Volume 6 Issue 9, September 2010

Malformations of cortical development are commonly associated with epilepsy and intellectual disabilities. Polymicrogyria is one of the most frequent cortical malformations but remains largely enigmatic. A new multicenter clinical and radiographic study of patients with polymicrogyria has identified anatomical patterns that could shed new light on the underlying pathogenesis of this condition.

A 2009 study found that cerebral venous drainage was impaired in all patients with multiple sclerosis examined, but was not affected in control individuals. The study's investigators suggested that venous obstruction in the neck—a treatable condition—caused perivenous inflammation and demyelination. A comprehensive ultrasound study has now challenged this hypothesis.

A large, retrospective study indicates that in patients with acute ischemic stroke, endovascular interventions performed under conscious sedation carry a lower risk of poor neurological outcome and mortality than those performed under general anesthetic. Owing to a number of potential confounding factors, however, the results must be interpreted with caution.

Antiepileptic drug randomized controlled trial (RCT) design has been criticized for its emphasis on regulatory, licensing aspects rather than clinical considerations. A new study that scrutinized RCT patient recruitment has also raised important ethical issues. At a time when RCT patient recruitment in resource-poor countries is increasing, changes in RCT design seem imperative.

The implementation of secondary stroke preventive measures can reduce the risk of recurrent stroke by ≈90%. Here, Spence reviews recent advances in this field, placing his focus on the prevention of recurrent ischemic stroke. In addition to highlighting the importance of lifestyle modification for effective secondary stroke prevention, Spence examines the use of various pharmacological therapies, and the value of endarterectomy and stenting in this setting.

High-frequency stimulation of the subthalamic nucleus has become a widely accepted treatment for some patients with advanced Parkinson disease. Various behavioral and cognitive adverse effects, however, have been associated with this therapeutic approach. In this Review, Volkmann and colleagues examine these detrimental neuropsychiatric effects, exploring their possible etiologies, and discussing the implications for patient management.

Dendritic cells are specialized antigen-presenting cells that are necessary for inducing immunity and regulating immune tolerance. Understanding how these cells regulate adaptive immune responses has aided the development of a number of novel immunotherapies. In this article, Comabella and colleagues provide an overview of dendritic cell function and evaluate the potential of these therapies to treat multiple sclerosis.

Noninvasive therapies such as cognitive intervention could aid the prevention and treatment of Alzheimer disease (AD). In this article, Buschert et al. provide an overview of the current knowledge relating to the use of cognitive intervention in patients with AD, and discuss recent findings that indicate that this treatment provides substantial benefits for patients with cognitive deficits. The authors also review recent studies that have used neuroimaging techniques to identify biological changes within the brain that are associated with cognitive intervention.

Shaikh et al. describe the case of a 60 year-old woman with multiple sclerosis who presented to a vestibular clinic with head tremor and vestibular hypofunction. This combination of symptoms caused oscillopsia, a visual sensation of oscillation of stationary objects. On the basis of eye and head movement measurements, the patient was diagnosed with pseudonystagmus resulting from diminished compensatory vestibulo-ocular reflex responses to the head tremor.