Volume 7 Issue 5, May 2011

Despite the emergence of genetic and molecular approaches, disease categorization on the basis of clinical features remains an appealing approach, especially where the molecular mechanisms are poorly understood. A new study supports distinct clinical subtypes of Parkinson disease that could have implications for understanding the etiology of this condition.

New research shows that a substantial proportion of patients with acute disseminated encephalomyelitis have serum antibodies against myelin oligodendrocyte glycoprotein. The relationship between these antibodies and other demyelinating disorders such as multiple sclerosis, however, remains unclear.

Various clinical scores are available to assess the outcome of chronic inflammatory demyelinating polyneuropathy (CIDP), but these existing scales have some major limitations. A novel, simple scoring system—the CIDP disease activity status—incorporates the concept of disease activity as a feature that informs the long-term outcome in CIDP patients.

Recent revisions to the diagnostic criteria for multiple sclerosis have simplified MRI definitions for dissemination of CNS lesions in space and time, and may enable an earlier and easier diagnosis of the disease. The validity of this approach needs to be assessed in real-world clinical practice.

A recent study has combined clinical, laboratory and imaging parameters, all acquired within 48 h of clinical onset of middle cerebral artery territory stroke, in the same logistic regression model to predict 1-month functional outcome. A composite set of five independent items was found to be associated with good outcome.

A number of established therapies are available for multiple sclerosis (MS), but the advent of numerous novel therapies has meant that treatment decisions for MS are becoming increasingly complex. In this Review, Kieseier and Stüve discuss the challenges that both neurologists and patients face in terms of treatment decision-making, and highlight the risks, benefits and treatment paradigms associated with MS therapy.

Corticobasal degeneration is a rare, progressive neurodegenerative disorder with highly variable clinical presentation, and is difficult to identify in living patients. The classic clinical presentation of this disease—corticobasal syndrome—often occurs in conjunction with other neurological diseases. Kouri et al. discuss the use of imaging and biomarkers to improve diagnosis, and examine the genomic data that should provide insights into novel pathways involved in the pathogenesis of tauopathy.

Evidence collected over the past decade has challenged the idea that essential tremor is a monosymptomatic tremorogenic disorder. In this Review, Bermejo-Pareja describes the nonmotor symptoms that are most commonly associated with essential tremor, focusing particularly on cognitive deficits.

Numerous neurological consequences of alcoholism have been identified, including hepatic encephalopathy, Wernicke encephalopathy, Korsakoff syndrome, Marchaifava–Bignami disease and central pontine myelinosis. Here, Zahr et al. focus on Wernicke encephalopathy and Korsakoff syndrome, exploring their position within a proposed spectrum of neurological disruption that begins with alcohol-related brain damage.

Multiple system atrophy is characterized by a combination of parkinsonian, cerebellar, autonomic and pyramidal features, but recent data indicate that the clinical spectrum also includes nonmotor symptoms such as urinary disorders and orthostatic hypotension. Colosimo argues that neurologists and other specialists should be made aware that this neurodegenerative disease can manifest with nonmotor symptoms long before patients develop any overt motor disorder.