Reviews & Analysis

Bipolar disorders are recurrent mood disturbances involving periods of depression and mania. Eric Taylor discusses the management of bipolar disorders in children and adolescents, including potential differential diagnoses and the results of treatment trials in these age groups. He also outlines the distinction between classic bipolar disorders and brief emotional outbursts.

Individuals over the age of 80 years account for 30% of the total number of people with ischemic stroke. Nevertheless, elderly patients are more likely to receive suboptimal care than are younger individuals. In this Review, Derex and Nighoghossian examine the effectiveness of thrombolysis therapy, stroke-unit care, and early rehabilitation in elderly patients with stroke.

The relative merits of clipping and endovascular coiling to treat ruptured intracranial aneurysms are the subject of an ongoing debate. The latest results from the International Subarachnoid Aneurysm Trial offer reassurance regarding the long-term outcomes of coiling and provide support for an individualized approach.

Patients with psychogenic movement disorders are usually diagnosed by neurologists and referred to psychiatrists for treatment. A survey of members of the Movement Disorder Society highlights difficulties in cross-specialty management of such patients. The findings have implications for the development of new criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders.

In utero exposure to antiepileptic drugs carries teratogenic risks, but little is known about the potential effects of such agents on neurocognitive development. The results from a large prospective study that set out to address this issue add to the mounting evidence against the use of valproate in women with epilepsy during childbearing years.

As the human lifespan increases, the number of people living beyond their nineties is rising rapidly. This changing population demographic will have an effect on many aspects of health and society, including the number of people living with dementia. To accurately diagnose dementia, we must understand the relationship between the observed neuropathology and age.

A method for determining which patients are at a high risk of developing dementia could improve preventative care, early diagnosis, and the identification of individuals for clinical trials. The late-life dementia risk index has been developed to fulfill this need in older adults, but does the model provide sufficient accuracy and reliability in assessing such risk?

Rasmussen encephalitis is a chronic inflammatory disease that results in progressive degeneration of one cerebral hemisphere. Immunotherapies for this condition have traditionally targeted T-cell-mediated immunity, but Thilo et al. now report a case in which effective seizure control was achieved through use of the anti-B-cell antibody rituximab.

Transient loss of consciousness is a spell of unconsciousness characterized by abrupt onset, short duration, and spontaneous and complete recovery. In this article, van Dijk et al. provide an overview of the various forms of TLOC, focusing particularly on reflex syncope. They highlight key clues to the diagnosis of these conditions and emphasize the importance of a multidisciplinary approach to the management of patients with TLOC.

Glioblastoma is the most common primary malignant brain tumor in adults, causing over 10,000 deaths each year in the US alone. Given the resistance of this tumor to standard surgery, radiation and chemotherapy, attention has focused on identifying the underlying genetic lesions in the hope of developing new treatment strategies. Purow and Schiff review the current state of knowledge of the genetics of glioblastoma and discuss the implications for future therapies.

Pregnancy can have an unpredictable effect on the frequency and nature of migraines. In this article, Contag et al. examine the association of migraine with pregnancy and pregnancy-related complications, notably pre-eclampsia. The authors also review the diagnosis and management of migraine headaches that precede or develop during pregnancy, and explore the risks associated with the available treatment options.

Patients with hemianopic dyslexia experience serious reading difficulties, with word identification and the abilities to plan and guide reading eye movements being severely disturbed. In this Review, Schuett explores the clinical features and the underlying functional and anatomical bases of hemianopic dyslexia, before critically examining the available therapies for rehabilitation of this condition.

The issue of whether progressive brain injury occurs in pharmacoresistant epilepsy remains important and controversial. A combined longitudinal and cross-sectional MRI study, in which an automated method was used to measure cortical thickness, has demonstrated accelerated brain atrophy in patients with chronic epilepsy.

The progression of Alzheimer disease might be monitored by measuring the rate of hippocampal volume loss by means of MRI. Research suggests that a reduction in hippocampal volume can be detected over a period as short as 6 months, and that such volume loss is associated with cognitive decline and other indicators of Alzheimer disease neuropathology.

In an era of etiology-specific therapies, defining the criteria for behavioral variant frontotemporal dementia is essential. How do we determine whether bad manners, laziness, or unsolicited friendliness represents the earliest presentation of this condition? Diagnostic criteria are being actively evaluated to help establish a foundation for diagnostic decisions regarding this and other neurodegenerative diseases.

On Wednesday 22 April 2009, Rita Levi-Montalcini, Nobel Prize laureate and discoverer of the first neural growth factor, turned 100 years old. Her scientific work drastically changed basic neuroscience and could have important implications for the treatment of neurological disorders.

Successfully treating chronic pain is challenging, as patients respond heterogeneously to analgesic treatments. Such variation in response can be attributed to differing underlying pain-generating mechanisms. A novel clinical bedside test that identifies distinct pain phenotypes might help deliver more-effective mechanism-based treatment strategies.

New-onset epilepsy in elderly individuals presents important diagnostic and therapeutic challenges for the clinician. Arain and Abou-Khalil highlight the conditions that should be considered in the differential diagnosis, and discuss the factors that need to be taken into account when devising an appropriate drug regimen, including age-related changes in pharmacokinetic factors, potential drug interactions, and adverse-effect profiles.

The developing brain is especially prone to seizure activity, and population studies have shown that seizure incidence peaks during the first month of life. Research into the factors responsible for this enhanced seizure susceptibility could yield potential therapeutic targets to prevent epileptogenesis and provide biomarkers to identify individuals who are at heightened risk of developing epilepsy.

In lumbar spinal stenosis (LSS), narrowing of the spinal canal leads to neural compression and, frequently, pain in the lower back. LSS has become the most common reason for lumbar spine surgery, partly reflecting the elevated demand for mobility and flexibility in the aging population. In this article, Siebert et al. review the underlying pathophysiology of LSS, and discuss how to diagnose and treat the condition.