News & Views

  • News & Views |

    Risk prediction scores for dementia can help clinicians to identify at-risk individuals. If appropriately validated, these scores can also help quantify prevention potential and direct individuals to the most appropriate interventions. A new study validated the CAIDE dementia risk score by associating it with biomarker change over time.

    • Ruth Stephen
    •  & Hilkka Soininen
  • News & Views |

    Evidence suggests that chronic neuroinflammation has an important role in the pathogenesis of Alzheimer disease. However, in a new clinical trial, the tetracycline antibiotic minocycline, which has anti-inflammatory properties, failed to delay disease progression in individuals with mild Alzheimer disease.

    • Erika Gyengesi
    •  & Gerald Münch
  • News & Views |

    In the first published efficacy study of cenobamate for treatment-resistant focal seizures, high doses produced high seizure-free rates, suggesting cenobamate can outperform existing options. A risk of serious rash and low tolerability at higher doses means further safety studies and clinical experience are needed to determine its clinical value.

    • Jacqueline A. French
  • News & Views |

    The influence of migration on disease risk has long been an important consideration in multiple sclerosis (MS) epidemiological research. Taking advantage of recent methodological advances, including access to population-based administrative health data, a new study highlights the importance of country of origin and duration of residence in the host country in determining MS risk.

    • Maura Pugliatti
    •  & Caterina Ferri
  • News & Views |

    Two new studies show that gliomas can manipulate normal elements of neuronal development and plasticity to create neuron–glia synapses, activation of which leads to glioma proliferation. Interventions that target the AMPA receptor could slow down tumour growth by altering this synaptic transmission.

    • Mary Jane Lim-Fat
    •  & Patrick Y. Wen
  • News & Views |

    Artificial intelligence algorithms are well suited to the fast decision making needed in the management of large vessel occlusive stroke. In a new study, a fully automated CT angiography algorithm identified large vessel occlusions with impressive sensitivity, but the work highlights the need for high reporting standards to maximize translatability.

    • Thabele M. Leslie-Mazwi
    •  & Michael H. Lev
  • News & Views |

    A new study provides direct biological evidence for a prodromal phase of multiple sclerosis (MS), with implications for studying disease aetiology and underscoring the limitations of therapies that solely target inflammation. The findings also suggest an opportunity to apply secondary prevention strategies at the very earliest stages of the disease.

    • Ruth Ann Marrie
  • News & Views |

    A new study shows that the monoclonal antibody fremanezumab is effective for migraine prophylaxis, even in patients who have failed to respond to multiple preventive treatments. However, not all patients benefit from this treatment, and detailed investigation of non-responders could help to identify additional pharmacological targets and increase the number of responders.

    • Tessa de Vries
    •  & Antoinette MaassenVanDenBrink
  • News & Views |

    A new study — unique in its size, scope and collaborative nature — has identified genetic variants that are associated with progression of Parkinson disease (PD). However, limitations of the study highlight the need for large-scale, phenotype-harmonized, multi-ethnic, longitudinal studies to characterize PD subtypes and develop individualized therapies.

    • Gregor Kuhlenbäumer
    •  & Daniela Berg
  • News & Views |

    Outdated knowledge of arterial perfusion territories still guides clinical decisions and management in acute and chronic stroke. In a new study, application of machine learning techniques provides more detail than ever before, laying the foundation for improved stroke management and new research.

    • Meike W. Vernooij
  • News & Views |

    Understanding the heterogeneity of typical Alzheimer disease (AD) is of increasing importance for the development of new and effective treatments. A new study in patients with AD described two robust cognitive subtypes with different pathology distributions, genetic backgrounds and clinical trajectories.

    • Frank Jessen
  • News & Views |

    The benefits of targeting calcitonin gene-related peptide (CGRP) could go beyond migraine prevention, and three new studies report success with a new small-molecule CGRP receptor antagonist in acute migraine and with a monoclonal antibody in cluster headache.

    • Jes Olesen
    •  & Messoud Ashina
  • News & Views |

    Guillain–Barré syndrome (GBS) outbreaks associated with endemic and epidemic infections have increased in recent decades, and the need for standard treatment guidelines is compelling. A new study presents data from a worldwide prospective observational registry, providing insights into current treatment practices and laying the foundations for future clinical trials.

