News & Views

Recently published findings from the ENDORSE study provide 5 years of randomized safety and efficacy data for two doses of dimethyl fumarate (DMF) in multiple sclerosis. The report complements results from the pivotal CONFIRM and DEFINE trials; however, postmarketing data from clinical practice is needed to complete the risk–benefit profile of DMF.

A recent study demonstrates that amyloid-β (Aβ) can function as an antimicrobial peptide, and additional data show that bacteria and yeast can seed Aβ deposition into amyloid. These data suggest a complex interplay between the normal function of Aβ, its accumulation in the brain, and host immune defence.

A new meta-analysis, which evaluated individual patient data from randomized trials of aspirin in patients with non-disabling acute brain ischaemia, found this drug to be much more efficacious at reducing early stroke recurrence than was previously estimated.

Alteplase is widely used for acute stroke at a dose of 0.6 mg/kg in Asian patients, whereas the standard in Europe and the USA is 0.9 mg/kg. The ENCHANTED study did not show that 0.6 mg/kg alteplase is noninferior to 0.9 mg/kg, as previously suggested, raising questions about standard practice in Asia.

The American Academy of Neurology (AAN) has updated its guidelines on the use of botulinum neurotoxins in neurological disorders. The new guidelines provide individual recommendations for the four products that are commercially available in the USA; however, the clinical differences between the products are still not clear.

The Response Assessment in Neuro-Oncology Working Group has analysed the role of clinically established PET methods in the diagnostic assessment of brain tumours. The group emphasizes the clinical value of PET imaging, particularly amino acid PET imaging, over conventional MRI, and recommends its use at every stage of management.

The ongoing Zika virus (ZIKV) epidemic in the Americas raises urgent questions about the risks of microcephaly in the children of ZIKV-infected mothers. New research into the 2013–2014 ZIKV outbreak in French Polynesia supports a link between maternal ZIKV infection during the first trimester of pregnancy and microcephaly.

Two new studies report on the potential of a number of antioxidants and a cholesterol-lowering drug to prevent neurodegeneration in a Drosophila genetic model of parkinsonism. This research shines a spotlight on the power of invertebrate models as an in vivo screening tool.

A new study reports that the incidence of dementia in one population has declined by over 40% between the 1970s and 2010s. The finding could have implications for the future prevalence of dementia, and illustrates the importance of environmental factors in the risk of dementia disorders.

A recent study of clinical and genetic characteristics in patients with hereditary spastic paraplegia highlights the difficulties of making clinicogenetic correlations in a heterogeneous group of diseases. Genetic analysis beyond the causative variants, and independent of the core clinical symptoms (pyramidal signs versus ataxia), might offer a more pertinent way to approach phenotypic variability.

The end of 2015 saw the passing of John F. Kurtzke and Richard T. Johnson, two legends in neurology, and founding fathers of neuroepidemiology, neurovirology and neuroimmunology. Here, we pay tribute to these two giants by discussing their impact on the genesis of these profoundly important disciplines.

Two new studies highlight the potential of neuroimaging to aid the differential diagnosis of neurodegenerative disease, for both clinical practice and emerging trials. Although this approach holds great promise, meaningful implementation of neuroimaging as part of a tailored precision medicine strategy may require additional imaging and non-imaging biomarkers.

Classification of migraine into different endophenotypes could aid diagnosis and treatment, but requires detailed characterization of different phenotypes. A new study provides insight into the clinical features of migraine with unilateral cranial autonomic symptoms, but raises questions about the value of such classifications.

A new study has shown that both in patients with multiple sclerosis (MS) and in healthy controls, dopamine inhibits production of IL-17 and IFN-γ by peripheral blood mononuclear cells. The finding adds to previous evidence for the potential benefit of dopaminergic drugs in MS.

Fingolimod is approved for the treatment of relapsing–remitting multiple sclerosis (MS), and evidence suggests that it has neuroprotective effects. The recent INFORMS phase III trial in primary progressive MS demonstrated no beneficial effects of fingolimod on disability progression or whole-brain atrophy, but provides important information for future therapeutic development.

A recent longitudinal study indicates that the incidence of new-onset epilepsy has remained stable in children and young adults but has increased in elderly individuals over the past 40 years. Rather than signalling a failure to prevent epilepsy, however, this phenomenon might be attributable to the comorbidities of epilepsy.

Prognostic scoring systems are widely used as objective outcome predictors in neurocritical care, for example, after haemorrhagic stroke. A new study, however, has unexpectedly shown that clinicians can predict outcome after intracerebral haemorrhage more accurately than do formal scoring scales.

A recent study that applied new criteria for diagnosing neuromyelitis optica spectrum disorders in the absence of serum aquaporin 4 antibodies highlights difficulties with clinical application of these criteria. Classification on the basis of molecular markers might offer a more practical alternative.

Epilepsy surgery is the standard of care for focal drug-resistant epilepsy, but it is underutilized. Knowledge gaps and attitudes toward epilepsy surgery are partly responsible, and a new study explores whether the health-care infrastructure in developed countries influences access to and utilization of epilepsy surgery.

A new study suggests that the application of uniform diagnostic criteria for mild cognitive impairment (MCI) substantially reduces variation in MCI prevalence estimates. Refinement and harmonization of clinical and research criteria are essential milestones towards improved testing of therapeutic interventions aimed at curbing the epidemic of MCI and dementia.