Reviews & Analysis

Subthalamic nucleus deep brain stimulation (STN DBS) is an effective treatment for Parkinson disease. Although the breadth and severity of neurobehavioral changes with STN DBS is debated, the frequency of serious adverse events is probably low. New research has identified patient characteristics that predict cognitive and emotional morbidity after STN DBS.

As the mortality rates of premature and newborn babies have decreased, the incidence of neurological morbidity in these neonates has increased. Bonifacio et al. highlight advances in the care of neonates who have sustained a neurological insult, discussing available treatments and therapies, and the utility of brain monitoring techniques to predict long-term neurological outcomes. They also present a new model of care for the treatment of neonates with brain injury.

Brain tumors are among the most common childhood cancers and are the leading cause of cancer-related childhood mortality. In this Review, Pollack and Jakacki describe the clinical presentation, diagnosis and management of childhood brain tumors, with a particular focus on how treatment of the most common subtypes of childhood brain tumors has evolved over time, and the future approaches that could lead to improved outcome for these pediatric patients.

The negative clinical results seen after retinal cell transplantation in patients with Parkinson disease highlight the importance of understanding the mechanisms by which a graft can improve neurological function. Scientific and safety issues must be thoroughly addressed before any cell transplantation approach can progress as a therapy for neurological diseases.

Despite probable higher rates of recanalization with endovascular therapies, limited evidence exists to support the clinical benefits in patients with stroke who are unresponsive to standard intravenous reperfusion. A new study supports combined intravenous-intra-arterial treatment in a subset of acute stroke patients, and recognizes the need for definitive randomized trials.

A recently published case report describes the use of epidural spinal cord stimulation to treat a patient with a complete cervical spinal cord injury. Clear improvements in facilitated standing and stepping were demonstrated, as well as some conscious control of movement.

Cladribine, an oral immunomodulatory drug, has been denied FDA and European Medicines Agency approval for the treatment of relapsing–remitting multiple sclerosis. However, a new post-hoc analysis of CLARITY study data shows that cladribine treatment is associated with a significantly increased likelihood of sustained freedom from disease activity.

Monitoring for secondary brain injury is central to neurocritical care. Hemphill and colleagues provide an overview of multimodal monitoring in neurocritical care and discuss how bioinformatics tools for data acquisition, analysis and storage could be used in the clinical management of patients with acute brain injuries.

Many individuals with Parkinson disease (PD) adopt a sedentary lifestyle as a result of the motor and nonmotor complications associated with the disease. In this article, Speelman et al. discuss 10 reasons why exercise may be of benefit to patients with PD, suggesting that increased levels of physical activity can have disease-specific and, potentially, disease-modifying effects. The limitations and obstacles to changing the sedentary lifestyles of patients with PD are also discussed.

In this Review, Hoppe and Elger discuss the etiological factors underlying depression as a comorbidity of epilepsy, comprising psychological factors such as learned helplessness and the 'burden of epilepsy', and neurobiological factors directly related to the seizures. The authors highlight the need for more clinical studies of antidepressants and psychotherapy, and emphasize the importance of an integrated approach to treatment that addresses both the psychological and the neurobiological factors.

Disease-modifying therapies can positively influence the progression of multiple sclerosis, but how many patients continue to take their medications? A new study shows that the majority of patients with multiple sclerosis stop treatment. Research should focus on ways to improve adherence to disease-modifying therapies.

Research in neurodegenerative disease is generating vast neuroimaging data sets, necessitating the development of powerful new e-infrastructures for data collection, storage, access and analysis. In this article, Frisoni et al. provide an overview of the currently available e-infrastructures—LONI, neuGRID and CBRAIN—and consider how computational neuroscience in neurodegenerative disease might evolve in the future.

Malignant brain tumors such as glioma have a poor prognosis. Large-scale efforts to compile and store genome-wide data on gliomas have recently been initiated. Riddick and Fine describe these key initiatives and how these genomic approaches aim to improve tumor classification and elucidate the underlying biology of glioma. Use of these genomic technologies in the development of new diagnostic and therapeutic strategies in personalized medicine will also be discussed.

The clinical presentation of Guillain–Barré syndrome (GBS) is heterogeneous and, despite effective treatments, some patients die or sustain severe disabilities. An improved clinical prognostic score for GBS facilitates early identification of patients expected to have poor outcomes. These individuals might benefit from modified treatment or participation in therapeutic trials.

In this article, Carsten Bönnemann describes the clinical and diagnostic features of the entire spectrum of collagen VI-related myopathies, ranging from severe Ullrich congenital muscular dystrophy to mild Bethlem myopathy. He also considers the genetic and molecular mechanisms that underlie this group of diseases, and discusses current and future approaches to treatment.

Accumulating evidence suggests that prestroke statin therapy could improve functional recovery following acute ischemic stroke. A recent meta-analysis of previous findings and a new study support this suggestion. These findings should, however, be interpreted with caution owing to possible publication bias favoring small studies with positive results.

John W. Griffin, internationally renowned expert on peripheral nerve disorders, founding Director of the Johns Hopkins Brain Science Institute and launch Editor-in-Chief of Nature Reviews Neurology, died on 16^th April 2011. He will be remembered for his leadership in academic medicine, strong advocacy for young neurologists, and many original research contributions.

Increased blood pressure is associated with poor outcomes in acute stroke, but studies assessing the use of antihypertensive agents have been inconclusive. The recent SCAST trial has found that the angiotensin receptor blocker candesartan does not benefit patients with acute stroke and elevated blood pressure, and might even be harmful.

Thrombolysis was first shown to be effective for treating acute ischemic stroke around 15 years ago, but therapeutic uptake worldwide has been modest to date. Here, Donnan et al. outline the various strategies that are being explored to optimize the use of thrombolysis, including enhancement of thrombolytic efficacy, extension of the therapeutic time window, reduction in the risk of intracerebral hemorrhage, and improvements in prehospital and in-hospital patient management.

Consistent with previous findings, two recent studies of temporal lobectomy from Kerala, India demonstrate that early seizure recurrence bodes poorly for long-term seizure control, and that relapse following drug discontinuation affects one-third of patients. Key questions in the field now concern advanced preoperative and intraoperative techniques for improving surgical outcomes.