Volume 5 Issue 5, May 2009

An analysis of 12 different second-generation antidepressants rated sertraline and escitalopram as having the most favorable balance between benefit and harm for the treatment of major depressive disorder in adults. A second look at the methods and results from the study reveals that such a positive conclusion might not be warranted.

The triptan drugs provide effective migraine relief for many people. Nevertheless, a substantial number of migraine-affected individuals are unresponsive to triptans, and such therapy can also lead to an array of adverse effects. A new class of antimigraine drugs, currently undergoing clinical trials, could offer hope to those for whom triptan medication is unsuitable.

Parkinson disease is commonly recognized as a neurodegenerative disorder that leads to disabling motor and cognitive impairment, but less widely appreciated is the association of this condition with a variety of pain syndromes. A recent survey emphasizes the high prevalence and severity of pain in patients with Parkinson disease.

The need for early diagnosis of Alzheimer disease is gathering importance with the prospect of disease-modifying therapy. Medial temporal lobe atrophy on MRI is a characteristic, early and predictive feature of the disease. A new visual rating system has been proposed to facilitate assessment of such atrophy in routine clinical practice.

Agitation and aggression are common symptoms of Alzheimer disease (AD), causing risk and distress to the patient and others. Atypical antipsychotics are the most widely prescribed pharmacological treatments for these symptoms, but they can cause harmful effects. Here, Clive Ballard and colleagues review the risks associated with atypical antipsychotics and present the many alternative treatments and approaches that are available for managing agitation and aggression in AD.

Multiple sclerosis is traditionally considered to be an inflammatory disease, but it also has a neurodegenerative component, which can manifest early in the disease course. New therapeutic strategies are being developed to elicit CNS neuroprotection and repair in patients with multiple sclerosis, and Barkhof et al. review the available data on imaging outcome measures that could be used to track the efficacy of these approaches.

Impaired consciousness is a hallmark of epileptic seizures, but the degree of impairment differs depending on the seizure type. Here, Andrea Cavanna and Francesco Monaco review recent insights into the brain mechanisms that underlie alterations of consciousness during epileptic seizures and argue that clinical assessment should take into account both patients' levels of awareness and their subjective contents of consciousness.

The hereditary optic neuropathies, which include dominant optic atrophy, Leber hereditary optic neuropathy and certain types of glaucoma, result in characteristic changes in the morphology of the optic nerve head and the surrounding retinal nerve fiber layer. In this article, O'Neill et al. review the currently available retinal imaging technologies and describe the typical morphological features of the optic nerve head in various hereditary optic neuropathies.

Sips and colleagues describe the onset of intravascular lymphomatosis (IVL) of the brain in a 77-year-old retired research pharmacologist with a history of anemia, pancytopenia, and a recently confirmed diagnosis of myelodysplastic syndrome (MDS). The authors discuss the mechanisms of IVL and MDS and possible relationships between the conditions, as well as a beneficial effect of treatment of IVL with high-dose combination chemotherapy and rituximab