Volume 5 Issue 11, November 2009

Continuous EEG monitoring in intensive care units seems to affect physicians' decisions regarding prescription of anticonvulsant drugs. We are just beginning to understand what the EEG patterns mean and to learn whether and when these prescribing changes matter.

A new device, comprising a catheter and wire combination that aspirates clot from an occluded vessel, has received FDA approval for the treatment of stroke. Although the device accomplishes the removal of clot at a higher rate than usual, improvement in patient outcomes remains elusive.

Biomarkers are generally used as diagnostic and prognostic tools in clinical practice, but are not yet available for neuropathies. Studies now suggest that neural protein levels in serum and cerebrospinal fluid reflect axonal damage and predict poor outcome in patients with immune-mediated neuropathy, although validation studies are needed to define their clinical relevance.

Data from a large multicenter study demonstrate that donepezil can delay the rate of progression from mild cognitive impairment to Alzheimer disease in patients with depressive symptoms, but not in individuals without notable depression. How important are these findings for clinical practice in neurology and psychiatry?

Generic drug substitution can markedly decrease the cost of health care. For conditions where agents have a relatively narrow therapeutic index, notably epilepsy, financial savings through generic substitution might be offset by increases in patient complications and related costs. Results from a study with topiramate support this view, particularly when a patient receives a drug from multiple manufacturers.

The incidence of cerebral microbleeds, which are acknowledged to be markers of hypertensive vasculopathy and cerebral amyloid angiopathy, increases with age. Cerebral microbleeds are particularly prevalent in patients with intracerebral hemorrhage, and a population-based, cross-sectional study indicates that they are also positively associated with antiplatelet drug use.

Incidentally identified demyelinating pathology within the CNS has been extensively documented in neuropathological studies, and is increasingly being reported during MRI-based premortem investigations. In this article, Okuda reviews data on unanticipated demyelinating pathology from both autopsy and imaging studies, and considers the clinical implications of these findings, including the recently introduced concept of the radiologically isolated syndrome.

Primary dystonia is characterized by involuntary twisting and turning movements that occur in the absence of overt brain lesions or evidence of neurodegeneration. As Tanabe et al. discuss in this article, advances in structural and functional imaging have facilitated the identification of motor circuit abnormalities in patients with primary dystonia. In addition, the discovery of dystonia-related genes is providing important insights into the cell biological mechanisms that underlie circuit dysfunction.

High-grade gliomas are highly vascularized tumors that represent attractive targets for antiangiogenic therapies. In this article, Norden et al. discuss the rationale for targeting angiogenesis in high-grade gliomas and review the published clinical trial evidence, focusing primarily on therapies that target vascular endothelial growth factor and its receptors.

Despite its relative rarity, pediatric multiple sclerosis (MS) is an important entity, as it provides unique insights into disease processes related to MS. Clinical, MRI and laboratory data suggest differences in the immune response and CNS environment between adults and children with MS. Yeh et al. provide a comprehensive overview of the pediatric MS field, including epidemiology, disease mechanisms, diagnosis and treatment.