BackgroundWomen with ADHD and autism experience elevated rates of premenstrual problems, yet no direct comparisons between these conditions exist in adults.ObjectivesThis study examined premenstrual dysphoric disorder (PMDD) prevalence, symptoms, and impairment across ADHD, autism, and neurotypical women.DesignCross-sectional data from 199 women aged 20-40 without hormonal contraceptive use were analyzed across two samples.MethodsParticipants included 89 with ADHD, 39 with autism, and 71 controls. Premenstrual symptoms were assessed using the Premenstrual Symptoms Screening Tool (PSST), alongside measures of ADHD characteristics, autism traits, and sensory hypersensitivity.ResultsBoth ADHD and autistic women showed significantly elevated provisional PMDD rates according to the PSST screening instrument compared to controls, with no significant difference between neurodivergent groups. Dimensional analyses revealed positive associations between premenstrual symptoms and neurodiverse traits, particularly inattention, hyperactivity-impulsivity, and social skills difficulties. The impact of premenstrual problems was similarly associated with these traits across diagnostic groups. Contrary to hypotheses, sensory hypersensitivity was not independently associated with premenstrual symptoms after controlling for ADHD and autism characteristics.ConclusionsPremenstrual problems constitute a significant burden for both ADHD and autistic women, with dimensional associations suggesting that individuals with more severe neurodivergent traits face heightened risk. Yet our findings also demonstrate that prevalence estimates are only as reliable as the recruitment strategies behind them. Advancing this field requires both greater clinical attention to menstrual cycle-related difficulties in neurodivergent populations and recruitment strategies that yield dependable estimates.

Chronic migraine (CM) refractory to conventional pharmacotherapy (r-CM) remains a debilitating neurological condition with limited therapeutic options. High-frequency spinal cord stimulation at 10 kilohertz (HF-SCS) has recently emerged as a distinct neuromodulatory paradigm for this patient population. Unlike traditional spinal cord stimulation, HF-SCS operates above the frequency range that generates paresthesia, thereby eliminating stimulation-induced sensation while potentially engaging unique analgesic mechanisms.

Plozasiran (Redemplo®) is a small interfering RNA that reduces hepatic production of apolipoprotein C-III and circulating triglycerides. It degrades ApoC-III mRNA and results in reduced levels of hepatic and serum ApoC-III protein, which leads to an increased clearance of serum triglycerides. In the phase 3 PALISADE trial, plozasiran 25 mg reduced fasting triglyceride levels by approximately 80% at 10 months in patients with familial chylomicronemia syndrome (FCS) and was associated with a lower incidence of pancreatitis compared with placebo. This provides supportive, yet not definitive, evidence for pancreatitis prevention as the PALISADE trial was powered to investigate triglyceride lowering. Across completed clinical studies, plozasiran demonstrated a generally favorable safety profile, with a low incidence of thrombocytopenia and adverse events primarily limited to abdominal pain, nasopharyngitis, headache, and nausea. Hyperglycemia was observed in some patients with preexisting diabetes or prediabetes at baseline. Ongoing phase 3 trials (SHASTA-3, SHASTA-4, SHASTA-5, SHASTA-10, MUIR-3 and CAPITAN) are further evaluating the efficacy and safety of plozasiran in broader populations with hypertriglyceridemia, including its potential role in reducing cardiovascular risk and preventing pancreatitis. Compared with earlier ApoC-III-targeted antisense oligonucleotides, plozasiran offers the advantages of less frequent dosing, sustained pharmacodynamic effects, and potentially a more favorable tolerability profile based on indirect evidence, positioning it as a promising therapeutic option for patients with FCS and other severe hypertriglyceridemia disorders inadequately managed with existing therapies.

BackgroundMigraine is characterized by recurrent headaches and sensory hypersensitivities, with photophobia affecting up to 90% of patients during attacks. The mechanisms underlying ictal photophobia remain unclear, potentially involving altered excitability of the visual cortex, trigeminovascular sensitization, or cone-driven retinal pathways. Prior interictal studies have shown preserved macular cone opponent mechanisms, but ictal investigations are lacking.MethodsIn this prospective study, we simultaneously recorded Ganzfeld blue-red (B-R) and blue-yellow (B-Y) focal flash (8 Hz) macular cone electroretinogram (ERG) and the subsequent visual evoked potential (VEP) in 11 patients with migraine without aura during acute attacks and in 20 healthy volunteers. First (1F) and second (2F) harmonic amplitudes and phases were analyzed using discrete Fourier transformation and T2circ statistics. Responses were correlated with clinical variables, including photophobia severity (0-10 scale) during attacks, using Spearman's coefficient.ResultsFor B-Y stimuli, a selective reduction in ERG 1F amplitude was noted in patients (F = 4.19, p = 0.02), with preserved phases and no differences in other harmonics or VEP responses. A significant negative correlation was observed between the phase of the first harmonic of the VEP and the level of photophobia during the attack. No significant differences were observed in 1F or 2F ERG/VEP amplitudes or phases for B-R stimuli between patients with migraine and HVs.ConclusionsIctal macular cone-opponent pathways remain largely intact in migraine, with a specific S-cone amplitude attenuation suggesting an autonomic-mediated inference on blue-light hypersensitivity. The finding of a correlation of B-Y VEP phase with photophobia implies that this symptom may arise from subcortico-cortical integrations (e.g., thalamic-trigemino-cortical convergence) rather than focal retinal dysfunction.

