During skull base surgery in neurosurgery, bradycardia or cardiac arrest due to the trigeminocardiac reflex (TCR) or the vagal reflex is occasionally encountered. Sudden bradycardia or cardiac arrest can be life-threatening for the patient and can also cause psychological stress for the surgeon. Intracranial TCR is induced in the orbital apex, cavernous sinus, and tentorium cerebelli, while the vagal reflex is induced in the jugular foramen. Procedural triggers include physical compression, electrical stimulation during nerve identification, and hemostasis using bipolar coagulation. In most cases, bradycardia resolves upon cessation of physical or electrical stimulation. However, if TCR recurs after re-stimulation, surgery may have to be interrupted. Among the 10 cases that progressed to bradycardia or cardiac arrest, we review the 5 cases considered to be TCR and examine the pathophysiology of TCR and its management.

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NEURO^®, a treatment that combines rTMS with intensive rehabilitation, has been reported to bring significant improvement in upper limb function. We conducted a retrospective study on 126 patients who underwent NEURO^®, a 15-day inpatient treatment at our hospital. The results showed significant improvements in upper limb function assessments such as FMA, ARAT, and WMFT, as well as subjective evaluations including JASMID and VAS. Additionally, for patients who underwent multiple sessions, the improved function was maintained from the time of the first discharge to the start of the second session, suggesting that experiencing subjective improvement in upper limb function through NEURO^® is important for long-term maintenance or further enhancement of upper limb function after NEURO^®.

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This study examined the effects of NEURO-15 (NovEl intervention Using Repetitive TMS and intensive Occupational therapy-15 days protocol) on spasticity and cortical activity in 25 patients with chronic post-stroke hemiplegia. After the intervention, spasticity in the elbow, wrist, and finger flexor muscles significantly decreased, and Fugl-Meyer Assessment scores improved. Functional near-infrared spectroscopy analysis revealed a significant change in the Laterality Index in the premotor/supplementary motor area (BA6), indicating a shift toward greater activation in the affected hemisphere. These findings suggest that NEURO-15 may promote functional readjustment within the cortex–brainstem–spinal cord pathway and contribute to the reduction of post-stroke spasticity.

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Repetitive transcranial magnetic stimulation (rTMS) treatment and intensive speech and language therapy were administered to patients with severe aphasia in the chronic phase. The subjects were four patients diagnosed with severe aphasia using the Standard Language Test of Aphasia (SLTA). As an analytical method, SLTA scores obtained at admission and three months after discharge were converted to Z-scores and subsequently compared. The mean total Z-score changed in all participants, and when broken down by language modality, improvements were especially noted in auditory comprehension. rTMS treatment for patients with severe aphasia may contribute to improving auditory comprehension. A treatment combining rTMS and intensive speech and language therapy may be one possible treatment option for patients with severe aphasia in the chronic phase.

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This study investigated the severity-dependent effects of an artificial intelligence (AI)-integrated, electromyography (EMG)-driven hand training device (MELTz) in patients with upper limb hemiparesis during the subacute phase of stroke. Ten inpatients admitted to a convalescent rehabilitation ward participated in a two-week MELTz intervention program. Upper limb motor function and cortical hemodynamics, quantified by the laterality index (LI) using functional near-infrared spectroscopy (fNIRS), were evaluated before and after the intervention. Patients were stratified according to baseline motor impairment severity, as determined by the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Significant functional improvements were observed in the moderate-to-mild subgroup, whereas gains were limited in the severe subgroup. These findings suggest that MELTz may enhance finger motor function and promote cortical activation; however, its therapeutic efficacy appears to depend on baseline severity. Careful candidate selection and optimization of central motor recovery before device implementation may be essential to maximize the clinical benefits of MELTz.

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Spastic movement disorder (SMD) after stroke can cause abnormal muscle tone during voluntary movement, even when no spasticity is observed at rest, leading to impaired mobility and reduced quality of life. We report a case of a woman in her 30s who developed equinovarus foot following a right putaminal hemorrhage. Although conventional therapies such as shockwave treatment and taping were ineffective, improvement was achieved through a combination of botulinum toxin type A (BoNT-A) injections and functional electrical stimulation (FES). BoNT-A was administered to suppress abnormal muscle activity, and FES targeting the tibialis anterior muscle and common peroneal nerve was applied to promote motor relearning of appropriate ankle dorsiflexion during gait. After three treatment sessions, dynamic ankle inversion during walking was markedly reduced. This case suggests that the combination of BoNT-A and FES can improve motor control in SMD by addressing the mismatch between motor intention and sensory feedback. The findings highlight the therapeutic potential of integrating neuromodulation and motor relearning approaches in post-stroke SMD.

