News & Views in 2011

In the past two decades, there has been concern that levodopa—the gold-standard therapy for Parkinson disease (PD)—may be toxic to dopaminergic neurons. However, findings from a recent study suggest that chronic use of levodopa does not enhance progression of PD pathology. Can we make sense of this controversy?

Neurological markers are used to predict outcomes in patients resuscitated after cardiac arrest, and are crucial in informing treatment decisions in comatose patients. A multicenter study reports that therapeutic hypothermia in cardiac arrest alters the reliability of several recommended prognostic parameters, and the authors highlight challenges to optimization of prognostic paradigms.

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.

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.

Combination therapy is a rational strategy to optimize therapeutic benefits and minimize risks associated with treatment of patients with multiple sclerosis (MS). A recent study reporting negative results of combination therapy in MS should not discourage investigators from future attempts to identify optimal combinations for the treatment of this disease.

Clazosentan—a drug previously demonstrated to reduce angiographic vasospasm in patients with aneurysmal subarachnoid hemorrhage—had no significant effect on vasospasm-related morbidity and mortality in the CONSCIOUS-2 trial. A multifactorial cause for delayed ischemic neurological deficits might partly account for these negative findings.

A recent clinical trial showed no beneficial effects of statin treatment in patients with Alzheimer disease (AD) and normal cholesterol levels. Other studies show that the effects of statins can vary depending on cholesterol levels and stage of disease, so statins should not be ruled out as an AD therapy.

Rituximab is an immunosuppressive monoclonal antibody therapy that is used in some cases to help prevent relapses of neuromyelitis optica, an inflammatory CNS demyelinating disease. A new study provides evidence supporting efficacy and a strategy for optimizing the timing of repeated courses of treatment for the individual patient.

A recent study has identified mutations in the ubiquilin 2 gene in patients with dominant X-linked amyotrophic lateral sclerosis (ALS) and ALS–dementia. The results suggest that ubiquilin 2 inclusions and impairment of the protein degradation pathway contribute to the pathogenesis of ALS and possibly other neurodegenerative disorders.

Glial cell line-derived neurotrophic factor (GDNF) has proved efficacious in treatment of neurodegeneration in toxin-induced models of Parkinson disease (PD), but clinical trials have been equivocal. Do the results of a recent study—suggesting that GDNF is ineffective in an α-synuclein-overexpression PD model—exclude GDNF as a therapy for PD?

For patients with transient cerebral ischemia, prompt diagnostic evaluation and rapid initiation of treatments markedly reduces the incidence of subsequent acute stroke. However, controversy exists about which patients to evaluate, and where and how quickly to perform the testing. Do current guidelines provide the best answers?

Perinatal brain injury is associated with a substantial risk of long-term disability. A recent study has shown that the severity of injury to the deep nuclear gray matter and brainstem, determined by early MRI, correlates with the risk of death and/or cerebral palsy at 2 years.

Bacterial meningitis, one of the infections most feared by parents, and on the mind of every pediatrician who evaluates a febrile child, is an important cause of morbidity and mortality in childhood. New vaccines have the potential to prevent the majority of these cases and could transform child health.

Treatment of Parkinson disease (PD) with dopaminergic medication is associated with the development of impulse control disorders (ICDs). A new study suggests that, irrespective of medication, patients with PD are more likely to make impulsive decisions. How and why might the risk of ICDs be increased in patients with this disease?

The diagnosis of rapidly progressive dementias (RPDs), particularly sporadic Jakob–Creutzfeldt disease (sCJD), can prove challenging. Treatable RPDs can mimic sCJD, which is currently untreatable. A recent review of a large cohort of patients with suspected CJD highlights the extent of misdiagnosis and possible sources of error.

Early supported discharge (ESD) is a model of stroke care that decreases the inpatient length of stay and provides superior functional benefit compared with inpatient rehabilitation. Recently published consensus guidelines from a panel of ESD trialists provide a practical blueprint for implementing the ESD model and measuring its effectiveness.

Othello syndrome, as demonstrated by Shakespeare's fictional character of that name, describes individuals with severe delusional jealousy. Retrospective analysis of data from patients with this syndrome suggests that it is frequently associated with neurological disorders, particularly those affecting the right frontal lobe. What are the implications of these findings?

Subthalamic nucleus deep brain stimulation (STN DBS) is an effective treatment for Parkinson disease. Although the breadth and severity of neurobehavioral changes with STN DBS is debated, the frequency of serious adverse events is probably low. New research has identified patient characteristics that predict cognitive and emotional morbidity after STN DBS.

The negative clinical results seen after retinal cell transplantation in patients with Parkinson disease highlight the importance of understanding the mechanisms by which a graft can improve neurological function. Scientific and safety issues must be thoroughly addressed before any cell transplantation approach can progress as a therapy for neurological diseases.