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Cover image supplied by David Fernandes-Cabral, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. The corticospinal tract of the human brain on high-definition fibre tracking. The corticospinal tract, the longest white matter tract in the CNS, originates from the primary motor cortex, and crosses the internal capsule, brainstem and, finally, the spinal cord. Lesions such as brain tumours, arteriovenous malformations and strokes can displace, disrupt or infiltrate this tract. Advanced fibre tracking methods allow precise reconstruction of the tract, which can help improve outcomes after neurosurgical procedures.
In 2016, the literature on neurological infections was, understandably, dominated by Zika virus. However, we should not overlook important publications on the treatment of cryptococcal and bacterial meningitis.
Brain tumours encompass a heterogeneous collection of neoplasms, traditionally classified by histopathological criteria. In 2016, the WHO published an updated classification that, for the first time, defines brain tumour types according to integrated histological and molecular parameters. Furthermore, clinical trial results were reported that inform therapeutic decision-making in diffuse gliomas.
In 2016, new highly active treatment options for relapsing–remitting multiple sclerosis (MS) emerged. At the same time, large clinical trials in progressive MS highlighted the limitations of immune-directed therapies, and called for new strategies to treat disease progression in MS.
Investigational treatments to impede the progression of Alzheimer disease (AD) are being evaluated in clinical trials, and biomarkers to detect and track the disease are being developed and deployed. Recent findings underscore the importance of ongoing clinical trials and biomarker developments in the understanding, treatment and prevention of AD.
In the field of movement disorders, areas that have seen important advances in 2016 include the pathogenesis of Parkinson disease involving extra-CNS α-synuclein pathology, treatment of hyperkinetic disorders with novel dopamine-depleting drugs, and MRI-guided ultrasound surgery for the treatment of essential tremor.
The past 2 years have seen major breakthroughs in endovascular treatment for acute ischaemic stroke. As highlighted in 2016, we now need to refine the logistics for delivery of this treatment, including patient selection. We should not forget, however, that it is better to prevent strokes in the first place.
The publication of a consensus definition of Parkinson disease (PD) psychosis in 2007 led to a rapid expansion of literature focusing on clinical aspects, mechanisms and treatment. The authors review this literature and discuss the evolving view of PD psychosis, from distinct classes of symptoms to a continuum progressing over the course of PD.
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease predominantly affecting upper and lower motor neurons. Here, the authors outline previous and current efforts to characterize genes that are associated with ALS, and describe what is currently known about the genetic architecture of ALS.
Real-world observational studies have the potential to answer questions about multiple sclerosis (MS) treatment that randomized controlled trials cannot. Trojano and colleagues discuss the pitfalls and necessary safeguards in observational studies, and the insights that such studies have provided into treatment decisions for patients with MS.
In this Perspectives article, Espay and colleagues argue that that the adoption of precision medicine in Parkinson disease will require a revision of biomarker development efforts, with the ultimate goal of testing putative disease-modifying interventions in well-defined disease subgroups.