Viewpoint

In 2019, the Alzheimer’s Association International Conference featured a debate on the role of infections in AD pathogenesis. Here, participants from that debate discuss the evidence regarding the infectious theory of AD and suggest avenues for future investigation.

The latest revision of the McDonald criteria for the diagnosis of multiple sclerosis (MS), released in 2017, was designed to facilitate early diagnosis of MS. Here, a panel of world-renowned MS specialists share their personal experiences of the new criteria.

Since the launch ofNature Clinical Practice Neurologyin 2005, we have seen remarkable progress in many areas of neurology research, but what does the future hold? For this special Viewpoint article, we invited a panel of Advisory Board members and other journal contributors to outline their research priorities and predictions for the next 10 years.

The use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke has been limited by the need to administer the treatment within 3 hours of symptom onset, although recent findings indicate that this therapeutic window can be extended to 4.5 hours. In this Viewpoint, Maulaz et al. argue that the safety and efficacy of thrombolysis might be further improved by narrowing the selection criteria for this therapy.

Many issues surround the treatment of patients with idiopathic normal pressure hydrocephalus by use of shunting. In this Viewpoint, Sachin Batra and Daniele Rigamonti advise on how to achieve the best results with this procedure—including use of appropriate patient selection methods, and accurate monitoring after surgery. They believe that many patients can have good outcomes from shunting but urge physicians to actively work to maintain high standards.

What is the duty of care owed by neurologists to the 'man on the street'? Does the ethical imperative to treat exist only in a medical emergency or after the establishment of a formal doctor–patient relationship? In this Viewpoint, Lim et al. draw on their personal experiences to explore these important questions.

In this Viewpoint, Markus Schürks and Hans-Christoph Diener make the case that patent foramen ovale closure should not be used as a treatment for migraine. They argue that the causal link between patent foramen ovale and migraine has not been verified and highlight shortcomings in the existing data.

Several studies have indicated that a relationship exists between patent foramen ovale (PFO) and the incidence of migraine; however, the nature of the relationship and whether PFO closure could be used as a treatment for migraine are controversial. In this Viewpoint, Gian Paolo Anzola lists evidence in support of a relationship between PFO and migraine and suggests that, subject to further trials, PFO closure could in the future benefit some patients with migraine.

The therapeutic potential of cannabinoids in neuropathic pain has recently generated much interest. In this Viewpoint, Andrew Rice reports on the possible efficacy of cannabinoids in the treatment of pain in conditions including multiple sclerosis and HIV neuropathy. However, he warns that long-term therapeutic cannabinoid administration could be associated with psychosis, schizophrenia, and other mental illnesses.

The decision whether to withdraw antiepileptic drugs in adults who have been seizure-free for 2 years is a difficult one, with relief from adverse events weighing against the possibility of seizure recurrence with all its consequences. In this Viewpoint, Alla Guekht calls on clinicians not to dismiss lightly the risk of relapse.

The concept of consciousness has evolved as technology has progressed, and our understanding of coma and disorders of consciousness has deepened accordingly. In this Viewpoint, Steven Laureys traces the beginnings of coma research and shows how the introduction of functional neuroimaging has revolutionized this field.

Functional neuroimaging is emerging as a novel tool to evaluate patients with disorders of consciousness. This Viewpoint looks at one of the most vexing ethical challenges resulting from this development: how should doctors react if families request a functional MRI scan for a loved one who is in a limited state of consciousness?

Against the background of the debate about the best models of stroke unit care, Lenzi and Di Piero present their argument that patients with stroke have better outcomes if their stay in a dedicated stroke unit is extended, enabling prolonged and intensive monitoring for stroke complications.

This Viewpoint contributes to the topical debate on the therapeutic benefits of deep brain stimulation in Parkinson's disease (PD). The authors argue that there is more to this treatment approach than just providing symptomatic benefits, and suggest that it may actually become the first therapy proven to slow the progression of PD.

The future of the Wada test as a predictor of verbal memory function following epilepsy surgery has been debated for some time. Memory mapping based on functional MRI is emerging as a potential alternative. Here, Andres Kanner examines where functional MRI currently stands in this setting.

For the practicing physician, the recognition of pain in patients with dementia can represent a challenge because these patients are often unable to verbally report their pain. Can facial expressions of pain be used as an alternative pain indicator in this population? Elliott Ross considers this question by examining relevant neurobiological research.

Immunotherapy seems to alter the natural course of multiple sclerosis (MS), so there is a general view that treatment should be initiated as soon as a diagnosis is made. In this Viewpoint, Giancarlo Comi makes a case for extending the early treatment approach to patients with a first neurological event suggestive of MS.

Multiple sclerosis (MS) is a complex disease with a high degree of clinical and neuropathological variability between patients. In this Viewpoint, Aksel Siva argues that such a heterogeneous disease demands a heterogeneous approach to treatment and questions the practice of initiating long-term immunotherapy before the MS diagnosis has become definite.

Mandatory generic substitution of antiepileptic drugs is an increasingly common practice that has many physicians and patients concerned because of the potential for breakthrough seizures and adverse effects. Do the same concerns apply to the treatment of newly diagnosed epilepsy? Peter Wolf investigates.

The conceptualization of attention-deficit hyperactivity disorder (ADHD) has been the subject of some controversy. In this article, two US-based academic child psychiatrists discuss the prevailing approach to diagnosis and treatment of ADHD in the USA and suggest potential reasons for the variability in prevalence estimates between the USA and Europe.