Reviews & Analysis

In this Viewpoint, Markus Schürks and Hans-Christoph Diener make the case that patent foramen ovale closure should not be used as a treatment for migraine. They argue that the causal link between patent foramen ovale and migraine has not been verified and highlight shortcomings in the existing data.

Several studies have indicated that a relationship exists between patent foramen ovale (PFO) and the incidence of migraine; however, the nature of the relationship and whether PFO closure could be used as a treatment for migraine are controversial. In this Viewpoint, Gian Paolo Anzola lists evidence in support of a relationship between PFO and migraine and suggests that, subject to further trials, PFO closure could in the future benefit some patients with migraine.

Creange et al. describe the case of a woman who presented with sudden-onset neuropathy, elevated levels of vascular endothelial growth factor, thrombocytosis, leukocytosis, and thrombosis. Diagnosed with POEMS syndrome, the patient was successfully treated with high-dose chemotherapy and autologous hematopoietic stem-cell transplantation.

Multiple sclerosis is characterized by both demyelination and neurodegeneration. The lack of myelin in the retina makes this an ideal structure in which to visualize the latter process. In this Review, Frohman et al. describe the novel use of retinal imaging technology, and in particular optical coherence tomography (OCT), to model the disease process in multiple sclerosis. They suggest that OCT could ultimately be used to identify strategies aimed at neuroprotection in the CNS.

The management of pain that is refractory to conventional treatments represents a considerable challenge for clinicians. Botulinum toxin has recently emerged as a potential novel approach to the control of refractory pain, and in this article Bahman Jabbari weighs up the available evidence for the efficacy of botulinum toxin therapy in various pain syndromes, including cervical dystonia, headache, neuropathic pain and postoperative pain.

The therapeutic potential of cannabinoids in neuropathic pain has recently generated much interest. In this Viewpoint, Andrew Rice reports on the possible efficacy of cannabinoids in the treatment of pain in conditions including multiple sclerosis and HIV neuropathy. However, he warns that long-term therapeutic cannabinoid administration could be associated with psychosis, schizophrenia, and other mental illnesses.

Despite remarkable success in the fight against leprosy, the disease remains an important public health problem. This Review focuses on the neurological manifestations of leprosy and the pathophysiology of nerve damage. Special emphasis is given to developments in the early detection and treatment of leprosy-related nerve impairment.

The decision whether to withdraw antiepileptic drugs in adults who have been seizure-free for 2 years is a difficult one, with relief from adverse events weighing against the possibility of seizure recurrence with all its consequences. In this Viewpoint, Alla Guekht calls on clinicians not to dismiss lightly the risk of relapse.

Therapeutic approaches to febrile seizures have changed since the 1970s when the main reference studies on this topic were published. It is, therefore, timely to consider whether outcomes of febrile seizures have changed in the intervening years. Here, Chungath and Shorvon assess data published since 1993 with respect to three outcomes: mortality, later development of afebrile seizures or epilepsy, and hippocampal or mesial temporal sclerosis.

Mitochondrial dysfunction and oxidative stress have been strongly implicated in the pathogenesis of Parkinson disease (PD), and the products of several PD-associated genes become localized to the mitochondria under certain conditions. In this article, Henchcliffe and Beal review recent developments in mitochondrial biology that have contributed to our understanding of the disease process in PD, and they discuss how this knowledge might aid in the development of 'mitochondrial therapies' for PD.

This Case Study describes an 18-year-old woman who presented to a stroke center with dysphasia and right hemiparesis. The patient was diagnosed with cocaine-induced cerebral vasculitis. BOLD MRI cerebrovascular reactivity findings were particularly useful in the diagnosis and follow-up of this case, and the authors point to the technique's potential for imaging cerebral vasculitis in general.

Over the past few years, evidence has accumulated to indicate that B cells have a pivotal role in the pathogenesis of various autoimmune neurological disorders, including multiple sclerosis, myasthenia gravis and inflammatory myopathies. In this article, Marinos Dalakas highlights the roles of B cells in these and other autoimmune disorders, and summarizes the experience to date with anti-B-cell therapies, focusing particularly on the B-cell-depleting monoclonal antibody rituximab.

Waldenstrom's macroglobulinemia—a condition that is characterized by overproduction of IgM antibodies and most commonly occurs in lymphoplasmacytic lymphoma—is often accompanied by nervous system complications, such as peripheral neuropathy or complications related to serum hyperviscosity. This Review provides an overview of the diagnosis and treatment of such neurological manifestations.

The concept of consciousness has evolved as technology has progressed, and our understanding of coma and disorders of consciousness has deepened accordingly. In this Viewpoint, Steven Laureys traces the beginnings of coma research and shows how the introduction of functional neuroimaging has revolutionized this field.

In mammalian neurons, cation–chloride cotransporters (CCCs) have vital roles in regulating the intracellular chloride concentration—which in turn determines the strength and polarity of γ-aminobutyric-acid-mediated neurotransmission—and in cell volume homeostasis. In this Review, Kahle et al. consider how breakdowns of chloride homeostasis resulting from alterations in CCC activity might contribute to various neurological disorders, including seizures and neuropathic pain, and they discuss the potential of CCCs as targets for novel therapeutic strategies.

Functional neuroimaging is emerging as a novel tool to evaluate patients with disorders of consciousness. This Viewpoint looks at one of the most vexing ethical challenges resulting from this development: how should doctors react if families request a functional MRI scan for a loved one who is in a limited state of consciousness?

Muscle strength is believed to be an important factor contributing to postural control, yet surprisingly few studies have explicitly examined the relationship between muscle weakness and postural instability. In this article, Horlings et al. search the current literature for evidence indicating that muscle weakness is a risk factor for falls, citing studies performed in elderly individuals and in patients with focal muscular deficits. In addition, they consider the effects of muscle strength training on falls and balance measures.

This article discusses the case of a 40-year-old man with basilar artery thrombosis, which, after numerous investigations, was found to be attributable to cocaine use. The authors highlight the importance of asking patients about cocaine exposure as part of a routine cardiovascular history, and they provide the first description of the use of thrombolysis to treat cocaine-induced stroke.

Migraine is a common neurological disorder, which, according to figures from US population studies, affects around 18% of women and 6% of men. In this Review, Stephen Silberstein highlights the approach to acute and preventive migraine treatment in the US, drawing on his own experiences at the Headache Center at Thomas Jefferson University Hospital.