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A new cross-sectional study proposes three subtypes of Alzheimer disease: hippocampal-sparing, typical and limbic-predominant, associated with average lifespans of 72, 79 and 86 years, respectively. A longitudinal view suggests that age might be a major neuropathological determinant, with typical cases having younger onset and limbic-predominant cases having older onset.
Spinal angiography has historically been associated with a high risk of complications, but up-to-date safety reports are lacking. A recent retrospective review found a low complication rate of catheter angiography of the spine, and suggests that MRI performs poorly as an alternative approach to the diagnosis of spinal vascular disorders.
Cases of postural tachycardia syndrome (PoTS) have been described dating back to the 19thcentury; however, the condition remains poorly understood, and the diagnosis is not readily made. Mathias and colleagues provide a comprehensive Review detailing the characteristics and possible pathophysiological mechanisms of PoTS, as well as investigation and treatment.
Lesion activity detected on MRI scans has become an accepted surrogate for disease activity in relapsing–remitting multiple sclerosis (MS). Barkhof and colleagues provide key recommendations for efficient use of MRI in clinical trials for relapse-onset MS, including practical issues related to acquisition, analysis and reporting of MRI data, approaches to optimization of trial design, and safety considerations.
Now that antipsychotic medication is all but proscribed for the treatment of distress and disturbed behavior in people with dementia in care homes, the drive to identify effective alternative approaches is pressing. A study from Norway suggests that paracetamol may be effective in many cases, but some caution is required.
Multifocal motor neuropathy (MMN) is a rare inflammatory disorder that features slowly progressive, asymmetric distal limb weakness. Leonard van den Berg and colleagues describe the diagnostic criteria for MMN, which are important for distinguishing this disease from mimic disorders such as amyotrophic lateral sclerosis. The authors also discuss the pathophysiology of MMN, emphasizing the role of GM1-specific autoantibodies, and outline current treatment options and possible new therapeutic strategies.
Training in different countries and societies can provide important insights into the sociocultural factors that influence the perception and management of disease. In this article, Michele Viana compares and contrasts his experiences of training at headache centers in Italy and the USA, highlighting differences in attitudes towards headache and its treatment between these two countries.
Tourette syndrome, characterized by motor or vocal tics, is a multifactorial neurodevelopmental disorder that affects up to 1% of children and adults worldwide. In this Review, McNaught and Mink describe the history of Tourette syndrome and its clinical presentation, and provide an overview of its epidemiology and pathophysiology. Current treatment strategies and potential future therapies are also discussed.