Reviews & Analysis

Biologics are emerging as important therapeutic tools in myasthenia gravis. In this Review, Marinos Dalakas considers the promise of these drugs and how they could overcome the limitations of current standard treatments.

In this Review, Reindl and Waters provide an overview of what we currently know about anti-myelin oligodendrocyte glycoprotein antibodies and their association with demyelinating diseases, including the value of detection assays and evidence for antibody pathogenicity and its mechanism.

Dementia with Lewy bodies (DLB) causes about one-tenth of all instances of dementia. This Review considers the substantial progress made in the basic and clinical research in DLB within the past few years, with discussion of the definition, pathology, genetics, prognosis, clinical features and current and future treatment of DLB.

Impairment of cerebral autoregulation after traumatic brain injury (TBI) is associated with poor outcomes, but the reasons underlying this association are poorly understood. This Review highlights genetic polymorphisms that might be linked to cerebrovascular function after TBI that might promote improved understanding of the pathogenic mechanisms underlying impaired vascular reactivity and offer potential targets for new therapies.

A new study has identified key differences between women and men with regard to the nature and burden of Alzheimer disease (AD) pathology in the brain. In addition to highlighting possible sex differences in AD pathophysiology, the findings could have important implications for the diagnosis and management of this condition.

Early diagnosis of Alzheimer disease (AD) is crucial for efficient selection of clinical trial participants for drug development and ultimately for timely treatment of individuals with AD. Here, Claire Murphy examines the potential for olfactory and other sensory impairments as very early indicators of AD and considers the important questions that remain to be answered.

A nationwide German study of prescription data has demonstrated that switching to an antiepileptic drug from a different manufacturer increases the risk of seizure relapse. This finding sparks a debate about the reason for seizure worsening after switching and whether or not it is a pharmacological issue.

Pathogenic variants in POLG, which encodes the catalytic subunit of DNA polymerase γ, cause a spectrum of overlapping disease phenotypes. This Review describes the clinical features, pathophysiology, natural history and treatment of POLG-related disorders, focusing particularly on the neurological manifestations.

In this Review, Handel and colleagues examine the contribution of thymic T cell selection to CNS autoimmune conditions and consider how a better understanding of this contribution could lead to novel therapeutic strategies for these conditions.

Premonitory symptoms of migraine can start hours to days before the onset of headache. In this Review, Karsan and Goadsby discuss the phenotypes of these premonitory symptoms and the insights that they provide into the neurobiology of migraine.

New technological advances in genomics have enabled the rapid discovery of hundreds of gene mutations linked to epilepsy. This Review considers the prospects for precision medicine in genetic epilepsies, the use of conventional and novel experimental models to unpick the complex pathogenic mechanisms of these diseases and the opportunities and challenges that face basic and clinical researchers.

Amyotrophic lateral sclerosis (ALS) is a progressive motor disorder, and many patients also show non-motor symptoms including executive, behavioural and language dysfunction. A new study demonstrates a robust relationship between progression of these non-motor symptoms and declining motor disease in patients with ALS, providing important insights into mechanisms of ALS pathogenesis.

Traumatic brain injury (TBI) susceptibility and outcomes are influenced by numerous factors, many relating to sex and gender. The authors review recent research exploring the influence of sex and gender in the TBI context, focusing particularly on marginalized populations.

New research indicates that most patients with epilepsy exhibit cyclic (24 h or multi-day) seizure patterns. The findings could have important implications for the design of antiseizure drug regimens.

The development of treatment for multiple sclerosis over the past 25 years is a success of translational medicine. In this Timeline article, Tintore et al. chart major developments and discuss the implications for current and future patient management.

Advances in biomarker research are aiding the development of targeted therapies and prevention strategies for Alzheimer disease (AD). In this Review, an international working group assesses the current status of blood-based AD biomarkers and outlines a roadmap for future research.

Prevention of dementia through moderation of risk factors presents a promising strategy to counter the rising dementia epidemic. In this Review, Kivipelto and colleagues discuss lifestyle-related risk factors for dementia, results from clinical trials of lifestyle interventions and new multinational initiatives that aim to identify and test effective dementia prevention strategies.

A committee has developed a guideline on prolonged disorders of consciousness. Caution in prognostication is advocated because patients who have been unconscious or barely conscious for a long time might improve. The new guideline voices concern about persistent vegetative state as a clinical diagnosis but also rejects several unsupported therapies.

Many disorders of brain and behaviour affect human and veterinary patients. In this Perspectives, Orrin Devinsky and colleagues outline a cross-species approach to understanding neurological and psychiatric conditions, including pain, cognitive decline, epilepsy, anxiety and CNS infections, and propose that collaborations between physicians and veterinarians will generate new insights for therapy development.

The TOLEDO study provides new evidence to support the use of subcutaneous apomorphine infusion to control motor fluctuations in patients with advanced Parkinson disease. The findings should encourage neurologists to consider implementing apomorphine infusion or other device-aided therapies earlier in the disease course, before the emergence of troublesome dyskinesias.