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Psychiatric and neurological comorbidities are relatively common in epilepsy, affecting 30–50% of patients. Neurologists should be able to treat psychiatric comorbidities in patients with epilepsy and identify patients at risk of adverse events from psychotropic medications, because psychiatric care is not available to all patients. In this Review, Andres Kanner discusses the complex relationship between epilepsy and psychiatric and neurological comorbidities, and provides considerations for selection of antiepileptic and psychotropic drugs in patients with epilepsy.
Suspected non-Alzheimer disease pathophysiology (SNAP) is a biomarker-based concept that applies to individuals with normal levels of amyloid-β biomarkers in the brain, but in whom biomarkers of neurodegeneration are abnormal. Clinically normal and mildly impaired individuals with SNAP are at increased risk of poor clinical and cognitive outcomes. In this Perspectives article, Clifford Jack and colleagues describe the available data on SNAP and address topical controversies in the field.
2015 saw the publication of five randomized controlled trials of endovascular treatment for acute stroke caused by vascular occlusion, with huge implications for the future of patient management. Mokin and colleagues consider the findings of these trials in the context of their designs, in particular the criteria for patient selection, and their likely impact on future management of acute stroke.
The chemokine receptor CCR5 is thought to have a role in several CNS inflammatory diseases and infections. The role of CCR5 in HIV has already led to the development of effective and well-tolerated CCR5 antagonists, which could offer a readily available option for the treatment of CNS diseases. In this Review, Martin-Blondel et al. consider the evidence for a role of CCR5 in several CNS diseases and the rationale for use of CCR5 anatagonists in these conditions.
The past year has seen practice-changing findings in stroke research. Strong evidence now supports endovascular thrombectomy as the new gold standard of care in acute ischaemic stroke, and a pragmatic trial raised concerns over early intensive mobilization after stroke. Moreover, new insights were gained into the trajectory of stroke-associated cognitive decline.
