Volume 9 Issue 9, September 2013

Vascular and neurodegenerative pathologies are known to co-occur in Alzheimer disease, and were recently proposed to drive progression to dementia through independent pathways. A new study provides evidence in support of this hypothesis, by showing dissociation between the pathologies and regional brain metabolism. But might the two pathways converge?

The month of birth effect describes the apparent association between month of birth and future risk of multiple sclerosis, whereby people born in spring months have slightly increased risk. A recent analysis of the available data, however, suggests that this relationship is spurious because studies have not adequately controlled for confounders.

Quantitative sensory testing (QST) is being used increasingly in the research environment to measure somatosensory responses, both in patients with pain disorders and in normal individuals. A recent consensus meeting on the use of QST in clinical practice provides recommendations for the implementation of QST in patient diagnosis and monitoring.

Intracerebral haemorrhage is the most serious complication of intravenous thrombolysis in ischaemic stroke, and whether thrombolysis can be performed in patients receiving anticoagulants is an unresolved issue. Data from a large European registry now confirms that thrombolysis in some patients receiving warfarin is as safe as in non-anticoagulated patients.

Recently developed criteria for diagnosis of mild cognitive impairment due to Alzheimer disease make use of clinical and biomarker information. A new study reports that these criteria apply in both community and research settings; however, results from the community-based cohort conflict with a proposed biomarker-based model of disease progression.

The majority of patients with multiple sclerosis (MS) will at some point experience the progressive form of the disease, involving relentless functional decline and axonal degeneration. No cure for progressive MS is currently available, and clinical trials in this patient population are problematic. Koch and colleagues describe current limitations of trials in progressive MS, such as lack of suitable outcome measures, and present approaches to address these challenges.

As the range of therapeutic options for multiple sclerosis (MS) continues to expand, the ability to select the most appropriate treatment for each patient becomes increasingly important. In this Review, Sormani and De Stefano assess the studies that have attempted to classify patients with MS on the basis of their response to IFN-β treatment. The authors also discuss the development and use of scoring systems that combine different clinical and MRI markers to aid definition of an early response to this drug.

The pathophysiological processes underlying onset and progression of amyotrophic lateral sclerosis (ALS) remain poorly understood. Unlike conventional imaging techniques, which provide information only at a gross structural level, advanced imaging modalities have shed light on the microstructural changes that accompany this disease. Eva Feldman and colleagues describe how advanced neuroimaging studies have delineated key factors, such as white matter tract integrity and brain metabolism, that are altered in ALS, and consider how such insights could aid diagnosis and treatment.

Determination of prognosis in patients with status epilepticus (SE)—a life-threatening state of ongoing or repetitive seizures—is difficult, and current outcome prediction scales do not take into account novel outcome markers, such as EEG and imaging findings. Here, Sutter et al. review the available data on major prognostic determinants of outcome in SE, and propose a novel paradigm for assessment of these predictive factors over the course of the seizure.

Uhthoff's phenomena are transient disturbances in neurological functioning that can be triggered by an increase in core body temperature in patients with multiple sclerosis (MS). In this article, Frohman et al. discuss the pathophysiological underpinnings of Uhthoff's phenomena, and highlight the importance of differentiating between these events and true MS exacerbations in the clinic.