Reviews & Analysis

Studies of preclinical Alzheimer disease (AD) have unexpectedly shown amyloid-β deposition and/or AD-like neurodegenerative changes in the brains of a high proportion of clinically normal elderly individuals. As two recent reports illustrate, imaging and fluid biomarker studies in these individuals are yielding new insights into the pathophysiology of cognitive ageing.

A recent study proposed a modified version of the current diagnostic criteria for neurocysticercosis, but the value of the modifications is unclear and the study design limits conclusions about the validity of the new criteria. Instead, the suggested changes might contribute to future revision of the existing diagnostic criteria.

According to new research, oestrogen therapy in postmenopausal women is associated with ventricular enlargement and increased white matter hyperintensities in the brain, but not with cognitive decline. This disconnect between structural and functional effects suggests that brain-derived lipids can be harnessed to meet the bioenergetic demand imposed by normal cognition.

Evidence is accumulating that cortical dysfunction — in particular, cortical hyperexcitability — is an early feature of amyotrophic lateral sclerosis (ALS), thereby lending support to the 'dying-forward' hypothesis of ALS pathogenesis. The authors present an overview of recent insights into ALS pathophysiology, focusing on the importance of cortical hyperexcitability as a pathogenic and diagnostic biomarker.

According to a recent study, a high percentage of children with epilepsy show comorbid somatic, neurological, and developmental or psychiatric disorders. To provide comprehensive care for paediatric patients with epilepsy, all their needs must be evaluated and managed, including careful consideration of comorbid disorders.

Owing to a lack of objective diagnostic tools, the diagnosis of mild traumatic brain injury (TBI) and related conditions, such as postconcussive syndrome and chronic traumatic encephalopathy must be made on clinical grounds. Here, Zetterberg and Blennow review the most recent developments in search for biomarkers for mild TBI and related conditions.

Recently published American Headache Society evidence-based guidelines for cluster headache management provide updated guidance on which therapies are superior to placebo in randomized controlled trials. These valuable recommendations do not always translate to real-world settings, however, and other criteria should be taken into account when attempting to treat cluster headache.

Drawing on data from social network studies, Dhand and colleagues suggest that focusing on a patient's personal network can help identify individuals at risk of poor health outcomes. The authors provide an overview of the terminology used in social network studies, discuss social network structures that put patients at risk, and suggest how social network research might be applied in the neurology clinic.

Proinflammatory conditions have been associated with an increased risk of stroke. In this Review, Esenwa and Elkind look at the association between infection, inflammation and ischaemic stroke, and discuss recommended approaches to reducing the risk of stroke associated with inflammation.

Angelman syndrome is a severe neurodevelopmental disorder, the characteristics of which include severe learning disability, epilepsy, ataxia, and a happy, sociable disposition. The authors review past and recent developments in Angelman syndrome research, highlighting the role of multicentre and international collaboration in addressing this rare condition.

Medication-overuse headache (MOH) is a common disorder, but it remains under-recognized, and although several risk factors have been identified, the pathophysiology of the disorder is not completely understood. Here, Hans-Christoph Diener and colleagues review the epidemiology and pathophysiology of MOH, and suggest strategies for prevention and treatment.

A recent observational study showed that patients with stroke who participated in clinical research received better care and had lower mortality than patients who did not participate. However, the study has several limitations, and the available evidence suggests that patients should not be advised that participation in research improves outcomes.

In a powerful display of international collaboration, a new genome-wide association study has mapped susceptibility loci for migraine on the basis of genetic data from 375,000 individuals. The study implicates several new loci in migraine — many of them suggestive of vascular pathophysiology — but the functional relevance of many now-detected risk alleles remains elusive.

Brain–computer interfaces (BCIs) enable severely disabled patients to interact with the environment. In this Review, Chaudhary et al. provide an overview on current use of BCIs for communication, movement and rehabilitation in patients who are paralyzed as a result of amyotrophic lateral sclerosis, stroke or spinal cord injury.

A new study has shown that dietary supplementation with a serotonin precursor reduces seizure-induced respiratory arrest (S-IRA) and death in mouse models. Development of strategies to prevent S-IRA is paramount, because S-IRA is thought to be associated with a high risk of sudden unexpected death in epilepsy (SUDEP).

In this Review, Mishra and Yong consider how myeloid cells — monocytes, macrophages, microglia and dendritic cells — contribute to the pathology of multiple sclerosis (MS). The authors also consider how current multiple sclerosis treatments might directly and indirectly affect these cells.

Although no cure exists for amyotrophic lateral sclerosis (ALS), supportive and symptomatic care can prolong survival and improve quality of life. This Review discusses best strategies to manage symptoms in patients with ALS, including respiratory and nutritional support. Such interventions should involve a specialist multidisciplinary team, and patient should be given an active role in planning of the care.

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.

Cognitive and behavioural comorbidities are common in children with epilepsy, and correlate with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. This review outlines the most common cognitive comorbidities in different types of epilepsy, and outlines the current understanding of the pathophysiology of epilepsy-associated cognitive and neurodevelopmental problems in children with epilepsy. Moreover, the authors provide suggestions for screening for cognitive comorbidity in this patient group.

Drawing on data from the Global Burden of Disease 2013 Study, Feigin and colleagues highlight the increasing global stroke burden, which indicates deficiencies in current primary prevention strategies. The authors present a four-point plan to improve primary stroke prevention, which includes a shift in emphasis from a high-risk approach to a more comprehensive approach that targets people at all levels of cardiovascular disease risk.