Reviews & Analysis

Improvements in the survival of critically ill patients over the past few decades have led to an increased incidence of acquired muscular weakness in intensive care units. Zink and colleagues review the clinical and diagnostic features of critical illness polyneuropathy and myopathy and discuss preventive and therapeutic approaches to these severe and costly medical complications.

Investigators in Germany have solicited the views of neurologists and psychiatrists on the effectiveness of antidementia drug treatments. The study concludes that clinicians generally consider these treatments to be beneficial, and that the provision of support to caregivers seems to further enhance the perceived benefits.

In light of claims of improved efficacy and lower incidence of adverse effects compared with older drugs, second-generation antipsychotics have emerged as the predominant treatment for schizophrenia. A new meta-analysis concludes that the difference in efficacy between newer and older agents is small, and the current classification scheme for antipsychotics does not survive close scrutiny.

Epidemiological studies suggest that the risk of developing cognitive impairment and dementia is increased in individuals with diabetes mellitus, although the evidence from clinicopathological studies on neurodegenerative changes is at odds with these observations. A thorough appraisal of concomitant vascular changes in dementia might resolve this incongruity.

Most grade II and grade III gliomas, as well as the secondary glioblastomas that arise from these tumors, possess point mutations that affect the substrate binding site of isocitrate dehydrogenase. These mutations are essentially unique to gliomas, seem to represent an early step in gliomagenesis, and confer a favorable prognosis.

A trial of autologous hematopoietic stem cell transplantation to treat multiple sclerosis has yielded promising results, generating considerable interest within both the clinical literature and the mainstream press. The findings should, however, be interpreted with some caution, and larger, randomized trials will be required to establish the true efficacy of the approach.

Bipolar disorder and schizophrenia share common clinical features, and antipsychotic medications can treat both conditions effectively. An assessment of 73,929 people with bipolar disorder and/or schizophrenia from a Swedish registry found evidence that the two disorders also share more than half of their genetic determinants.

Complex regional pain syndrome is a chronic condition arising mainly after tissue injury and involves both inflammatory and neurogenic factors. Use of angiotensin-converting-enzyme inhibitors has been associated with an increased risk of developing the chronic pain condition, which suggests possible roles for substance P and bradykinin in the underlying pathogenic process.

The neuroendocrine tumor pheochromocytoma is usually detected via measurement of levels of catecholamines and their metabolites in plasma and urine. In patients with Parkinson disease, however, the results of these tests can be confounded by dopaminergic medications. Mehtaet al. present the case of a 59-year-old man with Parkinson disease in whom a diagnosis of pheochromocytoma was confirmed by means of structural and functional imaging.

Patients with Parkinson disease can experience a range of hallucinatory phenomena, which can have considerable psychosocial effects and be important factors determining the admission of patients into nursing homes. This Review explores the wide array of hallucinations in Parkinson disease, and examines the contribution of both pharmacological therapies and the underlying disease pathology to their formation.

Alterations in the levels and activities of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), have been described in various neurodegenerative disorders, most notably Huntington disease. In this article, Zuccato and Cattaneo review the current knowledge about the involvement of BDNF in these diseases and critically assess whether BDNF treatment would be a beneficial and feasible therapeutic approach in the clinic.

Nearly 80% of the worldwide burden of epilepsy is borne by resource-poor countries. The quality of epilepsy care in these countries is compromised by numerous factors, including poverty, illiteracy, inefficient health-care systems, and social stigma. In this article, Kurupath Radhakrishnan highlights these difficulties and suggests practical solutions, drawing on his own experiences in southern India.

An analysis of 12 different second-generation antidepressants rated sertraline and escitalopram as having the most favorable balance between benefit and harm for the treatment of major depressive disorder in adults. A second look at the methods and results from the study reveals that such a positive conclusion might not be warranted.

The triptan drugs provide effective migraine relief for many people. Nevertheless, a substantial number of migraine-affected individuals are unresponsive to triptans, and such therapy can also lead to an array of adverse effects. A new class of antimigraine drugs, currently undergoing clinical trials, could offer hope to those for whom triptan medication is unsuitable.

Parkinson disease is commonly recognized as a neurodegenerative disorder that leads to disabling motor and cognitive impairment, but less widely appreciated is the association of this condition with a variety of pain syndromes. A recent survey emphasizes the high prevalence and severity of pain in patients with Parkinson disease.

The need for early diagnosis of Alzheimer disease is gathering importance with the prospect of disease-modifying therapy. Medial temporal lobe atrophy on MRI is a characteristic, early and predictive feature of the disease. A new visual rating system has been proposed to facilitate assessment of such atrophy in routine clinical practice.

Sips and colleagues describe the onset of intravascular lymphomatosis (IVL) of the brain in a 77-year-old retired research pharmacologist with a history of anemia, pancytopenia, and a recently confirmed diagnosis of myelodysplastic syndrome (MDS). The authors discuss the mechanisms of IVL and MDS and possible relationships between the conditions, as well as a beneficial effect of treatment of IVL with high-dose combination chemotherapy and rituximab

Multiple sclerosis is traditionally considered to be an inflammatory disease, but it also has a neurodegenerative component, which can manifest early in the disease course. New therapeutic strategies are being developed to elicit CNS neuroprotection and repair in patients with multiple sclerosis, and Barkhof et al. review the available data on imaging outcome measures that could be used to track the efficacy of these approaches.

Agitation and aggression are common symptoms of Alzheimer disease (AD), causing risk and distress to the patient and others. Atypical antipsychotics are the most widely prescribed pharmacological treatments for these symptoms, but they can cause harmful effects. Here, Clive Ballard and colleagues review the risks associated with atypical antipsychotics and present the many alternative treatments and approaches that are available for managing agitation and aggression in AD.

The hereditary optic neuropathies, which include dominant optic atrophy, Leber hereditary optic neuropathy and certain types of glaucoma, result in characteristic changes in the morphology of the optic nerve head and the surrounding retinal nerve fiber layer. In this article, O'Neill et al. review the currently available retinal imaging technologies and describe the typical morphological features of the optic nerve head in various hereditary optic neuropathies.