Volume 5 Issue 10, October 2009

A survey conducted in Canada examined the prevalence of perceived genetic discrimination against patients with Huntington disease. The respondents reported discrimination not only by insurance or mortgage companies, but also in family and social contexts. Discrimination was more frequently attributed to family history than to genetic test results.

Clinical trials aimed at preventing hematoma expansion in patients with intraparenchymal hemorrhage have failed to show benefit from experimental intervention. Novel methods for identifying those patients at the highest risk of hemorrhage growth might enable better patient selection and, hence, increase the chance of demonstrating an improvement in clinical outcome.

A genome-wide association study has identified the R92Q variant of the TNFRSF1A gene as a new susceptibility locus for multiple sclerosis. This locus is of special interest because the R92Q substitution was previously detected in a group of multiple sclerosis patients who had additional symptoms compatible with the autoinflammatory syndrome TRAPS.

The management of acute migraine in the emergency department presents a therapeutic challenge for physicians, who need to provide adequate pain relief while minimizing adverse events and relapses. New research suggests that phenothiazines are effective drug therapies for acute migraine, highlighting their potential use as first-line treatments for acute migraine in the hospital setting.

Nonmotor symptoms are assuming an increasingly important place in the constellation of clinical traits that characterize Parkinson disease. A multicenter survey of patients with Parkinson disease highlights the prevalence of these symptoms. The findings indicate that further research into the pathophysiology and treatment of nonmotor symptoms is warranted.

The incidence of Parkinson disease (PD) increases with age, so age-related conditions are expected to feature prominently among the comorbidities associated with this disease. In this article, Nanhoe-Mahabier et al. explore a possible link between PD and cerebrovascular disease, discussing the pathophysiological mechanisms that could underlie such a relationship, and considering how comorbid cerebrovascular disease might affect the clinical presentation of PD.

Chronic kidney disease is a serious global health problem, and almost all patients with severe forms of the disease develop neurological complications, which can include cognitive impairment, cerebrovascular disease and peripheral neuropathies. Krishnan and Kiernan review the clinical features and pathophysiology of the most common neurological complications of chronic kidney disease, and highlight the currently available treatment options.

Early detection of a poor treatment response to disease-modifying agents could be of great benefit to patients with relapsing–remitting multiple sclerosis. Such individuals could be switched to a potentially more effective treatment before too much neurological damage has occurred. In this Review, Río and colleagues examine the use of clinical measures, MRI, and pharmacogenomics in assessing and predicting the treatment response in patients with this condition.

Clinical overlap between the various types of neurodegenerative parkinsonism, particularly in the early stages of disease, can make differential diagnosis problematic. Biological fluid biomarker assays are being explored as adjunctive tests to aid the diagnostic work-up of patients with neurodegenerative parkinsonism, and in this article Eller and Williams cast a critical eye over the currently available cerebrospinal fluid, plasma and urine biomarkers.

Complete brachial plexus injury leads to paralysis and loss of sensation in the affected arm and hand. Carlstedt et al. present a long-term follow-up assessment of a 9-year-old boy who underwent spinal cord surgery after sustaining such an injury in a motorcycle accident. The patient showed recovery of hand motor function without restoration of sensation.