most potent compounds reduced the intracellular ROS levels up to 80% in SH-SY5Y cells at 25 μM concentration. The compounds were found to be neuroprotective and noncytotoxic even at a concentration of 25 μM against SH-SY5Y cells. In silico studies showed that the compounds were nicely accommodated in the active sites of the receptors along with thermodynamically stable orientations. Compound VN-19 exhibited a balanced multitargeting profile against AChE, BuChE, MAO-B, and Aβ1-42 enzymes and was further evaluated for in vivo activities on the scopolamine-induced zebrafish model. VN-19 was found to ameliorate the cognitive decline in zebrafish brains by protecting them against scopolamine-induced neurodegeneration. Thus, VN-3, VN-14, and VN-19 were identified as potent multitarget-directed ligands with a balanced activity profile against different targets and can be developed as therapeutics for AD.