Volume 12 Issue 11, November 2016

Analysis of data from a large number of deep brain stimulation (DBS) recipients in North America has revealed a higher rate of revisions and removals of DBS leads than was previously reported. Hardware malfunction, lead infection and malpositioning were the most frequent reasons for revision or removal.

In a randomized, sham-controlled trial, transcranial focused ultrasound thalamotomy was shown to benefit patients with medication-refractory essential tremor, although the technique has limitations and the long-term benefits are unclear. Nevertheless, the work suggests that focused ultrasound thalamotomy will become an alternative to other surgical procedures for refractory essential tremor.

Studies of preclinical Alzheimer disease (AD) have unexpectedly shown amyloid-β deposition and/or AD-like neurodegenerative changes in the brains of a high proportion of clinically normal elderly individuals. As two recent reports illustrate, imaging and fluid biomarker studies in these individuals are yielding new insights into the pathophysiology of cognitive ageing.

The earliest stages of Parkinson disease (PD) offer the best opportunity to intervene, but detecting early disease is difficult. In this Review, Postuma and Berg provide an overview of established and potential markers of prodromal PD, and consider how these markers can be combined to identify patients who have prodromal PD and could benefit from treatment.

The primary headache disorders are among the most common diseases worldwide. Nathaniel Schuster and Alan Rapoport discuss new and emerging preventive and acute treatments that have the potential to address unmet needs of patients with headache disorders, and to help treat and reduce headache-associated disability.

Evidence is accumulating that cortical dysfunction — in particular, cortical hyperexcitability — is an early feature of amyotrophic lateral sclerosis (ALS), thereby lending support to the 'dying-forward' hypothesis of ALS pathogenesis. The authors present an overview of recent insights into ALS pathophysiology, focusing on the importance of cortical hyperexcitability as a pathogenic and diagnostic biomarker.

Opportunistic infections of the CNS, such as cryptococcal meningitis, cerebral toxoplasmosis, and tuberculous meningitis, are a major cause of morbidity and mortality in HIV-positive individuals. This Review provides an update on diagnosis and treatment of opportunistic infections, as well as management of immune reconstitution inflammatory syndrome in the setting of HIV-associated CNS infections.