Articles in 2010

A new study indicates that deep brain stimulation (DBS) plus best medical therapy markedly improves quality of life of patients with advanced Parkinson disease compared with best medical therapy alone. The frequency of serious adverse events related to DBS was similar to that reported in other DBS trials, underscoring the need for careful patient selection and counseling for this invasive therapy.

Bacterial meningitis causes substantial neurological morbidity and mortality worldwide. The use of corticosteroids as adjunctive therapy to antibiotics has been studied in clinical trials and debated for decades. A new meta-analysis attempts to reconcile some of the disparate findings from trials in this field.

After a stroke, seizures and later development of epilepsy can have a devastating impact on patient outcome and quality of life. Predicting the risk of developing poststroke epilepsy is currently an inexact science, and improving the accuracy of this process could lead to more-targeted use of prophylactic antiepileptic drugs for a defined period of time.

Malignant gliomas are aggressive tumors that often progress despite multimodality therapy. At recurrence, treatment approaches must balance the potential morbidity of a given therapy against the survival benefit that might be achieved. A new study reports that irradiation in this setting is well tolerated and could prolong survival.

Deep brain stimulation of the subthalamic nucleus or the internal pallidum can be an effective treatment for the disabling motor complications arising from dopaminergic treatment for Parkinson disease. The subthalamic nucleus has emerged as the preferred target for such treatment; however, no data exist to guide the choice between these two sites.

Intracerebral hemorrhage (ICH) carries a high risk of morbidity or death, and no effective therapies are available to combat this condition. In this article, Adeoye and Broderick discuss the natural history of such hemorrhages before providing an overview of medical and surgical ICH clinical trials that have been completed or initiated within the past decade.

Multiple sclerosis is an incurable condition that introduces great uncertainty into virtually all aspects of a person's life. In this Review, Simmons considers the ways in which this uncertainty is being addressed by improved diagnostic tools, advances in immunotherapy, multidisciplinary rehabilitation, community programs, and provision of information specifically designed to facilitate shared decision-making and empowerment. He discusses these issues in the context of three philosophical frameworks: the biomedical, biopsychosocial and sociopolitical models.

Extreme hypoglycorrhachia is usually caused by bacterial meningitis; however, suspicion should be raised if a patient with persistent extreme hypoglycorrhachia, pleocytosis and negative microbiological studies remains refractory to antimicrobial therapy. Viola describes the case of a 55-year-old man with chronic leptomeningitis and persistent hypoglycorrhachia, who was found to have Currarino syndrome. This syndrome is a complex genetic disorder that includes the following triad: sacral bony defect, presacral mass, and an anorectal malformation. Leptomeningitis in this patient was attributed to cholesterol crystals contained in a large presacral cyst with a communicating fistula to the CNS.

Surgical intervention can represent an effective treatment for some patients with medically refractory epilepsy. In this Review, Duncan explores the various imaging techniques that can be used in epilepsy surgery to identify the epileptic source and/or to reduce the risk of surgery-related morbidity. In addition to examining established clinical practice, Duncan highlights recent advances in this field.

Neuroimaging is highly recommended in the diagnosis and management of acute stroke, including disease characterization, and monitoring of responses to medical interventions. In this Review, Merino and Warach consider the diagnostic information that clinicians might gain from CT and MRI scanning of patients with suspected stroke, and the relative advantages and drawbacks of these imaging techniques.

Diabetes has been implicated to be a risk factor for Alzheimer disease (AD), but the underlying biological mechanisms that link the development of diabetes and AD are not fully understood. In this article, Sims-Robinson et al. summarize the mechanistic pathways that might link these two age-related diseases and discuss the possible points of intervention that future therapies could exploit to treat AD.

Over the past 300 years, the migraine field has been dominated by two theories—the vascular theory and the central neuronal theory. The vascular theory was bolstered by the finding that vasoconstrictors are effective in acute migraine treatment, but evidence is now emerging that vasodilatation is neither necessary nor sufficient to trigger a migraine attack. Ho et al. consider the evidence pointing towards a neuronal mechanism in migraine development, highlighting the role of calcitonin gene-related peptide and its receptors.