News & Views in 2010

Surgical revascularization has been accepted as an effective therapeutic option to improve cerebral hemodynamics, reduce further cerebrovascular events and improve long-term outcomes in pediatric moyamoya disease. A large clinical study now provides us with additional meaningful information on the benefits of surgical revascularization for patients with this condition.

The neural mechanisms of many symptoms associated with migraine have yet to be elucidated. New research suggests that a non-image-forming retinal pathway and signals from the dura mater contribute to photophobia in patients with migraine. More research is needed to understand the mechanisms behind other migraine-associated symptoms such as nausea and osmophobia.

Ganglioglioma is a rare form of low-grade glioma that mainly affects children and young adults. The low incidence of this tumor has precluded prospective studies of available treatment strategies. A large retrospective study has now examined the effectiveness of these strategies, specifically the influence of postoperative radiotherapy on patient outcome.

Substantial progress has been made over the past four decades in treating the symptoms of Parkinson disease, but treatments that slow its inexorable progression have remained tantalizingly out of reach. New research raises hopes that a means might have been found to safely and effectively slow progression of Parkinson disease and delay its clinical emergence.

A large, retrospective analysis of patients with amyotrophic lateral sclerosis (ALS) and progressive muscular atrophy (PMA) indicates that a substantial proportion of PMA patients develop upper motor neuron signs indicative of an ALS diagnosis. The findings suggest that PMA should be considered as part of the ALS spectrum rather than as a distinct entity.

The first practice parameters published on amyotrophic lateral sclerosis (ALS) by the American Academy of Neurology (AAN) enhanced the care of people with this condition. These guidelines have now been updated on the basis of new evidence and will continue to provide the impetus for new research and better care; however, harmonization of the AAN and European guidelines is desirable.

Migraine—in particular, migraine with aura—seems to confer an increased risk of ischemic stroke and might also be linked with other cardiovascular events. Findings from a new meta-analysis support the former association; however, insufficient data exist to conclude whether this type of headache increases the risk of nonstroke cardiovascular disease.

The results of the ADAGIO trial, combined with those of the TEMPO trial and a large body of additional clinical and preclinical data, indicate that the possibility of treatment with rasagiline should be discussed with all patients with early Parkinson disease.

A new study has compared the utility of optical coherence tomography and visual evoked potentials in the diagnosis of optic neuritis—an inflammatory condition that is frequently the presenting symptom of multiple sclerosis. The results indicate that the two techniques can provide complementary information for the diagnosis of this condition.

Stroke is a frequent cause of neurological morbidity and death in children. Standardized treatment guidelines for childhood stroke can improve patient outcomes when such protocols are implemented early after symptom onset. Medical professionals, however, seem to have a limited awareness of childhood stroke that perpetuates the delay to diagnosis and, hence, intervention.

Poststroke dementia is a clinically heterogeneous syndrome with various underlying mechanisms. A better understanding of the pathophysiology of poststroke dementia together with an improved ability to differentiate between various dementia syndromes will be useful for optimizing therapeutic interventions, and for informing patients and carers about treatment options and prognosis.

Gene therapies have entered clinical trials for several neurological disorders, most notably Parkinson disease. A study in a nonhuman primate model of Parkinson disease has reported motor deficit improvements following the use of a lentiviral vector to restore extracellular dopamine levels. A clinical trial is now underway to evaluate the effectiveness of this approach in humans.

Ultrasound-based technologies are emerging as promising noninvasive approaches to treat brain disorders. Researchers in Switzerland have shown that chronic pain can be alleviated through thermal ablation of thalamic tissue by high-intensity focused ultrasound.

Genome-wide association studies (GWAS) have uncovered over two dozen candidate Alzheimer disease susceptibility genes; however, the results of these studies showed limited overlap. Two independently performed GWAS involving cohorts from Europe and the US have now identified three additional putative Alzheimer disease genes that show modest but remarkably consistent effects across data sets.

Clinical trials comparing surgical and endovascular interventions for carotid artery stenosis have produced inconclusive and conflicting results. Companion studies now provide data on the long-term efficacy and durability of these therapies for treating carotid artery stenosis. What do these findings tell us about the relative merits of the two techniques?

Prion diseases are fatal and untreatable neurodegenerative brain diseases that can mimic other brain illnesses. Therapies for these conditions are most likely to work in the early stages of the disease, but no simple, early diagnostic tests are currently available. New findings, however, indicate that brain MRI could aid diagnosis.