Reviews & Analysis

Reproductive hormones influence migraine in women but the basis of these effects is unknown. In this Review, the authors discuss what is known about sex hormones and their receptors in migraine-related areas of the CNS and the trigeminovascular pathway and propose a simple model to explain how hormones influence menstrual migraine.

The FDA recently granted accelerated approval to aducanumab for the treatment of Alzheimer disease. Here, the authors reflect on the events that led to this controversial approval and consider whether any lessons can be learned for the field.

In this Review, Akinyemi and colleagues provide an overview of stroke in Africa, including epidemiology, risk factors, genetics and available stroke services. The authors also discuss the future of stroke care in Africa, highlighting the promise of biobanking and novel leadership initiatives.

Evidence is accumulating that both central and peripheral immune responses are dysregulated in Alzheimer disease (AD). This roadmap reviews the current status of this research and provides a new research prospectus to advance our understanding of peripheral–central immune crosstalk in AD.

More than 90% of people with Down syndrome develop Alzheimer disease but receive little or no treatment for their dementia. Novel biomarkers of ageing and dementia bring new hope to this medically vulnerable population and can also help researchers understand dementia in other populations.

A randomized, placebo-controlled trial has found the neonatal Fc receptor modulator efgartigimod to be an effective therapy for generalized myasthenia gravis. If a pending FDA application is approved, the treatment will be the first recombinant antibody-based therapy for selective IgG depletion, adding to a growing spectrum of treatment options for myasthenia gravis.

In this Review, Stamelou et al. present an overview of the latest research in 4-repeat tauopathies, with a focus on progressive supranuclear palsy, and discuss how current evidence dictates ongoing and future research goals.

The maternal immune activation (MIA) hypothesis proposes that inflammatory perturbations in utero can affect fetal neurodevelopment. This Review examines the emerging human evidence for an association between MIA and childhood neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder and Tourette syndrome.

During Parkinson disease progression, the accumulation of α-synuclein pathology is paralleled by changes in structural and functional connectivity in the brain. Two new studies pinpoint specific alterations in the brain connectome in the early stages of Parkinson disease and suggest future avenues of research to develop connectome-based biomarkers.

Headaches and epilepsy frequently co-exist in the same individual, but the pathophysiological mechanisms underlying this relationship are not yet clear. Here, the authors discuss the epidemiological and pathophysiological links between epilepsy and headache, and apply this knowledge to the clinical management of the two disorders.

In this Review, the authors discuss the alterations to structural and functional brain networks that occur in Alzheimer disease, with a particular focus on the influence of amyloid and tau pathology and genetic factors.

The AT(N) system is a classification scheme based on biomarkers that reflect the core pathophysiological features of Alzheimer disease. This Perspective outlines the conceptual framework and clinical importance of the AT(N) system and considers its potential expansion to incorporate biomarkers for additional pathophysiological mechanisms.

Results of a new study have identified an association between risk of incident Parkinson disease and exposure to NO₂, which is released into the atmosphere as a result of burning fuels. Parkinson disease has a long prodromal phase, so these findings suggest an opportunity to apply early prevention strategies.

In this Perspective, Makhani and Tremlett provide an overview of the evidence for a prodromal phase in multiple sclerosis, discuss possible characteristics and markers of this prodrome, and consider its profound clinical and research implications.

MRI is an important tool in neuro-oncology but is still predominantly used in a qualitative manner. In this Review, Marion Smits discusses the development of MRI biomarkers for use in neuro-oncology and highlights the clinical potential of quantitative image analysis techniques.

In this Consensus Statement, which is endorsed by the European Headache Federation and the European Academy of Neurology, an expert panel provides recommendations for the diagnosis and management of migraine to support clinical decision-making by general practitioners, neurologists and headache specialists.

In this article, Kirton et al. discuss our growing knowledge of the developmental plasticity that occurs after perinatal stroke and highlight the promise of emerging therapies, including non-invasive brain stimulation, brain–computer interfaces and robotics, that aim to modulate that plasticity.

People with epilepsy have an elevated risk of dementia, and seizures have been detected in the early stages of Alzheimer disease. Here, the authors review evidence that amyloid-β forms part of a shared pathway between epilepsy and cognitive decline.

An international consortium analysis has shown that stroke location strongly predicts post-stroke cognitive impairment, but the effect could be confounded by the characteristics of the infarct and of different patients. Taking pre-stroke cognition and risk factors into consideration might put information about infarct location into a more appropriate context.

In this Review, the authors discuss the roles of B cells in multiple sclerosis and consider the insights gained from the immunological effects of B cell-targeted therapies and autologous haematopoietic stem cell transplantation as well as the potential for these insights to improve our understanding.