AimFremanezumab is approved for migraine prevention in Europe, the United States (US), Japan, South Korea, and several other countries; however, there are no data available on fremanezumab as a migraine preventive treatment in a Chinese population. This study evaluated the efficacy and safety of fremanezumab in Chinese adults with migraine.MethodsThis randomized, multicenter, Phase 3 trial consisted of a 4-week screening period, a 12-week double-blind period (DBP), and a 12-week open-label extension (OLE). Chinese adults with episodic and chronic migraine were randomized 1:1:2 to receive fremanezumab monthly (225 mg), fremanezumab quarterly (675 mg), or matched monthly placebo during the DBP. During the OLE, all participants received fremanezumab monthly (225 mg). The primary endpoint was mean change from baseline in monthly migraine days (MMD) during the DBP. Secondary endpoints included mean change from baseline in migraine days during the first 4 weeks of treatment and in monthly number of days with acute headache medication use during the DBP. Similar endpoints were assessed during the OLE. Safety assessments included, but were not limited to, adverse event (AE) reporting.ResultsIn total, 365/454 screened participants were randomized to fremanezumab (n = 182 [monthly, n = 91; quarterly, n = 91]) or placebo (n = 183). Significantly greater changes from baseline in MMD were observed with fremanezumab versus placebo during the DBP (-4.6 vs -2.8; p < 0.0001) and in mean migraine days during the first 4 weeks of treatment (-4.5 vs -2.2; p < 0.0001). The mean change from baseline in days of acute headache medication use during the DBP was -3.0 with fremanezumab and -1.1 for placebo (p < 0.0001). During the OLE, the mean change from baseline in MMD was -6.8 and -7.2 for those assigned to fremanezumab and placebo, respectively, during the DBP. The percentage of participants with any AE was similar between fremanezumab and placebo groups during the DBP (47% vs 43%); serious AEs were infrequent (fremanezumab, 1%; placebo, <1%). Similar trends in AEs were observed during the OLE.ConclusionIn this study, fremanezumab demonstrated significant improvements over placebo with respect to reductions in MMD and days with acute headache medication use, with these reductions being maintained over the OLE. Fremanezumab demonstrated a favorable safety profile, with no safety signals. These results are comparable to pivotal adult trials in Europe and the US, supporting the use of fremanezumab in Chinese adults living with migraine.Clinical trial pre-registrationClinicalTrials.gov identifier: NCT05458011; submitted: 11 July 2022; first participant enrolled: 30 September 2022; available at: https://clinicaltrials.gov/study/NCT05458011; first submitted: 11 July 2022).

Intracranial hypotension is a typically self-limiting or treatable condition characterized by orthostatic headache and neck stiffness. However, it may be severe and may be associated with neurological complications, particularly sixth cranial nerve palsy. We report two young women who presented to the emergency department with diplopia secondary to acute unilateral sixth cranial nerve paresis in the context of intracranial hypotension following anesthetic procedures. In both cases, clinical and radiological findings consistent with a cerebrospinal fluid (CSF) deficit were documented, including bilateral subdural collections in one case. One case required an epidural blood patch, which resulted in complete resolution, whereas the other resolved spontaneously. The clinical manifestations, radiological findings, and therapeutic options are reviewed. These cases underscore the importance of careful clinical and radiological assessment in patients with acute ophthalmoplegia, in whom orthostatic headache is a key diagnostic clue, as well as of treatment aimed at correcting the CSF deficit.

Chronic non-specific low back pain (CNLBP) is a common condition associated with persistent pain, functional limitation, reduced quality of life, and substantial healthcare and socioeconomic burden. Mindfulness-based cognitive therapy (MBCT) has been increasingly used in chronic pain management and may provide a promising therapeutic approach for CNLBP. The emergence of virtual reality (VR) further provides an immersive, standardized, and accessible platform for delivering MBCT. This study aims to evaluate the effects and safety of a CNLBP-specific VR-integrated MBCT intervention in patients with CNLBP.

Monkeypox (mpox) is a viral infection characterized by polymorphic cutaneous lesions and systemic symptoms, including fever, lymphadenopathy, headache and myalgia. Given its broad differential diagnosis, accurate recognition requires a high level of clinical suspicion; in this context, dermoscopy represents a potentially useful tool to improve diagnostic accuracy. We conducted a retrospective case series of six patients with RT-PCR-confirmed mpox and dermatologic involvement between July 2022 and July 2025. A total of six patients were included; three (50%) were evaluated in the macular/vesicular phase and three (50%) in the crusted phase. In the macular/vesicular phase, eight lesions were analysed. In the crusted phase, five lesions were analysed. In our series, we observed pinkish-yellow structureless areas during the macular/vesicular phase. Recognition of these dermoscopic features may increase clinical suspicion and support the diagnosis.