Reviews & Analysis

A recent study that applied new criteria for diagnosing neuromyelitis optica spectrum disorders in the absence of serum aquaporin 4 antibodies highlights difficulties with clinical application of these criteria. Classification on the basis of molecular markers might offer a more practical alternative.

Epilepsy surgery is the standard of care for focal drug-resistant epilepsy, but it is underutilized. Knowledge gaps and attitudes toward epilepsy surgery are partly responsible, and a new study explores whether the health-care infrastructure in developed countries influences access to and utilization of epilepsy surgery.

The application of imaging biomarkers has provided new insights into the mechanisms of damage in multiple sclerosis (MS) and the risk of MS development and progression. The goal of eliminating all disease activity requires a timely escalation of treatment. This increasing complexity is compounded by the need to treat comorbidities.

Diagnosis and management of epilepsy remain challenging, particularly among women of child-bearing age. In 2015, notable steps were taken in the right direction, with work that provided insight into the diagnosis of epilepsy, management of this condition during pregnancy, and new treatment options.

Tau protein abnormalities are key pathogenic features of Alzheimer disease and other neurodegenerative diseases. In 2015, new studies of the less common tauopathies, including progressive supranuclear palsy, chronic traumatic encephalopathy and frontotemporal lobar degeneration, have identified in vivo biomarkers and mechanisms that initiate tau pathology.

Important advances in Parkinson disease (PD) in 2015 included a revision of its clinical diagnostic criteria and a proposal for research criteria defining prodromal PD. Research published in the past year has also continued to expand our understanding of the roles of Lewy pathology and α-synuclein in the pathobiology of PD.

Gliomas are the most common form of malignant primary brain tumour. In the past year, substantial progress has been made in the classification and treatment of lower-grade gliomas (WHO grades II and III), and the FDA has approved a new therapy for newly diagnosed glioblastomas.

A new study suggests that the application of uniform diagnostic criteria for mild cognitive impairment (MCI) substantially reduces variation in MCI prevalence estimates. Refinement and harmonization of clinical and research criteria are essential milestones towards improved testing of therapeutic interventions aimed at curbing the epidemic of MCI and dementia.

Psychiatric and neurological comorbidities are relatively common in epilepsy, affecting 30–50% of patients. Neurologists should be able to treat psychiatric comorbidities in patients with epilepsy and identify patients at risk of adverse events from psychotropic medications, because psychiatric care is not available to all patients. In this Review, Andres Kanner discusses the complex relationship between epilepsy and psychiatric and neurological comorbidities, and provides considerations for selection of antiepileptic and psychotropic drugs in patients with epilepsy.

Suspected non-Alzheimer disease pathophysiology (SNAP) is a biomarker-based concept that applies to individuals with normal levels of amyloid-β biomarkers in the brain, but in whom biomarkers of neurodegeneration are abnormal. Clinically normal and mildly impaired individuals with SNAP are at increased risk of poor clinical and cognitive outcomes. In this Perspectives article, Clifford Jack and colleagues describe the available data on SNAP and address topical controversies in the field.

2015 saw the publication of five randomized controlled trials of endovascular treatment for acute stroke caused by vascular occlusion, with huge implications for the future of patient management. Mokin and colleagues consider the findings of these trials in the context of their designs, in particular the criteria for patient selection, and their likely impact on future management of acute stroke.

The chemokine receptor CCR5 is thought to have a role in several CNS inflammatory diseases and infections. The role of CCR5 in HIV has already led to the development of effective and well-tolerated CCR5 antagonists, which could offer a readily available option for the treatment of CNS diseases. In this Review, Martin-Blondel et al. consider the evidence for a role of CCR5 in several CNS diseases and the rationale for use of CCR5 anatagonists in these conditions.

The past year has seen practice-changing findings in stroke research. Strong evidence now supports endovascular thrombectomy as the new gold standard of care in acute ischaemic stroke, and a pragmatic trial raised concerns over early intensive mobilization after stroke. Moreover, new insights were gained into the trajectory of stroke-associated cognitive decline.