Volume 6 Issue 7, July 2010

Hereditary eye diseases can feature extraocular neurological complications, although such additional phenotypes can go undetected when a patient's visual defect is dramatic. A consortium has found that extraocular neurological phenotypes are common in patients with OPA1 mutation-related autosomal dominant optic atrophy, occurring in one-fifth of all such individuals.

To maximize the benefits of thrombolytic therapy at the population level, identifying which stroke patients are most likely to respond positively to this treatment is vital. The EPITHET Investigators propose specific diffusion-weighted and perfusion-weighted MRI lesion volume criteria that could be used for patient selection.

Proteins linked to neurodegenerative diseases can potentially be used as biomarkers. A study now shows that after accounting for confounding variables such as age and blood contamination, cerebrospinal fluid levels of α-synuclein and DJ1 are substantially reduced in patients with Parkinson disease compared with healthy controls or individuals with Alzheimer disease.

Analysis of two recombinant tissue plasminogen activator (rtPA) trials by means of the disability-adjusted life year metric has provided readily understandable data on the benefits of rtPA therapy in acute ischemic stroke. Approximately one-third of patients treated with rtPA could gain more than 4 years of healthy life, which is twice that previously estimated.

Stem cell therapy has the potential to provide a valuable treatment approach for spinal cord injury, but no consensus yet exists regarding which type of stem cell is likely to be most effective in the clinical setting. In this article, Sahni and Kessler review the various stem cell strategies that have been tested in animal models for the treatment of spinal cord injury, and discuss ongoing clinical trials and future prospects for stem cell therapy in humans.

Only moderately effective therapies are currently available for the treatment of multiple sclerosis (MS). New treatments for MS that have neuroprotective properties as well as anti-inflammatory effects are needed. Fingolimod could be one such potential treatment. In this article, Aktas et al. examine the underlying biological actions of this prospective new therapy, review the data from phase II and phase III oral fingolimod clinical trials and provide an update on the emerging field of sphingosine-1-phosphate receptor-mediated therapies for MS.

Neuromyelitis optica is a CNS inflammatory disorder that predominantly affects the optic nerves and spinal cord. Jarius and Wildemann review the latest experimental and clinical evidence that supports a direct role for antibodies to aquaporin-4—the most abundant water channel in the brain—in the immunopathogenesis of this condition. The authors also evaluate the range of diagnostic tests that are currently available for the detection of these antibodies.

Many individuals who survive traumatic brain injury (TBI) experience long-term complications. The prevention and management of such complications, however, remain challenging goals for clinicians. Here, Shlosberg and colleague examine the role of blood–brain barrier (BBB) breakdown in the pathophysiology of TBI, particularly in the development of delayed TBI-related conditions. The authors also discuss novel BBB-targeted therapeutic strategies that might be explored to counter or prevent long-term complications in patients.

Activated microglia are a feature of many neurodegenerative disorders, including amyotrophic lateral sclerosis and Alzheimer disease. Conflicting results exist, however, for the effectiveness of anti-inflammatory drugs in such conditions. In this article, Schwartz and Shechter propose a model that describes the complexities of the immune response in neurodegenerative diseases and offer an explanation for why such drugs have so far yielded inconsistent data in this setting.