Background: Virtual Reality (VR) is an emerging non-pharmacological treatment for anxiety in palliative care patients. Anxiety, a common symptom in this population, has a significant effect on living standards. The aim of this systematic review is to evaluate the effectiveness of VR interventions in reducing anxiety and improving quality of life in palliative care. Methods: The systematic review protocol was registered in PROSPERO (CRD42024517914). The comprehensive search was performed in nine databases, including PubMed, PsycINFO, and EMBASE, and included studies published up to 15 November 2024. RCTs, pilot studies, and feasibility trials involving adult palliative care patients in which VR interventions were used, were compared with standard care. Two reviewers independently extracted and assessed the quality of the data using the RoB 2 tool. Results: A total of 13 studies were considered eligible, with 333 participants aged 15 to 85 years old. In these experiments, anxiety decreased steadily, and in some cases mood and quality of life were improved significantly. The VR interventions ranged from guided nature walks to memory-training sessions. Sessions lasted between 5 and 30 min and ranged in duration from single sessions to daily use. Personalized and participatory VR-based content was particularly effective in alleviating anxiety. The heterogeneity of the study designs and VR protocols hampered meta-analysis, despite promising findings. Conclusions: VR has considerable potential as an adjunctive anxiety therapy for palliative care. The personalization and immersion that VR provides are psychologically unique and have the potential to lower anxiety and improve well-being. But standardizing intervention protocols and more studies are required to define the best VR strategies and evaluate outcomes over the long term. The article highlights the promise of VR as part of palliative care as a viable bio-psycho-socio-spiritual approach.

Background: Virtual Reality (VR) is an emerging tool in the management of anxiety, one of the most disturbing symptoms of Alcohol Use Disorder (AUD), which often leads to relapse. Still, patients with Alcohol Use Disorder frequently have a history of Acute Symptomatic Seizures, and they are subsequently excluded from studies using VR because of the hypothesized fear of inducing photosensitive seizures. The first part of this narrative review explores the pathophysiological mechanisms of seizures associated with AUD, specifically acute symptomatic seizures. In contrast, the second part explores virtual reality’s safe use in seizure-prone individuals, highlighting that the current state-of-the-art is based on a biased per-ception and old epidemiological data from studies conducted on photosensitive seizures in the late 90s. VR exposure has yet to be reported as triggering seizures within known pharmacovigilance databases. Significance: The implications weigh heavily on VR research currently associated with this significant adverse event. Further studies are necessary to address the risk of seizures triggered by VR in patients predisposed to developing seizures, like alcohol use disorder patients with a history of acute symptomatic seizures. Such research is essential to ensure that the potential benefits of Virtual Reality as a tool for managing anxiety in individuals with alcohol use disorder and acute symptomatic seizures are not unduly restricted. Furthermore, AUD can also serve as an intervention model feasible to de-bias attitudes toward the current lack of evidence base concerning the significant adverse events of VR-induced seizures, therefore facilitating the clinical implementation of this unharnessed digital treatment interface.

This article examines the complex relationship between seizures, epilepsy, and multiple sclerosis (MS) in pediatric patients, based on detailed findings from a single-center study. Background: Although multiple sclerosis is primarily recognized as an adult-onset disease, its occurrence in children presents distinctive challenges, especially related to seizure disorders. Methods: We reviewed 120 pediatric MS patients evaluated over 7 years; six of these (5%) experienced seizures (including one case of acute status epilepticus), and five were diagnosed with epilepsy according to the latest International League Against Epilepsy (ILAE) classification. This study aimed to evaluate the occurrence rates and types of seizures while investigating their management strategies in this specific group. Results: Through a detailed case analysis and patient follow-up, we identified key factors contributing to seizure onset and explored implications for treatment and care. In our cohort, children with MS and seizures showed a higher risk for disease progression and greater cumulative disability, evidenced by a significantly higher last Expanded Disability Status Scale (EDSS) score (after a minimum 2-year follow-up) in the seizure group (p < 0.006). The analysis recognized early MS onset and highly active disease types as further risk factors that led to worse health outcomes. Conclusions: Genetic causes of epilepsy in children are common and may interact with MS-related inflammation in the same patient; our observations underscore the need to investigate how these two conditions interact. This work contributes to the broader understanding of epilepsy comorbid with MS among pediatric patients, seeking to facilitate the creation of improved interdisciplinary clinical practices in pediatric neurology.

