Volume 10 Issue 9, September 2014

Many patients with brain tumours possess inadequate mental capacity to provide informed consent, but this situation often goes undetected because clinicians do not routinely conduct formal cognitive assessments. This oversight should be recognized and rectified to enable optimum ethical and medical care of these vulnerable individuals.

Levodopa is the standard therapy for Parkinson disease, but prolonged use promotes the development of adverse motor effects. A new trial compared the effectiveness of levodopa administration early in the disease with therapies that used alternative dopaminergic agents before levodopa. No clinically relevant differences were found between the treatment strategies.

Copy number variants (CNVs; deletions or duplications of chromosomal regions) have emerged as an important cause of human disease. In a recent study, epilepsy could be attributed to a pathogenic CNV in 5% of patients, but understanding the implications of a CNV for an individual patient can be challenging.

Neuromyelitis optica (NMO) is characterized by inflammatory demyelinating lesions of the spinal cord and optic nerve, and can lead to paralysis and blindness. Currently, several treatment options for NMO exist, but many have been adapted from multiple sclerosis, and no controlled clinical trials specific to NMO have been conducted to date. Here, Marios Papadopoulos and colleagues review the various treatment strategies in NMO, and discuss the drugs that are in development or could be repurposed to treat this condition.

Patients with multiple sclerosis (MS) frequently experience depression, which profoundly reduces quality of life, and increases disease mortality. In this Review, Feinstein and colleagues present multiple approaches to the diagnosis and quanitfication of mood disorders, and critically evaluate the various treatment options for MS-related depression.The authors also discuss the extent to which depression can be teased apart from the neurological, immunological and psychosocial sequelae of MS.

In complex regional pain syndromes (CRPS), pain—typically of neuropathic type—in the affected limb is accompanied by a variety of sensory, motor and autonomic signs and symptoms. Treatment for CRPS has been largely adapted from therapies for neuropathic pain states, but a better understanding of CRPS pathologenesis might provide opportunities for mechanism-based treatment. Here, the authors discuss available and emerging mechanism-based treatments in CRPS, including pharmacotherapy targeting central and peripheral sensitization and aberrant inflammatory response; sympathetic ganglion block interventions; and alleviation of symptoms by reversing body perception disturbances.

More than 80% of patients with the demyelinating disorder neuromyelitis optica (NMO) experience pain from this condition, which severely affects their quality of life. NMO-associated pain is largely refractory to contemporary pain therapy, suggesting that the mechanisms underlying pain in NMO differ from those underlying other causes of pain. In this article, Bradl and colleagues explore the mechanisms underlying pain in patients with NMO, and attempt to identify molecular and cellular targets for therapy.

Several distinct autoimmune neuropathies can be referred to collectively as Guillain–Barré syndrome (GBS). Wakerley and colleagues argue that confusing terminology hinders diagnosis, and they present a revised classification of 'classic' GBS, Miller Fisher syndrome and related conditions. This new approach to diagnosis might facilitate work-up, thereby helping to identify the correct treatment as quickly as possible.