Volume 9 Issue 7, July 2013

Definition, evaluation and management of concussion are contentious issues in sports medicine, and evidence-based guidelines on these issues are urgently needed. An updated practice parameter on sport-related concussion from the AAN is, therefore, timely. However, these new guidelines fail to meet the needs of clinicians in this field.

Surgical intervention in children with hypothalamic chiasmatic low-grade glioma, diffuse intrinsic pontine glioma, or high-grade glioma is controversial, and randomized controlled trials are lacking. A recent consensus statement provides recommendations for optimal management of these patients, including situations in which surgical resection represents the preferred option.

Race is a recognised risk factor for intracerebral haemorrhage (ICH). A new study reports that the incidence of ICH is higher in black individuals than white people in young populations. In elderly populations, however, ICH incidence is higher in white than black individuals, suggesting ethnicity-related variation in ICH aetiology.

Prion diseases are rare, clinically heterogeneous, rapidly progressive and invariably fatal. Late diagnosis and difficulties in adequately assessing disease progression are major obstacles to development and evaluation of treatments. The recent validation of a new outcome measure for therapeutic trials in prion disease represents a substantial advance in this field.

In patients with stroke, weekend hospitalization has been associated with increased mortality and worse outcomes compared with hospitalization on weekdays, prompting calls for interventions to improve off-hours hospital care. New data suggest that organized systems of stroke care could be one means of attenuating this so-called weekend effect.

Alzheimer disease (AD)-associated loci identified by genome-wide association studies (GWAS) only partly explain the genetic risk for this common neurodegenerative dementia. A recent GWAS of an alternative phenotype—cerebrospinal fluid tau levels—has uncovered new genetic variants that might further account for risk of AD and provide novel pathophysiological insights.

The pathological underpinnings of Alzheimer disease (AD) are now known to begin up to two decades before manifestation of clinical disease, and intervention during preclinical AD stages is increasingly recognized as key to therapeutic success. Here, Eric Reiman and colleagues discuss strategies to study changes in the brain and bodily fluids that precede clinical AD, focusing in particular on genetic at-risk individuals, who might be suitable candidates for secondary prevention trials.

The average age of the elderly population is increasing. In this Review, the authors examine the prevalence of dementia in the elderly population, and especially in the oldest old. Furthermore, they discuss the absence of dementia in the oldest old as a model of successful ageing, and the impact of genetic and environmental factors on various dementia phenotypes.

Daclizumab is a humanized monoclonal antibody that targets the IL-2 receptor α chain, and has shown promise as a novel treatment for multiple sclerosis (MS). Here, Wiendl and Gross provide an overview of clinical experience with daclizumab in MS, including results from phase II trials. They also discuss the putative mechanisms of action of this drug in MS pathogenesis, which involve dampening of early T-cell activation and upregulation of immunomodulatory natural killer cells.

Decompressive craniectomy (DC)—a surgical procedure that involves removal of part of the skull—has been used for many years in the management of patients with brain oedema and/or intracranial hypertension; however, the risk of post-surgery disability has raised important ethical issues. Here, Kolias et al. outline the history of DC, and review current considerations and evidence with regard to the use of this procedure in stroke, traumatic brain injury and other indications. The direction of future studies of DC is also discussed.