Volume 4 Issue 5, May 2008

Immunotherapy seems to alter the natural course of multiple sclerosis (MS), so there is a general view that treatment should be initiated as soon as a diagnosis is made. In this Viewpoint, Giancarlo Comi makes a case for extending the early treatment approach to patients with a first neurological event suggestive of MS.

Multiple sclerosis (MS) is a complex disease with a high degree of clinical and neuropathological variability between patients. In this Viewpoint, Aksel Siva argues that such a heterogeneous disease demands a heterogeneous approach to treatment and questions the practice of initiating long-term immunotherapy before the MS diagnosis has become definite.

Sleep disturbances, such as insomnia, rapid eye movement sleep disorders and excessive daytime sleepiness, are symptoms that are commonly associated with movement disorders. This article discusses the prevalence and underlying mechanisms of sleep disturbances in patients with Parkinson's disease or atypical parkinsonism, and proposes therapeutic approaches that could benefit both the patient and their sleeping partner.

Currently, idiopathic Parkinson's disease can only be diagnosed definitively by the demonstration of intracellular Lewy body inclusions on histological specimens of brain tissue—an approach that is impractical in living individuals. In this Review, David Brooks discusses recent advances in noninvasive imaging approaches that are providing important insights into the structural, pathophysiological and pharmacological changes associated with Parkinson's disease, and could have major implications for the future diagnosis and management of this condition.

This article describes the case of a female patient who presented with transient right-sided weakness, and went on to develop further transient neurological signs and symptoms. A diagnosis of amyloid-β-related angiitis was made at autopsy following a sudden, fatal intracerebral hemorrhage. The authors highlight the importance of considering this diagnosis in patients with difficult-to-localize transient neurological symptoms.

This Case Study describes a 63-year-old woman with a history of metastatic breast cancer who presented with rapidly progressing myelopathic symptoms and an elevated titer for the neuromyelitis optic antibody. The appearance of myelopathy correlated with recurrence of the patient's breast cancer on two separate occasions, and the authors suggest this case represents a possible paraneoplastic syndrome associated with the neuromyelitis antibody.