Reviews & Analysis

Currently, there is considerable scientific interest in modes of imaging that rely on the metabolic characteristics of tissues. Metabolic imaging is emerging as a promising diagnostic tool for the evaluation of cerebral gliomas, although it remains to be seen whether treatment decisions based on this approach will produce significant improvements in outcome.

It is estimated that epilepsy affects up to 1% of the world's population, and although many patients derive considerable benefits from antiepileptic drugs or resective surgery, new therapeutic approaches are still needed. In this Viewpoint, William Theodore assesses the potential of techniques that involve direct or indirect electrical stimulation of the epileptic focus.

Despite advances in surgery, radiotherapy and chemotherapy, the median survival for patients with glioblastoma—the most common primary brain tumor in adults—has changed little in 40 years. A recent trial, however, has shown that administration of the DNA methylating agent temozolamide during and after radiotherapy can prolong survival in patients with newly diagnosed glioblastomas.

Statins are best known for their cholesterol-lowering effects, but they also have immunomodulatory properties that might be exploited to treat neuroinflammatory disorders, such as multiple sclerosis. This review describes the molecular and cellular mechanisms that are thought to underlie the immunomodulatory effects, and discusses the results of initial clinical trials of statins in patients with multiple sclerosis.

The imaging of amyloid plaques in the living brain should not only aid the diagnosis of Alzheimer's disease, but also help us to understand its underlying pathophysiology. In this review, Dan Huddleston and Scott Small discuss the encouraging results that have been obtained in humans using positron emission tomography, and they assess the potential of MRI-based approaches for future investigations.

Autoantibodies against nerve glycosphingolipid antigens have been shown to have a central role in Guillain–Barré syndrome pathogenesis. Until recently, research has focused on antibody reactivity to highly purified single species of gangliosides, but new findings highlight the importance of analyzing antibody reactivity to ganglioside complexes.

Spinal fusion is the conventional surgical option for treating degenerative disc disease, but it can decrease the spine's overall range of motion, thereby increasing stress on adjacent discs and accelerating their degeneration. Artificial disc replacement should allow motion to be retained at the operative level, and the results of initial trials have been encouraging, but randomized studies are still needed to assess the long-term outcome of this procedure.

MRI has a pivotal role in the diagnosis of CNS disorders but has only recently been applied to diseases of the peripheral nervous system. Martin Bendszus and Guido Stoll discuss how MRI is being used to assess peripheral nerve lesions in experimental and clinical contexts, including recent advances in the development of novel contrast media.

The autoimmune channelopathies are a group of neurological disorders in which patients develop autoantibodies to ion channels or related functional proteins. Camilla Buckley and Angela Vincent review the proposed roles of these antibodies in disease pathogenesis, and discuss how antibody measurement can aid the diagnosis and management of the autoimmune channelopathies.

Therapeutic monoclonal antibodies have shown considerable promise for the treatment of multiple sclerosis in animal models, but the translation of this approach to the clinic has been impeded by unexpected effects and adverse reactions. In this review, Reinhard Hohlfeld and Hartmut Wekerle discuss the current state of development of various monoclonal antibodies for the treatment of multiple sclerosis.