    • Kalliopi Pitarokoili
    •  & Ralf Gold
  • News & Views |

    A new report presents post-mortem neuropathological follow-up of patients 4 months to 15 years after they received active amyloid-β (Aβ) immunization during its first trial in Alzheimer disease. The study documents effects on plaque clearance, tau pathology, plasma anti-Aβ antibody titres and final cognitive status; variability was seen between patients.

    • Thomas Wisniewski
  • News & Views |

    A new study has found that levels of primary fatty amides in plasma correlate with amyloid-β pathology and other Alzheimer disease (AD)-related phenomena. In addition to identifying potential plasma biomarkers for AD, the findings suggest new avenues for investigation into the early stages of AD.

    • Niklas Mattsson
    •  & Oskar Hansson
  • News & Views |

    A new trial has demonstrated the benefits of intravenous thrombolysis, guided by perfusion imaging, 4.5–9.0 h after stroke onset and in individuals with wake-up stroke. In addition to extending the time window for thrombolysis after acute ischaemic stroke, these findings could aid the refinement of imaging and thrombolytic protocols.

    • Min Lou
  • News & Views |

    The Global Burden of Disease, Injuries and Risk Factors 2016 study has shown that neurological diseases have the highest burden and that this burden is increasing. Stroke is the biggest contributor, highlighting a need to improve resources globally for stroke prevention, management and rehabilitation.

    • Ryuji Kaji
  • News & Views |

    Patients present to general practitioners with a variety of symptoms that eventually turn out to be caused by early Parkinson disease. Now, methods to calculate Parkinson disease risk in general practitioner settings are becoming available.

    • Ronald B. Postuma
  • News & Views |

    A new study has demonstrated recovery of brain circulation and some cellular function in a decapitated pig model. Although these results are exciting and thought-provoking, they do not challenge the concept or practical implications of brain death, as no evidence of global electrical activity or functional recovery of the brain was presented.

    • David M. Greer
    •  & Ariane Lewis
  • News & Views |

    A new study suggests that patients with relapsing–remitting multiple sclerosis can experience long-term increases in disability in the absence of disease relapses. Monitoring this ‘silent progression’ will require a paradigm shift in the way disease progression is evaluated.

    • Massimo Filippi
    •  & Maria A. Rocca
  • News & Views |

    In a new study of 1,102 patients, a multi-item prognostic tool has been developed and validated for use in acute stroke. Using a mix of clinical variables (age and stroke severity), a process variable (administration of thrombolysis) and a biomarker (plasma copeptin), the authors were able to predict 3-month disability.

    • Terence J. Quinn
    •  & Bogna A. Drozdowska
  • News & Views |

    Previous open-label trials testing glial cell line-derived neurotrophic factor (GDNF) family ligands in Parkinson disease have shown promising clinical effects. However, in placebo-controlled trials, the treatments have failed. A new randomized placebo-controlled trial of intraputamenal delivery of GDNF designed to resolve this conundrum has again failed to do just that.

    • Agnete Kirkeby
    •  & Roger A. Barker
  • News & Views |

    Studies in melanoma and lung cancer indicate that shifting use of immune checkpoint inhibition from palliative stages to the neoadjuvant setting improves response rates and patient outcomes. Three studies now show that neoadjuvant programmed cell death 1 (PD1) inhibition modulates the immune tumour microenvironment — but does this effect translate into a real patient benefit?

    • Anna S. Berghoff
    •  & Matthias Preusser
  • News & Views |

    A new study has identified novel genes involved in sporadic frontotemporal lobar degeneration with neuronal inclusions of TAR DNA-binding protein 43. These findings might enable the elucidation of pathogenic mechanisms of the disease and have implications for the identification of potential therapeutic targets.

    • Daniela Galimberti
  • News & Views |

    A new study, using a mouse model of multiple sclerosis, applied single-cell RNA sequencing to determine how immune cells in the CNS respond during inflammation. In addition to highlighting novel subtypes of cells that evolve over the course of disease, the findings have important implications for developing targeted therapies for inflammatory demyelinating diseases.

    • Ravikiran M. Raju
    •  & Li-Huei Tsai
  • News & Views |

    The risk of Alzheimer disease is substantially influenced by genetic factors. A new genome-wide association study of more than 600,000 individuals identifies nine novel Alzheimer disease risk genes, raising the total count of independent risk loci to 29.

