Reviews & Analysis

Although the most common neuropathy associated with diabetes mellitus is distal symmetric polyneuropathy, inflammatory neuropathies such as chronic inflammatory demyelinating polyneuropathy (CIDP) can also occur, and might be amenable to treatment. In this Review, Rajabally et al. consider the features of CIDP in diabetes, how this condition can be differentiated from other neuropathies, and management options for CIDP and other inflammatory neuropathies in diabetes.

Tuberculous menigitis (TBM) presents a major health burden around the world, especially in individuals with concomitant HIV infection, in whom mortality is nearly 50%. Here, members of the TBM International Research Consortium summarize our current understanding of TBM pathogenesis, diagnosis and management, and discuss key avenues for future research.

Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of such uses of brain imaging.

Cerebral venous thrombosis (CVT) is a prominent cause of stroke, particularly in young adults. Knowledge of this condition has greatly increased in the past two decades, primarily owing to new data from international patient registries. This Review provides an overview of the epidemiology, pathophysiology, diagnosis and treatment of CVT, with a focus on new advances in the field.

A new study based on WHO data reports rates of mortality from neurological diseases in the developed world from 1989–1991 to 2012–2014. The reported increase in neurological disease mortality, which was greatest in the USA, highlights the rise of neurological diseases as an emerging threat to global health.

Cognitive and neuropsychiatric impairment pose a considerable burden to patients with secondary progressive multiple sclerosis, but no effective therapies have been approved to treat these symptoms. A new trial has shown modest benefits of simvastatin treatment in this context. These results are much welcomed, but require more-rigorous testing.

Deep brain stimulation is used to treat a variety of neurological conditions, including Parkinson disease, dystonia and intractable pain, but the mechanisms underlying its therapeutic effects remain unclear. Drawing on clinical and experimental data, the authors examine hypotheses that have been proposed to explain the effects of DBS, and present the case for a change in terminology to 'deep brain neuromodulation'.

A retrospective population-based cohort study has shown that outcomes were worse for patients with neuropathic pain who received long-term opioid treatment than for those who received short-term opioid treatment. The finding highlights a need for improved pain education for non-specialists and for more-effective therapies.

The prevalence of stroke in women is predicted to increase rapidly in the near future. Yet, despite the presence of numerous female-specific risk factors for stroke, women remain under-represented in stroke clinical trials. Here, members of the Women Initiative for Stroke in Europe (WISE) group summarize new advances and future research priorities in the research of stroke in women.

Accumulation of misfolded protein in neurons is a common feature of many neurodegenerative diseases. In this Review, Hetz and Saxena discuss the latest advances in our understanding about the mechanisms by which protein misfolding causes neurodegeneration, and look at novel insights into the role of cellular responses to protein misfolding in synaptic function and in inflammatory and mechanical injury in the nervous system.

The process of phenotyping and classification of dementia has improved over decades of careful clinicopathological correlation, and through the discovery ofin vivobiomarkers of disease. Elahi and Miller review the salient features of the most common dementia subtypes, emphasizing neuropathology, epidemiology, risk factors, and signature signs and symptoms.

The discovery that IgG4 autoantibodies against node of Ranvier proteins are linked to distinct subsets of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represents a key advance in our understanding of the chronic inflammatory neuropathies (CINs). Here, Querol and colleagues discuss the clinical implications of these autoantibodies in patients with CIDP and other immune-mediated neuropathies.

A recent article published in Brain proposes a clinical method for subtyping Parkinson disease cases on an individual basis, with implications for better patient stratification for personalized medicine. The authors report biological validity in terms of imaging and cerebrospinal fluid parameters, but long-term predictive validity remains to be established.

Despite intensive investigation, the genetic basis of chemotherapy-induced peripheral neurotoxicity (CIPN) remains elusive. In this critical update, Argyriou and colleagues highlight strategies for overcoming the methodological flaws of pharmacogenetic studies and the inadequacy of current tools for assessing CIPN. As yet, however, genetic profiling cannot identify patients at risk of CIPN or guide their management.

A variant in the TNFSF13B gene that encodes B-cell-activating factor has been found to increase the risk of multiple sclerosis and systemic lupus erythematosus in the Sardinian population. The findings underscore, and offer new insight into, the role of B cells in these autoimmune disorders, and have implications for personalized therapy.

Reliable biomarkers for frontotemporal dementia (FTD) are required for accurate discrimination between dementia types, prediction of clinical progression and tailoring of pharmacological interventions. This Review discusses the increasing number of available biomarkers for FTD — including novel imaging modalities and fluid biomarkers — and the future challenges in their implementation.

Autologous haematopoietic stem cell transplantation has produced striking results in patients with aggressive multiple sclerosis in small trials. In this Review, Muraro et al. provide an overview of the procedure, detail evidence for its high efficacy in multiple sclerosis, and provide recommendations for its clinical use and future trials.

The American Academy of Neurology and the American Epilepsy Society have jointly issued a new guideline on sudden expected death in epilepsy (SUDEP). The guideline emphasizes the importance of discussing SUDEP with patients and their caregivers, and uncovers gaps in the current literature that warrant further investigation.

In patients with acute ischaemic stroke resulting from anterior circulation occlusion, endovascular therapy provides greater long-term benefits than does intravenous tissue plasminogen activator. However, further improvement of systems of care and research regarding adjunct therapies is still needed.

Chronic pain presents a major health burden, affecting more than 20% of adults worldwide, but currently available analgesics lack efficacy and/or are associated with severe adverse effects. Here, Ellen Niederberger and colleagues discuss epigenetic modulation as a new opportunity in pain-relief therapy, and consider the future challenges for the clinical development of these drugs.