Reviews & Analysis

The first large trial of a multimodal lifestyle intervention combined with a nutritional supplement for dementia prevention was unsuccessful and adds to conflicting evidence from similar studies. Whether lifestyle interventions are biologically ineffective or whether the lack of efficacy is due to methodological limitations remains to be determined.

Effective drug treatments for intracerebral haemorrhage (ICH) are still lacking. However, therapies that target microglial phenotype switching might soon become available for affected patients. Here, Wang and colleagues summarize key advances in understanding of microglial function after ICH, including modulators of microglial function and interactions with other cells.

Determining how the incidence and prevalence of dementia changes over time requires population-based studies that use consistent methods over time. In this Review, the authors discuss the results of 14 worldwide studies that have attempted this approach. The findings consistently indicate that the incidence and prevalence of dementia, at least in Western countries, is stable or declining.

In the past few years, paradigms for the treatment of low-grade glioma have shifted, owing to new diagnostic criteria and new clinical trial evidence. Here, Jan Buckner and colleagues discuss how molecular markers are challenging previous assumptions about low-grade glioma, and examine how new data will affect diagnostic testing, surgery, chemotherapy and radiation therapy for individuals with these tumours.

This Review presents an overview of vaccine-based immunotherapies for human glioma. Although efficacy remains unproven for the vaccines in clinical development, Weller and colleagues highlight promising strategies for antagonizing glioma-associated immunosuppression and boosting immune responses in vaccinated patients. Ultimately, such approaches might help to control the growth of human gliomas.

The International League Against Epilepsy has published a new classification of seizure types and epilepsies that attempts to reflect recent scientific advances in the epilepsy field. This classification potentially offers a number of advantages, but it leaves some ambiguities and needs to be rigorously tested before entering routine clinical practice.

Genome-wide association studies have provided important insights into the genetic underpinnings of Alzheimer disease (AD), but the relevance of the identified variants to AD pathogenesis is often unclear. A new study uses a powerful quantitative trait approach to identify genetic variants that are associated with biologically meaningful parameters in AD.

Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves. In this Review, Collins and Hadden provide an update on the classification, diagnosis and treatment of NSVN, and propose definitions and an up-to-date differential diagnosis of multifocal neuropathy.

Central vestibular disorders, including vestibular migraine, account for around 25% of cases of vertigo and dizziness. In this Review, the authors present the key signs and symptoms of central vestibular disorders, and they also consider higher vestibular dysfunctions, which involve more than one sensory modality as well as cognitive domains.

A growing body of evidence indicates that people with migraine have an increased risk of cervical artery dissection (CeAD). A new study in young patients with ischaemic stroke has identified a specific link between CeAD and migraine without aura.

Clinical recognition of autoimmune encephalitis is vital in order for effective early treatment to be provided. Here, van Sonderen and colleagues describe the syndromes associated with antibodies against LGI1, Caspr2 and voltage-gated potassium channels and highlight the importance of determining the molecular identity of patient antibodies for diagnosis and treatment.

Human induced pluripotent stem cells (hiPSCs) enable researchers to recapitulate an individual's neural development in a dish, with the potential to provide unique insight into the pathogenic mechanisms of neurodevelopmental disorders. Here, the authors provide an overview of disease modelling with hiPSCs and discuss existing hiPSC models of neurodevelopmental disorders.

A new survey of clinicians from 21 different countries has found a lack of consensus regarding the definition of familial amyotrophic lateral sclerosis. In addition, attitudes towards genetic testing vary greatly between practitioners. These attitudes must be changed if future therapeutic strategies are to succeed.

MRI has become the standard method for diagnosis and monitoring of patients with brain tumours, but conventional MRI sequences have important limitations. This Review summarizes the clinical role of the rapidly developing field of amino acid PET and advanced MRI techniques in adults with brain tumours, and provides an outlook for future developments in PET and MRI.

Progress in the development of PET radiotracers has enabled the noninvasive assessment of the pathological hallmarks of Alzheimer disease (AD) and other neurodegenerative disorders. New reports have revealed the potential usefulness of tau PET imaging in AD and non-AD tauopathies.

In this Review, Krismer and Wenning discuss the risk factors for and the clinical presentation and neuropathology of multiple system atrophy (MSA) — a devastating and fatal neurodegenerative disorder. They provide an overview of ongoing trials and international efforts to improve care in patients with MSA.

Although our understanding of the biological mechanisms of stroke have advanced considerably in animal models, this progress has not been translated into improvements to restorative therapies following stroke in humans. Here, Nick Ward discusses the reasons behind this lack of benefit, and the prospects for understanding poststroke plasticity in humans, with a focus on the development of biomarkers that can reconcile preclinical and human studies.

Gasparotti et al. provide an overview of new and emerging technologies for assessing a variety of peripheral neuropathies, including magnetic resonance neurography, diffusion tensor imaging and ultrasonography for large-fibre neuropathies, and corneal confocal microscopy, evoked potentials and microneurography for small-fibre neuropathies.

Comorbidity is common in multiple sclerosis (MS). In this Opinion article, Ruth Ann Marrie discusses how comorbidity affects diagnosis, progression, mortality, and health-related quality of life in patients with MS, and how clinicians should incorporate the prevention and management of comorbidities when treating MS.

A whole-exome sequencing study has identified a series of ultra-rare variants that provide a genetic link between common and rare epilepsy syndromes. This discovery could open up new possibilities for personalized treatment of common epilepsies.