Reviews & Analysis

Posterior reversible leukoencephalopathy syndrome (PRES) is a complex disorder with many hypothesized mechanisms. Here, Bhatt and colleagues present a patient who developed PRES subsequent to administration of chemotherapy. The authors discuss in detail the potential causative mechanisms for PRES, emphasizing the need for early recognition of the syndrome and prompt withdrawal of the offending agent in affected patients

Findings from laboratory studies have indicated that long-chain omega-3 fatty acids, which are found in abundance in fish, have neuroprotective properties against cognitive decline and dementia. As Majid et al. report in this article, however, the clinical trials conducted to date have failed to support a role for omega-3 fatty acids in the treatment of Alzheimer disease or other dementias. Ongoing clinical trials are expected to provide more-definitive answers in the next 2–3 years.

In this Review, Leone and colleagues provide comprehensive guidance on the available treatments for cluster headache, the most severe primary headache syndrome. They advise on the use of acute and preventive pharmacological agents and give the latest findings and recommendations regarding use of neurostimulation.

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.

Dinakar and Höke report on the case of a woman who presented to a neuromuscular clinic with a history of progressive stiffening and painful spasms of the lower extremities. The patient was diagnosed with paraneoplastic fasciitis–panniculits syndrome associated with recurrence of gastric adenocarcinoma. The symptoms improved on initiation of chemotherapy and worsened on discontinuation of chemotherapy.

Zinc overload is an unusual cause of copper-deficiency myeloneuropathy, in which affected patients have low serum copper and ceruloplasmin levels and high serum zinc levels. This Case Study describes a patient whose copper-deficiency myeloneuropathy was secondary to long-term use of a denture cream that contained high levels of zinc.

Over the past few years, there has been increasing interest in the use of complementary and alternative therapies to treat multiple sclerosis. Dietary supplementation with polyunsaturated fatty acids, which are thought to have anti-inflammatory properties, has been cited as a potential treatment for multiple sclerosis. However, as Mehta et al. discuss in this article, clinical trials have so far provided only limited evidence for the efficacy of this approach.

The cranial movement disorders constitute a diverse group of disorders that can be specific to the facial muscles or part of a generalized movement disorder. A lack of diagnostic tests and biomarkers for the cranial movement disorders means that their differential diagnosis can be difficult. In this Review, Fabbrini et al. summarize the available information pertaining to the clinical features, pathophysiologies and therapies of the main disorders within this group, with a view to aiding their diagnosis and treatment

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.

Maternal herpes simplex virus encephalitis is a life-threatening condition for the mother and fetus. To treat the maternal disease and prevent infection in the neonate, a multidisciplinary approach is needed. In this Case Study, Sellner and colleagues demonstrate how with early diagnosis, prompt initiation of antiviral treatment, and suitable neurocritical care, a favorable outcome can be achieved in both mother and child.

Pain management is particularly problematic in infants. Fitzgerald and Walker detail the many challenges presented by a developing pain system for the detection and treatment of pain. They then describe the ways in which knowledge of the neurophysiological and neuropharmacological processes that underlie infant pain can improve future management of this vulnerable patient group.

Mirror neurons are motor neurons that discharge both when an individual performs a given motor act and when they observe another individual performing the same act. As Rizzolatti et al. discuss in this Review, the study of the mirror system is providing important insights into the mechanisms that underlie the symptoms of autism, and is also facilitating the development of new neurorehabilitation strategies.

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.

Creange et al. describe the case of a woman who presented with sudden-onset neuropathy, elevated levels of vascular endothelial growth factor, thrombocytosis, leukocytosis, and thrombosis. Diagnosed with POEMS syndrome, the patient was successfully treated with high-dose chemotherapy and autologous hematopoietic stem-cell transplantation.

Multiple sclerosis is characterized by both demyelination and neurodegeneration. The lack of myelin in the retina makes this an ideal structure in which to visualize the latter process. In this Review, Frohman et al. describe the novel use of retinal imaging technology, and in particular optical coherence tomography (OCT), to model the disease process in multiple sclerosis. They suggest that OCT could ultimately be used to identify strategies aimed at neuroprotection in the CNS.

The management of pain that is refractory to conventional treatments represents a considerable challenge for clinicians. Botulinum toxin has recently emerged as a potential novel approach to the control of refractory pain, and in this article Bahman Jabbari weighs up the available evidence for the efficacy of botulinum toxin therapy in various pain syndromes, including cervical dystonia, headache, neuropathic pain and postoperative pain.

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.

Despite remarkable success in the fight against leprosy, the disease remains an important public health problem. This Review focuses on the neurological manifestations of leprosy and the pathophysiology of nerve damage. Special emphasis is given to developments in the early detection and treatment of leprosy-related nerve impairment.

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.