Volume 9 Issue 10, October 2013

In patients with chronic epilepsy, MRI-based detection of an underlying brain lesion can offer the potential for surgical treatment, but a substantial proportion of patients have normal MRI scans. A recent study has shown that repeat neuroimaging with improved MRI technology can enable detection of previously unidentified epileptogenic lesions.

The heterogeneity of traumatic spinal cord injury necessitates large clinical trials to differentiate natural improvements from enhanced recovery due to therapeutic intervention. Recent development of an imaging biomarker to visualize changes in the corticospinal motor system could offer the opportunity to directly visualize anatomical evidence of repair, regeneration and plasticity.

A Task Force of the International League Against Epilepsy has proposed a new pathology-based classification of three types of hippocampal sclerosis—the most frequent brain lesion in drug-resistant temporal lobe epilepsy. This classification is designed to be reproducible across centres, thereby aiding communication of histopathological findings.

Patients with transient ischaemic attack or minor ischaemic stroke have a high risk of early recurrence. A new study in Chinese patients suggests that this risk is reduced following treatment with clopidogrel plus aspirin compared with aspirin alone. However, whether the findings can be extrapolated to other populations remains unclear.

Sepsis-associated encephalopathy (SAE) is a severe neurological consequence of sepsis that carries a high risk of mortality. Although the signs and symptoms of SAE are well-recognized, the underlying pathomechanisms of sepsis-associated neurological dysfunction are poorly understood. In this Review, Stubbs et al. discuss how imaging can provide insight into the pathophysiology of SAE, outlining current approaches to diagnostic imaging in research and clinical studies, and highlighting how 'next-generation' imaging technologies might improve understanding, diagnosis and management of SAE.

Charcot–Marie–Tooth disease (CMT) encompasses a group of inherited motor and sensory neuropathies. Over the past two decades, considerable advances have been made in identification of the causative genes. Here, Rossor et al. outline the role of next-generation sequencing in enabling rapid, parallel screening of multiple CMT-associated genes, and propose a diagnostic algorithm for application of genetic screening when CMT is suspected.

Neuropathic pain is a common feature of many nervous system disorders, and carries a substantial morbidity burden. In this Review, Cruccu and colleagues describe the distinct pathological mechanisms that are thought underlie the various types of neuropathic pain, such as ongoing burning sensations and allodynia. The authors argue that a symptom-based framework could be used to tailor diagnostic and treatment approaches.

The concept of lysosomal storage disorders (LSDs) has existed for over 50 years, but our understanding of the causes and pathobiology of these diseases have come to light only recently, following advances in genetic technology. In this Review, Rose-Mary Boustany summarizes current understanding of known LSDs, highlighting existing treatment approaches for patients with these often devastating disorders, and outlining the barriers to development of novel therapies.