Volume 9 Issue 6, June 2013

A recent study of a large multi-ethnic cohort has shown that cumulative serum titres of antibodies against five common microbial pathogens are associated with an increased risk of cognitive impairment. Further studies are needed to better understand this risk and enable translation of the findings into effective preventative strategies.

Oligoclonal IgG bands are present in the cerebrospinal fluid of most patients with multiple sclerosis (MS) and constitute a useful tool to enable accurate diagnosis. A recent meta-analysis has explored the precise prevalence of these antibodies in MS and their possible relationship with geographical location and patient outcome.

Systemic inflammation has been associated with dementia. A new study has found an increased rate of autoimmune disorders and elevated serum levels of tumour necrosis factor in patients with frontotemporal dementia associated with TDP-43 pathology. These findings help in understanding disease mechanisms and in identification of biomarkers of this heterogeneous disease.

Cerebrovascular disease is the most frequently identified antecedent of new-onset seizures or epilepsy in industrialized countries. Three recent publications have evaluated the risk of epilepsy following a first cerebrovascular insult. Each report provides evidence for a substantial risk in some patient subgroups, although the study methodologies and definitions of epilepsy vary.

Susac syndrome is an important differential diagnosis in many neurological disorders, but our understanding of this rare disease has largely been limited to reports of single cases and small case series. In this article, Dörr and colleagues review all reported cases of Susac syndrome to provide a comprehensive overview of demographic, clinical and diagnostic data on this disorder. On the basis of their findings, Dörr et al. make recommendations for diagnosis and management of individuals with suspected Susac syndrome.

Primary CNS lymphoma (PCNSL) is a rare malignancy with an aggressive course, for which treatment has yet to be optimized. Here, Korfel and Schlegel discuss diagnostic approaches in patients with suspected PCNSL, and review the latest studies on new and more established therapeutic interventions. Ongoing issues—including the utility of whole-brain radiotherapy, and treatment of young, elderly and immunocompromised patients—are also considered.

MicroRNAs (miRNAs) are short, single-stranded RNA molecules that inhibit translation of target mRNAs, and are key regulators of molecular and cellular responses in development, health and disease. A role for miRNAs in the regulation of pathology of CNS injuries has recently emerged, and in this Review, Bhalala et al. discuss findings from miRNA microarray studies in stroke, traumatic brain injury and spinal cord injury. They highlight how improved understanding of miRNA changes following CNS injuries can inform novel treatment strategies for these pathologies.

This Review focuses on the growing area of telemedicine in the diagnosis and treatment of patients with acute stroke who are geographically remote from primary care centres. Hess and Audebert discuss telemedicine as a means to improve the availability of care for stroke patients, and the financial implications of this approach. Furthermore they highlight technological advances that might help to overcome barriers to the wider application of telemedicine in acute stroke care.

Psychogenic movement disorders (PMDs) manifest with physical symptoms but currently lack a clear pathology and standard of care. However, some physicians support the use of placebo therapy for patients with PMDs. In this Perspectives article, Karen Rommelfanger outlines the need for further research and international dialog regarding the treatment of patients with PMDs, and the use of placebo therapy in these patients.