Viewpoint

Levodopa remains the gold standard for treating Parkinson’s disease, but there has long been controversy about this drug’s potential to exert toxic effects on nigral cells, thereby accelerating disease progression. William Weiner evaluates the evidence and explores the implications of this debate for interpreting research data.

As our understanding of the molecular basis of neurodegenerative diseases continues to improve, the prospect of using gene therapy to treat these conditions becomes increasingly realistic. This Viewpoint article discusses initial trials of an RNA interference gene-silencing strategy to modify the expression of mutant proteins in animal models of amyotrophic lateral sclerosis, and considers the hurdles that will need to be overcome to translate this approach into the clinic.

As our understanding of the pathophysiology of spinal cord injury deepens, novel neuroprotective agents are being developed, some of which have already entered clinical trials. In this Viewpoint, Sipski and Pearse examine the status of translational research in this field, focusing specifically on issues surrounding the concurrent use of methylprednisolone. The authors also discuss other potential confounders of clinical trials for spinal cord injury and suggest possible solutions.

Telemedicine has the potential to improve access, efficiency and quality of health care. In this Viewpoint, Victor Patterson and Richard Wootton explore how telemedicine might change the face of neurological practice.

The hypothesis that brain cancer might arise from a small population of cancer stem cells has received much attention in recent years. In this Viewpoint, however, Fomchenko and Holland argue that brain tumorigenesis might be more complex than this. They suggest that many of the stem-like cells found in brain tumors might have been recruited from surrounding tissues, and they discuss the implications for cancer therapy.

The ability to classify brain tumors on the basis of molecular data is expected to revolutionize the diagnosis and treatment of brain cancer. In this Viewpoint article, Mischel and Cloughesy discuss the current status of molecularly targeted therapies for brain tumors, and outline a 'roadmap' for future investigations.

The risk of stroke following transient ischemic attack has been underestimated. In this Viewpoint, Peter Rothwell examines the risk of stroke at relevant time intervals following transient ischemic attack, evaluates the available methods for predicting stroke risk in these patients, and describes potential approaches to stroke prevention.

The clinical role of acetylcholinesterase inhibitors in the treatment of Alzheimer's disease remains unresolved. This Viewpoint examines the evidence from clinical trials and argues for a conservative approach to the use of these drugs in patients with dementia.

Procedures for handling incidental findings in brain imaging research vary widely. Through considering the principles that govern how incidental findings should be dealt with, the author highlights concepts and strategies to help guide researchers and practitioners through the choices they must make.

This Viewpoint examines the management options for arteriovenous malformations and the grading scales that can be used to guide treatment decisions. The authors consider the natural history of unruptured arteriovenous malformations and evaluate the risks associated with available treatments.

Currently, there is considerable scientific interest in modes of imaging that rely on the metabolic characteristics of tissues. Metabolic imaging is emerging as a promising diagnostic tool for the evaluation of cerebral gliomas, although it remains to be seen whether treatment decisions based on this approach will produce significant improvements in outcome.

It is estimated that epilepsy affects up to 1% of the world's population, and although many patients derive considerable benefits from antiepileptic drugs or resective surgery, new therapeutic approaches are still needed. In this Viewpoint, William Theodore assesses the potential of techniques that involve direct or indirect electrical stimulation of the epileptic focus.

Autoantibodies against nerve glycosphingolipid antigens have been shown to have a central role in Guillain–Barré syndrome pathogenesis. Until recently, research has focused on antibody reactivity to highly purified single species of gangliosides, but new findings highlight the importance of analyzing antibody reactivity to ganglioside complexes.

Spinal fusion is the conventional surgical option for treating degenerative disc disease, but it can decrease the spine's overall range of motion, thereby increasing stress on adjacent discs and accelerating their degeneration. Artificial disc replacement should allow motion to be retained at the operative level, and the results of initial trials have been encouraging, but randomized studies are still needed to assess the long-term outcome of this procedure.