Reviews & Analysis

Thrombolytic therapy is often used to treat arterial ischemic stroke in children, despite lack of FDA approval in this age group. The International Pediatric Stroke Study investigators have assessed the extent and nature of recombinant tissue plasminogen activator use in children in their registry, and have compared their findings with previously published case reports.

The ABCD system uses clinical features identifiable in primary or emergency care to reliably predict the risk of stroke in the acute phase following a transient ischemic attack. Further study is required to establish both the effectiveness of a refined system that includes carotid and brain imaging, and how such a refined system should be implemented in clinical practice.

Estimates of the incidence of cognitive dysfunction following ischemic stroke vary considerably in the medical literature. New research suggests that cognitive dysfunction might occur more frequently than was previously thought, emphasizing the importance of assessing such dysfunction beyond the standard deficits measured on most stroke severity scales.

Chinese investigators performed a well-designed, randomized trial to investigate the efficacy of true Chinese acupuncture compared with two different sham acupuncture approaches for the treatment of acute migraine attacks. Real acupuncture was superior to sham acupuncture, but the absolute pain relief was minimal.

Frontotemporal lobar degeneration often presents with distinct language impairments that are associated with different distributions of cortical atrophy. Two studies have now demonstrated that these clinical syndromes are associated with highly characteristic patterns of cortical thinning. Specific cortical atrophy profiles do not, however, seem to reliably predict histologically distinct frontotemporal lobar degeneration variants.

The relative merits of clipping and endovascular coiling to treat ruptured intracranial aneurysms are the subject of an ongoing debate. The latest results from the International Subarachnoid Aneurysm Trial offer reassurance regarding the long-term outcomes of coiling and provide support for an individualized approach.

Patients with psychogenic movement disorders are usually diagnosed by neurologists and referred to psychiatrists for treatment. A survey of members of the Movement Disorder Society highlights difficulties in cross-specialty management of such patients. The findings have implications for the development of new criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders.

In utero exposure to antiepileptic drugs carries teratogenic risks, but little is known about the potential effects of such agents on neurocognitive development. The results from a large prospective study that set out to address this issue add to the mounting evidence against the use of valproate in women with epilepsy during childbearing years.

As the human lifespan increases, the number of people living beyond their nineties is rising rapidly. This changing population demographic will have an effect on many aspects of health and society, including the number of people living with dementia. To accurately diagnose dementia, we must understand the relationship between the observed neuropathology and age.

A method for determining which patients are at a high risk of developing dementia could improve preventative care, early diagnosis, and the identification of individuals for clinical trials. The late-life dementia risk index has been developed to fulfill this need in older adults, but does the model provide sufficient accuracy and reliability in assessing such risk?

The issue of whether progressive brain injury occurs in pharmacoresistant epilepsy remains important and controversial. A combined longitudinal and cross-sectional MRI study, in which an automated method was used to measure cortical thickness, has demonstrated accelerated brain atrophy in patients with chronic epilepsy.

The progression of Alzheimer disease might be monitored by measuring the rate of hippocampal volume loss by means of MRI. Research suggests that a reduction in hippocampal volume can be detected over a period as short as 6 months, and that such volume loss is associated with cognitive decline and other indicators of Alzheimer disease neuropathology.

In an era of etiology-specific therapies, defining the criteria for behavioral variant frontotemporal dementia is essential. How do we determine whether bad manners, laziness, or unsolicited friendliness represents the earliest presentation of this condition? Diagnostic criteria are being actively evaluated to help establish a foundation for diagnostic decisions regarding this and other neurodegenerative diseases.

On Wednesday 22 April 2009, Rita Levi-Montalcini, Nobel Prize laureate and discoverer of the first neural growth factor, turned 100 years old. Her scientific work drastically changed basic neuroscience and could have important implications for the treatment of neurological disorders.

Successfully treating chronic pain is challenging, as patients respond heterogeneously to analgesic treatments. Such variation in response can be attributed to differing underlying pain-generating mechanisms. A novel clinical bedside test that identifies distinct pain phenotypes might help deliver more-effective mechanism-based treatment strategies.

Investigators in Germany have solicited the views of neurologists and psychiatrists on the effectiveness of antidementia drug treatments. The study concludes that clinicians generally consider these treatments to be beneficial, and that the provision of support to caregivers seems to further enhance the perceived benefits.

In light of claims of improved efficacy and lower incidence of adverse effects compared with older drugs, second-generation antipsychotics have emerged as the predominant treatment for schizophrenia. A new meta-analysis concludes that the difference in efficacy between newer and older agents is small, and the current classification scheme for antipsychotics does not survive close scrutiny.

Epidemiological studies suggest that the risk of developing cognitive impairment and dementia is increased in individuals with diabetes mellitus, although the evidence from clinicopathological studies on neurodegenerative changes is at odds with these observations. A thorough appraisal of concomitant vascular changes in dementia might resolve this incongruity.

Most grade II and grade III gliomas, as well as the secondary glioblastomas that arise from these tumors, possess point mutations that affect the substrate binding site of isocitrate dehydrogenase. These mutations are essentially unique to gliomas, seem to represent an early step in gliomagenesis, and confer a favorable prognosis.

A trial of autologous hematopoietic stem cell transplantation to treat multiple sclerosis has yielded promising results, generating considerable interest within both the clinical literature and the mainstream press. The findings should, however, be interpreted with some caution, and larger, randomized trials will be required to establish the true efficacy of the approach.