Reviews & Analysis

Patients with hemianopic dyslexia experience serious reading difficulties, with word identification and the abilities to plan and guide reading eye movements being severely disturbed. In this Review, Schuett explores the clinical features and the underlying functional and anatomical bases of hemianopic dyslexia, before critically examining the available therapies for rehabilitation of this condition.

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.

New-onset epilepsy in elderly individuals presents important diagnostic and therapeutic challenges for the clinician. Arain and Abou-Khalil highlight the conditions that should be considered in the differential diagnosis, and discuss the factors that need to be taken into account when devising an appropriate drug regimen, including age-related changes in pharmacokinetic factors, potential drug interactions, and adverse-effect profiles.

The developing brain is especially prone to seizure activity, and population studies have shown that seizure incidence peaks during the first month of life. Research into the factors responsible for this enhanced seizure susceptibility could yield potential therapeutic targets to prevent epileptogenesis and provide biomarkers to identify individuals who are at heightened risk of developing epilepsy.

In lumbar spinal stenosis (LSS), narrowing of the spinal canal leads to neural compression and, frequently, pain in the lower back. LSS has become the most common reason for lumbar spine surgery, partly reflecting the elevated demand for mobility and flexibility in the aging population. In this article, Siebert et al. review the underlying pathophysiology of LSS, and discuss how to diagnose and treat the condition.

Improvements in the survival of critically ill patients over the past few decades have led to an increased incidence of acquired muscular weakness in intensive care units. Zink and colleagues review the clinical and diagnostic features of critical illness polyneuropathy and myopathy and discuss preventive and therapeutic approaches to these severe and costly medical complications.

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.

Bipolar disorder and schizophrenia share common clinical features, and antipsychotic medications can treat both conditions effectively. An assessment of 73,929 people with bipolar disorder and/or schizophrenia from a Swedish registry found evidence that the two disorders also share more than half of their genetic determinants.

Complex regional pain syndrome is a chronic condition arising mainly after tissue injury and involves both inflammatory and neurogenic factors. Use of angiotensin-converting-enzyme inhibitors has been associated with an increased risk of developing the chronic pain condition, which suggests possible roles for substance P and bradykinin in the underlying pathogenic process.

The neuroendocrine tumor pheochromocytoma is usually detected via measurement of levels of catecholamines and their metabolites in plasma and urine. In patients with Parkinson disease, however, the results of these tests can be confounded by dopaminergic medications. Mehtaet al. present the case of a 59-year-old man with Parkinson disease in whom a diagnosis of pheochromocytoma was confirmed by means of structural and functional imaging.

Patients with Parkinson disease can experience a range of hallucinatory phenomena, which can have considerable psychosocial effects and be important factors determining the admission of patients into nursing homes. This Review explores the wide array of hallucinations in Parkinson disease, and examines the contribution of both pharmacological therapies and the underlying disease pathology to their formation.

Alterations in the levels and activities of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), have been described in various neurodegenerative disorders, most notably Huntington disease. In this article, Zuccato and Cattaneo review the current knowledge about the involvement of BDNF in these diseases and critically assess whether BDNF treatment would be a beneficial and feasible therapeutic approach in the clinic.