Volume 6 Issue 11, November 2010

A direct role for large tau aggregates in neurodegeneration has been challenged by new data indicating that, in relation to degeneration of neurons, caspase activation precedes tangle formation. The findings suggest that any toxic tau moiety related to neurodegeneration is likely to be soluble rather than aggregated.

Oligoclonal bands are present in the cerebrospinal fluid of most patients with multiple sclerosis (MS) and represent a useful diagnostic measure. Two recent studies indicate that the identification of such bands might provide insight into the underlying mechanism of disease in MS and guide the treatment of individuals with this disorder.

Levodopa treatment alleviates the motor symptoms that characterize Parkinson disease, but is associated with motor complications. Treatments that prolong the action of levodopa could potentially reduce the risk of these adverse events, but a new study reports that one such approach—entacapone as an adjunct to levodopa–carbidopa—is associated with earlier dyskinesia onset than with levodopa–carbidopa alone.

The growing literature on comorbidity in multiple sclerosis (MS)—in particular, the association of MS with other autoimmune diseases—provides interesting clues to the complex pathogenesis of this disease, but also raises awareness of the important issues that need to be considered in its management.

Intracerebral hemorrhage (ICH) carries a high risk of morbidity or death, and no effective therapies are available to combat this condition. In this article, Adeoye and Broderick discuss the natural history of such hemorrhages before providing an overview of medical and surgical ICH clinical trials that have been completed or initiated within the past decade.

Multiple sclerosis is an incurable condition that introduces great uncertainty into virtually all aspects of a person's life. In this Review, Simmons considers the ways in which this uncertainty is being addressed by improved diagnostic tools, advances in immunotherapy, multidisciplinary rehabilitation, community programs, and provision of information specifically designed to facilitate shared decision-making and empowerment. He discusses these issues in the context of three philosophical frameworks: the biomedical, biopsychosocial and sociopolitical models.

Impaired decision-making is a clinical symptom associated with a number of neurodegenerative diseases. In this article, Gleichgerrcht et al. review the neural basis of decision-making cognition in relation to the neuroanatomical changes associated with neurodegenerative diseases. The authors also suggest a number of recommendations that future studies could adopt to aid our understanding of decision-making cognition.

Botulinum neurotoxin (BoNT) is an effective treatment for a wide range of conditions that are frequently seen in the neurology clinic. In this article, Lim and Seet provide an overview of the mechanisms of action of BoNT and its use in the treatment of conditions such as dystonia, spasticity, essential tremor, hemifacial spasm and headaches. Important practical considerations, such as the reconstitution of BoNT, dosing, and methods of administration, are also reviewed.

Extreme hypoglycorrhachia is usually caused by bacterial meningitis; however, suspicion should be raised if a patient with persistent extreme hypoglycorrhachia, pleocytosis and negative microbiological studies remains refractory to antimicrobial therapy. Viola describes the case of a 55-year-old man with chronic leptomeningitis and persistent hypoglycorrhachia, who was found to have Currarino syndrome. This syndrome is a complex genetic disorder that includes the following triad: sacral bony defect, presacral mass, and an anorectal malformation. Leptomeningitis in this patient was attributed to cholesterol crystals contained in a large presacral cyst with a communicating fistula to the CNS.