Review Articles

The incidence of Parkinson disease (PD) increases with age, so age-related conditions are expected to feature prominently among the comorbidities associated with this disease. In this article, Nanhoe-Mahabier et al. explore a possible link between PD and cerebrovascular disease, discussing the pathophysiological mechanisms that could underlie such a relationship, and considering how comorbid cerebrovascular disease might affect the clinical presentation of PD.

Chronic kidney disease is a serious global health problem, and almost all patients with severe forms of the disease develop neurological complications, which can include cognitive impairment, cerebrovascular disease and peripheral neuropathies. Krishnan and Kiernan review the clinical features and pathophysiology of the most common neurological complications of chronic kidney disease, and highlight the currently available treatment options.

Clinical overlap between the various types of neurodegenerative parkinsonism, particularly in the early stages of disease, can make differential diagnosis problematic. Biological fluid biomarker assays are being explored as adjunctive tests to aid the diagnostic work-up of patients with neurodegenerative parkinsonism, and in this article Eller and Williams cast a critical eye over the currently available cerebrospinal fluid, plasma and urine biomarkers.

Thrombolytic therapy is an effective treatment for ischemic stroke, but only when delivered within a short period after the onset of the condition. Delay in patients being admitted to hospital is one of the main reasons why the therapeutic window is often missed. This Review examines the factors that affect prehospital delay, and describes strategies designed to overcome the problem.

Sudden unexpected death in epilepsy most frequently occurs in people with chronic epilepsy, and seems to be a seizure-related event. In this article, Surges et al. review the incidence of sudden unexpected death in epilepsy and the risk factors associated with this condition, before exploring the pathological mechanisms related to chronic epilepsy that could lead to sudden death.

Bipolar disorders are recurrent mood disturbances involving periods of depression and mania. Eric Taylor discusses the management of bipolar disorders in children and adolescents, including potential differential diagnoses and the results of treatment trials in these age groups. He also outlines the distinction between classic bipolar disorders and brief emotional outbursts.

Individuals over the age of 80 years account for 30% of the total number of people with ischemic stroke. Nevertheless, elderly patients are more likely to receive suboptimal care than are younger individuals. In this Review, Derex and Nighoghossian examine the effectiveness of thrombolysis therapy, stroke-unit care, and early rehabilitation in elderly patients with stroke.

Transient loss of consciousness is a spell of unconsciousness characterized by abrupt onset, short duration, and spontaneous and complete recovery. In this article, van Dijk et al. provide an overview of the various forms of TLOC, focusing particularly on reflex syncope. They highlight key clues to the diagnosis of these conditions and emphasize the importance of a multidisciplinary approach to the management of patients with TLOC.

Glioblastoma is the most common primary malignant brain tumor in adults, causing over 10,000 deaths each year in the US alone. Given the resistance of this tumor to standard surgery, radiation and chemotherapy, attention has focused on identifying the underlying genetic lesions in the hope of developing new treatment strategies. Purow and Schiff review the current state of knowledge of the genetics of glioblastoma and discuss the implications for future therapies.

Pregnancy can have an unpredictable effect on the frequency and nature of migraines. In this article, Contag et al. examine the association of migraine with pregnancy and pregnancy-related complications, notably pre-eclampsia. The authors also review the diagnosis and management of migraine headaches that precede or develop during pregnancy, and explore the risks associated with the available treatment options.

Patients with hemianopic dyslexia experience serious reading difficulties, with word identification and the abilities to plan and guide reading eye movements being severely disturbed. In this Review, Schuett explores the clinical features and the underlying functional and anatomical bases of hemianopic dyslexia, before critically examining the available therapies for rehabilitation of this condition.

New-onset epilepsy in elderly individuals presents important diagnostic and therapeutic challenges for the clinician. Arain and Abou-Khalil highlight the conditions that should be considered in the differential diagnosis, and discuss the factors that need to be taken into account when devising an appropriate drug regimen, including age-related changes in pharmacokinetic factors, potential drug interactions, and adverse-effect profiles.

The developing brain is especially prone to seizure activity, and population studies have shown that seizure incidence peaks during the first month of life. Research into the factors responsible for this enhanced seizure susceptibility could yield potential therapeutic targets to prevent epileptogenesis and provide biomarkers to identify individuals who are at heightened risk of developing epilepsy.

In lumbar spinal stenosis (LSS), narrowing of the spinal canal leads to neural compression and, frequently, pain in the lower back. LSS has become the most common reason for lumbar spine surgery, partly reflecting the elevated demand for mobility and flexibility in the aging population. In this article, Siebert et al. review the underlying pathophysiology of LSS, and discuss how to diagnose and treat the condition.

Improvements in the survival of critically ill patients over the past few decades have led to an increased incidence of acquired muscular weakness in intensive care units. Zink and colleagues review the clinical and diagnostic features of critical illness polyneuropathy and myopathy and discuss preventive and therapeutic approaches to these severe and costly medical complications.

Patients with Parkinson disease can experience a range of hallucinatory phenomena, which can have considerable psychosocial effects and be important factors determining the admission of patients into nursing homes. This Review explores the wide array of hallucinations in Parkinson disease, and examines the contribution of both pharmacological therapies and the underlying disease pathology to their formation.

Alterations in the levels and activities of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), have been described in various neurodegenerative disorders, most notably Huntington disease. In this article, Zuccato and Cattaneo review the current knowledge about the involvement of BDNF in these diseases and critically assess whether BDNF treatment would be a beneficial and feasible therapeutic approach in the clinic.

Nearly 80% of the worldwide burden of epilepsy is borne by resource-poor countries. The quality of epilepsy care in these countries is compromised by numerous factors, including poverty, illiteracy, inefficient health-care systems, and social stigma. In this article, Kurupath Radhakrishnan highlights these difficulties and suggests practical solutions, drawing on his own experiences in southern India.

Multiple sclerosis is traditionally considered to be an inflammatory disease, but it also has a neurodegenerative component, which can manifest early in the disease course. New therapeutic strategies are being developed to elicit CNS neuroprotection and repair in patients with multiple sclerosis, and Barkhof et al. review the available data on imaging outcome measures that could be used to track the efficacy of these approaches.

Agitation and aggression are common symptoms of Alzheimer disease (AD), causing risk and distress to the patient and others. Atypical antipsychotics are the most widely prescribed pharmacological treatments for these symptoms, but they can cause harmful effects. Here, Clive Ballard and colleagues review the risks associated with atypical antipsychotics and present the many alternative treatments and approaches that are available for managing agitation and aggression in AD.