Viewpoint in 2007

Despite decades of debate, no consensus has been reached on the role of carotid endarterectomy in patients with asymptomatic carotid stenosis. Anne Abbott argues that the time for deliberation is over. In this Viewpoint, she makes a case for the suspension of surgery in favor of medical interventions.

The question of whether carotid endarterectomy should be performed on patients with asymptomatic carotid stenosis is one of the big medical controversies of our time. Uncertainty over surgical benefits hasn't stopped people from operating, however, with surgery rates soaring in some countries. Vincent Thijs reminds clinicians of the open questions in the field and calls for a more selective and cautious approach to surgery.

The search for the perfect pain reliever continues, with several drugs targeting pain-specific pathways in clinical and preclinical development. Pain is a protective mechanism, however, so complete pain control might also have its downsides. This Viewpoint aims to launch a debate on how the use of a perfect pain blocker can be implemented in a safe and effective fashion.

There is strong evidence that clinical trials with a positive outcome are more likely to be published than are trials with negative results. In this Viewpoint, Richard Johnson and Kay Dickersin explore the reasons for this phenomenon and discuss possible solutions.

Recent data show that MRI at term-equivalent age can predict neurodevelopmental outcomes in infants born far before term. So should cranial MRI screening replace cranial ultrasound in preterm babies? The authors of this Viewpoint weigh up the options.

The rostral ventrolateral medulla has a major role in the regulation of sympathetic and cardiovascular activities. It has been suggested that neurovascular compression of this area might be causally linked to essential hypertension. In this Viewpoint, the authors highlight the pertinent issues and the clinical relevance of this important debate.

Restless legs syndrome has become increasingly prominent in the clinical literature in recent years, but the prevalence of this condition is still unknown. In this Viewpoint, Claudia Trenkwalder highlights the debate regarding whether restless legs syndrome is overdiagnosed or underdiagnosed, and she considers possible explanations for the differences in opinion within the neurology field.

A recent study has shown that brain research is poorly funded compared with research in fields such as cancer and heart disease. In this Viewpoint, Jes Olesen discusses possible reasons for this discrepancy, and describes how the European Brain Council is bringing together basic neuroscientists, clinical neurologists and patient organizations to promote brain research and to facilitate the translation of new advances into real benefits for patients.

In this Viewpoint, Williamsonet al. highlight the distinction between genetic research and clinical testing in Alzheimer's disease. They consider how neurologists can bridge the gap between scientific advances and patient management, helping patients and their families to navigate this complex territory.

Despite encouraging preclinical results, clinical trials of neuroprotective agents for Parkinson's disease have failed to show consistent clinical benefit. In this Viewpoint article, Karl Kieburtz and Bernard Ravina analyze the reasons behind this lack of success and draw conclusions on how to move forward.

Nanotechnology is often hailed as a revolutionary technology. In this Viewpoint article, Gabriel Silva presents emerging nanotechnology applications directed towards neurological disorders and assesses their potential to provide patients with novel and advanced therapeutic choices.

In recent years, we have witnessed an alarming worldwide shortage of intravenous immunoglobulin, an agent that is commonly used to treat various autoimmune and systemic inflammatory diseases, many of which affect the nervous system. In this Viewpoint, Bayryet al.explain the reasons for this shortage, and propose some potential solutions to the problem.

Ronald Petersen developed the concept of mild cognitive impairment (MCI) in the late 1990s. The concept has since been expanded to include several subtypes, with amnestic MCI being recognized as a risk state for Alzheimer's disease. This Viewpoint highlights the benefits of retaining the MCI classification, both from a research and from a clinical point of view.

Mild cognitive impairment has become a popular concept for classifying the boundaries between normal aging and dementia, but is it a legitimate diagnosis? In this Viewpoint article, Peter Whitehouse argues that the concept of mild cognitive impairment is fundamentally flawed and driven to a large extent by stakeholder interests.

In this Viewpoint article, Alastair Buchan and James Kennedy evaluate emerging options for the treatment of acute ischemic stroke and discuss the difficulties associated with choosing the patients who might benefit most from them.