Reviews & Analysis

In 2010, progress in the headache field was marked by four very different key advances: clarification of the mechanisms of extracephalic allodynia, approval of onabotulinumtoxinA for chronic migraine prophylaxis, validation of combined pharmacological and behavioral treatments for migraine, and establishment of oxygen as an effective acute treatment for cluster headache.

Many articles were published in 2010 that had or will conceivably have a major impact on the field of stroke. With regard to practical patient care, however, several pivotal studies investigating avenues for optimal management of carotid artery atherosclerotic disease were especially important.

The most appropriate treatment for absence seizures and the teratogenic effects of valproate were clarified in 2010. Advances were also made in the use of both functional MRI to predict the adverse effects of neurosurgical resection and electrical stimulation to control epilepsy in patients who are not suitable for resection.

2010 represented a milestone in the history of multiple sclerosis monitoring and treatment. MRI and immunological biomarkers were identified to track disease evolution and, ultimately, to guide treatment decisions. Moreover, oral disease-modifying therapies emerged that should increase treatment regimen adherence and improve patient outcomes.

Advances in Alzheimer disease (AD) research during 2010 have identified promising novel diagnostic tools and therapeutic targets for this condition, and suggest that amyloid-β immunotherapy reduces plaque load in patients with AD. A new lexicon for AD has also been proposed.

Research conducted in 2010 has shown that surgical and dopaminergic treatments for Parkinson disease (PD) can promote the development of nonmotor symptoms, such as impulse control disorders and apathy. Lesions in cholinergic pathways have also been shown to partly underlie deficits in gait and posture in patients with advanced PD.

Following a stroke, patients can have problems speaking and understanding language (aphasia). During the past decade, several therapies for poststroke aphasia have been developed on the basis of knowledge gained from advances in neuroscience research. In this article, Berthier and Pulvermüller provide an overview of these advances in poststroke neurorehabilitation and highlight the physiological processes that are considered to underlie their beneficial effects.

Labate et al. argue that benign mesial temporal lobe epilepsy (bMTLE)—defined as at least 24 months of seizure freedom with or without antiepileptic medication—has been under-recognized because of a bias in the literature towards refractory forms of epilepsy. Here, the authors discuss emerging concepts on bMTLE, some of which were formulated during an international workshop held in Italy.

Monoclonal antibodies are being used to treat a variety of autoimmune disorders, including multiple sclerosis, neuromuscular diseases and rheumatoid arthritis, but neurological adverse effects have been reported in a substantial number of patients. Bosch et al. describe the characteristics, pathogenesis and outcomes of neurological disorders associated with monoclonal antibody therapy, and make recommendations regarding their management.

Motor impairment is a common symptom of stroke. Several processes, such as innate neuroplasticity, are considered to underlie gains in motor function after stroke. In this article, Dimyan and Cohen provide a review of neuroplasticity associated with poststroke motor impairment and highlight the latest experimental interventions being developed to manipulate neuroplasticity to enhance motor rehabilitation.

Drug-resistant focal epilepsy is potentially curable by surgery, but conventional MRI based on visual evaluation is sometimes unable to reveal a lesion for resection. In this Review, Bernasconi and colleagues consider recent advances in brain imaging for the detection of lesions in cases of so-called cryptogenic epilepsy, covering developments in MRI morphometry, computational modeling and diffusion tensor imaging.

To date, existing and emerging therapies for multiple sclerosis (MS) have been evaluated solely in adult patients. MS in children is being increasingly recognized, however, and optimization of pediatric MS care requires that promising new therapies be made available to children and adolescents. Banwell et al. highlight the immunological, clinical and practical factors that must be considered when introducing new MS therapies into the pediatric population.

Observational studies suggest that high homocysteine levels are a risk factor for brain atrophy and Alzheimer disease, but intervention studies have been inconclusive. New evidence that B vitamin therapy can slow brain atrophy will allow re-examination of elevated homocysteine levels as a potentially treatable risk factor for this disease.

Mutations in six genes have been unequivocally linked to Parkinson disease (PD). A recent study found that among 953 patients with the early-onset form of PD, ≈17% harbored a mutation in one of these genes. This finding raises important issues concerning genetic testing and genetic counseling for early-onset PD.

The development of disease-modifying therapies for amyotrophic lateral sclerosis (ALS) is a priority for researchers in this field. Two studies have independently identified plasma and cerebrospinal fluid biomarkers for ALS, and these biomarkers could provide a means of testing the efficacy of novel ALS drug treatments in future clinical trials.

Dolichoectasia is a condition that causes dilatation and/or tortuosity of both intracranial and extracranial arteries. Intracranial dolichoectasia can be asymptomatic or manifest with compressive and/or vascular symptoms, such as cranial neuropathies or hemorrhagic stroke. In this article, Gutierrez et al. provide a review of the existing dolichoectasia literature and identify gaps in our knowledge to aid future research.

Copper metabolism is critical for numerous biological processes, and is mediated by various copper chaperones and transporters, including copper-transporting ATPase 1 (ATP7A). Here, Kaler examines the role of ATP7A in normal neurological function, and explores the three distinct clinical syndromes—Menkes disease, occipital horn syndrome and the newly described ATP7A-related adult-onset distal motor neuropathy—that are associated withATP7Amutations.