    • Lars Bertram
    •  & Rudolph E. Tanzi
  • News & Views |

    Parkinson disease is a clinicopathological construct at a crossroads. A new study reinforces the prognostic value of subtypes, but its findings challenge the relevance of pathology to the clinical expression of disease as data-driven Parkinson disease subtypes did not match up with severity or distribution of Lewy or Alzheimer pathologies.

    • Alberto J. Espay
    •  & Connie Marras
  • News & Views |

    In the past few years, a number of new migraine treatments have emerged, including monoclonal antibodies against calcitonin gene-related peptide (CGRP) and the CGRP receptor. Now, a position statement from the American Headache Society offers guidance on the integration of these agents into clinical practice in the prevention of migraine.

    • Hans-Christoph Diener
  • News & Views |

    A new analysis has found that concussion and mild traumatic brain injury (mTBI) are linked to an increased risk of suicidal behaviours and thoughts. However, a host of risk factors might influence this correlation, and careful investigation is required to establish which individuals with mTBI might be most at risk of suicide.

    • Lisa A. Brenner
    •  & Nazanin H. Bahraini
  • News & Views |

    Chronic migraine is a debilitating condition that arises from the worsening of episodic migraine. A large population-based questionnaire study showed that individuals with chronic migraine reported more sleep apnoea and worse sleep quality than individuals with episodic migraine. This finding provides important insights into the association between sleep disturbances and chronic migraine.

    • Min Kyung Chu
  • News & Views |

    A new study has identified key differences between women and men with regard to the nature and burden of Alzheimer disease (AD) pathology in the brain. In addition to highlighting possible sex differences in AD pathophysiology, the findings could have important implications for the diagnosis and management of this condition.

    • Rosha Babapour Mofrad
    •  & Wiesje M. van der Flier
  • News & Views |

    A nationwide German study of prescription data has demonstrated that switching to an antiepileptic drug from a different manufacturer increases the risk of seizure relapse. This finding sparks a debate about the reason for seizure worsening after switching and whether or not it is a pharmacological issue.

    • Martin Holtkamp
  • News & Views |

    Amyotrophic lateral sclerosis (ALS) is a progressive motor disorder, and many patients also show non-motor symptoms including executive, behavioural and language dysfunction. A new study demonstrates a robust relationship between progression of these non-motor symptoms and declining motor disease in patients with ALS, providing important insights into mechanisms of ALS pathogenesis.

    • Murray Grossman
  • News & Views |

    New research indicates that most patients with epilepsy exhibit cyclic (24 h or multi-day) seizure patterns. The findings could have important implications for the design of antiseizure drug regimens.

    • Iván Sánchez Fernández
    •  & Tobias Loddenkemper
  • News & Views |

    A committee has developed a guideline on prolonged disorders of consciousness. Caution in prognostication is advocated because patients who have been unconscious or barely conscious for a long time might improve. The new guideline voices concern about persistent vegetative state as a clinical diagnosis but also rejects several unsupported therapies.

    • Eelco F. M. Wijdicks
  • News & Views |

    The TOLEDO study provides new evidence to support the use of subcutaneous apomorphine infusion to control motor fluctuations in patients with advanced Parkinson disease. The findings should encourage neurologists to consider implementing apomorphine infusion or other device-aided therapies earlier in the disease course, before the emergence of troublesome dyskinesias.

    • Angelo Antonini
    •  & Peter Jenner
  • News & Views |

    A new publication from the Whitehall study confirms earlier findings that light to moderate alcohol drinkers have a reduced risk of dementia compared with abstainers and heavy drinkers. Importantly, the study follows a cohort from middle age, whereas most previous research on this topic has focused on older adults.

    • Kaarin J. Anstey
    •  & Ruth Peters
  • News & Views |

    A new study has shown that peritoneal dialysis and isochronic parabiosis can clear misfolded tau proteins from mouse brain. The findings add to our understanding of how Alzheimer disease-associated proteins can be therapeutically removed by peripheral interventions.

    • Mony J. de Leon
    •  & Kaj Blennow
  • News & Views |

    During cluster headache attacks, plasma levels of calcitonin gene-related peptide (CGRP) increase, and trigeminal nerve activation leads to pain. A new study shows that CGRP infusion can induce cluster headache attacks in some patients, with important implications for the investigation of CGRP-targeted therapies in cluster headache.