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This case report describes the first attempt to apply repetitive peripheral magnetic stimulation (rPMS) synchronized with pain and a feeling of tightness to the lower limb of a 54-year-old man with intractable thalamic pain following a thalamic hemorrhage. Previous interventions, including repetitive transcranial magnetic stimulation (rTMS), rPMS, botulinum toxin type A (BoNT-A), and extracorporeal shockwave therapy, had yielded insufficient effects and low patient satisfaction. In contrast, the present intervention produced marked improvements: the pain visual analog scale (VAS) decreased from 100 mm to 6 mm, the spastic sensation score improved from 100 mm to 0 mm, and patient satisfaction increased substantially. Functional outcomes also improved, including increased range of motion (ROM), higher Berg Balance Scale (BBS) scores, and the ability to ascend and descend stairs one foot per step. These findings suggest that rPMS synchronized with the symptom occurrence could represent a potential novel treatment strategy for thalamic pain.

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We report the case of a young adult with cerebral infarction who wished to regain the ability to type on a personal computer (PC). Multiple courses of NEURO^® were administered, resulting in improved upper limb function and partial acquisition of typing skills. The patient was a male in his 20s, diagnosed with right cerebral hemisphere infarction. To achieve the goal of acquiring PC typing ability, four NEURO^® sessions were conducted, incorporating stepwise occupational therapy ranging from proximal upper limb training to fine motor exercises involving the fingers. At the final assessment, the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) improved from 49 to 62 points, and the Action Research Arm Test (ARAT) improved from 36 to 44 points. The patient was able to perform part of the typing tasks required in his workplace. These findings suggest that repeated NEURO^® interventions in a young adult with cerebral infarction contributed to progressive improvement in upper limb function and supported the resumption of social roles.

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We evaluated the immediate effect of a single Hand Jiggling (HJA-100) session on spasticity in a chronic-phase stroke patient with upper limb paralysis. The measurement task involved the upper limb washing motion, which was the patient's specific need. A reflective marker was attached to the non-paralyzed upper limb, and the paralyzed upper limb performed repeated movements between the markers for 20 seconds. Spasticity was assessed using the Modified Ashworth Scale (MAS), and changes in muscle tone during movement were evaluated using the average task completion time. Results showed improvement in MAS scores and a reduction in task completion time immediately after Hand Jiggling, with effects persisting for a certain period. Comparison of mean task completion times before and after treatment revealed a significant difference in the extension direction (p<0.001). Multiple comparisons showed significant improvement immediately after treatment, as well as at 5 and 10 minutes post-treatment. Hand Jiggling suggested the potential to reduce spasticity and suppress increased muscle tone during movement as an immediate effect. Future studies should accumulate more cases to determine the target population and indications for Hand Jiggling therapy.

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We report a case of delayed encephalopathy following carbon monoxide (CO) poisoning due to a charcoal briquette suicide attempt, in which combined high-frequency repetitive transcranial magnetic stimulation (rTMS) and occupational therapy (OT) resulted in improved initiative and enhanced activities of daily living (ADL). The patient was a male in his twenties who was diagnosed with delayed encephalopathy after CO poisoning and subsequently started on OT. At the initiation of treatment, the patient exhibited decreased initiative, with an Abilities of Basic Movement Scale-II (ABMS II) score of 10 and a Barthel Index (BI) score of 0. High-frequency rTMS was administered concurrently with OT to improve initiative, resulting in improvements to an ABMS II score of 15 and a BI score of 30. Electroencephalogram (EEG) assessments before and after treatment revealed changes in power values. This case suggests that high-frequency rTMS may be effective in treating decreased initiative caused by delayed encephalopathy following CO poisoning. Furthermore, frontal EEG measurements may serve as an objective tool for evaluating patient improvement.

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This case report presents a male patient in his 70s who presented with significant cognitive and physical impairments following a hemorrhagic stroke. To address these, an eight-week dual-task training program was implemented, combining physical exercise on a stepping device with vocal cognitive tasks like reading aloud and answering memory- and language-related questions. After the intervention, the Japanese version of the Montreal Cognitive Assessment (MoCA-J) score improved from 9 to 20. Similarly, the Functional Independence Measure (FIM) score rose from 33 to 111, indicating marked gains in daily function and independence. Clinically, improvements were noted in speech fluency, articulation, and spontaneity. He also regained the ability to use a computer and resumed digital journaling, reflecting recovery in instrumental activities of daily living. This refers to complex daily tasks such as computer use, journaling, etc. These results suggest that combining physical movement with vocal cognitive tasks can effectively enhance attention, memory, and executive function. This dual-task approach offers a practical, engaging rehabilitation strategy that targets both cognitive and motor systems and may help improve quality of life and autonomy in stroke and neurological recovery.

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