News & Views

Bipolar disorder and schizophrenia share common clinical features, and antipsychotic medications can treat both conditions effectively. An assessment of 73,929 people with bipolar disorder and/or schizophrenia from a Swedish registry found evidence that the two disorders also share more than half of their genetic determinants.

Complex regional pain syndrome is a chronic condition arising mainly after tissue injury and involves both inflammatory and neurogenic factors. Use of angiotensin-converting-enzyme inhibitors has been associated with an increased risk of developing the chronic pain condition, which suggests possible roles for substance P and bradykinin in the underlying pathogenic process.

An analysis of 12 different second-generation antidepressants rated sertraline and escitalopram as having the most favorable balance between benefit and harm for the treatment of major depressive disorder in adults. A second look at the methods and results from the study reveals that such a positive conclusion might not be warranted.

The triptan drugs provide effective migraine relief for many people. Nevertheless, a substantial number of migraine-affected individuals are unresponsive to triptans, and such therapy can also lead to an array of adverse effects. A new class of antimigraine drugs, currently undergoing clinical trials, could offer hope to those for whom triptan medication is unsuitable.

Parkinson disease is commonly recognized as a neurodegenerative disorder that leads to disabling motor and cognitive impairment, but less widely appreciated is the association of this condition with a variety of pain syndromes. A recent survey emphasizes the high prevalence and severity of pain in patients with Parkinson disease.

The need for early diagnosis of Alzheimer disease is gathering importance with the prospect of disease-modifying therapy. Medial temporal lobe atrophy on MRI is a characteristic, early and predictive feature of the disease. A new visual rating system has been proposed to facilitate assessment of such atrophy in routine clinical practice.

MRI provides a very sensitive reflection of the histopathological changes in multiple sclerosis. Many short-term studies fail to appreciate the relationship between MRI and clinical findings, although such shortcomings might be argued to reflect a weakness of clinical measures, rather than of MRI.

The use of repeated microcatheter injections during intra-arterial procedures to treat acute stroke is associated with an increased risk of intracranial hemorrhage. The number of such injections performed should, therefore, be minimized.

Distinguishing between a first episode of multiple sclerosis and acute disseminated encephalomyelitis in children who present with an initial demyelinating event can be a clinical challenge. New brain MRI criteria that aim to differentiate these clinical presentations, and revised McDonald MRI criteria specific for the pediatric population, are both worthy of note.

Differences in the frequencies of physician and emergency-room visits and hospitalizations across socioeconomic and ethnic groups may lead to poor health outcomes in disadvantaged populations. Analyzing the causes and implementing interventions to redress such disparities is a high priority in the US, but neurology lags behind other clinical specialties in this research.

Human prion diseases are sometimes difficult to diagnose because few clinical features distinguish them reliably from other neurological disorders. A new study suggests that analysis of movement disorders might contribute to the clinical differentiation of sporadic Creutzfeldt–Jakob disease from Alzheimer disease and dementia with Lewy bodies.