    • Massimo Leone
  • News & Views |

    Multimodal imaging in neurodegenerative disorders can provide insights on structural, functional and neurochemical alterations that might not be possible via clinical testing alone. New findings on multimodal imaging in idiopathic REM sleep behaviour disorder (iRBD) have implications for the relationship between iRBD, the clinical phenotype of Parkinson disease and the underlying substrate of Lewy body disease, particularly for understanding the pathophysiology and designing disease-modifying therapies.

    • Bradley F. Boeve
    •  & Kejal Kantarci
  • News & Views |

    Patent foramen ovale (PFO) is prevalent among young patients with cryptogenic stroke, and PFO closure reduces the risk of recurrent stroke in these individuals. A new study confirms that PFO is also frequent in patients with cryptogenic stroke aged >60 years, but the optimal management of such patients remains unresolved.

    • Heinrich P. Mattle
    •  & Jeffrey L. Saver
  • News & Views |

    In a recent study, rivaroxaban was not superior to aspirin for secondary prevention of stroke and systemic emboli after an initial embolic stroke of undetermined source (ESUS) but was associated with a higher risk of bleeding. What does that mean for the concept of ESUS and for future trials?

    • Didier Leys
    •  & Solène Moulin
  • News & Views |

    Moderate and severe traumatic brain injuries (TBIs) have long been recognized as risk factors for dementia, but the relationship between mild TBI (mTBI) and dementia is unclear. New research demonstrates that even an mTBI without loss of consciousness is associated with a twofold increase in the risk of dementia.

    • Cassandra L. Pattinson
    •  & Jessica M. Gill
  • News & Views |

    Eteplirsen, a compound designed to restore dystrophin in patients with Duchenne muscular dystrophy, controversially received approval by the FDA in 2016. Owing to limited clinical data, the approval was based on eteplirsen’s effect on dystrophin expression. Now, the dystrophin quantification results have been published, and although low levels of dystrophin expression are shown, the quantification remains debatable.

    • Annemieke Aartsma-Rus
    •  & Virginia Arechavala-Gomeza
  • News & Views |

    Tackling intertumoural and intratumoural heterogeneity is one of the most important challenges in the study and treatment of glioblastoma. A new anatomical transcriptional atlas of human glioblastoma associates established anatomical features with distinct molecular subclasses and provides open access to these well-annotated data for drug target validation and data-mining projects.

    • Wolfgang Wick
    •  & Tobias Kessler
  • News & Views |

    Following on from a recent European Academy of Neurology guideline on pharmacological treatment of multiple sclerosis (MS), the American Academy of Neurology has issued an updated practice guideline on disease-modifying therapies (DMTs) for MS. The guideline provides 30 general recommendations for initiating, switching and stopping DMTs, and indicates future research directions.

    • Stefan Bittner
    •  & Frauke Zipp
  • News & Views |

    The WHO’s revised classification system for CNS tumours now incorporates genetic features, including the mutation status of isocitrate dehydrogenase (IDH) genes. A new article proposes that mutational status of CDKN2A and CDKN2B should also be included to facilitate grading of IDH-mutated gliomas with both prognostic and clinical relevance.

    • Christopher J. Pirozzi
    •  & Hai Yan
  • News & Views |

    In a recent study, individuals with brain amyloid-β accumulation but no cognitive impairment were classified as being at risk of Alzheimer disease, yet amyloid-β is widely considered to be a pathological biomarker of Alzheimer disease rather than a risk factor — it cannot be both.

    • Clifford R. Jack Jr
    •  & Prashanthi Vemuri
  • News & Views |

    An incomplete grasp of how the G4C2 repeat expansion in C9orf72 leads to amyotrophic lateral sclerosis and frontotemporal dementia has hindered progress in treatment development. Now, a study has combined unbiased genetic screens and CRISPR–Cas9 gene editing to validate known molecular pathways and identify novel therapeutic targets involved in G4C2 repeat pathogenesis.

    • Sarah Pickles
    •  & Leonard Petrucelli
  • News & Views |

    New research has found that anaesthesia and surgery are associated with increased blood levels of two markers of neuronal injury — neurofilament light (NFL) and tau. The findings highlight the neurotoxic effects of anaesthesia and surgery and indicate that tau and NFL could present useful biomarkers for postoperative neurocognitive disorders.

    • Zhongcong Xie
    •  & Yuan Shen