BACKGROUND Performance anxiety represents a significant challenge for students, manifesting as a fear of failure and difficulties managing examination-related concerns and academic pressures. According to recent statistics, anxiety affects >4% of the global population, underscoring the need for effective management methods. Studies indicate that yoga and virtual reality (VR) training can alleviate symptoms of performance anxiety. OBJECTIVE This trial aims to compare VR-assisted cognitive behavioral therapy (CBT) with yoga interventions to find effective treatments. METHODS A single-blinded randomized controlled trial will be conducted with 60 participants (n=30, 50% per intervention group) recruited from university and preuniversity counseling centers. The trial will measure whether the interventions reduce performance anxiety in students. Stratified randomization will be used to ensure equal distribution of baseline anxiety levels and gender across both groups. The primary outcome is a reduction in anxiety, measured using the State-Trait Anxiety Inventory-Y1 and State-Trait Anxiety Inventory-Y2 subscales. Secondary outcomes include emotional regulation and quality of life. Data will be collected at baseline, after the intervention, and during follow-up assessments. Statistical analyses will include parametric tests (eg, repeated-measures ANOVA and t tests) to compare anxiety reduction, emotional regulation, and quality of life across groups. The intention-to-treat approach will be applied to minimize bias due to participant dropouts. Sensitivity analyses will assess the robustness of the findings. RESULTS This study is planned to start in September 2025 and end in June 2026. VR-assisted CBT is expected to reduce anxiety very quickly, whereas yoga is predicted to have long-term benefits. CONCLUSIONS More generally, this research highlights the need for new, accessible forms of mental health support. VR-assisted CBT is an emerging digital mental health intervention, and it enables individuals to access and explore anxiety in virtual, safe environments. In contrast, yoga is a more conventional, all-encompassing discipline that enhances mental health through physiological and psychological processes that may have long-term effects. CLINICALTRIAL ClinicalTrials.gov NCT06639841; https://clinicaltrials.gov/study/NCT06639841 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/66112

This article examines the complex relationship between seizures, epilepsy, and multiple sclerosis (MS) in pediatric patients, based on detailed findings from a single-center study. Background : Although multiple sclerosis is primarily recognized as an adult-onset disease, its occurrence in children presents distinctive challenges, especially related to seizure disorders. Methods : We reviewed 120 pediatric MS patients evaluated over 7 years; 6 of these (5%) experienced seizures (including one case of acute status epilepticus), and 5 were diagnosed with epilepsy according to the latest ILAE classification. This study aims to evaluate the occurrence rates and types of seizures while investigating their management strategies in this specific group. Results: Through detailed case analysis and patient follow-up, we identified key factors contributing to seizure onset and explored implications for treatment and care. In our cohort, children with MS and seizures showed a higher risk for disease progression and greater cumulative disability, evidenced by a significantly higher last Expanded Disability Status Scale (EDSS) score (after a minimum 2-year follow-up) in the seizure group (p < 0.006). The analysis recognized early MS onset and highly active disease types as further risk factors that led to worse health outcomes. Conclusions: Genetic causes of epilepsy in children are common and may interplay with MS-related inflammation in the same patient; our observations underscore the need to investigate how these two conditions interact. This work contributes to the broader understanding of epilepsy comorbidity with MS among pediatric patients, to facilitate the creation of improved interdisciplinary clinical practices in pediatric neurology.

Background: Baló’s concentric sclerosis stands out as a rare form of multiple sclerosis that features large tumor-like demyelinating lesions, which resemble brain tumors and create significant diagnostic and therapeutic obstacles for pediatric patients. Case Presentations: We present two case studies of pediatric patients, aged 11 and 15, diagnosed with extensive cerebral tumefactive inflammatory lesions indicative of Balo’s type multiple sclerosis (MS). Both cases highlight the unique challenges faced in the diagnosis and treatment of this rare form of MS, characterized by the presence of large, tumor-like lesions that can mimic primary brain tumors. We will explore the diagnostic complexities, including the need for advanced imaging techniques, MR (Magnetic Resonance) spectroscopy, along with the time needed for differential diagnoses, which might delay the start of proper treatment. Current therapies, such as corticosteroids and immunomodulators, require customization to individual patients, carefully monitoring of clinical outcomes and possible side effects. This paper emphasizes that handling these cases requires a multidisciplinary approach, addressing not only the medical treatment but also the psychosocial needs of affected children and their families. By sharing these experiences, we aim to increase awareness about Balo’s type MS in pediatric populations and provide clinical insights into effective management strategies for similar cases in clinical practice. Conclusions: Timely detection of atypical demyelinating lesions together with immediate treatment intervention plays a crucial role in pediatric Baló-type MS. These cases demonstrate the essential role of advanced imaging and immunological testing in precise diagnosis while showcasing successful treatment approaches through corticosteroids and second-line immunotherapies, which improve patient outcomes in this atypical MS variant.