Volume 15 Issue 2, February 2019

2018 saw the failure of several large clinical trials that were based on the premise that reduction of amyloid-β levels is an effective treatment for symptomatic Alzheimer disease. Yet, over the same time period, good news also emerged about the diagnostic value of tau PET imaging.

In 2018, the distinguishing pathological features of white matter lesions in patients with progressive multiple sclerosis (MS) were refined, and serological and MRI biomarkers of clinical worsening and evolution to progressive MS were identified. We also saw therapeutic advances in progressive MS with the emergence of new neuroprotective strategies and putative markers of neurodegeneration.

In the past few years the scientific community has witnessed a prodigious surge in research activity, publication of data and progress in understanding the mechanistic components of migraine. This renaissance is the result of efforts initiated decades ago that are finally being translated into benefits for individuals affected by this disease.

Publications on epilepsy in 2018 have shed light on the aetiology and management of the condition and raised new questions. Translation from mechanisms to clinical practice, driven by cooperation among multiple fields, will be crucial to further advances.

In 2018, developments in Parkinson disease (PD) research yielded improved diagnostic criteria and provided evidence for the effects of some treatments, both old and new. These developments enrich the treatment options available for PD and are likely to change important guideline recommendations.

The past year saw progress in acute treatment of ischaemic stroke, but large inequalities in stroke services were revealed, warranting strategical initiatives to improve treatment access. Reclassification of stroke as a disease of the nervous system in the WHO International Classification of Diseases 11th revision is likely to help such initiatives.

Potential disease-modifying therapies for Alzheimer disease have mostly targeted brain accumulation of amyloid-β, but this approach has yet to provide substantial clinical benefits. The authors consider the reasons for this failure and suggest alternative strategies, including modification of risk factors.

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.

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.