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Bacterial meningitis causes substantial neurological morbidity and mortality worldwide. The use of corticosteroids as adjunctive therapy to antibiotics has been studied in clinical trials and debated for decades. A new meta-analysis attempts to reconcile some of the disparate findings from trials in this field.
A new study indicates that deep brain stimulation (DBS) plus best medical therapy markedly improves quality of life of patients with advanced Parkinson disease compared with best medical therapy alone. The frequency of serious adverse events related to DBS was similar to that reported in other DBS trials, underscoring the need for careful patient selection and counseling for this invasive therapy.
After a stroke, seizures and later development of epilepsy can have a devastating impact on patient outcome and quality of life. Predicting the risk of developing poststroke epilepsy is currently an inexact science, and improving the accuracy of this process could lead to more-targeted use of prophylactic antiepileptic drugs for a defined period of time.
Malignant gliomas are aggressive tumors that often progress despite multimodality therapy. At recurrence, treatment approaches must balance the potential morbidity of a given therapy against the survival benefit that might be achieved. A new study reports that irradiation in this setting is well tolerated and could prolong survival.
Deep brain stimulation of the subthalamic nucleus or the internal pallidum can be an effective treatment for the disabling motor complications arising from dopaminergic treatment for Parkinson disease. The subthalamic nucleus has emerged as the preferred target for such treatment; however, no data exist to guide the choice between these two sites.
Surgical intervention can represent an effective treatment for some patients with medically refractory epilepsy. In this Review, Duncan explores the various imaging techniques that can be used in epilepsy surgery to identify the epileptic source and/or to reduce the risk of surgery-related morbidity. In addition to examining established clinical practice, Duncan highlights recent advances in this field.
Diabetes has been implicated to be a risk factor for Alzheimer disease (AD), but the underlying biological mechanisms that link the development of diabetes and AD are not fully understood. In this article, Sims-Robinson et al. summarize the mechanistic pathways that might link these two age-related diseases and discuss the possible points of intervention that future therapies could exploit to treat AD.
Neuroimaging is highly recommended in the diagnosis and management of acute stroke, including disease characterization, and monitoring of responses to medical interventions. In this Review, Merino and Warach consider the diagnostic information that clinicians might gain from CT and MRI scanning of patients with suspected stroke, and the relative advantages and drawbacks of these imaging techniques.
Over the past 300 years, the migraine field has been dominated by two theories—the vascular theory and the central neuronal theory. The vascular theory was bolstered by the finding that vasoconstrictors are effective in acute migraine treatment, but evidence is now emerging that vasodilatation is neither necessary nor sufficient to trigger a migraine attack. Ho et al. consider the evidence pointing towards a neuronal mechanism in migraine development, highlighting the role of calcitonin gene-related peptide and its receptors.
